Does twice-weekly cabergoline improve anthropometrical and biochemical profiles in prediabetes? a randomized double-blind clinical trial pilot study

Dopaminergic signaling is one of the regulatory pathways being investigated for its implication in glucose metabolism. The aim of this study was to determine the effect of cabergoline on biochemical and anthropometric parameters in prediabetes stage [impaired fasting glucose and impaired glucose tolerance]. In this double blind, placebo-controlled, pilot study, 27 prediabetic adults were randomized to receive 0.25-mg cabergoline twice weekly for two weeks, followed by 0.5 mg twice weekly for next 14 weeks [n = 13] or placebo [n = 14]. All subjects were advised to follow a 500 kcal-deficit energy diet. Fasting plasma glucose [FPG], oral glucose tolerance, glycated hemoglobin [A1c], fasting, and 2-h insulin were measured at baseline and at 16-week follow-up. Homeostasis model assessment [HOMA] 2 was calculated to estimate steady-state beta-cell function, insulin sensitivity, and insulin resistance. Our results showed significant reductions in fasting [P = 0.004] and 2-h plasma glucose [P = 0.01] after treatment, and significant improvements in beta-cell function [P = 0.03] and insulin resistance [P = 0.04] in the cabergoline group. The trend of non-significant A1c changes was decreasing in the cabergoline group versus an increasing trend in the placebo group. All anthropometric parameters were similar between the two groups. Our results revealed that twice-weekly cabergoline could improve glucose metabolism in prediabetes stage. Larger studies of longer duration are warranted to investigate the effect of cabergoline in preventing progression of prediabetes to type 2 diabetes mellitus

Costs of treatment after renal transplantation: is it worth to pay more?

The present study aimed to provide an estimation of the current financial burden of renal transplantation therapy for insurance organisations. An Excel-based model was developed to determine the treatment costs of current clinical practice in renal transplantation therapy [RTT]. Inputs were derived from Ministry of Health and insurance organizations' database, hospital and pharmacy records, clinical trials and available literature. A one-way sensitivity analysis and Monte-Carlo simulation were performed to illustrate total cost changes made by cost components and to test the reliability of model probabilities respectively. According to the model, 2200 patients received RTT in the study year which resulted in the first year total treatment cost of almost $14,000,000. These costs corresponded to annual total cost per patient of almost $6500 for the payers. According to the results of the study, treatment cost per patient in RTT is almost $6500 for the payers in Iran. Although RTT is almost fully reimbursed by government in Iran, an improvement in insurance decision making especially regarding new effective immunosuppressive drugs is quite necessary for controlling growing trends of OOP expenditures in these patients. The present study aimed to improve efficiency in budget allocation by providing insurance decision makers with an estimation of financial impact of current clinical practice in RTT, making it possible for them to compare current financial burden of the disease with the future cost burden of including newly submitted drugs to their formulary in RTT and also provided practical policy making recommendations in the end

Effect of adiantum capillus veneris linn on an animal model of testosterone-induced hair loss

Androgenetic alopecia is the most common form of hair loss in men. The present study was designed to evaluate the hair growth-promoting activity of a preparation of the Adiantum capillus-veneris Linn. [A. capillus-veneris] on albino mice using a testosterone-induced alopecia model. Five groups of albino mice were studied: [A] Testosterone solution only [n=6]; [B] Testosterone + Finasteride solution [2%] [n=6]; [C] Testosterone + vehicle [n=6]; [D] Testosterone + A. capillus-veneris solution [1%] [n=6]; [E] intact control [n=2, without testosterone]. Alopecia was induced in all intervention groups by testosterone 1.0 mg subcutaneous. A. capillus-veneris solution was applied topically to the back skin of animals in the respective group. Hair growth was evaluated by visual observation and histological study of several skin sections via various parameters as follicle density [number of follicles/mm] and anagen/telogen ratio. After 21 days, a patch of diffuse hair loss was seen in animals received testosterone while animals treated with A. capillus-veneris showed less hair loss as compared to those treated with testosterone only. The follicular density observed in the A. capillus-veneris-treated group was 1.92 +/- 0.47, compared to 1.05 +/- 0.21 in testosterone-group and 2.05 +/- 0.49 in finasteride-treated animals. Anagen/telogen ratio was significantly affected by A. capillus-veneris, which was 0.92 +/- 0.06 as compared with 0.23 +/- 0.03 and 1.12 +/- 0.06 for testosterone and finasteride treated groups, respectively. According to visual observation and quantitative data [follicular density and anagen/telogen ratio], A. capillus-veneris was found to possess good activity against testosterone-induced alopecia

effect of amlodipine and sildenafil on the NT-ProBNP level of patients with COPD-induced pulmonary hypertension

