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Biomedical subjects

Jamshid Ahmadi

Publications and source records attributed to Jamshid Ahmadi.

At least 19 recordsLinked to original sources
PubMed2006

Long-term administration of mifepristone (RU486): clinical tolerance during extended treatment of meningioma.

BACKGROUND: Mifepristone (RU486) is an oral antiprogestational and, to a lesser extent, antiglucocorticoid agent commonly used for short-term (single-day) therapy. However, treatment of neoplasms or chronic conditions will require long-term administration. Meningioma is a benign central nervous system tumor that is often progesterone-but not estrogen-receptor positive, making long-term antiprogestational therapy a logical treatment strategy. METHODS: Patients with unresectable meningioma were treated with oral mifepristone 200 mg/day. This dose was selected to provide significant antiprogestational but not antiglucocorticoid activity. Patients also received oral dexamethasone 1 mg/day for the first 14 days. Serial follow-up allowed evaluation for tolerability and side effects of long-term therapy as well as observation for efficacy (tumor shrinkage or improvement in visual fields). RESULTS: Twenty-eight patients received daily oral mifepristone for a total of 1,626 patient-months of treatment. The median duration of therapy was 35 months (range 2-157 months). Repeated oral administration was well tolerated with mild fatigue (22 patients), hot flashes (13 patients), and gynecomastia/breast tenderness (6 patients) being the most common side effects. However, endometrial hyperplasia or polyps were documented in 3 patients and one patient developed peritoneal adenocarcinoma after 9 years of therapy. Minor responses (improved automated visual field examination or improved CT or MRI scan) were noted in 8 patients, 7 of whom were male or premenopausal female. CONCLUSIONS: Long-term administration of mifepristone is feasible and clinically well tolerated, with generally mild toxicity. However, endometrial hyperplasia was noted in several patients. In view of the association between long-term treatment with tamoxifen (another agent that can induce an unopposed estrogen effect) and endometrial cancer, this observation will require further investigation and screening. Minor regression of meningioma that can result in significant clinical benefit is suggested in the male and premenopausal female subgroups of patients.

Adult↗
PubMed2006

Suicide for scrutinizers.

OBJECTIVES: The aim is to present information which may be useful to those who scrutinize mental health professionals and systems in the aftermath of completed suicide. CONCLUSION: Suicide has been known in all cultures, throughout history, and may be committed in the absence of mental disorder. Risk factors for suicide are known but they are of limited clinical utility. Prediction and prevention of suicide are beyond current abilities. Criticism of mental health professionals and systems in the aftermath of suicide may be destructive and work to the disadvantage of patients.

Acute Disease↗
PubMed2006

Analysis of opium use by students of medical sciences.

AIMS AND OBJECTIVES: To investigate the prevalence of opium use in university students. BACKGROUND: University health professionals and authorities are very concerned about substance use among university students. DESIGN: A survey with a representative sample of 2519 (1126 men and 1393 women) university students and opium use disorders assessed by means of DSM-IV criteria (Diagnostic Statistical Manual-IV Axis I during the year 2003). FINDINGS: Mean age of the sample was 23.8 year and SD was 3.9. Of the students, 110 (4.4%) admitted using of opium once or more during their lives (9.1% of men and 0.6% of women; P < 0.01). Fifty (2%) were occasional opium user (4.2% of men and 0.2% of women; P < 0.01). Nineteen (0.8%) were current opium user (1.4% of men and 0.2% of women; P = 0.001). Mean age of opium users was higher than the remainder. Opium use was significantly related to gender (P = 0.001), and life stress (P = 0.04). CONCLUSION: These findings can be considered for preventive and therapeutic programmes, because early intervention during the formative university years may present an opportunity to reduce the risk of long-term problems, to decrease social and individual harm and also to promote public health of society. RELEVANCE TO CLINICAL PRACTICE: These findings can be considered in clinical practice for detection and treatment of opioid abuse.

