Comorbidity of metabolic syndrome components in a population-based screening program: A latent class analysis.

Background: The prevalence of metabolic syndrome (MS) is rapidly increasing in the world. Thus, the aim of the present study was to identify the latent subgroups of Iranian male adults based on MS components and investigate the effect of abnormal alanine aminotransferase (ALT) and aspartate aminotransferase (AST), high total cholesterol (TC), and low-density lipoprotein (LDL) on the odds of membership in each class. Methods: In the present study, we used the data of a population-based screening program conducted on 823 urban adult men aged 25 years and older in city of Qom in 2014. Abdominal obesity, fasting blood sugar (FBS), blood pressure, and serum lipid profile were measured in participants after for at least 8 hours. MS was defined according to the Adults Treatment Panel III criteria. Latent class analysis was used to achieve the aims of study. Analyses were conducted using PROC LCA in SAS 9.2 software. In all analysis, p value < 0.05 was considered statistically significant. Results: There were 3 different latent classes among participants. Latent class 1, non-MS, 55.1%; latent lass 2, at risk, 21.3%; and finally latent class 3, MS, with 23.6% of the participants. Age (OR=0.98, 95% CI: 0.98-0.99, high LDL (OR=0.27, 95% CI: 0.13-0.56), high TC (OR=8.12, 95% CI: 4.40-15.00), and abnormal ALT (OR=2.25, 95% CI 1.49-3.41) were associated with at risk class. Also, only age (OR=1.02, 95% CI: 1.01-1.04) was associated with MS class. The most prevalent components among the participants were having low HDL (34.0%) and high WC (33.9%). Conclusion: Notable percent of samples fell in "at risk" and "MS" classes, which stress the necessity of designing preventive interventions for these specific stratums of population.

Efficacy of peritonsillar infiltration with dexmedetomidine versus tramadol in comparison to placebo for pain control and sedation after tonsillectomy in pediatric patients: A randomized clinical trial.

Objective: This article aimed to assess the efficacy of peritonsillar infiltration with dexmedetomidine-ropivacaine versus tramadol-ropivacaine for pain control and sedation after tonsillectomy in pediatric patients. Materials and Methods: This double-blind clinical trial recruited 99 eligible children (4-8 years old) undergoing tonsillectomy and assigned to three block-randomized groups, receiving dexmedetomidine-ropivacaine (group A), tramadol-ropivacaine (group B), or placebo-ropivacaine (group C). The vital signs included blood pressure, heart rate, and SaO2 before anesthesia induction, during surgery at regular intervals until 24 h after surgery. The duration of surgery and recovery, complications, and analgesic consumption were recorded and pain scores were measured by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Oucher scales as well as sedation scores by the Wilson sedation scale. Data were analyzed within SPSS 20 at a significance level of 0.05. Results: The lowest pain scores were measured by the CHEOPS scale in the dexmedetomidine-ropivacaine group (P < 0.05). Statistically significant difference was observed in the CHEOPS pain score between the first two groups at 30 min, 1 h, 2 h, and 4 h after surgery (P < 0.01). The differences were revealed in the Oucher pain assessments among all groups from the time of recovery to four postoperative hours (P < 0.05), with the lowest in the dexmedetomidine-ropivacaine group whose sedation score was greater during recovery and 5 min after surgery (P < 0.05). Subjects in tramadol group had six cases of dizziness and nausea, while no side effects were observed in two other groups (P < 0.05). Only seven participants receiving dexmedetomidine required acetaminophen, but 29 in the tramadol group and all in the placebo group demanded to receive acetaminophen (P = 0.001). Conclusion: The authors concluded that dexmedetomidine as an adjuvant to ropivacaine has better performance in local infiltration for intra- and post-tonsillectomy analgesia and postoperative sedation, without any special side effects (like the placebo group), and that it hence is recommended to be used for local infiltration during tonsillectomy.

Effects of ketamine, granisetron and dexmedetomidine on postoperative shivering and hemodynamic changes after general anesthesia: a double-blind randomized clinical trial.

