Characteristics of care and caregivers of alzheimer's patients in elderly care homes: a qualitative research

Due to the increase in the number of Alzheimer's patients in Iran and also the limitation of cultural knowledge about caring of these patients, this study was designed to explore the perceptions of Iranian caregivers about caring Alzheimer patients in the elderly care homes. A qualitative content analysis method was conducted on two elderly care homes of Shiraz/Iran, during 2009-2011. Fourteen key informants [10 women and 4 men, between 25-35 years of age], who had been working in elderly care homes caring for the elderly with Alzheimer disease for about 1-11 years [Mean=30 months] were selected by purposive sampling method. The caring experience and ability of transferring their experience to others were the main criteria for selection of the participants. They were participated in 2 focus groups and 4 interviews. Nearly, 800 initial codes were extracted and categorized into 3 groups of "multidimensional care", "going along with the patients" and "need to be professional" and 12 subcategories. Although several aspects of care were mentioned by the participants but the main aspect was physical care. Infantilizing the patients was the main feature of care and caring personality was an important characteristic of caregivers. An appropriate schedule of care considering main categories and subcategories of this research based on cultural context should be prepared. Moreover, consistent promotion of the schedule, employment of trained staff and plans for continued education for them can improve the quality of care and patient's life in elderly care homes

Tramadol induced seizure: report of 106 patients

Seizure is one of the possible adverse effects of tramadol hydrochloride, a synthetic, centrally-acting analgesic, prescribed for the treatment of moderate to severe pain. In this study, we describe 106 patients with tramadol induced seizures. The patients, who were referred to Nemazee Hospital, Shiraz, Iran, from March 2006 to March 2008, were examined in this cross-sectional study. All of the patients had experienced seizure[s] after ingesting tramadol. Each patient was interviewed for demographic data, history of epilepsy, family history of epilepsy, duration of tramadol use, total dose and the last dose of ingested tramadol. Neurological examinations, routine laboratory tests, electroencephalography, and brain computed tomography were performed for each patient. One hundred and six patients were studied [102 males and 4 females, mean age: 26.7 +/- 6 g years]. Among them, 92 [86.8%] had new-onset provoked seizure[s] induced by tramadol and in 14 patients [13.2%], tramadol ingestion was considered as a precipitating factor in the setting of previously-known epilepsy. Tramadol was prescribed by the physicians for alleviation of pain in 20 patients [18.9%] and abused in the remainder [86 patients, 81.1%]. The dose of ingested tramadol before the seizure[s] was 50 to 1500mg. Tramadol may provoke seizures in patients with epilepsy and also in previously healthy people even within the recommended dose ranges. Because most of the cases had occurred in young abusers, strategies to prevent tramadol addiction should be sought

Seizure characteristics in patients with seizure attacks, visited in neurology emergency unit of Ghaem Hospital [2002-2003]

As a common symptom of brain diseases, seizure often indicates severe brain tissue involvement. The purpose of this study was to evaluate the different etiologies of seizure disorders. In this descriptive study, from Marches 2002 to February 2003 497 epileptic patients in Neurology Emergency Unit of Ghaem Hospital, Mashhad were studied. Routine laboratory tests, EEG, and brain CT-Scan was performed for all patients and brain MRI was done for some of them. Demographic data and results of laboratory tests, EEGs and brain CT-Scans were recorded in specific data collection sheets and were analyzed by SPSS software. In our patients [497 cases], 51.3% were male and the others [48.7%] were female. The mean age of our population was 37.6 years and most of patients were middle aged [35-60 years]. The prevalence of different seizures was as follows: Generalized seizures in 82.8%, Focal seizures in 7.5%, and focal seizures with secondary generalization in 9.7%. The prevalence of different etiologies of seizures was: idiopathic and cryptogenic in 48.5%, cerebral vascular diseases in 13.5%, brain tumors [primary or metastatic] in 6.8%, trauma in 6%, acquired metabolic diseases in 6%, drug intoxication or withdrawal in 4.8%, brain infections in 4.6%, developmental disorders in 2.6%, collagen vascular diseases in 2.2%, hypoxic-ischemic encephalopathy in 1.8%, phakomatosis in 0.8%, degenerative disorders in 0.8%, hypertensive encephalopathy in 0.6%, demyelinating diseases in 0.6%, and eclampsia in 0.2%. 65.85 of our patients had a previous history of at least one seizure attack, 25.25 had experienced their first seizure and 9.1% had been admitted because of status epilepticus. 15.3% of patients had positive family history for epilepsy. The most common cause of epilepsy in this study was idiopathic and cryptogenic and cerebral vascular diseases and tumors were the next common causes. Being so common as a cause of seizure and having significant morbidity and mortality, cerebral vascular diseases and brain tumors should be prevented or treated vigorously. Besides, recurrence of seizure attacks as the result of inappropriate drug intake or insufficient drug dose draws particular concern

Efficacy of intravenous dexamethasone in treatment of acute migraine headache: a randomized clinical trial running title

Migraine is characterized by unilateral and pulsatile headache with or without aura. There are various treatments of migraine attack. One of them is intravenous [IV] Corticosteroids which is used in status migrainous. The aim of this study is comparison of the efficacy of I.V Dexamethasone with intramuscular [I.M] Methadone in improvement of migraine attacks. This study was a controlled double- blind randomized clinical trial on all patients whom referred to emergency room with diagnosis of migraine attack. The patients were randomized in four groups. Groups I and II received intravenous 8 mg Dexamethasone, while groups III and IV received intramuscular 10 mg Methadone. Thereafter all of them were evaluated after 2, 4 and 6 hours. One-hundred and eighty one patients were evaluated; 107 patients were treated with IV Dexamethasone and 74 patients with IM Methadone. One-hundred and three of 107 patients [96.2%] had complete or significant improvement whereas 63 of 74 patients [85%] whom received IM Methadone had similar improvement [P= 0.01]. Our study showed that treatment of acute migraine headache by using intravenous Dexamethasone is more effective than Methadone