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ORIGINAL ARTICLES
Factors effective on medication errors: A nursing view
Akram Shahrokhi, Fatemeh Ebrahimpour, Arash Ghodousi
January-March 2013, 2(1):18-23
DOI:10.4103/2279-042X.114084  PMID:24991599
Objective : Medication errors are the most common medical errors, which may result in some complications for patients. This study was carried out to investigate what influence medication errors by nurses from their viewpoint. Methods: In this descriptive study, 150 nurses who were working in Qazvin Medical University teaching hospitals were selected by proportional random sampling, and data were collected by means of a researcher-made questionnaire including demographic attributes (age, gender, working experience,…), and contributing factors in medication errors (in three categories including nurse-related, management-related, and environment-related factors). Findings : The mean age of the participant nurses was 30.7 ± 6.5 years. Most of them (87.1%) were female with a Bachelor of Sciences degree (86.7%) in nursing. The mean of their overtime working was 64.8 ± 38 h/month. The results showed that the nurse-related factors are the most effective factors (55.44 ± 9.14) while the factors related to the management system (52.84 ± 11.24) and the ward environment (44.0 ± 10.89) are respectively less effective. The difference between these three groups was significant ( P = 0.000). In each aforementioned category, the most effective factor on medication error (ranked from the most effective to the least effective) were as follow: The nurse's inadequate attention (98.7%), the errors occurring in the transfer of medication orders from the patient's file to kardex (96.6%) and the ward's heavy workload (86.7%). Conclusion : In this study nurse-related factors were the most effective factors on medication errors, but nurses are one of the members of health-care providing team, so their performance must be considered in the context of the health-care system like work force condition, rules and regulations, drug manufacturing that might impact nurses performance, so it could not be possible to prevent medication errors without paying attention to our health-care system in a holistic approach.
  7,986 1,246 7
Double-disk synergy test for detection of synergistic effect between antibiotics against nosocomial strains of staphylococcus aureus
Rasool Soltani, Hossein Khalili, Fateme Shafiee
July-September 2012, 1(1):21-24
PMID:24991583
Objective: Synergistic effect between commonly used antibiotics against nosocomial multidrug-resistant strains of Staphylococcus aureus, if present, could provide a viable option as an alternative therapy for infections due to this pathogen. The aim of this study was searching for any synergistic effect between several antibiotics against drug-resistant strains of S. aureus with nosocomial origin using double-disk synergy test and to determine the applicability of this test for such a purpose. Methods: Over a 6-month period, strains of S. aureus isolated from clinical specimens of hospitalized patients with documented nosocomial infection underwent disk diffusion test using antibiotic disks of oxacillin, cephalothin, clindamycin, ciprofloxacin, vancomycin, cotrimoxazole, rifampin, erythromycin, gentamicin and meropenem. Double-disk synergy test was performed for all isolates resistant to at least two of applied antibiotics. Combinations of all possible pairs of antibiotics (to which the microorganism was resistant) were tested by placing antibiotic disks at distance of 20 mm from each other (center to center). After 16- 20 hours of incubation, if synergistic effect was present among two antibiotics, an inhibition zone was formed between their disks. Findings: Among all of possible two-antibiotic combinations tested for 41 resistant isolates, only two cases of synergistic effect were detected; both effects were among rifampin and cotrimoxazole. Conclusion: The combination of rifampin and cotrimoxazole could provide a viable option for treatment of infections due to resistant strains of S. aureus; however, clinical trials are needed before any new recommendation. Also, double-disk synergy test seems to be capable of detecting the synergistic effect between antibiotics at in vitro level.
  7,277 771 -
Emerging doctor of pharmacy program in India: A survey on general opinion of selected educated Indians
Raman Garipelly, Shilpa Garg, Uday Venkat Mateti
October-December 2012, 1(2):48-54
DOI:10.4103/2279-042X.108370  PMID:24991589
Objective: The aim of this study was to evaluate the awareness and perception of general educated Indian individuals about Doctor of Pharmacy course. Methods: A cross-sectional structured Pharm.D questionnaire survey was conducted at educational institutions of India mainly through e-mails. Pharm.D questionnaire survey was conducted over a period of six months. The questionnaire was classified into four major categories, including course-related questions, roles-related questions, critical comparative questions, and opinion-based questions. The responses were collected and analyzed to assess the opinions and attitudes of the study population regarding the course Pharm.D. Findings: Out of 2819 responses, 66.01% agreed that Indian syllabus, teaching procedure, and hospital training in institutions are enough to prepare an ideally graduated Pharm.D. Respondents of about 70.59% agreed that Pharm.Ds should take care of complete responsibility of drug therapy rather than physicians prescribing the medications and Pharm.Ds fixing the dose. The statement "Pharm.Ds play a vital role in improving medication adherence through patient counseling" was accepted by 47.80%, whereas 41.40% did not accept it as they felt that the Pharm.D's role in this regard is not more than the physician's role, and 10.80% suggested that other healthcare professionals would play a better role. Among all the respondents, 73.64% of the study population was found to be ready for giving equal credit and respect to Pharm.Ds as physicians. Conclusion: Our survey emphasizes on the opinion of educated people of having Pharm.Ds in both government and private hospitals to take care of complete therapy and for improving medication adherence.
