فهرست مطالب

  • Volume:12 Issue: 2, Spring 2020
  • تاریخ انتشار: 1399/05/01
  • تعداد عناوین: 8
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  • Seyed Mojtaba Sohrevardi, Mostafa Pournamdari, Razieh Salimi, Farhad Sarrafzadeh, Mehdi Ahmadinejad* Pages 69-76
    Background

    Few studies have been conducted regarding the comparison of the efficacy of methadone and tincture of opium (TOP) in controlling agitation induced by withdrawal syndrome. Therefore, the current randomized trial study is carried out with the aim to evaluate comparisons on the efficacy of methadone and TOP in controlling agitation caused by withdrawal syndrome in opium addicted patients in the intensive care units (ICUs).

    Methods

    This clinical trial study was conducted on 60 patients admitted to ICU of Shahid Bahonar Hospital, Kerman, Iran. After classification of the patients into two groups, the first and second groups consumed methadone syrup (5 mg/ml) and TOP (10 mg/ml), respectively. Agitation in these patients was assessed through the Richmond Agitation-Sedation Scale (RASS). Vital signs were also assessed. Paired sample t-test and independent t-test were used for data analysis.

    Findings

    In the current study, the administered dose of methadone and TOP was 36.17 ± 26.99 and 112.67 ± 102.74 mg, respectively (P < 0.010). Methadone administration led to a significant decrease of the patients’ vital signs, including systolic blood pressure, heart rate, respiratory rate, and Glasgow Coma Scale (GCS) (P < 0.05). Though TOP administration decreased systolic blood pressure and GCS significantly (P < 0.05), it had no effect on patients’ diastolic blood pressure, body temperature, heart rate, and respiratory rate (P > 0.05). In total, no significant difference was detected between two groups regarding vital signs (P > 0.05). However, a significant difference was seen between methadone and TOP groups in terms of RASS score (P < 0.01).

    Conclusion

    According to the results of the current study, lower dose of methadone, compared to TOP, could control agitation caused by opium withdrawal symptoms.

    Keywords: Methadone, Opium dependence, Intensive care units
  • Khadijeh Keshavarzian, Haidar Nadrian, Hamid Allahverdipour, Asghar Mohammadpoorasl* Pages 77-86
    Background

    The worldwide trend of hookah use among adolescents is increasing, and literature shows a relationship between obscenity and adolescents’ tendency toward hookah smoking. As there is a lack of appropriate instruments to measure the obscenity of hookah smoking, in the present study, we aimed to develop an instrument to measure hookah smoking obscenity among adolescents.

    Methods

    In this methodological study, a sequential exploratory design was used to conduct the study from February 2017 to July 2018 on adolescents in Tabriz, Iran. In the qualitative phase, we conducted semi-structured individual interviews (with 18 students) and a focus group discussion (FGD) (with 13 students) to explain the concept of obscenity and develop the items of hookah smoking obscenity scale (HSOS). We then examined the psychometric properties of the HSOS based on face, content, construct and predictive validities as well as internal consistency and repeatability.

    Findings

    The HSOS was developed with 21 items based on the results of qualitative data analysis. Applying confirmatory factor analysis (CFA), the χ2/degree of freedom (df) ratio was found to be 3.792 for the four-factor structure of the questionnaire and the fit indices of this structural model were satisfactory. The values of Cronbach’s alpha and the intraclass correlation coefficient (ICC) for the constructs in the HSOS ranged 0.81-0.93 and 0.79-0.92, respectively.

    Conclusion

    We found the HSOS with a good level of fit indices, validity, and reliability. The HSOS may be applied by school healthcare providers and health practitioners to find valid and reliable data on the obscenity of hookah smoking when developing hookah smoking

    Keywords: Methadone, Opium dependence, Intensive care units
  • Masoudeh Babakhanian, Mehran Zarghami*, Abbas Alipour, Ardeshir Khosravi, Seyed Saeed Hashemi Nazari, Mehdi Saberi, MohammadReza Ghadirzadeh Pages 87-97
    Background

    The Ministry of Health and Medical Education (MOHME) and the Legal Medicine Organization (LMO) are the 2 death registration systems in Iran for registering drug-related deaths. The aim of the present study was to assess the number of undercount and the overlap between the deaths registered by the 2 sources.

    Methods

    In this descriptive study, according to the 10th revision of the International Classification of Diseases (ICD-10), the registered data on drug-related deaths in the years 2014-2016, as recorded by the MOHME and the LMO, were collected and the number of deaths was estimated using 2-source capture-recapture method and Excel and SPSS software.

