Evidence-based Medicine versus the Conventional Approach to Journal Club Sessions: Which One Is More Successful in Teaching Critical Appraisal Skills? / 전남의대학술지

This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.

Evidence-based Medicine versus the Conventional Approach to Journal Club Sessions: Which One Is More Successful in Teaching Critical Appraisal Skills? / 전남의대학술지

This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.

Microleakage of three types of glass ionomer cement restorations: effect of CPP-ACP paste tooth pretreatment

Statement of the Problem: Casein phosphopeptide-amorphous calcium phosphate [CPP-ACP] increases the mineral content of tooth structure. This may enhance the chemical bonding of glass ionomer cements [GIC] and marginal sealing of their restorations

Purpose: The aim of this study was to evaluate the effect of CPP-ACP paste pretreatment on the microleakage of three types of GIC

Materials and Method: In this study, 72 Class V cavities were prepared on the buccal and lingual surfaces of molars with occlusal margins in enamel and gingival margins in root. The cavities were divided into 6 groups. Cavities in group 1 and 2 were restored with Fuji II, group 3 and 4 with Fuji II LC, and group 5 and 6 with Ketac N100 with respect to the manufacturers' instructions. In groups 2, 4 and 6, CPP-ACP containing paste [MI paste] was placed into the cavities for 3 minutes before being filled with GIC. The teeth were thermocycled, stained with dye, sectioned, and scored for microleakage under stereomicroscope. Kruskall- Wallis and Chi-Square tests were used to analyze the data

Result: There were no statistically significant differences between the control and the CPP-ACP pretreatment groups in enamel and dentin margins. In pairwise comparisons, there were no significant differences between the control and the experimental groups in enamel margin, and in dentin margins of G1 and 2, G5 and 6; however, a significant differences was detected in dentin margins between G3 and 4 [p= 0.041]

Conclusion: CPP-ACP paste pretreatment did not affect the microleakage of Fuji II and Ketac N100 in enamel or dentin, but decreased the microleakage in dentine margins of Fuji II LC when cavity conditioner was applied before surface treatment

55-year old man with acute painful flank mass, a case report

Lumbar hernias [LH] accounts for less than 1.5% of total hernia incidence. It can occur in two separate triangular areas of the flank. About 300 cases have been reported in the literature. Here, we report a 55-year old man with acute painful left side flank mass and final diagnosis of LH. The mass was appeared about three hours before admission and his pain was slight at first but became more severe gradually. He had stable vital sign and the only positive finding on his physical examination was the sphere shape, firm, mobile, and mild tender mass at his left flank

effects of gluten-free diet on hypertransaminasemia in patients with celiac disease

Celiac disease [CD] is an immune mediated condition that leads to small bowel atrophy that resolves with a gluten free diet [GFD]. Extra-intestinal manifestations of CD include hypertransaminasemia. In this study, the effects of a GFD on hypertransaminasemia in patients with newly diagnosed CD were studied. Ninety eight new diagnosed consecutive patients with CD 40 males and 58 females] with mean age of 32 +/- 17.1 were studied. All patients with CD were treated with a GFD. Patients with hypertransaminasemia, at diagnosis, had a cirrhosis screen performed. Patients with a negative cirrhosis screen were reviewed, 6 months after the introduction of a GFD, and serum levels of liver transaminases were measured again. Nine patients had hypertransaminasemia. One patient was Hepatitis B surface antigen positive and was excluded from this study. The 8 remaining patients had no obvious cause for the hypertransaminasemia. Mean [ +/- SD] of baseline aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels were 42.6 +/- 16.5 IU/L [range: 16-66 IU/L] and 69.3 +/- 9.3 IU/L [range: 52-81 IU/L]. Six months after treatment with a GFD, mean AST and ALT levels decreased to 24.5 +/- 5.1 IU/L [range: 18-31 IU/L] [P: 0.04] and 24.6 +/- 6 IU/L [range: 17-32 IU/L] [P: 0.01], respectively. In 7 patients the hypertransaminasemia, at diagnosis had resolved. This study provides further evidence that some patients with CD have a reversible hypertransaminasemia that resolves with a GFD