  6,005 651 2
Effect of high-dose Ascorbic acid on vasopressor's requirement in septic shock
Mohadeseh Hosseini Zabet, Mostafa Mohammadi, Masoud Ramezani, Hossein Khalili
April-June 2016, 5(2):94-100
DOI:10.4103/2279-042X.179569  PMID:27162802
Objective: Effects of ascorbic acid on hemodynamic parameters of septic shock were evaluated in nonsurgical critically ill patients in limited previous studies. In this study, the effect of high-dose ascorbic acid on vasopressor drug requirement was evaluated in surgical critically ill patients with septic shock. Methods: Patients with septic shock who required a vasopressor drug to maintain mean arterial pressure >65 mmHg were assigned to receive either 25 mg/kg intravenous ascorbic acid every 6 h or matching placebo for 72 h. Vasopressor dose and duration were considered as the primary outcomes. Duration of Intensive Care Unit (ICU) stay and 28-day mortality has been defined as secondary outcomes. Findings: During the study period, 28 patients (14 in each group) completed the trial. Mean dose of norepinephrine during the study period (7.44 ± 3.65 vs. 13.79 ± 6.48 mcg/min, P = 0.004) and duration of norepinephrine administration (49.64 ± 25.67 vs. 71.57 ± 1.60 h, P = 0.007) were significantly lower in the ascorbic acid than the placebo group. No statistically significant difference was detected between the groups regarding the length of ICU stay. However, 28-day mortality was significantly lower in the ascorbic acid than the placebo group (14.28% vs. 64.28%, respectively; P = 0.009). Conclusion: High-dose ascorbic acid may be considered as an effective and safe adjuvant therapy in surgical critically ill patients with septic shock. The most effective dose of ascorbic acid and the best time for its administration should be determined in future studies.
  4,166 1,635 22
CASE REPORT
Errors of oral medication administration in a patient with enteral feeding tube
Shahram Emami, Hadi Hamishehkar, Ata Mahmoodpoor, Simin Mashayekhi, Parina Asgharian
July-September 2012, 1(1):37-40
PMID:24991587
Enteral feeding tube is employed for feeding of critically ill patients who are unable to eat. In the cases of oral medication administration to enterally fed patients, some potential errors could happen. We report a 53-year-old man who was admitted to intensive care unit (ICU) of a teaching hospital due to the post-CPR hypoxemic encephalopathy. The patient was intubated and underwent mechanical ventilation. A nasogastric (NG) tube was used as the enteral route for nutrition and administration of oral medications. Oral medications were crushed then dissolved in tap water and were given to the patient through NG tube. In present article we report several medication errors occurred during enterally drug administration, including errors in dosage form selection, methods of oral medication administration and drug interactions and incompatibility with nutrition formula. These errors could reduce the effects of drugs and lead to unsuccessful treatment of patient and also could increase the risk of potential adverse drug reactions. Potential leading causes of these errors include lack of drug knowledge among physicians, inadequate training of nurses and lack of pharmacists participation in medical settings.
  4,780 1,014 -
REVIEW ARTICLES
Rational use of medicine in the pediatric age group: A summary on the role of clinical pharmacists
Roya Kelishadi, Firoozeh Mousavinasab
July-September 2012, 1(1):10-13
PMID:24991581
Medication errors (ME) and adverse drug reactions still continue to be the important factors for out- and in-patient treatments. MEs are critical troubles in all hospitalized populations that can increase length of hospital stay, expenses, mortality and morbidity. In many countries, clinical pharmacists have been involved in reducing MEs from years ago. A growing body of evidence suggests that pharmacist interventions have major impact on reducing MEs in pediatric patients, thus improving the quality and efficiency of care provided. This paper presents a literature review on the role of clinical pharmacists in reducing MEs, and underscores the importance of pharmacist-physician-patient collaboration for all patients notably in the pediatric age group.
