Atomoxetine Efficacy in Methamphetamine Dependence during Methadone Maintenance Therapy.

BACKGROUND: Co-occurring methamphetamine (METH) use during methadone maintenance therapy (MMT) is a highly prevalent and progressive problem in Iran. There are no registered pharmacological treatments for treating METH use disorder. The present study investigates the potential efficacy of atomoxetine in the treatment of these patients. METHODS: In a double-blind, controlled clinical trial, 86 METH-dependents on MMT randomly received either atomoxetine (40 mg/d) or placebo. We measured the craving scores with visual analog scale (VAS) on a weekly basis, and evaluated depression, anxiety and stress with the Depression Anxiety Stress Scales (DASS) on a monthly basis. Measurements were made in each weekly visit with urinary METH drug test. RESULTS: Atomoxetine significantly reduced METH craving (P < 0.001). Negative METH urine test increased significantly in the drug group compared to the placebo group (P = 0.007). While initially the METH urine test was positive for all patients, 56% (25/45) in the atomoxetine group and 26% (11/41) in the placebo group had negative METH urine tests after 8 weeks. DASS were decreased in both groups with a greater reduction in the atomoxetine group [depression (P = 0.028), anxiety (P = 0.038), and stress (P = 0.031)]. Only mild side effects were observed. CONCLUSION: This study confirms the safety and clinical tolerance of atomoxetine, and its appropriate efficacy in suppressing METH craving and possible potential effects on its treatment.

Effects of pregabalin and gabapentin on postoperative pain and opioid consumption after laparoscopic cholecystectomy.

BACKGROUND: Gabapentin and pregabalin are antiepileptic drugs that are also used for chronic pain treatment. This study evaluated the effects of pregabalin and gabapentin on postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS: A total of 108 candidates for elective laparoscopic cholecystectomy were randomly assigned to gabapentin (n = 36), pregabalin (n = 36), and placebo (n = 36) groups. Patients received 800 mg of gabapentin or 150 mg of pregabalin orally one hour before surgery. Postoperative analgesia was administered by pethidine via patient-controlled analgesia. The amount of opioid consumed, number of nausea events, vomiting, and pain scores at 2, 6, 12, and 24 hours after surgery were recorded. RESULTS: The gabapentin and pregabalin groups had significantly lower pain intensity than the placebo group, and pain intensity in the pregabalin group decreased more compared to the gabapentin group. The mean amount of pethidine consumption in the placebo group was significantly higher than in the gabapentin and pregabalin groups. CONCLUSIONS: A single dose of gabapentin or pregabalin decreased postoperative pain and nausea, as well as vomiting and opioid consumption after laparoscopic cholecystectomy. Moreover, the findings revealed that pregabalin was superior to gabapentin for reducing postoperative pain.

Preemptive Analgesic Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain: A Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic method used to control different types of pain. OBJECTIVES: The aim of this study was to evaluate the effects of preoperative TENS on post inguinal hernia repair pain. PATIENTS AND METHODS: This randomized, double-blind, placebo-controlled clinical trial was performed on 66 male patients with unilateral inguinal hernias who were admitted to the Shahid Beheshti hospital in Kashan, Iran, from April to October 2014. Participants were selected using a convenience sampling method and were assigned to intervention (n = 33) and control (n = 33) groups using permuted-block randomization. Patients in the intervention group were treated with TENS 1 hour before surgery, while the placebo was administered to patients in the control group. All of the patients underwent inguinal hernia repair by the Lichtenstein method, and pain intensity was evaluated at 2, 4, 6, and 12 hours after surgery using a visual analogue scale. Additionally, the amounts of analgesic administered by pump were calculated and compared between the two groups. RESULTS: The mean estimated postoperative pain intensity was 6.21 ± 1.63 in the intervention group and 5.45 ± 1.82 in the control group (P = 0.08). In the intervention group pain intensity at 2 and 4 hours after surgery were 3.54 ± 1.48 and 5.12 ± 1.41 (P < 0.001), respectively. In the control group these values were 4.0±1.5 and 4.76 ± 1.39 (P = 0.04), respectively. No significant differences were observed in mean pain intensities at 6 and 12 hours. CONCLUSIONS: TENS can reduce postoperative pain in the early hours after inguinal hernia repair surgery.

Gastrointestinal complaints in shift-working and day-working nurses in Iran.

BACKGROUND: There is evidence in the scientific literature of the adverse physiological and psychological effects of shift work. The work of nurses in hospitals is connected with shift and night work. Several publications have described gastrointestinal disturbances in shift workers. The aim of this study was to compare the frequency of gastrointestinal (GI) complaints of nurses on a rotating shift with that of nurses on a regular day shift. METHODS: The study involved 160 nurses (133 working in shifts and at night and 27 working on day shifts) in the Shahid Beheshti Hospital in Kashan, Iran. These nurses answered a Gastrointestinal Symptom Questionnaire regarding the presence of gastrointestinal symptoms (including heartburn, regurgitation, constipation, diarrhea and bloating). Positive responses required frequent symptom occurrence in the past 4 weeks. Significance of group differences was assessed by chi-square and Fisher-exact tests. RESULTS: Prevalence of GI symptoms was significantly higher (p = 0.009) in rotating-shift nurses (81.9%) than in day-shift nurses (59.2%). Irregular meal consumption (p = 0.01) and GI medications (p = 0.002) were all significantly higher among the rotating shift nurses. In both groups, regurgitation was the most common symptom. CONCLUSION: Nurses on rotating shifts in Iran experience more GI disturbances than do nurses on day shifts.

Adherence to American Society of Health-System Pharmacists surgical antibiotic prophylaxis guidelines in Iran.

We assessed the appropriateness of surgical antibiotic prophylaxis in 6 teaching hospitals in Shiraz, Iran, using the American Society of Health-System Pharmacists guideline as a reference. We reviewed the medical records of 1,000 patients who underwent 1 of 9 different surgical procedures (1 procedure per patient). The proportion of procedures in which there was compliance with all guideline recommendations was 0.3%. The most common mistakes were overuse and misuse of antibiotics.