Medical Journal of The Islamic Republic of Iran (MJIRI)

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A study was designed to evaluate the normal value of 24 hr urinary calcium levels in the city of Yazd. The average urinary excretion of calcium in a sample of 329 persons randomly selected was 232 mg/day, while patients with a history of recurrent urolithiasis excreted 20X mg/day. There is evidence which shows that more important factors than the amount of urinary calcium exist which influence stone formation. On the other hand the urinary excretion of calcium was related to blood pressure. These observations showed that measuring the amount of urinary calcium excretion in patients with urolithiasis provided little or no helpful information for the evaluation of these patients. Nevertheless, this test may be valuable in other diseases such as hypertension.

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Tuberculosis remains as an important socioeconomical and medical problem throughout the world and especially in Iran. Early and timely diagnosis of pulmonary and extrapulmonary tuberculosis is vital to initiate prompt treatment. Current diagnostic methods are either slow or lack enough sensitivity or specificity. Several mycobacterial antigens are involved in the complex interaction with the immune system of the host. Their identification is important for both diagnosis and protection against mycobacteria. Antigen 60 (A60) is a thermostable antigen found in the cytosol of M. bovis and M. tuberculosis. An ELISA test using A60 is designed for diagnosis of tuberculosis with satisfactory results. In previous studies, A60 has also showed a protective effect against experimental infections and useful immunotherapeutic effects in promotion of cancer development. In the present work we tried to purify A60 from the cytoplasm of BCG. A60 was purified by exclusion gel chromatography using sepharose 4B. A60 was recognized by bidimensional immunoelectrophoresis with anti-BCG and anti-A60 antiserum, where it appears as the less mobile component. In agarose electrophoresis, A60 showed only one band but in immunodiffusion it showed two immunoprecipitinogen lines with anti-BCG anti-serum. In analyzing with dot blotting, both cytoplasm and cell wall of BCG showed positive reaction with antiA60 anti-serum. When A60 was fractionated by SDS-PAGE and analyzed by: western blot using anti-A60 antibody, 65,46, 40, 38 and 35 KDa protein fractions' were identified. It is concluded that A60 is a macromolecular antigen of BCG with a molecular weight of 106_107 Da and is a lipoprotein-polysaccharide complex which contains several proteins. A60 is present in both cytoplasm and cell wall of BCG and can easily be purified from BCG vaccine using exclusion chromatography by sepharose 4B, to be used for designing diagnostic tests for TB.

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Telomerase activation is one of the main pathways to immortalize cancer cells. In many kinds of cancer cells, this special reverse transcriptase stabilizes and elongates telomeres and prevents telomere erosion that naturally occurs in every cell division. Esophageal cancer is the fifth most frequent cause of cancer death worldwide, and is highly associated with alcohol, smoking, cultural habits, and environmental factors. Telomerase has been suggested as a tumor marker and a molecular target for drug design in several kinds of cancers. In this work telomerase activation was inspected among Iranian patients with Esophageal Squamous Cell Carcinoma (ESCC), and detected in 90% of samples of different stages. This may be an indication that telomerase activation happens in an initial step in the development of ESCC. Although there is no correlation between telomerase activity and the progress of ESCC, it could be considered as a good tumor marker in ESCC. Telomerase activity tests are suggested for screening purposes in high risk areas for ESCC, which can be easily done on a small amount of scrapped samples of esophageal mucosa. It is also possible that ESCC results from incomplete differentiation or a failure in telomerase gene switching off that nonnally occurs during the differentiation of esophageal epithelial cells.

