Zahra Karimian

Background: Global progress toward the Sustainable Development Goals (SDGs) is severely off track. Iran hosts the world’s largest migrant and refugee population, but sanctions, inflation, and workforce migration have strained its capacity. Since the attitudes of service providers influence whether inclusive policies are translated into practice, this study explores frontline staff perspectives on access to public health services for non-citizens in one of Tehran’s largest public health networks. Methods: We conducted a cross-sectional survey among staff in three public health centers that serve migrant and refugee populations. The questionnaire assessed five Likert scale outcomes: support for separate centers, shared user fees, prioritization of citizens under conditions of scarcity, equal service provision, and preference for working with citizens. Demographic variables included age, sex, years of experience, and role (clinical vs. non-clinical). Items were analyzed descriptively; subgroup comparisons were conducted using two-sided Mann–Whitney U tests. Results: Of approximately 150 eligible healthcare workers, 87 provided complete responses. Agreement with prioritizing citizens was highest at 93.1% (median 5). Support for equal service provision was lowest, with 56.3% of participants expressing disagreement (median 2). A preference for working with citizens was endorsed by 61.9% of the respondents (median 4) and differed by age, experience, and role, with younger, less-experienced, and clinical staff reporting stronger preferences (all p < 0.01). Conclusion: Healthcare workers’ perspectives can serve as a rapid, low-burden proxy indicator for equitable service delivery. In this exploratory study, workers favored citizen prioritization and fee-based models under conditions of scarcity, with the lowest support expressed for equal access for non-citizens; these preferences were strongest among younger and clinical staff. Adapted service delivery models, targeted training, and clear operational guidance are needed to support equitable access in resource-constrained settings.

Background: Sudden influxes of displaced populations can strain health systems, especially in low- and middle-income countries. Iran hosts one of the world’s largest migrant and refugee populations –predominantly from Afghanistan – and provides inclusive access to public health and education services. In August 2021, the crisis in Afghanistan triggered a sharp increase in Afghan arrivals to Iran, raising healthcare demand amid the COVID-19 pandemic. This study examines how one of the largest public health networks in Tehran responded to this surge and the resulting impact on equitable service coverage and system resilience. Methods: We retrospectively analyzed monthly healthcare utilization data over a 13-month period (February 2021–February 2022) from the largest public health network in western Tehran, which serves approximately 5.5 million residents, including nearly 1 million migrants and refugees. Patients were categorized into six demographic subgroups: children, women of childbearing age, adolescents, young adults, middle-aged adults, and the elderly. Changes in the number and proportion of patients receiving the full Essential Health Service Package (EHSP) were assessed using six-month pre-/post-event comparisons, with statistical significance determined via chi-square tests (p < 0.05). Results: The total number of patients served increased eight-fold, from 88,091 in February 2021 to 717,382 in February 2022. In the six-month period following the crisis, the number of Afghan patients receiving full EHSP coverage rose by 84,522; however, the proportion of full-service coverage declined by 3.2%. Children were the most affected subgroup: despite 2,739 additional patients receiving full services, their coverage rate fell by 10.6%. In contrast, young Afghan adults experienced an increase in both number and proportion of patients receiving full services (+ 25,421, + 1.2%). All subgroup changes were statistically significant (p < 0.001). Conclusions: Although the public health network rapidly expanded service delivery, maintaining proportional coverage for full services proved challenging, particularly for vulnerable groups. Even established health systems with decades of experience in serving displaced populations may face transient coverage shortfalls amid demand surges compounded by pandemic-related strain. Strengthening public health emergency management through targeted resource allocation, surge capacity, and real-time monitoring of coverage indicators is essential to sustaining health equity and system resilience during future crises.

Vaccine effectiveness (VE) studies provide real-world evidence to monitor vaccine performance and inform policy. The WHO Regional Office for the Eastern Mediterranean supported a regional study to assess the VE of COVID-19 vaccines against different clinical outcomes in four countries between June 2021 and August 2023. Health worker cohort studies were conducted in 2707 health workers in Egypt and Pakistan, of whom 171 experienced symptomatic laboratory-confirmed SARS-CoV-2 infection. Test-negative design case–control studies were conducted in Iran and Jordan in 4017 severe acute respiratory infection (SARI) patients (2347 controls and 1670 cases) during the Omicron variant dominant period. VE estimates were calculated for each study and pooled by study design for several vaccine types (BBIBP-CorV, AZD1222, BNT162b2, and mRNA-1273, among others). Among health workers, VE against symptomatic infection of a complete primary series could only be computed compared to partial vaccination, suggesting a benefit of providing an additional dose of mRNA vaccines (VE: 88.9%, 95%CI: 15.3–98.6%), while results were inconclusive for other vaccine products. Among SARI patients, VE against hospitalization of a complete primary series with any vaccine compared to non-vaccinated was 20.9% (95%CI: 4.5–34.5%). Effectiveness estimates for individual vaccines, booster doses, and secondary outcomes (intensive care unit admission and death) were inconclusive. Future VE studies will need to address challenges in both design and analysis when conducted late during a pandemic and will be able to utilize the strengthened capacities in countries.

