Efficacy of intramuscular haloperidol versus haloperidol plus promethazine in controlling aggressive behavior of psychiatric patients admitted to emergency rooms

Introduction: The aim of this study was to compare the therapeutic and adverse effects of haloperidol to the combination of haloperidol and promethazine (antipsychotic + antihistamine) for controlling patients with aggressive or violent behavior referred to psychiatric emergency rooms. Methods: Using a double-blind randomized controlled trial, 100 psychiatric patients admitted to emergency room of Taleghani hospital, Tehran/Iran, randomly received intramuscular haloperidol or haloperidol plus promethazine. The patients were observed at 20, 40, 60, 120 minute intervals and then at 6, 12 and 24 hourly intervals to determine if they were tranquil or asleep, need for further injection, serious adverse effects, acute dystonia, akathisia, need for other medications, and need for admission to hospital based on clinical judgment. Results: The mean age of patients was 36.25 years and 69% were male. Patients receiving promethazine plus haloperidol were more tranquil after 2, 6 and 12 hours and sustained sleep after hours 2 and 6. Adding promethazine to haloperidol decreased the need for repeated involvement of the psychiatrist on duty, using additional medications and hospital admission. Patients taking the combination of haloperidol and promethazine did not experience more adverse effects than those taking only haloperidol. Conclusion: The combination of haloperidol plus promethazine can be safely used in emergency rooms for controlling patient with agitation and aggressive behavior resulting in a sustained tranquilization or asleep and lower need for further intervention

Cinnarizine versus Topiramate in Prophylaxis of Migraines among Children and Adolescents: A Randomized, Double-Blind Clinical Trial

