The Revolutionary Impacts of the COVID-19 Pandemic on Mobile Health; Highlights of the Fourth Shiraz International Congress on Mobile Health

Mobile health (m-health) is considered an undeniable part of health service delivery, planning, and marketing, which has dramatically changed due to the unique situation caused by the COVID-19 pandemic. The Forth International Congress of Mobile Health, from February 14^th to 16^th, 2021, in Shiraz, Iran, aimed to provide a venue to exchange ideas, techniques, relevant experiments, and applications with a particular focus on the COVID-19 pandemic impacts. More than 70 experts from different countries in engineering, biomedical sciences, and humanities presented their recent experiences in m-health advancements, particularly in response to the COVID-19 outbreak. In this article, highlights of the most valuable ideas presented at the congress are concisely summarized to give scientists, entrepreneurs, policymakers, and other stakeholders a better understanding of the growing opportunities, and challenges toward the development of m-health.

Clinical predictors of Covid-19 mortality in a tertiary hospital in Lagos, Nigeria: A retrospective cohort study

Background

The predictors of mortality among patients presenting with severe to critical disease in Nigeria are presently unknown.

Aim

The aim of this study was to identify the predictors of mortality among patients with COVID-19 presenting for admission in a tertiary referral hospital in Lagos, Nigeria.

Patients and Methods

The study was a retrospective study. Patients' sociodemographics, clinical characteristics, comorbidities, complications, treatment outcomes, and hospital duration were documented. Pearson's Chi-square, Fischer's Exact test, or Student's t-test were used to assess the relationship between the variables and mortality. To compare the survival experience across medical comorbidities, Kaplan Meir plots and life tables were used. Univariable and multivariable Cox-proportional hazard analyses were conducted.

Results

A total of 734 patients were recruited. Participants' age ranged from five months to 92 years, with a mean ± SD of 47.4 ± 17.2 years, and a male preponderance (58.5% vs. 41.5%). The mortality rate was 9.07 per thousand person-days. About 73.9% (n = 51/69) of the deceased had one or more co-morbidities, compared to 41.6% (252/606) of those discharged. Patients who were older than 50 years, with diabetes mellitus, hypertension, chronic renal illness, and cancer had a statistically significant relationship with mortality.

Conclusion

These findings call for a more comprehensive approach to the control of non-communicable diseases, the allocation of sufficient resources for ICU care during outbreaks, an improvement in the quality of health care available to Nigerians, and further research into the relationship between obesity and COVID-19 in Nigerians.

Association between food additives and prevalence of allergic reactions in children: a systematic review

Food additives contain synthetic and natural chemical compounds and are one of the causes of food allergies. In this regard, it is necessary to recognize the food additives that are of special interest for children. In this survey, the relation between food additives and allergic reactions and attention-deficit hyperactivity disorders in children was studied. The research studies with keywords "allergic reactions", "hypersensitivity", "food additives" and "children" were searched in PubMed, Scopus, Science Direct, Web of Science, and SID databases, from 1984 to 2020. Three hundred twenty-seven studies were obtained and only seven articles were finally selected according to exclusion and inclusion criteria. In the final review, seven articles were selected to investigate the relationship between food additives and hypersensitivity reactions. Some clinical factors such as urticaria, eczema, rhinitis and gastrointestinal symptoms and the prevalence of laboratory evidence in atopic children are due to increased exposure to food additives including artificial colors and sweeteners, preservatives, and monosodium glutamate. Clinical signs and laboratory evidence prove a significant association between some food additives and allergenic adverse reactions. It was also found that food additives such as artificial colors and sweeteners, preservatives, and monosodium glutamate are responsible for most cases of hypersensitivity in children, and the prevalence of hypersensitivity to food additives was estimated to be about 1.2% based on data extracted from studies.

Comparative effects of Er:YAG laser, and EDTA, MTAD, and QMix irrigants on adhesion of stem cells from the apical papilla to dentin: A scanning electron microscopic study

Background

Dentin conditioning can affect the adhesion of stem cells in endodontic regenerative treatments. This study aimed to assess the effects of the most commonly used endodontic irrigants, namely, ethylenediaminetetraacetic acid (EDTA), MTAD, and QMix in comparison with Er:YAG laser (as a novel modality for root canal disinfection) on the adhesion of stem cells from the apical papilla (SCAPs) to dentin.

Material and Methods

Forty dentin specimens were prepared and subjected to different treatments in 5 groups (n=8) of control, irrigation with EDTA for 1 minute, irrigation with MTAD for 5 minutes, irrigation with QMix for 5 minutes, and Er:YAG laser irradiation. SCAPs were isolated from third molar tooth buds that two-thirds of their roots had formed. The cells were cultured on dentin specimens for 3 days and were counted using scanning electron microscopy (SEM).

Results

MTAD resulted in significantly lower adhesion of cells to dentin compared with other groups (P<0.05). All other modalities induced cell adhesion with no significant difference with each other (P>0.05).

