Medical Journal of The Islamic Republic of Iran (MJIRI)

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Paraquat (PQ) is a widely used herbicide. However, a large number of cases of accidental or suicidal poisoning from PQ has been reported. Membrane damage induced by lipid peroxidation, inactivation of protein or damage to DNA by radical formation have been suggested as toxicity mechanisms of PQ. In the present work, the effects of atropine, propranolol, procainamide and dipyridamole on PQ-induced intoxication have been studied. Oroups of male albino mice were used under standard conditions. All the drugs were injected intraperitoneally in different doses. The results indicated that administration of PQ (40 mg/kg, i.p.) increased the death rate of animals (77%) during 3 days, whereas a dose of 20 mg/kg of PQ only decreased the lung tissue total protein and glutathione (OS H) content. This poison also produced serious histopathologic changes in lung tissue. Administration of propranolol ( 10 and 20 mg/kg), procainamide (20 and 40 mg/kg), dipyridamole (30 and 60 Mg/kg) and atropine (5 and 10 mg/kg) decreased the PQ (40 mg/kg)-induced mortality rate in the pre- or post-treatment regimens. These drugs were also effective in reversing the PQ-induced alteration in the lung tissue protein and OSH content, however the pathological findings attenuated in the treated animals. Although the exact mechanism of these drugs against paraquat-toxicity in mice is still unknown, it appears that some of the drugs used may be effective in reversing PQ-induced poisoning in mice and possibly their effects are related to the inhibition of membrane lipid peroxidation via different mechanisms.

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A perplexing issue in diagnosing the cause of renal allograft dysfunction is differentiation between rejection----the most common cause--and many other possibilities that have detrimental effects on graft function. This study was designed to determine whether technetium - 99m sulfur colloid (TSC) accumulation could predict graft rejection. We prospectively studied 54 episodes of allograft dysfunction in 53 kidney transplant recipients who had undergone TSC scintiscanning and graft biopsy, within one week of evidence of allograft dysfunction. Visual analysis of TSC uptake was done by comparing allograft uptake with that of the fifth lumbar vertebra (L5) marrow. A 3+ result meant that allograft uptake was greater than L5 marrow uptake 2+, allograft uptake was the same as L5 marrow uptake 1+, less than and 0, no allograft uptake. Transplant accumulation of 􀁀2+ was considered consistent with rejection (p=0.01). Allotransplant biopsies were interpreted based on the Banff Working Classification and rejection was noted in 45 of 54 renal biopsies. 42 of 45 biopsy -proven rejection episodes had ≥2+ graft uptake. This nuclear medicine technique has a sensitivity of 93.3%, specificity of 44.4%, a positive predictive value of 89.3%, a negative value of 57.1 % and an efficiency of 83.3% in the diagnosis of renal allograft rejection.

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The use of bovine amnion in the urinary tract for reconstructive purposes following ablative surgery in cases of trauma, cancer or infection is now a common practice in urological surgery. To evaluate urinary bladder reconstruction with bovine amniotic membrane (BAM), ten healthy mongrel dogs of either sex weighing 10-40 kg were used. The animals were randomly divided into two groups of five animals each. A piece of the cranial wall of the bladder 5 cm in diameter was resected and replaced with fresh and formalin-preserved BAM respectively. The graft compatibility was evaluated on the basis of clinical, biochemical ultrasonographical, radiological and histopathological changes. Clinically all of the dogs were dull and depressed with blood tinged urine for the first few post-operative days. The biochemical parameters didn't show any significant changes in BUN and creatinine. Ultrasonographic findings consisted of floating masses in the bladder lumen (40%), chronic cystitis (10%), bladder adhesion with adjacent tissues (90%) and radiological findings were lack of normal distension of the graft site (100%) and filling defect (30%). No inflammatory responses and leakage were observed. The regeneration of uroepithelium, and proliferation of granulation tissue, infiltration of lymphoid cells, degenerative changes at the junction of the bladder and graft and heterotopic bone formation were observed. Keeping in view the compatibility of the fresh and preserved BAM, this study showed that it can act as a scaffold for repairing urinary bladder defects in dogs.