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Hepatitis C virus (HCV) infection is highly prevalent in thalassemic patients, and this may decrease the serum antibody response to hepatitis B virus (HBV) vaccine. There is also some alteration of the immune system in multi-transfused thalassemic patients, as a consequence of iron overload. We investigated whether HCY infection may reduce the effectiveness of HBY vaccine in multi - transfused thalassemic patients. Subjects were cited and studied prospectively in three groups: group I: 125 multi-transfused thalassemic patients with negative serum HCY antibody group 2: 96 multi-transfused thalassemic patients with positive serum HCV antibody (ELISA II), in at least 2 different occasions group 3: 100 healthy subjects. Matching was performed between three groups in sex, age and body mass index and subjects in all groups had negative serum HBsAg, anti-HBc and anti-HBs and received three 20 flgr/dose injections of recombinant HBV vaccine (Heberbiovac HB) in months 0, 1, 6. Anti-HBs titer was obtained one month after the last dose of vaccine and it was considered seroprotective if it was 2: 10 lUlL. Seroprotection rate was 83.2% in group 1 and 80.2% in group 2 (p=0.74) and was 86% in healthy subjects, which didn't significantly differ with HCV positive and negative thalassemics (p>0.05). Moreover, the mean values of ALT among the responders and non-responder thalassemic patients were 55.5 ± 4 l .9 and 57.4 ± 48.5 U/L respectively(p=0.802). During vaccination periods, patients in all 3 groups did not show any significant adverse reactions. Our study shows that three standard doses of HBV vaccine are immunogenic and safe in multi-transfused thalassemic patients with or without HCV infection.

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ABSTRACT

 

Background: A polymerase chain reaction (PCR) assay with primers from "hpd" gene was compared with culture for the detection of Haemophilus influenzae type b (Hib) in CSF samples from children suspected of meningitis.

 

Methods: 300 cerebrospinal fluid (CSF) samples from suspected meningitis cases were studied by culture (Leventhal & Chocolate Agar) and PCR.

 

Results: The latter method could detect Hib in all 5 culture positive and in 2 of 295 culture negative cases, showing sensitivity, specificity, and an accuracy index of 100%, 99% and 99%, respectively. The PCR result was available within a day.

 

Conclusion: This study has shown that PCR is a rapid, sensitive, and specific diagnostic test for Hib from CSF samples. Futthermore, to maximize management of meningitis cases to reduce the morbidity, mortality, and complications of invasive Hib infection a combination of culture and PCR is necessary for the detection ofHib infection. The incidence ofHib meningitis among children in Children's Medical Center in Tehran based on culture and PCR results were 2.4% and 1.7% respectively. Based on culture results, Hib causes 15.6% of all cases ofbacte1ial meningitis in children.

 

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Background: Carotid artery stenting (CAS) has recently been recommended as an alternative to carotid endarterectomy (CEA) by some clinicians. Objective: This study was designed to evaluate the success rate and in-hospital and 30-day adverse events in our first experiences in Iran for CAS with protection devices, to document our results and guide further use of CAS. Methods: From December 2003 to December 2004 we performed 21 consecutive CAS procedures. 16 were men and 5 were women with mean age of 62 years (range 46-78 years). Indications for CAS included primary lesions in all patients with stenosis >50% in symptomatic and stenosis >80% in asymptomatic patients. Results: CAS was technically successful in a1l 21 patients. Mean severity of stenosis before CAS was 85%+14% compared with 15%+10% after CAS. No periprocedural death occurred. No in-hospital and 30-days minor or major stroke/ death was seen. Conclusion: Our data suggest that percutaneous stenting of the carotid artery when a cerebral protection device is used is feasible and effective but not without technical difficulties and potential complications. We recommended CAS for high-risk patients for carotid endarterectomy, but this technique has a learning curve for those willing to perform the procedure with a low rate of complications.

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Background and Objectives: Annexin is the common name for genes and proteins that were identified as calcium-dependent phospholipid-binding proteins. Recently a more complex set of functions has been recognized for this superfamily of proteins including in vesicle trafficking, cell division, apoptosis, calcium signalling, mineralization, crystal nucleation inside the extracellular organelles-matrix vesicles (MY s) and growth regulation. Methods: In the present work Aureobasidium pullulans strain PRAFS8 genomic DNA was extracted. Using designed primers from a highly conserved region of annexin genes of Aspergillus Jumigatus and Aspergillus niger a 800 bp PCR product was obtained from degenerated PCR. The 800 bp PCR product was gel purified and cloned into E. coli using the suitable plasmid and standard cloning procedures. From grown transformed E. coli, plasmid was extracted and the presence of expected insert in the plasmid, was confirmed by digestion of plasmid by Eco RI restriction enzyme. Results: Gel purified 800 bp band was sequenced and submitted at NCBI gene bank with accession No.: AY848856. A phylogenetic tree for obtained partial gene of annexin was drawn using bioinformatic software in order to understand the evolutionary relationship of annexin genes between some microrganisms. Also southern analysis of800 bp PCR product using digoxigenin (DIG) labeled probe demonstrated the probability of two copies of annexin genes existence in the A. pullulans genome. Conclusion: This study for the first time presented the presence of annexin gene in yeast-like fungi and this result is important due to the existence of this superfamily of genes in moulds but not in yeasts. We emphasize for future additional work to clone and sequence the full length of annexin gene(s) from A. pullulans and also additional studies for this gene expression and annexin mRNA transcription to understand the effective factors for expression of annexin.

