ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 43 (4)
Volume: 43  Issue: 4 - 2021
EDITORIAL COMMENTS
1.COVID-19: Infection Control Strategy and Public Health Awareness for Disabled Individuals in Turkey
Selma Metintaş
doi: 10.14744/etd.2021.65725  Pages 315 - 317
Abstract | Full Text PDF

INVITED REVIEW
2.COVID-19: The Impact of Public Health Interventions on the Outbreak—Public Health Perspective and Future Trends
Hülya Şirin, Toker Erguder, Seçil Özkan
doi: 10.14744/etd.2021.29895  Pages 318 - 324
In March 2019, before the first confirmed cases in Turkey, a scientific advisory board was created to develop guidelines for disease control and preventive health care. Public health interventions and treatment protocols were implemented by the health authority and scientific advisory board with daily analyses obtained from the databases. Soon after, the pandemic management process intensified with the closure of schools and partial curfews. Despite the decline in the number of cases and deaths, the number of cases plateaued and did not decrease further with the effect of the normalization period. With the end of the summer, the increase in spending time indoors, and the gradual start of face-to-face education in schools, the number of new cases has significantly increased. Therefore, the strict implementation of public health interventions has been established. In this period, the health literacy level of the population and the perception of risk also affected their compliance with health protocols. Moreover, vaccine studies and the application of practices for COVID-19 were deemed essential to effectively contain the virus. In the coming months, it is necessary to implement vaccination programs along with good planning and communication strategy. It is important to have a multi-sectoral approach, considering the possible security, health, economic, social, psychological, political, and social effects of this epidemic and other future outbreaks. Furthermore, it is necessary to comply with individual measures and restrictions for the benefit of society.

SYSTEMATIC REVIEW
3.The Rate, Trends, and Lethality of Common Violent Suicide Attempt Methods in Iran, a Systematic Review and Meta-Analysis
Yousef Veisani, Samira Faramarzi, Salman Khazaei
doi: 10.14744/etd.2020.41882  Pages 325 - 332
This systematic review aimed to determine frequency, trend, and lethality of common methods of suicide in Iran through literature in relevant studies by meta-analysis. We searched MeSH heading suicide and/or keyword combinations in published articles in English major databases (PubMed, Scopus, and ISI) and Persian databases (Magiran, Medlib, SID, and Iran Medex). Based on the inclusion and exclusion criteria, we enrolled 47 relevant studies for the final analysis. The data were analyzed based on a random-effects model using Stata11.2. We found that hanging had the highest lethality among suicide methods; so that hanging with 14.9% (95% CI: 12.6, 17.3) and followed by self-immolation with 11.8% (95% CI: 10.2, 13.3) lethality were the common lethal methods. Results showed a decreasing trend in the rate of using lethal methods (β=−0.02, 95% CI: −0.005–0.05), (p=0.017) across the study period. Our results approve this assumption that the rate of using lethal methods for suicide is decreasing in recent years in Iran, perhaps opposite to non-violent methods. This is an important finding that investigators should be assessed it in forward studies to clarify the possible causes.

REVIEW
4.LC3 and Beclin-1 as Markers of Autophagic Activity in Breast Cancer
Nursultan Nurdinov, Venhar Çınar, Ahsen Güler, Sevda Gökçe Yılmaz, Nesrin Delibaşı, Zuhal Hamurcu
doi: 10.14744/etd.2020.99997  Pages 333 - 336
Autophagy is a catabolic pathway meaning “self-eating” that facilitates nutrient recycling from damaged and aged organelles and other impaired cellular components through lysosomal degradation. Regulation of this process has been associated with the development of cancer. It can play different roles at different tumors and developmental stages of tumors. In breast cancer, similarly, autophagy functions as a mechanism promoting survival or leading to death. Whereas, it is very important to define the role of autophagy as an effective treatment strategy in breast cancer cells. Therefore, in this review, the role of inhibited autophagy is discussed with specific RNAs targeting Beclin-1 and LC3 genes in breast cancer.