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Carbamazepine, a drug effective in pain, seizure, and affective disorders, was studied for its effects and toxicity on spontaneously beating isolated guinea pig atria, Carbamazepine (20-􀁽0 J.lg/mL) has a negative chronotropic effect on artria, without any significant effect on contractile force. The most significant effect (12.5%) was seen with 30 J.lg/mL of carbamazepine on atria. With higher doses (>30 µg/mL) carbamazepine produced toxic effects which resulted in atrial standstill. Pretreament of atria with theophylline (5-5 0 µg/mL) prevented the negative chronotropic effect of carbamazepine (30 µg/mL). Three dose ratios of carbamazepine (1.33,2,2.33) in the presence of three different doses of theophylline (30,50 and 60 µg/mL) were obtained. These results suggest that the negative chronotropic effect of carbamazepine and its toxicity may be due to its action as an agonist on adenosine Al receptoCarbamazepine, a drug effective in pain, seizure, and affective disorders, was studied for its effects and toxicity on spontaneously beating isolated guinea pig atria, Carbamazepine (20-􀁽0 J.lg/mL) has a negative chronotropic effect on artria, without any significant effect on contractile force. The most significant effect (12.5%) was seen with 30 J.lg/mL of carbamazepine on atria. With higher doses (>30 µg/mL) carbamazepine produced toxic effects which resulted in atrial standstill. Pretreament of atria with theophylline (5-5 0 µg/mL) prevented the negative chronotropic effect of carbamazepine (30 µg/mL). Three dose ratios of carbamazepine (1.33,2,2.33) in the presence of three different doses of theophylline (30,50 and 60 µg/mL) were obtained. These results suggest that the negative chronotropic effect of carbamazepine and its toxicity may be due to its action as an agonist on adenosine Al receptors and as an antagonist on A2 receptors of the atria. Moreover, using adenosine antagonists such as theophylline may overcome the toxic effect of carbamazepine on the heart. This may explain the reason for the interaction between carbamazepine and theophylline in clinical settings.

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Various biological bone g rafts have been used for osteogenes i s , osteoconduction and even osteoinduction, but due to systemic influences and local factors, the outcome of successful incorporation of a bone graft has not been satisfactory. This study was therefore conducted on 15 clinically healthy adult dogs between 1 to 3 years of age weighing 20 to 30 kg to evaluate the effect of bone cement and autogenous bone grafts. A piece of 3 cm complete mid-shaft right tibial cortical bone was removed in all animals. Then they were subsequently divided into three groups of 5 animals each. In group I the bone was fixed with a suitable intramedullary pin, whereas the gap was filled with harvested autogenous rib bone graft in group II animals. Bone cement was used to fill the gap in animals of group III for the first 30 days, then it was replaced with iliac bone chips and observation was made accordingly for 60 days in all animals of the three groups. After 60 days, before collection of callus samples, there was granulation and fibrocartilage tissue in groups I and II respectively, whereas a thick fibrous capsule or pseudomembrane layer was seen around bone cement on day 30 before removal of cement and on day 60 after replacement by iliac bone graft in group III animals. There were combinations of heavily impacted fibrous a n d fibrocartilagineous tissues with thick bundles of collagen fibers among hypertrophic chondroblasts in histomorphological cross section in group I animals, whereas active sequestra were present in group II animals. Fibrotic capsule, periosteal layer, lacunae, osteoblasts, osteocytes and well formed bone marrow with RBC and adipose tissue were noted in group III animals. It appears that the local reaction induced by bone cement leading to fibrotic capsule formation was quite helpful in delaying iliac bone graft resorption and enhancing osteogenic stimulation as to fill the gap with impacted callus with normal cortical structure. The application of bone cement in gap non:::union:::, crushed bone and fragmental fractures is therefore highly recommended.

