Publications by authors named "Mohammad Reza Vaez-Mahdavi"

43 Publications

Correction to: Combining health insurance funds in a fragmented context: what kind of challenges should be considered?

BMC Health Serv Res 2020 03 19;20(1):231. Epub 2020 Mar 19.

Department of Health Policy and Management,Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.

In the original publication of this article [1], there are two corrections.
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http://dx.doi.org/10.1186/s12913-020-5052-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081534PMC
March 2020

Effects of as an Add-On Therapy on Insomnia in Patients with Obsession or Depression: A Pilot Randomized Double-Blind Placebo-Controlled Trial.

J Altern Complement Med 2020 May 19;26(5):398-408. Epub 2020 Feb 19.

Immunoregulation Research Center, Shahed University, Tehran, Iran.

The present study was conducted to investigate the effect of extracted syrup on the quality and patterns of sleep in patients with depression or obsessive-compulsive disorder (OCD) as add-on therapy. A pilot double-blind randomized placebo-controlled trial. Psychiatric Clinic of Imam Hossein Hospital, Tehran, Iran. Participants were 16-15 years of age with mild and moderate depression or OCD having insomnia. This pilot study was conducted on patients with insomnia divided into two groups with depression (40 patients) or OCD (43 patients). Each group randomly assigned into two arms with the same conditions at baseline. The intervention arm daily received 5 mL syrup every 12 h for 4 weeks, and the control arm received 5 mL placebo syrup every 12 h for 4 weeks. None of the participants was deprived of their routine treatment for depression or OCD. The scores of insomnia symptoms were evaluated using total score of the Pittsburgh Sleep Quality Index (PSQI) and the scores of its components, the depression score using the final Beck depression inventory-II (BDI-II) score, and OCD score using the Yale-Brown Obsessive-Compulsive Scale (YBOCS). The total PSQI score was found to be improved significantly in the intervention arms with depression or OCD ( < 0.001) compared with the corresponding control arms. Significant improvements were also observed in the final mean difference of BDI-II ( = 0.009) and YBOCS ( = 0.001) scores in the intervention arms. syrup significantly improved insomnia symptoms and the scores of depression and OCD.
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http://dx.doi.org/10.1089/acm.2019.0254DOI Listing
May 2020

Combining health insurance funds in a fragmented context: what kind of challenges should be considered?

BMC Health Serv Res 2020 Jan 8;20(1):26. Epub 2020 Jan 8.

Department of Health Policy and Management,Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Iran's Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran.

Methods: A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework.

Results: This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to "the justification of the consolidation process" in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system.

Conclusions: Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations.
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http://dx.doi.org/10.1186/s12913-019-4858-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950996PMC
January 2020

Pharmacological and biochemical properties of (L.) Roscoe ex Sm. and its therapeutic efficacy on osteoarthritis of knee.

J Family Med Prim Care 2019 Dec 10;8(12):3798-3807. Epub 2019 Dec 10.

Department of Health and Social Medicine, Shahed University, Tehran, Iran.

Osteoarthritis (OA) as the most frequent form of knee arthritis is one of the most annoying complications amongst old peoples. There are different pharmacological and non-pharmacological remedies which could be applied for treatment of knee OA. It's while, significant side effects mostly in patients who are older are the dangerous limiting factors. Integrative, supplementary, traditional remedies have been applied from long time ago in treatment of such chronic diseases like OA. Various topical and oral remedies have been presented in treatment of OA worldwide. In spite of the fact there are multiple remedies for reduction symptoms of patients who suffer from disorders and related inabilities which could enhance their life quality. Remedies which have been applied for a long time for treatment of OA have newly discovered to induce injury to some patients. On the other side, additional knowledge about alternative and supplementary remedies is a main way for enhancing health of patients who suffer from OA disorders. Zingiber zerumbet (Z. zerumbeton) is a kind of herb of the ginger family and is a natural compound with various biomedical characteristics like anti-proliferative, anti-inflammatory, and antioxidant effect. However, Z. zerumbet could be applied for reduction of OA symptoms because of its circulatory stimulant and anti-inflammatory effects. Anyway, up to now there is not any methodical literature review for evaluating the Z. zerumbet clinical effectiveness productiveness in treatment of OA. The main aim of the current study is to review scientific resources around therapeutic effectiveness of Zingiber zerumbet in treatment of adverse symptoms of OA disorder.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_594_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924210PMC
December 2019

Alteration in serum levels of immunoglobulins in seriously eye-injured long-term following sulfur-mustard exposure.

Int Immunopharmacol 2020 Mar 29;80:105895. Epub 2019 Nov 29.

Department of Biostatistics and Social Medicine, Zanjan University of Medical Sciences, Zanjan 4515613191, Iran.

Introduction: Sulfur mustard (SM) is a potent toxic agent that cause local and systemic changes in the human body such as dysregulation of the immunological system. This gas affects different organs such as lungs, skin, eyes and the gastrointestinal tract.

Methods: 128 veterans with SM-induced eye injuries were examined and compared to 31 gender- and age-matched healthy controls. Serum levels of IgM, IgE, IgA, IgG, and IgG subclasses were measured using ELISA method.

Results: There was no significant difference in IgM level between two groups with abnormal and normal ocular conditions except for those having bulbar conjunctiva-limbal ischemia and bulbar conjunctiva-hyperemia abnormalities. There were not significant difference in IgA, IgE, and IgG levels between two groups with and without ocular problem also between study groups. IgG1 level in some ocular abnormalities were significantly lower than the healthy control groups. IgG2 level in SM-exposed participants with stromal abnormality was higher in the SM-exposed groups without this problem. IgG2 levels in the exposed group with some ocular problems were significantly increased compared with control. IgG3 level in all patients did not reveal any significant changes compared with the controls except the fundus abnormality. IgG4 level was not significantly different between two groups with normal and abnormal ocular conditions. Nonetheless, IgG4 level in the exposed participants with some ocular abnormalities significantly increased compared with the controls.

