Lung cancer vaccination from concept to reality: A critical review of clinical trials and latest advances.

Lung cancer is a highly lethal malignancy that poses a significant burden on public health worldwide. There have been numerous therapeutic approaches, among which cancer vaccines have emerged as a promising approach to harnessing the patient's immune system to induce long-lasting anti-tumor immunity. The current study aims to provide an overview of cancer vaccination in the context of lung cancer to establish a clearer landscape for lung cancer treatment. To provide a comprehensive review, we not only gathered the published studies of lung cancer vaccination and discussed their effectiveness and safety profile but also analyzed all the relevant clinical trials registered on www.clinicaltrials.gov until March 2024. We demonstrated all utilized vaccine platforms along with having a glance at novel technologies such as mRNA vaccines. The present review discussed the challenges and shortcomings of lung cancer vaccination, as well as the way they could be managed to pave the way for reaching the most optimized vaccine formulation.

Mono and polycyclic aromatic hydrocarbons in waterpipe wastewater: Level and ecotoxicological risk assessment.

Increasing of tobacco consumption around the world has led to the production of a large volume of waterpipe wastewater that enter the environment (e.g., coastal areas)and threaten aquatic creatures. However, until now, no research has been carried out on the amounts of monocyclic and polycyclic aromatic hydrocarbons (PAHs) in hookah wastewater. In the current study, the levels of PAHs and BTEX compounds in waterpipe wastewater resulting from the use of different tobacco brands were determined and their eco-toxicological effects were also evaluated. The mean levels of Æ©PAHs in waterpipe wastewater of Al Tawareg, Al-Fakher, Nakhla, Tangiers and traditional tobacco brands samples were 3.48 ± 1.65, 3.33 ± 1.52, 3.08 ± 1.25, 2.41 ± 0.87 and 0.70 ± 0.13 µg/L, respectively. The mean levels of Æ©BTEX in waterpipe wastewater of Al Tawareg, Al-Fakher, Nakhla, Tangiers and traditional tobacco brands samples were also 2.53 ± 0.61, 2.65 ± 0.78, 2.51 ± 0.72, 2.35 ± 0.56, and 0.78 ± 0.12 µg/L, respectively. The maximum level of PAHs and BTEX compounds in all brands/flavors samples were for naphthalene (Naph) and toluene, respectively. The concentrations of some PAHs (fluoranthene (Flrt), anthracene (Ant), benzo(b)fluoranthene (BbF), benzo(b)fluoranthene (BkF), benzo (g,h,i)perylene (BghiP) and dibenzo (a, h) anthracene (DahA)) and BTEX compounds (benzene) in the waterpipe wastewater samples were more than recommended guidelines and standards by the international reputable organizations such as World Health Organization (WHO) for water quality. Waterpipe wastewater can be introduced as an important origin for the release of these dangerous contaminants into the environmental matrixes. Therefore, more stringent regulations should be considered for the safe disposal of such hazardous wastes including waterpipe wastewater.

Treadmill exercise with nanoselenium supplementation affects the expression of Irisin/FNDC5 and semaphorin 3A in rats exposed to cigarette smoke extract.

In the current study, we investigated the impacts of 6 weeks of aerobic interval training (AIT) with selenium nanoparticles (SeNPs) on muscle, serum, and lung irisin (FNDC5) and Sema3A in rats exposed to cigarette smoke extract (CSE). To this end, 49 male Wistar rats (8 weeks old) were divided into seven groups: control, SeNPs (2.5 mg/kg b.w by oral gavage, 3 days/week, 6 weeks), AIT (49 min/day, 5 days/week for 6 weeks, interval), SeNPs + AIT, CSE (150 µL by IP injection, 1 day/week for 6 weeks), CSE + AIT, and CSE + SeNPs + AIT. The CSE group showed a significant reduction in irisin and Sema3A serum levels, as well as a decrease in FNDC5 and Sema3A gene expression in lung tissue (p < 0.05). A combined treatment (AIT with SeNPs) significantly increased the serum level and the expression of muscle and lung irisin (FNDC5) and Sema3A in CSE received groups (p < 0.05). There was a positive and significant correlation between muscle FNDC5 and lung FNDC5 in the CSE + SeNPs + AIT group (r = 0.92, p = 0.025). In addition, there was a positive and significant correlation between serum Sema3A and lung Sema3A of CSE + SeNPs + AIT group (r = 0.97, p = 0.004). Seemingly, performing aerobic exercises with the antioxidant and anti-inflammatory supplement nano-selenium in the model of lung damage (similar to COPD) can boost myokine irisin and Sema3A, especially in serum and lung tissue. These results displayed the paracrine/endocrine regulatory function of these myokines on other tissues. In other words, these interventions emphasized the creation of crosstalk between skeletal muscles and damaged lung, focusing on its recovery; however, further research is needed.

