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Depression and anxiety disorders are increasing globally and represent major public health concerns. The relationship between fasting and the physical, social, psychological, and mental health of both healthy individuals and those suffering from various diseases has been reported in several studies. This systematic review aims to determine the association between fasting and anxiety.

This systematic review examined studies, including cohort, case-control, cross-sectional, and clinical trials, that explored the relationship between different types of fasting and anxiety. In this study, the population (P) consisted of participants with fasting experience, the intervention (I) was fasting, the comparison (C) was between the periods before and after fasting, and the outcome (O) was the level of anxiety before and after fasting. International databases, including Google Scholar, Medline, Scopus, Web of Science, and ScienceDirect (up to the end of 2021), were searched using the keywords "anxiety" and "fasting" in both English and Persian. The extracted data were entered into a checklist, which included the researcher's name, type of study, year of implementation, instrument used, type of fasting, and the mean and standard deviation of anxiety scores before and after fasting. Data were analyzed using Stata software (version 11). To estimate the difference in standardized means, the number of samples, the mean, and the standard deviation of the anxiety scores were extracted from the primary studies. Using the Metan command, the random-effects model, and Cohen's estimator, the standardized mean difference in anxiety scores with a 95% confidence interval was calculated. Heterogeneity between the results of the primary studies was assessed using the Q statistic and I-squared index, and publication bias was evaluated using the Begg and Egger tests. The NOS checklist was used to evaluate the quality of the included studies.

A total of 1,408 articles were retrieved, of which 13 were related to the topic. Four articles were excluded from the analysis because they did not report the mean. Finally, nine articles were included in the systematic review (nine studies) and meta-analysis (eight studies). The results of the eight studies included in the meta-analysis using the random-effects model showed that the standardized mean difference of the anxiety scores before and after fasting, with a 95% confidence interval (-1.14, -0.21), was estimated to be -0.67. Additionally, the results of the meta-analysis, stratified by the type of fasting and the questionnaire used in the primary studies, indicated that the overall estimate of the standardized mean difference in anxiety scores before and after fasting was not significant when considering the data collection tool and the type of fasting. Based on the heterogeneity indices (I-squared: 93.9%, Q= 114.88, P<0.001), the level of heterogeneity between the results of the primary studies was high. Publication bias was evaluated using the Begg (P=0.322) and Egger (P=0.753) tests, which indicated that publication bias was not significant.

The results of this systematic review and meta-analysis showed that the average anxiety score after fasting decreased by 0.67 units (67%) compared to before fasting, indicating a significant reduction in anxiety following a period of fasting.

Osteoarthritis is the most common joint disease in humans, the main symptoms of which are joint pain and dryness. On the other hand, the knee is the most common joint affected by osteoarthritis. The main goals in the treatment of this disease are to reduce pain restore function and improve the patient's quality of life. In many parts of the world, non-steroidal anti-inflammatory drugs are used as the first-line treatment for osteoarthritis. However, researchers are still investigating herbal and alternative treatments. Therefore, this research aimed to make a local herbal lipogel that can be effective in improving the symptoms of osteoarthritis.

This study was a double-blind randomized clinical trial study. Seventy patients were randomly selected from those who were referred to the rheumatologist's office and were diagnosed with osteoarthritis and ruled out systemic rheumatism diseases by observing the entry and exit criteria. The patients had been referred to the doctor for the treatment of 1st and 2nd-degree osteoarthritis and after explaining to them the objectives of the study, after obtaining written consent, they entered the study and were divided into two groups receiving lipogel Arthrohil (35 people) and receiving lipogel placebo (35 people) were divided. To prepare plastic base gel, first, 5% low-density polyethylene (LDPE) was added in 95% liquid paraffin and it was indirectly heated at 130°C for three hours. Then we cooled it very quickly to form a plastic base gel. The gel obtained from Plastibase was investigated in terms of physical stability in ambient and refrigerator temperatures, in terms of occurrence of turbidity, syneresis phenomenon, appearance change of consistency, and pH. The extracts of each of the plants Turmeric (2%), Betula (4%), and Marmaki (4%) were added separately to the gel base and mixed until the gel reached the appropriate consistency. Lipogel was used topically for two months twice a day each time in the amount of two knuckles on each joint. The results of the WOMAC and VAS questionnaires were collected before the treatment, at the end of the first month, and the end of the second month after the treatment. The significance level of the tests was considered P<0.05.

