reza afshari

Archaeologists, historians, and physicians have frequently examined historical pieces including images or sculptures (visual arts) and found evidence that allow them to make interpretations under certain assumptions. Iconography examines archaeological evidence and provides clues and symbols for more information about the past.This manuscript aims to highlight "iconography" as another source for studying the history of health literacy. We hope to persuade professional readers of health and medicine to begin researching and reporting the rich iconographic figures, particularly in Iran, attributed to health and medicine across the country.

We have evaluated a pre-Columbian ceramic mask from the Olmec civilization (1500-400 BCE, south-central Mexico) discovered in 1955 by the famous archaeologist Matthew Williams Stirling and is kept at the Museo Internazionale delle Ceramiche in Faenza, Italy.

This mask consists of two halves (earth jaguar and divine human). It looks like the skull that is transforming from an anxious jaguar earthly creature into a perfect and holy figure of the human face. First, this hybrid deity mask manifests auditory and visual hallucinations from a medical and psychological perspective. The jaguar's ear is small with no hole. However, its human ear is shaped like a horn with a large hole which could symbolize a relatively more remarkable hearing ability. The jaguar's eye is just an empty and presumably blind hole. Yet, the celestial eye is anatomically intact, suggesting the ability to see beyond the eyeless earth creature.Additionally, the human (holy) half of the figurine has a skull and nose that resembles the cap and stem of a mushroom. Enhanced visual and auditory abilities, today classified as hallucinations, provide evidence of psychoactive chemicals such as the effects of magic mushrooms containig psilocybin.

The pre-Columbian Olmec civilization ichnographically documented magic mushrooms' medical and psychological effects long before any medical texts described their manifestation.

The purpose of this research was the investigation of sanding sequence and coating thickness effect on adhesion strength of coating in two species: beech and elm. For this purpose, beech and elm veneers with 0.6 mm thickness were laminated on MDF with 16 mm thickness by UF and hot press. The surface of the laminated panels was sanded by two different sequences; the soft (180-280 grits) and rough (150-180 grits) one. Before the coating application, the surface was sanded with 400 grits. Then they were coated with polyurethane in two forms of one and two-layered coating. After that, the adhesion strength test was done on specimens according to ASTM D4541. To have a more precise investigation of the interphase region of coating-veneer, photomicrographs were captured by fluorescent microscopy to analyze and calculate the effective penetration parameter of the coating into the wood texture. The results showed that two species respond to sanding sequences differently and a thicker coating layer increased the adhesion strength. Beech as a diffuse-porous wood had the finer texture and higher density compared with elm. Therefore, the adhesion strength of the beech veneer was declined by 13.8 % and reaches 2.59 MPa due to the use of a rough sanding sequence. However, these sequences caused the opposite result in elm veneer and led to a 25.7 % adhesion improvement (3.23 MPa). The study on microphotographs and the effective penetration parameter stated that an even thickness of the coating layer and effective penetration reduction has been possible when the rough sequence and soft one are applied on elm and beech, respectively.

Despite sharing common evolutionary features, Viperidae species including Echis carinatus and Macrovipera lebetina possess venoms with different proportions of toxic agents, thereby causing clinical effects with potentially variable severity. This study was an effort to differentiate the clinical effects and outcomes of E. c. sochureki and M. l. obtusa victims.   

In this prospective cross-sectional study, snakebite patients treated at a reference poisoning center in northeast of Iran in 2012 were enrolled. The features of snakebite event, demographic and clinical data of patients were recorded in checklists.

Twenty-seven patients (63% male) with mean age of 34.8 ± 18.1 years were included. The offending snakes were recorded as "E. c. sochureki" in 63%, "M. l. obtusa" in 25.9% and "unknown" in 11.1% of cases. The most common clinical findings were fang mark in 100%, local pain in 81.5% and local edema in 74% of patients. Although the victims of both species showed classic features of viper envenoming syndrome including marked local effect and hemostatic disturbances, the victims of M. l. obtusa had significantly higher creatine kinase levels (P = 0.031) and lower platelet counts (P = 0.043), whereas marked edema (> 15cm) was significantly more common in E. c. sochureki victims (P = 0.028). Envenomation severity, other clinical effects and outcomes did not differ between the two species. Patients with delayed presentation to hospital had greater envenomation severity and edema extent and higher rate of coagulopathy.

