The effect of bergamot orange essence on anxiety, salivary cortisol, and alpha amylase in patients prior to laparoscopic cholecystectomy: A controlled trial study

The Molecular Mechanisms of Bergapten Against Abdominal Aortic Aneurysm: Evidence From Network Pharmacology, Molecular Docking/Dynamics, and Experimental Validation

This study endeavors to assess the potential protective role of bergapten (BP) in mitigating abdominal aortic aneurysm (AAA) and to decipher the underlying mechanisms and molecular targets. Network pharmacology was utilized to search for potential targets of BP against AAA. Molecular docking and molecular dynamics simulations were utilized to validate the interaction of BP with core targets, and then the therapeutic effect and mechanism of BP on AAA were verified by using an elastase-induced AAA model. Network pharmacology analysis identified five pharmacological targets for BP, including EGFR, SRC, PIK3CA, PIK3CB, and JAK2. Molecular docking and molecular dynamics simulations further prioritized JAK2 as the most promising candidate for the potential treatment of AAA. The results of animal experiments demonstrated that BP significantly reduced the expression of inflammatory cytokines IL-6, TNF-α, and IL-1β in the aortic tissue of AAA mouse model, and inhibited the phosphorylation of JAK2 and STAT3. BP plays an important role in the treatment of AAA, and it may become a promising drug to combat AAA progression. The inhibitory effect of BP on AAA vascular progression and the attenuation of inflammatory cell infiltration may be related to the regulation of JAK2/STAT3 signaling pathway.

The effectiveness of Melissa officinalis L. essential oil inhalation on anxiety and symptom burden of hemodialysis patients: a randomized trial study

BACKGROUND

Hemodialysis patients suffer from physical and mental symptoms for which aromatherapy might be useful. This study aimed to determine the effectiveness of Melissa officinalis L. (Lemon Balm) essential oil inhalation on anxiety and the burden of symptoms in hemodialysis patients.

METHODS

This study is a randomized clinical trial with a pretest-posttest design. Sixty-eight hemodialysis patients were randomly divided into intervention (who underwent Melissa officinalis L. inhalation aromatherapy 3 times a week for one month) and control (who inhaled refined sweet almond oil) groups. The intervention in both groups was conducted during the hemodialysis session. The data were collected using the state-trait anxiety inventory and Dialysis Symptom Index. Data were analyzed through SPSS-25, using Mann-Whitney, Wilcoxon, t-tests and MANOVA.

RESULTS

Before the intervention, both groups were similar in terms of anxiety and symptoms burden (P > 0.05). However, after the intervention, a significant difference was found between the groups in terms of state and trait anxiety, and severity of constipation, nausea, vomit, diarrhea, swelling in legs, muscle cramps and shortness, worry, nervousness and anxiety, and trouble staying asleep. Moreover, after the intervention, a significant difference was observed between the groups regarding the prevalence of symptoms burden such as feeling anxious and having a dry mouth (P < 0.05).

CONCLUSION

Melissa officinalis L. essential oil inhalation aromatherapy reduced the symptoms burden and anxiety in hemodialysis patients. Given the effectiveness of aromatherapy in hemodialysis patients, it is suggested that healthcare workers should use this complementary and integrative health to reduce the anxiety and symptoms burden in hemodialysis patients.

TRIAL REGISTRATION RCT REGISTRY

Iranian Registry of Clinical Trials (IRCT) number: IRCT20191021045178N3; Registration date 27/04/2021.

The effect of education on pre-operative anxiety in patients undergoing extracorporeal shock wave lithotripsy

BACKGROUND

The period before diagnostic and therapeutic procedures is associated with increased anxiety levels in patients due to a lack of sufficient information. This study aimed to determine the effect of education on physiological and psychological anxiety levels in patients before extracorporeal shock wave lithotripsy (ESWL).

