No Abstract

Backgrounds: New- onset diabetes after transplantation (NODAT) is a serious complication which runs the risk of infections, morbidity and mortality. Older age, male sex, immunosuppressive agents and hepatitis C are reported as risk factors. The focus of this research is evaluating some demographic and clinical factors in development of NODAT in hepatic transplanted patients. This study aims to help identifying high risk recipients in order to prevent NODAT and improve transplantation prognosis.
Methods: In this study 134 liver recipients without pre- transplantation diabetes were investigated; 70 euglycemic and 64 with NODAT within 2 years after transplantation. All the patients were on tacrolimus- based immunosuppressive regimen. The role of recipients’ age, sex, body mass index (BMI), model for end- stage liver disease (MELD) score, blood group, diseases leading to transplantation, tacrolimus dose and serum level, mycophenolate mofetil (MMF) and prednisolone dose in the incidence of NODAT were assessed.
Results: The prevalence of NODAT in this study was 17.92%. The means of duration after transplantation that NODAT occurred, was 98.36± 21.62 days. The mean age of all patients was 37.83±16.26 years and 60.40% were females. Two groups were similar in terms of pre- transplantation fasting blood sugar (FBS) (P=0.091). Age (P=0.001,OR=1.063,CI:1.025-1.102) and prednisolone dose (P<0.0001,OR=1.270,CI:1.163-1.388) the only independent predictors of NODAT, while tacrolimus daily dose and plasma level, MMF daily dose, sex, BMI and underlying diseases were not risk factors for NODAT.
Conclusions: Recipients with older age and higher prednisolone dose are more prone to NODAT and need more accurate monitoring.

Background: Tuberculosis (TB) still remains a major health concern both in developing and developed countries. The rate of the liver injury due to anti-TB drugs in developed countries has been reported up to 4%. The goal of this study is to assess the rate and risk factors for anti-tuberculosis drug-induced liver injury (DILI). Also, a model has been designed to predict DILI in patients with pulmonary tuberculosis.
Methods: We conducted an observational study. The investigation was carried out in the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran. Anti-tuberculosis drug treatment course and patients’ demographic data, medical and drug history, and social habits were extracted from their medical records. DILI was defined as an increase in serum alanine aminotransfrase (ALT) or aspartate aminotransfrase (AST) greater than three times of the upper limit of normal (ULN), with symptoms of liver injury, or five times of the ULN without symptoms.
Results: In this study, 87 patients (33 male, 54 female, mean age 54.29±21.79 years) with tuberculosis diagnosis were followed. Anti-tuberculosis induced liver injury was detected in 14 (16.1%) patients. Concomitant use of hepatotoxic drugs (Isoniazid, Rifampin and Pyrazinamide) and the abnormal baseline serum liver enzyme levels before the initiation of therapy were found as risk factors for anti-tuberculosis induced liver injury.
Conclusion: Anti-tuberculosis induced liver injury is a major problem in tuberculosis patients which lead to treatment interruption in 14 (16.1%) patients. Due to the lack of evidence regarding the mechanism of this side effect, we recommend to monitor anti-tuberculosis drug levels in order to study their probable correlations with DILI.

Background: The most common types of medical error are medication errors (MEs) which defined as any preventable event that may be caused by an inappropriate medication usage and lead to an adverse drug reaction (ADR) event in patients. In recent years, different approaches have been proposed to reduce MEs, one of which is reporting ADRs. The present study was designed to assess the Knowledge, Attitude and Practice (KAP) of medicine students towards MEs and ADRs reporting.
Method: The validated 12-item questionnaire included subsequently 4 questions, 5 items and the final 3 questions related to the knowledge, attitude, and practice that was given to each participant before and after of the clerkship course. The study population were 40 students of fourth-year of medicine.
Results: Demographic features of the participants have no significant difference. Medicine students had a poor KAP towards MEs. Only 8% of respondents had general knowledge about MEs and 50% of students believed MEs are inevitable events, less than 20% of them were acquainted with 5 rules of prescriptions. Students had good knowledge and attitude but poor practice towards ADRs reporting. 55% of participants were aware of their responsibility of ADRs reporting but only 5% of respondents were acquainted with ADRs reporting method and the ADR center in the hospitals.
Conclusion: The educational intervention, alteration in medicine student’s curriculum, and hold the interactive clerkship for health care professionals can improve the KAP towards ADRs reporting and diminish of the preventable medication errors.

Background: Drug utilization evaluation (DUE) is an effective process in order to identifying variability in drug use and subsequent application of effective interventions for improving  patient outcomes. In this study, appropriate uses of drugs were evaluated by pharmacy service.
Methods: A prospective, interventional study was designed for determining frequency and type of clinical pharmacists’ interventions and medication errors occurred in the infectious disease ward of Loghman hospital, affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran during 8 months.
Results: During the 8 months of the study period, 498 errors were detected among 419 patients that admitted to infectious disease ward of Loghman hospital. Most common errors were related to DVT prophylaxis, SUP and vancomycin monitoring.
Conclusion: Our result showed that clinical pharmacy interventions can have an important role in reducing adverse drug events and their activities can be effective for reducing of medication error.