Comparison of right and left side heart functions in patients with thalassemia major patients with thalassemia intermedia, and control group

Heart disease is the main cause of mortality and morbidity in patients with beta thalassemia, rendering its early diagnosis vital. We studied and compared echocardiographic findings in patients with beta thalassemia major, patients with beta thalassemia intermedia, and a control group. Eighty asymptomatic patients with thalassemia major and 22 asymptomatic cases with thalassemia intermedia [8-25 years old] were selected from those referredto All Asghar Hospital [Zahedan-Iran] between June 2008 and June 2009. Additionally, 80 healthy individuals within the same age and sex groups were used as controls. All the individuals underwent echocardiography, the data of which were analyzed with the Student t-test. The mean value of the pre-ejection period/ejection time ratio of the left ventricle during systole, the diameter of the posterior wall of the left ventricle during diastole, the left and right isovolumic relaxation times, and the right myocardial performance index in the patients with beta thalassemia major and intermedia increased significantly compared to those of the controls, but the other parameters were similar between the two patient groups. The mean values of the left and right pre-ejection periods, left ventricular endsystolic dimension, and left isovolumic contraction time in the patients with thalassemia intermedia increased significantly compared to those of the controls. In the left side, myocardial performance index, left ventricular mass index, isovolumic contraction time, and deceleration time exhibited significant changes between the patients with thalassemia major and those with thalassemia intermedia, whereas all the echocardiographic parameters of the right side were similar between these two groups. The results showed that the systolic and diastolic functions of the right and left sides of the heart would be impaired in patients with thalassemia major and thalassemia intermedia. Consequently, serial echocardiography is suggested in asymptomatic patients with beta thalassemia for an early diagnosis of heart dysfunction and proper treatment

Diagnostic value of electrocardiography compared with echocardiography in measuring left ventricular mass index in major thalassemia patients over 10 years of age

Patients suffering from major beta thalassemia need frequent blood transfusions and, if not treated well, would be at risk of heart dysfunction. This study was performed to determine the diagnostic value of electrocardiography versus echocardiography in measuring the left ventricular mass index in these patients. Between July 2010 and June 2011, 82 asymptomatic patients over 10 years of age with major thalassemia [42 men with a mean age of 17.65 +/- 3.39 years and 40 women with a mean age of 16.9 +/- 3.38 years] were enrolled in this study. For all the patients, standard electrocardiography [to measure R in aVL and S in V3 and calculate left ventricular mass index by electrocardiography] and echocardiography [to measure interventricular septum diameter in diastole, left ventricular posterior wall diameter in diastole, and left ventricular diameter in diastole in order to calculate left ventricular mass index by echocardiography] were performed, at least one week after transfusion. The calculated left ventricular mass indices were thereafter compared between the two methods [electrocardiography and echocardiography]. Sensitivity, specificity, positive predictive value, and negative predictive value in the two techniques in determining the left ventricular mass index were 67%, 25%, 89%, and 7% in the females, 65%, 33%, 92%, and 6% in the males, and 67%, 14%, 89%, and 3% in the total population, respectively. Furthermore, this study demonstrated that the average left ventricular mass index by echocardiography and electrocardiography was 104.86 +/- 21.65 gr/m[2] and 91.69 +/- 12.03 gr/m[2], respectively. Echocardiography was much more accurate than electrocardiography in determining the left ventricular mass index [p value = 0.0001]. The findings of this study demonstrated that echocardiography was more accurate and more reliable than electrocardiography in determining the left ventricular mass index in major thalassemia patients

Relationship between gender and in-hospital morbidity and mortality after coronary artery bypass grafting surgery in an Iranian population

