Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia

INTRODUCTION: Immune thrombocytopenia (ITP) is an immune disorder commonly presents as isolated thrombocytopenia. Generally corticosteroids are the main treatment of ITP. This study was designed to evaluate effectiveness of high dose dexamethasone comparing conventional corticosteroid therapy in the treatment of ITP. MATERIALS AND METHODS: In a randomized prospective study, sixty adult patients with newly diagnosed primary symptomatic ITP (Platelet count < 20,000) were evaluated. Patients divided into two groups. In group A, thirty patients (mean age of 24.9 years) received Dexamethasone 40 mg/IV/daily for four days (10 mg/q6h); and then Prednisolone 1 (mg)/(kg)/day/PO with rapid tapering of prednisolone (10 mg/week). From the other hand, in group B, thirty patients (mean age of 27.2 years) were treated with Prednisolone 1 (mg)/(kg)/day/PO for four weeks, then the drug tapered weekly. RESULTS: All the patients in group A showed favorable response within the first seven days, 27 cases presented complete response (CR) and three cases revealed response (R). In group B, 11 cases had CR, 13 cases showed R and six cases had No response (NR). After three months, rates of CR were 80% and 23.3% in group A and B; respectively. Responses were 16.7% and 33.3%, NRs were 6.6% and 43.3% in group A and B; respectively (P < 0.0001). After 6 months, CR was 73.3% vs.16.7%, and R was 16.7% vs.36.7% and NR was 10% vs. 46.7% in group A and B; respectively (P < 0.0001). After 12 months, there was no change in response rate in group A, but in group B 53% were non responsive, 40% showed R (chronic ITP) and complete response was observed only in 6.7% (P < 0.0001). Three cases in group A and 12 cases in group B had needed splenectomy (P < 0.00002). CONCLUSION: We showed that high dose dexamethasone is more effective than conventional steroid therapy in newly diagnosed ITP as initial treatment with less relapses and toxicities

Tears and smiles in the urban protests against local decisions: searching for footprint of power in urban management (Evidence from Tehran)

To achieve plural power in the urban planning scene, two distinguished parties, including both official and unofficial, should be able to interact with each other. In the absence of participation in the planning and decision-making processes, protests are a way for unofficial parties to force the government to reconsider their plans. The present research investigates the chain of power in respond to urban protests by analysing two case studies from the City of Tehran. The main research question concerned how city authorities in Tehran responded to the citizens' demands by establishing whether, through powerful organisation of the city, people can change the governance trends of city authorities, or if their demands remain ignored or only slightly slowed down the execution of the plans. This study applied Interpretive Structural Modelling (ISM) for analysing relations between different players (Citizens, Government, Institutions, Guilds etc.) and illustrating the structure of power in both cases. The input data includes interviews and facts from published newspapers and after calculating data with ISM, MICMAC analysis employed to explain the drive power and dependence power of players. According to the results of interpretive structural modelling, citizens' demands in both cases had only a marginal effect on the governance trends of city authorities. The results also showed that citizens were on the bottom of the power hierarchy to see their demands met

An empirical investigation on factors influencing on work stress: Evidence from banking industry

An individual with a career faced with various career challenges may experience work-related stress. Work related stress is a factor that threatens employees’ health. The most common negative consequences of stress are particularly the deterioration of performance and efficiency, decrease in productivity and quality of customer’s services, which results in health problems. Work-related stress is a global issue, and banks are no exception. This paper presents a survey to investigate the influencing factors on work stress in banking industry. The study designs a questionnaire and distributes it among 200 randomly selected bank department managers in city of Tehran, Iran. Using principle component analysis, the study has detected five factors including organizational characteristics, external environment, work content, personal characteristics and top management

Causes of New Cases of Major Thalassemia in Sistan and Balouchistan Province in South-East of Iran

