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Characteristics, sources and health risks of atmospheric PM10-bound polycyclic aromatic hydrocarbons (PAHs) on residents living in different regions of Ahvaz, Southwest Iran were investigated during 2016-2017. 84 samples were taken from the different regions: (S1) industrial; (S2) high traffic and (S3) residential sites in Ahvaz metropolitan. Urinary samples were collected from people who came to the east health center of Ahvaz. Urinary 1-hydroxypyrene and PAHs levels were analyzed by Gas Chromatography with Mass Spectrometry (GC/MS). Exposure and risk assessment (Incremental Lifetime Cancer Risk (ILCR), Lifetime Average Daily Dose (LADD) and hazard index (HI)) of these pollutants were estimated, using USEPA's exposure parameters. Results of this study showed that in the air of residential and industrial areas observed the lowest and the highest level of PAHs, respectively. High molecular weight compounds (2-4rings), contributed to 85 of n-ary sumation PAHs mass in the atmospheric PM10-bound samples. Industrial processing and petroleum refining, were identified to be major outdoor resources of PAHs. Based on the result of this study, the highest and the lowest concentration of PAHs metabolites were observed in the industrial and residential areas. Average urinary 1-hydroxypyrene levels of S1, S2 and S3 regions were 0.4735; 1.311 and 1.4942 ng/dL, respectively. The values of ILCR in cold (0.06913) and warm (0.052854) seasons were higher than EPA which, was significantly correlated with the concentration of PAHs. In conclusion, increasing exposure concentration of polycyclic aromatic hydrocarbons would have a significant potential for increased ILCR and risk of health endpoint. ILCR in different areas was significantly higher than standard. Our results show that the air quality of Ahvaz city was in an unfavorable condition and increasing exposure concentration of PAHs would have a significant potential for increased ILCR and risk of diseases.

Introduction There is limited information on the risk factors of epidemiological of bronchial asthma in adults. This research aims at studying the risk factors associated with asthma in adults. Methods The validated European Community Respiratory Health Survey questionnaire was used to conduct a field study on adults aged 20–65 years old in Khuzestan province, Iran. For this, the researchers used a two-stage cluster sampling method. Univariate and multiple logistic regression modeling were used to obtain odds ratio of potential risk factors. Results The researchers handed out 5720 questionnaires of which 5708 were filled in. 231 cases of 478 individuals with asthma were male. The results showed that having airway hyper responsiveness (OR = 13.52; 95% CI: 9.61–19.02), having a family history of asthma (OR = 2.88; 95% CI: 2.23–3.71), residence in urban areas (OR = 2.15; 95% CI: 1.43–3.21), the presence of mildew in the building (OR = 1.95; 95% CI: 1.29–2.92) and the location of the house in the main street with respect to the auxiliary road (OR = 1.44; 95% CI: 1.14–1.82), respectively, were the most potent risk factors for asthma in adults. However, the presence of dense green space in the 200-m radius of the residential home (OR = 1.69; 95% CI: 1.30–2.20) and home gardening (OR = 1.42; 95% CI: 1.12–1.80) are the most important protection factors against asthma. Conclusions This study showed the association between some environmental factors with the odds of having asthma. These factors can be considered in primary prevention programs for asthma.

A disastrous outbreak of thunderstorm-induced asthma attacks posed a major public health threat in Ahvaz, Iran in autumn of 2013 (>15,000 referrals to hospital emergency rooms and pulmonary clinics). City officials claimed that promoting factors included acid rain, particulate matter, ozone, and polycyclic aromatic hydrocarbon compounds (PAHS) could lead to this phenomenon. After these potential causes were rejected by careful research, the next possible cause that this study addresses is a potential link of the asthma attacks to airborne pollen grains and fungal spores. In order to sample these parameters, a Hirst-type volumetric spore sampler was used, which was installed on the rooftop of the sampling site. Sampling was done during two six-month periods to characterize the regional bioaerosol. The first period included the autumn (September 22 to December 20 of 2016) and winter seasons (December 21 of 2016 to March 19 of 2017), while the second period included the following autumn (September 23 to December 21 of 2017) and winter seasons (December 22 of 2017 to March 20 of 2018). In both studied periods, airborne weed pollen grains, especially Amaranthaceae sp., were by far the greatest contributor to total airborne pollen grain concentrations (50.45%, 3757 pollen grains/m3 and 52.12%, 2392 pollen grains/m3, respectively). Among fungal spores, Cladosporium had the highest concentrations (75.29%, 258677 spores/m3 and 80.33%, 247693 spores/m3, respectively). Findings also showed that concentrations of airborne pollen grains were higher in autumn seasons (6361 and 4167 pollen grains/m3, respectively) in comparison with winter seasons (1085 and 423 pollen grains/m3, respectively), while the concentrations of fungal spores were enhanced in winter seasons (189216 and 160962 spores/m3, respectively) versus autumn seasons (154377 and 147377 spores/m3, respectively). Fungal spores exhibited a uniform distribution during the entire study period, but airborne pollen grains were significantly higher in autumn seasons. The numbers of referrals associated with thunderstorm asthma attacks decreased drastically after implementing Conocarpus erectus tree pruning activities. We concluded that the autumnal thunderstorm asthma attacks in Ahvaz might be triggered by a combination of bio-allergens (fungal spores and airborne pollen grains such as from Conocarpus erectus) and high levels of air pollutants from industrial activity. The results of this work suggest controlling bio-allergen levels by preventive measures such as tree pruning, weed removal, and emasculating urban green infrastructures before the flowering season.

