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Association between biological factors and disruptive behaviors in children and adolescents is important to investigate. Antisocial, aggressive and delinquent behaviors in adults often begin early in life. Basal cortisol is a valuable biological characteristic of children with disruptive behavior disorder (DBD). In this study the effect of family training on basal salivary cortisol in children with DBD was investigated. Materials and Methods: This is a clinical trial study. Basal salivary cortisol levels were studied in 19 children between 8-13 years old with DBD, before and 2 months after intervention (family training). The disruptive behavior of the child was assessed with child behavior checklist (CBCL). Cortisol levels and score of behavior were compared before and after intervention. Data was analyzed using descriptive statistics, paired t-test and pearson correlation. Results: Salivary cortisol before family training was 7.9±4.6 nmol/L and after that was 10.46±3.84 nmol/L which was significantly different (p<0.001). Behavior score before intervention was 72.05±10.10 and after that was 49.361±1.89 that was also significantly different (p<0.0001). Children with lower basal salivary cortisol had a better response to intervention. Conclusion: Parent training is an effective method for behavioral modification in DBD. Salivary cortisol can be considered as a predictive factor for severity of disruptive behavior, also a factor to assess the response to parent training in children with DBD.

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Background: Reducing the duration of the effect of sedatives and increasing their quality is one of the tasks of ICU staff. The aim of this study is to compare the sedative effects of these medications on neurosurgery patients under mechanical ventilation.

Materials and Methods: In this double-blind clinical trial, 70 patients requiring mechanical ventilation in neurosurgery ICU were enrolled. Patients were randomly assigned to one of remifentanil or fentanyl groups. The first group received 0.05 µg/kg/min remifentanil and the second group received 1 µg/kg/hr fentanyl infusion for sedation and analgesia in the first 24 hours. Sedation score, Minogue scale and hemodynamic parameters were evaluated throughout the study and at regular intervals. 

Results: There was no significant statistical difference in demographic variables such as age, sex, and body weight between two groups. The results of this study showed a significant difference in sedation score (p=0.0001) and Minogue scale (p=0.0001) and both variables were lower in remifentanil group. Also, heart rate (p=0.011) and mean arterial blood pressure (p=0.007) were significantly higher in fentanyl group.

Conclusion: Generally, sedative effect of remifentanil has several relative advantages over older medication of fentanyl and causes more effective sedation and better control of hemodynamic parameters in patients under mechanical ventilation.