First report on BTEX leaching from waterpipe tobacco wastes (WTWs) into aquatic environment.

Waterpipe tobacco wastes (WTWs) may contain considerable levels of hazardous contaminants such as BTEX (benzene, toluene, ethylbenzene, o-xylene, and m/p-xylene). However, no research has been carried out on BTEX levels in WTWs and the release of these pollutants into the water environment. This research examined the levels of BTEX in WTWs of flavored/local tobacco and also the release rate of these toxins into three kinds of water, including seawater (SW), tap water (TW), and distilled water (DW) with different leaching times (15, 30 min, 1.2, 4, 8 h, and 1, 2, and 4 days). The mean contents of BTEX in WTW samples of Al-Mahmoud, Al-Fakher, Mazaya, Al-Ayan brands, and local tobacco samples were 17.0 ± 4.14, 19.1 ± 4.65, 19.6 ± 4.19, 18.8 ± 4.14, and 3.16 ± 0.63 µg/kg, respectively. The mean BTEX levels in flavored tobacco samples were considerably greater than that of local tobacco (p < 0.05). The WTWs leaching experiments showed that the levels of BTEX ranged from 5.26 to 6.12, 5.02-5.60, and 3.83-5.46 µg/L in DW, TW, and SW, respectively. All target compounds were found for all exposure times in DW, TW, and SW samples. After adding sodium azide as an antibacterial agent to water samples (simulating biodegradation processes), higher levels of BTEX compounds were detected in SW. Further research is needed to address the potential environmental hazards due to WTWs leaching into aquatic environments.

Post-consumption waterpipe tobacco waste as an unrecognized source of toxic metal(loid)s leachates into aquatic environments.

Waterpipe is a common form of tobacco smoking, and recently, its use has been increasing globally. Therefore, concern arises regarding the large quantity of post-consumption waterpipe tobacco waste produced and released into the environment and which can contain high levels of dangerous pollutants such as toxic meta(loid)s. This study reports the concentrations of meta(loid)s in waste from fruit-flavoured and traditional tobacco smoking as well as the release rate of these pollutants from waterpipe tobacco waste into three types of water. These include distilled water, tap water, and seawater and contact times ranging from 15 min to 70 days. The mean concentration levels of Æ©metal(loid)s in waste samples of Al-mahmoud, Al-Fakher, Mazaya, Al-Ayan brands and traditional tobacco brands were 212 ± 92.8, 198 ± 94.4, 197 ± 75.7, 214 ± 85.8 and 40.6 ± 16.1 µg/g, respectively. The concentration levels of Æ©metal(loid)s in fruit-flavoured tobacco samples were significantly higher than for traditional tobacco samples (p < 0.05). It was found that waterpipe tobacco wastes leached toxic metal(loid)s into different water samples with similar trends. In addition distribution coefficients showed that most metal(loid)s are highly likely to enter the liquid phase. The concentration levels of these pollutants (except Ni and As) in deionized water and tap water exceeded the surface fresh water standards for sustaining aquatic life during long contact time (up to 70 days). In seawater, concentration levels of Cu and Zn exceeded the recommended standards for maintaining aquatic life in the sea. Therefore, due to the possibility of contamination by soluble metal(loid)s through disposal of waterpipe tobacco waste in wastewater, there is concern that these toxic chemicals might enter the human food chain. Appropriate regulatory measures for disposal of waterpipe tobacco waste are necessary to prevent environmental pollution due to discarded wastes into aquatic ecosystems.

