فهرست مطالب شکوفه نیکفر

Cardiovascular diseases are the leading cause of mortality each year. Both environmental and genetic risk factors significantly influence the incidence and progression of these diseases. In recent decades, with the development of genetics and genome-determining tools, different genes have been found associated with numerous diseases. Determining these genes helps us to suggest a more effective treatment, specifically for each individual. Determining the genes involved in each disease, finding them in patients, and finally, treatment based on them are the main goals of personalized medicine. Another achievement of personalized medicine is determining the drug's efficiency and side effects in individuals. In particular, one of the most common drug side effects is bleeding from Warfarin. This complication can be prevented by accurately determining the required dose in each person. Personalized medicine is able to suggest the most appropriate dose by identifying genes involved in drug metabolism and detecting them in patients. In this review study, we examine the genes involved in cardiovascular disease as well as the drugs used in this field. Personalized medicine has a special role in determining the prognosis, risk factors and the most effective type of treatment for each disease. One of the main challenges in this field is finding precise diagnostic tools to find the most accurate gene and determine the patients who can benefit most from personalized medicine.

Precision medicine, the selection of treatment based on the genetic characteristics of patients, is one of the new paradigms of medical science. Using genetic characteristics and biomarkers, patients' response to different treatments is evaluated and finally, a specific one is selected for them. In other words, using genetic information or biomarkers, the safety, effectiveness and outcomes of treatments are evaluated and then decisions are made for the best method of prevention or efficient treatment. In recent decades, precision medicine has been focused and placed beyond laboratory knowledge in health services and policies. Besides, the tendency to apply this approach has increased due to the ineffectiveness and unsafety of all available medicines. The main issue of precision medicine is a targeted treatment approach based on pharmacogenetic tests. Performing such tests by checking for the presence or absence of specific biomarkers, when prescribing a drug or medication regimen, will help to increase the effectiveness of treatment and prevent adverse drug reactions during therapy. The present article reviews the types of medicines in Iran drug list (the official list of drugs in the country) that have biomarkers and require pharmacogenetic tests. In addition, this article points out the importance of applying these tests in cases other than determining the drug indication.

The approach of personalized medicine has received a great deal of attention over the last century, emphasizing attention to the patient rather than the disease. Personalized medicine tries to plan the patient's condition and treatment method by considering the culture, personal preferences and experiences and health beliefs of the person as well as the values and lifestyle of the person, and even considering the psychosocial condition. Acknowledging the lack of knowledge of traditional medicine such as Persian, Chinese and Ayurvedic medicine about "Omixes", it can be argued that these medical paradigms have been emphasizing individual differences and their relationship with health for thousands of years. Many people know Iranian medicine as the famous theory of temperaments and quadrant humor. Without entering into a philosophical fallacy about the abrogation or obsolescence of this theory, from a practical point of view, it should be said that the separation of human beings and attention to their inherent differences and consequently the same functions and responses of their bodies, whether congenital (Intrinsic temperament) and whether under the influence of extrinsic and environmental factors (acquired temperament) is the basis of this thinking. Therefore, every human being, in turn, is an independent book that is influenced by his inner and outer and all direct and indirect biological factors of his life, and the spectrum of his health and illness is defined in this framework. In this study, the relationship between traditional persian medicine and personalized medicine has been studied.

Nowadays, metabolomics studies are performed with different approaches to identify biomarkers, clarify the underlying mechanisms of diseases and achieve novel treatment strategies. In this context, gut microbiota-derived metabolites are known as one of the most important mediators of gut microbiota effects on human health and various diseases. Due to the inefficiency of conventional therapies in some cases, personalized medicine is of great clinical importance. Recent studies have shown that alterations in gut microbiota metabolites like short-chain fatty acids (SCFAs), amino acids, bile acid metabolites, and choline metabolites can link gut microbiota to numerous chronic non-communicable diseases including obesity, diabetes, inflammatory bowel diseases, psychological disorders, cardiovascular diseases and cancers. Understanding the composition of gut microbiota and the relationship between its derived-metabolites and the occurrence of various diseases is necessary to achieve new clinical applications. Furthermore, potential therapeutic agents such as prebiotic supplements and next-generation probiotics, dietary interventions, antibiotics, and fecal microbiota transplantation (FMT) could be among the leading strategies for personalized medicine in prognosis, diagnosis and treatment of various diseases, via modulating the diversity and composition of gut microbiota and its metabolites.

Pharmacogenomics may well have substantial effects on the clinical, economic and regulatory aspects of health sector; which can lead to complications in access. Therefore, there is a need for evidence-based frameworks based on national drug policy components. The objective of the current study is to identify pharmacogenomics-based complications and develop a conceptual model.

