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Background: Zinc deficiency has been reported frequently in hepatitis C patients in the literature. Furthermore, a decrease in zinc level has been shown in beta thalassemia major as well. Iranians consume a large amount of phytate in their regimens which can bind with zinc and decrease its gastrointestinal absorption. Objectives: This study was designed to determine plasma zinc level in an Iranian sample with the diagnosis of hepatitis C with or without concomitant beta thalassemia major. Patients and Methods: Between April 2011 and April 2012, plasma zinc level was determined via atomic absorption method, in 130 hepatitis C patients with or without beta thalassemia major in a known referral center of hepatic diseases in Tehran, Iran. Results: Mean ± standard deviation (SD) of plasma zinc levels was determined as 0.78 ± 0.22 mg/L. Also zinc level was 0.76 ± 0.19 mg/L and 0.80 ± 0.24 mg/L in thalassemic and non thalassemic patients, respectively. T-test analysis showed that there is no significant difference between these two groups regarding plasma zinc level (P = 0.235). Conclusions: It is concluded that zinc level of studied patients is less than which is reported in normal Iranian population. Moreover, there is not a significant difference in plasma zinc levels between thalassemic and non thalassemic patients and it seems to be a common problem in both ones. Addition of zinc supplement may be recommended in both groups in order to optimize the nutritional support and probably improve the treatment response.

To review the acute and chronic pathological effects of sulfur mustard on the genitourinary system and male fertility.We searched PubMed and Google Scholar to find studies related to the sulfur mustard-induced genitourinary effects and male infertility. Information in the abstracts of non-English related papers as well as those in the proceedings of congresses on sulfur mustard were reviewed as well.In acute phase after sulfur mustard exposure, evidences are in favor of microscopic and macroscopic renal lesions, very low androgen levels, and impaired spermatogenesis. Several years following sulfur mustard exposure, the long-term pathological effects vary from the renal function impairment to the gonadal damage, in particular the spermatogenesis. Nevertheless, carcinogenic effect of sulfur mustard on the genitourinary system as well as the prevalence of male infertility among sulfur mustard-exposed veterans in the chronic post-exposure phase is still unclear.Sulfur mustard causes both acute and chronic injuries to different parts of the genitourinary system.

Recombinant human erythropoietin is the cornerstone of therapy for anemia associated with chronic kidney disease or renal transplantation. However, it is not affordable and available for all patients. The present randomized double-blind trial compared the efficacy and safety of a biogeneric erythropoietin, Epolyrec, with the original product, Eprex, in correcting post-transplantation anemia (PTA).Fifty patients who had undergone kidney transplantation surgery and had a hemoglobin level of11 g/L and a hematocrit of30% were recruited. These patients were randomly assigned to Epolyrec (n = 25) or Eprex (n = 25) at a dosage of 80 - 120 IU/kg body weight, three times/week. Patients were followed-up for two months unless they achieved the target levels for hemoglobin (1 g/L increase compared to baseline) and hematocrit (2 - 3% increase compared to baseline). Hemoglobin, hematocrit, and complete blood count with differential (CBC/DIFF) were evaluated at baseline and at months 1 and 2 of study. Other biochemical parameters were assessed at baseline and at the end of trial.Serum hemoglobin and hematocrit progressively increased from baseline to month 2 in both Epolyrec (p = 0.001) and Eprex (p0.001) groups, with no significant difference between the groups (p0.05). Mean corpuscular hemoglobin (MCH) and platelet count showed a significant increase during the course of the trial in both Epolyrec (p = 0.041 and 0.004 for MCH and platelet count, respectively) and Eprex (p = 0.036 and 0.003) groups. However, no significant change was observed between the groups regarding erythrocyte count, mean corpuscular volume, white blood cell count or reticulocyte count from baseline to the end of trial in any of the groups (p0.05). The incidence of adverse events were generally low in both groups and without any significant difference between Epolyrec and Eprex (p0.05).Epolyrec was equivalent to Eprex with respect to efficacy and safety. Hence, Epolyrec could represent a much more affordable and available biogeneric alternative to Eprex in correcting PTA.