Polycyclic aromatic hydrocarbon (PAH) leachates from post-consumption waterpipe tobacco waste (PWTW) into aquatic environment- a primary study.

Post-consumption waterpipe tobacco waste (PWTW) is an unrecognized type of hazardous waste that is produced and released in large quantities into the aquatic environment. It may contain high amounts of various pollutants including PAH, and to date, there has been no research on the potential for contamination by PAH from PWTW leaching into aquatic environments. In this study, the concentrations of PAH via PWTW of fruit-flavored and traditional tobacco leachate into three water types, including distilled water (DW), tap water (TW) and sea water (SW) at different contact times were evaluated. There were significantly higher concentration levels of Æ©PAH in waters with leachates from fruit-flavored PWTW than traditional tobacco (P-value<0.05). The concentration levels of Æ©PAH in DW, TW and SW at a total contact time of two months ranged from 0.13 to 3.51, 0.12 to 3.63 and 0.11-3.64 µg/L, respectively. Lower molecular weight PAH such as naphthalene (Naph), acenaphthylene (Acen) and fluorine (Flu) were detected in leachates immediately after a short contact time of 15 min. Higher molecular weight PAH including benzo [a]anthracene (BaA), benzo [b]fluoranthene (BbF), benzo [k]fluoranthene (BkF), chrysene (Chr), and benzo [a]pyrene (BaP) were detected after one month contact time, while indeno [1,2,3-cd] pyrene (Indp), benzo [ghi]perylene (BghiP) and dibenz [a,h]anthracene (DahA) were only observed at the contact time measurement of two months. By adding sodium azide as an antimicrobial agent and chemical preservative to SW samples, higher concentrations of PAH including IP, DahA and BghiP were observed. The concentration levels of PAH in water samples after two months contact time were higher than water quality standards provided by the World Health Organization (WHO) and other international organizations.

Biomonitoring of unmetabolized polycyclic aromatic hydrocarbons (PAHs) in urine of waterpipe/cigarette café workers.

Fresh tobacco or the smoke resulting from waterpipe and cigarette contains large amounts of polycyclic aromatic hydrocarbons (PAHs), which consumption can cause releasing of these contaminants into the indoor air of cigarette and waterpipe cafés. This study was conducted to investigate the urinary concentrations of unmetabolized PAH compounds among the employed workers as well as the customers in waterpipe and cigarette cafés along with its association with oxidative stress factors plus kidney injury biomarkers. For this, 35 staffs and 35 customers in these cafés (as an exposed group (EG)), 20 staffs in non-smoking cafés (as 1st control group (CG-1)), and 20 of the public population (as 2nd control group 2 (CG-2)) were chosen and their urine specimens were collected. The results indicated that there is a significant difference between urinary concentration of Æ©PAHs in the exposed and control groups (P value < 0.05). Also, "type of tobacco" can be considered as an influential and determining factor for the urinary levels of PAHs among the subjects. Considering the contribution of PAHs to the total toxic equivalents, benzo[a]pyrene (BaP), dibenzo[a,h]anthracene (DahA), and fluoranthene (Flrt) with 32.76%, 27.62%, and 18.65% claimed the largest share in waterpipe/cigarette cafés. The results also indicated a positive and significant relationship between some PAHs and oxidative stress biomarkers as well as uKIM-1 (biomarker for assessing and diagnosing glomerular damage) and TIMP-1 (biomarker of stress in primary steps of injury in tubular cell). Thus, it can be expressed that the workers of these smoking cafés are prone to the detrimental health impacts. Accordingly, proper policies and decisions should be taken to limit the activity of these cafés or proper protective strategies should be adopted to protect the health of exposed individuals.

National Plan for Chronic Respiratory Diseases Prevention and Control in Iran.

