Comparison of blood lead levels between oral and inhalation opium addicts and its relationship with hematological parameters

Background and objectives: The current study aimed at comparing the level of blood Pb in oral and inhalation opium addicts and its relationship with hematological parameters. Materials and method: For this purpose, a total of 166 patients (83 addicts as the case and 83 non-addicts as the control groups) were enrolled in the study. A venous blood sample was taken from all the subjects in order to determine the serum level of Pb, iron (Fe), and other hematological parameters. In addition, the clinical and demographic status of the subjects were recorded and analyzed using appropriate statistical methods. Results: Among the enrolled patients, 48 were oral and 35 were the inhalation opium consumers. Oral and inhalation opium addict groups had higher levels of blood Pb compared with the control group (F = 131.13, P <0.001). There was no significant difference between oral and inhalation addict groups (P >0.05). More investigations showed a negative relationship between the blood levels of Pb, and those of Fe, hemoglobin(HB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and positive relationship with red cell distribution width (RDW) (P >0.05). Conclusion: The results showed that the serum level of Pb was associated with those of Fe and Hb in opium addicts in comparison with the controls. These changes had a significant effect on other hematological parameters in the case group in comparison with the control group. However, there was no significant relationship between different forms of opium us

Prevalence of metabolic syndrome in Qazvin Metabolic Diseases study (QMDs), Iran: A comparative analysis of six deinitions

objective. he aim of the present study was to compare the prevalence of metabolic syndrome (MS) according to six deinitions and evaluate the agreement between them in an urban sample in Qazvin, Iran. Methods. In a cross sectional study, 529 men and 578 women in age of 20-78 years were attended from September 2010 to April 2011 in Qazvin, Iran. Standardized measurements were available for waist circumference, blood pressure, fasting serum high-density lipoprotein cholesterol, triglycerides, glucose, and insulin. he diagnostic criteria proposed by World Health Organization (WHO), National cholesterol education program third Adult Treatment Panel (ATPIII 2001, 2004), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), and new Joint Interim Societies (JIS) were applied. he degree of agreement between diferent deinitions was assessed by kappa statistic. Results. he prevalence of MS was found to be 28% (WHO), 26.2% (ATPIII 2001), 30.6% (ATPIII 2004), 34.2% (IDF), 33% (AHA/NHLBI), and 39.3% (JIS). With regards to the gender, the prevalence of MS according to ATPIII 2001 and IDF was signiicantly greater in women than men. However, using other deinitions, the prevalence of MS was similar in both genders. he agreement of JIS criteria with IDF and AHA/NHLBI deinitions was excellent (IDF: 0.902; AHA/NHLBI: 0.862), while the agreement of IDF criteria with ATPIII 2004 and AHA/NHLBI was good (ATPIII 2004:0.719; AHA/NHLBI: 0.756). Conclusions. Although JIS deinition resulted in a higher prevalence of MS than other deinitions, an excellent agreement has been seen between these criteria. Widespread acceptance of JIS deinition may lead to management and therapy in a greater part of the population. Keywords: agreement, insulin resistance, deinitions, prevalence, metabolic syndrome, waist circumferenc

Is Vitamin D Deficiency associated with Non Specific Musculoskeletal Pain?

Backgrounds: Vitamin D deficiency is common worldwide, including Iran. It has been suggested that vitamin D deficiency is associated with non-specific musculoskeletal pain. The aim of this study is evaluation of the association of musculoskeletal pain with vitamin D deficiency and the response of the patients to vitamin D supplementation. Materials and Methods: sixty two adult patients with chief complaint of musculoskeletal pain were enrolled in the study. Serum concentrations of 25(OH)D, Calcium, Phosphate, Alkaline Phosphatase and PTH were determined. If there was vitamin D deficiency, oral vitamin D supplementation was given. Assessment of pain and its response to therapy was carried out using Visual Assessment Score (VAS). SPSS software version 15.0 was used for statistical analyses. Findings: Most of the patients (95.4%) had vitamin D deficiency. Pain in 53 patients (85.5%) with responded to the proposed treatment. In responder group post treatment vitamin D concentration was significantly higher than non responder group (60.6±27.6and 39.2±9.6 nmol/l respectively, p<0.01) pretreatment vitamin D and minerals concentrations and pain characteristics did not have significant differences in responder and non responder group. Conclusion: Treatment with vitamin D can relieve the pain in majority of the patients with vitamin D deficiency. Lack of response can be due to insufficient increase in serum vitamin D concentration.Physiologic differences of gastrointestinal vitamin D absorption, differences of body mass indexes, and noncompliance could be potential causes for this issue. Reassessment of serum 25(OH)D concentration is recommended in nonresponsive patients. Keywords: Vitamin D deficiency, musculoskeletal pain, Vitamin D supplementation, Ira

