Pre-operative rectal indomethacin for reduction of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double-blind randomized clinical trial

OBJECTIVE: To evaluate the effect of pre-operative indomethacin suppository on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. STUDY DESIGN: A double blind placebo-controlled randomized clinical trial. PLACE AND DURATION OF STUDY: Hazrat Rasoul Akram Hospital, Tehran, Iran, from February 2010 to September 2012. METHODOLOGY: One hundred and thirty patients, scheduled for laparoscopic cholecystectomy, were randomly divided into case and control groups. Sixty-five patients received indomethacin suppository and 70 patients received rectal placebo in the case and control groups respectively. All patients underwent the same protocol in laparoscopic surgery and anesthesia, then nausea and vomiting was recorded after 1, 6, 12 and 24 hours postoperatively and compared between the two groups. Independent-sample t test or Mann-Whitney tests were used for statistical analysis. Level of statistical significance was set at P ² 0.05. RESULTS: Patients' nausea was statistically lower in the case group at the 1st hour (43.1 vs. 92.9), 6th hour (20.0 vs. 68.6) and 12th hour (7.7 vs. 24.3) after surgery (for all periods, P < 0.001). Fewer patients in the case group experienced vomiting at the first (13.8 vs. 51.4) and 6th hour (0 vs. 20) after surgery (for both P < 0.001). The use of pethidine was also statistically less in the case group in the same hours after surgery (for all of them, P < 0.001). CONCLUSION: Rectal indomethacin before laparoscopic cholecystectomy led to lower postoperative nausea and vomiting

Occurrence of Fusarium spp. and Fumonisins in Stored Wheat Grains Marketed in Iran

Wheat grains are well known to be invaded by Fusarium spp. under field and storage conditions and contaminated with fumonisins. Therefore, determining Fusarium spp. and fumonisins in wheat grains is of prime importance to develop suitable management strategies and to minimize risk. Eighty-two stored wheat samples produced in Iran were collected from various supermarkets and tested for the presence of Fusarium spp. by agar plate assay and fumonisins by HPLC. A total of 386 Fusarium strains were isolated and identified through morphological characteristics. All these strains belonged to F. culmorum, F. graminearum, F. proliferatum and F. verticillioides. Of the Fusarium species, F. graminearum was the most prevalent species, followed by F. verticillioides, F. proliferatum and then F. culmorum. Natural occurrence of fumonisin B1 (FB1) could be detected in 56 (68.2%) samples ranging from 15–155 μg/kg, fumonisin B2 (FB2) in 35 (42.6%) samples ranging from 12–86 μg/kg and fumonisin B3 (FB3) in 26 (31.7%) samples ranging from 13–64 μg/kg. The highest FB1 levels were detected in samples from Eilam (up to 155 μg/kg) and FB2 and FB3 in samples from Gilan Gharb (up to 86 μg/kg and 64 μg/kg)

Identifying outcome-based indicators and developing a curriculum for a continuing medical education programme on rational prescribing using a modified Delphi process

<p>Abstract</p> <p/> <p>Background</p> <p>Continuing medical education (CME) is compulsory for physicians in Iran. Recent studies in Iran show that modifications of CME elements are necessary to improve the effectiveness of the educational programmes. Other studies point to an inappropriate, even irrational drug prescribing. Based on a needs assessment study regarding CME for general physicians in the East Azerbaijan province in Iran, rational prescribing practice was recognized as a high priority issue. Considering different educational methods, outcome-based education has been proposed as a suitable approach for CME. The purpose of the study was to obtain experts' consensus about appropriate educational outcomes of rational prescribing for general physicians in CME and developing curricular contents for this education.</p> <p>Methods</p> <p>The study consisted of two phases: The first phase was conducted using a two-round Delphi consensus process to identify the outcome-based educational indicators regarding rational prescribing for general physicians in primary care (GPs). In the second phase the agreed indicators were submitted to panels of experts for assessment and determination of content for a CME program in the field.</p> <p>Results</p> <p>Twenty one learning outcomes were identified through a modified Delphi process. The indicators were used by the panels of experts and six educational topics were determined for the CME programme and the curricular content of each was defined. The topics were 1) Principles of prescription writing, 2) Adverse drug reactions, 3) Drug interactions, 4) Injections, 5) Antibiotic therapy, and 6) Anti-inflammatory agents therapy. One of the topics was not directly related to any outcome, raising a question about the need for a discussion on constructive alignment.</p> <p>Conclusions</p> <p/> <p>Consensus on learning outcomes was achieved and an educational guideline was designed. Before suggesting widespread use in the country the educational package should be tested in the CME context.</p