Conclusion: The results showed SM exposure could alter immunoglobulins level compared with healthy controls and the changes of IgG2 and IgG1 levels were associated with some ocular problems.
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http://dx.doi.org/10.1016/j.intimp.2019.105895DOI Listing
March 2020

Alteration in inflammatory mediators in seriously eye-injured war veterans, long-term after sulfur mustard exposure.

Int Immunopharmacol 2020 Mar 1;80:105897. Epub 2019 Nov 1.

Immunoregulation Research Center, Shahed University, Tehran 3319118651, Iran; Department of Immunology, Shahed University, Tehran 3319118651, Iran. Electronic address:

Background: Sulfur mustard (SM) exposure produces extensive systemic and ocular adverse effects on the victims. One of the most important effects is immunological insults that can lead to other organ damages, including the eyes.

Methods: In this descriptive study, 128 SM-exposed veterans with severe eye injury were compared with 31 healthy controls. Tear levels of tumor necrosis factor (TNF)-α and serum concentrations of interleukin (IL)-1α, IL-1β, IL1Ra, IL-6, TNF-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and Fas Ligand (FasL) were compared between the two groups.

Results: Meibomian gland dysfunction (MGD); tear breakup time (TBUT < 10″); and conjunctival, limbal, and corneal abnormalities were more frequent among the cases (MS-exposed veterans) than the controls. Ocular involvement was mild in 14.8%, moderate in 24.2%, and severe in 60.9% of the cases. Serum levels of IL-1α and FasL were significantly higher among the cases than among the controls (P < 0.001 and P = 0.037, respectively). Also, a significant decrease was observed in serum and tear levels of TNF-α in the cases as compared with controls (P < 0.001, P < 0.001, respectively). Serum levels of FasL were significantly higher in cases with severe ocular involvement than in the controls (P = 0.03). Nonetheless, serum levels of IL-1β, IL-1Ra, IL-1α/IL-1Ra, and IL-6 were not significantly different between the two groups.

Conclusion: Serum levels of IL-1α and FasL may cause different ocular surface abnormalities in SM-exposed patients. Lower tear TNF-α concentration may be due to lower serum levels of this cytokine in these patients.
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http://dx.doi.org/10.1016/j.intimp.2019.105897DOI Listing
March 2020

Angiogenesis modulatory factors in subjects with chronic ocular complications of Sulfur Mustard exposure: A case-control study.

Int Immunopharmacol 2019 Nov 16;76:105843. Epub 2019 Oct 16.

Immunoregulation Research Center, Shahed University, Tehran 3319118651, Iran. Electronic address:

Background: Chronic ocular complications of Sulfur Mustard (SM) exposure leads to severe ocular morbidity during time. The aim of this study was to compare serum levels of Interleukin 17 (IL-17), IL-12, vascular endothelial growth factor (VEGF)-C, VEGF-D and nitric oxide (NO) in SM-exposed patients versus the control group and to measure tear concentration of VEGF-C only in the SM-exposed group.

Methods: In this prospective case control, 128 SM-exposed patients and 31 healthy control subjects were included. In the case group ocular manifestations were classified to three subgroups of mild (19 cases), moderate (31 cases) and severe (78 cases) forms of disease. Serum levels of IL-17, IL-12, NO, VEGF-C and VEGF-D, in all subjects and tear concentration of VEGF-C in SM-exposed group was evaluated.

Results: All subjects were male and mean ± standard deviation (SD) of age in the case and control groups were 44.9 ± 8.8 and 40.9 ± 10.1 years, respectively. Except for significantly lower serum level of IL-17 (p < 0.001) and NO (p = 0.003), other values were not significantly different. The tear concentration of VEGF-C and serum level of IL-12 were not different between subgroups in the SM-exposed group, yet were significantly lower among those with abnormally dilated and tortuous conjunctival vessels and corneal pannus, respectively (p = 0.01, p = 0.015).

Conclusions: Exposure to SM significantly reduced serum level of IL-17 and NO in the delayed phase, yet did not influence VEGF-C; VEGF-D or IL-12.
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http://dx.doi.org/10.1016/j.intimp.2019.105843DOI Listing
November 2019

Augmentation of morphine-conditioned place preference by food restriction is associated with alterations in the oxytocin/oxytocin receptor in rat models.

Am J Drug Alcohol Abuse 2020 05 14;46(3):304-315. Epub 2019 Oct 14.

Immunoregulation Research Center, Shahed University , Tehran, I.R. Iran.

Background: Studies indicate that food restriction (FR) reinforces the effects of morphine. The exact mechanisms by which FR influences the reward circuitry of morphine have not yet been determined.

Objectives: We hypothesized that the effects of FR on the oxytocin (OXT) system and HPA axis can be associated with substance abuse disorders. In this study, the serum levels of OXT and corticosterone, and the expression of / receptor (), glucocorticoid receptor (), and brain-derived neurotrophic factor ( in the hippocampus, prefrontal cortex, and nucleus accumbens were investigated in an FR model.

Methods: First, the male rats (n = 8 per group) were subjected to FR for 3 weeks. Then, morphine-induced conditioned place preference (CPP) was observed using two doses of morphine (3 and 5 mg/kg). The serum concentrations of corticosterone and OXT were determined by ELISA and the expression of genes was examined by qPCR.

Results: FR induced an enhanced preference in the animals for the 5 mg/kg dose of morphine compared to the controls. Serum corticosterone levels increased after FR but OXT levels decreased. Meanwhile, FR actuated downregulation of , and genes, while inducing the overexpression of .