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 Abstract

 Background: Different adjuvant drugs have been used with local anesthetics in order to decrease the time of onset and elongate the duration and quality of regional blocks. This study was performed to study the effects of one of the adjuvants, verapamil, in supraclavicular block.

 Methods: In this double blinded clinical trial, we divided 60 ASA class I and II patients who were to undergo upper extremity surgery (aged between 18-40 yrs) into 3 different groups randomly. In group I the patients received 30ml Bupivacaine 0.5% plus 2ml normal saline for injection. Group II included patients who received 30ml bupivacaine 0.5% plus 2.5mg verapamil locally and 1ml normal saline for injection. In group III the patients got 30ml bupivacaine 0.5% plus 5mg of local verapamil. All blocks were performed through a supraclavicular brachial plexus procedure, and time of initiating sensory and motor blocks and onset of complete anesthesia and also blood pressure alterations and heart rates were studied and taken into consideration. For data analysis we used SPSS 11.5 software.

 Results: Our results clarified that verapamil decreased the onset time of anesthesia, motor block and total anesthesia but there was no statistical difference between 2.5 and 5mg doses of verapamil (P>0.05). Among patients who received verapamil in the block, variation of more than 20% from baseline wasn’t detected in blood pressure and heart rate.

 Conclusion: According to our findings, verapamil causes a decrease in onset times of sensory and motor block and the initiation of complete anesthesia of bupivacaine in supraclavicular block, but there were no significant differences between groups II (verapamil 2.5mg) and III (verapamil 5mg). Blood pressure and heart rate fluctuations were not more than 20% in group II and III.

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  Abstract

  Background: Schizophrenia is a severe mental disorder and numerous genes and loci

  are beleived to be involved in this disease. Recent studies have reported a strong genetic association between DTNBP1 (dystrobrevin-binding protein 1) gene variants and schizophrenia.

  Methods: In this research, we used a case-control study to establish the possible association between the P1635 (rs3213207) polymorphism in the DTNBP1 gene and schizophrenia in an Iranian cohort of 200 unrelated patients and 200 controls. The allele and genotype frequencies of the polymorphism in the two groups were determined using

  PCR-RFLP and the data analyzed using logistic regression and Mantel-Haenszel chisquare tests.

  Results: The additive effect of the P1635 polymorphism in DTNBP1 and the previously

  reported G1001C polymorphism in the GRIN1 gene were investigated. Analysis of data

  revealed a strong association between the P1635 polymorphism and schizophrenia

  (AG genotype: OR=0.39, 95% CI= 0.24-0.62, P<0.001).

  Conclusion: Our results indicated that the coexistence of the Aand C alleles from the

  two polymorphisms, P1635 and G1001C, increase the risk for schizophrenia.

 

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  Abstract

  Background: The disrupted-in-schizophrenia 1 (DISC1) gene, on the chromosome

  position 1q42, was initially identified at the breakpoint of a balanced translocation,

  t(1,11)(q42.1q14.3), which segregated with major mental disorders in a large

  Scottish family.

  Methods: Our samples included 200 unrelated patients diagnosed with Schizophrenia

  on the basis of DSM-IV criteria and 200 normal controls, which were gathered

  from Iran. The allele and genotype frequencies of the polymorphism were determined

  using Polymerase Chain Reaction-Restricted Fragment Length Polymorphism

  (PCR-RFLP) and the data were analyzed by Logistic Regression test.

