RESUMEN
Toxicity and drug resistance against pentavalent antimonials, medications of choice in treatment of leishmaniasis for more than 5 decades, have become important subjects globally. This study was a randomized, open labeled trial that was designed to determine efficacy and safety of IMOD as a novel herbal immunomodulator drug for treatment of canine visceral leishmaniasis [CVL]. Twenty healthy mongrel dogs were infected with Iranian strain of L. Infantum amastigotes and randomly divided to 5 groups with four animals for each included on: I: negative control [non-infected] II: Glucantime[registered sign] III: Glucantime[registered sign] plus IMOD [immune-chemotherapy] IV: IMOD and V: positive control [non-treated]. Physical examination, hematological, biochemical, serological, parasitological, pathological and imaging evaluations were performed pre-/post- interventions every month for 3 months. Comparing with control groups [IandV], immune-chemotherapy group [Glucantime[registered sign] plus IMOD] showed significantly higher efficacy in resolving the clinical signs and hematobiochemistry factors. Based on our results, using IMOD in combination with meglumine antimoniate [Glucantime[registered sign]] has significantly improved CVL than the latter drug alone. So, it seems this new herbal medicine is useful as adjuvant therapy for canine visceral leishmaniasis
RESUMEN
Cytokines play a fundamental role in the regulation of immune responses in remission and/or relapsing of leishmaniasis. Therefore, immunotherapy for the treatment of canine visceral leishmaniasis [CVL] has represented a principle approach in control of the infection. The present research aimed to evaluating the immunotherapeutic potential of a novel herbal immunomodulator drug [IMOD] on CVL. Twelve mongrel dogs were intravenously infected with Iranian strain of L. infantum and randomly divided into three groups; 1: negative control [non-infected], 2: immunotherapy with IMOD and 3: positive control [non-treated]. Cell proliferation and Th1-/Th2-type cytokines were measured in peripheral blood mononuclear cell [PBMC] by cell proliferation kit I [MTT] and enzyme-linked immunospot [ELISpot] assays, respectively. At the 60 days follow-up assessment, no adverse effects were observed in treated interventional group. Cellular proliferation assay indicated that PBMCs of IMOD group had higher stimulation index [SI] than positive control group [p <0.05]. Enhancement of CD4+ T cells such as IL-2, IL-4 and IL-10 were detected in negative control group due to in vitro IMOD stimulation 30 days post-treatment. In accordance to decreasing trends of Th1 and Th2 cytokines in positive control group, the mean number of IFN-gamma, IL-2, IL-4 and IL-10 spot forming cells [SFCs] down regulated for IMOD group during the study. These data indicate that IMOD had immunomodulatory potential but is not sufficient for total parasitic cure due to balance of Th1/Th2 cytokines. This is a preliminary study and we propose to undertake a series of experiments to evaluate the CVL due to in vitro modulatory effects of IMOD
RESUMEN
Drug Utilization Evaluation [DUE] studies are designed to assess drug usage appropriateness. We aim to evaluate the drug utilization of intravenous ciprofloxacin and imipenem, two of the broad spectrum antibiotics that consume a significant proportion of our hospitals' outlay, in different wards of a teaching hospital in Zabol. During a 5 months period [December 2010 to May 2011], 263 patients who received imipenem or intravenous ciprofloxacin were assigned to this study. Retrospective review of patient's records was carried out. Data were converted to Defined Daily Dose [DDD] and the ratio of prescribed daily dose per DDD was calculated. Among these records, 100 patients received either imipenem or ciprofloxacin. The ratio of prescribed daily dose to DDD was 1.5 for both antibiotics. Almost all patients received empiric therapy in both groups. Only 13 patients [26%] in ciprofloxacin group and 4 patients [8%] in imipenem group received their antibiotics consistent with American Hospital Formulary System [AHFS] mentioned indication. Baseline Blood Urea Nitrogen [BUN] and serum Creatinine were ordered for only 37 patients [74%] in both groups with 15 abnormal results but dose adjustment performed just in one case with decreased renal function. In conclusion, the majority of courses with both drugs were empirically selected and continued and required lab tests for drug monitoring and dose adjustments were not performed in most cases. Educational interventions, developing a local formulary and a strict antibiotic prescribing policy for example by prior approval by an infectious disease consultant can help significantly to overcome these problems
RESUMEN
Albumin is a protein colloidal solution that possesses great value in the clinic, particularly for the resuscitation of critically ill patients. It has accounted for a high percentage of the cost in our center. This study evaluates the appropriateness of albumin usage at Masih Daneshvari Hospital, Tehran, Iran. This study evaluated 69 patient charts. Data included patient demographics, ward of admission, primary reasons for prescribing albumin, and details of albumin use. Possible correlations between the appropriateness of albumin usage, the number of albumin vials, and mortality rate were analyzed. Albumin was prescribed appropriately in 63.8% of patients. Cardiac surgery accounted for 37.3% of all indications. The most prevalent inappropriate indication of used albumin was for mild hypoalbuminemia and nutritional support. There was a significant correlation between the number of used albumin vials and mortality rate. In conclusion, the albumin use in Masih Daneshvari Hospital was not completely in accordance with the accredited references. Albumin is an expensive medication prescribed unnecessarily for many patients. Using the clinical pharmacist's prepared guideline could minimize the situations where its administration is not needed