Background:Substance abuse or drug addiction is one of the most important health issues in every society, which can lead to physical and mental problems.Objectives:This study aimed to compare the efficacy of tramadol plus gabapentin versus methadone use in the treatment of opiate withdrawal.Patients and Methods:Consenting male subjects who fulfilled the DSM-4 criteria for opiate dependence syndrome (opium, residue, and heroin) were randomly assigned in two groups to receive tramadol plus gabapentin or methadone. Assessment tools were Adjective Rating Scale for Withdrawal (ARSW), Clinical Opiate Withdrawal Scale (COWS) and Visual Analogue craving Scale (VAS). Fifty-nine subjects were enrolled and evaluated on days 1, 2, 3, 4, 6, and 8 during their 10 days of admission. Twenty-nine participants received methadone and the other 30 received tramadol plus gabapentin for their treatment.Results:Mean (SD) age of the patients in methadone group and tramadol plus gabapentin group were 33.9 (7.1) and 32.4. (8.1), respectively (P = 0.462). The overall ARSW (P value = 0.263) and COWS (P = 0.862) scores between the two groups were comparable. The differences in the VAS score for craving between the two groups was marginally significant (P = 0.057). The highest VAS score was at the third day of admission in both groups and it was generally higher in methadone group.Conclusions:The severity of withdrawal syndrome in two groups was not significantly different. The craving was higher in the group receiving methadone from the second day of admission even though the usage amount was higher in the tramadol plus gabapentin group. The findings of this study suggest that the combination of tramadol plus gabapentin is an efficient method for opioid detoxification.

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Background -Health anexity affects the doctor-patient relationship and also causes unnecessary further procedures. Therefore, early diagnosis of it with a valid instrument is very important. Objectives -The aim of this study was to evaluate psychometric properties of the Persian version of 14-item Whiteley Index. Material and Methods -This research was a cross sectional study carried out in the medical school of Kerman University of Medical Sciences. Our statistical population included all medical students who were studying in clerkship and internship in 2016. Data collected by using the Persian version of 14-item Whiteley Index and general health questionnaire. The reliability of the questionnaire determined using Cronbach's alpha and test-retest. The construct validity evaluated by principal component analysis and confirmatory factor analysis. Results -Three hundred and ten medical students participated. The reliability of Whiteley Index was 0.88 and 0.82 using Cronbach's alpha and intra class correlation coefficients. In the principal component analysis, two factors were extracted with the total amount of 50.4% explained variance. In confirmatory factor analysis the models had acceptable goodness of fit indices. Conclusion -Persian version of 14-item Whiteley Index can be used as a reliable and valid instrument for assessing Health anexity among Iranian young population.

Background: Stuttering as a communication disorder can lead to serious problems in interpersonal communication and affect the quality of life of the affected person. Objectives: The aim of this study was to investigate the effectiveness of telehealth in improving its treatment and its effect on maintenance phase of stuttering children. Methods: In this study, all 6 - 12 year-old stuttering children referred to the Speech Therapy Center of Shahid Beheshti Hospital in 2018 were selected by purposeful sampling method and divided into two groups of experiment and control. Children were healthy and without any disorder. All 12 children received a three-month course of treatment with a speech and language pathologist (SLP) weekly one session. Maintenance phase included 8 sessions of 30 minutes over a period of six months. Results: Six children in the experimental group received maintenance phase training exercises by the SLP in the form of audio and video files through the WhatsApp software. Average total satisfaction rating (4.22) the lowest satisfaction score (3.16) highest score (5). According to the total score of the questionnaire,17% of the parents were satisfied at a low rate, 33% of parents were satisfied with the average and 50% of parents were very satisfied. Conclusions: In this study, the efficacy of telehealth on the maintenance phase of stuttering children has been evaluated. Results showed that telemedicine, with its ability to completely remove distance and travel as barriers for both patients and health care professionals is one option. Telemedicine can be a viable alternative to traditional in-person physician-based care for stuttering.

ProblemVia a network analysis approach, following 2 weeks of the medication Ritalin, the present study investigated the quality of symptom interactions and the pattern of behavior changes to identify locations of functional weaknesses in the network interactions of symptomology.MethodsRitalin® prescribed for 112 children (aged 4–14) with attention deficit hyperactivity disorder (ADHD) as diagnosed by five child and adolescent psychiatrists. Their parents completed Swanson, Nolan, and Pelham‐IV questionnaire (SNAP‐IV) before and after Ritalin® onset as the pre and post‐test, respectively. Then, the network analysis approach was used to discover the pattern of changes in symptom interactions.FindingsThe results indicated that in 2 weeks following its initiation, Ritalin significantly reduced restlessness and interactions between symptoms of impulsivity. “Inability to follow instructions” and “difficulty waiting their turn” symptoms were the most central symptoms of strength. Three symptoms, “Often has difficulty waiting their turn,” “runs and climbs in situations where it is inappropriate” and “does not follow through on instructions,” had the most expected influence. In the 14‐day period of investigation, Ritalin® was effective in breaking some interactions and components of ADHD, but no significant mitigation of other components of the detected symptomatology network.ConclusionFollow‐up investigations using network analysis can clarify the dynamics of the network changes after initiation of medications.