BACKGROUND/AIMS: A recent study revealed increasing incidence and prevalence of inflammatory bowel disease (IBD) in Iran. The Iranian Registry of Crohn's and Colitis (IRCC) was designed recently to answer the needs. We reported the design, methods of data collection, and aims of IRCC in this paper. METHODS: IRCC is a multicenter prospective registry, which is established with collaboration of more than 100 gastroenterologists from different provinces of Iran. Minimum data set for IRCC was defined according to an international consensus on standard set of outcomes for IBD. A pilot feasibility study was performed on 553 IBD patients with a web-based questionnaire. The reliability of questionnaire evaluated by Cronbach's α. RESULTS: All sections of questionnaire had Cronbach's α of more than 0.6. In pilot study, 312 of participants (56.4%) were male and mean age was 38 years (standard deviation=12.8) and 378 patients (68.35%) had ulcerative colitis, 303 subjects (54,7%) had college education and 358 patients (64.74%) were of Fars ethnicity. We found that 68 (12.3%), 44 (7.9%), and 13 (2.3%) of participants were smokers, hookah and opium users, respectively. History of appendectomy was reported in 58 of patients (10.48%). The most common medication was 5-aminosalicylate (94.39%). CONCLUSIONS: To the best of our knowledge, IRCC is the first national IBD registry in the Middle East and could become a reliable infrastructure for national and international research on IBD. IRCC will improve the quality of care of IBD patients and provide national information for policy makers to better plan for controlling IBD in Iran.
Administrative Personnel ; Appendectomy ; Colitis ; Colitis, Ulcerative ; Consensus ; Cooperative Behavior ; Data Collection ; Dataset ; Education ; Feasibility Studies ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Iran ; Male ; Mesalamine ; Middle East ; Opium ; Pilot Projects ; Prevalence ; Prospective Studies

BACKGROUNDBrazil is among the nations with the greatest rates of annual cocaine usage. Pharmacological treatment of cocaine addiction is still limited, opening space for nonconventional interventions. Homeopathic Q-potencies of opium and Erythroxylum coca have been tested in the integrative treatment of cocaine craving among homeless addicts, but this setting had not proven feasible, due to insufficient recruitment.

OBJECTIVEThis study investigates the effectiveness and tolerability of homeopathic Q-potencies of opium and E. coca in the integrative treatment of cocaine craving in a community-based psychosocial rehabilitation setting.

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONSA randomized, double-blind, placebo-controlled, parallel-group, eight-week pilot trial was performed at the Psychosocial Attention Center for Alcohol and Other Drugs (CAPS-AD), Sao Carlos/SP, Brazil. Eligible subjects included CAPS-AD patients between 18 and 65 years of age, with an International Classification of Diseases-10 diagnosis of cocaine dependence (F14.2). The patients were randomly assigned to two treatment groups: psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca (homeopathy group), and psychosocial rehabilitation plus indistinguishable placebo (placebo group).

MAIN OUTCOME MEASURESThe main outcome measure was the percentage of cocaine-using days. Secondary measures were the Minnesota Cocaine Craving Scale and 12-Item Short-Form Health Survey scores. Adverse events were reported in both groups.

RESULTSThe study population comprised 54 patients who attended at least one post-baseline assessment, out of the 104 subjects initially enrolled. The mean percentage of cocaine-using days in the homeopathy group was 18.1% (standard deviation (SD): 22.3%), compared to 29.8% (SD: 30.6%) in the placebo group (P < 0.01). Analysis of the Minnesota Cocaine Craving Scale scores showed no between-group differences in the intensity of cravings, but results significantly favored homeopathy over placebo in the proportion of weeks without craving episodes and the patients' appraisal of treatment efficacy for reduction of cravings. Analysis of 12-Item Short-Form Health Survey scores found no significant differences. Few adverse events were reported: 0.57 adverse events/patient in the homeopathy group compared to 0.69 adverse events/patient in the placebo group (P = 0.41).

CONCLUSIONSA psychosocial rehabilitation setting improved recruitment but was not sufficient to decrease dropout frequency among Brazilian cocaine treatment seekers. Psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca were more effective than psychosocial rehabilitation alone in reducing cocaine cravings. Due to high dropout rate and risk of bias, further research is required to confirm our findings, with specific focus on strategies to increase patient retention.

TRIAL REGISTRATIONRBR-2xzcwz (http://www.ensaiosclinicos.gov.br).

