Sulfur mustard (SM), known as the "king of toxic agents," continues to pose a potential danger due to its ability to cause widespread damage, including ongoing corrosive effects. We aimed to determine the rheumatologic markers in SM veterans suffering from severe pulmonary manifestations. The serologic markers, including ANA, anti-DNA, rheumatoid factor (RF), and CRP, between SM-exposed veterans (n = 229) with severe problems and not-SM-exposed residents with no pulmonary disease history (n = 63), 25-30 years after SM exposure were compared. Moreover, SM-exposed veterans were divided into subgroups, including bronchiolitis obliterans, chronic bronchitis, and asthma, based on specialists' diagnoses, and all the data were compared among these clinical subgroups. Autoantibodies were assessed by standard indirect immunofluorescence and/or ELISA. The levels of serum hs-CRP were determined using an immunoturbidometry technique in both the patient and control groups. Statistical analysis was performed using SPSS software. Patients had significantly elevated ANA (P = 0.000), anti-DNA (P = 0.024), RF (P = 0.000), and CRP (P = 0.000) levels compared to the matched control group. These results indicate a possible autoimmune circumstance in this population and suggest the need to follow up the autoimmunity-related markers in all SM-exposed individuals, since they might be a valuable prognostic biomarker for stratifying patients for the future risk of autoimmunity development.

Background and Purpose: Osteoarthritis is a joint disease in which cartilage and bone tissues are gradually destroyed. The disease is a global problem and its prevalence is higher in Asia than Europe and the United States. According to WHO recommendations on the use of medicinal plants in the regional nature of any country, the present study aimed to evaluate the effectiveness of Zingiber zerumbet ointment compared with Diclofenac gel on clinical manifestations of patients with knee osteoarthritis. Material and Method: The present double-blind clinical randomized controlled trial (RCT) was conducted on patients with knee osteoarthritis in Tehran (Iran) from February 2017 to September 2018. In the present study, the first group (intervention) consumed Zingiber zerumbet ointment and the second group (positive control) consumed diclofenac gel at a dose of 1 g every 8 hours for 4 consecutive weeks. In the study, the severity of symptoms (pain, stiffness and physical functioning) were considered as the initial outcomes by the WOMAC (Western Ontario and McMaster Universities Arthritis Index), and the experimental tests, namely the CBC, Cr, BUN, ALP, ALT, AST, CRP, 10, and IL6 were considered as secondary outcomes of study. Results: The present study was conducted on 92 patients with Osteoarthritis (drug group: 48 individuals; positive control group: 44 individuals). In the present study, two groups were similar in terms of demographic characteristics. The research results indicated differences in scores of physical functioning (drug group = -11.94, MD of Control+ group = -6.43, P <0.001), Pain (MD of drug group = -3.94, MD of Control+ group = -2.43, P-value = 0.039), Stiffness (MD of drug group= -1.31, MD of Control+ group= -0.91, P-value= 0.135). Furthermore, further results indicated that except for CRP and Bun variables, other Laboratory variables had no significant changes in two groups, Zingiber zerumbet ointment and Diclofenac gel. Furthermore, both groups were similar in terms of number of taken acetaminophen pills. Conclusion: Given that Zingiber zerumbet ointment has an herbal base and its use in reducing symptoms of osteoarthritis is very simple and effective, is use can be recommend in improving symptoms for osteoarthritis.

