Shiraz E-Medical Journal Shiraz E-Medical Journal Shiraz E-Med J http://www.emedicalj.portal.tools 1735-1391 10.5812/semj. en jalali 2019 6 19 gregorian 2019 6 19 16 4
en 10.17795/semj21586 The Effect of Intravenous Midazolam on Duration of Spinal Anesthesia The Effect of Intravenous Midazolam on Duration of Spinal Anesthesia research-article research-article Background

A variety of systemic and intrathecal adjuvants to local anesthetics have been found to expand the duration and improve the quality of spinal block and decrease pain after surgeries.

Objectives

The aim of this study was to evaluate the effect of the addition of midazolam to lidocaine for spinal anesthesia in lower abdomen and lower limb surgeries.

Patients and Methods

In a prospective, randomized, double blind study, 36 patients aged 20 to 60 years, and American Society of Anesthesiologists (ASA) I or II, were randomly allocated to receive either intravenous midazolam (30 μg/kg) or placebo in spinal anesthesia. Level of sensory block, time to achieve maximum motor and sensory block, duration of sensory and motor block, recovery time, side effects, heart rate, blood pressure, arterial oxygen saturation and sedation score were measured and analyzed using the SPSS software version 15 by t-test and ANOVA. Data were considered significant at 0.05.

Results

The motor block duration in midazolam and control group was 82.9 ± 27.3 and 59.1 ± 26.5, respectively (P = 0.01). However the duration of sensory block was not different between the two groups (P = 0.07). The median of sensory block level was at T8 and T10 in midazolam and control group (P = 0.02). Recovery time was more prolonged in the midazolam group (P = 0.002). Hemodynamic indices did not show any significant differences between the two groups.

Conclusions

Addition of 30 μg/kg midazolam to lidocaine for spinal anesthesia improved duration of motor block and increased intraoperative sedation score without causing side effects in patients’ requiring lower abdomen and lower limb surgery.

Background

A variety of systemic and intrathecal adjuvants to local anesthetics have been found to expand the duration and improve the quality of spinal block and decrease pain after surgeries.

Objectives

The aim of this study was to evaluate the effect of the addition of midazolam to lidocaine for spinal anesthesia in lower abdomen and lower limb surgeries.

Patients and Methods

In a prospective, randomized, double blind study, 36 patients aged 20 to 60 years, and American Society of Anesthesiologists (ASA) I or II, were randomly allocated to receive either intravenous midazolam (30 μg/kg) or placebo in spinal anesthesia. Level of sensory block, time to achieve maximum motor and sensory block, duration of sensory and motor block, recovery time, side effects, heart rate, blood pressure, arterial oxygen saturation and sedation score were measured and analyzed using the SPSS software version 15 by t-test and ANOVA. Data were considered significant at 0.05.

Results

The motor block duration in midazolam and control group was 82.9 ± 27.3 and 59.1 ± 26.5, respectively (P = 0.01). However the duration of sensory block was not different between the two groups (P = 0.07). The median of sensory block level was at T8 and T10 in midazolam and control group (P = 0.02). Recovery time was more prolonged in the midazolam group (P = 0.002). Hemodynamic indices did not show any significant differences between the two groups.

Conclusions

Addition of 30 μg/kg midazolam to lidocaine for spinal anesthesia improved duration of motor block and increased intraoperative sedation score without causing side effects in patients’ requiring lower abdomen and lower limb surgery.

Anesthesia, Spinal;Midazolam;Intravenous Injection Anesthesia, Spinal;Midazolam;Intravenous Injection http://www.emedicalj.portal.tools/index.php?page=article&article_id=21586 Reihanak Talakoub Reihanak Talakoub Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, IR Iran Mehran Rezvani Mehran Rezvani Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, IR Iran Ameneh Alikhani Ameneh Alikhani Isfahan University of Medical Sciences, Isfahan, IR Iran Isfahan University of Medical Sciences, Isfahan, IR Iran Mohammad Golparvar Mohammad Golparvar Isfahan University of Medical Sciences, Isfahan, IR Iran; Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-3132237012 Isfahan University of Medical Sciences, Isfahan, IR Iran; Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-3132237012 Mitra Jabalameli Mitra Jabalameli Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, IR Iran Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, IR Iran Zahra Amini Zahra Amini Isfahan University of Medical Sciences, Isfahan, IR Iran Isfahan University of Medical Sciences, Isfahan, IR Iran
en 10.17795/semj27868 Lessons Learned From National Health Accounts in Iran: Highlighted Evidence for Policymakers Lessons Learned From National Health Accounts in Iran: Highlighted Evidence for Policymakers review-article review-article Conclusions