The studied patients were in the age range of 40 to 73 years. The prepared herbal lipogel can be used for clinical tests in terms of microbial control and it contained 0.03% of total flavonoid and 0.1027% of total phenol. The stability of herbal lipogel was more than 94%. According to the WOMAC questionnaire, compared to placebo, herbal lipogel significantly reduced pain, joint stiffness, and movement disorder in osteoarthritis patients (P<0.05). The results of the Friedman test, to compare the scores of the VAS questionnaire before the start of the treatment, at the end of the first month, and at the end of the second month showed that after the treatment with herbal lipogel, the amount of pain felt by the patients decreased significantly (P<0.05).

By comparing the scores obtained from the WOMAC and VAS questionnaires in the placebo and herbal lipogel groups, we found that the topical use of herbal lipogel has been effective in increasing the performance and pain control of patients with osteoarthritis, which is due to the antioxidant and anti-inflammatory properties of the compounds. In this lipogel, it seems obvious.

Trichoptilosis with fragility and hair loss is a common disorder, but, still there is no specific and effective treatment for this condition. The aim of this study was to evaluate the efficacy of gel from the seed of Trigonella foenum-graceum L. in prevention of trichoptilosis in people with trichoptilosis.

A double-blind placebo controlled clinical trial was carried out in 60 people with trichoptilosis in Sari Touba Clinic affiliated with Mazandaran University of Medical Sciences. The participants received either T. foenum-graceum seed gel or placebo gel. The extract was prepared at 500 μg/ml and the treatment period was two months. Data were analyzed using Independent t-test, Paired t-test, Fisher's exact test, and Generalized estimating equations.

In this study, the average rate of hair splitting in experimental group decreased significantly compared with the placebo group (P<0.001). Other factors such as dryness, fragility, and hair loss showed considerable decreasing rate in experimental group compared to the placebo group (P≤0.001, P<0.001, and P=0.042, respectively)

The positive effects of the herbal gel in reducing the incidence of trichoptilosis may probably be due to the presence of diosgenin and other steroidal saponins with antioxidant and anti-inflammatory effects.

Neonatal jaundice is as a disease caused by the abnormality of bilirubin metabolism that tendency of people to traditional medicine is very high for the treatment.

The aim of this study was to determine the therapeutic strategies, especially herbal treatments, in the neonatal jaundice, for mother and infant, based on verbally traditional medicine recommended by medicinal herbalists in Mazandaran province.

This descriptive cross-sectional study was performed on all medicinal herbalists in Mazandaran province in 1394 and a snowball questionnaire was used for sampling. Data on demographic characteristics and treat neonatal jaundice using natural products were collected by direct method and the results were analyzed.

In this study, 12 medicinal plants for the baby and 49 herbal preparations for the mother were recommended. Moreover, based on recommendation of eighty-nine (98.9%) of the medicinal herbalists, Cotoneaster discolor (shir-e-khesht) was first choice of herbal medicine for prescribing to mother and baby.

As based on this study, the medicinal plants such as: Cotoneaster discolor, Descurainia sophia, Cichorium intybus, and Alhagi maurorum are used for neonatal jaundice as the main herbal remedies in Mazandaran province. However, this study is the first step in identifying and developing new drugs to treat neonatal jaundice, and requires additional pharmacological studies, pharmacology, toxicology, animal studies, and in particular different clinical phases to assess the exact effects of these drugs.