The current, is an applied-quantitative study using soft system methodology. The first step adopted scoping review with systematic-search to identify early-adopters experiences. The second used cognitive mapping technique with strategic options development and analysis method using expert panels to assess the relativeness of the challenges and evaluated influence with interpretive structural modeling. In addition, stakeholder mapping was conducted using semi-structured questioners. The third step is used to develop the conceptual model.

Systematic search acknowledged 82 studies for qualitative analysis on the challenges. The identified challenges, which were confirmed by the experts subsequently, were clinical trial protocols, clinical utility of tests and identifying biomarkers in the efficacy/safety component, pricing, coverage and economic assessment in the affordability component, regulations, availability and stakeholders management in the access component and education, guidelines, patient compliance, information technology, bench-to-bedside strategies and ethical/legal/social hazards in the rational use of medicine component. The most influential issue was biomarker validity. The main stakeholder, as the owner and customer, was identified to be the ministry of health. All the results were included in the complicated conceptual model.

The current, was the first study identifying dynamic complications ahead of pharmacogenomics adoption, using soft system methodology. The results may be the basis of the first evidence-based policy on pharmacogenomics, in Iran and other developing countries.

Psychiatric disorders are important health issues in the world, and their management is facing some serious challenges. Drugs that are widely used in the treatment of psychiatric disorders, including antidepressants, antipsychotics, and mood stabilizers, are often associated with many side effects and are adequately effective only in a small proportion of patients. Many factors, including genetic factors, affect the effectiveness of medications prescribed for mental health disorders.  Pharmacogenetics is the study of the association between genetic variations in genes encoding carriers, receptors, and drug-metabolizing enzymes with drug response. Many genes have been identified as affecting the drugs responsible for psychiatric disorders and genetic variation can lead to variations in the efficacy and side effects of drugs. This review article summarizes some psychiatric drugs and related genes, which could have potential functional effects.

Personalized medicine (PM) refers to a set of medical, diagnostic, and therapeutic activities and approaches based on the specific characteristics of each patient chr ('39')s genome. In fact, individual-centered medical approaches are based on personalization, meaning that each person chr ('39')s gene sequence and polymorphisms (SNPs) are different and explain the different courses of urological cancers and the different efficiencies of individuals in a protocol. The treatment is constant. Based on data from the Human Genome and Gene Sequence Project, along with proteomics, metabolomics, and transcriptomics information, a number of molecular biomarkers are suggested as potential targets for guided cancer therapies. In urological malignancies, the expression and clinical significance of carbonic anhydrase in type IX in the bladder, kidney, and urinary tract cancers and the primary therapeutic approaches have been discussed. Prostate membrane antigen and radiolabeled analog neuropeptide receptors for prostate cancer are considered valuable prognostic factors in clinical trials. The results of the treatment of patients with urological cancers from a person-centered medical perspective will impose a lower cost on the patient and more effective treatment, which we will discuss in this article

COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the acute respiratory syndrome, acute inflammatory response of the respiratory system, vascular injury, microangiopathy, angiogenesis, and widespread thrombosis.
Four stages of COVID-19 have been determined; the first stage starts with an upper respiratory tract infection, the second stage starts by the onset of shortness of breath and pneumonia, the third stage starts by worsening of clinical symptoms followed by hyperinflammation, and the fourth stage is death or recovery of the patient. There is currently no successful treatment specifically for SARS-CoV-2 infection. Based on the pathological features and different clinical stages of COVID-19, especially in patients with moderate to severe COVID-19, the drug groups used includeed antiviral agents, anti-inflammatory drugs/anti-trauma drugs, and heparin with Low molecular weight, plasma, and hyperimmune immunoglobulin. During the emergency of the COVID-19 outbreak, clinical researchers are using a variety of possible therapies to test them. It seems that the precision medicine approach can answer the COVID-19 treatment questions. Therefore, the way to precision medicine in COVID-19 needs an extremely rapid pace. The aim of the present study was to discuss the most up-to-date effective drugs and vaccines against SARS-CoV-2 infection.

Precision medicine is a new approach in the field of medical sciences that utilizes the genetic characteristics of each patient along with clinical information to guide decisions related to diagnosis and early treatment of diseases. The Personalized Medicine Research Center, as the only center approved by the Ministry of Health, is working on precision medicine context and producing the related knowledge.

In this systematic review, studies that are conducted at the personalized medicine research center with a precision medicine theme based on specific eligibility criteria and a designed search strategy in three databases PubMed, Scopus, and Web of Science (Wos) from December 2016 to December 2019 were retrieved.