Pulmonary hypertension [PH] is an important cause of heart failure in chronic obstructive pulmonary disease [COPD]. The pro brain natriuretic peptide N-terminal [NT-proBNP] has been suggested as a noninvasive marker to evaluate ventricular function. However, there is no evidence to support the use of NT-proBNP in monitoring the benefits of vasodilators in COPD induced PH. Thus, we used NT-proBNP as a biomarker to evaluate the effect of oral vasodilators on cardiac function in COPD-induced PH. Forty clinically-stable PH patients were enrolled with history of COPD, normal left ventricular ejection-fraction [LVEF], right ventricular systolic pressure [RVSP] > 45 mmHg and baseline blood NT-proBNP levels >100 pg/mL. Patients were randomized into two groups, one group received sildenafil and second group were given amlodipine for two weeks. NT- proBNP and systolic pulmonary arterial pressure [systolic PA-pressure] were measured at the beginning and the end of study. Mean NT-proBNP level in the first group was 1297 +/- 912 pg/mL before therapy and 554 +/- 5 pg/mL after two weeks drug therapy, respectively. Similarly, in second group NT- proBNP level was 1657 +/- 989 pg/mL and 646 +/- 5 pg/mL before and after treatment. Amlodipine or sildenafil significantly reduced NT-proBNP levels in COPD-induced PH patients [p < 0.05]. Our study shows that amlodipine and sildenafil have a similar effect on NT-proBNP levels. In both groups NT- proBNP levels were significantly reduced after treatment. Therefore, our findings support the potential benefits of treatment with vasodilators in COPD induced PH

"Budget impact analyses": a practical policy making tool for drug reimbursement decisions

In the present article, Budget Impact Analysis as an effective, practical financial tool has been introduced to the policy makers for improving drug formulary and reimbursement decision making. In Iran, Ministry of Health [MOH], health insurance organizations, and health care providers such as hospitals could take the most advantage of the BIAs reports

Potential of drug interactions among hospitalized cancer patients in a developing country

Cancer patients are more susceptible to adverse drug-drug interactions [DDIs] due to receiving multiple medications especially chemotherapy medications, hormonal agents and supportive care drugs. The aim of this study is to describe the prevalence of potential DDIs and to identify risk factors for these potential interactions in hospitalized cancer patients in a developing country

A cross-sectional study conducted by reviewing charts of 224 consecutive in hospitalized patients in hematology-oncology ward of a teaching hospital in Tehran, during a 12 month period from July 2009 to July 2010. "Drug Interaction Facts 2008, 2009: The Authority on Drug Interactions" was used for screening the potential drug-drug interactions. Potential interactions were classified by levels of severity and documentation

The median age of patients was 50 years, the length of hospital stay for patient was 5 days and the number of drugs per patient was 8 drugs. Two hundred and twenty-eight potential interactions were detected. Nearly 14% of the interactions were major and 60% were moderate. Approximately 9% and 10% potential interactions were graded as established and probable. In multivariate analysis, being older than 61 years old, suffering from hematologic cancer, source of cancer in different specific organs [esophagus, testis and cervices more than other sources], and number of ordered drugs for patients were independent predictors of having at least one potential DDI in hospital order. Suffering from hematologic cancer, source of cancer in different organs, length of hospital stay and number of ordered drugs for patients were independent predictors for number of interactions per patients

Having a DDI seems to be more likely to occur in patients older than 61 years old. Hematologic cancers, having more medications in physician's order, longer length of hospital stay, esophageal cancer, testicular cancer and cervical cancer have related to having a DDI and also having more number of interactions

Decentralization and hospital pharmacy services: the case of Iranian university affilliated hospitals

The aim of this study was to evaluate the satisfaction rate of hospital managerial/clinical teams [HMCTs] including principles [chief executives], managers, supervisor pharmacists and head nurses from services presented by private sectors directing 10 pharmacy departments in hospitals affiliated to Shahid Beheshti University of Medical Sciences