Adult↗
PubMed2006

Physical trauma and substance abuse: a comparative study on substance abuse in patients with physical trauma versus general population.

AIM: To evaluate the prevalence of substance abuse in a sample of patients with acute physical trauma in comparison with the general population. METHOD: Prospective study using structured interview based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed) criteria for substance dependence and abuse. SETTING: Hospitals at Shiraz University of Medical Sciences, and the general population in Shiraz. PARTICIPANTS: 1,324 subjects selected randomly (324 subjects from patients with acute physical trauma, and 1,000 subjects from general population). RESULTS: The mean age was 37 (SD=15.5, age range=15-83 yr.) In the general population, the mean age was 36.5 (SD=14.29, age range=15-83). Substance use was much more prevalent among patients with acute physical trauma than in the general population. It should be mentioned that drug use precedes the trauma in the patient population and may contribute to the occurrence of trauma or disease. CONCLUSIONS: Substance use was significantly more prevalent in males than in females. Cultural attitudes toward usage of substances were found to affect the type and amount of the used substance. These findings should be considered when planning preventive and therapeutic programs.

Adolescent↗
PubMed2004

Mood disorders in opioid-dependent patients.

AIMS: To assess the rate of current mood disorders in opioid-dependent outpatients. DESIGN: Prevalence study of DSM-IV mood disorders. SETTINGS: Private and government clinics. PARTICIPANTS: Five hundred unpaid opioid-dependent patients who had voluntarily sought treatment. MEASUREMENTS: The Research version of structured clinical interview for DSM-IV Axis I Disorders (SCID-I). RESULTS: The mean age of the subjects (487 men and 13 women) was 33.4 years, ranging from 16 to 67. The majority (68.2%) had private sector job and 13.4% were unemployed. The majority (59.8%) had education at the level of primary, guidance or high school and only 3.8% were illiterate. Three hundred and thirty six (67.2%) subjects were diagnosed as having mood disorders. Of the subjects 274 (54.8%) had substance induced depression, 37 (7.4%) major depression, 14 (2.8%) dysthymia, five (1%) depression due to general medical condition, three (0.6%) cylothymia, three (0.6%) bipolar mood disorder type I. None was diagnosed as having bipolar mood disorder type II. Of the participants 319 (63.8%) reported more than 5 years use of opioid. Of the subjects only 16 (3.2%) reported no episode of abstinence and the majority 484 (96.8%) reported one or more episodes of abstinences. About 4.2% (21) reported less than 1 g/day and the majority 86.4% (432) reported between 1 and 5 g/day current use of opioid. CONCLUSION: Due to high rates of mood disorders in opioid-dependent subjects, psychiatric services should be open and accessible to the patients, especially those who voluntarily seek help and treatment.

Adolescent↗
PubMed2004

Twelve-month maintenance treatment of opium-dependent patients.

The goal of this study was to compare the effects of 1, 3 and 8 mg per day doses of buprenorphine in the maintenance treatment of opium-dependent subjects in Iran over a treatment period of 12 months. Participants were randomized to three equal groups (171 subjects per group) of opium-dependent individuals who met the DSM-IV criteria for opioid dependence and were seeking treatment. They were treated in an urban outpatient clinic, offering a 1-hour weekly individual counseling session. Overall, 282 subjects (55%) completed the 12 months study. Completion rates by dosage group were 46 (26.9%) for the 1 mg dose group, 102 (59.6%) for the 3 mg dose group, and 134 (78.4%) for the 8 mg dose group (p =.000). These findings are consistent with previous reports of effective buprenorphine use in western countries as a suitable maintenance treatment for opium dependence.

Adult↗
PubMed2004

Substance abuse: prevalence in a sample of nursing students.

