Original Article

Journal of Evidence-Based
Complementary & Alternative Medicine
Nutritional Aspects to Prevent Heart 2015, Vol. 20(1) 57-64
The Author(s) 2014

Diseases in Traditional Persian Medicine Reprints and permission:

sagepub.com/journalsPermissions.nav
DOI: 10.1177/2156587214553939
cam.sagepub.com

Gholamreza Kordafshari, MD1, Hoorieh Mohammadi Kenari, MD2,

Mohammad Mehdi Esfahani, PhD1,
Mohammad Reza Shams Ardakani, PhD1,
Mansoor Keshavarz, PhD1, Esmaeil Nazem1,
Maryam Moghimi, MD2, and Arman Zargaran, PharmD3,4

Abstract
Cardiovascular diseases are major health complications currently in various societies. Management of heart diseases as a
prevention step or as treatment with low-cost procedures like lifestyle modifications including nutrition are important current
trends. Although the term nutrition dates back to 2 past centuries, Persian physicians contributed to this term at least from
1000 years ago. Rhazes (865-925 AD) was one of the pioneers in this field. He preferred using foods in treating illnesses. Foods
and drinks were 1 subject from 6 principles (Setteh Zarorieh) that Persian physicians believed can affect human health. In this
review, we described some medieval Persian views on the role of nutrition in heart diseases and compare their prescriptions with
current findings. Interestingly, current investigations mostly support Persian medicine principles. Historically, this work shows
that the concept of nutrition in heart diseases has had a successful background at least from 1000 years ago in Persia.

Keywords
nutrition, heart diseases, traditional Persian medicine

Received July 8, 2014. Accepted for publication July 22, 2014.

Introduction
Cardiovascular diseases as well as heart diseases are major
health complications currently in various societies. Manage-
ment of heart diseases as a prevention step or as treatment with
low-cost procedures like lifestyle modifications are important
current trends.1,2
Before 1900, infectious diseases and malnutrition were the
most prevalent reasons of death in the world. It was about
40% in high-income countries and 28% in low- to moderate-
income countries. One fourth of these was sudden deaths.
Changing diseases and death factors in the 20th and 21st cen-
turies has caused a global increase of heart diseases. Nowadays,
heart diseases are the most widespread and serious diseases in
developed societies and their prevalence in underdeveloped
countries is increasing very fast. This change is mainly because
of rapid industrialization, civilization, and, as a result, changing
lifestyles across the entire world, including all races, family
groups, and cultures. One of the most important changes is peo-
ples diet.3 In fact, heart diseases are rooted in peoples lifelong
unhealthy diet.4
Development increases the use of processed food and hydro-
genated vegetable oil and also low level of natural food and
vegetables utilization, which is the basis for heart diseases. It
may affect people in families not only because of genetics but
also as a matter of familys behavioral routine and nutritional
habits.3
Heart disease complications are not only burdensome for the
person himself/herself but also increase emotional and eco-
nomic burden for the family and the society. One of the most
important strategies for reducing these consequences is to cor-
rect unhealthy family diets.3,5,6
Although attention to the importance of diet as a preventive
factor in heart diseases dates back to past decades,7 historically,
1
School of Traditional Medicine, Tehran University of Medical Sciences,
Tehran, Iran
2
Qoran, Hadis and Teb Sciences Research Center, Tehran University of
Medical Sciences, Tehran, Iran
3
Pharmaceutical Sciences Research Center and Department of
Phytopharmaceuticals (Traditional Pharmacy), Shiraz University of Medical
Sciences, Shiraz, Iran
4
Research Office for the History of Persian Medicine and Department of
History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Corresponding Author:
Hoorieh Mohammadi Kenari, MD, School of Traditional Medicine, Tehran
University of Medical Sciences, Tehran, Iran.
Email: hmk1358@gmail.com