Background: Lower respiratory tract infections, chronic obstructive pulmonary disease (COPD), tuberculosis, and lung cancer are among the leading 10 causes of death worldwide. The Board of Respiratory Diseases Research Network (RDRN), a sub-committee of the Iranian Non-Communicable Diseases Committee (INCDC) is particularly concerned that there should be a coordinated National strategy to address the burden caused by chronic respiratory diseases. Methods: Iranian Ministry of Health and Medical Education (MoHME) has decided to give promotion to the establishment of research networks and use them as the milestones for research management, particularly for the national health priorities. Results: National Service Framework (NSF), which was designed for Chronic Respiratory Diseases, is one of the main outcomes of the chronic respiratory diseases sub-committee of INCDC. The main seven strategies were represented by the Steering Committee in 2010 for a period of 10 years. Successful development and implementation of our goals provide the CRDs sub-committee of INCDC with the opportunity to develop a paradigm to prevent chronic respiratory diseases. Conclusion: A stronger national plan for controlling chronic respiratory diseases will ensure stronger advocacy to support respiratory health at national, sub-national, and regional levels.

The effect of price on cigarette consumption, distribution, and sale in Tehran: a qualitative study.

BACKGROUND: Appropriate increases in tobacco taxes and prices are an essential component of comprehensive tobacco control strategies. This study investigates factors related to the use, sale, and distribution of cigarettes in Iran, focusing on the relationship between cigarette price and its consumption. METHODS: This interview-based qualitative study was conducted among 20 participants, including cigarette smokers, retail shop owners, large-scale distributors, and an expert in tobacco control research. RESULTS: Seven themes were extracted from participant interviews, including the type and price of cigarette, the best time to sell cigarettes, profits from the sale of cigarette, affordability, rise in cigarette price and smokers' reaction to it, lobbying and black-market sales of cigarettes, and the sale and distribution of cigarettes across the country. Although the price of cigarettes in Iran has shown some increases in the past decade, the timing of these increases are not predictable and the limited amount of these increases has not reduced the use of cigarettes. Following a price increase, consumers are more likely to switch from buying packets to single cigarettes, or buy a less expensive brand, then to quit. Moreover, increases in prices may encourage smokers and sellers to buy a large number of cigarettes and store them for a rainy day. Another adverse effect may be increased smuggling of illicit cigarettes to balance the pressure caused by rising prices. CONCLUSIONS: Our findings highlight two important aspects concerning cigarette pricing in Iran. First is the change in the type of purchase from the whole box of cigarettes to the single stick cigarette or swapping to less expensive cigarettes. Second, increase in cigarette price (either through taxing or regular increases) could be offset by flooding smuggled cigarettes into the market. Therefore, in addition to raising cigarette prices, reducing cigarette consumption rates in Iran requires the development and effective implementation of regulatory policies to control cigarette smuggling, reduce purchasing, and subsequently curb the use of this leading cause of premature morbidity and mortality.

The Economic Burden of Smoking-Attribution and Years of Life Lost due to Chronic Diseases in Mashhad, 2015-2016.

BACKGROUND: Tobacco smoking is one of the most preventable causes of mortality related to noncommunicable diseases (NCDs). This study aimed to estimate the direct economic burden and years of life lost (YLL) attributable to smoking in NCDs in Mashhad, 2015-2016. METHODS: Hospital-based data were utilized to calculate the economic burden of four selected diseases related to smoking. An epidemiological population-attributable risk method was used to determine the smoking-attributable fraction (SAF). Moreover, the study was conducted by data related to disease-specific expenditures and patients' information on cost and the number of mortality for estimating the YLL for each disease, population and life expectancy data, the prevalence of smoking, and the relative risk of smoking. Data analysis was performed with STATA software, version 12. RESULTS: The total costs attributable to smoking for stroke, myocardial infarction, chronic obstructive pulmonary disease (COPD), and lung cancer were 94148, 151272, 1191396, and 574784 US Dollars, respectively (per 100000). In 2015, the YLL per deaths due to COPD were 4217 and 3522 among males and females, respectively. Furthermore, in 2016, the YLL per deaths due to the stroke in males and females were 8317 and 7563, respectively. In the same year, the highest proportion of years of potential life lost per 100000 smoking-attributable deaths belonged to COPD. CONCLUSIONS: The results of this study can be used to inform policy-makers about smoking-attributable diseases in Iran. To decrease the smoking-attributable costs, which have resulted in the spread of NCDs, policy-makers should adopt and implement effective policies regarding smoking prevention and control.

