Shiraz Emedical Journal
Volume:22 Issue: 8, Aug 2021

Pain management is essential for all patients, including those with liver diseases. Opiates should be used with caution in patients with liver diseases as they are well-known for constipation, sedation, and precipitation of encephalopathy. Meanwhile, the principal fear of the use of non-steroidal anti-inflammatory drugs (NSAIDs) in liver disease is the danger of hastening renal impairment. Thus, acetaminophen is considered first-line therapy because of the side effects of other analgesics. However, there is an assumption that patients with chronic liver disease may be in danger when consuming the drug at therapeutic doses.

Data were extracted from 33 papers. All articles were published until July 2020. The search was done using the following keywords: acetaminophen, paracetamol, cirrhosis, liver disease, chronic hepatitis, and safety in reliable databases. A total of 414 articles were selected some of which were excluded owing to irrelevance, studies on animals and the lack of access to the full text.

Cirrhotic patients could safely take acetaminophen in adjusted doses. Although acetaminophen was safely administered in therapeutic doses in alcoholic patients, there were reports of hepatotoxicity even in therapeutic doses. Acetaminophen was not recommended in patients with acute hepatitis but could be safely used in patients with chronic hepatitis. Patients with non-alcoholic fatty liver disease (NAFLD) were susceptible to acetaminophen toxicity.

In spite of the conception that acetaminophen has dire consequences in liver disease, it can be safely administered in adjusted doses in most liver diseases.

Sleep deprivation is a common problem among the elderly in the cardiac care unit (CCU).

The present study aimed to determine the effects of environmental modifications on sleep quality improvement in these people.

The study population included 60 elderly patients whose sleep quality was assessed by the Pittsburgh Sleep Quality Index with even domains. The environmental factors that can disturb sleep quality were determined via a questionnaire, including 13 questions on a 5-point Likert scale. Descriptive and inferential statistical analyses were performed in SPSS 22 software via independent sample student t-test and chi-square.

After environmental modifications, the total sleep quality scores changed from 11.8 to 5.96, indicating sleep quality improvement. Before executing the environmental modifications, there were no significant correlations between sleep quality scores and demographic variables (sex, age, marital status, and economic status). However, after the modifications, there was a significant relationship between sleep quality and economic status (P = 0.024).

Environmental factors can affect sleep quality in the elderly hospitalized in CCU. Therefore, it is possible to improve sleep quality in these individuals by modulating environmental conditions.

Tacrolimus is an immunosuppressive drug broadly used to avoid rejection of tissue transplantation. Some studies suggest that tacrolimus has destructive effects on the male reproductive system due to activation of the renin-angiotensin system (RAS) and inflammation.

The present study aimed at determining the toxic effects of tacrolimus on testis and evaluating the blocking effects of captopril and losartan on angiotensin-converting enzyme (ACE) and angiotensin receptors, respectively, in rats.

The present experimental study was conducted on 36 adultmaleWistar rats (weighing 200±20 g) randomly divided into six groups and treated based on the experimental design for 30 days. At the end of the intervention, the rats were anesthetized and their blood samples were obtained to measure the serum levels of testosterone and ACE2 enzyme. Also, both testes were removed for histopathological examinations after scarifying.

Tacrolimus decreased testosterone and ACE2 levels significantly. The ACE2 levels were lower in the groups treated with a combination of tacrolimus and losartan or captopril compared to the control group while testosterone level significantly increased in the groups receiving a combination of tacrolimus and captopril. The epithelial thickness of seminiferous tubules and the number of primary spermatocytes significantly decreased in the rats only receiving tacrolimus compared to the groups that received captopril and losartan, along with tacrolimus.

According to the findings, the administration of captopril or losartan, along with tacrolimus, can decrease its testicular toxicity. Captopril and losartan act through blocking RAS but cannot improve ACE2 level; therefore, the recovery of testicle tissue might not be attributed to the ACE2 approach but to the anti-inflammatory effect.

De Quervain tenosynovitis is mainly managed by conservative treatments, such as anti-inflammatory drugs, splint, and injection; however, surgical treatments are also recommended.

The present study aimed at assessing the efficacy of extracorporeal shockwave therapy in the treatment of de Quervain tenosynovitis.

The current clinical trial was conducted on 26 patients with de Quervain tenosynovitis eligible for treatment. The intervention group received extracorporeal shock wave therapy (1000 impulses, 2 bar, 15 Hz), and the sham group a treatment without shock wave. Both groups received the same conservative treatments as thumb spica splint and 200 mg celecoxib once daily for three weeks. The assessment instruments included the disabilities of the arm, shoulder, and hand (DASH) questionnaire, the visual analog scale (VAS), and the hand-grip strength test performed before and after treatment.

After treatment, the DASH and VAS scores decreased, while the hand-grip strength increased significantly in the groups. DASH and VAS scores were significantly lower in the intervention group than the sham group after treatment (P < 0.05).

Extracorporeal shockwave therapy is a safe and easy method to reduce pain and enhance upper extremity functions and hand-grip strength in patients with de Quervain tenosynovitis.

Type I bipolar disorder is a chronic mental illness with a recurrent nature.

This study was done to identify risk factors for relapse in patients with type I bipolar disorder using Poisson regression.

In this retrospective cohort study, data were collected from 331 bipolar type I patients admitted to the largest and the only psychiatric hospital in West of Iran, Kermanshah. Poisson regression was used to identify risk factors for the relapse numbers in STATA software.

