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Showing 15 results for Sezavar

Mohammadali Mohammadi , Hosein Doostkami , Behrooz Dadkhah , Seyedhashem Sezavar ,
Volume 2, Issue 2 (Summer 2002)
Abstract

  Background & Objectives : Coronary artery disease is one of the most important mortality causes in developed and developing countries. Many risk factors can influence coronary artery disease some of which can be controlled and prevented. Information should be given to people for controlling these factors and prior to this information – giving, the primary awareness of them about risk factors needs to be ascertained. This research is a study of the knowledge, attitude and practice of Ardabil people about CAD risk factors.

  Methods : This descriptive analytic study was done on 384 individuals (female and male) over 20 years old. These subjects were selected from five clusters. Synthetic questionnaire was used for data collection through direct interview at home. The collected data was then analyzed by SPSS software.

  Results : 50.5% of samples were females. 27.3 % of the subjects were high-school graduates. Most of them (70%) were aware of stress and lesion as risk factors. 66.9% of them were aware only of the effect of immobility on coronary artery disease but 13% of them had regular physical activity. 52.1% of them were aware of the harmful effect of salt on CAD, but 15% of them had low salt intake. 48.2% of people were aware of benefit of liquid oil on health, but only 25% of them consumed it. Results showed that, 48.2%, 51.3% and 40.9% of individual had moderate knowledge, positive attitude, and weak practice, respectively. The relationship among variables was significant (P<0.0001), and practice of people has been increased with increasing of knowledge and attitude.

  Conclusion : Regarding these results, regular programs are necessary for increasing awareness and practice of people as primary preventive steps for controlling CAD.


Shahnam Arshi , Homayoun Sadeghi , Mahdi Mohebali , Seyedhashem Sezavar, Arman Javanrozegar , Darioush Emdadi , Vahid Sepehram , Nayereh Aminisani ,
Volume 2, Issue 3 (Autumn 2002)
Abstract

 Backgrond & Objective: In recent years, malaria has been a serious problem in Parsabad (a north-western town in Iran). A lot of health-care funding has been allocated to malaria campaign program in this area. The objective of this study was to investigate clinical epidemiology of malaria during 1999-2000.

 Methods: The data collected through epidemiology forms filled for 509 malaria positive cases during 1999- 2000 was analyzed by EPI2000 software. Frequency tables, X2 test and one way ANOVA were used in this analysis.

 Results: All 509 Malaria cases diagnosed were P vivax. They belonged to the first seven-month of the year. 69.4% of malaria cases were related to the year 2000 and the others were related to 1999. The most frequent symptoms were chills in 488 cases (95.9%) and fever in 481 of them (94.5%). Sweating was found only in 3.9% of the reported cases. Mean age and standard deviation of patients was 22.9 + 15.6. There was no significant difference between men and women in terms of the distribution of fever and chills.

 Conclusions: The high prevalence of fever and chills was compatible with the findings of previous studies. If one of the two symptoms is positive in the residents of this area or those people traveling there, malaria should be suspected.


Effat Mazaheri , Seyedhashem Sezavar , Adalat Hosseinian , Nasrin Fooladi ,
Volume 2, Issue 4 (Winter 2002)
Abstract

  Background & Objective : Today, with changes in health care systems, most of the patients, receive occupational and special cares at home after being discharged from hospital . The aim of this study was to assess the effects of follow up on physical and emotional status of the patients with recent myocardial Infarction .

  Methods : This experimental study was done on 60 patients with acute myocardial infarction, who referred to Boali Hospital during 2000-2001.The patients were chosen randomly and were set in two different groups with 30 subjects in each group . Then, a home care program was designed for case group. but there was no intervention for control group . This home care program was completed and one week later the physical and emotional status of the patients in two groups were analyzed by Spilbergar and Beck tests and finally the results were compared in two groups using X2 test.

  Results : The X2 test showed that there is a significant difference between resting heart rate of two groups with P<0.05 but the difference among systolic and diastolic blood pressure, body weight, anxiety and depression was not statistically significant in two groups.

  Conclusions: Regarding the effects of follow-up on the physical and emotional status of the patients, nurses can improve the quality of the patienys life through active home - care and rehabilitation programs along with social supports.