  Results: In this study we genotyped the rs821616 polymorphism (Serin704Cystein)

  located within exon 11 of the DISC1 gene. The samples were matched on the basis

  of sex and ethnicity. We used the case control study to determine the possible association between the ser704cys (rs821616) polymorphism and Schizophrenia. Analysis of data in the samples, revealed no association between the rs821616 polymorphism and Schizophrenia (OR= 0.697, 95% CI= 0.47-1.033, P=0.072).

  Conclusion: In this study we did not find any association between the rs821616

  SNPand schizophrenia.

 

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  Absract

  Intracranial invasion of cellular blue nevus (CBN) from the skin is extremely rare

  and such a condition with malignant transformation is even rarer. A case of

  meningeal melanoma with malignant transformation which was derived from an Ota

  nevus is presented in this report.

  A21-year-old man with a neurocutaneous syndrome since childhood was referred

  with headache and mild left hemiparesia. CT scan and MRI demonstrated intracranial

  lesions and conjunctival biopsy leads to the pathologic diagnosis of blue nevus.

  Thereafter his parietal lesion was operated by craniotomy with total gross excision.

  On histopathological examination, diagnosis of malignant melanoma was confirmed.

  Approximately 2 months after radiotherapy and chemotherapy, he afflicted to

  diplopia and blurred vision on the leftside due to enlargement of orbital and cavernous

  sinus lesion. Following one year follow-up, he was survived and thrived with

  diffuse leptomeningeal nodular enhancement in favor of melanoma dissemination.

  Primary intracranial melanomas are though rare, but it should be suspected especially

  in the presence of periorbital blue nevus or nevus of Ota. Moreover, although CBN

  is considered benign, scalp or periorbital CBN has the potential for intracranial invasion and malignant transformation.

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 Abstract

 Background: Clinical Risk Index of Babies (CRIB), Score for Neonatal Acute Physiology

 (SNAP), an update of the Clinical Risk Index for Babies score (CRIB II) and

 Score for Neonatal Acute Physiology - Perinatal Extension (SNAP-PE) are scoring devices

 developed in neonatal intensive care units. This study reviewed these scoring systems

 in critically ill neonates to determine how well they could predict mortality.

 Methods: This prospective cohort study was conducted at the neonatal intensive care

 units of Mofid and Mahdieh hospitals between March 2006 and May 2009. We evaluated

 CRIB, CRIB II, SNAP, SNAPII and SNAP-PE score for each neonate and the final

 scores were then obtained. The predictive accuracy of these parameters were expressed

 as area under the receiver operative characteristic curve, sensitivity, specificity, positive

 predictive value and negative predictive value.

 Results: Of 404 neonate evaluated 53% were male. Primary diagnoses were respiratory

 distress syndrome, gastrointestinal obstruction, sepsis, prematurity, and neuromuscular

 diseases. The authors detected mortality in 20.5% and found a significant difference

 in scoring systems between survived and death groups. The mean CRIB score in

 survived neonates was 2.57±3.66 and in death neonates 8.43±4.66 (p value<0.001). We

 also found that the SNAP score had the highest area under the curve and the highest sensitivity,

 specificity, positive predictive value, negative predictive value and we had the

 lowest score for CRIB II.

 Conclusion: We concluded that the neonatal scoring systems could be a useful tool

 for prediction of mortality in NICUs and SNAP can predict the mortality better than the

 others.

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 Abstract

 Background: The Gamma Knife Radiosurgery (GKR) is an established management option for Cerebral Ar-teriovenous Malformations (AVMS). Therapeutic benefits of radiosurgery for arteriovenous malformations are complete obliteration of nidus with minimal neurological deficit.

 Methods: Radiosurgery was performed between February 2003 and April 2010 at Kamraniye day clinic, Teh-ran, Iran, using the Leksell gamma knife model B (Elektra Instruments AB, Stockholm, Sweden) on 82 consecu-tive patients with AVMs. The male-to-female ratio was 1.4:1(48M, 34F). The age of the patients ranged from 9 to 70 years (mean, 28.5±12 years). The marginal dose to the AVM nidus was 45 to 85% (median, 60%) isodose and ranged from 14 to 30 Gy (mean, 20.57±13Gy).The maximum dose ranged between 20 to 60 Gy (mean, 37.5 Gy ± 10.17Gy ). Follow up of patients for complete AVM obliteration and in the case of complications MRI were performed.