Monitoring of National Drug Policy (NDP) and its standardized indicators; conformity to decisions of the national drug selecting committee in Iran

BACKGROUND: Pharmaceuticals have made an important contribution to global reductions in morbidity and mortality. To help save lives and improve health, it is important to be sure about equity to access to drugs, drug efficacy, quality and safety, and rational use of drugs, which are standardized National Drug Policy (NDP) objectives. NDP's indicators are useful to evaluate the pharmaceutical system performance in a country. Iran has adapted a National Drug List (NDL). Since management of drug supply in Iran takes place only for drugs that have been selected in NDL and this list is selected by the member of Iran Drug Selecting Committee (IDSC), thus evaluation of IDSC's decision making during last 5 years is an appropriate way to evaluate the implementation of drug supply system in the country. METHODS: To identify strengths and weaknesses of pharmaceutical policy formation and implementation in Iran, four standard questionnaires of the World Health Organization (WHO) were used. To assess the agreement between decisions of IDSC and standardized NDP indicators in the last 5 years (1998–2002), a weighted questionnaire by nominal group technique based on the questions that should be answered during discussion about one drug in IDSC was designed and used. RESULTS: There is a totally generics based NDP with 95% local production, that provides affordable access to drugs. The system, structures, and mechanisms were in place; however, they did not function properly in some topics. Assessment of 59 dossiers of approved drugs for adding to NDL during last 5 years showed that IDSC's members pay more attention to efficacy, safety, and rationality in use rather than accessibility and affordability. CONCLUSION: Revision of drug system in term of implementation of the processes to achieve NDP's objectives is necessary to save public health. Clarification of NDP's objectives and their impact for IDSC's members will result in improvement of the equity in access to pharmaceuticals

Clinical efficacy of convalescent plasma for treatment of COVID-19 infections: Results of a multicenter clinical study

Since Dec. 2019 the new coronavirus (SARS-CoV-2) has infected millions and claimed life of several hundred thousand worldwide. However, so far no approved vaccine or drug therapy is available for treatment of virus infection. Convalescent plasma has been considered a potential modality for COVID-19 infection. One hundred eighty-nine COVID-19 positive patients including 115 patients in plasma therapy group and 74 patients in control group, registered in the hospitals with confirmed COVID-19 infection, entered this multi-center clinical study. Comparison of outcomes including all-cause mortality, total hospitalization days and patients� need for intubation between the two patient groups shows that total of 98 (98.2 ) of patients who received convalescent plasma were discharged from hospital which is substantially higher compared to 56 (78.7 ) patients in control group. Length of hospitalization days was significantly lower (9.54 days) in convalescent plasma group compared with that of control group (12.88 days). Only 8 patients (7) in convalescent plasma group required intubation while that was 20 in control group. This clinical study provides strong evidence to support the efficacy of convalescent plasma therapy in COVID-19 patients and recommends this treatment for management of these patients. Clinical efficacy, immediate availability and potential cost effectiveness could be considered as main advantages of convalescent plasma therapy. © 2020 Elsevier Lt

