fatemeh soleymani

Metastatic colorectal cancer (mCRC) constitutes a significant health burden globally, accompanied by elevated mortality rates. This study aimed to assess the cost-effectiveness of regorafenib, an orally administered multi-kinase inhibitor, compared to the combination of Cetuximab and Irinotecan (CetIri) as third-line therapy for mCRC in Iran. A model-based cost-utility analysis was conducted employing a semi-Markov model for a hypothetical cohort of 1,000 patients, integrating time-dependent transition probabilities. From the perspective of the Iranian healthcare payer, the analysis included direct medical costs, such as therapy, monitoring, and adverse effect-related expenses, sourced from national databases in Iran. A yearly discount rate of 5% was applied to both costs and outcomes. Data analysis utilized Microsoft Excel, R version 4.1.3, and TreeAge Pro Healthcare version 2022 software, with the significance threshold set at 0.05. The base-case analysis revealed that regorafenib offers a cost saving of $12,154 and an incremental gain of 0.1 quality-adjusted life years per patient over a 19-month horizon compared with the CetIri regimen. Probabilistic sensitivity analysis showed a greater than 99% probability of regorafenib being cost-effective. Consistent with existing evidence, the findings advocate regorafenib as a cost-effective alternative to CetIri for third-line treatment of mCRC in Iran, considering the specific healthcare system context. Given the foundational assumptions, caution is advised when extrapolating these results to other regions.

One of the main challenges in the field of agricultural higher education is finding a balance between teaching and research activities. The main goal of this study was to analyze the content of this balance in the field of agriculture. To achieve this goal, a systematic review method was used in the form of qualitative interpretive content analysis. After searching and evaluating relevant studies, 125 studies were considered as the final sample. Relevant research evidence was identified and extracted from reputable databases (Science Direct, Google Scholar, Jihad University Scientific Information Center, Civilica, and Mogiran). The analysis of the results showed that the components of the balance between teaching and research in agricultural higher education include current activities in the classroom, current processes in the structure of higher education system, existing infrastructure in the higher education system, interaction of agricultural faculties with the surrounding environment, resources and time, collaboration and interaction, evaluation and accreditation, and organizational culture are the factors contributing to or lack of balance between teaching and research. In this regard, to maintain the balance between teaching and research, it is necessary for three key factors, including curriculum relevant to current agricultural issues, faculty members, and students, to pay attention to this issue; furthermore, the attention of policymakers is also essential to create a suitable balance in this area.

Context: 

In recent years, antimicrobial resistance (AMR) has become a global public health threat. Health system decision-makers need valid and reliable situation analysis to better plan for mitigating this threat.

 This scoping review investigated the research gaps in AMR publications in Iran and provided an evidential base to support the identification of priority research to better address antibiotic resistance needs in Iran.

 A search of academic databases, including Scopus, Institute for Scientific Information (ISI), Web of Science, MEDLINE/PubMed, EMBASE, and Iranian Database of Medical Literature (IDML), was performed in February 2018. The identified studies evaluated the resistance or susceptibility of antibiotics against any bacteria in an Iranian population. Title, abstract, and full-text screening were conducted, and the included studies were accordingly analyzed with respect to the study protocol.

 From 37,769 identified studies, 1,718 studies met all inclusion criteria. These studies evaluated the susceptibility of 131 antibiotics to 82 types of bacteria by conducting 3,509 antibiotic resistance tests. Ofloxacin, ciprofloxacin, and gentamicin had the highest number of studies, samples, and tested bacteria. Regarding the characteristics of the studies, 306 studies had an insufficient explicit definition of study characteristics, 231 studies published their results more than three years after conducting them, and 803 studies (46.7%) were published in local journals.

 Considering the importance of the AMR crisis, this scoping review debates the low quality of reporting in AMR-related publications in Iran despite extensive research.

The spread of the corona virus in China at the end of 2019 and the beginning of 2020 has once again turned the minds of the world community towards the issue of biological attacks. At the same time, the development of biological weapons has become a challenge for the present age. Accordingly, the question is whether humanitarian law developments cover biological attacks. What are the dimensions of this regarding the spread of the virus?