This study is an observational and descriptive study in which a questionnaire containing 16 questions evaluating the satisfaction of the HMCTs from private sectors, and questions about demography of the responders was used for data collection. Collected data was applied to assign a satisfaction score [maximum 64] for each respondent. SPSS 17.0 and Microsoft Office Excel 2007 were used for statistical description and analysis of this information [where applicable]

Overall, 97 people in charge of the hospitals [HMCTs] entered the study. The average satisfaction score was 26.38 +/- 6.81 with the lowest satisfaction rate observed in Mofid children specialty hospital [19.5%] and the highest rate obtained for Imam Hussein [p.b.u.h] general hospital [65.3%]. Generally, 59% of the HMCTs believed that the function of the private sector in the pharmacy of hospitals is satisfactory

Assuming that the satisfaction scores under 75% of the total obtainable score [i.e. 48 out of 64] could not be considered as an indicator of desired pharmacy services, our results revealed that the status of the services offered by private sectors are far behind the desired satisfactory level

Impact of UGT1A9 polymorphism on mycophenolic acid pharmacokinetic parameters in stable renal transplant patients

There are wide individual differences in pharmacokinetic parameters of mycophenolate mofetil [MMF] among transplanted patients. Some studies have shown that single nucleotide polymorphisms [SNPs] of the Uridine Diphosphate Glucuronosyl Transferase1A9 [UGT1A9] are responsible for these differences in early days after transplantation. Therefore it was decided to evaluate the influence of UGT polymorphism on MMF pharmacokinetics among stable Iranian transplant patients. This was a cross sectional study from March 2008 through December 2008 in Imam Khomeini Hospital affiliated to the Tehran University of Medical Sciences in Iran. Blood samples were taken from 40 de novo stable Iranian renal transplant patients taking 2 g MMF daily with Sr[Cr]

effect of capital structure on the profitability of pharmaceutical companies the case of Iran

Funding combination is the most important issue for the companies while they know the amount of required capital. Companies should be careful regarding the appliance of financial providing methods compatible with the investment strategy of company and profitability. This study seeks to examine the relationship between the capital structure and the profitability of pharmaceutical companies in Iran. For this purpose, top 30 Iranian pharmaceutical companies defined as study samples and their financial data were gathered for the period of 2001-2010. In this study, the net margin profit and debts to asset ratio were used as indicators of profitability and capital structure, respectively and sales growth was used as a control variable. Results showed that there was significant negative relationship between the profitability and the capital structure which means that the pharmaceutical companies have established a Pecking Order Theory and the internal financing has led to more profitability

model to predict short-time asthma morbidity: what could be the explanatory factors?

There is an increase in the worldwide prevalence, morbidity and mortality of asthma. Therefore, study of the possible factors related to the burden of this disorder could help the health providers to introduce effective initiatives and reduce adverse consequences due to this condition. This study was designed to investigate any relationship between asthma morbidity with inhaler technique and other probable explanatory factors in asthmatic patients. An observational, cross-sectional study was designed in which asthmatic patients referring to the outpatient respiratory clinic of the Shaheed Labbafinezhad hospital were entered the study using a non-probability sampling method. Their demographic, socio-economic, medical and medication history, inhaler technique [using a 10-step check list], as well as short-term morbidity index [in the past 4 weeks using the .Tone's morbidity questionnaire] were determined and recorded in organized data collection forms. These data were entered the Excel and SPSS [version 17.0] worksheets and analyzed using appropriate statistical tests. A step-by-step analysis method was used in order to find out any relationship between possible explanatory factors and the morbidity index of the patients. 199 adult asthmatic patients [94 male and 105 female] with mean +/- SD age of 54.29 +/- 15.52 years enrolled the study. In the first step of data analysis only 5 factors out of 20 explanatory factors were eligible to be included in the multivariate analysis leading to the final predictive model. In the multivariate regression analysis, 2 out of 5 factors could remain in the final model, which were [history of systemic steroid usage] and [age] [p=0.007, r=0.32]. So that, patients with a positive history of systemic steroid use and those with a younger age had higher asthma morbidity rate. The observed positive relationship between history of systemic steroid usage and asthma morbidity remarks the importance of asthma control in the primary care level and highlights its role on patient's quality of life. Possible reasons leading to a higher morbidity rate in younger asthmatic patients should be evaluated in the future studies

drug utilization evaluation study of amphotericin B in neutropenic patients in a teaching hospital in Iran

