[Unreasonable consumption of narcotic drugs following appendectomy and hernioraphy]

Unreasonable consumption of narcotic drugs may cause several problems such as the incidence of some side effects, dependence and inappropriate pain relief. Drug Utilization Review [DUR] program - that nowadays is one of the Ministry of Health and Medical Education's priorities - is to assess the problems of drug prescribing and usage, and present reforming suggestion to medical providers. This descriptive cross-sectional study was performed in surgical ward of one of Tehran's hospitals for Two Six months' periods. At first a standard protocol was prepared. All hospitalized patients who had received narcotic drugs via injection after surgery entered the study. In whole 200 reviewed patients, generally 26 [13%] patients taking narcotic drugs were according to protocol and 174 [87%] cases were against the protocol. In this cross-sectional study only 49 of 100 patients had pain relief after receiving narcotic drugs via injection. Physician orders were inappropriate and in 13 [6.5%] cases, there was no medical prescription. 50% of patients still had pain after drug injection that was due to medical providers' concern for drug dependence in patients and lack of due supervision by the physician in charge

Population pharmacokinetics of oral high-dose busulfan in adult patients undergoing hematopoietic stem cell transplantation

Many factors have been reported that contribute to the wide intra- and inter-patient variability of Busulfan [Bu] disposition. The purpose of this study was to develop a population pharmacokinetic model and to determine the covariates affecting the pharmacokinetics [PK] of Bu in Iranian adult patients who received oral high-dose as a conditioning regimen before Hematopoietic Stem Cell Transplantation [HSCT]. A population PK analysis was performed in 30 patients who received an oral Bu and cyclophosphamide regimen before HSCT. Bu was given orally according to the protocol of the institution. In order to prevent seizures caused by Bu, phenytoin was administered orally one hour before each dose of Bu. A total of 180 blood samples were analyzed by HPLC and PK parameters were estimated by the non-linear mixed effect model by MONOLIX 3.1 program. A one-compartment model with an additive error model was used to describe the concentration-time profile of Bu. CL=13.4[1+ [0.141xDisease]], Vd=42.6[1+0.010x [Weight - 63.9]] Patients' disease and weight was found to be the determinant factors for clearance [CL] and the volume of distribution [Vd] according to Monolix analysis. The covariate entered in final model followed by these equations: In this limited study, the age [15-43 years] had no significant effect. For a patient weighting 60 kg, the typical CL and Vd were estimated to be 13.4 l/hr and 42.6 L, respectively. The interindividual variability of CL and Vd were 13.6 and 6.3%, respectively. There was no significant metabolic induction in these four days as is evident by comparing the trough levels of Bu. However it should be mentioned that, one tailed t-test p-values of the days of two and three, two and four and three and four were 0.083, 0.069 and 0.388, respectively. Results of this study showed that the type of disease was a determinant of CL and the weight of patient was a determinant of Vd for Bu population PK parameters. A reliable PK parameters and Css, estimated from only one plasma concentrations [5 hrs after the first dose], were validated. Since these methods require few sampling and are easy to be used, the limited sampling methods might be advantageous in the routine clinical practice

[Keratocyte density in normal and keratoconic corneas using confoscan]

To compare keratocyte density between normal and keratoconic corneas in non-contact lens wearers. Confocal scanning was performed on 39 corneas of 26 patients with keratoconus and 28 corneas of 14 normal control subjects. None of the cases were contact lens wearer. All individuals underwent ophthalmic examination and computed topography in addition to confocal microscopy. Main outcome measures were anterior [10%], middle [33-67%] and posterior [10%] stromal keratocyte densities. Mean age of the subjects was 27.7 +/- 6.6 [range 18-45] years. Mean keratocyte density in the control group was 736.7 +/- 65.6 cell/mm2 in the anterior stroma, 623.4 +/- 72.6 cell/mm2 in the middle stroma and 608.6 +/- 45.8 cell/mm2 in the posterior stroma. Corresponding values in the keratoconus group were 787.9 +/- 103.5, 665.2 +/- 58.1 and 604.2 +/- 69.0 respectively. No significant difference was noted between the two groups regarding stromal keratocyte density; however stromal keratocyte density significantly decreased from anterior toward posterior stromal layers within both groups. Keratocyte density showed statistically insignificant decrease with aging. Keratocyte density was significantly higher in female subjects [P= 0.019]. No significant difference was seen between normal and keratoconic corneas in terms of stromal keratocyte density