No Abstract

Introduction: Inappropriate use of antibiotics in health care systems can lead to bacterial resistance, nosocomial infections and increased hospital costs. So, evaluation programs for these medications are needed. This study evaluates the pattern of vancomycin utilization in Imam Reza hospital, Mashhad, Iran. 
Methods: At first, according to drug information sources a check list was designed for appropriate indication and dosing of vancomycin. One hundred patients were selected randomly from different wards of hospital during a 6 months period and their data were collected in predesigned check list. Then, data were evaluated according to prepared checklist.
Results: In this study, 100 patients (48 female and 52 male) were evaluated. Empiric therapy in 20% of patients was not initiated appropriately based on prepared checklist. Empiric regimen was changed in 10 patients based on culture results and in 28 patients regarding clinical response. Prescribed doses were according to the guideline in only 31% of patients. Duration of treatment were inappropriate in 35 patients. Vancomycin induced nephrotoxicity occurred in 7 patients and red man syndrome in 1 patient. Administration procedure was correct in all patients. 
Conclusion: According to the results, lots of error occurred in vancomycin administration and dosing in our center. It is necessary to develop localized guideline for vancomycin utilization in this hospital to prevent unwanted adverse reactions and antimicrobial resistance and also reduce treatment cost.

Background: Drug and Poison Information Centers (DPICs) provide quick, easy, valid and reliable access to medication and toxin information for professionals, health workers and the public. The purpose of this study is to report the services provided by a university hospital DPIC within 1 year.
Methods: This descriptive study reports all scientific questions asked from DPIC of Namazi hospital in Shiraz from the September 2016 to the August 2017. The information include the number of questions, the ward that ask the question, the questioner's profession, the method of asking questions, the method of responding, the type of question, and the resources used to answer them. After extraction of duplicates, data were analyzed by using the Excel software.
Results: The total number of contacts registered during the study period was 485. The most number of questions were received in July and the lowest in November. Major questions were asked from the health-care team working in Namazi hospital and mostly from the nursing group (44.7%). Most of the questions (79.6%) were asked and responses were provided (67.1%) by the telephone device. Of all incoming inquiries, drug indication (13.3%), adverse drug reactions (ADR) (13.3%), storage (11.8%), and the method of preparation as well as administration (11.7%) were among the most common types of questions. The most frequent ward in asking questions was the pediatric intensive care unit (13.1%). The most widely used drug information resource to answer questions was the UptoDate^® (47.5%).
Conclusion: DPIC services in the hospital settings can decrease or prevent ADRs as well as medication errors, improve the pattern of medication use, and result in cost saving.

Background: Resistance to antibiotics exists around the world. In patients with various types of cancer and also in patients undergoing bone marrow transplantation, infections and febrile neutropenia can be very dangerous. Administration of intravenous ceftazidime alone or in combination with other antibiotics is one of the first empirical treatment regimens. The present study was carried out to determine the resistance pattern of various gram – and gram + microorganisms to different antibiotics at shafa hospital in Ahvaz.
Method: This retrospective descriptive cross-sectional study was conducted for a period of one year including all referral clinical specimens from patients with malignancies to Shafa Hospital's Microbiology Laboratory. Isolated bacteria were tested for sensitive antibiotics used in clinics, especially ceftazidime, using a disc diffusion method.
Results: After reviewing the records of all patients with malignancies admitted to Shafa hospital from July 2016 toJuly 2017, 310 patients had a recorded culture result (438 cultures in total). The patients were between 1 -85 years old (mean ± SD: 29.96±24.63 years). 50.64% of the patients were male and 49.35% female, mostly admitted to emergency pediatric hematology ward(25.806%). The most common type of malignancy was acute lymphoblastic leukemia(27.096%).Pseudomonasaeroginosa was the most commonisolated pathogen (34.0182%). Only 63 positive cultures containing pseudomonas were tested for antimicrobial resistance, and among these cultures, 55.55% were resistant and 42.85% were sensitive to ceftazidime. Among 9 isolated E.coli cultures, 66.6% were resistant and 33.33% were sensitive to ceftazidime.For Acintobacter and Staph epidermidis, only1 positive culture (out of 33 and 34 respectively) was tested,and in both cases was resistant to ceftazidime.
Conclusion: Pseudomonas was the most common pathogen among isolated pathogensand about 56% of positive cultures were resistant or had intermediate sensitivity. Itseems that ceftazidime empiric therapy of infections in patients with malignancies atHematology-Oncology hospital might face high resistance.