AIMS: The aim of this research was to evaluate the prevalence of substance abuse in a sample of Iranian nursing students. DESIGN AND MEASUREMENTS: Four hundred nursing students (85.25% were females and 14.25% were male) were assessed by a confidential questionnaire based on DSM-IV, which was distributed, completed by the students and collected in the same session. FINDINGS: Mean age of the females was 20.3 and of males was 22.8. Of the subjects, 27.3% (21.4% of females and 61% of males) reported usage of substance(s) once or more sometime during their lives: cigarette (25.3%), alcohol (5.8%), opium (8.5%), cocaine (1.5%), hashish (1.5%), marijuana (0.8%) and morphine (0.5%). Only 3.8% of the participants (1.8% of females and 15.3% of males) reported still using substances: cigarettes (3.3%), alcohol (1.7%), opium (0.8%), cocaine (0.5%) and marijuana (0.3%). About 11.8% of the subjects (10% of females and 22% of males) reported using of substances occasionally (at least once a month): cigarette (10.8%), alcohol (3.5%), opium (4.3%), cocaine (0.5%) and hashish (0.3%). Some used or were using more than one substance. CONCLUSIONS: Substance use was significantly related to sex: higher among males than females. Tobacco and opium were found to be the most prevalent form of substance use among students. Pleasurable purposes, habit, need (to avoid withdrawal symptoms) and tension were the major reasons for substance use. There was no report of psychedelics use. These results are, however, different from those studies carried out in the west, although there is some overlap. Cultural attitudes toward substance use quite likely affect the types and patterns of use. These findings can be considered when planning preventive and therapeutic programmes. RELEVANCE TO CLINICAL PRACTICE: Substance use can reduce scientific progress and academic achievement of nursing students; therefore, authorities of the university must be able to assess the extent of the problem, understand the contributing factors, recognize signs and symptoms, and use educational interventions in identifying and preventing substance dependency.

Adult↗
PubMed2004

Why do doctors dislike treating people with somatoform disorder?

OBJECTIVE: To consider the question of why doctors dislike treating people with somatoform disorder, with a view to assisting debate and improving services. METHODS: The literature was examined, and compared with clinical experience. RESULTS: Psychological, sociological and evolutionary theory make relevant contributions. Important factors include that these conditions are problematic and positive outcomes may not be possible given current knowledge and clinical skills and techniques. Patients may not accept that their problem is a form of psychiatric or brain disorder. Most importantly, the doctor may not accept that somatoform disorders are beyond the control of patients, setting the scene for irritation and unsatisfactory interactions. CONCLUSIONS: There are many factors that underlie the dislike of some doctors for treating people with somatoform disorder. There is a pressing need for educational efforts to help students and doctors accept that the symptoms of somatoform disorder are beyond the control of those who suffer them.

Attitude of Health Personnel↗
PubMed2003

Prevalence of substance use among Iranian high school students.

AIMS: This study assessed the rate of substance use among Iranian high school students. PARTICIPANTS: 397 high school students (200 girls and 197 boys) were selected randomly and were assessed. MEASUREMENTS: A confidential questionnaire was distributed, completed by the students, and collected in the same sessions in 2000. RESULTS: The mean ages for high school girls and boys were 15.85 and 17.28 years, respectively. Of the subjects, 30.23% reported usage of substance(s) once or more sometime during their lives: cigarettes (25.4%), alcohol (9.6%), opium (3.5%), hashish (2.8%), marijuana (1%), heroin (2%), LSD (0.5%), cocaine (1%), and morphine (0.8%). Only 13.86% of the students were currently using substances: cigarettes (8.3%), heroin (1%), morphine (0.3%), alcohol (4.3%), opium (0.8%), LSD (0.3%), cocaine (0.5%), hashish (0.8%), and marijuana (0.8%). Some used or were using more than one substance. CONCLUSIONS: Substance use was significantly higher among males than females. Cigarettes, alcohol, and opium were found to be the most prevalent forms of substance use. Seeking pleasure and release of tension were the most common reasons for substance use.