Conclusions

Despite many favorable properties, MTAD cannot serve as an optimal irrigant in endodontic regenerative procedures since it inhibits the adhesion of SCAPs to dentin and impairs an important step in tissue engineering.

Key words:Endodontic Regeneration, Er-YAG laser, MTAD, QMix, EDTA, SCAP, stem cell adhesion.

Covid 19: A Prospective Observational Study on the Cutaneous Manifestations of Patients in Lagos, Nigeria

BACKGROUND

Cutaneous manifestations of COVID-19 have been documented from Europe, USA, and China but none from Africa to date. Skin findings among Africans differ from Caucasians and it is important to report these in Nigerians with COVID-19.

METHODS

A prospective observational review involving patients seen at the Emergency triage, and Isolation wards of the Lagos University Teaching Hospital. Demographic and clinical data were captured; skin and appendages were examined by a dermatologist between 0800hrs and 1600hours to minimise visual errors of artificial light masking cutaneous lesions.

RESULTS

Of 235 participants, 17 (7.23%) had recent onset skin rash, with 7 (41.2%) experienced itching and 11 confirmed with COVID-19. There was a male: female ratio of 97:43 (2.3:1) among COVID-19 patients. Cutaneous findings were seen in 12 (5.1%) participants, with the face and trunk mostly affected and acne plus papular eruptions predominating. There was no significant relationship between COVID-19 and recent onset skin rash (χ2, p = 0.87). Only 2 of the 17 participants had a previously existing dermatoses ((χ2, p = 0.84). There was no significant relation between use of medications and onset of rashes (χ2, p = 0.72) or between those with co-morbidities and onset of rashes (χ2, p = 0.51).

CONCLUSION

Cutaneous manifestations were found among Nigerian patients with SARS-CoV-2 infection. Most presented with pruritus and papular eruptions and no morphologic pattern was demonstrated. Physicians and dermatologists need to be aware and look out for skin changes in SARS-CoV-2 infection as they may be early pointers to COVID-19. Keywords: Cutaneous findings, manifestations, Skin, COVID-19, Nigeria.

Osteoprotegerin changes in saliva and serum of patients with knee osteoarthritis

OBJECTIVE

The scope of this study was to assess salivary and serum osteoprotegerin (OPG) levels in knee osteoarthritis (OA).

METHODS

Serum and saliva OPG levels of 30 knee OA and 30 matched healthy controls in this cross-sectional study was assessed by ELISA. Knee pain was assessed by WOMAC. Data were analyzed by Student's t-test, Spearman correlation test and ROC.

RESULTS

The mean serum but not saliva OPG level was lower in knee OA than that of the healthy group. WOMAC negatively correlated with serum OPG (r=-0.501; P=0.000). The serum OPG cutoff value was 237.5pg/ml for the diagnosis of knee OA.

CONCLUSIONS

As serum OPG was lower in knee OA and negatively correlated with WOMAC, it seems that detection of OPG in serum but not in saliva may be a probable marker to the diagnosis of knee OA.

KEY MESSAGES

Osteoprotegerin decreases in knee osteoarthritis.

Epidemiologic profile of nosocomial infections among paediatric patients in a referral hospital in Hamadan, west of Iran

Healthcare-associated infections (HC-AI) are major health problem with high financial impact. HC-AIs are one of the main causes of morbidity and mortality in paediatric hospitals. This study was performed to determine the epidemiology of HC-AIs in children admitted to medical wards of Besat Hospital in Hamadan, west of Iran. Data on cases of HC-AIs in paediatrics were collected from March 2017 to February 2018 in Besat Hospital. The medical records of eligible cases were extracted from Iranian Nosocomial Infections Surveillance Software. During the study period, a total of 355 HC-AIs in children were detected, 213 (60%) in boys and 214 (60.3%) in the 0-4-year age group. Of these, bloodstream infection was the most frequent infection in both age groups (37.38% in 0-4 years and 34.75% in 5-14 years). Escherichia coli was the common detected microorganism in girls (25.84% in those aged 0-4 years and 24.53% in 5-14 years), whereas Staphylococcus was more prevalent in boys (33.6% in those aged 0-4 years and 29.55% in 5-14 years). HC-AIs were more prevalent in burn, haematology and intensive care unit wards. In Besat Hospital, bloodstream infection and urinary tract infection were the most frequent infections among paediatric patients, and E. coli and Staphylococcus were the commonest detected microorganism in girls and boys respectively. Preventive activities should be targeted to reduce the rate of HC-AIs in wards associated with more contamination.

The occurrence and impact of blood transfusion in cardiogenic shock patients supported by an Impella device: a retrospective study

Background

Cardiogenic shock (CS) patients are frequently supported by mechanical devices, such as the Impella. The use of these devices is associated with device-related complications, such as hemolysis and bleeding, which may necessitate blood transfusion. Blood transfusion has been associated with worse clinical outcome. Information on the occurrence and impact of blood transfusion in these patients is scarce.

