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Open access

Amirhossein Sahebkar


Background: C-reactive protein (CRP) has been proposed as a risk marker and risk factor of cardiovascular disease. There have been a number of clinical reports suggesting that supplementation with L-carnitine can modulate systemic inflammation and lower circulating CRP concentrations, but the results have not been consistent.

Methods: A comprehensive literature search in Medline, Scopus and Cochrane Central Register of Controlled Trials was performed in December 2012 to identify clinical trials investigating the impact of oral L-carnitine supplementation on serum/plasma CRP concentration. A random effect method was used to calculate the combined effect size.

Results: Six studies comprising 541 cases and 546 controls met the inclusion criteria. Meta-analysis of included trials revealed a significant reduction of circulating CRP concentrations in subjects under L-carnitine intervention compared to the control treatment. The calculated combined weighted mean reduction in CRP concentrations was -0.39 mg/L [95% CI (-0.62 - -0.16)]. This effect size estimate was found to be robust and remained unaffected by the removal of each single study.

Conclusions: The overall findings of the present metaanalysis support the clinically relevant benefit of L-carnitine supplementation in lowering the circulating levels of CRP.

Open access

Amirhossein Sahebkar and Mehrdad Iranshahi


The genus Ferula (Apiaceae) comprises about 170 species occurring from central Asia westward to northern Africa. This genus is well-known in folk medicine for the treatment of various organ disorders. Most of Ferula species possess strong aromatic smell that is due to the presence of essential oil or oleoresin in their different organs. This article reviews anti-bacterial, anti-fungal and other biological activities of Ferula oils reported to date. For medicinal applications, the chemical composition of volatile oils obtained from different Ferula species is summarized in Appendix.

Open access

Masoud Sabouri Ghannad, Soroor Afagh Hojati, Mohammad Mirzaei and Amirhossein Sahebkar


Backgroud: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the main causes of liver related morbidity and mortality.

Objective: To assess the epidemiologic features of HBV and HCV infections between 2004 and 2007 in the Hamadan province, Iran.

Methods: In a cross-sectional study, epidemiologic and demographic characteristics of patients infected with HBV or HCV, or both, during about four years were collected from health centers in the Hamadan province.

Results: Overall, there were 1533 infected patients (66.2% with HBV, 32.5% with HCV, and 1.3% with both). Male patients comprised 74.4% of patients. In view of marital status, 71.3% were married, 27% single, and 1.7% were widowed or divorced. The majority of patients (78.4%) inhabited urban areas while 21.6% inhabited rural areas. Patients <4 years old had the lowest rate of infection (0.26%), while the highest incidence (13.11%) was found in the 25-29-year-old age range. With respect to serologic markers, 61.4%, 33.7%, 4.4% and 0.3% of patients were HBsAg+, HCVAb+, HBsAb+ and HBeAg+, respectively. Overall, the incidence of HBV was found to be decreased from 2004 to 2007, while the incidence of HCV increased from 2004 to 2007.

Conclusion: The prevalence of HBV infection decreased during the period of study. This could be attributed to the increasing public vaccination of neonates and people at high-risk, which began about 15 years ago. However, it seems that an increasing incidence of high-risk behaviors including intravenous drug abuse with shared syringes has led to an increased incidence of HCV infection.

Open access

Yunes Panahi, Fatemeh Beiraghdar, Hossein Akbari, Hossein Bekhradi, Mohsen Taghizadeh and Amirhossein Sahebkar


Background: Silver sulfadiazine (SSD) is the most used topical agent for the treatment of burn wounds. However, it has some side effects such as delayed and incomplete epithelialization, generation of black scars, and limited penetration to the depth of a wound.

Objective: The present study investigated the efficacy of herbal combination cream containing Aloe vera gel and essential oils of Lavandula stoechas and Pelargonium roseum in the alleviation of symptoms in patients with superficial second-degree burns and comparison of its effects with those of SSD 1% cream.

Methods: One hundred eleven patients with second-degree burns (occurring in the preceding 48 hours and affecting <50% body area) were randomized to receive either herbal cream (n = 56) or SSD 1% cream (n = 55) applied once daily for 14 days. Prevalence of skin dryness and pain severity (assessed using a visual analogue scale) and evidence of infection was determined for patients at baseline as well days 2, 7, and 14.

Results: Both groups experienced a significant reduction in the pain severity at day 14 compared to baseline (p <0.001). As for the magnitude of change in pain score, there was a significantly greater reduction from baseline to the seven (p = 0.014) and 14 (p = 0.05) day in the herbal cream compared to control group. The frequency of skin dryness was not significantly different between the groups at any of the assessed time points (p >0.05). There was a single case of infection in the herbal cream group, which cleared with continuation of treatment.