  4,562 982 -
Chronopharmacokinetics of drugs in toxicological aspects: A short review for pharmacy practitioners
Pinar Erkekoglu, Terken Baydar
July-September 2012, 1(1):3-9
PMID:24991580
A rough 24-hour cycle driven endogenously in biochemical, physiological or behavioral processes is called circadian rhythm. Chronobiology is the study of biological temporal rhythms. For decades, we know that the biological rhythm and the drug metabolism are also affected from daylight and chronopharmacology became recognized by scientists in the early 1970s. Its lateral branch chronocopharmacokinetics is the study of rhythmic, predictable-in-time differences in the pharmacokinetics of drugs. Chronopharmacokinetic studies are performed at every step of the biotransformation i.e., absorption, distribution, metabolism and excretion. Feeding schedules, sex and phenotype must be taken into consideration while applying pharmacotherapy to increase the efficiency and to decrease side effects. The impact of drugs on circadian rhythm should be not neglected. On the other hand, new special drug delivery systems can be used to synchronize drug concentrations according to circadian rhythms. "Chronopharmaceuticals" can identify the proper dosing time and this amelioration will lead to improved progress and diffusion of pharmacotherapy. Chronopharmaceuticals coupled with nanotechnology could be the future of drug delivery systems, and lead to safer and more efficient disease therapy in the future. In this review, we will discuss the pharmacokinetic effects of circadian rhythm and its toxicological outcomes. Besides, we will try to give some practical points for clinical pharmacist/pharmacy practitioners, concerning chronopharmacokinetics.
  4,497 1,019 -
REVIEW ARTICLE
What pharmacy practitioners need to know about ethics in scientific publishing
Lejla Zunic, Izet Masic
October-December 2014, 3(4):112-116
DOI:10.4103/2279-042X.145356  
Pharmacy practice is an ever-changing science and profession. We are witnessing many advancement of pharmacy technology, drug-related information and applied clinical pharmacy literature, which influence our every day's life. Thus, new knowledge generated by research and clinical experience widen the knowledge; change the understanding of drugs and their application in therapeutics and every days life. Thus, policy makers, pharmacists, clinicians and researchers must evaluate and use the information existing in the literature to implement in their healthcare delivery. This paper is prepared for pharmacy researchers and pharmacy students and analyzes the major principles of ethical conduct in general science and also closely related topics on ghost authorship, conflict of interest, assigning co-authorship, redundant/repetitive and duplicate publication. Furthermore, the paper provides an insight into fabrication and falsification of data, as the most common form of scientific fraud. Scientific misconduct goes against everything that normal scientific method wants to reach for and pharmacy practitioners as one the first line available health care professionals all round the world should be enough aware of its importance and details when they want to evaluate the medical and pharmaceutical literature and deliver unbiased and ethically published knowledge of drugs both for the research or during consultations for patients care.
  4,941 453 1
The role of pharmacoeconomics in current Indian healthcare system
Akram Ahmad, Isha Patel, Sundararajan Parimilakrishnan, Guru Prasad Mohanta, HaeChung Chung, Jongwha Chang
January-March 2013, 2(1):3-9
DOI:10.4103/2279-042X.114081  PMID:24991597
Phamacoeconomics can aid the policy makers and the healthcare providers in decision making in evaluating the affordability of and access to rational drug use. Efficiency is a key concept of pharmacoeconomics, and various strategies are suggested for buying the greatest amount of benefits for a given resource use. Phamacoeconomic evaluation techniques such as cost minimization analysis, cost effectiveness analysis, cost benefit analysis, and cost utilization analysis, which support identification and quantification of cost of drugs, are conducted in a similar way, but vary in measurement of value of health benefits and outcomes. This article provides a brief overview about pharmacoeconomics, its utility with respect to the Indian pharmaceutical industry, and the expanding insurance system in India. Pharmacoeconomic evidences can be utilized to support decisions on licensing, pricing, reimbursement, and maintenance of formulary procedure of pharmaceuticals. For the insurance companies to give better facility at minimum cost, India must develop the platform for pharmacoeconomics with a validating methodology and appropriate training. The role of clinical pharmacists including PharmD graduates are expected to be more beneficial than the conventional pharmacists, as they will be able to apply the principles of economics in daily basis practice in community and hospital pharmacy.
  4,145 780 1
Antibiotic regimens for treatment of infections due to multidrug-resistant Gram-negative pathogens: An evidence-based literature review
Mandana Izadpanah, Hossein Khalili
July-September 2015, 4(3):105-114
DOI:10.4103/2279-042X.162360  PMID:26312249
Evidences regarding the efficacy of different antibiotic regimens proposed for treatment of multidrug-resistant (MDR) Gram-negative pathogens have been reviewed. Available data in Scopus, Medline, EMBASE, the Cochrane central register of controlled trials, and Cochrane database of systematic reviews have been collected. Several antibiotic regimens are proposed for treatment of MDR Gram-negative infections (defined as nonsusceptibility to at least one agent in three or more antimicrobial categories). The most challenging issue is the treatment of carbapenem-resistant (CR) Gram-negative pathogens. A carbapenem plus either colistin or tigecycline was the most effective regimen for treatment of CR Gram-negative pathogens with low-level resistance (minimal inhibitory concentration [MIC] ≤ 8 mg/L). However, in high-level resistance (MIC > 8 mg/L), combination of colistin and tigecycline showed promising effect.
