Nifedipine, Captopril or Sublingual Nitroglycerin, Which can Reduce Blood Pressure the Most?

BACKGROUND: Hypertension (HTN) is one of the most important problems in all parts of the world. Although the disease is usually asymptomatic, its diagnosis and treatment are easy. The aim of this study was to compare the effect of Nifedipine (Adalat®), Captopril and sublingual Nitroglycerin on reducing blood pressure (BP). METHODS: This study was a parallel group randomized controlled trial. From the patients referred to our heart clinic, 120 patients with severe HTN were enrolled in the study. The patients were randomly allocated into 3 groups A, B, and C. The patients were advised to use 5 drops of Adalat in group A, Captopril 25 mg sublingually in group B, and 1 sublingual Nitroglycerin pearl in group C. The BP was measured every 20 minutes during one hour. RESULTS: Systolic BP was reduced significantly by Adalat and Captopril compared with sublingual Nitroglycerin in the 20th, 40th and 60th minutes (P = 0.001), but there was no significant difference between Adalat and captopril in reducing systolic BP. In addition, the result of reducing diastolic BP was not significantly different among the three groups. CONCLUSION: We saw the same effect on reducing BP by Captopril, Adalat, and sublingual Nitroglycerin. Among these three drugs, the side effects of Captopril were the least frequent. Adalat caused headache and flushing. Thus, it seems Captopril can be used instead of Adalat in medical centers. Keywords: Adalat, Captopril, Nitroglycerin, Severe Hypertensio

Evaluation of medical error status in various wards of Shohadaye Ashayer Hospital, Khorramabad, Iran

Abstract: Medical errors are known as the most important challenges that healthcare systems in all countries are encountered to them. To provide security and safety for patient is one of the major items in the health care systems. Confessing medical errors imposed on patient and education system is found to be an important aspect of medical ethics and care in turn lowers incidence of errors. Given the importance of identifying and reporting occurred medical errors, the present research aimed to assess medical errors in hospital wards of Shohadaye Ashayer Hospital Khorramabad so that findings of this research can inspire us to incorporate medical errors as a very important subject in the curriculum of medical students and finally physicians can do best examination and treatment with minimal or no errors and inaccuracies. The present research is descriptive in nature which lasted from April to March 2015. Statistical population (subjects) included employees and supervisors, nurses, staffs, lab safety facilitator, pharmacy safety facilitator, surgery room personnel, equipment and personnel in the hospital wards, including the emergency department, men surgery, women surgery, operating room, orthopedics, internal medicine ward, neurology, laboratory room, surgery, infectious, ophthalmic, reception, pharmacy and CCU hospital in Shohadaye Ashayer Hospital- Khorramabad. © 2009-2016, JGPT

Electrocardiogram Changes in Patients With Acute Ethanol Poisoning

Background: Alcohol consumption leads to a significant number of deaths, mostly in men, worldwide. Considering the effect of ethanol toxicity on the heart, we studied various Electrocardiographic (ECG) changes in patients with acute ethanol poisoning. Methods: A cross-sectional study was performed on patients admitted to Khorshid Hospital (affiliated to Isfahan University of Medical Sciences) due to ethanol poisoning. All 15- to 50-year-old patients with acute ethanol intoxication were included in the study (N=250). The patients’ information, including the demographic characteristics, clinical manifestations, and ECG changes were recorded and analyzed. Different variables were compared between the patients with or without ECG changes.Results: Most of the research patients (n=208) were men (83.82%). The Mean±SD age of the study patients was 26.8±8.87 years. About 54.8% of the patients presented abnormal ECG. The changes in ECG were not significantly different based on the demographic characteristic and clinical manifestations. The time interval between ethanol consumption and admission was significantly higher in patients with abnormal ECG, compared to those with normal ECG (Mean±SD: 7.09±10.67 vs. 4.77± 4.54 hours, respectively) (P=0.03).Conclusion: ECG changes are common in patients with ethanol poisoning. The time interval between ethanol consumption to hospital admission may be an important factor in the occurrence of ECG changes

Substance abuse behaviors among university freshmen in Iran: a latent class analysis