This research was carried out in terms of practical purpose and in terms of gathering information by documentary method and through the study of valid laws and sources, and the obtained information was analyzed in a descriptive-analytical manner.

One of the most dangerous non-conventional weapons of mass destruction are biological weapons, based on the 1925 Geneva Protocol and the 1975 Convention on Biological and Toxin Weapons; Their production, acquisition, transfer and storage is prohibited. In spite of the prohibitions stipulated in international humanitarian law, the special characteristics of biological weapons in terms of the impossibility of distinguishing between military and civilians, the difficulty of identifying the type and origin of these weapons have practically created a huge challenge in the way of applying these regulations. These huge changes in biological weapons require bigger changes in international humanitarian law, changes that should be made both in the concepts and examples and in the nature of the said regulations. This important issue undoubtedly requires the participation of all countries and international governmental and non-governmental organizations.

The possibility of using SAR radar images to detect and measure the sea surface roughnesses, which are mainly caused by winds and water turbulence, has been investigated. Various images of Sentinel-1 SAR radar data in C band and the incidence angle of 39.16 degree were obtained and processed in both VV and VH polarizations to produce images of backscatter coefficient and intensity for Nowshahr maritime region. According to the results, when the average value of backscatter coefficient at VV polarization is 0.00735, the sea surface roughness in Nowshahr region is low and the wave height is 0.9 m. But when this coefficient is 0.034004, the roughness of the sea level is high and the wave height is 2.7 m. Also, the results confirm that the amounts of backscattering from the sea surface near the shore are higher than the offshore areas in the maritime area of Nowshahr.

Paroxysmal Nocturnal Hemoglobinuria (PNH) is a rare, acquired disorder of hematopoietic stem cells, in which red blood cells become susceptible to complement- mediated hemolysis. PNH is associated with a wide range of medical consequences and costs. This study was done to estimate the economic burden of PNH and the secondary consequences caused by PNH in Iran.

This study is a cross-sectional and non-interventional study conducted using the cost-of-illness framework. The top-down prevalence method was used to quantify the annual PNH-related costs. This study was conducted from the societal perspective, including all direct medical, non-medical, and indirect costs associated with PNH. Productivity losses were calculated using the human capital method. Costs were collected using the relative value unit of health services in Iran, related literature, and from one of the referral hospitals in Iran, as well.

The average annual costs of blood transfusion and anemia, thromboembolic events, and renal problems are estimated to be around $5400, $5382, and $6422, respectively. The total average costs of the three mentioned consequences caused by PNH are estimated to be $17,204 US dollars per PNH patient per year in Iran.

This study suggests that the average cost of managing anemia, blood transfusion, thromboembolic events, and renal problems in PNH equals $17,204 annually. Dependent on the severity of the disease and other factors, this amount could increase significantly. Additional cost-effectiveness studies should be carried out to identify the most cost-efficient disease management protocol.

All patients with stable coronary artery diseases (CAD) require medical therapy (MT) to prevent disease progression and recurrent cardiovascular events, alleviate symptoms, and reduce mortality. Nonetheless, little is known about the clinical outcomes of unrevascularized patients taking MT for stable coronary artery disease and the status of coronary artery disease (CAD) risk factor control in Iran

This study aims to evaluate the impact of medical therapy in unrevascularized CAD patients on risk factor modification and re-hospitalization among patients referred to the Rajaie Cardiovascular Medical and Research Center.

An unmatched cohort study was conducted to collect demographic, risk factors, comorbidity, and re-hospitalization data about stable CAD patients in 2014 and followed until 2021. A multivariate regression analysis was applied to explore the relationship between re-hospitalization as the dependent variable and independent variables.

290 stable CAD patients were included in our cohort. More than 60% were males. The mean age of participants was (55.9±5.4) years. Being male, AOR = 0.513 (95% CI, 0.24 – 0.85, p= 0.048); hypercholesterolemia, AOR = 4.10 (95% CI, 1.07 – 15.62, p= 0.040); ejection fraction below 40%, AOR = 4.05 (95% CI, 1.50 – 10.97, p= 0.006); current smoker, AOR = 2.18 (95% CI,1.03 – 4.62, p= 0.042); three-vessel involvement AOR = 10.39 (95% CI, 2.37-45.77, p=0.002) were independently associated with re-hospitalization.