Background Asthma and allergic complications are the most common chronic disorders in children and adolescents. This study aimed to determine the prevalence and severity of asthma, allergic rhinitis, eczema among schoolchildren, and some related risk factors. Methods The cross-sectional study was performed in 2019 and involved 4000 students aged 6–7 years and 4000 students aged 13–14 years (both girls and boys) from urban schools in Khuzestan Province, southwestern Iran. We used the multi-stage sampling method. Data were collected using the Persian version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Results The prevalence of current wheeze, wheeze ever and asthma ever in the age group of 6–7 years was 3.8, 4.5, and 1.8%, respectively; in the age group of 13–14 years, it was 4.4, 5.9, and 3.4, respectively. In terms of gender, males (4.9, 6.0, and 2.7 percent, respectively) had substantially higher rates of current wheeze, wheeze ever, and asthma ever compared to the girls (2.8, 3.6, and 2.0 percent, respectively) (p p p p Conclusions The prevalence and severity of asthma symptoms were significantly associated with allergic rhinitis, eczema, and gender.

More than a year after the onset of the coronavirus disease pandemic in 2019, the disease remains a major global health issue. During this time, health organizations worldwide have tried to provide integrated treatment guidelines to control coronavirus disease 2019 (COVID-19) at different levels. However, due to the novel nature of the disease and the emergence of new variants, medical teams' updating medical information and drug prescribing guidelines should be given special attention. This version is an updated instruction of the National Research Institute of Tuberculosis and Lung Disease (NRITLD) in collaboration with a group of specialists from Masih Daneshvari Hospital in Tehran, Iran, which is provided to update the information of caring clinicians for the treatment and care of COVID-19 hospitalized patients.

Objectives To compare the therapeutic effects of high-flow-oxygen-Therapy (HFT) and noninvasive-ventilation (NIV) for stabilizing chronic obstructive pulmonary disease during exacerbation. Methods In this randomized clinical trial at Masih-Daneshvari hospital, between July 2019 and Oct 2019, 30 exacerbated-COPD-patient with PaCO2 64.58 ± 11.61 mm Hg, Respiratory Rate 24.43 ± 2.75, and PH 7.31 ± 0.02 were divided into two groups, N = 15. By a simple randomized allocation, patients receive either NIV or HFT for 1 hour, and following a washout period of 30 minutes, they switched to the other treatment option. Arterial Blood Gas Parameters, as well as Respiratory Rate (RR), Dyspnea Score, Heart Rate (HR), and Oxygen Saturation (SO2 ), were compared before and after the intervention and between groups. Results Baseline patient characteristics were similar in the two groups. Pre and post-analysis revealed that in both groups, all improved significantly. After the first period, there was no difference in all parameters between groups except for SO2 which was significantly higher in HFT (%92.1 ± 1) than that of NIV (%89 ± 1), P = .001. Likewise, following the washout period, patients in HFT and NIV had a dyspnea score of 1.93 ± 0.7 and 2.73 ± 0.9, respectively, P = .01. No carryover-effect and was observed but the period effect was significant for some outcomes. A significant improvement in SO2 and HR was observed by HFT according to treatment effect by combining two periods' results. During the study, no side effects were reported. Conclusion In this short-term study HFT appears feasible for patients with COPD exacerbation to reduce dyspnea score and improve respiratory distress.

Climate change may be associated with human morbidity and mortality through direct and indirect effects. Ahvaz is one of the hottest cities in the world. The aim of this study was to investigate the relation between physiological Equivalent Temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran. Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on death. The effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted.The results showed that in cold stress [1st percentile of PET (2.7 °C) relative to 25th percentile (11.9 °C)] the risk of total respiratory mortality, respiratory mortality in men, and mortality in people under 65 year olds, significantly decreased in the cumulative lags of 0–2, 0–6 and 0–13; but the risk of respiratory mortality increased in the elderly and in the final lags. In contrast, heat stress [99th percentile of PET (44.9 °C) relative to 75th percentile (43.4 °C)] significantly increased the risk of total cardiovascular mortality (CVD), cardiovascular mortality in men, ischemic heart disease and cerebrovascular disease mortality in lags 0 and 0–2. It seems that high PET values increase the risk of cardiovascular mortality, while low PET values increase respiratory mortality only among the elderly in Ahvaz.

