Publications by authors named "Amir Mohammad Kazemifar"

28 Publications

  • Page 1 of 1

A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic.

Sci Rep 2022 06 13;12(1):9741. Epub 2022 Jun 13.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

A methanol poisoning outbreak occurred in Iran during the initial months of coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the epidemiology of the outbreak in terms of hospitalizations and deaths. A cross-sectional linkage study was conducted based on the hospitalization data collected from thirteen referral toxicology centers throughout Iran as well as mortality data obtained from the Iranian Legal Medicine Organization (LMO). Patient data were extracted for all cases aged > 19 years with toxic alcohol poisoning during the study period from February until June 2020. A total of 795 patients were hospitalized due to methanol poisoning, of whom 84 died. Median [interquartile ratio; IQR] age was 32 [26, 40] years (range 19-91 years). Patients had generally ingested alcohol for recreational motives (653, 82.1%) while 3.1% (n = 25) had consumed alcohol-based hand sanitizers to prevent or cure COVID-19 infection. Age was significantly lower in survivors than in non-survivors (P < 0.001) and in patients without sequelae vs. with sequelae (P = 0.026). Twenty non-survivors presented with a Glasgow Coma Scale (GCS) score > 8, six of whom were completely alert on presentation to the emergency departments. The time from alcohol ingestion to hospital admission was not significantly different between provinces. In East Azerbaijan province, where hemodialysis was started within on average 60 min of admission, the rate of sequelae was 11.4% (compared to 19.6% average of other provinces)-equivalent to a reduction of the odds of sequelae by 2.1 times [95% CI 1.2, 3.7; p = 0.009]. Older patients were more prone to fatal outcome and sequelae, including visual disturbances. Early arrival at the hospital can facilitate timely diagnosis and treatment and may reduce long-term morbidity from methanol poisoning. Our data thus suggest the importance of raising public awareness of the risks and early symptoms of methanol intoxication.
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http://dx.doi.org/10.1038/s41598-022-14007-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9189800PMC
June 2022

Comparison of elevated cardiac troponin I with SAPS-II and APACHE-II score in predicting outcome of severe intoxications.

Indian J Anaesth 2022 Apr 20;66(4):248-254. Epub 2022 Apr 20.

Department of Community Medicine, Clinical Research Development Unit, Bu Ali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.

Background And Aims: To date, different methods have been invented to risk-stratify critically ill patients, however, there is a paucity of information regarding assessing the severity of poisonings. This study was designed to determine the comparative efficacy of Simplified Acute Physiology Score-II (SAPS-II) and Acute Physiology and Chronic Health Evaluation-II (APACHE-II)score with cardiac troponin I (cTnI) in predicting severe intoxication outcomes.

Methods: This was a prospective study conducted on patients who fulfilled defined severe intoxication criteria necessitating intensive care unit (ICU) admission over a period of 6 months. SAPS-II and APACHE-II scores were calculated and cTnI concentrations were measured. These indicators were compared to determine which has the better ability to prognosticate mortality and complications.

Results: A total of 55 cases (median age, 35 [24-49] years) were enroled. Eight patients (14.5%) died. Mean SAPS-II, median APACHE-II score and median cTnI concentrations were 32.05 ± 11.24, 13 [10-17] and 0.008 [0.002-0.300] ng/ml, respectively, which were significantly different between the survivors and non-survivors. Receiver operating characteristics curve results of SAPS-II, APACHE-II score and cTnI concentrations in predicting mortality were 0.945, 0.932 and 0.763 and in predicting complications were 0.779, 0.739 and 0.727, respectively. High cTnI concentration (>0.37 ng/ml) correlated with soft clinical outcomes, including length of ventilatory support, length of ICU stay and length of hospital stay (LOS) (r: 0.928, 0.881 and 0.735 respectively; all < 0.001).

Conclusion: SAPS-II scores were superior in predicting death and complications, while cTnI correlated more closely with soft clinical outcomes, such as the length of ventilator support, length of ICU stay or LOS.
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http://dx.doi.org/10.4103/ija.ija_465_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159406PMC
April 2022

COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study.

Alcohol Clin Exp Res 2021 09 6;45(9):1853-1863. Epub 2021 Sep 6.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: During the first wave of COVID-19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID-19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID-19 and the previous year. For poisoning admissions during COVID-19, we also evaluated the cause by age and clinical outcomes.

Methods: This retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol-poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre-COVID-19 reference period (same dates in 2019).

Results: Hospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p < 0.001). During COVID-19, in patients ≤15 years, the odds of intoxication from hand sanitizers were significantly higher than from alcoholic beverages, while in 15- to 18-year-olds, alcoholic beverage exposure was 6.7 times more common (95% CI 2.8, 16.1, p < 0.001). Of 375 children/adolescents hospitalized for alcoholic beverage and hand sanitizer exposure in 2020, six did not survive. The odds of fatal outcome were seven times higher in 15- to 18-year-olds (OR (95% CI) 7.0 (2.4, 20.1); p < 0.001).

Conclusion: The Iranian methanol poisoning outbreak during the first wave of COVID-19 was associated with significantly increased hospitalization rates among children and adolescents-including at least six pediatric in-hospital deaths from poisoning. Public awareness needs to be raised of the risks associated with ingesting alcoholic hand sanitizers.
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http://dx.doi.org/10.1111/acer.14680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653331PMC
September 2021

Effects of Intravenous Lipid Emulsion on Tramadol-Induced Seizure; a Randomized Clinical Trial.

Arch Acad Emerg Med 2021 20;9(1):e20. Epub 2021 Feb 20.

Medicinal Plants Research Center, Maragheh University of Medical Sciences, Maragheh, Iran.

Introduction: There are numerous studies on the efficacy of intralipid emulsion (ILE) in various xenobiotic toxicities. This study aimed to evaluate the potential role of ILE as an antidote in tramadol-induced seizure.