Background: Venous thromboembolism (VTE) is a major cause of mortality among cancer patients. The aim of this study was to evaluate drug regimens used for the prophylaxis of thromboembolic events in cancer patients.
Methods: A retrospective study was conducted using medical records of patients hospitalized from March 2012 to March 2014 at Cancer Division of A tertiary university-affiliated hospital in North of Iran. The risk factors of patients regarding need of venous thromboembolic (VTE) prophylaxis were recognized and dosage and duration of thromboembolic prophylactic agents were evaluated according to the National Comprehensive Cancer Network (NCCN) 2012 guidelines. Statistical analysis was performed using SPSS v.23.
Results: Of a total of 1160 medical records, VTE prophylaxis regimens of 186 patients were evaluated. In 18(13.1%) and 15(10.9%) of patients, administrations were compatible with NCCN guidelines with respect to the "type of drug" and "dosage", respectively. Only in 7(5.1%) of patients administrations were compatible with respect to the "duration of thromboembolic prophylaxis regimen". Forty patients (21.7%) had relative contraindication for thromboembolic prophylaxis and 7(3.8%) patients had absolute contraindication. In 32(80%) of 40 patients with relative contraindications and only in 1(14.3%) of 7 patients with absolute contraindications, physicians’ orders were compatible with NCCN guidelines.
Conclusion: The rate of concordance of the VTE prophylaxis with recommendations provided by NCCN is very poor. This study emphasizes need of a multidisciplinary action to improve the VTE prophylaxis in cancer patients. 

Today, due to ever-increasing knowledge and large volumes of information, educational planners of various fields around the world, have been seeking to establish a better and faster refresh for learning. Integration can be a good educational strategy by blending different subjects and contents when presented to students. The aim of this study is to evaluate the medical literature about integration in the curriculum; its process, importance, necessity and different types of it.
This review article was prepared by searching the PubMed database, Google Scholar and science direct websites, national and international journals in the field of medical education curricula. The keywords were educational planning, curriculum integration, and medical education with integration and incorporation.
Integration and its eleven steps can be an important strategy in educational planning. According to various studies, integration can enhance the students’ learning and skills in medicinal and pharmaceutical care. It also improves the satisfaction of faculty and students, the quality of education and increases the students’ grades at their examinations. Considering the proper planning, cooperation and co-teaching of faculty members, focus on the desired performance of students and correct assessment of the fundamental principles of integration are crucial to this strategy.

Background: Attendance management is one of the most important issues in the educational institutions. The traditional method for attendance recording is manually recording by professors in the school or university which is associated with several problems. We proposed the design and utilization of an electronic application for students’ attendance recording via smartphones and PCs.
Methods: This study was a cross-sectional and Quasi-experimental study, which held in the department of clinical pharmacy in the school of pharmacy in Ahvaz Jundishapur University of medical sciences. Group I was assigned to the manually recording of student attendance. Group II was assigned to the design and utilization of an electronic application for registration of attendance. Each of the professors records the students’ attendance in the class by smartphones. Finally, the satisfaction of the professors about the application was assessed with the 6-item questionnaire. Also, the efficacy of the application was evaluated through the comparison of the number of recorded attendance and the number of absent recorded in group I and II.
Results: The results of satisfaction survey illustrated that all of the professors found the electronic recording of the attendance was the more useful than the traditional method and lead to the reducing the possibility of errors, the time spent, and the pleasure of students. Also, the comparison between the numbers of students’ recorded attendance and numbers of absence recorded were higher by utilization of the application more than by the traditional method.
Conclusion: The students’ attendance recording application can improve performance compared to the manually attendance management system via decreasing the possibility errors and continuous assessing during a semester.

An 80-year-old man developed nightmares while using citalopram for mild depression. During the first two weeks of treatment with citalopram (10 mg daily), he didn’t experience any adverse reactions. After two weeks, he developed nightmaresand vivid dreams that were repeated every night and awakened him in midnight. Although the signs of depression were relatively disappeared, the patient was anxious during the day due to nightmares and nocturnal awakenings. We, as pharmacists, consulted his family to decrease the dose to 10 mg every other day, and tell his physician as soon as possible. He decreased the doses and after two weeks the frequencyof nightmares was less. More follow-up revealed that the nightmares were totally disappeared one month after drug withdrawal. A Naranjo assessment score of 7 was obtained, showing a probable relationship between theadverse reaction and suspected drug.

Gross hematuria or macroscopic hematuria is a high risk urologic condition that might occur in different settings. In the case of continued gross hematuria, blood clot size may grow and lead to complete obstruction of urinary outflow. Placement of three-way catheter, continuous bladder irrigation with normal saline, and cystoscopy are conventional treatments. Here we introduce a case with urinary obstruction who did not respond to conventional therapies. A subject of Hodgkin lymphoma with urinary obstruction caused by heavy gross hematuria was presented to emergency department. Three-way catheter was inserted to facilitate urination. However, there was no urinary drainage and bladder was distended. Consequently, 100 ml solution of hydrogen peroxide 0.15% was prepared and administered into the bladder to irrigate and evacuate the clots. A single intravesical infusion of hydrogen peroxide rapidly resolved urinary obstruction and improved patient distress. After administration of hydrogen peroxide solution, blood clots and bloody urine were evacuated successfully. These findings suggest that an intravesical injection of hydrogen peroxide can induce dissolution of blood clots and may be a simple and efficient therapy for urinary obstruction due to gross hematuria.