Efficacy of Topiramate Alone and Topiramate Plus Vitamin D3 in the Prophylaxis of Pediatric Migraine: A Randomized Clinical Trial

Objective Topiramate is effective in the prevention of pediatric migraine, and studies show that vitamin D3 supplementation might also be useful in the treatment of adult migraineurs with a normal vitamin D3 level.The present study aimed at comparing the efficacy and safety of topiramate plus vitamin D3 and topiramate alone in the prophylaxis of pediatric migraine. Materials & Methods In a single-blinded, randomized, clinical trial, 5-15-year-old children with migraine headaches, referred to the Pediatric Neurology Clinic of Shahid Sadoughi Medical Sciences University, Yazd, Iran from January 2016 to January 2017, were randomly allocated to receive 2 mg/kg/day of topiramate or 2 mg/kg/day of topiramate plus one 500,000 IU vitamin D3 pearl weekly for two consecutive months. Primary outcomes were the reduction of monthly frequency, severity, duration, and the disability score of migraine, and the secondary outcomes included a good response to treatment (more than 50% reduction in monthly headache frequency) and a lack of clinical adverse events. Results Totally, 31 female and 26 male children with the mean age of 10.02±2.11 years were evaluated. Both drugs were effective in the reduction of monthly frequency, severity, duration, and disability for headaches. Nevertheless, the combination of topiramate and vitamin D3 was more effective than topiramate alone in reducing the monthly headaches frequency (6.12±1.26 vs. 9.87±2.44 times, P=0.01) and disability score (19.24±6.32 vs. 22.11±7.91, P=0.02). Good response to treatment was observed in 60.7% and 75.9% of the subjects in the topiramate alone and topiramate plus vitamin D3 groups, respectively, and topiramate plus vitaminD3 was more effective (P= 0.01). Transient mild side effects were observed in 14.3% and 17.2% of the subjects in the topiramate alone and topiramate plus vitamin D3 groups, respectively (P=0.8). Conclusion A combination of Topiramate and vitamin D3 might be considered safe and more effective than Topiramate alone in the prophylaxis of pediatric migraine

Comparing the Efficacy of Methadone and Tincture of Opium in Controlling Agitation Caused by Withdrawal Syndrome in Opium-Addicted Patients in the Intensive Care Unit: A Randomized Trial Study

Background: Few studies have been conducted regarding the comparison of the efficacy of methadone andtincture of opium (TOP) in controlling agitation induced by withdrawal syndrome. Therefore, the currentrandomized trial study is carried out with the aim to evaluate comparisons on the efficacy of methadone andTOP in controlling agitation caused by withdrawal syndrome in opium addicted patients in the intensive careunits (ICUs).Methods: This clinical trial study was conducted on 60 patients admitted to ICU of Shahid Bahonar Hospital,Kerman, Iran. After classification of the patients into two groups, the first and second groups consumedmethadone syrup (5 mg/ml) and TOP (10 mg/ml), respectively. Agitation in these patients was assessedthrough the Richmond Agitation-Sedation Scale (RASS). Vital signs were also assessed. Paired sample t-testand independent t-test were used for data analysis.Findings: In the current study, the administered dose of methadone and TOP was 36.17 ± 26.99 and112.67 ± 102.74 mg, respectively (P 0.05). In total, no significant difference was detected between two groups regardingvital signs (P > 0.05). However, a significant difference was seen between methadone and TOP groups interms of RASS score (P < 0.01). Conclusion: According to the results of the current study, lower dose of methadone, compared to TOP, couldcontrol agitation caused by opium withdrawal symptoms

The Efficacy of Amlodipine and Diltiazem in Cyclosporine Dose Adjustment with Respect to Trough and 2-hour Concentrations in Kidney Transplant Patients

Abstract: Background & Aims: Hypertension, hyperuricaemia and nephrotoxicity are some common side-effects of Cyclosporine A (CsA) treatment in renal transplant recipients. Previous studies suggest that Calcium Channel Blockers (CCB) can increase serum level of CsA and may improve graft function in patients receiving CsA. The aim of this study was to evaluate the effects of Diltiazem and Amlodipine on cyclosporine dose adjustment with respect to trough and 2-hour concentrations in renal transplant recipients treated with CsA. Methods: This observer-blind randomized clinical trial was performed on 120 renal transplant recipients treated with CsA. Patients received either Amlodipine (5-10mg/day) or Diltiazem (90-180mg/day) for 3 months and were compared with control group receiving no CCB. Data were analyzed using ANOVA, Post Hoc and Correlation tests. Results: Diltiazem significantly decreased CsA dosage (20%) from 162.03 ± 40.6 mg/dl to 128.5 ± 25.5 mg/dl (P=0.000) and Amlodipine, too, decreased it to 140.5 ± 22.3 mg/dl (13%) which was significant (P=0.008). Trough concentration in patients who had received Amlodipine were significantly higher than control group (P=0.019). Diltiazem significantly decreased Cholesterol Level (P=0.027) but other parameters were not significantly different between Amlodipine / Diltiazem and control groups. Discussion: Diltiazem and Amlodipine were well tolerated in co-administration with CsA with no adverse effect on graft function and did not affect blood pressure or heart rate. Our findings support that these two CCBs can be used in clinical settings to reduce the administered dose of cyclosporine. Keywords: Cyclosporine, Amlodipine, Diltiazem, Renal transplantatio