Over 80% of the world population depends on herbal medicines and products for healthy living, and also, around 80% of all pharmaceutical materials are derived directly or indirectly from plant sources. So, there is increasing general acceptability of the use of medicinal plants in today’s medical sciences researches. Plants are valuable for modern medicine in four basic ways; they are used as a source of direct therapeutic agents, as a raw material for semi synthetic chemical compounds, as models for new synthetic compounds and finally medicinal plants can be used as taxonomic markers for the discovery of new compounds.
Herbal extracts are not a simple task since many factors influence the biological efficacy and reproducible results. Standardized herbal extracts of consistent quality and containing well-defined constituents are required to provide reliable and consistent clinical effects. Herbal drug technology is used for converting botanicals materials into medicines, where standardization and quality control with proper integration of modern scientific techniques and traditional knowledge is important.
Quality control and standardization of herbal medicines involve several steps. The source and quality of raw materials play essential role in guaranteeing the quality and stability of herbal preparations.
Standardization is a process of evaluating the quality and purity of medicinal plants and their extracts by various parameters like morphological, microscopical, physical, chemical and biological specifications.
The researches, however, suffer from lack of standardization parameters and proper documentation based on scientific screening procedures.
In this present study, an attempt has been made to give an overview of necessity of standardization of extract of medicinal plants in the investigations and the manner to perform it.
Keywords: Standardization, Quality control, Herbal extracts, Medicinal plants, Evaluation of extracts

Background and Those who inherit medical history of Iran have the crucial responsibility of transferring the scientific findings of traditional medicine to modern medicine through a scientific experimental process. Cotoneaster, scientifically known as purgative manna, is an herb with the capacity of being used both in traditional and in modern medicine. This study was conducted to review active ingredients of cotoneaster in Iranian traditional medicine.
Material and This library study was performed through a narrative review of books on traditional medicine and searching databases such as Google scholar, Pubmed, Magiran, SID, and Science Direct.
First, traditional medicine references and experiences of hakims on cotoneaster are presented, and then, new findings of modern scientists about medicinal properties of cotoneaster and its active ingredients. The last section of this study briefly describes the specific use of cotoneaster for treatment of infant jaundice.
Regarding the history of using cotoneaster for treatment of some diseases and that the cotoneaster shrub is native to Iran, research centers are recommended to use modern technologies to examine the efficiency of cotoneaster given its socioeconomic benefits.

Background and Teaching evaluation questionnaire of instructors is one of the important instruments used in educational processes which can be performed using different methods including student's feedbacks. This is now considered as a challenging educational issue and different positions exist in this regard. The purpose of this study was to assess the reliability of student's feedback in different terms and majors in the evaluation of instructors teaching the same course. Ïn a cross-sectional analytic study, evaluation of 40 instructors was carried out by 89 groups of students. Ëach instructor was teaching a specific course to several groups of students. The questionnaire was classified into four areas. The total score was assessed for each instructor and analyzed using descriptive statistics and correlation test. Reliability was assessed by Çronbach's alpha coefficient. The reliability of the questionnaire was high (α=0.96) based on Çronbach's alpha coefficient. The reliability index was the highest in the area of teaching skills (α=0.96) and the lowest in terms of educational discipline (α=0.81). There was a significant correlation among different studied variables scored by different groups of students for each instructor. Â significant correlation was also found between the total and the average score (P<0.001).Çonclusion: The questionnaire used for the evaluation of the instructors was highly reliable and reliability was higher than optimal level in all areas. Therefore, it seems that student's feedback is one of the reliable methods in the evaluation of instructors using an appropriate questionnaire.

Background and Low back pain is a common and costly problem in pregnancy. Ït is one of the main reasons of disability and absence from work with extremly direct and indirect economical impact. Women are more prone to low back pain and pregnancy is one of the predisposition. The purpose of this study was to assess the effect of an exercise program and ergonomic advices on the treatment of low back pain in pregnant women. Following ethical approval and through a randomized controlled clinical trial, 120 pregnant women with low back pain were recruited into experimental and control groups. The experimental group (n=60) received therapeutic exercise combined with ergonomic advices and the control group (n=60) was given no intervention. Pain experienced by patients was assessed using Visual Ânalogue Scale and functional disability on Ôswestry Low Back Disability Questionnaire after the planned intervention within three months follow-up. Ïntra-group changes indicated that there was a significant reduction on pain intensity and functional disability in the experimental group (P<0.01 in both instances) but no such difference was found in the control group (P>0.05). Ïnter-groups changes showed significant improvements in both pain intensity and functional disability following intervention (P<0.01) in the experimental group in comparison with the control group (P<0.01 in both instances). The significance of differences held up within three months follow–up between the two groups (P<0.01 in both instances).Çonclusion: Ôur results demonstrate that therapeutic exercise and ergonomic advices could be considered as effective approaches in the treatment of low back pain during pregnancy. Therefore, we offer regular exercise and ergonomic advices during pregnancy and afterwards in order to prevent and to control low back pain

