Iranian Red Crescent Medical Journal
Year:2014 | Volume:16 | Issue:9|Papers Count:19

Background: Awareness during general anesthesia in different types of surgery is an important described adverse event. Bispectral (BIS) monitoring is one of the recent techniques proposed to monitor the depth of anesthesia.Objectives: The present study tested the hypothesis that the awareness rate and changes in hemodynamic parameters within anesthesia would be lower in patients allocated to BIS-guided management than those allocated to routine monitoring.Materials and Methods: In total, 333 adult patients with the American Society of Anesthesiologists (ASA) physical status I-III, aged between 18 and 65 years scheduled for elective abdominal surgery under general anesthesia were included in this randomized double-blind placebo controlled trial. Patients were randomly allocated to BIS monitoring (n=163) or routine monitoring (n=170). BIS values and hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and SPO2 were marked before induction (control value), after intubation and laryngoscopy, at intubation, after incision, and also during the operation every 15 minutes until extubation.Results: The overall incidence of awareness in the BIS and routine monitoring groups were 5.5% and 4.1%, which was not significantly different. There were no significant differences in hemodynamic indices including SBP, DBP, HR, and SPO2 before induction of anesthesia between the two groups. These between-group differences in the studied indices remained insignificant at different time points after anesthesia induction as well as post ICU hospitalization. Furthermore, the trend of changes in hemodynamic parameters was comparable in the two groups.Conclusions: BIS-guided management may not be superior to routine monitoring protocols to prevent awareness as well as hemodynamic changes during general anesthesia in patients undergoing abdominal surgeries.

Background: Stachys pilifera Benth has long been used to treat infectious diseases as well as respiratory and rheumatoid disorders in Iranian folk medicine. Antioxidants, antitumor, and antimicrobial properties of the plant have been reported.Objectives: This experimental study was designed to evaluate systemic and topical anti-inflammatory effects of the hydro-alcoholic extract from aerial parts of Stachys pilifera (HESP).Materials and Methods: Anti-inflammatory effects of HESP was studied in four well-known animal models of inflammation, including carrageenan- or formalin-induced paw edema in rat (thirteen groups, 6 rats per each group), and 12-O-tetradecanoylphorbol-13-acetate (TPA)- or xylene-induced ear edema in mouse (ten groups, 6 mice per each group). The rats received HESP (50-400 mg/ kg) orally 45 minutes before the subplantar injection of carrageenan or formalin. In TPA or xylene tests, HESP (1, 2.5, and 5 mg/ear) was applied topically simultaneous with these phlogistic agents on the ear mice. Finally, pathological examination of the inflamed tissues (paw and ear) was carried out.Results: Acute toxicity study of the extract showed that no rats were killed at 5000 mg/kg (LD50>5000 mg/kg). The extract (100 and 200 mg/ kg) significantly suppressed carrageenan-induced paw edema 1, 2, 3, and 4 hours after carrageenan challenge in comparison with the control group (P<0.001). The HESP (100 and 200 mg/ kg) also produced a considerable antiedematogenic effect in the formalin test over a period of 24 hours (P<0.01). Furthermore, topical administration of the HESP (1, 2.5, and 5 mg/ear) inhibited TPA- and xylene-induced ear edema in comparison with the control group (P<0.001). The pathological analysis of the paws and ears revealed that HESP was capable of reducing tissue destruction, cellular infiltration, and subcutaneous edema induced by the indicated phlogistic agents.Conclusions: The present data confirmed systemic and topical anti-inflammatory effects of Stachys pilifera which is comparable to indomethacin.

Background: As individuals live a longer life, health-promoting lifestyle (HPL) becomes even more essential, particularly with regard to maintaining functional independence and improving quality of life (QoL).Objectives: This study aimed to determine the association between QoL and HPL in the Iranian elderly living in Shiraz.Materials and Methods: This analytical cross-sectional study was conducted in 2013 at retirement centers of Shiraz City, Iran. The sample included 500 elderly who aged>60 years. Proportional stratified random sampling was used to select the elderly from retirement centers. QoL was assessed by the Farsi version of Short Form Health Survey questionnaire (SF-36) and HPL was measured by health-promoting lifestyle profile (HPLP II). Data were analyzed using independent-samples t test, one-way ANOVA, Pearson’s correlation, and stepwise multiple regression using SPSS 21.Results: There were significant differences in QoL in terms of sex, age, education, and marital status. There were significant differences in HPL in terms of gender, age and education (P<0.05) There was a statistically significant association between QoL and HPL in the elderly (r=0.42, P<0.05). Based on HPLP II constructs, the significant predicting factors of QoL in the elderly consisted of spiritual growth, stress management, and physical activity (P<0.05).Conclusions: Health providers should improve the QoL in the elderly by facilitating HPL through health-promoting interventions, which will maintain and increase physical activity, stress management, and spiritual growth.