  3,602 1,019 11
BRIEF COMMUNICATIONS
Polypharmacy in the elderly
Negar Golchin, Scott H Frank, April Vince, Lisa Isham, Sharon B Meropol
April-June 2015, 4(2):85-88
DOI:10.4103/2279-042X.155755  PMID:25984546
Objective: The objective was to assess the frequency of polypharmacy and potential complications among local seniors. Methods: A cross-sectional convenience sample of 59 adults aged above 65 years was interviewed at Cuyahoga county (U.S. state of Ohio) senior programs. Polypharmacy was defined as more than five prescribed medications. Primary outcomes were frequent missed doses, one or more duplicate drug/s, and equal or more than one contraindicated drug combinations. Findings: Among seniors with the mean age of 76.9 years (25.4% male), 40.6% used multiple pharmacies and 35.6% had polypharmacy. Of all seniors with polypharmacy, about 57% had contraindicated drug combinations. Polypharmacy was associated with duplication (P = 0.02), but not frequent missed doses (P = 0.20). Conclusion: As shown by this study, polypharmacy was associated with duplicated therapy and contraindicated drug combinations. Improved communications among seniors, physicians, and pharmacists is necessary to minimize adverse consequences of polypharmacy.
  3,300 833 5
BRIEF COMMUNICATION
The effect of pseudocatalase/superoxide dismutase in the treatment of vitiligo: A pilot study
Farahnaz Fatemi Naini, Alireza Vaez Shooshtari, Bahareh Ebrahimi, Razieh Molaei
October-December 2012, 1(2):77-80
DOI:10.4103/2279-042X.108375  PMID:24991594
Objective : Pseudocatalase/superoxide dismutase (PSD) is a topical gel considered having therapeutic effects in vitiligo. This study was designed to evaluate the efficacy of this combination in vitiligo. Methods : This was a pilot randomized, double-blind, placebo-controlled trial on 46 symmetrical vitiligo lesions of limbs in 23 patients referring to dermatology clinics, Isfahan, Iran in 2010. Patients were received this formula or placebo gels for the right and left lesions. Lesion area and degree of pigmentation were assessed at baseline, 2, 4, and 6 months. Findings : There were no significant changes in lesion area and perifollicular pigmentation in each group (P > 0.05). Conclusion : The results indicated no significant therapeutic effect for PSD in vitiligo.
  3,666 411 6
ORIGINAL ARTICLES
Resuscitation of preterm newborns with low concentration oxygen versus high concentration oxygen
Amir Mohammad Armanian, Zohreh Badiee
July-September 2012, 1(1):25-29
PMID:24991584
Objective: It is well known that a brief exposure to 100% oxygen for only a few minutes could be toxic for a preterm infant. The effectiveness of neonatal resuscitation was compared with low concentration oxygen (30%) and high concentration oxygen (HOG) (100%). Methods: Thirty-two preterm neonates were born in Isfahan Shahid Beheshti hospital with gestational age of 29-34 weeks who required resuscitation were randomized into two groups. The resuscitation was begun with 30% O 2 in low concentration oxygen group (LOG). The infants were examined every 60-90 seconds and if their HR was less than 100, 10% was added to the previous FIO 2 (fraction of inspired oxygen) until the HR increased to 100 and SO 2 (saturation of oxygen) increased to 85%. In HOG resuscitation begun with 100% O 2 and every 60-90 seconds, FIO 2 was decreased 10 - 15% until the HR reached to 100 and SO 2 reached to 85%. Findings: The FIO 2 in LOG was increased stepwise to 45% and in HOG was reduced to 42.1% to reach stable oxygen saturation more than 85% at the fifth minute in both groups. At the first and third minutes after birth and there was no significant differences between groups in heart rate and after 1,2,4 and 5 minutes after the birth there was also no significant differences in SO 2 between groups, regardless of the initial FIO 2 . Conclusion: We can safely initiate resuscitation of preterm infants with a low FIO 2 (approximately 30%) oxygen and then oxygen should be adjusted with the neonates needs.
  3,620 428 -
EDITORIAL
Can Pharmacy Doctors act as valuable assets in rural areas with a physician shortage?
