Diabetic retinopathy clinical practice guidelines: Customized for Iranian population

Purpose: To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. Methods: Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology Preferred Practice Pattern 2012, and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefts, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. Results: Agreed recommendations were accepted as the fnal recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. Conclusion: This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy. © 2016 Journal of Ophthalmic and Vision Research

Intravitreal injection of anti-vascular endothelial growth factor agents for ocular vascular diseases: Clinical practice guideline

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients. © 2018 Journal of Ophthalmic and Vision Research

Intravitreal injection of anti-vascular endothelial growth factor agents for ocular vascular diseases: Clinical practice guideline

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients. © 2018 Journal of Ophthalmic and Vision Research

Comparison of the Outcomes of Three Detoxification Methods (Clonidin, Methadon, Rapid) in Opioid-dependents Referred to Kerman Shaheed Beheshti Hospital in a 6 -month Follow- up

Abstract: Background & Aims: In this study the efficacy of traditional method, methadone tapering method and rapid method as three opiate detoxification treatments was compared based on demographic features and naltrexone consumption in a 6- month follow up. Method: This Cohort prospective study was performed on 140 opioid addict men referred to opiate detoxification center of Shahid Beheshti Hospital, Kerman/ Iran from 2005-2007. They were divided into three groups of traditional method (n= 61), methadone tapering (n= 34) and rapid treatment (n= 45) and followed up for 6 months in order to evaluate the results of detoxification treatments. Results: At the end of the first month, the rate of abstinence in whole was 80.7%, and this rate was 83.6% in traditional treatment group, 82.4% in methadone group and 75.6% in rapid treatment group that shows no significant difference. After the 6th month the rate of abstinence was 12.8% in whole, 16.7% in traditional treatment group, 16.7% in methadone group and 6.3% in rapid treatment group. These rates, too, show no significant difference among three groups. The rate of naltrexone consumption at the end of the 1st month was 75.7% in whole, 52.5% in traditional group, 47.1% in methadone group and 97.8% in rapid treatment group that shows significant difference among three groups (P<0.05). There was no case of naltrexone consumption at the end of the 6th month. Conclusion: Since the rate of relapse and results of three detoxification methods have been the same the best detoxification method for each patient should be selected based on the physical condition of the patient, available facilities, probable expenses and physician's clinical judgment. Keywords: Opiate substitution treatment, Naltrexone, Methadone, Relaps

The Frequency of Mental Disorders among Kerman Residents above 15 Years of Age

Abstract: Background & Aims: In developed countries mental disorders are recognized by screening questionnaires and clinical interviews. Since there is a limited number of epidemiological studies about mental disorders in Iranian population, the present study was performed to find the prevalence and type of mental disorders among Kerman residents older than 15 years old. Method: At the first step, GHQ – 28 was completed door – side for 1527 residents selected through stratified cluster sampling. The cut off point of 6 was considered as disorder presence. At the second step, 490 ones who had obtained the cut off point participated in DSM – IV clinical interview. Results: In whole, 32.1% (34.5% female and 27.1% male) were diagnosed as psychiatrically ill. The frequency of mental disorders was 35.1% among those over 65 years, 35.3% among 45 – 64 years subjects, 100% in divorced, 45.8% in widows, 40.2% in illiterates, 36.9% in students, 34.7% in housewives and 34.8% in low socioeconomic class. Major depressive and panic disorders were the most frequent disorders (6.8% and 4.3% respectively). The frequency of generalized anxiety disorder was 2.8%, schizophrenia was 0.9% and Bipolar disorder was 0.3%. Conclusion: The frequencies of major depressive and generalized anxiety disorder were higher than other studies in Iran and similar to some studies from other countries. Different cultures and screening questionnaires maybe some reasons for these incompatibilities. The results of this study my help mental health providers to improve their programs. Keywords: Epidemiology, Mental disorders, Adult, Adult childre

The prevalence of hypertension among 7-12 year old schoolchildren in Kerman, Iran: A population-based study