Three Dimensional Culturing of Human Jaw Osteoblasts in PLLA/HA Scaffold

Abstract: Background & Aims: Tissue engineering using somatic cells and synthetic extracellular matrix (scaffold) represents a new approach for regeneration of mineralized tissue and bone. This study was carried out to investigate the ability of a PLLA/HA scaffold to culture osteoblast cells in a three dimensional milieu. Method: Three bony samples were taken from extraction sites during surgical extraction of wisdom teeth. Osteoblasts were obtained from specimens by using trypsin and collagenase and were cultured in monolayer up to passage four. Cells were seeded on PLLA/HA scaffolds at density of 106 cells/ml and then incubated for 21 days. The seeded cells were evaluated by Hoechst, von kossa and H&E stainings and scanning electron microscopy. Results: Cellular growth was more pronounced when isolation was carried out by collagenase. According to scanning electron microscopy, osteoblast cells had been proliferated and attached to the scaffolds. H&E, Hoechst and von kossa stainings confirmed the presence of the harvested cells in the scaffold too. Conclusion: Our findings suggest that osteoblast cells can grow onto PLLA/HA scaffold in vitro. Keywords: Keywords: Osteoblasts, Tissue engineering, PLLA Polymer, Hydroxyapatite, Tissue scaffold

Evaluation of Long-term Effect of Adding Low-Dose Daclizumab to Standard Protocol on Kidney Rejection in Kidney Recipients

Abstract: Background & Aims: Daclizumab is a monoclonal antibody directed against CD25 subunit of interlukin 2 receptor. Several studies have shown the effectiveness of daclizumab on reduction of acute rejection in renal transplantation with regular or limited dose. The present study assessed the outcomes of 3 and 5 years follow-up of a prospective case-control trial comparing safety and efficacy of induction therapy with two doses of daclizumab, compared with no induction treatment, in renal transplant recipients. Methods: This clinical-trial study was started in 2006 on 140 living donor kidney recipients admitted to kidney transplant ward of Kerman Afzalipour hospital, Iran. These patients were randomly assigned into two 70 patients, intervention and control groups. All patients received cyclosporine, mycophenolate mofetil and prednisolone. Intervention group recieved daclizumab at a dose of 1 mg/kg before transplantation and then two weeks later, also. All patients were followed up for 3 and 5 years for graft and patient survival and side effect of daclizumab, so. Results: After 3 years, 58 patients remained in case and 61 in control group. Function of transplanted kidney was evaluated on base of calculated glomerular filtration rate (GFR), and after 3 and 5 years, were same between two groups. Rate of sepsis was same between two groups but infection with varicella zuster, in first 6 months after transplantation, was significantly more in intervention group (P = 0.04). Conclusion: Daclizumab did not have any effect on patient or graft survival. It did not increase the rate of sepsis but might increase the rate of varicella zuster infection. Keywords: Keywords: Daclizumab, Renal transplantation, Graft survival, Sep

Evaluation of Myocardial Performance Index(Mpi) in Beta Thalassemia Major Patients at the Ali Asghar Hospital , Zahedan , Iran

Introduction : Patients with major thalassemia need recurrent transfusions and if not treated are at risk of heart dysfunction. Heart tissue could be abnormal in patients who use desferral continously due to iron deposits , fibrosis , hypertrophy and side effects of chronic anemia. Cardiac involvement is the main cause of morbidity and mortality in major thalassemics, so we decided to improve early diagnosis of cardiac involvement by measuring myocardial performance index( MPI ). Method & Materials : This case-control study was performed from April 2003 to December 2003 at the Ali-Asghar pediatrics hospital, Zahedan, Iran. MPI of both ventricles was measured by Doppler echocardiography in 48 patients with major thalassemia aged between 10-18 years and compared with 48 age , sex-matched controls. Patients had no abnormality in physical examination , chest x-ray and ECG and echocardiography did not show heart failure. Hemoglobin and serum ferritin levels was measured in all patients before echocardiography. Results: Mean age of patients was 12.3±2.4 years and that in the control group was 12.7±2years . Right ventricle isovolumetric relaxation time (RVIRT) (107 ± 14 vs 94 ±14 , p0.05) and LVICT (31 ± 13 vs 21 ± 15 , p0.05) in the two groups. Finally, RVMPI (0.59 ± 0.12 Vs 0.46 ± 0.12 , p<0.001) was increased in 87% of patients and LVMPI (0.49 ± 0.12 Vs 0.41± 0.09 , p0.05). Conclusion: This study showed that RVMPI and LVMPI increase in major thalassemia patients that indicates systolic and diastolic dysfunction and RVMPI increases more than LVMPI. On the other hand, MPI has a direct correlation with serum ferritin . On the basis of this study ,we suggest MPI measurement in serial echocardiography in asymptomatic major thalassemia patients