57
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Figure 1. A romanticized image of Rhazes (865-925 AD) visiting sick
children.
nutrition and diet were important subjects for Persian physicians
during the medieval age. Rhazes (865-925 AD) was one of the
first pioneers in this field (Figure 1).8 He wrote many special
manuscripts on nutrition and dietary regimen in medicine, such
as Manfe al aghzie va mazareha (Benefits of Food and Its
Harmfulness), Atame al marza (Food for Patients),
Ma iaghdam men al favakeh va al aghzieh va ma yoakhar
(Fruits Before or After Meal), Keifiat al eghteza (Tempera-
ment and Quality of Foods), and Al aghziat al mokhtasareh
(Brief Facts About Foods).8,9 A thousand years ago, he advised
physicians as follows: If a physician can treat a patient with
food he has been fortunate; if patient was not cured, he should
use simple drugs and as last line use compound drugs, or If Qarabadin/Pharmacopea),16 and Makhzan al Adviyeh (Store-
physician can treat a patient with food, he achieves bliss!10
After him, attention to nutrition was one of the important princi-
ples to keep health in Persian medicine. Overall, Persians
believed that 6 main subjects (called as Sette Zaroorieh, or 6
principles) can affect body health including air (cleanness, tem-
perature, and geographical situation), nutrition (food and drinks),
exercise, sleep and wake, exertion of unnecessary materials from
the body, and finally physiological concepts (Figure 2). Persian
physicians believed prevention of diseases is in following the
principles well.11
Regarding to this brief explanation about the importance
of nutrition to prevent diseases, we aim to consider Medieval
58
Journal of Evidence-Based Complementary & Alternative Medicine 20(1)
Figure 2. Sette Zaroorieh (6 principles to keeping health) in traditional
Persian medicine.
Persian physicians views about the role of nutrition in preven-
tion of heart diseases.
Medieval Persian physicians such as Ibn Sina (Avicenna)
and Zakaria Razi (Rhazes) believed that the heart is one of the
most important body organs. Also in historical Persian medi-
cine references, it is mentioned as one of the chief organs in the
body. Its action is to supply vita to the whole body. The bodys
health, strength, and equability is dependent on the health of the
heart, because it is the base of human creation and the body is
alive and stabled with.12,13
In this study, we provide a description of heart diseases,
complications, nutritional facts related to 2 aspects of heart
health and heart disease treatment, and also the mechanisms
affecting the heart in Persian medicine references such as
Qanon fi al-Teb (Canon of Medicine),12 Exir e Azam (Great
Elixir),13 Teb e Akbari (Akbaries Medicine),14 Mojarrabat e
Farangi (Foreign Experiences),15 Qarabadin e Kabir (Great
house of Medicaments)17 (Table 1). Also their useful and harm-
ful components from different nutritional groups are discussed
and compared with current findings in medicine. Furthermore,
nutritional strategies to prevent and treat heart diseases are
being evaluated and then useful and harmful nutritional compo-
nents are discussed based on traditional Persian medicine.
Persian Medicine
The history of Persian medicine is divided into 2 main parts:
ancient era (before Islam, from the beginning of history to
637 AD) and Islamic period (medieval age).18,19 Persian med-
icine started from ancient times.20 It seems that Persians started
Kordafshari et al 59

Table 1. The List of Persian Manuscripts Used in This Article. Table 3. The List of Medicinal Plants Mentioned in the Article.

