No Abstract

Background: Children with leukemia would go through different diagnostic and therapeutic procedures during their process of their disease, including lumbar punctureand bone marrow aspiration; these procedures are usually associated with pain andstress. The aim of the present study was to compare the effect of two combinations ofPropofol-Ketamine and Propofol-Sufentanil on sedation and analgesia during painfulprocedures in children with acute lymphoblastic leukemia.
Methods: In a randomized, double-blind clinical trial, 70 children with acutelymphoblastic leukemia undergoing painful procedures were randomly allocated intotwo parallel groups and took Intravenous Ketamine (1 mg/kg/dose) or Sufentanil (0.5mcg/kg/dose). Both groups received Intravenous propofol (1.2mg/kg). Hemodynamicvariables and analgesic effect were compared between groups.
Results: There was no significant difference between the two groups in terms of thechanges in vital signs at the time before, during and after the procedure. But, theincidence of patient’s movements and the need for repeated propofol boluses wassignificantly lower in the Ketamine group compared to the Sufentanil group (P: 0.008).
Conclusion: Ketamine is a good choice for conducting painful procedures on childrenwith acute lymphoblastic leukemia. Ketamine might be a good option for pain reliefduring painful procedures such as intrathecal injection, bone marrow aspiraion.Ketamine could also be more effective in controlling the movements and decreasing theneed for repeating the drug dosage compared to the Sufentanil.

Background: Carbapenems are beta-lactam antibiotics with broad-spectrum activity for Gram-positive, Gram-negative and anaerobic bacteria and have become the antibiotics of last resort for many serious bacterial infections. The irrational use of carbapenems (imipenem or meropenm) has increased the risk of multi-drug resistant pathogens. The aim of this study was to evaluate the pattern of carbapenem utilization within 9 months and measure compliance with references in Imam Reza Hospital, Tabriz, Iran.
Methods: During 9 months, 100 patients who received carbapenems randomly get selected under the supervision of the attending physician in Imam Reza Hospital affiliated to the Tabriz university of Medical sciences. After coordination with supervisor of each ward, the necessary information was extracted and American Hospital Formulary System (AHFS) and UpToDate 21.3 references were used to assess appropriate indication and accurate dosage of carbapenems.
Results:: The most common cause of prescribing was lower respiratory tract infection (29%). Carbapenems were prescribed for 64% of patients as an appropriate indication. The dose of carbapenems was correct in 74% of patients and duration of carbapenems therapy was correct in 84% of cases. Dose readjustment was necessary for 28 patients, although for 25 of whom it was performed. Only 19 patients had positive culture results.
Conclusion: Despite the global guidelines, carbapenem consumption in health care systems is incorrect. So, comprehensive programs for rational drug use in all medical centers conducted by a clinical pharmacist seems necessary to be employed.

Background: In Iran, the health system reform plan (HSRP) has been implemented since 2014. We aimed to evaluate the prescriptions in Zabol city before and after the implementation of this national plan.
Methods: 2000 prescriptions received to six pharmacies in Zabol city were evaluated. 1000 prescriptions were randomly selected in April 2014 and the pharmacy code, distance from clinic, type of insurance, number of drugs prescribed, total price of drugs, price of the drugs under insurance coverage and not under insurance coverage, and most prescribed drugs were compared with 1000 prescriptions randomly selected from the same pharmacies in April 2015.
Results: Of 68822 prescriptions before HSRP, 71.8% and after HSRP, of 56536 prescriptions, 66.5% were related to pharmacies close to clinic. The mean number of the prescriptions reduced from 260.4±132.2 to 242.9±102.3 and that of prescribed drugs in each prescription reduced from 3.42±1.6 to 3.1±1.4 (both P<0.001), while the price of the drugs did not change (P>0.05).
Conclusion: HSRP reduced the number of the drugs prescribed, but not the price, although the type of drugs most commonly prescribed varied between the two study phases. HSRP was successful in Zabol city regarding reducing the total number of drugs prescribed.