MATERIALS AND METHODS

This randomized clinical trial was conducted at Baharloo Hospital in Tehran on 122 patients, and the samples were selected in two stages. In the first stage, the samples were selected using convenience sampling. In the second stage, they were randomly assigned to the intervention and control groups. The data were collected using demographic information and Spielberger's State-Trait Anxiety Inventory to measure psychological anxiety. Salivary cortisol was measured to evaluate physiological anxiety by both groups before the intervention and entering the room. The intervention group received the information before ESWL via face-to-face lectures and the broadcast of pre-recorded lecture videos. The control group received only the usual care in the ward. The data analysis was performed by SPSS version 25 using descriptive statistics that included the calculation of mean, standard deviation, and frequency distribution and inferential statistics (independent t-test, paired t-test ANOVA, and Chi-square test).

RESULTS

There was no significant difference in demographic characteristics between the intervention and control groups (P > 0.05). A significant decrease in the mean salivary cortisol level was found in the intervention group compared with the control group (P < 0.001). The anxiety level was markedly decreased in the intervention group compared with the control group (P < 0.001).

CONCLUSION

Adequately informing patients before ESWL could decrease patients' physiological and psychological anxiety levels. So, people in the field of nursing education can take an important step towards using this method and reducing the anxiety of patients. The existence of such videos and holding training sessions can be a suitable solution for educating the patient.

Essential oils for treating anxiety: a systematic review of randomized controlled trials and network meta-analysis

Background and purpose

The findings of clinical studies exploring essential oils (EOs) for anxiety remain disputed, and no studies have yet clarified the differences in the efficacy of EOs. The purpose of the study was to directly or indirectly compare the efficacy of different types of EOs on anxiety by pooling the results of randomized controlled trials (RCTs).

Methods

PubMed, Cochrane Library, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to November 2022. Only full texts of RCTs that investigated the effects of EOs on anxiety were included. The trial data were extracted and the risk of bias was assessed by two reviewers independently. Pairwise meta-analysis and network meta-analysis were performed by Stata 15.1 or R 4.1.2 software.

Results

Forty-four RCTs (fifty study arms) involving 10 kinds of EOs and 3419 anxiety patients (1815 patients in EOs group and 1604 patients in control group) were included. Pairwise meta-analyses showed that EOs were effective in reducing State Anxiety Inventory scores (SAIS) [WMD = -6.63, 95% CI-8.17, -5.08] and Trait Anxiety Inventory scores (TAIS) [WMD = -4.97, 95% CI-6.73, -3.20]. Additionally, EOs could decrease systolic blood pressure (SBP) [WMD = -6.83, (95% CI -10.53, -3.12), P < 0.001] and heart rate (HR) [WMD = -3.43, (95% CI -5.51, -1.36), P < 0.001]. Network meta-analyses demonstrated that regarding the outcome of SAIS, Jasminum sambac (L.)Ait. (jasmine) was the most effective with a weighted mean difference (WMD) of-13.61 (95% CrI-24.79, -2.48). Followed by Citrus (citrus aurantium L.), which had a WMD of-9.62 (95% CrI-13.32, -5.93). Moderate effect sizes were observed for Rosa rugosa Thunb. (damask rose) (WMD = -6.78, 95% CrI-10.14, -3.49) and Lavandula angustifolia Mill. (lavender) (WMD = -5.41, 95% CrI-7.86, -2.98). Regarding the results of TAIS, citrus aurantium L. was the best ranked intervention with a WMD of-9.62 (95% CrI-15.62, -3.7). Moderate-to-large effect sizes were observed for Citrus limon (L.) Burm. F. (lemon) (WMD:-8.48; 95% CrI-16.67, -0.33) and lavender (WMD:-5.5; 95% CrI-8.7, -2.46).

Conclusion

According to the comprehensive analysis, EOs are effective in reducing both state anxiety and trait anxiety, and citrus aurantium L. essential oil seems to be the most recommended type of EO for treating anxiety because of its significant effects in reducing SAIS and TAIS.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022331319.

Does Modifying the Consent Process Based on the Dominant Intelligence Type Reduce Anxiety During 3rd Molar Operations?

PURPOSE

Third molar surgery is one of the most commonly performed operations, usually associated with high anxiety. The purpose of this study was to determine if patients' anxiety would reduce if consent was modified to match their dominant intelligence type (DIT).