Aim: Transbronchial cryobiopsy(TBC) is a new technique in obtaining large tissue samples in diffuse interstitial lung disease(DILD) with high diagnostic yield comparable to surgical lung biopsy(SLB). Yet, the exact role of SLB in pathologic diagnosis(DX) of DILD is unclear when TBC provides no definite diagnosis. We evaluated the rate of definite DX by SLB when TBC was not diagnostic in DILD patients. Method: Consecutive consenting DILD patients(n=26) underwent TBC. An individual experienced lung pathologist(ELP) examined all the specimens. Pattern-based histopathological approach was used in examining the samples. If analysis of TBC specimens showed unclassifiable DILD, the cases would be reviewed at multidisciplinary discussion(MD) including clinicians, radiologists, and a different EPL.MD diagnosis(MDD) was recorded for each case. Then they underwent SLB. The primary outcome was diagnostic yield of SLB in unclassifiable DILD by TBC. The secondary outcome was agreement of MD diagnosis and SLB pathologic diagnosis. Result:26 patients (male=18, age:48±12yrs) were enrolled. TBC reached the specific diagnosis in 73%patients (n= 19). In the remaining, pathologic exam showed indeterminate pattern of fibrosis and cellular infiltrates; unclassifiable DILD (27%).In the 7 with non-diagnostic TBC, SLB reclassified only 3 to definite diagnoses (43%).There was high agreement between SLB diagnosis and MDD in these 3 (100%). In the remaining(n=4), SLB was non-diagnostic and didn’t reclassify to alternative diagnosis rather than MDD. Conclusion: In case of unclassifiable DILD by TBC, MD might be more helpful than SLB.

Air pollution is likely to have adverse effects on human health. This study was conducted to determine the effect of air pollution on respiratory disease hospital admission in Ahvaz, one of the most polluted cities in the Middle East. Daily information about respiratory disease admissions and air pollutants during 2008–2018 were inquired. Adjusted Quasi-Poisson regression combined with linear distributed lag models were used. There was a significant relation between increased O3 and respiratory hospital admissions for 65–74 year olds, ≥75 year olds, and pyothorax-abscesses of the lung and mediastinum; between increased NO and respiratory hospital admissions for ≥75 year olds, chronic lower respiratory diseases, diseases of upper respiratory tract and respiratory diseases principally affecting the interstitium; between increased NO2 and respiratory hospital admissions for ≥75 year olds; between increased CO and respiratory hospital admissions and between increased SO2 and respiratory hospital admissions for ≥75 year olds. The risk of respiratory hospital admissions increased in both males and females for increase in PM2.5. Ambient O3, NO, NO2 CO and SO2 can increase admission for respiratory diseases on the same day and at short lags in Ahvaz. This evidence emphasizes the need to implement policies for reducing air pollution.

The aim of this study was to determine the correlation between PM2.5 and NO2 pollutants and oxidative stress marker (8-isoprostane) and lung function tests (FVC and FEV1) in healthy children who were living and studying in three different areas of Ahvaz city including A1: Naderi site with high traffic, A2: Alavi Alley site with average traffic, and A3: Ein 2 site with low traffic (a rural area on the suburb of Ahvaz). 30 students in the 12–13 year-old range were selected from each studied zone (1, 2 and 3 sites) during three months of year. Of each student, one sample was taken every two weeks to measure 8-isoprostane of exhaled breath condensate (EBC). Air pollution data were collected from three air quality monitoring stations. Also, the relationship between air pollution and 8-isoprostane as well as lung function tests were determined using generalized estimating equations (GEE). The mean concentration of PM2.5 and NO2 in A1, A2 and A3 areas were 116, 92 and 45 (μg/m3) also 77, 53 and 14 (ppb) respectively. Among all studied students, there was a significant correlation between the increase of mean concentration of PM2.5 and NO2 in 1–4 before sampling day, increased 8-isoprostane concentration and decreased FEV1, while there was no significant correlation between them and decreased FVC. In A1 site, an increase in IQR (13 μg/m3) PM2.5 and IQR (6.5 ppb) NO2 on 1–4 days before sampling was associated with 0.38 unit (95% CI: 0.11, 0.65) and 1.1 unit (95% CI: 0.85, 1.35) increase in 8-isoprostane concentration, also decreased 121 ml and 190 ml FEV1, respectively. Results showed that the short-term exposure to traffic-related air pollution can decrease the values of lung function indices and increase the oxidative stress. It may adversely affect children’s lungs. Keywords: Air pollution, Lung function, 8-Isoprostane, Traffic, Ahvaz, Iran

Background: The medical profession has always been an inspiration for human societies throughout its diverse history. This position and historical authority in the field of ethics has had a different and higher status, in such a way that many of the norms of general ethics and professional ethics, especially principles, such as trust, confidentiality and respect for human dignity, have been developed by medical professionals. Developing guidelines of general and professional ethics is one of the inherent duties of the Medical Council of the Islamic Republic of Iran (IRIMC) as a professional organization. In this regard, the Supreme Council of IRIMC has approved the "Code of Ethics for Medical Professionals" and, in accordance with its legal authority, has annexed it to the disciplinary regulations of IRIMC. Methods: A draft document, the result of extensive literature review, was discussed in 27 expert panel meetings and after receiving and endorsing the stakeholders’ point of view, was approved by the IRIMC Supreme Council. Results: The first edition of "Code of Ethics for Medical Professionals, Medical Council of Islamic Republic of Iran" was developed on July 6, 2017 by the Supreme Council of IRIMC. The guideline was set to take effect one year after its enactment. The first edition was revised and completed and final edition was adopted on August 9, 2018 by IRIMC in 13 chapters and 140 articles (original full text is available in the Supplementary file 1). Conclusion: According to the approved decision by the Supreme Council of IRIMC on May 10, 2018, the final edition takes effect as of October 7, 2018.