Gaps were identified concerning CAD risk factor control. Higher re-hospitalization was associated with female gender, smoking, presence of hypercholesterolemia, and reduced ejection fraction. Therefore, improving health lifestyle modification interventions tailored to individual patients with a particular focus on females is essential.

Given the impact of the COVID-19 pandemic on routine healthcare delivery, access to the drugs they needed was challenging for patients with non-communicable diseases. This study endeavored to identify the problems of these patients in accessing their medicine during the COVID-19 and the proposed solutions from the perspective of stakeholders.

This qualitative study was conducted through semi-structured individual interviews. Participants (=34) were purposefully selected from Tehran's health policymakers, physicians, pharmacists, and patients with chronic diseases. Data were analyzed through the content analysis method.

Data analysis was categorized into six themes and 15 sub-themes. Primary challenges included medical care, providing the required drugs, financial ability, and access to information. Elevating governance in the drug sector and organizing the drug supply chain were identified as strategies.

To improve patients' access to the medicine they need in crises, proper planning to supply the medicine, use the capacity of pharmacies and pharmacists, set up systems related to telemedicine, and faster implementation of prescription and electronic prescription is recommended.

Plaque psoriasis is a chronic inflammatory disease with skin manifestations that affect the patients' quality of life negatively. The prevalence of psoriasis is approximately 2-3% worldwide and appears to be still on the increase. Due to the stigma problems, psoriasis has a significant effect on one's life that is often overlooked. The current study aimed to conduct the cost-utility evaluation and budget impact analysis of adding-on apremilast ahead of biologic therapy in the treatment of moderate to severe plaque psoriasis. The psoriatic patients who did not undergo the conventional systemic therapy were eligible to enter the defined sequences.

An excel-based Markov model with 40 cycles of 3 months, each of which was adopted to compare the outcomes of each exclusively administered sequence in the treatment of moderate to severe plaque psoriasis. Two exclusive therapeutic sequences were considered. In the first sequence, apremilast was followed by biologics and in the second one, biologics were administered initially without apremilast. The results were extrapolated up to 10 years. The designed Markov model was also used in budget impact analysis. The cost-saving potential of the new treatment was accounted for the next 5 years.

Incremental cost and incremental effect were reported in the base case scenario. Using the sequence consisting apremilast provided an additional 0.10 quality-adjusted life years and decreased total costs by about 11,100 USD per patient. These results were in line with the findings from sensitivity analysis. The cost-saving over 5 years is estimated to be around 30 million dollars for the Iran market following the use of the new treatment.

In the treatment of moderate to severe plaque psoriasis, apremilast supplementation prior to biological treatments is more cost-effective than biological treatment alone.

Bisphenol A (BPA) is a widely used chemical with toxic effects on the liver. Resveratrol (RES) is an herbal compound with protective properties. This study aimed to investigate the protective effects of RES on the liver in rats exposed to BPA.

This study was conducted in 2018 in Shiraz, Iran. Thirty Sprague-Dawley male rats were divided into five groups: a control group (distilled water), a sham group (olive oil as a BPA solvent), a BPA group (50 mg/kg), an RES group (100 mg/kg), and a RES+BPA group (50 mg/kg+100 mg/kg). Olive oil, BPA, and RES were administered to the animals via gavage for eight weeks. After eight weeks, the animals’ livers were removed, and stereological measurements were made to obtain the total liver volume, portal triad volumes, hepatocyte nucleus and cytoplasm volumes, hepatocyte numbers, sinusoidal space volumes and lengths, and Kupffer cell (KC) numbers. The data were analyzed using the one-way analysis of variance test.

The hepatocyte number, the total liver volume, and hepatocyte nucleus and cytoplasm volumes in the BPA group decreased by 41% (p <0.001), 18% (p <0.001), 32% (P=0.030), and 37% (P=0.014), respectively. The number of KCs and the length of sinusoids in the BPA group were increased compared with all the other groups (p <0.001). Our histological study revealed vacuolization, sinusoidal space dilatation, and congestion in the BPA group.