Persian Name of English Translation Date of English

Manuscript of Manuscript Title Author Writing Persian Common Scientific
Name Name Name Family
Qanon fi al-Teb Canon of Medicine Avicenna 1025 AD
Teb e Akbari Akbaries Medicine Arzani 1700 AD Sib Apple Malus domestica Borkh., Rosaceae
Makhzan al Storehouse of Medicaments Aghili Shirazi 1771 AD 1803
Adviyeh Golabi Pear Pyrus syriaca L. Rosaceae
Qarabadin e Great Qarabadin/ Aghili Shirazi 1772 AD Beh Quince Cydonia oblonga Mill. Rosaceae
Kabir Pharmacopea Reyhan Basil Ocimum basilicum L. Lamiaceae
Exir e Azam Great Elixir Azam Khan 1810 AD Nana Peppermint Mentha  piperita L. Lamiaceae
Mojarrabat e Foreign Experiences Doon Kheiri 1838 AD Gol Sorkh Damask rose Rosa damascena Mill. Rosaceae
Farangi Pesteh Pistachio Pistacia vera L. Anacardiaceae
Zaferan Saffron Crocus sativus L. Iridaceae
Sir/Soom Garlic Allium sativum L. Amaryllidaceae
Table 2. Four Temperaments in Persian Languages. Limoo Persian limes Citrus  latifolia Tanaka Rutaceae
Anar Pomegranate Punica granatum L. Lythraceae
Common Sassanid Pahlavic Medieval Zereshk Barberry Berberis vulgaris L. Berberidaceae
English (Ancient Persian) Persian Narenj Sour orange Citrus  aurantium L. Rutaceae
Name Name Name Quality Darchin Cinnamon Cinnamomum verum Lauraceae
J.Presl
Blood Xon Xon-Dam Hot and wet Zireh Sabz Cumin Cuminum cyminum L. Apiaceae
Phlegm Blagm Balgham Cold and wet Mikhak Clove Syzygium aromaticum (L.) Myrtaceae
Yellow bile Wis i suxr Safra Hot and dry Merrill & Perry
Black bile Wis i sya Soda Cold and dry Hel Cardamom Amomum subulatum Zingiberaceae
Roxb.
Ananas Pineapple Ananas comosus (L.) Merr. Bromeliaceae
the paradigm of humorism for the first time and then it became Sfenaj Spinach Spinacia oleracea L. Amaranthaceae
a worldwide theme of medicine in ancient age and later in Kadoo Pumpkin Cucurbita pepo L. Cucurbitaceae
medieval age.21 This paradigm was based on 4 temperaments Piaz Onion Allium cepa L. Amaryllidaceae
including blood, phlegm, black bile, and yellow bile (Table 2). Mash Vetch Vicia spp. Fabaceae
Ancient Persia was the time of great empires. Achaemenids Badam Almond Prunus amygdalus Batsch Rosaceae
Otroj Citron Citrus medica L. Rutaceae
(550-330 BC), Parthians (247 BC-224 AD), and Sassanids Tamr Tamarind Tamarindus indica L. Fabaceae
(224-637 AD) were the main ancient Persian dynasties. They Geshniz Coriander Coriandrum sativum L. Apiaceae
were the main civilized and powerful governments in the ancient
world. Medicine was well organized in these empires, especially
in the Sassanid period. Advanced medical organizations and 1. Sometimes after hunger and insufficient food intake for
laws, medical councils, hospitals, medical universities, and so some days, low-quality blood will be made in the body,
forth, are some examples of advanced structures in ancient Per- which causes body weakness. Then we have to use the
sian times.21,22 In the Sassanid dynasty, Jundishapour University foods that strengthen the heart such as meat gravy, soft
and Hospital in south west Persia was the main medical center in boiled egg, apple (Malus domestica Borkh., 1803), pear
the whole world.23 In the early Islamic period, when Persians (Pyrus syriaca L.), quince (Cydonia oblonga Mill.),
lost their political strength, they showed more interest toward basil (Ocimum basilicum L.), peppermint (Mentha 
science, especially medical knowledge. Medical science was piperita L.), rose water, pistachio (Pistacia vera L.),
popularized and spread by Persian scientists such as Akhawayni, and saffron (Crocus sativus L.).13
Rhazes, Avicenna, Hally Abbas, Jorjani, and others during 9th to
12th century AD.24-29 During later centuries, the growth of med- Also, we can see some combination foods such as formula-
ical sciences decreased but continued in Persia until Renais- tions given below:
sance. After Renaissance, gradually the Persian holistic
paradigm of medicine (humoral theory) was replaced by the cur-  Apple regimen: 7 to 8 glasses of apple juice, or couple of
rent concept of medicine (molecular paradigm) worldwide.30 cups from apples faloodeh (a traditional formulation) or
10 to 15 apples per day.
 Saffron syrup is very useful for heart diseases and body
Result weakness. Put 1 teaspoon of saffron in 2 glasses of hot
water and let it infuse. Then add some water, rosewater,
Nutritional Strategies for Heart Disease Treatment
honey, or sugar and drink it.
In medieval Persian manuscripts, we can find some main stra-
tegies about using foods and drinks in heart-related complica- 2. Persian physicians believed that sometimes heart vessel
tions. Some of these strategies are listed below. obstruction occurs following ingestion of foods that

