فهرست مطالب mohammad abbasinazari

Our objective was to assess the efficacy and safety of adding alpha-pinene (a herbal terpenoid) to quadruple therapy compared to a placebo in improving symptoms and Helicobacter pylori (H. pylori) eradication rates in Functional dyspepsia (FD) patients.

FD is a prevalent upper gastrointestinal condition, and no definitive pharmacological treatment is available for its management.

We conducted a randomized, double-blinded, placebo-controlled trial on FD patients diagnosed with H. pylori infection. We collected baseline demographic data and assessed FD symptoms in the participants. Patients were randomly allocated to receive either standard quadruple therapy with α-pinene capsules (0.25 mg/day) or quadruple therapy with a placebo for two weeks. We employed a validated questionnaire, the Short Form Leeds Dyspepsia Questionnaire (SF-LDQ), to evaluate FD symptoms. The eradication rate of H. pylori was compared between the two groups one month after completing the treatment regimens. Any reported adverse drug reactions (ADRs) were documented throughout the trial.

Over four months, a total of 66 patients completed the trial. Notably, there were no significant differences in baseline SF-LDQ scores between the two groups (p=0.83); however, a significant divergence emerged at the trial's conclusion (p=0.03). The H. pylori eradication rates did not show notable differences between the two treatment arms (p=0.43). Importantly, there were no dropouts from the trial due to ADRs. Among reported ADRs, participants experienced abdominal pain, headache, diarrhea, and a metallic taste, with no significant variance in incidence rates observed between the two groups (p=0.62).

These findings suggest that α-pinene could be an effective and safe agent for reducing FD symptoms.

In recent decades, the number of cases developing drug-induced esophagitis (DIE) has been identified to an increasing extent, which shows the significance of detecting medicines capable of causing this adverse reaction. This study aims to provide an updated review on recent case reports of DIE, evaluate the possible mechanism of this side effect, and provide helpful management. Data was gathered through searching three databases, including PubMed, Medline, and Cochrane. Seven drug categories were evaluated, including antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), cardiovascular medicines, bisphosphonates, chemotherapeutic agents, miscellaneous agents, and supplements. According to our findings, retrosternal pain, heartburn, odynophagia, and dysphagia are the typical symptoms. In most cases, DIE is a self-limiting side effect that can resolve by removing the causative agent and supportive therapy.

Antibiotic-resistant Helicobacter pylori isolates have become a global concern. The standard triple or quadruple therapies have recently become the most effective protocol for eradicating H. pylori in the gastrointestinal tract. There is evidence regarding the impact of different complementary or dietary supplements on H. pylori eradication. This review article intended to search electronic bibliographic databases for any clinical studies that evaluated the use of any herbal or dietary supplements to eradicate H. pylori up to June 2021. A total of 20 human studies met our criteria and were reviewed. Although some herbal medicines have shown their efficacy and safety in eradicating H. pylori in different clinical trials, more randomized blind, placebo-controlled human trials with a large sample size must be performed to extend our knowledge.

The current study aimed to evaluate the safety profile and efficacy of a cannabis-based sublingual spray, CBDEX10® (containing 100 µg cannabidiol and 10 µg Δ9-tetrahydrocannabinol per puff; CBD/Δ9-THC 10:1), in improving lipid profile and glycemic state of the diabetic patients. Fifty diabetic patients were randomly allocated to the treatment (n = 25; receiving two puffs of CBDEX10® twice daily) or the control groups (n = 25; receiving two puffs of placebo). The primary endpoint of the study was to evaluate the efficacy of the CBDEX10® adjunctive therapy in improving the lipid profile and glycemic state of diabetic patients; the secondary endpoint was to assess the safety profile and tolerability of the spray. A statistically significant decline in total cholesterol [estimated treatment difference (ETD) = −19.73 mg/dL; P < 0.05], triglyceride (ETD = −27.84 mg/dL; P < 0.01), LDL-C (ETD = −5.37 mg/dL; P < 0.01), FBS (ETD = −12 mg/dL; P < 0.01), HbA1c (ETD = −0.21 mg/dL; P < 0.01) and insulin secretion (ETD = -5.21 mIU/L; P < 0.01) was observable in the patients treated with CBDEX10® at the end of the 8-week treatment period. Regarding safety, the mentioned adjunctive regimen was well, and there were no serious or severe adverse effects. Overall, CBDEX10® sublingual spray could be a new therapeutic agent for lipid and glycemic control in diabetic patients.