The issues highlighted in last NHA in Iran were: changes in the health insurance system, adopting approaches for increasing an insurance coverage in noninsured population, informing the population about insurance scheme, private insurance scheme according to indigenous conditions, applying a concerted national effort towards controlling the high cost of medicine alongside concerning about equity and coverage, and applying effective indigenous strategies for decreasing out-of-pocket health care expenditures.

Results

Reevaluation of data highlighted some issues, which were compared with the national and international available data and useful evidences for policy makers were extracted. These evidences are mentioned in following part.

Context

National Health Account (NHA) is an accepted tool for tracing the flow of health resources at country level. As policy makers concern about the effective allocation of scarce resources, thus NHA can play a dominant role in evidence-based decision making. Reevaluation of last NHA in Iran is required for helpful highlights.

Evidence Acquisition

We reviewed last NHA documents in Iran which was performed in 2008 to highlight a good evidence for policy makers and compared it with other national and international available data.

Conclusions

The issues highlighted in last NHA in Iran were: changes in the health insurance system, adopting approaches for increasing an insurance coverage in noninsured population, informing the population about insurance scheme, private insurance scheme according to indigenous conditions, applying a concerted national effort towards controlling the high cost of medicine alongside concerning about equity and coverage, and applying effective indigenous strategies for decreasing out-of-pocket health care expenditures.

Results

Reevaluation of data highlighted some issues, which were compared with the national and international available data and useful evidences for policy makers were extracted. These evidences are mentioned in following part.

Context

National Health Account (NHA) is an accepted tool for tracing the flow of health resources at country level. As policy makers concern about the effective allocation of scarce resources, thus NHA can play a dominant role in evidence-based decision making. Reevaluation of last NHA in Iran is required for helpful highlights.

Evidence Acquisition

We reviewed last NHA documents in Iran which was performed in 2008 to highlight a good evidence for policy makers and compared it with other national and international available data.

Learning;Health;Iran;Policy, National Health Learning;Health;Iran;Policy, National Health http://www.emedicalj.portal.tools/index.php?page=article&article_id=27868 Kamran Bagheri Lankarani Kamran Bagheri Lankarani Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Sulmaz Ghahramani Sulmaz Ghahramani Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7112309615, Fax: +98-7112309615 Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7112309615, Fax: +98-7112309615 Mohammadreza Zakeri Mohammadreza Zakeri Department of Health Care Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Health Care Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran Hassan Joulaei Hassan Joulaei Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 10.17795/semj24676 Hepatitis B Virus Infection Serology and the Associated Risk Factors Among Patients With HIV in Shiraz, Iran Hepatitis B Virus Infection Serology and the Associated Risk Factors Among Patients With HIV in Shiraz, Iran research-article research-article Conclusions

The current study showed that less than half of the HIV positive participants had evidence of previous exposure to HBV. Also, the risk of chronic HBV was higher in the subjects than the normal population. It is suggested to educate HIV positive individuals regarding prevention and transmission of other viral infections such as HBV, HCV, and compliance with their medication.

Patients and Methods

In this cross-sectional study, 186 HIV infected individuals above 18 years old, referring to Shiraz Voluntary Counseling and Testing Center from 2010 to 2011were enrolled. All participants were assessed for the serological status of HBV infection using Hepatitis B surface antigen, Hepatitis B surface antibody, Hepatitis B core antibody levels, and HBV Polymerase Chain Reaction.

Results

A total of 186 HIV positive individuals eligible for analysis including 164 (88.2%) males and 22 (11.8%) females were selected for the study. Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (HBsAb) and Hepatitis B core antibody (HBcAb) were detected in 66 (35.5%), 62 (41.3%), and 39 (21%) subjects, respectively. HBV DNA was detected in 39 subjects (21%).