In this study, the RES group, compared with the BPA group, exhibited a decrease in the total volume and length of sinusoids and the number of KCs. Additionally, the RES group showed an increase in the total liver volume, hepatocyte nucleus and cytoplasm volumes, portal triad volumes, and hepatocyte numbers after oral administration.

Benign prostatic hyperplasia is a common chronic disease that is age-dependent. There are two main types of interventional treatment, transurethral resection of prostate as a gold standard (TURP) and open prostatectomy (OP); also, there are two pharmacological groups for managing BPH: alpha-blockers and 5-alpha-reductase inhibitors (5-ARIs). In this economic evaluation study, one 5-ARIs, dutasteride and two main surgical treatments are compared as alternatives for treating moderate BPH in Iran. A cost-utility study with an Iranian health provider perspective was conducted. Markov model in a cohort of 1000 patients with BPH with annual cycle length and ten years’ time horizon was developed by using MS EXCEL 2013. The effectiveness measure was an improvement in the IPSS score and transformed to the utility. The transition probabilities, utilities and adverse events were extracted from published clinical trials. The direct medical costs were measured in the 2017 US Dollar. One way sensitivity analysis and scenario analysis were conducted.For treating moderate BPH, seventy-year-old men, in the base case scenario, the utility of pharmacotherapy is 18 QALY less than surgery, and the cost of pharmacotherapy is 136,301.1 $ less than surgery. ICER for pharmacotherapy was 7,572.3 $ compared to surgery. In the sensitivity analysis, the model is not sensitive to most variables but the unit cost of dutasteride. Based on scenario analysis conducted for different age groups, pharmacotherapy with dutasteride is preferred to surgery in patients over 60 years of age in Iran. However, for younger adult men between 40-60 years old, surgery is a cost-effective alternative.

This study aimed to search for randomized clinical trials evaluating the clinical effectiveness of ertapenem compared to piperacillin/tazob actam in adult patients with mild to moderate intra-abdominal infections.

Design: 

A literature review was performed in PubMed, Scopus, Google Scholar, and Cochrane databases in order to find articles published up to April 2019. Then, the pairwise method was used to compare the difference between the mean score of the clinical effectiveness of these two interventions before and after the intervention by the means of a non-direct method (the comparison of drugs with each other).

The analysis of 4 studies involving 767 patients in the ertapenem group and 728 patients in the piperacillin/ tazobactam group showed that ertapenem can be 3% more effective than piperacillin/tazobactam (Weighted mean differences = 3.02, confidence interval (0.79-6.84) although the difference was insignificant (I-squared = 0.0%, P=0.98)

In general, the findings demonstrated that there is no significant difference in the clinical effectiveness of ertapenem in comparison with piperacillin/tazobactam in adult patients with mild to moderate intra-abdominal infections.

Antibiotics contribute to a lot of patients’ treatment. However, improper prescription and wasteful use of antibiotics may lead to various side effects or complications such as medicinal resistance and lack of treatment, resulting in an excessive financial burden. The present study aimed to compare antibiotics prescription pattern and their financial burden before and after intervention based on prophylactic antibiotics guidelines in traumatic surgical sections. This analytical and cross-sectional study was conducted in 2018 on patients undergoing surgery in 4 general, urology, neurosurgery, and orthopedics surgery sections. The sample consisted of 464 patients with traumatic injuries. A researcher-made questionnaire was used as a principal instrument for gathering data. The data was analysed using SPSS (version 21). The accordance of dose, method and kind of prescribed antibiotics with the instructions and guidelines after intervention increased to 29, 5.1 and 28.8%, respectively. There was a significant relationship between dose, method, and kind of prescribed antibiotic before and after the intervention (p <0.05). The financial burden of prescribed antibiotics before and after the intervention was 56400480 and 52789290 IRR, respectively. Based on the results, the intervention was effective in accordance with dose, method and kind of prescribed antibiotics. Also, financial burden reduced by 6.4% after the intervention. Continuous monitoring of antibiotic prescription based on instructions, training instructions of prophylaxis antibiotics to physicians, and infectious monitoring committee meetings can prevent irrational prescriptions and reduce the excessive financial burden on society, government and insurance organizations.

