Gabapentin effect on pain associated with heroin withdrawal in Iranian crack: a randomized double-blind clinical trial

Gabapentin seems to be a safe and well tolerated medication for treating heroine dependence. This study examined the efficacy of gabapentin for relieving withdrawal-related pain due to heroin use. Sixty men were recruited from an inpatient psychiatric ward of Fatemieh hospital in Semnan and randomized to receive either placebo [n = 30] or gabapentin [1800 mg/day] [n = 30] for 7 days. Subjective Opioid Withdrawal Scale [SOWS] was measured as a self-administered scale for grading body pain at baseline, and on days 1, 2, 3, 4, 6, and 7. Mean of pain score had a significant decrease trend in both gabapentin and placebo groups. Pain severity during the most of detoxification duration was significantly lower in gabapentin group compared with the placebo group. It is suggested that gabapentin may have an effective role in removing heroin withdrawal-related pain

Percutaneous transvenous mitral commissurotomy: significance of echocardiographic assessment in prediction of immediate result

The current study aims to identify demographic, clinical characteristics, echocardiographic and/or mitral valve morphological parameters that may predict the successful result of percutaneous transvenous mitral commissurotomy [PTMC]. The medical records of 196 patients [48 males, mean age: 42.7 +/- 11.5 years] who underwent PTMC were reviewed. Prior to PTMC, a combination of transthoracic and transesophageal echocardiography were used to investigate substantial mitral valve morphological subcomponents [thickening, mobility, calcification, and subvalvular thickness] and suitability for PTMC. The second transthoracic echocardiographic assessment was performed within six weeks after PTMC. Patients were divided into two categories of successful or unsuccessful according to PTMC results. Successful PTMC was defined as: final mitral valve area [MVA] >/= 1.5 cm[2] without a post-procedure mitral regurgitation [MR] grade >2. The significant predictor of the result was identified by comparing demographic data, initial echocardiographic assessment and mitral valve morphological scores within both groups. The mean MVA increased from 1.0 +/- 0.2 cm[2] to 1.7 +/- 0.4 cm[2], and mitral valve mean gradient [MVMG] decreased from 11.5 +/- 5.2 to 5.2 +/- 3.3 mmHg [P < 0.001 for both]. Successful results were obtained in 139 [70.9%] patients compared to unsuccessful results in 57 [29.1%]. Unsuccessful results were due to suboptimal secondary MVA < 1.5 cm[2] in 50 [25.5%] patients and post-procedure MR grade >2 in 7 [3.6%]. Multiple logistic regression analysis indicated that young age, lower size of the left atrium [LA], and smaller degree of mitral valve thickness were the predictors of successful result. Pre-procedure echocardiographic assessment appears to be helpful in predicting PTMC results. Successful PTMC is influenced by the patients' age, LA size, and mitral valve thickness

Comparison of short-term clinical outcome of non-ST elevation versus ST elevation myocardial infarction

Studies on the prognosis of ST elevation myocardial infarction [STEMI] versus non-ST elevation myocardial infarction [non-STEMI] have shown different results. The present study was designed to compare the early outcome and left ventricular systolic function of patients with ST and non-ST elevation myocardial infarction. The patients' information was derived from 10,065 consecutive patients hospitalized in Tehran Heart Center with acute MI [2007 patients with STEMI and 8058 with non-STEMI]. The baseline clinical characteristics, post-MI complications, left ventricular systolic functions, and 30-day mortality rates were compared. A history of current cigarette smoking, opium addiction, and brain stroke was more frequent in the STEMI patients, whereas hyperlipidemia, hypertension, and obesity were found more in the non-STEMI group. Ejection fraction was higher in the non-STEMI patients than that in the STEMI group, and anterior wall infarction was detected more frequently in the STEMI cases. A history of coronary artery bypass grafting and also percutaneous coronary intervention was observed more in the non-STEMI group. Amongst the in-hospital complications, ventricular arrhythmias [1.4 vs. 0.5, P<0.001] and pulmonary edema [0.4 vs. 0.1, P=0.002] were more prevalent in the STEMI cases. The 30-day mortality rate in the STEMI group was higher than that in the non-STEMI group [5.5 vs. 2.4, P<0.001]. Early mortality in both groups was dependant on advanced age, diabetes mellitus, post-MI bradycardia, and atrioventricular block. Also, female gender and pulmonary edema in the STEMI group and family history of MI in the non-STEMI patients could predict 30-day mortality. There were several differences in the baseline characteristics and early outcome between the two types of STEMI and non-STEMI. The 30-day mortality rate was higher in the STEMI group than that in the non-STEMI group