Methods: A single-blind clinical trial was undertaken to establish the efficacy and safety of ILE in patients with acute tramadol intoxication, who referred to Booali Hospital in Qazvin. Patients were randomly assigned to 2 groups. The Control group received standard care while the intervention group received intralipid emulsion (ILE) 20% in addition to the standard care. The occurrence of in-hospital seizure was compared between the groups.

Results: 80 patients who abused tramadol and met the study criteria were randomly assigned to either the intervention (40 cases) or the control (40 cases) group. Seizure occurred in 44 (56%) patients before admission to the emergency department. There were not any statistical differences between the groups regarding sex distribution (p=0.513) and mean age (p=0.19), presenting vital signs (p < 0.05), laboratory findings (p < 0.05), and mean abused dose of tramadol (p = 0.472) as well as occurrence of prehospital seizure (p = 0.7). In-hospital seizure occurred in 15 (18.75%) cases (all in the control group; p < 0.001). The mean duration of admission was 2.01 ± 1.13 days in the control group and 2.15 ± 1.04 days in the intervention group (p = 0.6). The number needed to treat for ILE to prevent tramadol-induced seizure was 2.7 (37.5% absolute risk reduction).

Conclusions: The findings of this study supported ILE administration, as an adjunct to standard antidote protocols, in tramadol intoxication to prevent tramadol-induced seizures.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035696PMC
February 2021

Evaluation of different types of arsenic methylation and its relationship with metabolic syndrome in an area chronically exposed to arsenic.

Environ Anal Health Toxicol 2020 Jun 24;35(2):e2020006. Epub 2020 Jun 24.

Department of Internal Medicine, Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.

Evidence suggests that the relationship between arsenic metabolism and diseases, including metabolic syndrome, is complex. The aim of this study was to evaluate the different types of arsenic methylation and its association with metabolic syndrome in an arsenic endemic area. A cross-sectional study was conducted on 132 subjects from Shahid-Abad Village, Qazvin province, Iran (arsenic endemic area). Demographic characteristics, metabolic syndrome, and urinary arsenic species, including iAs (inorganic arsenic), MMA (monomethylarsonic acid), and DMA (dimethylarsinic acid) were measured for all patients and their relationship was analyzed by appropriate statistical methods. In this study, 34.5% of the participants had metabolic syndrome. The decrease in %MMA, increase in %DMA and increase in secondary methylation index (DMA/MMA) were associated with increased risk of metabolic syndrome (p<0.05). We did not find any association between the incidence of metabolic syndrome with primary methylation index (MMA/iAs) and %iAs (p>0.05). This study showed that the prevalence of metabolic syndrome was significantly higher in people with metabolic syndrome than in the general population. A closer examination revealed that the secondary methylation index is related to the metabolic syndrome and its components. Given the higher prevalence of cardiovascular disease and diabetes in patients with metabolic syndrome, it is necessary to change the pathogenesis of the disease using comprehensive management methods for decreasing patient complications.
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http://dx.doi.org/10.5620/eaht.e2020006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374187PMC
June 2020

Prevalence of HCV, HBV, and HIV Seropositivity among Cadavers Referred to Autopsy Hall of Legal Medicine Bureau of Tehran, Iran.

Adv Prev Med 2017 29;2017:2043840. Epub 2017 Nov 29.

Arak University of Medical Sciences, Arak, Iran.

A large number of dead bodies are referred to forensic autopsy halls for medicolegal examination. They can be a source of transmission of infectious diseases through direct contact or autopsy tools. The main aim of this study was to estimate the virus infection rates in the dead bodies. One thousand consecutive dead bodies that had been referred to autopsy hall of Legal Medicine Bureau of Tehran, Iran, during 2016, were included. The blood samples were analyzed in the laboratory for detection of HBs Ag, HBs Ab, HIV Ab, and HCV Ab, after providing informed consent from legal next of kin of the dead bodies. The general characteristics of the dead bodies were also collected by a checklist. Forty-seven cases of HIV seropositivity, 80 cases of HBs Ag seropositivity, and 97 cases for HCV Ab seropositivity were found. Among them, 27 cases of HIV, 40 cases of anti-HBC positive, and 94 cases of RIBA testing positive for HCV were proved through confirmatory tests. In other words, 2.6% of the dead bodies were infected with HIV, 3.8% with HBV, and 9% with HCV. The total infection rate was 15.5%. This is a worrying risk for pathologist and autopsy technicians.
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http://dx.doi.org/10.1155/2017/2043840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5727642PMC
November 2017

Sleep quality in long haul truck drivers: A study on Iranian national data.

Chin J Traumatol 2016 Aug;19(4):225-8

Occupational Sleep Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: Iran has a high rate of road traffic accidents. Poor quality of sleep brings about loss of attention, which is an important cause of road traffic accidents particularly in monotonous roads. The causes of poor quality of sleep in occupational drivers are multifactorial. The objective of the present study was to assess the prevalence of poor sleep quality among occupational drivers with rotating work schedules and analyze its different risk factors.

Methods: 2200 professional long-haul truck drivers who had been referred to the Occupational Health Clinic for routine education course were invited. We obtained data from eight provinces from various parts of Iran during 2012-2013. Data were collected using a questionnaire including questions about demographic and job characteristics. Pittsburg Sleep Quality Index (PSQI) was used to assess drivers' sleep quality.

Results: Mean working (driving) time was (9.3±2.5) hours daily and (55.5 ± 18.29) hours weekly. About 23.5% of the drivers reported history of smoking, 14.5% had low job satisfaction and 60% had irregular work schedule. 16.4% of drivers had an accidents leading to injury during the past five years. The mean PSQI score was 4.2 ± 2.7; 54% had a PSQI>5 (poor quality of sleep). Multivariate logistic regression showed that smoking, job satisfaction, history of accidents, shift work and work hours per day were the most important risk factors for poor sleep quality.