Purpose

To assess the incidences of hemolysis, bleeding and red blood cell (RBC) transfusion in CS patients receiving Impella support, to identify patients at risk for RBC transfusion and to assess mortality in transfused and non-transfused patients.

Methods

We performed a single center retrospective cohort study between August 2006 and April 2019, collecting data on all patients supported by an Impella device (type 2.5, CP or 5.0) for more than 24 hours. Patient baseline characteristics, clinical course and outcomes were compared between patients transfused with RBCs and non-transfused patients. Multivariate logistic regression analysis was used to identify factors associated with RBC transfusion. Correlations between patient characteristics and the number of units of RBCs administered were tested using the Spearman's Rank correlation coefficient.

Results

We included 122 CS patients who received Impella support for longer than 24 hours. Seventy-eight percent was male and the median age was 60.0 years. Transfused patients had a longer support duration compared with non-transfused patients (respectively; 97 (52–173) hours versus 51 (39–76) hours, p&lt;0.001). Of all included patients, 68% received RBC transfusion. Transfused patients received a median of 1.5 (0.6–2.8) units of RBCs per day. The incidence of hemolysis was 10% in transfused patients and 11% in non-transfused patients (p=NS). Bleeding occurred in 61% of the transfused patients and 11% of the non-transfused patients (p&lt;0.001). Higher age, lower hemoglobin level prior to Impella implant and longer support duration increased the odds of receiving RBC transfusion. The 30-day mortality was similar in transfused and non-transfused patients, respectively 58% and 42% (p=NS) (Figure 1. Kaplan-Meier Curve showing 30-day mortality of transfused and non-transfused patients).

Conclusion

RBC transfusion was required in more than two-third of the CS patients who received Impella support for longer than 24 hours. Higher age, lower hemoglobin level prior to implant and longer support duration were independent risk factors for RBC transfusion. In contrast to previous studies, transfusion was not associated with 30-day mortality. Future research should focus on the effects of RBC transfusion on morbidity and mortality and investigate the optimal transfusion criteria and aims.

Funding Acknowledgement

Type of funding source: None

Antihypoxic activities of Eryngium caucasicum and Urtica dioica

OBJECTIVE

Urtica dioica and Eryngium spp. have been used in traditional medicine for many years. In spite of many works, nothing is known about their protective effect against hypoxia-induced lethality.

MATERIALS AND METHODS

Protective effects of U. dioica (UD) aerial parts and E. caucasicum (EC) inflorescence against hypoxia-induced lethality in mice were evaluated by three experimental models of hypoxia, asphyctic, haemic and circulatory.

RESULTS

Statistically significant protective activities were established in some doses of extracts in three models. Antihypoxic activity was especially pronounced in polyphenol fractions in asphyctic model. EC polyphenol fraction at 400 mg/kg prolonged survival time (48.80 ± 4.86, p < 0.001) which was comparable with that of phenytoin (p > 0.05). It was the most effective extract in circulatory model, too. It prolonged survival time significantly respect to control group (p < 0.001). UD extracts protected the mice but the response was not dose-dependent. In haemic model, extracts of EP significantly and dose dependently prolonged survival time as compared to control group (p < 0.001). At 600 mg/kg, EP was the most effective one, being capable of keeping the mice alive for 12.71 ± 0.75 min. Only the concentration of 300 mg/kg of UD was effective (p < 0.001).

CONCLUSIONS

Extracts showed remarkable antihypoxic effects. Pharmacological effects may be attributed to the presence of polyphenols in the extracts.

Comparison antinociceptive activity of the aqueous methanolic extracts of Salvia Hypoleuca and Phytolacca americana in mice

OBJECTIVES

Anti-nociceptive activity of aerial parts of Phytolacca (P.) americana and Salvia Hypoleuca were investigated, using the hot plate method in mice.

MATERIALS AND METHODS

Antinociceptive activity of aerial parts of Phytolacca americana and Salvia Hypoleuca were investigated using the hot plate method. In addition, the effect of its aerial parts on morphine dependence was investigated in mice. After induction of dependence by morphine, different concentrations of plants aerial parts extract were injected to treated groups. To assess morphine withdrawal, mice were injected naloxone (5 mg/kg) i.p. on the 5th day. After four consecutive days of morphine injection, withdrawal syndrome was assessed by placing each mouse in a 30 cm high glass box and recording the frequency of escape jumps for 60 minutes.

RESULTS

The aqueous methanolic extract of aerial parts of P. Americana and S. Hypoleuca produced a statistically significant increase in pain threshold after 30 min of i.p. injection of extract, in comparison with the control groups, at adose of 190 and doses of 500, 1000 and 1500 mg/kg (p < 0.001) respectibility. The activity was comparable to that of morphine (30 mg/kg i.p., p > 0.05). The anti-nociceptive activity of P. Americana and S. Hypoleuca increased until the 60th min (p < 0.05 compared to morphine).

