No Abstract

Introduction: Inappropriate use of antibiotic, leads to microbial resistance, nosocomial infections and increased hospital costs. Therefore, it is necessary to control and evaluate the use of these medications, especially broad-spectrum antibiotics. This study evaluated the pattern of meropenem utilization in Imam Reza hospital, Mashhad, Iran.
Methods: First, a guideline for proper indications of meropenem was designed and finalized based on the clinical pharmacists and infectious disease specialist’s comments. One hundred patients were chosen randomly from different wards of the hospital and their data were recorded in predesigned questionnaires. Then, the pattern of meropenem consumption was analyzed according to the guideline.
Results: This study was performed in 100 patients, including 48 women and 52 men. In 13 cases (13%), patients had no approved indication for meropenem. The initial regimens were changed in 6 cases (6%) based on culture results and in 73 cases (73%) relied on clinical response. In 64 cases (64%), administrated doses were compatible with prepared guideline. Renal dose adjustment was acceptable based on guideline only in 30% of patients with renal impairment (30 patients out of 100). Hyper-sensitivity reaction, one of the adverse reactions of meropenem, was seen in 1 patient (1%).
Conclusion: According to the results, considerable errors occurred in meropenem administration and dosing. Therefore, it is necessary to design and implement a localized guideline for meropenem consumption in Imam Reza hospital of Mashhad, Iran.

Background: Several essential roles defined for pharmacists which the important skills must possess in support of their roles. One of them is the essential ability, knowledge, and confident for the interactive and appropriate communication with other health professionals and the public. According to the importance of communication skills, there is a need to evaluation this ability in the pharmacist, and pharmacy students.
Methods: The criteria of the communication skills assessment extracted from the “communication skills in pharmacy practice” book and the health professional educations and investigations with the focus on communication skills in pharmacy practice. Then the content validity ration (CVR) and the content validity index (CVI) were evaluated for assessing the necessity, relevancy, clarity, and simplicity. In addition, the reliability analysis was carried out for assessing of the internal consistency by the calculation of Cronbach’s alpha. The data were analyzed by using the Statistical Package for Social Sciences (SPSS) version 16.
Results: The finally valid and reliable survey of the communication skills assessment of the pharmacist and pharmacy students have 15 items, which include the verbal and non-verbal skills such as greeting with patients, speaking clearly, listening to what patient had to say, the professional appearance, and clear writing medication orders.
Conclusion: Communication skills in pharmacy practice can be a critical ability for the development of the dealing with patients, physicians, and other health care professionals and lead to improvement of the quality health care delivery.

Background: Selenium (Se), mainly through its incorporation into selenoproteins, plays an important role in inflammation and immunity. Evidence has emerged regarding roles for individual selenoproteins in regulating inflammation and immunity. The aim of this study was to evaluate the response on the inflammatory biomarker C-reactive protein, and its possible impact on the incidence of delirium.
Methods: This prospective, non-randomized, open-label, single-center clinical trial included 100 critically ill patients. Patients in the Selenium group (n = 50) received Se for 5 days (500 μg twice daily infused over 2 hours). Plasma levels of C-reactive protein (CRP), was determined on days 1-5. The incidence of delirium was assessed by the Confusion Assessment Method (CAM) on a daily basis.
Results: CRP decreased in the selenium group from day 1 onwards. The mean of CRP was 11.1 ± 2.20 in the Se group compared to 16.7±1.6 in the control group, the difference was significant (P < 0.0001). 32% of patients in the selenium group and 52% in the control group had delirium (P = 0.07).
Conclusions: Se administration in critically ill patients decreased CRP levels, but did not reduce the incidence of delirium