Background: Deep vein thrombosis (DVT) is a well-recognized complication in patients with cancer. Chemotherapy and cancer surgery increase the risk of DVT in these patients. There are a few reports about the prevalence of DVT in patients with cancer regarding different managing modalities.Objectives: This study aimed to assess the prevalence of DVT in patients with cancer, who were hospitalized in teaching hospitals, according to their treatment intervention.Patients and Methods: A cross-sectional retrospective study was conducted on 602 patients with cancer in Kerman, Iran, during years 2006-2007. Among the subjects, 301 had been operated and the rest had received chemotherapy. The prevalence of DVT was determined based on patients’ variables, cancer factors, and therapeutic modalities.Results: Totally, 349 subjects (58%) were male. DVT incidence was 19.9%, most of the cases were over 40 years of age (82.2%), and 21.2% of males and 18.2% of females had developed DVT. The prevalence of DVT in chemotherapy group was higher than that in surgery group (21.9% and 17.9%, respectively); however, this difference was statistically insignificant. DVT developed more frequently in lung cancer (42%) with small cell carcinoma being the most common pathologic finding (42.9%) in those with lung cancer (P=0.0001).Conclusions: DVT occurs frequently in patients with malignancies. In this study, there was no association between DVT prevalence and age as well as sex; nonetheless, the prevalence was significantly higher in some sites and in patients with certain pathologies. Although DVT prevalence was higher in chemotherapy than in surgery, the difference was insignificant. Informing patients with cancer about symptoms of DVT and prophylactic interventions are warranted.

Background: Anxiety is the most common emotional response in women during delivery, which can be accompanied with adverse effects on fetus and mother.Objectives: This study was conducted to compare the effects of aromatherapy with rose oil and warm foot bath on anxiety in the active phase of labor in nulliparous women in Tehran, Iran.Patients and Methods: This clinical trial study was performed after obtaining informed written consent on 120 primigravida women randomly assigned into three groups. The experimental group 1 received a 10-minute inhalation and footbath with oil rose. The experimental group 2 received a 10-minute warm water footbath. Both interventions were applied at the onset of active and transitional phases. Control group, received routine care in labor. Anxiety was assessed using visual analogous scale (VASA) at onset of active and transitional phases before and after the intervention. Statistical comparison was performed using SPSS software version 16 and P<0.05 was considered significant.Results: Anxiety scores in the intervention groups in active phase after intervention were significantly lower than the control group (P<0.001). Anxiety scores before and after intervention in intervention groups in transitional phase was significantly lower than the control group (P<0.001).Conclusions: Using aromatherapy and footbath reduces anxiety in active phase in nulliparous women.

Context: Cleft palate is the second most common birth defect and is considered as a challenge for pediatric plastic surgeons. There is still a general lack of a standard protocol and patients often require multiple surgical interventions during their lifetime along with disappointing results.Evidence Acquisition: PubMed search was undertaken using search terms including 'cleft palate repair', 'palatal cleft closure', 'cleft palate+stem cells', 'cleft palate+plasma rich platelet', 'cleft palate+scaffold', 'palatal tissue engineering', and 'bone tissue engineering'. The found articles were included if they defined a therapeutic strategy and/or assessed a new technique.Results: We reported a summary of the key-points concerning cleft palate development, the genes involving this defect, current therapeutic strategies, recently novel aspects, and future advances in treatments for easy and fast understanding of the concepts, rather than a systematic review. In addition, the results were integrated with our recent experience.Conclusions: Tissue engineering may open a new window in cleft palate reconstruction. Stem cells and growth factors play key roles in this field.