Conclusion: Results obtained from the current study showed a high prevalence of poor quality of sleep among professional drivers. It warrants more attention to this significant problem using some measures to improve working conditions in professional drivers, as well as health promotion interventions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992135PMC
http://dx.doi.org/10.1016/j.cjtee.2016.01.014DOI Listing
August 2016

A local experience of treatment response in chronic hepatitis C infection.

Infez Med 2015 Dec;23(4):343-8

Department of Infectious Diseases, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.

Hepatitis C virus infection is the major cause of liver cirrhosis. Antiviral treatment can achieve persistent viral clearance to prevent long-term complications of the disease. Despite the introduction of direct acting antivirals (DAAs) as effective therapy in recent years, the standard regimen consisting of interferon and ribavirin which are more accessible and inexpensive is still widely prescribed for the majority of worldwide hepatitis C patients in developing countries. The present study was conducted to demonstrate a local experience of treatment response (with combination therapy; interferon and ribavirin) and outcome in patients with chronic hepatitis C infection. In all, 107 patients from a referral centre for infectious diseases participated in the study from 2007 to 2012. They were evaluated for demographic characteristics, the disease, the presence of metabolic syndrome and its sub-scores, and lab characteristics. The resulting data were analysed with paired T-test, chi-square test, Fisher exact test and logistic regression, according to relevance. The virus eradication rate was 72.9% and 72% at the end of treatment and 6 months later, respectively. Of the patients with HCV chronic hepatitis, 27.96% had concomitant metabolic syndrome. There were statistically significant relationships between response to the treatment and the patient's age and gender, the genotype of the virus, presence of metabolic syndrome, waist circumference, BMI, viral load prior to the treatment and blood pressure (systolic and diastolic). Presence of metabolic syndrome (OR: 20.69, CI: 2.83-151.34, P=0.003) and the genotype of the virus (OR: 6.64, CI: (1.48-29.72), P=0.013) were independent risk factors of failure to achieve sustained virologic response in treatment of chronic hepatitis C with interferon and ribavirin in multivariate logistic regression analysis. According to the current study, HCV infection should be considered a metabolic disease, further to a viral infection. Metabolic factors may impact outcome of the antiviral therapy. Patients should be evaluated for metabolic factors prior to and during antiviral treatment.
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December 2015

Post-operative Analgesia in Opioid Dependent Patients: Comparison of Intravenous Morphine and Sublingual Buprenorphine.

Addict Health 2015 Winter-Spring;7(1-2):60-5

Associate Professor, Clinical Toxicologist, Department of Internal Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.

Background: Acute and chronic pain is prevalent in patients with opioid dependence. Lack of knowledge concerning the complex relationship between pain, opioid use, and withdrawal syndrome can account for the barriers encountered for pain management. This study was designed to evaluate the efficacy of sublingual (SL) buprenorphine for post-operative analgesia, compared with intravenous (IV) morphine.

Methods: A total of 68 patients, aged 20-60 years were randomly selected from whom had been underwent laparotomy due to acute abdomen in a University Teaching Hospital in Arak, Iran, and were also opioid (opium or heroin) abuser according to their history. After end of the surgery and patients' arousal, the patients were evaluated for abdominal pain and withdrawal syndrome by visual analog scale (VAS) and clinical opioid withdrawal score (COWS), respectively 1, 6, and 24 h after the surgery. They received either morphine 5 mg IV or buprenorphine 2 mg SL, 1 h after end of the surgery, and then every 6 h for 24 h.

Findings: VAS was 4.47 ± 0.73 and 2.67 ± 0.53 at h 6 and 24 in buprenorphine group, respectively. The corresponding score was 5.88 ± 0.69 and 4.59 ± 0.74 in morphine group. At the same time, patients in buprenorphine experienced less severe withdrawal syndrome.

Conclusion: The present study confirmed the efficacy of SL buprenorphine as a non-invasive, but effective method for management of post-operative pain in opioid dependent patients. Result of this study showed that physicians can rely on SL buprenorphine for post-operative analgesia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530195PMC
August 2015

Restless leg syndrome in hemodialysis patients: A disorder that should be noticed.

Saudi J Kidney Dis Transpl 2015 May-Jun;26(3):625-50

Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.

Restless leg syndrome (RLS) is a distressing sleep disorder that is commonly experienced by patients undergoing maintenance hemodialysis. The aim of this study was to assess the prevalence of RLS and its related factors among hemodialysis patients. This was an analytical cross-sectional study that was performed on hemodialysis patients of the Bu"Ali Hospital of Qazvin during 2009 and 2010. One hundred and twelve patients were selected by the census sampling method as the study sample. Data collection was performed using the Insomnia Severity Index (ISI), Pittsburg Sleep Quality Index (PSQI), Berlin, Epworth Sleepiness Scale (ESS) and International Restless Leg Syndrome Study Group criteria (IRRLS) questionnaires. Student's ttest and chi-square test were applied to analyze the collected data. RLS complaints were very common among patients on long-term dialysis therapy and were reported in about 42.9% of the patients. Patients with RLS had higher daytime sleepiness, insomnia complaints and poorer sleep quality. Percentage of patients in the high-risk group was higher in the RLS group. RLS symptoms appear to be correlated with age (P = 0.012) and use of sedative drugs (P = 0.035). RLS is common in dialysis patients and is associated with a higher prevalence of other sleep disturbances. Therefore, the effective assessment and management of this sleep disturbance has the potential to significantly enhance patient outcomes.
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http://dx.doi.org/10.4103/1319-2442.157431DOI Listing
May 2015

Does ingestion of tincture of opium notably raise blood alcohol concentration?

Addict Health 2014 Summer-Autumn;6(3-4):100-4

Assistant Professor, Clinical Toxicologist, Department of Internal Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.

