effect of curcumin on some of traditional and non-traditional cardiovascular risk factors: a pilot randomized, double-blind, placebo-controlled trial

Numerous interventional studies in clinical and preclinical setting stated that intake of curcumin may provide protection against cardiovascular disease. The aim of this trial was investigation of curcumin efficiency on some cardiovascular risk factors in patients with coronary artery disease [CAD]. A total of 33 patients with CAD who fulfilled inclusion and exclusion criteria were entered the study. Patients were randomly assigned to receive curcumin or placebo, 500 mg capsules, four times daily for 8 weeks. Lipid profile, blood glucose and high sensitive C-reactive protein [hs-CRP] levels were analyzed at baseline and two months after treatment. Serum levels of triglycerides [P=0.01], LDL-cholesterol [P=0.03] and VLDL-cholesterol [P=0.04] significantly decreased in the curcumin group compared to baseline, without significant changes in total cholesterol, HDL-cholesterol, blood glucose and hs-CRP levels. In all mentioned laboratory parameters, significant difference was not detected between curcumin and placebo. Although curcumin improved some of lipid profile components, it did not show appreciable effect on inflammatory markers in patients with CAD. Therefore, more detailed assessment of metabolic effects or anti-inflammatory activities of curcumin need to perform by extensive human study

Plasma vitamin D status and its correlation with risk factors of thrombosis, P-selectin and hs-CRP level in patients with venous thromboembolism; the first study of iranian population

Low plasma level of vitamin D is linked to the increased risk of cardiovascular diseases such as hypertension, diabetes, dyslipidemia and peripheral vascular diseases. Vitamin D deficiency is a worldwide problem that involves Iranian population. To the best of our knowledge, this was the first investigation on venous thromboembolism [VTE] subjects that assessed the correlation of vitamin D level with plasma P-selectin, hs-CRP, and risk factors of thrombosis. In this prospective study, patients with diagnosis of acute deep vein thrombosis and or pulmonary eboembolism were enrolled. All patients' clinical data, demographics and risk factors of thrombosis were evaluated. Plasma level of P-selectin and hs-CRP were measured by ELISA method. Radio immune assay method was used to determine plasma level of 25-hydroxy vitamin D. In this study, 60 subjects were included. The mean +/- SD plasma 25-hydroxy vitamin D level [25[OH] D] of participants was 21.4 +/- 14.6 ng/mL. The vitamin D deficiency was reported in 60% of patients. No significant relation was found between the plasma 25[OH]D level and P-selectin and hs-CRP. In multiple regression analysis, there was a significant relationship between the level of 25[OH]D and the patients' age [beta = 0.452; p = 0.001], diabetes [beta = 0.280; p = 0.036] and positive family history of cardiovascular diseases [beta = 0.373; p = 0.003]. Vitamin D deficiency is a frequent problem in Iranian VTE patients. Moreover, Plasma level of vitamin D is not associated with increase level of P-selectin and hs-CRP in VTE patients

Study of potential drug-drug interactions in prescriptions of university- based pharmacies

Drug-Drug Interactions [DDIs] are adverse reactions caused by a combination of drugs; they are often predictable and therefore avoidable or manageable. The objective of this study was to evaluate the nature, type and prevalence of potential DDIs in prescriptions dispensed in university-based community pharmacies in Tehran, Iran. From July 2012 to February 2014, sample of 1260 prescriptions were collected from community and outpatient hospital pharmacies affiliated to Tehran University of Medical Sciences [TUMS], Iran. The prescriptions were assessed using the reference text "drug interaction facts". The identified DDIs were categorized according to their level of significance into three classes [minor, moderate, major]. At least one drug-drug interaction was present in 339 [26.9%] of prescriptions and a total of 751 cases of interactions were found in prescriptions. Major DDIs represented 7.3% of all DDIs detected, whereas moderate DDIs were 75% of all DDIs. The mean number of drugs per prescriptions was 3.2, with a median of 4 [range, 2-10].There was a positive association between number of prescribed drugs and occurrence of DDIs [OR: 2.14, 95% CI: 1.9-2.4]. The prescriptions of medical specialist had greater risk of occurrence of moderate severity DDIs than general practitioners [OR: 1.52, 95%CI: 1.08-2.15]. Despite the prescriptions were collected from university-based pharmacies, but the overall prevalence of potential DDIs were high among patients. Physicians should be aware of potentially harmful DDIs. Meanwhile Pharmacists can contribute to the detection and prevention of drug-related injuries. Appropriate education, collaborating drug selection and pharmaceutical care are strongly recommended for physicians and pharmacists

Vancomycin utilization review in patients undergoing bone marrow transplantation

Infections in neutropenic patients are considered as major causes of mortality and the emergence of drug resistance. Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including Methicillin Resistant Staphylococcus Aureus [MRSA]. In this study, we evaluated the appropriate utilization of this agent in bone marrow transplantation [BMT] patients. In a cross sectional study, all patients who received vancomycin in a seven months period at bone marrow transplantation research center in Shariati teaching hospital in Tehran, Iran, were entered to the study. Clinical and preclinical parameters such as serum creatinine, microbial culture, antibacterial sensitivity, WBC count and fever were collected and recorded for analysis. We also measured vancomycin trough level after administration of three doses. Fifty one patients were entered in the study and reviewed in two adult BMT wards. The age range was 18 to 65 years. Most patients received allogenic versus autologous transplantation [56.9%, 43.1%]. About 80% of the vancomycin used for the patients with febrile neutropenia was compatible with National Comprehensive Cancer Network [NCCN] guideline. 21.6% of patients received appropriate doses. Vancomycin trough serum concentration range was 15.0 +/- 11.9 microg/mL. Vancomycin is an antibiotic used to treat resistant gram-positive infections and must be prescribed by a specialist. Vancomycin wrong dosing or initiation prescribing with dose 1 gr/q12h increases the resistance and toxicity to drug, and cause an inappropriate response to the drug