Background: Corrective strabismus surgery is associated with moderate pain and a very high incidence of postoperative nausea and vomiting (PONV). In our treatment centers Morphine is used a lot and it’s associated with high incidence of PONV and we have few alternative analgesics. The aim of this study was to compare the incidence of postoperative emesis with intravenous morphine in patients undergoing corrective strabismus surgery with propofol anesthesia with the control group.
Methods: In a prospective, double-blind, randomized study, 126 patients who were candidates for strabismus surgery (either sex or any age) were randomly assigned to receive morphine or placebo. None of the patients received any premedication and a standardized anesthesia technique was used for all the patients. The incidence of PONV in patients within 24 hours after the surgery was compared.
Results: During 24 hours after strabismus surgery, 29 (46%) patients in the morphine group and 27 (42.9%) in the control group had nausea. The frequency of vomiting was 11 (17.5%) patients in morphine group and 9 (14.3%) in the control group. There was no significant difference between the two groups regarding nausea episodes (P=0.85) and vomiting episodes (P= 0.8).
Conclusion: According to the results of this study, morphine does not increase PONV after strabismus surgery

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Background: Diabetic foot ulcer (DFU) is the most frequent complication of DM with an upward trend over the last two decades.The present study was implemented to determine how DFU was managed in a major referral hospital in Isfahan.
Methods: This prospective cross-sectional study was conducted from the 1^st July 2016 to 15^th December 2017 in Al-Zahra Hospital, in Isfahan, Iran. The information was collected by atrained pharmacy student by recordingbaseline characteristics of patients, current approach to investigate the DFU, management of the infected wound, and assessment of risk factors related to patients' outcomes.
Results: The mean (±S.D) age of patients was 59.13±10.80 years. The majority of our patients had affected with Type 2 DM (96.3 %). Most of the patient (61%) had wound with grade 3 in the Wagner classification. Lesions mainly involved toes (46.3%). The most lesions (42%) had a mean size of the 5-10 cm2.The most frequently prescribed combination antibiotics were meropenem and Targocid® (teicoplanin) (34.1%), Tazocin® (piperacillin + tazobactam) and Targocid® (24.3%). Mean (±SD) duration of parenteral therapy (alone or in associated with oral treatment) was 14.95±7.62 days. Ulcer size (cm2) (P=0.04), and Wagner classification (P=0.012) had significant association with unhealed ulcer.
Conclusion: Although, our diabetic center is university-affiliated, there are still several points, and pitfalls must be considered and revised in DFU patients. Obtaining microbiological sampling, antibiotic management and baseline assessment of wound in patients are the most troublesome complications discovered by our investigation.

Detection and resolution of Drug Related problems (DRPs) are one of the most important parts of Pharmaceutical care. As many as 4.6% of deaths in the United States may be the result of a DRPs, making DRP one of the top 5 leading causes of death. According The high prevalence of DRPs in an outpatient setting, lack of information about this setting rather than inpatient setting and the importance of detection and resolution of them, reviewing the articles in this regard is necessary. In this review article, PubMed, Scopus, and Google scholar databases were used for finding the relevant studies about the prevalence of DRPs in an outpatient setting and ambulatory care services. In the past 20 years the incidence of drug-related drug problems in the ambulatory care unit has increased and it's more important in the elderly patient due to pharmacokinetic changes and polypharmacy. patients with cardiovascular diseases or diabetes mellitus and patients who require chronic pain management are important target groups for DRP Screening. the lack of medication counseling in ambulatory care and in pharmacy settings are an important cause of DRPs in an outpatient setting. According the knowledge about physiology, pharmacology and toxicology, pharmacokinetics and Pharmacotherapy, the most qualified health care provider for detection and management of DRPs in the outpatient setting is pharmacist Quality improvement programs in the base of pharmaceutical care, such as medication therapy management service should target DRPs, especially for patient groups using cardiovascular drugs, analgesics, hypoglycemic agent’s and anti-Seizure agents.

Levodopa is considered one of the most important medication for parkinson symptoms control, it also first line agent for elderly and patients who symptoms don’t control with other agents. However, it has several drug and nutrition interactions. A few case of levodopa enteral nutrition has been reported.