Finally, 18 studies focusing on different approaches of precision medicine in prediction, prevention through “omics” including genomics, transcriptomics, and proteomics were selected for further evaluation. Finally, 18 studies focusing on precision medicine in non-communicable diseases (diabetes) and cancer (prostate and thyroid) were selected for further studies.

Since one of the important goals of precision medicine is prediction and prevention, the identified genetic changes can be used for early diagnosis in high-risk individuals. Actually, the initiative studies are needed to meet the goal of precision medicine.

In recent years, Health System Reform Plan has been implemented in Iran to improve health care system. Medication costs, including medical prescriptions are major parts of the budget in this project. In the meantime, health insurance plays a significant role in providing these costs. This study aimed at evaluating the effect of Health System Reform Plan on the cost of medical prescriptions of patients with Health Insurance in selected public hospitals in Sari, Iran.

In this analytical study, inpatient prescriptions in two periods (2011-2013 and 2014-2015) were obtained from the health insurance organization. Data analysis was done in SPSS software.

The trend of cost changes was not significantly different in years before implementation of the Health System Reform Plan (2011-2013) and subsequent years. But, significant cost changes were seen in 2013-2016 (P= 0.311) and 2013-2014 (P=0.0204).

Implementation of the Health System Reform Plan in 2014 increased the cost of medication prescriptions for health insurance, which continued in 2015, but in most hospitals the trend declined in 2016.

The purpose of this study was investigating and identifying the dimensions and components of quality promotion and determining the gap between existent and available status the quality of pharmacy education. The purpose of this research is a functional one, its data is a quantitative and the research methodology and also manipulating variables method id descriptive-survey. The society and statistical sample includes 140 persons (all pharmaceutical seniors) of Tehran medical universities in (2016-2017) that they used Whole counting method. The main data collection tool was a researcher made questionnaire to determine content validity after the questionnaire being confirmed by the supervisor and adviser then it is confirmed by 30 certified expert in higher education field and to determine the reliability of the questionnaire. They used, Cranach’s alpha calculation (0.96). The collected data was analyzed by Structural Equations Modeling using SPSS20 and PLS. These findings showed respectively how teaching methods in pharmacy with load (0.86) and behavioral skills of professor with total load (0.83) had highest effect on the improving the quality of training pharmacy and application of educational standards with a factor of (0.65) had the lowest effect on. The research results showed that there is significant difference between the current and desired situation of all detected dimensions, and also showed that the desired situation is significantly higher than current situation.

Thrombolytic therapy, an appropriate treatment option, if primary angioplasty is not available for the treatment of these patients in the early hours after the onset of the symptoms. The aim of this study was to evaluate the safety and effectiveness of new tenecteplase (TNKase) drug vs. streptokinase in the treatment of ST elevation myocardial infarction (STEMI) patients in Iran.
A systematic review and meta-analysis that was conducted in Iran University of Medical Sciences in September 2017. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE (1980 to March 2017) with number of strategies by the words “myocardial infarction, heart infarction, streptokinase, tenecteplase” in combination with other names of drugs and brands for clinical effectiveness. We hand searched US, European, and Iranian cardiovascular journals. Clinical trials and related observational studies in one of the Persian, English and Korean languages were included in this study. Two review authors independently assessed randomized controlled trials (RCTs) and non-RCT studies eligibility and quality, and extracted the data using data extraction form for interventions reviews. We cross-checked and resolved discrepancies by discussion to reach consensus. Finally, the data were entered to the Review Manager, Version 5.3 (The Nordic Cochrane Centre, Cochrane Collaboration, 2014, Copenhagen, Denmark), and then the Cochran-Mantel-Haenszel test (CMH) were used to analyzed the data. The I2 test has been used to calculate the Heterogeneity.
We included 4 observational studies. Observational study assessment by strengthening the reporting of observational studies in epidemiology (STROBE) checklist and quality was high described. All studies entered the final analysis after the quality assessment. All studies reported mortality. In the meta-analysis of mortality, three studies with a sample of 812 people entered. No difference was observed between tenecteplase and streptokinase in the risk of mortality (RR=0.45, CI 95%: 0.20-1.03, P=0.40), hypotension (RR=1.86, CI 95%: 0.53-6.49, P=0.33), bleeding (RR=1.40, CI 95%: 0.49-3.99, P=0.53), and no difference was observed in the ST Segment resolution >50% (P=0.81).
The results of this study showed that the effectiveness and safety of streptokinase are similar to the tenecteplase drug

The aim of this research, is identifying pharmacy quality education elements of improvement and also presenting a model correspondent with local conditions.