Use of toenail-bounded heavy metals to characterize occupational exposure and oxidative stress in workers of waterpipe/cigarette cafés.

Tobacco smoke is known for releasing metals in indoor air of waterpipe/cigarette cafés. However, the worker exposure to metals, and its association with oxidative stress in these cafés are still unclear. To this end, 54 workers and 38 customers from waterpipe/cigarette cafés (the exposed group), 30 workers from non-smoking cafés (the control group 1 (CG_1)) and 32 individuals from the general population (the control group 2 (CG_2)) were selected and toenails samples were then taken from them. Our findings revealed a significant difference in terms of toenail-bounded metal levels between the exposure and control groups (CG_1 and CG_2) (Mann-Whitney U test, Pvalue < 0.05). This study has also indicated that "type of tobacco" could be considered as a predictor for toenail-bounded heavy metals. Furthermore, our research's results suggest that toenail-bounded heavy metals are positively and significantly correlated with urinary levels of 8- hydroxy-2'-deoxyguanosine (8-OHdG, as a biomarker for the degradation of deoxyribonucleic acid (DNA) oxidative stress). Therefore, it can be concluded that workers of waterpipe/cigarette cafés are at high risks of adverse health of DNA oxidative degradation.

Prevalence of smoking and its association with health-related behaviours among Iranian university students: a large-scale study.

BACKGROUND: The prevalence of smoking and contributing factors among Iranian university students has been paid little attention. AIMS: The aim of this study was to assess the prevalence of smoking in Iranian university students and its association with health-related behaviours. METHODS: This cross-sectional study was carried out on a sample of 82 806 Iranian university students admitted in 2012-2013. Information on demographic characteristics and health-related behaviours, including physical activity, sleep pattern, use of electronic devices and dietary habits, were collected using a standardized questionnaire. Weight and height were measured using a standard protocol and body mass index calculated. Smokers were defined as students who smoked ≥ 1 cigarette per week. RESULTS: Smoking was prevalent among 6.0% of university students (males 6.6%, females 5.6%). Moderate physical activity was inversely associated with odds of smoking. A significant positive association was also found between obesity and odds of being a smoker. Higher intake of fruits and dairy products were associated with lower odds of smoking. However, intake of vegetables, fast foods and carbonated beverages was positively associated with smoking. Breakfast consumption was also associated with greater odds of being a smoker. CONCLUSIONS: Demographic characteristics and health-related behaviours, including marital status, occupation, economic status, sleep pattern, physical activity, use of electronic devices and dietary intake, were significantly associated with smoking.

An Overview of Oncology Researches in Iran: A Scientometric Approach (1974 - February 2019).

BACKGROUND: With the growing rate of tumors, cancer has become one of the most important health concerns in Iran. The urgency with which Iranian researchers and health professionals address this challenge leads to a load of scientific materials. METHODS: To reveal gaps in produced knowledge and suggest future research directions, applying well-validated scientometric tools, we assessed the trends of Iranian published scientific articles and citations in the field of oncology. The inclusion criteria consisted of all oncology-related articles that were data-based, and peer-reviewed; with at least an abstract published in English; and authored by at least one researcher affiliated with Iranian institutions. RESULTS: Amongst 5063525 oncology research records indexed in at least one of PubMed, Scopus, or Web of Science Core Collection (WoS) from the start to February 2019, Iranian researches accounted for about 24867 (0.49%). Published articles on all cancers by Iranian researchers had a sharp continuously ascending trend, with the same pattern for citations received. Some important topics such as complementary and alternative medicine (CAM) therapies have been missing and some such as diagnostic and pharmaceutical innovations have been less investigated. The most collaborative country was the United States, while no close collaboration was observed with China that was introduced as the most productive country in the field of oncology over the past decades. CONCLUSION: Despite the progressive trend in most oncology fields, some significant practical topics are still missing. Systematic reviews of produced theoretical innovations and translating them to functional knowledge can be of importance to fulfill the mentioned gaps.