Conclusion: We propose the inclusion of OXT and OXTR alterations in the enhancement of morphine-induced CPP and addiction vulnerability following FR. Moreover, we conclude that altered BDNF levels and HPA axis activity may be the mechanisms involved in the effects of FR on morphine-induced behavior.
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http://dx.doi.org/10.1080/00952990.2019.1648483DOI Listing
May 2020

Decomposing disparity in adult individual's mental health in Tehran among lower and higher economic groups; an Oaxaca- Blinder analysis on urban HEART Survey- round 2.

Afr Health Sci 2018 Dec;18(4):1018-1026

Substance Use and Dependence Research Center, University of Social Welfare& Rehabilitation Sciences, Tehran, Iran.

Background: Mental health is one of the main aspects of social well-being. Tehran -capital of Iran- is metropolitan, where the mental health status of citizens is not prioritized effectively.

Objectives: The purpose of this study was identifying contributors of mental health inequality between lower and higher economic groups in Tehran through Oaxaca- Blinder method.

Methods: The study was conducted by the data of Tehran's Urban Heart Survey- Round 2 (2012). Through a three- stage stratified and clustered sampling method, 34,700 were selected as samples. The mental health status was measured by the General Health Questionnaire 28- items (GHQ- 28) and the quantity of the inequality in mental health was measured by corrected concentration index. The Fairlie's decomposition approach was performed in STATA 14.

Results: The corrected concentration index were: -0.0967 and -0.1004 by Erreyger's and Wagstaff 's approaches. Being of the Iranian origin, disability conditions, employment status and smoking were identified as the main contributors of inequality in mental health among lower and higher economic groups.

Conclusion: Thus, re-organizing strategies and plans on promoting the socio- economic status of non-Iranian residents, improving employment opportunities, developing well-designed environment for disabled individuals and supporting plans to reduce smoking is recommended to the urban policy makers.
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http://dx.doi.org/10.4314/ahs.v18i4.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354884PMC
December 2018

Association of Sulfur Mustard-Induced Ocular Problems with Serum and Blood Biochemical Parameters Changes.

Iran J Pathol 2018 17;13(2):157-166. Epub 2018 Jul 17.

Immunoregulation Research Center, Shahed University, Tehran, Iran.

Background & Objective: Many biochemical features of sulfur mustard (SM) intoxication have remained unknown. So far, the direct association between biochemical parameter changes and ocular problems in patients exposed to SM is not evaluated. The current study aimed at evaluating the associations between the ocular findings in patients with SM intoxication and the changes of serum and blood biochemical parameters.

Methods: In the current study, 372 patients exposed to SM and 128 matched controls were compared concerning the association between their ocular problems and biochemical parameters. Ocular problems include photophobia, ocular surface discomfort (OSD), etc. Biochemical parameters include uric acid, creatinine (Cr), hematocrit (HCT), total, direct and indirect bilirubin, high-density lipoproteins (HDL), alanine aminotransferase (ALT), calcium (Ca), fasting blood sugar (FBS), mean corpuscular hemoglobin concentration (MCHC), etc.

Results: The SM-exposed group with photophobia, OSD, tearing, blurred vision, abnormal tear status, and slit-lamp findings had significantly higher mean serum and blood levels of uric acid, Cr, HCT, and total and indirect bilirubin than the controls. The SM-exposed group with photophobia, tearing, ocular pain, blurred vision, bulbar conjunctival and limbal abnormalities had significantly higher mean serum and blood levels of HDL, ALT, Ca, FBS, MCHC, and HDL, indirect and total bilirubin, compared to the control group.

Conclusion: The association of photophobia with uric acid, OSD and tearing with Cr, photophobia with HDL, ocular pain with Ca, and blurred vision with FBS may be explained for their known ocular effects in the SM-exposed subjects. SM-induced biochemical changes may intensify the ocular problems induced by the direct effects of SM.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339492PMC
July 2018

Sulfur Mustard-induced Changes in Blood Urea Nitrogen, Uric Acid and Creatinine Levels of Civilian Victims, and Their Correlation with Spirometric Values.

Iran J Public Health 2018 Nov;47(11):1725-1733

Immunoregulation Research Center, Shahed University, Tehran, Iran.

Background: The aim of this study was assessment of the chronic effects of sulfur mustard (SM) among victims.

Methods: In this cohort study, 355 SM-exposed subjects from Sardasht, and 123 controls from Rabat, both from West Azerbaijan Province, Iran were included. The spirometric evaluation and the global initiative for chronic obstructive lung disease (GOLD) classification were applied for all. Serum levels of urea, creatinine (Cr), and uric acid (UA) and glomerular filtration rate (GFR) were assessed. Data analysis was conducted using IBM SPSS.

Results: All were male, with a mean age of 43.7±10.7 and 41.6±9.9 years in case and control groups, respectively. The case group had significantly higher values of Cr (<0.001) and UA (=0.018) than the control group. This was also the case in the Cr level (<0.001) in subjects without pulmonary dysfunction, between both groups. There was significant difference in the GFR (=0.047) between both groups and between subgroups with pulmonary dysfunction in the case and control groups (=0.045), as well as between SM-exposed subjects with and without pulmonary dysfunction (=0.009). Serum Cr, UA, sUA/Cr ratio, and BUN as well as the GFR did not have any significant correlation with forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio.

Conclusion: Despite significantly high levels of Cr and UA in the case group, no significant correlation was found between serum Cr, UA, sUA/Cr ratio, BUN, and GFR with spirometric values. Further studies are required to reveal the underlying molecular and clinical significance of these findings.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294863PMC
November 2018

Depressed Immune Responses and Accelerated Splenic Apoptosis due to Experience of Food Deprivation and Inequality but not Unstable Social Status in Balb/c Mice.