    Findings

    The total number of drug-related deaths, as registered by the 2 sources, was 8639 during the 3 years. A major part of the drug-related deaths (75% of the data) had been registered by the LMO and only 25% of deaths had been registered by the MOHME. There was also a small overlap (7.7% of deaths) between the data from the 2 sources. The final estimation from the capture-recapture model and analysis of sensitivity showed that, during the 3 years, the total number of drug-related deaths was 14517 [95% confidence interval (CI):14498-14558]. Based on the complete overlap assumption and 50% of unidentified individuals in the 2 sources, the number of deaths was estimated at 11341 and 12418, respectively. The largest number of drug-related deaths had occurred within the age range of 25-39 years and in men. Kermanshah, Hamedan, and Zanjan Provinces (Iran) had the largest number of cumulative incidences of drug-related deaths. Based on the data provided by the MOHME, the most common cause of death was Methadone poisoning.

    Conclusion

    There was a small overlap between the MOHME and the LMO in the registration of drug-related deaths. Failure to enter accurate and correct information has led to miscalculations of these deaths in Iran.

    Keywords: Death, Substance-related disorders, Iran
  • Monireh Faghir-Gangi, Hadith Rastad, Saharnaz Nejat, Afarin Rahimi-Movaghar, Kamran Yazdani*, Ali Mirzazadeh Pages 98-108
    Background

    This qualitative study was undertaken with the aim to identify the reasons for sharing syringes or needles among people who inject drugs (PWID) in Iran.

    Methods

    We used purposive sampling to recruit 4 groups of participants, male PWID (n = 14), female PWID (n = 6), service providers (n = 8), and human immunodeficiency virus (HIV)/addiction experts (n = 9). Data were collected through 2 focus group discussions (FGDs) among male PWID, and semi-structured interviews with female PWID, service providers, and HIV/addiction experts. Using conventional content analysis, themes were extracted for reasons for sharing needles to inject drugs.

    Findings

    We found 13 themes for barriers such as low perceived risk of HIV, high stigma around drug injection and use, low access to harm reduction education and prevention services due to their limited working hours as a well as uneven geographical distribution of services, some structural barriers like incarceration, poverty, and homelessness, and several competing survival needs beyond the injection-related safe behaviors.

    Conclusion

    Our study was able to provide the perspectives of both PWID and health care authorities and providers towards several barriers to accessing HIV prevention services that lead to needle sharing among PWID in Iran. These barriers need to be addressed to achieve the target of HIV epidemic contro

    Keywords: Drug users, Needle Sharing, Qualitative research
  • Mohammad Reza Nakhaee, Mohammad Reza Zolfaghari, Siyavash Joukar*, Nouzar Nakhaee, Yaser Masoumi Ardakani, Maryam Iranpour, Mozhdeh Nazari Pages 109-117
    Background

    The use of waterpipe tobacco smoking (WTS) is on the rise throughout the world, especially among young people and even athletes. There is a belief among consumers that exercise prevents the harmful effects of hookah smoke on the body. We examined this belief by evaluation of lung injury following to concurrent WTS and swimming endurance training in male Wistar rats.

    Methods

    Animals were randomly divided to sedentary control (CTL) group, exercise training group (Ex group), sedentary WTS (S) group, and exercise plus WTS (S + Ex) group.

    Findings

    8 weeks of WTS was associated with significant increase in serum level of cotinine, lung damage, reduction in alveolar number AN/SA (mm2) and increase in malondialdehyde (MDA) level of lung tissue. Combination of exercise with WTS significantly decreased these negative effects; however, it could not fully protect the lung from smoking damage. Waterpipe smoking (WPS) also significantly increased the pro-inflammatory cytokines of lung tissue such as tumor necrosis factor alpha (TNF-α) (P < 0.001), interleukin 1 beta (IL-1β) (P < 0.010), and IL-6 (P < 0.050) in comparison with CTL group. Exercise training to some degree reduced the levels of pro-inflammatory cytokines and increased the level of IL-10 as an anti-inflammatory IL and glutathione peroxidase (GPX) activity in animals exposed to WTS.

    Conclusion

    It is suggested that combination of mild to moderate exercise with WTS may attenuate the hookah smoking-induced lung damage. This effect partly is mediated through balancing of pro/anti-inflammatory and redox systems.