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  Abstract

  Introduction: It is demonstrated that the degree of clinical improvement in

  Parkinson's disease (PD) achieved by deep brain stimulation (DBS) is largely dependent

  on the accuracy of lead placement. In addition, individual variability in the

  situation of subthalamic nucleus (STN) is responsible for spatial inter-individual

  fluctuations of the real patient's target.

  Objective: Our study was aimed to identify the anatomic location of STN from

  midcommissural point (MCP) in Iranian Parkinson's disease patients who underwent

  DBS by means of a 3-dimentional magnetic resonance imaging (MRI).

  Methods: Forty-six patients with the PD were recruied as candidates for bilateral

  implantation of STN-DBS (92 subthalamic nucleuses) were recruited. All these patients

  had bilateral implantation at the same operation. DBS and MRI parameters including

  the target coordinates (X, Y, Z) and the distances from MCP to the center of

  STN in all three axes on both sides were reported and calculated for each patient.

  Results: The location of STN was approximated by a site with 11 mm lateral, 3 mm

  inferior and 3 mm posterior to the midcommissural point. This distance was significantly

  lower in PD patients who aged >50 years in both right and left sides in the Y-axis

  direction.

  Conclusion: Our findings led to a considerable set of information which could

  help neurosurgeons during DBS procedure in Iranian PD patients. Despite the differences observed between various population of PD patients in the anatomical location of STN, our results further depicted the clustration of active contact points in same region.

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  Medulloblastoma is quite uncommon in the adult population and even rarer in extra-axial site in cerebello-

  pontine (CP) angle. In this report, a 23-year-old male patient with a two month history of deafness, nausea, vomiting and ataxia is presented. Clinical and radiological findings demonstrated a heterogeneously enhanced extra-axial lesion in the right CP angle. Total excision was performed and the histopathological features of medulloblastoma were confirmed. After surgery, the patient had no neurological deficit and the audiometric findings were improved. In addition, he underwent adjuant radiotherapy and no sign of metastatic mass was observed in follow-up spinal cord MRI. Although extremely rare, medulloblastoma must be considered in the differential diagnosis of extra-axial CP angle lesions.

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    Background: One of the main goals of health systems is to protect people against financial risks associated with diseases that can be catastrophic for patients. In 2014, Health Sector Evolution Plan (HSEP) was implemented in Iran; one of the objectives of HSEP was to reduce out-of-pocket payments and provide more financial protection for people. Therefore, the present study aimed at exploring the likelihood of facing catastrophic health expenditures (CHE) among households with members suffering from dialysis, kidney transplant, or multiple sclerosis (MS) after the implementation of HSEP.
   Methods: A total number of 385 households were selected using stratified random sampling and were asked to complete the World Health Survey questionnaire through telephone conversations. As outlined by the World Health Organization (WHO), when household out-of-pocket expense for health services is ≥40% of its capacity to pay, then that household is considered to be facing CHE. Furthermore, determinants of CHE were identified using logistic regression.
   Results: The percentage of facing catastrophic health care expenditures for households with a MS, dialysis, and kidney transplant patient was 20.6%, 18.7%, and 13.8%, respectively. Results of logistic regression analysis revealed that patient’s economic status, level of education, supplementary insurance status, type of disease, multiple members with special diseases in the household, rural residence, use of inpatient, dental, and rehabilitation services were effective factors for determining the likelihood of facing CHE.    
   Conclusion: Despite the implementation of HSEP, the percentage of CHE is still high for households that have members who suffer from special diseases. However, basic health insurance packages should be amended and more cost-sharing exemptions should be granted to provide more financial protection for the vulnerable households.   
 