The impact of a full-range leadership training program in a small town

The purpose of this study was to describe and understand conditions, processes and outcomes associated with twelve leaders in a small town who participated in a full-range leadership workshop. This study used a qualitative case study design. The primary data collection method employed was through individual interviews with the twelve selected leaders from this workshop and ten of their randomly selected followers after ninety days and two small group sessions. Four research questions were considered and they attempted to examine the impact of an intervention leadership-training program on individual leaders, organizations, community and followers of these leaders. The primary findings of this study are the following. Participants experienced that attitude of leaders toward a training program before, during and after the workshop as a vital factor to implement the new concepts. Motivation and readiness emerged as two major component of this theme. External factors, trust and reward were mentioned as contributing factors for readiness to change. Dissatisfaction and personal and professional growth were mentioned as motivating factors. Next theme was learning of leaders and two sub-themes of community leadership and gradual change had emerged from this theme. All leaders were interested to improve their leadership skills, but this was affected by the context in which the leader operates. Nature of a small town, tradition and bureaucracy were mentioned as other factors affecting the learning process. Next theme was support for leaders, with the two sub-themes of re-enforcement and fellowship. All participants in this workshop welcomed the idea of small group sessions following the workshop. This theme appeared to be the most important finding of this study. Any intervention leadership training program without follow-ups will have a temporary impact in a community. Implications and recommendations for future studies are also presented

Surgical Repair Outcomes of Inflammatory and Degenerative Abdominal Aortic Aneurysms

Inflammatory abdominal aortic aneurysm (IAAA) is characterised by thick aortic wall, with perianeurysmal fibrosis extending to adjacent organs. This study aimed to determine the early surgical outcomes of 10 IAAAs and compare the risk factors, perioperative complications, and 30-day mortality of these patients to 50 degenerative AAAs (dAAA), who underwent open repair in Sina Hospital, Tehran, Iran. The study was conducted from 2011 to 2019. IAAA patients were followed for 22.7 ± 3.8 months. The frequency of IAAA was 4.9. All IAAA patients were males and smokers. There was no statistical difference in preoperative risk factors (age, smoking, hypertension, chronic kidney disease, ischemic heart disease, chronic obstructive pulmonary disease), operation time, blood loss, postoperative complications between dAAA and IAAA patients. The thirty-day mortality rate of open surgeries in degenerative and inflammatory cases was 8 (N=4) and 10 (N=1), respectively. Open repair with proximal/and/or distal clamping, avoids severe adhesiolysis, procedure-related morbidity, and 30-day perioperative mortality. © 2022 College of Physicians and Surgeons Pakistan. All rights reserved

Frequency of Complications Following Endovascular Repair of Abdominal Aortic Aneurysm in Tehran Sina Hospital, 2011-2019

Background and purpose: Abdominal aortic aneurysms (AAA) is a localized enlargement of infrarenal abdominal aorta. Endovascular aneurysm repair (EVAR) is a surgical method introduced for AAA repair. This study, for the first time in Iran, investigated the complications and mortality rate associated with EVAR. Materials and methods: In this cross-sectional study, medical records were reviewed and all patients admitted to Sina Referral Hospital with infra renal abdominal aortic aneurysms who underwent elective EVAR between 2011 and 2019 (n=130) were studied. Results: There were 121 complete files, including those of 104 (85.9) men and 17 (14.1) women. The mean age of patients was 70.56±9.4. Renal complications were the most frequent systemic complication after elective EVAR (n=15, 12.6). Cardiac complications (n=10, 8.4), respiratoty complications (n=6, 5), cerebral complications (n=3, 2.5), and deep vein thrombosis (n=2, 1.7) were also reported. There was no graft infection. More than half of the procedure-related complications occurred in 6 months of surgery (n= 29, 24). Conclusion: Endovascular repair of abdominal aortic aneurysm especially in patients with comorbidities has acceptable results in short term and long term surveillance. © 2022, Mazandaran University of Medical Sciences. All rights reserved