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Background: Crocin can be utilized as an anti-inflammatory component of Saffron in diabetic macular edema (DME), which is known as the most common cause of vision loss in patients with diabetes mellitus (DM). Although anti-vascular endothelial growth factor (VEGF) agents are common in non-center involving DME (NCI-DME), there is no consensus on NCI-DME treatment.
Methods: This before-after study was performed from October 2019 to August 2021. Twenty-six eyes of 16 patients with type 2 DM in Baghayipoor Clinic in Yazd, were treated with 15 mg crocin per day for 90 days. Patients had at least one eye with non-proliferative DR (NPDR) and NCI-DME along with no adherence to intravitreal injection or a contraindication of intravitreal injection. Central subfield thickness (CST), visual acuity, fasting blood sugar (FBS), and HbA1c were assessed once before and once after the study (day 90).
Results: After 90 days of therapy, the mean CST significantly decreased to 2.8 μm (P-value=0.030), four patients had increased CST and 1 patient had a significantly decreased CST (≥25μm). The mean Logarithmic Minimum angle of resolution increased during the study. The Mean (±SD) FBS showed a significant improvement during the study from 174.7 (±60.41) at baseline up to 161.8 (±47.7) at day 90 (P-value = 0.012). HbA1c had no significant reduction. Nausea/vomiting and insomnia were among the reported adverse effects. Nevertheless, no one withdrew from the study because of the adverse effects.
Conclusion: This study suggests Crocin’s positive impact on NCI-DME. It may also improve the glycemic profile of diabetic patients; however, more high-quality randomized clinical trials with larger sample sizes and longer durations are needed for validation.

Background: The high prevalence of chronic diseases such as diabetes mellitus, hypertension, and dyslipidemia is a concern for pharmacists. Pharmacists are expected to participate in these efforts by implementing Home Medication Review (HMR). HMR is a community-based collaborative service outside of health facilities that involves physicians and pharmacists to improve the effectiveness of therapy. This study aimed to determine the incidence of drug-related problems (DRPs), the level of patient satisfaction, and the effect of improving the quality of life of patients with chronic diseases who received Home Medication Review services at the Banjarbaru Utara Primary Health Care.    

Methods: This study used a quasi-experimental method with a single group pre-test and post-test design. Data were obtained prospectively, from January to May 2024. DRPs were measured by the Pharmaceutical Care Network Europe (PCNE) form. Patient satisfaction was measured using the five-dimensional service quality questionnaire. Quality of life was measured using the EQ-5D-5L questionnaire with the EQ-5D-5L Index and EQ Visual Analog Scale (VAS) parameters.  

Results: The study showed that DRPs in patients with chronic diseases before undergoing HMR were 92.50%. Patient satisfaction with HMR services reached 91.33%. Quality of life in chronic disease patients increased, based on the EQ-5D-5L Index, from 0.802 + 0.199 before to 0.854 + 0.189 after HMR (p-value 0.002), and based on the EQ VAS from 72.25 + 12.80 before to 78.12 + 14.19 after HMR (p-value 0.001).     

Conclusion: This study concludes that HMR services can identify DRPs, and improve satisfaction, knowledge, and quality of life of patients with chronic disease.

Background: During the COVID-19 pandemic, different drug protocols were used to treat and manage patients. Considering the diversity in these protocols and the high costs associated with the disease, we aimed to evaluate the costs and effects of the most common therapeutic protocols among critically ill COVID-19 patients.

Methods:  In this retrospective cross-sectional study,  a total of 235 critically ill COVID-19 patients  were randomly selected from those hospitalized in the Intensive Care Units of Alzahra Hospital, Isfahan, Iran, between July and December 2020. The study assessed demographic data, outcomes (mortality rate), severity of the disease (SOFA score), and average direct costs of each therapeutic regimen. Statistical analysis included Cox-Regression analysis and Kaplan-Meier survival curve.