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Background: 3,4- methylenedioxymethamphetamine (MDMA) is a chemical derivative of amphetamine that can induce learning and memory impairment. Due to  the effect of neurotrophins  on memory and learning, the impact of MDMA was evaluated  on the brain - derived neurotrophic factor (BDNF), neurotrophin- 4 (NT-4), and tropomyosin- related kinase B (Trk- β) expression in the hippocampus.
   Methods: In this study, 20 adult male Wistar rats (200-250 g) received saline (1 mL) or 10 mg/kg of MDMA intraperitoneally as single or multiple injection for 2 consecutive days per week for 2 months. Expression of BDNF, Trk-β, and NT4 were assessed using Western blotting and RT PCR methods. 
   Results: Our results revealed that the expression of BDNF, Trk- β, and NT4 proteins and genes significantly decreased in MDMA groups compared to the sham group (p<0.05). Furthermore, the acute group showed the lowest expression of these proteins.
   Conclusion: The results of the present study suggest that ecstasy administration may downregulate the expression of BDNF, Trk- β, and NT-4 in hippocampus, which is more extensive in case of acute treatment. It seems that in the chronic group, hippocampus was able to compensate the ecstasy- induced neurotoxicity. 
 
 

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Background: Societies are characterized by evolving health needs, which become more challenging throughout time, to which health system should respond. As such, a constant monitoring and a periodic review and reformation of healthcare systems are of fundamental importance to increase the efficiency and effectiveness of healthcare services delivery, equity, and sustainable funding. The establishment of President Rouhani’s government in Iran, on May 5, 2014, the settlement of the new Ministry of Health and Medical Education administration (MoHME) and the need for change in the provision of healthcare services has led to the “Health System Transformation Plan” (HSTP). The aim of the current investigation was to critically evaluate the health transformation plan in Iran.
   Methods: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis enables to identify and assess the strengths and weaknesses within an organization or program, as well as the threats and opportunities outside the given organization or program. To identify SWOT of the HSTP in Iran, all articles concerning this program published in scholarly databases as well as in the gray literature were systematically searched. Subsequently, all factors identified at the first round were thematically classified into four categories and for reaching consensus on this classification, the list of points and factors was sent to 40 experts – policy- and decision-makers, professors and academicians, health department workers, health activists, journalists.
   Results: Thirty-four subjects expressed comments on classification. Incorporating their suggestions, the SWOT analysis of Iran’s HSTP was revised, finalized and then performed.
   Conclusion: HSTP in Iran, like many of the initiatives that have been recently introduced and not fully implemented, have various challenges, difficulties and pitfalls that health policymakers need to pay attention to. Interacting with criticisms, taking into account public opinion and strengthening the plan can make the project more effective, and it can be anticipated that in the future, better conditions in the health sector will be achieved.
 

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Background: Health Transformation Plan (HTP) has been one of the biggest reforms in Iran's health system over the past 3 decades. The plan has been implemented since May 2014 and includes several packages that can affect the utilization of health care services. We aimed to assess the effect of implementation of HTP on utilization of specialist outpatient visit rate in clinics affiliated to university hospitals.
   Methods: We chose Kurdistan province to collect monthly specialist outpatient visit data for 50 months because this province was not a patient referral hub. An interrupted time series (ITS) analysis and segmented regression analysis were used to evaluate the effects of HTP on specialist outpatient visit rates. Statistical analyses were conducted using STATA version 13.
  Results: A significant increase was observed in the specialist outpatient visit rate (12.1 outpatient visit per 1000 population) in the first month after the implementation of HTP (p= 0.000, 95% CI= 6.36-17.83). Also, after the implementation of HTP, a significant increase was observed in the monthly trend of specialist outpatient visit rate equivalent to about 0.53 every month per 1000 population compared to the monthly trend in specialist outpatient visit rate before the intervention (p= 0.033, 95% CI= 0.04-1.01).
   Conclusion: HTP has significantly increased the specialist outpatient visit rate in clinics affiliated to university hospitals in Kurdistan province. Thus, it is necessary to perform some comprehensive studies on all public, private, and semi-private sectors in different parts of the country to provide a better and more comprehensive picture of the effects of HTP on utilization of specialist outpatient visit services.
 