59
60
make low-quality blood in the body. So for resolving
the obstructions and also treating high blood pressure,
the instruction given below was suggested by the
Persian physicians:
Add 30 garlic (Allium sativum L.) beans to 5 fresh limes (Citrus
 latifolia Tanaka) (with peels having some cuts on them) and
mix them until a paste was formed. The resultant paste must be
added to 1 liter of water and boiled on a low flame. Let the mix-
ture get cold. Then filter and keep it in the refrigerator. Drink
50 cc before breakfast for 40 days. Repeat it every 6 months
to 1 year.15
3. Patients who have heat temperament on heart, with
symptoms of palpitation, restlessness, thirst, and feel
the need for breathing in cold air.14
 Avicenna said the following: Eating fruit sauce, espe-
cially apple and quince sauce, is the treatment for such
patients.22
 Drinking apple, pomegranate (Punica granatum L.),
quince, and lime syrup with rosewater and sugar is use-
ful. Barberry (Berberis vulgaris L.) and verjuice are also
helpful.13-15
 Lime syrup: Pour some sugar in a jar and add as much as
lime juice to cover it up. Then close the jar and put it in
room temperature for 24 hours. Then filter the resultant
mixture and boil with some more lime juice. Dilute it
with water on administration.
 Sour orange (Citrus  aurantium L.): Boil the sour
orange juice (400 g) with 2/3 of that from sugar and
some rosewater on a mild flame.16
 Pomegranate syrup: Boil the pomegranate juice with
rock candy.
 Rice and chicken, flavored with lime juice, verjuice, and
barberry.
 Chicken soup with pomegranate juice, verjuice, or lime
juice.13-15
4. Patients who have cold temperament on heart with
symptoms of slow pulses, shallow breathing, pallid
skin, and total body weakness, anxiety, and phobia.14
Persian physicians suggested the following:
 Patient has to avoid eating cold temperament foods and
cold water as much as possible.
 Birds meat such as partridge, pet hen, pigeon, sparrow,
and francolin cooked with hot temperament spices such
as cinnamon (Cinnamomum verum J. Presl), saffron,
cumin (Cuminum cyminum L.), clove (Syzygium aroma-
ticum (L.) Merrill & Perry), and cardamom (Amomum
subulatum Roxb.).
 Soft boiled yolk with cinnamon.13-15
60
Journal of Evidence-Based Complementary & Alternative Medicine 20(1)
5. Patients who have moist temperament on heart and
symptoms such as excitement rapidly influencing the
patient the effect disappearing soon.14 In such diseases
the most important strategy is decreasing the amount of
food intake. Some simple foods suggested by Persian
physicians are the following:
 Chicken soup with bread
 Grilled chicken meat
 Apple syrup
 Minted pomegranate syrup
 Sekanjabin (Oxymel): Mix the same amount of honey
and vinegar. Then boil it on mild flame for 15 seconds
to be homogenous.12-15,17
6. Patients who have dry temperament on heart and the
symptoms are leanness, insomnia, and dry cough and
also can be explained as excitement not easily affecting
the patients, but if they do, the effect remains for long
time.14
In such conditions, Persian physicians believed that patients
have to eat moisturizing foods, and if coldness is also there with
dryness, they must avoid cold water. Some of suggested foods
and drinks are the following:
 Fresh milk (in case of no fever)
 Pineapple (Ananas comosus (L.) Merr.) juice
 Spinach (Spinacia oleracea L.), potage, pumpkin
(Cucurbita pepo L.), kid or lamb meat cooked with
onion (Allium cepa L.), and dried vegetables with spices
useful for heart
 Peeled vetch (Vicia spp.) with almond (Prunus amygda-
lus Batsch) oil, spinach, and cucurbit.
 Porridge cooked from wheat flour, almond oil, milk, and
sugar.12,13,15
Even in favor of heart health or regarding heart disease treat-
ment, laxatives have to be taken to avoid constipation, so that
accumulation of harmful substances and their vapors cannot
harm the heart.12,13
7. Prohibiting advices for general heart complications.
People have to avoid the conditions listed below, even
for retaining heart health or to treat heart diseases:
 Excessive use of cold tempered food without adjuster
 Surfeiting foods that make harmful vapors, like onion
 High-fat foods, high-density tea, coffee, cocoa, and
excessive use of meat12,13
Some Examples of Nutrients Effective in Retaining
Healthy Heart
Hakim Azam Khan, one of the last medieval Indo-Persian phy-
sicians, categorized some of the nutrients that are suggested to
Kordafshari et al
be effective in heart health in his great medical encyclopedia
Exir Azam:
Meats: Fat-less lamb or young kid, small fishes, birds
with soft meat such as pet hen, sparrow, francolin,
pigeon, and the heart of halal animals
Fruits: Sweet and ripe apple and pear, quince, pomegra-
nate, lime, sour orange, citron (Citrus Medica L.),
tamarind (Tamarindus indica L.), and pineapple
Vegetables: Peppermint, basil, coriander (Coriandrum