Postoperative shivering is one of the most common complications of surgeries. The current research compared the effects of ketamine, granisetron, and dexmedetomidine on reducing postoperative shivering after general anesthesia. This double-blind clinical trial enrolled 148 patients (39.08 ± 5.99 years old) who had been admitted to Vali-Asr Hospital of Arak, Iran in 2019-2021. The study drugs, including dexmedetomidine, ketamine, granisetron and normal saline, were administered in corresponding groups 30 minutes before the end of surgery. The results showed that dexmedetomidine reduced mean arterial pressure and heart rate in patients. The lowest incidence of shivering was observed in the dexmedetomidine group and it increased the duration of recovery. Overall, dexmedetomidine is recommended to reduce postoperative shivering after general anesthesia, but the increase in duration of recovery should be considered.

Comparison of the effects of tranexamic acid, nitroglycerin, and remifentanil on the prevention of bleeding during herniated lumbar intervertebral disc surgery: A randomized clinical trial.

Background: Surgery is a well-known and effective method of treating lumbar intervertebral disc herniation. The present study aimed to compare the effects of administering tranexamic acid (TXA), nitroglycerin (NTG), and remifentanil (REF) on hemorrhage prevention during herniated lumbar intervertebral disc surgery. Methods: A double-blind clinical trial was conducted on 135 participants undergoing lumbar intervertebral disc surgery. A randomized block design was used for subject assignment to three groups including TXA, NTG, and REF. The hemodynamic parameters, bleeding rate, hemoglobin level, and the amount of infused propofol were measured and recorded after surgery. Data were then analyzed in SPSS software using Chi-square test and analysis of variance. Results: The mean age of participants in the study was 42.12 ± 7.93 years, and all three groups were equal in terms of demographic characteristics (P > 0.05). The mean arterial pressure (MAP) of the TXA and NTG groups was notably higher than the REF group (P < 0.008). The mean heart rate (HR) of the TXA and NTG groups was notably higher than the REF group (P < 0.05). The propofol dosage used in the TXA group was higher than the two groups of NTG and REF (P < 0.001). Conclusion: Among participants undergoing lumbar intervertebral disc surgery, the greatest MAP variability was observed in the NTG group. Higher mean HR and propofol consumption was observed in the NTG and TXA groups when compared to REF. No statistically significant differences were noted between groups in oxygen saturation or bleeding risk. Based on these findings, REF may be considered a preferred surgical adjunct over TXA and NTG during lumbar intervertebral disc surgery.

Comparison of adjuvant therapy with midazolam, paracetamol, tramadol, or magnesium sulfate during intravenous regional anesthesia with ropivacaine: A randomized clinical trial.

Background: Intravenous (IV) regional anesthesia is an easy, safe, reliable, and efficient option for inducing anesthesia during surgeries but with tourniquet-related pain. This study aimed to evaluate midazolam, paracetamol, tramadol, and magnesium sulfate administration as adjuvants with ropivacaine on pain relief and hemodynamic changes in IV regional anesthesia. Methods: A randomized, double-blind, placebo-controlled trial was conducted in subjects undergoing forearm surgery with IV regional anesthesia. The block randomization method was used to assign eligible participants to each of five study groups. Hemodynamic parameters were assessed before applying the tourniquet, at prespecified time points (5, 10, 15, and 20 min), then and every subsequent 10 min until surgery completion. A Visual Analog Scale was used to assess pain severity at baseline followed by every 15 min until completion of the surgery, and after tourniquet deflation every 30 min to 2 h, and at 6, 12, and 24 h postoperative. Data were analyzed using Chi-square and analysis of variance with repeated data testing. Results: The shortest onset and the longest duration of sensory block were observed in the tramadol group and the shortest onset of motor block in the midazolam group (P < 0.001). Pain score was estimated to be significantly lower in the tramadol group at the time of tourniquet application and release, and 15 min to 12 h after tourniquet release (P < 0.05). In addition, the lowest dose of pethidine consumption was observed in the tramadol group (P < 0.001). Conclusion: Tramadol appeared to be able to effectively relieve pain, shorten the onset of sensory block, prolong the duration of sensory block, and achieve the lowest consumption of pethidine.

The Pain Control Efficacy of Zolpidem versus Melatonin after Intervertebral Disc Herniation Surgery under General Anaesthesia: A Randomised Clinical Trial.