Osteoarthritis (OA) as the most frequent form of knee arthritis is one of the most annoying complications amongst old peoples. There are different pharmacological and non-pharmacological remedies which could be applied for treatment of knee OA. It's while, significant side effects mostly in patients who are older are the dangerous limiting factors. Integrative, supplementary, traditional remedies have been applied from long time ago in treatment of such chronic diseases like OA. Various topical and oral remedies have been presented in treatment of OA worldwide. In spite of the fact there are multiple remedies for reduction symptoms of patients who suffer from disorders and related inabilities which could enhance their life quality. Remedies which have been applied for a long time for treatment of OA have newly discovered to induce injury to some patients. On the other side, additional knowledge about alternative and supplementary remedies is a main way for enhancing health of patients who suffer from OA disorders. Zingiber zerumbet (Z. zerumbeton) is a kind of herb of the ginger family and is a natural compound with various biomedical characteristics like anti-proliferative, anti-inflammatory, and antioxidant effect. However, Z. zerumbet could be applied for reduction of OA symptoms because of its circulatory stimulant and anti-inflammatory effects. Anyway, up to now there is not any methodical literature review for evaluating the Z. zerumbet clinical effectiveness productiveness in treatment of OA. The main aim of the current study is to review scientific resources around therapeutic effectiveness of Zingiber zerumbet in treatment of adverse symptoms of OA disorder.

IntroductionIn this study, the serum levels of soluble intercellular adhesion molecule 1 (ICAM-1), P-, E-, and L-selectins were investigated in seriously eye-injured patients exposed to sulfur mustard (SM).Material and methodsA total of 128 individuals with SM-induced serious eye injuries and 31 healthy male controls were included in this study. The serum concentration of soluble forms of adhesion molecules was measured by enzyme-linked immunosorbent assay (ELISA) method.ResultThe serum level of soluble ICAM-1 was significantly higher in the SM-exposed individuals with an abnormality in tear meniscus height, corneal verticillata, and pannus compared with SM-exposed individuals without these abnormalities. There were no significant differences in the level of all three measured selectins between the SM-exposed group and the control groups. SM-exposed individuals with corneal defect had a significantly higher level of soluble E-selectin than SM-exposed individuals without this abnormality. The serum level of soluble P-selectin in the SM-exposed group with limbal abnormality was significantly lower than that in the SM-exposed without this abnormality; also it was significantly higher in SM-exposed group with fundus abnormality compared to that in the control group or SM-exposed group without this abnormality.ConclusionThe changes in the levels of selectins and ICAM-1 in the SM-exposed group with various ocular abnormalities is a defense mechanism against the toxicity of SM. Further analysis is required to understand the molecular mechanisms of the relationship between adhesion molecules with ocular complications in SM-exposed individuals.

Background: Sulfur mustard (SM) exposure produces extensive systemic and ocular adverse effects on the victims. One of the most important effects is immunological insults that can lead to other organ damages, including the eyes. Methods: In this descriptive study, 128 SM-exposed veterans with severe eye injury were compared with 31 healthy controls. Tear levels of tumor necrosis factor (TNF)-alpha and serum concentrations of interleukin (IL)-1 alpha, IL-1 beta 3, IL1Ra, IL-6, TNF-alpha, granulocyte macrophage colony-stimulating factor (GM-CSF), and Fas Ligand (FasL) were compared between the two groups. Results: Meibomian gland dysfunction (MGD); tear breakup time (TBUT < 10 ''); and conjunctival, limbal, and corneal abnormalities were more frequent among the cases (MS-exposed veterans) than the controls. Ocular involvement was mild in 14.8%, moderate in 24.2%, and severe in 60.9% of the cases. Serum levels of IL-1 alpha and FasL were significantly higher among the cases than among the controls (P < 0.001 and P = 0.037, respectively). Also, a significant decrease was observed in serum and tear levels of TNF-alpha in the cases as compared with controls (P < 0.001, P < 0.001, respectively). Serum levels of FasL were significantly higher in cases with severe ocular involvement than in the controls (P = 0.03). Nonetheless, serum levels of IL-1 beta, IL-1Ra, IL-1 alpha/IL-1Ra, and IL-6 were not significantly different between the two groups. Conclusion: Serum levels of IL-1 alpha and FasL may cause different ocular surface abnormalities in SM-exposed patients. Lower tear TNF-alpha concentration may be due to lower serum levels of this cytokine in these patients.