Background: The aim of this study was to find the prevalence of chronic hypertension and prehypertension conditions among children. Methods: In this cross-sectional study, a total of 1017 students in Kerman schools were examined during a period from 2013 to 2014. The weight, height, body mass index (BMI), systolic and diastolic blood pressure and family history of high blood pressure were obtained. Pediatric Hypertension was defined as a mean systolic or diastolic reading (or both) � 95th percentile and prehypertension was defined as the blood pressure reading between the 90th and 95th percentiles of the predicted values based on gender, age and height. Results: According to the results, the prevalence of prehypertension and hypertension in schoolchildren was 1.9 and 3, respectively. According to BMI, 13.7 of children were overweight and 14.3 were obese. There was a positive association between BMI and the development of hypertension. Conclusion: Our findings demonstrated that approximately 3 of schoolchildren were afflicted with hypertension. Hypertension showed a positive association with overweight and obesity. © 2020, Kerman University of Medical Sciences. All rights reserved

A Study of the Sexual Function, Sleep, and Weight Status of Patients after 6 Months of Methadone Maintenance Treatment

BACKGROUND: Methadone is a synthetic opioid and receptor agonist morphine; thus, its consumption has the effects and side effects of opioid. Methadone maintenance treatment (MMT) is used as an alternative treatment for people who are suffering from substance abuse and do not have the ability to withdraw. Despite its benefits, this drug also has side effects. The purpose of this study was to investigate the effects of methadone treatment on sexual function, sleep, and weight after 6 months. METHODS: The study subjects consisted of 200 patients who had referred to the Methadone Clinic of Shahid Beheshti Training Hospital, Kerman, Iran, during a 6-month period and were treated using MMT. Data collection tools consisted of the demographic questionnaire, Pittsburgh sleep quality index (PSQI), and Arizona sexual experience scale (ASEX). The questionnaires were completed by the participants before and 6 months after the treatment. FINDINGS: The results of this study showed that methadone consumption has significant effects on sexual dysfunction, sleep disorders, and weight gain. CONCLUSION: The consideration of the side effects of MMT can result in consumers' commitment to the treatment

Prevalence of attention deficit hyperactivity disorder and its relation with depression

Background and Objective: According to destructive consequences of untreated attention deficit hyperactivity disorder (ADHD), this study was done to evaluate of the prevalence of adult ADHD and its relation with depression among Iranian students. Methods: This descriptive study was carried out on 414 students of Kerman University of Medical Sciences, Kerman, Iran during 2010-11. ADHD was screened by ADHD self report scale for adult ADHD and asking DSM-IV criteria from parents for childhood ADHD. Beck depression inventory questionnaire was used to determine depression. Results: The prevalence of adult ADHD and childhood ADHD was 3.9% and 8.5%, respectively. Depression was more prevalent in those with adult or childhood ADHD. Depression was more prevalent in under graduate than post graduate students (P<0.05). Conclusion: Depression is more prevalent in students with adult ADHD or with history of childhood ADHD

A study on the incidence of postoperative Delirium in the operated patients in Kerman medical sciences university hospitals in 1999

Abstract: Delirium is a syndrome consisting of cloudiness of consciousness, attention deficit, and cognitive impairment, with quick onset, but varring paths in its progression. Delirium is more common after major surgeries in the elderly and hospitalized patients, resulting in high morbidity and mortality rates. The incidence rate that has been reported in previous studies varies from 1-3% in cataract surgery to 73.5% in orthopedic and open heart surgeries. The objective of the present study was to determine the incidence of delirium during the first postoperative 5 days in 250 patients older than 40 undergoing elective surgeries in Kerman. MMSE test was used to screen the population and DSM-IV was used to confirm the diagnosis. Postoperative delirium developed in 19 patients (7.6%; 95% Confidence Interval: 4.7% to 11.7%). It seems that postoperative delirium incidence in our surgery wards is lower than western countries which can be due to less risk factors such as alcoholism and loneliness. Nonetheless, attention should be paid to old patients undergoing prolonged major operations. Keywords: Delirium, Postoperative care, Postoperative complication