Background: Postoperative pain management has been linked with multiple clinically relevant complications such as thromboembolism, myocardial ischaemia, and cardiac arrhythmias. Objectives: The present study moves towards an evidence-based approach to the therapeutic efficacy of zolpidem and melatonin in a better clinically meaningful pain relief following intervertebral disc herniation surgery under general anaesthesia. Materials and Methods: Undertaking a randomised, parallel-group, double-blind, clinical trial, 60 patients meeting eligibility (mean age ≈ 39, 50% female and 50% men) were offered intervertebral disc surgery at the Arak-based Valiasr Hospital and stratified into two interventional arms by block randomisation. Data including (i) pain (visual analog scale) and sedation (Ramsay sedation scale) scores during recovery and at all five initial 24-h time points (two, four, six, 12, 24); (ii) adverse events inclusive of mild nausea and dizziness, pethidine consumption; and (iii) ongoing haemodynamic parameters, including heart rate, blood pressure, and oxygen saturation were collected. Data were analysed at a significance level of P = 0.05 (SPSS 20.0, IBM Corp). Results: Our results showed no perceived statistically significant between-arm difference in three functional haemodynamic parameters, duration of surgery, and adverse events, as well as in sedation and pain scores (P < 0.05). Our results showed no between-arm difference in analgesia and sedation, haemodynamic changes, and postoperative adverse events. Conclusion: The findings taken together lent a strong support for the highly encouraging efficacy of both drugs in affording adequate analgesia at 24 postoperative hours without any adverse events needing to be thought of. Therefore, both zolpidem and melatonin were promising postoperative pain relievers, while no drug is demonstrably superior to the other.

Comparison of the Sedative, Hemodynamic, and Anesthetic Effect of Dexmedetomidine, Ketamine, and Etomidate on Cataract Surgery by Phacoemulsification Method: A Randomized Clinical Trial.

Purpose: To compare dexmedetomidine, ketamine, and etomidate in the induction of sedation and hemodynamic changes in patients undergoing cataract surgery by phacoemulsification method. Methods: This was a double-blind clinical trial study carried out on 128 patients. Using the block randomization method, the patients were divided into four equal groups (dexmedetomidine, ketamine, etomidate, and control). Mean arterial pressure, heart rate, and arterial oxygen saturation, Ramsay Sedation Score were recorded every 5 min intraoperatively, in recovery, and 1, 2, 4, and 6 h postoperatively. Moreover, the Aldrete score was measured in recovery time for discharge from the recovery room. Results: The mean age of participants was found to be 63.16 ± 6.07 years, and there was no statistically significant difference between the groups in terms of age, sex, and body mass index, SpO2, and heart rate (P > 0.05). From 15 min after the start of surgery to 6 h postoperatively, the mean arterial pressure in the dexmedetomidine group was significantly lower than that in the other three groups, including ketamine, etomidate, and control (P < 0.05). The mean sedation score (Ramsay) during recovery and 1 h postoperatively was higher in the dexmedetomidine group compared with that in the control group, whereas the recovery time in the dexmedetomidine group was higher than that in the other groups (P < 0.001). In addition, the amount of propofol consumption in the two groups of dexmedetomidine and ketamine was significantly less than that in the etomidate and control groups (P < 0.001). Conclusions: According to the results, dexmedetomidine caused better hemodynamic changes with more reduction in blood pressure and heart rate, and patients in the dexmedetomidine group did not require any specific medical treatment. Moreover, higher patient satisfaction and longer recovery duration were observed in the dexmedetomidine group than in the other study groups. As such, it is suggested that dexmedetomidine be used as an adjuvant in cataract surgery for more sedation, analgesia, and optimal intraoperative conditions.

Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries: a randomized clinical study.