Species-specific description of clinical effects following snakebite envenoming is useful for syndromic approach to human victims. The clinical envenoming syndromes by E. c. sochureki and M. l. obtusa show many common similarities despite the difference in severity of some effects. The delay in hospital admission and antivenom therapy is a risk for increased severity of envenomation and development of poorer clinical outcomes.

Geospatial distribution analysis is a highly useful tool, especially in the field of health research and health economics. We aimed to study the geospatial distribution of poisoned patients and the risk factors in Mashhad, Iran.

This was a retrospective cross-sectional study of patients treated at the Medical Toxicology Center, Imam Reza Hospital, Mashhad, Iran, which is the only referral center in northeast of Iran, in 2013. Negative binomial and Poisson approach via generalized linear mixed models were performed to investigate the association between socio-demographic characteristics with the number of reported cases of poisoning.

A total of 5064 poisoned patients (52% females) were included. Most of the poisoned patients were within the age group of 20-29 years old (41.4%). Pharmaceutical agents were the most common cause of poisonings (64.6%). The local test of spatial autocorrelation (Moran’s I) confirms that the poisoning had cluster pattern in Mashhad. Number of poisoning events were found to be associated with population density (RR= 1.00011; 95% CI 1.0001-1.00013), and the frequency of people with less than high school education (RR=1.49; 95% CI 1.32-1.68).

The geospatial factors may have impact on the number of acute poisoning events in a city. Some parts of a city may exhibit spatial clustering in poisoning events. Once clusters are found, interventions can be focused to specific geographic locations and would be helpful for healthcare policymakers to focus on prevention programs.

This editorial aims at exploring the centrifugal and centripetal forces in the process of effective medical education within the preceding, performing and following up the standard medical and health training. It advocates for magnifying the educators’ enthusiasm and energy in teaching. In this proactive school of thinking, educators more than students should keep themselves eager and disciplined!
As an example, recall one of many TED (Technology, Entertainment, Design) Talks. Presenters are highly successful academics and non-academics (1) disseminators of science. The fact is that people who present TED talks have never been told what to talk about or how. Within each talk, passion plays an important role. The presenters are natural speakers that first communicate a love for science before they discuss the content.
Do your current lectures reach that level of efficacy? (2). Do we put in enough time to work on our presentations? The fact is that beyond a reasonable or even baseline level of adequacy in teaching, no credential incentives supports excellence (3-5). As a result a big subset of lecturers do not feel the need to play a wider role in the scientific discourse. Even if they do, how much do others hear about ‘down to business’ medical lecturers in the classroom in order to acknowledge them? --- Any publication in a highly prestigious medical journal receives general applause, doesn’t it? (6). The same professional recognition should be provided to educators who use their lectures to inspire the next generation of medical professionals.
The fact is that while some part of the knowledge of the educationist currently disseminates, there is no plan in place to support their urges in more efficient teaching. --- I would like to advocate for the adoption of a perspective anchored in passion; an educator as a militant person, who is simultaneously an activist, enthusiast and a devotee to the cause of medical education. How do you actively involve yourself in a resuscitation process for a near death person? --- Every second counts! The same should be applied to teaching time.
How does militant medical education work?
Suggested militant medical education is a step towards an evolutionary perspective in teaching which promotes the sharing of the educators’ passion. It is a call to mentorship for more engagement and action, and to ignite enthusiasm among the students. --- Do not be passive in education, or so called “passion killers”.
Why not encourage talking dissent to seek opening up students’ participation? If one can apply strategies to intensify health concerns for vulnerable populations such as the elderly, children, and the disadvantaged, they would encourage students to take responsibility in the process of education.
Through a militant education, embolden students to picture the pain and suffering of the sick, and escalate controversies to mobilize students’ attitudes. Inspire proficiency and offer meaningful mechanisms for navigating the students’ rage against illnesses and health injustices among less privileged populations as a part of your teaching (7).
Judiciously integrate passion into your teaching. Let students come out of the panopticon and feel and see the problems. Militant education is outreach, is caring, and is perseverance and resilience. It is having a fire in your heart. Medical education in this school is a holy art!
Popularizing the history of medicine can help to inspire trainees (read 8). It provides attractive evidence and veracity of the postulate “caring is sharing the passion”! (9-23). Create an excited atmosphere in the classroom, discuss ethical dilemmas, provide pearls for the bedside and questions on the fly (24). These will unleash the craving as well as the potential of the students.
Heads up! The “lecturerosphere” is expanding rapidly, and is likely to do so for years to come. State-of-the-art trainee teaching activities including - what I would like to call it - militant education with their scholastic, scientific, and popularizing benefits will gain momentum soon in medial faculties. It has already done so in the case of public education and in the popularisation of science such as TED talks. --- Be inspiring, generate passion among the students, create opportunities for developing the hitherto neglected medial educational potentials. Do not fall behind the academic and non-academic militant educators!

