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Background: Stimulants such as methylphenidate and atomoxetine, a nonstimulant norepinephrine reuptake inhibitor, are approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Associations between the use of methylphenidate or atomoxetine with suicidal ideation and suicide-related behavior have been reported in the literature. The present study aimed to compare the effects of atomoxetine with that of methylphenidate on suicidal ideation and behavior in children and adolescents. Methods: Children and adolescents between 7 to 17 years of age with the diagnosis of ADHD, based on DSM-5 criteria, were included in this observational, cross sectional study. The suicidal ideation was assessed among children and adolescents who have been receiving either atomoxetine or methylphenidate for at least 12 months prior to entering the study. A Farsi version of Positive and Negative Suicide Ideation (PANSI) inventory was applied for the assessment. Differences among age groups, duration of therapy and comparison of positive and negative scores in both genders were analyzed using t-test. In addition, a one-way analysis of variance (ANOVA) was applied to examine the differences in positive and negative scores among different age groups. Moreover, chi-square and Fisher’s exact tests were performed to examine the effects of past history of drugs and other present illnesses on suicidal ideation. P-value of <0.05 was considered as significant. Results: A total of 57 students between 7 to 17 years of age were enrolled in this study. Twenty-eight patients have been taking atomoxetine at doses of 10 to 60 mg/day while 29 were on methylphenidate 7.50-55 mg/day. The mean positive and negative scores in the atomoxetine group were found to significantly differ (P=0.001) from those in the methylphenidate group. No risk of suicidal ideation was detected in the atomoxetine group, while in the methylphenidate group 15 out of 29 patients (51.7%) scored above the cutoff point. In terms of the relationship between suicidal ideation and history of other drugs prior to the current therapy and other concurrent disorders, chi-square test showed no significant difference in methylphenidate group (P=0.100 and 0.500 respectively). This analysis was not considered in atomoxetine group due to the absence of suicidal ideation. Conclusion: The authors of this study suggest that atomoxetine may be a safer choice than methylphenidate for the treatment of ADHD when suicidal ideation is a concern. In this regard, monitoring suicidal ideation and behavior along with family education should be considered in all children and adolescents suffering ADHD.

Background: The respiratory distress syndrome (RDS) is a common pulmonary disorder that usually occurs as a result of preterm labor and is associated with lack of surfactant. The aim of this study was to evaluate the pattern of surfactant prescription in Alzahra teaching hospital in Tabriz, Iran. Methods: This drug use evaluation (DUE) study was conducted in the neonatal intensive care unit (NICU) of Al-Zahra Hospital, Tabriz, Iran. The demographic and clinical data collection was performed using clinical records of patients. The pattern of surfactant replacement therapy was evaluated and compared with the European Consensus Guideline on the management of respiratory distress syndrome in 2016. Results: A total of 252 premature infants who received surfactant between August 2017 and March 2018 were included. 80.8% of neonates were born by cesarean section. The most used surfactant was Curosurf^®, which was used in 82.1% of cases. Only 34.9% of the infants received within 8 hours of birth. Moreover, 79% of infants received the standard dose of surfactant, while 9.5 % and 11.5% were given high and low doses of surfactant, respectively. Conclusion: The pattern of surfactant replacement therapy was not completely according to the guidelines, particularly regarding the time of administration.  Considering the importance of dose and timely administration of surfactant, providing strategies to decrease these errors are important. 

Background: Pain is one of the patients' common problems, and usual morbidity after coronary artery bypass graft (CABG). This study aimed to assess the effect of Paracetamol and fentanyl in reducing post-CABG pain.Methods: This double-blind randomized clinical trial was conducted on 160 patients undergoing elective CABG (80 in group F (Fentanyl) and 80 in group P (Paracetamol)), at the cardiac surgery department of hospitals affiliated with Zahedan University of Medical Sciences. In group F, 50μg of Fentanyl (intravenous (IV)) was injected followed by a solution of 10 μg/cc at a rate of 4 cc/hr. For patients in group P, 15 mg/kg of Paracetamol (IV) was administered followed by a solution of 25 μg/cc at a rate of 4 cc/hr. Patients have been infused with the named drugs within the first 24 hours after the operation. Pain severity was assessed by the visual pain score (VAS) tool at baseline, and two, four, eight, twelve, and twenty-four hours after the surgery.Results: The mean of pain score in 12 (P-value=0.002) and 24 (P-value<0.0001) hours after surgery in group P was significantly less than that of group F. The mean heart rate in patients receiving Paracetamol was significantly (P-value = 0.005) less than that of patients receiving Fentanyl for 4 hours after surgery. The mean of increasing creatinine postoperatively in two groups was significant. The mean of increasing AST and ALT postoperatively in group P was significant with no case of liver function impairment.Conclusion: It seems Paracetamol is a good choice for reducing post-CABG pain with no significant complication, although further and more comprehensive research is needed.