The aim of this study is to evaluate the clinical pattern of thunderstorm asthma (TA) and the possible environmental hypotheses involved in the escalation of these epidemics.This retrospective descriptive study examined patients with respiratory problems referred to the clinics and emergency departments in Ahvaz, Iran during 2013-2016 periods following the first episodes of rainfall in autumn. The seasonal profile of airborne pollens and fungal spores in Ahvaz were characterized and clinical and spirometry findings of 443 patients were evaluated.Of 56,000 people referred to the emergency department due to respiratory problems associated with the first rainfall in Khuzestan province, 91.4% displayed asthma-like symptoms and 71.3% had a history of allergic rhinitis. According to the results of spirometry test 38%, 52.9%, and 9.1% of patients had normal, obstructive, and restrictive patterns, respectively. Our results highlight the importance of allergic rhinitis as risk factors of TA epidemics. In terms of pollen, seasonal pollen integral was much higher in autumn than in winter.Our results highlight the importance of seasonal allergy and rhinitis as risk factors for thunderstorm asthma epidemics.

This study reports on the characteristics, sources, and health risks of atmospheric PM10-bound heavy metals (HMs) on citizenship living in different regions of Ahvaz, Southwest of Iran were investi...

Nowadays, a large number of health endpoints such as disease rates, treatment costs, and death, by air pollutants, have been a serious health problem for humans. One of the most hazardous air pollutants, which is highly dangerous for human health, is polycyclic aromatic hydrocarbons (PAHs). The existence of the emission of industries’ pollutants and seasonal variations are the primary agents affecting PAHs’ concentration. The purposes of this study were to calculate the cancer risk and measure PAHs’ exposure in the ambient air of Ahvaz, southwest of Iran, during 2017. Three distinct areas ((S1) industrial, (S2) high traffic, and (S3) residential) of Ahvaz metropolitan were selected. Omni sampler equipped with polytetrafluoroethylene (PTFE) filters were used for active sampling of PAHs. To detect the level of PAHs, gas chromatography with mass spectrometry (GC/MS) was used. Incremental lifetime cancer risk (ILCR) and lifetime average daily dose (LADD) were used to estimate the health risk caused by PAHs. The results showed that the residential and industrial areas had the lowest and highest level of PAHs. Moreover, the average levels of PAHs in industrial, high traffic, and residential areas were 8.44 ± 3.37, 7.11 ± 2.64, and 5.52 ± 1.63 ng m−3, respectively. Furthermore, ILCR in autumn and winter was higher than EPA standard, 0.06307 and 0.04718, respectively. In addition, ILCR in different areas was significantly higher than standard. Research findings imply that the levels of exposure to PAHs can increase ILCR and risk of health endpoint. The cancer risk attributed to PAHs should be further investigated from the perspective of the public health in metropolitans.

Heavy metals (HM) are one of the main components of urban air pollution. Today, megacities and industrial regions in southwest of Iran are frequently suffering from severe haze episodes, which essentially caused by PM10-bound heavy metals. The purpose of this study was to evaluate the health risk assessment on human exposed to heavy metals (Cr, Ni, Pb, and Zn) in the ambient air PM10 in Ahvaz, southwest Iran. In this study, we estimated healthy people from the following scenarios: (S3) residential site; (S2) high-traffic site; (S1) industrial site in Ahvaz metropolitan during autumn and winter. In the current study, high-volume air samplers equipped with quartz fiber filters were used to sampling and measurements of heavy metal concentration. Inductively coupled plasma optical emission spectroscopy (ICP-OES) was utilized for detection of heavy metal concentration (ng m−3). Also, an estimate of the amount of health risk assessment (hazard index) of Cr, Ni, Pb, and Zn of heavy metal exposure to participants was used. Result of this study showed that the residential and industrial areas had the lowest and the highest level of heavy metal. Based on the result of this study, average levels of heavy metal in industrial, high-traffic, and residential areas in autumn and winter were 31.48, 30.89, and 23.21 μg m−3 and 42.60, 37.70, and 40.07 μg m−3, respectively. Based on the result of this study, the highest and the lowest concentration of heavy metal had in the industrial and residential areas. Zn and Pb were the most abundant elements among the studied PM10-bound heavy metals, followed by Cr and Ni. The carcinogenic risks of Cr, Pb, and the integral HQ of metals in PM10 for children and adults via inhalation and dermal exposures exceeded 1 × 10−4 in three areas. Also, based on the result of this study, the values of hazard index (HI) of HM exposure in different areas were significantly higher than standard. The health risks attributed to HM should be further investigated from the perspective of the public health in metropolitans. The result of this study showed increasing exposure concentrations to heavy metal in the studied scenarios have a significant potential for generating different health endpoints, while environmental health management in ambient air can cause disorders in citizenship and causing more spiritual and material costs.