This trial-based paper strives to address the comparative efficacy of some ropivacaine adjuvant options, comprising dexmedetomidine, granisetron, and nitroglycerin, on pain and hemodynamic changes in intravenous anesthesia for forearm surgeries. This double-blind, placebo-controlled study enrolled four block-randomized eligible groups with patients (overall, n=128) undergoing orthopedic forearm surgeries in the dexmedetomidine, nitroglycerin, granisetron, and placebo groups. Intra- and post-operative vital signs (mean arterial pressure/heart rate/ oxygen saturation) were monitored at baseline and captured every 10 minutes until the end of the surgery, as well as the onset of sensory and motor block and length and duration of the block and mean opioid use within 24 hours. Lastly, pain was noted after tourniquet inflation (at 15, 30, and 45 minutes every 15 minutes until the end of surgery) and after deflation (every 30 minutes to 2 hours at 30, 60, 90, and 120 minutes), as well as 6, 12, and 24 hours after the tourniquet was deflated. The dexmedetomidine-sedated subjects appeared to demonstrate quicker onset and longer length and duration of sensory and motor block, plus less pain and opioid use at all scheduled times (both P = 0.0001). Dexmedetomidine is recommended as an adjuvant to regional anesthesia (Bier's block), while being coupled with the rapid onset and prolonged length and duration of sensory and motor blocks, in addition to soothed pain and diminished opioid use within postoperative 24 hours. The study was approved by Ethics Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1398.112) on July 21, 2019, and registered at Iranian Registry of Clinical Trials (registration number IRCT20141209020258N123) on November 2, 2019.

A randomized parallel design trial of the efficacy and safety of tranexamic acid, dexmedetomidine and nitroglycerin in controlling intraoperative bleeding and improving surgical field quality during septorhinoplasty under general anesthesia.

In this blinded clinical trial, we attempted to compare the efficacy and safety of administering tranexamic acid, dexmedetomidine and nitroglycerin in preventing intraoperative bleeding and improving the quality of the surgical field during septorhinoplasty under general anesthesia. A total of 105 patients scheduled for septorhinoplasty were enrolled and randomly assigned into three groups based on the balanced-block randomization method. First group received 1 µg/kg intravenous injection dexmedetomidine, second group received 10 mg/kg intravenous injection tranexamic acid and third group received 0.5 µg/kg nitroglycerin, intravenously. The study sample was composed of 105 participants with the total mean age of 25.85 ± 6.52 years, and 59.05% of participants were female and the mean of body mass index was 24.34 ± 2.57 kg/m2. The results showed that there was no statistically significant difference in terms of arterial oxygen saturation, mean arterial pressure, heart rate, bleeding rate, duration of surgery, and surgeon satisfaction among the three groups; however, there was a significant difference in the extubation time, recovery time and the dose of administered propofol among the three groups. Dexmedetomidine reduced the dose of administered propofol while increasing the extubation time and recovery time. In the tranexamic acid group compared with the other two groups, the recovery time was shorter. However, all the three drugs could reduce intraoperative bleeding and lead to surgeon satisfaction. It can be concluded that all these three drugs can be utilized to control bleeding and improve the quality of the surgical field but the ultimate decision lies with the anesthesiologist's judgment and the conditions of the patient. The study protocol was registered in the Iranian Registry of Clinical Trials (registration No. IRCT20141209020258N121) on September 24, 2019 and it was ethically approved by the Ethical Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1397.355) on February 24, 2019.

Effects of adding dexmedetomidine, fentanyl, and verapamil to 0.5% ropivacaine on onset and duration of sensory and motor block in forearm surgeries: a randomized controlled trial.

This study was aimed to compare the onset and duration of axillary block with ropivacaine 0.5% plus either dexmedetomidine, fentanyl, or verapamil in forearm surgeries. This double-blind clinical trial enrolled three equal-sized block-randomized groups of patients (n = 105) scheduled for hand and forearm surgery at Arak, Iran in 2019, who received: (i) ropivacaine (40 mL/0.5%) + dexmedetomidine (1 µg/kg), (ii) ropivacaine (40 mL/0.5%) + fentanyl (1 µg/kg), and (iii) ropivacaine (40 mL/0.5%) + verapamil (2.5 mg), respectively. We recorded some vital signs such as mean arterial pressure, heart rate and oxygen saturation, onset of complete sensory and motor block, duration of the block, opioid use, as well as pain score at recovery and certain time points (2, 4, 6, 12, and 24 hours post-operation). Adding dexmedetomidine to ropivacaine (40 mL/0.5%) prolonged the duration of sensory (P = 0.001) and motor block (P = 0.001) in compared to adding fentanyl and verapamil and it also shortens the time to onset of sensory (P = 0.001) and motor block (P = 0.001). There is a significant difference between three groups in terms of visual analog scale mean and the lowest pain score was obtained in the dexmedetomidine group (P = 0.001), significant time trend (P = 0.001), as well as the time and groups interaction (P = 0.001). Dexmedetomidine was concluded to be associated with alleviated pain; reduced opioid use; short onset of sensory block; and prolonged duration of sensory and motor block. It hence is recommended to lengthen the duration of axillary block and to help relieve postoperative pain and ultimately to move to cut down the postoperative opioid use in forearm surgery. The study was approved by the Ethical Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1397.266), and registered on Iranian Registry of Clinical Trials (registration No. IRCT20141209020258N111) on May 9, 2019.