Background: Tuberculosis is still a public health concern in Iran. The main challenge in monitoring epidemiological status of tuberculosis is to estimate its incidence accurately.Objectives: We used a newly developed approach to estimate the incidence of tuberculosis in Sistan, an endemic area in southeast of Iran in 2012-13.Patients and Methods: This cross-sectional study was conducted on school children aged 6-9 years. We estimated a required sample size of 6350. Study participants were selected using stratified two-stage cluster sampling method and recruited in a tuberculin skin test survey. Indurations were assessed after 72 hours of the injection and their distributions were plotted. Prevalence and annual risk of tuberculosis infection (ARTI) were estimated using the Bayesian mixture model and some traditional methods. The incidence of active disease was calculated using the Markov Chain Monte Carlo technique.Results: We assumed weibull, normal and normal as the best distributions for indurations due to atypical reactions, BCG (Bacillus Calmette-Guerin) reactions and Mycobacterium tuberculosis infection, respectively. The estimated infection prevalence and ARTI were 3.6% (95%CI: 3.1, 4.1) and 0.48%, respectively. These estimates were lower than those obtained from the traditional methods. The incidence of active tuberculosis was estimated as 107 (87-149) per 100000 population with a CDR of 54% (40%-68%).Conclusions: Although the mixture model showed slightly lower estimates than the traditional methods, it seems that this method might generate more accurate results for deep exploration of tuberculosis endemicity. Besides, we found that Sistan is a high endemic area for tuberculosis in Iran with a low case detection rate.

Background: Studies in higher education indicated that students’ expectation for their educational services are not provided sufficiently, particularly in developing countries that implies on gap between the students perception on current situation and their expectations from educational services.Objectives: The aim of this study was to determine the gap between student perception and expectations of students in various levels of the undergraduate educational courses at Urmia University of Medical Sciences, Iran.Patients and Methods: This is a longitudinal study, which was conducted in academic year 2007-2008 at the Urmia University of Medical Sciences. In total, 173 students were selected as sample size, among various courses. SERVQUAL questionnaire was used as instrument.Descriptive statistics following by Friedman and Wilcoxon tests were used to determining significance of quality gap between five dimensions and to evaluate significant gap between student perceptions and their expectations, respectively. Spearman test was also used to determine the relationship between dimensions.Results: In overall, 80% of educational expectations were not meet; there was a negative gap at all phrases and dimensions and the gap was more negative for educational experts (-1.45±0.89) compared to teachers (-0.97±0.97). The highest gap for teachers was in empathy dimension (-1.11±1.51), while for experts it was in assurance dimension (-1.58±1).Conclusions: Existences of gap in dimensions indicated that expectations of students are not met and it indicates their dissatisfaction, and thus it is a necessity for improvement in all dimensions.

Background: Acupuncture has recently received considerable attention around the world due to its cost-effectiveness, few side effects, and well-established analgesic properties.Objectives: The present study aimed to identify the factors that might lead to using acupuncture for pain relief.Patients and Methods: This qualitative study was conducted using conventional content analysis method. The study population included eight patients and six highly experienced acupuncturists, who were able to express their opinion and were willing to take part in the study. The inclusion criteria for patients were being under treatment with acupuncture for pain relief or a history of treatment during the last year and age>18 years. All highly trained acupuncturists with minimum of one-year active experience were included. The data were collected via semi-structured in-depth interviews. Categories were extracted through inductive analysis and codes and eventually, themes emerged. Data rigor was assured by data collection triangulation, participants’ variety, and external and members' check.Results: Initially, 1311 primary codes were extracted, then the related codes were divided into 127 subcategories according to their similarities, and after reduction and integration process, 16 categories were developed from subcategories and eventually five themes were determined, including conventional medicine limitation, efficacy of acupuncture, external promoters, internal promoters, and acupuncture inhibitors.Conclusions: The important factors that affect choosing acupuncture for pain relief included conventional medicine limitations, external promoters, internal promoters, acupuncture efficacy, and acupuncture inhibitors. More interest can be drawn to this technique by basic planning to enhance some of the underlying factors and eliminate obstacles to its further applicability.

