[Exercise test interpretation in patients with major depressive disorder; Are any specific considerations needed?]

Exercise test [ET] is the first line of ischemia assessment in patients with suspected Coronary Artery Disease [CAD]. We conducted this study to evaluate whether Major Depressive Disorder [MDD] influences the parameters of ET performance and affects the interpretation of test results. In an ex-post facto study, 265 patients [191 Men, 74 women; mean age 48 +/- 10 years, 22-75 years old] referred for ET were enrolled through convenient sampling after completing and signing informed consent forms. After exercise testing, Beck Depression Inventory [BDI] was used to assess depression. Data was analyzed using t- paired, k2 and correlation co-efficient tests under SPSS10 software. The prevalence of depression was 41.5%. The proportion of positive ET in depressed and non-depressed groups was 23.6% and 19.4% respectively [p > 0.05]. After adjustment for age, sex, family history of CAD, and smoking habit, total exercise duration showed negative correlation with BDI scores [p < 0.001]. Correlation analysis for Maximum Predicted Heart Rate showed a strong trend of negative relation [p = 0.06]. Duration of performing ET was significantly lower in MDD patients [p = 0.001]. Negative correlation of BDI with ET performing duration was true both before and after corrections for the mentioned variables [p = 0.001]. Decreased psychomotor activity in depression may lead to inadequate exercise duration and affect the performance indices. However, if the performance indices of ET in a depressed patient are acceptable, the test result could be interpreted with confidence

Preemptive analgesia with ibuprofen and acetaminophen in pediatric lower abdominal surgery

Postoperative pain is a significant problem in pediatrics. Preemptive administration of analgesics has recently emerged as a method to enhance pain management associated with surgery. The objective of this study was to compare the analgesic efficacy of a single-dose of preoperative oral ibuprofen versus acetaminophen in preventing pain after lower abdominal surgery in pediatrics. In this randomized, double-blind study, following lower abdominal surgery, 75 children, aging 3 to 12 years, were assigned to receive either ibuprofen 20 mg/kg [n=25] or acetaminophen 35 mg/kg [n=25] or placebo [n=25] 2 hours before surgery. Agitation in recovery was measured and postoperative pain was quantified 3 and 24 hours after surgery by Oucher's scale. The amount of postoperative analgesic needed in the ward was also assessed. It was found that preoperative administration of ibuprofen and acetaminophen can reduce agitation in recovery but there was no difference in the agitation score between ibuprofen and acetaminophen groups [P=0.145]. Agitation score was significantly lower in ibuprofen group compared to placebo [P>0.005]. Similarly, patients in the acetaminophen group were considerably less agitated than those in the placebo group [P=0.002]. No significant difference was observed in pain intensity 3 and 24 hours after operation between the three groups [[P=0.495] and [P=0.582] respectively]. The amount of postoperative analgesic needed during ward hospitalization was not significantly different among the three groups [P>0.005].These results provide evidence that preemptive acetaminophen and ibuprofen may reduce agitation during recovery but they neither improve the postoperative pain nor reduce analgesics consumption in ward