Role of Common Variables: Age, Gender, BMI, Rhinosinusitis, and Smoking among Asthmatic and Severe Asthmatic Patients.

BACKGROUND: This study was done to determine the role of common variables, including age, gender, body mass index (BMI), rhinosinusitis, and smoking among a group of asthmatic and severe asthmatic patients in 2016. MATERIALS AND METHODS: This retrospective study was carried out from mid-June to the end of September 2016. Of 678 patients with asthma referred to private asthma clinics in Tehran, 163 subjects were selected. Severe asthma (SA) cases were diagnosed according to the SA definition (severe shortness of breath, chest tightness or pain, and coughing or wheezing, low peak expiratory flow (PEF) using a peak flow meter, and more than two days of wheezing and coughing per week). Patients with the presence of concomitant diseases, such as gastroesophageal reflux disease, sleep apnea, hypo- and hyperthyroidism, as well as users of nonsteroidal anti-inflammatory drugs (NSAIDs) were excluded.According to the signs and symptoms and classic criteria of asthma, the subjects with SA were assigned to the case group and subjects with asthma to the control group. Besides, general information, including age, gender, BMI, smoking history, and the presence of Rhinosinusitis was collected. RESULTS: Of 163 subjects, 92 patients (56.4%) were in the control, and 71 patients (43.6%) in the case group. The rate of SA among 678 patients was 10.47%. The mean age of the case group was 49.08 ±11.66 and the control group was 50.05 ±15.65 years. There was a significant difference in BMI between the case and control groups (p=0.034), especially among females in the case group (p=0.001). BMI was significantly higher in females than in males (p=0.002). Also, smoking status was not significant between the case and control groups (p=0.751). Rhinosinusitis was significantly higher in the case groups compared with the control groups (p= .014). CONCLUSION: Rhinosinusitis was higher in SA patients (case group). SA was more observed among females than males and those who were more overweight. It seems that rhinosinusitis and obesity are more important risk factors. Moreover, obese female patients require more serious attention.

Water-pipe Smoking Addiction in Iran; Evaluation of Reliability and Validity of Lebanon Water-pipe Dependence Scale Among Iranian Water-pipe Tobacco Smokers.

BACKGROUND: Water-pipe smoking is increasing around the world. However, there is no comprehensive information on nicotine addiction in water-pipe smokers. This study was carried out to translate and validate the Lebanon Water-pipe Dependence Scale- into Persian language; besides, tobacco dependence was evaluated in Iranian water-pipe smokers. METHODS: A forward-backward translation procedure was done to provide the Iranian version of the questionnaire. Our subjects were current water-pipe smokers who were known in prevalence study that conducted in Tehran. Psychometric properties of the instrument including validity (content, face and construct validity) and reliability (internal consistency and test-retest analysis), were evaluated. RESULTS: A total of 465 participants took part in this study, of whom 298 (64%) were male. The mean age was 30 (standard deviation 10.2). Fifty three percent of subjects got score more than 10 on LWDS questionnaire that indicating dependence. The internal consistency of the LWDS (Persian Version) was 0.85. The physiologic dependence, psychological craving, and negative reinforcement domains had acceptable reliability (Cronbach's alpha was 0.94, 0.81, 0.77 respectively), but reliability was low (alpha = 0.45) in the positive reinforcement domain. External consistency of the LWDS was assessed by test retest. Intra class correlation (ICC) was calculated for all items (n = 20) and ICC for all of them was >0.7 and the mean ICC was 0.9. Content validity was acceptable; all of obtained content validity indexes (CVIs) were above 80%. The result of goodness of fit shows an adequate model (Comparative Fit Index (CFI = 0.94), Root Mean Square Error of approximation (RMSE) = 0.08). CONCLUSIONS: The study revealed strong documents for the reliability and validity of the LWDS for use in Iran. However, further study may be required to improve the reliability results in the positive reinforcement domain.