Background: Tincture of opium (TOP) is currently used for maintenance therapy in treatment of opioids addiction. It contains ethanol. The present study was conducted to assess the increase in blood alcohol concentration (BAC) in its users; a process which may interfere with breath-alcohol test performed by law enforcement or traffic police.

Methods: A total of 143 individuals were selected randomly from drug users who had been referred to an addiction treatment clinic. They were asked to undergo breath-alcohol test 15, 30, 45, and 60 min after taking their daily dosage of TOP. The resulting figures were statistically analyzed by t-test and chi-square test using SPSS for Windows.

Findings: The calculated blood ethanol concentration rose to 26.33 ± 14.34, 29.15 ± 6.70, and 33.03 ± 8.46 in persons taking 20, 25, and 30 ml TOP respectively, 5 min after their drug ingestion. The figures turned into zero after 15 min.

Conclusion: Users of TOP should be reassured about its alcoholic content. Its alcoholic content cannot produce equilibrium disturbance or notable BAC. However, it is recommended that users of TOP are observed in addiction treatment centers for 15 min after taking their drug to reach a higher degree of certainty about any effect of alcoholic content of TOP.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354214PMC
May 2015

Treatment outcome in chronic hepatitis C infection: a four years survey among Iranian patients.

Glob J Health Sci 2014 Nov 17;7(3):75-81. Epub 2014 Nov 17.

Qazvin university of medical sciences.

Background: Hepatitis C virus (HCV) infection is universal. Side effects of its treatment are observed in many patients. The present study was designed to evaluate treatment outcome and side effects of the treatment in chronic HCV infection.

Materials & Methods: The current study was conducted prospectively on patients with hepatitis C infection. They had been treated with the standard drug regimen, if indicated. They were followed for treatment response, side effects of therapy, and its related factors.

Findings: From ninety one patients, eighty four persons finished their treatment course. They comprised 71 (84.5%) males and 13 (15.5%) females. Their mean age was 41.5 ± 11.90 years (20-69 years). Genotype 3 was the most common virus genotype (51.2%). Sustained virologic response (SVR) was 84.5% for genotype 3 and 47.5% for genotype 1. Decrease in hemoglobin (43%), weakness and fatigue (26%), neutropenia (13%), and thrombocytopenia (13%) were the most common side effects of the treatment. Seven patients can not finish their treatment course, because of the side effects.

Conclusion: Genotype 3, viral load less than 600000, and more than 3- fold rise in AST are associated with higher SVR. Early administration of the added drugs such as erythropoietin and G-CSF to not reduce the drug doses were also influential.
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http://dx.doi.org/10.5539/gjhs.v7n3p75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802067PMC
November 2014

Association of serum 25-hydroxyvitamin d levels and vitamin D dietary intake with metabolic syndrome: a case control study.

J Res Health Sci 2015 ;15(1):32-6

Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.

Background: Association between the vitamin D deficiency and metabolic syndrome (MetS) has previously been noted and reported to be controversial. The aim of this study was to determine the association of serum 25 (OH) D Level and Vitamin D dietary intake with MetS among Iranian population.

Methods: This analytical study was conducted on 122 patients with MetS based on the ATPIII criteria and 128 subjects without MetS as control from September 2010 to April 2011. Serum levels of calcium, phosphorus and 25(OH) D were compared between the two groups. A food frequency questionnaire (FFQ) was used to calculate dietary intake. Data were analyzed using Chi- square test, t-test, Mann-Whitney U test and logistic regression analysis.

Results: Serum concentrations of 25 (OH) D, calcium and phosphorus and calcium intake were significantly lower in subjects with MetS compared to the subjects without MetS. 98.4% of subjects with MetS and 88.3% without MetS had Vit. D deficiency and this difference was statistically significant (P=0.005). In regression analysis, lower concentration of serum 25 (OH) D, calcium and phosphorus and lower calcium and diary intake were predictors of MetS.

Conclusions: Serum 25 (OH) D Level, calcium and phosphorus and calcium intake are associated with metabolic syndrome. However, the mechanism of this association requires further studies.
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December 2015

Low dose furazolidone for eradication of H- pylori instead of clarithromycin: a clinical trial.

Glob J Health Sci 2014 Aug 31;7(1):235-9. Epub 2014 Aug 31.

Qazvin university of medical sciences.

Background: Helicobacter pylori infection is a common chronic human bacterial infection. Triple- therapy regimen containing a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole is commonly used as first-line treatment for its eradication. However, it may not provide the acceptable eradication rate. The present study was designed to evaluated efficacy of low dose furazolidone with amoxicillin and omeprazole for eradication of H- pylori.

Materials & Methods: One hundred twenty patients with non- ulcer dyspepsia or peptic ulcer confirmed by upper GI endoscopy, plus H- pylori infection confirmed by rapid urease test were included in the study. They were randomly divided into two groups, and then received clarithromycin, amoxicillin, and omeprazole, or furazolidone (100 mg PO bid), amoxicillin, and omeprazole. They were evaluated using urea breath test at the end of the study.

Findings: The eradication rates were 57.6% and 78.8% in clarithromycin and furazolidone groups, respectively. Their difference was statistically significant (P value 0.013). No side effect was seen in the furazolidone group.

Conclusion: Low dose furazolidone rather than clarithromycin can be used as low- cost and effective drug for eradication of H- pylori, in combination with amoxicillin and omeprazole.
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http://dx.doi.org/10.5539/gjhs.v7n1p235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4796360PMC
August 2014

Variation in Anatomical Position of Vermiform Appendix among Iranian Population: An Old Issue Which Has Not Lost Its Importance.

Anat Res Int 2014 10;2014:313575. Epub 2014 Sep 10.

Department of Internal Medicine, Qazvin University of Medical Sciences, Qazvin 34137 86165, Iran.

