The effect of acupuncture on the day of embryo transfer on the in vitro fertilization outcomes: An RCT

Background

Acupuncture is an adjunct therapy to support infertile women received in vitro fertilization (IVF) treatment; however, the efficacy of this approach needs more evaluation.

Objective

This randomized clinical trial (RCT) study aimed to evaluate the influence of acupuncture on reproductive outcomes in women undergoing IVF treatment.

Materials and Methods

The study was carried out on 186 participants who had undergone IVF treatment in the Mother and Child Hospital between September 2015 and February 2016. Subjects were randomly divided into three groups: Acupuncture 25 min before embryo transfer (ET) (ACU1 group, n = 62), acupuncture 25 min before and after ET (ACU2 group, n = 62), and ET without acupuncture (control group, n = 62). Pregnancy rates (biochemical, clinical, and ongoing) were evaluated and compared between groups.

Results

There were significant differences between the ACU1 group and the control group regarding biochemical (p = 0.005), clinical (p = 0.006), and ongoing (p = 0.007) pregnancies. Also, our results showed that two-session acupuncture (ACU2) lead to a significant reduction in frequency of biochemical (p = 0.002), clinical (p = 0.003), and ongoing (p = 0.01) pregnancy rates when compared to the one-session acupuncture (ACU1). No significant difference was found between the ACU2 and control groups regarding the aforementioned terms (p = 0.50).

Conclusion

Acupuncture 25 min before ET significantly increased the IVF outcomes in women undergoing IVF compared with no acupuncture. Repeating acupuncture 25 min after ET did not improve the IVF outcome.

Sensitivity and Specificity of Modified Bragard Test in Patients With Lumbosacral Radiculopathy Using Electrodiagnosis as a Reference Standard

Objective

The purpose of this study was to assess the diagnostic accuracy of a modified Bragard test compared with the straight leg raise (SLR) test in patients presenting with electrodiagnostic evidence of L5 and S1 nerve root compression.

Methods

This was a cross-sectional study conducted on 506 consecutive patients with signs and symptoms consistent with lumbosacral radiculopathy confirmed by electrodiagnostic study. Patients were evaluated from September 2013 to September 2015 in the physical medicine and rehabilitation outpatient clinic of Shahid Faghihi Teaching Hospital, Shiraz, Iran. The SLR test was investigated concomitantly to determine the sensitivity and specificity.

Results

Electrodiagnostic study findings indicated lumbosacral radiculopathy in 312 patients. Of these participants, 198 were positive on SLR testing, and of 114 SLR-negative patients, 79 were positive on Modified Bragard testing. Sensitivity of the Modified Bragard test was 69.3%, and specificity was 67.42%. Positive and negative predictive values were 73.15% and 63.16%, respectively. Positive likelihood ratio was 2.13, and negative likelihood ratio was 0.46. Diagnostic odds ratio was 4.63. In patients with symptom duration of less than 3 weeks, SLR sensitivity and specificity decreased as the Modified Bragard test diagnostic accuracy increased.

Conclusions

The Modified Bragard test is easy to perform and has an acceptable test performance, which can help to increase the discriminative power of clinical examination in patients with L5 or S1 nerve root compression who exhibit a negative SLR test result, especially in the acute phase of disease.

Efficacy of topical chamomile oil for mild and moderate carpal tunnel syndrome: A randomized double-blind placebo-controlled clinical trial

OBJECTIVE

To evaluate the efficacy of topical chamomile oil in patients with mild and moderate carpal tunnel syndrome (CTS).

METHOD

Eighty six patients with electrodiagnostic criteria of mild and moderate CTS were enrolled in this randomized double-blind placebo-controlled clinical trial and received wrist splint plus topical chamomile oil or placebo for 4 weeks. They were evaluated at the baseline and end of the study regarding functional and symptomatic scores, dynamometry, and electrodiagnostic indexes.

RESULTS

Dynamometry, functionality, and symptom severity scores of the patients were significantly improved in the chamomile oil group compared with the placebo group (P = 0.040, P = 0.0001, P = 0.017, respectively). Additionally, compound latency of the median nerve in the chamomile oil group significantly decreased (P = 0.035) compared to the placebo group. Other electerodiagnostic measurements did not change significantly.

CONCLUSION

Complementary treatment with topical chamomile oil may have some benefits for patients with mild and moderate CTS, both subjectively and objectively.

Effects of kinesiotaping versus non-steroidal anti-inflammatory drugs and physical therapy for treatment of pes anserinus tendino-bursitis: A randomized comparative clinical trial

OBJECTIVE

Pes anserinus tendino-bursitis is a condition caused by repetitive friction over the bursa or direct trauma to knee joint and it presents with proximal medial tibial pain and swelling. The aim of this study is to determine the effects of kinesiotaping in comparison with naproxen and physical therapy in treatment of pes anserinus tendino-bursitis.