Living in areas with high air pollution may have adverse effects on human health. There are few studies about the association between breathing polluted air and adverse pregnancy outcomes in the Middle East. The aim of this study was to determine the relationship between air pollution and spontaneous abortion, premature birth, and stillbirth in Ahvaz. A time-series study was conducted. Data about spontaneous abortion, premature deliveries, and stillbirth was collected from Ahvaz Imam Khomeini Hospital. Air pollution data including NO, CO, NO2, PM10, SO2, O3, and climate data were, respectively, collected from the Environmental Protection Agency and the Khuzestan Province Meteorology Office from March 2008 until March 2015. The relationship between air pollutants with the number of abortions, premature births, and stillbirths was found using a quasi-Poisson distributed lag model, adjusted by trend, seasonality, temperature, relative humidity, weekdays, and holidays. The average daily dust in Ahvaz on 7.2% days of the year was higher than 500 μg/m3 (very dangerous). Findings from this study indicate a significant association between each 10-unit increase in SO2 and spontaneous abortion in lag 0 and 9 days. There was a significant relation between each 10-unit increase in NO2 and CO, and premature birth in lag 0. Also, we found a significant association between each 10-unit increase in CO and premature delivery in lag 1; PM10 and premature delivery in lags 10, 11, and 12; and NO and premature delivery in lags 3, 4, 10, 11, 12, and 13 (p value

The aim of this study is to survey the concentrations of air pollutants in rural and urban areas in Ahvaz city during two seasons. We used ANOVA to determine the differences between the areas. Paired t-test was used to compare the concentrations of the air pollutants in cold season and hot season. The concentration of the air pollutants in cold season was higher than warm season except for O3. Mobile vehicles represent the major source of air pollution in many areas, and the concentrations of traffic pollutants are greater near urban areas. The trend of changes in PM concentration in cold and warm seasons depends on dust storms occurrence.

Polycyclic aromatic hydrocarbons (PAHs) are one of the main components of urban air pollution. The level of concentration PAHs and effects are depended on seasonal variations and amount of exposure to PAHs. Nowadays, PAHs are one of the important pollutants that threat the public health. The purpose of this study was to evaluate the polycyclic aromatic hydrocarbons of the outdoor air in Ahvaz, southwest Iran using active sampling system during the warm and cold seasons of 2016. Data collection was performed daily during the study period in three stations in Ahvaz citizens at industrial, high traffic and residential areas. Omni sampler and equipped with PTFE filters (8*10) were utilized for sampling in this study. Gas chromatography with mass spectrometry (GC/MS) were utilized for detection of PAHs concentration (ngm−3). Statistical SPSS software (SPSS version 16) was used to determine the effects of PAHs during warm and cold season. According to result this study, the industrial and residential ar...

Children are the vulnerable group at risk of adverse health effects related to air pollution due to dust storm in Ahvaz. The purpose of this study was to compare the values of fractional exhaled nitric oxide (FENO) and lung functions as parameters of adverse health effects of particulate matter (PM) in dusty and normal (non-dusty) days in elementary schoolchildren. The study was conducted among elementary school students in Ahvaz. The healthy elementary schoolchildren (N = 105) were selected from different districts for FENO and lung function sampling during the dusty and normal days. The values of PM10 and PM2.5 during dusty days were higher than during normal days. Mean values of FENO during the normal and dusty days were 14.23 and 20.3 ppb, respectively, and the difference between these values was statistically significant (p

Ozone is a highly oxidative compound and is one of the important pollutants present in the atmosphere and at ground level. Concentration of ground-level ozone (GLO) pollutant depends on different factors such as the amount of VOC and NOX, heat and location in the atmosphere. Ozone can cause health effects such as problems to breathe deeply and vigorously, inflame and damage the airways, bronchitis, reduced lung function in children and adults, emphysema and increase the frequency of asthma attacks. In this work, we focused on the determination of number of hospital admissions associated with ozone in Ahvaz with population of 1 000 000, during 2013. In this study, ozone data collections were through Iranian Environmental Protection Agency (Iranian EPA) and Meteorological Organization. Ozone data and meteorological parameters were used in Excel software to prepare input file of AirQ model. After running model, outputs presented in term of hospital admissions of ozone exposure were calculated. Accord...