Since at the time of this study fusidic acid was not available in the pharmaceutical market of Iran, this study was designed to investigate the economic aspects of the availability of fusidic acid for the treatment of topical infection in Iran.

A decision tree model was used to compare circumstances, in which only mupirocin and fusidic acid were available. Medical and hospitalization costs were considered as direct medical costs. Budget impact analysis and sensitivity analysis were performed to examine the robustness of the base-case analysis.

It was assumed that a 50/50 ratio exists between burn patients to other patients. The treatment cost of 1000 cohort hypothetical patients was estimated at $54766 when mupirocin was the only available treatment choice and $15951 when fusidic acid was available as well. In other words, overall, $39 per patient was saved when physicians could consider fusidic acid as another choice of treatment.

The availability of fusidic acid appears to be reasonable because it reduces the costs of skin infection treatment. It also improves antibiotic consumption appropriateness.

Access to medicines needs to be fully integrated with health financing, human resource planning, service delivery, information and governance systems. We aimed to explore key themes for the identification of priority policy research questions in the area of access to and use of medicines.

We interviewed a purposeful sample of twenty participants in Iran. The interviewees were selected from diverse stakeholders and the listing comprised of the Ministry of Heath, Departments of Health, Industry, Researchers, Development Partners, Advocates, Clinicians, Pharmacists and Private Providers. Qualitative data was analyzed using the framework approach. We then conducted a nominal group technique meeting to reach consensus on research priorities.

Seven themes explain important access to medicine policy and practice issues: health sector organization, health sector pharmaceutical policies, health system financing/ insurance system, drug distribution system in the country, individual, household and community level, health care providers, and policies beyond the health sector. As a result of the consensus development process, 17 research priorities related to access to and use of medicines were identified.

The key informant interviews clearly demonstrate that the majority of policy concerns were not addressed. There was a mismatch between the concerns and research, and hence the outcomes of this study can contribute to developing a research agenda for improving access to and appropriate use of medicines.

An economic crisis has been defined as a situation in which the scale of a country’s economy becomes smaller in a period of time. Economic crises happen for various reasons, including economic sanctions. Economic crises in a country may affect national priorities for investment and expenditure and reduce available resources, and hence may affect the health care sector including access to medicines. We reviewed the pharmaceutical policies that the countries adopted in order to mitigate the potential negative effects on access to medicines. We reviewed published reports and articles after conducting a comprehensive search of the PubMed and the Google Scholar. After extracting relevant data from the identified articles, we used the World Health Organization (WHO) access to medicines framework as a guide for the categorization of the policies. We identified a total of 40 studies, of which 10 reported the national pharmaceutical policies adopted to reduce the negative impacts of economic crises on access to medicines in high‑income and middle‑income countries. We identified 89 policies adopted in the 11 countries and categorized them into 12 distinct policy directions. Most of the policies focused on financial aspects of the pharmaceutical sector. In some cases, countries adopted policies that potentially had negative effects on access to medicines. Only Italy had adopted policies encompassing all four accesses to medicine factors recommended by the WHO. While the countries have adopted many seemingly effective policies, little evidence exists on the effectiveness of these policies to improve access to medicines at a time of an economic crisis.

The objective was to quantify the specialists’ prescription pattern in Iran and to point out the prescribing behavioral differences among several specialties.

A retrospective cross‑sectional study was carried out on the claim data. National prescription data were obtained on the basis of the claims that the pharmacies submitted to the insurers during 1 year period of the study. More than 85 million prescriptions were analyzed using “Rx‑Analyst” software that is designed and applied by National Committee of Rational Use of Medicines in Iran. Specified medical specialties were considered and the World Health Organization prescription indicators were used to evaluate the physicians’ prescribing behavior.