Antibiotic-resistant Helicobacter pylori isolates have become a global concern. The standard triple or quadruple therapies have recently become the most effective protocol for eradicating H. pylori in the gastrointestinal tract. There is evidence regarding the impact of different complementary or dietary supplements on H. pylori eradication. This review article intended to search electronic bibliographic databases for any clinical studies that evaluated the use of any herbal or dietary supplements to eradicate H. pylori up to June 2021. A total of 20 human studies met our criteria and were reviewed. Although some herbal medicines have shown their efficacy and safety in eradicating H. pylori in different clinical trials, more randomized blind, placebo-controlled human trials with a large sample size must be performed to extend our knowledge.

Melatonin is the "clock factor" produced from the pineal gland dominating regular circadian rhythm in mammalians. It is an indoleamine with potent multifunctional pharmacological effects, both receptor dependent and non-receptor dependent effects, including antioxidant and anti-inflammatory activities. The aim of this review is to summarize clinical evidence related to melatonin's effectiveness in the treatment of liver and pancreas diseases. Databases including PubMed, Scopus, and Cochran Library were searched up to November 2020.Finally, this review has summarized up-to-date clinical evidence to investigate the efficacy and safety of melatonin for the management of liver and pancreas diseases. Melatonin has been demonstrated to have beneficial effects on the management of Non-alcoholic fatty liver disease (NAFLD), sleep disturbance of cirrhotic patients, prevention of drug/poison induced liver toxicity,and prevention of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP);more data is needed to recommend melatonin administration in the treatment of mentioned disorders.

Ulcerative colitis (UC) is characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. The exact etiology of UC is unknown, but the role of autoimmunity and activated inflammatory cascade is quite clear. Melatonin possesses anti-inflammatory and immune-modulative properties in animal and clinical trials. The aim of the present study was to evaluate the efficacy and safety of oral melatonin as an adjudicative therapy in clinical, biochemical, and quality of life in UC patients. Thirty patients diagnosed with mild to moderate UC, were randomly allocated to either receive melatonin (3 mg/d) or the placebo group for three months. Simple clinical colitis activity index (SCCAI), fecal calprotectin (FC), C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), and Sf-36 questionnaire have been used for assessment at the baseline and the end of the trial. Melatonin significantly improve SCCAI score, FC, role-emotional, energy and general health relative to placebo (p = 0.03, 0.05, 0.002, 0.032, 0.004 respectively). Regarding CRP, ESR, and the other components of SF-36 there is not any significant difference between melatonin and placebo group. Melatonin supplementation over a three-month period is effective and safe in improving clinical index, FC, and some quality of life in patients with mild to moderate UC.

Statins are associated with several muscle complaints, such as: myositis, myalgia, muscle weakness, muscle spasms and rhabdomyolysis. Age, race, gender, dose of statin, concomitant medications, concomitant disorders and genetics have been reported as the most important risk factor for statin-induced myalgia. The aim of this study was to determine the prevalence and associated risk factors of atorvastatin-induced myalgia in hospitalized patients in Tehran, Iran.

In this cross sectional study, a questionnaire was developed by expert panel opinions. The questionnaire was included various items regarding demographic data and myalgia evaluation factors. Seven hundred patients were included in the study and necessary data were gathered. Finally, the data were analyzed and a statistical model was designed to predict the myalgia risk factors.

The rate of myalgia was 44.3% among studied patients. By developing a multivariate logistic model, female gender (OR= 0.47, P-value<0.001) was one of the most important factors in myalgia occurrence.

The results of this study suggest that gender, age, atorvastatin dose, duration of atorvastatin usage and presence of myotoxic disease are the main predictors of myalgia in Iranian population. Hence, the findings of this study can be considered to predict the myalgia incidence risk in Iranian population.

Melatonin is available as a dietary supplement and is frequently used for sleep disorders. Decrease in cholesterol absorption, increase in LDL oxidation, and decrease in free fatty acids have been associated with melatonin use. The present study aimed to evaluate the effects of melatonin on changes in the lipid profile of patients with type 2 diabetes mellitus.

