Cutaneous leishmaniasis (CL) is most common form of leishmaniasis and is characterized by ulcerative skin lesions. The objective of this study was to conduct a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime for the treatment of CL. We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform search portal of World Health Organization, Sid, Irandoc, Magiran, and clinicaltrials.gov. We used keywords including “miltefosine,” “glucantime,” and “Leishmania.” The quality of studies was assessed using the Cochrane risk of bias tool. A random-effects model was employed for the analysis. We assessed heterogeneity by the chi-square test and the I² index statistic. When heterogeneity was present, meta-regression analyses were performed. The Egger method was used to assess publication bias; when it was significant, the trim-and-fill method was used to test and adjust for publication bias. A total of 1,570 reports were identified, of which 10 studies were included in the meta-analysis. In the meta-analysis, there was no significant difference between the efficacy of miltefosine and glucantime; however, subgroup analysis showed that, regarding parasite species other than Leishmania braziliensis, miltefosine was significantly superior to glucantime (intention to treat; relative risk, 1.15; 95% confidence interval, 1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p=0.1 level. The Egger test found statistically significant publication bias; however, including the 3 missing studies in the trim-and-fill analysis did not change the results. This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.
Bias (Epidemiology) ; Leishmania braziliensis ; Leishmaniasis ; Leishmaniasis, Cutaneous ; Methods ; Parasites ; Population Characteristics ; Publication Bias ; Skin ; Sudden Infant Death ; Ulcer ; World Health Organization

Cutaneous leishmaniasis (CL) is most common form of leishmaniasis and is characterized by ulcerative skin lesions. The objective of this study was to conduct a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime for the treatment of CL. We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform search portal of World Health Organization, Sid, Irandoc, Magiran, and clinicaltrials.gov. We used keywords including “miltefosine,” “glucantime,” and “Leishmania.” The quality of studies was assessed using the Cochrane risk of bias tool. A random-effects model was employed for the analysis. We assessed heterogeneity by the chi-square test and the I² index statistic. When heterogeneity was present, meta-regression analyses were performed. The Egger method was used to assess publication bias; when it was significant, the trim-and-fill method was used to test and adjust for publication bias. A total of 1,570 reports were identified, of which 10 studies were included in the meta-analysis. In the meta-analysis, there was no significant difference between the efficacy of miltefosine and glucantime; however, subgroup analysis showed that, regarding parasite species other than Leishmania braziliensis, miltefosine was significantly superior to glucantime (intention to treat; relative risk, 1.15; 95% confidence interval, 1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p=0.1 level. The Egger test found statistically significant publication bias; however, including the 3 missing studies in the trim-and-fill analysis did not change the results. This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.
Bias (Epidemiology) ; Leishmania braziliensis ; Leishmaniasis ; Leishmaniasis, Cutaneous ; Methods ; Parasites ; Population Characteristics ; Publication Bias ; Skin ; Sudden Infant Death ; Ulcer ; World Health Organization

Cutaneous leishmaniasis (CL) is most common form of leishmaniasis and is characterized by ulcerative skin lesions. The objective of this study was to conduct a systematic review and meta-analysis of clinical trials that compared the efficacy of miltefosine and glucantime for the treatment of CL. We searched the following databases: Cochrane, PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform search portal of World Health Organization, Sid, Irandoc, Magiran, and clinicaltrials.gov. We used keywords including “miltefosine,”“glucantime,” and “Leishmania.” The quality of studies was assessed using the Cochrane risk of bias tool. A random-effects model was employed for the analysis. We assessed heterogeneity by the chi-square test and the I² index statistic. When heterogeneity was present, meta-regression analyses were performed. The Egger method was used to assess publication bias; when it was significant, the trim-and-fill method was used to test and adjust for publication bias. A total of 1,570 reports were identified, of which 10 studies were included in the meta-analysis. In the meta-analysis, there was no significant difference between the efficacy of miltefosine and glucantime; however, subgroup analysis showed that, regarding parasite species other than Leishmania braziliensis, miltefosine was significantly superior to glucantime (intention to treat; relative risk, 1.15; 95% confidence interval, 1.01 to 1.32). In the meta-regression, only the glucantime injection type was significant at the p=0.1 level. The Egger test found statistically significant publication bias; however, including the 3 missing studies in the trim-and-fill analysis did not change the results. This meta-analysis found that miltefosine seems to be more effective than glucantime, at least in species other than L. braziliensis, for treating CL.

