Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 10 2016 11 19 683 685 EN Maryam Mobini Department of Rheumatology, Diabetes Research Center, Mazandaran University of Medical Sciences, Mazandaran, Iran. Roya Ghasemian Department of Infectious Diseases, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Mazandaran, Iran. Fatemeh Zameni Department of Infectious Diseases, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Mazandaran, Iran. 2016 11 05 2016 11 05 Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. There is not currently any specific serological markers for AOSD , and  diagnosis still relying on the exclusion of other likely diagnoses. Yamaguchi’s criteria are used as a diagnostic criterion which contains negative serologic markers for other collagen vascular diseases including systemic lupus erythematosus and rheumatoid arthritis. Here we report a 28-year-old woman with arthralgia, fever, rash, leukocytosis, lymphadenopathy, sore throat, abnormal liver function and negative rheumatoid factor and ANA but  seropositive for anti-CCP, anti-dsDNA, and C-ANCA. It seems that despite AOSD is considered as a seronegativedisorder; it should be remembered in patients with compatible findings who are seropositive. https://acta.tums.ac.ir/index.php/acta/article/view/5998 https://acta.tums.ac.ir/index.php/acta/article/download/5998/4855

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 10 2016 11 19 678 682 EN Rita Rezaee Quality Improvement in Clinical Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Neda Moadeb Shiraz University of Medical Sciences, Shiraz, Iran. Nasrin shokrpour English Department, Shiraz University of Medical Sciences, Shiraz, Iran. 2016 01 15 2016 05 10 Team-based learning is designed to provide students with both conceptual and procedural knowledge, aiming to enhance active learning and critical thinking. In the present study, team-based learning and lecture methods in teaching the “hospital organization and management” course among hospital management students were compared. This quasi-experimental study was conducted on 25 undergraduate students of management. Teaching sessions were divided into two parts. The first part was taught with interactive lectures and the second part with team-based learning method. The students' knowledge was measured before, immediately and two months (late post-test) after teaching. Finally, the mean scores of the final exam and students' satisfaction towards the methods of teaching were measured. There was an improvement in test scores of the students after the TBL sessions when compared to the test scores after lecture sessions (P<0.001). Also, TBL group had significantly a higher amount of knowledge retention compared to the lecture group (P<0.001), but no significant relationship was found between the mean scores of the final exam in the TBL and lecture groups (P=0.116). Finally, the majority of the respondents were more satisfied with TBL sessions compared to the ones held through lecture (P=0.037). The results indicated that TBL provides a better outcome for students. We found that the TBL approach allowed us to create an active learning environment that contributed to the improvement of the students’ performances. https://acta.tums.ac.ir/index.php/acta/article/view/5366 https://acta.tums.ac.ir/index.php/acta/article/download/5366/4853

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 10 2016 11 19 620 623 EN Sima Shokri Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Mohammad Nabavi Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Tatjana Hirschmugl CeMM Research Center for Molecular Medicine, Austrian Academy of Sciences, Vienna, Austria. Asghar Aghamohammadi Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Saba Arshi Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Mohamad Hassan Bemanian Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Morteza Fallahpour Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Rasool Molatefi Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Mahsa Rekabi Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Narges Eslami Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Javad Ahmadian Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Kian Darabi Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Gholam Reza Sedighi Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Maryam Monajemzadeh Pediatrics Center for Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Modaresi Pediatrics Center for Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. AND Pediatric Respiratory Diseases Education and Research Network (PRDERN), Universal Scientific Education and Research Network (USERN), Tehran, Iran. Nima Parvaneh Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Kaan Boztug CeMM Research Center for Molecular Medicine, Austrian Academy of Sciences, Vienna, Austria. AND Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. Nima Rezaei Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Boston, MA, USA. 2016 07 13 2016 07 28 LPS-Responsive Beige-like Anchor (LRBA) deficiency is a disease which has recently been described in a group of patients with common variable immunodeficiency (CVID) in association with autoimmunity and/or inflammatory bowel disease (IBD)-like phenotype. We here describe a 10-year-old boy who experienced recurrent infections, mainly in the respiratory system, associated with thrombocytopenia and anemia. Immunological workup showed low numbers of B cells and low IgG, but normal IgM levels. In spite of therapeutic doses of antibiotics, antivirals, and antifungal agents, in addition to immunoglobulin replacement therapy, he developed disseminated involvement of both lungs with peripheral nodules; transbronchial lung biopsy revealed possible bronchiolitis obliterans organizing pneumonia (BOOP). Combined homozygosity mapping and exome sequencing identified a homozygous LRBA mutation in this patient (p.Asp248Glufs*2). Such clinical and immunological findings have not been described to date and illustrate the broad and variable clinical phenotype of human LRBA deficiency. https://acta.tums.ac.ir/index.php/acta/article/view/5773 https://acta.tums.ac.ir/index.php/acta/article/download/5773/4844