Adolescent↗
PubMed2003

Prevalence of substance use among offspring of opioid addicts.

AIMS: This study assessed the prevalence of substance use in sons and daughters of opioids addicts in Iran. MEASUREMENTS: A confidential semistructured interview and DSM-IV criteria were used. Data were gathered from 500 subjects (225 men and 275 women). These subjects were selected randomly from sons and daughters of 500 opioids addicts (out of 1500 opioids addicts) who sought treatment in 2000. RESULTS: Of these subjects, 33.8% were in the age range of 20-29, 33.1% in 30-39, 28% were >40, and 7.1% were <20 years; of them, 81.6% were married and 18.4% were single. The majority (36.2%) used cigarettes, 19% used opium, 18.2% used alcohol, 2.6% used hashish, and 1.6% used marijuana once or more at some time in their lives. Nobody used cocaine or psychedelics. Of the current substance dependents, using DMS-IV criteria, 46.7% of men and 5.5% of women were nicotine dependent, 12.9% of men and 1.1% of women were opium dependent, and 0.9% of men and 0.7% of women were heroin dependent. (Some used or were using more than one substance.) Enjoyment (56.8%) was the first and modeling (49.6%) was the second most common reason reported for substance use. CONCLUSIONS: Substance use was significantly higher in men, in single, and also in illiterate subjects. There was a nonsignificant relation between age group and substance use. Cultural attitudes toward drug use quite likely affect the type and amounts of use. These findings can be considered when planning preventive programs.

Adolescent↗
PubMed2003

Methadone versus buprenorphine maintenance for the treatment of heroin-dependent outpatients.

The aim of this study was to assess the efficacy of methadone compared with buprenorphine maintenance therapy in heroin-dependent patients over a treatment period of 18 weeks. Subjects were randomized to receive either methadone or buprenorphine in a comparative double-blind study and consisted of 164 heroin-dependent male patients who met the DSM-IV criteria for heroin dependence and were seeking treatment. The 164 subjects included 41 patients in 1-mg, 41 patients in 3-mg, and 41 patients in 8-mg dosage group of buprenorphine, and also 41 patients in the 30-mg dosage group of methadone. The mean age was 31.4 years for total buprenorphine group and 33.7 years for methadone group (the mean age differences in 4 groups were not statistically significant). Subjects received buprenorphine at a dose of 1, 3, or 8 mg per day or methadone at a dose of 30 mg per day and were treated in an urban outpatient clinic, offering a 1-hour weekly individual counseling session. Days retained in treatment were measured. Completion rates by buprenorphine dosage group were 29.3% for the 1-mg dose group, 46.3% for the 3-mg dose group, 68.3% for the 8-mg dose group, and 61% for the 30-mg methadone dose group. Retention in the 8-mg dose group was significantly better than in the 1-mg dose group (p=.00041) and in the 3-mg dose group (p=.045); other comparison (1 mg dose with 3 mg dose) was not significant. Methadone group was significantly better than 1mg buprenorphine dose group (p=.004), but was not significantly different from 3 mg buprenorphine dose group (p=.18) or 8 mg buprenorphine dose group (p=.49). The results support the efficacy of buprenorphine for outpatient treatment of heroin dependence and seem to indicate that the highest dose (8 mg) of buprenorphine was the best of the three doses of buprenorphine, and also support the superiority of 30 mg of methadone compared to 1 mg dose of buprenorphine for Iranian heroin-dependent patients to increase their retention in treatment.

Adult↗
PubMed2003

Twenty-four week maintenance treatment of cigarette smoking with nicotine gum, clonidine and naltrexone.