METHODS AND MATERIALS

A singlecenter, prospective randomized clinical study was conducted in the Maxillofacial Surgery Clinic of Ordu University on patients admitted for lower third molar removal between October 2020 and June 2021. The participants were randomly assigned to a study group where consent was based on DIT or a control group where consent was obtained in the standard fashion. DIT was determined using the multiple intelligence test and was further categorized as visual/spatial, verbal/linguistic, and bodily/kinesthetic. The consent method was the primary and the type of DIT was the secondary predictor variable. The primary and secondary outcome variables were the salivary cortisol level and Modified Dental Anxiety Scale (MDAS) scores measured before and after the consent, and after the operation. Mann-Whitney U, Friedman, Pearson correlation, and χ²tests were conducted for statistical analysis.

RESULTS

Eighty patients (55 females and 25 males; mean age 23.5 ± 6.2) were included. No significant difference was observed between the study and control groups for the change in cortisol levels and MDAS scores before-after consent (-11.15 ± 62.64; -6.84 ± 32.9) (P = .389), -0.6 ± 3.46; -0.7 ± 2.49) (P = .832) and before consent-after operation (-39.80 ± 108.2; -39.72 ± 77.04) (P = .987), (-4.31 ± 5.97; -3 ± 4.34) (P = .867). The change in MDAS scores and cortisol levels was not correlated after consent (P = .587, r = 0.62) and operation (P = .406, r = 0.94).

CONCLUSION

Providing consent based on DIT is not statistically different than providing consent in the standard fashion. The role of consent strategy in managing anxiety and lack of correlation between salivary cortisol and MDAS requires further investigation.

Pharmacological Properties of Bergapten: Mechanistic and Therapeutic Aspects

Bergapten (BP) or 5-methoxypsoralen (5-MOP) is a furocoumarin compound mainly found in bergamot essential oil but also in other citrus essential oils and grapefruit juice. This compound presents antibacterial, anti-inflammatory, hypolipemic, and anticancer effects and is successfully used as a photosensitizing agent. The present review focuses on the research evidence related to the therapeutic properties of bergapten collected in recent years. Many preclinical and in vitro studies have been evidenced the therapeutic action of BP; however, few clinical trials have been carried out to evaluate its efficacy. These clinical trials with BP are mainly focused on patients suffering from skin disorders such as psoriasis or vitiligo. In these trials, the administration of BP (oral or topical) combined with UV irradiation induces relevant lesion clearance rates. In addition, beneficial effects of bergamot extract were also observed in patients with altered serum lipid profiles and in people with nonalcoholic fatty liver. On the contrary, there are no clinical trials that investigate the possible effects on cancer. Although the bioavailability of BP is lower than that of its 8-methoxypsoralen (8-MOP) isomer, it has fewer side effects allowing higher concentrations to be administered. In conclusion, although the use of BP has therapeutic applications on skin disorders as a sensitizing agent and as components of bergamot extract as hypolipemic therapy, more trials are necessary to define the doses and treatment guidelines and its usefulness against other pathologies such as cancer or bacterial infections.

Non-pharmacologic Approaches in Preoperative Anxiety, a Comprehensive Review

During the pre-operation period, surgical candidates experience situations that stimulate psychological anxiety leading to stress during and after surgery which is known as preoperative anxiety. This condition can cause psychological and physiological adverse effects on both children and adults. Due to the high prevalence and adverse effects of preoperative anxiety, different treatments have been evaluated including pharmacological and non-pharmacological approaches. As pharmacological treatments may cause adverse effects such as breathing problems, drowsiness, interfering with anesthetic drugs, and prolonged recovery, non-pharmacological interventions are becoming more popular. These methods include cognitive-behavioral therapy, music therapy, pre-op preparation video, aromatherapy, hypnosis, guided imagery relaxation therapy, and massage. In this study, the most popular non-pharmacological approaches to preoperative anxiety are reviewed focusing on more recent evidence provided by clinical studies. The reviewed clinical evidence on the mentioned methods shows the efficacy of non-pharmacological interventions for the treatment of preoperative anxiety, so they can be used in patients of different ages and types of disease and surgery.

Influence of aromatic essential oil nursing on mental state of patients undergoing laparoscopic cholecystectomy: A protocol for systematic review and meta-analysis

BACKGROUND

There are no evidence-based data to confirm the efficacy of aromatic essential oil nursing in patients after laparoscopic cholecystectomy (LC). Therefore, in order to provide new evidence-based medical evidence for clinical treatment, we undertook this protocol for systematic review and meta-analysis to assess the effectiveness and safety of aromatic essential oil nursing on mental state of patients undergoing LC.