Background: Linezolid has been recognized as a safe and effective medicine against a wide variety of Gram-positive pathogens.The primary objective of this study was to assess utilization appropriateness of linezolid and explore the efficiency of protocol intervention to proceed to rational drug usage.
Methods: The project was conducted in a referral teaching hospital from September 2015 to January 2017 in two phases. In the first step, a six-month survey was performed to evaluate the prescribing appropriateness of linezolid. Patients receiving linezolid were identified using hospital IT system and the medical charts were analyzed based on accurate indications and duration of linezolid prescription. Subsequently, a restrictive protocol was developed and communicated after a consensus by Drug and Therapeutics Committee in May 2016. After introduction of the protocol, an active daily surveillance of patients was done by hospital pharmacists. The appropriateness of linezolid utilization and infectious consultations were compared before and after protocol implementation.
Results: In the first phase of the study, the indication of linezolid was appropriate in 56.2% of cases and improved considerably to 68.6% (P value: 0.04) after protocol enforcement. Furthermore the duration of the linezolid consumption was correct in 66.6% of patients, increasing to 88.5% after protocol introduction (P value 0.07). In the first step, 56.9% of linezolid prescriptions were based on infectious disease consultation which enhanced remarkably to 87.5% in the second step (P value 0.001), while, 65.5% and 73.8% of these consultations were appropriate in the study surveys respectively.
Conclusions: The protocol intervention could improve appropriate prescribing of linezolid in the hospital setting. However, ongoing audit studies are recommended to maintain the rational prescription of linezolid.

Background: Adverse drug events can cause serious consequences including death. A published report by Lazarou et al in 1998 showed that adverse drug events were the 4^th to 6^th leading cause of death in the United States. These events may lead to drug safety crises in some issues, which need to take crises management process for solving the problem and/or preventing similar events.
Objectives: To evaluate nature of drug safety crises based on adverse events reported to Iranian Pharmacovigilance Center from 1999 through 2012. To mention success and failure outcomes of crises management process taken against detected crises.
Methods: All adverse drug events received by Iranian Pharmacovigilance Center from 1999 through 2012 were evaluated for reports with fatal outcome. All alerting letters and manuscripts published by the Center during the same period were reviewed for detailed information on detected crises. World Health Organization definition was used for detecting drug safety crises.
Results: Among 42036 registered cases in our database, 463 deaths were recorded. The most frequent suspected drug for adverse events with fatal outcome was ceftriaxone (100 cases). Ten different drug safety crises issues were detected during the study period and their successful or failure outcomes were evaluated. There were 112 issued alerting letters and 17 published manuscript during the same period which was monitored for detailed information.  
Conclusion: It is necessary for national pharmacovigilance centers to have prepared programs for crises management. This could be useful for reducing drug related mortality.

With the emergence of various developments in determining pathophysiology behind diseases, emergence of resistance against diseases and to utilize drugs for the long-term effects, and the need to design an effective treatment against most common infectious and non-infectious diseases, the need of developing more effective drug comes under the limelight. At present, more studies are being carried out on the utilization of monoclonal antibodies as successful therapeutic agents and to design them in such a way to target specific health-related conditions. This include conditions which affect livelihood of people, the most common an widespread diseases, infectious diseases caused by more virulent or drug-resistant micro organisms and viruses and also inherited diseases. Current review thus targets cancer, diabetes, autoimmune diseases, hypercholesterolemia, ophthalmology and infectious diseases and briefly discusses the pathophysiology behind the mode of action of the therapeutic agents based on monoclonal antibodies and the benefits and drawbacks of such developed agents. This also focuses on the areas where studies can be carried out to determine effective use of monoclonal antibodies in the future to answer and treat major medical related issues. 

Prostatitis causes up to 25% of male genitourinary complaint. However, due to technical restrictions in sampling, only in 10% of cases pathogens were identified. In this paper, a patient with chronic prostatitis due to Staphylococcus hemolyticus is described. A 48-year-old man was referred with longstanding (approximately for 18 months) complaint of increased genitourinary symptoms and pain in perineum. In evaluation, moderate growth of methicillin-resistant Staphylococcus hemolyticus (MRSH) in post-prostatic massage voided urine and expressed prostatic secretion (EPS) was positive. Culture of urethral urine (urine or voided bladder 1; VB1), midstream urine (VB2) and post-ejaculation urine specimens were negative. Leukocyte count values in EPS and post-prostatic massage voided urine were 14 and 8 per oil immersion field respectively. PCR of urine samples was positive for Ureaplasma urealyticum and confirmed by repeated analysis. Based on the antimicrobial susceptibility results patient was treated with teicoplanin 400 mg intramuscularly every 12 hours for three doses followed by the daily maintenance dose of 400 mg.  In addition, doxycycline 100 mg twice daily was added to cover Ureaplasma urealyticum. Treatment course completed in 6 weeks. Alleviation of patient’s symptoms begun within the first week of treatment and this trend continued until the end of the treatment.