Akram Ahmad, Isha Patel, Muhammad Umair Khan, Jongwha Chang
October-December 2014, 3(4):109-111
DOI:10.4103/2279-042X.145345  
  3,311 575 1
ORIGINAL ARTICLES
Turkish community pharmacists' self-report of their pharmacies' physical atmosphere
Simge Cagirci, Selen Yegenoglu, Mehmet Mithat Uner
July-September 2012, 1(1):14-20
PMID:24991582
Objective: There is a great recognition that store interiors and exteriors can be designed to create feelings in potential customers which can have an important reinforcing effect on purchase. In this study it is mainly aimed to explore the behaviors of the community pharmacists related to their store's physical environment. Also we aimed to determine whether any difference exist between behaviors of pharmacists serving in high and low socio-economic regions. Methods: A total of 200 pharmacists that work socio-economically different regions were randomly selected from 1424 pharmacists registered in Ankara Chamber of Pharmacists. A uniform questionnaire was applied to the pharmacists by using a face-to-face interview technique. Findings: There are differences in terms of behavior between the pharmacists serving in high and low socio-economic regions within the context of putting importance to their stores' atmosphere. More pharmacists attach importance to the physical sight of their pharmacy serving in high socio-economic regions (90%) vs. pharmacists in low socio-economic regions (70%). Also pharmacists in high socio-economic regions indicated higher importance level of selection of the decoration equipments (84%) than pharmacists serving in high socio-economic regions (60%). Conclusion: Our study suggests that some pharmacists pay more attention to interior atmospheric elements and others do not. There is a difference in terms of attaching importance to some store atmospheric elements (i.e. physical site, decoration equipment, it's color, wall color, etc.) serving in high versus low socio-economic regions in this context.
  3,196 490 -
Health-care cost of diabetes in South India: A cost of illness study
Sadanandam Akari, Uday Venkat Mateti, Buchi Reddy Kunduru
July-September 2013, 2(3):114-117
DOI:10.4103/2279-042X.122382  PMID:24991617
Objective: The objective of this study is to analyze the health-care cost by calculating the direct and indirect costs of diabetes with co-morbidities in south India. Methods: A prospective observational study was conducted at Rohini super specialty hospital (India). Patient data as well as cost details were collected from the patients for a period of 6 months. The study was approved by the hospital committee prior to the study. The diabetic patients of age >18 years, either gender were included in the study. The collected data was analyzed for the average cost incurred in treating the diabetic patients and was calculated based on the total amount spent by the patients to that of total number of patients. Findings: A total of 150 patients were enrolled during the study period. The average costs per diabetic patient with and without co-morbidities were found to be United States dollar (USD) 314.15 and USD 29.91, respectively. The average cost for those with diabetic complications was USD 125.01 for macrovascular complications, USD 90.43 for microvascular complications and USD 142.01 for other infections. Out of USD 314.15, the average total direct medical cost was USD 290.04, the average direct non-medical cost was USD 3.75 and the average total indirect cost was USD 20.34. Conclusion: Our study results revealed that more economic burden was found in male patients (USD 332.06), age group of 51-60 years (USD 353.55) and the patients bearing macrovascular complications (USD 142.01). This information can be a model for future studies of economic evaluations and outcomes research.
  2,948 649 9
Assessing health conditions and medication use among the homeless community in Long Beach, California
Mok Thoong Chong, Jason Yamaki, Megan Harwood, Richard d'Assalenaux, Ettie Rosenberg, Okezie Aruoma, Anupam Bishayee
April-June 2014, 3(2):56-61
DOI:10.4103/2279-042X.137073  PMID:25114938
Objective: Persons experiencing homelessness are a vulnerable population and are at increased risk for morbidity and all-cause mortality compared to the general population. This study sought to evaluate medication use, regular physician visits, and identify health conditions among the homeless population of Long Beach, California. Methods: Two "brown bag" medication review events were held at homeless shelters in the Long Beach area. Demographic information, medication use, and comorbid disease states were obtained through surveys. Findings: Three-fourths of the cohort (95 participants) consisted of males, and the average age of participants was 48 years. Psychiatric disorders and cardiovascular disease were the most common disease states reported at 32% and 46%, respectively and so were medications used in treating these chronic diseases. Medication adherence was found to be a significant problem in this population, where more than 30% of patients were nonadherent to medications for chronic diseases. Furthermore, foot problems, hearing and vision difficulties constitute the most commonly overlooked health problems within the homeless population. Conclusion: Based on this and other similar finding, we must accept that the homeless represent a vulnerable population, and that because of this fact, more programs should be focused at improving availability and access to health care among the homeless. Regarding the high number of reported health problems in the study, more studies are needed and more studies should incorporate screening for foot, hearing, and vision issues, both to increase awareness and to provide an opportunity for devising possible solutions to these highly preventable conditions.
