Evaluation of nurses' knowledge and performance regarding preparation and injection of intravenous drugs in pediatric wards in Iran.

BACKGROUND: A error in intravenous injection in pediatric wards can cause irreparable injuries. This study aimed to determine the level of knowledge and performance of nurses in terms of preparation and injection of intravenous drugs in pediatric wards of hospitals affiliated to Isfahan University of Medical Sciences. METHODS: This cross-sectional study was conducted in 2022 on 156 nurses working in pediatric wards. The data was collected with demographic information questionnaire and the knowledge and performance of the participants were determined using a researcher-made questionnaire, including the five rights of medication administration (preparation and injection, medication error, drug side effects, family empowerment, and documentation) using self-reporting and observation methods. Formal and content validity was calculated using the opinions of 10 experts and Cronbach's alpha with 40 samples. RESULTS: The mean and standard deviation of total nurses' knowledge and performance scores were 58.31 + 10.1 and 66.1 + 14.4, respectively. Moreover, the mean and standard deviation of nurses' knowledge scores were 63.55 + 14.3 for documentation, 46.1 + 7.9 for preparation and injection, 73.9 + 12.3 for drug side effects, 58.4 + 10.2 for medication error, and 69.4 + 9.4 for family empowerment. Besides, the mean performance was 69.1 + 17.6 for documentation, 61.3 ± 9.9 for preparation and injection, 78.21 + 12 for drug side effects, 58.6 + 15 for medication error, and 65.4 + 17.7 for family empowerment. CONCLUSION: The results showed that the mean knowledge and pharmacological performance of nurses working in pediatric wards in different areas of the principles of medicine were not at the desired level, and this can affect children adversely.

Topical sucralfate for treatment of mucocutaneous conditions: A systematic review on clinical evidences.

Sucralfate is an aluminum salt of sucrose octasulfate, generally considered safe in terms of adverse effects. Systemic sucralfate is FDA-approved for the treatment of duodenal ulcers. Since 1991, topical sucralfate has been used in various mucocutaneous conditions, but it is not approved by the FDA yet. In this systematic review, the online databases were searched with appropriate keywords, and the papers were screened by the authors. After screening steps, the relevant articles were selected according to the inclusions and exclusions criteria. Finally, the full texts of 18 articles were included for final evaluations. In conclusion, topical sucralfate has some clinical benefit in several mucocutaneous conditions, including mucocutaneous inflammatory conditions (e.g., post-radiotherapy reaction, diaper dermatitis, keratoconjunctivitis sicca, etc.), mucocutaneous infectious disorders (e.g., peristomal wound reaction/infection); ulcers; burns, and also pain relief.

Topical sucralfate for prevention of peristomal wound reaction related to percutaneous endoscopic gastrostomy in children: A randomized controlled trial.

There are no standard protocols for peristomal skin care in children with percutaneous endoscopic gastrostomy (PEG) tubes. This clinical study aimed to evaluate the efficacy of topical sucralfate as a prophylactic intervention in the peristomal wound reaction (PWR)/infection-associated PEG insertion in children. This study was a randomized, single-blind, controlled trial recruiting child under 18 years old who submitted for PEG insertion. Patients were randomly divided to receive topical sucralfate + peristomal wound care (intervention) or peristomal wound care alone (control). In the intervention group, the participants used topical 4% sucralfate cream four times a day for 2 months. Participants were assessed using the total peristomal infection score and PWR grading system at baseline week 1, and monthly up to 5 months after the initiation of the study. Forty-four children after PEG insertion were randomly assigned to two groups. Baseline characteristics of both groups were statistically similar (p > 0.05). Friedman test demonstrated statistically significant differences in grades of PWR during the follow-up period in the control group (p = 0.01); while there was not significantly different in the intervention group (p = 0.47). This finding suggests that the intervention had a prophylaxis effect. Also, there were statistically differences in the score of erythema (p = 0.001) and exudate (p = 0.06) at the seven-time points in the control group. Topical 4% sucralfate can be considered an affordable and available prophylactic treatment for reducing the PWR/infection associated with PEG insertion in children.

The efficacy of hemodialysis on paraquat poisoning mortality: A systematic review and meta-analysis.