Aortic stenosis (AS) is the most common type of valvular cardiac disorders. AS has many risk factors in common with atherosclerosis. Hypercholesterolemia is an important pathomechanism for AS. However, the impact of statin drugs on slowing AS progression has not yet been well established.To investigate the impact of statin therapy on slowing AS progression.This was a randomized double-blind placebo-controlled trial in which 75 patients with mild to moderate AS were randomized to receive either simvastatin (20 mg/day) or placebo for a period of one year. Serum lipid profile, C-reactive protein (CRP), and echocardiographic parameters were evaluated at baseline as well as at the end of trial.Treatment with atorvastatin was associated with significant decreases in total cholesterol, triglycerides, and LDL-C and an elevation of HDL-C. None of the lipid profile parameters changed in the placebo group. Serum CRP was not significantly altered in any of the groups. Left ventricular end-systolic volume was significantly increased by the end of trial in the statin group (p = 0.012). In the placebo group, significant increases were observed for aortic valve mean (p = 0.017) and peak (p0.001) gradient. Other echocardiographic measures remained statistically unchanged in the statin and placebo groups. The number of patients whose disease progressed into severe stage was comparable between the groups and post-trial echocardiographic assessment did not reveal any significant change in the severity of AS between atorvastatin and placebo (p0.05).The findings of the present randomized trial did not support a beneficial effect of statin therapy (20 mg/day) against AS progression in Iranian patients with mild to moderate disease.

BACKGROUND Smoking is among the established yet modifiable risk factors for cancers, cardiovascular diseases, and pulmonary disorders. Oxidative stress has been proposed as a key mechanism mediating the deleterious consequences of smoking. The present study evaluated the effect of supplementation with Chlorella vulgaris, a nutrient and bioactive green microalgae with proven antioxidant capacity, on the burden of oxidative stress in Iranian smokers. METHODS Thirty-eight smokers (mean age: 37.11 +/- 1.69 years; females: 18.4%) were administered C. vulgaris extract (3600 mg/day) for a period of 6 weeks. Fasted serum samples collected at baseline and after the completion of study were analyzed for the concentrations of vitamin C, vitamin E, glutathione, and malonedialdehyde (MDA) as well as activities of superoxide dismutase, glutathione peroxidase, and catalase. Total antioxidant capacity of serum was also determined by the ability of serum to inhibit the formation of ferryl myoglobin radical species. RESULTS Six-week supplementation with C. vulgaris extract in smokers was associated with marked elevation of all assessed serum antioxidant measures (p < 0.001) and significant reduction of MDA levels (p = 0.002). After gender segregation, a similar pattern of changes was observed for both male and female subjects apart from lack of significant change in serum vitamin E status in females. Although the magnitude of change in serum vitamin E was significantly greater in males compared to females (p = 0.014), there was no significant change in the magnitude of changes for other assessed parameters between the genders. CONCLUSIONS Supplementation with C. vulgaris extract significantly improves antioxidant status and attenuates lipid peroxidation in chronic cigarette smokers. Hence, C. vulgaris might prevent the disease burden and mortality rate associated with smoking.

To investigate the advantage of Chlorella vulgaris supplementation as an adjunctive therapy in patients with non-alcoholic fatty liver disease (NAFLD).In a randomized, open-label clinical trial, 76 individuals with NAFLD were randomly assigned to: 1) Chlorella group (n=33), receiving C. vulgaris extract (1200 mg/day) + metformin (750 mg/ day) + vitamin E (200 mg/day) for 3 months, or 2) Metformin group (n=43), receiving metformin (1250 mg/ day) + vitamin E (200 mg/day) for 3 months. Weight, body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR) index as well as serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), insulin, total and direct bilirubin, fasting blood sugar (FBS), glycated hemoglobin (HbA1c), uric acid, albumin and lipid profile were evaluated at baseline and at the end of trial.Weight and BMI were decreased in both groups. Serum ALT, AST, triglycerides, uric acid, HbA1c and HOMA-IR index were reduced only in the Chlorella group whereas significant changes in total cholesterol, LDL, HDL and FBS were only observed in the metformin group. There were also borderline significant reductions in insulin and FBS in the Chlorella group.The findings of the present trial indicated that addition of C. vulgaris extract to the therapeutic regimen of NAFLD including metformin and vitamin E, is associated with favorable effects on serum levels of transaminases, triglycerides as well as insulin sensitivity. Therefore, C. vulgaris extract might be a promising hepatoprotective supplement for patients with NAFLD.