  3,012 538 3
BRIEF COMMUNICATION
Knowledge, attitude and practice of B.Sc. Pharmacy students about antibiotics in Trinidad and Tobago
Akram Ahmad, Muhammad Umair Khan, Isha Patel, Sandeep Maharaj, Sureshwar Pandey, Sameer Dhingra
January-March 2015, 4(1):37-41
DOI:10.4103/2279-042X.150057  PMID:25710049
Objective: The aim of this study was to assess the knowledge, attitude and practice of B.Sc. Pharmacy students about usage and resistance of antibiotics in Trinidad and Tobago. Methods: This was a cross-sectional questionnaire-based study involving B.Sc. Pharmacy students. The questionnaire was divided into five components including Demographics data, knowledge about antibiotic use, attitude toward antibiotic use and resistance, self-antibiotic usage and possible causes of antibiotic resistance. Data were analyzed by employing Mann-Whitney and Chi-square tests using SPSS version 20. Findings: The response rate was 83.07%. The results showed good knowledge of antibiotic use among students. The overall attitude of pharmacy students was poor. About 75% of participants rarely use antibiotics, whereas self-decision was the major reason of antibiotic use (40.7%) and main source of information was retail pharmacist (42.6%). Common cold and flu is a major problem for which antibiotics were mainly utilized by pharmacy students (35.2%). Conclusion: The study showed good knowledge of pharmacy students regarding antibiotic usage. However, students' attitude towards antibiotic use was poor. The study recommends future studies to be conducted with interventional design to improve knowledge and attitude of pharmacy students about antibiotic use and resistance.
  2,932 566 4
ORIGINAL ARTICLES
Social risk factors and outcome analysis of poisoning in an Iranian referral medical center: A toxico-epidemiological approach
Ali Mohammad Sabzghabaee, Marzieh Soleimani, Ziba Farajzadegan, Sarah Hosseinpoor, Seyyed Mohammad Mahdy Mirhosseini, Nastaran Eizadi-Mood
October-December 2013, 2(4):151-155
DOI:10.4103/2279-042X.128144  PMID:24991624
Objective: Suicide is the second major reason of death in the age range of 15-24 and is the eighth reason for overall death of adults. Because of high accessibility of people to different medications in our society, one of the easiest ways for suicide is intentional self-poisoning with medications. Therefore, the aim of this study was to determine the rate of suicide with respect to influencing social factors on patients with intentional self-poisoning. Methods: This was an analytic-descriptive prospective study. All study data were collected through a checklist in patients with intentional self-poisoning who had been referred to referral hospital within 2011-2012. Findings: A total of 400 patients (60% female) were evaluated. Age average ± standard deviation of participants was 22.57 ± 9.20 years. About 78.2% had high school degree or less. Nearly 27.8% of all happened suicides take place as a result of family disputes, marital problems (21%) and poverty (11.5%). Love issues with a rate of 10.3% were set in the next step. About 23.2% had a history of a past psychological disorder. Around 97.5% of the patients survived. The shorter the time of hospitalization is for each patient, the better survival rate is obtained through post-suicidal medical care. A statistically meaningful relationship was observed between self-poisoning to commit suicide and absence of academic education (P = 0.02). Conclusion: Suicide attempt through self-poisoning is more common in female, married individuals, people without academic education and those with a poor socio-economic status. Furthermore, results announce family disputes as the most pre-disposing factor for suicide.
  3,132 266 1
Evaluation of Glucosamine sulfate and Ibuprofen effects in patients with temporomandibular joint osteoarthritis symptom
Abbas Haghighat, Ali Behnia, Naser Kaviani, Behnam Khorami
January-March 2013, 2(1):34-39
DOI:10.4103/2279-042X.114087  PMID:24991602
Objective: Ibuprofen - a non-steroidal anti-inflammatory drug (NSAID)- and glucosamine sulfate - a natural compound and a food supplement- are two therapeutic agents which have been widely used for treatment of patients with temporomandibular joint (TMJ) disorders. This study was aimed to compare the effectiveness and safety of these two medications in the treatment of patients suffering from TMJ disorders. Methods: After obtaining informed consent, 60 patients were randomly allocated to two groups. Patients with painful TMJ, TMJ crepitation or limitation of mouth opening entered the study. Exclusion criteria were history of depressive disorders, cardiovascular disease, musculoskeletal disorders, asthma, gastrointestinal problems, kidney or liver dysfunction or diabetes mellitus, dental diseases needing ongoing treatment; taking aspirin or warfarin, or concomitant treatment of TMJ disorder with other agents or methods. Thirty patients were treated with ibuprofen 400 mg twice a day, (mean age 27.12 ± 10.83 years) and 30 patients (mean age 26.60 ± 10) were treated with glucosamine sulfate 1500 mg daily. Patients were visited 30, 60 and 90 days after starting the treatment, pain and mandibular opening were checked and compared within and between two groups. Findings: Comparing with baseline measures, both groups had significantly improved post-treatment pain (P < 0.0001 for both groups) and mandibular opening (P value: 0.001 for glucosamine sulfate and 0.03 for ibuprofen). Post treatment pain and mandibular opening showed significantly more improvement in the glucosamine treated patients ( P < 0.0001 and 0.01 respectively). Rate of adverse events was significantly lower in the P value glucosamine sulfate group (P < 0.0001). Conclusion: This investigation demonstrated that comparing with a commonly prescribed NSAID - ibuprofen-, glucosamine sulfate is a more effective and safer therapeutic agent for treatment of patients with TMJ degenerative join disorder.