Objectives: Colistin is an old antibacterial agent which is used in multiple drug resistant (MDR) infections. Due to increased rate of MDR infections, the use of this agent is raised in worldwide. The aim of this study was to identify colistin utilization patterns in a teaching hospital and to demonstrate the importance of the need to reconsider prescribing strategies for colistin administration.
Methods: This retrospective cross-sectional study was performed between Augusts 2017and December 2017 at Firoozgar hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. All colistin prescriptions for adult patients during the study period were enrolled for appropriateness evaluation according to the Lexi comp acquired by Wolters Kluwer and NHS guideline.
Results: Among 70 patients who received colistin, pneumonia (70%) was the chief indication of colistin prescription. In 93% of cases, colistin was prescribed according to microbiological laboratory results. In 14% of patients, colistin administration was before providing microbiological laboratory evidence. Seventeen percent of the patients received loading dose of colistin. The indication of colistin therapy was inappropriate in 16% of patients.  The initial and end dose, and duration of treatment of colistin were appropriate in 20%, 40%, and 52% of patients, respectively. Among 70 cases, 24 (34%) and 36 (51%) patients required dose adjustment in first and end dose of colistin therapy which only dose correction was performed in 13 (18%) and 15 (21%) cases, respectively.  
Conclusions: These findings, along with aforementioned guidelines supports the requirement for physicians’ educational programs, proper strategies for appropriate prescriptions.

Background: Cleft palate repair is associated with hemorrhage and hemodynamic changes in children. This study aimed to compare hemodynamic changes during cleft palate repair in patients anesthetized with isoflurane-remifentanil and propofol-remifentanil.
Methods: In this randomized, double blind study, 100 cleft palate repair candidates who aged under three years were allocated to two groups of 50 to receive either isoflurane-remifentanil or propofol-remifentanil for maintaining anesthesia.  
Results: The mean systolic and diastolic blood pressure and the mean arterial pressure were significantly lower in the propofol-remifentanil group (P < 0.001). The mean extubation time (P < 0.001), time to first analgesic administration (P = 0.04), and recovery time (P < 0.001) were significantly longer in the isoflurane-remifentanil group.
Conclusion: Propofol-remifentanil-based anesthesia caused more stable hemodynamic state in patients undergoing cleft palate repair. The mean systolic and diastolic blood pressure, as well as the mean arterial pressure, were lower with propofol-remifentanil administration. Therefore, this combination can lower the risk of intraoperative hemorrhage.  

The senior population in Iran is growing, and polypharmacy is common among them. Certain drugs are considered inappropriate in elderly due to age related changes and awareness of clinicians in this area is crucial. The Beers criteria is the most evidence based reference for proper drug selection in geriatric patients. This study reviews the scholarly articles published in English or Farsi that had studied potentially inappropriate medications (PIMs) according to beers criteria and polypharmacy in the Iranian geriatric population.By searching Pubmed, Scopus and Google scholar databases from 1989-2016, all studies in Farsi or English with key terms polypharmacy, drug-drug interactions, Beers, medication, drug, prescribing, older adult, geriatric, elderly, aging, pharmacotherapy, persian and Iran were evaluated. 11 studies were found: 5 studies on polypharmacy, 3 studies on polypharmacy and PIMs, one study on PIMs, one study on drug drug interactions and PIMs, and only one study on polypharmacy, PIMs and drug-drug interactions. The majority of these studies were published in Farsi (8 articles). The oldest found article was conducted in 2005 and the most recent published study was in 2016. Studies in aging population in Iran are very few. This growing patient group with the highest number of drug consumption seems to be under-researched in Iran 

Granulomatosis with polyangiitis (GPA) is a granulomatous disorder linked with systemic necrotizing vasculitis with varied initial manifestations. We describe a case of a 49-year-old Malay female patient who gradually developed more symptoms of GPA over the past 14 years. This case emphasizes early detection and optimal treatment to minimize any further complications of GPA.