The efficacy of topical baclofen 5% on posthemorrhoidectomy pain : A randomized double blind placebo controlled clinical trial

Background : baclofen is gamma-amino butyric acid (GABA) agonist is an inhibitory neurotransmitter in the mammalian nervous system and is also found in peripheral tissue including lung. It is also used in muscle spacity and cerebral spacity . in this study the efficacy of baclofen cream 5 % in reducing postoperative pain during defecation after hemorrhoidectomy was investigated. Introduction: A total of 66 patient with third and fourth degree hemorrhoids open hemorrhoidectomy were included  in this prospective double blind randomized controlled trial. The patients were randomly assigned to either baclofen cream or placebo immediately after surgery and then every 12 h for 14days. The primary outcomes were intensity of pain during defecation, measured with a visual analog scale. Methods and Results: there was no significant difference in the average postoperative pain score in the first 48 h ( P24= 0.3 , P48= 0.5 ) after the surgery between the two groups, but at week 1 the pain score during defecation were considerably lower in the baclofen group than in placebo group ( P=0.01) , which also was the same at the week 2 (P=0.02) . there was no significant difference in the average acetaminophen administration at 24 , 48 h between 2 group after surgery, but  Acetaminophen requirement after week1  and week 2 in baclofen group significant lower than placebo ( Pweek1= .025      Pweek2 = .024 )   Conclusions: . compared with baclofen cream and placebo reduced postoperative pain and painkiller requirment during defecation

Comparison of Dabigatran vs. Warfarin in Acute Vnous Thromboemboly: Systematic Review

Abstract Acute Venous Thromboembolism (VTE) is a common disease associated with the significant morbidity and mortality. We reviewed clinical outcomes systematically with Dabigatran as a direct oral anticoagulants (DOAC) for treatment of acute VTE. We used Ovide, PubMed, Cochrane (CENTRAL), EMBASE, Scopus, Science Direct, LILAC(for article written not English) and also Iranian database; Magiran, Isc, Iran Medex, Iran DOC, Doaj up to May 2014 to identify randomized clinical trials of Dabigatran compared with conventional treatment for VTE. Two investigators extracted data independently. Number of 5107 patients including two trails were selected. The risk of recurrent VTE was similar with the Dabigatran and standard treatment (Hazard Ratio, 95% confidence interval 1.09 (0.76-1.57). Dabigatran reduced the risk of minor bleeding in comparison with standard treatment; Warfarin (0.62) (0.50-0.76). Finally-in minor bleeding-the Dabigatran seemed as effective as, and probably safer than standard treatment of acute VTE. But in some aspects such as adherence to treatment, pregnant patient, impact on quality of life, new researches are needed to be clarified

Negative Correlation between Serum S100B and Leptin Levels in Schizophrenic Patients During Treatment with Clozapine and Risperidone: Preliminary Evidence

Abstract Recently, extensive efforts have been made to understand the rate of energy expenditure and the weight gain associated with atypical antipsychotic treatment, including identification of markers of obesity risk. In recent years, leptin, an adipocyte hormone, has gained significant interest in psychiatric disorders. S100B has been considered as a surrogate marker for astrocytespecific damage in neurologic disorders. Also, S100B has been detected in adipose with concentration as high as nervous tissue as a second release source. In this study we evaluated the relationship between S100B and leptin in schizophrenic patients under treatment with clozapine and risperidone.This study included 19 patients meeting the DSM-IV-TR criteria for schizophrenia, having body mass index (BMI) of 16-25 kg/m 2 and suffering schizophrenia for more than 3 years and from this study. Twenty five healthy controls were group matched for age and gender whose BMI was 16-25 kg/m 2 . Serum S100B and leptin levels and positive and negative symptom scale (PANSS) were assessed at admission and after six weeks. During the study, S100B showed a strong and negative correlation with leptin (r = -0.5, P = 0.01). Also, there were negative correlation between serum S100B level and PANSS negative subscale after 6 weeks of treatment (r = -0.048, P = 0.8). Positive correlation between leptin level and PANSS suggested a potential role for leptin which can mediate the link between antipsychotic induced weight gain and therapeutic response in schizophrenia

The usage pattern of Anti-inflammatory drugs-steroidal and non-steroidal- in patients referred to13 Aban pharmacy in Sari

(Received 12 September, 2009 ; Accepted 18 November, 2009)AbstractIn the present study, the usage pattern of Anti-inflammatory drugs-steroidal and non-steroidal- in patients referred to 13 Aban Pharmacy in Sari was evaluated. The results show a high rate of anti-inflammatory drug prescriptions, mainly by general practitioners with ibuprofen, diclofenac and mefenamic acid being the most widely used NSAIDs and prednisolone, dexamethasone and betamethasone being the most prescribed corticosteroids respectively. Training physicians regarding the rational use of anti-inflammatory drug prescriptions may be effective in modifying the usage pattern of these drugs and avoiding the risks associated with their heavy usage.J Mazand Univ Med Sci 2009; 19(72): 82-84 (Persian)

