[Unreasonable consumption of narcotic drugs following appendectomy and hernioraphy]

Unreasonable consumption of narcotic drugs may cause several problems such as the incidence of some side effects, dependence and inappropriate pain relief. Drug Utilization Review [DUR] program - that nowadays is one of the Ministry of Health and Medical Education's priorities - is to assess the problems of drug prescribing and usage, and present reforming suggestion to medical providers. This descriptive cross-sectional study was performed in surgical ward of one of Tehran's hospitals for Two Six months' periods. At first a standard protocol was prepared. All hospitalized patients who had received narcotic drugs via injection after surgery entered the study. In whole 200 reviewed patients, generally 26 [13%] patients taking narcotic drugs were according to protocol and 174 [87%] cases were against the protocol. In this cross-sectional study only 49 of 100 patients had pain relief after receiving narcotic drugs via injection. Physician orders were inappropriate and in 13 [6.5%] cases, there was no medical prescription. 50% of patients still had pain after drug injection that was due to medical providers' concern for drug dependence in patients and lack of due supervision by the physician in charge

[Extra cellular superoxide dismutase activity in lung injuries due to sulfur mustard]

Pulmonary complications are known to occur in over half of the patients exposed to sulfur mustard [SM]. There is controversial regarding the role of extracellular superoxide dismutase [EC-SOD] in different airway diseases. The aim of this study was to evaluate the correlation between lung function and EC-SOD activity in patient with lung injuries due to SM. This was a case-control study carried out on 220 patients with lung complication due to SM in the city of Sardasht [Iran] in 2007. Spirometry was used to assess pulmonary function followed by measurement of EC-SOD activity. T test was employed to examine the differences between study groups. Pearson correlation coefficient was also used to find the possible correlation between EC-SOD activity and the lung function. The mean EC-SOD activity in control group [70.5 +/- 10.8U/L] was higher than that of moderate to severe group 67.0 +/- 6.1 U/L [p < 0.001]. There was no significant difference for mean EC-SOD activity between mild and control groups. Significant and direct association between EC-SOD activities and lung function was established [p < 0.001]. According to our findings, inactivation of EC-SOD may lead to progressive inflammation and lung injury due to sulfur mustard

[Comparison between therapeutic effects of doxepine and hydroxyzine on resistant pruritic lesions due to sulfur mustard]

Chronic pruritus is one of the major complaints in chemically-injured patients. It may cause many psychological problems and consequently, decrease the patient's quality of life. The aim of this study is to compare the safety and efficacy of Doxepin and Hydroxyzine in treatment of chronic pruritus due to Sulfur Mustard. This randomized, double-blind clinical trial was carried out in Baqiyatallah hospital on 50 chemically-injured patients for a period of 4 weeks. Patients randomly divided into 2 groups, first group [mean age of 42.3 +/- 5.4 years old] received Doxepin capsules [10 mg/day] and the second group [mean age of 41.1 +/- 6.2 years old] received Hydroxyzine capsules [25 mg/day]. Pruritus score was measured by a standard questionnaire and Visual Analogue Scale [VAS]. The mean before and after-treatment puritus scores of Hydroxyzine, were 34.6 +/- 3.4 and 25.9 +/- 3.1, respectively [P<0.001] and those of Doxepin were 33.8 +/- 4.4 and 24.5 +/- 4.1, respectively [P<0.001]. Both drugs decreased pruritus, similarly [P = 0.245]. 18 patients in the hydroxyzine-received group and 11 patients in the Doxepin-received group were complaining from sedation as a side-effect [P=0.035]. Both drugs are of significant effectiveness in decreasing pruritus. However, considering its fewer side effects, Doxepin seems to be more useful in these conditions

[Evaluation efficacy of combination therapy of %0.5 antralin and %2 minoxidil solution in treatment of alopecia areata]

Background: alopecia Areata is a prevalent inflammatory chronic disease which %2 of general population is suffering from it. All current therapies of the disease have their own limitations, so the object of this study is to evaluate efficacy of combination therapy with local %0.5 Antralin and %2 minoxidil solution in treatment of alopecia areata

Materials and Methods: in this placebo-controlled clinical trial, 53 subjects were included. 26 patients received combination therapy for 30 days, they used local %0.5 antralin 20 on their lesions 20 minutes every night, and after washing and drying the area used %2 minoxidil solution the same night and next morning. The rest 27 patients used placebo on their lesions. At the end of study, their hair growth were measured by assessing terminal hair growth

Results: there were 53 subjects with mean age of 18.35±4.23 [%60.4] of the patients were men and the rest %39.6 were women. The drug were more effective than the placebo [%67.9 vs %32.1, P=0.063].Erythema and hyperpigmentation were seen in %96.1 and %100 of patients receiving drug, respectively, while just %29.6 of the placebo group had erythema and no one had hyperpigmentation

Conclusions: most patients who used combination therapy took benefit of the drug and it seems that by increasing number of subjects and continuing the treatment, the rate of efficacy will increase considerably