This is a Mix method study that its l population is 140 graduated students of Tehran Medical University, two questionnaires which the first one was Responded-made is specialized for dimensions and components of improving the quality of education and the appropriateness of model and that second one specialized for model correspondent data collection which was complete by 20 university professors. This data was analyzed confirmatory and PLS software.

Regarding the quality and effective factors on improving the quality of pharmacy education, the 9 main factors of the goals and missions of the faculty, the quality of the curriculum, space and educational facilities, teaching and learning process, assessment, behavioral skills of professors, skills Professional faculty members, students, application of educational standards, and influence of teaching methods in pharmacy have the most impact on improving the quality of pharmacy education.

The results showed that the effect of teaching methods with total load (0.86), behavioral skills of faculty members with total load (0.83) had been effective the application of educational standards with a factor of 0.65 The least impact has on improving the quality of pharmacy education. Therefore, the use of modern teaching methods such as flipped classroom, clinical teaching method ... and in the behavioral skills of professors based on appropriate treatment, mutual respect, self-esteem and ... toward other factors are more influential than other factors.

Due to the lack of evidence about the most cost-effective thrombolytic drug in the treatment of acute myocardial infarction with the ascension of the ST segment, this study was conducted to evaluate the cost effectiveness of tenecteplase, as a new medicine, versus Reteplase in the treatment of acute myocardial infarction patients with the ascension of the ST segment in Iran. This study was a type of health technology assessment study. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE databases (from March1980 to March 2017) by using related keywords for finding cost-effectiveness, safety and economic studies. The qualities of studies were independently assessed by STROBE checklist and data were extracted using Cochrane data extraction form.   Three studies were eligible for inclusion and all three were of high quality. Mortality had been compared between Tenecteplase and Reteplase. The results of two studies with 781 samples had showed the same efficacy for Tenecteplase and Reteplase in regard to mortality rate. According to the cost-effectiveness analysis, Reteplase is more cost effective than TNK-ase (250 $ versus 537.49 $). Reteplase, due to the same safety and effictiveness but lower cost, is preferred to Tenecteplase and considering the current economic conditions of Iran, it is recommended to be used in the treatment of acute myocardial infarction patients with the ascension of the ST segment.   Key words: Health Technology Assessment, Acute Myocardial Infarction, Tenecteplase, Reteplase, Economic evaluation   Citation: Bashzar S, Tourani S, Nikfar S, Ravaghi H, Habibi M. Health Technology Assessment  of TNK-ase vs. Reteplase in the Treatment of Acute Myocardial Infarction in Iran. Journal of Health Based Research 2018; 4(1): 51-62.

Regarding request of corresponding author article with entitled “Comparative Study of Direct Patient and Drug Costs before and after the Implication of Healthcare Reform Program in Sari, Iran.” that published in volume number 26 and issue 144 in this journal, there are mistake regarding affiliations of Shokoufeh Nikfar and Pardis Zaboli. The corrected affiliation of these authors are in below.

Background and In many countries, measurements are taken to support cancer patients. In Iran the high costs of cancers and increasing incidence of cancer have made health system authorities to plan for this issue as a top priority of healthcare reform program. The aim of this study was to evaluate the performance of this program in cancer patients in Sari Imam Khomeini teaching hospital, Iran.
An analytical study was performed in which the costs of leukemia patients admitted in Sari Imam Khomeini Hospital (in two six-month periods, April-October 2013 and 2014) were obtained using their medical and billing records. Data analysis was done in SPSS V.21 applying t-test.
Percentage of direct patient costs were 17.12% and 3.02% in 2013 and 2014, respectively. The portion of the medicine fee paid by patients reduced to 7.7% in 2014 (after implementing the healthcare reform program) from 16.8% in 2013.
Implementation of healthcare reform program has dramatically reduced the direct patient costs in 2014. Also, the fee paid by patients for medicine has reduced by 9% following the program. Therefore, adopting new policies that could reduce the costs of medications can be of great benefit in reducing financial barriers to patients.