Evaluation of community pharmacists' knowledge, attitude and practice towards good pharmacy practice in Iran

The principles of pharmaceutical care are embedded in the concept of Good Pharmacy Practice [GPP]. GPP is poorly applied in community pharmacies not only in Asian countries, but even in United States and Europe. The present study was undertaken to evaluate the knowledge, attitude and practice of the community pharmacists in Iran, regarding GPP. A total of 794 pharmacists were evaluated with a reliable and validated KAP [Knowledge, Attitude, and Practice] questionnaire regarding GPP in September 2008. The most important finding in the present study was the pharmacists' low knowledge [Mean= 13.42] and practice [Mean= 29.85] level about GPP, while their attitude towards this subject was at a high level [Mean= 74.83]. Increase in their knowledge of good pharmacy practice aligned with an increase in their attitudes towards this issue. Also increase in our pharmacists' knowledge and attitude aligned with an increase in quality of their practice. The current practice of Iranian community pharmacists needs further improvement. National pharmaceutical organizations should organize educational programs for the community pharmacists to equip them for their main role in community practice: promoting rational drug use.

Effects of pantoprazole on systemic and gastric pro- and anti-inflammatory cytokines in critically three patients

Stress-related mucosal damage [SRMD] is a significant cause of morbidity and mortality in critically ill patients due to the gastrointestinal blood loss. Prophylaxis of SRMD with proton pump inhibitors or histamine-2 blockers has gained widespread use in intensive care units. Both demonstrated to be effective in reducing clinically significant bleedings, while PPIs has shown to exert some anti inflammatory effects including the inhibition of producing pro-inflammatory cytokines. As cytokines have role in developing SRMD, the aim of this study was to evaluate the effect of PPIs on the inhibition of cytokine release following the critical illness. A total of 27 critically ill patients with risk factors of developing stress ulcer and intragastric pH < 3.0 enrolled to this Randomized clinical trial study. Patients were randomly assigned in three treatment groups; group one received 40 mg of intravenous pantoprazole every 12 h for 48 h [four doses], group two received 80 mg of intravenous pantoprazole every 24 h continuous infusion for 48 h and the third group received 150 mg of ranitidine intravenously as 24 h continuous infusion for 48 h. Plasma and gastric juice samples were obtained at 0th, 12th, 24th and 48th h for the measurement of EGF, IL-1beta, IL-6, IL-10 and TNF-alpha. Pantoprazole infusion have decreased the plasma IL-1beta concentrations [p = 0.041]. No other significant differences in concentrations of EGF, IL-6, IL-10 and TNF-alpha were detected. There were reverse correlations between the intragastric pH with gastric juice IL-1beta and TNF-alpha concentrations and a direct correlation between the intragastric pH and gastric juice EGF in pantoprazole groups. Our data suggest that pantoprazole may have some anti-inflammatory effects on patients. However, the exact impact of this effect on patients should be assessed by further studies

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

Evaluation of knowledge and expectations of Dr. shariati Hospital health care professionals regarding the services of the Hospital's Drug and Poison Information Center

This study was conducted to clarify the expectations of the health care professionals [professors, residents, interns, nurses and head nurses] in Dr. shariati Hospital regarding the services of the Drug and Poison Information Center in this Hospital. Data was collected from a questionnaire which was distributed among 400 people in April 2009. Only 157 respondents fulfilled the questionnaire. So a return rate of 39% was achieved. According to the results, medical reference books and drug information textbooks [36.7%] and expert colleagues [29.7%] were the [most commonly] used drug information resources. 77.8% of respondents [almost never] use DPICs. According to the results, 77.5% of respondents were non- acquainted with these centers' activities. 44.4% of respondents included [adverse drug reactions] and 33.3% included [availability of drugs in pharmacy] in the blank space considered for them to mention any expectation [s] they rank as the most important. In addition, 74% of them rank [incompatibility of injectable drugs] and [70.1% rank] drug interactions [as the [extremely important] issues. Being non acquaintance with services of DPIC centers can be considered as the most important reason of not using them. Even after 13 years of opening of the first DPIC in IRAN, the health care professionals are not familiar with these centers' services and activities yet. It shows an urgent need for culture building activities to introduce them these centers services

Comparison of sucralfate and hydrocortisone enemas in treatment of active ulcerative proctitis; a double-blind randomized clinical trial

Sucralfate enema has been proposed and investigated in treatment of ulcerative proctitis, but its efficacy is still a matter of debate. Hydrocortisone enema is still an established drug in treatment of ulcerative proctitis. This study was designed to compare the effect of sucralfate enema with hydrocortisone enema. Patients with active sigmoidoscopic and histologic features of ulcerative proctitis were included. All patients had clinical manifestations of proctitis for at least four weeks prior to the study and had negative parasitic stool culture. The total of 25 patients entered the study. They were randomly divided in two groups; group I [n =14] and group II [n = 11] who received sucralfate and hydrocortisone enemas respectively for 4 weeks. Both groups had a significant improvement in clinical features, histologic activity and sigmoidoscopic evaluation in comparison with the baseline. Furthermore there was no significant differences between the two groups concerning mean changes of clinical, sigmoidoscopic, and histologic grading, after treatment. Considering the low cost and minimal adverse effects of sucralfate, and almost equal efficacy in comparison with hydrocortisone enema, its usage can be recommended