Health Culture and Presenting a Paradigmatic Model Focusing on Human Papillomavirus Disease.

Objective: In this study, we developed a paradigmatic model focusing on human papillomavirus (HPV) diseases, in order to formulate a theory by investigating pathology in health culture using Grounded Theory, as an inductive and exploratory research method. Materials and methods: It was a qualitative study, and data were collected using in-depth interviews with 20 people (10 men and 10 women) with cultural and religious specialties (clergy). In total, twenty interviews were conducted (mean duration = 45 min) using a semi-structured guide consisting of open-ended questions. All recordings were transcribed verbatim in Persian. All items were extracted based on the participants' responses and related literature. After data collection, the basic theory analysis was performed in terms of the three steps as follows: free coding, axial encryption, the implementation, refinement, and writing the theories in line with selective coding theoretical models. Finally, the paradigm model was determined from the presented models. Results: The paradigm model emerged from professors, clergy, and authorized people, showed that religious taboos about sexually transmitted diseases; lack of wise management, comprehensive supervision, compliance with health standards in the country, proper legislation regarding sexually transmitted diseases as causal factors, awareness, health education in the country, public demand for health, individual dignity, punishment for health detractors, familiarity with individual rights as intervening factors, concern for human lives, health, and belief in fatalism; ethnic differences; irresponsibility; risk perception; high cost of HPV vaccine; immorality in health speech; disregard for people's lives; gender differences as contextual factors; and the consequences is increasing burden of diseases due to sexually transmitted disease such as (HPV). Conclusion: It seems the overall lack of a health-based approach could be a major concern due to the weakness of cultural management in society that requires the involvement and intervention of all policymakers, health planners, authorized people, professors, elites, and clerics to control this major cultural health problem.

Air pollutants associated with smoking in indoor/outdoor of waterpipe cafés in Tehran, Iran: Concentrations, affecting factors and health risk assessment.

Despite increasingly growth in waterpipe smoking in Tehran, so far no study has been conducted on the air quality of the waterpipe and cigarette cafés. Thirty-six cafés were selected and the concentration of three pollutants including formaldehyde, carbon monoxide and nicotine were measured in both indoor and outdoor air of cafés two times (week-day and weekend's session). Air sampling was performed for 180 min for each pollutant. It was observed that the concentration of pollutants inside the cafés was higher during weekend session (with a higher number of "active waterpipe heads") compared with findings during the week-day sessions. Furthermore, the concentration of pollutants in the indoor air of the cafés was significantly higher than that of the outdoors (p < 0.05). According to path analysis, the number of "active waterpipe heads" had the maximum impact on generation of pollutants inside the cafés, followed by the type of tobacco as the second influential factor. The average of lifetime cancer risk (LTCR) resulted by formaldehyde exposure through inhalation in waterpipe (WS), cigarette (CS), waterpipe and cigarette (WCS) and none-smoking (NS) cafés in week-day and weekend sessions were estimated to be 111 × 10-5 and 61.2 × 10-5, 33.7 × 10-5 and 39.4 × 10-5, 271 × 10-5 and 322 × 10-5, and 4.80 × 10-5 and 5.90 × 10-5, respectively, which exceed the limit value by the U.S.EPA and WHO. The concentration of pollutants in the indoor air of smoking cafés in Tehran is significantly high, such that it can pose serious risks for the health of both personnel and customers. Therefore, decision makers are expected to enact applicable and strict policies so as to abate this public health risk.

