No Abstract

Background: Sleep disturbance is a common complaint in major depressive disorder (MDD) including impairment of both subjective and objective parameters, additionally selective serotonin reuptake inhibitors (SSRIs) that are among highly consumed antidepressant, affect sleep architecture (SA) as well. This randomized trial was designed to compare the effects of trazodone with melatonin on sleep quality (SQ) of patients with MDD who were started on sertraline per their psychiatrists’ orders. The diagnosis of MDD based on Diagnostic and Statistical Manual for Mental Disorders –5th edition (DSM-5) criteria.
Methods: Patients with MDD who complied with the study criteria entered this trial. Subjects were randomized into two groups receiving and started on either trazodone or melatonin concurrent with sertraline. They were evaluated for sleep quality and depression severity by using Pittsburgh Sleep Quality Index (PSQI) and Hamilton Depression Ratin Scale (HAM-D) respectively, at baseline and after weeks 4 and 8. 
Results: 246 patients were screened out of whom sixty met the criteria of the trial. 32 patients completed the study. Fourteen patients received melatonin and eighteen patients received trazodone before sleep time. After 4 and after 8 weeks treatment with melatonin or trazodone, significant improvements in SQ were shown in both groups (p<0.001). Additionally, a significant reduction in sleep latency (SL) was shown after 4 weeks of treatment with melatonin but not with trazodone.
Conclusions: This study demonstrated that both melatonin and trazodone would improve SQ in outpatients with MDD after 8 weeks of treatment with sertraline. However, melatonin created greater reduction in SL than trazodone did after the first 4 weeks of use.

Background: Following the changes in the basic concepts of pharmaceutical science, the main opinion in pharmacy practice changed from “drug-oriented pharmacy” to “patient-oriented pharmacy”, leading to changes in the pharmacy education in many aspects.
Methods: In the presented study, we compare Iran’s Pharm.D education system and the four of high ranking systems available in the world in term of pharmaceutical care related educations and how much is the portion of this type educations in the curriculum. The University of California, San Francisco (UCSF) with a rank of 2, The University of Michigan with a rank of 7, and the Universities of Pittsburgh and Purdue with ranks of almost under 50 in the world ranking have been selected.
Results: The results showed, in the United States (US) colleges about 60.5% of educational program was related to the pharmaceutical care concept. This calculation for the University of Waterloo was about 74%. The Saudi University compared, had about 47% related units. Regarding the Iranian program, when the specialized units after basic science were considered as the professional course, about 24% of them had a relationship with the pharmaceutical care. However, this was in the case that a student chooses the hospital internship instead of industry internship in the final year; otherwise, the percentage would reduce to 22.7%.
Conclusion: Based on the results of this study, and regarding internationally accepted standards, we strongly recommend to change the structure of pharmacy curriculum in Iran to improve the ability of students for patient-oriented services.

Background: This study aims to determine the prevalence of early (less than 4 days of hospitalization) –and late-onset (more than 4 days after hospitalization) ventilator-associated pneumonia in the intensive care units of Al-Zahra center in Isfahan.
Methods: Through a prospective study, 100 patients with ventilator-associated pneumonia who were hospitalized in the intensive care units of Al-Zahra hospital during 2015 were investigated, and early and late onset pneumonia were determined. Moreover, the etiology of bacterial strains and other clinical and demographic characteristics were compared in two groups.
Results: The patients, 23 and 77 suffered from late –and early-onset pneumonia, respectively. The mean score of pneumonia in the two groups (early –and late-onset pneumonia) was 7.3± 2.1 and 7.2±1.6, respectively, which showed no significant difference (P: 0.8). The most common types of bacteria that caused pneumonia were methicillin-resistant Staphylococcus aureus (MRSA) (43% of frequency) and Acinetobacter Baumannii (34% of frequency) in early –and late-onset pneumonia, respectively. However, the frequency distribution of the type of bacteria by the type of pneumonia was not significantly different (P:0.1).
Conclusion: A significant percentage of pneumonia in intensive care units are of early-onset type, which can lead to patients’ prolonged hospitalization in intensive care units and it may be lead to increased mortality rate among them. Therefore, it is recommended that the patients hospitalized in intensive care units should be carefully examined in terms of the occurrence of pneumonia symptoms.