This study compared the effectiveness of relaxation training and stress management training in treating anxiety, depression, stress, and pain in women with fibromyalgia. Twenty-two women with fibromyalgia participated in this randomized, controlled trial. They were assigned to stress management (n=7), relaxation training (n=7), and control (n=8) groups. All participants completed the Depression, Anxiety, and Stress Scale (DASS-42) and the Visual Analog Scale (VAS) for pain. The stress management group participated in eight weekly two-hour sessions of a stress management program; the relaxation group participated in eight weekly sessions of relaxation training. Then, participants completed the DASS-42 and VAS again. Analyses of Covariance (ANCOVA) and post hoc analyses were used to compare the participants’ pre- and post-therapy responses and the two treatment types. Both relaxation training and stress management training were found to be effective in treating patients’ anxiety (P= 0.005), depression (P= 0.006), stress (P= 0.002), and pain (P= 0.001). Post hoc analyses indicated that participants in the treatment groups showed improvement compared with those in the control group (all P values< 0.01). However, there was no significant difference in effectiveness between the relaxation training and the stress management training. The relaxation training and stress management training both significantly improved women’s fibromyalgia symptoms (depression, stress, anxiety, and pain).

Macrophage Activating Syndrome (MAS) is a life-threatening disease seen in autoimmune diseases including lupus erythematosus, rheumatoid arthritis, Still's disease, polyarteritis nodosa. It is characterized by fever, pancytopenia, liver failure, coagulopathy, and neurologic symptoms and high serum ferritin. A 27 yr. old female patient was admitted in shahid Mostafa Khomeini Hospital (Tehran-Iran) in May 2011 because of lower extremities edema and ascites and fever from 1.5 month ago. In physical examinations she had generalized lymphadenopathy, splenomegaly and pleural effusion. In laboratory tests she had pancytopenia, positive ANA and Anti DNA (ds), hypocomplementemia, hypertriglyceridemia and high ferritin level. Gradually she had signs of RPGN and ARDS. The patient had no skin and musculoskeletal signs of SLE and no liver failure nor coagulopathy of MAS. Her lymph node biopsy was reported as Castleman syndrome. Unlike other studies, the patient showed MAS before treatment with cytotoxic for lupus nephritis.

Background: Chronic spinal cord injury has an important role in sensorimotor disor-ders which is associated with many complications and the rate of these complications should be certainly considered. The most important complications are the changes in bones and joints which come with pain and lead to increase in their motor disability. In this paper, the radiographic images were studied and the ossifications of spinal cord and pelvis were described and also the type of changes and their prevalence was eval-uated. Methods: In this study, 500 patients and veterans with spinal cord injuries who were hospitalized in Khatam-Ol-Anbia Hospital were examined. The spinal and pelvis x-ray of the patients have been studied for spinal cord ossification, the hip joint narrowing, sacroiliitis, heterotopic ossification, osteophyte and the presence of quiver in the graph. Results: Among the patients, 485 cases were males and 15 cases were females, the av-erage age was 50.26 and the mean duration of injury was 26 years. Four hundred and forty six patients were paraplegic and 54 cases were quadriplegic. There was a signifi-cant relationship between age and the number of involved vertebrae (P= 0.000), psori-asis like ossifications (P= 0.048) and large osteophytes (P= 0.037), also between the du-ration of the injury and the hip joint narrowing (P= 0.008), the number of involved ver-tebrae (P= 0.008). In addition the presence of shrapnel in the graph is correlated with large osteophytes and more heterotopic ossification. Conclusion: The most frequent cause of chronic spinal injuries of our patients has been the injury by quiver, it seems our results may not be extended to all patients with spinal cord injury. In lumbar spine radiography of the patients, osteophytes, the quiver and psoriasis like ossifications were mostly seen. In the pelvis x-rays the most changes were hip joint narrowing, sacroiliitis and the heterotopic ossification.