There are many studies about statins showing that these drugs have some anti-inflammatory and immunomodulatory effects and might reduce inflammatory markers in rheumatoid arthritis. The aim of this study is to evaluate atorvastatin effect on clinical and laboratory markers in rheumatoid arthritis. Patients and This study is a randomized, double-blind, clinical trial carried out from March 2005 to July 2006. 66 patients with active rheumatoid arthritis who had been referred to rheumatology clinic in Hazrat Rasool-e-Akram Hospital were selected and divided into two groups to receive atorvastatin or placebo in a double-blind manner. The two groups were similar in terms of disease duration and activity and anti-rheumatoid therapy. 32 patients received atorvastatin and 34 patients received placebo. Patient's data were recorded in the first visit and at the end of the 4th and 24th weeks of therapy. The mean age of the subjets was 51.84 years in atorvastatin group and 47 years in placebo group. Mean duration of the disease was 7.06 years in atorvastatin group and 7.8 years in placebo group. Except for morning stiffness in placebo group, no significant difference was seen in clinical and laboratory findings. This study showed no significant decrease in inflammatory markers in rheumatoid arthritis treated with atorvastatin.

Background and Low back pain (LBP) is one of the most common and costly work-related conditions and nursing profession has one of the highest rates of back injuries (more than 50%) among all occupations. The purpose of the present study was to determine the prevalence and risk factors for back injuries in nursing personnel. Following ethical approval, 1226 nurses were randomly recruited from 13 hospitals in North of Ïran. Different questionnaires were designed to cover a) personal and professional data b) the prevalence of back pain and c) possible causes and their effects on nursing activities. LBP was reported by 51.5%, 56.3%, 58.9%, 59.6% and 62% of nurses indicating point, last month, 6 month, last year and lifetime prevalence of LBP respectively. There was a correlation between LBP and age, BMÏ, number of pregnancy and delivery, socio-economical class, anxiety and depression (p<0.01). There was also a significant correlation between duration of work, nursing post, ward and job satisfaction (p<0.01). Lifting was the most common mechanism for back injury (30.4%). Prolonged standing and rest were found to be the significant aggravating and relieving factors (57.6% and 59.2% respectively). Âbsenteesm due to LBP in the last month was reported by 33.7% of the sample with an average of 79 days/year. Çonclusion: The results demonstrate that the magnitude of LBP amongst nursing personnel appears to be high and therefore more resources should be allocated to prevent such an injury in nursing profession. However, further research is certainly needed to evaluate the effects of different prevention strategies.

Low back pain (LBP) is common in youth, although `associated with chronic pain in adults. The purpose of this study was to determine the prevalence and risk factors of LBP in school children age 11-14. A cross sectional study was carried out on school children aged 11-14 in north of Iran. Using random multistage sampling 5000 children were selected. Demographic, mechanical and lifestyle data as well as the prevalence and LBP characteristics were collected by a questionnaire. Data analysis was carried out using SPSS (version11) software. Of the original sample, 4813 (96.2%) children returned the questionnaire. Point, last month, last 6 months and annual prevalence were 15%, 14.4%, 15.6%, and 17.4%, respectively. LBP was significantly correlated with age (p<0.05), lifting (p<0.05), position and duration of watching TV, doing homework and duration of exercise (p<0.05). The results indicated that the prevalence of LBP in school children is relatively high. Further studies evaluating the effect of different preventive strategies to reduce the prevalence of LBP in school children is strongly recommended.