Avoidable systematic differences in health status of different population groups are called health inequalities. They cause significant social and economic costs to both individuals and societies (1, 2). For example, life expectancy at birth among Canadian First Nation Population is lower (73 for males and 78 for females) than that of total Canadian population (79 and 83, respectively, projected for 2017) according to Statistics Canada (3). In this commentary, we used Canadian First Nation Population, coastal residents and Native American population who self-harvest as example. Toxicology regulation could be considered as a determinant of health, as policies introduced by regulatory toxicology agencies influence health services and are effective at the community level. These policies, however, could be distributed differently among the subgroups of the populations in a systematic manner, which may be a source of inequality. Consumption of home grown or self-harvested foods can result in exposure to various chemicals but such contaminant levels in these products are often not monitored by inspection agencies (4). To date, many drivers of health inequality have been defined, such as gender, race and economic growth. However, no literature is available on “inequality” and “potential food toxicity”. We argue in this editorial that while all population including Canadian First Nation Population, Coastal Residents and Native American population groups are benefitted from implementing new toxicology regulations, the magnitude of health inequalities might increase for some minority groups. Health Canada has set a maximum level of 0.5 mg/kg (50 ppm) in the edible portion of all retail fish, subject to some exceptions (5). This level is applied to commercial fish and enforced by the inspection agencies. However, fish consumption advisories that reduce the risk borne by the general population might not provide much health benefit to subsistence fishermen, which include First Nation (Native American) populations. In another example, and following an outbreak of amnesic shellfish poisoning (ASP) in Canada in 1987, which is related to high exposure to Domoic acid (DA), a neurotoxin,regulations were put in place in North America, limiting the concentration of Domoic acid to 20 ppm in commercial shellfish products (6, 7). Prior to the promulgation of regulations limiting mercury or DA concentrations in fish and shellfish, the general population consuming commercial products and the Native American-First Nation population, largely consuming self-harvested products, were at similar risk of exposure to these contaminants. Limiting mercury concentration to 50 ppm and DA concentration to 20 ppm in commercial products thus protects the general population, a step that certainly should be celebrated. First Nation population, who mainly self-harvest, did not benefit from this protection, thus increasing the health inequalities with regard to exposure to seafood contaminants (8). These examples show that (i) inequality exists regarding potential food toxicities and (ii) a new regulation can create or exacerbate health inequalities. We suggest the need to consider the impact on potential health inequalities as part of the deliberations on new toxicology regulations. As different subgroups of population might be affected by a new regulation to a different extend, strategies should be considered to insure that increased health inequalities do not result. In case of First Nation populations and subsistence fisherman, and while they are generally benefitted from implementing new regulations on contaminant concentrations of commercial foods, a subset of the population who self-harvest may not be benefitted equally. We would like to suggest including educational materials and guidance for self-harvesters; a recommendation that should go to all new regulatory toxicology guidelines. The proposed dimension adds to the current higher burden of adverse effects from contamination to land and waterways that are caused by industry on First Nations’ territories and coastal areas.