Background: Human intravenous immunoglobulin (IVIG) has been used widely for different indications that only a few of them is now approved by the Food and Drug Administration (FDA) as primary immunodeficiency, idiopathic thrombocytopenic purpura (ITP). Although it has been approved for selected indications, the list of its clinical indications, particularly off-labels, has grown considerably. Unfortunately, many of these conditions, lack sufficient clinical data of efficacy and might not always be appropriate.
Method: It was a cross sectional study performed in Amir-al-momenin teaching hospital affiliated to Zabol University of medical sciences. All hospitalized patients who received IVIG during a 6 month period (autumn and winter 2015) were included in this study. We used predesigned data collection forms for data gathering as patient’s demographics, diagnoses, as well as drug related data, such as dose regimen, duration, rate of infusion, any related lab test.
Results: In this study total of 49 patients received IVIG. Only in 25 cases, the mentioned indications were FDA approved (51%).Total of 189 IVIG vials (945 grams) that cost 146,475,000 Tomans (39481 USD) was administered during this study period, of which 560 grams (112vials) (59.2%) were used for FDA approved indications. From 19 ITP patients only 6 (12.2%) fulfilled the criteria for IVIG therapy. Considering cases of wrong doses and whom were not indicated to receive IVIG therapy, total of (93 vials) 465 grams, that cost 72,075,000 Tomans (19427 USD) were spent irrationally.
Conclusion: We concluded that IVIG was widely used irrationally in our institution and cost of this irrational administration is huge. This fact justifies the need for establishing multidisciplinary supervisory procedure in our hospital.

Background: In previous studies, extract of 3 herbs, celery, fenugreek and saffron was effective on primary dysmenorrhea. However, the health effects of saffron alone on primary dysmenorrhea have not been yet studied. The aim of this double blind, single center clinical trial is to examine the effects of saffron on primary dysmenorrhea pain in women aged 18-27 years old.
Methods: One hundred eighty patients were randomly divided into three groups. Group 1 received saffron capsules three times per day for three days of menstrual period for three consecutive menstrual cycles. Group 2 received mefenamic acid, and group 3 has received identical placebo. Visual Analogue Scale (VAS) has been recorded at baseline and after each menstrual period.
Results: In saffron group VAS was reduced from 6.8 to 3.6, 3.4, and 3 in 3 consecutive months. This effect was significantly greater than mefenamic acid and placebo (P:0.0001).
Conclusions: It was found that the effect of saffron in reducing pain is more than mefenamic acid and far more than placebo.

Invasive fungal infections are one of important complication in patients receiving chemotherapy or hematopoietic stem cell transplantation. Voriconazole is a triazole antifungal agent widely used for prophylaxis and treatment of fungal infections. It is also administered for empiric treatment of fungal infections in patients with febrile neutropenia.
Although amphotericin B preparations and fluconazole generally are used for empiric antifungal therapy and antifungal prophylaxis, but it should be noted that there are insufficient data to draw any firm conclusion about use of other new alternatives as drug of choice.
This paper will review the researches that conducted on voriconazole as an empiric antifungal therapy or antifungal prophylaxis in patients with neutropenia following chemotherapy or HSCT.

Backgrounds: Verification and authentication of the paper-based handwritten prescriptions is of great importance for antineoplastic medications that are good targets for forgery and fraud. Pharmacists usually investigate handwriting, signature and name stamp of prescribers to verify prescriptions in Iran. Anecdotal reports of variations in handwriting and name stamp of physicians who wrote antineoplastic prescriptions raised concerns in this regard. The aim of the study was to investigate the reported diversity and evaluate the quality of writing physician identity and required items in antineoplastic prescriptions.
Methods: All insured hand-written prescriptions contained at least one antineoplastic medication and were dispensed by four main authorized community pharmacies dispensing antineoplastic medications in Tehran during one month were included. Prescriptions that were written by specialties other than oncology-related fields were excluded. Prescriptions of each physician were evaluated considering handwriting and name stamp by experienced pharmacy staff and the frequency of detected handwriting and name stamp types was recorded.
Results: Of the 11022 included prescriptions, 10944 were eligible and written by 241 physicians. Median (third quartile) number of physicians’ prescriptions was 17 (51). Maximum number of observed handwriting and name stamp types were eight and six respectively. High prescribers tended to have several handwriting and name stamp types.
Conclusion: The observed diversity and variation in handwriting and name stamp of the physicians in antineoplastic prescriptions may facilitate the entrance of forged prescription and makes fraud detection difficult. Administrative and regulatory interventions in addition to notification of health care professionals about the observed potential might be necessary.

Herbal products are one of the most popular medications in the world. Nevertheless, herbal medications are not always safe and several cases of side effects have been reported. A 34 years old man was referred to Tehran heart center (THC) for implantation of permanent pacemaker (PPM). Recently, he had experienced several episodes of presyncope and according to the diagnosis of Complete Heart Block (CHB) with accelerated junctional rhythm, a temporary pacemaker (TPM) was implanted for him in another medical center. He had rheumatoid arthritis, type 2 diabetes mellitus and fatty liver in his past medical history. In his drug history, the patient took only herbal medications for the treatment of his ailments among them daily use of Trachyspermum ammi and Zingiber officinale (ginger) products were the main causes of this adverse effect.