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    Background: Antimicrobial resistance (AMR) is one of the most important threats to health worldwide. Therefore, the World Health Organization (WHO) have invited countries around the world to work together to inhibit AMR, and all the member states are expected to prepare a national plan for tackling AMR by 2017. This project was aimed to prepare the National Action Plan of the Islamic Republic of Iran for combating antimicrobial resistance (NAP-IRIAMR) during 2016 to 2021.
   Methods: In this article, the literature and available documents were reviewed to identify key stakeholders. Moreover, interviews, brain storming sessions, and meetings with key stakeholders were held to determine NAP-IRIAMR objectives, strategies, policies, and indicators for monitoring and evaluation. To reach consensus and make a conclusion, participants’ views and comments were analyzed using Delphi method and expert panel. 
   Results: In this national action plan for combating AMR, 13 key stakeholders were identified and 5 objectives were set: (1) raising public awareness and increasing trainings on AMR, (2) continuous monitoring of AMR, (3) preventing the spread of microorganisms resistant to antimicrobials, (4) promoting the rational use of antimicrobials, (5) promoting research and development in the field of AMR.
   Conclusion: The NAP-IRIAMR was prepared for the years 2016- 2021. Intersectoral cooperation is needed to combat AMR. It is expected that implementing the NAP-IRIAMR and reaching the determined goals will help overcome the problems related to AMR.

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Background: According to the Global tuberculosis (TB) Report 2014, released by World Health Organization (WHO), difference between estimated number of TB patients and the number of patients who are registered by the National Tuberculosis Programs (NTBP) is about 3 million annually in the world. In the current study, we investigated the level of under-reporting of TB cases between labs with poor collaboration background with NTBP in Tehran.
   Methods: In the context of TB, this is an inventory study that evaluating the level of under-reporting of TB cases. To do inventory study, first, after selecting laboratories based on poor collaboration background with NTBP and developing patient’s list we matched the patient’s list with the MoHME’s database then, patients that were not recorded in NTBP’s list were identified, and those with available telephone numbers were called.
    Results: Out of 23 selected labs, 10 (5 private, 5 public (other than PHC)) had individuals with positive results. 71.6% of all samples are tested in public labs. Out of 23633 performed tests, 1396 individuals were positive. The under-reporting was, 62.5% and 39% in public and private laboratories, respectively.
   Conclusion: Public and private sector laboratories will be able to significantly reduce their failure to report if they comply with the recommended requirements and standards of the NTBP in their Processes and software for registering patient information.
 

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Background: The new Coronavirus disease (COVID-19) was first identified in China in 2019. Case fatality rate (CFR) indicator of the disease is one of the most important indices noticed by experts, policymakers, and managers, based on which daily evaluations and many judgments are made. CFR can change during epidemics. This study aimed to estimate the actual number of COVID-19 cases in Iran and to calculate the early CFR for the disease based on official statistics.
   Methods: This was a descriptive study whose data were obtained from the website of the Ministry of Health and Medical Education of Iran from February 20, 2020 until March 26, 2020. CFR has been obtained by dividing the total number of deaths by the total number of confirmed cases at one point in time. In this study, the actual number of COVID-19 cases in Iran was estimated based on the mortality model in 4 scenarios. Excel 2013 software was used to analyze the data.
   Results: According to the findings of this study, In Iran, until March 26, 2020, a total of 27 017 people have been infected by COVID-19 and 2077 died of it. However, CFR indicator had a descending trend in Iran: 100%, 18.6%, 8.8%, 3.3%, 6.9%, and 7.7% on days 1, 5, 10, 20, 30, and 35, respectively. The actual number of COVID-19 cases in Iran was estimated to be 4 789 454, 2 873 673, 1 436 836, and 718418 as of March 26, 2020 according to the 4 scenarios, respectively.
   Conclusion: In emerging epidemics, CFR indicator must not be used as a basis to judge the performance of a health system unless that epidemic condition has been clarified. Moreover, it is suggested that in the outbreak of an epidemic, specifically emerging diseases, CFR must not be the base of judgment. Making judgments, specifically in the outbreak of emerging epidemics, based on fatality rate can lead to information bias. It is also possible to estimate the total number of patients based on the CFR in circumstances where little information is available on the disease.