The effect of dexmedetomidine on decrease of cough, hemodynamic parameters and Ramsay score versus lidocaine during general anesthesia: a randomized clinical trial.

Physiological responses remain common during anesthesia emergence and endotracheal extubation, causing some complications. We aimed to address the effect of dexmedetomidine (DEX) on decrease of cough, hemodynamic parameters and Ramsay score in comparing to lidocaine (LID) during anesthesia. In this double-blinded randomized clinical trial 120 hospitalized patients undergoing general anesthesia were enrolled after obtaining written consent. Block random allocation was used to assign patients into three groups including DEX (intravenous injection; 0.5 µg/kg), LID (1.5 mg/kg), and PBO (10 mL normal saline) at 10 minutes before anesthesia. No statistical significance was uncovered among three groups in blood pressure, oxygen saturation, frequency of laryngospasm and duration of surgery amongst the groups (P > 0.05), but DEX having lower heart rate and cough frequency (P < 0.05). Moreover, the mean of Ramsay score was statistically higher in DEX and LID groups than PBO except at the 50th and 60th minutes after extubation (P < 0.05). Since the mean of Ramsay score was higher in DEX vs. LID groups and reduced heart rate and cough frequency demonstrates in DEX, it seems that DEX could be an appropriate drug on suppressing cough during anesthesia without side effects. The study protocol was approved by the Ethical Committee of Arak University of Medical Sciences by code IR.ARAKMU.REC.1397.140 on August 19, 2018, and the protocol was registered at Iranian Registry of Clinical Trials by code IRCT20141209020258N97 on February 22, 2019.

Efficacy of dexmedetomidine-ketamine vs. fentanylketamine on saturated oxygen, hemodynamic responses and sedation in cystoscopy: a doubleblinded randomized controlled clinical trial.

Cystoscopy is a diagnostic and invasive procedure for treatment and follow-up of genitourinary system patients and could be performed with a variety of anesthesia techniques. The study aimed to assess the efficacy of dexmedetomidine-ketamine vs. fentanyl-ketamine on sedation and analgesia for cystoscopy. This double-blind randomized controlled clinical trial enrolled 60 patients undergoing cystoscopy in two groups. Patients were assigned randomly by block random allocation method into dexmedetomidine-ketamine group (1 µg/kg dexmedetomidine) and fentanyl-ketamine group (2 µg/kg fentanyl) receiving ketamine (0.5 mg/kg). Subsequently, mean blood pressure, heart rate, saturated oxygen, respiratory rate, pain intensity, Ramsay score for sedation level, cystoscopy duration, and urologic satisfaction were measured and compared between two groups. Both the groups were similar regarding age, sex and baseline hemodynamic parameters (P > 0.05). Lower heart rate and pain score were revealed in the dexmedetomidine-ketamine group at 25-50 and 30-60 minutes, respectively, after cystoscopy (P < 0.05). Moreover, repeated measure test showed that there was significant difference in trend of respiratory rate and pain score between two groups (P = 0.017) and was lower in dexmedetomidine-ketamine group. The dexmedetomidine-ketamine group relieves pain 30 minutes after cystoscopy with stable hemodynamic parameters during operation. Therefore, dexmedetomidine-ketamine is recommended to be employed for pain relief in subjects undergoing cystoscopy. The study was approved by Ethical Committee of Arak University of Medical Sciences with IR.ARAKMU.REC.1397.108 on July 2, 2018, and registered in Iranian Registry Clinical Trial center with code IRCT20141209020258N105 on April 21, 2019.

Efficacy of dexmedetomidine versus remifentanil to blunt the hemodynamic response to laryngoscopy and orotracheal intubation: a randomized clinical trial.