Burden of obstructive lung disease study in Iran: First report of the prevalence and risk factors of copd in five provinces.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a global health burden that affects 300 million people worldwide. Globally, COPD was reported as the fourth leading cause of death in 2004 and is projected to occupy the third position in 2030. The goal of the present project is to describe the prevalence and determine the causes and risk factors of COPD in five provinces of Iran. METHODS: This study followed a stratified cluster sampling strategy with proportional allocation within strata. The target population is all noninstitutionalized inhabitants, aged 18 and over, who inhabit in different provinces in Iran in the year 2017. The stratification of the sample according to the 31 provinces of Iran is incorporated in the sampling process. The core questionnaire was developed from preexisting validated questionnaires. The single most important outcome measure obtained as part of this protocol was spirometry before and after the administration of 200 mg (two puffs) of salbutamol. RESULTS: The most commonly reported respiratory symptoms were as follows: wheezing (N=217, 20.4%, 95% confidence interval [CI]: 18%-22.8%), sputum production (N=173, 16.5%, 95% CI: 14.3%-18.8%), and dyspnea (N=131, 12.3%, 95% CI: 10.3%-14.3%). The overall COPD prevalence defined by the postbronchodilator spirometric Global Initiative for Chronic Obstructive Lung Disease criteria was 4.9%, higher in men (6.4%) than in women (3.9%). The prevalence of COPD was strongly dependent on smoking status, age, and sex. CONCLUSION: COPD is considered a preventable disease, and avoidance of exposure to major risk factors can prevent the vast majority of cases. The present study findings add to the literature on the prevalence of COPD in Iran and will help policy-makers, specialists, and all stakeholders to strategize and evaluate medical services required for reducing the prevalence of respiratory diseases. The data from our present study will serve as baseline information for future national and regional studies of COPD.

Evaluation of the Effects of Low Level Laser Therapy on the Healing Process After Skin Graft Surgery in Burned Patients (A Randomized Clinical Trial).

Introduction: Skin graft is the standard therapeutic technique in patients with deep ulcers, but like every surgical procedure, it may present some complications. Although several modern dressings are available to enhance comfort of donor site, the use of techniques that accelerate wound healing may enhance patient's satisfaction. Low level laser therapy (LLLT) has been used in several medical fields, especially for wound healing, but it may take several months for large ulcers treated with laser to heal completely. Methods: Nine patients with bilateral similar grade 3 burn ulcers in both hands or both feet were selected as candidates for split-thickness skin graft (STSG). One side was selected for laser irradiation and the other side as control, randomly. Laser was irradiated every day for 7 days with red 655 nm light, 150 mW, 2 J/cm2 at the bed of the ulcer and with infra-red 808 nm light, 200 mW for the margins. Results: The rate of wound dehiscence after skin graft surgery was significantly lower in laser treated group in comparison to control group which received only classic dressing (P=0.019). Conclusion: The results showed LLLT to be a safe effective method which improves graft survival and wound healing process and decreases the rate of wound dehiscence in patients with deep burn ulcers.

Prevalence of tobacco use and associated factors in Tehran: Burden of Obstructive Lung Disease study.

BACKGROUND: Tobacco use is one of the leading causes of preventable deaths in the world. The aim of this study was to determine the prevalence of all common types of tobacco use and identify factors associated with tobacco use among adults in Tehran based on information from the population-based Burden of Obstructive Lung Disease study in Tehran. MATERIALS AND METHODS: This study had a stratified cluster sampling strategy with proportional allocation within strata. The target population was all noninstitutionalized residents of Tehran over 18 years of age in 2013. A total of 1798 individuals were visited in 22 districts of Tehran; 811 (45.1%) men and 987 (54.9%) women participated in structured interviews. RESULTS: The estimated prevalence of current cigarette smoking was 10.6% overall, 20.9% in men and 2.2% in women. The prevalence of smoking was the highest among respondents between 45 and 54 years in both males and females. The mean age of initiation of tobacco smoking was 21.04 ± 6.42 years. The mean Fagerström test score was 2.87 ± 2.36 among current smokers. The mean number f cigarettes smoked daily by the participants was 11.39 ± 10.92 cigarettes/day (95% confidence interval = 12.58-10.21) (range 1-60 cigarettes). CONCLUSIONS: The 10.6% prevalence of cigarette smoking is alarming in Tehran. We found that male gender, hookah smoking experience, and poor health status were major risk factors in our study population. Hookah smoking can be considered as a reflection of tobacco smoking in the society.