Prescribing of Potentially Inappropriate Medications to ElderlyPeople by Medical Specialists in Isfahan, Iran: Inappropriate prescription

The goal of this study is to identify the types of potentially inappropriate drugs prescribed by the medical specialists of Isfahan province to elderly patients. A number of 31,254 randomly selected prescriptions from medical specialists of Isfahan province were reviewed for elderly patients who were insured by the Social Security Organization. Three thousand and seven prescriptions were identified and Beers'Criteria was applied to figure out the type of inappropriate medications. The study concluded 49% males and 51% females. Sixty one percent of patients were 65-74 years old and 39% older than 74 years old. Of all the prescriptions reviewed, 24.4% contained inappropriate medications. The ten most common medications detected in the prescriptions were: Naproxen (18.4%), fluoxetine (8.3%), clidinium C (7.2%),indomethacin (7.2%), chlordiazepoxide (5.8%), doxepin (4.76%), dipyridamole (4.4%), amitriptyline (4.27%), methocarbamol (4.15%) and piroxicam (3.88%). Theresults are comparable to what has been reported in the literature. This is also inaccordance with the national drug consumption as NSAIDs are heavily usedthroughout Iran. Due to the extent of inappropriateness of medicine use in the elderly population, we need to define a strategy to curtail this problem including educational classes for physicians and launching national geriatrics residency programs

Paclitaxel-Induced Peripheral Neuropathy Using NCI-CTCin Isfahan, Iran: Paclitaxel-induced peripheral neuropathy

Paclitaxel is a highly effective anticancer agent. It is active against a broad range of cancers that are generally considered refractory to conventional chemotherapy.Paclitaxel induces a peripheral neuropathy (PN) that is characterized by sensory symptoms such as numbness and paresthesia in a glove and stocking distribution.PN may be severe and dose limiting at initial doses above 275 mg/m2. Our purpose was to evaluate the incidence, severity, dose dependency, and reversibility of paclitaxel-induced neuropathy. We studied 45 patients with breast cancer, treated with Paclitaxel (240, 270, 300 mg/m2) in an average of 4 cycles of treatment.Paclitaxel was administered by a 3 h intravenous infusion every 3 weeks in all patients.We used National Cancer Institute-Common Toxicity Criteria (NCI-CTC) to evaluate peripheral neuropathy. The cumulative dose of paclitaxel in each patient was also measured. The severity of symptoms was graded. Incidence and reversibility of neuropathy was measured in an interview with the patient. Paresthesias appeared in 39 (86.6%) patients after an average cumulative dose of 394 mg/m2.In most patients, PN was seen after the first or second dose (68%) of paclitaxel and then stabilized in 36%, improved in 36%, resolved completely in 24% and progressed in 4%. There was no need to discontinue Paclitaxel in any of the patients due to PN.In view of our experience in the present study, we found that Paclitaxel-induced neuropathy is a dose-dependent phenomenon, and most of the symptoms occurred after the first or second phase of treatment