Background: Bioflavonoids are well known for their multi directional biologic activity including antidiabetic effect. It has been demonstrated that flavonoids can act as insulin secretagogue or insulin mimetic agents.Objectives: This experimental study was designed in Arak University of Medical Sciences, Arak, Iran, to investigate the effects of biochanin A (a bioflavonoid) on fasting blood glucose (FBG), body weight, glycosylated hemoglobin (HbA1c), lipid profile, serum enzymes, and visfatin of streptozocin-induced diabetic rats.Patients and Methods: We used 24 male Wistar rats and randomly allocated them to four groups of six rats. One group was randomly assigned as control and diabetes was induced in three other groups by administration of streptozocin (35 mg/kg of body weight) intraperitoneally. The groups received the following treatments: group 1 (control), 5% DMSO; group 2 (diabetic control), 0.5% DMSO; and group 3 and 4, respectively 10 and 15 mg/kg biochanin A for 30 days. Body weight and biochemical parameters including FBG, HbA1c, lipid profile, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and visfatin were measured in all rats.Results: FBG level was significantly reduced in treated diabetic rats (139.8±9.3 and 206±11 mg/dL in groups 3 and 4, respectively) in comparison to the diabetic control (295.1±14 mg/dL) (P<0.05). Administration of biochanin A significantly decreased HbA1c in group 3 (6.66±0.33) and group 4 (7.11±0.31) in comparison to the diabetic control group (8.26±0.44) (P<0.05). Levels of serum visfatin were improved to near normal levels in the treated rats (249±35.5 and 161.33±13.07 in groups 3 and 4, respectively) in comparison to the diabetic control (302.17±19.4) (P<0.05). Furthermore, biochanin A showed a protective effect against weight loss in diabetic rats (P<0.05). In treated rats, serum total cholesterol, triglyceride, and low-density lipoprotein cholesterol (LDL-c) were significantly decreased and high-density lipoprotein (HDL-c) was increased in comparison with the diabetic control group. In addition, biochanin A restored the altered plasma enzymes (AST, ALT, and ALP) activities to near normal. Histopathologic examination of the pancreas also indicated that biochanin A had protective effects on b-cells in streptozocin-induced diabetic rats.Conclusions: This study demonstrated that biochanin A possessed hypoglycemic and antilipemic activities and could increase visfatin expression, which suggests its beneficial effect in the treatment of diabetes.

Introduction: Sialolithiasis is the most common disease of salivary glands. Sialography is particularly important for the assessment of the outflow tract and in diagnosing obstructive salivary gland lesions including calculi.Case Presentation: We report on a 38-year-old female with sialolithiasis whom had Wharton’s duct perforation, complicating the sialography. She was treated conservatively with a course of co-amoxiclav, oral prednisolone for three days and pain-killers. The patient was clinically well on follow-up reassessments at the end of the first week and three weeks post procedure.Conclusions: Perforation of salivary duct complicating the sialography is rare. Awareness of this potential complication and utilizing a good sialography technique need to be advocated amongst radiologists. Response to treatment by conservative management is preferred as illustrated in this case.

Context: Keeping in mind the burden of psychotherapy can play a crucial role concerning chronic pain (CP).Psychotherapy techniques are widely used to relief Chronic Pain (CP) worldwide. Appling psychotherapy needs to consider both individual and popular cultures. In addition to international requirements; nation-wide legitimacy should be regarded too. Psychological methods have provided a lot of articles in Iran, but they were neglected by the reviewers because the documents only have abstracts in English. The current study aimed to assess all Farsi Randomized Control Trials (RCTs) addressing psychotherapy to relieve chronic pains.Evidence Acquisition: Six nation-wide medical databases were investigated in 2012 using the keyword chronic pain in the Abstracts, systematically. Appling PICO question format (patient problem or population, intervention, comparison, and outcomes) all the interventional studies were reviewed for eligibility. Retrieving full text (in Farsi) and making the articles indistinguishable, two native reviewers assessed the quality of the articles independently using Jadad scale.Results: Inclusion criteria met 1542 abstracts. After refining and excluding, seventeen experimental studies were retrieved and evaluated. Mean quality score of Jadad was 1.53±1.37 (median=1.0). Cognitive Behavior Therapy (CBT) was the dominant approach (11 out of 17) and the majority (6 out of 17 studies) of the treated cases was Low Back Pain (LBP). Patient-therapist gender adjustment has clearly reported in most of the studies, based on the requirements.Conclusions: Cognitive Behavior Therapy was more effective than the other psychotherapy approaches relieving chronic pain in the studies. Well-designed studies and comprehensive clarification of the studies demonstrating groups, intervention, follow-up and drop outs can improve the quality of the RCTs.