How to Cite This Article: Ashrafi MR, Najafi Z, Shafiei M, Heidari K, Togha M. Cinnarizinev ersus Topiramate in Prophylaxis of Migraines among Children and Adolescents: A Randomized, Double-Blind Clinical Trial. Iran J Child Neurol. 2014 Autumn;8(4): 18-27. AbstractObjectiveMigraines, a common health problem in children and adolescents, still do not have an FDA approved preventive treatment for patients under the age of 18 years. This study compares and contrasts the efficacy and safety of cinnarizine and topiramate in preventing pediatric migraines.Materials & MethodsIn this randomized, double-blind clinical trial 44 migrainous (from 4–15 years of age) were equally allocated to receive cinnarizine or topiramate. The primary efficacy measure was monthly migraine frequency. Secondary efficacy measures were monthly migraine intensity and ≥ 50% responder rate. Efficacy measures were recorded at the baseline and at 4, 8, and 12 weeks of treatment.ResultsDuring the double-blind phase of the study, monthly migraine frequency and intensity were significantly decreased in both the cinnarizine and topiramate groups when compared to the baseline. However, at the end of the study, the cinnarizine group exhibits a significant decrease from the baseline in the mean monthly migraine intensity when compared to the topiramate group (4.7 vs. 3, respectively; 95% CI = -0.8 to -3.2).ConclusionNo significant difference between cinnarizine and topiramate was found for the prevention of pediatric migraines. Both treatments were well tolerated.ReferencesHershey AD, Winner PK. Pediatric Migraine: Recognition and Treatment. J Am Osteopath Assoc. 2005;105:2S-8.Lewis DW, Yonker M, Winner P, Sowell M. The treatment of pediatric migraine. Pediatric Annals. 2005;34:448-460.Abu-Arefeh I, Russell G. Prevalence of headache and migraine in schoolchildren. BMJ. 1994;309:765-769.Linet MS, Stewart WF, Celentano DD, Ziegler D, Sprecher M. An Epidemiologic Study of Headache among Adolescents and Young Adults. JAMA: The Journal of the American Medical Association. 1989;261:2211-2216.Stewart WF, Linet MS, Celentano DD, Van Natta M, Ziegler D. Age- and sex-specific incidence rates of migraine with and without visual aura. Am J Epidemiol. 1991;134:1111-1120.Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of Migraine Headache in the United States. JAMA: The Journal of the American Medical Association. 1992;267:64-69.Split W, Neuman W. Epidemiology of Migraine among Students from Randomly Selected Secondary Schools in Lodz. Headache: The Journal of Head and Face Pain. 1999;39:494-501.Hershey AD, Kabbouche MA, Powers SW. Treatment of pediatric and adolescent migraine. Pediatr Ann. 2010;39:416-423.Hershey AD, Powers SW, Vockell AL, LeCates S, Kabbouche MA, Maynard MK. PedMIDAS: development of a questionnaire to assess disability of migraines in children. Neurology. 2001;57:2034-2039.Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S. Practice Parameter: Pharmacological treatment of migraine headache in children and adolescents. Neurology. 2004;63:2215-2224.Brandes JL, Saper JR, Diamond M, et al. Topiramate for Migraine Prevention. JAMA: The Journal of the American Medical Association. 2004;291:965-973. Lakshmi CVS, Singhi P, Malhi P, Ray M. Topiramate in the Prophylaxis of Pediatric Migraine: A Double-Blind Placebo-Controlled Trial. Journal of Child Neurology. 2007;22:829-835.Lewis D, Winner P, Saper J, et al. Randomized, Double- Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Topiramate for Migraine Prevention in Pediatric Subjects 12 to 17 Years of Age. Pediatrics. 2009;123:924-934.Winner P, Pearlman EM, Linder SL, et al. Topiramate for Migraine Prevention in Children: A Randomized, Double-Blind, Placebo-Controlled Trial. Headache: The Journal of Head and Face Pain. 2005;45:1304-1312.Winner P, Gendolla A, Stayer C, et al. Topiramate for Migraine Prevention in Adolescents: A Pooled Analysis of Efficacy and Safety. Headache: The Journal of Head and Face Pain. 2006;46:1503-1510.Campistol J, Campos J, Casas C, Herranz JL. Topiramate in the prophylactic treatment of migraine in children. Journal of Child Neurology. 2005;20:251-253.Hershey AD, Powers SW, Vockell A-LB, LeCates S, Kabbouche M. Effectiveness of Topiramate in the Prevention of Childhood Headaches. Headache: The Journal of Head and Face Pain. 2002;42:810-818.Unalp A, Uran N, Ozturk A. Comparison of the effectiveness of topiramate and sodium valproate in pediatric migraine. J Child Neurol. 2008;23:1377-1381. Younkin DP. Topiramate in the treatment of pediatric migraine. Headache: The Journal of Head and Face Pain. 2002;42:456.Rossi P, Fiermonte G, Pierelli F. Cinnarizine in migraine prophylaxis: efficacy, tolerability and predictive factors for therapeutic responsiveness. An open-label pilot trial. Funct Neurol. 2003;18:155-159.Togha M, Ashrafian H, Tajik P. Open-label trial of cinnarizine in migraine prophylaxis. Headache. 2006;46:498-502.Togha M, Rahmat Jirde M, Nilavari K, Ashrafian H, Razeghi S, Kohan L. Cinnarizine in refractory migraine prophylaxis: efficacy and tolerability. A comparison with sodium valproate. J Headache Pain. 2008;9:77-82.Headache Classification Committee of The International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia. 2004;24(Suppl. 1):1–160.Tonekaboni SH, Ghazavi A, Fayyazi A, Khajeh A, Taghdiri MM, AbdollahGorji F, Azargashb E. Prophylaxis of Childhood Migraine: Topiramate Versus Propranolol. Iran J Child Neurol. 2013 Winter; 7 (1):9-14.Fallah R, AkhavanKarbasi S, Shajari A, Fromandi M. The Efficacy and Safety of Topiramate for Prophylaxis of Migraine in Children. Iran J Child Neurol. 2013 Autumn; 7(4):7-11.Ferraro D, Di Trapani G. Topiramate in the prevention of pediatric migraine: literature review. J Headache Pain. 2008;9:147-150

Comparative Evaluation of the Effects of CO2 and Er:YAG Lasers on Smear Layer Removal and Blood Cell Attachment to Tooth Root Surfaces

Background: The tooth root surfaces are modified by different agents for better removal of the smear layer, formation of fibrin clots and attachment of blood cells. This in vitro study compared removal of the smear layer, formation of fibrin clots and attachment of blood cells after exposing periodontally compromised root surfaces to ER:YAG and CO2 laser beams.Methods: Eighteen dentin block samples were prepared from freshly extracted periodontally compromised teeth that were deemed hopeless, and divided into 3 groups; exposed to Er:YAG laser beams, exposed to CO2 laser beams and the control group. The samples were evaluated using scanning electron microscopy and micrographs were taken. Smear layer removal and blood cell attachment were scored. Data were analyzed with SPSS using Kruskal-Wallis and Mann-Whitney tests.Results: In the Er:YAG laser group, the smear layer was removed completely. In the specimens exposed to blood, better fibrin clot formation and blood cell attachment were observed in the Er:YAG laser group. In the CO2 laser group, the smear layer was also removed; however, there were no significant differences between the CO2 laser and control groups in fibrin clot formation and blood cell attachment.Conclusion: Application of Er:YAG laser to the root dentin appears to result in the formation of a suitable surface for fibrin clot formation and blood cell attachment. Further clinical studies are necessary to support these results