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

Pattern of Traumatic Injuries in Patients with Tramadol Poisoning: A Cross-Sectional Study in a Tertiary Care Hospital

Objective: This study aimed to investigate the incidence and pattern of tramadol-induced seizures and injuriesin patients admitted to the hospital.Methods: The cross-sectional study included 300 patients with alleged tramadol intoxication. Demographicinformation, tramadol dosage and duration of abuse, co-existing illicit drug abuse, hospital stay length, andoccurrence of seizures and trauma (type and site of injuries) were collected. Different statistical tests, includingthe Mann-Whitney U-test, Pearson’s Chi-square test, and Student’s t-test, were conducted to compare thepatients with and without seizures, trauma, and co-ingestion of illicit drugs. The analysis was performed usingSPSS software (version 21.0). A p value of less than 0.05 was considered statistically significant.Results: The average patient’s age was 24.66±5.64 years, with males comprising 84.3% of the sample. Themean tramadol dose and duration of abuse were 1339.3±1310.2 mg and 2.43±1.35 years, respectively. Seizureswere observed in 66% of patients, with men having a higher incidence (69.6% vs. 46.8%; p=0.004). Trauma wasreported in 23% of patients, accounting for 35.4% of seizure cases. All trauma patients had experienced seizures,with the head and neck being the most prevalent injury sites (55.1%), typically presenting as abrasions (55.9%).Patients with seizures and trauma had an average hospital stay of 1.73±0.94 days, which was significantlylonger.Conclusion: Trauma occurs in more than one-third of tramadol-induced seizures, highlighting the needto perform physical examinations to detect and localize injuries. Tramadol-associated traumas prolongedhospitalization times and thus required prompt attention to prevent further injuries during pre-hospital handlingand transferring to hospitals

Investigating effect of Helicobacter pylori treatment on improvement of non-alcoholic fatty liver parameters: a randomized trial

Background and objective: The correlation between the eradication of Helicobacter pylori (HP) and non-alcoholic fatty liver disease (NAFLD) is a controversial one. The aim of this study is to investigate the effect of Helicobacter pylori treatment on liver function tests and lipid profiles and to compare its effects with exercise therapy and diet alone. Method: This was a double-blind randomized clinical trial conducted at Qazvin University of Medical Sciences. One hundred patients with NAFLD having a positive test for urea breath testing were randomly assigned into one of the intervention and comparison groups. The diet and physical activity program were given to two groups of patients for 8 weeks, three sessions per week. In addition to the above therapy, the patients in the intervention group also received HP treatment for 2weeks. The data corresponding to anthropometric and clinical features before and after the intervention were collected in both groups and compared using appropriate statistical methods. Results: After the treatment interventions, the variables of weight, BMI, blood glucose, triglyceride, AST, ALT, total cholesterol, and LDL-C were significantly decreased in both groups (p < .05). In the between-group comparisons, only ALT was significantly lower in the intervention group (HP) (p < .05). Conclusion: Findings of this study showed that the eradication of Helicobacter pylori could significantly improve the ALT index, but it had no additional effect on changes in metabolic indicators. Trial registration: Registration number: IRCT2015042020951N2 Name of trial registry: The study of treatment of Helicobacter pylori in improvement of non-alcoholic fatty liver disease The date of registration: 2015-05-12 Where the full trial protocol can be accessed: https://fa.irct.ir/trial/18489 Keywords: Non-alcoholic fatty liver disease, Helicobacter pylori, Alanine transaminase, Aspartate aminotransferase

Beneficial Effects of Rosmarinus Officinalis for Treatment of Opium Withdrawal Syndrome during Addiction Treatment Programs: A Clinical Trial

