No Abstract

Background: the Employees’ motivation is a very important part of management, both practically and theoretically. Motivation has been regarded as an indispensable part of performance, and structural element for management practice theories. The most important factor of the health care system is its workforce. They possess the highest impact on the input of health care system. Also they are one of the main determinant key of their efficacy and performance is their motivation. Although Motivated and qualified staff is the critical element for health care system performance, it is one of the hardest goal to reach due to health care complexity.
Method: the Sample consisted of 326 men and women pharmacists and pharmacy staff, which are 155 women and 81 men. Wright (2004) work motivation 6-item scale were used to asses pharmacists and pharmacy staff work motivation. Data were analyzed by One-way ANOVA test method.
Results: the results indicated that there is no significant difference in pharmacists and pharmacy staff work motivation according to their gender, education, job, job location and income.
Conclusion: income, Location of job, Job, education might be considered as the hygiene factors. Other intrinsic or socio-cultural factor might be motivators for pharmacists and pharmacy staff.

Introduction: Gastrointestinal tract cancers are the most common cancers in Iran with a growing incidence in the past two decades, especially in the Northern provinces of the country. Different chemotherapy regimens have been used in the treatment of colorectal cancers (CRC). Considering lack of data, this study aimed to determine the adverse drug reactions (ADRs) of chemotherapy regimens used in treatment of patients with CRC.
Material and methods:This cross-sectional prospective study was carried out in Emam Khomeini Hospital and Tooba Clinic, both affiliated to Mazandaran University of Medical Sciences. ADRsof chemotherapy regimens including nausea, vomiting, fever and neutropenia, diarrhea, oral mucositis, neuropathy and hair loss were documented based on CTCAE Version 4.0 (Common Terminology Criteria for Adverse Events).
Results:Two hundred sixty seven different courses of chemotherapy regimens received by 48 patients were evaluated in terms of adverse events. Three more common chemotherapy regimens wereFOLFOX (Folinic acid, Fluorouracil, Oxaliplatin), FOLFIRI (Folinic acid, Fluorouracil, Irinotecan) and XELOX (Capecitabine, Oxaliplatin).FOLFIRI and FOLFOX regimens were associated with more nausea and vomiting compared to XELOX. The rate of vomiting was marginally different between regimens (P=0.06). Most of nausea and all vomiting were as grade 1 or 2. The diarrhea was more common with FOLFOX (P=0.027). Whereas 14% of patients received FOLFIRI experienced neutropenia, none of patients in XELOX and almost 5% of FOLFOX patients experienced neutropenia. Mucositis happened in 16.1 and 17.8% of patients received FOLFOX and XELOX, respectively. The rate of neuropathy was different among regimens, as XELOX and FOLFOX were associated with more neuropathy compared with FOLFIRI (P=0.019). The rate of hair loss and headache were not different between three regimens.Most of the side effects (e.g., nausea, neuropathy, and headache) were acute. Vomiting and mucositis with XELOX occurred after 24 hours of initiation of chemotherapy.
Conclusion:The results of our study showed that the GI adverse events including nausea, vomiting and severe diarrhea were more common with FOLFIRI regimen. Mucositis and neuropathy were more common with XELOX. Hair loss was more common with FOLFIRI followed by XELOX and FOLFOX. 

Background:  Hepatic dysfunction in patients who have undergone allogeneic haematopoietic stem cell transplantation (HSCT) is a major cause of morbidity and mortality. The aim of this study is to evaluate the incidence of post-transplantation hepatic complications in these patients.
Methods: A total of 121 patients (age above 15 with no abnormality in their hepatic tests) participated in the study. The influence of a variety of risk factors on the incidence, type, and pattern of hepatic dysfunction as well as the length of hospital stay related to these complications were studied.
Results:  As a whole, 76 patients (62%)—44 males and 32 females—were diagnosed with hepatic dysfunction after transplantation. As many as 31(25%) of the patients showed increased measures in their hepatic enzyme, while 45(37%) of them ended up with both abnormal enzyme measure and clinical symptoms including diarrhoea, skin rash, jaundice, and anorexia. The hepatic dysfunction rates owing to drug toxicity and GVHD (21.5% and 16.5%, respectively) proved to be the highest in our study. Analysing risk factors, the immunosuppressive regimen could affect the type of hepatic dysfunction—i.e., less patients with GVHD were found in the group who received ATG in their regimen (p-value =0.034).
Conclusion: According to these findings, the immunosuppressive regimen can play a role in preventing the incidence of GVHD. Less occurrence of hepatic complications, especially GVHD, may lead to less clinical symptoms and time of hospital stay.

