لیلا صفاییان

Clostridium difficile (C. difficile) is an important factor in the development of the gastrointestinal diseases because of irrational antibiotic prescription and antimicrobial resistance. In the past, this bacterium was introduced as an agent of the infection in the hospitals called "hospital acquired Clostridium difficile infection". This infection is a main cause of morbidity and mortality internationally. But changing in the epidemiology of the infection was observed in recent years. People not taking antibiotics as well as any contact with the clinical system were hospitalized due to the infection named "Community-Associated Clostridium difficile infection". Furthermore, the hypervirulent strains of C. difficile were identified outside of the health care facilities in different sources such as environment, animals and food products. Today the role of C. difficile has not been confirmed as a zoonotic agent or foodborne pathogen. Taking into account, it should be taken attention to the sensitive individuals such as pregnant women, elderly and children for the consumption of the contaminated food products with C. difficile spores and probable cause of the infection in these individuals. For this purpose, presentation of the guidelines or the prevention strategies for the transmission of bacteria in the society as well as the healthcare facilities is important. In this review study, the history, the risk factors of disease and the reports of infection in the healthcare facilities and outside of this environment in Iran were discussed. Finally, we supposed that based on the isolation of C. difficile with different genetic profile in Iran in comparison with international ribotypes, the existence of native strains leading to the infection in the community and the healthcare facilities is possible. This hypothesis shows the significance of regional differences in the epidemiology and microbiology of disease. In addition, according to the present reports on the irrational prescription of the antibiotics in our country, it seems that C. difficile infection is increasing but any continuous monitoring is not being occurred for the supervision in Iran. Approving these hypotheses need to the careful and continuous assessment besides comprehensive examination of molecular epidemiology of disease in the organizations related to the health in Iran.

During the past 10 years, drug budget have grown enormously from 500 million Dollars to 3 billion Dollars in Iran. Irrational drug prescription can cause additional costs on people/government and can waste the resources. Designing and implementing appropriate interventions to control drug prescription and usage can be effective in controlling the issue. This study was carried out to presenta framework for the most important reasons of the WHO's 12 strategies about irrational use and drug prescription.
In this review article, we have searched the Google, Google scholar, SID, Magiran, Irandoc, and the PubMed with the following keywords: WHO's Strategies, rational prescribing, rational drug use, and rational use of medicine. A total of 70 related articles published in the two last decades were retrieved. After excluding the unrelated articles, data of 43 articles were extracted and analyzed.
According to this study, WHO's 12 strategies were classified in four educational, managerial, regulatory, and financial dimensions. Most studies had been focused on the educational and managerial strategies that seemed to be the most important reasons of irrational drug prescription.
The results of this study provided information on the WHO's strategies in different countries. The results can be used by the policymakers to consider different dimensions of rational use and prescription of drugs in planning appropriate programs.

Abstract There are many reports about the glucose lowering effects of medicinal plants in animal models. There are a some reports in Iranian traditional medicine about glucose lowering effect of septum water extract of Juglans Regia L. In the present study effect of aqueous extract of the septum of Juglans Regia L. on plasma glucose is assessed. After preparing the water extract of Juglans Regia L. and concentrating of it the lyophilized extract was tested in diabetic (ip injection of streptozocin) and normal rats. Comparison between groups was made by analysis of variance (ANOVA) and the differences between the means assessed using student s t test. In an oral glucose tolerance test (OGGT) a single oral administration of the water extract at doses of 50 250 and 750 mg/kg body weight did not lowered the plasma glucose level in the normal rats. Although that insulin administration (5IU/kg) caused a reduction of serum glucose(P0.005). These results demonstrated that the water extract of the septum of Juglans regia s fruit did not have a significant hypoglycemic effect in rats.

Abstract Silymarin the active principle of Silybum marianum has antifibrotic effects in hepatic fibrosis by several mechanisms. Since the pathogenesis of fibroproliferative diseases is similar the effect of silymarin in bleomycin-induced pulmonary fibrosis was evaluated in this study. Silymarin (50 mg/kg i.p.) was administered two days before the bleomycin instillation (3 U/kg) and throughout the test interval in mice. After two weeks lung tissues of mice were evaluated for fibrosis by biochemical measurement of collagen deposition and histological analysis of pathological lung changes. Data were evaluated by one-way ANOVA and Dunnett analysis. P