Adalat Hosseinian , Seyedhashem Sezavar , Mohammadtaghi Nikneghad , Farid Ghosseili, Zahra Mussavi , Eilnaz Mohammadi ,
Volume 3, Issue 2 (Summer 2003)
Abstract

 Background & Objective: Despite all improvements in diagnosis and treatment, one third of patients with Myocardial infarction lose their life. Different studies have shown that cardiac arrhythmia are the most common cause of death in MI, and cardiac blocks are one of the important groups of these arrhythmia, which are effective in prognosis, duration of hospitalization and hospital mortality of the patients.

  Methods : In this study, 630 patients with AMI, who were admitted in CCU of Bou-Ali hospital in Ardabil from January 1998 to January 2001 were studied and the data were callected with the help of questionnaires and secondary data analysis method. The data were analyzed with statistical methods.

  Results : 9.4% of cases in this study had AV block and 30.2% had bundle branch block. 40.5% of men and 37.6% of women had at least one kind of block(in AV node or bundle branch), but no significant relation was found between sex and these blocks. Also, 62% of in-hospital mortalities of patients with AMI were in association with blocks (AV or bundle branch) and only 38% of mortalities were without blocks. This showed a meaningful relation between hospital mortality and these kinds of blocks (p <0.05 ).

 Conclusions: The total frequency of AV and bundle branch blocks due to AMI, was 39.6% which is similar to other studies, but what is remarkable in this study, is the higher prevalence of bundle branch blocks due to AMI.


Ali Majidpour , Hasan Adalatkhah , Seyedhashem Sezavar , Nayereh Aminisani , Masoud Shabani , Ali Nemati ,
Volume 3, Issue 3 (Autumn 2003)
Abstract

  Background & Objective : Promoting health has always been considered as one of the basic priorities in international, national, regional and local policies. Moreover, retention and promotion of individual health requires a good knowledge of essentials and priorities of the future. Consequently, determining heslth priorities and devising public health programs and policies is just one of the crucial issues to be considered and implemented by the organizations involved. So a fundamental revising of the health care services based on health promotion indices seems to be necessary in order to increase the influence of health interference programs, extend the quality of health care services and improve activities concerning public health.

  Methods: This project started in 2001 and was defined by precise planning of its organization chart. Its two basic concerns included the current status of health and determining its priorities. The first point, that is the current status of health was performed through investigating the previous researches as well as qualitative and field studies. In this phase of research 1000 urban and 1000 rural families were interviewed about different aspects of health including population characteristics, nutrition, risk factors, treatment habits and so forth. To measure the parameters such as hemoglobin, hematocrite, sugar and lipids, blood samples were taken from members of 200 families who were above 15. Weight, height and blood pressure of all the subjects who were above 15 years of age and weight, height and Mid Arm Circumference (MAC) of the children aged below 6 were measured. The data were collected and scored based on scientific indices and finally the research priorities in the field of health were determined. It should be noted that many people and organizations participated in this research.

  Results : The findings indicated that mortality of children under 5 years of age, casualties, accidents, etc. were among 34 most essential health priorities.

  Conclusions : Regarding the great experience of determining health priorities which was conducted through need assessment and wide cooperation of the public and organizations, it seems important to conduct such researches once in some years and transfer their findings to other sectors in order to prevent wastage of costs, time and labor. This will also lead the researches towards the real needs and necessary interference in order to promote public health.


Seyedhashem Sezavar , Leili Abbaszadeh , Adalat Hosseinian , Manoochehr Iranparvar , Minaye Khodamoradzadeh ,
Volume 3, Issue 3 (Autumn 2003)
Abstract

 Background & Objective: Hypertension and diabetes mellitus coexist more commonly than predicted by chance and the synergistic effect of these two diseases is the cause of early disability and high rate of mortality in these patients. Controlling the blood pressure has a critical role in decreasing cardiovascular mortality in diabetic hypertensive cases. The goal of this study is to determine the rate of recognition and treatment of hypertension in type II diabetic subjects referring to diabetes clinic of Bou-ali hospital, Ardabil.

 Methods: In this cross-sectional study 300 type II diabetic patients were examined in terms of blood pressure control.