Many previous studies have investigated the influence of gender on coronary artery bypass grafting surgery [CABG] outcomes. Despite the great volume of reports on this issue, it is still not clear whether it is the gender of the patient or pre-existing comorbid conditions that is the best predictor for the different outcomes seen between men and women. Multiple studies have shown that women are at higher risk of postoperative complications than men, particularly in the perioperative period. The goal of this study was to determine whether sex differences exist in preoperative variables between men and women, and to evaluate the effect of gender on short-term mortality and morbidity after CABG in an Iranian population. Data were collected prospectively from 690 consecutive patients [495 men and 195 women] who underwent isolated CABG. Preoperative, intraoperative, and postoperative variables, major complications and death were compared between the male and female patients until hospital discharge using multivariate analysis. Women were older [P = 0.020], had more diabetes [P = 0.0001], more obesity [P = 0.010], a higher New York Heart Association functional class [P = 0.030], and there was less use of arterial grafts [P = 0.016]. Men had more tobacco smokers [P = 0.0001] and lower preoperative ejection fractions [EF] [P = 0.030]. After surgery, women had a higher incidence of respiratory complications [P = 0.003], higher creatine kinase [CK] - MB levels [P = 0.0001], and higher inotropic support requirements [P = 0.030]. They also had a higher incidence of decreased postoperative EF versus preoperative values [P = 0.020]. The length of ICU stay, incidence of return to ICU and postoperative death, were similar between men and women. Nevertheless, after adjusting for age and diabetes, female gender was still independently associated with higher morbidity in patients over 50 years of age. Women had more risk factors, comorbidities, and postoperative complications. Women older than 50 years of age were at a higher risk of postoperative complications than men. This difference decreased with younger age. In-hospital mortality rates were not influenced by sex, as there was no difference found between the two groups [2.5% women vs. 2.2% men; P > 0.05]

Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake

Fasciotomy may increase the morbidity and mortality in patients with crush-induced acute kidney injury [AKI], by creating an open wound, increasing the risk of bleeding, coagulopathy, and potentially fatal sepsis. This study evaluates the outcomes of fasciotomy in these patients after Bam earthquake in Iran. We reviewed medical records of victims of Bam earthquake complicated with crush-induced AKI. Demographic, biochemical, and clinical data of patients who underwent fasciotomy were evaluated and compared with other patients with AKI. Fasciotomy was performed for 70 of 200 patients with crush-induced AKI [35.0%]. There were no significant differences regarding sex, age, time under the rubble, and muscle enzymes level between these patients and those without fasciotomy. They did not experience higher rates of disseminated intravascular coagulopathy, sepsis, adult respiratory distress syndrome, amputation, and dialysis session. Neither did they have a longer hospitalization period or higher death rate. This study showed that fasciotomy did not have any deteriorating effect on morbidity and mortality of patients with crush-induced AKI after Bam earthquake

Comparison of Bispectra Index [BIS] and AEPEX monitoring systems in coronary bypass surgery

Spontaneous recall of events during general anesthesia is called awareness. Awareness during the operation is common in coronary artery bypass grafting [CABG], especially in urgent cases and in patients with unstable hemodynamic condition before the operation. A standard method for the measurement of the depth of anesthesia [DoA] has not yet been introduced. A variety of techniques have been used for monitoring DoA like electroencephalography [EEG], monitoring muscle movement in the distal esophagus, and new methods of auditory evoked potentials [AEPs] and bispectra index [BIS]. Recently, a more sensitive method, called aepEX which is a modified form of AEPs, has been used for the monitoring and controlling of DoA. This study was designed to compare the sensitivity of the aepEX system with the BIS system for DoA monitoring using current clinical and paraclinical methods. In this prospective, controlled trial, 36 patients who were candidates for CABG were enrolled in the study. All the patients underwent a standard induction method for anesthesia with remifentanil, atracurium, and midazolam. Before anesthesia, both aepEX and BIS monitoring systems were controlled simultaneously in each patient. These systems had no effect on each other. Finally, all data about DoA, clinical data of awareness including BP, tear secretion, hemodynamic information, and demographic characteristics were collected and analyzed. This study compared the monitoring techniques for DoA, BIS, and aepEX. Results of this study were diagrams for the comparison of BIS and aepEX in different stages during CABG. According to these diagrams, essential analysis could be done about the quality of these two systems in DoA. Our data demonstrated that the aepEX monitoring system had greater sensitivity in all the stages of anesthesia compared to the BIS system

efficacy of tramadol used with ketamine or morphine in pain control after coronary artery bypass graft surgery

