Management of Acute Diarrhea: A Study on Community Pharmacists' Attitudes in Iran.

Diarrhea disease is one of the most important problem which leads to mortality and morbidity in under developing country. Pharmacists play an important role in providing health services to local communities for this common health issues. The purpose of our study was to assess diarrhea related attitude and knowledge of pharmacist in Iran. This study has been performed in Iranian Pharmacist Association congress in 2012. This is conducted as a questionnaire base, in 100 randomly Persian pharmacists, consists of questions about demographic data of pharmacists such as age, sex, college, year of study, attitude and knowledge of pharmacists on management of acute diarrhea. Pharmacists believed that it was important to ask about the age of patients (98%), initiation (98%) and frequency (95%) of diarrhea, blood (90%) in diarrhea, other symptoms such as fever or pain (95%) as well as recent foods consumption (91%). However there was a significance differences between male and female pharmacist about their diarrhea knowledge. Among pharmacists, 75% asked about the recent travel and 63% asked about other affected family members .Most pharmacists (78) dispensed ORS for the pediatric acute diarrhea. However, some believed in recommending ORS+antimotility drugs (9%), ORS+antismaspolitic (11%) and ORS+antibiotics (2 %). Although Iranian pharmacist were in a good attitude however the rule of periodic studies should highlighted.

Study of the possible medical and medication explanatory factors of angiographic outcomes in patients with acute ST elevation myocardial infarction undergoing primary percutaneous intervention.

BACKGROUND: Myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) and corrected TIMI frame count (cTFC) are indices of successful angiographic reperfusion. This study sought to determine the predictors of angiographically successful reperfusion including demographic, clinical and angiographic factors in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). MATERIALS AND METHODS: A cross-sectional study of patients with a confirmed diagnosis of STEMI undergoing pPCI was designed. Eligible patients referring to a university heart center were enrolled in the study from March 2012 to December 2012. Successful epicardial reperfusion was defned as TIMI flow grade 3 or cTFC<= 28 frames and successful myocardial reperfusion as MBG 2 or 3. RESULTS: The study population consisted of 100 patients, including 74 males and 26 females, with mean ± standard deviation age of 58.27 ± 11.60 years. Achieving open microvasculature (MBG 2/3) was positively associated with a history of nitrate intake (P = 0.03) and history of calcium channel blocker (CCB) intake (P = 0.005). Hyperglycemia was inversely associated with achieving a final cTFC ≤ 28 frames (r = -0.32, P = 0.001). CONCLUSIONS: Our findings suggest that patients with a history of nitrate and CCB intake had a higher likelihood of successful PCI. In addition, patients with a higher blood glucose level on admission may have a reduced rate of reperfusion success. Future studies with a larger sample size are recommended to investigate the significant relationships observed in this study.

Atherosclerotic changes in common carotid artery, common femoral artery, and ascending aorta/aortic arch in candidates for coronary artery bypass graft surgery.

We assessed the association between common carotid and common femoral artery intima-media thickness (ccIMT and cfIMT, respectively), histopathologic severity of atherosclerosis in the ascending aorta/aortic arch, and the extent of coronary artery disease (CAD) in 150 candidates for elective coronary artery bypass grafting (CABG). One-, 2-, and 3-vessel diseases were present in 20%, 25.9%, and 54.1%, respectively. Although no significant relationship was present between the ccIMT and the number of occluded coronary vessels (P = .41), both the cfIMT and severity of atherosclerosis in the ascending aorta/aortic arch were predictive of more extensive CAD (P = .03 and .01, respectively). Neither the ccIMT nor the cfIMT was correlated with the severity of aortic atherosclerosis (P = .81 and .63, respectively). In conclusion, both cfIMT and atherosclerosis of ascending aorta/aortic arch are independent predictors of CAD extent. However, interrelationships between these 2 variables as well as the ccIMT are complex in CABG candidates.

Comparison of parenteral promethazine versus midazolam effect as a preoperative medication on postoperative nausea and vomiting after appendectomy.

BACKGROUND: Postoperative nausea and vomiting is a high unpleasant symptom in surgical procedures. This study compares the effectiveness of midazolam with promethazine as multipurpose drug in postoperative nausea and vomiting as a preoperative and anesthetic medication after appendectomy. Methods : This randomized, double - blind clinical trial study was performed in patients who underwent appendectomy. These patients randomly received either placebo or midazolam or promethazine 5 minutes before appendectomy. All episodes of vomiting and nausea within 24 hours after surgery were recorded. The study population (N=75) comprised 3 comparable subgroups (N=25 in each group). A standard general anesthetic technique and postoperative analgesia were used. The data were collected and analyzed. RESULTS: Vomiting and nausea occurred in 19.20%, 0% and 81.80% of the patients in the midazolam, promethazine and placebo groups, respectively. The frequency of postoperative nausea and vomiting was as follows: the first 6 hours after surgery 0%, 0% and 50%, during the second 6 hours after surgery 19%, 0% and 19%, during the third 6 hours after surgery 0%, 0% and 7%, during the fourth 6 hours after surgery 0%, 0% and 4% in the midazolam, promethazine and placebo groups, respectively. There were no significant differences between promethazine with midazolam in reduction of postoperative nausea and vomiting. CONCLUSION: Our study suggests that midazolam can be used as multipurpose drugs in postoperative nausea and vomiting as a preoperative medication after appendectomy and treatment using midazolam for anti-emetic, prophylaxis provide a similar effect compared to promethazine in the present study.

Nomograms of Iranian fetal middle cerebral artery Doppler waveforms and uniformity of their pattern with other populations' nomograms.

BACKGROUND: Doppler flow velocity waveform analysis of fetal vessels is one of the main methods for evaluating fetus health before labor. Doppler waves of middle cerebral artery (MCA) can predict most of the at risk fetuses in high risk pregnancies. In this study, we tried to obtain normal values and their nomograms during pregnancy for Doppler flow velocity indices of MCA in 20-40 weeks of normal pregnancies in Iranian population and compare their pattern with other countries' nomograms. METHODS: During present descriptive cross-sectional study, 1037 normal pregnant women with 20th-40th week gestational age were underwent MCA Doppler study. All cases were studied by gray scale ultrasonography initially and Doppler of MCA afterward. Resistive Index (RI), Pulsative Index (PI), Systolic/Diastolic ratio (S/D ratio), and Peak Systolic Velocity (PSV) values of MCA were determined for all of the subjects. RESULTS: Results of present study showed that RI, PI, S/D ratio values of MCA decreased with parabolic pattern and PSV value increased with simple pattern, as gestational age progressed. These changes were statistically significant (P=0.000 for all of indices) and more characteristic during late weeks of pregnancy. CONCLUSION: Values of RI, PI and S/D ratio indices reduced toward the end of pregnancy, but PSV increased. Despite the trivial difference, nomograms of various Doppler indices in present study have similar pattern with other studies.