Background and Preeclampsia is a hypertensive disorder in pregnancy and is known as a specific syndrom of pregnancy. Several studies have been done to asses the indicators of preeclampsia for early detection of the disease. Uric acid is considered by some investigators as one of the most sensetive indicators in preeclampsia. In contrast some researchers have found it not useful in prediction of preeclampsia. Hence, more studies are needed about the role of uric acid levels in diagnosis of preeclampsia. The aim of this research is to compare the serum uric acid levels in preeclamptic and normal pregnant women and its sensivity as an indicator of preeclampsia. In this case-control study 304 pregnant women were enrolled in the study at Fatmeh Zahrah Hospital of Sari. Among them, 151 preeclamptic women were allocated in case group and 153 healthy pregnant women in control group. SPSS were used for analysis of data and variables were compared by Chi square, ANOVA, Pearson correlation index, and sensivity and specifity were calculated. Difference in the number of term delivery and primi gravidity between the three groups (normal, mild and severe preeclampsia) were significant (P<0.05). Considering maternal and fetal outcomes, only Decolman (two cases) had no significant difference between 3 groups. Mean of uric acid levels differed between three groups (P<0.0001). Severe preeclampsia had the most significant difference with normal group. Elevated uric acid (defined as up of 5.5 mg/dl) was observed in 34/2% in hyperuricemia group, 71.2 % in preeclamtic and 28.8% in control group (P<0.0001) The sensivity of uric acid levels for determining the preeclampsia and its severity elevated with increasing in concentration of uric acid but the specifity decreased. Results showed that the sensivity of uric acid levels in diagnosis of preeclampsia is moderate and measuring uric acid can be used in determining the severity of preeclampsia, maternal and specially fetal outcomes (LBW, preterm, IUGR, low apgar).

Background and Low back pain (LBP) is a common and costly problem during pregnancy and assumes to be a part of normal pregnancy caused by normal physiological changes. Pregnancy-related LBP is one of the main reasons for disability, absence from work and responsible for huge direct and indirect economical impact. This article systematically reviews papers concerning the epidemiology and risk factors on LBP in pregnant women. MËDLÏNË, ÇÏNÂHL, Rose-Net, ÔVÏD, and BÏDS were searched for the period of 1985-2003, using the key words 'low back pain', 'epidemiology', 'pregnancy', 'risk factors'. Ïn addition, references given in relevant publications were used. Ëighteen studies were identified. Ëleven studies investigated epidemiology of LBP during pregnancy and the prevalence were reported >50% in 8 (73%) studies. Ten studies were carried out on the epidemiology of LBP after pregnancy. The prevalence of LBP were reported >40% in 6 (60%) studies. Âmong different reported risk factors, previous LBP as well as younger age were the most important risk factors. Çonclusion: Âlthough there were some methodological flaws (e.g., small sample size of the study population, lack of clear classification and definition for LBP, different study design, different methods of study implementation, etc.) which precludes strong conclusion, it appears that LBP is one of the most common problem, during pregnancy and after delivery. Ït should also be noted that education and certain exercises can be beneficial to the pregnant women in the absence of medical complications.

Background and Macrosomia can increase maternal & neonatal complications.These complications and their relevance to macrosomia was evaluated in this study. This was a cohort study done, by selecting 5440 delivery files, in which 4400 cases had natural delivery and 104 patients with cesarean section. Patients with full term delivery of neonate with 4000 grams were selected as a case group and the patients with full term delivery of neonate with 25000-3999 grams weight were selected as a control group. Factors like, parity, and delivery status were the same for both groups, the patients with repeated cesarean were omitted in this study. The results of this study showed that the total rate of cesarean section in control group was 15.5% against the rate of 11.5% in control group (P<0.037), and the main reason of cesarean in macrosomic group was due to fetal distress. Shoulder dystocia and excretion of moconium was the only complication of Macrosomic infants, which showed no statistically significant difference (P<0.002), post delivery bleeding and administration of oxytocin for acceleration of labour in case groups showed no significant difference with cantrol groups (P<0.01). This study indicated that, despite high rate of vaginal delivery, of macrosomic infant, excluding shoulder dystocia, delivery of macrosomia and post delivery bleeding, there was no significant difference in maternal complications and further study is recemmonded in such type of deliveries.