Average items per prescription were ranged from 3.68 in cardiologists’ to 2.06 in dermatologists’ prescriptions. The highest and the lowest mean price were belonged to neurologists’ and ophthalmologists’ prescriptions, respectively. In addition, 45% of patients received antibiotics, 41% of patients received injectable form of drugs, and 23% received corticosteroids. A high tendency toward prescribing corticosteroids and antibiotics as well as an injectable form of medicines was observed among general physicians.

There is an inevitable need to improve prescription habits among different specialties, especially among general practitioners. This causes the policymakers to put more emphasis on priorities such as continuous education.

Pharmacists have a remarkable role in rational use of drugs by dissemination of drug information to guide patients, physicians, and policy makers. The present study was undertaken to evaluate the pharmacists’ view point about the main factors affecting current drug use pattern regarding rational drug use and the most effective strategies for improving and promoting rational drug use among pharmacists.

In a cross‑sectional survey, pre‑designed questionnaires were filled in convenient sampling by pharmacists who had attended the congress of rational drug use in Tehran, Iran.

A total of 144 pharmacists with the average age of 40.78 years old were enrolled to the study. Data indicated that the most priorities in irrational use of drugs from pharmacists’ view point were lack of appropriate cooperation and communication between physicians and pharmacists(39%), pharmacists’ low tariff and economic issues (34%), lack of public knowledge about drug usage (45%), and lack of supervisory regulations on pharmacy practice (15.8%).

In this study, lack of public knowledge and awareness about appropriate use of medicines was the most important element from pharmacists’ viewpoint in occurrence of irrational drug use. Dissemination of information and compiling of diverse strategies in education, management, regulation, and finance can be very efficient due to a strong relationship between drug policies and performance of regulations and supervisions as well as drug services.

Global experience as well as expert views weight the Family Physician program (FPP) as a primary solution for various problems of healthcare system in Iran. In spite of the valuable information has been collected during conducting FPP, few studies have been done to evaluate the actual performance of this program. This study reviewed the studies related to the evaluation of the FPP systematically. The authors systematically searched PubMed, Web of Science, Scopus, Embase, Irandoc and SID for articles published in English and Persian until Nov 2017 without limitation for starting time. Selection stages of the articles were done based on PRISMA flow diagram guidelines. Of all articles evaluated, 19 were selected. Four articles were removed due to inadequate quality of the study. Only one article evaluates urban and the rest are about rural. Eight articles were categorized as the process evaluations and 12 outcome assessments (one of them was common). We achieved three main findings. First, the rural FPP has improved access to the healthcare services, but improvement in patient finding and quality of cares remains questionable. Second, there are considerable concerns in the referral system between levels I and II in both urban and rural programs. Third, there was no efficient planning to implement the FP as the gatekeepers of health care system effectively. These issues deprived the efficiency aim of FPP and need serious consideration.

Indices are necessary prerequisites for evaluation and assessment of health policies. One of the main issues in this regard is the inspection of pharmaceuticals. The aim of this study was to provide an indicator-based model of the assessment of paragraph 5 of the general health policy document of Iran. This qualitative study used literature review, expert panel, stakeholders analysts, policy review and the Status quo analysis assessments. Drafts of indices derived from the literature review were finalized by an expert panel and stakeholder delegates. All keywords were described and a comprehensive description of generic policy were defined by a board from the Iranian Academy of Medical Sciences. Five indices were finalized for demand management parts of paragraph 5 whilst 10 indices were for the policy part and13 indices were ascribed to the assessment of general policy. Emphasis on effective interventions and determination of key indices play a crucial role in achieving policy goals.