Sufficient analgesia after coronary artery bypass graft surgery [CABG] is important to prevent postoperative complications. One of these analgesic techniques is patient controlled analgesia [PCA], in which the patient has self-controlled administration of anesthetics. The purpose of this study was to evaluate the analgesic effect and side effects of tramadol used with ketamine or morphine for post-CABG surgery analgesia. In this prospective, controlled randomized study, we selected 150 patients who were candidates for CABG. The inclusion criteria were adult patients aged 30-60 with coronary artery disease, candidates for CABG, elective surgery, surgery using cardiopulmonary bypass, and ASA II and III. The patients with uncontrolled and significant underlying diseases [diabetes, liver and kidney disease and clotting disorders], excessive obesity and weight over 115 kg, and non-consenting patients were excluded. The patients were divided into three groups of 50 each. At the end of surgery, all the patients were transferred to the post-surgical intensive care unit, where they were extubated. PCA was commenced when the patients were able to communicate. The first group was provided with 100mg of tramadol with normal saline, the second group 50mg of tramadol plus 20mg of morphine, and the third group 50mg of tramadol plus 50mg of ketamine. During the use of the PCA pump, the patients were observed for respiratory depression [respiratory rate and SPO[2], PaCO[2] every two hours during the first 8 hours and then every 4 hours]. The severity of pain was evaluated with the visual analog scale [VAS] method, where zero was no pain and ten was severe pain. The VAS results were recorded 1, 3, 6, 12, 18, 24, 36, and 48 hours after awareness and extubation and recording the base VAS of the patients. The average respiratory rate was 14 in all the three groups and respiratory depression was not seen in any of them. At the third hour, the VAS was similar in all the groups [p value<0.05]. The decrease in VAS at 6, 12, and 18 hours was significant and the minimum VAS was seen in the second group [tramadol + morphine]. PCA is a safe and appropriate method for analgesia after CABG. It seems that the combination of tramadol plus morphine can be an effective solution for analgesia after CABG with fewer respiratory complications than other combinations

Intraoperative magnesium sulfate can reduce narcotic requirement after coronary bypass surgery

Narcotics are the most common drugs used after cardiac surgery and their side effects, including respiratory depression, hemodynamic instability, nausea and vomiting, and itching are dose dependent. Magnesium is both an N Methyl D Aspartate [NMDA]-receptor and a calcium-receptor antagonist and can modify the important mechanisms of nociception. The purpose of this study was to investigate the effect of magnesium sulfate on the pain score and reducing narcotic requirement in coronary artery bypass grafting surgery [CABG] patients. This randomized, double blinded, placebo-controlled trial recruited 185 patients [105 male and 80 female] undergoing elective CABG. Mean age was 58 +/- 11 years [range 24 to 79 years]. The patients were divided into two groups randomly: Group I received magnesium sulfate as an IV infusion [80 mg/kg] during a one-hour period post induction and Group 2 received the same volume of normal saline as a placebo. During the postoperative period, the patients' morphine requirement and pain score [visual analogue seale scaled as 0 to 10, 0=no pain and 10= worst possible pain] at 6[th], 12[th], 18[th], and 24[th] hours were recorded and documented. There were no significant differences between the two groups with respect to the baseline data. In the magnesium sulfate group, only 30 [32%] patients needed morphine sulfate, whereas 75 [83%] patients in the placebo group required some doses of morphine sulfate [p value < 0.001]. The odds ratio showed that magnesium sulfate could strongly prevent the need for opioid analgesics for pain control. The intraoperative use of magnesium sulfate can reduce the need for opioids post CABG