Vermiform appendix has diverse anatomical positions, lengths, and conditions of mesoappendix. Knowing the exact anatomical position of vermiform appendix is important in view of surgeons for on-time diagnosis and management of acute appendicitis. The aim of present study is determination of these characteristics of vermiform appendix among Iranian population. The present study was conducted on 200 bodies, selected from the dead bodies that had been referred to local bureau of legal medicine, Zenjan province, Iran, for medicolegal autopsy since 21 Mar 2010 to 21 Mar 2011. According to the results, the anatomical positions of the appendix were pelvic, subcecal, retroileal, retrocecal, ectopic, and preileal in 55.8%, 19%, 12.5%, 7%, 4.2%, and 1.5% of the bodies, respectively. The mean length of vermiform appendix was 91.2 mm and 80.3 mm in men and women, respectively. Mesoappendix was complete in 79.5% of the bodies. No association was found between sex and anatomical position of vermiform appendix. Anterior anatomical position was the most common position for vermiform appendix. It is inconsistent with most related reports from western countries. It might be possible that some factors, such as race, geographical changes, and dietary habits, play roles in determining the position of vermiform appendix.
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http://dx.doi.org/10.1155/2014/313575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176911PMC
October 2014

Methylphenidate vs. resperidone in treatment of methamphetamine dependence: A clinical trial.

Saudi Pharm J 2014 Jul 5;22(3):191-4. Epub 2013 Sep 5.

Arak's University of Medical Sciences, Arak, Iran.

Background And Aims: Currently, there is no widely accepted evidence-based pharmacotherapy regime for the treatment of psychostimulant dependence. Yet, different pharmacological approaches have been tried in the treatment of MA addiction. The present study was conducted to compare efficiency of methylphenidate which is relatively easily accessible in our country, with resperidone for this purpose.

Methods: Eighty-six patients with MA dependence according to criteria defined by DSM IV-TR were divided into two groups. Patients in group R were given oral resperidone 1 mg daily for 1 week; then 2 mg daily in a divided dose for 3 weeks. Patients in group M were given oral methylphenidate 10 mg daily for 2 weeks, 7.5 mg daily for 1 week, then 5 mg daily for 1 week. They were evaluated for drug craving, psychological, neurologic and somatic symptoms at the start and end of the study.

Findings: Both drugs were useful for lowering drug craving in patients; however resperidone was more effective (6.31 ± 8.31 vs.19.6 ± 12.45 cravings per week, respectively). The effects of resperidone were more notable in lowering frequency and intensity of psychiatric, neurologic, cardiac and somatic symptoms of the patients after discontinuation of MA abuse; however methylphenidate was effective too; though with a lower potency.

Conclusion: The present study confirmed that both methylphenidate and resperidone can successfully be used for treatment of MA dependence, in order to reduce drug craving and psychological, neurologic, and somatic problems in patients. However, the efficacy of methylphenidate was estimated to be less than that of resperidone for this purpose.
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http://dx.doi.org/10.1016/j.jsps.2013.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099559PMC
July 2014

Determination of specificity and sensitivity of anti-RA 33 in diagnosis of early rheumatoid arthritis.

Glob J Health Sci 2014 May 28;6(4):292-7. Epub 2014 May 28.

MD, rheumatologist, assistant professor, Metabolic Diseases Research Center, Qazvin University of Medical Science, Qazvin, Iran.

Background: Rheumatoid arthritis is a chronic inflammatory disease with uncertain etiology characterized by symmetric polyarthritis in peripheral joints. Its diagnosis is based on clinical findings and serologic tests. They are rarely conclusive in early course of the disease. So, its early diagnosis could be difficult. The present study was designed to evaluate the role of Anti -RA33; an Auto-Antibody against RA33 in early diagnosis of the disease.

Materials & Methods: forty three patients who had been visited in a Rheumatology Clinic were randomly selected. Their disease has been diagnosed by a Rheumatologist. 55 persons were chosen from healthy individuals who had attended in other clinic. Their age and sex were matched with the case group. Anti-RA33 and RF titers were measured in their blood sample using standard methods.

Findings: RF and Anti-RA33 titers had significant correlation in case group (p=0.015). Anti -RA33 test had 98% sensitivity, 20% specificity, 55% positive predictive value, and 90% negative predictive.

Conclusion: Anti -RA33 could have diagnostic and prognostic value in diagnosis and evaluation of patients with RA, and its differentiation from other small joint disorders, particularly when the other serologic tests are negative.
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http://dx.doi.org/10.5539/gjhs.v6n4p292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825359PMC
May 2014

Oxidative stress and lipid peroxidation in prolonged users of methamphetamine.

Drug Metab Lett 2014 Jul;7(2):79-82

Qazvin's University of Medical Sciences, Qazvin, Iran.

Background And Aims: Methamphetamine abuse results in numerous adverse health effects. Formation of free radicals may be a contributing factor. Methamphetamine has produced free radicals in animal studies. Present study was conducted to evaluate status of oxidative stress and lipid peroxidation among chronic methamphetamine users.

Methods: Ninety six individuals were selected randomly from methamphetamine abusers who had referred to rehabilitation and treatment center for drug abuse and their closed relatives, after providing informed consent. Blood samples were taken from each of the studied individuals. Ferric reducing ability of plasma (FRAP) assay and serum level of MDA (malondialdehyde) were used to assess the total anti-oxidant power and status of lipid peroxidation of the body, respectively. The results were analyzed by SPSS software version 16.0. Differences among groups were determined by T-test.

Findings: Total anti-oxidant powers of plasma were 0.31±0.04 micromoles/liter and 0.46±0.05 micromoles/liter in methamphetamine abusers and control groups respectively. The difference was statistically significant (p-value=0.04). Levels of MDA were 4.38±5.05 micromoles/liter and 1.72±2.04 micromoles/liter in methamphetamine abusers and control group. The difference was statistically significant (p-value=0.01).