Adolescent ; Adult ; Aged ; Cocaine ; adverse effects ; Cocaine-Related Disorders ; psychology ; rehabilitation ; therapy ; Craving ; drug effects ; Double-Blind Method ; Female ; Homeopathy ; Humans ; Male ; Middle Aged ; Opium ; therapeutic use ; Pilot Projects ; Treatment Outcome ; Young Adult

This article demonstrates the medicinal usage of ginseng in the West from 1660 to 1914. Asian[Korea] ginseng was first introduced into England in the early 17th century, and North American ginseng was found in the early 18th century. Starting from the late 17th century doctors prescribed ginseng to cure many different kinds of ailments and disease such as: fatigue general lethargy, fever, torpidity, trembling in the joints, nervous disorder, laughing and crying hysteria, scurvy, spermatic vessel infection, jaundice, leprosy, dry gripes and constipation, strangury, yellow fever, dysentery, infertility and addictions of alcohol, opium and tobacco, etc. In the mid-18th century Materia Medica began to specify medicinal properties of ginseng and the patent medicines containing ginseng were widely circulated. However, starting in the late 18th century the medicinal properties of ginseng began to be disparaged and major pharmacopoeias removed ginseng from their contents. The reform of the pharmacopoeia, influenced by Linnaeus in botany and Lavoisier in chemistry, introduced nomenclature that emphasized identifying ingredients and active constituents. Western medicine at this period, however, failed to identify and to extract the active constituents of ginseng. Apart from the technical underdevelopment of the period, the medical discourses reveal that the so-called chemical experiment of ginseng were conducted with unqualified materials and without proper differentiation of various species of ginseng.
Americas* ; Botany ; Chemistry ; Constipation ; Crying ; Dispensatories ; Dysentery ; England ; Fatigue ; Fever ; Hysteria ; Infertility ; Jaundice ; Joints ; Leprosy ; Lethargy ; Materia Medica ; Nonprescription Drugs ; Opium ; Panax* ; Scurvy ; Tobacco ; Yellow Fever

OBJECTIVES: The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis. METHODS: This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test. RESULTS: A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20–29 and 30–39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8±1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8±0.3 mg/dL and 140.4±4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%). CONCLUSIONS: Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment.
Analgesics, Opioid ; Checklist ; Critical Care* ; Cross-Sectional Studies ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Intensive Care Units* ; Iran* ; Male ; Methadone ; Mortality ; Opium ; Poisoning* ; Potassium ; Renal Insufficiency ; Rhabdomyolysis* ; Sodium ; Street Drugs ; Urea

OBJECTIVES: The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis.METHODS: This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test.RESULTS: A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20–29 and 30–39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8±1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8±0.3 mg/dL and 140.4±4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%).CONCLUSIONS: Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment.
Analgesics, Opioid ; Checklist ; Critical Care ; Cross-Sectional Studies ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Intensive Care Units ; Iran ; Male ; Methadone ; Mortality ; Opium ; Poisoning ; Potassium ; Renal Insufficiency ; Rhabdomyolysis ; Sodium ; Street Drugs ; Urea

After the defeat of the Opium War and the Sino-Japanese War, China's intellectuals realized necessity of modernization (Westernization) to survive in the imperial order of the survival of the fittest. In particular, it was urgent to accept Western medicine and train the doctors who learned Western medicine to change the sick and weary Chinese to be robust. Thus, new occupations of the Western Medicine Group (xiyi, doctors who learned Western medicine) emerged in China. As with the first profession, the new Western Medicine Group tried to define standards of Western medicine and medical profession; however, it was difficult in the absence of the strong central government. In addition, they formed a faction by the country where they studied or the language they learned. The factions included the Britain - America faction(yingmeipai) consisting of the Britain - America studied doctors or graduates from Protestant missions based medical schools, and the Germany - Japan faction(deripai), graduates from medical schools by Japanese or German government and the Chinese government. In 1915, they founded the National Medical Association of China mainly consisting of the Britain - America faction and the National Medical and Pharmaceutical Association of China led by the Germany – Japan faction. Initially, exchanges were active so most of eminent doctors belonged the two associations at the same time. They had a consciousness of a common occupation group as a doctor who had learned Western medicine. Thus, they actively cooperated to keep their profits against Chinese medicine and enjoy their reputation. Their cooperation emitted light particularly in translation of medical terms and unified works. Thanks to cooperation, the two associations selected medical terminologies by properly using the cases of the West and Japan. Additionally, medical schools of the Britain - America faction and the Germany – Japan faction produced various levels of the Western Medicine Group doctors for China to timely respond to the rapidly increased demand. However, a conflict over the promotion of hygiene administration and the unification, organization of medical education did not end. This conflict was deepening as the Nanjing nationalist government promoted sanitary administration. It was the Britain - America faction who seized a chance of victory. It was because figures from the Britain - America faction held important positions in the hygiene department. Of course, some related to the National Medical and Pharmaceutical Association of China were also involved in the hygiene department; however, most took charge of simple technical tasks, not having a significant impact on hygiene administration. To solve the problem of factions of the Western Medicine Group, the Britain - America faction or the Germany - Japan faction had to arrange the education system with a strong power, or to organize a new association of two factions mixed, as in Chinese faction(zhonghuapai). But an effort of the Britain - America faction to unify the systems of medical schools did not reach the Germany - Japan faction's medical schools. Additionally, from 1928, executives of the two Chinese medical associations discussed their merger; however they could not agree because of practitioners'interests involved. Substantially, a conflict between factions of the Western Medicine Group continued even until the mid-1930s. This implies that the then Chinese government had a lack of capacity of uniting and organizing the medical community.
Americas ; Asian Continental Ancestry Group ; China* ; Consciousness ; Education ; Education, Medical ; Germany ; Humans ; Hygiene ; Japan ; Occupations ; Opium ; Protestantism ; Religious Missions ; Schools, Medical ; Social Change