ORIGINAL ARTICLE
5.Association of Angiotensin II Type 1 Receptor A1166C Gene Polymorphisms with Coronary Artery Disease in Thrace Region of Turkey
Gökay Taylan, Orkide Palabıyık, Flora Özkalaycı, Mustafa Yılmaztepe, Nasır Sivri, Yüksel Aksoy
doi: 10.14744/etd.2020.90248  Pages 337 - 342
Objective: Although the risk factors for coronary artery disease (CAD) are well established, a significant gap still exists in understanding the pathology of atherosclerotic heart disease evolving without conventional risk factors. Therefore, genetic factors are considered to play a significant role in this setting. The present study aimed to assess the relationship between angiotensin 2 type 1 receptor (AT1R) A1166C gene polymorphism and CAD.
Materials and Methods: Patients with documented CAD (n=121) were compared with controls with normal coronary arteries (n=121). CAD was diagnosed using a coronary angiography. The median age of participants was 59±12 years with an equal sex distribution. A comparison between the two groups with regard to the AT1R A1166C gene polymorphism was made through the amplification of DNA using polymerase chain reaction.
Results: This study demonstrated that adenine-adenine and cytosine-cytosine (CC) genotypes were more frequent, yet adenine-cytosine genotype was less frequent among patients with CAD compared with controls [p=0.003), 95% confidence interval (CI)]. The AT1R A1166C gene polymorphism along with the CC genotype and C allele was found to be associated with CAD. Further, gender, hypertension, family history, age, and low levels of serum high-density lipoprotein also had a significant relationship with AT1R A1166C gene polymorphism.
Conclusion: The present study suggested AT1R A1166C gene polymorphism, CC genotype, and C allele as potential risk factors for atherosclerotic CAD. Patients harboring these genetic variants should be under close supervision for the development of CAD.

6.Attitudes of Medical Faculty Students Toward Ageism: A Cross-Sectional Study From Kayseri
Belgin Oral, Dilek Ener, Osman Günay, Fevziye Çetinkaya
doi: 10.14744/etd.2020.00878  Pages 343 - 349
Objective: Attitudes of medical faculty students toward ageism are an important issue in terms of public health. In Turkey, there is not enough study to attract attention to ageism. In this study, it was aimed to determine some factors related to the attitudes of the first and last year students of Erciyes University Faculty of Medicine toward the elderly in the 2017–2018 academic year.
Materials and Methods: In this cross-sectional study, the data of 468 (71.6%) students studying in the first and last years were analyzed. As a data collection tool, a sociodemographic questionnaire and Ageism Attitude Scale (AAS) were used. The dependent variable of the study was the attitude toward ageism, independent variables were age, gender, grade, economic situation, family structure, the condition of staying with the elderly before and currently, and willingness to care for the elderly.
Results: The average age of participants was 21.8±3.0 years, 51.0% were first grade and 51.5% were women. The total AAS score of the students was 84.9±8.8, the restricting the life of the elderly was 36.8±4.3, the positive ageism score was 30.3±5.0, and the negative ageism score was 17.8±3.0. The AAS total score and the restricting the life of the elderly score were significantly higher in women and last grade students (p<0.05).
Conclusion: To develop students’ attitudes toward the elderly in a positive way, elderly health and old age lessons should be included in the curriculum and students should be provided with spending time with the elderly.

7.Effects of Ramadan Fasting on Gastrointestinal System
Umut Payza, Ahmet Kayalı, Zeynep Karakaya, Fatih Esat Topal, Serkan Bilgin, Firdevs Topal, Pinar Yesim Akyol, Umur Suadiye
doi: 10.14744/etd.2020.03442  Pages 350 - 354
Objective: The aim of this study was to investigate the effects of Ramadan model intermittent fasting (IF) on acute pancreatitis, acute cholecystitis, and acute cholangitis, which is closely related to nutrition.
Materials and Methods: This retrospective research study was conducted from 2014 to 2018. Patients over 18 years old with acute pancreatitis, acute cholecystitis, and acute cholangitis were included in the study. Patients with lipid metabolism disorders such as hyperlipidemia, pregnant women, malignancies, viral infections, hepatic insufficiency, and cirrhosis were excluded from the study. A total of 3940 patients were included in the study. Hospital applications in Ramadan were compared with the rest of the year.
Results: One thousand eight hundred and sixteen male and 2124 female patients were included in the study. 1797 patients (45.6%) with pancreatitis, 1032 patients (26.2%) with cholangitis and 1015 patients (25.8%) with cholecystitis. Pancreatitis (46.4%), cholangitis (29.8%), and cholecystitis (19.3%) were the most frequently diagnosis in Ramadan. The monthly admission rates were calculated in a 5-year period. It was found that the admission rates were 26.6% more in Ramadan than other months. Ramadan fasting significantly increased acute pancreatitis and acute cholangitis. However, cholecystitis decreased. Both sexes were similarly affected from the Ramadan period.
Conclusion: Ramadan model of IF induces an increase in the incidence of acute pancreatitis and acute cholangitis and a decrease in acute cholecystitis. Ramadan model may not be a suitable model for a healthy diet.