The effect of chemical, biological and organic fertilizers and irrigation treatment on some growth indices and yield of sunflower (Helianthus annuus (L.) Var. Euroflour) were studied by a split-plot experiment based on randomized complete block design with three replications at Research Farm of Bu-Ali Sina University in 2015. Main plots consisted of two irrigation levels: optimum irrigation and deficit irrigation stress (irrigation after 60 and 120 mm evaporation from evaporation pan, class A, respectively) and sub-plots included of fertilizer treatments: 1- control (no fertilizer application), 2- full recommended dose of chemical fertilizers (NP), 3- vermicompost, 4- phospho-nitro kara, 5- vermicompost phospho nitro kara, 6- vermicompost ½ chemical fertilizers, 7- phospho nitro kara ½ chemical fertilizers, 8- vermicompost phospho nitro kara ½ chemical fertilizers, 9- ½ chemical fertilizers. Deficit irrigation reduced all traits, significantly. Growth indices, chlorophyll and carotenoid content, biological yield, seed, oil and protein yield increased as effected by fertilizer treatments. Generally, in optimum irrigation, maximum amount of mentioned traits were achieved in full dose of chemical fertilizers. But, in deficit irrigation treatment, biological and organic fertilizers, especially treatments of vermicompost ½ chemical fertilizers and phospho nitro kara ½ chemical fertilizers had the better rating than the full application of chemical fertilizers. In general, by comparing the studied fertilizers it could be concluded that bio and organic fertilizers with reduced doses of chemical fertilizers could provide sunflower nutritional needs, especially in deficit irrigation conditions.

Overuse of injections is a common problem in many low-income and middle income countries. While cultural factors and attitudes of both physicians and patients are important factors, physicians› financial intensives may play an important role in overprescribing of injections. This study was designed to assess the effects of providing injection services in physicians› ambulatory offices on prescribing injectable medicines. This cross-sectional study was conducted in Tehran in 2012 -2013and included a random sample of general physicians, pediatricians and infectious disease specialists. We collected data on the provision of injection services in or in proximity of physician offices, and obtained data from physicians› prescriptions in the previous three-month period. We analyzed the data using ANOVA, Student›s t-test and linear regression methods. We obtained complete data from 465 of 600 sampled physicians. Overall 41.9% of prescriptions contained injectable medicines. 75% of physicians offered injection services in their offices. Male physicians and general physicians were more likely to offer the services, and more likely to prescribe injectables. We observed a clear linear relationship between the injection service working hours and the proportion of prescriptions containing injectables (p-value

The complexation of Cd2 by diallyl disulfide (DADS) and diallyl sulfide (DAS) has been studied by differential pulse voltammetry. Stability constants, (log β), of the 1:1 (PbL) and 1:2 (PbL2) complexes, where L = ligand, were found to be in the range of ca. 5.8 - 6.2 and 9.6 -10.6, respectively. Complex formation is accompanied with a significant decrease in the peak current and the shift of the Cd2ﰧ half-wave potential to a higher one upon the addition of the sulfur containing ligands (L). The formation of 1:1 and 1:2 complexes, i.e., CdL2 and Cd 22 was observed in the case of the two ligands. The consecutive formation constants of labile lead complexes with DADS and DAS were determined at 298K by the method of DeFord and Hume. Apparently due to the large size of the cadmium ion, steric hindrance caused by the greater steric bulk of DADS compared to that of DAS have little or no effects on the formation constants, so that very similar values were obtained in the case of the two ligands. Also, the possible participation of C=C double bonds in coordination with the metal center in the case of DADS appears to compensate for the steric effects caused by the larger size of this ligand. In agreement with the Jorgensen principle of symbiosis, the second formation constants were found to be approximately six orders of magnitude greater than the first ones.

Many countries including Iran have used “audit and feedback” (A&F) and “printed educational materials” (PEMs) interventions to improve physicians’ drug prescribing behavior. In addition, several trials have shown low to moderate effects of the two interventions. Nevertheless, few studies have assessed physicians’ satisfactions with A&F or PEM interventions. This is a cross-sectional survey which was carried out in Tehran and Mashhad Cities, Iran, in 2014.
181 general physicians, pediatricians and infectious disease specialists working in outpatient practices completed the questionnaire covering demographic characteristics, satisfaction with the A&F and PEM, and the perceived effectiveness of the interventions in improving physicians’ behavior.
Almost all physicians who reported receiving A&F or PEM reports, indicated reading them. In addition, 84% and 86% of the physicians agreed with the efficiency of feedback reports and PEM, respectively.
Findings showed that general physicians study A&F reports more carefully or frequently than the specialists. Physicians believed that revising the feedback report’s format and content could increase its effectiveness.