BACKGROUND: There are a number of adjuvants to be used for local anesthetics in spinal block. The aim of this study was to demonstrate the possible effect of intrathecal midazolam compared with bupivacaine as adjuvants in spinal anesthesia with bupivacaine in chronic opium abuses. METHODS: In a double blind, randomized clinical trial, 90 opium abuser patients undergoing lower limb orthopedic surgery were selected and randomly assigned into 3 groups (30 cases each). The patients received 15 mg plain bupivacaine, or 15 mg bupivacaine plus 25 mcg fentanyl or 15 mg bupivacaine plus 1 mg midazolam, intrathecally. RESULTS: The duration of anesthesia was much longer in the bupivacaine-midazolam group than the bupivacaine-fentanyl group; both were longer than the plain bupivacaine group (P < 0.05). CONCLUSIONS: Subarachnoid injection of adjuvant midazolam or fentanyl with plain 0.5% bupivacaine in opium abusers in lower limb orthopedic surgery increases the duration of sensory block. Therefore midazolam is more effective than fentanyl in such cases.
Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Fentanyl ; Humans ; Lower Extremity ; Midazolam ; Opium ; Orthopedics

Female ; Humans ; Lead ; blood ; Lead Poisoning ; diagnosis ; etiology ; Male ; Opioid-Related Disorders ; blood ; Opium ; administration & dosage

INTRODUCTIONThe number of cases of lead poisoning (LP), a widely known disease with various aetiologies, being reported globally has decreased over the years due to both limited domestic applications of lead and enforcement of stringent safety measures. However, a new presentation of lead poisoning, lead-contaminated opium (LCO), is gradually emerging in our region. This study aimed to determine the prevalence and clinical effects of lead toxicity associated with opium use.

METHODSBetween November 2006 and December 2007, all patients diagnosed with LP at a central laboratory in Tehran, Iran, were assessed for potential causes of poisoning. Patients with a history of LCO abuse were evaluated and recruited for the study.

RESULTSOverall, there were 240 patients with LP, and poisoning from LCO was diagnosed in 25 patients. The duration of addiction was between three months and 40 years, and the duration of symptoms was 28.1 ± 17.7 days. Mean blood lead levels of the patients were 145 ± 61 (range 61-323) μg/dL. The average creatinine and haemoglobin levels were 77.4 ± 8.1 μmol/L and 105 ± 25 g/L, respectively. The association between the duration of addiction and levels of lead in blood was not statistically significant (r = -0.142, p = 0.54). The most common symptoms were gastrointestinal complaints, followed by musculoskeletal complaints with muscle weakness (92%). Anorexia was also a leading complaint.

CONCLUSIONThe results of our study suggest that the possibility of LP should be considered with high suspicion among opium users presenting with acute abdominal symptoms.

Abdomen, Acute ; etiology ; Adult ; Creatinine ; blood ; Cross-Sectional Studies ; Female ; Hemoglobins ; biosynthesis ; Humans ; Iran ; Lead ; blood ; Lead Poisoning ; complications ; diagnosis ; etiology ; Male ; Middle Aged ; Muscle Weakness ; etiology ; Opioid-Related Disorders ; blood ; complications ; Opium ; administration & dosage ; Pain ; etiology ; Prevalence ; Time Factors

BACKGROUND: Opium use in diabetic populations is associated with major depressive disorder (MDD). This study was designed to investigate the relationship between opium use and severity of depression in Iranian diabetic patients. METHODS: In this case-control study, 642 type 2 diabetic patients were recruited from those presenting at two outpatient clinics at the Akhavan Hospital in Kashan, Iran; of them, 600 diabetic patients were included in the study and divided into two groups: opium-abusers (150 patients) and non-opium-abusers (450 patients). Clinical and demographic information was obtained through a detailed questionnaire. Depression symptomalogy and severity were assessed with the Beck Depression Inventory (BDI), and a corresponding diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders-IV, Text Revision, 2000 (DSM-IV TR) criteria. RESULTS: The mean depression score was higher in the opium abuse group than in the non-abuser group (29.27+/-1.44 vs. 18.29+/-1.31, P<0.001). In general, a significant association was found between opium abuse and depression among patients (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.87 to 7.44; P=0.001). No significant relationship was found between dysthymia and opium abuse (OR, 0.68; 95% CI, 0.18 to 1.192; P=0.155), while MDD was significantly higher in the opium abuser group (OR, 7.32; 95% CI, 5.20 to 12.01; P<0.001). CONCLUSION: Depression is more frequent in opium-dependent diabetic patients, and its severity is also greater. Given these findings, opium-dependent diabetic patients should be advised about the increased risks of depression and related comorbidities.
Ambulatory Care Facilities ; Case-Control Studies ; Comorbidity ; Depression ; Depressive Disorder, Major ; Diabetes Mellitus ; Humans ; Opium ; Surveys and Questionnaires