Background: Paraquat (PQ) poisoning is a serious public health concern, especially in developing countries, due to its easy access and lack of awareness of potential harms. No effective treatment has been reported yet. Conventional hemodialysis (HD) is still used in many centers for excreting PQ or reducing acute kidney injury, but there is no consensus on its efficacy. Therefore, we aimed to review the HD efficacy in PQ poisoning mortality. Materials and Methods: We searched Web of Science, PubMed, Excerpta Medical Database, Google Scholar, Scopus, Cochrane, Web of Knowledge, Pro-Quest, ScienceDirect, Springer, Clinical Key, Scientific Information Database, Magiran, and Iran-doc, in publications before January 1, 2020. We compared patients who underwent HD (Group 1) with those who did not (Group 2). The outcome was considered mortality/survival. The data were analyzed by Comprehensive Meta-analysis Software. Results: This systematic review and meta-analysis included five studies with a combined total of 203 patients. The patients in the Group 1 had higher mortality than Group 2 (odds ratio, 2.84; 95% confidence interval: 1.22-6.64; P = 0.02). There was no evidence of publication bias (P value for Egger's test = 0.833). Conclusion: Although HD did not affect the survival of patients, other variables such as the amount of ingested PQ, poisoning severity, the time between PQ ingestion and the start of HD, duration, and times of HD sessions may influence the results regarding mortality.

Toll-like receptor 4 activation on human amniotic epithelial cells is a risk factor for pregnancy loss.

BACKGROUND: Maternal-fetal tolerance plays a fundamental role in the maintenance of pregnancy. However, this immunological tolerance can be influenced by intrauterine infections. Human amniotic epithelial cells (hAECs) have immunomodulatory effects and respond to invading pathogens through expressing various toll-like receptors (TLRs). We hypothesize that bacteria or bacterial products affect the immunosuppressive effects of hAECs through TLR stimulation. Here, we investigated how a successful pregnancy can be threatened by TLR4 activation on hAECs on lipopolysaccharide (LPS) engagement. MATERIALS AND METHODS: hAECs were isolated from the amniotic membrane received from six healthy pregnant women. The immunophenotyping of hAECs was studied by flow cytometry. The isolated hAECs (4 × 105 cells/ml) were cultured in 24-well plates in the presence or absence of LPS (5 µg/ml). After 24, 48, and 72 h of incubation, the culture supernatants of hAECs were collected, and the levels of interleukin-5 (IL-5), IL-6, IL-1ß, tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta 1 (TGF-ß1), and prostaglandin E2 (PGE2) were measured by enzyme-linked immunosorbent assay. RESULTS: TLR4 activation showed a stimulatory effect on TGF-ß1 production of hAECs (P < 0.001-0.05). PGE2 production of LPS-stimulated hAECs was significantly increased (P < 0.01-0.05). Moreover, TLR4 could induce TNF-α and IL-1ß production of hAECs (P < 0.0001-0.01), while this effect was not observed on IL-6 production of hAECs. The IL-5 was produced at a very low level in two culture supernatants of hAECs, in which its production was independent of LPS effect. CONCLUSION: TLR4 activation by bacterial components on hAECs may be a potential risk factor for pregnancy complications.

Does hemoperfusion in combination with other treatments reduce the mortality of patients with paraquat poisoning more than hemoperfusion alone: A systematic review with meta-analysis.

BACKGROUND: Paraquat (PQ) poisoning is a serious public health problem in many countries. In spite of different treatments, the mortality is still high. We performed a meta-analysis to see whether hemoperfusion (HP) in combination with other treatments reduces the mortality more than HP alone in patients with PQ poisoning. MATERIALS AND METHODS: We searched EMBASE, PubMed, Google Scholar, ISI Web of Knowledge, Cochrane Central Register of Controlled Trials, Scopus, Springer, TRIP, ProQuest, and references of the included studies from January 2000 to August 2017. Two reviewers independently searched and extracted data. We measured I 2 to determine variance contributed by heterogeneity. To investigate the publication bias, Begg's and Egger's tests were used along with funnel plot analysis. RESULTS: Ultimately 12 articles were included in the meta-analysis. Five articles compared HP with conventional therapy with a total of 1311 patients, and seven articles compared mortality of patients received HP versus those received HP in combination with an additional treatment. HP alone reduced the odds of death (odds ratio [OR] = 0.20; 95% confidence interval [CI]: 0.11-0.40, P < 0.0001) compared to conventional therapy. Furthermore, the odds of death was higher in HP group compared to those received HP in combination of additional treatments (OR = 1.24; 95% CI: 1.05-1.46, P = 0.01). CONCLUSION: The mortality was less in HP-treated group compared to those received only conventional therapy. Addition of other treatments with HP reduced the mortality more than HP alone.