Background: This study sought to investigate the evaluation of academic achievement, academic motivation and hope for the future and life satisfaction of Pharmacy Students of the Medical Sciences University of Ahvaz and their relationship with the school years passed.
Methods: The samples in this study were all pharmacy students studying in the College of Pharmacy, the Medical University of Ahvaz in the year 93-94. Moreover, standard questionnaires were used by this study for collecting data. In order to collect data with regard to hope, life satisfaction, motivation and academic satisfaction, the questionnaire of Snyder hope Scale (1991), Satisfaction with Life Scale questionnaire (SWLS), lepper motivation scale (2005) and Bahrani and Jokar questionnaire (1378) were used respectively.Moreover, data on Academic performance were acquired using the score of the students and the number of students dropping out in each entry and the data were analysed by using SPSS 20.
Results: The results did not indicate any significant different in an investigation of five class of students and from four variables of hope, Academic motivation, academic achievement, life satisfaction. But contrast test for combined group showed that academic motivation and academic performance in freshmen students are significantly higher than the other four inputs.Third-year students possess less Academic motivation than other students.Senior students' Academic performance was also significantly lower than of students from other school years.
Conclusion: freshmen students face challenges of the new environment, and this affects their academic performance. Besides in the third year of pharmacy school curriculum, pharmacy students pass the basic exam and the main pharmaceutical courses start for them, this might be the reason that their intrinsic motivation increase. 

Background: Invasive fungal infection is one of the most important causes of morbidity and mortality in pediatric patients undergoing Hematopoietic stem cell transplantation (HSCT). Voriconazole as a broad-spectrum anti-fungal agent which has been used widely for prevention and treatment of invasive fungal infections in immunocompromised patients. Alteration in voriconazole plasma concentrations may be resulted in lack of efficacy and some adverse effects.
Methods: This observational cohort study assessed the therapeutic plasma concentration of voriconazole and its relationship with hepatotoxic adverse effect in pediatric patients undergoing HSCT. Plasma concentration of voriconazole was measured by High-performance liquid chromatography (HPLC) assay with technique extracted from Khoschsorur et al.
Results: Among a total of 14 pediatric patients,5 patients received voriconazole orally and 9 patients received voriconazole intravenously. The median plasma concentration of voriconazole was 1.8 mcg/ml (range, 0.75-5.54 mcg/ml). There was no correlation between voriconazole dose and plasma concentration of voriconazole(p=0.166). Trough concentration of ≥ 4 mcg/ml was observed in 2 of 3 patients who experienced severe hepatic dysfunction. The plasma concentration of voriconazole did not significantly differ in patients with or without hepatotoxicity(p=0.406).
Conclusions: Our study showed that trough levels of voriconazole were sub-therapeutic in 21.4% of children. Furthermore, hepatic enzyme abnormalities were observed in half of pediatric patients following voriconazole initiation during hospitalization. We didn’t find any correlation between plasma concentration of voriconazole and the incidence of hepatotoxicity. We also didn’t observe any correlation between voriconazole dose and plasma concentration of voriconazole, but the correlation was linear after exclusion of outlier data.

Studies from different regions of the world show that vitamin D deficiency is a common problem across the globe, even in military personnel. Risk factors of this deficiency includes elderly and female population, higher geographical latitudes, winter season, darker skins, low sunlight exposure, diet, and lack of vitamin D supplementation /fortification, although the deficiency in areas with higher sun exposure also has been documented. 
We reviewed some of the clinical trials and observations regarding vitamin D deficiency and supplementation. It has been shown that vitamin D deficiency is associated with more acute respiratory tract infections and acute pharyngitis resulting in more days off from training, more bone stress fractures, poor physical performance, and increased risk for suicide.
Clinical trials that utilized supplemental vitamin D shows decreased incidence of stress fractures in female navy recruits, lower incidence of influenza A and lower risk of acute respiratory tract infections, and improved bone density during initial military training, although one systematic review found conflicting data in supplementation with vitamin D for the prevention of acute respiratory infection.
These data opens a window for supplementation with vitamin D in populated military bases to decrease rate of respiratory infection and to minimize stress fractures for better performances; doses used for these purposes ranges from 300 to 1200 IU per day. Further clinical trials of vitamin D supplementation or dietary fortification for these military purposes should be conducted to determine the optimum dose and duration.

