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.

Effect of Arbidol (Umifenovir) on COVID-19: a randomized controlled trial.

BACKGROUND: Treatment of patients with COVID-19 has included supportive care to mainly relief symptoms of the disease. Although World Health Organization (WHO) has not recommended any effective treatments for COVID-19, there are some reports about use of antiviral drugs. The aim of this study is to determine the effect of Arbidol (ARB) on COVID-19 disease. METHODS: Using an open-label randomized controlled trial, we examined the efficacy of ARB in patients with COVID-19 in a teaching hospital. One hundred eligible patients with diagnosis of COVID-19 were recruited in the study and assigned randomly to two groups of either hydroxychloroquine followed by KALETRA (Lopinavir/ritonavir) or hydroxychloroquine followed by ARB. The primary outcome was hospitalization duration and clinical improvement 7 days after admission. The criteria of improvement were relief of cough, dyspnea, and fever. Time to relief from fever was also assessed across the two groups. Without any dropouts, 100 patients were entered into the study for the final analysis at significance level of 0.05. RESULTS: The mean age of patients was 56.6 (17.8) years and 56.2 (14.8) years in ARB and KALETRA groups, respectively. Majority of patients were male across two groups (66 and 54%). The duration of hospitalization in ARB group was significantly less than KALETRA arm (7.2 versus 9.6 days; P = 0.02). Time to relief fever was almost similar across two groups (2.7 versus 3.1 days in ARB and KALETRA arms, respectively). Peripheral oxygen saturation rate was significantly different after 7 days of admission across two groups (94% versus 92% in ARB and KALETRA groups respectively) (P = 0.02). Based on multiple linear regression analysis, IHD, Na level, and oxygen saturation at the time of admission and type of therapy were the independent adjusted variables that determined the duration of hospitalization in patients with COVID-19. CONCLUSION: Our findings showed that Arbidol, compared to KALETRA, significantly contributes to clinical and laboratory improvements, including peripheral oxygen saturation, requiring ICU admissions, duration of hospitalization, chest CT involvements, WBC, and ESR. We suggest further studies on ARB against COVID-19 using larger sample size and multicenter design. TRIAL REGISTRATION: IRCT20180725040596N2 on 18 April 2020.

A comparative study of characteristics and risky behaviors among the Iranian opium and opium dross addicts.

BACKGROUND: Iran ranks first per capita in the use of opiates, but we have little information about possible differences regarding the 2 most commonly used illicit drugs, namely opium and its dross (residue). DESIGN: This is a cross-sectional study. SETTING: A cross-sectional study about drug abuse and drug dependence in Iran was conducted from April 2006 to August 2008 in the prisons of 28 Iranian provinces, in the treatment centers, and in the streets. PARTICIPANTS: To pursue the objectives of this research, participants included 2979 opiate addicts including opium users (n = 2636) and dross users (n = 343), who were not significantly different by gender (P = 0.269) or age (P = 0.452). MEASUREMENTS: An anonymous questionnaire was completed through an interview that gathered sociodemographic characteristics and information about some high-risk behaviors. RESULT: : By the end of the study, we concluded that dross addicts, in comparison with opium addicts, were mostly immigrants from rural areas to urban areas (P = 0.031 χ test, 95% confidence interval [CI]), mostly uneducated, illiterate, or semiliterate (P = 0.04 χ test, 95% CI), had illegal occupations (P = 0.048 χ test, 95% CI), were cigarette smokers (P < 0.000 χ test, 95% CI), and had experienced drug injections (P = 0.032 χ test, 95% CI) and drug overdose (P = 0.007 χ test, 95% CI). They also had a history of hospital admission within the preceding year because of drug overdose (P < 0.000) and a record of being arrested and jailed in the past year (P = 0.028 χ test, 95% CI). CONCLUSION: These results indicated the need for more intensive and effective care for the opioid addicts in Iran.

Efficacy of oral metronidazole in treatment of cutaneous and mucosal lichen planus.

INTRODUCTION: Response to different antimicrobial agents supports the infection hypothesis for lichen planus (LP). There are individual case reports describing the improvement of LP with oral metronidazole treatment in patients with concomitant intestinal amebiasis or giardiasis. There are two small studies that reported metronidazole might be effective in some patients with idiopathic LP who did not have concomitant protozoal infections of the intestinal or genital tracts. The authors performed an open trial to evaluate the effectiveness of metronidazole, as a single treatment, on different forms of LP. PATIENTS AND METHODS: A total of 49 patients, 24 male and 25 female, were selected from the dermatology outpatient clinic with a diagnosis of LP in one of its forms. Metronidazole was administered at 250 mg every eight hours daily without any concomitant therapy. Patients were examined at baseline and at days 21, 42, 63, 84 of treatment, and the follow-up period was three months. The authors used SPSS software (Version 15) for data analysis. RESULTS: A total of 20 (40.82%) skin lesions had complete response (CR) to treatment by metronidazole, 16 (32.65%) had relative healing (PR) and 13 (26.53%) did not improve (NR). The overall treatment response (CR + PR) of LP skin lesions was 73.47 percent in this study. In mucosal involvement, the overall treatment response was 66.6 percent, and finally the overall treatment response for itching was obtained in 75 percent of the cases. CONCLUSION: Based on the authors' findings, metronidazole can be an alternative therapy in treatment of LP, and is a safe agent to be considered.

The efficacy of time-based short-course acyclovir therapy in treatment of post-herpetic pain.

INTRODUCTION: Various treatments have been used to manage post-herpetic neuralgia (PHN). Safe and effective therapies to prevent PHN are needed. METHODOLOGY: A clinical trial involving 152 patients diagnosed with acute herpes Zoster (HZ) was conducted to determine whether short-course acyclovir therapy (800 mg five times a day for four days) can alleviate HZ-associated pain and prevent post-herpetic neuralgia (PHN).  The patients were divided into two groups: Group 1 had a rash with a duration of less than 72 hours and Group 2 had a rash with a duration of more than 72 hours. To assess PHN, the patients categorized and assessed the severity of their symptoms using a four-point verbal rating scale (VRS). RESULTS: By the fourth week, 134 out of 152 patients (88.2%) had complete pain response (CPR). Of these, 68 patients (89.5%) were from Group 1 and 66 from Group 2 (86.8%). After four weeks, the mean VRS scores had changed significantly in both groups compared to the scores at the beginning of study (p = 0.001), but there was no difference between the two groups (0.88 ± 0.66 Vs. 0.94 ± 0.72; p = 0.66) After three months no differences were observed in the treatment results between the two groups (0.51 ± 0.13 Vs.0.54 ± 0.19; p = 0.77). CONCLUSION: Short-course acyclovir therapy is an effective treatment for zoster and its efficacy in patients with a rash duration of more than 72 hours is similar to that in patients with rash duration of less than 72 hours.