Background: There is an increasing trend in the prevalence of coronary artery disease (CAD) in Iran.Objectives: The present study aimed to investigate the relationship of anxiety, depression, diabetes and coronary artery disease among patients undergoing angiography in Ghaem Hospital, Mashhad, Iran.Patients and Methods: This case-control study was conducted between September 2011 and August 2012 among 200 patients undergoing coronary angiography for symptoms of coronary disease at Ghaem Hospital, Mashhad, Iran. The control group consisted of 697 healthy adults recruited from the individuals who attended the clinic for routine medical checkups or pre-employment examinations. The Beck anxiety and depression inventory scores and fasting blood glucose results were assessed in all the subjects. Data were analyzed using SPSS version 16. P<0.05 was regarded as statistically significant.Results: The mean age of patients was 57.52±9.33 years old and for the control group it was 55.35±8.45 years; there was no significant difference between the subjects (P=0.647) regarding age. There was also no significant difference in gender distribution between the patients and control groups (P=0.205). There was however a significant difference in anxiety and depression scores between the patients and healthy controls (P<0.001). There was a significant positive correlation between anxiety score and depression score in both groups when data were analyzed by Pearson test. (P<0.001, r=0.604 and r=0.521). Moreover, there was a significant positive linear correlation between the depression/anxiety scores and fasting blood glucose concentrations in the patients group (r=0.3, P<0.001) and a weak negative correlation in the healthy controls (r=-0.096, P<0.05).Conclusions: Depression and anxiety are potentially important factors among patients with angiographically-defined CAD. There appear to be significant associations between glucose tolerance and anxiety and depression in these patients.

Background: Breast cancer is the most common malignancy in women. Global statistics indicate increasing rates of this cancer. Nutrition, diet, and healthy behaviors are among influential factors in prevalence of breast cancer, and possibly affect its incidence through inflammatory and immune system responses.Objectives: This study was designed to compare nutritional and unhealthy behaviors in women with and without breast cancer referred to Mahdieh Imaging Center in Hamadan in 2013.Patients and Methods: This cross-sectional study is conducted on 232 women with r and without breast cancer referred to Mahdieh Imaging Center of Hamadan, Iran) in 2013 using random sampling method. Data were collected using nutritional and unhealthy behaviors questionnaires, and analyzed with SPSS-17 software using descriptive statistics and Mann-Whitney, independent t, and chi-square tests.Results: The mean scores of feeding type in the patients with and without breast cancer was 56.14 and 66.25, respectively. Results obtained from data analysis showed that there was statistically significant difference between the two groups in terms of nutrition (P<0.001), but no relationship was observed between breast cancer and unhealthy behaviors.Conclusions: Given the results, improving skills, training and awareness is necessary for women and emphasis on modified diet is recommended as a non-medical option for prevention of breast cancer.

Introduction: Pyometra is an accumulation of purulent material or pus in the uterine cavity. Spontaneous perforation of uterus by pyometra is rare. This is a clinical presentation and management of a spontaneous perforation of uterine caused by pyometra.Case Presentation: This is a case report on spontaneously perforated associated with pyometra secondary to cervical malignancy. The patient underwent exploratory laparotomy with total hysterectomy and bilateral salpingo-oophorectomy.Conclusions: Spontaneous rupture of pyometra duo to cervical cancer in cases of acute abdomen in elderly patients should be considered.

Introduction: Hydatid cyst is a significant health problem in underdeveloped and developing countries, particularly among sheep breeders. Although cardiac involvement is seen only in 0.2% to 3% of the cases, early diagnosis and treatment are important.Case Presentation: A 13-year-old boy with dyspnea and atypical pericardial type chest pain for three months was referred to us. Chest X-ray revealed linear calcification in the left side of the heart. Computed tomography demonstrated a cyst with peripheral calcification and without internal septation in the lateral left ventricle (LV) myocardium. Serologic IgG test was positive for Echinococcosis. No other cyst was seen in the other organs such as the lungs and liver. By midline sternotomy on pump, an incision was made 2-cm lateral to the left ascending artery through the LV myocardium and without entering any cardiac chamber. After injecting hypertonic (5%) saline, the cyst was punctured and its fluid contents were aspirated, the cyst was enucleated, and the cavity marsupialization was done for protection of the myocardium. LV ejection fraction before operation was 40% but after operation and repairing LV myocardium, ejection fraction increased to 50% in. Histopathologic examination confirmed a hydatid cyst.Conclusions: In myocardial hydatid cysts, we recommend a direct approach without entering the cardiac chambers to avoid dissemination of the infection. We recommend excision of the germinative membrane without capitonnage to avoid impairment of myocardial contraction.