Background: Withdrawal syndrome may influence patient's motivation for participation in addiction treatment programs. Management of the symptoms can improve the success rate of addiction treatment programs. In the present study, we have evaluated the efficiency of an herbal product as adjunct therapy for alleviation of withdrawal syndrome in opium abuse. Methods: In the present clinical trial, 81 patients were assigned into case and control groups. The control group was treated with methadone and placebo for 4 weeks. The case group was treated with methadone and powdered dried leaves of Rosmarinus officinalis for the same interval. Occurrence of withdrawal syndrome was compared between groups on days 3, 7, and 14 after beginning of the treatment, and the possible signs and symptoms of withdrawal syndrome were checked. The clinical opioid withdrawal scale (COWS) was used for evaluation of withdrawal syndrome in the patients. Findings: Patients in the case group experienced less severe withdrawal syndrome compared to those in the control group; chiefly bone pain, perspiration, and insomnia. Conclusion: The present study showed that rosemary can be used as an optional extra drug for treatment of withdrawal syndrome during treatment programs for opium addiction and possibly addiction to other opioids. Keywords: Withdrawal syndrome, Rosmarinus officinalis, Opium, Addictio

Post-operative Analgesia in Opioid Dependent Patients: Comparison of ‎Intravenous Morphine and Sublingual Buprenorphine

Background: Acute and chronic pain is prevalent in patients with opioid dependence. Lack of knowledge concerning the complex relationship between pain, opioid use, and withdrawal syndrome can account for the barriers encountered for pain management. This study was designed to evaluate the efficacy of sublingual (SL) buprenorphine for post-operative analgesia, compared with intravenous (IV) morphine. Methods: A total of 68 patients, aged 20-60 years were randomly selected from whom had been underwent laparotomy due to acute abdomen in a University Teaching Hospital in Arak, Iran, and were also opioid (opium or heroin) abuser according to their history. After end of the surgery and patients’ arousal, the patients were evaluated for abdominal pain and withdrawal syndrome by visual analog scale (VAS) and clinical opioid withdrawal score (COWS), respectively 1, 6, and 24 h after the surgery. They received either morphine 5 mg IV or buprenorphine 2 mg SL, 1 h after end of the surgery, and then every 6 h for 24 h. Findings: VAS was 4.47 ± 0.73 and 2.67 ± 0.53 at h 6 and 24 in buprenorphine group, respectively. The corresponding score was 5.88 ± 0.69 and 4.59 ± 0.74 in morphine group. At the same time, patients in buprenorphine experienced less severe withdrawal syndrome. Conclusion: The present study confirmed the efficacy of SL buprenorphine as a non-invasive, but effective method for management of post-operative pain in opioid dependent patients. Result of this study showed that physicians can rely on SL buprenorphine for post-operative analgesia

Diagnostic performance of ocular ultrasonography compared to fundoscopy to predict papilledema

BAC KGR OUND: The aim of this study was to determine the association between the diameters of optic nerve sheath assessed by ultrasonography, grading of papilledema in fundoscopy among patients suspected to raising intracranial pressure and determining the sensitivity and specificity of ultrasonography to detect optic nerve sheath dilatation. MET HODS: This prospective blinded cohort study was performed on 223 consecutive patients with clinical suspicion to optic papilledema. The patients were assessed using direct fundoscopy. The diameter of the optic nerve sheath was determined by ocular ultrasonography. RESULTS: In fundoscopy, 46 patients were revealed to have papilledema in at least one of the two eyes. A significant correlation was found between diameter of optic nerve sheath and age in total population as well as in those without papilledema, but not in the group with papilledema. The mean diameter of optic nerve sheath in bilateral assessment was significantly higher in the group with papilledema. The association between the mean diameter of optic nerve sheath and grade of papilledema was strongly significant. The assessment of the area under ROC analysis showed that measuring diameter of optic nerve sheath could effectively discriminate papilledema from normal condition. CONCL USIONS: Ultrasonography can effectively discriminate papilledema from normal condition by measuring diameter of optic nerve sheath. (Cite this article as: Namdar P, Yousefian S, Farzaneh Khanshir Z, Zohal MA, Kazemifar AM, Torabi Goodarzi Z. Diagnostic performance of ocular ultrasonography compared to fundoscopy to predict papilledema. Minerva Oftalmol 2017;59:1-6. DOI: 10.23736/S0026-4903.17.01770-6) Key words: Ultrasonography - Papilledema - Intracranial hypertension - Optic nerve. Minerva Oftalmol 2017 March;59(1):1-6 DOI: 10.23736/S0026-4903.17.01770-6 © 2017 EDIZIONI MINER VA MEDICA Online version at http://www.minervamedica.it COPYRIGHT© 2017 EDIZIONI MINERVA MEDICA This documen