Drug Utilization Evaluation [DUE] studies facilitate assessing the appropriateness and rational use of medications.The goal of the present study was to evaluate Amphotericin B usage in neutropenic patients. A prospective DUE study was performed in Hematology-Oncology and Stem Cell Transplantation wards at Taleghani hospital for one-year. National comprehensive cancer network, clinical practice guidelines in oncology, American Hospital Formulary Service and other relevant medical practice and up-to dated articles were used to evaluate whether Amphotericin B is properly used according to the guidelines. All data collected by a pharmacist in daily review using information of physician and nursing records as well as laboratory findings. During the one-year study, 35 patients receiving amphotericin B were evaluated. 29 patients [82.9%] received amphotericin B due to neutropenia and fever and 6 patients had confirmed fungal infections. All of the injectable solutions of amphotericin B were appropriately prepared for intravenous infusion. In addition, for all patients, ordering [indication] of the study drug was in accordance with the guidelines. Twenty-five [71.4%] patients received an appropriate dose according to the guidelines. Duration of treatment was properly selected in 21 [60%] patients. Twenty-two [62.8%] patients developed hypokalemia as the most frequent adverse drug event. Although, preparation and indication of amphotericin B was in compliance with the current guidelines, dosage and duration of treatment were considered to be incoherent with the designed protocol used in this study. We conclude more attention should be paid to dosage and duration of treatment with amphotericin B in order to optimize its administration

Three years evaluation of drug shortages from educational pharmacies in Tehran

The effectiveness of any drug supply systems in providing a trustworthy supply of essential drugs is a critical issue. To evaluate this effectiveness, it is necessary to watch over the status of the essential medicines in any country impartially and continuously. Some countries and also the World Health Organization [WHO] have codified a list of minimum medicines needed for a basic health care system and published them in assortments as a list of essential medicines. The aim of this study was to give an evaluation of the shortages status in Iran and identify the strengths and weaknesses of policies made in Ministry of Health during the years 2005 to 2008 in providing the essential drugs based on the WHO list of essential medicines. The reports used in this retrospective study were collected from the central purchasing unit of one of the main chain drugstores in the country [13-Aban Pharmacy] every 2 to 3 weeks. In these reports, a drug is added to the list of shortages when the requested drug is not delivered. The reports were studied and the results were analyzed based on the WHO list of essential medicines and the national drug list of Iran. The shortages always included 20 to 40 medicines from the list of essential drugs compiled by WHO. Based on this finding, the Ministry of Health and particularly Food and Drug Organization can compile a National List of Essential Medicines and try to always supply them and prevent their shortage

Evaluation and monitoring of isotretinoin use in Iran

Isotretinoin [13-cis retinoic acid] is used for treatment of nodular cystic acne unresponsive to conventional therapy. It is an expensive, potent teratogenic drug with serious adverse drug reaction [ADRs]. Recently, use of this drug has increased in Iran. To date, there are no published data about the use of isotretinoin in Iran; therefore, this study aims to assess its use in this country. This was a prospective, drug utilization evaluation [DUE] study conducted in an institutional community pharmacy affiliated with Tehran University of Medical Sciences [TUMS]. Drug prescription, administration, and evaluation of appropriateness were recorded and compared with standard protocols. Collected data were analyzed by SPSS software. A total of 274 outpatients treated with isotretinoin enrolled in the study. Of these, 51.3% were prescribed isotretinoin under the usual recommended daily doses of 0.5mg/kg/day. Data also indicated that 33.5% of the patients were given total doses of less than 100 mg/kg [72.4 +/- 17.2 mg/kg] and 12.2% received more than 150 mg/kg. With regards to the teratogenic effects of isotretinoin, only 6.8% of couples simultaneously used two methods of contraception [P = 0.001]. In addition, we detected improper use of isotretinoin for mild and moderate acne in about 20% of cases. The most important finding of this study is that the doses of isotretinoin are incorrect in many cases. Incorrect dosages would decrease drug efficacy and increase the risk of relapse. In addition, patients have not been adequately counseled about isotretinoin's teratogenicity and the seriousness of its adverse effects

