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BACKGROUND: PCOS is a common condition among women of reproductive age, marked by irregular menstrual cycles, hyperandrogenism, and ultrasound abnormalities. Infertility treatments such as metformin and myoinositol often have side effects and low adherence. Ziziphus jujuba has the potential in improving PCOS outcomes, prompting this study to compare its effect on pregnancy rates with conventional therapies. METHODS: This double-blind, randomized trial involved 196 infertile PCOS patients (ages 18-45), with 49 participants in each group. Participants were randomly assigned to four groups: metformin (500 mg daily), myoinositol (2000 mg daily), Ziziphus jujuba hydroalcoholic extract (15 g daily), or placebo (sachet/pill) for 12 weeks. Biochemical (FBG, lipid profile, ALT, AST, ESR, CRP, TyG index) and anthropometric (weight, BMI, waist circumference) measurements were taken pre- and post-study. Ovulation induction with letrozole was performed, and pregnancy occurrence was the primary endpoint, assessed via Beta hCG and ultrasound 6-7 weeks after treatment. RESULTS: No significant differences in pregnancy as primary outcome were found (Ziziphus jujuba: 10, Metformin: 7, Myoinositol: 5, Placebo: 4; p > 0.05). However, significant improvements in cholesterol, TG, HDL cholesterol, and FBG were observed in the Ziziphus jujuba compared to other groups (p < 0.05). CONCLUSION: The Ziziphus jujuba extract demonstrated significant improvements in FBG levels, lipid profiles, and insulin resistance; however, it did not significantly increase pregnancy occurrence compared to metformin, and myoinositol. No serious adverse effects were observed, with only one participant reporting mild constipation. These findings suggest that while Ziziphus jujuba shows promise in metabolic management of PCOS, its efficacy in enhancing fertility outcomes requires further investigation or consideration in combination therapies. TRIAL REGISTRATION: Registered at the Mashhad Medical University of Medical Science: IR.MUMS.MEDICAL.REC.1402.191. The date of enrolment of the first patient into the trial is January 21, 2023. © 2025. The Author(s).

Functional constipation is a common disorder of the gastrointestinal tract in children without specific treatment. Ziziphus jujuba has been used in traditional medicine for various diseases such as constipation. A safe and inexpensive treatment with few side effects can be used as an effective alternative to current medications. In this study, we sought to compare Ziziphus jujuba syrup (ZS) with polyethylene glycol (PEG) for the treatment of pediatric functional constipation. A double-blind, randomized clinical trial was performed on children aged 2-10 years with functional constipation who were referred to the gastroenterology clinic of the 17-Shahrivar Hospital in Rasht, Iran. Eligible patients were randomized into two groups: PEG group; 1-5 cc/kg/day (40% w/v solution without electrolytes; average dose: 0.2-1 g/kg), and ZS group; 1-5 cc/kg/day (average dose: 5-25 mg/kg). All patients were followed up for three months, every 2 weeks in the first month, and then monthly for 2 months. At the beginning and end of the study, liver and kidney function tests and blood sugar levels were checked. Data were analyzed using SPSS software version 19 at a significance level of 0.05. Out of 90 eligible children, 32 patients in the PEG group and 30 patients in the ZS group completed the follow-up visits. The mean age of the subjects was 4.31 ± 1.97 years. There was no significant difference between the two groups in terms of age (P = 0.181), gender (P = 0.218), age at onset of constipation (P = 0.083), and weight (P = 0.199). The average therapeutic response score in the ZS group improved prominently compared to the PEG group (P < 0.05). The average number of encopresis and visual analog scale pain scores significantly decreased in the ZS group compared to the PEG group (P < 0.05). Other indices, including frequency of defecation, and medication adherence in the ZS group were significantly improved compared to the PEG group (P < 0.05). Only in the PEG group, a few cases reported self-limiting side effects. ZS can be a treatment choice for functional constipation without any adverse events or liver or kidney injury in children. However, further studies are necessary to find p

OBJECTIVES: The effects of jujube (Ziziphus jujube) consumption on metabolic and mental health outcomes in subjects diagnosed with metabolic syndrome (MetS) is unknown and remains to be examined. Hence, we carried out a parallel-group, randomized controlled trial to investigate this issue. METHODS: Eligible participants were randomly assigned to the intervention (n = 30) or the control (n = 30) groups to receive either jujube or a placebo for eight weeks. Subjects were provided with 30 g dried jujube powder or placebo and were asked to consume half of the powder at 10 a.m. and the rest at 4 p.m. Lipid profile, fasting blood glucose (FBG), waist circumference (WC), and blood pressure were evaluated as primary outcomes. Secondary outcomes collected were mental health measures (e.g., depression, anxiety, and stress). RESULTS: Jujube consumption failed to decrease FBG, total cholesterol, low-density lipoprotein cholesterol, and blood pressure, as well as depression and anxiety scores (P > 0.05). However, the between-group comparison revealed a significant improvement in WC (- 3.98 vs. - 0.51, P = 0.01), triglyceride (TG) (- 24.96 vs. - 0.73, P = 0.03), and high-density lipoprotein cholesterol (HDL-C) (2.83 vs. 0.40, P = 0.01) in the jujube group compared to the placebo. In addition, compared to the control group, jujube consumption led to a significant improvement in the score of stress (- 5.80 vs. - 2.86, P = 0.01). CONCLUSION: Jujube consumption only had beneficial effects on WC, TG, and HDL-C in subjects with MetS. However, the current study has methodological weaknesses in blinding and herb purity/potency testing, which should be addressed in future studies. Nomogram for Predicting the Risk of Complications after Endoscopic Foreign Body Removal from the Adult Upper Gastrointestinal Tract. Chen Z(1), Yin M(2), Xia P(2), Han X(2), Zhu H(3). Author information: (1)Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, 226000, China. (2)Department of Gastroenterology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China. (3)