sativum L.)
Others: Lamb, kid or above-mentioned birds meat gravy,
soft boiled yolk, rose water, saffron, cardamom, cinna-
mon, pistachio, fruit juices, syrups, and jams made
from aforementioned fruits.13
Some examples of useful foods frequently advised by
Persian physicians for heart that are made from above-
mentioned materials are as follows:
Medical Jollab syrup: Boil 1 kg of sugar with 3 kg rose-
water on a mild flame; put the foam away until it
reaches half its size. Then add 1 g powdered saffron.
Keep the resultant mixture in a jar; dilute it with water
at the administration time and drink.
Apple Faloodeh: Mix grated apples with little bit of rose-
water and honey.
Apple syrup: Put some apple juice on the flame to reach
half in volume. Then filter and put it aside for 1 night.
Then again put it on the flame to be concentrated. Fil-
ter it again and pour it in a jar. If it is summer time,
expose it in sunshine for some days to vaporizing its
water. Keep it in a glass bottle. If you want it sweet,
add 450 g sugar per 3 kg apple juice and consolidate
it.12-17
All the plants mentioned in this article listed in Table 3.
Discussion
From the medieval Persian physicians point of view, heart
cannot tolerate regular diseases because of its sensitivity and
key function, and therefore, its affliction to some of these dis-
eases causes death. So it deserves to have the physicians high-
est attention toward its health and diseases prevention.12,13
Modern medical references concede that general health was
mainly based on primary prevention (health improvement) and
in next level on secondary prevention (treatment and rehabili-
tation) in prior time.4
Persian scholars have mentioned some facts useful to retain
heart health, such as avoiding awful odors and smelling aro-
matic plants and fruits instead and stopping anger, sorrow,
obsessive thoughts, sudden excitements, longsome awakening,
excessive activities, massive sports, and also paying attention
to the nutritional facts, which is very important.12-14
Foods affecting the heart can prevent heart diseases with dif-
ferent mechanisms. From Persian traditional medicine point of
61
view, useful meats for heart health such as young lamb and
chicks contain different nutrients, can be digested fast and eas-
ily, and cause good blood production in the body.
Persian physicians believed that eating the heart of animals
used regularly for their meat causes merriment in patient and so
is useful for the heart. The aforementioned fruits and vegeta-
bles also contain nutrients and vitamins, reinforce the heart,
and avoid the accumulation of harmful substances in heart and
vessels.12-17
From traditional medicine point of view, eating apples is
joyful and is heart reinforcing, especially if used with rose-
water.12,13,17 Modern medicine articles also claimed that eating
apple and apple juice reduces the low-density lipoprotein oxi-
dation in a healthy person31 and prevents hypercholesterole-
mia, oxidative stresses,32 and arthrosclerosis,33 and so
reduces risk of heart diseases.
According to Persian medicine, sweet pear also regulates the
blood and is breezy and heart reinforcing agent.17 A study in
Mexico in 2010 claims that having a pear every day will
decrease the cholesterol level in smoking people34 and so pre-
vents heart diseases in people who have 2 risk factors of smok-
ing and high cholesterol level.
Aghili Shirazi mentioned that pistachio is also very aromatic
and so heart reinforcing in his manuscript.17 A study in United
States in 2012 showed that pistachio decreases systolic blood
pressure in dyslipidemic patients.35 Another study claimed that
pistachio decreases the plasma level of oxidized low-density
lipoprotein in hypercholesterolemic patients.36 Also, smelling
aromatic fruits and vegetables such as apple, quince, and basil
is effective in heart reinforcement.
Although all the mentioned food substances are good for
keeping the heart healthy, different foods will be chosen
depending on the nature of the patient and disease and also the
patients temperament (individual medicine).
Among the foods effective in retaining health and also for
cardiac patients, saffron has a special role. From the traditional
medicine point of view, saffron increases the tendency and
penetration of nutrients and medicines to the heart. Also, it
is breezy and a heart reinforcing agent. Avicenna and other
Persian scholars recommended adding saffron to the combina-
tion of medicines for patients with heart diseases so that leading
and penetration of medicines to the heart will be better.12,13
From the modern medicine perspective, saffron prevents
cholesterol, triglycerides, and low-density lipoprotein elevation
and also avoids their residuum in vessels.37
Also in patients who have a history of cardiac infarction,
saffron decreases the size of the infarcted area and prevents