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The novel coronavirus disease (COVID-19) pandemic has been exhausting the entire global economy. As the greatest challenge to sustainable development in all societies and health systems, noncommunicable diseases (NCDs) and their relevant risk factors are the main causes of illness and death during the 21st century in high, middle, and low-income countries (LMICs). NCDs are also among the main underlying causes of death among COVID-19 patients in many countries. People living with or affected by NCDs (PLWANCDs) are more vulnerable to becoming severely ill with COVID-19. Although the ongoing pandemic will be a fundamental game-changer for prioritization and resource allocation in many countries in years to come, ample evidence indicates that NCDs will remain the main killer of people and the costliest barrier to sustainable societies. Looking through the lenses of universal health coverage (UHC), this paper advocates rebuilding our world during COVID-19 aftermath, in a way to harmonize efforts to live with pandemics and make our health systems resilient, balanced, and comprehensive enough to accommodate all threats to humanity, including both communicable and noncommuincable diseases.

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Background: Studies of treatment methods for patients with acute ischaemic stroke should include aetiological causes, concomitant pathology, and localisation of the lesion, and the extent of the lesion in the brain. The purpose of the study was to determine changes in clinical and neurological parameters in patients with ischaemic stroke in the acute period.
   Methods: This is an open clinical study for which 240 patients were selected with an acute condition after an ischaemic stroke. All patients were divided into 4 groups (depending on the treatment). Clinical neurological examination and testing was performed upon admission to the hospital and upon discharge– after treatment. Electroencephalographic biofeedback (EEG-BFB) therapy was performed using a EEG-BSE device (Bio-Link). Data was processed according to the statistical method of experimental data assessment.
   Results: To study the effectiveness of treatment upon acute ischaemic stroke, a comprehensive treatment system was developed, involving acupuncture, Qigong breathing exercises, and electroencephalographic biological feedback (EEG-BIOFEEDBACK), based mainly on the mechanisms of action. The study investigated the features of the acupuncture treatment in patients with ischaemic stroke during recovery. The authors noted the degree of effectiveness of EEG-BFB therapy, Qigong therapy, acupuncture, and standard treatment. Studies revealed that the development of ischaemic stroke begins gradually and at an early age.
   Conclusion: It was concluded that the most effective method for treating the clinical and neurological manifestations of acute ischaemic stroke is EEG-BFB therapy, followed by acupuncture, Qigong therapy, and standard treatment.

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Background: Postoperative pain has detrimental physiologic and psychologic effects on patients’ outcomes, such as increased postoperative morbidity, delayed recovery, and reduced patient satisfaction. This study aimed to determine the effect of preoperative sublingual melatonin on pain severity after colorectal surgery.
   Methods: We performed a randomized, placebo-controlled, triple-blinded study to test the efficacy of 6 mg of sublingual melatonin or placebo 1 hour preoperative on pain severity and sedation of 60 patients after colorectal surgeries. Pain and sedation were assessed by numerical verbal response (NVR) and the Ramsey sedation score, respectively, at the baseline, 1, 2, 6, 12, and 24 hours after surgery. The repeated measures analysis of variance was used to assess group × time interaction, and the Bonferroni adjustment was used for between-group comparisons.
   Results: A total of 60 patients with a mean ± SD age of 49.35 years were equally randomized to the study groups. There was no significant difference between groups with respect to the baseline characteristics. The mean score of pain severity of patients in the melatonin group was significantly lower compared with the placebo group at 2, 6, 12, and 24 hours after surgery. The total mean pain score for the first 12 hours (mean difference [MD] [SE], 0.41 [0.12]; 95% CI, 0.17-0.65; [P = 0.012]) and the mean score of pain in 24 hours after surgery were significantly lower in the melatonin group in comparison with the placebo group (MD [SE], 0.44 [0.13]; 95% CI, 0.19-0.69; [P = 0.001]). Compared with the placebo group, the percent of patients who were cooperative, aware, and calm was significantly higher in the melatonin group at the baseline (43.3% vs 53.3%) and at 1 (36.7% vs 60%) and 2 hours (33.3% vs 80%).
   Conclusion: The use of 6 mg preoperative melatonin sublingual tablet in patients with colorectal surgeries could reduce the severity of postoperative pain, patients’ restlessness and anxiety, and increase patients' cooperation and calmness. Therefore, it seems that sublingual melatonin is an effective drug in controlling postoperative pain.

