Complementary and alternative medicine use in Iranian patients with diabetes mellitus

OBJECTIVE： There is increasing interest in complementary and alternative medicine generally, and especially by those affected by chronic diseases, such as diabetes mellitus. We aimed to determine the prevalence and pattern of complementary and altemative medicine use among patients suffering from diabetes mellitus in Shiraz, southern Iran. Another objective was to explore associated factors for use of complementary and alternative medicine among patients with diabetes mellitus. METHODS： A 19-item semi-structured questionnaire （open- and close-ended） was administered to 239 patients with diabetes mellitus in this cross-sectional study. It was carried out in two outpatient diabetes clinics affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran. RESULTS： One hundred and eighty patients （75.3%） used at least one type of complementary and alternative medicine in the last year prior to the interview. Patients with diabetes mellitus who were living in a large family （〉 5 members）, not taking insulin, and believed that complementary and alternative medicine have synergistic effects with conventional medicine, were independently and significantly （P values： 0.02, 0.04, and 0.01, respectively） more likely to use complementary and alternative medicine. Most of the users （97.7%） reported use of herbal preparations, and 89.4% of users did not change their medication, neither in medication schedule nor its dosage. CONCLUSION： The use of complementary and alternative medicine, especially herbal remedies, is popular among diabetes patients in Shiraz, Iran. This use is associated with patients＇ family size, type of conventional medications and their view about concomitant use of complementary and conventional medicine.

An increase in heart rate variability can be an index for end point of resuscitation in trauma patients

Purpose: The measurement of heart rate variability (HRV) is a non-invasive method to analyze the balance of the autonomic nervous system. The aim of this study was to compare the changes of HRV and base deficit (BD) during the treatment of trauma patients. Methods: Forty-three trauma patients with a low injury severity scores (ISS < 24) and negative base excess on admission were included in this study. Based on the BD changes, patients were divided into three groups:‘end pointed’ group (n =13), patients' BDs instantly cleared after primary hydration;‘needs further resuscitation’ group (n=21), patients' BDs did not reach the end point and thus required further hydration or packed red blood cells transfusion;and ‘hydration minimal change’ group (n=9), patients' BDs lower than 2.5 mmol/L at the onset of admission and thereafter had minimal change (near normal range). The changes in HRV during fluid resuscitation were detected and compared to BD changes in their arterial blood gases. All data were analysed using the SPSS software Version 15.0. Repeated measures ANOVA was used to determine the changes in HRV, heart rate, blood pressure, and BD among groups. Results: A significant reverse correlation was found between the BD ratio and the HRV ratio (r=0.562;p= 0.01). The HRV of patients with aggravated BDs after fluid resuscitation was decreased. There was an increase in HRV at the time of BD clearance. A decrease in HRV after primary crystalloid hydration bore a significant connection with the need for an ICU (p = 0.021) and transfusion of packed red blood cells (p < 0.001). Conclusion: Increase in HRV may be a new non-invasive index for the end point of resuscitation in trauma patients.