 Results: Complete obliteration of AVM was achieved in 56 cases (68.29%). It was marked in average 3.62 [SD=3.19] years (from 1 to 5 years) after GKR. Partial obliteration (≥50% reduction of the nidus volume) was marked in 24 cases(31%), and less than 50% reduction of the nidus volume was marked in 2 cases(2.4%) with a follow-up of 5 years. Complete obliteration of AVM had statistically significant associations with smaller score of Spetzler-Martin arteriovenous malformation grading system for AVMs. (p< 0.05)

 Conclusion: The Gamma Knife Radiosurgery can offer total and partial obliteration to acceptable percent of treated AVM with a low risk of morbidity. Higher success observed in patients with Spetzler-Martin Grade I and II AVMs, which was attributed to smaller volume of AVMs in this group.

 

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 Abstract

 Background: CuT380A intra uterine device Intra Uterine Device (IUD) is used in the health system of Iran. The most important and frequent side effects of the IUDs are hypermenorrhea and polymenorrhea. In Iran, iron supplement are not prescribed for the IUD users and there are no documents indicating their iron reservation status. This study was performed to determine the iron status in Gorganian IUD users.

 Methods: This historical cohort study was performed on 100 IUD users (exposed group) and 100 non-IUD users (non-exposed group) in the Golestan province in north east of Iran in 2008. To evaluate the iron status hemoglobin and ferritin levels were measured. Data was analyzed by SPSS 13 by using Chi square and Independent T-test. A p-value less than 0.05 were considered as statistically significant.

 Results: Hgb less than 10.5 was seen in 5% and 6% of IUD users and non-IUD users respectively which was not statistically significant (OR: 1.43, 95% CI: 0.39-5.25). Low Ferretin Level (less than 15) was seen in 53% of IUD users and in 35% of non-IUD users which was statistically significant (OR: 2.35, 95% CI: 1.28-4.29) Duration of menstrual period in the two groups was statistically significant (7.5±2.4 vs. 6.4±1.8, p= 0.005) but interval of menstruation (days) was not statistically significant (26.7±4.7 vs. 28±11.2, p> 0.05).

 Conclusion: On the basis of the results obtained we suggest either routine iron supplementation following application of IUD, or use of the hormone releasing IUD as an alternative for copper IUDs.

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 Background: Spinal muscular atrophy (SMA) is the second most common lethal autosomal recessive disease. It is a neuromuscular disorder caused by degenerative of lower motor neurons and occasionally bulbar neurons leading to progressive limb paralysis and muscular atrophy. The SMN1 gene is recognized as a SMA causing gene while NAIP has been characterized as a modifying factor for the clinical severity and age at disease onset in SMA patients (SMA subtypes). The relationship between NAIP deletion and type of SMA remains to be clarified we investigated this gene alteration in all types of SMA patients.

 Methods: Molecular analysis was performed on fifty patients with a clinical diagnosis of SMA in Khuzestan province. In addition to common PCR-RFLP analysis for exon 7 and 8 of SMN1 gene, as an internal control we analysed NAIP deletion with PCR of exon 5 of this gene in a multiplex PCR with exon 13 of it.

 Results: Homozygous-deletion frequency rate for the telomeric copy of SMN (SMN1) exon 7 in all types (type I, II, Ш) of SMA was approximately 90% and the frequency of deletion in exon 7 and 8 together in all types estimated about 70%. Moreover NAIP gene was deleted in about 60% of these patients and this shows deletion in 91% of type I SMA patients. The correlation between NAIP-deletion and SMN1 mutation showed a high frequency rate.

 Conclusion: In this study, high frequency of NAIP gene deletion in all type of disease shows the importance role of it in disease pathogenesis. High frequency of NAIP deletion in SMA type I, also shows the importance of the gene in type and severity of disease so it may be a modifier factor in severity of disease.

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Harlequin ichthyosis is a rare and the most severe form of congenital ichthyosis. Although prenatal diagnosis is difficult for this disorder, recently, this obstacle has markedly improved with the use of DNA-based prenatal diagnosis. Here in, we presented a neonate with harlequin ichthyosis born by assisted reproductive technology (ART). In this case, the diagnosis of harlequin ichthyosis was not established by conventional prenatal screening.