Neuroimmunomodulation 2017 17;24(4-5):200-210. Epub 2017 Nov 17.

Department of Physiology, Medical Faculty, Tehran University of Medical Sciences, Tehran, Iran.

Objective(s): We aimed to show that the immune system is sensitive to the detrimental effects of inequality and social injustice, and splenic vulnerability to apoptosis may also increase.

Methods: In order of better determination of immune responses to chronic social stress, we implemented food deprivation, food intake inequality, and unstable social status (a change of cage-mate every 3 days) for a period of 14 days in 60 male Balb/c mice. At the end of this stress period, nitric oxide (NO) production by peritoneal adherent cells and the serum concentration of corticosterone were measured. Moreover, the viability of peritoneal adherent cells and spleen lymphocytes was evaluated by MTT assay. The terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay was done to reveal the TUNEL-reactive apoptotic bodies in the spleen.

Results: Our results showed that food deprivation and inequality caused significant changes in the apoptosis of splenic cells in comparison with the control group (p < 0.05). Moreover, the vital activities of lymphocytes and peritoneal adherent cells, as well as NO production by the latter, increased significantly (p < 0.05). However, the experience of unstable social status did not cause a further increase in the viability of lymphocytes and peritoneal adherent cells, or NO production in animals that were food-deprived or experienced inequality. Serum concentration of corticosterone in all experimental groups, except for animals that experienced unstable social status only, significantly decreased versus the control group (p < 0.05).

Conclusions: The results suggest that poverty and social inequality, but not unstable social status, affect immune responses and are likely involved in the induction of splenic apoptosis in mice.
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http://dx.doi.org/10.1159/000480732DOI Listing
January 2019

Identifying associated factors with social capital using path analysis: A population-based survey in Tehran, Iran (Urban HEART-2).

Med J Islam Repub Iran 2016;30:414. Epub 2016 Sep 17.

Assistant Professor of Epidemiology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran.

Social capital has been defined as norms, networks, and social links that facilitate collective actions. Social capital is related to a number of main social and public health variables. Therefore, the present study aimed to determine the factors associated with social capital among the residents of Tehran, Iran. In this large cross-sectional population-based study, 31531 residents aged 20 years and above were selected through multi-stage sampling method from 22 districts of Tehran in 2011. The social capital questionnaire, 28-item General Health Questionnaire (GHQ-28), and Short-Form Health Survey (SF-12) were used. Hypothetical causal models were designed to identify the pathways through which different variables influenced the components of social capital. Then, path analysis was conducted for identifying the determinants of social capital. The most influential variables in 'individual trust' were job status (β=0.37, p=0.02), marital status (β=0.32, p=0.01), Physical Component Summary (PCS) (β=0.37, p=0.02), and age (β=0.34, p=0.03). On the other hand, education level (β=0.34, p=0.01), age (β=0.33, p=0.02), marital status (β=0.33, p=0.01), and job status (β=0.32, p=0.01) were effective in 'cohesion and social support'. Additionally, age (β=0.18, p=0.02), PCS (β=0.36, p=0.01), house ownership (β=0.23, p=0.03), and mental health (β=0.26, p=0.01) were influential in 'social trust/collective relations'. Social capital can be improved in communities by planning to improve education and occupation status, paying more attention to strengthening family bonds, and provision of local facilities and neighborhood bonds to reduce migration within the city.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307624PMC
September 2016

Association between Acne and Serum Pro-inflammatory Cytokines (IL-1α, IL-1β, IL-1Ra, IL-6, IL-8, IL-12 and RANTES) in Mustard Gas-Exposed Patients: Sardasht-Iran Cohort Study.

Arch Iran Med 2017 Feb;20(2):86-91

Department of Biostatistics and Social Medicine, Zanjan University of Medical Sciences, Zanjan, I.R. Iran.

Background: Acne vulgaris is a very common chronic inflammatory disorder, yet its pathogenesis is not clearly understood. As part of the SICS, this study was conducted to evaluate the association between the incidence of acne vulgaris in SM-exposed subjects (20 years after the exposure) and serum levels of proinflammatory cytokines (IL-1α, IL-1β, IL-1Ra, IL-6, IL-8, IL-12 and RANTES) in an attempt to better understand the pathogenesis of long-term skin disorders of these individuals.

Methods: Serum concentrations of cytokines (IL-1α, IL-1β, IL-1Ra, IL-6, IL-8, IL-12 and RANTES) were measured using sandwich ELISA technique.

Results: The median of serum levels of IL-1β, IL-8 and RANTES were significantly higher in the exposed patients with acne than those without acne (P = 0.05, 0.03 and 0.001 respectively). There was no significant difference in serum levels of IL-1α, IL-1Ra and IL-6 between the exposed subgroups.

Conclusion: We found a positive association between serum levels of pro-inflammatory cytokines (IL-1β, IL-8, IL-12 and RANTES) and acne among SM-exposed population.
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http://dx.doi.org/0172002/AIM.005DOI Listing
February 2017

Post-infarct sleep disruption and its relation to cardiac remodeling in a rat model of myocardial infarction.

Chronobiol Int 2017 3;34(5):587-600. Epub 2017 Feb 3.

g Shiraz Burn and Wound Healing Research Center, Amir-al-momenin Burn Hospital, Shiraz University of Medical Sciences , Iran.