Animal bites and rabies are perceived and managed differently from bites and stings related to envenoms snakes, scorpions and spiders. This study aimed at evaluating knowledge, attitudes and practices (KAP) of local population regarding animal bites and rabies, as a point of comparison for future studies on venomous animals. This cross-sectional KAP study included 1093 subjects from four rural areas of Mashhad. Data gathered through a validated and reliable structured questionnaire. In total, 1093 respondents included in the study consist of 53% male and 42% adults of 20 to 9 years old. Assessing knowledge; 70% of cases were presented with weak and moderate knowledge related to clinical manifestations, but just the opposite, majority of the respondents (83%) were categorised as good or excellent in their knowledge of prevention. Assessing attitudes; almost all (91%) of respondents categorised as good or attitude. Assessing practices; 33% of cases revealed that there are no good practices with regard to animal bites and rabies.
Respondent’s knowledge of prevention was significantly correlated with age (P = 0.01) and educational level (P = 0.002). Both attitudes and practices had significant relations with age. Respondents aged 20- 39 years showed better practices than other age groups (P < 0.01). this study found that while information on prevention is acceptable, clinical findings of bites and rabies are relatively unknown. Preventive measure should include clinical manifestations as well as currently implemented focus on prevention, vaccination and treatment.

Chemical warfare agents (CWA) were most notably used during the First World War in Europe, against Iranians and Kurdish citizens of Iraq at the hands of Saddam Hossein’s regime in 1980s and more recently in Syria. The use of CWA is banned under the international law. Ancient uses of CWA are not well studied. Recently, their use during the Persian siege of the Roman-held Dura-Europos (Salihiyah) in modern Syria in 256 C.E. has been theorized by revisiting the archaeological findings from Dura-Europos from the 1930s. Case study: The paper describes the history of Persia (Iran) and Rome in that era and particularly Shapur I, the second King (Shah) of the [Sasanian] Persian Empire (215 - 270 C.E.) and Valerian, Publius Licinius Valerianus Augustus, the Roman Emperor (193/200 - 264 C.E.). In addition, composition of the potentially applied CWA and clinical findings related to the exposure are postulated through a medical toxicology lens taking into account archeological evidence (carbonized top of the tunnels and bodies and yellow crystals found in the tunnel), recent research and contemporary historical notes. It is plausible that a combination of fire accelerant or so called pitch (oil based substance, naphtha, bitumen or crude oil) and Sulphur dioxide (SO2) were used in this occasion. SO2 in combination with water on the body membranes creates highly toxic sulphurous acid (H2SO3) which is life threatening in a small enclosed space. As a result, a burning sensation in the nasopharynx and eyes, coughing, dyspnea, choking that led to pulmonary edema and death would have shortly followed. Severe clinical manifestations, panic and consequent mass hysteria of the toxic exposure should have prevented any organized retreat. In this incident, nineteen Roman and one Persian soldier were killed.