Conclusion: results of present study suggest that prolonged use of methamphetamine exerts oxidative stress on the body and enhances lipid peroxidation. The event may contribute to emergence of adverse effects of acute and prolonged use of methamphetamine; such as loss of attention, psychomotor dysfunction, and cognitive deficits. It is recommended that antioxidants were included in drug regimens prescribed for methamphetamine abusers who referred to physicians to seek medical care for any reason.
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http://dx.doi.org/10.2174/187231280702140520191324DOI Listing
July 2014

Sleep Quality and Quality of Life in COPD Patients with and without Suspected Obstructive Sleep Apnea.

Sleep Disord 2014 22;2014:508372. Epub 2014 Jan 22.

Department of Health, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran.

Present study was designed to obtain association between sleep apnea with sleep quality and quality of life in COPD patients. This cross-sectional descriptive study was conducted on 139 patients with COPD in a chest clinic of a university hospital. All patients were evaluated by pulmonary function test for determination of severity of their disease. Also, Berlin questionnaire, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, and St. George Respiratory questionnaires (SGRQ) were employed for assessment of patients. Analysis of data showed that quality of sleep was significantly correlated with quality of life (P < 0.001). About half of the patients were at high risk for sleep apnea. The patients were divided into two groups according to the result of Berlin questionnaire. Significant differences were found between the groups for total score and each of three subscores of SGRQ suggesting worse quality of life in overlap syndrome (P < 0.001). Also, patients with overlap syndrome had worse quality of sleep compared to patients without it (8.1 ± 1.7 versus 6.2 ± 2.3; P < 0.001). Stepwise multiple regression analysis showed that severity of COPD, coexisting obstructive sleep apnea, and sleep quality accounted for the SGRQ significantly (r (2) (coefficient of determination) = 0.08, 0.21, and 0.18, resp.). It is recommended that patient with COPD be evaluated for sleep apnea and sleep disorders during routine examinations and followups.
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http://dx.doi.org/10.1155/2014/508372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920678PMC
March 2014

Clinicopathological features of colon adenocarcinoma in Qazvin, Iran: a 16 year study.

Asian Pac J Cancer Prev 2014 ;15(2):951-5

Department of Pathology, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran E-mail :

Background: Colorectal cancer (CRC) was the fourth most commonly diagnosed cancer in Iran between 2000 and 2009, with adenocarcinoma (AC) as the most common histological type. Demographic, topographic and histological variables are important in the epidemiology and biology of cancer. The aim of this study was to investigate clinicopathological features of colon adenocarcinomas in Qazvin, Iran.

Materials And Methods: With a retrospective design, patient records of two pathology wards from March 1997 to March 2013 were studied with regard to anatomical location and histological classification. A broader anatomical grouping was also used including distal vs proximal regions and right sided vs left sided tumors. Data were analyzed using T-test and chi-square test.

Results: 118 (50.9%) male and 114 (49.1%) female patients were included in the study. Mean age was 57.3±14.7 years, with 29.2% under 50 years. There was no significant gender difference for age at diagnosis. The rectum (56%) and sigmoid colon (25%) were the most frequent anatomical locations. Proximal cases accounted for 18.6% in males and 8.8% in females (p=0.02). AC was more prevalent than other usual types in younger patients. The proportion of proximal cancer was 1.7% in first eight years of the study period vs 12.1% in the second one (p=0.005). A similar trend was also seen in right sided colon cancers (p=0.018).

Conclusions: Young people are also at risk for the cancer with poor prognosis. Screening programs and weight loss in obese individuals can reduce incidence and complications of CRC.
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http://dx.doi.org/10.7314/apjcp.2014.15.2.951DOI Listing
November 2014

Beneficial Effects of Rosmarinus Officinalis for Treatment of Opium Withdrawal Syndrome during Addiction Treatment Programs: A Clinical Trial.

Addict Health 2013 Summer-Autumn;5(3-4):90-4

Assistant Professor, Department of Internal Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.

Background: Withdrawal syndrome may influence patient's motivation for participation in addiction treatment programs. Management of the symptoms can improve the success rate of addiction treatment programs. In the present study, we have evaluated the efficiency of an herbal product as adjunct therapy for alleviation of withdrawal syndrome in opium abuse.

Methods: In the present clinical trial, 81 patients were assigned into case and control groups. The control group was treated with methadone and placebo for 4 weeks. The case group was treated with methadone and powdered dried leaves of Rosmarinus officinalis for the same interval. Occurrence of withdrawal syndrome was compared between groups on days 3, 7, and 14 after beginning of the treatment, and the possible signs and symptoms of withdrawal syndrome were checked. The clinical opioid withdrawal scale (COWS) was used for evaluation of withdrawal syndrome in the patients.

Findings: Patients in the case group experienced less severe withdrawal syndrome compared to those in the control group; chiefly bone pain, perspiration, and insomnia.

Conclusion: The present study showed that rosemary can be used as an optional extra drug for treatment of withdrawal syndrome during treatment programs for opium addiction and possibly addiction to other opioids.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905473PMC
February 2014

Silymarin in treatment of non-alcoholic steatohepatitis: A randomized clinical trial.

Caspian J Intern Med 2014 ;5(1):9-12

Arak University of Medical Sciences, Arak, Iran.

Background: No pharmacologic agents have been approved for the treatment of non-alcoholic steatohepatitis (NASH) that is common in our region. The present study was designed to evaluate the efficacy of silymarin, a known herbal drug, in the treatment of NASH.

