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Rahim INA, Omar E, Muid SA, Kasim NAM. Antiatherogenic and plaque stabilizing effects of saffron ethanolic extract in atherosclerotic rabbits. BMC Complement Med Ther 2025; 25:187. [PMID: 40410745 PMCID: PMC12102833 DOI: 10.1186/s12906-025-04927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 05/19/2025] [Indexed: 05/25/2025] Open
Abstract
BACKGROUND Saffron, the dried stigma of the flower Crocus sativus L., has been shown to have therapeutic effects on cardiovascular diseases. Several studies have explored the impact of saffron on atherosclerosis. However, the mechanism underlying the plaque-stabilizing and antiatherosclerotic effects of saffron has not been widely studied. Therefore, this study aimed to investigate the mechanism of the antiatherosclerotic and plaque-stabilizing effects of saffron ethanolic extract in experimentally induced atherosclerotic rabbits. METHODS New Zealand White rabbits were fed a 1% high-cholesterol diet (HCD) for 8 weeks to induce established atherosclerosis. The rabbits were then treated with 50 or 100 mg/kg/day saffron ethanolic extract (SAF), simvastatin (2.5 mg/kg/day) or placebo for another 8 weeks. Body weight, lipid profile, percentage of atherosclerotic lesions, immunohistochemical analysis, and quantitative real-time polymerase chain reaction were performed at baseline, after high-cholesterol diet feeding, and after the intervention. RESULTS The results showed that SAF had no significant effect on body weight. However, treatment with both doses of SAF markedly attenuated the levels of low-density lipoprotein (LDL) and total cholesterol (TC) in atherosclerotic rabbits. Higher doses of SAF markedly reduced atherosclerotic lesions in rabbit aortas. Additionally, SAF suppressed the tissue and gene expression of adhesion molecules and pro-inflammatory biomarkers in the aorta. SAF also reduced MMP-9 tissue expression in the aortas of atherosclerotic rabbits, thereby increasing plaque stability. CONCLUSIONS Our findings suggest that saffron ethanolic extract exhibits therapeutic potential in rabbits with HCD-induced atherosclerosis. This effect may be associated with the modulation of inflammatory pathways, leading to reduced expression of pro-inflammatory cytokines, endothelial activation markers, and matrix metalloproteinases. The observed reduction in vascular inflammation and endothelial activation may contribute to improved lipid profiles, decreased atherosclerotic lesion severity, and enhanced plaque stability. While these findings highlight the potential of saffron ethanolic extract as an adjunctive treatment for atherosclerosis, further studies are warranted to clarify its direct effects on lipid metabolism and underlying molecular mechanisms. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Iman Nabilah Abd Rahim
- Cardiovascular Advancement and Research Excellence Institute (CARE Institute), Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
| | - Effat Omar
- Cardiovascular Advancement and Research Excellence Institute (CARE Institute), Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
| | - Suhaila Abd Muid
- Cardiovascular Advancement and Research Excellence Institute (CARE Institute), Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
- Department of Biochemistry & Molecular Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
| | - Noor Alicezah Mohd Kasim
- Cardiovascular Advancement and Research Excellence Institute (CARE Institute), Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia.
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia.
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Fazilat S, Tahmasbi F, Mirzaei MR, Sanaie S, Yousefi Z, Asnaashari S, Yaqoubi S, Banagozar Mohammadi A, Araj-khodaei M. A systematic review on the use of phytotherapy in managing clinical depression. BIOIMPACTS : BI 2024; 15:30532. [PMID: 40256221 PMCID: PMC12008507 DOI: 10.34172/bi.30532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 04/22/2025]
Abstract
Introduction The use of medicinal plants in the management of depression, also known as phytotherapy or herbal medicine for depression, is an area of growing interest in the field of mental health and complementary medicine. Methods This study used a systematic assessment of pertinent literature to assess the effectiveness of medicinal herbs in treating mild to severe depression. A comprehensive literature search was conducted to identify randomized controlled trials (RCTs) that reported data on the intervention, control group, adverse events, outcome measurements, and main findings. A summary and analysis were done on the included research data. Results We included 23 RCTs investigating the efficacy of herbal medicines, including Crocus sativus, Lavandula angustifolia, Melissa officinalis, and Echium amoenum, in treating depression. In general, saffron showed encouraging outcomes when used to treat mild to severe depression. With no discernible variations in the reported adverse effects, it proved to be equally efficacious as well-known antidepressants like imipramine and fluoxetine. However, it is noteworthy that not all trials yielded favorable results. Conclusion More investigation is required to fully understand the mechanisms of action, ideal dosage schedules, long-term effects, and relative efficacy of medicinal plants in depressive treatment.
