review of medication errors in Iran: sources, underreporting reasons and preventive measures

Medication error [ME] is the most common preventable cause of adverse drug events which negatively affects patient safety. Inadequate, low-quality studies plus wide estimation variations in ME from developing countries including Iran, decreases the reliability of ME evaluations. To clarify sources, underreporting reasons and preventive measures of MEs, we reviewed Iran current available literature. We searched Scopus, WOS, PubMed, CINAHL, EBSCOHOST and Persian databases [IranMedex, and SID] up to October 2012. Two authors independently selected and one reviewed and extracted data. Results reported by more than 30% of studies considered as the most important topics. Finally 25 articles were included. All study designs were cross-sectional [except for two interventional studies] and in hospital settings. Nursing staff and students were the most observed populations. Individual factor, with "inadequate knowledge of medication" as its most frequent reason, were the mostly reported source of MEs. Fear and reporting process were two most important reporting barriers. The sense of being reprimanded and ignoring to report respectively were their most frequent factors. Anti-infectives were the most frequent drugs involved in MEs. Preventive measures were varied and reporting of their effectiveness was inconsistent. There are still many research gaps which need to be explored by further studies. Based on our findings, further researches may be focused on design, implementation, and evaluation of a ME reporting system as groundwork, assessing systems-related factors to ME alongside individual factors and evaluating the effectiveness of preventive measures for MEs in trials

Assessment of cyclosporine serum concentrations on the incidence of acute graft versus host disease post hematopoietic stem cell transplantation

Allogeneic hematopoietic stem cell transplantation [HSCT] is a curative treatment option for hematological disorders. Cyclosporine [CsA] is one of the major immunosuppressive agents for the prophylaxis against graft versus host disease [GvHD]. In this retrospective study, we evaluated the effects of CsA serum levels on the incidence of acute GvHD and transplant outcomes. 103 adult patients received Hematopoitic Stem Cell Transplantation[HSCT] in the Hematology-Oncology, Bone Marrow Transplantation center at Shariati Hospital in Tehran, Iran. All participants received prophylactic regimen of cyclosporine plus methotrexate. CsA dose titration was done according to patients' serum levels and drug toxicity. Serum levels tested on the twice weekly basis in first 4 weeks after transplantation.Acute GvHD [grades II-IV] developed in 44 patients [43%, 95%CI: 33%-52%]. The median time to ANC and PLT recovery was 13 days [range: 9-31 days] and 16 days [range: 0-38 days], respectively. Univariate analysis of risk factors related to aGvHD [grade II-IV] development showed a higher risk of incidence of aGvHD [grades II-IV] for patients having the lowest blood CSA concentration [<200ng/ml] in the third weeks after transplantation [36% vs. 12%, P=0.035]. The only risk factors related to incidence of aGvHD grades III-IV was also blood CsA concentration at 3rd week post transplant [15% vs. 3%, P=0.047]. The CsA concentration at 3rd week was not related to disease free survival and overall survival [P=0.913 vs. P=0.81] respectively. Higher CsA serum levels in the third week post HSCT significantly decreased incidence of acute GvHD.

Comparison of efficacy and tolerability of different brands of amlodipine in patients with mild to moderate hypertension

The efficacy of amlodipine, a calcium channel blocker, in treating systemic hypertension is well established but the most efficacious brand of this drug is still uncertain. The cost of different brands of amlodipine is tremendously different which may affect decision-making in hypertension treatment. The purpose of this study was to compare the efficacy and safety of different brands of amlodipine [Amlodipine, Amlopress, and Norvasc] in the treatment of hypertension in adult patients. This was a double-blind, randomized, three-sequence crossover study. Ambulatory patients with hypertension who had the inclusion criteria were enrolled. Patients were randomized and entered into three groups to receive either brand of amlodipine in a crossover method. After every four weeks of treatment completed, the other brand of drug was prescribed. The total period of the study was 12 weeks for all three drugs including four weeks for each brand. A total of 20 patients entered to the study, 15 completed the 12-week treatment schedule. The absolute reductions in seated and supine systolic blood pressure [SBP] and diastolic blood pressure [DBF] were similar with all three brands during the 4 weeks of treatment. Headache, malaise and weakness were the most common reported adverse effects [AE] with all three drugs. Generic amlodipine had the most AE as compared with other brands. These AE were mild and did not require withdrawal of the drug. There is no statistical difference in lowering blood pressure by three different brands of amlodipine thus everyone which has the lowest price can be the first choice