No Abstract

Background:  It is suggested that surgery results in changes in kinetic profile of some medication. The aim of this study was to investigate possible alterations in pethidine’s half-life in postoperative pain management following orthopedic surgery of the inferior limb.
Methods: Twelve patients who were classified as class I patients according to the American society of anesthesiologists physical status classification were enrolled. Following the surgery of the lower limb, 25 mg of pethidine was injected intravenously. After that, 5, 30, 60 and 180 minutes following the injection, blood samples were taken and concentration of pethidine in blood samples were measured by High Performance Liquid Chromatography method. Moreover, patients’ pain levels were assessed on visual analogue scales.
Results: The average half-life of pethidine was measured to be 29.68 minutes. Thirty minutes after the injection, significant relationship between plasma levels of pethidine and pain scale was reported (p= 0.041, r= 0.595). Moreover, men were found to perceive more pain than women. Pain scale was considerably different between smokers and non-smokers (p= 0.006), although blood concentration of pethidine was not significantly different between these two groups (p=0.09).
onclusions: Orthopedic surgery most probably results in alterations in pharmacokinetic profile of pethidine. Moreover, gender and smoking status of the patients influence pain perception. Thus, pharmacokinetic alterations due to inferior limb orthopedic surgery, gender-related factors and smoking status of the patients should be considered in pain management in clinical settings.

Background: IV acetaminophen has become the most commonly chosen analgesic medication in critical care settings. Overall, the cost of the drug is higher than oral and rectal acetaminophen. As a result, numerous studies have been performed to evaluate the appropriateness of IV acetaminophen use based on guidelines. A lot of studies have shown that there is poor quality in compliance with guideline in developing countries. Current study aims to evaluate prescribing behavior of IV acetaminophen regimens in hospitalized adults in Tehran, Iran.
Material and methods: We reviewed 277 patients' charts (including 137 men and 140 women) with age ranged between 18-65 years in Ziaeian hospital, Tehran, Iran. Demographic data and clinical and lab parameters such as blood urea nitrogen (BUN) and creatinine levels, name of ward, prescribing reason, doses, dose intervals, number of doses, type of vehicle used and durations of infusion were collected and recorded for analysis.
Results: Our results showed that guideline concordance was seen only in 20 (7.22%) out of 277 patients. IV acetaminophen is prescribed mostly by emergency medicine specialists, and it is more inappropriately prescribed by these specialists in comparison to other specialists. It was also found that non-compliance of IV acetaminophen prescribing with guideline imposes 1038 USD additional expenditure on health care system of the hospital. Indirect costs resulting from preventable adverse events, physician and nurse manpower and time was not calculated.
Conclusion: The evaluation of prescribing indicators showed low quality prescription by medical specialists. The pattern of prescribing depending on the medical specialties was also different. In addition, overuse and misuse of IV acetaminophen imposes substantial cost and the economic burden on healthcare system.

Introduction: Premenstrual dysphoric disorder (PMDD) is a common condition affecting females' quality of life in a significant negative manner. Verities of medical treatments have been investigated for whether the prevention or treatment of this condition with uncertain outcomes. The current stud has aimed to assess the efficacy of N-acetylcysteine (NAC) versus fluoxetine for the treatment of PMDD.
Methods: The current randomized clinical trial has been conducted on 119 childbearing females, randomly divided into three groups of either treatment with 10 mg of fluoxetine twice daily or 450 mg of NAC twice daily or placebo in 2016-18. The participants used the agents for two weeks following menstruation. These treatment approaches performed for two menstrual cycles. The questionnaires of Hamilton and daily record of severity of problems (DRSP) were filled before and following the interventions for both groups, and the results were compared.
Results: The baseline DRSP and Hamilton scores were not statistically different among the three groups(P-value>0.05) while by the end of the study all of the groups presented significantly improved scores(P-value<0.001). Comparison of three groups revealed remarkable inferiority of placebo to the other two groups(P-value<0.05) while no statistical difference was found between N-acetylcysteine with fluoxetine in terms of neither Hamilton(P-value=0.120) nor DRSP scores(P-value=0.749).
Conclusion: The current study showed significant improvement in the PMDD symptoms following use of whether placebo or fluoxetine or NAC. Comparison of the agents revealed remarkable superiority of both fluoxetine and NAC to the placebo while NAC and fluoxetine had similar efficacy on the PMDD symptoms relief.