8.Frequency of Epistaxis by Months and Daytime Hours
Muhammed Gazi Yıldız, İsrafil Orhan, İrfan Kara, Nagihan Bilal, Saime Güzelsoy Sağıroğlu, Adem Doğaner
doi: 10.14744/etd.2020.25826  Pages 355 - 360
Objective: Epistaxis, which is a common otorhinolaryngologic emergency, is not a disease itself but an important nose symptom. It affects 60% of the population at any given life stage. However, only 6% seek medical attention. This study aims to investigate the daily and monthly variations and frequency of epistaxis and to determine the relationship between bleeding foci and comorbidities.
Materials and Methods: The study involves examining the retrospective records of patients who presented with epistaxis to Kahramanmaraş Sütçü İmam University, Medical Faculty’s Otorhinolaryngological Unit. Parameters evaluated include age, sex, bleeding time, comorbidities, arterial blood pressure, bleeding site, and month of presentation. The bleeding occurrence time was categorized as morning (06: 01–12: 00), afternoon (12: 01–18: 00), evening (18: 01–00: 00), and night (00: 01–06: 00).
Results: Seven hundred and thirty-five patients presented with epistaxis during March 2015–December 2019. One hundred and fourteen patients (19.6%) experienced epistaxis in the morning, 60 (8.2%) in the afternoon, 408 (55.5%) in the evening, and 123 (16.7%) in the night. Epistaxis was more common in the morning and evening in hypertensive patients and in the evening in other comorbidities (p=0.005). Bleeding rate was higher in the evening in all months (p=0.002). Increased epistaxis frequency in winter was statistically significant (p=0.027). Posterior epistaxis cases were the elderly, hypertensive, and having increased comorbidities (p>0.001).
Conclusion: In general, bleeding cases were high in winter and in the evening. Comorbidities were found to be among the provocative factors for epistaxis, especially of posterior origin. This shows that circadian rhythm is effective in epistaxis.

9.Is the Examination of a Single Night Polysomnography Sufficient for a Diagnosis of OSAS in Adolescent Patients?
Mehmet Metin, Mustafa Avcu
doi: 10.14744/etd.2020.40359  Pages 361 - 365
Objective: The objective of the study was to evaluate the first night effect (FNE) on sleep architecture and respiratory parameters of adolescent patients with suspected obstructive sleep apnea syndrome (OSAS).
Materials and Methods: A retrospective investigation was made of a total of 88 patients (51 males and 37 females, mean age 15.52±1.30 years, range 13–17 years) applied with polysomnography (PSG) because of suspected OSAS between March 1, 2016, and August 31, 2019. PSG was applied on two consecutive nights. The presence of OSAS was evaluated separately on the two consecutive nights and diagnostic accuracy was compared.
Results: When the patients were investigated in respect of sleep architecture, there was seen to be a significant difference between the two nights in the values of total sleep time (min) (p=0.001), time in bed (min) (p=0.001), sleep latency (min) (p=0.001), and rapid eye movement (REM) latency (min) (p<0.001), and the FNE was seen to have an effect on the REM percentage (p=0.001). No statistically significant difference was determined in the non-REM sleep parameters between the two nights. In the patient-based examination, two patients with borderline apnea/hypopnea index values and evaluated as normal on the first night were diagnosed as mild OSAS on the second night, and one patient diagnosed with moderate OSAS on the first night was diagnosed with severe OSAS on the second night.
Conclusion: There was seen to be a significant FNE on the sleep parameters of the adolescent age group, and in the evaluations made in respect of the respiratory parameters, the second night PSG examination can be considered useful, especially in patients with borderline values.