Background and Objectives: Ahvaz has become one of the most polluted cities in the world. Only on 11 November 2013, over one thousand residents in Khuzestan Province attended the nearest health center with severe symptoms, particularly shortness of breath, cough, wheezing, and high blood pressure. During a week, more than 7 thousand patients were registered with this syndrome. This study was conducted to investigate the evidence for the confirmation of an epidemic in acute respiratory syndrome among the residents of Ahwaz in November 2013. Methods: In this cross-sectional study, we evaluated the data of the use of drugs related to acute respiratory attacks from November 2008 to 2013 in Ahvaz. Then, we conducted a descriptive study on the general population. The sample size was 120 and the study participants included different segments of the general population. The data collection tool was a researcher-made questionnaire and the data were analyzed using SPSS.18. Results: The use of the respiratory drugs increased from 2008 to 2013. The drug consumption was markedly higher in November 2013. In the study of the general population, 93% of the participants declared that they had never seen a similar event, and 92.5% mentioned that they had never heard of a similar occurrence. Conclusion: Due to the significant increase in respiratory medicine in November 2013 and the unexpected nature of the event, an epidemic seems to be obvious.

Reports on the effects of PM10 from dust storm on lung cells are limited. The main purpose of this study was to investigate the chemical composition and in vitro toxicological impacts of PM10 suspensions, its water-soluble fraction, and the solvent-extractable organics extracted from Middle Eastern Dust storms on the human lung epithelial cell (A549). Samples of dust storms and normal days (PM10200 μg m(-3)) were collected from December 2012 until June 2013 in Ahvaz, the capital of Khuzestan Province in Iran. The chemical composition and cytotoxicity were analyzed by ICP- OES and Lactase Dehydrogenase (LDH) reduction assay, respectively. The results showed that PM10 suspensions, their water-soluble fraction and solvent-extractable organics from both dust storm and normal days caused a decrease in the cell viability and an increase in LDH in supernatant in a dose-response manner. Although samples of normal days showed higher cytotoxicity than those of dust storm at the highest treated dosage, T Test showed no significant difference in cytotoxicity between normal days and dust event days (P value0.05). These results led to the conclusions that dust storm PM10 as well as normal day PM10 could lead to cytotoxicity, and the organic compounds (PAHs) and the insoluble particle-core might be the main contributors to cytotoxicity. Our results showed that cytotoxicity and the risk of PM10 to human lung may be more severe during dust storm than normal days due to inhalation of a higher mass concentration of airborne particles. Further research on PM dangerous fractions and the most responsible components to make cytotoxicity in exposed cells is recommended.

Background Health information on the dimensions of asthma and allergic conditions in Khuzestan Province, as a major industrial and polluted area in Iran as and the Middle East, is inadequate. This study was performed to measure the prevalence of asthma and other allergic conditions in adults in Khuzestan Province. Methods This population-based cross-sectional study was carried out in 17 villages and 27 cities of Khuzestan Province during the years 2017–2018 on 20 to 65 year old respondents. Two-stage cluster sampling was used. The ECRHS (European Community Respiratory Health Survey) questionnaire was completed for individuals with additional questions regarding other allergic conditions. Results In the study, 5720 questionnaires were distributed of which 5708 were returned. The prevalence of current asthma was 8.5% and that of asthma-like symptoms was 19.0%. The most common symptoms of asthma were nocturnal cough (13.6%), chest tightness (12.3%) and wheezing (13.1%). The prevalence of allergic rhinitis (AR), eczema and airway hyperresponsiveness were 27.2, 10.7, and 38.7%, respectively. The prevalence of current asthma was strongly correlated with age, current location (city, village), and the smoking status of respondents (p

Background: The aim of the present study was threefold: to assess the association between baseline FEF25-75 and Airway Hyper-responsiveness (AHR), to specify whether a decrease in FEF25-75 may reflect severe hyper-responsiveness, and finally to confirm a FEF 25-75 cut-off value. Materials and Methods: In a cross sectional study in Imam Khomeini Hospital, Ahvaz, patients suffering from respiratory symptoms due the 2013 autumn rainfall with normal FEV1 and FEV1/FVC were evaluated by methacholine challenge test. Those with PD202000 μg were classified as severe, moderate and mild AHR, respectively. Data were analyzed using Chi-square, Independent t-test, One-way ANOVA and Receiver Operating Characteristic (ROC) curve. Results: Among the 234 patients, mean baseline FEF25-75 was 84.2±22.7% for 54 patients having a negative bronchial provocation test result and 70.9±19.2% for 179 patients with a positive bronchial provocation test result (P < 0.0001). No change was observed in the median PD20 among patients with a higher baseline FEF25-75. ROC analysis showed that FEF25-75 could potentially be a predictor of AHR, but it could not confirm the cut-off value of FEF25-75 for these patients. Conclusion: When asthma begins, AHR could be predicted by impaired FEF25-75 with normal FEV1 and FEV1/FVC. However, we could not determine a cut-off value, and no association was found between a greater impairment of FEF25-75 and a more severe AHR.