Is Admission Serum Sodium Concentration a Clinical Predictor for the Outcome of Therapy in Critically Ill Poisoned Patients?

BACKGROUND: Disorders of serum sodium concentration are some of the most electrolyte abnormalities in the intensive care unit (ICU) patients. These disorders adversely affect the function of vital organs and are associated with increased hospital mortality. PURPOSE: In the present study we aimed to evaluate the effects of serum sodium concentration abnormalities at the time of hospital admission on the clinical outcome of therapy in a cohort of critically ill poisoned patients. METHODS: In this cross-sectional study, 184 critically ill poisoned patients aged >18 years and in the first 8 hours of their poisoning, hospitalized in the ICU of a tertiary care university hospital (Isfahan, Iran) between 2010-2012, were evaluated at the admission time and 24 hours later for serum sodium concentration abnormalities and its relationship with age, gender, consciousness status, ingested drugs and clinical outcome of therapy. The clinical outcome was considered as recovery and mortality. Logistic Regression analysis was performed for predictive variables including serum sodium concentration abnormalities in patients' clinical outcome. FINDINGS: On admission, 152 patients (82.6%) were eunatremic, 21 patients (11.4%) were hyponatremic and 11 patients (6%) were hypernatremic. In the second day eunatremia, hyponatremia and hypernatremia was observed in 84.4%, 13% and 2.2% respectively. Age (OR=1.92; CI=1.18-3.12) and severity of toxicity (OR=1.32; CI=1.12-2.41) were predicting factors of mortality in ICU poisoning patients. CONCLUSIONS: Serum sodium concentration abnormalities are prevalent in critically ill poisoned patient but do not seem to have a predictive value for the clinical outcome of therapy.

Adherence to statin therapy in patients with type 2 diabetes: An important dilemma.

BACKGROUND: Despite the importance of patients' adherence to their drug treatments for achieving desired therapeutic goals and the proven role 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) for the health status of patients with cardiovascular diseases, there is not enough information regarding diabetic patients' adherence to statin therapy in developing countries. In this clinical study we aimed to assess the adherence of diabetes type 2 patients to statin therapy in a research based community clinic in Iran. MATERIALS AND METHODS: In this prospective clinical study which was done at Isfahan Endocrinology and Metabolism Research Center, 204 diabetic type 2 patients under treatment with statin were interviewed twice and their demographic data (age, gender, body mass index, education), statin information (type, dose) and their serum lipid profile were recorded. Three months after the initial visits, patients were assessed using pill counting method and according to patients' self-reporting and also assessed low-density lipoprotein (LDL) cholesterol goal attainment <100 mg/dl. RESULTS: Adherence rate was 79.7% and 69% according to pill counting and self-reporting among study population. Moreover, 68.4% of patients achieved their LDL cholesterol goal of <100 mg/dl and adherent patients reached therapeutic goal significantly more than those who were considered non-adherence to statin therapy (P < 0.01). CONCLUSION: Adherence to statin therapy, as reflected by pill count method, is significantly related to LDL cholesterol goal achievement in patients with diabetes and dyslipidemia. Pill count method can be used to identify patients who are nonadherent to statin therapy and at high risk for failure to attain LDL cholesterol goals.

N-acetylcysteine, Ascorbic Acid, and Methylene Blue for the Treatment of Aluminium Phosphide Poisoning: Still Beneficial?

OBJECTIVES: Intentional and accidental intoxication with aluminium phosphide (ALP) remains a clinical problem, especially in the Middle East region. Considering the high mortality rate besides lack of any recommended first option drug for its treatment, this study was aimed to compare the therapeutic effects of N-acetylcysteine (NAC), vitamin C (Vit C), and methylene blue; both in isolate and also in combination, for the treatment of ALP intoxication in a rat model. MATERIALS AND METHODS: In this experimental animal study, 80 male Wistar rats in eight groups were intoxicated with ALP (12.5 mg/kg) and treated with a single dose of NAC (100 mg/kg) or Vit C (500-1,000 mg/kg) or methylene blue (1 mg/kg/5 min, 0.1%) or two of these agents or all three of them (controls were not treated). Rats were monitored regarding the parameters of drug efficacy as increased survival time and reduced morbidity and mortality rate for 3 consecutive days to ensure toxin neutralization. Macroscopic changes were recorded and biopsy sections were taken from brain, cerebellum, kidney, liver, and heart for microscopic evaluation regarding cellular hypoxia. RESULTS: The mean survival times of rats exposed to ALP and treated with VitC + NAC was 210.55±236.22 minutes. In analysis of survival times, there was a significant difference between Group 5 which received VitC + NAC and the other groups (P < 0.01). Serum magnesium levels after death were higher than normal (P = 0.01). CONCLUSIONS: Despite the higher survival rate of antioxidant-treated rats compared with controls, this difference was not statistically significant.