Results: We identified 21 therapeutic protocols based on prescribed medications, with six protocols being the most commonly used. The protocol containing dexamethasone + methylprednisolone showed the highest survival probability (0.79) with a median length of hospital stay of 17 days. Cost evaluation revealed that the dexamethasone protocol had the lowest average cost per patient, while the dexamethasone + methylprednisolone + remdesivir protocol had the highest. Hoteling costs accounted for 45% of the total costs, followed by medication costs (25%).

Conclusion: The dexamethasone + methylprednisolone therapeutic regimen demonstrated the highest effectiveness in terms of survival probability and was also associated with the lowest average cost per patient.

Background: Diabetic Peripheral Neuropathy (DPN) is a common yet challenging complication of diabetes, particularly in managing neuropathic pain. Palmitoylethanolamide (PEA), a naturally occurring nutraceutical from the ALIAmides group, has demonstrated potential for pain modulation, inflammation reduction, and improving quality of life.

Method: A 9-month prospective observational study at PSG Hospital evaluated the impact of adding oral capsule PEA (708 mg in two divided doses) to standard therapy for DPN patients unresponsive to maximum tolerated dosages of Gabapentin, Pregabalin, amitriptyline, or duloxetine. The outcomes were the pain severity and quality of life. Pain was assessed using the Visual Analog Scale (VAS), sensitivity was evaluated via monofilament testing, and quality of life was measured using the American Chronic Pain Association (ACPA) Quality of Life Scale (QOLS).

Results: Sixty patients with DPN were treated with adjunctive PEA and monitored for 8 weeks. Pain scores decreased significantly (6.05±1.096 to 4.15±1.233 at 4 weeks and 3.57±1.155 at 8 weeks, p˂0.05). Sensitivity improved via monofilament testing (7.12±1.58 to 9.43±0.78). Quality of life scores rose from 7.67 to 9.41 at 4 weeks and 9.68 at 8 weeks, indicating notable benefits.

Conclusion: PEA proved effective as a supplemental treatment for nonresponsive DPN patients, yielding significant reductions in pain, enhanced sensitivity, and better quality of life. Importantly, no side effects were reported, affirming its tolerability and safety.

Aims: This study aims to calculate the total cost of educational services delivered by the School of Pharmacy at Isfahan University of Medical Sciences, focusing on the cost associated with training pharmacy students using time-driven activity-based costing (TDABC).

Methods: Data were collected through designed forms, interviews, and direct observations. Financial, budgetary, and educational experts ensured compliance with administrative guidelines. A cost accounting system via TDABC was designed and implemented to allocate costs accurately.

Results:  In 2019, the Faculty of Pharmacy at Isfahan University of Medical Sciences allocated an average of 2 billion and 50 million and 29 thousand rials per pharmacy student for educational and research purposes. This figure increased to 2 billion and 997 million and 845 thousand rials in 2020 and slightly decreased to 2 billion and 730 million and 260 thousand rials in 2021.

Conclusion: "This study delves into a crucial issue of accurately estimating the cost of pharmacy education at the School of Pharmacy, Isfahan University of Medical Sciences. The research emphasizes the optimal utilization of resources, which can be achieved through data analysis and the adjustment of certain costs.

Isotretinoin is a potent retinoid drug that is primarily used for the treatment of severe acne. Because of this the drug has attracted attention and has the potential for abuse and misuse. This review manuscript aims to explore the dimensions of isotretinoin abuse in South Africa. Discussed herein are the epidemiological trends, underlying motivations and associated health risks of Isotretinoin.
The sociocultural and economic factors that contribute to this abuse is explored. Furthermore, Isotretinoin is rather perceived as a cosmetic enhancement tool, while it has controlled its accessibility. Hence, the regulatory framework that governs the access to controlled substances such as isotretinoin in South Africa is analysed and the gaps and enforcement challenges that allow for the misuse are explored.
Isotretinoin remains an valuable drug in the management of severe acne. However, its potential for abuse in South Africa requires a comprehensive approach involving healthcare professionals, policymakers, and the public to ensure safe and appropriate use through implementing innovative rational medicine use (RMU) interventions that aim to protect public health while ensuring access for those with sincere need.