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Background: Excessive screen time has been associated with a variety of negative health outcomes. We aimed to evaluate screen time and phone and tablet use in Iranian adolescents and their relation to the socioeconomic status of adolescents’ families in 2018.
   Methods: This descriptive-analytical study was carried out on 10-12-year-old adolescents from Kurdistan, Fars, and Markazi provinces. Cluster sampling was used for sampling. Data were collected by completing demographic questionnaires, calculating the BMI of adolescents and phone and tablet use, screen time, and socioeconomic status of the families. We used linear and logistic regression to estimate the final model. The concentration index was used to measure inequality and the Oaxaca decomposition to examine the different determinants of the inequality.
   Results: 1590 adolescents (52.58% boys) were enrolled in our study. Screen time activities were significantly higher in boys, older adolescents, higher BMIs, more educated mothers, and 35< year-old fathers (P < 0.05). The use of mobile phones and tablets was significantly higher among boys, ten-year-olds, families with four or fewer members, higher BMIs, adolescents with higher levels of parental education, and more educated mothers (P < 0.05). In addition, the concentration index for screen time activities (C = 0.083) and phone and tablet use (C = 0.536) showed that screen time and phone and tablet use activities were higher in adolescents with high socioeconomic status.
   Conclusion: Screen time, phone and tablet use were higher in adolescents with high socioeconomic status. Also, many other factors like gender, age, BMI, parents' education and age can affect screen time, phone and tablet use in adolescents.
 

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    Background: Inflammation is the first response to tissue damage. A hematoma occurs when blood leaves the damaged vessels, and platelets play an important role in this process. This study aimed to investigate the effect of herbal bioactive compounds on the angiogenic factors and modulation of inflammatory mediators in deep second-degree burn patients.
   Methods: In a randomized clinical trial, 54 patients were divided into two groups :Swalin ointment (n=31) and silver sulfadiazine (SSD) (n=23). Ointments were administered every other day for 28 days. The concentration of compounds in ointment oils was measured using the GC-MS technique. Serum levels of TNF-α and IL-6 were measured on days 3, 7, and 14, and tissue levels of VEGF, FGF, and PDGF variables were measured on day 14 by ELISA method. Student t-test was used to compare the mean in 2 groups, depending on the type of normal/abnormal distribution. The chi-square test was also used to check the relationship between qualitative variables.
   Results: The most common compounds in Swalin ointment were Linoleic acid (41.37%), Elaidic acid (37.45%), and Palmitic acid (9.45%), respectively. The tissue level of VEGF, FGF, and PDGF on the 14th day was higher in the Swalin group compared to the SSD group (P<0.001). The serum level of IL-6 and TNF-α in both groups increased until day 7, but gradually decreased on day 14, which was significant in the Swalin group. IL-6 serum level was significant in the Swalin group (P<0.001). The serum level of TNF-α was also significant in the Swalin group (P<0.001).
   Conclusion: The present study showed that Swalin ointment, due to the presence of a wide range of fatty acids, especially linoleic acid, leads to the modulation of systemic tissue inflammation. The ingredients of the ointment, especially hemp and sesame oil, increase the tissue level of angiogenic factors and accelerate remodeling and wound healing.