Barriers to pharmaceutical care in Iran

<p><strong>Editorial</strong></p

Optimizirano određivanje lorazepama u humanom serumu visokotlačnom tekućinskom kromatografijom

The present research was designated to evaluate a rapid and sensitive method for determining low concentrations of the highly active drug lorazepam in serum. Isolation of the drug from biological fluid after addition of nordazepam as the internal standard was achieved using a simple liquid-liquid extraction with dichloromethane and the extracted compounds were quantified by high-performance liquid chromatography. Chromatographic separation on a reversed phase column containing a stationary phase with low silanol activity resulted in a perfectly symmetrical peak with a tailing factor of 1.0. The limit of quantitation in serum is 2.5 ng mL-1 for both lorazepam and internal standard. The procedure is rapid and sensitive enough for determination of lorazepam in serum.U radu se vrednuje brza i osjetljiva metoda za određivanje niskih koncentracija lorazepama u serumu. Lorazepam je izoliran iz seruma ekstrakcijom diklormetanom, zajedno s nordazepamom, koji je upotrebljen kao interni standard i zatim određivan visokotlačnom tekućinskom kromatografijom. Kromatografskim razdjeljivanjem na reverzno-faznoj koloni sa stacionarnom fazom s niskom aktivnošću silanola dobiveni su potpuno simetrični signali faktorom završnog povlačenja 1,0. Granica određivanja u serumu je 2,5 ng mL-1 za lorazepam i interni standard. Metoda je brza i dovoljno osjetljiva za određivanje lorazepama u serumu

Optimizirano određivanje lorazepama u humanom serumu visokotlačnom tekućinskom kromatografijom

The present research was designated to evaluate a rapid and sensitive method for determining low concentrations of the highly active drug lorazepam in serum. Isolation of the drug from biological fluid after addition of nordazepam as the internal standard was achieved using a simple liquid-liquid extraction with dichloromethane and the extracted compounds were quantified by high-performance liquid chromatography. Chromatographic separation on a reversed phase column containing a stationary phase with low silanol activity resulted in a perfectly symmetrical peak with a tailing factor of 1.0. The limit of quantitation in serum is 2.5 ng mL-1 for both lorazepam and internal standard. The procedure is rapid and sensitive enough for determination of lorazepam in serum.U radu se vrednuje brza i osjetljiva metoda za određivanje niskih koncentracija lorazepama u serumu. Lorazepam je izoliran iz seruma ekstrakcijom diklormetanom, zajedno s nordazepamom, koji je upotrebljen kao interni standard i zatim određivan visokotlačnom tekućinskom kromatografijom. Kromatografskim razdjeljivanjem na reverzno-faznoj koloni sa stacionarnom fazom s niskom aktivnošću silanola dobiveni su potpuno simetrični signali faktorom završnog povlačenja 1,0. Granica određivanja u serumu je 2,5 ng mL-1 za lorazepam i interni standard. Metoda je brza i dovoljno osjetljiva za određivanje lorazepama u serumu

Studying the Prevalence of Medical Interventions in the Recipes

BACKGROUND: Drug interaction is a term used to refer to unfavourable side effects caused by mixing or taking two or more drugs simultaneously. Although it is not possible to identify all drug interactions, awareness of therapeutic team of potential drug interactions, risk factors that enhance the possibility of these interactions and familiarity with mechanisms of drug interactions can help reduce real drug interactions. AIM: The present research seeks to study the frequency and intensity of possible interactions among various age groups and their correlation with doctor’s speciality, time of drug prescription, patient’s gender, etc.MATERIAL AND METHOD: This is observational, cross-sectional research conducted in spring and winter to study the prevalence of drug interactions among 6000 recipes belonging to 2 private and 2 public drug stores. The information associated with recipes was recorded, and drug interactions were studied based upon quick index of interactions using Up to Date software. Quick index of medical interactions is a response to data dealing with how drugs interact with one another. The risk factor is divided into groups A, B, C, D, and X according to this index with each one having its own definition. The data analysis was studied in terms of prevalence type of drug interactions and the possible correlation with other parameters. SPSS v.16 was used for statistical analysis. RESULTS: The average age of the patients was 42.07 ± 21.56 years. The frequency of male patients was 41.7%. An average number of 4.82 ± 1.91 drugs were prescribed for each patient and an average number of 1.95 ± 2.40 drugs had interaction with one another with levels C, D, and X having the following drug interaction levels: 1.60 ± 2.05, 0.275 ± 0.69, and 0.072 ± 0.31. No such interactions were observed in 31.1% (1846 cases) of recipes. The presence of drug interaction was statistically significant in terms of age, season, drug store and speciality of doctor (P-value &lt; 0.05). The average number of interactions in the recipes issued by psychologists, cardiologists, rheumatologist, neurologists, and general practitioners was more, and this result was statistically significant (P-value &lt; 0.05). CONCLUSION: Considering the results achieved in this research, we may conclude that the drug interactions in recipes exhibit a noticeable frequency with the highest frequency observed in level C influenced by factors such as age, season, class of drugs, and expertise of the doctor

Antimicrobial Susceptibility Pattern of Staphylococcus aureus Strains Isolated from Hospitalized Patients in Tehran, Iran