This research study investigated the effect of nicotine gum, clonidine, and naltrexone, in the maintenance treatment of cigarette smoking. In a double blind study, 171 nicotine-dependent male subjects who met DSM-IV criteria for nicotine dependence and smoking 10 cigarettes or more per day, were allocated randomly to three equal groups of 57. Subjects received nicotine gum, clonidine, or naltrexone over a 24-week treatment period. The nicotine gum dose was 2 mg every 1 to 2 h for the first 6 weeks, 2 mg every 2 to 4 h for the next 3 weeks, and 2 mg every 4 to 8 h for the remaining 15 weeks. The clonidine dose was 0.4 mg and the naltrexone dose was 50 mg per day. Continuous abstinence rates were recorded weekly for 24 weeks from the quit date. The abstinence rates by treatment groups were 36.8% for the nicotine gum group, 19.3% for the clonidine group, and 5.3% for the naltrexone group,and all between groups differences were significant. These results support the efficacy and safety of nicotine gum and clonidine for smoking relapse prevention among Iranian nicotine-dependent patients, but call in question the utility of naltrexone treatment for smoking relapse prevention.

Adult↗
PubMed2003

Imaging of the pituitary and parasellar region.

The pituitary is part of a chain of enormous biologic amplification, which is regulated by a small amount of releasing factors in the portal blood from the hypothalamus. The pituitary is a master gland that regulates a number of hormones. A subtle abnormality in the pituitary can cause significant changes in body metabolism. Because the pituitary glands are small structures, high-resolution imaging techniques are required to satisfactorily evaluate the gland. It is imperative for the radiologist to be familiar with the anatomy, physiology, and pathology of the pituitary gland, which provides a solid foundation for accurate interpretation of the imaging studies of the pituitary gland.

Adenoma↗
PubMed2003

Treatment success rate among Iranian opioid dependents.

AIMS: The goal of this study was to assess the characteristics and treatment success rate (outcome) among Iranian opioid addicts. MEASUREMENTS: The data were gathered from 437 opioid addicts (using DSM-IV criteria) seeking treatment in 1998. FINDINGS: Their mean age was 35.6yr., and 72.8% were married. Of these subjects 34.1% listed secondary school, 25.9% primary school, and 23.6% listed high school as their level of education. Of these addicts 26.1% were unemployed, 24.5% miscellaneous workers, and 22.4% were drivers. About 49.4% reported opium, 31.8% heroin, 12.4% cooked dross, and 6.4% reported other opioids as the substance currently used. Of the 437 addicts, the majority (54%) did not complete detoxification phase, 35% had experienced abstinence at least for three months, and 11% relapsed prior to completion of three months of abstinence. The relation was statistically significant between outcome and type of used opioid and also between dose of used opioid and outcome. CONCLUSIONS: The most commonly used opioids were opium, heroin, and cooked dross. During recent years, some demographic characteristics of the Iranian addicts have changed. Cultural attitudes toward drug use are quite likely to affect types and amount of use and also outcome of treatment. These findings can be considered when planning preventive and therapeutic programs.

Adolescent↗
PubMed2003

Psychiatric disorders in opioid dependants.

AIMS: Psychiatric disorders are common among substance dependants. The objectives of this study were to assess the rate of neurotic disorders among opioid addicts, and reassess the rate of those neurotic disorders two weeks after complete detoxification of the patients. MEASUREMENTS: Data were gathered from 500 (496 men and 4 women) opioid dependants, using DSM-IV criteria. The Middlesex Hospital Questionnaire (MHQ) was used to measure free-floating anxiety, depression, phobia, obsession, hysteria and somatization. RESULTS: Four hundred and ninety-six (99.2%) of the subjects were men of whom the majority (65.2%) were married, 26.4% single and the others were divorced or separated. Three hundred and thirty-four (66.8%) were in age range of 20 to 39 years. Of the subjects 154 (30.8) were self-employed, 116 (23.2%) were factory workers, 100 (20%) unemployed, 64 (12.8%) employees and 32 (6.4%) retailers. The majority, 322 (64.4%), reported elementary and high school as their level of education and only 20 (4%) were illiterate. The means for neurotic disorders (using the MHQ) before and two weeks after detoxification were 10.12 and 9.98 for anxiety, 7.54 and 7.41 for phobia, 10.10 and 9.76 for depression, 11.11 and 11.05 for obsession, 8.47 and 8.49 for hysteria and 9.82 and 9.46 for somatization, respectively. The mean difference was significant only for depression. CONCLUSIONS: Present findings indicated that the rate of neurotic disorders in opioid dependants is high and (except for depression) was not significantly different before detoxification and two weeks after detoxification. Opium was found to be the most prevalent form of opioid used. Also it can be concluded that during the last years some demographic characteristics of Iranian opioid addicts in this sample have changed. Cultural attitudes toward substance use quite likely affect the pattern of substance use. These findings can be considered when planning preventive and therapeutic programs.