Enoxaparin utilization evaluation in inpatients with or at risk of thromboembolic disorders: A one-year, single-centered, retrospective Study

The aim of this study was evaluation of enoxaparin utilization in hospitalized patients who had received enoxaparin either for prophylaxis or for treatment of thromboembolic disorders. A total of  356 patients were included in this retrospective study and were analyzed for enoxaparin utilization in terms of prescription patterns, treatment strategy, dosing regimen, indications/contraindications, adverse drug reactions, bleeding events, drug-drug interactions and monitoring parameters. The inpatient records and charts were used to extract the relevant data. 47.8% of the patients were prescribed inappropriate doses of enoxaparin, and 35.7% were treated with enoxaparin for inappropriate duration. Lack of appropriate monitoring of platelet count, complete blood count (CBC), activated partial thromboplastin time (aPTT), serum potassium level and serum creatinine during enoxaparin therapy was also noted in nearly one third of the patients. Furthermore, dose adjustment was not performed for 85% of the patients who had elevated serum creatinine. Co-administration of enoxaparin and anti-platelet drugs (aspirin and clopidogrel) or non-steroidal anti-inflammatory drugs were noted in 72% of the patients. No cases of major bleeding occurred but hematuria was observed in 16.3% of the patients. High doses of enoxaparin (120 mg/day), concurrent administration of antiplatelet drugs and increased age were found to be the main risk factors for bleeding. Overall, inappropriate utilization of enoxaparin in terms of prescription, dosing regimen, drug interaction and monitoring was observed in a large proportion of the patients which indicates the need for more careful consideration of the patients' conditions and the treatment guidelines before treatment with enoxaparin in the studied healthcare setting

Role of Pharmacist in Reducing the Rate of Drug Interactions; An Experience from North of Iran

Background and purpose: Drug interactions are one of the serious subsets of medication errors and occur when the effects or toxicity of one drug are affected by another. This study aimed to investigate drug interactions and the role of pharmacist in reducing drug interactions in Ramsar Imam Sajjad Hospital, Iran. Materials and methods: This cross-sectional study was performed in all prescriptions of medicinal products by specialist physicians in Ramsar Special Clinic from March to May 2019. Drug interactions were determined based on Drug Interaction Facts (2014) and Drugs website (www.drugs.com). A list of drug interactions prescribed by each physician was compiled and discussed in face-to-face visits with physicians. They were then provided with a list of unsafe combinations of medications. Prescriptions of physicians who had previous history of prescriptions with drug interactions were reviewed within two months in January and February 2020. Results: In first phase, 2864 prescriptions were studied of which 268 (9.3%) were detected with drug interactions. There were 40 (14.9%) cases of major drug interactions and 228 (85%) cases of moderate drug interactions. After providing feedback to physicians about drug interactions, the rate of drug-drug interactions decreased from 9.3% to 6.4%. Conclusion: Many drug interactions are preventable and communications between physicians and pharmacists can help identifying drug interactions and minimizing their incidence

Comparison of Rapid Bronchodilatory Effects of Salmeterol and Formoterol in Patients with Moderate to Severe Asthma

Backgrounds: All of Long-acting β2-agonists are beneficial in maintenance treatment of asthma but their use in relieving acute asthma attacks is not well known. The aim of this study was to compare rapid bronchodilatory effects of Salmeterol and Formoterol in patient with moderate to severe asthma. Methods: It was a randomized, double blind, cross-over study on 60 patients with moderate to severe asthma. Patients randomly received 50 micrograms of salmeterol or 18 micrograms of formoterol  and  after  one-week  washed  out  period  exchanged  their  medications. All  patients undergone spirometry for four times (before receiving the drugs, as well as 3, 30 and 60 minutes after drug inhalation) and Forced Expiratory Volume in 1 second (FEV1), Forced Vital Capacity (FVC), FVC percentage predicted value, FEV1/FVC, Peak Expiratory Flow Rate (PEFR) and PEFR percentage predicted value were measured. Results: Both medications could significantly increase FEV1/FVC and PEFR at 3, 30 and 60 minutes after inhalation (P<0.001 compared to baseline).Three minutes after inhalation of salmeterol and formoterol, FEV1 increased by 8.7% and 12.2% respectively. Formoterol was associated with more increase in the amounts of FEV1 compared to Salmeterol. Conclusion: This study showed that fromoterol has a more rapid onset of bronchodilating action compared with salmeterol at 3 minutes after inhalation. Both agents had significant increases in FEV1/FVC and PEFR compared to baseline with no significant differences between two drugs

Assessment of mortality rate and its relation to off-hours and holidays in patients admitted to the CCU of a Noor general hospital