Conclusion: Our findings suggested that the herbal cream used here is superior to SSD 1% cream in the alleviation of pain and may serve as a natural alternative for treatment of second-degree burns.

Open access

Farzad Khademi, Arshid Yousefi-Avarvand, Amirhossein Sahebkar, Fahimeh Ghanbari and Hamid Vaez


Background: Bacterial infections are the most common complications in people with HIV/AIDS. There has been no previous report on the prevalence of bacterial co-infections in Iranian HIV/AIDS-positive subjects.

Aim: To evaluate the frequency of bacterial infections in hospitalized HIV/AIDS-infected patients in Iran.

Materials and methods: Based on PRISMA guidelines, a computerized search in related data banks using relevant keywords was performed in both Persian and English languages for articles that were published until March 10, 2017. A total of 1118 original articles were systematically reviewed to identify eligible studies on the prevalence of bacterial co-infections in HIV/AIDS-infected patients from Iran. After screening for inclusion and exclusion criteria, we extracted data from 28 eligible articles for the meta-analysis.

Results: The overall bacterial infection rate among Iranian HIV/AIDS-positive individuals was estimated to be 48.6%. Gastrointestinal disorders (59.5%) were the most frequent bacterial infections in this group of patients followed by bacterial lymphadenopathy (38.9%), TB infection (38.2%), bacterial pneumonia (31.2%), brucellosis (26.3%), skin infections (13.3%) and sexually transmitted infections (9.7%). The prevalence of other bacterial infections including endocarditis, sepsis and Staphylococcus aureus (S. aureus) were 10%, 9.1%, and 6.9%, respectively. Conclusion: The prevalence of a wide spectrum of bacterial co-infections, especially endemic infections, in Iranian HIV/AIDS-infected patients, is alarming and calls for urgent need to improve the currently applied diagnostic and preventive methods. In addition, timely treatment of these infections is pivotal to decrease the morbidity and mortality rates in HIV/AIDS-infected patients.

Open access

Mohammad Taghi Rajabi-Mashhadi, Seyed Hadi Mousavi, Khosravi-Mashizi Mh, Majid Ghayour-Mobarhan and Amirhossein Sahebkar


Background: Inappropriate use of antibiotics for perioperative antimicrobial therapy can cause considerable complications including emergence of antibiotic resistance, risk of drug reactions and economic implications.

Objective: We assessed the use of antibiotics in patients with acute non-perforated appendicitis.

Methods: The study was performed on 317 patients aged 15 to 70 years with non-perforated appendicitis who were undergoing open appendectomy. All patients received intravenous ceftriaxone (1 g) and metronidazole (500 mg) immediately after appendectomy. Patients were randomized into one of the following three treatment protocols; A: no further antibiotics, B: three more doses of antibiotics for 1 day (ceftriaxone 1 g every 12 hours and metronidazole 500 mg every 8 hours), or C: a 3-day course of antibiotics (ceftriaxone 1 g every 12 hours and metronidazole 500 mg every 8 hours) as the postoperative antibiotic regimen. Postoperative infective complication was the primary endpoint within the 10-day postoperative follow-up period.

Results: A total of 291 patients (female 37.5%), were subjected to final analysis. This included 97 patients in each group. Twenty-six patients failed to return for wound assessment. The groups were comparable in baseline characteristics including age and gender. The Overall frequency of surgical site infection was 6.25%, with 8.2% in group A, 6.25% in group B and 5.2% in group C. The rate of postoperative surgical infection was not significantly different among all groups. There were no perioperative mortalities. No untreated control group could be included for ethical reasons.

Conclusion: A combined preoperative single dose of metronidazole and ceftriaxone appears to be sufficient for the prevention of surgical site infections in patients with uncomplicated appendicitis.

Open access

Yunes Panahi, Gholamhossein Yousefi, Amirhossein Sahebkar, Seyyed Mohsen Foroutan, Afshin Zarghi, Alireza Shafahati, Arash Khoddam and Alireza Saadat


Background: Pyridostigmine is a reversible acetylcholinesterase inhibitor that is used in military medicine as a prophylactic agent against intoxication by nerve agents and in the treatment of myasthenia.

Objective: We developed and validated a high-performance liquid chromatography (HPLC) method for the quantification of pyridostigmine in plasma samples.

Methods: Pyridostigmine was isolated from plasma using one-step protein precipitation by chloroform. The separation was performed on an analytical C18 column (250 × 4.6 mm; 4 μm particle size). The detector wavelength was set at 270 nm. The mobile phase was a mixture of acetonitrile and aqueous solution (15:85 v/v) of sodium-1-hepatene sulfonate and triethylamine, adjusted to pH 3.0 at a flow rate of 1.5 ml min-1. Hydrochlorothiazide was used as internal standard.