  2,801 588 1
The effect of intravenous Dexamethasone on post-cesarean section pain and vital signs: A double-blind randomized clinical trial
Azar Danesh Shahraki, Awat Feizi, Mitra Jabalameli, Shadi Nouri
July-September 2013, 2(3):99-104
DOI:10.4103/2279-042X.122370  PMID:24991614
Objective: Any operation leads to body stress and tissue injury that causes pain and its complications. Glucocorticoids such as Dexamethasone are strong anti-inflammatory agents, which can be used for a short time post-operative pain control in various surgeries. Main purpose of this study is to evaluate the effect of administration of intravenous (IV) Dexamethasone on reducing the pain after cesarean. Methods: A double-blind prospective randomized clinical trial was performed on 60 patients candidate for elective caesarean section. Patients were randomly assigned into two groups: A (treatment: 8 mg IV Dexamethasone) and B (control: 2 mL normal saline). In both groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), pain and vomiting severity (based on visual analog scale) were recorded in different time points during first 24 h after operation. Statistical methods using repeated measure analysis of variances and t-test, Mann-Whitney and Chi-square tests were used for analyzing data. Findings: The results indicated that within-group comparisons including severity of pain, MAP, RR and HR have significant differences (P < 0.001 for all variables) during the study period. Between group comparisons indicated significant differences in terms of pain severity (P < 0.001), MAP (P = 0.048) and HR (P = 0.078; marginally significant), which in case group were lower than the control group. Conclusion: IV Dexamethasone could efficiently reduce post-operative pain severity and the need for analgesic consumption and improve vital signs after cesarean section.
  2,752 605 6
Onset of action of atypical and typical antipsychotics in the treatment of acute psychosis
Seyed Ghafur Mousavi, Hamze Rostami, Mohammad Reza Sharbafchi, Atefeh Saeidi Boroujeni, Behzad Mahaki
October-December 2013, 2(4):138-144
DOI:10.4103/2279-042X.128142  PMID:24991622
Objective: Antipsychotic medications are the frontline treatment for the most psychotic disorders. The aim of this study is to compare the onset of action of the first and second generation antipsychotics and the rate of their side-effects in the treatment of acute psychosis. Methods: In a double-blind, controlled clinical trial, 40 acute psychotic patients were randomly allocated in four groups and treated with each of the four antipsychotics: olanzapine, risperidone, haloperidol or thiothixene. The onset of action of each drug was assessed by the Positive and Negative Symptoms Scale. The data were analyzed by Wilcoxon (Gehan) survival and Log Rank analysis, using SPSS version 20.0. Findings: Initial response was observed in 97.5% (N = 39) of subjects during 2 weeks of intervention. The mean time to the first response was 6.15 ± 2.9 days and this was significantly shorter for risperidone than others. The most common side-effects were sedation and drug induced Parkinsonism. Conclusion: Risperidone represented shorter onset of action for the treatment of acute psychotic symptoms compared with olanzapine, haloperidol and thiothixene.
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Efficacy of local use of probiotics as an adjunct to scaling and root planing in chronic periodontitis and halitosis: A randomized controlled trial
Soumya Penala, Butchibabu Kalakonda, Krishnajaneya Reddy Pathakota, Avula Jayakumar, Pradeep Koppolu, Bolla Vijaya Lakshmi, Ruchi Pandey, Ashank Mishra
April-June 2016, 5(2):86-93
DOI:10.4103/2279-042X.179568  PMID:27162801
Objective: Periodontitis is known to have multifactorial etiology, involving interplay between environmental, host and microbial factors. The current treatment approaches are aimed at reducing the pathogenic microorganisms. Administration of beneficial bacteria (probiotics) has emerged as a promising concept in the prevention and treatment of periodontitis. Thus, the aim of the present study is to evaluate the efficacy of the local use of probiotics as an adjunct to scaling and root planing (SRP) in the treatment of patients with chronic periodontitis and halitosis. Methods: This is a randomized, placebo-controlled, double-blinded trial involving 32 systemically healthy chronic periodontitis patients. After SRP, the subjects were randomly assigned into the test and control groups. Test group (SRP + probiotics) received subgingival delivery of probiotics and probiotic mouthwash, and control group (SRP + placebo) received subgingival delivery of placebo and placebo mouthwash for 15 days. Plaque index (PI), modified gingival index (MGI), and bleeding index (BI) were assessed at baseline, 1 and 3 months thereafter, whereas probing depth (PD) and clinical attachment level were assessed at baseline and after 3 months. Microbial assessment using N-benzoyl-DL-arginine-naphthylamide (BANA) and halitosis assessment using organoleptic scores (ORG) was done at baseline, 1 and 3 months. Findings: All the clinical and microbiological parameters were significantly reduced in both groups at the end of the study. Inter-group comparison of PD reduction (PDR) and clinical attachment gain (CAG) revealed no statistical significance except for PDR in moderate pockets for the test group. Test group has shown statistically significant improvement in PI, MGI, and BI at 3 months compared to control group. Inter-group comparison revealed a significant reduction in BANA in test group at 1 month. ORG were significantly reduced in test group when compared to control group. Conclusion: Within the limitations of the study, the present investigation showed that the adjunctive use of probiotics offers clinical benefit in terms of pocket depth reduction in moderate pockets and reduced oral malodor parameters.