Background Chronic cutaneous complications such as pruritus are among the very frequent complaints of sulphur mustard (SM)-exposed patients. The present trial investigated the impact of curcumin on serum inflammatory biomarkers and their association with pruritus severity and quality of life (QoL). Methods This was a randomized, double-blind trial among 96 male Iranian veterans (age 37–59 y) who were suffering from chronic SM-induced pruritic skin lesions. Patients were randomly assigned to curcumin (1 g/d, n = 46) or placebo ( n = 50) for four weeks. Serum concentrations of interleukins 6 (IL-6) and 8 (IL-8) together with high-sensitivity C-reactive protein (hs-CRP) and calcitonin gene-related peptide (CGRP) were measured at baseline and at the end of the trial. Assessment of pruritus severity was performed using the pruritus score and QoL using the Dermatology Life Quality Index (DLQI). Results Serum IL-8 and hs-CRP were significantly reduced in both groups but the magnitude of reduction was greater in the curcumin group ( P < 0.001). Serum CGRP was only decreased in the curcumin group ( P < 0.001). No significant change was observed in serum IL-6. There were significant correlations between CGRP and IL-6 changes ( P = 0.011) and between DLQI and IL-8 changes ( P = 0.026) in the curcumin group. In the curcumin group, changes in serum IL-8 concentrations were found as the significant predictor of DLQI scores ( P = 0.026) but none of the independent variables could predict pruritus scores. Conclusions Curcumin supplementation effectively mitigates inflammation in patients suffering from chronic SM-induced cutaneous complications. This anti-inflammatory effect might account for the observed pruritus alleviation and QoL improvement by this phytochemical.

Recombinant human erythropoietin (rHuEPO) is the cornerstone therapy for anemia associated with chronic kidney disease. However, not all patients with renal anemia receive sufficient doses of rHuEPO due to its high cost. The present trial aimed to evaluate the efficacy of Epolyrec, a biogeneric rHuEPO, in the management of renal anemia in patients on hemodialysis.Seventy-two patients with end stage renal disease (ESRD) who were receiving hemodialysis were assigned to receive Epolyrec subcutaneously at a dose of 40-80 IU/Kg in 2-3 divided doses after each dialysis session for 12 weeks. Hemoglobin, hematocrit, and CBC/DIFF together with biomarkers of iron status, renal function, and trace elements were evaluated at baseline and during the course of trial.Hemoglobin concentrations and hematocrit progressively increased from baseline (8.45 +/- 1.42 mg/dL and 27.05 +/- 4.64% for hemoglobin and hematocrit, respectively) to the end of trial (10.56 +/- 1.93 and 34.06 +/- 6.70) (p0.001). RBC count (p = 0.026), reticulocyte count (p = 0.045), and MCV (p0.001) were also significantly increased at the end of trial (3.86 +/- 0.91x10(6)/microL, 0.78 +/- 0.31%, and 93.50 +/- 10.90 fL for RBC count, reticulocyte count, and MCV, respectively) compared to baseline (0.98 +/- 3.38, 0.18 +/- 0.63, and 89.75 +/- 9.35). Serum iron and ferritin were decreased while creatinine and phosphorous increased by the end of trial. No significant change was observed in WBC count, RDW, MCH, MCHC, BUN, PTH, Na, Ca, K, and Mg (p0.05). The frequencies of evaluated side effects were generally low and10%.Epolyrec is clinically efficacious in the elevation of hemoglobin and hematocrit in anemic ESRD patients receiving hemodialysis. Future comparative trials are warranted to compare the efficacy and safety of Epolyrec to those of innovator products.

One of the foremost negative effects of sulfur mustard (SM) is chronic pruritus, which affects the quality-of-life. In the present study, pruritus was assessed in relation with inflammatory factors in the blood. Seventy-two blood samples were collected from SM-injured veterans of the Iran-Iraq War (Case Group; n = 36) and non-exposed patients (Control Group; n = 36) suffering from skin pruritus. Pruritus severity in all subjects was assessed, as were levels of IFNγ, TGFβ, and TNFα. The results indicated that total pruritus severity did not significantly differ between the two groups. While WBC counts in Control patients were significantly higher than among the exposed veterans, there were no significant differences in levels of any specific WBC sub-classes. Levels of serum IFNγ and TGFβ in the control subjects were significantly greater than those in the exposed veterans. In contrast, serum TNFα in the SM-exposed group appeared to be in the normal range, albeit significantly higher than that of the control group. A positive correlation between pruritus and each of the evaluated cytokines was noted in the Case Group. As for the non-SM-exposed veterans, correlations were significant only in the cases of IFNγ (stimulated) and TGFβ. The results of the present study suggested that there might be a relationship between cytokine alterations and pruritus in SM-exposed veterans. Based on these studies, designing of new treatments to modulate blood levels of mediators might be helpful to decrease the problem of SM-induced pruritus, thereby improving the quality-of-life in exposed veterans.