Thromboelastography analysis after autologous transfusion in patients undergoing coronary artery bypass surgery

Acute normovolemic hemodilution [ANH] includes the removal of blood from a patient either immediately before or shortly after the induction of anesthesia and the simultaneous replacement with an appropriate volume of plasma substitute to maintain normovolemia. Thromboelastography [TEG] is a non-invasive diagnostic approach designed to monitor and analyze the coagulability state of a blood sample in order to assist clinical assessment of the haemostatic condition of the patient. The aim of this study was to use the ANH technique in patients requiring coronary artery bypass graft [CABG] surgery and to confirm the advantages of the ANH technique along with TEG. A controlled randomized clinical trial was conducted in 130 patients [32 females mean age 57 +/- 9.0 years, range 38 to 79 years] who were scheduled for CABG surgery with cardiopulmonary bypass [CPB]. They were equally divided into two equal-sized ANH and control groups [n=65]. Patients in group A underwent ANH with an average of 500 ml whole blood removal after the inducting of anesthesia and their removed blood was replaced with crystalloid solution; blood was not removed in the subjects of the control group. Serum levels of hemoglobin and platelets, TEG parameters analysis, homodynamic changes before and after the operation, and the amount of blood transfused during surgery and in the ICU were checked in both groups. Statistical analysis was performed using repeated measures ANOVA models. After the surgery, there were significant decreases in hemoglobin and platelets levels [p < 0.005], but the decrease was less in the ANH group. However, no difference was found in the amount of platelets decrease between the two groups. Changes in TEG parameters - K, ANGLE, EPL and CI- in the ANH group were statistically significant before and after the surgery [all p-values < 0.05]. Also, there were significant differences in Ma, EPL, and CI parameters between the ANH and control groups [all p-values < 0.05]. Use of ANH in patient undergoing CABG surgery results in greater preservation of coagulation factors and platelets that may reduce the amount of bleeding

12-year experience with primary cardiac tumors

We report our experience with 117 patients with primary cardiac tumors who underwent surgery at our institute [a referral center] between March 1995 and February 2006.The patients comprised 47 men and 70 women with a mean age of 44.97 years [range: 2.5- 81 years]. The predominant symptom was dyspnea on exertion and palpitation. In all the patients, echocardiography was the main diagnostic tool, but magnetic resonance imaging [MRI] and CT scan and coronary angiography were also performed if indicated. Most of the tumors were found in the left atrium [LA] [77.77%], but the other chambers were also involved with lesser prevalence [right atrium: 7.5%, left ventricle: 5.1%, and right ventricle: 2.5%]. Involvement of multiple chambers was found in 8 [6.8%] patients.All the patients survived the surgical procedure and were discharged from hospital. Follow-up ranged from 1-10 years [mean: 2.4 years]. The most prevalent tumor was myxoma [104 cases], followed by sarcoma [4 cases] and fibroma [2 cases]. Four patients had secondary [metastatic] cardiac tumors [two Hodgkin lymphoma, one renal cell carcinoma, and one osteosarcoma] and were consequently excluded from the study

Intravenous sufentanil and morphine for post-cardiac surgery pain relief using patient-controlled analgesia [PCA] device: a randomized double-blind clinical trial