The study aims to compare the efficacy of dexmedetomidine (DEX) vs. remifentanil (REM) to blunt the hemodynamic response to laryngoscopy and orotracheal intubation. Enrolled in a double-blind clinical trial, 124 patients undergoing elective surgery under general anesthesia at Amirkabir Hospital (Arak, Iran), were assigned into four groups equally (31 patients in each group), DEX, REM, DEX-REM, and normal saline (NS), who received intravenous DEX (1 µg/kg), REM (1 µg/kg), their equal mixture (each 0.5 µg/kg, 1 minute before tracheal intubation), and NS, respectively. Then, blood pressure (BP), heart rate (HR), and arterial oxygen saturation (SaO2) were measured on arrival to the operating room, 1 minute before laryngoscopy and tracheal intubation, immediately after intubation, and afterwards every 5 to 15 minutes, and finally the data were analyzed using SPSS 18.0. The groups were same regarding to age, sex and baseline hemodynamic variables including mean of BP (P = 0.157), HR (P = 0.105) and SaO2 (P = 0.366). Tukey post-hoc test showed that there DEX, REM, and a DEX + REM groups was same regarding to MBP and HR, but these hemodynamic responses were higher in NS group than other groups at all time after laryngoscopy and intubation (P < 0.05). Moreover, repeated measure test showed a decreasing trend in MBP and HR in three intervention groups at all time after intubation (P > 0.05). A DEX/REM mixture had the lowest BP and three intervention groups had lower HR than the NS group. A mixture of the drugs used seems to lead to not only a prevented increase in HR and BP during laryngoscopy but also a decreased BP and HR. This study was registered in Iranian Registry Clinical Center with the registration No. IRCT2016092722254N1.

Prevalence of Metabolic Syndrome and Associations with Lipid Profiles in Iranian Men: A Population-Based Screening Program.

PURPOSE: Metabolic syndrome (MS) is characterized by a collection of interdependent disorders, including abdominal obesity, dyslipidemia, hyperglycemia, hypertension, and diabetes. The current study aimed to estimate the prevalence of MS in Qom, Iran. MATERIALS AND METHODS: A population-based screening program was conducted in the city of Qom, in 845 urban adult men over 25 years old in 2014. Abdominal obesity, fasting blood glucose (FBG), blood pressure, and the serum lipid profile were measured in subjects after fasting for at least 8 hours. MS was defined according to the Adult Treatment Panel III criteria. Data were analyzed using the chi-square test, t-test, and multiple logistic regression. RESULTS: The overall prevalence of MS was 23.0%, and the most common prevalent metabolic abnormalities associated with MS were low high-density lipoprotein cholesterol (<40 mg/dL) in 34.3% of subjects, a waist circumference >102 cm in 33.9%, blood pressure ≥130/85 mmHg in 27.6%, fasting triglycerides (TG) ≥150 mg/dL in 25%, and FBG ≥110 mg/dL in 20.6%. A FBG level ≥110 mg/dL (odds ratio [OR]=4.85; 95% confidence interval [CI], 2.14~8.24), dyslipidemia (OR=3.51; 95% CI, 2.10~5.89), and a fasting TG ≥150 mg/dL were the most important factors contributing to MS. CONCLUSIONS: The prevalence of MS in men in Qom was higher than has been reported in other countries, but it was lower than the mean values that have been reported elsewhere in Iran. FBG was the most important factor contributing to MS, and all elements of the lipid profile showed important associations with MS.

Comparison of petal of Crocus sativus L. and fluoxetine in the treatment of depressed outpatients: a pilot double-blind randomized trial.

Depression is one of the most common neuropsychiatric conditions, with a lifetime prevalence approaching 17%. Although a variety of pharmaceutical agents is available for the treatment of depression, psychiatrists find that many patients cannot tolerate the side effects, do not respond adequately, or finally lose their response. On the other hand, many herbs with psychotropic effects have far fewer side effects. They can provide an alternative treatment or be used to enhance the effect of conventional antidepressants. A number of recent preclinical and clinical studies indicate that stigma and petal of Crocus sativus have antidepressant effect. Our objective was to compare the efficacy of petal of C. sativus with fluoxetine in the treatment of depressed outpatients in an 8-week pilot double-blind randomized trial. Forty adult outpatients who met the DSM- IV criteria for major depression based on the structured clinical interview for DSM- IV participated in the trial. Patients have a baseline Hamilton Rating Scale for Depression score of at least 18. In this double-blind and randomized trial, patients were randomly assigned to receive capsule of petal of C. sativus 15 mg bid (morning and evening) (Group 1) and fluoxetine 10 mg bid (morning and evening) (Group 2) for a 8-week study. At the end of trial, petal of C. sativus was found to be effective similar to fluoxetine in the treatment of mild to moderate depression (F=0.03, d.f.=1, P=0.84). In addition, in the both treatments, the remission rate was 25%. There were no significant differences in the two groups in terms of observed side effects. The present study is supportive of other studies which show antidepressant effect of C. sativus.