Background. Nausea and vomiting are among the most prevalent and disturbing side effects of chemotherapy. Therefore, there is a need for additional antiemetic agents that could effectively reduce chemotherapy-induced nausea and vomiting (CINV), whether alone or in combination with current standard therapies. Since clinical data on the effectiveness of ginger in patients with advanced breast cancer is lacking, the present study aimed to evaluate the effects of ginger against both acute and delayed forms of CINV in a population with advanced breast cancer as the main malignancy. Methods. In this pilot, randomized, open-label clinical trial, 100 women (mean age = 51.83 ± 9.18 years) with advanced breast cancer who were initially assigned to standard chemotherapy protocol with docetaxel, epirubicin, and cyclophosphamide (the TEC regimen) were randomized to receive ginger (1.5 g/d in 3 divided doses every 8 hours) plus standard antiemetic regimen (granisetron plus dexamethasone; the ginger group) or standard antiemetic regimen alone (control group). The duration of treatment with ginger was specified to 4 days from the initiation of chemotherapy. Prevalence, score, and severity of nausea, vomiting, and retching were assessed using a simplified form of Rhodes index in the first 6 hours, between 6 to 24 hours, and days 2, 3, and 4 postchemotherapy. Results. A significantly lower prevalence of nausea was observed in the ginger group during 6 to 24 hours postchemotherapy. Despite this effect, no other significant additional benefit from ginger (1.5 g/d) was observed against prevalence or severity of nausea, vomiting, and retching in any of the assessed periods. Conclusion. Addition of ginger (1.5 g/d) to standard antiemetic therapy (granisetron plus dexamethasone) in patients with advanced breast cancer effectively reduces the prevalence of nausea 6 to 24 hours postchemotherapy. However, there is no other additional advantage for ginger in reducing prevalence or severity of acute or delayed CINV.

Introduction. Diaper dermatitis (DD) is a common inflammatory disorder among children and infants. The objective of the present randomized and double-blind trial was to compare the therapeutic efficacies ofAloe veracream andCalendula officinalisointment on the frequency and severity of DD in children.Methods. Sixty-six infants with DD (aged < 3 years) were randomized to receive eitherAloecream (n=32) orCalendulaointment (n=34). Infants were treated with these drugs 3 times a day for 10 days. The severity of dermatitis was graded at baseline as well as at the end of trial using a 5-point scale. The adverse effects of study medications were assessed during the trial.Results. Although improvement in the severity of DD was observed in both treatment groups (P<0.001), patients receivingCalendulaointment had significantly fewer rash sites compared toAloegroup (P=0.001). No adverse effect was reported from either of the medications.Discussion. The evidence from this study suggests that topicalAloeand in particularCalendulacould serve as safe and effective treatment for the treatment of diaper dermatitis in infants.

Skin is among the first and most heavily damaged organs upon sulphur mustard (SM) exposure. Pruritus is the most common chronic skin complication of SM, which adversely affects the quality of life (QoL). However, current therapies for the management of SM-induced pruritus are very limited and associated with side effects. The present trial investigated the efficacy of curcumin in the alleviation of SM-induced chronic pruritic symptoms. A total of ninety-six male Iranian veterans (age 37–59 years) were randomised to receive either curcumin (1 g/d, n 46) or placebo (n 50) for 4 weeks. Serum concentrations of substance P and activities of antioxidant enzymes were measured at baseline and at the end of the trial. Assessment of pruritus severity was performed using the pruritus score, visual analogue scale (VAS) and scoring atopic dermatitis (SCORAD) index. QoL was evaluated using the Dermatology Life Quality Index (DLQI) questionnaire. Serum concentrations of substance P (P P = 0·02), glutathione peroxidase (P = 0·006) and catalase (P P P P P = 0·009), and DLQI's first question (P P P = 0·003 in the curcumin and placebo groups, respectively), the magnitude of reduction was significantly greater in the curcumin group (P

Skin is among the most heavily damaged organs upon sulfur mustard (SM) exposure. Chronic complications due to SM-induced dermatotoxicity are quite frequent among intoxicated patients. Nevertheless, the exact pathophysiology of SM-induced chronic cutaneous complications has not been well clarified yet. The present review highlights clinically important findings on the management of SM-induced chronic skin complications with a particular focus on pruritus as the most prevalent symptom that has a significant impact on patients' quality of life. Some methodological pitfalls that implicate the validity of the trials have also been identified.

Measures of cumulative residual entropy (CRE) and cumulative entropy (CE) about predictability of failure time of a system have been introduced in [8, 4] respectively. In this paper, we propose the weighted forms of CRE and CE. These information-theoretic uncertainty measures are shift-dependent. We study various properties of these measures, including their connections with CRE and CE and weighted mean residual lifetime. We also obtain the estimators of proposed measures by means of order statistics.