Background: Thalassemia is the most common monogenic disease in South-East of Iran. Despite the 70% reduction in Iranian thalassemia cases after thalassemia control comprehensive program, 601 affected babies were born in Sistan and Balouchistan Province, Iran from 2002 to 2010, so this study aims at investigating the causes of new thalassemia cases.Methods: Data from this retrospective cross-sectional study was collected through interviews and information in the patients’ hospital records.Results: Data revealed that 52.4% of fathers and 78.4% of mothers of thalassemic children had elementary education or less. In addition, 78.6% of the couples did not undergo premarital screening for thalassemia and 71.2% of the couples were not notified of their own minor thalassemia until a child was born with major thalassemia. Of the diagnosed minor couples, about 25% did PND and the others did not carry out because mothers were unaware of proper gestational age and of the importance of this issue, financial problems, and the husbands’ disagreement to take the tests. Moreover, 16 mothers, in spite of being diagnosed of having a major fetus, refused to terminate the pregnancy.Conclusion: The most preventable causes for affected births include couples’ unawareness of being minor and unawares of the PND importance and process

Effect of Deficit Irrigation at Different Stages on Physiological Traits and Water Use Efficiency of Roselle (Hibiscus sabdariffa L.) under Two Planting Methods

IntroductionThe increasing demand for medicinal plants in traditional medicine as well as the pharmaceutical industry has created the need for some plants to be grown commercially, but the lack of soil moisture poses a serious threat to their production. Planting method can affect the emergence and growth rate of crop and lead to decrease water consumption and increase irrigation water efficiency as yield increases. Roselle (Hibiscus sabdariffa L.) is one of the drought tolerant plants. Saving water consumption by cultivating drought tolerant plants has been proposed as a strategy to combat drought. It should be noted, however, that irrigation without proper planning can reduce the growth and production of crops. In this regard, determining time of deficit irrigation with minimum damage is an appropriate solution that achieves optimum yield while saving water consumption. The aim of this study was to investigate the effect of different irrigation regimes and planting method on some physiological traits, yield and water use efficiency of Roselle plant.Materials and MethodsThe experiment was conducted as split plot based on randomized complete blocks design with three replications at the Research Farm of Kashmar Agricultural and Natural Resources Research Station, during two growth seasons 2016 and 2017. Irrigation (in seven levels i.e. I100: 100% crop water requirement (CWR), I180: 80% CWR from 8-leaf stage to end of flowering, I280: 80% CWR from 8-leaf stage to beginning of flowering, I380: 80% CWR from beginning to end of flowering, I160: 60% CWR from 8-leaf stage to end of flowering, I260: 60% CWR from 8-leaf stage to  beginning of flowering, I360: 60% CWR from beginning to end of flowering) and planting method (in two levels i.e. direct and indirect) were in main plots and sub plots, respectively. In the transplanting method, the seeds were sown in the transplant tray on March 10, 2016 and 2017 and transplanted to the farm in four-leaf stage. Direct cultivation was also carried out in April, in 2.5 × 7 meter plots at a depth of 1.5 cm.In order to measure physiological traits, sampling from the youngest leaves of plants under stress and control conditions was carried out at the maximum flowering stage. Physiological traits including chlorophyll a, chlorophyll b, carotenoid, leaf relative water content and proline content were measured using these leaves. At the harvest time, two square meters of each plot were harvested. Then, seed and calyx yield were measured and using the measured amount of water consumed, water use efficiency based on seed and calyx were calculated.Data were analyzed with SAS software; obtained averages compared with using Tukey's Studentized Range (HSD) Test at the 5% probability level.Results and DiscussionThe results showed leaf relative water content was affected only by irrigation and planting method and seed and calyx yields were affected only by irrigation. The leaf relative water content in seedling planting method was higher than direct planting. The highest relative leaf water content (84.66%), seed (667.54 kg ha-1) and calyx yield (392.73 kg ha-1) were obtained in I100 treatment that for yield had no significant difference with I801 treatment. The lowest these traits were also obtained in I360 treatment.The interaction effect between irrigation and planting method was significant on chlorophyll a, chlorophyll b, carotenoids, leaf proline content, seed and calyx water use efficiency. In most irrigation levels, transplanting improved these traits compared to direct sowing. I100 and transplanting treatment had the highest chlorophyll a (0.31 μmol g-1 fw), chlorophyll b (0.16 μmol g-1 fw) and carotenoids (0.56 μmol g-1 fw) and I360 and transplanting treatment had the highest leaf proline content (7.95 μmol g-1 fw). The highest seed (0.15 kg m-3) and calyx (0.08 kg m-3) water use efficiency were obtained in I160 and transplanting treatment and I180 and transplanting treatment was located in the second level. I360 and direct planting method had the lowest seed (0.06 kg m-3) and calyx (0.03 kg m-3) water use efficiency.ConclusionThe results of this study revealed that deficit irrigation at 80% of the crop water requirement from 8-leaf stage to the end of flowering along with transplanting method was more effective in saving irrigation water with a good yield of the Roselle plant compare to treatment of 100% of the crop water requirement