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Antimicrobial resistance pattern of bacterial isolates from burn wounds in an Iranian University Hospital
Ali Mohammad Sabzghabaee, Dariush Abedi, Hossein Fazeli, Abbasali Javadi, Mohammad Jalali, Mohammad Reza Maracy, Rasool Soltani, Mohammad Javad Karamyafti
July-September 2012, 1(1):30-33
PMID:24991585
Objective: About 73% of death cases in the first 5 days after burning are due to infection complications. The aim of this study was to identify the causing agents of infections in burn patients and the sensitivity pattern of them to the commonly used antimicrobials in an Iranian Burn center University Hospital. Methods: In this cross-sectional study, patients who were admitted to one of the Iranian Burn center University hospitals in 2009 and had nosocomial infection due to burn wound, whom received antimicrobial agents for therapeutic reasons, with a hospitalization period of more than 48 hours were enrolled. Gram stain analyses were performed to help identifying growing colonies. Differential tests for identification of pathogenic bacteria species were performed following primary tests. E-test strips of each antimicrobial were placed on the culture medium plate in order to determine the minimum inhibitory concentration Studied antimicrobials for isolated Gram-negative bacteria were meropenem, piperacillin/tazobactam, ceftriaxone, cotrimoxazole, and for Staphylococcus aureus, vancomycin, piperacillin/tazobactam, cotrimoxazole, and cephalothin. Findings: Only 16% of Pseudomonas aeruginosa species were sensitive to meropenem, and 13% were sensitive to piperacillin/tazobactam. Ten out of 29 Klebsiella species (34%) were sensitive to meropenem and piperacillin/tazobactam. All isolated strains of Staphylococcus aureus were sensitive to vancomycine while they were all resistant to cotrimoxazole. Conclusion: Pseudomona, Klebsiella and Staphylococcoci are the most common species causing burn infection in this medical center. Results showed the importance of limiting irrational use of wide-spectrum antimicrobials and recommends strict management of infections in burn injury centers.
  2,664 489 -
Effects of Levothyroxine and thyroid stimulating hormone on bone loss in patients with primary hypothyroidism
Mansoor Karimifar, Farah Esmaili, Amirhossein Salari, Ali Kachuei, Ziba Faragzadegan, Mozhgan Karimifar
July-September 2014, 3(3):83-87
DOI:10.4103/2279-042X.141099  PMID:25328897
Objective: Previous studies on bone mineral density (BMD) abnormalities associated with hypothyroidism are scarce and not conclusive. The effect of thyroid hormone therapy on BMD has shown mixed results. The aim of the present study was to determine the severities of osteoporosis in female patients with hypothyroidism in comparison to healthy women. Methods: This cross-sectional descriptive study was performed on 150 women aged over 50 years. Totally, 100 patients with primary hypothyroidism and 50 healthy subjects were enrolled in this study and divided into three groups. Group A, which consisted the patients who had been recently diagnosed with primary hypothyroidism. The second group of patients diagnosed with primary hypothyroidism for at least 2 years and was treated with levothyroxine (Group B). The third group of healthy individuals was selected as a control group (Group C). Blood samples were taken for the measurements of thyroid stimulating hormone (TSH), and bone densitometry was performed to determine the BMD reported as T-score in order to measure the severity of osteoporosis. T-score of the lumbar vertebra (L2-L4) and femoral neck were measured with dual energy X-ray absorptiometry and were compared between the three groups. Data were analyzed by SPSS using regression analysis and Mann-Whitney, Kruskal-Wallis, or analysis of variances statistical tests. The statistical significance was set at a P < 0.05. Findings: The average age of patients and baseline serum TSH levels in Group B was significantly different from the other two groups (P < 0.001). T-score of the lumbar spine (L2-L4) in Group B was significantly lower than the other groups (P = 0.01). The linear regression between serum TSH levels and BMD categories were not clearly associated. However, after removing the effect of the baseline TSH level in Group B, bone loss was significantly greater than the other two groups (P = 0.01). Conclusion: According to the present study, it seems that the treatment of hypothyroidism with thyroid hormones reduces both serum levels of TSH and bone density. Hence, proper control of this risk factor can be an effective way in prevention of osteoporosis.
  2,584 554 7
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