“Pro re nata” (PRN) or “as needed” medicine administration and usage is a relatively neglected area in medication management (pharmacotherapy/pharmaceutical care) which contributes to error‐prone use of medications and is unsafe for patients. In this case, we report the incident of diclofenac toxicity in a 51‐year‐old woman due to a prescription of 100 mg diclofenac suppositories PRN, or as needed, for postoperative pain control without explanation of the maximum daily dose (150 mg daily), which led to arbitrary consumption of 3 g of diclofenac over 5 days (600 mg daily) by the patient, and subsequent development of metabolic acidosis, acute kidney injury, and sudden cardiac arrest. The implementation of practical guidelines and training programs for health care workers to appropriately prescribe, dispense, and administer PRN medicines are necessary, and should at least include providing clarification for their indication, dose and frequency, as well as any cautionary instructions to ensure safe and effective use of such medicines.

Pruritus is one of the disturbing complications induced by chronic liver disease (CLD), bearing a negative impact on patient quality of life and potentially resulting in early liver transplants. Given the main role of the autotaxin enzyme in pruritus induced by CLD and the suppressive effects of melatonin on the expression of the autotaxin gene, this study was designed to evaluate the antipruritic effect of melatonin in patients with CLD. A double-blind, cross-over, randomized, placebo-controlled pilot trial was conducted on patients with CLD -induced pruritis. Patients were randomly assigned to two groups where they received melatonin 10-mg at night or placebo for 2 weeks. After a 2-week washout period, patients were then crossed over to the other group. The Visual Analog Scale (VAS) and the 12-Item Pruritus Severity Score (12-PSS) were used to assess patient response to therapy as the co-primary outcomes, while liver function tests were assayed too. Forty patients completed the study. The VAS score showed alleviation of 3.21 ± 2.24 (in pruritus) with melatonin (p-value <0.05). The study goal (a reduction of at least 20% in VAS) was achieved in 33 (82%) of study participants. In patients who received melatonin, the 12-PSS and Body Surface Area (BSA) affected by pruritus decreased on average 46.57% and 51.71%, respectively, with mood, sleep pattern and daily activity levels also demonstrating significant improvement (p-value < 0.05). Melatonin was found to be effective for managing pruritus in patients with CLD.

Medication errors are the second most common cause of adverse patient safety incidents and the single most common preventable cause of adverse events in medical practice. Given the high human fatalities and financial burden of medication errors for healthcare systems worldwide, reducing their occurrence is a global priority. Therefore, appropriate policies to reduce medication errors, using national data and valid statistics are required. The primary objective of this study was to provide a national ‘characteristic profile’ of medication error-associated adverse drug reactions (ADRs), which are also known as preventable ADRs (pADRs). A retrospective study of pADR reports submitted to the national pharmacovigilance center (PCV) within Iran’s Food and Drug Administration was conducted over a 2-year period (2015-2017). Preventability Method (P-Method), which is a standardized tool developed and recommended by the World Health Organization (WHO), was used for preventability assessment. The results of the analyses revealed that while the number of pADRs increased from year one to two (601 to 630), their proportion out of all ADRs per year decreased (7.32% to 6.44%). The percentage of pADRs was higher in females (61.01%) and adults (83.27%), and the highest number of reports were received by nurses (71.57%). Having ‘a documented hypersensitivity to an administered drug or drug class’ was the most common preventable factor in both years (61.23% and 54.29% respectively), and ‘anti-infectives used systemically’ were the medication class which primarily contributed to both serious (53.29%) and non-serious pADRs (39.19%). The specific characteristics of medication errors associated with ADRs from this study, especially the preventable criteria which led to their occurrence, can help devise more specific preventative policies.

Background: There are currently ten intravenous enzyme replacement therapy (ERT) products available for the treatment of eight different lysosomal diseases (LD) in the USA. Additional ERT products are in clinical trials. The most common ERT adverse events are infusion reactions (IR). While IR are often defined as hypersensitivity or anaphylactoid reactions occurring concurrently with (i.e., during) infusion administration (CIR), there exists the potential for delayed infusion reactions (DIR), which present after completion of infusion administration. Hypothesis: Concurrent infusion reactions (CIR) are not the only infusion reactions associated with enzyme therapy. Methods: This study evaluated the occurrence of infusion reactions in 46 patients with LD who had received ERT for a minimum of 2 years. Infusion reactions were evaluated according to symptoms, time of onset, and duration of reactions. The frequency of infusion reactions with each ERT product was compared to that reported in the FDA-approved product package insert. Results and Conclusions: In this study, DIR were observed and occurred as often as CIR in the study population, despite not being characterized or reported in most ERT product package inserts. Effective methods for managing DIR and CIR differed, thus emphasizing the importance of monitoring for both types of infusion reactions in order to optimize outcomes for patients using ERT.

The Objective of this study was to assess possible association of history of migraine with pre-eclampsia (PE). This was a retrospective study to compare history of migraine in 90 women affected by PE with 90 women without PE as the control group. They recruited by a nonrandomized consecutive sampling method. Data were collected by a questionnaire including demographic, medical, obstetrics, and migraine assessment sections. Data were analyzed using SPSS. Results showed an increased risk of PE in women with history of migraine (odds ratio: 2.87; p < 0.05). Result demonstrated that migraine history in the case group is 14/4% and in control group is 5/6%. Gestational age (GA) at delivery and weight of neonate (WN) were significantly lower compared to control (GA: 37.3 ± 2.6 vs. 38.7± 1.3 weeks T test; P < 0.01) (WN: 2930 ± 690 vs. 3330 ± 420; T test; P < 0.0). Cesarean section was more frequent in the PE group compared to the control group [37 (42%) vs. 14 (15.6%)]; chi square; p < 0.01]. The association of migraine with PE is the result of some similar mechanism leading to endothelial dysfunction. Frequent reports of an association between migraine and PE in different populations suggest a history of migraine as a risk factor for PE/gestational hypertension (GH).