Objectives

The current study aimed to determine HBV infection serological profile and the associated risk factors among HIV positive individuals in Shiraz.

Background

Human Immunodeficiency Virus-1 (HIV-1) and Hepatitis B Virus (HBV) are transmitted through common routes; therefore, simultaneous infection with both viruses is common.

Conclusions

The current study showed that less than half of the HIV positive participants had evidence of previous exposure to HBV. Also, the risk of chronic HBV was higher in the subjects than the normal population. It is suggested to educate HIV positive individuals regarding prevention and transmission of other viral infections such as HBV, HCV, and compliance with their medication.

Patients and Methods

In this cross-sectional study, 186 HIV infected individuals above 18 years old, referring to Shiraz Voluntary Counseling and Testing Center from 2010 to 2011were enrolled. All participants were assessed for the serological status of HBV infection using Hepatitis B surface antigen, Hepatitis B surface antibody, Hepatitis B core antibody levels, and HBV Polymerase Chain Reaction.

Results

A total of 186 HIV positive individuals eligible for analysis including 164 (88.2%) males and 22 (11.8%) females were selected for the study. Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (HBsAb) and Hepatitis B core antibody (HBcAb) were detected in 66 (35.5%), 62 (41.3%), and 39 (21%) subjects, respectively. HBV DNA was detected in 39 subjects (21%).

Objectives

The current study aimed to determine HBV infection serological profile and the associated risk factors among HIV positive individuals in Shiraz.

Background

Human Immunodeficiency Virus-1 (HIV-1) and Hepatitis B Virus (HBV) are transmitted through common routes; therefore, simultaneous infection with both viruses is common.

Co-infections;HIV;Risk Factors Co-infections;HIV;Risk Factors http://www.emedicalj.portal.tools/index.php?page=article&article_id=24676 Mohammad Ali Davarpanah Mohammad Ali Davarpanah Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Nasrin Motazedian Nasrin Motazedian Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +987137386272 Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +987137386272 Ebrahim Fallahzadeh Ebrahim Fallahzadeh Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Maryam Rasti Maryam Rasti Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Hashem Rahmati Hashem Rahmati Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran Nadia Motazedian Nadia Motazedian Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 10.17795/semj23620 Physician Labor Participation and Unemployment Rate in Iran Physician Labor Participation and Unemployment Rate in Iran research-article research-article Results

The results of this study showed that the physician labor participation rate and the unemployment rate were 61.6% and 7.8%, respectively. Both of these statistics were better than the overall labor force statistics of the country. The unemployment rate of male physicians was lower than female ones and the labor force participation rate for male physicians was higher than female ones. The results of the labor supply regression showed a positive relationship between age, being male, being married and labor supply. Moreover, a negative relationship was found between continuing the study at universities and physician labor supply.

Conclusions

In this study, some additional facts about Iranian physician labor behavior were presented. These results alert policymakers about the decisions in human resource management and play a major role in policy decisions.

Background

The behavior of physicians after graduating from universities is very important for policymakers. They want to follow these behaviors to find what happened to physicians after graduation. Increasing in physician labor participation rate and an efficient distribution of them by gender and geographical concerns are crucial decisions of policymakers.

Patients and Methods

In this study, we used population and census data of Iran in 2011. Data of the graduate medical university students were extracted. Some descriptive statistics like the physician labor participation rate and physician unemployment rate were calculated in this study. Also, a regression model for physician labor supply was estimated.

Objectives

This study aimed to determine the factors that affect the physician labor supply in Iran. We focused on the presence and absence of medical graduate students in the labor market and we also investigated the changes in labor supply in age groups and the differences in male and female physician labor supply. Moreover, the unemployment rate among physicians was calculated.

Results

The results of this study showed that the physician labor participation rate and the unemployment rate were 61.6% and 7.8%, respectively. Both of these statistics were better than the overall labor force statistics of the country. The unemployment rate of male physicians was lower than female ones and the labor force participation rate for male physicians was higher than female ones. The results of the labor supply regression showed a positive relationship between age, being male, being married and labor supply. Moreover, a negative relationship was found between continuing the study at universities and physician labor supply.