Oral doxepin was shown to reduce chronic pruritus due to sulfur mustard. The present study compared the effects of topical doxepin 5% with betamethasone 1% for the treatment of pruritus in veterans exposed to sulfur mustard. This investigator-blinded, randomized, clinical trial was conducted in an outpatient dermatology clinic. Seventy-five men who were exposed to sulfur mustard 23 to 28 years ago during the Iran-Iraq war who complained of pruritus were randomized to receive doxepin cream 5% (n = 40) or betamethasone cream 0.1% (n = 35) twice a day for 6 weeks. Pruritus severity and Dermatology Life Quality Index (DLQI) were evaluated before and after each treatment. Both groups showed significant improvement regarding pruritus (P.05), burning sensation, skin dryness (P.001), and skin scaling (P0.05). The lesions of all regions significantly reduced after treatments (P.05), except those on the head, face, and genitalia. Pruritus, visual analog scores, and DLQI significantly decreased (P.01, P.01, and P.001, respectively) in doxepin- and betamethasone-treated groups, and there was no difference between groups. All DLQI subscores decreased after both type of treatments (P.01). Equal efficacy of doxepin cream and betamethasone suggest that doxepin is a potential alternative to control pruritus caused by sulfur mustard in exposed veterans.

BackgroundUnlike civilian post-traumatic stress disorder (PTSD), the efficacy of sertraline for the treatment of combat-related PTSD has not yet been proven. The present study aimed to evaluate the clinical efficacy of sertraline against combat-related PTSD in a randomized, double-blind, placebo-controlled trial.MethodSeventy Iranian veterans of the Iran–Iraq war who met the DSM-IV criteria for diagnosis of PTSD were randomized to receive either flexibly dosed sertraline (50–200 mg/day) (n=35, completers=32) or placebo (n=35, completers=30) for 10 weeks. Efficacy was evaluated by the Impact of Event Scale – Revised (IES-R) and the Clinical Global Impression scale – Severity (CGI-S) and Improvement (CGI-I) ratings. Responder criteria were defined as a ⩾30% reduction in the IES-R total score plus a CGI-I rating of ‘much’ or ‘very much’ improved.ResultsOn both intention-to-treat (ITT) and per protocol (completer) methods of analysis, the mean reductions in the IES-R total and subscale (re-experiencing/intrusion, avoidance/numbing and hyperarousal) scores (ppp⩽0.001). The number of responders in the sertraline group was significantly higher than in the placebo group (44% v. 3%, p⩽0.001). Sertraline was well tolerated, with a 6% discontinuation rate as a result of adverse reactions.ConclusionsThe results of this study suggest that sertraline can be an effective, safe and tolerable treatment for combat-related PTSD in Iranian veterans.

Sulfur mustard (SM) and similar bifunctional agents have been used as chemical weapons for almost 100 years. Victims of high-dose exposure, both combatants and civilians, may die within hours or weeks, but low-dose exposure causes both acute injury to the eyes, skin, respiratory tract and other parts of the body, and chronic sequelae in these organs are often debilitating and have a serious impact on quality of life. Ever since they were first used in warfare in 1917, SM and other mustard agents have been the subjects of intensive research, and their chemistry, pharmacokinetics and mechanisms of toxic action are now fairly well understood. In the present article we review this knowledge and relate the molecular-biological basis of SM toxicity, as far as it has been elucidated, to the pathological effects on exposure victims.

Background Sulfur mustard (SM) is a blister-forming agent that has been used as a chemical weapon. Sulfur mustard can cause damage in various organs, especially the skin, respiratory system, and eyes. Generally, the multiple complications of mustard gas result from its alkalizing potency; it reacts with cellular components like DNA, RNA, proteins, and lipid membranes. TGF-β is a multi-functional cytokine with multiple biological effects ranging from cell differentiation and growth inhibition to extracellular matrix stimulation, immunosuppression, and immunomodulation. TGF-β has 3 isoforms (TGF-β 1, 2, 3) and its signaling is mediated by its receptors: R1, R2 and intracellular Smads molecules. TGF-β has been shown to have anti-inflammatory effects. TGF-βs and their receptors also have an important role in modulation of skin inflammation, proliferation of epidermal cells, and wound healing, and they have been implicated in different types of skin inflammatory disorders. Methods Seventeen exposed SM individuals (48.47 ± 9.3 years), 17 chronic dermatitis patients (46.52 ± 14.6 years), and 5 normal controls (44.00 ± 14.6 years) were enrolled in this study. Evaluation of TGF-βs and their receptors expressions was performed by semiquantitative RT-PCR. Only TGF1was analyzed immunohistochemically. Results Our results showed significant decreases in the expression percentages of TGF-β 1, 2 and R1, R2 in chemical victims in comparison with chronic dermatitis and normal subjects and significant decreases in the intensity of R1 and R2 expressions in chemical victims in comparison with chronic dermatitis and normal controls. (P value < 0.05) Conclusions TGF-βs and their receptors appear to have a noticeable role in chronic inflammatory skin lesions caused by sulfur mustard.