METHODS

In a randomized comparative clinical trial 56 patients with clinical diagnosis of pes anserinus tendino-bursitis were randomly assigned to kinesiotaping and naproxen/physical therapy (28 patients in each group). Kinesiotaping on the tender area in the form of space-correction (lifting) technique was used and repeated for three times with a one-week interval. Another group received naproxen (250mg TID for 10 days) and ten sessions of daily physical therapy. The visual analog scale (VAS) was used for evaluation of pain. The depth of swelling of the area was measured with sonography before and after treatment. Wilcoxon signed ranks test has been used for determining the influence of interventions on pain (VAS) and swelling scores in each group. The ANCOVA (Analysis of covariance) test was applied for comparing the influence of interventions on VAS and swelling scores after adjustment for co-variables.

RESULTS

At end of the study, 27 patients remained in the kinesiotaping group and 19 patients in naproxen/physical therapy group. Treatment with kinesiotaping significantly decreased the pain (P=0.0001) and swelling scores (P=0.0001) in comparison with naproxen/physical therapy after adjustment for baseline characteristics. Kinesiotaping was safe without any complications except for a mild local skin irritation in one patient.

CONCLUSION

Kinesiotaping is more effective than naproxen plus physical therapy in reduction of pain and swelling in patients with pes anserinus tendino-bursitis.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov identifier is NCT01680263.

Topical Citrullus colocynthis (bitter apple) extract oil in painful diabetic neuropathy: A double-blind randomized placebo-controlled clinical trial

BACKGROUND

The aim of the present study was to examine the safety and efficacy of a topical formulation of Citrullus colocynthis in patients with painful diabetic polyneuropathy (PDPN).

METHODS

The study was designed as a two-arm double-blind randomized placebo-controlled clinical trial using a parallel design. Sixty patients with PDPN were randomly allocated to receive either a topical formulation of C. colocynthis or placebo (1:1 allocation ratio) for 3 months. Patients were evaluated before and after the intervention using the neuropathic pain scale, electrodiagnostic findings, World Health Organization Biomedical Research and Education Foundation (BREF) quality of life (WHOQOL-BREF) scores, and reported adverse events.

RESULTS

There was a significantly greater decrease in mean pain score after 3 months in the C. colocynthis (-3.89; 95% confidence interval [CI] -3.19, -4.60) than placebo (-2.28; 95% CI -1.66, -2.90) group (P < 0.001). Mean changes in nerve conduction velocity of the tibial nerve, distal latency of the superficial peroneal nerve and sural nerve, and sensory amplitude of the sural nerve were significantly higher in the intervention than placebo group (P < 0.001) in favour of the intervention. In the different domains of WHOQOL-BREF, there was a significant improvement only for the mean score in the physical domain.

CONCLUSIONS

Application of a topical formulation of C. colocynthis fruit extract can decrease pain in patients with PDPN. It also may have some uncertain effects on nerve function and the physical domain of quality of life, which require further investigation in studies with larger sample sizes and of longer duration.

A pilot randomized double-blind placebo-controlled trial on topical chamomile (Matricaria chamomilla L.) oil for severe carpal tunnel syndrome

OBJECTIVE

To assess the effectiveness of standardized topical Chamomile (Matricaria chamomilla L.) oil in patients with severe carpal tunnel syndrome, as a complementary treatment.

METHOD

A pilot randomized double-blind placebo-controlled trial was conducted. Twenty six patients with documented severe carpal tunnel syndrome were treated in two parallel groups with a night splint plus topical chamomile oil or placebo. They were instructed to use their prescribed oil for 4 weeks, twice daily. Symptomatic and functional status of the patients and their electrodiagnostic parameters were evaluated when enrolled and after the trial period, as our outcome measures.

RESULTS

A significant improvement of symptomatic and functional status of patients in the chamomile oil group was observed (p = 0.019 and 0.016, respectively) compared with those in the placebo group. However, electrodiagnostic parameters showed no significant changes between the two groups.

CONCLUSION

Chamomile oil improved symptomatic and functional status of patients with severe carpal tunnel syndrome.

COMPARISON OF THE EFFECT OF AQUATIC PHYSICAL THERAPY AND CONVENTIONAL PHYSICAL THERAPY IN PATIENTS WITH LUMBAR SPINAL STENOSIS (A RANDOMIZED CONTROLLED TRIAL)