Background: Albumin has long been a critical medication in many hospitalized cases, especially for patients in the intensive care unit (ICU) section. Some adverse clinical impacts and economic limitations have made the human albumin an appropriate therapeutic agent for extensive analyses.
Materials and Methods: This retrospective follow-up study was performed in Firozabadi hospital as a General Medical Teaching and Research Center with 12 major units and ICU sections. Information of the patients was collected based on the charts, physician and the nursing reports. We evaluated all 153 patients who used albumin in Jan to June 2016 (first 6-months) before guideline distribution and then during Jan to June 2018 (second 6-months).
Results: We evaluated current management protocols for hypoalbuminemia, sepsis shock, nephrotic syndrome, hepatorenal syndrome, CVA (Cerebrovascular Accident), cirrhosis, electrolyte disorder, cardiovascular surgery, edema and ARDS (Acute Respiratory Distress Syndrome). During this study, we found that before guideline distribution, 297 numbers (27.1% of total prescribed albumin vials) of albumin vials prescribed for 20 patients (18.6%); while after 18-month interval, guideline adoption the second 6-month administration pattern was less inappropriate; Nevertheless, the number of patients, vials, duration and level of albumin was different in comparison with the first evaluated group and were more accordant with standard instructions. 
Conclusion: A considerable change in administration strategies would be observed after executing the standard operating procedures and confirms that this approach might remarkably alter the physician’s attitude toward more rationalized prescription of critical agents that subsequently reduce the associated implied costs on health systems.

Background: Carbapenems is frequently prescribed for treatment or prophylaxis in neutropenic patients. It is cleared that antimicrobial misuse can cause poor patient outcomes, through raise of antibiotic resistance, increased adverse events, and prolonged length of hospital stay.
Objectives: to evaluate the rational use of Imipenem- Cilastatin and Meropenem for empirical antibacterial therapy in neutropenic patients based on IDSA guideline.
Methods: through this cross-sectional study, we assessed the appropriateness of administration of Carbapenems in neutropenic patients admitted in hematology–oncology and bone marrow transplant wards in Namazee hospital, Shiraz, Iran, from March 2012 to May 2013.
Results: Total of 90 patients were enrolled. Drug therapy duration was appropriate in 69.6% of Imipenem-Cilastatin and 75% of Meropenem groups. Sampling time of culture was appropriated in 59.1% of Imipenem-Cilastatin and 78.3% of Meropenem group, interval of drug administration was correct in 74.5% at initiation and 79.4% during therapy in Imipenem-Cilastatin group. For dosing these values were 74.5% and 72.2%, respectively. These values were evaluated in patients who received Meropenem too, interval was correct in 89.5% at initiation and 90.3% during therapy, dosing was correct in 12.3% either at initiation and during therapy.
Conclusion: These finding suggest that attention to correct dose, correct interval, renal dose adjustment, logical indication for administration of carbapenem should be considered by health care system

Whey nowadays considered as nutritional power house of future. Presently, whey mainly used as energy base drinks for sportsman and for therapeutic application in many countries. The two primary sources of protein in milk are the caseins and whey. After processing occurs, the caseins are the proteins responsible for making curds, while whey remains in an aqueous environment. Whey protein is a reliable source of amino acids and biologically active proteins which act as a nutritional supplement. The components of whey include beta lactoglobulin, alpha lactoalbumin, bovine serum albumin, lactoferrin, immunoglobluins, lactoperoxidase enzymes, glycomacropeptides, lactose, and minerals. Whey proteins have a high amount of branched chain amino acids such as leucine, isoleucine, and valine. These are also rich in the sulfur-containing amino acids cysteine and methionine, which enhance immune functions through their intracellular conversion to glutathione. The present review paper gives information about the potential beneficial properties of whey protein and focuses on using whey protein supplementation as an immuno-modulator, antioxidant, anti-inflammatory, anti-diabetic, anti-cancer. In this context, the current review presented that whey protein supplementation is shown to maintain a high concentration of cellular antioxidants and boost immune defenses that promote carcinogen detoxification. Due to the positive findings, whey protein supplementation is starting to be viewed as a non-pharmaceutical adjunct therapy in the treatment of cancer. Also, whey protein provides an abundant supply of essential amino acids to organs and tissues, which stimulates tissue regenerative mechanisms and help minimize immune suppression.

Macrolide antibiotics are commonly prescribed and are usually well tolerated. Azithromycin-related anemia and thrombocytopenia has not been reported previously. Here, we present the case of a 63-year-old man with bicytopenia following azithromycin treatment for ocular toxoplasmosis. He developed both thrombocytopenia and anemia after less than 7 days of treatment. Pyrimethamine, known for its hematologic side effects, was stopped on admission. However, the platelets drop continued to worsen. Then, azithromycin has been incriminated. All his symptoms and laboratory abnormalities were recovered within 7 days after the discontinuation of azithromycin treatment. Physicians must be aware of azithromycin-induced bicytopenia because its early detection can decrease the severity of these side effects.

The most reported form of statin induced pain is myalgia, conversely peripheral neuropathy is a rare side effect. We report a patient who received rosuvastatin for hypercholesterolemia and experienced episodes of pain in both hands during the night. Rosuvastatin was stopped and atorvastatin was replaced. Re-introduction with another statin resulted in a more severe form of the similar adverse effect after 4 months. This is a rare adverse effect of a extensively prescribed class of drug. Physicians should be aware of the possibility of peripheral neuropathy symptoms in patients on statin therapy.