Herbal distillates have been used for many centuries as herbal medicines in Traditional Persian medicine. The main purpose of this study was to determine methanol and ethanol contents in commonly-used industrial herbal distillates produced by three famous factories in Khorasan Razavi, Mashhad, Iran (2014-2015).
Ninety herbal waters of ten types of most commonly used herbal distillates including Willow (Salix alba), Ajava seeds (Carum copticum), Fennel (Foeniculum vulgare), Poleigamander (Teucrium polium), Forty plants, Peppermint (Mentha piperita), Camel thorn (Alhagi camelorum), Chicory (Cichorium intybus), Fumitory (Fumaria officinalis) and Rose water (Rosa damascene) of three famous company in Mashhad were randomly bought from market. Methanol and ethanol contents of each sample were measured by Gas chromatography according to the standard method. Collected data were analyzed by SPSS using appropriate descriptive statistical tests.
The highest average amount of methanol of all tested distillates is for forty plants (46.06 mg/dl) and M. piperita (46.72 mg/dl) and the lowest for ajava seed (8.46 mg/dl). The maximum and minimum ethanol level was reported for rose water (0.39 mg/dl) and ajava seed (0.15 mg/dl), respectively.
High methanol and ethanol concentrations may induce toxicity in people taking these products regularly for a long time. Therefore, considering the harmful effects of methanol and ethanol on human health, further studies are required for determining permitted levels of methanol and ethanol in herbal distillates.

Considering to drought stress importance as most important limiting factor in rice production in world, identification of tolerant genotypes to drought can be a valuable approach to deal with the drought stress. In the present experiment plant materials contains 53 rice genotypes including 31 aerobic and 22 lowland (landrace) rice that were grown in two conditions under drought stress and normal as randomized complete block design with three replications in Sangar Rasht, Iran. The 18 plant characteristics including morphological traits, yield and yield components were measured. The results of ANOVA revealed for all traits differences among genotypes were significant at 0.01 probability level that showing high level diversity and different reaction of varieties among genotypes under two conditions. The cluster analysis assigned all genotypes in three groups in each condition. In normal condition second group with 21 memberships including 14 aerobic genotypes and 7 lowland genotypes gained average of yield traits such as grain yield, weight of total plant panicle, weight of main stem panicle, number of total grain, number of filled grains higher than other genotypes. Under drought stress condition the most desirable genotypes belonged to the second group. This group contains 19 aerobic genotypes and 4 lowland genotypes in term of traits related to yield including weight of total plant panicle, weight of main stem panicle, grain yield, dry weight of plant, 1000 grain weight, number of total grain and number of filled were better than other genotypes. Totally 11 aerobic genotypes and 2 lowland genotypes (Dorfak and Gohar) were in better group in term of grain yield and yield components.

In maintenance therapy for opioid addiction, to reduce the risk of buprenorphine (BUP) abuse, the combination of BUP and naloxone (NX) has been developed and is commercially available as suboxone (BUP/NX). This study was designed to compare addiction relapse frequency in patients receiving BUP and BUP/NX as maintenance therapy.
In this double-blind clinical trial with cross over design, 100 opioid abusers were randomly assigned to two treatment groups to receive either BUP or BUP/NX. After three months, without a time-out period, subjects undertook treatment with the other drug. The subjects were screened weekly for urinary morphine.
In each of the study arms, when the patients were given BUP/NX, the number of relapses was significantly higher compared to when they received BUP (0.13±0.24 vs. 0.04±0.09, P = 0.001). If participants’ age was taken into account, the number of relapses was significantly higher when BUP/NX was given in age groups of 31 to 40 years and over 50 years (P BUP seems to be more effective than BUP/NX in preventing addiction relapse in opioid abusers under maintenance treatment.

Envenomation is common in Asia including Iran that induces morbidity and mortality. This study investigated the epidemiological characteristics of cases with snake, spider and scorpion bites.
In this cross-sectional design, epidemiologic data of admitted cases to the Toxicology Department of Imam Reza Hospital of Mashhad, Iran were analyzed across a 7-yr period, from 2004 to 2011. SPSS was used for data analysis.
This study reports 686 admissions due to animal envenomation with an incidence rate of 2.9 per 100000. Mean (SD, min-max) age of admitted patients was 30 (19, 1-90) yr, and 471 (69%) were male. Snakebite (n, percentage, annual incidence) (299, 44%, 1.3 per 100000) and spider bite (188, 27%, 0.8 per 100000) and scorpion sting (126, 18.4%, 0.5 per 100000) were most frequent cases. Overall, case fatality rate was 0.09 per 100000 which were due to scorpion and unknown bite. No cases of snakebites died in this period. The highest age-specific incidence rate was 4.6 per 100000 and related to 10-20 yr of age.
Animal envenomation is frequent in this area and a matter of health concern. While deaths related to snake bite are no longer reported-presumably due to using effective anti-venom - managing unknown and scorpion bites need to be addressed. Envenomation was not overtly an age-specific event in this province.