Sleep disruption after myocardial infarction (MI) by affecting ubiquitin-proteasome system (UPS) is thought to contribute to myocardial remodeling and progressive worsening of cardiac function. The aim of current study was to test the hypothesis about the increased risk of developing heart failure due to experience of sleep restriction (SR) after MI. Male Wistar rats (n = 40) were randomly assigned to four experimental groups: (1) Sham, (2) MI, (3) MI and SR (MI + SR) (4) Sham and SR (Sham + SR). MI was induced by permanent ligation of left anterior descending coronary artery. Twenty-four hours after surgery, animals were subjected to chronic SR paradigm. Blood sampling was performed at days 1, 8 and 21 after MI for determination of serum levels of creatine kinase-MB (CK-MB), corticosterone, malondialdehyde (MDA) and nitric oxide (NO). Finally, at 21 days after MI, echocardiographic parameters and expression of MuRF1, MaFBx, A20, eNOS, iNOS and NF-kB in the heart were evaluated. We used H&E staining to detect myocardial hypertrophy. We found out that post infarct SR increased corticosterone levels. Our results highlighted deteriorating effects of post-MI SR on NO production, oxidative stress, and echocardiographic indexes (p < 0.05). Moreover, its detrimental effects on myocardial damage were confirmed by overexpression of MuRF1, MaFBx, iNOS and NF-kB (p < 0.001) in left ventricle and downregulation of A20 and eNOS (p < 0.05). Furthermore, histological examination revealed that experience of SR after MI increased myocardial diameter as compared to Sham subjects (p < 0.05). Our data suggest that SR after MI leads to an enlargement of the heart within 21 days, marked by an increase in oxidative stress and NO production as well as an imbalance in UPS that ultimately results in cardiac dysfunction and heart failure.
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http://dx.doi.org/10.1080/07420528.2017.1281823DOI Listing
February 2018

Health Priority Setting in Iran: Evaluating Against the Social Values Framework.

Glob J Health Sci 2016 10 1;8(10):53834. Epub 2016 Oct 1.

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Health systems, as part of the social system, consider public values. This study was conducted to examine the role of social values in the health priority setting in the Iranian health system.

Methods: In this qualitative case study, three main data sources were used: literature, national documents, and key informants who were purposefully selected from health care organizations and other related institutions. Data was analyzed and interpreted using the Clark-Weale Framework.

Results: According to our results, the public indirectly participates in decision-making. The public representatives participate in the meetings of the health priority setting as parliament members, representatives of some unions, members of the city council, and donors. The transparency of the decisions and the accountability of the decision makers are low. Decision makers only respond to complaints of the Audit Court and the Inspection Organization. Individual choice, although respected in hospitals and clinics, is limited in health care networks because of the referral system. Clinical effectiveness is considered in insurance companies and some hospitals. There are no technical abilities to determine the cost-effectiveness of health technologies; however, some international experiences are employed. Equity and solidarity are considered in different levels of the health system.

Conclusion: Social values are considered in the health priority decisions in limited ways. It seems that the lack of an appropriate value-based framework for priority setting and also the lack of public participation are the major defects of the health system. It is recommended that health policymakers invite different groups of people and stakeholders for active involvement in health priority decisions.
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http://dx.doi.org/10.5539/gjhs.v8n10p212DOI Listing
October 2016

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran.

Int J Health Policy Manag 2016 Feb 11;5(4):253-8. Epub 2016 Feb 11.

Department of Health Services Management, School of Management and Medical Informatics, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran.

There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper.
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http://dx.doi.org/10.15171/ijhpm.2016.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818990PMC
February 2016

The prevalence of adulthood overweight and obesity in Tehran: findings from Urban HEART-2 study.

Med J Islam Repub Iran 2015 14;29:178. Epub 2015 Feb 14.

Department of Epidemiology, School of Public Health and Oncopathology Research Centre, Iran University of Medical Sciences, Tehran, Iran.

Background: To estimate and compare prevalence of overweight and obesity among adult people across the 22 districts of Tehran in 2011.

Methods: This was a cross-sectional study using data on 47,406 women and 47,525 men aged≥ 15 years from a large population-based survey (Urban HEART-2). Age-standardized prevalence (ASP) of overweight (25≤BMI<30) and obesity (BMI≥30) were estimated for the Tehran's districts. Pearson Chi2 tests and logistic regression were used to examine any significant differences in prevalence of these disorders across sociodemographic groups.

Results: ASPs of overweight were 36.5% and 32.0 % among men and women, respectively (p<0.001). These figures for obesity were 10.7% and 15.3% among men and women, respectively (p<0.001). Crude prevalence of overweight and obesity rose with age up to the age of 54 years and decreased thereafter. Across education groups, the lowest prevalence of overweight/obesity was seen among most educated people. The results showed that being young, single and student were associated with lower odds of overweight/obesity.

Conclusion: This study showed a high prevalence of overweight and obesity among adult in Tehran. There were significant associations between sociodemographic characteristics and prevalence of overweight/obesity among adults in Tehran. The results of this study might be used in identifying high risk groups of overweight and obesity in Tehran.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431433PMC
June 2015

Absolute and relative educational inequalities in obesity among adults in Tehran: Findings from the Urban HEART study-2.

Obes Res Clin Pract 2016 09 21;10 Suppl 1:S57-S63. Epub 2015 May 21.

Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. Electronic address:

Background: The prevalence of obesity is increasing in Iran. Previous studies showed mixed results in relation to association between socioeconomic status and obesity in the country. The current study aimed to examine educational inequalities among adults in Tehran in 2011.

Method: Data on 90,435 persons 18 years and older from Urban Health Equity Assessment and Response Tool (Urban HEART-2) were analyzed. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were used for assessing educational inequalities in obesity. These measures were quantified using generalized linear models for the binomial family adjusted for sex and age. Subgroup analysis was conducted across sex, age groups and the 22 districts of Tehran.

Results: Both SII and RII showed substantial educational inequalities in obesity in favour of more educated adults [RII and SII (95% CI were equal to 2.91 (2.71-3.11) and 0.12 (0.12-0.13)), respectively]. These educational inequalities were persistent even after adjusting for employment, marital status and smoking. Subgroup analysis revealed that educational inequalities were more profound among women. While among men educational inequalities were generally increasing with age, an inverse trend was observed among women. Educational inequalities were observed within all 22 districts of Tehran and generally there were no statistically significant differences between districts.