Clinical Effects of Rhus coriaria Fruits on Dyslipidemia308 in Adolescents: a Triple-blinded Randomized Placebo-controlled Trial.

OBJECTIVE: Children and adolescents are considered as the best target groups for preventing and controlling the cardiovascular diseases risk factors and reducing mortality in adulthood. Alternative medicine and herbal drugs have been taken into account for managing dyslipidemia in this population. The beneficial effects of Sumac (Rhus coriaria L.) on lipid profile have been confirmed in some laboratory and animal studies. This study was designed to investigate the clinical effects of sumac fruits on dyslipidemia in 12-18 years-old adolescents. METHODS: This randomized triple-blinded clinical trial was conducted on 72 obese adolescents with dyslipidemia from August 2011 to June 2012 in Isfahan Cardiovascular Research Center, Isfahan, Iran. Eligible adolescents were randomly assigned to two case and control groups. The control group received placebo capsules and the case group received capsules containing 500 mg of powdered sumac fruits, each three times a day for one month. Biochemical parameters including 12-hrs fasting serum levels of total cholesterol (Total-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured before the initiation and after the completion of the study protocol. Statistical analysis was performed using the SPSS software, version 16.0, using Independent Samples T-test, or Paired Samples T-test, for between-group and within-group analysis, respectively. FINDINGS: The plasma levels of Total-C, LDL-C, and TG changed significantly over-time in the case group. Furthermore, between-group analysis showed a statistically significant difference between case and control groups with this regard (P < 0.05, for all statistical comparisons). However, HDL-C levels have not been changed significantly over-time within the case or control group, neither between the two study groups. CONCLUSION: In this study, the considerable effects of Rhus coriaria (sumac) on reducing serum levels of Total-C, LDL-C, and TG have been noticed during one-month trial. However, probably due to the concise period of sumac consumption, its effect on HDL-C was not statistically significant.

Clinical Effects of Portulaca Oleracea Seeds on Dyslipidemia in Obese Adolescents: a Triple-blinded Randomized Controlled Trial.

OBJECTIVE: Childhood obesity is a major public health concern worldwide while the current epidemic may be secondary to over consumption of high-fat, energy-rich foods. Purslane (Portulaca oleracea L.) has been traditionally used in medicine for several antioxidant and anti-atherogenic activities. In this study the anti-dyslipidemic effects of P.oleracea was evaluated in obese adolescents. METHODS: In this triple-blinded randomized placebo-controlled clinical trial which was done from July 2011 to June 2012, obese adolescent patients whom were referred to the Isfahan Cardiovascular Research Institute (Iran) were randomly allocated to the two arms of cases and controls. The cases group was asked to take one capsule containing powdered P. oleracea seeds (500 milligrams) two times a day for one month, and the controls group were asked to take identical but placebo (lactose) capsules in the same way. Biochemical parameters including 12-hours fasting serum levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured before the initiation and after the completion of the study protocol. FINDINGS: Total cholesterol, LDL-C, and TG showed statistically significant changes over time (one month) in the P. oleracea group (p < 0.05). However, between-group analysis using general linear model (multivariate) test revealed that the differences in the mentioned parameters between two study groups were statistically significant just for LDL-C and TG, while others did not differ significantly. CONCLUSION: P. oleracea L. may have positive effects on serum lipids profile which may be attributed to its polyphenolic and antioxidant compounds. This herbal drug seems to be well-tolerated in adolescent population as well. Further studies are recommended.

Role of protein phosphatases inhibitors on the histamine release and the functional desensitization in human lung mast cells.