This double-blind randomized clinical trial was conducted on patients with diagnosis of type 2 diabetes mellitus. They were allocated to receive either 6 mg/d of melatonin or placebo for a minimum of eight weeks. The levels of cholesterol, triglyceride, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were evaluated at baseline and at the end of the study.

The demographic characteristics, baseline lipid profiles, and current medication use were found to be similar in the two groups, except for metformin use (100% vs. 86.11%; P=0.02). There was no significant difference between the two groups in terms of the lipid parameters, such as cholesterol, triglyceride, LDL, and HDL levels (P=0.26, 0.81, 0.21, and 0.66, respectively). There were no serious adverse drug reactions in the two groups during the study.

According to the results of this trial, 6 mg/d of melatonin does not change the lipid profile of patients with type 2 diabetes mellitus.

Proton pump inhibitors (PPIs) are recommended as first line treatments for gastroesophageal reflux disease (GERD). Failure to PPIs has been mentioned as a problem in pharmacotherapy of GERD. The present study compared the symptom relief, quality of life (QoL) and adverse drug reactions (ADRs) of omeprazole plus buccal buspirone with that of omeprazole alone.This was a prospective, randomized trial between buccal buspirone (10 mg/d) plus omeprazole (20 mg/d) and omeprazole (20 mg/d) plus placebo administered for 4 weeks to patients with GERD symptoms. Patients who had GERD symptoms enrolled in this study.67 patients were randomly assigned to either the buspirone plus omeprazole group (n = 33) or the placebo plus omeprazole group (n=34). Finally, 58 patients completed the study (29 in each group). Treatment response rates in each drug group were evaluated according to the Frequency Scale for the Symptoms of GERD (FFSG). The QoL and ADRs have been also evaluated too.The treatment score rates for symptom relief according to the FFSG were 7.13 ± 5.13 in the buspirone group and15.34 ±8.17in the placebo group. Regarding FFSG score, there is a significant difference between the groups (p < 0.0001). QoL were 6.86 ± 6.65 and 27.2 ± 20.95 in placebo and buspirone group respectively after four weeks and there is a significant difference in two groups (p < 0.0001).The total incidence of ADRs were similar in the buspirone and placebo groups (p = 0.36). A combination of buccal buspirone plus omeprazole may be a more effective treatment for GERD than omeprazole alone.

Tenofovir is an antiviral agent prescribed for patients suffering from hepatitis B. It is associated with some side effects such as reduction in the level of patients’ adherence. The aim of this study was to evaluate the impact of clinical pharmacist consultation on patients’ adherence to the use of Tenofovir. In this prospective study, a total of 80 patients were enrolled into the study and were divided into two groups. Patients in group one, received their medication in a routine clinic manner, while patients in the second group, by clinical pharmacist intervention, received Tenofovir along with verbal and written tips about the drug dosage, side effects, drug interactions, food-drug interactions and administration. Finally, patients’ adherence to their medication was evaluated using a standard scale. Also, adverse drug reaction (ADR) occurrence and some laboratory parameters were recorded for further analysis. The patients' adherences to their medication was higher in case group than the control group in first three month of follow up. Moreover, lower ADRs were observed in patients who received clinical pharmacist consultation. It can be concluded that consultation provided by clinical pharmacist can lead to better adherence to Tenofovir usage, better therapeutic response and better tolerance of side effects.

Glutamine has been considered as a dietary supplement with a non-essential amino acid structure. Some studies found that liver failure may be associated with a high plasma glutamine level. Consumption of this product may be associated with potential adverse effect. This report describe the first case of glutamine induced hepatotoxicity. A 35-year-old female athlete with severe abdominal pain and scleral icterus was referred to the hospital. She has been taking glutamine powder for the past three weeks ago. Impaired liver function test and imaging evaluation suggested hepatotoxicity. Glutamine consumption was discontinued and the patient was closely monitored. Finally, after two weeks, the patient recovered successfully. This novel case was the first report regarding glutamine induced hepatotoxicity. Health care providers must know that consumption of dietary supplement such as glutamine may be associated with serious side effects. Liver damage is a possible side effect of glutamine. Hence it is necessary to consider hepatotoxicity as an adverse reaction in case of glutamine supplement consumption.