Conclusion: An inverse association between education and obesity was observed in the current study. To decrease educational inequalities in Tehran, priority should be given to younger women and older men. Further analyses are needed to explain these inequalities.
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http://dx.doi.org/10.1016/j.orcp.2015.05.002DOI Listing
September 2016

Different patterns of association between education and wealth with non-fatal myocardial infarction in Tehran, Iran: A population-based case-control study.

Med J Islam Repub Iran 2015 13;29:160. Epub 2015 Jan 13.

Associate Professor, Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran & Oncopathology Research Centre, Tehran, Iran. .

Background: Myocardial Infarction (MI) is a main cause of death and disability worldwide, which involves a number of genetic, physiopathologic and socio-economic determinants. The aim of this study was to assess the patterns of association between education, wealth and some other risk factors with non-fatal MI in Tehran population.

Methods: Data derived from a second round of large cross-sectional study, Urban HEART-2, conducted in Tehran in 2011. Out of 118542 participants, all 249 self-reported incident cases of nonfatal MI were selected as the case group. A number of 996, matched on age and sex, were selected as controls. Principle component analysis (PCA) was used to calculate wealth index and logistic regression model to assess relations between the study variables.

Results: Mean (SD) age of participants was 60.25 (12.26) years. A total of 870 (69.9%) of the study subjects were men. Education, wealth status, family violence, hypertension and diabetes were observed as independent predictors of non-fatal MI. Overall, as the level of education increased, the odds of non-fatal MI decreased (p<0.001). We observed an almost J-shaped association between wealth status and non-fatal MI. No significant associations were found between marital status, BMI and current smoking with non-fatal MI (p<0.05).

Conclusion: We found different patterns of association between education and wealth with nonfatal MI among Tehran adults. Lower risk of non-fatal MI is linked to high educated groups whereas economically moderate group has the lowest risk of non-fatal MI occurrence.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431366PMC
May 2015

Food deprivation and social inequality may lead to oxidative damage: a study on the preventive role of melatonin in the male rat reproductive system.

Reprod Fertil Dev 2015 Feb 16. Epub 2015 Feb 16.

Spermatogenic cells are susceptible to oxidative stress and apoptosis. Food deprivation (FD) has been reported as a stressor that could increase reactive oxygen species. In the present study, FD-induced oxidative stress and apoptosis, as well as the protective effects of melatonin, were evaluated in the testes. Wistar rats in the control group were fed a standard diet, whereas a sham group was administered saline as the melatonin vehicle. A third group received daily injections of melatonin (5mgkg-1 bodyweight). These rats were further divided into four groups of rats that were either subjected to FD, FD + isolation, FD + melatonin injection and FD + melatonin injection + isolation. Testicular tissues were evaluated for malondialdehyde (MDA) and reduced glutathione (GSH) concentrations, as well as and DNA damage. FD increased MDA and reduced GSH concentrations, whereas melatonin treatment improved these parameters. Immunohistochemistry for capsase-3 and terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labelling revealed that the number of apoptotic cells was increased in rats subjected to FD alone. Melatonin treatment offset the number of apoptotic cells following FD. The results provide evidence that FD can increase oxidative stress, leading to activation of apoptosis, and that melatonin has the ability to protect the testes against oxidative damage induced by FD.
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http://dx.doi.org/10.1071/RD14432DOI Listing
February 2015

Prevalence and associated factors of self-reported hypertension among Tehran adults in 2011: a population-based study (Urban HEART-2).

Med J Islam Repub Iran 2014 29;28:105. Epub 2014 Sep 29.

8. Professor, Department of Social Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

Background: Hypertension is an important public-health challenge worldwide. The prevalence of hypertension greatly varies across countries. The aim of this study was to estimate the prevalence of self-reported hypertension and to determine related factors in a large random sample of Tehran population in 2011.

Methods: In this cross sectional study, 69173 individuals aged 25-64 years were selected using multistage cluster random sampling method. All participants were interviewed by trained personnel using standard questionnaires. Weighted prevalence and incidence rates were calculated and principle component analysis (PCA) was used to construct wealth index. Chi-square and odds ratio were used to assess associations in univariate analysis. Logistic Regression model was used in multivariate analysis.

Results: The prevalence of self-reported hypertension was 5.27% in total, 3.83% in men and 6.64% in women (p< 0.001). The annual incidence rate of self-reported hypertension was 6.87 per 1000; 5.26 in men and 8.43 in women (p< 0.001), obviously varied across various districts. In multivariate analysis, age, sex (woman), marital status (single), obesity and smoking were positively associated with prevalence of self-reported hypertension. Education level was negatively associated to hypertension. On the other hand, wealth status was not associated to self-reported hypertension.

Conclusion: Our study findings highlighted low awareness rates of hypertension among Tehran adults especially in men and younger people. Hence, we recommend public health strategies to improve health education programs. Moreover, programs to develop the surveillance system and screening programs to early detection of undiagnosed cases are urgently needed particularly in high risk population subgroups.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301203PMC
February 2015

Chronic, long-term social stress can cause decreased microtubule protein network activity and dynamics in cerebral cortex of male Wistar rats.

J Mol Neurosci 2015 Mar 9;55(3):579-86. Epub 2014 Aug 9.

Department of Biochemistry, Institute of Biochemistry Biophysics, University of Tehran, Tehran, Iran.