CONCLUSIONS

The results of this study support the extensive use of S. Hypoleuca and P. americana in Western Asia and America. The LD50 of extracts S. Hypoleuca and P. americana following a 14 days acute toxicity study were calculated to be a bout 1800 and 208 mg kg-1 i.p. respectability.

[Periapical regeneration. About one case of necrotic immature tooth treated with mineral trioxide aggregate (MTA)]

Therapeutic of apexification with calcium hydroxide has been extensively used in clinical practice, but this technique has some drawbacks (long duration of treatment, weakening of the radicular walls). Different studies have proposed to close the apex opened with MTA (Mineral trioxide Aggregate) which is biocompatible, bacteriostatic, this material induces regeneration of the periapical region through the formation of cementum, bone and periodontal ligament (1, 2). This case report describes the technique of setting up in a single step of the Mineral trioxide Aggregate as an apical barrier for immature permanent roots. This method has allowed us an immediate apical sealing and a root canal filling and a coronary restore permanently as soon as possible. The radiological control confirmed that this type of apexification could be successful with periapical regeneration ad-integrum.

Predictive factors of response to phase I complete decongestive therapy in upper extremity lymphedema following breast carcinoma in Iran

Post-mastectomy chronic lymphedema as a complication of breast cancer treatment is primarily managed with Complete Decongestive Therapy (CDT). We examined various factors for correlating with results of Phase I CDT treatment in controlling the upper extremity lymphedema. Study population consisted of patients with lymphedema referred to the Lymphedema Clinic of the Iranian Breast Cancer Research Center for control of arm edema. After obtaining the demographic and clinical data, patients were treated with CDT for 2 - 3 weeks. One hundred and thirty seven patients (mean age +/- SD; 53.5 +/- 10 years) were studied. In 48.7% of patients, the affected arm was the dominant limb. Fifty percent of patients experienced lymphedema during the first year after surgery, and mean duration of lymphedema was 35 +/- 43 months. Mean volume reduction was 43% +/- 14.87% (p = 0.03). There was a significant relationship between the percent of volume reduction and initial lymphedema volume (p=0.003) as well as duration of lymphedema (p=0.002). Our results demonstrate that Phase I CDT treatment is very effective for post mastectomy lymphedema, and particularly if it is provided in earlier stages of disease. In addition, CDT also has an important role in reducing clinical symptoms and improving limb function. In the appropriate setting, Phase I CDT has been an effective method of controlling post mastectomy lymphedema in this Iranian population.

The effect of palm oil or canola oil on feedlot performance, plasma and tissue fatty acid profile and meat quality in goats

Twenty-four entire male Kacang kid goats were fed diets containing 3% canola (n=12) or palm oil (n=12) supplements for 16 weeks. The goats had an initial live weight of 14.2±1.46 kg and were fed a mixed ration ad libitum (10.4 MJ/ME and 14% crude protein). There was no difference in feedlot performance due to diet. Inclusion of canola oil reduced (P<0.05) kidney fat weight and increased (P<0.05) linolenic acid (18:3n-3) concentration in the blood plasma, m. longissimus lumborum (LL), liver, and kidney. The palm oil diet increased (P<0.05) myristic (14:0) and palmitic (16:0) acid content in the blood, but this did not alter these fatty acids in the LL muscle. Lipid oxidative substances in the liver and LL from palm oil fed kids were higher (P<0.05) than those from canola supplemented kids. The incorporation of canola oil into the goats' diet increased muscle omega-3 fatty acid content, but lipid oxidation was lowered in the blood and muscle LL.

Phylogenetic status of brown trout Salmo trutta populations in five rivers from the southern Caspian Sea and two inland lake basins, Iran: a morphogenetic approach

Interrelationships, origin and phylogenetic affinities of brown trout Salmo trutta populations from the southern Caspian Sea basin, Orumieh and Namak Lake basins in Iran were analysed from complete mtDNA control region sequences, 12 microsatellite loci and morphological characters. Among 129 specimens from six populations, seven haplotypes were observed. Based on mtDNA haplotype data, the Orumieh and southern Caspian populations did not differ significantly, but the Namak basin-Karaj population presented a unique haplotype closely related to the haplotypes of the other populations (0·1% Kimura two-parameter, K2P divergence). All Iranian haplotypes clustered as a distinct group within the Danube phylogenetic grouping, with an average K2P distance of 0·41% relative to other Danubian haplotypes. The Karaj haplotype in the Namak basin was related to a haplotype (Da26) formerly identified in the Tigris basin in Turkey, to a Salmo trutta oxianus haplotype from the Aral Sea basin, and to haplotype Da1a with two mutational steps, as well as to other Iranian haplotypes with one to two mutational steps, which may indicate a centre of origin in the Caspian basin. In contrast to results of the mtDNA analysis, more pronounced differentiation was observed among the populations studied in the morphological and microsatellite DNA data, except for the two populations from the Orumieh basin, which were similar, possibly due to anthropogenic causes.