Conclusions

In this study, some additional facts about Iranian physician labor behavior were presented. These results alert policymakers about the decisions in human resource management and play a major role in policy decisions.

Background

The behavior of physicians after graduating from universities is very important for policymakers. They want to follow these behaviors to find what happened to physicians after graduation. Increasing in physician labor participation rate and an efficient distribution of them by gender and geographical concerns are crucial decisions of policymakers.

Patients and Methods

In this study, we used population and census data of Iran in 2011. Data of the graduate medical university students were extracted. Some descriptive statistics like the physician labor participation rate and physician unemployment rate were calculated in this study. Also, a regression model for physician labor supply was estimated.

Objectives

This study aimed to determine the factors that affect the physician labor supply in Iran. We focused on the presence and absence of medical graduate students in the labor market and we also investigated the changes in labor supply in age groups and the differences in male and female physician labor supply. Moreover, the unemployment rate among physicians was calculated.

Iran;Determinant Factors;Unemployment;Physicians;Logistic Model Iran;Determinant Factors;Unemployment;Physicians;Logistic Model http://www.emedicalj.portal.tools/index.php?page=article&article_id=23620 Enayatollah Homaie Rad Enayatollah Homaie Rad School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran Satar Rezaei Satar Rezaei School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran; School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran. Tel: +98-9184293208 School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran; School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, IR Iran. Tel: +98-9184293208 Razieh Fallah Razieh Fallah Imam Reza Hospital, Mazandaran University of Medical Sciences, Amol, IR Iran Imam Reza Hospital, Mazandaran University of Medical Sciences, Amol, IR Iran
en 10.17795/semj27856 Socioeconomic Determinants of Health: An Adult Population Based Study in Shiraz, Southern Iran Socioeconomic Determinants of Health: An Adult Population Based Study in Shiraz, Southern Iran research-article research-article Conclusions

At least 1 out of 2 adult people in Shiraz does not have physical activity and has high BMI, while 1 out of 3 has at least one abnormal components in their lipid profile. Prediabetes, hypertensive, and diabetic groups comprised a significant portion of population. Among different groups, women and less educated people belonged to the high risk groups. Therefore a multidisciplinary approach is needed to control this event, especially in high risk population.

Results

Overall, 777 participants, mean age of 42.6 ± 13.8 (ranging from 18 to 88) year, were included in this study while female (451; 58%), middle-aged (203; 26.1%), married (653; 84%), and those with up to 12 years of education (470; 60.5%) were the majorities. Among the participants, 453 (58.3%) were among overweight to severely obese groups, 441 (56.7%) did not have physical activity, 148 (19.3%) were smokers, 280 (36%) had hypercholesterolemia, 239 (30.8%) had hypertriglyceridemia, 54 (6.9%) had high LDL, 93 (11.9%) had low HDL, and 49 (6.3%) were anemic. Women had significantly lower height (P < 0.001), weight (P < 0.001), and waist circumference (P < 0.001), but higher BMI (P < 0.001) compared to those parameters in men. Of total participants, 240 (30.9%) had prehypertension, 62 (8.0%) had stage I hypertension, and 16 (2.1%) had stage II hypertension. Overall, 76 (9.8%) subjects had hypertension, while most of them (57; 75%) were aware of their disease and consumed antihypertensive drugs. Of 777 participants, 148 (19.1%) had impaired glucose tolerance test and 51 (6.5%) were diabetic. However, 46 (5.9%) were aware of their disease and only 35 (4.5%) consumed glucose lowering agents to control plasma glucose. Those with fewer years of education had significantly higher prevalence of obesity (P = 0.001), hypertension (P < 0.001), and DM (P = 0.02).

Background

Noncommunicable diseases (NCDs) are now the most important causes of mortality and morbidity in Iran.

Objectives

Therefore, knowing about NCDs status and its socioeconomic determinants are the cornerstone for the interventions that policymakers and health providers apply to improve the health of community. This research includes a full exploration of the relevant data.

Patients and Methods

This was a population-based cluster randomized sampling carried out in Shiraz, Iran. In this regard, demographic, socioeconomic status, and medical history of adult participants (at least 18 year old) were collected. In the next step, physical examination and anthropometric data were taken. Finally, fasting blood glucose (FBS), lipid profile, and complete blood count (CBC) measurement were done.

