Collaboration between pharmacists and general practitioners in the health care system in the Islamic Republic of Iran

Collaboration between pharmacists and general practitioners [GPs] has been shown to enhance patient care and outcomes. The aim of the present study was to investigate the collaborative working relationship between pharmacists and GPs in terms of their attitudes, role perceptions, experience with collaborative practice, preferred method of communication, areas of current and further collaboration, and perceived barriers to interprofessional collaboration in a sample of the Iranian population. We distributed 318 questionnaires to community pharmacists and GPs in Tehran. Both groups had a positive attitude towards collaboration; however, about half the respondents reported only occasional collaborative practice. Both groups preferred communication by telephone or face-to-face communication by fax or letter. Few current areas of collaboration were identified; however, an area favoured by both groups was "decision-making for patients' pharmacotherapy. The two groups expressed concern about possible fragmentation of patient care with the involvement of multiple health care providers, and perceived lack of face-to-face communication as a possible barrier to collaboration

[A] comparison of the effects of reboxetine and placebo on reaction time in adults with attention deficit-hyperactivity disorder [ADHD]

Some studies have demonstrated that Reaction Time [RT] is longer in patients with ADHD which in turn may be associated with educational and occupational impairment and increased driving risks. Any alteration on RT which is induced by the treatment in this population may have great consequences positively or negatively. This study was designed to examine the effects of reboxetine on RT in adults with Attention Deficit-Hyperactivity Disorder [ADHD]. A total of 30 adult patients with ADHD who did not suffer from any other major psychiatric disorder were eligible to participate in this double blind, placebo controlled study. Patients were randomly assigned to receive either reboxetine [4 mg/day for one week, then 8 mg/day] or placebo for 4 weeks. RT was assessed at baseline and after 4 weeks by validated software which collects and analyses the data for auditory and visual stimulants. Numbers of correct responses, omission and substitution errors for each stimulus were calculated. Regarding visual tasks and in comparison with baseline scores, the number of correct responses increased significantly and the number of omission errors decreased significantly after 4 weeks of treatment [P<0.05] in both groups. However, with regard to auditory tasks scores, no significant differences were found at the end of the study compared to the baseline in each of the two groups. Additionally, no significant differences were noted between the two groups when both visual and auditory tasks were considered. Results of this study showed that reboxetine did not affect the RT of the patients when both visual and auditory tasks were assessed. Further studies with larger number of patients and for a longer period of time are required to confirm the result of this study

Mast cell stabilizers as a potential treatment for Irritable bowel syndrome: a randomized placebo-controlled clinical trial

Mast cells are believed to play a role in irritable bowel syndrome pathogenesis and symptom genesis due to their close neighborhood to gastrointestinal innervations. This study was designed to evaluate the efficacy of orally administered cromolyn for reduction of symptoms in patients with irritable bowel syndrome [IBS]. A randomized placebo-controlled double-blinded 6x6 weeks cross-over study was performed in a private gastrointestinal clinic. 10 patients were allocated to group A and 6 patients to group B. Patients in group A received 150 mg cromolyn divided in three equal doses for the first 6 weeks and placebo for the next 6 weeks but patients in group B received placebo for the first 6 weeks and cromolyn in the next 6 weeks. Weekly evaluation was performed and visual analogue scale was used to determine severity of symptoms. Sixteen patients completed the study. Mean age of the patients was 40.3 +/- 10.9 years old [range: 24-57]. Eight patients had D-IBS [Diarrhea dominant] and other 8 had CIBS [Constipation dominant]. Both cromolyn sodium and the placebo decreased the severity of bloating [Freidman test, p 0.001 and 0.006 respectively]. The severity of the main symptom [diarrhea or constipation] did not decrease in patients of group A and B who were treated with different sequences of the drug or placebo. The severity of pain decreased drastically after 6th week of treatment with cromolyn. Freidman test showed a significant difference between the pain levels of the former defined treatment spots [p 0.01, and 0.02 for patients in group A and B, respectively]. No adverse drug reactions were observed during the study. In conclusion, long term administration of cromolyn seems to be partially effective for treatment of abdominal pain in patients with IBS while main symptoms [diarrhea or constipation] might not decrease during this treatment

[Results of endoscopic mechanical dacryocystorhinostomy in primary nasolacrimal duct obstruction]

Epiphora and dacryocystitis following nasolacrimal duct obstruction arc considered as two widely common complaints among the patients and dacryocystorhinostomy [DCR] is the treatment choice for such conditions. To determine success rate of DCR with endoscopic and mechanical techniques. In this prospective analytic study 67 patients were operated during 2000-2003. Based on clinical history, results of regurgitation and irrigation tests and also dacryoscintigraphy, the patients with primary nasolacrimal duct obstruction, were operated using nasal endoscopes and mechanical instruments. Intraoperative bleeding, postoperative pain and bleeding, and periobital ecchimosis were recorded and success rate after a follow up of 6 and 12 months was determined. After a follow up of 6 and 12 months duration, success rates were 91.4% and 88.5%, respectively. Severe intraoperative bleeding was observed in 11.4% of patients and periorbital ecchimosis found in 7.1% of cases. Three days following the surgery, mild and moderate pain was seen in 32 patients whereas moderate nose bleeding observed in only 2 cases. Endoscopic mechanical DCR without expensive equipments and with high success rate could be substituted for external DCR

[ case report of huge retropharyngeal lipoma]

A 60-year-old woman presented to the Ear, Nose, Throat out patient clinic of Imam hospital, Hamedan, with history of slowly progressive dysphagia and snoring. She did not know anything about beginning of her history. Clinical examination revealed a soft mass: measuring approximately 6x6 cm. in the right side of the neck, just under sternocleidomastoid muscle. Inspection of the oropharynx demonstrated a submucosal bulging of the posterior pharyngeal wall which on palpation was homogeneous and doughy, and the overlying mucosa was normal. CT study with contrast revealed a huge radiolucent mass extending from nasopharynx to the level of the hyoid bone and which displaced the larynx and trachea anterolaterally and carotid sheet posterolaterally. The mass was resected en bloc by a transcervical approach, and all neurovascular in that region were preserved. Histological evaluation revealed a lipoma measuring 10x8x4cm

Association between peritonsillar abscess and molar caries

Peritonsillar abscess is the most common deep neck infections that are related with periodontal disease which has the same pathogenesis. We determined the relationship between peritonsillar infection and molar caries. In a cross-sectional study, 33 consecutive patients whom referred to Hamadan university clinic of otolaryngologic for peritonsillar abscess were examined by otolaryngologist and dentist who investigated relationship between peritonsillar infection and molar caries. There were 27 males and 6 females with mean age 26.7 +/- 7 years. The frequency caries on ipsilateral peritonsillar infection sides was in relation to molars caries on opposite sides [conterol group]. This corrolation was significant with odds ratio 2.5. Molar caries were seen 2.5 times more likely to have peritonsillar infection compared with normal molar sides