The effect of participatory community-based diabetes cares on the control of diabetes and its risk factors in western suburb of Yasouj, Iran

This study aimed to investigate whether a community-based participatory diabetes care program could efficiently improve diabetic care and reduce its risk factors. To induce a participatory approach, a local group was established in partnership with academics, local leaders, health providers and public representatives. The group conducted community needs assessment and priority setting process. Diabetes was identified as the first priority health problem in this area. A total of 2569 30- to 65-year-old residents were screened for diabetes and 405 of them took part in a 13-week nutrition education and physical exercise intervention. Out of 1336 high-risk individuals, 17% had fasting blood sugar (FBS) ≥126 mg/dl and 13.5% with FBS between 110 and 125 mg/dl. Percentages of participants with triglycerides (TG) ≥150 mg/dl and cholesterol ≥200 mg/dl were 33.8% and 23.5%, respectively. After completion of the intervention, the mean FBS, HbA1C, TG and cholesterol were decreased significantly. Although systolic and diastolic blood pressure and body mass index were decreased too, the differences were not statistically significant. The mean physical activity increased and consumption of fried foods and saturated oil decreased significantly. The results suggest that participatory community-based care could be a feasible model for control of diabetes and its risk factors.

Life expectancy at birth in rural areas based on corrected data of the Iranian vital horoscope

BACKGROUND

Life expectancy at birth as an alternative summary measure of mortality represents number of years which a newborn will be alive based on the current age specific death rates. As it summarizes death rates across all age range in a given population is the most common summary measure of mortality. The aim of this study was to correct death rates for underreport and estimate life expectancy at birth in rural population of Iran in 2008. In addition, this study aimed to assess the Vital Horoscope system's data quality.

METHODS

Data were obtained from all Health Houses in Iranian villages in 2008. In order to adjust over 5 years old death rates for underreport, we used Brass Growth Balance method. Since this method is not applicable to under 5 years old, we used child mortality rates projected based on the Iranian Demographic and Health survey 2000 to correct death rates.

RESULTS

Adjusted life expectancy at birth for males was 71.5 year and for females was 74.4 year. Completeness of the death data was 88% for males and 79% for females. Adjusted child (under 5) mortality rate by sex in males and females was 25.9 and 23.8 per 1000 live births respectively. Adult mortality for males was 167.2 and 98.3 for females per 1000.

CONCLUSION

Data based on Vital Horoscope system are a suitable source to estimate life expectancy and other mortality statistics. Also has an acceptable completeness on death registration. Further studies to investigate accuracy of data from the Vital Horoscope system are suggested.

Estimating the proportion of diabetes to the attributable burden of cardiovascular diseases in iran

BACKGROUND

This study aimed at estimating the proportion of diabetes as a risk factor to the attributable burden of cardiovascular diseases in Iran.

METHODS

Comparative Risk Assessment methodology was used to calculating Potential Impact Fraction (PIF). To calculate PIF, data on the prevalence of newly diagnosed diabetes mellitus (NDM) and known diabetes mellitus (KDM) were obtained from 3rd Iranian surveillance of risk factors of non-communicable diseases and data on corresponding measures of effect were derived from a cohort study. PIF were estimated on both theoretical minimum and feasible minimum risk. Uncertainty for the attributable burden was estimated by Monte Carlo simulation-modeling techniques incorporating sources of uncertainty.

RESULTS

According to multivariate-adjusted hazard ratios, by reducing the prevalence of Iranian women with diabetes from 10.05 percent to the feasible minimum risk level i.e. 5 percent, 6.8% (95% uncertainty intervals: 3.5-9.8) of attributable Disability Adjusted Life Years (DALYs) to CVD are avoidable and the corresponding value for men were 3.1% (95% uncertainty intervals: 1.4-4.8).

CONCLUSION

Although data on the prevalence of diabetes and corresponding measures of associations were obtained from an updated and country-specific source, but to better priority setting, PIF should be applied to updated and revised burden of CVDs.

Estimating the contribution of selected risk factors in attributable burden to stroke in iran

BACKGROUND

Knowledge of the magnitude of avoidable burden by risk factors is needed for health policy, priority setting, and preventing stroke. The aim of this study was to estimate the contribution of selected risk factors including hypertension, overweight, obesity, tobacco use, and physical inactivity to the attributable burden of stroke in Iran.

METHODS

The World Health Organization Comparative Risk Assessment (CRA) methodology was employed to calculate the Potential Impact Fraction (PIF) and percentage of avoidable burden of stroke, which attributed to its risk factors among Iranian adults in 2009. Prevalence of risk factors was obtained from the 5(th) STEPS survey of chronic disease risk factors which conducted in 2009. PIF was estimated on both theoretical minimum and feasible minimum risk. A simulation procedure incorporating sources of uncertainty was used to estimate the uncertainties for the attributable burden.