 Results: The patients who participated in this study ranged between 28 to 80 years of age (mean: 55.5 ± 11.4). About 61.6% of diabetic patients had hypertension (BP>140/ 90 mmHg) 76.7% of these patients were aware of their hypertension. Only 8.8% of these patients with hypertension had a well-controlled blood pressure and the rest of them (91.2%) had a poorly- controlled blood pressure (BP>130/80 mmHg). About 21.8% of hypertensive diabetics although aware of their hypertension were not on any anti- hypertensive agents.

 Conclusions: This study indicates poor control of hypertension in diabetic patients. It seems that reconsidering CME programs for the physicians, emphasizing the control of risk factors especially in high-risk groups and educating the diabetic patients will improve the control of hypertension in these patients.


Homayoun Sadeghi , Nayereh Aminisani , Shahnam Arshi, Seyedhashem Sezavar ,
Volume 3, Issue 3 (Autumn 2003)
Abstract

 Background & Objective: World health organization (WHO) has paid a special attention to the reproduction health, which plays a crucial role in women health care and its promotion. The purpose of this study is to determine reproductive factors among Ashayer women in Ardabil province.

 Methods: Part of the plan entitled Investigating health and disease among Ashayer in Ardabil which was conducted in 2003 aimed at determining the reproduction indices using a structured questionnaire. The present research was a cross-sectional study in which the data regarding the reproductive status of the Ashayer women were extracted, collected and analyzed using SPSS software and descriptive statistics.

 Results: 268 women at the age of 10-49 completed the questionnaire. Mean age of marriage among women was 18.2, 8.6% of them had a history of stillbirth, 18.1% abortion and 38.19% unwanted pregnancy. 31.4% of the subjects did not have any reproductive health care, and 67.6% of those who did so were taken care less than four times.

 Conclusion: Improvement of reproductive indices among these women requires proper health care programs in order to enhance family planning services as well as reproductive health. This can prevent future outcomes such as unwanted pregnancy and other related complications.


Shahnam Arshi , Ali Majidpoor , Homayoun Sadeghi , Seyedhashem Sezavar , Reza Gasemi Bargi , Darioush Emdadi , Nategh Abbasgholizadeh , Parvaneh Naftchi ,
Volume 4, Issue 1 (spring 2004)
Abstract

 Background & Objective: Ardabil province is the main area of Iran affected by relapsing fever (RF) for which Borrelia Persica is the most common cause. The aim of this study was to determine the epidemiologic characteristics of the disease, and the frequency of infection among ticks in this region in order to take necessary measures to decrease it is incidence and increase awareness about the characteristics of this disease.

 Method: In this study a total of 391 patients who were diagnosed to have been effected by tick borne relapsing fever were investigatated in terms of clinical epidemiology between 1998 and 2001. The kind of Borrelia as well as the clinical characteristics of the disease were observed. The kind and prevalence of Borrelia infection was determined in 1,421 ticks collected from 130 indoor and 14 outdoor sites. The ticks were crushed and the suspension obtained was injected into the peritoneum of two mice and two guinea pigs to determine the frequency of infection among the ticks living in this region. Data including the tick species determination were collected through a questionnaire and analyzed using Chi-square and ANOVA tests.

 Results: The most prevalent clinical manifestations were fever, chills and headache. Other findings included nausea, vomiting, sweating, abdominal pain, arthralgia, cough, photophobia, eosinophilia, hematuria, jaundice, petechiae and sclera congestion. Laboratory tests performed on 60 patients showed leukocytosis, high erythrocyte sedimentation rate (ESR) and anemia. Of the 1,421 ticks collected, 45.9%, 40.3% and 13.8% were infected by Ornithodoros lahorensis Ornithodoros tholozani and Argas persicus species, respectively. The prevalence of ticks was highest in Khanadabil village. The ticks collected from three villages were found to be infected with Borrelia.

 Conclusions: The clinical manifestations were similar to those reported in other studies. Petechiae occurred less frequently in our study compared to louse-borne RF. The high frequency of anemia in this region, which was not stated in other reference articles, requires further investigation.


Ali Nemati , Hosein Ali Mohammadi , Hamdollah Panahpoor , Seyedhashem Sezavar ,
Volume 4, Issue 1 (spring 2004)
Abstract

 Background & Objective: Foods of high fat may increase the risk of coagulation heart attacks. They can also increase coagulating factors and lead to higher mortality due to cardiovascular diseases and heart attacks. The aim of this study was to find out the effect of saturated (butter) and unsaturated (sunflower oil) fat intake on coagulating factors such as factor VII and fibrinogen as well as Bt, serum cholesterol and triglycerides.