Background: Inflammation is a one of common medical problems. Inflammation is a part of the complex biological response of vascular tissues to harmful stimulants, such as pathogens, damaged cells, or irritants. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are the main medications used to reduce pain and inflammation in damaged tissue, but they have a lot of side effects. Traditional medicine schools can be considered as a source of many new therapeutic methods and medicines. Furthermore, now today there are a large number of traditional pharmaceutical products used in the world for treatment of diseases. Extraction of Anethum Graveolens L. (Marham-e-Shevid) is used as a local application to reduce inflammation, however, profile of such drug are not fully understood. One of important test for dermal application is skin irritation and sensitization test. This study was designed to examine this test. Material and Method: In this study, extraction of Anethum Graveolens L. (Marham-eShevid) was investigated in animals following standard procedures for irritation and sensitization tests. Results: The skin irritation test on rabbits showed that this product is not irritant. Furthermore sensitization test on mice by the Mouse Ear Swelling Test (MEST) method revealed that Marham-e-Shevid to be non-sensitizer. Discussion: Given the proven anti-inflammatory effects of this drug in the previous study and based on the results from this study suggest that this drug does not have dermatotoxicity side effects; Therefore, this drug can be used as a topical anti-inflammatory product.

Inflammation is one of the symptoms of many common and harmful diseases. As it is incurable through chemical drugs, the study on this ailment using new methods and drugs seems necessary. In addition, the adverse effects of the present anti-inflammatory drugs like NSAIDS and Glucocorticoid appeared in the long time use make such study more demanded. Accordingly, in this study we examined the effects of aerial organs' extract and seed of a plant commonly used in Iranian traditional medicine named Dill on the inflammation caused by plantar injection of formalin in rats and compared them with Diclofenac-gel.One of the methods used for the inflammation assessment is injecting formalin in the rat paw and then measuring the paw volume by the new plethysmometer (weighing method). The assessment is done at a specific time on day for 8 days and then recorded.This study includes 3 groups of 6 male rats: Formalin, Dill-Oil and Diclofenac-gel groups.The Dill-Oil group received 2 g of Dill-Oil, containing 100 mg Dill-extract and the Diclofenac group received 2 g gel containing, 20 mg Diclofenac Na.Data were analyzed with SPSS 17 using ANOVA, Kruskal-Wallis, and Repeated-Measures.The average paw volumes changes in these groups after Formalin-induced inflammation on 1st day, were 0.31 (standard error (SEM) = 0.02), 0.30 (SEM = 0.01) and 0.32 (SEM = 0.05) respectively, with no significant difference.Regarding the peak of inflammation on the 2nd day, it was indicated that the average inflammations in Formalin, Dill-Oil and Diclofenac-gel groups were 0.44 (SEM = 0.03), 0.15 (SEM = 0.04) and 0.36 (SEM = 0.08), respectively.The paw volume changes in groups receiving Dill-oil and Diclofenac-gel, after the daily formalin injection in 8 days compared to the blank group, had a significant decrease (p < 0.001). The Dill group showed even more decrease in the paw volume compared to the Diclofenac one.The results of paw volume measurement analyzed by the Plethysmometer manifest that the Dill-Oil is able to decrease the paw volume significantly.

Background and Objective: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy with involvement of median nerve. Patients with this syndrome refer for pain and paresthesia in hand that leads to thenar muscles atrophy. Diagnosis of CTS is made by history, physical examination and electrophysiological study. Recently, Volar Hot Dog (VHD) sign has been proposed for diagnosis of this disease. Thus, we studied VHD as a diagnostic tool in CTS patients according to evidence based medicine. Materials and Methods: In 50 patients referred for pain and paresthesia in median nerve area in hand, a diagnosis of CTS was made by NIOSH criteria and 50 control subjects were also examined for this sign. Results: The sensitivity of VHD was 0.84, the specificity of VHD was 0.32, the accuracy of the test was 0.58 and pretest probability of the disease was 0.5 and post-test probability of the disease with a positive result was 0.55 and post-test probability of the disease with a negative result was 0.35. Meanwhile, positive likely ratio (LR+) was 1.23 and negative likely ratio (LR-) was 0.5. Conclusion: VHD sign (test) had a higher sensitivity than Hoffman-Tinel and Phalen tests with a lower specificity of the test with LR+ 1.2 and LR0.5 and this test is a poor to fair test for diagnosis of CTS and will be mainly valuable for screening of the syndrome.