Conclusions

At least 1 out of 2 adult people in Shiraz does not have physical activity and has high BMI, while 1 out of 3 has at least one abnormal components in their lipid profile. Prediabetes, hypertensive, and diabetic groups comprised a significant portion of population. Among different groups, women and less educated people belonged to the high risk groups. Therefore a multidisciplinary approach is needed to control this event, especially in high risk population.

Results

Overall, 777 participants, mean age of 42.6 ± 13.8 (ranging from 18 to 88) year, were included in this study while female (451; 58%), middle-aged (203; 26.1%), married (653; 84%), and those with up to 12 years of education (470; 60.5%) were the majorities. Among the participants, 453 (58.3%) were among overweight to severely obese groups, 441 (56.7%) did not have physical activity, 148 (19.3%) were smokers, 280 (36%) had hypercholesterolemia, 239 (30.8%) had hypertriglyceridemia, 54 (6.9%) had high LDL, 93 (11.9%) had low HDL, and 49 (6.3%) were anemic. Women had significantly lower height (P < 0.001), weight (P < 0.001), and waist circumference (P < 0.001), but higher BMI (P < 0.001) compared to those parameters in men. Of total participants, 240 (30.9%) had prehypertension, 62 (8.0%) had stage I hypertension, and 16 (2.1%) had stage II hypertension. Overall, 76 (9.8%) subjects had hypertension, while most of them (57; 75%) were aware of their disease and consumed antihypertensive drugs. Of 777 participants, 148 (19.1%) had impaired glucose tolerance test and 51 (6.5%) were diabetic. However, 46 (5.9%) were aware of their disease and only 35 (4.5%) consumed glucose lowering agents to control plasma glucose. Those with fewer years of education had significantly higher prevalence of obesity (P = 0.001), hypertension (P < 0.001), and DM (P = 0.02).

Background

Noncommunicable diseases (NCDs) are now the most important causes of mortality and morbidity in Iran.

Objectives

Therefore, knowing about NCDs status and its socioeconomic determinants are the cornerstone for the interventions that policymakers and health providers apply to improve the health of community. This research includes a full exploration of the relevant data.

Patients and Methods

This was a population-based cluster randomized sampling carried out in Shiraz, Iran. In this regard, demographic, socioeconomic status, and medical history of adult participants (at least 18 year old) were collected. In the next step, physical examination and anthropometric data were taken. Finally, fasting blood glucose (FBS), lipid profile, and complete blood count (CBC) measurement were done.

Socioeconomic Factors;Health;Life Style;Population Socioeconomic Factors;Health;Life Style;Population http://www.emedicalj.portal.tools/index.php?page=article&article_id=27856 Kamran Bagheri Lankarani Kamran Bagheri Lankarani Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Fariborz Ghaffarpasand Fariborz Ghaffarpasand Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Behnam Honarvar Behnam Honarvar Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran; Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9173154560, Fax: +98-7132309615 Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran; Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9173154560, Fax: +98-7132309615 Mojtaba Mahmoodi Mojtaba Mahmoodi Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Omid Mirzaee Omid Mirzaee Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Soheila Mehravar Soheila Mehravar Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Mohammad Saeid Khaksar Mohammad Saeid Khaksar Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Tahereh Rastegar Tahereh Rastegar Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Nima Zamiri Nima Zamiri Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Sayed Taghi Heydari Sayed Taghi Heydari Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Mohammad Kazem Fallahzadeh Mohammad Kazem Fallahzadeh Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Najmeh Maharlouei Najmeh Maharlouei Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, IR Iran Bita Geramizadeh Bita Geramizadeh Transplant Research Center, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Transplant Research Center, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran Khosrow Daneshbod Khosrow Daneshbod Dr. Daneshbod Pathology Laboratory, Shiraz, IR Iran Dr. Daneshbod Pathology Laboratory, Shiraz, IR Iran Yahya Daneshbod Yahya Daneshbod Dr. Daneshbod Pathology Laboratory, Shiraz, IR Iran Dr. Daneshbod Pathology Laboratory, Shiraz, IR Iran