Due to the development of drugs and With regard to this matter that customers of health services are unable to assess the clinical and financial aspects of medical technologies, evaluation the clinical efficacy of drugs is avery important. The Study aim was to evaluate the clinical efficacy of zoledronic acid in the prevention and treatment of postmenopausal osteoporosis. This study was a systematic review. Cochrane, PubMed and Google scholar databases were searched using keywords: “Bone mineral density, Male Osteoporosis, Zoledronic acid postmenopausal women osteoporosis”. Inclusion criteria were all menopausal women at risk of osteoporosis or suffering from it that have been used zoledronic acid at least once for the prevention or treatment of osteoporosis. Desired outcomes include reduced bone fractures, bone resorption and bone turnover markers, increase bone density, significant improvement in health-related quality of life in patients who have had a fracture. The designs of included studies were randomized clinical trials and their languages were English. The use of zoledronic acid significantly increased BMD at the total hip, lumbar spine, femoral neck, hip trochanter, the distal radius, reduced the incidence of hip fractures, morphometric vertebral fractures, vertebral fractures, any clinical fracture, clinical vertebral fractures, risk of nonvertebral fracture and decreased bone turnover markers in the intervention group compared with the control group. According to safety and clinical effectiveness of zoledronic acid, using this medication in the prevention and treatment of osteoporosis in postmenopausal women is recommended.

To determine health needs of a population living in the Tehran's 17th municipal district and identify appropriate strategies to deal with them.

This research included 2 phases: the first phase was a qualitative study with 2 stages, focus group discussion, in-depth interview with key informants of the 17th district and expert panel methods with specialists. The second phase was a cross sectional study carried out with a closed questionnaire based on the results of phase 1.

The results of the first phase indicted that the presence of railway tracks in the 17th district was the most important problem affecting people's health status. Comparing the opinions of community leaders and health professionals with those of local residents, and study of cause-effect chain, it was obvious that with the transfer of Tehran-Tabriz railway, the major problems of this area will decrease. On the basis of this we arranged a meeting and invited officials from the municipality and railway organization to convey problems.

The findings indicated that it is possible to disseminate community-based investigations to improve public's health.

This study was done to investigate the relative role of sweetness and comparative effects of different taste sensation of non-caloric sweetener, saccharin, on pain and morphine antinociception by Formalin-test in mice. The Formalin-test was chosen because it measures the response to a long-lasting nociceptive stimulus and thus may closely resemble clinical pain. Twelve day pretreatment of animals with saccharin (0.04%, 0.08%, 0.16%) potentiated the low dose (1.5 mg/kg) of morphine-induced analgesia in early phase significantly but their effects diminished by increasing the concentration of morphine. Also in the early phase of the antinociception recording, all doses of saccharin antagonized the effect of morphine (3 mg/kg) dose-dependently and the effect of high doses of morphine (6-9 mg/kg) was antagonized by dose of saccharin (0.04%) but the effect of morphine (6 mg/kg) potentiated with high concentrations of saccharine (0.08% and 0.16%). All doses of saccharine decreased morphine analgesic effect at a dose of 9 mg/kg. Analgesic effects of low doses of morphine (1.5-3 mg/kg) were decreased by all doses of saccharine in late phase. Different concentrations of saccharin also affected the antagonistic effect of naloxone (0.4 mg/kg) on morphine-induced analgesia in both phases in Formalin-test. The high dose of saccharin (0.16%) potentiated the effect of naloxone in late phase. The obtained results support that hedonic is an important factor in morphine analgesia. Moreover, it seems important to consider sweet taste sensation. It is therefore inappropriate to use different concentrations of sweet saccharin solutions interchangeably.

Barbiturates as hypnotic drugs are widely used in medicine. They act as sedative or analgesic and are used to control seizure disorders. References show that the number cases of poisoning by this drug is very high. Rapid determination of Phenobarbital in blood of poisoned patients can lead to good treatment approaches. Several laboratory methods are currently available for the detection of barbiturates, but few are suitable for emergency use. In this study we evaluated the use of a modified uv-spectrophotometric method in determination of Phenobarbital levels in blood of poisoned patients. This method is based on differential spectrums of Phenobarbital in two alkaline environments. We compared analytical results obtained by this method with previous acceptable spectrophotometry method. There is good correlation (r=0.998) between these two methods. Our results indicate that the procedure time was approximately 45 minutes, sensitivity 2 mg/ml, precision 7.034%, recovery 99.1%. The clinical signs and symptoms and medical examinations of poisoned patients are also recorded. Our results indicated that Phenobarbital overdose is mainly manifested by sedation, tachycardia, neurologic disturbances, hypotension, myosis and hypoxemia. All of the patients had attempted suicide and were discharged alive from the hospital. We found good correlation (r=0.945) between increase in pulse rate and blood Phenobarbital levels. It may be of value in diagnosis of the severity of Phenobarbital overdose. We could not find any correlation between blood Phenobarbital levels and the rate of consciousness or grade of coma. In conclusion, the use of this method for an emergency determination of phenobarbital overdose in toxicology centers is recommended.