Considering the modern lifestyle (including the diets, lack of physical activity, overweight, so on), joint diseases are among the common disorders. In classical medicine, treatment of joint disease mainly includes "maintenance therapy." The current study addresses joint disorders from the viewpoint of Iranian traditional medicine to provide different approaches for prevention and treatment of these disorders. In the study, diagnostic and therapeutic methods of joint disorders in different centuries were collected. In Iranian traditional medicine, joint disorders are called "Oja-e Mafasel", and classified into two main categories of simple and material ones, each of which have several subcategories. Depending on the type of the disorder, specific prevention and treatment strategies are presented.

In classical medicine maintenance therapy in joint disorders is common. Now we are planning to present joint disorders from the viewpoint of Iranian traditional medicine to provide different plans to prevention and treatment of these disorders. Method to achieve this aim is using library traditional medicine resources which related to different centuries. Joint disease in Iranian traditional medicine is called “Oja-e- Mafasel”. This disorder divided in 2 categories: Simple (Sadah) Material (Maddy) Depending on each category, any one has different sub titles which related to any subtitles, there are several prevention and treatment solutions. According to the etiology of joint diseases and those risk factors in viewpoint of Iranian traditional medicine, it seems that, with lifestyle modification and respect to six principles of life “Settah-e-Zarory”, probably it is possible to prevent joint disorders and in disease condition, offer better, cost effectiveness and lower complication solution.

Purpose Adverse drug reactions (ADRs) are a major cause of hospital admission and inpatient morbidity. The department of internal medicine is not an exception to this issue. This study was performed to determine the nature and frequency of ADRs in an internal medicine ward in Iran.Methods This survey was a prospective observational study based on admissions of 400 patients to the internal medicine ward over a 15-week period. Patients were intensively followed in order to assess any ADR as a cause of admission or occurring during hospitalization. Any suspicious ADR was confirmed by a pharmacist/pharmacologist.Results There were 47 patients of 400 patients (11.75%) that experienced at least one ADR. ADR leading to the admission was seen in seven cases (1.75%) and in 40 (10%) it occurred during hospitalization. ADRs were identified as preventable reactions in 50% of cases and as predictable in 94.3%. The severity of 18.6% of the ADRs was identified as mild, 62.9% as moderate, 14.3% as severe and 4.3% as lethal. Gastrointestinal system disorders (44.3%) represented the most frequent ADRs. The therapeutic groups that most commonly associated with suspected ADRs were antineoplastic, immunosuppressive and medicines used in palliative care (54.8%).Conclusions ADRs are common among hospitalized patients in department of internal medicine and can be severe and even lethal. Since most ADRs occurred during hospitalization in studied patients and half of them were preventable, prevention strategies should be considered in hospitals. Also, our findings confirmed the role of hospital pharmacists in the reducing ADRs. Copyright (C) 2008 John Wiley & Sons, Ltd.

Sulfur mustard (SM) is a vesicant or blistering chemical agent that possesses mutagenic and carcinogenic properties and alkylates DNA. Little is known about the long-term effects of sulfur mustard on blood cells. The aim of this study is to examine the long-term effects of SM on peripheral blood cells in SM victims of the Iraq-Iran war (1980-1988). This study, which is a part of Sardasht Iran Cohort Study (SICS) was designed in two groups: exposed (372 participants from Sardasht) and control (128 unexposed people from Rabat). The exposed group was divided into hospitalized and not hospitalized subgroups based on the severity of lesions at exposure time. A comparison was made between the study groups' overall blood exams. The hospitalized group had significantly higher numbers of red blood cells (p=0.003) than not hospitalized and the control groups. The exposed group had significantly higher HCT and MCV (P=0.007) than the control group. Exposure group had significantly lower numbers of PLT (P=0.001), WBC (P=0.006) and PMN (P=0.001) than the control group but from clinical viewpoint this difference is not valuable. Further, lymph cells (P=0.001) in the exposed group were significantly higher than in the control group. Our research findings suggested the probability of severe damage to bone marrow and predisposing to infection in other organs (especially lung) due to exposure to SM in the exposed group.