RESULTS

About 15.7% (95% uncertainty intervals: 5.8- 23.5) of attributable Disability Adjusted Life Years (DALYs) to stroke in adult males and 15.8% (95% uncertainty intervals: 5.8- 23.5) in adult females are avoidable after changing the current prevalence (16.0% and 16.1% for males and females, respectively) of hypertension to 10% in both sexes.

CONCLUSION

This work highlighted the important role of hypertension and overweight. Accordingly, policy makers are advised to consider these risk factors once implementing interventional program in Iran.

Antinociceptive activity and effect of methanol extract of Salvia limbata on withdrawal syndrome in mice

OBJECTIVES

Salvia (S.) is an important genus consisting of about 900 species in the Lamiaceae family. They are several reports that some Salvia spp. has effects on the central nervous system (CNS). The present experiments were undertaken to study the protective effect of S. limbata on the development of dependence to morphine in mice.

MATERIAL AND METHODS

Antinociceptive activity of aerial parts of S. limbata was investigated using the hot plate method. In addition, the effect of its aerial parts on morphine dependence was investigated in mice. After induction of dependence by morphine, different concentrations of plant aerial parts extract were injected to treated groups. To assess morphine withdrawal, mice were injected naloxone (5 mg/kg) i.p. on the 5th day. After four consecutive days of morphine injection, withdrawal syndrome was assessed by placing each mouse in a 30 cm high glass box and recording the frequency of escape jumps for 60 minutes.

RESULTS

Animal receiving acute treatment with morphine displayed dependence. The animals treated with different extract concentrations could decrease frequency of escape jumps in number or decrease development of morphine dependence. Addiction was observed following naloxone administration. Methanol extract of S. limbata produced a statistically significant inhibition of pain induced by hot plate latency at 500, 1000 and 1500 mg/kg i.p. A significant increase in pain threshold was observed after 30 and 60 min (p < 0.001). The activity was comparable to that of morphine (30 mg kg(-1) i.p., p > 0.05). The anti-nociceptive activity of S. limbata increased until the 60th min (p < 0.05 compared to morphine).

CONCLUSIONS

S. limbata extract produced statistically significant inhibition of pain and development of morphine dependence in mice.

Findings on the phytoextraction and phytostabilization of soils contaminated with heavy metals

As a result of human activities such as mining, metal pollution has become one of the most serious environmental problems today. Phytoremediation, an emerging cost-effective, non-intrusive, and aesthetically pleasing technology that uses the remarkable ability of plants to concentrate elements can be potentially used to remediate metal-contaminated sites. The aim of this work was to assess the extent of metal accumulation by plants found in a mining area in Hamedan province with the ultimate goal of finding suitable plants for phytoextraction and phytostabilization (two processes of phytoremediation). To this purpose, shoots and roots of the 12 plant species and the associated soil samples were collected and analyzed by measurement of total concentrations of some elements (Fe, Mn, Zn, and Cu) using atomic absorption spectrophotometer and then biological absorption coefficient, bioconcentration factor, and translocation factor parameters calculated for each element. Our results showed that none of the plants were suitable for phytoextraction and phytostabilization of Fe, Zn, and Cu, while Chenopodium botrys, Stipa barbata, Cousinia bijarensis, Scariola orientalis, Chondrila juncea, and Verbascum speciosum, with a high biological absorption coefficient for Mn, were suitable for phytoextraction of Mn, and C. bijarensis, C. juncea, V. speciosum, S. orientalis, C. botrys, and S. barbata, with a high bioconcentration factor and low translocation factor for Mn, had the potential for the phytostabilization of this element.

Trends in incidence of gastrointestinal tract cancers in Western iran, 1993-2007

BACKGROUND

Few studies have addressed the secular trend of malignancies in developing countries such as Iran. This study aimed to determine the trend in the incidence of gastrointestinal cancers during a period of 15 years in Kermanshah, Iran.

METHODS

All of the confirmed positive pathologic reports for esophageal, gastric and colorectal cancers from 1993 to 2007 were collected and compared with the data compiled in the provincial health center. The incidence rate was standardized for world population using a direct method. The Fay and Feuer method was used to calculate the 95% confidence intervals for each cancer in each year. Trends were investigated using linear regression.

RESULTS

Over the period, 2951 cases of gastrointestinal cancer were reported in Kermanshah Province. The age-standardized incidence rates for gastric, esophageal and colorectal cancers were 9.2, 8.1 and 4.5 per 100,000 respectively over 15 years. In all types, the incidence increased with age. The study showed that the incidence of gastric and esophageal cancers decreased annually by 0.28 (-0.67-0.11) and 0.36 (-0.70 - (-0.02)), respectively. Colorectal cancer demonstrated an increase in the incidence [0.14 (95% CI: -0.01-0.29) annually].

CONCLUSION

A decrease in the incidence of gastric and esophageal cancers and an increase in the incidence of colorectal cancer are in line with reports from other developing countries in epidemiologic transition. Such trends warrant in depth investigation for the exact reasons.