 Methods: In this clinical trial 46 male healthy individuals from Ardabil University of Medical Sciences took part in this study (age: 18-28 years old) in 2002. These individuals were divided into two groups. The first group consumed 30 g of butter and the second group took 30g of sunflower oil everyday, for 14 days. Before the fat intake and at the end of first and second week blood sample was taken test to fibrinogen, factor VII, cholesterol, BT and triglycerid. Also during the study the 24-hour food-recall was taken three days a week. The collected data were analyzed with SPSS and Food Processor.

 Results: The results indicated that butter intake increases factor VII significantly at the end of the first and second week (p<0.05). But no significant about sunflower oil. BT decreased after butter intake at the end of first and second week. This decrease was significant at the end of first week (p<0.05). Bt increased significantly after sunflower oil intake at the end of second week (p<0.05). Serum fibrinogen after butter intake decreased significantly at the end of first and second week (p<0.05), but was not significant after sunflower oil intake (p<0.05). There was no significant difference in serum cholesterol and triglyceride level after butter intake, but at the end of first week after sunflower intake serum cholesterol decreased significantly (p<0.05).

 Conclusions: We concluded that the intake of saturated fat can affect factors in a short period of time and sunflower oil can decrease serum cholesterol level and as results increase the bleeding time.


Nayereh Aminisani , Seyedhashem Sezavar , Rasool Lotfollahzadeh , Nazila Vosogh,
Volume 4, Issue 2 (Summer 2004)
Abstract

 Background & Objectives: Research has always been considered as a powerful tool in creating change and development and like any other process it demands careful planning, providing facilities and special resources. Investigating research trends can pave the way for systematic thinking in this regard. This study was conducted to examine trends in research methodology in order to promote the research quality in Ardabil University of Medical Sciences.

 Methods: In this cross-sectional descriptive study, data regarding research methodology and its administration was evaluated by a questionnaire during six years from 1997 to 2003. The data regarding the author of the research were collected through the interview. These data were then analyzed by SPSS software (release 12) using descriptive statistics.

 Results: Between 1997 and 2003, 196 research proposals were approved. The number of research designs increased from 3 to 45 during this period. Most of these studies (58.2%) had cross-sectional design. The experimental researches came second with 43 cases (21.9%). During this period the number of trials and analytic studies increased, but descriptive studies were still in the highest rank. Only 32% of the proposals were completed properly and in most of the cases they were not completed in the proper way and some subsections of the forms such as design, variable table, methods of data analysis, data collection procedures and administration problems were incomplete or missing in most of the designs. These problems were more evident before the establishment of research consultation office in 2001. 75% of the researchers had attended research workshop before conducting any research.

  Conclusion: The findings indicated a remarkable increase in the number of researches compared to the preceding years. Moreover, they have been more analytically-oriented. However, descriptive researches are in the top rank. Some necessary measures have to be taken in order to improve the present condition.


Seyedhashem Sezavar , Nayere Aminisani , Seyedalireza Alavizadeh ,
Volume 4, Issue 3 (Autumn 2004)
Abstract

 Background & Objective: Cardiovascular disease is a major global health problem. Countries with low to moderate income contribute significantly to the global burden of cardiovascular disease accounting for 78% of all deaths and 86.3% of all disabilities. This study was an attempt to determine the factors contributing to premature myocardial infarction among young adults in Ardabil city.

 Methods: In this Case-control study 52 subjects, under 45, with myocardial infarction, admitted to Buali hospital in 2003-2004, were compared with 52 age and sex matched population based controls. Odds ratio and confidence interval of 95% were used to evaluate the risk factors such as smoking, physical activity, family history, history of diabetes and similar factors. Analysis of variance was used to compare the means.

 Results: The mean age of the subjects was 37.2 and 96.2% of them were male. The positive family history of cardiovascular disease with odds ratio of 9.4 (95% CI=2.6-34.3) and current smoking with odds ratio of 2.8 (95% CI=1.3-6.2) associated with myocardial infarction. Mean of the body mass index and mean of concentration of FBS, LDL and HDL were different in case and control groups. Physical activity with odds ratio of 0.4 had protective effect. (95% CI= 0.2-0.8). There was no meaningful relationship between passive smoking, total cholesterol, education and job with myocardial infarction risk.