4. Dig Dis Sci. 2024 Apr;69(4):1361-1371. doi: 10.1007/s10620-024-08343-7. Epub 2024 Feb 28. Nomogram for Predicting the Risk of Complications after Endoscopic Foreign Body Removal from the Adult Upper Gastrointestinal Tract. Chen Z(1), Yin M(2), Xia P(2), Han X(2), Zhu H(3). Author information

BACKGROUND: Although antihistamines are the first-line treatment for chronic spontaneous urticaria (CSU), 50% of patients don't respond to standard doses. In this study, the effectiveness of Ziziphus jujube fruit syrup in combination with antihistamines was assessed in patients with CSU. METHODS: This double-blind randomized clinical trial was conducted in Shiraz between December 2019 and December 2020. 64 patients with CSU who had experienced hives for at least six weeks and did not respond to the usual treatments were enrolled in the study. They were randomly assigned to intervention and control groups using permuted block random allocation. For four weeks, the intervention group received 7.5 mL Ziziphus jujube syrup twice a day, while the control group received 7.5 mL simple jujube syrup twice a day. Both groups received cetirizine 10 mg every night. Urticaria activity score (UAS) and CU-Q2oL questionnaires were used to assess urticaria state and sleep quality before and after each week for four consecutive weeks. Data were analyzed using SPSS software version 18, and P<0.05 was considered statistically significant. RESULTS: Before the intervention, there was no statistically significant difference between the two groups' mean of UAS (P=0.490) and sleep quality (P=0.423). During the follow-up, UAS in the intervention group was significantly lower (P=0.001). Moreover, this difference was significant on the day 28 (P=0.046). During the follow-up, the quality of sleep in both groups improved significantly, and this improvement was more significant in the intervention group. CONCLUSION: Ziziphus jujube syrup could be an effective adjuvant treatment for CSU.Trial Registration Number: IRCT20190304042916N1. Copyright: © Iranian Journal of Medical Sciences.

BACKGROUND & AIMS: In the current study, we aimed to assess the effect of dried Ziziphus jujube on blood glucose, lipid profiles, anthropometric indices, and inflammatory factors in type 2 diabetic(T2D) patients. METHODS: In this randomized controlled clinical trial, 48 patients, aged 30-65 years, were randomly assigned to two intervention(n = 24) and control(n = 24) groups. The subjects in the intervention group received 30 g Ziziphus jujube daily for 12 weeks. At baseline and the end of the 12th week, 10 ml of blood was taken from each patient after a 12- to 14-h overnight fasting. Plasma levels of fasting plasma glucose (FPG), triglycerides(TGs), total cholesterol(TC), high-density lipoprotein-cholesterol(HDL-C), low-density lipoprotein-cholesterol(LDL-C), high-sensitivity C-reactive protein(hs-CRP), and interleukin-6(IL-6) were measured. Anthropometric indices were determined. RESULTS: Plasma FPG, TG, TC, and LDL-C decreased significantly up to -11.36%, -13.59%, -7.46%, -7.65% in the Ziziphus jujube group at the end of week 12 compared to baseline, respectively (P < 0.05), and this reduction was significant in comparison with the control group (P < 0.05). The plasma hs-CRP reduced significantly up to -24.46% in the Ziziphus jujube group at the end of week 12 compared to baseline (P < 0.05), however, this reduction was not significant in comparison with the control group (P < 0.05). Also, there were no significant differences between the two groups in mean changes of body mass index, plasma HDL-C, and IL-6. CONCLUSIONS: The current study showed that daily consumption of Ziziphus jujube may have beneficial effects on the lipid profiles and blood glucose levels in T2D. CLINICAL TRIAL REGISTRATION NUMBER: T his clinical trial was registered at the Iranian registry of clinical trials (IRCT registration number: IRCT20181210041913N1).

