BackgroundCarthamus tinctorius L., known as Kafesheh (Persian) and safflower (English) is vastly utilized in Traditional Medicine for various medical conditions, namely dysmenorrhea, amenorrhea, postpartum abdominal pain and mass, trauma and pain of joints. It is largely used for flavoring and coloring purposes among the local population. Recent reviews have addressed the uses of the plant in various ethnomedical systems.ObjectiveThis review was an update to provide a summary on the botanical features, uses in Iranian folklore and modern medical applications of safflower.MethodsA main database containing important early published texts written in Persian, together with electronic papers was established on ethnopharmacology and modern pharmacology of C. tinctorius. Literature review was performed on the years from 1937 to 2016 in Web of Science, PubMed, Scientific Information Database, Google Scholar, and Scopus for the terms “Kafesheh”, “safflower”, “Carthamus tinctorius”, and so forth.ResultsSafflower is an indispensable element of Iranian folklore medicine, with a variety of applications due to laxative effects. Also, it was recommended as treatment for rheumatism and paralysis, vitiligo and black spots, psoriasis, mouth ulcers, phlegm humor, poisoning, numb limbs, melancholy humor, and the like. According to the modern pharmacological and clinical examinations, safflower provides promising opportunities for the amelioration of myocardial ischemia, coagulation, thrombosis, inflammation, toxicity, cancer, and so forth. However, there have been some reports on its undesirable effects on male and female fertility. Most of these beneficial therapeutic effects were correlated to hydroxysafflor yellow A.ConclusionMore attention should be drawn to the lack of a thorough phytochemical investigation. The potential implications of safflower based on Persian traditional medicine, such as the treatment of rheumatism and paralysis, vitiligo and black spots, psoriasis, mouth ulcers, phlegm humor, poisoning, numb limbs, and melancholy humor warrant further consideration.

tized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Background Fatigue is a common symptom in patients with multiple sclerosis (MS). It has significant negative effects on the quality of life of patients with the condition. There are few therapeutic modalities for fatigue, which are also usually not sufficiently effective. The aim of this study was to evaluate the efficacy of acupuncture on this common symptom of patients with MS. Methods In this before-and-after clinical trial, 40 patients with definite diagnoses of MS, according to the ‘McDonald’ criteria, were studied. Patients who had Expanded Disability Status Scale (EDSS) scores greater than 4, or who had another disease that could be potentially responsible for their fatigue, were excluded from the study. In all, 20 patients with fatigue refractory to amantadine underwent 12 sessions of acupuncture. Fatigue was scored according to the Fatigue Severity Scale (FSS). Results A total of 15 (37.5%) patients with MS with fatigue responded to amantadine. The mean FSS score reduction after 2 months of treatment was 8±4, which was statistically significant (p<0.001). Of the 20 patients who were resistant to amantadine, 5 (25%) responded to acupuncture combined with amantadine treatment. The FSS scores of the 20 patients who were refractory were significantly reduced after this treatment (mean: 13±6, p<0.001). Conclusions Acupuncture appears to be associated with benefits for a proportion of patients with fatigue who are resistant to conventional drugs such as amantadine, and this finding justifies further research.

Background Stroke is the second leading cause of death in adults worldwide. There are remarkable geographical variations in the accessibility to emergency medical services (EMS), and transport delays have been documented worldwide to affect stroke outcomes significantly. Therefore, this study examines whether there are spatial variations in in-hospital mortality among suspected stroke patients transferred by EMS and attempts to determine its related factors using the auto logistic regression model. Methods In this historical cohort study, suspected stroke patients transferred to Ghaem Hospital of Mashhad by the EMS from April 2018 to March 2019 were included. Using emergency mission IDs, the baseline EMS data were integrated with the follow-up hospital records. The autologistic regression model was applied to examine the possible geographical variations in in-hospital mortality and its related factors. All analysis was carried out by SPSS version 16 and R 4.0.0 at the significant level of 0.05. Results 1,222 suspected stroke patients were included in this study, and the in-hospital mortality rate was 14.2%. Overall in-hospital stroke mortality was related to age, accessibility rate of an ambulance, screening time, and length of stay (p < 0.05). After stratifying by sex, we observed that mortality in men was related to age and length of stay, whereas, in women, variables of age, length of stay, accessibility rate of an ambulance, and screening time had a significant effect on in-hospital mortality among suspected stroke patients (p < 0.05). Conclusion Our results showed considerable geographical variations in in-hospital stroke mortality in Mashhad neighborhoods. Also, age- and sex-adjusted results from this study highlight the direct association between accessibility rate of an ambulance, screening time and length of stay, and in-hospital stroke mortality. The prognosis of in-hospital stroke mortality could be improved by reducing delay time and increasing the EMS access rate.