Background:Myocardial infarction (MI) is a heart condition caused by the suspension of blood circulation in a part of the myocardium. There are different risk factors contributing to a heart attack. Some believe that endorphins and endogenous opioids play an important role in causing MIs.Objectives:This study intended to determine the relationship between opium dependency and mortality rate among patients with MI.Patients and Methods:This retrospective study investigated patients who had MI for the first time and were hospitalized in the coronary care unit (CCU) of Khatamolanbia hospital in Zahedan, Iran, from 2007 to 2010. These patients were either opium dependent or not. Four hundred patients were selected. The patients’ possibilities of death and re-hospitalization after the first MI were confirmed over the phone. Data was analyzed through t-test and chi-squared test.Results:Of all the patients, 19.5% were opium-dependent. The mortality rate in the non-opium-dependent group was 5.9%, while in the dependent group this rate was 11.5% (P = 0.072). The number of re-hospitalizations due to heart problems was higher in the opium-dependent patients (P < 0.001).Conclusions:There was no meaningful relationship between the mortality rate of patients with MI who were either opium-dependent or non-opium-dependent. The number of re-hospitalizations due to heart problems was meaningfully higher in the opium-dependent patients; hence, educating people and training them on the destructive effects of opium, specifically in patients with heart conditions is highly recommended.

Aim:The study aimed to determine the prevalence of post-traumatic stress disorder (PTSD) among postpartum women in Zahedan city, Iran. Method: Data in this cross-sectional study were gathered from healthcare centres of Zahedan, a city in south-east Iran. Four-hundred women with childbirth experience over the past few months were selected; between 6 and 24 weeks had passed since their delivery. We used three questionnaires in order to evaluate the demographic data, PTSD symptoms and traumatic childbirth experience. Results: The mean parity was 3.40±2.55 children and the mean duration of pain was 19.44±9.16 hours. Overall, 7.8%, 36% and 0.5% of the subjects had a previous history of curettage, episiotomy and vacuum evacuation, respectively. In total, 32% of the participants showed PTSD symptoms. Prevalence of PTSD was not significantly associated with parity, pain duration, education level or employment status. Significant correlation with PTSD was found with the mode of delivery (P=0.013), curettage (P=0.005) and length of hospitalization. Also, prevalence of PTSD was substantially associated with the type of pregnancy (planned or unintended) (P=0.011). Conclusion: Women with PTSD were not significantly different from those without PTSD in terms of parity, pain duration, education level or employment status. History of curettage, episiotomy and vacuum evacuation increased the incidence of PTSD in postpartum women. Moreover, unwanted pregnancy was more common among women with PTSD compared with normal subjects and length of hospitalization was longer. post-traumatic stress disorder / postpartum stress disorder / normal vaginal deliveryPost-traumatic stress disorder (PTSD) is a debilitating mental condition. This anxiety disorder occurs following exposure to an extremely traumatic, terrifying or tragic event and is common among soldiers and veterans returning from war [1]. People with PTSD remember horrible memories and harbour persistent frightening thoughts. PTSD can result from various traumatic incidents including natural disasters, serious accidents, and violent attacks such as rape and mass destruction. Most people with PTSD have repeated traumatic recollections during the day and experience insomnia or nightmares at night. They respond to traumatic experiences with fear and develop high levels of anxiety. People with PTSD may feel more irritable, aggressive, violent or easily startled than they did in the past. In ad-