BACKGROUND: The ß2-adrenoceptor agonist, isoprenaline, is an effective inhibitor of histamine release from human lung mast cells (HLMC). Since phosphorylations of the ß2-adrenoceptors are probably important in inducing desensitization, we sought to investigate the importance of phosphorylation events by targeting protein phosphatases (PPs) in mast cells. To this end, the effects of the inhibitor of on the functional desensitization of ß-adrenoceptor-mediated responses in mast cells were investigated. MATERIALS AND METHODS: In this study the effects of PP inhibitors on the inhibition of histamine release from HLMC, on ß-agonists in mast cells and on desensitization were investigated. RESULTS: Long-term exposure of mast cells to both isoprenaline and salbutamol substantially reduced the extent to which isoprenaline inhibited histamine release. Pretreatments of up to 24 h with inhibitors alone had no effect on immunoglobulin E-mediated histamine release. Shorter (≤4 h) pretreatments had little effect on the activity of isoprenaline and salbutamol to inhibit histamine release from mast cells. CONCLUSION: Collectively, these data suggest that PP has an important role in regulating mast cell ß2-adrenoceptors.

Prediction of endotracheal intubation outcome in opioid-poisoned patients: A clinical approach to bispectral monitoring.

BACKGROUND: Some opioid-poisoned patients do not respond appropriately to naloxone; consequently, intubation is required. Although various measures have been used to evaluate the level of consciousness of poisoned patients, no study has assessed the role of the bispectral index (BIS) to ascertain the depth of anesthesia in opioid-poisoned patients who require endotracheal intubation. OBJECTIVE: To compare BIS scores between opioid-poisoned patients with and without intubation, and to determine the BIS cut-off point for endotracheal intubation in these patients. METHODS: In the present cross-sectional study, conducted in an Iranian university referral hospital for poisoning emergencies between 2012 and 2013, opioid-poisoned patients (n=41) were divided into two groups according to their requirement for endotracheal intubation. BIS analyses were performed at the time of admission and at the time of intubation for those who required it. In addition, electromyography and signal quality index were evaluated for all patients at the time of admission, and cardiorespiratory monitoring was performed during the hospitalization period. Using ROC curves, and sensitivity and specificity analyses, the optimal BIS cut-off point for prediction of intubation of these patients was determined. RESULTS: The optimal cut-off point for prediction of intubation was BIS ≤78, which had a sensitivity of 86.7% (95% CI 66.1 to 98.8) and specificity of 88.5% (95% CI 73.9% to 98.8%); the positive and negative predictive values were 81.2 % and 92%, respectively. CONCLUSIONS: BIS may be considered an acceptable index to determine the need for intubation in opioid-poisoned patients whose response to naloxone is inadequate.

HISTORIQUE: Certains patients empoisonnés par des opioïdes ne répondent pas bien au naloxone et doivent être intubés. Diverses mesures sont utilisées pour évaluer le niveau de conscience des patients empoisonnés, mais aucune étude n'a porté sur le rôle de l'index bispectral (IBS) pour déterminer la profondeur de l'anesthésie chez les patients empoisonnés par des opioïdes qui doivent subir une intubation trachéale. OBJECTIF: Comparer les indices de l'IBS entre les patients empoisonnés par des opioïdes intubés ou non et déterminer le seuil d'IBS pour l'intubation trachéale de ces patients. MÉTHODOLOGIE: Dans la présente étude transversale menée entre 2012 et 2013 dans un hôpital universitaire iranien spécialisé dans les urgences causées par des empoisonnements, les patients empoisonnés par des opioïdes (n=41) ont été divisés en deux groupes, en fonction de la nécessité qu'ils subissent une intubation trachéale. Les chercheurs ont analysé l'IBS au moment de l'admission et de l'intubation des patients qui devaient la subir. Ils ont aussi évalué l'électromyographie et l'indice de qualité du signal chez tous les patients au moment de l'admission et assuré un monitorage cardiorespiratoire pendant la période d'hospitalisation. À l'aide des courbes ROC et des analyses de sensibilité et de spécificité, ils ont déterminé le seuil d'IBS optimal pour prédire l'intubation de ces patients. RÉSULTATS: Un IBS de 78 ou moins, d'une sensibilité de 86,7 % (95 % IC 66,1 à 98,8) et d'une spécificité de 88,5 % (95 % IC 73,9 % à 98,8 %), était le seuil optimal pour prédire l'intubation. Les valeurs prédictives positives et négatives s'établissaient à 81,2 % et 92 %, respectivement. CONCLUSIONS: L'IBS peut être considéré comme un index acceptable pour déterminer la nécessité d'intuber les patients empoisonnés par des opioïdes qui répondent peu au naloxone.