The Best Iron Chelation Therapy in Major Thalassemia Patients is Combination of Desferrioxamine and Deferiprone

Introduction: The best and effective iron chelation remain one of the major strategy in clinical management of thalassemia major patients. The purpose of this study was to evaluate the safety and effectiveness of combined therapy with Desferrioxamine and Deferiprone in patients with thalassemia major that undergoing in regular administration of adequate desferrioxamine (5-6 days/week). Patients and Methods: This study was performed in two groups: one group with combination therapy, that had received oral deferiprone 70 mg/kg /day for 6 days and two days desferrioxamine 40 mg/kg with subcutaneous injection. Other group treated with only desferrioxamine with doses of 40 mg/kg 5- 6 day/week resemble to one year ago. (In past year both groups had regular & adequate administration and consumption of desferrioxamine with doses of 40 mg/kg 5-6 day/week). Thirty six patients were entered in this study. The efficacy of combined therapy was evaluated in 19 patients that treated with Desferrioxamine and deferiprone and 17 patients that treated with Desferal alone for at least 12 month. In both group the patients were received Desferal in Regular program in one year ago until to start of this study. Age of the patients was over 10 years old. Deferiprone administered orally 70 mg/kg/day in three divided dose and desferrioxamine 40 mg/kg/day by subcutaneus infusion overnight for 8-12 hr twice weekly. Serum ferritin concentrations were measured at base, 6 and 12 month. Full blood count were performed every 15 day for 2 first months and then monthly. The evaluation of cardiac function was performed in regular manner (every 6 months) and all of patients had normal cardiac function. Results: The mean decreased of ferritin level was 493 &mu;g/L in combination therapy and mean increased in ferritin level was 637.6 &mu;g/L in desferrioxamine group. Statistical analysis was performed with using T-test, and Paired T-test. There were significant differences between the two groups (p-value= 0.0001). The most common side effects in combined therapy group were dyspepsia and nausea in 6 patients (18.1%), especially in the first month of treatment. Joint pain and stiffness were observed in 4 cases (13.6%). Significant neutropenia and agranulocytosis were not observed. The serum ferritin level was increased in 64.7 % of patients that treated with desferrioxamine alone. Conclusion: The results of this study confirmed that the thalassemia major patients with iron overloaded whom received desferrioxamine as a regular manner (at least 40 mg/kg for 5 days /week) can be safety treated with a combination of deferiprone and desferrioxamine. This combination therapy was effective in reducing iron burden, as assessed by serum ferritin level

Anemia as a Public Health Issue in Mashhad, Iran: Evidence from the First Population-Based Study

Anemia is one of the main conditions that impose an adverse impact on the socioeconomic state of any country; however, evidence on the prevalence of anemia is scant in Northeastern Iran. This study was conducted to determine the overall and age- and sex-specific prevalence of anemia in the city of Mashhad, Iran. In a cross-sectional, population-based survey, 1675 individuals aged 1-90 years (29.1±18.5 years) were selected from approximately 2.4 million residents by a multistage cluster sampling method during May to September 2009. Blood samples were evaluated to determine erythrocyte indices and anemia was defined according to hemoglobin (Hb) levels based on World Health Organization (WHO) guidelines. The prevalence of anemia was 9.7% with considerable difference between both sexes; 6.2% and 12.7% in males and females, respectively (P<0.001). The higher prevalence of anemia was detected in females of 15-54 and ≥ 65 years old (16% and 12.5%, respectively). However, the higher rates were observed in males 65 years and older as well as boys below 5 years old (16.3% and 14.6%, respectively). Current findings show that anemia is a considerable public health problem in the population of Mashhad, Iran, especially among the pre-school children, adult women and the elderly. Great attention should be paid to the pre-school boys who are more affected by anemia than what was previously assumed

Therapeutic approaches for neonatal abstinence syndrome: a systematic review of randomized clinical trials

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