Background: Considering the high prevalence and risk of Deep Vein Thrombosis (DVT) and pulmonary thromboembolism (PTE) in hospitalized patients and the existence of different prophylaxis methods in these patients, the necessity of evaluating the rational administration of heparin or enoxaparin and mechanical prophylaxis is one of the important priorities. The present study aimed to evaluate the consistency of the Heparin/Enoxaparin administration in comparison to guidelines in patients admitted to Imam Reza Hospital. Methods: In this prospective study drug use evaluation (DUE), 300 hospitalized patients receiving venous thrombosis prophylaxis were enrolled, of which 150 patients were selected from surgical wards and 150 patients from internal wards. The demographic and clinical data of patients were collected using clinical records of them. We used the checklists based on the Geneva System for patients admitted to internal wards and the Caprini Questionnaire for patients in surgical wards to evaluate whether patients had received heparin/enoxaparin prophylaxis and mechanical DVT prevention according to guidelines. Results: In the surgical ward, prophylactic treatment for venous thrombosis was administered in 85 (56.6%) patients admitted to surgical wards in accordance with the clinical guideline and in the internal ward, in 42 (28%) patients, with a significant difference between two sections (P: 0.0001). Mechanical prophylaxis, including compressive socks, was performed in 99 (66%) patients in the surgical ward and in the internal ward only in 56 (37.4%) patients, according to the guideline. Drug prophylaxis was administered in surgical wards in 116 (77.3%) patients and in internal wards, in 79 (52.6%) patients according to the guideline.Conclusion: Intravenous thrombosis prophylaxis, according to the guidelines, is more common in patients admitted to surgical wards than in internal wards. But in both sectors, statistics are far from international standards. 

Background: Drug utilization Evaluation is the main tool to assess the clinical and economic effects of drug on health-care system. The aim of the current study is to evaluate the regimens of antibiotic prophylaxis in common gynecological surgeries in a referral teaching hospital Methods: This cross-sectional study was done in Alzahra hospital, Tabriz, Iran, from July 2017 to December 2017. Patients who received antibiotics as surgical site infection prophylaxis were enrolled. Data were collected from patients’ medical records and adherence rate to the American Society of Health-System Pharmacists (ASHP) guideline was studied as the primary endpoint. Results: A total of 210 patients who undergoes common gynecological surgeries were evaluated. Cesarean section (58.6%) and total abdominal hysterectomy (28.1%) were the majority of surgeries. The type of administered antibiotic was adherent to guideline in 71.4%. Doses and duration of prescribed antibiotic (Cefazolin, the most prescribed antibiotic) were not in accordance with the guideline in 100%. Only in 58%, the time of antibiotic administration was corrected. Conclusion: In this study, the misuse of antibiotics in most cases was documented in terms of type, dose and duration of drug administration in Al-Zahra Hospital. It seems necessary to publish evidence-based guidelines and monitor their proper implementation, not only to reduce costs but also to combat antibiotic resistance.

Bipolar disorder is a chronic psychological condition that disturbs many patients' lives around the world. The exact pathophysiology of bipolar disorder is yet unknown, but there are several hypotheses to explain this condition. One of the most challenging theories is the role of oxidative stress in the progression of bipolar disorder. Here, we conducted a narrative review to gather the studies that investigated the relationship between bipolar disorder and oxidative stress. We searched PubMed, Scopus, Web of science, and google scholar databases using the following keywords: “bipolar disorder,” “oxidative stress,” “oxidative markers,” and “bipolar patients.”     A majority of studies showed that oxidative markers such as Thiobarbituric acid reactive substances are significantly higher in bipolar patients compared to healthy subjects. Based on the included articles, bipolar disorder is associated with oxidative stress. Nevertheless, further well-established Cohorts are required to support these results.

At the end of 2019, a new coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) emerged in China and then spread worldwide. Presently, Coronavirus Disease 2019 (COVID-19) is a main public health issue. As of August 2021, more than 200 million confirmed cases from coronavirus and more than 4 million deaths have been reported by WHO in 222 countries. The data sources are Google Scholar, PubMed, and Science Direct articles. Publications were searched without regard to time in order to obtain a holistic and comprehensive perspective of the research done on this issue thus far. The SARS-CoV-2 can be transmitted from the human-to-human by respiratory droplets and shows great potential for a pandemic. Therefore, on March 11, 2020, COVID-19 was introduced as a global pandemic by WHO. Cancer patients are at high risk for exposure to the coronavirus. In the present article, we discuss the impact of the COVID-19 pandemic on the quality of life of cancer patients and their treatment process. One of these challenges is not visiting the patients in medical centers and hospitals for afraid of contracting the virus. Therefore, the diagnosis and treatment of cancer patients may be delayed, which is a serious threat to the lives of cancer patients. In this article, in addition to the impact of coronavirus on the lives of cancer patients, the severity of the disease in these patients, their required medical care, and the vaccination process are discussed.

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