Comparison between Diazepam and Phenobarbital in Prevention of Febrile Seizure: Clinical Trial

AbstractObjectiveFebrile convulsions (FC) are the most common convulsive events in childhood, occurring in 2-5% of children. About one third of these children will have  a recurrence during a subsequent febrile infection. This sudden neurologic problem is extremely frightening and emotionally traumatic for parents so some physicians try to prevent recurrence of FC by prescribing different drugs.Materials and MethodsThis is a randomized clinical trial in 85 healthy children, aged 6 months to 5 years, who were not treated before. These children received randomly either oral diazepam (0.33 mg/kg/TDS for two days during febrile illness) or continuous oral Phenobarbital (3-5mg/kg /24 h).ResultsUltimately 64 patients completed the study and were followed up for an average of 13 months (12-18 months). The rate of recurrence of febrile seizure was 18.2% in diazepam group and 32.3% in Phenobarbital group; the difference is not statistically significant (p=0.16).ConclusionThere was no significant difference between intermittent oral diazepam and continuous oral Phenobarbital for FC prevention

Effect of pretransplant depression on neutrophil recovery following hematopoietic stem cell transplantation

Maria Tavakoli-Ardakani,1,2 Narges Beyraghi,3 Mahtabalsadat Mirjalili,4 Ehsan Mirzaei,4 Maryam Mehrpooya51Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Neurofunctional and Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 5Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, IranPurpose: Pre-transplantation depression is known to exert negative effects on clinical outcomes after hematopoietic stem cell transplantation (HSCT). Accumulating evidence shows a bidirectional association between inflammation and depression. Systemic inflammation can affect clinical outcomes after transplantation, such as time to engraftment. This study evaluated the effect of pre-transplantation depression and serum level of pro-inflammatory and anti-inflammatory cytokines on clinical outcomes such as neutrophil recovery time and mortality in patients undergoing HSCT.Patients and methods: In this cross-sectional study, we recruited 73 patients who were autologous or allogeneic HSCT candidates. Hospital Anxiety and Depression Scale questionnaire was used to assess depression in the first 2 days after their hospital admission. Serum levels of IL-10, IL-6, and hs-CRP were measured at the same time. Neutrophil engraftment time, length of hospitalization, rate of mortality, relapses, readmissions, and occurrence of major complications following HSCT in a 1-year follow-up period were recorded as comparative outcomes.Results: Thirty-five patients with depression and 38 patients without depression participated in the study. Among the related outcomes, time of engraftment (P=0.020) and mortality rate (P=0.059) were statistically different between the two groups. Depressed patients had longer neutrophil engraftment time and higher mortality rate 1 year following transplantation (14.14±3.95 days and 31.43%) in comparison to non-depressed patients (12.21±2.81 days and 13.16%). Depressed patients showed significantly higher serum levels of IL-6 and IL-6-to-IL-10 ratio compared to non-depressed participants (P<0.001 and P=0.004).Conclusion: According to the results, pre-transplant depression can negatively impact neutrophil recovery time and mortality rate following HSCT. Higher levels of inflammatory factors in depressed patients might be one of the mechanisms that negatively affect clinical outcomes after HSCT.Keywords: depression, inflammation, hematopoietic stem cell transplantation, neutrophil recovery tim

Outbreak of exogenous Cushing's syndrome due to unlicensed medications

Objective: Despite the widespread medical use of glucocorticoids, reports of factitious administration of these hormones have been uncommon. We herein report an outbreak of Cushing's syndrome in Tehran among the addicts using Tamgesic (a brand of Buprenorphine) to help them through the narcotic withdrawal stage, without knowledge of the glucocorticoid content of the black-market drug. Design and measurements: Case histories of 19 patients with a final diagnosis of iatrogenic Cushing's syndrome were reviewed. Liquid chromatography/mass spectrometry (LC-Mass) method was used to evaluate glucocorticoid existence in the brand. High performance liquid chromatography was used to determine plasma dexamethasone level. Results: No buprenorphine was present in the vials. Each Tamgesic vial contained 0.4 mg of Dexamethasone disodium phosphate; Heroin was also found in them. The duration of injection abuse and the total dexamethasone intake was 4.5 (1-18) months and 2.6 (0.8-8) mg/day, respectively. Median plasma dexamethasone concentration was 5.8 nmol/l, with a range of 5-8.7. Physical findings of the cases were not different from those of the classic endogenous Cushing's syndrome but their serum cortisol and urinary free cortisol were suppressed. Severe life-threatening complications were demonstrated in five cases. Conclusion: Surreptitious use of steroids resulting in Cushing's syndrome may be more common in opium addicts; a high degree of suspicion is needed to uncover this disorder. Whenever facing a cushingoid appearance in addicts, the possibility of using black market drugs with corticosteroid contents should be kept in mind. © 2008 The Authors