[ study of the prevalence of skin tumors in chemically injured patients in comparison with the general population]

Background: During Iran-Iraq war between the years 1980-1988, several chemical warefare agents were used which the most common was Mustard gas [SM]. The side effects of mutation and tumor-formation of sulfur mustard in human beings and animals are well described. The aim of current study is to determine the late-onset complications in Iranian veterans exposed by SM in formation of skin tumors

Materials and methods: During this retrospective descriptive-analytic study, 9605 chemically injured patients who were examined by dermatologists and their characteristics were studied

Results: Sixty-two out of 9605 of chemically injured patients exposed to sulfur mustard after 10-15 years from exposure had skin tumors. Four of them were malignant and diagnosed as BCC and the others were benign. Lipoma and Becker nevus where the most common benign lesions

Conclusions: The results showed that no significant difference between prevalence of BCC in the chemically injured patients and the general population based on previous reports and as far as the age range and frequency of exposure was considered[P>0.05]

study of the prevalence of skin tumors in chemically injured patients in comparison with the general population

During Iran-Iraq war between the years 1980-1988, several chemical warefare agents were used which the most common was Mustard gas [SM]. The side effects of mutation and tumor-formation of sulfur mustard in humanbeings and animals are well described. The aim of current study is to determine the late-onset complications in Iranian veterans exposed by SM in formation of skin tumors. During this retrospective descriptive-analytic study, 9605 chemically injured patients who were examined by dermatologists and their characteristics were studied. Sixty-two out of 9605 of chemically injured patients exposed to sulfur mustard after 10-15 years from exposure had skin tumors. Four of them were malignant and diagnosed as BCC and the others were benign.Lipoma and Becker nevus where the most common benign lesions. The results showed that no significant difference between prevalence of BCC in the chemically injured patients and the general population based on previous reports and as far as the age range and frequency of exposure was considered [P>0.05]

Evaluation of phenytoin utilization based on key pharmacokinetic parameters in patients with head trauma

Phenytoin is commonly administered as an anticonvulsant agent to critically traumatic patients for seizure prophylaxis and treatment. It exhibits non-linear pharmacokinetic characteristic and requires frequent plasma level monitoring and dose adjustment. Based on the previous study, it is often difficult to achieve therapeutic levels in patients with head trauma using the recommended phenytoin dosing strategies. Therefore, we conducted a prospective, randomized study to evaluate pharmacokinetic parameters of phenytoin in patients with head trauma. In this prospective randomized study, eighty-three patients were enrolled. The dosing regimen of phenytoin was designed and individualized for each patient based on available population pharmacokinetic data and was compared with the administered dose. The peak and trough concentrations of collected blood samples were determined by TDX. Statistical analysis of the findings indicated that there were significant differences between administered doses of phenytoin and calculated doses based on peak and trough [P<0.0001]. Additonally, our findings indicate the significant difference between previous population Vmax and Vmax obtained from this study. Furthermore, this study showed that phenytoin plasma concentrations were sub therapeutic in the majority of cases [71%].It seems that blood level monitoring ot phenytoin in patients with neurosurgical trauma on the basis of drug pharmacokinetic parameters such as Vmax is necessary

Comparison of efficacy of topical tretinoin 0.05% cream with placebo in treatment of melasma

Melasma is a common disorder of macular hyperpigmentation, which involves mostly in sun-exposed areas of face and neck. Women are more affected. Multiple factors have been postulated to involve in the etiology and pathogenesis of melasma including pregnancy, oral contraceptives, genetics, sun exposure, cosmetics and race. Fifty women completed a randomized, double blind vehicle controlled clinical trial, in which they applied 0.05% tretinoin [n=25] or vehicle cream [n=25] once daily on the face for 12 weeks. 2 weeks after treatment 6 out of 25[24%] tretinoin-treated patients [group 1] were clinically improved, compared with 0 out of 25[0%] in the vehicle group [group2][p=0.022]. 4 weeks after treatment 14[56%] of groupl and 5[20%] of group2 improved [p=0.006]. After 12 weeks, 21 [84%] of groupl and 6[24%] ofgroup2 were improved [p=0.0001] which demonstrated significant improvement in the tretinoin-treated patients compared with the vehicle group. This controlled study demonstrates that topical 0.05% tretinoin alone is considered to be effective in the treatment of melasma patients

[Evaluation of phenytoin utilization based on key pharmacokinetic parameters in patients with head trauma]

Background: Phenytoin is commonly administered as an anticonvulsant agent to critically traumatic patients for seizure prophylaxis and treatment. It exhibits non-linear pharmacokinetic characteristic and requires frequent plasma level monitoring and dose adjustment. Based on the previous study, it is often difficult to achieve therapeutic levels in patients with head trauma using the recommended phenytoin dosing strategies. Therefore, we conducted a prospective, randomized study to evaluate pharmacokinetic parameters of phenytoin in patients with head trauma