The impact of higher education on political development; a comparative study in Iran and Turkey

Abstract The aim of this research is to compare the effect of higher education on political development in the two countries of Iran and Turkey in 2022-2023. In terms of purpose and nature, this research is in the category of applicable research; and in terms of method, it is descriptive-survey. The statistical population of the research includes experts and specialists in higher education and political development, and a purposeful sampling method was used to sample this population. Finally, 18 experts participated in this research and completed the valid researcher-made questionnaire. The findings of the research showed that in several factors, the higher education system has a significant effect on political development at the 0.01 level: Policy making and planning for the development of higher education, internationalization of higher education, using the experiences of developed countries in higher education management, training of expert staff and improving the level of knowledge and literacy in society through higher education, knowledge production in the education system. higher education, commercialization of university ideas in the higher education system and university's relationship with industry and society, innovation system in higher education, technological innovations, development of educational technology, independence of universities, culture building and citizenship education. Also, based on this research, some of the components of higher education affecting political development in Turkey have a more favorable situation than in the Islamic Republic of Iran: using the experiences of developed countries in managing higher education, training specialist staff, and improving the level of knowledge and literacy in society through higher education, knowledge production in the higher education system, commercialization of university ideas in the higher education system and the relationship between the university and industry and society, the innovation system in higher education, technological innovations, the development of educational technology and the independence of universities. In this article, the reason for the difference between the models of the two countries has been investigated. Extended abstract Introduction With the introduction of the element of knowledge as the main source and capital of universities, a new window has been opened in the administration of affairs and management of organizations. Today, the online presence of universities is an important and vital issue in academic systems (Memon & Rathore, 2018). University leaders believe that by using online technology systems, they can continue the long-term superiority of universities in scientific and knowledge fields. In such a period, the creation of the flow of knowledge has become the main support, and we dare say that today universities and higher education institutions can survive in a highly competitive world if they have the ability to cope with and adapt to changes and constantly apply new ideas in the organization. Universities and higher education institutions will be more successful in responding to changing environments by creating online learning streams and developing new capabilities that allow them to perform better. Since in today's world, the university is considered one of the main institutions of the society, ignoring the university and its missions can have harmful consequences for the society. Modern societies are full of complex issues and problems that universities can be effective in solving and preventing (Palme, 2012). The higher education system and the university institution have an impact on various aspects of human life, nations and countries, including the national and international political arena. The main and key issue is that despite the great importance and sensitivity of political affairs and political development in efficient governance and providing suitable living conditions for citizens and the extraordinary range of scope, goals, missions and expectations from higher education and universities in the country; research and analysis has not been sufficiently done on the impacts and effects of higher education on political development in the scientific sense and recognition of strengths, weaknesses, challenges and opportunities. As a result, the upcoming research seeks to answer the following question: What effect does higher education have on political development. Theoretical Framework Political development is a process that happens with the authority of the government in the society and brings its own effects and consequences. That is why political development has also been considered as change. Lucien Pai says about ten important aspects of political development, which include; a prerequisite for economic development, the policy of industrialization of the country, the practical authority of the nation-state system, legal and administrative-executive development, mass mobilization and political participation, the creation of democracy and stability, and orderly change (Harasim, 2018). Higher Education Higher education systems are experiencing a new change in the "structure", "action" and "mission" of the university institution. In recent years, the fourth generation university is gradually being formed. In the fourth generation of universities, value is defined on the basis of strategic partnership, entrepreneur training and the degree of absorption of income from external sources and guidance and leadership, as well as the degree of influence on other factors in societies. Education is done based on the needs of society and students, and solving society's challenges is considered as the basis of research. International partnerships are an important part of the entrepreneurial university. Promoting risk-taking culture, creating a sense of belonging to entrepreneurship, academic freedom, valuing culture, talent management, creating a suitable entrepreneurial atmosphere, teamwork culture, introducing entrepreneurial faculty members as role models and their participation in decision-making and policy-making, attention and valuing entrepreneurial students are among the components of entrepreneurial culture (Khodabakhsh & Taghi Pur, 2023). Shafiei Chafi & Mahdi (2022) investigated the impact of higher education policies on political development indicators in Iran. The analysis of the data showed that the internationalization of education has a significant effect on the political development of Iran. Also, the effect of commercialization of academic ideas on the political development of Iran is significant at the level of (0.01).Nazarzadeh et al, (2021) conducted a comparative study of quantum management, human resource productivity and organizational empathy in higher education (case study: Lorestan Universities and Lorestan Medical Sciences). According to the results of data analysis, there is a significant difference between the amount of quantum management and productivity of human resources in Lorestan universities and Lorestan medical sciences, but there is no difference between the levels of organizational empathy in these two universities.  Research methodology In terms of purpose and nature, this research is in the category of applicable research; and from the point of view of implementation, it is a descriptive-survey method. The statistical population of the research consists of experts and specialists in higher education and political development, and a purposeful sampling method was used to sample from this population. The research data collection tool in this section includes the use of a researcher-made questionnaire based on the dimensions and indicators identified and screened by experts, which has been used in the studied community after checking its validity and reliability. In this research, 18 experts have participated in the field of higher education and political development in Iran and Turkey. Research findings SPSS software was used to analyze the data. The findings of the research showed that the higher education system has a significant effect on political development in several factors at the 0.01 level: policy making and planning of higher education development, internationalization of higher education, using the experiences of developed countries in higher education management, education expert force and improving the level of knowledge and literacy in the society through higher education, knowledge production in the higher education system, commercialization of university ideas in the higher education system and the connection of the university with industry and society, innovation system in higher education, technological innovations, development of educational technology, independence of universities, culture and citizenship education. Also, based on this research, some components of higher education affecting political development in Turkey have a more favorable situation than in the Islamic Republic of Iran: Using the experiences of developed countries in the management of higher education, training of expert staff and improving the level of knowledge and literacy in the society through higher education, producing knowledge in the higher education system, commercializing university ideas in the higher education system and connecting the university with industry and Society, innovation system in higher education, technological innovations, development of educational technology and independence of universities. Conclusion The purpose of this research is the effect of higher education on political development; a comparative study which has been done in Iran and Turkey. The results of this research are consistent with the results of Shafiei Chafi & Mahdi (2022), Fischer & Hanze (2019), Nithyanandam (2020), Evans (2020), Oztel (2020), and Shatzer (2021). In explaining the findings of the research, it can be said that higher education has an important economic role and influence, because it represents an important type of investment in human resources that is developed by providing and improving the knowledge, attitudes and skills required by human resources in different fields and areas; helps politically, economically, socially and culturally. The role and position of higher education in this field can be clarified when we pay attention to the fact that scientific predictions and estimates depict rapid changes and developments in the field of technology and, consequently, in the functioning of economic, political, social and cultural institutions. Finally, based on the findings of this research, it is suggested: Based on the findings of research and approval of higher education development policy and planning as a component of higher education, it is suggested that higher education policies and their implementation in universities and long-term and mid-term programs of higher education and their implementation in universities should be formulated. 2. Based on the research findings and confirmation of the internationalization of higher education as a component of higher education, it is suggested that international interactions with world universities be facilitated and international databases be created in the field of higher education