Results: The recovery of drug from plasma samples was above 90%. Using the current method, pyridostigmine (rt = 7.3) and hydrochlorothiazide (rt = 6.4) peaks were well resolved. The calibration curve was linear over the concentration range of 15-60 ng ml-1. The inter- and intraday assay coefficients of variation were found to be less than 8%.

Conclusion: The currently described procedure could be used as a simple, rapid and sensitive tool in bioavailability and bioequivalency investigations for the quantification of pyridostigmine in human plasma samples.

Open access

Mehrangiz Khajeh Karamoddini, Seyed Ahmad Emami, Masoud Sabouri Ghannad, Esmaeel Alizadeh Sani and Amirhossein Sahebkar


Background: Drug resistance to current anti-herpetic drugs has been increasingly reported. Therefore, there is a need for finding new antiviral agents, in particular from natural sources.

Objective: In the present study, antiviral activity of subset extracts obtained from aerial parts of Artemisia including A. incana, A. chamaemelifolia, A. campesteris, A. fragrans, A. annua, A. vulgaris, and A. persica were investigated against Herpes Simplex type I (HSV1).

Methods: Different concentrations of extracts (400, 200, 100, 50, 25, 12.5, 6.25, and 3.125 μg/mL) were obtained from subset of each plant separately, and used against KOS strain of HSV1 in HeLa cells. After 24 hours incubation, tetrazolium dye (MTT), was added. The dye absorption by viable cells was measured and compared to the positive control (extract-untreated cells) and acyclovir (as anti-viral agent).

Results: The extracts obtained from A. annua had the highest antiviral activity while those of A. chamaemelifolia showed the lowest activity.

Conclusion: Subset extracts of A. annua may be an appropriate candidate for further development of anti HSV1 infection.

Open access

Hassan Boskabadi, Jalil Tavakol Afshari, Majid Ghayour-Mobarhan, Gholamali Maamouri, Mohammad T Shakeri, Amirhossein Sahebkar and Gordon Ferns


Background: Perinatal asphyxia is a major cause of neurologic morbidity and mortality in infants. Objective: Determine the serum level of interleukin-6 (IL-6) in neonates with perinatal asphyxia and its relation to the severity of hypoxic-ischemic encephalopathy and short term neurological outcome. Methods: Serum IL-6 levels were measured at birth, and at 24 and 48 hour post-partum in 37 consecutive uninfected neonates with peri-natal asphyxia and 45 randomly selected healthy newborns. Results: Serum IL-6 concentrations in the infants who developed hypoxic-ischemic encephalopathy was 43 folds higher compared to values in the normal infants (p < 0.001) and 1.9 folds higher as compared to infants with asphyxia who did not subsequently develop hypoxic-ischemic encephalopathy (p <0.001). Serum IL-6 concentrations were also related to the degree of hypoxic-ischemic encephalopathy and neurologicaldevelopmental outcomes at the time of discharge. Conclusion: Serum levels of IL-6 increased in neonates with asphyxia, and this was most pronounced in neonates with adverse outcomes.

Open access

Shima Tavallaie, Mehrnoosh Zobeiri, Zohreh Haghighat-Khazaee, Mohammad Hassanzadeh-Khayyat, Hooriyeh Nassirli, Bizhan Malaekeh-Nikouei, Amirhossein Sahebkar and Majid Ghayour-Mobarhan


Background: Oxidative modification of low-density lipoprotein (LDL) seems to play a role in the development of atherosclerosis and coronary artery disease (CAD). Although in many experiments a role for vitamin E in prevention of LDL oxidation and therefore CAD has been suggested, some clinical studies have failed to confirm these findings.

Objective: A case- control study was conducted to find out the association between serum vitamin E levels and coronary artery disease susceptibility in Iranian patients with CAD.

Methods: Ninety-one patients with angiographically confirmed CAD (defined as coronary obstruction >50%) and 39 age and sex matched controls that their atherosclerosis was not proven according to angiography were included. Serum vitamin E concentration was measured in plasma by high performance liquid chromatography (HPLC) for all patients.

Results: No significant difference in serum levels of vitamin E and standardized vitamin E [vitamin E/total cholesterol, and vitamin E/ (total cholesterol+triglycerides)] and lipid profile parameters was observed between patients and control groups. The association between vitamin E and CAD remained unchanged independent of age, sex, smoking habit, hypertension, hyperlipidemia and diabetes. Serum vitamin E levels were positively associated with waist/hip ratio, high-density lipoprotein cholesterol (HDL-C) and total cholesterol in the control group and inversely associated with HDL-C in the CAD group. Vitamin E/total cholesterol levels were inversely associated with HDL-C and low-density lipoprotein cholesterol (LDL-C).

Conclusion: Our data does not support the results of other studies which have shown an association between lower amounts of vitamin E and enhanced risk of coronary heart disease.