Background: Common carotid artery (CCA) ultrasound with measurement of intima-media thickness (IMT) is a safe and noninvasive technique for assessing subclinical atherosclerosis and determining cardiovascular risks. Moreover, the pattern of wall thickening in the brachial artery (BA) is rather diffuse compared to the carotid artery and may be a more sensitive indicator of long-term systemic exposure to risk factors. Therefore noninvasive evaluation of mechanical parameters changes of both arteries has gained the attention of researchers.Objectives: The aim of this study was to compare different edge detection techniques with speckle reducing anisotropic diffusion (SRAD) de-noising filter in ultrasound images of both arteries.Patients and Methods: In a cross-sectional design, an examination was performed on ten men with mean age of 40±5 years from September 2012 to March 2013 through random sampling. An ultrasonic examination of the left CCA and BA was performed. The program was designed in the MATLAB software to extract consecutive images in JPEG format from the AVI. Another program was designed in the MATLAB software to apply regions of interest (ROI) on the IMT of the posterior wall of common carotid and brachial arteries. Next, different edge detections and SRAD filter were applied to the ROI, separately. Finally, the program measured mean-squared error (MSE) and peak signal to noise ratio (PSNR).Results: The lowest values of MSE and highest values of PSNR were achieved by Canny edge detection with de-noising SRAD filter for IMT of left CCA and BA in 90 frames.Conclusions: Based on the result, by measuring the MSE and PSNR, this study showed Canny edge detection with SRAD filter is better than other edge detections in terms of speckle suppression and details preservation in CCA and BA ultrasound images.

Dear Editor; Recently, we conducted a preclinical investigation to find the ameliorative properties of metformin on renal biochemical and histologic alterations of gentamicin-induced kidney damage in male Wistar rats (1). In this investigation, attenuation of gentamicin-induced acute kidney injury was found. Likewise, Taheri et al. conducted a study on the effects of metformin on renal tubular cells after unilateral ischemia reperfusion in rats’ kidney. They observed that metformin provided kidney protection against ischemia and reperfusion-induced injury (2). They concluded that metformin has tissue-protective effect through activation of adenosine monophosphate-activated protein kinase (AMPK) and endothelial nitric oxide synthase (2). More recently we conducted a study on 70 male Wistar rats to test the efficacy of coadministrating garlic extract and metformin in prevention of gentamicin-induced renal tubular damage in Wistar rats (3). The result of this study showed that metformin, garlic juice, or their combination had both curative and protective effects on gentamicin-induced kidney injury. In addition, Kim et al...

Background: Nowadays drug dependence has become one of the main concerns worldwide. Indeed, drug dependence and abuse have become personal, social and, health problems that intensively threat human resources.Objectives: This study aimed to examine the effect of mindfulness-based stress reduction (MBSR) on health-related quality of life (HRQOL) in drug-dependent males.Patients and Methods: An experimental research with pretest/posttest design and a control group was conducted on 49 drug-dependent males. The selected individuals were randomly allocated to the study groups (24 to the experimental and 25 to the control groups). Afterwards, the Short Form Health Survey for HRQOL (SF-36) questionnaire was completed by participants. Subsequently, the experiment group experienced eight 90-minute sessions of training in MBSR. At the end of the training, the subjects were evaluated once again by SF-36. The independent-samples t test and analysis of covariance (ANCOVA) were used to analyses data.Results: The results suggested that the mean differences between groups regarding scales of role emotional, vitality, mental health, social functioning, and bodily pain were statistically significant (P<0.05).Conclusions: Using MBSR is recommended for improving HRQOL in drug-dependent males who are undergoing treatment for their drug dependence in addiction treatment center; however, more studies concerning different drugs as well as drug dependence in women must be performed.