The prevalence of phantom vibration/ringing syndromes and their related factors in Iranian' students of medical sciences.

BACKGROUND AND AIM: Mobile phone abuse can cause pathologic stress that may lead to addictive behavior such as Phantom Vibration Syndrome (PVS) and Phantom Ringing Syndrome (PRS). The current study aimed to determine the PVS and PRS due to mobile phone use in students of Qom University of medical Sciences in Iran. DESIGN: Cross-sectional study. PARTICIPANTS: The participants were 380 students selected by proportional stratified random sampling method in each stratum. MEASUREMENTS: Data were collected by a self-administered questionnaire and analyzed by descriptive and analytic statistical methods including t-test, chi square and analysis of variance. FINDINGS: The prevalence of PVS and PRS due to mobile phones in students of medical sciences was estimated to be 54.3% and 49.3%, respectively. PVS was higher in female students than in males while the PRS was higher in male students. There was a significant relationship between PVS and using social networks such as Viber, WhatsApp, and Line. In addition, a significant association was observed between PVS and friend-finding, chatting and entertainment. CONCLUSION: Studies should be done in the future to assess the long-term complication of overusing mobile phones. In the current study, the prevalence of PVS and PRS in half of students is considerable.

Endotracheal intubation in patients with difficult airway: using laryngeal mask airway with bougie versus video laryngoscopy.

Airway management is essential for safe anesthesia and endotracheal intubation is the most important procedure by which critically ill patients can be better managed, especially if done quickly and successfully. This study aimed to compare the techniques of intubation through laryngeal mask airway (LMA) using a bougie versus video laryngoscopy (VL) regarding to intubation success and the quality of intubation indices in patients with difficult airways. This randomized clinical trial was performed on 96 patients aged 16-76 years with Mallampati class 3 or 4 who underwent elective surgery. Once the demographics were recorded, patients were randomly divided into two groups and the first group intubated with VL, and the second group intubated through laryngeal mask using a bougie. Then vital signs, arterial oxygen saturation, the time required for successful intubation, and ease of intubation were recorded. Here t-tests, chi-square, Fisher exact tests, and analysis of variance for repeated measurement were used to analyze the data in SPSS software. The overall success rates of intubation in VL and LMA groups were 46 (96%) and 44 (92%), respectively. The mean duration of intubation for the LMA and VL groups was 18.70 ± 6.73 and 14.21 ± 4.14 seconds, respectively (P < 0.001). Moreover, visual analogue scale score for pain in throat was significantly lower in VL group than LMA (1.65 ± 0.76 vs. 1.33 ± 0.52). Moreover, easy intubation in bougie group was 50%, while the easy intubation in VL was 73% (P = 0.023). In addition, incidence of cough was 31% in the LMA with bougie group and 9% in VL group (P = 0.005). The VL technique is an easier method and has a shorter intubation time than LMA using bougie, and causes a lower incidence of coughing, laryngospasm in patients that need intubation. Moreover, cough and discomfort in the throat tend to be less in VL, and the LMA could be used as replacement of VL in hard situations.

Comparing the efficacy and safety of laryngeal mask airway, streamlined liner of the pharyngeal airway and I-gel following tracheal extubation.