Background & Aims of the Study : Ground-Level Ozone (GLO) is the component of one of greatest concern that threatened human health in both developing as well as developed countries. The GLO mainly enters the body through the respiration and can cause decrements in pulmonary complications, eye burning, shortness of breath, coughing, failure of immune defense, decreases forced vital capacity, reduce lung function of the lungs and increase rate of mortality. Ahwaz with high emission air pollutants because of numerous industries is one of the metropolitan Iranian polluted. The aim of this study is evaluate to Chronic Obstructive Pulmonary Disease (COPD) and respiratory mortality related to GLO in the air of metropolitan Ahvaz during 2011. Materials & Methods: We used the generalized additive Air Q model for estimation of COPD and respiratory mortality attributed to GLO pollutant. Data of GLO were collected in four monitoring stations Ahvaz Department of Environment. Raw data processing by Excel software and at final step they were converted as input file to the Air Q model for estimate number of COPD Cases and respiratory mortality. Results: According to result this study, The Naderi and Havashenasi had the highest and the lowest GLO concentrations. The results of this study showed that cumulative cases of COPD and respiratory mortality which related to GLO were 34 and 30 persons, respectively. Also, Findings showed that approximately 11 % COPD and respiratory mortality happened when the GLO concentrations was more than 20 μg/m 3 . Conclusions: exposure to GLO pollution has stronger effects on human health in Ahvaz. Findings showed that there were a significant relationship between concentration of GLO and COPD and respiratory mortality. Therefore; the higher ozone pollutant value can depict mismanagement in urban air quality. &nbsp

Background & Aims of the Study: Among the environmental pollutions, noise pollution, due to the potential physiological and psychological effects on humans, is of a particular importance. Exposure to noise can result in hearing loss in citizens. Health risks from noise associated with road traffic. Noise health effects are the health consequences of elevated sound levels. This study was conducted to evaluate the noise pollution and health effects due to near roadway in Ahvaz, Iran. Materials & Methods: In this descriptive-cross sectional study, Equivalent sound pressure level was measured by sound level meters in 75 points in 4 roadways, which have high density of traffic in Ahvaz city during daytime. In them, at measuring stations, on 4 days of week, at three times totally 1038 measurements were recorded that including 6 parameters of traffic noise and each measurement was recorded for 30 minutes. SPSS software’s were applied for statistical analysis. Results: According to the research findings, the equivalent sound pressure levels in all stations were equal to 72.36±2.87 dB. Based on result of this study the highest noise health effects were the nervousness and sleep quality. Conclusions: Based on the results of this study, increasing trends of traffic load there is an increasing need for proper consideration plans organizations.

Purpose To evaluate the effects of oxygen therapy on corneal edema after cataract surgery. Setting Imam Khomeini Hospital, Ahvaz, Iran. Design Randomized controlled trial. Methods Patients with severe corneal edema were randomized into 3 groups. Group 1 (control) received conventional therapy including topical sodium chloride, timolol, and betamethasone. Group 2 received the same therapy in addition to systemic normobaric oxygen at a flow rate of 10 L/min for 1 hour twice daily for 3 weeks. Group 3 received conventional therapy and transcorneal oxygen at a flow rate of 5 L/min for 1 hour twice daily for 3 weeks. Preoperative pachymetry and specular microscopy were performed. Pachymetry was performed 1, 3, 5, 7, 10, and 14 days postoperatively. At 1, 3 and 12 months, pachymetry and specular microscopy were performed. Results The study enrolled 45 patients. Preoperatively, there was no significant difference between the groups. Pachymetry was more than 1000 μm 1 day postoperatively in all patients. The preoperative pachymetry was restored in 14 days in Group 3 only. After 1 year, the endothelial cell count (ECC) was 1603 cells/mm 2 , 1693 cells/mm 2 , and 1911 cells/mm 2 with a loss of 37%, 32%, and 25% in Group 1, Group 2, and Group 3, respectively ( P = .034, Groups 1 and 3). Group 3 had a higher ECC than the control group at 3 months ( P = .037) and 1 year ( P = .025). One patient in Group 1 and 1 patient in Group 2 developed bullous keratopathy. Conclusion Transcorneal oxygen decreased corneal edema more rapidly than conventional and systemic oxygen therapies and preserved more endothelial cells than conventional therapy. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Heavy metals (HM) are one of the main components of urban air pollution. Today, megacities and industrial regions in southwest of Iran are frequently suffering from severe haze episodes, which essentially caused by PM

The aim of this study was to report the characteristics and treatment strategies of all patients with acute bronchospasm who were presented to the emergency departments of Ahvaz, Iran, following the occurrence of a thunderstorm on November 2, 2013. A total of 2000 patients presenting with asthma attacks triggered by thunderstorm were interviewed and an initial questionnaire was completed for each individual. After twenty days, patients were asked to complete a supplementary questionnaire, but only 800 of them accepted to do so. The majority of subjects was aged 20–40 years (60.5%) and had no history of asthma in most cases (60.0%). The symptoms had started outdoors for 60.0% of the participants. In most patients, the onset of the condition was on November 2. Short-actingβ2-agonist (salbutamol) and aminophylline were the most commonly prescribed medications in the emergency department. Upon the second interview, 85.3% of the patients were still symptomatic. Overall, 63.6% did not have a follow-up visit after hospital discharge, although all of them were referred to the specialist. The findings of the present study suggest that thunderstorm-associated asthma could affect young adults with no gender priority, with or without asthma history, which put a strain on emergency medical services.