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Affiliation(s)
- Sutude Fazilat
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Persian Medicine, Faculty of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fateme Tahmasbi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-based Medicine Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Mirzaei
- Department of Persian Medicine, Faculty of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Yousefi
- Research Center of Psychiatry and Behavioral Sciences, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Solmaz Asnaashari
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shadi Yaqoubi
- Faculty of pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahad Banagozar Mohammadi
- Department of Persian Medicine, Faculty of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Araj-khodaei
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Singletary KW. Potential Benefit of Spices for Glycemic Control. NUTRITION TODAY 2024; 59:182-194. [DOI: 10.1097/nt.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
The prevalence of hyperglycemia is increasing worldwide in large part due to the escalating prevalence of obesity. It can occur along with other disorders and diseases, contributing to escalating health costs and accumulating disabilities. Besides dietary approaches and availability of antidiabetic medications, other complementary approaches and adjunct therapies using biologically active botanical phytochemicals have received growing attention for managing type 2 diabetes mellitus. Spices are one source of these bioactive plant constituents, and considerable preclinical studies have investigated their possible health benefits. There also are an increasing number of human clinical trials assessing the ability of spices and their individual plant constituents to improve glucose homeostasis in those with type 2 diabetes mellitus and other dysglycemic conditions. This narrative review provides a summary of the human studies evaluating the effects of select spices on glucose homeostasis and highlights areas for future research.
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Yan X, Zhao S, Feng X, Li X, Zhou Q, Chen Q. Effects of Crocus sativus on glycemic control and cardiometabolic parameters among patients with metabolic syndrome and related disorders: a systematic review and meta-analysis of randomized controlled trials. Nutr Metab (Lond) 2024; 21:28. [PMID: 38796446 PMCID: PMC11127410 DOI: 10.1186/s12986-024-00806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024] Open
Abstract
Metabolic syndrome (MetS) is a cluster of clinical syndromes that is closely associated with an elevated risk of developing atherosclerotic cardiovascular disease. In a series of animal experiments and clinical trials, crocus sativus and its component crocin have demonstrated promising hypoglycemic effects. However, there is currently insufficient evidence regarding their impact on cardiometabolic parameters. Our study aimed to assess the impact of Crocus sativus and crocin on glycemic control in individuals with metabolic syndrome and associated disorders, as well as their potential effects on improving cardiometabolic parameters. We searched Cochrane Library, PubMed, Embase, and Web of Science databases to ascertain the pertinent randomized controlled trials (RCTs) until December 30, 2023. Q-test and I2 statistics were utilized to evaluate heterogeneity among the included studies. Data were merged using a random-effects model and presented as (WMD) with a 95% confidence interval (CI). The current comprehensive review and meta-analysis, encompassing 13 RCTs involving a total of 840 patients diagnosed with metabolic syndrome and associated disorders, demonstrates that Crocus sativus was superior to placebo on Hemoglobin A1c(HbA1c) (WMD: -0.31;95% CI [-0.44,-0.19]. P = 0.002) and systolic blood pressure(SBP) (WMD:-7.49;95% CI [-11.67,-3.30]. P = 0.99) respectively. Moreover, Crocus sativus improved fasting blood glucose (FBG) (WMD:-7.25;95% CI [-11.82, -2.57]. P = 0.002) when used crocin and on other chronic diseases. Crocus sativus reduced the total cholesterol (TC) among the metabolic syndromepatients (WMD:-13.64;95%CI [-26.26, -1.03]. P = 0.03). We demonstrated that Crocus sativus exerts beneficial effects on glycemic control and cardiometabolic parameters in individuals with metabolic syndrome and related disorders.