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 10 2016 11 19 686 689 EN Rekha Lalwani Department of Anatomy, All India Institutes of Medical Sciences, Bhopal (M.P.), India. Sunita Athavale Department of Anatomy, All India Institutes of Medical Sciences, Bhopal (M.P.), India. Sheetal Kotgirwar Department of Anatomy, All India Institutes of Medical Sciences, Bhopal (M.P.), India. 2016 11 05 2016 11 05   Anatomical variations of duodenum such as atresia, stenosis, and variations in shape have been described by various authors, but the existence of a gross anomaly in shape and position of midgut segment of the duodenum is rare. Few reported cases of duodenal anomalies date back to early twentieth century. In the wake of advancement of imaging techniques and minimal access surgeries, authors report a case of a rare duodenal anomaly. The reported case assumes significance because of thepossibility of misinterpretation of radiological images which has been discussed while citing such references. The present case reports an anomaly of the position of the midgut segment of the duodenum in an adult female cadaver. It was observed that the lower half of second part of duodenum was coiled like a serpent on the upper pole of right kidney. This part coursed initially upwards running parallel and to the right of the upper half of the second part of the duodenum. The third part coursed downwards and to the left, posterior to head and neck of pancreas, in its course sandwiching the commencement of portal vein. https://acta.tums.ac.ir/index.php/acta/article/view/5997 https://acta.tums.ac.ir/index.php/acta/article/download/5997/4854

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 10 2016 11 19 624 630 EN Shokofeh Banaei Department of Physiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran. Nasser Ahmadiasl Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Alireza Alihemmati Department of Histology and Embryology, Tabriz University of Medical Sciences, Tabriz, Iran. 2015 10 31 2016 04 17 Renal ischemia-reperfusion (IR) contributes to the development of acute renal failure (ARF). Oxygen free radicals are considered to be principal components involved in the pathophysiological tissue alterations observed during renal IR. The purpose of this study was to investigate the combination effect of melatonin (MEL) and erythropoietin (EPO), which are a potent antioxidant and anti-apoptotic agents, in IR-induced renal injury in rats. Wistar Albino rats were unilaterally nephrectomized and subjected to 45 min of renal pedicle occlusion followed by 24 h reperfusion. MEL (10 mg/kg, i.p) and EPO (5000 U/kg, i.p) were administered prior to ischemia. After 24 h reperfusion, following decapitation, blood samples were collected for the determination of superoxide dismutase (SOD), glutathione peroxidase (GPx), and malondialdehyde (MDA) levels. Also, renal samples were taken for histological evaluation and apoptosis assay. Ischemia-reperfusion increased SOD, GPx, MDA levels, and TUNEL positive cells. Histopathological findings of the IR group confirmed that there was renal impairment in the tubular epithelium. Treatment with EPO and MEL decreased SOD, GPx, and MDA levels, histopathological changes, and TUNEL positive cells. These results indicated that the combination of MEL and EPO could not exert more nephroprotective and anti-apoptotic effects than MEL treatment in renal ischemia-reperfusion injury. https://acta.tums.ac.ir/index.php/acta/article/view/5095 https://acta.tums.ac.ir/index.php/acta/article/download/5095/4856

