Comparison of sublingual Buprenorphine and intravenous Morphine in reducing bone metastases associated pain in cancer patients

Bone metastases is one of the most common causes of pain in cancer patients and have a significant effect on their quality of life. The most common symptom of bone metastases is pain that gradually develops. Morphine is used to relieve pain in these patients, poorly accepted by patients due to its adverse events. Therefore, the current study was aimed to compare the effect of sublingual buprenorphine, with certainly lower complications with morphine. Fourth patients were divided into 2 groups. In group A, metastatic cancer patients received 2.5 mg of intravenous (IV) morphine. Furthermore, in group B, sublingual tablet of buprenorphine (one-fourth of a 500 μg tablet) was administered sublingually. Pain was measured 15, 30, and 45 minutes after the onset of pain using visual analog scale (VAS) Ruler. Based on the obtained data, two groups A and B were compared using SPSS 23 software. There was a significant difference between the patient's pain intensity after 15 and 30 minutes from the onset of pain in both groups. Due to the fact that the duration of the effect of morphine is 3-4 hours and the duration of the effect of sublingual buprenorphine is 6-8 hours, therefore, morphine showed fast acting forms of opioids (P= 0.001). The required dose level on the first day was similar in both groups and there was no statistically significant difference between the two groups. While on the second and third days, the median dose in group A (morphine) was greater than group B (buprenorphine), indicating prolonged duration of action for buprenorphine compared with morphine, thus requiring a lower subsequent doses. The results of this study suggested that sublingual buprenorphine is a higher effective drug compared to intravenous morphine during after operation. With regard to easy and painless administration, it seems that its use can be useful in controlling pain due to bone metastases in cancer patients

Does Ingestion of Tincture of Opium Notably Raise Blood Alcohol Concentration?‎

Background: Tincture of opium (TOP) is currently used for maintenance therapy in treatment of opioids addiction. It contains ethanol. The present study was conducted to assess the increase in blood alcohol concentration (BAC) in its users; a process which may interfere with breath-alcohol test performed by law enforcement or traffic police. Methods: A total of 143 individuals were selected randomly from drug users who had been referred to an addiction treatment clinic. They were asked to undergo breath-alcohol test 15, 30, 45, and 60 min after taking their daily dosage of TOP. The resulting figures were statistically analyzed by t-test and chi-square test using SPSS for Windows. Findings: The calculated blood ethanol concentration rose to 26.33 ± 14.34, 29.15 ± 6.70, and 33.03 ± 8.46 in persons taking 20, 25, and 30 ml TOP respectively, 5 min after their drug ingestion. The figures turned into zero after 15 min. Conclusion: Users of TOP should be reassured about its alcoholic content. Its alcoholic content cannot produce equilibrium disturbance or notable BAC. However, it is recommended that users of TOP are observed in addiction treatment centers for 15 min after taking their drug to reach a higher degree of certainty about any effect of alcoholic content of TOP

Dysregulation of miR-638 in breast cancer patients and bioinformatics investigation of its target genes in apoptosis, angiogenesis and autophagy pathways

Background: Breast cancer, as the most frequent cancer diagnosed in women worldwide, is affected by different regulatory mechanisms and cellular processes such as microRNAs (miRNAs) and autophagy, which influence tumor cell progression. MiRNAs play a crucial role in cancer progression. Aberrant miRNA expression has been described in various human cancers. Growing evidence proposes that miRNAs have a considerable role in tumor development and may constitute robust biomarkers for cancer diagnosis and prognosis. Objectives: The aim of this study was to evaluate miRNA-638 (miR-638) expression level in breast cancer patients and its bioinformatics analysis. Methods: In this case-control study, miR-638 expression was examined in fresh breast tissues of 47 patients with breast cancer using real time polymerase chain reaction (PCR). Then the role of miR-638 in various signaling pathways was studied using Target Scan, the MicroRNA-Target Interactions (miRTarBase) database, miRWalk2.0 and the database for annotation, visualization and integrated discovery (DAVID). Results: The miR-638 expression level showed a significant decrease in breast cancer patients. Also, this miRNA might be involved in apoptosis, angiogenesis, and autophagy. Conclusions: According to the results, miR-638 can be used as a potential prognostic biomarker for cancer growth, and its low expression is thought to increase cancer progression by disrupting cell death and autophagy, which are considered as important pathways in breast cancer