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Affiliation(s)
- Xiaodan Yan
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Shuyuan Zhao
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Xue Feng
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Xinrui Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Qian Zhou
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Qiu Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China.
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Abd Rahim IN, Mohd Kasim NA, Omar E, Abdul Muid S, Nawawi H. Safety evaluation of saffron extracts in early and established atherosclerotic New Zealand white rabbits. PLoS One 2024; 19:e0295212. [PMID: 38207245 PMCID: PMC10783933 DOI: 10.1371/journal.pone.0295212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
Previous research has shown that natural medications pose health risks, especially in subjects with comorbidities. This study aimed to evaluate the safety of saffron ethanolic extract (SEE) administration in early and established atherosclerotic rabbits. Rabbits were given a high-cholesterol diet (HCD) for 4 and 8 weeks to induce early and established atherosclerosis respectively, and then they were treated with 50 and 100 mg/kg/day SEE. The body weight of the animals was recorded. Blood samples were collected at baseline, pre-treatment, and post-treatment for hematological studies, lipid profiles, and biochemical profiles. Tissue specimens of the vital organs were subjected to histological examination. The above parameters were significantly altered post-intervention with 4 and 8 weeks of HCD. No significant differences in body weight were observed in all the groups post-treatment with 50 and 100mg/kg of SEE compared to pre-treatment. However, low-density lipoprotein cholesterol, total cholesterol, serum urea, and glucose significantly decreased post-treatment with 50 and 100mg/kg/day SEE compared to pre-treatment in early and established atherosclerosis groups. Hematological parameters that were affected post-intervention with HCD returned to their baseline values post-treatment with 50 and 100mg/kg/day SEE. There was a significant improvement in the vital organs post-treatment with 50 and 100mg/kg SEE. SEE can safely be administered without causing harmful effects on the hematological, biochemical profiles, and vital organs. Notably, SEE exerts hypolipidemic and hypoglycemic effects on atherosclerotic conditions. Further clinical trials are warranted to ensure the safety of saffron administration in patients with atherosclerosis-related diseases.
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Affiliation(s)
- Iman Nabilah Abd Rahim
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Noor Alicezah Mohd Kasim
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Effat Omar
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Suhaila Abdul Muid
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Department of Biochemistry & Molecular Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Hapizah Nawawi
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
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Kotanidou EP, Tsinopoulou VR, Giza S, Ntouma S, Angeli C, Chatziandreou M, Tsopelas K, Tseti I, Galli-Tsinopoulou A. The Effect of Saffron Kozanis ( Crocus sativus L.) Supplementation on Weight Management, Glycemic Markers and Lipid Profile in Adolescents with Obesity: A Double-Blinded Randomized Placebo-Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1814. [PMID: 38002905 PMCID: PMC10670718 DOI: 10.3390/children10111814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/05/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
Global rates of adolescent obesity have led the World Health Organization to consider the disease a pandemic that needs focus. In search of new anti-obesity agents, Crocus sativus, popularly known as saffron, is a nutraceutical agent, praised for its beneficial effects. The study aimed to investigate the possible effect of Kozanis saffron administration on weight management of obese prediabetic adolescents. Seventy-four obese prediabetic adolescents participated in a double-blind placebo-controlled trial of three arms, randomly assigned to receive either Kozanis saffron (n = 25, 60 mg/day), metformin (n = 25, 1000 mg/day) or a placebo (n = 24), for twelve weeks. Anthropometry, glycemic markers and lipid profiles were investigated at baseline and post-intervention. Saffron supplementation significantly reduced the weight z-score, BMI, BMI z-score and waist circumference (WC) of obese adolescents; however, this reduction was less significant compared to the effect of metformin. Metformin administration offered a significantly more profound improvement in anthropometry compared to saffron administration. Saffron administration also provided significant improvements in weight, weight z-scores, BMI values, BMI z-scores and WCs compared to the placebo. Saffron supplementation failed to change any glycemic marker, but provided a significant reduction in fasting triglyceride levels and also a significant increase in fasting HDL levels. Saffron Kozanis constitutes a promising nutraceutical option for adolescents and children with obesity and prediabetes in need of weight management.