Selection of the best analgesic technique in patients undergoing major surgeries can result in lower morbidity and satisfactory postoperative pain relief. In the present study, we tried to compare the effect of morphine and sufentanil on postoperative pain severity and hemodynamic changes by using patient-controlled analgesia [PCA] device in patients who were candidate for coronary artery bypass surgery [CABG]. It was a randomized double-blinded clinical trial in which 120 patients aged 30-65 years, ASA physical status I-Ill, candidate for CABG in Shahid Rajaee hospital in Tehran were included. Before anesthesia, patients were randomly assigned to one of three groups to receive sufentanil [n=40], morphine [n=40] or normal saline [n=40]. After tracheal extubation at intensive care unit, PCA was started by, sufentanil 4mg for the first group, morphine 2mg for the second group and normal saline, at same volume for the third group, intravenously with 10 minute lockout interval. Postoperative pain was evaluated by VAS scale, 1, 6, 12, 18 and 24 hours after extubation and systolic blood pressure, arterial oxygen saturation, PCO2 and PO2 were recorded 24 hours after extubation. VAS scores at rest revealed significantly less pain for patients in sufentanil and morphine groups than normal saline group, throughout the twenty-four hours after operation [P<0.001]. However, there were no significant differences in the means of VAS scores between sufentanil and morphine groups. Among studied hemodynamic parameters, only systolic blood pressure was reduced more in morphine than sufentanil group [P<0.001]. After CABG surgery, administration of intravenous sufentanil and morphine using PCA can lead to similar reduction of postoperative pain severity

BCG vaccination and active tuberculosis prevention: a three-year study

Six to eight million people are infected with tuberculosis [TB] annually throughout the world, out of which 2 to 3 million die. BCG vaccination and its efficacy are always used in tuberculosis control planning. There are different rates of BCG vaccination efficacy in the world from 0 to 80%. BCG vaccine has different efficacy in endemic and non-endemic areas. The prevalence of tuberculosis in Iran is high; therefore it was necessary to perform a study in this regard. This was a case-control descriptive study conducted from 2001- 2003. There were 50 cases of active pulmonary tuberculosis [according to WHO definitions], and 100 controls without tuberculosis admitted for other reasons. Vaccination was done in 10 [20%] people in the case group and 36 [36%] people in the control group [OR: 43%].Thus vaccine efficacy was calculated to be 57% in this study from the equation VE=1-OR [CI: 95% between 0.04-0.81]. Twenty percent of vaccinated people have been protected from active tuberculosis in this study. In this study vaccine efficacy was 57% [CI: 95% between 4-81%], and protection rate of vaccinated people against active tuberculosis was 20%. The effectiveness of BCG vaccine is not constant in all situations and old age and past history of contact with TB patients are confounding factors causing the low efficacy of the vaccine. While case control studies have limitations; thus, similar studies should be planned in different parts of our country for more accurate results

Comparing the efficacy of alpha-interferon and lamivudine in patients with chronic hepatitis B

Hepatitis B virus [HBV] infection is a worldwide health concern. Alpha-interferon and lamivudine have been approved for HBV patients; however, their efficacy remains a matter of controversy. The present study compares these two antiviral regimens in a group of Iranian patients with chronic hepatitis B. It was a randomized controlled clinical trial. Totally, 32 newly diagnosed hepatitis B patients were assigned in 2 groups of lamivudine [100mg per day orally] and alpha-interferon 2a [9 million units every other days subcutaneously]. Both groups were evaluated at weeks 0,1,2,4, and monthly after till the 6[th] month at Tehran Hepatitis Center. HBV DNA, HBeAg, anti-HBe, ALT activity, liver biopsy according to Knodell scoring system and drug side effects were determined, when appropriate. The mean age of the patients was 31.4 +/- 8.8 years. PCR studies revealed negative in 13 [81.3%] interferon- and 15 [93.8%] larnivudine-treated subjects after 6 months of therapy. Among 17 patients with ALT activity of less than 70IU/l prior to therapy, 9 [90%] interferon- and 7 [100%] lamivudine-treated patients were found to have negative PCR results following the therapy [p<0.001]. Primary response to therapy was detected in 3 interferon- and 6 lamivudine-treated subjects, while secondary response was reported in 8 [50%] interferon- and 12 [75%] lamivudine-treated patients. No lamivudine-associated side effect was demonstrated. Lamivudine is a well-tolerated cost-effective antiviral drug for hepatitis B patients. It could be prescribed as the initial drug for patients with chronic hepatitis B