OBJECTIVES Substance abuse behaviors among university freshmen in Iran are poorly understood. This study aimed to identify, for the first time, subgroups of university freshmen in Iran on the basis of substance abuse behaviors. Moreover, it examined the effects of socio-demographic characteristics on membership in each specific subgroup. METHODS Data for the study were collected cross-sectionally in December 2013 and January 2014 from 4 major cities in Iran: Tabriz, Qazvin, Karaj, and Khoramabad. A total of 5,252 first-semester freshmen were randomly selected using a proportional cluster sampling methodology. A survey questionnaire was used to collect data. Latent class analysis (LCA) was performed to identify subgroups of students on the basis of substance abuse behaviors and to examine the effects of students’ socio-demographic characteristics on membership in each specific subgroup. RESULTS The LCA procedure identified 3 latent classes: the healthy group; the hookah experimenter group; and the unhealthy group. Approximately 82.8, 16.1, and 2.1% of students were classified into the healthy, hookah experimenter, and unhealthy groups, respectively. Older age, being male, and having a family member or a close friend who smoked increased the risk of membership in classes 2 and 3, compared to class 1. CONCLUSIONS Approximately 2.1% of freshmen exhibited unhealthy substance abuse behaviors. In addition, we found that older age, being male, and having a close friend or family member who smoked may serve as risk factors for substance abuse behaviors

Online Self-management Training and Play Therapy for Treating Behavioral Problems of Children With T1DM

Background: Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in childhood and adolescence, which is associated with various psychological problems. This study aims to compare the effect of group internet-delivered self-management training (iSMT) and “patient child” play (PCP) on externalizing and internalizing problems in children with T1DM in Isfahan City, Iran. Methods: This randomized clinical trial was conducted from January 2020 to October 2021. From all children aged 8 to 11 years with T1DM diagnosed by endocrinologists, 75 children were selected based on inclusion and exclusion criteria and were randomly assigned into three groups, iSMT, PCP, and control (each group was 25). Their parents filled out the child behavior checklist (CBCL) for them in the pre and post-treatment stages. The iSMT group received 10 sessions of education via Skyroom and the playgroup performed PCP for 10 sessions. The control group did not receive any psychological intervention. All participants received routine diabetes medication. Data were analyzed using SPSS software, version 23 and analysis of variance (ANOVA) for 59 children in 3 groups (iSMT=19, PCP=20, and control=20). Results: The results showed that the PCP group had more improvement in SP compared to the iSMT group as well as a significant improvement in rule-breaking behaviors (RB) compared to the control group. Conclusion: PCP is effective in improving SP and RB of children with T1DM and can be used as a complementary treatment for them

Investigating the Relationship Between Psychological Flexibility, Mindful Ability, and Self-compassion With the Severity of Depression in Patients With Mood Disorders

Objectives: Considering the prevalence and importance of depression, it is necessary to study the new psychological variables involved in its formation, persistence, and recurrence. Accordingly, this study aims to investigate the relationship between psychological flexibility (PF), mindful ability (MA), and self-compassion with the severity of depression in patients with mood disorders. Methods: This cross-sectional study was conducted from October to January 2018. A total of 80 patients with various mood disorders were selected via a purposive sampling method based on the inclusion and exclusion criteria from the psychiatric wards of Noor Hospital and clinics affiliated with Isfahan University of Medical Sciences. They completed the self-compassion scale, acceptance and action questionnaire, Freiburg mindfulness inventory–short form, and the Beck depression inventory-II. The data were analyzed using the SPSS software, version 24. Meanwhile, the Pearson correlation coefficient and multiple regression were applied as well. Results: The correlation coefficient between PF and depression was -0.79. This coefficient was -0.91 and -0.87 between self-compassion and depression and MA and depression, respectively. This indicates a strong inverse relationship between depression scores and these variables. Stepwise regression analysis showed that gender and MA were respectively the best predictors of depression (P<0.05). Discussion: Based on the results, there was a significant relationship between low self-compassion, PF, and MA and depression in patients with mood disorders

A systematic review of oral health status in substance abusers

Background. Oral health is one of the most important issues for people and physicians, and it is very important to identify the factors that contribute to the damage to oral health. One of the factors that is always emphasized in harming oral health is drug addiction. Methods. This study is a systematic review and meta-analysis. We searched the electronic databases, including PubMed, Scopus, ProQuest, Google Scholar, and ISI for Persian and English articles and compared oral health indicators in patients with substance abuse with healthy subjects. The quality of the selected studies was measured by the Newcastle-Ottawa Scale. Heterogeneity of studies was performed using the Q test and I-square index. In case of heterogeneity of studies, a random effect model was used to combine the results. Publication bias was performed by funnel curves and Egger’s and Begg’s tests. Results. Substance abuse had a significant effect on (std dif in means 1/657[1.873-1/442], P<0/001) and it has a strong positive and significant effect on plaque index (OR. 1/42; 95% CI 1/18-1/7), P= 0/0002. Conclusion. The mean DMFT was higher in people with drug abuse than in healthy people. Periodontal problems are also more common in people with drug abuse than in healthy people. Hence, the oral health status of these people needs more attention. Practical Implications. Responsible organizations and social dentists should pay more attention to oral and dental health of substance abusers

Analgesic effect of expressed breast milk in neonates during venipuncture in comparison with formula and 50% dextrose