Materials and methods: In this prospective randomized study, eighty-three patients were enrolled. The dosing regimen of phenytoin was designed and individualized for each patient based on available population pharmacokinetic data and was compared with the administered dose. The peak and trough concentrations of collected blood samples were determined by TDX

Results: Statistical analysis of the findings indicated that there were significant differences between administered doses of phenytoin and calculated doses based on peak and trough [P<0.0001]. Additonally, our findings indicate the significant difference between previous population Vmax and Vmax obtain from this study. Furthermore, this study showed that phenytoin plasma concentrations were sub therapeutic in the majority of cases [71 %]

Conclusions: It seems that blood level monitoring of phenytoin in patients with neurosurgical trauma on the basis of drug pharmacokinetic parameters such as Vmax is necessary

[Comparison of efficacy of topical tretinoin 0.05% cream with placebo in treatment of melasma]

Background: Melasma is a common disorder of macular hyperpigmentation, which involves mostly in sun-exposed areas of face and neck. Women are more affected. Multiple factors have been postulated to involve in the etiology and pathogenesis of melasma including pregnancy, oral contraceptives, genetics, sun exposure, cosmetics and race

Materials and methods: Fifty women completed a randomized, double blind vehicle controlled clinical trial, in which they applied 0.05% tretinoin [n=25] or vehicle cream [n=25] once daily on the face for 12 weeks

Results: 2 weeks after treatment 6 out of 25[24%] tretinoin-treated patients [group 1 ] were clinically improved, compared with O out of 25 [0%] in the vehicle group [group2][p=0.022]. 4 weeks after treatment 14[56%] of group1 and 5[20%] of group 2 improved [p=0.006]. After 12 weeks, 21 [84%] of group 1 and 6[24%] of group2 were improved [p=0.0001] which demonstrated significant improvement in the tretinoin-treated patients compared with the vehicle group

Conclusions: This controlled study demonstrates that topical 0.05 % tretinoin alone is considered to be effective in the treatment of melasma patients

Comparison of endoscopic and pathologic findings and their relation to gastero-esophageal reflux disease in patients with dyspepsia

Dyspepsia and gastro-esophageal reflux disease [GERD] are among the most common problems in clinical practice. Given established association between GERD and esophageal adenocarcinoma this problem has significant importance; whereas, most of symptomatic patients have non-erosive reflux disease [NERD] The aim of this study was to compare the clinical complaints with endoscopic and pathologic findings. This study was done in 211 patients with clinical symptoms of dyspepsia for at least 3 months from October 2003 to September 2004 in Baquiatallah hospital. After completing clinical findings questionnaire, all patients underwent endoscopy and biopsy and then these methods' findings were compared. Patients' mean age was 37.53 and their mean weight was 68.59. Most frequent complaints were abdominal pain [72%], heart burn [54%] and nausea [44%], respectively. Endoscopy was abnormal in 87 [41.2%] patients [35.1% G I, 3.8% G II, 1.9% G III and 0.5% G IV esophagitis]. 124 [58.8%] patients had normal endoscopy. Esophageal biopsy were abnormal in 54 [25.6%] patients [14.2% non-inflammatory lesions, 10.4% inflammatory lesions and 0.9% metaplasia] and 157[74.4%] patients had normal biopsy. Difference between positive endoscopy and biopsy were not significant [P=0.159]. A considerable part of symptomatic patients have NERD. Pathology and endoscopy are not preferable to each other, so symptomatic patients should be treated regardless of para-clinic studies

[Comparison of endoscopic and pathologic findings and their relation to gastero-esophageal reflux disease in patients with dyspepsia]

Background: Dyspepsia and gastro-esophageal reflux disease [GERD] are among the most common problems in clinical practice. Given established association between GERD and esophageal adenocarcinoma this problem has significant importance; whereas, most of symptomatic patients have non-erosive reflux disease [NERD]. The aim of this study was comparison the clinical complaints with endoscopic and pathologic findings

Materials and Methods: This study was done in 211 patients with clinical symptoms of dyspepsia for at least 3 months from October 2003 to September 2004 in Baquiatallah hospital. After completing clinical findings questionnaire, all patients underwent endoscopy and biopsy and then these methods' findings were compared

Results: Patients' mean age was 37.53 and their mean weight was 68.59. Most frequent complaints were abdominal pain [72%], heart burn [54%] and nausea [44%], respectively. Endoscopy was abnormal in 87 [41.2%] patients [35.1% GI, 3.8% GII, 1. 9% GIII and 0. 5% GIV esophagitis]. 124 [58.8%] patients had normal endoscopy. Esophageal biopsy were abnormal in 54 [25.6%] patients [14.2% non-inflammatory lesions, 10.4% inflammatory lesions and 0.9% metaplasia] and 157 [74.4%] patients had normal biopsy. Difference between positive endoscopy and biopsy were not significant [P=0.159]

Conclusions: A considerable part of symptomatic patients have NERD. Pathology and endoscopy are not preferable to each other, so symptomatic patients should be treated regardless of para-clinic studies