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 10 2016 11 19 631 639 EN Fatemeh Sarhadi Kholari Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Reza Dehpour Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mitra Nourbakhsh Department of Clinical Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. AND Metabolic Disorders Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Amir Hossein Doustimotlagh Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Molood Bagherieh Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Abolfazl Golestani Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 25 2016 02 04 Cirrhosis is the consequence of chronic liver disease. Deleterious effects of oxidative stress on hepatocytes may be reflected in the erythrocyte membrane. Naltrexone (NTX) has been shown to attenuate hepatocellular injury in fibrotic animal models. The aim of this study was to investigate the progressive effect of CCl4 on the liver and whether the improvement of liver cirrhosis can be monitored through alterations in the erythrocyte membrane. In this study, 84 male Wistar rats were divided into 4 groups and received reagents (i.p.) as follows: 1- CCl₄, 2- NTX + CCl₄, 3- Mineral Oil (M), and 4- NTX + M. After 2, 6 and 8 weeks, the blood and liver tissue samples were collected. Plasma enzyme activities, the content of erythrocyte GSH and some membrane compositions, including protein carbonyl, protein sulfhydryl, and malondialdehyde were assessed. After 6 and 8 weeks, plasma enzyme activities and the content of protein carbonyl were higher in CCl4 group significantly, as compared to other groups (P<0.001). NTX significantly diminished protein carbonyl and plasma enzyme activities (P<0.001). GSH did not change until the 6th week. However, CCl4+NTX increased it significantly as compared to CCl₄ group (P<0.05). Protein sulfhydryl showed changes in NTX+CCl₄ group which indicated a significant increase in protein sulfhydryl content in a 6th week compared to CCl4 group (P<0.05). MDA did notCO2) up to 50 mmHg.  Further evaluation showed spiral wire damage resulted from Mouth Gag device that led to airway obstruction. Early anticipation of the complications leads to proper management of such critical and life threatening complications and prevention of hypoxia, hypercapnia, pneumothorax, and pulmonary edema. Based on our experience using an armoured endotracheal tube in tonsillectomy does not guarantee a safe airway and intensive monitoring is necessary. https://acta.tums.ac.ir/index.php/acta/article/view/4300 https://acta.tums.ac.ir/index.php/acta/article/download/4300/4255

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 9 2015 10 06 547 554 EN Reza Heidari School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Rafieh Alizadeh Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Niloufar Abbasi School of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran. Parichehr Pasbakhsh Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Azim Hedayatpour Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Farajpour School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Khaleghi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Abbasi Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Reza Dehpour Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 06 2015 10 06 Varicocele is one of the most common causes of primary male infertility. Pilea microphylla (PM) is being used as folk medicine. This study was aimed to investigate the effects of PM in a rat model of varicocele. A total of 30 male Wistar rats were divided into control, sham, varicocele, accessory varicocele and PM-treated groups. After 10 weeks of varicocele induction, sperm parameters and chromatin (Aniline blue, acridine orange and toluidine blue) were evaluated, except for the treated and accessory groups that received 50 mg/kg PM orally daily for 10 weeks and then were sacrificed. Sperm parameters significantly decreased in varicocele groups (P < 0.01).  Moreover, there was a negative correlation between the DNA fragmentation and sperm parameters in varicocelized rats. Administration of PM led to significantly increased sperm parameters and AO staining (P < 0.05). These findings suggest that PM improves sperm parameters and DNA fragmentation in varicocelized rats. PM can reduce the damage to sperm DNA but not chromatin condensation. https://acta.tums.ac.ir/index.php/acta/article/view/4291 https://acta.tums.ac.ir/index.php/acta/article/download/4291/4245