Background: Newborn infants routinely may undergo invasive procedures, even after uncomplicated birth. Evidence shows that neonates do feel pain and may even have increased sensitivity to pain and to its long term effects compared with older infants . Non pharmacologic interventions are valuable for pain relief during minor procedures in neonates. The aim of this study was to asses the effectiveness of expressed breast milk)EBM( in reducing pain due to venipuncture and its comparison with formula and 50% dextrose solution . Materials and Methods: A clinical trial study was conducted in 30 term neonates. Each infant received 3 treatments with EBM , formula and 50% dextrose solution during consecutive venus blood sampling and their responses were measured by behavioral acute pain rating scale for neonates (DAN Score ) . This study was done in form of double blind and observers were unaware of the prescribed matter. Results: This study showed that pain score significantly is lower in neonates who received EBM (P<0.001) .There was no statistical relationship between age , sex and weight with pain score . Conclusion : Expressed breast milk effectively reduces pain of venipuncture in term neonates and it could be natural, noninvasive and available analgesic particularly when mother can not be present to breastfeeding

Evaluation of the Effect of Memantine Supplementation in the Treatment of Acute Phase of Mania in Bipolar Disorder of Elderly Patients: A Double-blind Randomized Controlled Trial

Background: This study aimed to evaluate the efficacy of memantine in the acute treatment of geriatric with bipolar disorder (BD) hospitalized for mania. Materials and Methods: This study conducted on 70 patients older than 60 years with BD in the acute phase of mania. Oral sodium valproate was prescribed in both groups. The intervention group received memantine tablet and the placebo group received a placebo tablet based on a same procedure. Severity of mania, cognitive changes, and quality of life (QoL) were assessed and recorded 4 and 8 weeks after the beginning of the study. The collected data were analyzed with SPSS (version 20) using independent samples t-test, analysis of variance in repeated observations, Chi-squared test, and Fisher's exact test. Results: Mania severity score had no significant difference at the beginning of the study, but 4 and 8 weeks after the intervention, it was reduced significantly in both groups (P < 0.001) that was higher in memantine group (P = 0.038). The mean increase in score of cognitive variations was 6.74 in the memantine group and 3.62 in the placebo group with a nonsignificant difference (P = 0.125). The scores of each dimension of QoL in the two groups showed that in all four dimensions, the patient's physical, psychological, social, and environmental status increased significantly by time (P < 0.001). Conclusions: According to the results of this study, memantine as an adjuvant to administration of sodium valproate may have a significant effect on decreasing the intensity of mania in the long run

Comparison of Two Methods: Spinal Anesthesia and Ischiorectal Block on Post Hemorrhoidectomy Pain and Hospital Stay: A Randomized Control Trial

Objective: Hemorrhoidectomy is one of the most common hemorrhoid surgery. Many areas are innervated by nerves, and this makes the surgery to be very painful. Various anesthetic methods have been proposed, and the number of investigations and procedures demonstrated the absence of a reliable method for reducing pain. This study compares the cavity ischiorectal block with spinal anesthesia in reducing postoperative pain, analgesic consumption, and hospital stay. Research design: This study is a randomized control trial carried out on seventy patients sampled. Thirty-five (35) among them were placed in spinal anesthesia group, and the other 35 were placed in the ischiorectal block group. According to the study, questionnaire was designed in such a way that postoperative variables such as postoperative pain, analgesic consumption, changes in blood pressure, heart rate and hospital stay in both groups were evaluated and compared. Clinical trial registration: IRCT2015111616516N3 (http://en.search.irct.ir/search?query=IRCT2015111616516N3) Results: In this study, the pain scores on Visual Analogue Scale (VAS) at 0, 6, 12, and 24 hr for spinal anesthesia group after surgery were 0, 3.08 ± 0.78, 2.05 ± 1.02, 1.11 ± 0.83, respectively (p < 0.05). That of ischiorectal blocks were 0.98 ± 0.25, 1.57 ± 0.81, 0.91 ± 0.91, and 0.63 ± 0.31 respectively, which indicated lesser pain after surgery in the ischiorectal block at 6, 12, and 24 hr. In this study, out of the 35 patients that underwent spinal anesthesia, 28 patients (80%) were hospitalized in the first 6 hr, 13 patients (37.1%) in the second 6 hr, 3 patients (8.6%) in the second 12 hr after surgery. For patients under the ischiorectal block, the number of patients hospitalized were 13 patients (37.1%), in the first 6 hr, 4 patients (11.4%) in the second 6 hr, and 1 (2.9%) were hospitalized in the second 12 hr after surgery (p < 0.05). Conclusion: Ischiorectal blocks causes less pain, require fewer painkillers, and reduces the hospital stay after surgery than spinal anesthesia