Therapeutic Effect of Adding Magnesium Sulfate in Treatment of Organophosphorus Poisoning

BACKGROUND: In recent years, the prevalence of poisoning has increased dramatically due to population growth and access to drugs and toxins. Today poisoning is one of the important reasons for visiting hospitals. AIM: The present study aimed to investigate the effect of magnesium sulfate on organophosphorous toxicity. METHODS: Patients who had inclusion criteria in the study were randomly assigned to one of two groups (control group or case group) by an emergency medicine specialist. Patients' data including age, sex, ECG, vital signs, arterial oxygen saturation were recorded for patients. Patients in the case group (40 subjects) received 2 mg magnesium sulfate 50%, while the control group (40 subjects) received 100 cc normal saline (as placebo) as an intravenous infusion RESULTS: The distribution of gender in the two groups of patients was the same. Also, the mean age, Stature and weight of patients were similar in both groups. In the group receiving magnesium sulfate, diastolic blood pressure was lower when compared with another group, at 0 and 2 hours after intervention. Moreover, the mean of systolic blood pressure in both groups was determined to be the same at all hours. Furthermore, the heart rate in the group receiving sulfate was lower as compared to the control group for 8 hours, 16 and 24 hours after intervention. CONCLUSION: The use of magnesium sulfate in organophosphate poisoning reduces therapeutic costs an average hospital length of stay and mortality compared to those who did not receive magnesium sulfate

Age‑standardized mortality rate and predictors of mortality among COVID‑19 patients in Iran

BACKGROUND: To have a thorough understanding of epidemic surveillance, it is essential to broaden our knowledge of death tolls worldwide. This study aimed to determine the age‑standardized mortality rate (ASMR) and predictors of mortality among coronavirus disease 2019 (COVID‑19) patients. MATERIALS AND METHODS: In this cross‑sectional design, all COVID‑19 patients with a positive polymerase chain reaction test in the population covered by Arak University of Medical Sciences (AUMS) were entered to the study. Data collection was conducted by phone interview. The study variables comprised age, sex, coronary heart diseases, diabetes, and some symptoms at admission. The adjusted odds ratio (OR) and 95% confdence intervals (CIs) were obtained by logistic regression. The direct method was applied to calculate ASMR (per 100,000) of COVID‑19. The analysis was applied by STATA software 12.0. RESULTS: A total of 208 cases of COVID‑19 (out of 3050 total infected cases) were dead and 2500 cases were recovered. The mean age of dead patients was 70 years. The COVID‑19 fatality rate in the population equaled 6.8%; in those patients who were 70 years old or more, however, the case fatality rate was 16.4%. The ASMR of COVID‑19 was 12.9 (CI 95%: 11.2, 14.8). The odds of COVID‑19‑related death in the age over 60 were 10.87 (CI 95%: 6.30, 18.75) times than lower 45 years old. Moreover, it was observed that COVID‑19 signifcantly increased the odds of COVID‑19‑related death in diabetes patients (OR = 1.45, CI 95%: 1.02, 2.06, P = 0.036). CONCLUSION: The ASMR of COVID‑19 was relatively higher in males than females. In general, the COVID‑19 fatality rate was relatively high. We found that older age and diabetes can have impact on the death of COVID‑19, but the headache was found to have a negative association with the COVID‑19‑related death Age‑standardized, COVID‑19, epidemiology, Iran, mortalit

Evaluation of two years of mass chemotherapy against ascariasis in Hamadan, Islamic Republic of Iran

OBJECTIVE: To evaluate the mass treatment of ascariasis in rural areas of Hamadan Province, Islamic Republic of Iran. METHODS: A control programme in rural areas of Hamadan Province, which began in November 1997, involved giving all persons a single dose of 400 mg albendazole at intervals of three months. The efficacy of the treatment was evaluated by the formalin-ether concentration technique for stool examination and by the Stoll quantitative method. FINDINGS: The average rate of infection with Ascaris before treatment was 53.3%, ranging from 40% in Hamadan district to 75% in Toysercan. Two areas, Malayer and Nahavand, were excluded from the programme because the infection rates were only 13% and 4%, respectively. After two years of mass treatment the infection rate had decreased to 6%. The proportion of positive cases excreting only unfertilized eggs increased to 32%. No side-effects of mass treatment were observed. CONCLUSION: Systematic mass treatment giving high coverage proved to be very effective in the control of ascariasis, notwithstanding a lack of other preventive measures

Does Ingestion of Tincture of Opium Notably Raise Blood Alcohol Concentration?