Purpose: To assess and compare the effect of aquatic and conventional physical therapy, two well-known non-operative therapeutic options in patients with lumbar spinal stenosis (LSS). Methods: 50 patients with low back pain and the diagnosis of LSS were recruited in this prospective parallel randomized controlled trial. Patients in group one were enrolled in aquatic therapy program and those in group two attended physical therapy sessions through application of physical modalities and receiving a home-based exercise program. Pain and walking ability were measured in each group before therapy, immediately after therapy and three months later. Results: Patients in both groups improved regarding pain either assessed immediately after therapy (repeated measure test, p < 0.001) or three months later (Wilcoxon test, p < 0.001 for group one and p = 0.005 for group two). Functioning improved in both groups (repeated measure test, p < 0.001) but this advantage did not remain significant after three months follow up in group two (repeated measure test, p = 0.002 in group one and p = 0.181 in group two). Patients in group one had significantly more favorable outcome than group two regarding functioning (independent samples t-test, p = 0.02) and pain (Mann–Whitney test, p = 0.001); however, this superiority didn't sustain in long term follow up. Conclusion: Aquatic therapy can provide greater short term improvement in pain and functioning than conventional physical therapy in patients with LSS especially those with limited capability for exercise on land.

The effect of back massage on blood pressure in the patients with primary hypertension in 2012-2013: a randomized clinical trial

BACKGROUND

Tension and stress are among the factors that lead to hypertension. In most individuals, behavioral strategies, such as relaxation and massage, are effective in controlling the individuals' response to stress, thus reducing hypertension.

METHODS

This non-blind clinical trial was conducted on 90 patients with primary hypertension. The patients were randomly divided into a control and an intervention group. In both groups, blood pressure was measured and recorded twice a week before and after a 10-min Swedish back massage and rest for 6 weeks. The study data were collected using a questionnaire including demographic information, a check list of blood pressure record, and a fixed manometer.

RESULTS

In the intervention group, systolic and diastolic blood pressure decreased to 6.44 and 4.77 mmHg, respectively after back massage (P<0.001).

CONCLUSION

The obtained results were indicative of the effectiveness of back massage in reducing blood pressure in the study participants. Using stress control methods, such as massage, is a simple, acceptable, and teachable method for families to control blood pressure. After conducting more studies on this issue, back massage can be recommended as a non-pharmacological method to control blood pressure.

TRIAL REGISTRATION NUMBER

IRCT2013112615552N1.

Effect of Linum usitatissimum L. (linseed) oil on mild and moderate carpal tunnel syndrome: a randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Carpal tunnel syndrome is known as the most common entrapment neuropathy. Conservative treatments cannot reduce the symptomatic severity satisfactorily; therefore, effectiveness of Linum usitatissimum L. (linseed) oil on carpal tunnel syndrome, as a complementary treatment, was evaluated in the current study. Linseed oil is a well-known preparation in Iranian traditional medicine and its analgesic, anti-inflammatory and anti-oxidative effects have been shown in previous studies.

METHODS

A randomized, double-blind, placebo-controlled clinical trial was conducted. One hundred patients (155 hands) with idiopathic mild to moderate carpal tunnel syndrome aged between 18 and 65 years old were randomized in two parallel groups. These two groups were treated during 4 weeks with topical placebo and linseed oil. In addition, a night wrist splint was prescribed for both groups. Symptomatic severity and functional status were measured using Boston Carpal Tunnel Questionnaire. In addition, median sensory nerve conduction velocity, motor distal latency, sensory distal latency and compound latency as electrodiagnostic parameters were measured at baseline and after the intervention period.

RESULTS

After the intervention, significant improvement was observed regarding Boston Carpal Tunnel Questionnaire symptomatic severity and functional status mean differences (p <0.001) in the linseed oil group compared with those in the placebo group. Also, regarding the mean differences of both groups, significant improvement of nerve conduction velocity of the median nerve was seen in the linseed oil group by a value of 2.38 m/sec (p < 0.05). However, motor distal latency and sensory distal latency of the median nerve showed no between-group significant changes (p = 0.14 for both items). Finally, compound latency was improved slightly in the case group, comparing mean differences between the groups (p <0.05). No significant adverse events were reported from using linseed oil.

CONCLUSIONS

It seems that linseed oil could be effective in the management of mild and moderate carpal tunnel syndrome, especially in improving the severity of symptoms and functional status. In addition, its effect on electerodiagnostic parameters, especially on the nerve conduction velocity, can be considered as a valuable point.

Serum folate and vitamin B12 status in healthy Iranian adults

To assess the serum folate and vitamin B12 status in healthy Iranian adults, we designed a population-based cross-sectional study of 1200 individuals aged 20-80 years. Finally 984 participants (507 men and 477 women) were assessed. The mean serum folate was 4.61 (SD 2.40) ng/mL and the mean serum vitamin B12 level was 265.6 (SD 170.9) pg/mL. Overall 1.0% were folate deficient and 25.8% had low vitamin B12 levels according to the manufacturer's reference ranges (folate < 1.5 ng/mL and vitamin B12 < 160 pg/mL). The mean serum folate and vitamin B12 levels were significantly lower in men. The prevalence of vitamin B12 deficiency was considerably higher than folate deficiency. Implementation of preventive measures seems to be necessary.