myocardial ischemia-reperfusion damage.38 Also, it retains
hemodynamic balance and protects left ventricle action against
myocardial defection.39 Antihypertensive effects of saffron
have also been proved in some investigations.40
Persian physicians believed that to eliminate cardiovascular
obstructions and also reduce blood pressure, a mixture of garlic
and lime can be used. From the traditional medicine point of
view, garlic is blood diluter and eliminator of harmful and thick
substances.17 Lime is also an anti-inflammatory agent and the
61
62
eliminator of improper and harmful substances.17 In current
medicine, the efficacy of garlic in reducing blood pressure has
been shown.41-43
Medieval Persian physicians believed that aforementioned
fruits such as apple, pomegranate, and citrus are effective in
heart with hot temperament, and are also anti-inflammatory,
heart heat eliminator, and anti-thirst agent.12-17 In modern
medicine, eating pomegranate is very effective on the vascu-
lar system. It decreases atherosclerotic area and also intima-
media thickness in cardiac patients vessels under medical
treatment.44 Pomegranate decreases systolic blood pres-
sure,45 and citrus will prevent negative oxidative stresses
on myocardium.46
Aghili Shirazi mentioned that barberry and verjuice as food
spices can be used in these diseases, reliving thirst and resol-
ving the heat temperament heart symptoms.17 In current stud-
ies, antihypertensive and vessel dilating effects of barberry
have been reported.47 Also, barberry has been shown to prevent
myocardial ischemic-reperfusion defects.48 According to Per-
sian medicine, in food regimen for patients with cold tempera-
ment on heart, hot tempered spices such as cinnamon, saffron,
cumin, and cardamom should be included, which are effective
for treatment.17
One of the important suggestions in moist temperamental
heart diseases is to use Sekanjabin (Oxymel). In traditional
medicine, Sekanjabin is moderately hot tempered (moderate
heat) and is useful to eliminate excessive moist.16 In dry tem-
pered heart diseases, suggested foods to return moistness to the
body are milk, spinach, vetch, almond, and cucurbit. According
to Persian medicine, fresh milk is body reinforcing and fatten-
ing agent and also can retain body moisture. Spinach is fast
digested and can produce high-quality blood in the body and
returns the moisture to the body. Cucurbit also produces good
humors and substances in the body if being cooked with vetch
and other mentioned spices and is also a moisturizing agent.12-
17
Also, it is mentioned that vetch is very nutritious, produces
high-quality blood in the body, and is less flatulent than other
beans. Almond oil is moderate temperament and is very moist-
urizing.17 In current findings, it is mentioned that using spinach
in myocardial infarcted mice can regulate inflammatory factors
and protein profile.49 Almond is effective in reducing blood
cholesterol50,51 and preventing lipid oxidation.52
According to Persian medicine, one of the most harmful fac-
tors in cardiac heath is constipation. Laxatives must be consid-
ered for cardiac patients. Persian physicians believed that if
constipation happens, accumulation of substances and toxins
in the body will cause several complications such as cardiac
symptoms. Ignoring these complications especially in the intes-
tine will not allow the patient to be cured.12,13
Conclusion
In prevention and treatment of heart diseases, diet revision and
returning back to natural food substances, and choosing right
foods from all different nutritional groups based on individual
62
Journal of Evidence-Based Complementary & Alternative Medicine 20(1)
temperament are highly recommended by Persian physicians of
the medieval age. Many of their recommendations also are con-
firmed by current medical findings. Their medical views on the
role of nutrition in heart diseases are historically important and
can show a part of history of cardiology in medieval time. Also,
by comparing them with current findings, some new ideas can
be formed to help current approaches to prevent heart diseases
using natural foods and drinks.
Authors Note
This work is a part of a PhD thesis (No. 101) presented in the School of
Traditional Medicine, Tehran University of Medical Sciences.
Author Contributions
GK, HMK, and MM wrote the preliminary draft and contributed in
data gathering and first idea of starting this project. AZ rewrote the
draft and contributed in data gathering and writing the final version
of the article. The other coauthors contributed in the guidance, revi-
sion, and correction of the article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship,
and/or publication of this article.
Ethical Approval
Ethical approval is not required for this study as no human subjects
were involved.
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