To achieve the higher economic yield of crop plants, supplying enough nutrients to plants is very important. Moreover, nutrient uptakes by plants is influenced by the soil water contents. However, nowadays chemical fertilizer application is important agronomic factor that has significant effects on growth and quantity and quality of final yield, but traditional nutrient management and excessive use of chemical fertilizers may cause the environmental problems such as contamination of soil and water resources, low quality of agricultural products and reduction of soil fertility. These factors have drawn attention to health and ecological sustainable farming systems (Sharma, 2002). In this context, usage of organic and biological products for plant nutrition is considered as one of the solutions to achieve the goals of sustainable agriculture.
To evaluate the effect of various feeding systems on yield and yield components of sunflower (Helianthus annuus L.) under the influence of water deficit stress, a split-plot experiment based on randomized complete block design with three replications, was carried out in the Agricultural Faculty of Bu-Ali Sina University during the growing season of 2013-2014. Main plots consisted of two irrigation levels: optimum irrigation and deficit irrigation stress (irrigation after 60 and 120 mm evaporation from evaporation pan, class A, respectively) and sub-plots included of nine nutrition systems: 1- no bio or chemical fertilizer application, 2- 100% of the recommended chemical fertilizer , 3- vermicompost, 4- phospho nitro kara, 5- vermicompost phospho nitro kara, 6- vermicompost ½ chemical fertilizer, 7- phospho nitro kara ½ chemical fertilizer, 8- vermicompost phospho nitro kara ½ chemical fertilizer, 9- ½ proposed chemical fertilizer. Phospho-nitro-kara which contains phosphate solubilizing and nitrogen fixing bacteria (Bacillus coagulans, azotobactr chroocuccum and Azospirilium lipoferum) was impregnated with seeds. Vermicompost was mixed with the soil before planting based on the recommendation of the producer company (15 t.ha-1). After determining evapotranspiration of the reference plant (ET0) by FAO- Penman-Monteith method and crop coefficients (Kc) in different stages of crop growth, plant water requirement was determined (Allen et al., 1998). Finally, the irrigation water volume was estimated according to the effective rainfall, irrigation efficiency (60%) and 45% depletion of soil moisture in the root zone (Doorenbos & Kassam, 1979).
Water deficit stress and nutrient treatments significantly affected all measured traits except the harvest index. Water deficit stress significantly reduced head diameter by 24% in comparison with optimum irrigation. The maximum diameter (17.03 cm) was obtained in vermicompost treatment. One thousand seed weight of sunflower under optimum irrigation was 1.3 times as much as water deficit treatment. Combined treatment of vermicompost and half of recommended chemical fertilizer yielded maximum 1000- seed weight (56.67 g). Under optimum irrigation, the highest weight of the head was achieved from 100% chemical fertilizer application, while under water stress, maximum head weight (830.67 g) was obtained in vermicompost treatment and the minimum value (485.33 g) was obtained from chemical fertilizer vermicompost phospho nitro kara. In both irrigation levels, the highest biological yield was obtained from full application of chemical fertilizer, but this treatment in stress condition did not have significant difference with combined application of vermicompost and half of chemical fertilizer, vermicompost and 50% of chemical fertilizer. 100% recommended chemical fertilizer in optimum irrigation, had a maximum grain yield (693.67 g.m-2).
Organic fertilizers by increasing soil organic matter, improving soil chemical properties such as pH and CEC, increasing the activity of microorganisms and nutrient accessibility led to increase soil fertility. In this study, especially under stress condition, it was observed that vermicompost by increasing water holding capacity and nutrients availability, improvement of plant growth, increasing assimilation and transmission of assimilates to seeds, led to increase the economic yield of sunflower.
In conclusion, although chemical fertilizers play an important role in enhancement of crop yield, though may cause some environmental problems too. In addition,biological fertilizers alone can not provide nutrient requirements of crops. Generally, in order to achieve sustainable agriculture, especially under the influence of water stress condition, it seems that reduction of chemical fertilizers and replacing them with vermicompost can be an effective method.