Household catastrophic health expenditure

BACKGROUND

Fairness in financial contribution for health was determined by WHO (World Health Report, 2000) as the third goal of health systems which is measured by fairness in financial contribution index (FFCI). The aim of this study was to estimate FFCI and quantify extent of catastrophic household heath expenditures.

METHODS

We conducted a descriptive study during May 2008. Subjects were chosen by "Systematic Random sampling" among residents of Maskan's population-based research center (Maskan Center) in Kermanshah, Iran. After completing informed consent form, we collected data using a questionnaire by interview with head of family. In order to describing data and estimating FFCI, we used descriptive statistics and WHO methodology, respectively. Households with catastrophic expenditures and impoverished households were defined as those with health expenditures over 40% and 50% of their ability to pay, respectively.

RESULTS

The mean age of head of families was 48.96±12.86 years. From 189; 12.7% of household's heads were female. 75.1% of households were covered by at least one health insurance scheme. FFCI was 0.57. The proportion of households facing catastrophic health expenditures was 22.2% (95% CI=16.3%-28.1%)

CONCLUSION

The rate of FFCI among participants implied an inequality in health financing contribution. In addition, many of households (22.2%) faced catastrophic health expenditures while according to WHO estimation, the figure in the whole country was 2% in 1999. Our study revealed the importance of protecting households against the costs of ill-health.

Effect of Fe2+ and Fe3+ ions on human plasma cholinesterase activity

OBJECTIVES

Metals such as iron are needed for physiological functions of the body. However, their excess may cause serious damage including poisoning. The effects of Fe2+ and Fe3+ ions on human plasma cholinesterase activity were investigated.

MATERIAL AND METHODS

Plasma were obtained (n = 24) from healthy male volunteers, and treated with five various concentrations of Fe2+ and Fe3+ ions. Activity of butyryl cholinesterase (BChE) was assayed according to colorimetric EIIman procedure. The activity was calculated as micromole of hydrolyzed substrate, per minute in each ml.

RESULTS

Both ferric (Fe3+) and ferrous (Fe2+) ions significantly decreased the BChE activity in all tested concentrations. The effect of ferric (Fe3+) ions on the reduction of plasma enzyme activity was more pronounced than ferrous (Fe2+) ions (p < 0.001, respect to control group).

CONCLUSIONS

The present paper represents the effect of Fe2+ and Fe3+ ions on ButyrylChE activity in human plasma. It reveals that both ions suppress BChE activity.

H-point standard addition method applied to simultaneous kinetic determination of antimony(III) and antimony(V) by adsorptive linear sweep voltammetry

In this work, the applicability of H-point standard addition method (HPSAM) to the kinetic voltammetry data is verified. For this purpose, a procedure is described for the determination of Sb(III) and Sb(V) by adsorptive linear sweep voltammetry using pyrogallol as a complexing agent. The method is based on the differences between the rate of complexation of pyrogallol with Sb(V) and Sb(III) at pH 1.2. The results show that the H-point standard addition method is suitable for the speciation of antimony. Sb(III) and Sb(V) can be determined in the ranges of 0.003-0.120 and 0.010-0.240 microg mL(-1), respectively. Moreover, the solution is analyzed for any possible effects of foreign ions. The obtained results show that the HPSAM in combination to electroanalytical techniques is a powerful method with high sensitivity and selectivity. The procedure is successfully applied to the speciation of antimony in water samples.

Investigation of fine nanoparticles syngas catalyst (POM) considering their various morphology

Ni/SiO2 fine nanoparticles were prepared by coprecipitation method using various nonionic surfactants as templates with Tylose as a binder dispersant. Scanning Electron Microscope (SEM) and X-ray Diffraction (XRD) have been used to study the templates influence on the morphology of the produced samples. Although the phase structure remained as a tetrahedron amorphous cristobalite-sin-SiO2 (101,100), rhombohedron and cubic NiO, but samples with different morphology (homogeneous nano spherical, nano rose flower and nano cubic shapes) have been achieved. These fine nanoparticles as syngas catalysts in Partial Oxidation of Methane to Hydrogen and Carbon Monoxide (POM) have been studied. Because of high Hydrogen production, it is a candidate to be a green fuel. A fixed-bed reactor at P = 1 atm, T = 800 degrees C, H2/CO = 1.8, GHSV (CH4) = 6000/hr and BET = 25, 63.5 and 87.1 m2/gr have been used as POM catalyst. From other hand these fine compounds could be converted to metallic nanotube (nanofiber) at above 850 degrees C and also bamboo shape tip mode carbon nanotube by thermal chemical vapor deposition at 800 degrees C. Transmission Electron Microscopy confirmed the metallic nanotube or single nano crystal growth. The Raman spectroscopy of all samples has been studied to confirm the different formation of Ni-Si. Choosing different templates for production of these nanoparticles could create width range of medical and industrial applications.