10.Visual Impairments Among Immigrants Living in Northeast Turkey and Their Ocular Finding Differences Compared to the Local Population
Adem Uğurlu, Erel İçel, Nurdan Gamze Taşlı, Turgay Uçak
doi: 10.14744/etd.2020.39018  Pages 366 - 372
Objective: This study aims to evaluate the existing eye pathologies of immigrant patients due to visual impairment and to compare them with the local population.
Materials and Methods: Between November 2018 and August 2019, a total of 150 participants among immigrants and 440 participants among local people were included in the study. Analysis of disease prevalence was calculated as a ratio of the total cohort screened with available data. The average, standard deviation, percentage, and minimum and maximum values of the data were calculated.
Results: Of the 590 patients in the study, 440 were from the local population and 150 were immigrants comprising 90 Afghans and 60 Meskhetian Turks. The rate of the patients wearing glasses at presentation was higher in the local population than among the immigrant patients (p<0.001). The number of uncorrected refractive errors was significantly higher in immigrants than in the local population (p<0.001). The proportion of patients who stated that they had an eye examination for the 1st time was significantly higher among the immigrant patients (p<0.001). Infectious conjunctivitis, keratitis, and cataract were significantly higher among the Afghan patients (p<0.001). In the Afghan patients and local population, the history of ocular trauma was significantly higher compared to the Meskhetian Turks (p<0.001). In the Afghan patients, the presence of a corneal or conjunctival foreign body was significantly higher than in the other groups (p<0.001).
Conclusion: Ocular disorders, such as cataracts and associated legal blindness, infectious eye diseases, and uncorrected refractive error can be seen more in immigrants. To remedy this situation, there are many steps that all of the countries must take for these individuals to access the necessary health care.

11.Efficacy and Safety of Switching from Clopidogrel to Ticagrelor at the Time of Discharge in STEMI Patients Treated with a Pharmacoinvasive Approach
Ali Çoner, İbrahim Haldun Müderrisoğlu
doi: 10.14744/etd.2020.25478  Pages 373 - 378
Objective: The aim of the study was to search for the efficacy and safety of switching from clopidogrel to ticagrelor at the time of discharge in ST-segment elevation myocardial infarction (STEMI) patients treated with a pharmacoinvasive approach.
Materials and Methods: STEMI patients who were managed with pharmacoinvasive approach were involved in the study population. Patients were divided into two groups as clopidogrel and ticagrelor depending on the choice of P2Y12 inhibitor at the time of discharge. All-cause mortality, stent thrombosis, recurrent myocardial infarction, need for target lesion revascularization, and any major bleeding (BARC classification ≥2) were defined as composite clinical end points at the end of the 12th month follow-up.
Results: A total of 194 patients (male: 156 patients, 80.4%; mean age 60.2±11.5 years) were involved in the study population (130 clopidogrel and 64 ticagrelor patients). The median time interval for switching time to ticagrelor was 48 (48–72) h. In a subgroup analysis for patients with a stented segment ≥30 mm, discharge with clopidogrel was related to 6.9 times increase in composite end points compared to patients discharged with ticagrelor (odds ratio: 6.955, confidence interval 95%: 1.512–30.980, p=0.012).
Conclusion: Switching from clopidogrel to ticagrelor at the 48th h following fibrinolytic administration had similar safety end points in STEMI patients managed with pharmacoinvasive approach. In a subgroup of study patients with a total stent length of ≥30 mm, switching to ticagrelor was found to be superior to clopidogrel regarding composite clinical end points.

12.Evaluation of the Effect of Type 1 and Type 2 Diabetes Mellitus without Diabetic Retinopathy on Subfoveal Choroidal Thickness and Central Macular Thickness in Adolescents
Mustafa Hepokur, Hamdi Cihan Emeksiz, Merve Nur Hepokur, Ayşe Aşık, Halit Oğuz
doi: 10.14744/etd.2020.05695  Pages 379 - 384
Objective: Evaluation of the effect of Type 1 and Type 2 diabetes mellitus (DM) without diabetic retinopathy on subfoveal choroidal thickness (SCT) and central macular thickness (CMT) in adolescents.
Materials and Methods: This prospective cohort study included a total of 70 eyes of 35 patients and 42 eyes of 21 age-matched healthy control individuals. SCT and CMT were measured in all participants using enhanced depth imaging-optical coherence tomography.
Results: Forty eyes of 20 patients with Type 1 DM, 30 eyes of 15 patients with Type 2 DM and 42 eyes of 21 healthy controls were examined. SCT was significantly lower in type 1 DM group than in type 2 DM group (p=0.008). CMT did not significantly differ among the three groups (p=0.412). SCT and CMT did not correlate with HbA1c, BMI, fasting blood glucose, HDL, LDL, total cholesterol and triglycerides levels and also duration of diabetes.
Conclusion: We revealed that the SCT was significantly thinner in Type 1 diabetic adolescents than type 2 DM. Larger series and further studies are needed to better demonstrate this different effect on choroidal layer.