METHODS

The retrieval strategy will be developed by the evidence-based medicine librarians for the US Library of Medicine database, the Cochrane Database of Systematic Reviews, and the Excerpta Medica database. The databases will be searched between June 2022 and July 2022. Studies will be included according to the following criteria: study population undergoing LC; group with aromatic essential oil nursing compared to a control group; outcome measures including anxiety, salivary cortisol, alpha amylase, and patient satisfaction; randomized controlled trials. All data will be analyzed using R version 3.4.3 to calculate pooled standardized mean differences for outcomes. The Cochrane Collaboration's tool will be used to assess the risk of bias for each included article.

RESULTS

The results of this paper will fill a gap in the literature regarding this project.

CONCLUSION

We assume that the aromatic essential oil nursing has a positive effect.

REGISTRATION NUMBER

10.17605/OSF.IO/E5WC9.

Effect of aromatherapy with Melissa essential oil on stress and hemodynamic parameters in acute coronary syndrome patients: A clinical trial in the emergency department

Stress and hemodynamic changes are among the most significant symptoms and signs that could be observed in patients with acute coronary syndrome (ACS) upon admission to the emergency department. The present study was conducted to determine the effect of the fragrance of lemon balm (Melissa Officinalis) essential oil on stress level and hemodynamic parameters in patients with ACS in the emergency department.

METHODS

In this double-blind clinical trial, 72 patients were allocated to two groups of Melissa and placebo based on stratified block random sampling. The Melissa group inhaled two drops of Melissa essential oil, whereas the placebo group inhaled two drops of sunflower oil in two aromatherapy phases for 10 min with 90-min intervals. Stress level was measured using the depression, anxiety and stress scale (DASS-21), and hemodynamic parameters were measured and recorded in six time points by a cardiac monitoring system. Data analysis was carried out using descriptive statistics and ANOVA statistical tests, Chi-square test, independent t-test, and post-hoc Tukey's test.

RESULTS

Interaction between the time and group indicated the significant decrease in the mean score of stress and heart rate in the time points 2 and 5 (5 min after every occasion of aromatherapy) (p < 0.001) and also the remarkable decrease in the mean arterial pressure (MAP) in the time point 2 in the Melissa group in comparison with the placebo group (p < 0.001). There were no significant differences between the mean changes in stress, heart rate and MAP in the two group (P > 0.05).

CONCLUSION

Aromatherapy via the inhalation of Melissa essential oil with temporary impacts on certain time points could relieve stress and regulate hemodynamic changes in patients with ACS in emergent and acute conditions.

Therapeutic Effect and Mechanisms of Essential Oils in Mood Disorders: Interaction between the Nervous and Respiratory Systems

Essential oils (EOs) are extracted from plants and contain active components with therapeutic effects. Evidence shows that various types of EOs have a wide range of health benefits. In our previous studies, the potential of lavender EO for prevention and even treatment of depression and anxiety symptoms was demonstrated. The favourable outcomes may be due to multiple mechanisms, including the regulation of monoamine level, the induction of neurotrophic factor expression, the regulation of the endocrine system and the promotion of neurogenesis. The molecules of EOs may reach the brain and exert an effect through two distinctive pathways, namely, the olfactory system and the respiratory system. After inhalation, the molecules of the EOs would either act directly on the olfactory mucosa or pass into the respiratory tract. These two delivery pathways suggest different underlying mechanisms of action. Different sets of responses would be triggered, such as increased neurogenesis, regulation of hormonal levels, activation of different brain regions, and alteration in blood biochemistry, which would ultimately affect both mood and emotion. In this review, we will discuss the clinical effects of EOs on mood regulation and emotional disturbances as well as the cellular and molecular mechanisms of action. Emphasis will be put on the interaction between the respiratory and central nervous system and the involved potential mechanisms. Further evidence is needed to support the use of EOs in the clinical treatment of mood disturbances. Exploration of the underlying mechanisms may provide insight into the future therapeutic use of EO components treatment of psychiatric and physical symptoms.