Methods: This clinical-trial study was conducted on 64 patients with NASH who were randomly divided as case group (33) and control group (31). Abdominal sonography and persistent elevation in levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) more than 1.2 times of the upper normal limit within the last six months were selected as inclusion criteria. They were advised to take low-fat, low carbohydrate diet, do regular sport activity to lose weight up to 4 Kg. Patients in the case group received 210 mg/day silymarin orally for 8 weeks and those in the control group received placebo. After 8 weeks, the patients were reevaluated and their AST and ALT levels were measured. This study was registered in the Iranian Registry of Clinical Trial (www.irct.ir) with registration number ID: IRCT201202159018N1.

Results: The mean age of patients in case and control groups was 43.6±8.3 and 39.4±10.5 years, respectively. Their BMI were 27.4±1.7 and 27.5±1.9, respectively. Their weights were also 79±9.2 and 76.9±9.5 kg, respectively. Serum concentrations of ALT were 91.3±21.3 and 38.4±11.8 in case group before and after the study respectively, whiles the figures were 84.6±23.3 and 52.3±29 in the control group (P=0.026). The same trend was seen for AST (P=0.038).

Conclusion: The patients who had taken silymarin experienced more notable fall in hepatic enzymes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894463PMC
February 2014

Relationship between bone mineral density and maturity index in cervical smears, serum estradiol levels and body mass index.

Glob J Health Sci 2013 Sep 29;5(6):209-13. Epub 2013 Sep 29.

.

Objectives: Osteoporosis is a systemic skeletal disease with a consequent increased risk of fracture, decreased quality of life and economic burdens for both the patients and health care system. While Dual energy X-Ray absorptiometry remains the gold standard for assessment of bone mineral density, it cannot be requested for all patients for obvious reasons. By determining other variables that may correlate with osteoporosis, we can identify individuals who may be at risk for osteoporosis earlier. Then, they can be treated at the earlier stages of the disease. In the present study, relationships between bone mineral density, maturity index in cervical smear, serum estradiol level and body mass index were examined.

Materials & Methods: The present study performed on 128 women, who had been referred for bone mineral densitometry. Blood samples were obtained for determination of serum estradiol level. Cervical smear was taken for assessment of cell's maturity. Cervical smears were examined by a pathologist and were sorted as atrophic or mature. Body mass index was calculated too. Relationships among Body mass index, serum estradiol level, and maturity index and bone mineral densitometry were analyzed using proper statistical tests.

Results: Maturity index had significant relationship with T Score in the spine and femoral neck (P<0.001). Significant relationships were found between serum estradiol level and femoral neck T Score (P<0.004) and spine T Score (P<0.008). Also a significant relationship was found between body mass index and bone mineral density.

Conclusion: Pap smear is a routine examination which is performed mainly for screening purposes in gynecology. It is non-invasive, simple and low-priced. Results of current study suggest that women with atrophic cervical smear should be examined more rigorously for osteoporosis. If any patient has atrophic maturity index in her cervical smear, she will be at much higher risk of osteoporosis.
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http://dx.doi.org/10.5539/gjhs.v5n6p209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776888PMC
September 2013

Effects of additive therapy with spironolactone on albuminuria in diabetes mellitus: A pilot randomized clinical trial.

Caspian J Intern Med 2013 ;4(2):648-53

Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.

Background: Early diagnosis of albuminuria and the prevention of its progression to macroalbuminuria and diabetic nephropathy are crucial. Angiotensin converting enzyme inhibitors (ACEIs) and antagonists of angiotensin II receptors type I (ARBs) are currently used as first-line treatment for albuminuria in these patients. The present study was conducted to assess the efficacy of addition of spironolactone to ACEIs or ARB in the prevention of diabetic nephropathy.

Methods: Sixty patients were selected from the patients who referred to a Diabetes Clinic in this randomized clinical trial study. The control group received enalapril and the case group took additive therapy with spironolactone for 12 weeks. Blood pressure, concentrations of creatinine and albumin in the serum and urine, urinary albumin/creatinine ratio, serum potassium were determined for each patient in the beginning of and every 4-6 weeks until the end of the study. This clinical trial was registered in the Iranian Registry of Clinical Trials (www.irct.ir) with registration number ID: IRCT201105084849N2.

Results: There was statistically significant difference in albumin/creatinine ratio between the two groups (p<0.001). Albuminuria reduced more significantly in case group compared to control group. It was measured 66.6±26.8 mg/mmol and 45.7±19 mg/mmol in control and case groups, respectively. The patients did not develop any significant adverse effect including reduction in GFR, hyperkalemia, and hypotension.

Conclusion: Low to moderate doses of spironolactone can augment the effect of ACEIs in the prevention of diabetic nephropathy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3755820PMC
September 2013

Hearing loss in patients with systemic lupus erythematosus.

Glob J Health Sci 2013 Jun 15;5(5):102-6. Epub 2013 Jun 15.

Qazvin University of Medical Sciences.

Objectives: Systemic lupus erythematosus has its unique complications which warrant careful examination and assessment during follow/up visits of patients. The present study was conducted to evaluate prevalence of hearing loss in patients with SLE.

Materials & Methods: At present a case- control study has been performed on 45 patients with SLE in a clinic of a teaching university hospital, Qazvin city, Iran. The patients were examined and evaluated for auditory and hearing problems as well as parameters related to their disease severity and progression. The control group was selected from the same clinic.

Results: Five patients (11.1%) complained from hearing loss, 4 patients s (8.9%) complained from otorrhea, 3 patients (6.7%) had tinnitus in research group, moreover twelve patients (26.7%) in case group and 4 patients (8.9%) in control group had sensorineural hearing loss. The difference was found to be statistically significant. No statistical significant relationship was found between severity, age of onset, and duration of the disease, and the lab tests of the patients with hearing loss.

Conclusion: The present study implies that patients with systemic lupus erythematosus may develop sensorineural hearing loss during their course of the disease. It is recommended that audiology examination and/or audiometry become a part of routine follow/up studies of the patients.
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http://dx.doi.org/10.5539/gjhs.v5n5p102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776876PMC
June 2013

Daytime sleepiness and quality of sleep in patients with COPD compared to control group.