13.Anxiety and Loneliness Levels of Quarantined Citizens Who Brought from Abroad: An Example from Turkey
Erkut Etçioğlu, Abdülkadir Aydın, Feride Özen, Elif Köse, Muhammet Raşit Aydın, Gürkan Muratdağı, Oğuzhan Kılınçel, Şenay Kılınçel, Hasan Çetin Ekerbiçer
doi: 10.14744/etd.2020.67424  Pages 385 - 392
Objective: The quarantine process implemented to prevent the spread of infection during the coronavirus disease (COVID)-19 pandemic may negatively affect individuals. We aimed to evaluate the anxiety and loneliness levels of the quarantined individuals and determine the related factors.
Materials and Methods: Two hundred ninety individuals who were brought to Turkey from abroad in May 2020, quarantined in Sakarya province, participated in our descriptive cross-sectional study. The loneliness and anxiety levels, along with the effects of the quarantine process, were evaluated. The sociodemographic information form prepared, Loneliness Scale (UCLA), State Anxiety Scale (STAI-1), and Trait Anxiety Scale (STAI-2), were used to collect data.
Results: The mean age of the participants was 35.32±9.86 years and 79.7% were male. Participants who stated that they had a mental illness before the pandemic and those who reported that they needed a mental health professional during the pandemic scored significantly higher in the UCLA, STAI-1, and STAI-2 scales compared to others. The UCLA and STAI-2 scores of participants with a high concern about contracting COVID-19 were higher than those with moderate and low levels of anxiety. The quarantine process did not significantly affect the UCLA, STAI-1, and STAI-2 scales of participants.
Conclusion: Although quarantine was not found to affect anxiety and loneliness levels, it was observed that the basis of anxiety in highly anxious individuals was constituted by worry about themselves or loved ones contracting the disease and economic effects of the process.

14.Comparison of the Treatment Cost of COVID-19 and Non-COVID-19 Patients in the Intensive Care Unit
Gülsüm Kavalcı
doi: 10.14744/etd.2020.97572  Pages 393 - 396
Objective: This study aimed to compare the cost of treating coronavirus disease 2019 (COVID-19) and non-COVID-19 patients in our intensive care unit (ICU).
Materials and Methods: Patient data such as age, gender, comorbidities, radiological findings, treatments received, length of stay in the ICU, polymerase chain reaction (PCR) test result, and invoice issued at the time of discharge were recorded. The patients were divided into two groups, including patients being treated for COVID-19 (Group 1) and those being treated for other diseases (non-COVID-19) (Group 2). The chi-square test (χ2) was used to compare categorical variables. Continuous variables were compared using the Mann–Whitney U test. Spearman’s correlation coefficient was used to determine the correlation between treatment cost and variables. A p-value of <0.05 was considered statistically significant.
Results: A positive moderate statistically significant correlation was found between treatment cost and length of stay in the ICU (r=0.68; p<0.001).
Conclusion: The present study showed that the treatment cost increases with a prolonged length of stay in the ICU. In addition, it was shown that it is more expensive to treat COVID-19 patients.

CASE REPORT
15.Successfully Managed COVID-19 Pneumonia with Prone Positioning and Convalescent Plasma Therapy
Fulya Yılmaz, Koray Baş
doi: 10.14744/etd.2020.48991  Pages 397 - 399
Background: We report patient with a severe COVID-19 pneumonia, which was successfully managed with prone positioning and convalescent plasma therapy.
Case Report: A 56-year-old-woman presented to the emergency department with symptoms of cough, weakness and fever. The patient did not have any comorbid conditions apart from a well-controlled diabetes mellitus. She was hospitalized with a diagnosis of suspected COVID-19 pneumonia based on her chest CT scan. Due to deterioration in her follow-up, she was transferred to the ICU and was intubated, positioned to prone and convalescent plasma therapy was administered. Seven days after intubation, the patient was extubated, and on the 27th day of the ICU admission, she was discharged back to the ward from ICU.
Conclusion: COVID-19 still has no specific treatment. Urgent development of successful treatment modalities is necessary. However, until an effective treatment is found, the application of the existing alternative treatment methods and sharing the results may guide and help studies.