Clinical Evaluation of the Efficacy of Neodymium-Doped Yttrium Aluminium Garnet (Nd: YAG) Laser Therapy and Sensikin® in Treatment of Dentine Hypersensitivity

INTRODUCTION: Dentine hypersensitivity (DH) is characterized by a short sharp pain arising from the exposed dentine, in response to a thermal, evaporative, tactile, osmotic or chemical stimulus. The aim of this study was to evaluate the efficacy of Nd:YAG laser therapy and desensitizing gel (Sensikin®, Laboratorios Kin S.A., Barcelona, Spain) in treatment of dentine hypersensitivity.METHODS: A total of 20 patients with at least 6 hypersensitive teeth were selected and divided randomly into three groups: Nd:YAG laser (10 HZ, 1W, 60 S, two times) treated group, Sensikin® treated group and a control group. Subjects were asked to apply the gel at home for the next week and 3 times a day as they were instructed. Assessment of the pain was performed by visual analyzing scale (VAS) after stimulation of the teeth by compressed air at 6 intervals: before treatment, immediately after treatment, one week, one, three and six months later. The data obtained were analyzed using the SPSS software, one way ANOVA and repeated measurement ANOVA tests.RESULTS: VAS scores did not show any significant differences between the three groups prior to treatment (P value>0.05), but in all groups after treatment VAS scores differed significantly in comparison to VAS scores before treatment (Pvalue<0.05). This statistically significant difference in the control group demonstrated a placebo effect. However, the efficacy between the three groups was not significantly different. An overall comparison indicated no significant differences at various time intervals.CONCLUSION: Nd:YAG laser and desensitizing gel effectively reduce DH. However, we found no significant statistical differences between these two groups compared with the control group.