Ziziphus jujuba Mill. (jujube) is an invaluable medicinal plant in traditional and modern medicine. Jujube syrup is a complex of herbal extracts including Z. jujuba, Berberis vulgaris, Rhus coriaria, Prunus domestica, and Rosa damascene. The purpose of the present study was to formulate and investigate the efficacy and safety of jujube syrup on brightening of facial skin. In this randomized, double-blind, controlled clinical study, 46 participants consumed jujube syrup or placebo (23 in each group) twice a day for 8 weeks. The number of pigments, area of pigmentation, and physician's global assessment score (PGAS) were evaluated at baseline and after 8 weeks. The results showed the amounts of total phenolics and flavonoids were 81.97 ± 0.25 and 4.98 ± 1.04 mg/ml, respectively. The amounts of organic acids (gallic acid and chlorogenic acid) were quantified at 1140 ± 17.65 and 1520 ± 25.77 μg/ml, respectively. The amounts of total phenolic and flavonoids were stable under accelerated conditions. Eight weeks after treatment, the number of pigment counts reduced to 0.545 ± 0.307 compared to the placebo group. Moreover, the pigmented area and its percentages were significantly reduced to 0.556 ± 0.285 and 0.561 ± 0.288 in jujube syrup compared with placebo, respectively. Jujube syrup is efficient and safe for treating hyperpigmentation of the face. © 2022 Wiley Periodicals LLC.

Liver injury is the most common complication of anti-tuberculosis drugs that can cause significant problems. The study aimed to determine the effectiveness of Jujube syrup on the prevention of antituberculosis drug-induced hepatotoxicity (DIH). This pilot randomized double-blind study was conducted based on a placebo-controlled design in patients with tuberculosis (TB). The patients were divided into two groups based on the block random allocation method and received 10 cc of jujube or placebo syrup per day. The liver enzyme levels were assessed as primary outcomes, and the severity of cough, anorexia, and nausea along with the quality of life (QOL) was assessed as secondary outcomes. Finally, eight and nine patients in the jujube and placebo groups completed the study, respectively. In the second week of the study, 27.3% of the patients in the placebo group developed hepatotoxicity. Moreover, there was no liver toxicity in the jujube group. This difference between the two groups was statistically significant (p = .037). Furthermore, the severity of cough in patients in the jujube group decreased significantly during weeks 2 and 4. The QOL significantly improved in the jujube group, compared to the placebo group. This study suggested that Jujube syrup could prevent anti-TB DIH. It can also improve the severity of cough and the QOL in pulmonary TB patients. © 2021 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics.

Coronavirus disease 2019 (COVID-19) pandemic has caused an urgent need for investigating potential treatments. Traditional medicine offers many potential remedies that have been historically used and have the advantage of bypassing the cultural obstacles in the practice of medicine. We aimed to investigate the efficacy of Zufa syrup in the treatment of suspected patients with mild to moderate symptoms of COVID-19. This triple-blind randomized controlled trial recruited patients with evidence of COVID-19 on chest computed tomography without an indication of hospital admission from March 2020 until April 2020. Participants were assessed by a physician and completed a pre-specified form to assess the duration and severity of symptoms. Patients were randomized to receive Zufa syrup (a combination of herbal medicines: Nepetabracteata, Ziziphus jujube, Glycyrrhizaglabra, Ficuscarica, Cordia myxa, Papaver somniferum, Fennel, Adiantumcapillus-veneris, Viola, Viper's-buglosses, Lavender, Iris, and sugar) or identical-looking placebo syrup at a dose of 7.5 mL (one tablespoon) every 4 hours for 10 days. After applying the eligibility criteria, 116 patients (49.1% male) were randomized to trial arms with a mean age of 44.3. During the follow-up, Cough, dyspnea, headache, myalgia, anorexia, anxiety, and insomnia improved gradually in both groups, and showed no difference between Zufa syrup and placebo. Oxygen saturation and pulse rate had stable trends throughout the follow-up and were similar between study arms. No patient required hospital admission or supplemental oxygen therapy during the study period. To conclude, in patients with mild to moderate symptoms of COVID-19, Zufa syrup did not show any difference in symptomatology over a 10 days' period when compared with placebo. Due to potential effects of medicinal plants in the treatment of respiratory infections, further studies are warranted to clarify their role in COVID-19. The study was approved by the Ethics Committee of the Qom University of Medical Science (Ethics committee reference number IR.MUQ.REC.1398.165) on March 10, 2020 and was registered in Iranian Clinical Trial Center (approval ID: IRCT20200404046934N1

Physiologic changes due to aging, pregnancy, nutritional status, drug interactions, and can affect pharmacokinetics and pharmacodynamics of antiepileptic drugs. In this review article, the interactions between phenytoin and herbs recorded in the literature were summarized according to the Medline database (via PubMed). Our results revealed that, changes in phenytoin's bioavailability were reported for co-administration of herbs or herbal extracts. An increase in phenytoin blood levels was established with Piper nigrum, Mentat, and Lipidum sativum in in vitro and/or in vivo studies. In contrast, herbphenytoin interactions led to sub-therapeutic levels of phenytoin in other cases with herbs such as Cannabis, Ginkgo biloba, Morinda citrifolia, Nigella sativa, and Trigonella foenum graceum. In addition, the findings of other pharmcodynamic experiments showed that various herbs, including Zizyphus jujube, Terminalia chebula, Curcuma longa L, and Centella asiatica, improved the pharmacological impact of phenytoin. To reduce the patients' health risks, health professionals involved in their treatment are expected to be thoroughly educated about the interactions between phenytoin and medicinal plants.