PURPOSE To compare aqueous oxygen tension in eyes with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), and neovascular glaucoma (NVG), with normal eyes with senile cataracts. PATIENTS AND METHODS This study included 82 eyes of 82 patients with POAG (22 eyes), PXG (20 eyes), NVG (18 eyes), and cataracts (22 eyes). Before initiating surgery and while breathing room air, 0.2 mL of aqueous humor and 1 mL of arterial blood were aspirated in heparinized syringes under sterile conditions. Partial pressures of oxygen (PO2), carbon dioxide (PCO2), and pH of the samples were measured using a blood-gas analyzer. RESULTS Overall, aqueous PO2 was comparable among the study groups (P=0.202). After repeating the analysis in eyes with controlled and high intraocular pressure (IOP), a significant difference was observed in POAG eyes with high IOP (post-hoc test, P=0.046). Overall, a significant negative correlation (r=-0.184, P=0.045) was observed between IOP and aqueous PO2. The strongest correlation was observed in the POAG group (r=-0.507, P=0.016). Aqueous PO2 was higher than arterial PO2 in all study groups except POAG eyes, significantly so in the cataract and PXG groups (P=0.013 and P

The aim of this study was to determine the correlation between PM(2.5) and NO(2) pollutants and oxidative stress marker (8-isoprostane) and lung function tests (FVC and FEV(1)) in healthy children who were living and studying in three different areas of Ahvaz city including A(1): Naderi site with high traffic, A(2): Alavi Alley site with average traffic, and A(3): Ein 2 site with low traffic (a rural area on the suburb of Ahvaz). 30 students in the 12–13 year-old range were selected from each studied zone (1, 2 and 3 sites) during three months of year. Of each student, one sample was taken every two weeks to measure 8-isoprostane of exhaled breath condensate (EBC). Air pollution data were collected from three air quality monitoring stations. Also, the relationship between air pollution and 8-isoprostane as well as lung function tests were determined using generalized estimating equations (GEE). The mean concentration of PM(2.5) and NO(2) in A(1), A(2) and A(3) areas were 116, 92 and 45 (μg/m(3)) also 77, 53 and 14 (ppb) respectively. Among all studied students, there was a significant correlation between the increase of mean concentration of PM(2.5) and NO(2) in 1–4 before sampling day, increased 8-isoprostane concentration and decreased FEV(1), while there was no significant correlation between them and decreased FVC. In A(1) site, an increase in IQR (13 μg/m(3)) PM(2.5) and IQR (6.5 ppb) NO(2) on 1–4 days before sampling was associated with 0.38 unit (95% CI: 0.11, 0.65) and 1.1 unit (95% CI: 0.85, 1.35) increase in 8-isoprostane concentration, also decreased 121 ml and 190 ml FEV(1), respectively. Results showed that the short-term exposure to traffic-related air pollution can decrease the values of lung function indices and increase the oxidative stress. It may adversely affect children’s lungs.

To evaluate the effect of systemic oxygen therapy in the management of acute ocular chemical and thermal burns.Prospective, nonrandomized, comparative, interventional case series.Twenty-four eyes of 22 patients with grade III to IV acute ocular chemical and thermal burns received conventional medical therapy. The oxygen therapy group (13 eyes) additionally received 100% oxygen using a simple mask at a flow rate of 10 L/minute for 1 hour twice daily. Main outcome measures were time for healing of the corneal epithelial defect and improvement in perilimbal ischemia. Secondary outcome measures included visual acuity, corneal transparency and vascularization, and complications.Corneal epithelial defects healed within 15.23 ± 3.94 days (range, 10 to 21 days) in the oxygen group versus 59.9 ± 23.33 days (range, 28 to 95 days) in controls (P.001). Vascularization of ischemic areas was complete in 14.54 ± 2.70 days (range, 10 to 21 days) in the oxygen group versus 45.09 ± 22.20 days (range, 25 to 105 days) in controls (P = .001). In the oxygen group, the cornea was more transparent and less vascularized 3 and 6 months after injury. Mean final visual acuity (logarithm of the minimal angle of resolution) was 0.40 ± 0.52 (range, 0 to 1.3) versus 1.11 ± 0.83 (range, 0.1 to 3) in the oxygen and control groups, respectively (P = .018). In the oxygen group, symblepharon or corneoscleral melting did not develop in any patient; however, in the control group, symblepharon developed in 3 eyes and corneoscleral melting developed in 1 patient.In the acute phase of ocular chemical or thermal burns, oxygen therapy improves limbal ischemia, accelerates epithelialization, increases corneal transparency, and decreases corneal vascularization. It also may improve visual acuity and reduce complications.