One hundred sixty six of 331 patients (50.2%) were men. Mean and standard deviation of relapse rates in males and females were 2.93 ± 0.16 and 2.93 ± 0.15, respectively. In multivariate analysis, the results showed that with increasing age of disease onset (RR = 0.98, 95% CI :(0.97 -0.99)) and adherence to medication (RR = 0.86, 95% CI :(0.75-0.98)), the relapse rate ratio decreased, and being divorced or widowed (RR = 1.20,95% CI :( 1.01-1.45)), cigarette smoking (RR = 1.28, 95% CI: (1.52-1.09)), and birth season of winter (RR = 1.18, 95% CI: (1.00-1.41)) increased the rate ratio of relapse.

The results of this study showed that the frequency of relapse was lower in bipolar patients younger at the time of disease onset, cigarette smokers, divorced or widowed patients, and patients with no treatment adherent. It is necessary to prevent or reduce the likelihood of relapse, especially in patients who do not have therapeutic adherence through educational and therapeutic measurements.

Sleep, a physiological need, may be disturbed during pregnancy due to the psychological, anatomical, biochemical, hormonal, and emotional adaptations.

The present study aimed to investigate the frequency of morningness/eveningness, insomnia, and sleep disorders in pregnant mothers.

All healthy pregnant women who referred to Rasoul-Akram Hospital in 2018-2019 for prenatal care without severe medical diseases were included in the study by census method. They were asked to fill their demographics, Morningness Eveningness questionnaire (MEQ), Pittsburgh sleep quality index (PSQI), and insomnia severity index (ISI) after signing their informed consent. The data were analyzed using SPSS V.21. Women who gave birth before the third trimester were excluded from analysis.

A total of 347 women completed the study; mean age: 31.46 ± 5.36 years, mean gestational age: 24.68 ± 9.62 weeks. The mean MEQ score was 48.77 ± 5.15; 8.1% were moderate evening type, 85.3% intermediate, and 2.6% moderate morning type. Mean ISI score was 16.92 ± 5.51; 91.9% had insomnia; 31.1% reported (rather or very) poor sleep quality. The frequency of insomnia (based on ISI scores) and sleep disorders (based on PSQI dimensions) were neither different among the three trimesters of pregnancy, nor between complicated and uncomplicated pregnancies (P > 0.05). The MEQ score (P = 0.008, OR = 4.275) was positively, and the academic degree was negatively (P = 0.005, OR = 0.202) associated with sleep disorder.

The majority of pregnant mothers reported insomnia, and about one-third reported poor sleep quality, indicating the necessity of paying greater attention to the sleep disorders of pregnant women from the early trimester to prevent further complications.

Low birth weight (LBW < 2500 g) is one of the most serious problems in today’s world. It is also a predictor for mortality and stunting.

This study aimed to compare the growth and development at the age of 60 months between children born with low and normal birth weight in Shiraz, Iran.

This study is part of the Fars birth cohort (FBC) study with the data of children who were born in 2011. We called mothers and asked them to bring their children to the FBC clinic for further evaluation. We also determined the level of development at the age of 60 months for each child by using the Ages and Stages questionnaire (ASQ) for the children.

Of the children, 304 (51.4%) were girls. Most of them had normal birth weight (93.2%), had exclusive breastfeeding for five to six months (79.9%), and did not have any chronic diseases (77.8%). Growth indices at the age of 60 months were significantly higher in children with normal birth weight than in their LBW peers (P < 0.001). However, we found no significant difference in children’s development at the age of 60 months between normal and low birth weight children.

Although growth indices of children at the age of 60 months were higher in children with normal birth weight, we found no significant difference in children’s development at the age of 60 months between normal and low birth weight children.

Equity in the distribution of equipment and resources in the health sector constitutes one of the main dimensions of justice, improving health status and increasing people’s satisfaction.

The current study aimed at determining how health resources and bed are distributed in the poorest region of Iran.

The current retrospective, cross-sectional study was performed in Sistan and Baluchistan Province, as the poorest region of Iran, in 2020. Data were collected using a standard checklist from all five health centers affiliated to Zahedan University of Medical Sciences (ZAUMS). Excel and STATA software were used for data analysis; the Gini index was also calculated.

The Gini index for the distribution of midwives and rural health workers was equitable (0.216 and 0.287, respectively). The distribution of urban healthcare providers, nutrition and psychology counselors, and active beds in ZAUMS were 0.675, 0.545, 0.454, and 0.526, respectively. The distribution of general practitioners, based on the Gini index (0.492), was not fair. Also, the distribution of specialists and nurses was unfair (Gini index: 0.494 and 589, respectively).

The distribution of most resources in the poorest region of Iran was not fair. Unfair distribution and disparities can affect population health status in the future. Then, it is suggested that health policymakers and managers pay more attention to deprived regions.

Scheduling doctor appointments at healthcare centers have been a managerial challenge for health systems. In recent years, many efforts have been made to implement e-booking websites in medical universities and their affiliated healthcare centers.

The aim of this study was to analyze the recent situation of e-booking in the medical sciences affiliated clinics.

The present study was a descriptive cross-sectional study conducted in 2019 in 31 provinces, universities of medical sciences, and affiliated health centers. A checklist with 11 items was used for situation analysis.

The results showed that just 5 out of 31 (15.15%) provinces and their affiliated universities of medical sciences lacked an ebooking system. Moreover, 85.71% of cases had an integrated e-booking portal, 67.86% had mobile-based applications for e-booking, and just 14.29% of the cases had online payment gateway that was the lowest score in all items studied.

Based on the results of this study, there is a significant growth in the situation of e-booking websites in Iran in the last two years. If this improvement continues, it can lead to equity development in healthcare services, reduction of patients’ waiting time, a decrease in waste of resources, and an increase in patients’ satisfaction.