    Keywords: Water pipe smoking, Lung injury, Swimming, Interleukins, Antioxidants
  • Motahareh Koohsari, Nematollah Ahangar, Ebrahim Mohammadi, Fatemeh Shaki* Pages 118-129
    Background

    The aim of the present study was to investigate the protective properties of melatonin (MT) gainst oxidative stress, mitochondrial dysfunction, and apoptosis induced by tramadol-reproductive toxicity in male rats.

    Methods

    The rats were divided into the 7 groups of control, melatonin (1.5 mg/kg), tramadol (50 mg/kg), and melatonin (1, 1.5 and 2.5 mg/kg) administered 30 minutes before tramadol and vitamin C group (100 mg/kg). All injections were performed intraperitoneally. After administration for 3 consecutive weeks, the animals were
    killed and testis tissues were used for assessment of oxidative stress markers including lipid peroxidation LPO), glutathione (GSH) content and protein carbonyl (PrC), and sperm analysis. Mitochondria were isolated from rat’s testis using differential centrifugation technique and were studied in terms of mitochondrial
    viability, mitochondrial membrane potential (MMP), and mitochondrial swelling. The other part of the tissue sample was placed in RNA protector solution for assessment of Bax and Bcl-2 gene expression through realtime polymerase chain reaction (real-time PCR) assay.

    Findings

    Tramadol caused a significant decline in epidermal sperm count, motility, and morphology, as well as a significant decrease in GSH level and mitochondrial function, and a significant evaluation of LPO, PrC, MMP, and mitochondrial swelling. In addition, tramadol induced a significant decrease in Bcl-2 gene expression, and increase in Bax gene expression. However, pretreatment of rats with MT improved sperm analysis, and testicular antioxidative status, and mitochondrial function. Furthermore, MT pretreatment regulated testicular Bcl-2 and Bax expressions.

    Conclusion

    Considering the protective effects of MT against reproductive toxicity induced by tramadol, this compound can be used as a possible agent for the prevention and treatment of tramadol-induced reproductive toxicity

    Keywords: Tramadol, Melatonin, Oxidative stress, Mitochondria, Apoptosis
  • HamidReza Fathi, Ali Yoonessi*, Ali Khatibi, Fariborz Rezaeitalab, Amir Rezaei Ardani Pages 130-148

    Recent studies have revealed a growing number of patients affected by opioid use disorders (OUDs). Comorbid disorders are suspected to increase the risk of opioid-related adverse effects or treatment failure. The correlation of opioid use with sleep disturbances has been reported in many different studies and suggested to be linked to the brain regions involved in reward processing. This narrative review was intended to discuss the most recent developments in our understanding of the intricate interaction between sleep disturbance and OUD. In addition, in this study, the effects of sleep problems on the occurrence of unpleasant consequences in addiction management, such as craving and relapse in OCD patients, were highlighted. It has been shown that drug use may trigger the induction of sleep disturbances, and those suffering from difficulties in sleeping are prone to relapse to drug use, including opioids. Moreover, pharmaceutical sleep aids are likely to interfere with opiate use.

    Keywords: Craving, Analgesics, Opioid, Sleep aids, Pharmaceutical, Recurrence, Sleep wake disorders
  • Mahboobeh Mousavi Ramezanzade, Yunes Jahani*, Moghaddameh Mirzaee, Hamid Sharifi Pages 149-158
    Background

    A significant proportion of Female Sex Workers (FSWs) as a vulnerable population begin selling sex at an early age, which may lead the person to develop sexually-transmitted infections (STIs) and human immunodeficiency virus (HIV). Thus, this study seeks to identify the factors which influence the age of first sex for sale among the Iranian FSWs.

    Methods

    In 2010, 872 FSWs from 21 centers in 12 Iranian provinces were selected through multistage sampling and were interviewed individually by a standard questionnaire. Survival analysis of interval censored data was used to investigate factors which influence the age of first selling sex. The collected data were analyzed using Weibull parametric model and the hazard ratio (HR) index was reported. The software employed in this study was R version 3.4.2 and icenReg package was used.

    Findings

    The mean age of first selling sex was 24.94 ± 7.34 years. About 22% of the participants started to sell sex before the age of 18. The risk of experiencing the first selling sex was 23% higher in those individuals who had experienced alcohol consumption (HR = 1.23) and 51% higher in those who had drug injections (HR = 1.51). Also, age, education, and marital status were significant variables.

    Conclusion

    In order to cope with the issue of first selling sex at an early age, the following strategies are suggested: providing necessary trainings and building culture about the dangers of alcohol consumption and drug injections, poverty reduction, facilitating education and marriage for young females, and combating sex trafficking

    Keywords: Sex workers, Age of onset, Iran, Survival analysis