Abstract Background: Tincture of opium (TOP) is currently used for maintenance therapy in treatment of opioids addiction. It contains ethanol. The present study was conducted to assess the increase in blood alcohol concentration (BAC) in its users; a process which may interfere with breath-alcohol test performed by law enforcement or traffic police. Methods: A total of 143 individuals were selected randomly from drug users who had been referred to an addiction treatment clinic. They were asked to undergo breath-alcohol test 15, 30, 45, and 60 min after taking their daily dosage of TOP. The resulting figures were statistically analyzed by t-test and chi-square test using SPSS for Windows. Findings: The calculated blood ethanol concentration rose to 26.33 ± 14.34, 29.15 ± 6.70, and 33.03 ± 8.46 in persons taking 20, 25, and 30 ml TOP respectively, 5 min after their drug ingestion. The figures turned into zero after 15 min. Conclusion: Users of TOP should be reassured about its alcoholic content. Its alcoholic content cannot produce equilibrium disturbance or notable BAC. However, it is recommended that users of TOP are observed in addiction treatment centers for 15 min after taking their drug to reach a higher degree of certainty about any effect of alcoholic content of TOP. Keywords: Addiction, Treatment, Tincture of opium, Ethano

Prevalence and Complications of Drug-induced Seizures in Baharloo Hospital, Tehran, Iran

Background: Seizure is a frequent and important finding in the field of clinical toxicology. Almost all poisons and drugs can produce seizure. We have evaluated frequency and complications of drug-induced seizure in present study. Methods: The present descriptive cross-sectional study was done on patients who were referred to Baharloo Hospital, Tehran, Iran, that had developed seizure before or after hospitalization following intoxication between 20 March 2010 and 20 March 2011. The exclusion criteria were a positive history of epilepsy, head trauma, or abnormal findings in EEG or brain CT scan. Results: Tramadol and tricyclic antidepressants were the most common causes of drug-induced seizure (31.5% and 14.7% of the cases, respectively). Overall, 6 patients (4.2%) had developed persistent vegetative state in consequence of brain hypoxia, 16 patients (11.2%) had died due to complications of seizure or the poisoning itself. Tramadol was the leading cause of drug-induced seizure and its morbidity and mortality. Tonic-colonic seizure was the most common type of drug-induced seizure. Seizure had occurred once in 58% of the patients, twice in 37.1% of the patients, and had been revolutionized to status epilepticus in 4.9% of them. Among the 7 patients who had developed status epilepticus, 3 cases had died. Conclusion: Appropriate measures for treatment of seizure and prevention of its complications should be taken when patients with drug poisoning are admitted into hospital, especially when the offending drug(s) has a higher likelihood to induce seizure

Prevention of lung complications following paraquat poisoning by silymarin, n-acetyl cysteine and hydrocortisone: An experimental study

Background: Paraquat poisoning results in multi-organ failure, primarily pulmonary fibrosis, acute renal failure, and hepatic impairment. The present study was designed to evaluate three treatment regimens, such as N-Acetyl cysteine (NAC), silymarin and hydrocortisone in the prevention of lung fibrosis after ingestion of toxic doses of paraquat in rats. Methods: Male Sprague-Dawley rats (N=20) were randomly divided into four groups of five each. The drugs and paraquat were given to the rats orally. All rat groups received one oral dose of paraquat (10 mg/kg) once daily for 1 week. The first group received a daily oral dose of silymarin (600 mg/kg) for 2 weeks. The second group received a daily oral dose of NAC (500 mg/kg) for 2 weeks. The third group was given daily oral doses of NAC (500 mg/kg) and hydrocortisone (50 mg/kg) for 2 weeks. The fourth group (controls) received no drugs other than paraquat. The experiment continued for 4 weeks. After the experiment, autopsy was performed on all rats and the lungs were examined histopathologically. Results: The results of histopathology examinations for peribronchial inflammation in the groups were shown that NAC plus hydrocortisone and silymarin had notable effects in the prevention of lung inflammation. Septal widening in the lungs was also observed in group three less than that in the other groups. Conclusion: Based on the results, silymarin, NAC and hydrocortisone may be used as a palliative treatment in paraquat poisoning specifically aimed at preventing the acute and chronic lung injuries as the worst complication of the poisoning