 Conclusion: Family history, smoking, high Fasting Blood Sugar, high LDL, Low HDL and physical inactivity are the most important factors associated with acute myocardial infarction. Proper health interventions should be considered in order to lower the risk factors among young adults especially those under 45 years of age with a positive family history of myocardial infarction.


Homayoun Sadegi Bazargani , Shahnam Arshi, Ali Akbar Mortazazadeh, Jafar Bashiri , Naiere Aminisani, Saied Hashem Sezavar , Hasan Adalatkhah , Shahram Seifnejad, Ali Ruhi, Hale Shahlazadeh ,
Volume 5, Issue 2 (Summer 2005)
Abstract

 Background & Objectives : Providing health services for all population subgroups of a community is a major hallmark for health administration. Little is known about health status of Ashayer population in Iran. This study aims at evaluating health status and quality of health service delivery to them.

 Methods: In a cross-sectional research 320 households (1800 persons), entered the study. Moreover, blood samples from 458 dogs were taken and studied with both Direct Aglutination Test (DAT) and a newly presented dipstick test . All children under 12 were also studied with DAT. In computing the sample size the generalizability for 63 variables with a minimum and maximum probability level of 90% and 97% respectively were taken into account and since the cluster sampling was employed, the Design Effect would be at least 1.56 and for different variables in the first sample it would be at most 4.

 Results: Only 30 households(9.7%) used piped water supply inside their houses while most of the other families (41%) obtained their water from mobile water tanks. Residual water chlorine was measured to be zero in 88.7% of the samples taken from drinking water of Ashayer. 89 (27.8%) households had lavatories and 22 (7%) households had bathrooms inside their houses. 90.4% of those using raw vegetables washed them only with plain water. Monthly incidence rate for accidents was 230 per 10000. 18.1% of women in reproductive age had a history of abortion. Unwanted pregnancy rate was 38.9%. 47.1% of women with a labor history in past three years had never been visited by any person legally allowed to do so. Women in reproductive age had a poor knowledge about contraceptive methods. The minimum delay for vaccination was 16.9 (SD= 19.26) days regarding the third dose of OPV and the highest delay in vaccination was 46.44 (SD=60.7) days belonging to the third dose of HBV. From all 503 persons above 12 years old, 77 cases had hypertension. Periodontal easy bleeding was observed in 13.7 % and pyorrhea in 19.3%. 10.2 % had aching neck, 18.7% had backache and arthralgia was shown in 13.5%. The unmet need for physician's visit was 64.8%. The frequency of positive cases of leshmaniasis was 3.4% and 3.06% for boys and girls respectively. 28 male and 6 female dogs were positive in DAT test making an overall positive rate of 7.4%. Sensitivity of dipstick test was higher than 80 percent only when golden standard was considered to be DAT ≥ 1 /640.

  Conclusion: Many of the health indices of Ashayer except for vaccination were suitable. This requires further attemps on the part of govermental and health outhorities. Kale-azar disease can spread to the north of the province as well as the neighboring provinces due to the migration of these tribes. It is predicted that Bilesavar and Parsabad cities will be added to the andemic regions of this disease in coming years. Using dipstick test recently offered by WHO is recommended to be used to screen the infected dogs.


Shahnam Arshi, Seid Reza Majdzadeh, Homauoon Sadegi, Seid Hadi Sezavar, Zahra Tahmacian, Looeiz Amanati , Ali Ruhi,
Volume 6, Issue 1 (spring 2006)
Abstract

  Background & Objectives: Regarding the recent implementation of new information system in medical universities, it seems quite necessary to perform an evaluation study on its effectiveness as well as on the functioning of health care systems regarding the different parts of this system. The aim of this study was to investigate skills of family health personnel in health centers of Ardabil province on correctly completing two common data forms called family planning form and maternity care data form. This can be a reasonable criterion for how well the new system is working in the field of family health.

  Methods: This is a descriptive-analytical study. All family health care personnel from Ardabil province heal care centers were entered into the study. They were asked to enter data related to 10 case presentations into blank forms. After filling out the forms they were checked and evaluated for correctness and final scores were analyzed by SPSS.