Sulfur mustard (2,2-dichlorodiethyl sulfide: SM), the protagonist of vesicant chemical weapons, was first used in July 1917. Despite prohibition of its production and use by international conventions, it has been used in several conflicts. More than 100,000 soldiers and civilians were injured due to SM exposure during Iran-Iraq war (1980-1988). The acute skin lesions consist of erythema, edema, and blisters. Skin xerosis and pruritus, pigmentation disorders, scars, and cherry angiomas are among the most common long-term skin lesions after contact with SM. Although SM is a well-known carcinogenic substance, skin cancers are rarely reported.

To prepare and evaluate an allopurinol mouth rinse for prophylaxis of fluorouracil-induced mucositis, 33 patients with malignant disorders, who were going to receive 5-fluorouracil containing chemotherapy, were enrolled in a placebo-controlled double-blinded randomized clinical trial. Allopurinol mouthwash (1 mg/ml) or placebo was administered 1, 2 and 3 h after chemotherapy and three consecutive nights. A questionnaire consisting of demographic parameters, medical status, quality of life survey and mucosal injury scoring table (based on World Health Organization scales for mucositis) was completed for each patient at Day 1, 3 and 7 after chemotherapy. In allopurinol group nine participants (60.0%) were female and in placebo group, 10 (66.7%) (P = 0.705). Mean ages were 56.9 +/- 10.3 and 49.5 +/- 13.8 years in allopurinol and placebo groups respectively (P = 0.107). The analysis showed that the higher education level and the use of dentures significantly reduced the occurrence of mucositis, and allopurinol mouth rinse (1 mg/ml) was ineffective in the prophylaxis of fluorouracil-induced mucositis.

This study compared topical pimecrolimus with betamethasone in the treatment of pruritus and chronic skin lesions due to sulfur mustard exposure. Seventy male chemical-injured war veterans participated in this investigator-blinded clinical trial. They were randomized to receive pimecrolimus cream 1% (n = 35) or betamethasone cream 0.1% (n = 35) two times a day for 6 weeks. Dermatological examination and assessment of pruritus severity by a pruritic score questionnaire and visual analogue scale were done before and after the treatment course. A significant decrease (P0.05) in pruritus, burning sensation, and skin dryness was shown in both groups after the treatment. However, the severity of hyper- and hypopigmentation, vesicle, erythema, fissure, lichenification and excoriation did not decrease significantly in either group (P0.05). Mean (+/- standard deviation) pruritic scores at baseline for the pimecrolimus and betamethasone groups were 30.4 (+/- 8.0) and 33.6 (+/- 7.2), respectively (P = 0.103). These scores decreased to 18.8 (+/- 4.8) in the pimecrolimus and 20.8 (+/- 4.0) in the betamethasone groups after treatment; both showed a statistically significant decrease (P0.001). Change of pruritus score from baseline to after the treatment course was not statistically different between the two groups (P = 0.502). No serious side-effects were reported during the course of the treatment. Topical pimecrolimus 1% was as effective as betamethasone cream 0.1% in controlling pruritus, burning sensation and skin dryness of sulfur mustard-exposed patients.