BackgroundAbout 10 million children worldwide live or work on the street. International reports estimate the prevalence of substance use among street children to be between 25% - 90%, which is who were referredntal disorders and high-risk behaviors.ObjectivesThe objective of this study was to report the outcomes of assisted withdrawal of opioid-dependent vulnerable children and adolescents who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb hospital, an academic hospital in Zahedan city.MethodsClinical chart abstractions were performed on a convenience sample of 40 serial opioid-dependent street children and adolescents (mean age: 11.14 ± 3.6 years) who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb treatment and research center from November 2014 to May 2015. The demographic data, drug use history, comorbid physical and psychiatric conditions, symptomatology of opioid withdrawal syndrome, pharmacotherapies and psychosocial services, length of hospital stay, and any adverse events were extracted from the patients’ files using a checklist developed by the authors.ResultsTwenty-four (60%) patients were male, and 16 (40%) were female. The main drug used by all patients was opioids. Heroin Kerack (which has a street name of crystal in southeast Iran) was the most common (75%) drug of use, followed by opium (10%) and opium residue (7.5%). None of the participants self-reported using injected drugs. The high rate of a lack of eligibility for guardianship was documented among parents (87.5%) mainly due to their use of illegal drugs. Musculoskeletal pain and diarrhea were the most common withdrawal symptoms of the patients upon admission. The mean length of stay was 10.8 (± 7.30) days, and no significant adverse events were reported during the symptomatic treatment of opioid withdrawal syndrome.ConclusionsTo our knowledge, this is the first study to report on the safety and feasibility of inpatient symptomatic pharmacological treatment for assisted withdrawal among opioid-dependent children and adolescents in Iran. More well-designed studies to investigate the long-term outcomes of opioid treatment among children are warranted.

Opioid substitution therapy involves replacing the client's primary drug of use (opioid) with a medically safe drug or the same opioid in a safer mode of administration under medical supervision. Objectives and methodology:It is a prospective follow up study observing opioid withdrawal and its stabilization on buprenorphine sublingual tablets. Patients who fulfilled the criteria for Opioid substitution therapy by NACO guidelines were enrolled and given buprenorphine sublingual tablets; (0.2 mg and 2 mg). They were followed up on 1 st to 3 rd , 7 th , 14 th and 28 th day for assessment of withdrawal and its resolution on buprenorphine. The withdrawal was assessed using Clinical Opioid Withdrawal Scale (COWS). Duration of study was 2 years.Results and conclusions: Total 44 patients were enrolled. 37 IDU users completed the period of observation. They belonged to 19 to 52 years age group, the duration of use ranged from 2 to 32 years. Patients had mild to moderate range of withdrawal. The mean score of COWS was 11.2 with a range of 5 to 24. Mean buprenorphine dose requirement on 1 st day was 6.19 mg with range from 1.2 mg to 14 mg. Dose requirement at day 28 was in the range from 0.6 to 16mg. This study is empirical information on the issue of a reference dosage for buprenorphine regimen in an Indian population. We found that dosages required in our study population were lesser that dosage guidelines in western countries. However further research on such lines is required to suggest guidelines for Indian population.

Background: There are limited data supporting the effectiveness of buprenorphine treatment for opioid use disorder among adolescents. Objectives: The aim of this study was to investigate the outcomes of using buprenorphine for inpatient medically assisted withdrawal of vulnerable adolescents with opioid use disorder. Methods: Twelve consecutive vulnerable adolescents due to working or living in streets were admitted to the Child and Adolescent Psychiatric Ward of Ali Ibn-e-Abi Talib Hospital for treatment of opioid use disorder using buprenorphine-assisted withdrawal. The clinical chart abstraction of patients' files was made to provide the baseline situation of the patients, as well as treatment progress at discharge and one and three months post-discharge. Results: All the complaints of pain and other withdrawal signs and symptoms decreased dramatically within the first four days of treatment. At one-month follow-up, all study participants were still in the foster care and the urine tests for morphine and methamphetamine were negative. At the three-month follow-up, the older sister of the only one 15-year-old adolescent took the responsibility of his guardianship. The urine tests of all study participants were negative in month 3. Conclusions: Medically managed opioid withdrawal must be considered only as a part of a comprehensive psychosocial program providing a stable living environment, adolescent welfare, and custody services. The treatment program also proved its safety and effectiveness for the management of pain and other opioid withdrawal signs and symptoms among adolescents.