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Affiliation(s)
- Eleni P. Kotanidou
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Vasiliki Rengina Tsinopoulou
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Styliani Giza
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Stergianna Ntouma
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Chrysanthi Angeli
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Michail Chatziandreou
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Konstantinos Tsopelas
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | | | - Assimina Galli-Tsinopoulou
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
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Zamani M, Zarei M, Nikbaf-Shandiz M, Gholami F, Hosseini AM, Nadery M, Shiraseb F, Asbaghi O. The effects of saffron supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis. Front Nutr 2022; 9:1055517. [PMID: 36570145 PMCID: PMC9774508 DOI: 10.3389/fnut.2022.1055517] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) is one of the leading causes of death and disability in the world and is estimated to involve more people in the next years. It is said that alternative remedies such as herbs can be used to manage the complications of this disease. For this reason, we aimed to conduct this meta-analysis to systematically assess and summarize the effects of saffron supplementation as an important herb on cardiovascular risk factors in adults. Methods A systematic search was done in PubMed, Scopus, and Web of Science to find eligible articles up to September 2022. Randomized controlled trials (RCTs) that evaluated the effects of saffron on lipid profiles, glycemic control, blood pressure, anthropometric measures, and inflammatory markers were included. In the meta-analysis, 32 studies were taken into account (n = 1674). Results Consumption of saffron significantly decreased triglyceride (TG) (WMD = -8.81 mg/dl, 95%CI: -14.33, -3.28; P = 0.002), total cholesterol (TC) (WMD = -6.87 mg/dl, 95%CI: -11.19, -2.56; P = 0.002), low density lipoprotein (LDL) (WMD = -6.71 mg/dl, 95%CI: -10.51, -2.91; P = 0.001), (P = 0.660), fasting blood glucose (FBG) level (WMD = -7.59 mg/dl, 95%CI: -11.88, -3.30; P = 0.001), HbA1c (WMD = -0.18%, 95%CI: -0.21, -0.07; P < 0.001), homeostasis model assessment-insulin resistance (HOMA-IR) (WMD = -0.49, 95%CI: -0.89, -0.09; P = 0.016), systolic blood pressure (SBP) (WMD = -3.42 mmHg, 95%CI: -5.80, -1.04; P = 0.005), tumor necrosis factor α (TNF-α) (WMD = -2.54 pg/ml, 95%CI: -4.43, -0.65; P = 0.008), waist circumference (WC) (WMD = -1.50 cm; 95%CI: -2.83, -0.18; P = 0.026), malondialdehyde (MDA) (WMD = -1.50 uM/L, 95%CI: -2.42, -0.57; P = 0.001), and alanine transferase (ALT) (WMD = -2.16 U/L, 95%CI: -4.10, -0.23; P = 0.028). Also, we observed that saffron had an increasing effect on total antioxidant capacity (TAC) (WMD = 0.07 mM/L, 95%CI: 0.01, 0.13; P = 0.032). There was linear regression between FBG and the duration of saffron intake. Additionally, the non-linear dose-response analysis has shown a significant association of saffron intervention with HDL (P = 0.049), HOMA-IR (P = 0.002), weight (P = 0.036), ALP (P = 0.016), FBG (P = 0.011), HbA1c (P = 0.002), and TNF-α (P = 0.042). A non-linear association between the length of the intervention and the level of HDL and DBP was also found. Discussion That seems saffron could effectively improve TG, TC, LDL, FBG, HbA1c, HOMA-IR, SBP, CRP, TNF-α, WC, MDA, TAC, and ALT.
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Affiliation(s)
- Mohammad Zamani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Zarei
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Fatemeh Gholami
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amir Mehdi Hosseini
- Faculty of Medical Sciences and Technologies, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Maryam Nadery
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran,*Correspondence: Farideh Shiraseb,
| | - Omid Asbaghi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Omid Asbaghi,
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