16.A Case Report of Varicella Pneumonia in an Immunocompetent Adult
Nevin Ince, Özge Kılınçel, Işılay Tanışman, Ali Rıza Gürbüz
doi: 10.14744/etd.2020.88288  Pages 400 - 402
Background: Chickenpox is a mild, highly infectious viral disease seen in childhood. However, the course tends to be severe in adults and immunosuppressive individuals.
Case Report: A 40-year-old man with no known history of chronic disease presented to our hospital emergency department with widespread eruptions over the entire body and cough. Varicella pneumonia was diagnosed based on the patient being in contact with his children who had shortly previously contracted chickenpox, typical cutaneous lesions, and the clinical and thoracic computerized tomography findings. The patient was treated with acyclovir and antibiotics in terms of secondary bacterial infection. Complete healing was achieved after 7 days of treatment.
Conclusion: This case is presented to draw attention to pneumonia, a severe complication of chickenpox.

17.Celiac Disease and Autoimmune Hepatitis Presenting with Fulminant Hepatic Failure: A Case Report
Kadriye Nil Kaptan, Taner Özgür, Enes Turan, Tanju Özkan
doi: 10.14744/etd.2020.21456  Pages 403 - 405
Background: Fulminant hepatic failure (FHF) may be a rare presentation of autoimmune hepatitis (AIH) in previously asymptomatic adolescents. Celiac disease (CD) is a chronic immune disease that may be associated with severe forms of liver disease and coexists with AIH. We report a patient presenting with an FHF at the diagnosis of AIH and CD.
Case Report: An 8-year-old female patient who had no known background or family history of liver disease was referred to our center with an FHF diagnosis. Her clinical and laboratory findings fulfilled the criteria of seronegative AIH and CD. After 7 days of starting the medical treatment, encephalopathy and liver function tests gradually improved.
Conclusion: AIH and CD usually follow a chronic course and rarely coexist. However, they should be considered the etiologies of FHF and should be treated promptly.

IMAGE
18.Orbital Abscess in a Child: A Dangerous Complication of Rhinosinusitis
Nezaket Tektaş, Kerem Kökoğlu, Alperen Vural
doi: 10.14744/etd.2020.73669  Pages 406 - 407
Abstract | Full Text PDF

19.Maxillary Odontoameloblastoma
İrfan Kara, Muhammed Gazi Yıldız, Saime Güzelsoy Sağıroğlu
doi: 10.14744/etd.2020.47786  Pages 408 - 409
Abstract | Full Text PDF

LETTER TO THE EDITOR
20.COVID-19 Outbreak, Market, Food Supply and Food Safety
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
doi: 10.14744/etd.2020.34576  Pages 410 - 411
Abstract | Full Text PDF

HISTORY OF MEDICINE
21.Use of Saffron Against Dementia and Memory Impairment in Traditional Persian Medicine: A Historical Perspective
Leila Rasi Marzabadi, Reza Mohammadinasab, Javad Ghazi Sharbaf, Mostafa Araj-Khodaei, Seyyed MohammadBagher Fazljou, Mahnaz Talebi, Saeed Sadigh-Eteghad
doi: 10.14744/etd.2021.89248  Pages 412 - 416
In the last century, dementia became one of the most widespread diseases due to the aging world population. Alzheimer’s disease is the most common type of dementia. Persian medical literatures have discussed disorders such as forgetfulness and their treatment under the topic “Nesian.” Causes of these medical conditions have been also categorized. Poor memory and improving its treatment methods have long been important in traditional medical teaching. For example, saffron is one of the herbs used as a memory enhancer, and it has been cited many times in the related literature. This study sought to consider the history of saffron in the treatment of dementia by examining authentic books of traditional Persian medicine and by describing examples of medicinal compounds affecting saffron-based medications. In reviewing these books, in the eighth century CE, three centuries before Avicenna, Ibn Hakam from Damascus was the first physician who deliberated the role of saffron in the treatment of dementia in his book Haroniye (Aaron’s book). After him, other great scholars including IbnSina, Ibn Elias Shirazi, and Dawood ibn Omar Antaki developed saffron-based formulas to improve the memory status of patients with forgetfulness.

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