Effectiveness of topical gabapentin cream in treating pruritus in dialysis patients: A randomized controlled trial.

INTRODUCTION: Gabapentin is an antiepileptic drug that alleviates neuropathic pain. Its oral use reduces the intensity of pruritus in patients receiving chronic dialysis therapy. However, it could lead to toxicity because of the patients' renal deficiency. In this study, we assessed the use of gabapentin topical in treating pruritus in dialysis patients. METHODS: This randomized, triple-blinded trial was performed on 80 patients divided into two groups randomly (40 in each group). In intervention group, 92.5% of the patients were on hemodialysis. Patients in intervention and control groups were provided with 5% gabapentin and placebo topical creams every 2 weeks for a month. Both Visual Analog Scale and 12-item Pruritus Severity Score questionnaire were used to evaluate itching intensity and score before treatment, a month, and 2 months after starting treatment in both groups. In addition, the effect of itching on quality of life was investigated with the same questionnaire. FINDINGS: Eighty patients (40 in each group) participated in our study. No complication was found in our intervention group. Itching score significantly decreased after a month and 2 months of follow-up in intervention group (p < 0.001). DISCUSSION: Our results showed that 5% gabapentin topical cream can be effective in reducing itching in different areas of the body. None of our patients reported complications.

Efficacy of topical gabapentin in women with primary macular amyloidosis: A side-by-side triple-blinded randomized clinical trial.

BACKGROUND: Primary cutaneous macular amyloidosis (PCMA) is a chronic pruritic cutaneous disease characterized by heterogeneous extracellular deposition of amyloid protein in the skin. AIMS: This study aimed to evaluate the efficacy of topical 6% gabapentin cream for the treatment of patients with PCMA. MATERIALS AND METHODS: In this triple-blind clinical trial, a total of 34 patients, who were diagnosed with PCMA, treated using two different strategies of topical gabapentin as the active group and vehicle cream as the control group. RESULTS: Pruritus score reduction in both groups was statistically significant compared with the baseline value (p < 0.001). There was a significant pigmentation score reduction in intervention group compared with control group after 1 month of the study (p < 0.001). The differences of pigmentation score changes between the groups were not significant at month 2 (p = 0.52) and month 3 (p = 0.22). CONCLUSIONS: The results of this study suggest that topical gabapentin cream may be effective as a topical agent in the treatment of pruritus associated with PCMA without any significant adverse effects. It is recommended to perform similar studies with a larger sample size and longer duration in both sexes.

Effect of Zizyphus jujuba fruits on dyslipidemia in obese adolescents: a triple-masked randomized controlled clinical trial.

OBJECTIVE: This study aimed to assess the effects of Ziziphus jujuba (ZJ) fruit on controlling dyslipidemia in obese adolescents. METHODS: This triple-blind randomized placebo-controlled clinical trial comprised 86 obese adolescents aged 12-18 years with dyslipidemia, i.e. serum low density lipoprotein-cholesterol (LDL-C) or total cholesterol (TC) or triglycerides (TG) equal or more than the age- and gender-specific 95th percentile or high density lipoprotein- cholesterol (HDL-C) less than 5th percentile. They were randomly assigned into two groups of equal number Both groups received similar recommendations for dietary and physical activity habits. The case group received 5 grams of ZJ fruit powder three times a day for one month and controls took the same amount of a placebo powder. Fasting blood sugar, TC, LDL-C, HDL-C and TG were measured at the beginning and at the end of the trial. Data were analyzed using General linear method (multivariate) test. FINDINGS: Overall, 70 participants (51% boys, mean age of 14 +/- 2) completed the trial. The two groups studied did not differ in terms of age, gender, weight and body mass index (BMI). After the trial, serum TC decreased significantly (19 +/- 37 mg/dl in controls vs. 170 +/- 29 mg/dl in cases, P = 0.007) reduction. The corresponding figure was also significant for LDL-C (114 +/- 38 mg/dl vs. 104 +/- 22 mg/dl, respectively, P = 0.004). The changes in BMI and other lipids were not significant. CONCLUSION: This study suggest that ZJ's fruits is generally well tolerated and may have potential favorable effects on serum lipid profile. While healthy lifestyle is the mainstay of controlling childhood obesity, this nutraceutical may be considered as a complementary treatment. Key words: Zizyphus, dyslipidemia, adolescence, obesity.