Glob J Health Sci 2013 Feb 25;5(3):150-5. Epub 2013 Feb 25.

Qazvin University of Medical Sciences, Qazvin, Iran.

Objectives: Chronic obstructive pulmonary disease (COPD) is a widespread disease. It produces some night symptoms such as nighttime cough and dyspnea. Then subjective and objective changes in sleep pattern are expected. Present study was conducted to determine frequency of sleepiness and quality of sleep in patients with COPD.

Materials & Methods: Present case-control study has been performed on 120 patients with diagnosis of COPD who had been referred to pulmonary disease clinic in a University teaching hospital. One hundred twenty age- and sex- matched healthy individuals were recruited in the study and served as control. Spirometry (PFT) was performed for all patients. Patients were categorized under 3 groups in relation to their PFT as follow: mild COPD (FEV1/FVC<70% and >=80%), moderate COPD (FEV1/FVC<70% and 50%<=FEV1<80%), and severe COPD (FEV1/FVC<70% and FEV1<50%). Pittsburgh Sleep Quality questionnaire (PSQI) and Epworth Sleepiness Scale (ESS) were used to estimate quality of sleep and daytime sleepiness in the patients and control group. The collected data were analyzed using version 16 SPSS software. Student's T- test, Chi- square and multiple logistic regressions were used as appropriated.

Results: 120 patients with COPD (79 males and 41 females) and 120 normal individuals responded to the questionnaires. Mean scores of quality of sleep were 8.03±3.66 and 4.2±2.8 in COPD patients and control group respectively. 32.1% of the patients had good sleep quality (PSQI score less than 5) and 67.9% had poor sleep quality. Daytime sleepiness (ESS>=10) was present in 34.8% of the patients and 15% of control people. Multiple logistic regressions showed that the patients reported significantly worse sleep quality and more daytime sleepiness than control group [OR=2.9; 95% CI (1.6-3.7) & OR=3.5; 95% CI (2.5-4.3) respectively].

Conclusion: Results of present study confirmed that COPD is associated with daytime sleepiness and poor quality of sleep, possibly attributable to nighttime respiratory difficulties and concomitant sleep apnea. Assessment of the patients for symptoms of sleep apnea, daytime sleepiness should be a part of regular follow up visits of patients with COPD.
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http://dx.doi.org/10.5539/gjhs.v5n3p150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776817PMC
February 2013

Is vitamin D deficiency associated with non specific musculoskeletal pain?

Glob J Health Sci 2012 Nov 11;5(1):107-11. Epub 2012 Nov 11.

Metabolic Diseases Research Center, Qazvin University of Medical Science, Qazvin, Iran.

Backgrounds: Vitamin D deficiency is common worldwide, including Iran. It has been suggested that vitamin D deficiency is associated with non-specific musculoskeletal pain. The aim of this study is evaluation of the association of musculoskeletal pain with vitamin D deficiency and the response of the patients to vitamin D supplementation.

Materials And Methods: Sixty two adult patients with chief complaint of musculoskeletal pain were enrolled in the study. Serum concentrations of 25(OH)D, Calcium, Phosphate, Alkaline Phosphatase and PTH were determined. If there was vitamin D deficiency, oral vitamin D supplementation was given. Assessment of pain and its response to therapy was carried out using Visual assessment score (VAS). SPSS software version 15.0 was used for statistical analyses.

Findings: Most of the patients (95.4%) had vitamin D deficiency. Pain in 53 patients (85.5%) with responded to the proposed treatment. In responder group post treatment vitamin D concentration was significantly higher than non responder group (60.6±27.6and 39.2±9.6 nmol/l respectively, p<0.01) pretreatment vitamin D and minerals concentrations and pain characteristics did not have significant differences in responder and non responder group.

Conclusion: Treatment with vitamin D can relieve the pain in majority of the patients with vitamin D deficiency. Lack of response can be due to insufficient increase in serum vitamin D concentration. Reassessment of serum 25(OH)D concentration is recommended in nonresponsive patients.
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http://dx.doi.org/10.5539/gjhs.v5n1p107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776981PMC
November 2012

Hepatoprotective Property of Oral Silymarin is Comparable to N-Acetyl Cysteine in Acetaminophen Poisoning.

Gastroenterology Res 2012 Oct 20;5(5):190-194. Epub 2012 Sep 20.

Qazvin's University of Medical Sciences, Qazvin, Iran.

Background: N-Acetyl Cysteine (NAC) is usually used as antidote for prevention of acetaminophen-induced hepatotoxicity. In present study we have evaluated efficacy of oral silymarin in its prevention in rats intoxicated with lethal dose of acetaminophen.

Methods: A total of 50 Male Sprague-Dawley rats were randomly divided into five groups. The first group received only vehicle of acetaminophen and served as control. The second group was given 800 mg/kg acetaminophen by gavage with an orogastric canula. The third, fourth and fifth groups were given 300 mg/kg NAC and 150 and 300 mg/kg silymarin respectively. Analysis of serum AST, ALT, and ALP and liver histopathology were employed for assessment of hepatotoxicity.

Results: Mean serum ALT levels were significantly increased in the APAP group rats. The mean serum ALT levels returned to normal in both NAC treated and silymarin treated groups. Silymarin (150 mg/kg) had prevented hepatocytes necrosis similar to NAC. No severe hepatotoxicity were seen in groups 3 and 4; while it is seen in 70% of animals in group 2.

Conclusion: We found that a single dose of orally administered silymarin (150 mg/kg) significantly attenuated acetaminophen-induced liver damage in rat. Oral silymarin can be used in these patients instead of NAC.
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http://dx.doi.org/10.4021/gr463eDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051100PMC
October 2012
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