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 9 2015 10 06 555 561 EN Kaveh Khazaeel Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran. Yazdan Mazaheri Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran. Mahmood Hashemi Tabar Cellular and Molecular Research Center, Jundi-Shapour University of Medical Sciences, Ahvaz, Iran. Hossein Najafzadeh Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran. Hassan Morovvati Department of Basic Sciences, Faculty of Veterinary Medicine, Tehran University, Tehran, Iran. Alireza Ghadrdan Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University, Ahvaz, Iran. 2015 10 06 2015 10 06 Enrofloxacin is a synthetic chemotherapeutic agent from the class of the fluoroquinolones that is widely used to treat bacterial infections. It is metabolized to ciprofloxacin in the body as active metabolite. Fluoroquinolones change in the articular cartilage, especially with high doses and more than two weeks use. So, due to relatively excessive use of enrofloxacin in mammals and similarity of lambs to human subjects with respect to skeletal activity cycles, this study was done to investigate the effects of enrofloxacin on some cellular and molecular changes in growing lamb articular cartilage to evaluate some possible mechanisms involved these changes. Twelve, 2-month-old male lambs divided into three groups: control group received only normal saline; therapeutic group received 5mg/kg enrofloxacin subcutaneously, daily, for 15 days and toxic group received 35 mg/kg enrofloxacin in the same manner as therapeutic group. Twenty four hours after the last dose, the animals were sacrificed, and their stifle joints were dissected. Sampling from distal femoral and proximal tibial extremities was done quickly for further histological and molecular studies. Collagen-п content was studied with avidin-biotin immunohistochemistry method in different groups. Expression of Sox9 and caspase-3 was evaluated by Real–time PCR. Immunohistochemical changes were included decreases of matrix proteoglycans, carbohydrates, and Collagen-п in the toxic group. Some of these changes were observed in the therapeutic group with less intensity in comparison to the toxic group. Enrofloxacin were significantly decreased (P≤0.05). Sox9 expression in therapeutic and toxic groups compared to control group. But caspase -3 expressions in the toxic group significantly increased (P≤0.0001) with a comparison to other groups, while, between control and therapeutic groups, there were no significant differences. So, it can be concluded that enrofloxacin increases apoptosis in chondrocytes and decreases their numbers. Enrofloxacin use in growing lambs even at recommended therapeutic dose is not completely safe on articular cartilage. Moreover, higher doses of enrofloxacin induce severe changes in lamb articular cartilage. https://acta.tums.ac.ir/index.php/acta/article/view/4292 https://acta.tums.ac.ir/index.php/acta/article/download/4292/4246

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 9 2015 10 06 562 567 EN Atabak Najafi Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ali Khodadadian Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Sanatkar Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Reza Shariat Moharari Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farhad Etezadi Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Arezoo Ahmadi Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farsad Imani Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Khajavi Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 06 2015 10 06 The empiric antibiotic therapy can result in antibiotic overuse, development of bacterial resistance and increasing costs in critically ill patients. The aim of the present study was to evaluate the effect of procalcitonin (PCT) guide treatment on antibiotic use and clinical outcomes of patients admitted to intensive care unit (ICU) with systemic inflammatory response syndrome (SIRS).  A total of 60 patients were enrolled in this study and randomly divided into two groups, cases that underwent antibiotic treatment based on serum level of PCT as PCT group (n=30) and patients who undergoing antibiotic empiric therapy as control group (n=30). Our primary endpoint was the use of antibiotic treatment. Additional endpoints were changed in clinical status and early mortality. Antibiotics use was lower in PCT group compared to control group (P=0.03). Current data showed that difference in SOFA score from the first day to the second day after admitting patients in ICU did not significantly differ (P=0.88). Patients in PCT group had a significantly shorter median ICU stay, four days versus six days (P=0.01). However, hospital stay was not statistically significant different between two groups, 20 days versus 22 days (P=0.23).  Early mortality was similar between two groups. PCT guidance administers antibiotics reduce antibiotics exposure and length of ICU stay, and we found no differences in clinical outcomes and early mortality rates between the two studied groups. https://acta.tums.ac.ir/index.php/acta/article/view/4294 https://acta.tums.ac.ir/index.php/acta/article/download/4294/4249