Social stress is viewed as a factor in the etiology of a variety of psychopathologies such as depression and anxiety. Animal models of social stress are well developed and widely used in studying clinical and physiological effects of stress. Stress is known to significantly affect learning and memory, and this effect strongly depends on the type of stress, its intensity, and duration. It has been demonstrated that chronic and acute stress conditions can change neuronal plasticity, characterized by retraction of apical dendrites, reduction in axonogenesis, and decreased neurogenesis. Various behavioral studies have also confirmed a decrease in learning and memory upon exposure of animals to long-term chronic stress. On the other hand, the close relationship between microtubule (MT) protein network and neuroplasticity controlling system suggests the possibility of MT protein alterations in high stressful conditions. In this work, we have studied the kinetics, activity, and dynamicity changes of MT proteins in the cerebral cortex of male Wistar rats that were subjected to social instability for 35 and 100 days. Our results indicate that MT protein network dynamicity and polymerization ability is decreased under long-term (100 days) social stress conditions.
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http://dx.doi.org/10.1007/s12031-014-0394-4DOI Listing
March 2015

Response-oriented measuring inequalities in Tehran: second round of UrbanHealth Equity Assessment and Response Tool (Urban HEART-2), concepts and framework.

Med J Islam Repub Iran 2013 Nov;27(4):236-48

Assistant Professor, Department of Psychiatry, Medical School, Tehran University of Medical Sciences, Tehran, Iran.

Background: Current evidence consistently confirm inequalities in health status among socioeconomic none, gender,ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health ofthe population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural,educational, political or environmental problems. Measuring inequalities, improving daily living conditions, andtackling inequitable distribution of resources are highly recommended by international SDH commissioners in recentyears to 'close the gaps within a generation'. To measure inequalities in socio-economic determinants and core healthindicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2)was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre).

Method: For 'assessment' part of the project, 65 indicators in six policy domains namely 'physical and infrastructure','human and social', 'economic', 'governance', 'health and nutrition', and also 'cultural' domain were targetedeither through a population based survey or using routine system. Survey was conducted in a multistage random sampling,disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households(118000 individuals) were collected. For 'response' part of the project, widespread community based development(CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013.

Conclusion: Following the first round of Urban HEART project in 2008, the second round was conducted to trackchanges over time, to institutionalize inequality assessment within the local government, to build up community participationin 'assessment' and 'response' parts of the project, and to implement appropriate and evidence-based actionsto reduce health inequalities within all neighborhoods of Tehran.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011416PMC
November 2013

Protective Effect of Melatonin against Inequality-Induced Da mages on Testicular Tissue and Sper m Para meters.

Int J Fertil Steril 2014 Jan 22;7(4):313-22. Epub 2013 Dec 22.

Department of Clinical Trial Iranian Traditional Medicine Research Center and Health Equity, College of Medicine, Shahed University, Tehran, Iran.

Background: The goals of the study are evaluation the effects of food deprivation and isolation situation as a social stress on fertility; and in the following, investigation of the improving effect of melatonin as an antioxidant component.

Materials And Methods: In this experimental study, We investigated histopathological and serological effects of melatonin and social stress (food deprivation and isolation) on different features of sperm and testicular tissue among 42 male rats in 7 groups including control, sham, melatonin received (M), food deprivation (FD), Food deprivation and melatonin treatment (FDM), Food deprivation and isolation situation (FDi), and Food deprivation and melatonin treatment and isolation situation (FDMi) groups. Epididymal sperms of all rats were also counted. Histopathological evaluation of the testes was done under a light microscopy to determine the number of spermiogenic cells. Serological evaluation of testosterone, corticosterone, and melatonin was performed, as well. For statistical analysis, oneway ANOVA and Tukey's post hoc test were used, and the value of p≤0.05 was considered statistically significance.

Results: The result showed that food deprivation increased the number of abnormal, immotile, and dead sperms, while decreased the number of normal sperms (p<0.05). Isolation could improve sperm motility and viability, while enhanced the number of sper- matogenic cells. Melatonin had a protective effect on sperm count, motility, and viability, while reduced sperm abnormality.

Conclusion: Our results demonstrated that melatonin treatment and isolation situation improve the parameters related to epididymal sperms and spermatogenic cells after food deprivation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901188PMC
January 2014

Effects of dominant/subordinate social status on formalin-induced pain and changes in serum proinflammatory cytokine concentrations in mice.

PLoS One 2013 20;8(11):e80650. Epub 2013 Nov 20.

Department of Physiology, Faculty of Medical Sciences, Shahed University, Tehran, Iran ; Equity and Health research Department, Shahed University, Tehran, Iran ; Department of Physiology, Faculty of Medical Sciences, Tehran Medical University, Tehran, Iran.

Current investigations regarding social stress primarily focus on the health consequences of being in stressful social hierarchies. The repetitive nature of social conflicts seems to favor an induction of hyperalgesia or hypoalgesia, both in rodents and humans. Additionally, social conflicts may affect the immune system. In order to better establish the pain and immune responses to stress, the present study implemented a sensory contact model on 32 male BALB/c mice. Subsequent to establishing a dominance/submissive social relationship, each mouse was injected with formalin (20 μl, 2%) and their pain behavior was scored and serum concentrations of proinflammatory cytokines IL-1 and IL-6, and corticosterone were also measured. Test results revealed that subordinate mice were hypoalgesic during chronic phase of formalin test compared to control and dominant mice (P<0.05). On the other hand, subordinate mice were hyperalgesic compared to dominant mice during the whole acute phase of formalin test (P<0.05). Corticosterone, IL-1 and IL-6 concentrations were much higher in serum of dominant and subordinate mice than in the control group (p<0.05). The results indicated that, although both dominant and subordinate animals displayed an increase in serum corticosterone and proinflammatory cytokines during social interactions, their response to pain perception differently was affected with the social status.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080650PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835427PMC
December 2014

Endothelium-dependent Effect of Sesame Seed Feeding on Vascular Reactivity of Streptozotocin-diabetic Rats: Underlying Mechanisms.