Catastrophic health expenditures in kermanshah, west of iran: magnitude and distribution

BACKGROUND

Health policy makers are concerned about protecting people from catastrophic health expenditures and subsequent impoverishment. This study aimed to describe the magnitude and distribution of catastrophic health expenditures in Kermanshah western Iran.

METHODS

In this descriptive study, during May 2008, 189 households were chosen by "Systematic Random sampling" among the community of Maskan in Maskan Center for Population. After getting the informed consent forms signed, data ere collected using a questionnaire by interviewing the head of the families. The cut-off point for catastrophic expenditure was defined as health expenditures over 40% of household's capacity to pay.

RESULTS

From a total of 189 households, 22.2% (42) households (95% CI 16.3%- 28.1%) incurred catastrophic health expenditures. Out of 42 households, for 11.9%, the head of family was female. 40.5 % had one member younger than 12 years old, 26.2% had one member older than sixty years old, and 9.5% were households with at least one member with chronic condition. In addition, 19% were uninsured. In addition, because of financial burden of health expenditures 21.4% of the households sold their jewels, 16.7% used up their savings and 47.6% were in debt.

CONCLUSION

Compared to 2% of general population facing catastrophic health expenditure, 22.2% was a high proportion. Our study revealed the importance of protecting households against the cost of ill-health.

In vitro storage of unfertilized ova of endangered Caspian brown trout (Salmo trutta caspius) in artificial media

In order to study the effects of storage media and time of storage on the viability of unfertilized eggs of endangered Caspian brown trout (Salmo trutta caspius), the ova of this fish was stored in coelomic fluid and Cortland artificial media at 2-3 degrees C for 120 h. In this research, Cortland artificial medium was buffered with 20 mM of three different buffers: Hepes (C(8)H(18)N(2)O(4)S), Tris-HCl (C(4)H(11)NO(3)-HCl) and sodium salt Hepes (C(8)H(17)N(2)O(4)SNa). The pH of these media were adjusted according to natural pH of coelomic fluid. The eggs that stored in these media fertilized at times 0 h (eggs fertilized prior to storage), 48, 72 and 120 h of post-stripping, using fresh and pooled sperm obtained from four to six males. According to the results of present study, time of storage showed a significant (p<0.05) main effect on eyeing, hatching and eyed eggs mortality rates. Eyeing and hatching rates significantly (p<0.05) decreased from 97.4+/-2.1% and 95.1+/-4.4% at time 0 (eggs fertilized prior to storage) to 77.9+/-3% and 65.5+/-5% after 120 h of storage. Within a similar period of time, eyed eggs mortality significantly (p<0.05) increased from 2.4+/-2.4% to 17.2+/-3.9%. No significant (p>0.05) main effect was found among media buffered with Tris-HCl (82.8+/-3.2%, 73.4+/-5.4%, 12.1+/-4.5%), Hepes (88.2+/-3.4%, 80.7+/-5.5%, 9.3+/-3.4%), sodium salt Hepes (77.8+/-3.8%, 69.3+/-5.7%, 12.2+/-3.9%) and coelomic fluid (84.8+/-3.8%, 77.7+/-5.1%, 8.9+/-2.7%) for eyeing, hatching and eyed eggs mortality rates. There was a negative correlation (r=-0.895, p<0.001) between eyed eggs mortality and hatching rates. In conclusion, unfertilized eggs of endangered Caspian brown trout can be successfully stored for 48 h without significant loss of fertility. But, storage for 120 h results in the falling of hatching rate. In addition, no significant difference was found between viability rates of ova stored in coelomic fluid and artificial media, 120 h post-storage. It reveals that artificial media could be substituted for coelomic fluid as storage medium at least for 120 h in Caspian brown trout.

Comparison of cryotherapy and curettage for the treatment of pyogenic granuloma: a randomized trial

BACKGROUND

Pyogenic granuloma is a benign vascular lesion of the skin and mucous membranes. Many different treatments have been used, with variable success rates.

OBJECTIVES

To evaluate and compare the effects of cryotherapy and curettage in the treatment of pyogenic granuloma.

METHODS

Eighty-nine patients with pyogenic granuloma were randomized to receive cryotherapy with liquid nitrogen or curettage and electrodesiccation. Forty patients in the cryotherapy group and 36 patients in the curettage group completed the study period.

RESULTS

Among the patients who completed the study, treatment resulted in complete resolution of all lesions after one to three sessions (mean 1.42) in the cryotherapy group and after one to two sessions (mean 1.03) in the curettage group. The difference between the two groups was statistically significant (P < 0.001). Twenty-three patients (57.5%) in the cryotherapy group and 25 patients (69%) in the curettage group had no scar or pigmentation abnormality. Except for cosmetic problems, no other side-effect or complication was recorded in the study.

CONCLUSIONS

This study showed that both cryotherapy and curettage are safe and effective. Curettage had the advantage of fewer treatment sessions required to achieve resolution and better cosmetic results. We suggest that curettage could be the first-line treatment for pyogenic granuloma.