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 9 2015 10 06 568 572 EN Fatemeh Laloha Department of Gynecology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Negin Asiabar Department of Gynecology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Ameneh Barikani Department of Community Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Farideh Movahed Department of Gynecology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Ezzatossadat Haj Seyed javadi Department of Gynecology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. 2015 10 06 2015 10 06 The use of corticosteroids is one of the methods put forward for the strengthening and speeding up the process of labor. After identification of glucocorticoid receptors in human amnion, the role of corticosteroids in starting the process of labor has been studied in numerous studies.The purpose of this study was to determine the effect of intravenous Dexamethasone on preparing the cervix and on labor induction. A randomized, clinical, and double – blind trial was conducted on 172 women divided into a control and an experimental group. The inclusion criteria were that they had to be primparous, in or before the 40 the week of pregnancy, and with Bishop scores (B.S.s) of 4 or lower. The exclusion criteria were diabetes, preeclampsia, macrosomia, twin pregnancy, rupture of the membrane (ROM), breech, and women suffering from background diseases. The B.S.s of the women was measured in charge of the study, and each woman was intravenously injected with eight milligrams of Dexamethasone or eight milligrams of distilled water. Four hours after the injections, the B.S.s of the participants was measured, and they were put under the conditions of labor induction using oxytocin. Information was collected in checklists A and B. The patients were compared with respect to B.S., the time the induction started, the average interval between the start of induction and the beginning of the active phase of childbirth, and the average length of time between the start of the active phase and the second stage of childbirth.The first and five minutes Apgar scores of the two groups of women were compared. The frequencies, the means, and the standard deviations were calculated using the SPSS – 16 software, and analysis of the results was performed with the Student’s t- test and the chi-square test with P<0.05. There were no statistically significant differences between the two groups in terms of their age, period of pregnancy, and B.S. at the start of the study. The average B.S. of women four hours after the injections with Dexamethasone was 5.9 ± 1.57, and the corresponding figure for women in the control group was 4.6 ± 1.72. These figures were significantly different at P<0.001. The average interval between labor induction and the start of the active phase in the, group injected with Dexamethasone was significantly less than that of the control group (2.87±0.93 versus 3.80± 0.93 at P<0.001). The average duration of the active phase of the second stage of childbirth was 3.47±1.10 hours in the experimental group and 3.6 ± 0.99 hours in the control group at P<0.49. These two figures were not significantly different. The Apgar scores of the first and fifth minutes after the birth of the children of the two groups of women were not significantly different. It was found that intravenous Dexamethasone improves the Bishop score of the cervix and thus causes softening of the cervix and reduces the length of time between labor induction and the start of the active phase of childbirth.     https://acta.tums.ac.ir/index.php/acta/article/view/4295 https://acta.tums.ac.ir/index.php/acta/article/download/4295/4250

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 9 2015 10 06 573 578 EN Ramin Mehrdad Department of Occupational Medicine, Center for Research on Occupational Diseases, Tehran University of Medical Sciences, Tehran, Iran. Khosro Sadeghniiat Haghighi Department of Occupational Medicine, Occupational Sleep Research Center (OSRC), Tehran University of Medical Sciences, Tehran, Iran. Amir Hossein Naseri Esfahani Department of Occupational Medicine, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. 2015 10 06 2015 10 06 Professional firefighting is among the most demanding jobs. Prior studies have showed the notable prevalence of poor sleep quality among professional firefighters that may result in catastrophes. The aim of this study was in field confirmation of zolpidem usage (10 mg/PO/bed time) for short term management of poor sleeps quality among professional firefighters. In a double-blind, randomized, placebo-controlled crossover clinical trial among professional firefighters, 27 poor sleepers were assigned randomly to one of the two groups. Two 14 days experimental periods were separated by a 14-day washout phase. Sleep quality was assessed using the Persian version of Pittsburgh Sleep Quality Index (PSQI). Six of the 27 enrolled voluntaries dropped out. Two rare side effects of zolpidem occurred in the study. A significant improvement of the PSQI score was detected in zolpidem period versus placebo in both groups (7.14 ± 3.02 vs 12.38 ± 2.51, PP=0.89). Zolpidem significantly improved all components of PSQI (Subjective sleep quality, Sleep latency, Sleep duration, Habitual sleep efficiency, Sleep disturbances and Daytime dysfunction) in the current study except the use of sleep medication. Sleep onset latency was the component of PSQI with the greatest degree of abnormality among firefighters in a previous study. Interestingly, sleep latency was the component of PSQI with the most treatment effect of zolpidem in the current study. Zolpidem can be used as a part of treatment regimens in short time management of poor sleep quality among professional firefighters. https://acta.tums.ac.ir/index.php/acta/article/view/4296 https://acta.tums.ac.ir/index.php/acta/article/download/4296/4251

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 9 2015 10 06 579 581 EN Zarrin Keihani Douste Department of Pediatric Neurology, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran. Mohhamad Taghi Haghi Ashtiani