BACKGROUNDDysmenorrhea is a common gynecologic problem. In some cases, non-medical treatments are considered to be more effective, with fewer side effects. Ginger and exercise are alternative treatments for dysmenorrhea, but in the present study they were not combined.

OBJECTIVEIn this study, the effects of ginger and exercise on primary dysmenorrhea were compared.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONSThis randomized controlled trial was performed in Mazandaran University of Medical Sciences, Iran. Two groups of female students were recruited by simple random allocation. In each group, 61 students with moderate to severe primary dysmenorrhea with regular menstrual cycles and without a history of regular exercise were assessed. The ginger group received 250 mg ginger capsules from the onset of menstruation. In the exercise group, belly and pelvic stretching exercises were performed for 10 min, 3 times per week.

MAIN OUTCOME MEASURESIntensity of pain was assessed according to a visual analogue scale after the first and the second month.

RESULTSExercise was significantly more effective than ginger for pain relief (31.57 ± 16.03 vs 38.19 ± 20.47, P = 0.02), severity of dysmenorrhea (63.9% vs 44.3% mild dysmenorrhea, P = 0.02) and decrease in menstrual duration (6.08 ± 1.22 vs 6.67 ± 1.24, P = 0.006), in the second cycle.

CONCLUSIONStretching exercises, as a safe and low-cost treatment, are more effective than ginger for pain relief in primary dysmenorrhea.

TRIAL REGISTRATIONThe trial was registered in www.IRCT.ir with No. 201203118822N2.

Objective To evaluate the scolicidal and immunomodulatory effect of the Ziziphora tenuior (Z. tenuior) extract and its fractions. Methods Protoscolices were treated with six concentrations (3, 5, 10, 25, 50, and 100 mg/mL) of Z. tenuior extract and its fractions (ethanol, petroleum ether, ethyl acetate and chloroform) in periods of 10, 20, 30, 40, 50 and 60 min, and viability of protoscolices was evaluated using the 1.0% eosin. To examine the immunomodulatory effects of Ziziphora and its fractions on macrophage cells, the non-toxic concentration of extract and different fractions determined by MTT assay, and the Griess reaction was used to measure the level of nitrite as an indicator of nitric oxide by the macrophage cells in 10, 100 and 200 μg/mL in 24 h at 37 °C. Results In this study, the Z. tenuior extract at 10 mg/mL concentration was able to kill all protoscolices during 20 min. By increasing the concentration to 25 mg/mL, the scolicidal time reduced to 10 min. Regarding the effect of different fractions of Z. tenuior, the ethanolic fraction showed the highest scolicidal activity. The extract demonstrated an inhibitory effect on the activity of macrophages and reduced nitric oxide production. Although the petroleum ether and ethanolic fractions of the extract reduced nitric oxide production, nevertheless, this effect was only significant at 10 and 100 μg/mL concentrations (P < 0.05). Conclusion The Z. tenuior extract and its fractions were effective against protoscolices yet the effect of total extract was considerable. Our findings indicates that the extract and its ethanolic and petroleum ether fractions could have anti-inflammatory properties.

Objective To evaluate the possible involvement of programmed cell death strategy in hydatid cyst protoscolices following treatment with Myrtus communis (M. communis) as an herbal medicine. Methods Protoscolices were aseptically collected from sheep liver hydatid cysts. Evaluating the effect of M. communis extract on programmed cell death and increased activity of caspases 3, 8, and 9 in hydatid cyst protoscolices was conducted by treating the protoscolices with different concentration (5, 50, and 100 mg/mL) of M. communis extract at 37 °C and 5% CO