Abstract Staphylococcus aureus is a major bacterial pathogen that causes different community-and hospital-acquired infections. Over time, strains of S. aureus have become resistant to different antibiotics including penicillinase-resistant penicillins. Having data on the local antimicrobial susceptibility pattern of this pathogen is necessary for selection of appropriate antibiotics for empirical treatment of infections due to it. To determine the antimicrobial susceptibility pattern of Staphylococcus aureus strains isolated from hospitalized patients in Tehran, Iran, In a prospective cross-sectional study performed at Imam Khomeini Hospital, samples were collected from hospitalized patients and were cultured. All positive cultures which yielded S. aureus underwent antimicrobial susceptibility testing using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. The results were interpreted after 24 hours of incubation at 37 °C. A total of 160 clinical isolates of S. aureus were collected. Most isolates were obtained from blood (29%). The overall susceptibility of isolated S. aureus strains to antimicrobial agents was 100% for vancomycin, 49.4% for amikacin, 43.8% for gentamicin, 36.8% for co-trimoxazole and tetracycline, 36.3% for cefazolin, 30.6% for cephalexin, 24.4% for oxacillin, 23.8% for erythromycin, and 3.1% for penicillin. Other than vancomycin, none of the tested antibiotics are appropriate for empirical treatment of serious S .aureus infections in our area

Types and severity of medication errors in Iran; a review of the current literature

Medication error (ME) is the most common single preventable cause of adverse drug events which negatively affects patient safety. ME prevalence is a valuable safety indicator in healthcare system. Inadequate studies on ME, shortage of high-quality studies and wide variations in estimations from developing countries including Iran, decreases the reliability of ME evaluations. In order to clarify the status of MEs, we aimed to review current available literature on this subject from Iran. We searched Scopus, Web of Science, PubMed, CINAHL, EBSCOHOST and also Persian databases (IranMedex, and SID) up to October 2012 to find studies on adults and children about prescription, transcription, dispensing, and administration errors. Two authors independently selected and one of them reviewed and extracted data for types, definitions and severity of MEs. The results were classified based on different stages of drug delivery process. Eighteen articles (11 Persian and 7 English) were included in our review. All study designs were cross-sectional and conducted in hospital settings. Nursing staff and students were the most frequent populations under observation (12 studies; 66.7%). Most of studies did not report the overall frequency of MEs aside from ME types. Most of studies (15; 83.3%) reported prevalence of administration errors between 14.3%-70.0%. Prescribing error prevalence ranged from 29.8%-47.8%. The prevalence of dispensing and transcribing errors were from 11.3%-33.6% and 10.0%-51.8% respectively. We did not find any follow up or repeated studies. Only three studies reported findings on severity of MEs. The most reported types of and the highest percentages for any type of ME in Iran were administration errors. Studying ME in Iran is a new area considering the duration and number of publications. Wide ranges of estimations for MEs in different stages may be because of the poor quality of studies with diversity in definitions, methods, and populations. For gaining better insights into ME in Iran, we suggest studying sources, underreporting of, and preventive measures for MEs

Excess Molar Volumes of Binary Mixtures of Cyclohexane and y-Butyrolactone with Aromatic Hydrocarbons

This article discusses excess molar volumes of binary mixtures of cyclohexane and y-butyrolactone with aromatic hydrocarbons

The Evaluation of Albumin Utilization in a Teaching University Hospital in Iran

Abstract The goal of this study was to evaluate the pattern and the suitability of the human Albumin usage according to the available and reliable guidelines. A concurrent, cross-sectional study was performed in Shariati Hospital (associated with Tehran University of Medical Sciences, Tehran, Iran). All inpatient adults that were prescribed albumin during the study period were evaluated to register the indications for albumin usage patients during the study period. The most common reasons to prescribe albumin were volume expansion after the heart surgery (53.3%), nutrition source in malnourished patients (19.3%), paracentesis (12.9%), plasmapheresis (9.6%), hypoalbuminemia (3%) and the others (2.1%). Only 411 vials (32.1%) prescribed with 34 prescriptions (25.2%) were utilized appropriately based on the guidelines. The results showed that based on the guidelines, the most prescriptions of albumin in this hospital have not been written appropriately. Therefore, educational programs on using guidelines may help reduce albumin usage and treatment costs

Pharmacist-Led Medication Review: Supports for New Role of Pharmacists

In recent decades, by increasing complexity of drug therapy, pharmacists considered as health- care members who can help optimizing drug therapy. We know that medicines do not have the anticipated effects all the times and a vast variability may exist in their behaviors in the body. So, it is very crucial to individualize treatment for every single patient. Nowadays, optimizing drug therapy in patients needs a collaborative interdisciplinary approach to patients care and treatment. Specifically when drug therapy is considered for a condition, pharmacists can enroll as a valuable professional to help for modification of therapy along with other clinicians. Abundant number of studies and reports exist in the literatures which address usefulness of pharmacist engagement in patient care. In this review we have presented some valuable evidences supporting pharmacist role in different clinical settings

Costs of hospital admission on primary immunodeficiency diseases

Background Primary immunodeficiency diseases (PID) are heterogeneous group of inherited disorders mainly characterized by recurrent infections leading to several times hospital admissions. The economic impact of PID is a challenging issue; therefore, this study was designed to determine the medical costs of hospitalizations in this group of patients as an indicator of the direct cost of these diseases. Methods One hundred and ten children with PID hospitalized in the Children’s Medical Center Hospital, Tehran, Iran were included in this study during Jan 2011 and Jan 2012. All direct costs during the admission period were calculated, using the hospital information system. Results Medical cost was $7.090 per patient per admission. Among them, about 1.580$ belong to drug consuming during hospitalization. Anti-infective drugs for systemic use were the most cost-consuming group of drugs, followed by alimentary tract and metabolism and blood and blood forming organs agents. Investigation of anti-infective group internally showed that immune sera and immunoglobulin and antiviral agents for systemic use consisting the most important medication for PID patients during hospital admission. Conclusion Although the results of economic evaluations in a region cannot necessarily be applied to other regions, having an overall estimation of hospital admission costs and types of drugs used during admission could be helpful in health policy system