Melatonin is widely available as over the counter product. Despite promising effects of melatonin supplementation on glycemic control, there is a significant heterogeneity between studies. The current study aimed at determining the effect of melatonin on fasting blood glucose (FBG), insulin resistance/sensitivity indices, glycosylated hemoglobin A1c (HbA1c), and high sensitivity C-reactive protein (hs-CRP) among type 2 diabetes mellitus (T2D) population during 8 weeks in a randomized, triple-blind, placebo-controlled trial. Thirty four subjects with the mean age ± standard deviation of 57.74 ± 8.57 years and 36 subjects with the mean age of 57.61 ± 9.11 years were allocated to 6 mg nightly melatonin and placebo groups, respectively. Melatonin and placebo groups were matched by age, gender, body mass index, and duration of diabetes. Also, there was no significant difference in laboratory findings except for HbA1c, which was lower in the placebo group (7.00±0.89% vs 7.60±1.47%, P=0.042). After trial completion, the increase of serum levels of melatonin was greater in the intervention than the placebo group (3.38±1.33 vs 0.94±1.28 ng/L, P=0.192). Moreover, compared to placebo group, among melatonin users, homeostasis model assessment of insulin resistance (HOMA1-IR) tended to be unfavorable at the end of follow-up [-0.51 (-1.76-0.81) vs. 0.28 (-1.24-1.74), P=0.20]; the similar trend was also shown for insulin sensitivity index (HOMA1-S) [2.33 (-3.59-12.46) vs. -2.33 (-10.61-9.16), P=0.148]. No differences were observed in FBG, HbA1C, and hs-CRP changes between the trial groups. The current study did not support the improving effect of melatonin on glucose homeostasis.

Vitamin D deficiency is associated with cardiovascular and metabolic diseases. Cardiovascular diseases, in turn, are responsible for mortality of patients with type 2 diabetes (T2D). We investigated whether a single parenteral dose of 25(OH) Vit D could improve the endothelial function in T2D patients with ischemic heart disease. A randomized, placebo-controlled, and double-blind trial was performed on 112 patients randomly divided into vitamin D (n = 55) and placebo (n = 57) groups. A randomization table was used to administer a single dose of either vitamin D (300000 IU) or a matching placebo, intramuscularly. The levels of 25(OH Vit D, intercellular adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1) were measured at baseline and at 8 weeks. In the supplemented group, the level of serum 25(OH) Vit D was increased significantly (29.6 ± 20.8 vs. 44.5 ± 19.2 ng/mL; P < 0.05), whereas no changes were observed in the placebo group. Within the supplemented group, before and after vitamin D intervention no significant changes in the levels of ICAM-1 and VCAM-1 were observed. Expectedly, the level of 25(OH Vit D increased significantly in the supplemented group. The marginal means of the outcome variables (ICAM-1, VCAM-1, and 25(OH) Vit D) were compared between the groups using ANCOVA, adjusted for the baseline of each variable itself: no significant difference was seen in the markers of the endothelial function. A single parenteral dose of vitamin D in T2D patients with ischemic heart disease failed to show improvement in endothelial function.

Sexual dysfunction is a common cause of selective serotonin reuptake inhibitor (SSRI) withdrawal. Various studies indicate that decreased oxytocin is involved as a mechanism of delayed ejaculation induced by SSRIs. The aim of the present pilot study was to evaluate and compare sexual dysfunction and oxytocin levels in women being treated with either fluoxetine or citalopram. Thirty-nine women with the diagnosis of major depressive disorder were enrolled in the study. A baseline blood sample was collected and each participant was given either fluoxetine 20 mg/d or citalopram 20 mg/d. After 1 month, a second blood sample was collected and sexual dysfunction was evaluated via the Female Sexual Function Index (FSFI) questionnaire. Twenty-three women completed the study (12 and 11 in the fluoxetine and citalopram groups, respectively). After 1 month, the FSFI scores were 22.8 ± 7.8 and 22.5 ± 4.8 in the fluoxetine and citalopram groups, respectively. The oxytocin levels were 187.8 ± 38.8 pg/mL and 214.6 ± 23.1 pg/mL in the fluoxetine and citalopram groups, respectively. Statistical analysis did not reveal any difference in the FSFI score between the two groups after 1 month (p = 0.89). However, the oxytocin levels were significantly lower in the fluoxetine group than in the citalopram group (p = 0.05). We also observed a positive relationship between the FSFI score and oxytocin level at 1 month after starting fluoxetine or citalopram (r = 0.43, p = 0.04).A positive relationship between the oxytocin level and FSFI score supports the hypothesis that the oxytocin level plays a role in sexual dysfunction induced by SSRIs.