Background: Medication discrepancies occur at the time of medicine prescription in inpatient and outpatient settings, especially at patient transfer and discharge. Pharmacists can prevent these medication errors by reconciliation of the patients’ medications. In this study, medication discrepancies of the only hospital of a small town are assessed by a pharmacist.
Methods: A medication reconciliation form was designed to fully record all patients’ drug history and current therapies. All admitted patients during a six month interval were evaluated by a pharmacist and their medical records were compared to the detailed data form.
Results: 150 admitted patients were evaluated in this study from September 2015 to February 2016. 51% of the patients were male and 49% female. 56% of the patients had medication discrepancies when discharged. Interestingly none of the patients had documented drug history in their medical records.
Conclusion: More than half of the patients developed a medication discrepancy at the time of discharge. We think that a drug review of the patients at the time of admission and discharge and establishing medication reconciliation processes may be helpful in improvement of health care.

Background: Antibiotic-resistant pathogens are problem in many geographic areas. The selection of appropriate antibiotics to treat Gram-negative bacteremia may be life-saving. The aim of this study was to evaluate the incidence of decreased antibiotic susceptibility among aerobic gram-negative bacilli isolated from hospitalized patients of Bandar Abbas general hospital.
Methods: Consecutive specimens collected on clinical indications from hospitalized patients were cultured. The minimum inhibitory concentrations (MICs) of antimicrobial agents were determined by the agar dilution method according to the National Committee for Clinical Laboratory Standards (NCCLS) guidelines.
Results: In this study 494 positive samples during one year were evaluated. The most common site of isolation was urinary system. The most frequently isolated organisms were E.coli (%47.3), Kelebsiella pneumonia (%19.9) and Pseudomonas aeruginosa (%16.2). Resistance to ceftriaxone, ceftazidime and cefepime was more than %50. MIC results revealed that E.coli was sensitive to amikacin, ciprofloxacin and meropenem more than %75; whereas sensitivity to ceftriaxone, ceftazidime and cefepime wasless than %30. Klebsiella showed sensitivity to amikacin %77.1; however sensitivity to ceftriaxone, ceftazidime and cefepime less than %25. In addition, sensitivity of Pseudomonas aeruginosa to amikacin, ciprofloxacin and imipenem was more than %65; while sensitivity to ceftriaxone, ceftazidime and cefepime was %25 or less.
Conclusions: The high incidence of reduced antibiotic susceptibility among gramnegative bacteria in this hospital suggests that more effective strategies are needed to control the selection and spread of resistant organisms.

Cosmetic side effects are among important causes for non-compliance in patients on anti-epileptics. Telogen effluvium (TE) is one of the most encountered cosmetic adverse effects. This report presents three patients with seizure disorder who developed levetiracetam- induced TE. Levetiracetam was considered to be a proper option for the treatment of the presented cases and therefore was not changed to other anti-epileptics. To manage TE, it was decided to add zinc sulfate to the therapeutic levetiracetam regimen. All three patients reported improvement in their hair condition as well as in controlling their seizure. Levetiracetam has favorable safety and efficacy profiles. However; the hair loss caused by this medication is a major drawback. Zinc sulfate was decided to be added to the therapeutic levetiracetam regimen in order to manage TE. All three patients reported improvement in their hair condition. Zinc supplementation is suggested to be safe and cost effective when considering management of levetiracetam-induced TE.

Prolongation of the QT interval is a recognized adverse effect of fluoroquinolone antibiotics. This effect on ventricular repolarization can potentially lead to life-threatening arrhythmias such as Torsade de pointes. Torsade de pointes is a polymorphic form of ventricular tachycardia identified by twisting of the QRS axis around an isoelectric point. We report a case of torsade de pointes induced by ciprofloxacin treatment. The patient experienced an acquired QT interval prolongation followed by Torsade de pointes arrhythmia with ciprofloxacin administration for ileostomy closure surgery and unfortunately expired.