Halothane: How should it be used in a developing country?

The anaesthetic agent halothane is still widely used in developing countries including the Islamic Republic of Iran because of its low price. Because of halothane-induced hepatitis, a rare complication, it has been replaced by other inhalation anaesthetics in Western countries; it has been suggested by some Iranian professionals that the Islamic Republic of Iran should do the same. We evaluated various dimensions of this replacement through a literature review to assess the incidence of halothane-induced hepatitis and costs of anaesthetics in the country. We also conducted a questionnaire survey of 30 anaesthesiology/gastroenterology experts about their views on the subject. The results indicate that the incidence of halothane hepatitis in the Islamic Republic of Iran is very low and could mostly be avoided by strict adherence to guidelines. Complete withdrawal of halothane in the Islamic Republic of Iran might not be appropriate at present. Comprehensive cost-effectiveness studies are needed before a decision is made on complete replacement of halothane with other anaesthetics

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

Insulin resistance and related factors in non-alcoholic fatty liver disease [NAFLD]: an analytic cross-sectional study

Non-alcoholic fatty liver disease [NAFLD] is characterized by fatty change of liver without inflammation. The aim of this study was to evaluate presence of clinical and metabolic components in non-diabetic patients with NAFLD and to assess the relationship between insulin resistance and these factors. In this study, a group of 50 sonographically confirmed patients with NAFLD was studied. Following an overnight fasting, blood samples were obtained to measure serum levels of Triglyceride, Cholesterol, Low Density Lipoprotein [LDL-C], High Density Lipoprotein [HDL-C], SGOT and SGPT, haemoglobin A1C, Fasting Blood Sugar [FBS] and peripheral blood insulin level. Based on homeostatic model assessment [HOMA] score, patients were divided into four quartiles. Other variables including BMI, waist and hip circumference were also measured. The mean age was 42 +/- 10.3 years [range, 22-65], 33 cases [66%] were men, and 17 cases [34%] were women. Mean insulin level was higher in females [female=15.3 +/- 6.7, males=12.9 +/- 5.7]. Variables including waist [P=0.38] and LDL-C [P =0.49] were significantly different among defined study groups. The higher the HOMA index, the lower the HDL-C level [P <0.05]. Patients with insulin resistance showed significant higher values of LDL and Waist circumference. Values of HDL were significantly lower in these patients. Body mass index, Weight, Triglyceride, Cholesterol, AST and ALT values showed no relation with insulin resistance

[Effects of using mitomycin-C in treatment of benign esophageal strictures]

Using bouginage or balloon dilatation is the standard treatment for benign esophageal strictures. About two-thirds need repeated dilatations. For preventing recurrent strictures, many medications such as mitomycin-C have been used. Mitomycin-C is a special antibiotic with anti-neoplastic characteristics, which inhibits fibroblast proliferation, reduces collagen production and decreases scar formation. In this study, 12 patients with benign esophageal stricture during Azar 1386 to Bahman 1387 in Imam Khomeini Endoscopy Department were included. Esophageal endoscopy was done and mitomycin-C was applied on the place of stricture using a cotton ball. Then, response to treatment was categorized in three groups of complete response, partial response and non-response to treatment. Average number of using mitomycin-C was 4 +/- 3 times. Mean interval between endoscopies before using mitomycin-C was 3.5 +/- 1 weeks and after using this agent was 8.5 +/- 4.3 weeks. There were 4 cases of complete response, 5 cases of partial response and 3 patients of non-response. Conservative treatments in management of benign esophageal strictures are preferred to more invasive treatments. However, it seems using a topical solution of mitomycin-C carries better responses and reduces the rate of recurrent dilatations

effect of introducing evidence based medicine on critical appraisal skills of medical students

Evidence Based Medicine [EBM] is a set of methods and resources for finding and employing the best evidences among present resources in order to manage each patient. The aim of this study was to assess the effect of an introductory course of EBM on critical appraisal skills of medical students. This Randomized Clinical Trials [RCT] was performed on clerkship students in Tehran University of Medical Sciences in 2007. Thirty-five clerkship medical students enrolled in a two day EBM workshop in students' Scientific Research Center of Tehran University of Medical Sciences. Each participant filled out a standard questionnaire before and just after the workshop. Paired t-test was used to compare participants' responses to the questions before and after the workshop. According to the findings, a significant change was observed in critical appraisal skills of medical students after the intervention. A short-term introductory course on EBM may increase critical appraisal skills of medical students effectively