In the present experiment in order to identify tolerant rice genotypes to drought stress using tolerance indices, 53 rice genotypes including 31 aerobic rice and 22 lowland rice evaluated under normal and drought stress conditions by withholding water since 30 days after transplanting of the maximum tillering stage of rice until the end of growth period on cropping seasons of 2014 in the Sangar section of Rasht. The results revealed four indices; mean productivity (MP), geometric mean productivity (GMP), stress tolerance index (STI) and yield index (YI) have the highest correlation with grain yield under normal (YP) and drought (YS) stress conditions. Grouping of genotypes using cluster analysis divided all of genotypes to three groups including tolerant, semi tolerant and sensitive. The seven genotypes contain genotypes IR81024-B-254-1-B, IR82590-B-B-32-2, IR82635-B-B-82-2, IR82639-B-B-140-1 and Panda and two lowland varieties Dorfak and Sadri assigned to tolerant group. Out of these seven genotypes, the minimum of yield loss were for IR82590-B-B-32-2, Panda and IR81024-B-254-1-B with 1.28, 4.28 and 4.86 percent yield loss.The principle component analysis on the indices showed two first components explained 58 and 40 percent (totally 98 percent) of all variation. The biplot derived from graphical analysis in addition to confirmation of cluster analysis results showed the GMP, MP, YI and STI are the best indices in detecting of tolerant genotypes. Also the best genotypes under normal condition were included Dorfak, IR82639-B-B-140-1, IR82635-B-B-82-2 and IR82590-B-B-32-2 and under drought stress genotypes of IR82590-B-B-32-2, Panda, IR81024-B-254-1-B and Dorfak identified as the best genotypes.

Toxic mushrooms are distributed across the globe with over 5000 species. Among them, 100 species are responsible for most of the cases of mushroom poisoning. This study aimed to evaluate the epidemiologic pattern of mushroom poisoning among patients referred to the main toxicology center of Mashhad province located in North-east of Iran.

This cross-sectional study was conducted on patients with final diagnosis of mushroom poisoning referred to the toxicology center of Mashhad, Iran, from February 2005 to 2011. Patients’ demographic characteristics, clinical presentations, laboratory findings, outcomes, and therapeutic measures were collected using a predesigned checklist and searching patient’s profile.

32 cases with the mean age of 24.6 § 16.7 years were presented to the toxicology center following mushroom poisoning (59% female). Mushroom poisoning accounted for 0.1% of all admitted cases. The mean time elapsed from consumption to referral to poisoning department was 61.9 § 49.4 hours. 19 (59%) cases were discharged with complete recovery, 7 (22%) expired, and 6 (19%) cases left hospital against medical advice. Mushroom poisoning mortality accounted for 1.5% of deceased cases in the studied center. Therewas significant relationship between mortality rate and higher values of INR (p = 0.035), PT (p = 0.011) and PTT (p = 0.003). Likewise, there was significant relationship between the need for mechanical ventilation and higher values of INR (p = 0.035), PT (p = 0.006) and PTT (p = 0.014). The relationships between the need for ICU admission, mechanical ventilation, and mortality rate with the rise of hepatic transaminases and serum bilirubin were not significant.

Based on the findings, the prevalence of mushroom poisoning among patients referred to Mashhad toxicology center was very low (0.1%), but with a high mortality rate of 22%. Nausea and vomiting were the most common early symptoms of intoxication and higher values of coagulation profile were correlated with poor outcome.