Spirometric improvements with two commonly used spacers in asthmatic patients

Pressurized metered dose inhalers [pMDIs] are commonly used in patients with asthma. However, the need to coordinate inhalation with inhaler actuation means that they are not suitable for use per se. Spacer devices were developed to overcome some of the problems of pMDIs. Several types of holding chambers of different sizes are available in Iran. This study was designed to compare spirometric parameters between Asmyar and Damyar spacers in asthmatic patients. Materials and This was an observational comparative study. Patients with mild to moderate asthma were entered in this study. The ease of use, convenience, and portability of the mentioned spacers were evaluated using a visual analogue scale [VAS]. Lung function was assessed by using a portable spirometer [Spirolab Italy] and spirometric parameters of FEF50%, FEF25-75%, PEF, FEV1, FVC and FEV1/FVC were measured. Forty patients [25 females, 15 males] with a mean age of 43.10 +/- 12.99 years were studied. Mean +/- SD changes of FVC, FEV1, PEF, FEF25-75%, FEF50% and FEV1/FVC [as percentage of the predicted values] before and after using Asmyar were not significantly different from those of Damyar. However, patient satisfaction was significantly higher with Damyar [P<0.0001]. Lung response after using salbutamol with either Damyar or Asmyar spacers was not significantly different

Dental caries-associated microorganisms in asthmatic children

According to several studies, asthma medications especially beta2-agonists and corticosteroids have harmful effects on the dentition. This study was conducted to evaluate the prevalence of dental caries in asthmatic children in comparison with healthy controls. Some potential confounders of oral health were also evaluated. Asthmatic children aged 5-15 years under the care of the Pediatric Pulmonary Clinic of Masih Daneshvari Hospital were studied. DMFT index [decay, missing, filling teeth] was assessed in them by using the visual-tactile technique. Also, saliva samples were taken from each child and the number of Streptococcus mutans and Lactobacilli colonies in the samples was counted. Similar data were collected from the healthy controls. Forty-five asthmatic [mean age 10.90 +/- 3.16 yrs] and 46 healthy children [mean age 11.03 +/- 0.59 yrs] were studied. Mean DMFT was 3.98 +/- 2.53 in the control group and 4.30 +/- 2.81 in the study group which revealed a significant difference between the two groups regarding DMFT index. The number of Lactobacilli colonies was 8171.3 +/- 11956.0 and 16078.4 +/- 24305.5 in asthmatic and non-asthmatic groups, respectively which demonstrated no significant difference in this regard. Whereas, the number of Streptococcus mutans colonies was significantly different between the two groups [32331.7 +/- 46258.9 colonies in the control group versus 80883.4 +/- 74799.9 colonies in the study group; p-value < 0.05]. Multivariable analysis revealed that asthmatic children receiving anti-asthmatic medication including beta2-agonists and corticosteroids had a higher DMFT index. According to our study the prevalence of dental caries was higher in asthmatic children as compared to the healthy controls. Also, a significant correlation was detected between the saliva pathogens and dental caries. Dental caries were more prevalent in children receiving beta2-agonists alone than in those receiving both corticosteroids and beta2-agonists. Our study concluded that a more comprehensive precise oral health training program needs to be established by complete evaluation of the dental caries status in asthmatic children and also by training them regarding the technique of using inhalers with a spacer to lower the complications and costs of dental caries

Practice appointment rates for high-risk asthmatics: what could be the predictor[s]?

Practice appointment rates could have a significant impact on national health care costs and services offered by doctors. In this respect a study was designed to determine the relationship between practice appointments and possible predictors in high-risk asthmatics. An observational retrospective analysis of the predictors for the practice appointments in asthmatic patients with at least one hospital admission between years 1994-1998 was carried out. This study was performed in a local district general hospital and consenting practices in the UK. 115 asthmatics, aged over 5 years, admitted to the hospital for asthma exacerbations, between years 1994-1998, were enrolled in the study. Multivariate ridge regression was used to build the final model. Analysis revealed that the predictors age and the number of prednisolone rescue courses could remain in the final model [p=0.002, r=0.46]. As a conclusion, frequent oral steroid users and elderly asthmatics were found to have higher practice appointment rates. This is highly likely due to a more severe asthma condition as well as age-related problems in these groups of patients. These findings represent the importance of asthma management in unstable asthmatics and elderly patients in primary care level