Adverse events following surgical operations are common complications due to removal of tracheal tube in contrast to the tracheal intubation. Awareness about the new methods and strategies for tracheal tube extubation is necessary for a safe and successful extubation. Therefore, we aimed to assess the safety and efficacy of laryngeal mask airway (LMA), streamlined liner of the pharyngeal airway (SLIPA) and I-gel in extubation time of tracheal tube. A one-single randomized clinical trial was conducted in 105 eligible patients in three groups including LMA, SLIPA and I-gel. The patients were under surgery after general anesthesia with propofol (2-3 mg/kg) and fentanyl (1-2 µg/kg). Hemodynamic responses and extubation consequences including coughing rate, laryngospasm, airway obstruction, apnea, breath holding and straining of patients, vomiting, and need for re-intubation were recorded every 5 minutes since inserting of supraglottic airway devices (SADs) until patients restore consciousness. Analysis of data was conducted in SPSS software by analysis of variance (ANOVA) and ANOVA for repeated measurements tests. The overall successful insertion was 100% for LMA and I-Gel and this rate was 97.1% for SLIPA method. A significant decrease was observed in trend of hemodynamic responses in all three groups. Nevertheless, the MBP was lower in LMA group and lower HR was observed in I-Gel and higher HR occurred in SLIPA (P < 0.05). Three groups was same statistically regarding sore throat, vomiting, coughing, breath holding, apnea, laryngospasm, and re-intubation need (P > 0.05). However, the incidence rate of apnea, and laryngospasm, as well as re-intubation need in SLIPA group was 2.9%, respectively. LMA, I-GEL and SLIPA could be considered as useful and safe devices for ventilation control after tracheal tube removal at the end of operation. Three devices were same regarding to sore throat, vomiting, coughing, and breath holding. However, LMA showed lower side effects while SLIPA was related to more occurrences of apnea, laryngospasm, and re-intubation need.

Premedication effect of dexmedetomidine and alfentanil on seizure time, recovery duration, and hemodynamic responses in electroconvulsive therapy.

INTRODUCTION: Electroconvulsive therapy (ECT) is an effective treatment for many mental disorders, especially severe and persistent depression, bipolar disorder, and schizophrenia. The aim of this study is to compare the effect of dexmedetomidine and alfentanil on agitation, satisfaction, seizure duration, and patients hemodynamic after ECT. MATERIALS AND METHODS: In a three phase crossover randomized clinical trial, 75 patients aged between 18 and 50 years and candidate for ECT were enrolled and assigned into three groups (25 patients in each group). All patients, respectively, took premedication of dexmedetomidine, alfentanil, or saline in three consecutive phases. Patients received 0.5 µg/kg dexmedetomidine, 10 µg/kg alfentanil or normal saline intravenously, 10 min before induction. Finally, seizure and recovery duration, satisfaction and agitation score, and hemodynamic parameters were evaluated. RESULTS: There was no significant difference about seizure duration, agitation score, and hemodynamic parameters between groups but recovery duration was significantly lower in the control group than dexmedetomidine (P = 0.016) and alfentanil group (P = 0.0001). Patients' satisfaction was significantly higher in intervention groups (alfentanil and dexmedetomidine groups) (P = 0.0001). CONCLUSION: Given the equal effects of alfentanil and dexmedetomidine, it seems that choosing one of these two drugs for premedication of patients undergoing ECT is appropriate. Drug choice is influenced by numerous factors such as accessibility of each drug and the dominance of anesthesiologist and psychiatrist.

Omega-3 and Zinc supplementation as complementary therapies in children with attention-deficit/hyperactivity disorder.

OBJECTIVE: The aim of this study is to evaluate the effect of zinc and omega-3 supplements as adjunctive drugs in the treatment of attention-deficit/hyperactivity disorder (ADHD) of children. METHODS: This study is a randomized, double-blind clinical trial conducted on 150 children aged 6-15 years old that diagnosed as new cases of ADHD. Study subjects were evaluated for 8 weeks. Besides of drug of choice (methylphenidate) for the ADHD, patients received placebo in the control group (n = 50), zinc sulfate in second group (n = 50), and omega-3 (n = 50) in third group. Clinical improvement was checking by Conners' Parent and Teacher Rating Scales before and in 2(nd), 4(th), and 8(th) week of treatment. Results were analyzed with SPSS version 16 software. FINDINGS: In this study, mean scores of Conners' scale showed significant improvement during treatment in the zinc group compared to control group in children that affected to attention-deficit disorder subtype of ADHD (P = 0.02). Moreover, in omega-3 group, better clinical response was seen than other groups (P < 0.05). However, there was no significant difference between omega-3 group compared to placebo group in the mean scores of Conners' scale (P = 0.89). CONCLUSION: Zinc supplementation accompanied by the main treatment significantly improves symptom of attention-deficit disorder subtype of ADHD. However, omega-3 supplementation was superior to zinc and placebo in the clinical improvement of ADHD.