Iran J Pharm Res 2013 ;12(3):377-85

Cardiovascular disorders continue to constitute major causes of morbidity and mortality in diabetic patients. In this study, the effect of chronic administration of sesame (Sesamum indicum L) seed feeding was studied on aortic reactivity of streptozotocin (STZ)-diabetic rats. Male diabetic rats received sesame seed-mixed food at weight ratios of 3% and 6% for 7 weeks, one week after diabetes induction. Contractile responses to KCl and phenylephrine (PE) and relaxation response to acetylcholine (ACh) and sodium nitroprusside (SNP) were obtained from aortic rings. Maximum contractile response of endothelium-intact rings to PE was significantly lower in sesame-treated diabetic rats (at a ratio of 6%) relative to untreated diabetics and endothelium removal abolished this difference. Endothelium-dependent relaxation to ACh was also significantly higher in sesame-treated diabetic rats (at a ratio of 6%) as compared to diabetic rats and pretreatment of rings with nitric oxide synthase inhibitor, N(G)-nitro-l-arginine methyl ester (L-NAME) significantly attenuated the observed response. Two-month diabetes also resulted in an elevation of malondialdehyde (MDA) and decreased superoxide dismutase (SOD) activity and sesame treatment significantly reversed the increased MDA content and restored activity of SOD. We thus conclude that chronic treatment of diabetic rats with sesame seed could in a dose-manner prevent some abnormal changes in vascular reactivity through nitric oxide and via attenuation of oxidative stress in aortic tissue and endothelium integrity is necessary for this beneficial effect.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813278PMC
November 2013

Consequences of Medical Insurance on Social Welfare; an Evidenced Based Study.

Iran J Public Health 2013 Nov;42(11):1324-6

3. Research Associate, University of British Columbia , Canada.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499076PMC
November 2013

Clinical Evaluation of Commiphora Mukul, a Botanical resin, in the Management of Hemorrhoids: A randomized controlled trial.

Pharmacogn Mag 2013 Oct;9(36):350-6

Department of Traditional Iranian Medicine, Faculty of Medicine, Shahed University, Tehran, Iran.

Background: Hemorrhoids complaint is one of the most common problems in most society, especially in Asian countries. Current drug treatment protocols cannot cure the disease, and they are palliative. According to Persian traditional medicine, Commiphora Mukul (CM) resin is a medication choice.

Aim: This randomized study was undertaken to evaluate the efficacy and safety of crude CM resin compared to a combination of lactolose and anti-hemorrhoid (LandA) in patients with uncomplicated hemorrhoids grade 1 and 2.

Materials And Methods: This trial was carried out on 99 patients with hemorrhoids, in Ghaem and Imam Reaza Hospitals of the Mashhad University of Medical Sciences, Iran. They randomly received CM 3 g/d for 4 weeks (as study group) or LandA (Lactolose syrup in laxative dose for 1 month and anti-hemorrhoid suppository daily for 10 days) as control group. Subjective and objectives variables including painful defecation, flatulence, constipation, gastro-esophageal reflux (GER), dyspepsia, proctorrhagia, anal protrusion, and colonoscopic grading were assessed before, immediately after, and 4 weeks after the treatment period. An intent-to-treat analysis was used. Safety was assessed with evaluation of clinical adverse effects by common toxicity criteria version 4.0. Forty-nine patients were assigned randomly to receive LandA and 50 to receive CM. After 4 weeks, flatulence, dyspepsia, GER, and colonoscopic grading scores significantly decreased in study group, whereas in control group constipation, painful defecation, and proctorrhagia showed better but not significant improvement. After 4-weak follow-up, the rate of constipation, and proctorrhagia also showed significantly improvement in study group. Constipation and proctorrhagia in control group recurred significantly in 4-week follow-up than after the treatment, whereas this recurrence in test group was not seen.

Conclusion: CM was more effective than LandA in 4-week treatment of patients with uncomplicated hemorrhoids grade 1 and 2.
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http://dx.doi.org/10.4103/0973-1296.117832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793341PMC
October 2013

A clinicopathological approach to sulfur mustard-induced organ complications: a major review.

Cutan Ocul Toxicol 2013 Oct 16;32(4):304-24. Epub 2013 Apr 16.

Immunoregulation Research Center, Shahed University, Tehran, Iran.

Context: Sulfur mustard (SM), with an old manufacturing history still remains as potential threat due to easy production and extensive effects.

Objectives: Increasing studies on SM indicates the interest of researchers to this subject. Almost all human body organs are at risk for complications of SM. This study offers organ-by-organ information on the effects of SM in animals and humans.

Methods: The data sources were literature reviews since 1919 as well as our studies during the Iraq-Iran war. The search items were SM and its all other nomenclatures in relation to, in vivo, in vitro, humans, animals, eye, ocular, ophthalmic, lungs, pulmonary, skin, cutaneous, organs and systemic. Amongst more than 1890 SM-related articles, 257 more relevant clinicopathologic papers were selected for this review.

Results: SM induces a vast range of damages in nearly all organs. Acute SM intoxication warrants immediate approach. Among chronic lesions, delayed keratitis and blindness, bronchiolitis obliterans and respiratory distress, skin pruritus, dryness and cancers are the most commonly observed clinical sequelae.

Conclusion: Ocular involvements in a number of patients progress toward a severe, rapid onset form of keratitis. Progressive deterioration of respiratory tract leads to "mustard lung". Skin problems continue as chronic frustrating pruritus on old scars with susceptibility to skin cancers. Due to the multiple acute and chronic morbidities created by SM exposure, uses of multiple drugs by several routes of administrations are warranted.
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http://dx.doi.org/10.3109/15569527.2013.781615DOI Listing
October 2013