This study aimed to investigate the efficacy and the underlining mechanism of aspirin desensitization among patients with Aspirin Exacerbated Respiratory Disease (AERD). Thirtyeight patients, who had undergone an aspirin challenge test and were diagnosed as having AERD, were engaged in a double-blind randomized clinical trial. They were divided into two groups—an active group of patients who went through aspirin desensitization, and the control group, receiving placebo. Clinical symptoms and the quality of life of the patients—in addition to the levels of interleukin 4 and 5 (IL4), (IL5)—were documented at the beginning of the study and again after six months of aspirin desensitization. The quality of life of the patients was significantly higher in the active group after six months (P = 0.001). Medication requirements and symptom score were manifested to be significantly lower in the active group after six months than at the beginning of the study (P = 0.005, 0.017 respectively). Forcedexpiratory volume in the second one (FEV1) was, also, significantly higher in the active group after six months of the study (P = 0.032). IL5 was found to be significantly lower in the active group after six months (P = 0.019). However, no significant difference was observed in the levels of IL4 between the two groups (P = 0.152). The study revealed that aspirin desensitization can improve the quality of life of patients with AERD, lessen their symptoms and medication requirements, lower their levels of IL5, and improve some pulmonary function tests such as FEV1.

Ciprofloxacin (1-cyclopropyl-6-fluoro-1, 4-dihydro-4-oxo-7-(1- piperazinyl) - 3-quinoline carboxylic acid, cpfH) is a member of synthetic antibacterial agent widely used in clinical practice for the treatment of various gram negative and positive microorganisms. In concurrent use of ciprofloxacin with cations, they may bind together and result to formation complex by chelating. Formation of chelates ultimately reduces drug adsorption from the gastrointestinal tract. So, it is recommended a minimum of 2-hour interval between usage of ciprofloxacin and compounds containing cations. The aim of this study was to develop a novel amino-coated magnetic nanoparticle Fe 3 O 4 functionalized by ciprofloxacin (AF-Fe 3 O 4 -NP@cpf) to study the amount of cation which adsorbed on ciprofloxacin by Atomic Absorption Spectrophotometry (AAS). The synthesized AF-Fe 3 O 4 -NP@cpf was characterized using FT-IR, VSM and TEM. Separation of the adsorbed elements from reactive environment was fascinated with the aid of a magnet. The amount of residual metal in the solution was measured by AAS. Moreover our study investigated the effects of various conditions, such as pH, amount of nanoparticle and contact time of drug and metal in complex formation. The optimal condition of Cu(II) and Ni(II) absorbing was obtained.

Primary dysmenorrhea is a prevalent problem and its effects decrease the quality of life in many women across the world. Due to the side-effects of synthetic drugs, there is an increasing trend toward herbal medicine. The aim of this study was to research the effect of Teucrium Polium compared to placebo on the pain duration of Dysmenorrhea.
This triple-blind, randomized, clinical trial study was performed on 70 single female students between 20 and 30 years old educating in Shahid Beheshti University (Tehran, Iran) from October 2014 to February2014 .They were allocated randomly into two groups: In Teucrium Polium group (n =35) who took 250 mg of Teucrium Polium powder q6h for the first 3 days of menstruation for two cycles. The second group (pelacebo) (n=35) received 250 mg starch powder. The pain duration of Dysmenorrhea was determined by visual analog scale (VAS) and questionnaire related to the pain duration.
There were no differences between two groups for demographic or descriptive variables. Comprising the pain duration showed that the participants in Teucrium Polium groups had lower significant pain in the 1st and the 2nd months after the treatment (P Teucrium Polium can be effective in decreasing the pain duration in primary dysmenorrhea.

