نرجس هندویی

 This study aims to evaluate the efficacy and safety of adding pregabalin to standard antipsychotic treatment in patients with chronic schizophrenia.

In this randomized, double-blind, placebo-controlled clinical trial, participants were 48 male inpatients aged 18-65 years with chronic schizophrenia but with clinically stable conditions. They were randomly divided into two groups of intervention (n=24) and control (n=24). The intervention group received 75 mg of pregabalin per day for three weeks which was increased to 150 mg per day from the fourth week to the end of the study, in addition to standard antipsychotic medication for six weeks. The severity of psychotic symptoms was assessed by the Positive and Negative Syndrome Scale (PANSS), and their movement disorder symptoms were evaluated by the Barnes Akathisia Rating Scale (BARS) and Simpson-Angus Scale (SAS) at baseline and at 3th and 6th weeks of the intervention. Collected data were analyzed using repeated measures ANOVA in SPSS v.20 software, considering P<0.05 as the statistically significance level.

 No significant differences were observed in severity of disease based on the PANSS total score and its three subscales (positive scale, negative scale, and general psychopathology) and in the BARS and SAS scores at the end of 6th week in groups and between the two groups.

Adding 150 mg of pregabalin to the standard antipsychotic treatment of patients with chronic schizophrenia is not effective in improving their psychotic symptoms, but it is well tolerated.

The aim of this double-blind clinical trial was to evaluate the efficacy and safety of haloperidol on acute opioid withdrawal symptoms.

In this randomized double-blind clinical trial, fifty-two eligible patients were assigned to two groups according to previous opioid consumption, low dose (LD) and high dose (HD). Then, patients in each group were randomly assigned to one of the two subgroups of haloperidol or placebo. Patients in the haloperidol subgroup in LD group received 2.5 mg and in HD group received 5 mg/day haloperidol with methadone. Methadone was discontinued ten days after the beginning of the study and haloperidol or placebo continued for up to two weeks after methadone discontinuation. The severity of opioid withdrawal symptoms was assessed with the Objective Opioid Withdrawal Scale (OOWS) every other day.

Although both treatment protocols either in LD or HD opioid consumption groups significantly increased the score of the OOWS over the trial period (all subgroups, P < 0.001), the combination of 2.5 mg/day of haloperidol and methadone in LD opioid consumption group showed a significant superiority over methadone alone in decreasing opium withdrawal symptoms during the study (P = 0.001). The frequency of adverse effects was comparable between two treatment protocols in both groups (P > 0.05).

The results of this study suggest that 2.5 mg/day of haloperidol may be an effective adjuvant agent in the management of opium withdrawal symptoms in patients with LD opioid consumption. Nevertheless, results of larger controlled trials are needed before recommendation for a broad clinical application can be made

Burn patients are at high risk for thromboembolic events. According to recent studies, in most burn patients, standard dosage of enoxaparin cannot be effective in preventing thromboembolic events. The aim of this retrospective study was to evaluate the compliance of enoxaparin for the prevention of thromboembolic events in burn patients with the standard guidelines for management of burn in Sari Zare Hospital, Iran.

In this study, we reviewed the medical records of 61 burn patients admitted to Sari Zare Hospital for six consecutive months (2016) who had received enoxaparin. Prescribed dose and monitoring at the time of administration of enoxaparin were compared with standard guidelines for management of burn.

The mean age of patients was 47.37±15.6 and they were mainly male (73.8%). All patients received enoxaparin subcutaneously for prevention of thromboembolic events. Prophylactic dose was in accordance with recommended dose in 57.3% of the patients. Active anti-factor was not evaluated in any of the patients with body mass index (BMI) outside the normal range. The Platelet count was evaluated in all patients at the beginning and in 98% during the treatment. Drug interactions were reported in less than 10% of the patients with no side effects.

In most burn patients with normal BMI, the administered dose of prophylactic enoxaparin was not in accordance with the recommended dose. In patients out of normal range, the dose was not adjusted based on BMI. This could increase the risk of thromboembolic events or bleeding in these patients.

Decreasing the quality of life in cancer patients is an essential factor that influences their lives during the process of treatment and after that. A lot of studies have been done to evaluate the efficacy of medical agents on quality of life. In this study, we evaluate the efficacy of Bupropion as an antidepressant agent in quality of life of cancer patients.

In this double-blind randomized placebo-controlled clinical trial, a total of 30 eligible cancer patients suffering from fatigue were randomly divided into two 15-individual groups of bupropion and placebo. Bupropion was administered 75 mg/day for the first three days and 150 mg/day (in two doses) till the end of the study for group bupropion. Quality of life was measured by EORCT-QLQ-C3 scale. Adverse effects were assessed based on NCI Common Terminology Criteria for Adverse Events. The study was six weeks long and assessments were done at baseline, second week and sixth week.

There was no significant difference in scores between placebo and bupropion at baseline and second week. While, significant difference was seen at the week six (P=0.005 for function, P=0.036 for symptoms and P<0.001 for health).  Between group assessments showed better average score for bupropion in comparison to placebo. Only two cases of adverse effects were reported.

bupropion can be effective in improvement of quality of life in cancer patients

Hemodialysis patients (HD) with functional iron deficiency(FID) often develop resistance to recombinant human erythropoietin (rHuEpo). Recent studies suggest that intravenous ascorbic acid (IVAA) may circumvent rHuEpo resistance, while oral (AA) is readily attainable. The aim of this study was to evaluate efficacy and safety of oral versus intravenous vitamin C on FID and whether this can improve anemia in hemodialysis patients.

In this study, 31 hemodialysis patients with serum ferritin >100 µg/L, transferin saturation (TS)<30% and Hb <11g/dL were selected and randomly divided into the oral and IV groups. The IVAA group received vitamin C 1.5 g, administered weekly and the oral group, 125 mg vitamin C daily for two months. Hb, ferritin, serum iron, Tsat and serum oxalate were measured at the beginning of the study and 2 months later. Independent – sample T-Test were used for intergroup comparison. P value <0/05 was considered significant.

Mean Hb difference was 1.1±0.7g/dL in the oral and 0.1±1g/dL in the IVAA group, being significantly higher in the oral group (p=0.02). There were no significant differences between the two groups in the delta means of ferritin & Tsat (p=0.5,p=0.3). Delta means of serum oxalate in the 2 groups were 0.05±0.4mg/L, and 0.1± 0.3mg/L respectively, difference not significant(p=0.3).

Oral AA significantly increased Hb in HD patients suffering from FID. Considering the feasibility and cost-effectiveness, clinicians could consider oral instead IVAA in rHuEpo hyporesponsive patients undergoing HD.