Despite the reduction of mortality rate in the past years, coronary artery diseases (CADs) are the main reason of death in the world. Many factors including changes in nurses and medical staffs, numbers of beds influence the mortality rate of patients admitted in holidays and night time. The objectives of this study were to clarify the association between mortality rate and off-hours and holidays in patients admitted to the cardiac care unit (CCU) of Noor General Hospital. This is a retrospective study of 186 hospitalized patients in CCU that suffered cardiac arrest during 10 years. Patients 'data was gathered in a questionnaire including information about sex, date and cause of hospitalization and cardiac arrest, CPR duration, admission in working hours, off-hours and holidays. Data showed that patients were between the ages of 21 to 88 years old (66.92 &plusmn; 52.12), and 92 patients (50%) were female. Time of admission of 146 deceased patients (79.5%) and time of CPR of 145 of them (78.9%) were in off- hours and holidays. Patients who had died of pulmonary embolism were admitted in the evenings and holidays. Cardiac arrest and CPR of hospitalized patients diagnosed with cardiogenic shock and chronic renal failure were in the evening shift and holidays, too. Higher mortality of CCU patients&nbsp; admitted during nights, evening hours, and holidays or when CPR were performed on them during these times&nbsp; showed that patient care and diagnostic and treating procedures were not performed effectively; and this issue could be&nbsp; due to the fewer number of physicians, nurses or fatigue of staffs at night hours

Drug utilization evaluation of high-dose methotrexate in a cancer center in north of Iran

Background: Methotrexate (MTX) is commonly used in the hematology-oncology units and is frequently associated with adverse effects. High-dose methotrexate (HDMTX) is indicated in the treatment of acute lymphoblastic leukemia (ALL), osteosarcoma, systemic non-Hodgkin lymphoma and primary central nervous system (CNS) lymphoma. The side effect profile of MTX varies markedly according to dose. The aim of this study was to evaluate the uses and adverse effects of HDMTX in a cancer center in north of Iran. Methods: This cross-sectional descriptive study carried out in Emam Sajjad Hospital, Ramsar, Iran from June 2016 to July 2017. Doses more than 500 mg/m2 of MTX was considered as a high-dose. Hydration status, evaluation of the renal and hepatic function, blood tests, urine pH, doses and frequencies of leucovorin administration, measurement of serum levels of MTX and side effects were evaluated. Recommendations of UpToDate 2017 were considered as standards of administration of HDMTX. Results: Forty-four courses of HDMTX were evaluated in this study. HDMTX were prescribed for lymphoma (30 cases), ALL (8 cases) and osteosarcoma (6 cases). In all patients, hydration was done with 1340.9&plusmn;894 normal saline plus 25 ml sodium bicarbonate 8.4%, one to two hours before HDMTX. The solution used for dilution of MTX was 5% dextrose (1022.7&plusmn;105.5 ml). Urine pH was not measured in any patient. The frequency of leucovorin administration was 5.64&plusmn;3.03 times with doses of 17.6&plusmn;1.7 mg/m2 every 6 hours. Serum levels of MTX were not measured in any patient. Blood urea nitrogen and creatinine measurement was carried out before administration of HDMTX in all patients. The most common adverse effects were nausea (64.4%), anxiety (44%) and headache (43.2%). Conclusion: The appropriate aspects of HDMTX usage were good hydration, urine alkalinization with bicarbonate and administration of leucovorin in patients receiving HDMTX, whereas monitoring of serum levels of MTX and administration of bicarbonate based on urinary pH were not done in any of the patients. &nbsp

The role of Clinical Pharmacists in the improvement of a pharmacovigilance system: A review of the reported adverse drug reactions during 2004-2010 in Mazandaran Province of Iran

<p><strong>Background:</strong> Following establishment of Iranian Adverse Drug Reaction (ADR) Monitoring Center in 1997, ADR committees were established in all hospitals of Mazandaran Province of Iran. Clinical pharmacists from Mazandaran University of Medical Sciences have been involved with these committees since 2007. The aim of this study was to compare the results of the pharmacovigilance system before and after active involvement of clinical pharmacists.</p> <p><strong>Methods:</strong> This study included Yellow Cards filled out by healthcare providers in Mazandaran Province during 2004-2010. Frequency of Adverse Drug Reactions (ADRs), route of administration, reporters, number of reports in each years and damaged organs were focuses. Statistical analysis was performed by SPSS 16 software. P< 0.05 was considered as significant difference.</p> <p><strong>Results:</strong> A total of 793 yellow cards were completed during 2004 – 2010. Only 38 ADRs (4.8%) were related to 2004-2007. Most of the reports generated by Nurses (49.3%) followed by Pharmacists and Physicians (P< 0.001). Forty-one reactions (5.2%) were serious, most related to Ceftriaxone, Desfonac and Vancomycin.</p> <p><strong>Conclusion:</strong> Clinical pharmacists’ intervention regarding establishing ADR committees in the hospitals improved the output of the pharmacovigilance system, although under-reporting is still a major drawback of spontaneous reporting.</p> <strong>Keywords:</strong> Pharmacovigilance, Adverse Drug Reaction, Mazandaran, Adverse Drug Reaction Reporting System