Toxicoepidemiology of Phosphide Poisoning in the Central Part of Iran.

Objective: Aluminum phosphide (ALP) and zinc phosphide (ZnP) are toxic agrochemical pesticides, which are commonly used as an agent of self-harm in developing countries. Because of high toxicity of phosphides, we evaluated toxico-epidemiology ALP and ZnP poisoning in with respect to outcome. Methods: We performed a cross-sectional study with retrospective chart review including the records for patients admitted due to phosphide poisoning (ALP, ZnP) in a poisoning referral center in Khorshid Hospital, affiliated with Isfahan University of Medial Sciences, Isfahan, Iran. Demographic characteristics, clinical manifestations, outcome (survived or death), and length of hospital stay for the patients were recorded in a data collecting form. Binary backward stepwise logistic regression was used for outcome prediction. Findings: Sixty patients were evaluated in the study. The mean age of patients was 27.61. Thirty-nine patients were men. 96.7% of the patients ingested it intentionally. Most of the patients on admission were conscious (66.7%). Abnormality of EKG was noted in 8.3%. The mortality in ALP and ZnP poisoning was 39.2% and 22.2%, respectively. Serum bicarbonate and base excess in the venous blood gas analysis, systolic blood pressure, and serum sodium level were significantly different between patients with ALP and ZnP poisoning on admission time (P < 0.05). On admission, systolic blood pressure was an important predictive factor for mortality (odds ratio 4.87; 95% confidence interval: 1.5-15.45; P = 0.007). Conclusion: The rate of mortality in phosphide poisoning is high. Knowing predictive factors for mortality help physicians for selecting patients in intensive care unit admission and aggressive treatment.

Evaluation of the Factors Associated with Prescribed and Non-Prescribed Medicine: A Population-Based Study.

OBJECTIVES: Several factors influence medication patterns. The purpose of this study was to look into the role of social determinants in the use of prescribed and non-prescribed medications in a population-based setting of people over 18 in a southern metropolis of Iran (Shiraz) for 2 years. STUDY DESIGN: Prospective population-based cross-sectional. METHODS: This descriptive and cross-sectional survey was done in 2018-2020. A total of 1016 participants were randomly selected based on their postal codes and recruited to the study. The demographic characteristics (age, sex, and education), social profiles (insurance, supplementary insurance, health status, and daily exercise plan), and outpatient visits (family/general physician or specialist/ subspecialist) were recorded by gathering sheets. Descriptive analyses and multinomial logistic analyses were carried out using SPSS software. RESULTS: The medication use pattern was classified into three categories: non-prescribed type I, non-prescribed type II, and prescribed. The mean age of participants was 45.54 ± 15.82 years. The results indicated that most of them took their medication without a prescription (non-prescribed type II). However, people who had insurance and referred to a family physician commonly used the prescribed medications. This study also found that patients who visited a family doctor or a general practitioner used fewer prescribed drugs than those who visited a specialist. CONCLUSION: This study describes social determinants as additional effective factors in health services that influence the use of prescribed and non-prescribed medications in Shiraz. These evidence- based findings can help policymakers to plan the best programs.

The modifiable noncommunicable risk factors among an Iranian population.

Noncommunicable diseases (NCDs) are a major cause of morbidity and mortality in developing countries. Risk factors, such as hypertension, dyslipidemia, obesity and smoking play an important role in the high prevalence of NCDs. In this study we assessed the type and prevalence of NCD risk factors among an Iranian adult population. We conducted a cross sectional study of 500 men and 500 women, aged 15-65 years, selected by multi-stage random cluster sampling from urban areas of Isfahan, the second largest city in Iran. The prevalences of 8 risk factors were determined in this study: sedentary lifestyle (47.2%), overweight and obestity (body mass index > or = 25 kg/m2) (60.8%), hypertension (elevated systolic and/or diastolic blood pressure) (22%), low high density lipoprotein level (27.6%), high total cholesterol level (16.9%), high triglyceride level (22.1%) and high fasting blood sugar (7.6%). Sedentary life and overweight/obesity were common at all ages, especially among women. Given the high prevalence of NCD risk factors in the studied population, there is an urgent need for age-appropriate interventions to result in lifestyle changes to decrease the prevalence of NCD risk factors.