Aminophylline Infusion Induced Excretion of Magnesium DuringMagnesium Loading Test in Critically Ill Patients: Aminophylline induced excretion of magnesium

The aim of this study was to investigate the prevalence of Mg deficiency and effectof aminophylline infusion on urine magnesium concentration after magnesiumloading test (MLT). To determine serum Mg, venous blood specimens were obtainedjust before the first MLT. Two MLTs were performed. The first one was donebefore starting aminophylline infusion and the 2ndone was done during aminophyllineinfusion. Urine samples were collected from the starting of Mg infusion in each phase.Although low serum Mg was present only in 2 patients, MLTshowed Mg deficiencyin 18 patients. MLTdetected Mg deficiency in 13 out of 14 patients with normalserum Mg, in 2 out of 2 subjects with serum hypomagnesemia, and in 3 out of 5 caseswith serum hypomagnesemia. There was no relationship between Mg retention, ageand serum Mg concentrations. Aminophylline administration increased the 24-h urineMg concentration by 29.3%

Kerman Health System Workers Knowledge and AttitudesRegarding the Spontaneous Reporting System forAdverse Drug Reactions: ADR reporting by health system workers

Adverse drug reaction (ADR) is one of the most life threatening problems, and the economic burden of ADR is considerable. The main objective of this study was to assess the attitude of the Kerman health system staff, to evaluate their knowledge of the spontaneous reporting system and to identify the reasons for low reporting rate. In this descriptive study, a Persian translated questioner was used based on standard European pharmacovigilance research group. Among 800 distributed questionnaires, 78% were filled and returned. Returned questioner (82%) indicated to have already suspected an ADR but only 4% reported it to Iranian ADR centre.The 4 major reasons for not reporting were: a) reporting process was unknown (65%),b) Iranian pharmacovigilance centre was unknown for the staff (45%), c) the yellow cards for reporting ADR were not available (30%), and d) ADR were not important (22%). We concluded that our medical staff's knowledge about ADR is little. Appropriate teaching and acceptable effort is needed to strengthen the current system and to prevent other serious ADRs

Kerman Health System Workers Knowledge and Attitudes Regarding the Spontaneous Reporting System for Adverse Drug Reactions

Abstract Adverse drug reaction (ADR) is one of the most life threatening problems, and the economic burden of ADR is considerable. The main objective of this study was to assess the attitude of the Kerman health system staff, to evaluate their knowledge of the spontaneous reporting system and to identify the reasons for low reporting rate. In this descriptive study, a Persian translated questioner was used based on standard European pharmacovigilance research group. Among 800 distributed questionnaires, 78% were filled and returned. Returned questioner (82%) indicated to have already suspected an ADR but only 4% reported it to Iranian ADR centre. The 4 major reasons for not reporting were: a) reporting process was unknown (65%), b) Iranian pharmacovigilance centre was unknown for the staff (45%), c) the yellow cards for reporting ADR were not available (30%), and d) ADR were not important (22%). We concluded that our medical staff&apos;s knowledge about ADR is little. Appropriate teaching and acceptable effort is needed to strengthen the current system and to prevent other serious ADRs

Intravenous Immunoglobulin: A Drug Utilization Review at Shahid Sadoughi Hospital in Yazd

 Background: Drug use evaluation (DUE) aims at improving the patients’ care. Studying the administration pattern of intravenous immunoglobulin (IVIG) is an important research topic due to its significant role in the treatment and controlling of many disorders, high prices, and limited availability of this drug. Methods: This observational cross-sectional study was conducted at Shahid Sadoughi Hospital in Yazd, central Iran, from May to September 2014. The orders of different wards in the hospital for IVIG given to the hospital central pharmacy were surveyed. Also, a special form developed for evaluation the method of administration. The related physician and nurse were consulted on drug complications and the causes. Finally, the gleaned data were compared to the available standards on the prescription and administration of IVIG. Results: A total of 75 patients received IVIG during this study. 58.7% of the prescriptions belonged to the cases approved by Food and Drug Administration (FDA). The most frequent cause of the use of IVIG was idiopathic thrombocytopenic purpura (ITP). The rate and dose of administration was suitable in most of the patients, yet, the measurement of laboratory parameters required for IVIG were observed in only a few cases. Complications occurred in 26.7% of the patients receiving it, which was mostly related to infusion-related reactions. On the whole, 3922 g IVIG was used during this study of which 1848 g belonged to the cases approved by FDA. Conclusion: Regarding the high costs of IVIG, complications, and limited information on the quality of the effect of this drug in the treatment of many cases, physicians should be cautious enough with its appropriate use. Besides, the presence of a clinical pharmacist in the health-care team not only improves the quality of drug therapy and treatment results, but also plays an important part in decreasing the treatment costs for the patients