BACKGROUND:Insights into long-term clinical consequences of sulfur mustard have emerged from some investigations but less is known about the basic and molecular mechanisms of these complications. Sardasht-Iran Cohort Study is a comprehensive historical cohort study on Sardasht chemical victims' population which was designed to find out the long-term complications of sulfur mustard exposure and the basic mechanisms underlying clinical manifestations. This paper describes the design and methodology of Sardasht-Iran Cohort Study.METHODS:In Sardasht-Iran Cohort Study, 500 individuals including 372 subjects from Sardasht, as the exposed group, and 128 subjects from Rabat, as the unexposed age-matched control group were evaluated. The exposed group was divided into two groups based on the severity of clinical complications at the time of exposure. Different samples including blood, sputum, saliva, tear, urine, and semen were collected for immunologic, hematologic, biochemical, and other laboratory analysis. Data were gathered from medical records, clinical examinations, laboratory tests, and questionnaires for psychological and lifestyle situations.CONCLUSION:The important distinctions setting this study apart from the previous ones are discussed. The Sardasht-Iran Cohort Study provides important information on various aspects of long-term consequences of sulfur mustard exposure. This database will provide a better position to suggest guidelines for the diagnosis, treatment, and prevention of delayed complications in the patients exposed to sulfur mustard.

Sulfur mustard (SM) has widely been used against the military and civilians during the Iraq-Iran war (1980-1988). It mostly affects the respiratory system. A large historical cohort study was designed to evaluate the pulmonary status of non-military victims in Sardasht, Iran, in comparison with a matched control group 20 years after a single massive exposure. The exposed group was divided into two subgroups of hospitalized and non-hospitalized based on the severity of the injuries indicated by hospitalization a few days following exposure. All participants' respiratory symptoms and signs were evaluated by internists. Dyspnea (n = 261; P = 93.2%) was the most common symptom. Chronic cough, cough severity, sputum, hemoptysis, dyspnea, pattern of dyspnea, severity of dyspnea (P < 0.001 for all), and chest pain (P = 0.003) were statistically significantly different between the two groups. Wheezing was the most common pulmonary finding (11.4%). There was also a statistically significant difference in the auscultation of wheezing (P = 0.045) and rhonchi (P = 0.018) between the hospitalized and control groups. Considering objective findings, pulmonary involvement was observed in 24.3% (n = 68, P = 0.007).

Introduction: Fibromyalgia is a chronic musculoskeletal syndrome whose main symptom is widespread pain in the body associated with particular tender points, which seriously affects the patient’s functionality and quality of life. This study aimed to evaluate the effect of fibromyalgia on Iranian women’s quality of life and to compare it with that of healthy women. Material and methods: Eighty women with fibromyalgia attending the rheumatology clinic in Tehran and 74 healthy women were entered into the study based on inclusion criteria. SF-36 questionnaire was used to study quality of life. Independent t-test was used to analyze data. Results: Comparing healthy women with fibromyalgic ones showed a significant difference between mean scores of the two groups on subscales of physical functioning, bodily pain, general health, vitality and emotional functioning. However, social functioning and mental health did not show a significant difference between the two groups. Conclusions: The findings of the study show that fibromyalgia negatively affects different aspects of women’s quality of life, especially physical functioning, emotional functioning and general health. So, health authorities should pay more attention to these patients.