Although pericarditis with lupus nephritis is a recognized complication of systemic lupus erythematosus (SLE) [1], there are very few data on its manifestations and outcome in children. In this single-center report, we have reviewed outcome for 13 Iranian children with lupus nephritis who developed pericarditis. All patients were under follow up in the Pediatric Nephrology Department of Tehran University of Medical Sciences during the period from 1985 to 2005. The diagnosis of SLE met the criteria of the American Rheumatism Association (ARA) [2]. To characterize disease activity, we used the criteria of the SLEDAI (systemic lupus erythematosus disease activity index) [3]. All patients studied had at least one trans-thoracic echocardiography and all were documented by echocardiography as having pericarditis. Because of the retrospective nature of the study and incomplete records, we were unable to retrieve data about the severity and complications of pericarditis, for example cardiac tamponade, constrictive pericarditis, and purulent pericarditis, but no patient required pericardiocentesis or pericardial surgery. End-stage renal disease (ESRD) was defined as patients who required renal replacement therapy with dialysis and renal transplantation. All patients were initially treated with oral corticosteroids (CS) prescribed at a dose of 2 mg/kg per day, with a daily maximum of 60 mg/day. Additional therapy included intravenous cyclophosphamide (CP), azathioprine (AZA), and mycophenolate mofetil (MMF). Maintenance treatment varied for individual patients: AZA was used to treat patients diagnosed before 2001 and MMF in cases starting with 2001. To assess potential predictive factors for developing pericarditis we reviewed our data registry to find matched controls with the highest levels of similarity in their lupus nephritis, sex, and age classes for each of our pericarditis patients. Nonparametric tests and Kaplan–Meier and Cox proportional regression methods were used where appropriate. Table 1 shows data for the 13 children included in this study. Study population consisted of five (39%) males and eight females. Mean age was 10.8 ± 2.6 years; mean creatinine value at the time of pericarditis was 1.4 ± 0.9 mg/dl. Mean follow up F. Beiraghdar E. Nemati B. Einollahi Nephrology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Chronic bronchitis is the most frequent late respiratory disease among Iranians exposed to mustard gas during the Iraq-Iran war. The aim of this study was to investigate efficacy of oral and intravenous corticosteroid therapy in improving lung function in mustard gas induced chronic bronchitis patients. 65 mustard gas-exposed chronic bronchitis patients, who were not responsive to standard treatments in exacerbation occasions, were randomly divided into two groups: an intravenous group (39 patients) receiving 500 mg intravenous methylprednisolone daily, and an oral group (26 patients) receiving 1 mg/kg oral prednisolone daily. Corticosteroid was tapered over the study period in both groups. Spirometery was performed on admission and on day 8 of therapy for assessment of effectiveness of therapy. There was significant improvement in spirometery indexes of both groups in approximately half of the patients over the study period. Furthermore, there was no difference between the pulse corticosteroid versus oral corticosteroid therapy in these patients. Since short-term corticosteroid therapy has a significant effect on lung function of almost fifty percent of patients with mustard gas-induced chronic bronchitis in exacerbation occasions, we suggest a short-term bolus steroid treatment to triage the patients into responders and non-responders for subsequent treatment.

Background: The efficacy of human recombinant erythropoietins (rHuEPOs) in the treatment of anemia with different etiologies is proven. Development of biosimilar rHuEPO products with lower cost and wider availability is important for the care of anemic patients. Objective: The aim of the present study was to determine the bioequivalence and safety of a biosimilar rHuEPO (Pastopoitin®) and compare it with the innovator product Eprex®, as a standard rHuEPO. Methods: One hundred and seven anemic patients on stable hemodialysis were recruited to this randomized double-blind comparative trial and assigned to either subcutaneous Pastopoitin (n = 50) or Eprex (n = 57). Each study group received rHuEPO at a dose of 80–120 IU/kg/week in 2–3 divided doses for a period of 3 months. Hematologic parameters including Hemoglobin, hematocrit, RBC, EBC, platelet, MCV, MCH and MCHC were checked every 2 weeks. Blood iron, ferritin, TIBC, creatinine, BUN and electrolytes (Na, K, Ca and P) were evaluated monthly over the 3 months. Results: A significant increase in hemoglobin, hematocrit and RBC was observed by the end of study in both Pastopoitin and Eprex groups (p 0.05). Likewise, the groups were comparable regarding MCV, MCH, MCHC, iron, ferritin, TIBC, creatinine, BUN and electrolytes at baseline as well as at the end of trial. Adverse events were not serious and occurred with the same frequency in the study groups. Conclusion: Pastopoitin showed comparable efficacy and safety profile with Eprex in anemic patients on hemodialysis. Hence, Pastopoitin may be considered as a rHuEPO with a lower cost and wider availability compared with the innovator product Eprex.