The purpose of this study was to evaluate the efficacy of oral selenium in alleviation of oral mucositis induced by radiotherapy in head and neck cancer patients.
In a randomized double blind pilot study, 35 patients under radiotherapy, due to primary tumors localized in the head or neck, who had at least two oral sites were studied. They were randomly divided into the treatment group (oral selenium 400 mcg/day) and placebo group. The intervention started one day before radiotherapy and continued for three weeks after the end of the treatment. Mucosal evaluation was done every week during the course of radiotherapy. NCI-CTC (version 2) grading system and Epstein scoring system were used for the assessment of mucositis. Oral cavity was divided into the 14 anatomical sites and relevant sites were examined weekly. Based on the degree of mucositis, each site was scored using 4-point scale and then mean mucositis score was calculated.
In whole, 35 patients were enrolled into the study. Mean score of mucosistis in selenium group was less than placebo group in the first, second and third weeks (respectively, 0.51 ± 0.28, 1.35 ±0.55 and 1.75 ±0.34 in the selenium group and 1.21 ±0.81, 1.79 ± 0.43, 2.08 ± 0.46 in the placebo group). Repeated measure ANOVA analysis revealed significant increase in mucositis (p=0.019) in the placebo group compared to the selenium group.
Results of this study support the hypothesis that oral selenium can be considered as an effective and well-tolerated medication for the prevention of radiation induced oral mucositis.

Dopaminergic signaling is one of the regulatory pathways being investigated for its implication in glucose metabolism. The aim of this study was to determine the effect of cabergoline on biochemical and anthropometric parameters in prediabetes stage (impaired fasting glucose and impaired glucose tolerance). In this double blind, placebo-controlled, pilot study, 27 prediabetic adults were randomized to receive 0.25-mg cabergoline twice weekly for two weeks, followed by 0.5 mg twice weekly for next 14 weeks (n = 13) or placebo (n = 14). All subjects were advised to follow a 500 kcal-deficit energy diet. Fasting plasma glucose (FPG), oral glucose tolerance, glycated hemoglobin (A1c), fasting, and 2-h insulin were measured at baseline and at 16-week follow-up. Homeostasis model assessment (HOMA) 2 was calculated to estimate steady-state beta-cell function, insulin sensitivity, and insulin resistance. Our results showed significant reductions in fasting (P = 0.004) and 2-h plasma glucose (P = 0.01) after treatment, and significant improvements in beta-cell function (P = 0.03) and insulin resistance (P = 0.04) in the cabergoline group. The trend of non-significant A1c changes was decreasing in the cabergoline group versus an increasing trend in the placebo group. All anthropometric parameters were similar between the two groups. Our results revealed that twice-weekly cabergoline could improve glucose metabolism in prediabetes stage. Larger studies of longer duration are warranted to investigate the effect of cabergoline in preventing progression of prediabetes to type 2 diabetes mellitus.

Previous studies have reported the efficacy of baclofen in the treatment of Gastroesophageal Reflux Diseases (GERD). The objective of present study is to evaluate the effect of co-administration of omeprazole 20 mg/d plus sustained Release baclofen (SR baclofen) vs omeprazole 20 mg/d plus placebo on alleviation of symptoms in patients with a diagnosis of GERD. A prospective, double blind, placebo controlled trial included 50 patients with diagnosis of GERD have been done. Patients were randomly selected to receive either SR baclofen or a placebo in addition to omeprazole 20 mg/d for a period of 2 weeks. Patients were questioned regarding heartburn, regurgitation, chest pain and hoarseness at the base line and after 2 weeks. All patients tolerated the medications and no patients failed to complete the study due to adverse drug reactions. A total of 53 patients completed the study, 25 in SR baclofen and 28 in placebo group. After 2 weeks, 1 patient (4%) in SR baclofen group reported heartburn and regurgitation. However 13(46.4%) and 15 (53.6%) of patients in the placebo group had heartburn and regurgitation respectively. The analysis of the data shows that there is a significant difference between the two groups in heartburn and regurgitation (p < 0.0001, p < 0.0001 respectively). Statistical analysis revealed a significant difference in two groups regarding total GERD score (p <0.0001). The results of the present study suggest that a combination of SR baclofen and omeprazole may be a more effective treatment for heartburn and regurgitation than omeprazole alone

