مجله دانشکده پزشکی اصفهان
پیاپی 508 (هفته چهارم بهمن 1397)

In view of the high prevalence of poisoning with antipsychotics, antidepressants, and benzodiazepines, the aim of this study was to compare the cardiovascular complications of poisoning with antipsychotic and antidepressant drugs with or without benzodiazepines. In this case-control study, 120 patients poisoned with psychiatric drugs were divided into two groups of case (with benzodiazepine) and control (without benzodiazepine). Demographic and clinical features as well as cardiac complications of patients were extracted from their files at the time of admission to the emergency department, and then the data were analyzed. There was no significant difference between the groups in terms of demographic information, poisoning way, drug type, duration of hospitalization, pupil size, hemodynamic data, electrocardiography findings, and outcomes (P > 0.05). Poisoning with antidepressants and antipsychotics, when combined with benzodiazepines, led to a decreased level of consciousness than those who did not take benzodiazepine. Meanwhile, hemodynamic symptoms, changes in electrocardiography, vital signs, nervous system status, and even the outcome of patients in the benzodiazepine group were not significantly different from those who did not take this drug.

Measurement of gastric pH potentially could be benefit to apply in various medical fields such as stress-related mucosal damage (SRMD) management especially in critically ill patients. So, we designed this study to measure gastric acidity in high-risk patients for gastrointestinal (GI) bleeding in intensive care unit (ICU), and evaluate variables associated to gastric pH. In a prospective clinical study, gastric secretions of 200 patients in ICU were aspirated if they received stress ulcer prophylaxis (SUP) or had indication to receive it, and had nasogastric tube to aspirate gastric secretion. Thereafter, the acidity of aspirated gastric juice was tested for recruited patients with the laboratory pH-meter, and the patients were categorized to have gastric pH values < 4 or ≥ 4. Aspirated gastric juice was also tested to determine the degree of occult bleeding. Among 740 gastric pH tested during patients' follow-up, 26.5% were less than 4. Acute Physiology and Chronic Health Evaluation (APACHE) score, all major risk factors of GI bleeding, chronic organ insufficiency, multiple trauma, number of major and minor risk factors, and current occult bleeding were factors which could predict pH < 4 in our population. Intravenous pantoprazole had also significantly effect on pH > 4 compared with other administered SUP medications. It seems that measurement of gastric pH in high-risk patients for GI bleeding, and paying more attention to the variables related to gastric acidity, is a scientific practical method for rational prescription of more potent acid-suppressing medications to protect gastric mucosa, and prevent overt bleeding in vulnerable population.

This study aimed to compare the effectiveness of extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) therapy on the treatment of plantar fasciitis inflammation. In this randomized clinical trial study, the patients diagnosed with plantar fasciitis were included. According to their agreement, all patients underwent radiography and foot magnetic resonance imaging (MRI) to rule out stress fractures and other bone injuries. Two PRP and ESWT treatment methods were used separately in two groups, and each group was given specific exercises after the treatment. All patients were evaluated at the beginning of the study, and 3, 6, and 12 weeks, and 6 and 12 months after it using visual analog scale (VAS), and their average score was recorded. A comparison of the mean pain scores in plantar fasciitis inflammation at different time points determined by PRP and ESWT methods with control of two variables of age and gender, showed a significant difference between the two methods (P = 0.007). According to the mean values of the two methods, the pain in PRP method was reduced more than the ESWT method, and the auxiliary variables of age and gender had no effect. Meanwhile, it showed a significant difference between the results of repeated measurements in at least one of these methods (P = 0.006); and based on the mean values of the repeated measurements, the PRP method was that. The study results showed the successful effectiveness of PRP therapy in the treatment of plantar fasciitis inflammation compared to ESWT method.

Some of recent studies have shown that epicardial and abdominal fat are linked to heart diseases. The aim of this study was to determine the relationship between epicardial and peripheral fat thicknesses with coronary stenosis in patients undergoing multislice computed tomography (CT) angiography referring to Alzahra hospital, Isfahan, Iran, during 2014-2015. In a cross-sectional study, 190 patients undergoing multislice CT angiography were selected, and epicardial and peripheral fat thicknesses, as well as coronary stenosis, were measured among them. Then, the relationship between these variables was determined. The mean peripheral subcutaneous fat thickness was 20.39 ± 6.11 and 19.05 ± 8.91 mm in patients with and without significant coronary stenosis, respectively; and there was no statistically significant difference between the two groups (P = 0.240). The mean epicardial adipose tissue was 5.19 ± 0.58 and 3.86 ± 0.28 mm in patients with and without significant coronary stenosis, respectively; and the difference between the two groups was statistically significant (P < 0.001). Regarding the higher peripheral fat in patients with coronary stenosis, and according to high prevalence of cardiovascular diseases, diabetes mellitus, smoking, and other risk factors of atherosclerosis among them, and additive effect of these factors on these diseases, measurement of epicardial fat thickness in at-risk patients must be done. Moreover, several activities must be done to prevent and decrease epicardial and peripheral fat thickness.

Nowadays, as a result of urbanization and change in lifestyle, teenagers' health is increasingly at risk. Adolescents do not have the correct knowledge, attitude, and performance in the field of reproductive health. The challenge is parents' lack of awareness of their important role in information transmission to adolescents. This study was conducted to evaluate the articles related to the educational needs of parents about sexual and reproductive health of adolescents inside and outside Iran. In this systematic review study, published articles in Google Scholar, Pubmed, ScienceDirect, Scopus, Iranmedex, Irandoc, Scientific Information Database (SID), and Magiran were searched. Using keywords of reproductive health, sexual health, educational needs, parents, and adolescents for Persian and English articles. After evaluating the articles, 45 articles conducted inside and outside Iran from 2010 to 2017 were included in this study. The findings of 45 studies were categorized in four main domains of parents’ needs to proper knowledge and attitude about adolescents’ reproductive and sexual problems (14 studies), parent-adolescent communication barriers (15 studies), appropriate educational content (10 studies), and factors affecting parent empowerment in teaching reproductive and sexual problems to teenagers (12 studies); 6 studies were shared in all 4 domains. Discussion on the issues of reproductive health in the family increases the knowledge of reproductive and sexual issues, and reduces the high risk of sexual behavior in adolescents. To empower parents, designing and implementing appropriate interventions is required.