  Results : From all the data collected from 9 cities of the province, 38.5% lacked an academic education and 52% were graduated in midwifery. Mean personnel skill was 4.38 out of 10 and only 11.7% had acceptable skills in filling out the forms. Those with academic education outperformed the non-academic ones. Discrepancies regarding the correct ways of filling the forms, were observed among different cities’ health care centers.

  Conclusion: The findings indicated family health personnel were not skillful enough in completing the data forms. This led to their weak and non-dependable statistic which in turn would waste budget and energy. Moreover, the validity of the collected data would be under question. So the form 108 is very complicated and needs revision.


Seyed Hashem Sezavar , Maryam Valizadeh , Mazyar Moradi , Mohammad Hosein Rahbar,
Volume 10, Issue 1 (spring 2010)
Abstract

  Background & Objectives : In spite of effective advances in diagnosis and management, ST Elevation Myocardial Infarction (STEMI) is a major health problem in industrialized world and an increasingly important problem in developing countries. Considering the role of age and gender in Myocardial Infarction (MI) and socioeconomic and cultural changes in Iran in recent decades which can affect the epidemiology of the disease, we aimed to determine trend of changes in age and gender of patients with first STEMI in recent decade.

  Methods :This observational cross-sectional study was based on completing check lists for patients with first STEMI in Rasul-e-Akram Hospital from 1998 to 2007. The Data were analyzed with ANOVA, chi2 and Mann-Whitney tests at = 0.05 using SPSS 14.

  Results :Out of 1829 patients with first STEMI, 76.4% were men and 23.6% women who had mean age of 59.09 ± 12.7 years totally. The mean age of men (56.9 ± 12.2 years) was significantly lower than women (66.1 ± 11.6 years) (p < 0.001) ­.

  Trend of change in mean age for men, women and overall had no specific patterns of change in 10 years. Premature MI occurred in 15% of patients without any particular change during study period. No statistically significant change in proportions of gender and risk factors was seen in a period of 10 years. The most common risk factors were smoking (43.7%) and hypertension (32.8%) respectively. 23 . 7% of patients had hyperlipidemia and 18.8% were diabetics.

  Conclusion: Trend of changes in age and gender of mentioned patients had no significant change over 10 years which can indicate main role of biologic factors. Although this was an observational study unchanged major risk factors in a decade may mark out inadequate primary prevention.


Ali Abedi , Babak Teimorzade, Mehran Zarifi , Vadood Norouzi, Hashem Sezavar , Mostafa Mohammadi Naghade, Saeid Khamane, Rasool Lotfolahzade,
Volume 10, Issue 2 (summer 2010)
Abstract

  Background and Objectives: Tobacco usage is one of the most common problems in human societies that, In addition of getting several social, economic and health effects, it can cause respiratory, digestive and bladder cancer, also chromosomal and blood factors changes. Little study has been done about hookah effects on human. The aim of this study was to evaluate pulmonary function tests in hookah users in Ardabil city.

  Materials & Methods: In this case – control study, 133 male subjects which have used hookah 3 times a day for at least 3 years or more, were selected from Coffee house of ARDABIL city and then pulmonary function tests were carried out at least triplicate. For comparison of pulmonary parameters, the same number of healthy subjects without hookah consumption in the same age and socioeconomic status were used and spirometery was done. The data were analyzed with SPSS 11 software program and presented as mean ± SD. Statistical significance was assayed by student’s t-test for unpaired data and the differences were considered to be significant at the p<0.05 level.

  Results: Age range of hookah smokers and normal subjects was 17-78 and 20-82 years old, respectively. Age average of hookah smokers and normal subjects was 44.37 ± 14.9 and 41.54 ± 14.46 years old, respectively .Mean differences of age was not statistically significant. The average of PEF, FEV1%, FEV1, FEF25-75 and FEF 25 in hookah smokers were: 7.73, 83.11%, 3.56, 3.81, 6.32, respectively and in normal subjects was: 8.51, 85.69%, 3.78, 4.35, 7.29 respectively. The mean differences between two groups were statistically significant in each parameter (p < 0.05). In this study, there were 27 (20%) COPD patients in hookah smokers. Ten percent of hookah smokers had FEV1% less than 70.

  Conclusion: The results showed that using hookah disrupts pulmonary function parameters. So as cigarette, using hookah may have devastating effects on respiratory system. Knowing about effects of hookah to people, especially to young is necessary.



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