Judicious use of antibiotics is essential considering the growth of antimi-crobial resistance and escalating costs in health care. Ceftriaxone is a third-generation cephalosporin used widely for the treatment of various infections in outpatient and in-patient. The purpose of this study was to evaluate the ceftriaxone utilization before and after implementation of guidelines and physicians education. A descriptive cross-sectional، before-after intervention study was performed in 6 wards of a teaching hospital in Tehran، Iran. The study was conducted in three phases: pre-guideline، educational interventions and post guideline implementation. The pre intervention phase included chart analysis of current ceftriaxone use in 200 consecutive patients from the representative wards included in the study. The educational interventions included preparation and distribution of ceftriaxone guidelines as pamphlets among physicians working in the studied wards. Also the clinical pharmacist returned to each ward and trained physicians regarding the correct use of ceftriaxone. In the post intervention phase immediately after the instruction، and in the follow up phase، one month later، a prospective analysis of ceftriaxone utilization was performed by chart review of 200 patients to detect changes in ceftriaxone utilization pattern. Four hundred cases were evaluated during study (200 before and 200 after physician’s education). The correct indication of ceftriaxone was 93% and 96% before and after the educational interventions respectively. Analysis showed that correct indi-cation of ceftriaxone did not change significantly before and after education (P= 0. 188). Regarding to proper administration (dose، interval and duration) ceftriaxone utilization significantly changed after education (P< 0. 001). Adoption of the guidelines with associated training resulted in significant improvement in ceftriaxone administration pattern in the hospitals.

Pulmonary hypertension (PH) is an important cause of heart failure in chronic obstructive pulmonary disease (COPD). The pro brain natriuretic peptide N-terminal (NT-proBNP) has been suggested as a noninvasive marker to evaluate ventricular function. However, there is no evidence to support the use of NT-proBNP in monitoring the benefits of vasodilators in COPD induced PH. Thus, we used NT-proBNP as a biomarker to evaluate the effect of oral vasodilators on cardiac function in COPD-induced PH.Forty clinically-stable PH patients were enrolled with history of COPD, normal left ventricular ejection-fraction (LVEF), right ventricular systolic pressure (RVSP) > 45 mmHg and baseline blood NT-proBNP levels >100 pg/ml. Patients were randomized into two groups, one group received sildenafil and second group were given amlodipine for two weeks. NT-proBNP and systolic pulmonary arterial pressure (systolic PA-pressure) were measured at the beginning and the end of study.NT-proBNP levels in the first group was 1297±912 pg/ml before therapy and 554±5 pg/ml after two weeks drug therapy, respectively. Similarly, in second group NT-proBNP level was 1657±989pg/ml and 646±5 pg/ml before and after treatment. Amlodipine or sildenafil significantly reduced NT-proBNP levels in COPD-induced PH patients (p<0.05).Our study shows that amlodipine and sildenafil have a similar effect on NT-proBNP levels. In both groups NT-proBNP levels were significantly reduced after treatment. Therefore, our findings support the potential benefits of treatment with vasodilators in COPD induced PH.

Zinc deficiency has been reported frequently in hepatitis C patients in the literature. Furthermore, a decrease in zinc level has been shown in beta thalassemia major as well. Iranians consume a large amount of phytate in their regimens which can bind with zinc and decrease its gastrointestinal absorption.. This study was designed to determine plasma zinc level in an Iranian sample with the diagnosis of hepatitis C with or without concomitant beta thalassemia major..Patients and Between April 2011 and April 2012, plasma zinc level was determined via atomic absorption method, in 130 hepatitis C patients with or without beta thalassemia major in a known referral center of hepatic diseases in Tehran, Iran.. Mean ± standard deviation (SD) of plasma zinc levels was determined as 0.78 ± 0.22 mg/L. Also zinc level was 0.76 ± 0.19 mg/L and 0.80 ± 0.24 mg/L in thalassemic and non thalassemic patients, respectively. T-test analysis showed that there is no significant difference between these two groups regarding plasma zinc level (P = 0.235).. It is concluded that zinc level of studied patients is less than which is reported in normal Iranian population. Moreover, there is not a significant difference in plasma zinc levels between thalassemic and non thalassemic patients and it seems to be a common problem in both ones. Addition of zinc supplement may be recommended in both groups in order to optimize the nutritional support and probably improve the treatment response..