Adult↗
PubMed2002

A controlled trial of buprenorphine treatment for opium dependence: the first experience from Iran.

AIMS: To evaluate the effect of a 4 mg/day sublingual dose of buprenorphine in the maintenance treatment of opium dependence in comparison with a 1 mg/day dose over an 18-week treatment period. As a secondary objective, the results were determined concurrently for subjects treated with a 2 mg/day dose. DESIGN: Subjects were assigned randomly to three dosage groups. PARTICIPANTS: 330 consecutive (320 men and 10 women) opium addicts who met the DSM-IV criteria for opioid dependence and were seeking treatment. INTERVENTION: Subjects received a 1, 2 or 4 mg/day dose of buprenorphine and were treated in an outpatient clinic where they also received a weekly 1-hour clinical counseling session. MEASUREMENTS: Addiction Severity Index, retention in treatment, and illegal opioid use as determined by random urine testing. FINDINGS: The mean age was 37.5 years (SD=11.4, range 19-72). Overall, 194 (58.8%) of the patients completed the 18 week study. Completion rates by dosage groups were 47.3% for the 1 mg group, 58.2% for the 2 mg group and 70.9% for the 4 mg group (chi(2)=12.7, df=2, P=0.0017). CONCLUSIONS: The results support the efficacy and safety of buprenorphine for opium addiction and suggest that an adequate dose of buprenorphine would help to increase the success rate.

Adult↗
PubMed2002

Substance use among Iranian cardiovascular patients.

AIMS: This study assessed the prevalence of substance use among Iranian patients with cardiovascular disease who were admitted in different cardiac wards at Shiraz general hospitals. DESIGN: Cross-sectional survey using structured interview and also using DSM-IV criteria for substance dependency. SETTING: General hospitals in Shiraz city (Patients with cardiovascular disease admitted in different cardiac wards). PARTICIPANTS: Ninety-six patients selected randomly. FINDINGS: Data were gathered by a structured interview from 96 patients admitted in cardiac ward of general hospitals in 2001. The mean age was 52.6 yr., (SD = 14.64) ranging from 15 to 100 yr. About 38.5% (58.3% of men and 18.8% of women) reported the use of substance(s) once or more in their lives. The majority (36.5%) used tobacco, 9.4% used opium and 8.3% used alcohol. No body used cocaine or LSD. About 24% (39.6% of men and 8.3% of women) were current substance dependent, using DSM-IV criteria. The majority (22%) were nicotine dependent, 5.2% were opium dependent and 3.1% were alcohol dependent. The reported reasons for initial use of substance(s), in order of frequencies, were Enjoyment, Modeling and Release of tension, and also for current users were, Habit, Enjoyment, Release of tension and Need. CONCLUSIONS: Substance use especially cigarettes, opium and alcohol was found to be high among patients. There was no report of cocaine or LSD use. Cultural attitudes toward substance use were found to affect the type and amount of use. These findings can be considered when planning preventive programs. cardiovascular disease; substance dependency; alcohol; tobacco; opium; heroin; LSD; cocaine; hashish; marijuana; morphine

Adolescent↗