Objective To investigate the use of Aloe vera (A. vera) for the treatment of gastroesophageal reflux disease (GERD) symptoms and compare its effects with those of omeprazole and ranitidine. Methods In this pilot, randomized controlled trial, 79 subjects were allocated to A. vera syrup (standardized to 5.0 mg polysaccharide per mL of syrup) at a dose of 10 mL/d, omeprazole capsule (20 g/d) or ranitidine tablet (150 mg in a fasted state in the morning and 150 mg 30 min before sleep at night) for a period of 4 weeks. The frequencies of eight main symptoms of GERD (heartburn, food regurgitation, flatulence, belching, dysphagia, nausea, vomiting and acid regurgitation) were assessed at weeks 2 and 4 of the trial. Results A. vera was safe and well tolerated and reduced the frequencies of all the assessed GERD symptoms, with no adverse events requiring withdrawal. Conclusion A. vera may provide a safe and effective treatment for reducing the symptoms of GERD.

BackgroundAntibiotics and anti-inflammatory agents are the mainstay of acute external otitis (AEO) treatment. The present study investigated the effectiveness of a combination herbal drop (Lamigex) composed of essential oils from Syzygium aromaticum, Lavandula angustifolia, and Geranium robertianum in the alleviation of AEO symptoms and compared its effects to those of ciprofloxacin 0.3% drop.MethodsSeventy patients were randomly assigned to receive ciprofloxacin 0.3% (n = 35) or Lamigex (n = 35) drop. Each group was administered with three drops every 12 hours for a week. Patients were examined for AEO symptoms and ear discharge cultures at baseline as well as at the end of trial. Pain severity was also recorded using a visual analogue scale at baseline, the 3rd day, and the 7th day of the trial.ResultsAll assessed symptoms (tenderness, itching, erythema, edema and discharge) were equally improved in the ciprofloxacin and Lamigex groups by the end of trial (p > 0.05). There were remarkable reductions in the visual analogue scale score by the end of trial in both groups (p 0.05). The numbers of positive cultures for all tested microorganisms were clearly reduced by the end of the trial in both groups but were not significantly different between the groups (p > 0.05).ConclusionThe herbal combination drop that was investigated in the present study exhibited good efficacy in reducing the burden of infection as well as AEO symptoms.

Healthcare wastes are produced from all medical and therapeutic activities in hospitals and healthcare centres. Around 15-20% of these wastes are classified as infectious wastes that could be hazardous. Therefore, an effective approach is required for handling costs and environmental issues. In this paper, a bi-objective Mixed-Integer Linear Programming (MILP) model is presented for logistics of infectious and non-infectious wastes. The proposed bi-objective model aims to minimize network costs and the risk of exposure to contamination. In this respect, a multi-stage network consisting of hospitals, recycling centres, treatment centres, disposal centres, mainly covering the location-routing problem, is considered. To deal with computational complexity of the proposed model, a Benders Decomposition Algorithm (BDA) has been employed. The researchers were faced with two important questions: (1) whether the proposed model can be applied to real-world scenarios or not, and (2) how efficient is the proposed algorithm in solving standard test problems and real-world cases. To answer these questions, the outputs of the BDA have been compared with the optimal solutions provided by the CPLEX software. The results imply that the BDA has been able to achieve optimal solutions in less computation times. Moreover, the proposed model and algorithm have been applied to a real-world study in Alborz Province of Iran. The outputs demonstrate that the proposed model and algorithm can yield applicable solutions for the case study which have been approved by experts. The proposed model can be extended by considering compatibility of wastes in storage.

Oral mucositis is one of the common complications of cancer chemotherapy and about 40% of the patients who take chemotherapy protocols, experience this irritating problem. The purpose of this study was to draw comparison between the therapeutic effects of our treatment modalities (topical steroid, honey, honey plus coffee) in patients suffering from oral mucositis. This was a double blinded randomised clinical trial of a total of 75 eligible adult participants which they randomly fell into three treatment groups. For all the participants a syrup-like solution was prepared. Each 600 grams of the product consisted of “20 eight-mg Betamethasone solution ampoules” in the Steroid (S) group, “300 grams of honey plus 20 grams of instant coffee” in the Honey plus Coffee (HC) group, and “300 grams of honey” for the Honey (H) group. The participants were told to sip 10 ml of the prescribed product, and then swallow it every three hours for one week. Severity of lesions was clinically evaluated before the treatment and also one week after the initiation of the intervention. This study adhered to the principles of the Declaration of Helsinki and guidelines of Good Clinical Practice. This study showed that all three treatment regimens reduce the severity of lesions. The best reduction in severity was achieved in HC group. H group and S group took the second and third places. In other words, honey plus coffee regimen was the most effective modality for the treatment of oral mucositis. Oral mucositis can be successfully treated by a combination of honey and coffee as an alternative medicine in a short time. Further investigations are warranted in this field. Iranian Registry of Clinical Trials IRCT: 201104074737N3 , (9 May 2011).