 

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  Background :Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval.

  Methods :Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTBautograft, and 41 were treated with STautograft.At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion,IKDC (International Knee Documentation Committee) score and complications.

  Results : At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). Theactivity levelswerehigher in BPTB group(p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patientsin BPTB and ST group, respectively(p=0.019).Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications.

  Conclusion : Theresults indicate a trend toward increased graft laxityand pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function.

 

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  Background: Toll- like receptors (TLRs) play an important role in the recognition of DAMPs and PAMPs and induction ofinflammation. Previous studies demonstrated that depression and anxiety can influence the expression levels of immune related molecules. Our previous study revealed that mRNA levels of IRAK4, TRAF3 and IRF7 were significantly decreased in chronic HBV infected (CHB) patients when compared to healthy controls. Therefore, the aim of this study was to evaluate the effects of depression and anxiety on the expression levels of these molecules in CHB patients.

  Methods : Sixty CHB patients participated in this studyand filled out the standard questionnaires and the expression of IRAK4, TRAF3 and IRF7 were examined using Real-Time PCR techniques.

  Results : The results of this study demonstrated that expression of IRAK4, TRAF3 and IRF7 did not differ between patients with various stages of depression and anxiety (all p>0.05).

  Conclusion : According to the results, it seems that declined expression of IRAK4, TRAF3 and IRF7 inCHB patients were not related to depression and anxiety, and other factors including genetic and immunoregulatory effects of HBV may be responsible for the declined expression of these molecules.

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Background: The National Health Accounts keep track of all healthcare related activities from the beginning (i.e. resource provision), to the end (i.e. service provision). This study was conducted to address following questions: How is the Iranian health system funded? Who distribute the funds? For what services are the funds spent on?, What service providers receive the funds? Methods: The required study data were collected through a number of methods. The family health expenditure data was obtained through a cross sectional multistage (seasonal) survey while library and field study was used to collect the registered data. The collected data fell into the following three categories: the household health expenditure (the sample size: 10200 urban households and 6800 rural households-four rounds of questioning), financial agents data, the medical universities financial performance data. Results: The total health expenditure of the Iranian households was 201,496,172 million Rials in 2008, which showed a 34.4% increase when compared to 2007. The share of the total health expenditure was 6.2% of the GDP. The share of the public sector showed a decreasing trend between 2003-2008 while the share of the private sector, of which 95.77% was paid by households, had an increasing trend within the same period. The percent of out of pocket expenditure was 53.79% of the total health expenditure. The total health expenditure per capita was US$ 284.00 based on the official US$ exchange rate and US$ 683.1 based on the international US$ exchange rate.( exchange rate: 1$=9988 Rial). Conclusion: The share of the public and private sectors in financing the health system was imbalanced and did not meet the international standards. The public share of the total health expenditures has increased in the recent years despite the 4th and 5th Development Plans. The inclusion of household health insurance fees and other service related expenses increases the public contribution to 73% of the total.

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Background: An obvious gradient in health outcomes has been implicated in many evidences relating to social and economic factors. Proper data are requested to convince policy-makers calling for intersectoral action for health. Recently, I.R. of Iran has come up with 52 health equity indicators to monitor health equity through the country. Conducting regular surveys on 14 out of 52 national health equity indicators is needed to provide a basis for the health inequality analysis through the country. We aimed to introduce a survey tool and its related protocols on health equity indicators.

Methods: This study was conducted through addressing the literature and expertise of health and demographic surveys at the national and international levels. Also, we conducted technical and consultative committee meetings, a final consensus workshop and a pilot study to finalize the survey tool.

Results: We defined the study design, sampling method, reliable questionnaires and instructions, data collection and supervision procedure. We also defined the data analysis protocol on health equity indicators, generated from non-routine data.

Conclusion: A valid and reliable tool, which could be employed at the national and sub-national levels, was designed to measure health equity in Iran. Policy-makers can use this survey tool to generate useful information and evidence to design appropriate required intervention and reduce health inequality across the country.