No Abstract .This is an editorial without any abstract.

Background: Congestive heart failure (CHF) is a chronic disease that incidence is growing in the population. Vitamin D effects on directly myocardial cells. The aim of this study was to investigate the association between vitamin D levels with ejection fraction of left ventricle.
Methods: The study population consisted of 101 patients admitted with heart failure. Age, gender, and demographic characteristics (diabetes mellitus, hypertension, smoking-nonsmoking, coronary artery disease) of all patients were recorded. In all patients for blood analyses vitamin D, creatine, crp and lipid profile were studied. And all patients were studied echocardiography.
Results: CHF patients, in our population 35 (34.7%) patient is female and 66 (65.3%) patient is male. The mean age of our patients was calculated as 67.4±12.9 years. Our patients laboratory parameters mean were measured for vitamin D 24.3±17.3 ng/ml. Left Ventricular Ejection Fraction (LVEF) mean was measured 31.8±9.5. In our study group LVEF and vitamin D was correlated with each other
Conclusion: Vitamin D and LVEF had a positive correlation in heart failure patients. It may be occured with the protective effect of vitamin D or consequence of hipovitaminosis.

Background: Irrational use of antibiotics is a healthcare problem which can lead to antibiotic resistance. Vancomycin resistance is developing worldwide and is a huge financial burden to healthcare systems. Antimicrobial control programs are an essential component of educational programs in ensuring the optimal use of antibiotics. This study aimed to evaluate the effects of an educational program implemented at an Educational Medical Center on vancomycin prescription patterns.
Methods: This was a cross-sectional, pre-post interventional study carried out at Imam Hussein Hospital affiliated with Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran, between 2014 to 2016. Vancomycin protocol was prepared, then all physicians and assistants were trained through workshops and instructed to order vancomycin based on the approved protocol. The primary objective of this study was to determine the change in vancomycin usage – calculated based on the Defined Daily Dose (DDD) per 100 patient-days in each ward – collected in three phases: at baseline, during the educational program and post-intervention phase.
Results: The data revealed that total vancomycin consumption significantly decreased at the baseline and post-intervention phases in comparison with during the educational program (p=0.007, p= 0.105, respectively).
Conclusion: The educational programs in this study were effective at optimizing antibiotics usage and the study results showed that antimicrobial training programs can be successfully implemented for the management of vancomycin usage at our university-affiliated hospital.

Background: Pharmacotherapy in elderly patients has become a major concern due to their physiological changes, pharmacokinetic and pharmacodynamics variations and poly-pharmacy. In considering the global trend in population aging, we aim to evaluate the effect of “Beers Criteria” education on prescribing medications for elderly patients by General Practitioners (GPs).
Methods: Thirty GPs with the highest number of prescriptions were included in this pilot study. All prescriptions written over a three-month period were considered, then prescriptions for geriatric patients were selected and evaluated. The GPs were trained using pamphlets and booklets which were prepared based on Beers 2015 explicit criteria. In order to evaluate the effect of education, appropriateness of prescriptions was analyzed before and 1 month following training.
Results: Of 15,447 prescriptions selected during the first step, 1,281 prescriptions were related to geriatric patients in which the prevalence of inappropriate drug prescriptions was 37.3%. The most inappropriate medications identified were Bisacodyl, Alprazolam, and Hyoscyamine. While in the second step 1,055 of 15,154 prescriptions concerned the elderly and inappropriate drug prescription rate was noted as 23.6%. The most common inappropriate medications included Alprazolam, Amitriptyline, and Hyoscyamine. Based on our results, the prevalence of prescribing potentially inappropriate medications (PIMs) for elderly patients is high among GPs and educational interventions that raise awareness about “Beers Criteria” significantly reduce the prescribing PIMs.
Conclusion: Given the importance of GP training programs in reducing inappropriate prescription rates among geriatric patients, it will be necessary for the National Committee of Rational Use of Drugs (NCRUD) to consider undertaking comprehensive educational strategies for reducing the prevalence of inappropriate medication use in elderly people.

Background: One of the complications of critical ill patients admitted to intensive care unit (ICU) are stress-related mucosal damage. Stress ulcer prophylaxis (SUP) should be administered to all critically ill patients with at least one major risk factor and two or more minor criteria.
Methods: This study was performed during 6 months from October 2013 to December 2013 in Namazi Hospital intensive care units to assess the appropriate administration of SUP, according to American Society of Health-System Pharmacists (ASHP) protocol. Candidate for SUP according the ASHP guideline is considered if there is a at least one major risk factor or two or more minor risk factors.
Results: Ninety-four patients were enrolled (46 men and 48 women). The mean age of study subjects was 51.5 years. The most major risk factor to stress ulcer found to be mechanical ventilation more than 48 hours (53%). The most minor risk factor for stress ulcer was ICU admission for less than one week (23.5%). Most prescribed medication for stress ulcer prophylaxis was intravenous Pantoprazole (44.7%). Our results have shown that about 74% patients were candidate for SUP according the ASHP guideline. 13(13.8%) of patients had only major risk factors. 5 (5.3%) of patients received SUP while they did not have at least one major risk factor or two or more minor risk factors.
Conclusion: Our results have shown that 76.2% of the total SUP administrations were compliant with the ASHP guideline. Among the prescribed medication for SUP, intravenous pantoprazole had the highest percentage of administration (44.7%) and oral omeprazole had the lowest percentage of administration (7.4%). According to the results of our study, 72% of the route administrations are compliant with the ASHP guideline.

Background: Vancomycin is a potent antibiotic and has central role in the managing of infections with known resistance to other antibiotics or in patients with allergy to beta-lactams. Irrational use of vancomycin is associated with increased morbidity and mortality as well as the antibiotic resistant.
Methods: The DUE was done in Imam Reza Hospital, Tabriz, Iran. A total of 100 patients were included during a 6‐month period. We aimed to evaluate vancomycin administration pattern and assess its compliance with Centers for Disease Control and Prevention (CDC) and the American Society of Health-System Pharmacists (ASHP) protocols as the primary outcome and its adverse effects as the secondary outcome.
Results: The mean duration of hospitalization and antibiotic therapy were 22.11 ± 1.76 and 19.08 ± 1.51 respectively (mean ± SD).  The most causes of vancomycin administration (51%) were for surgery prophylaxis. In 38% of patients, vancomycin administration was not in accordance to standard guidelines. Dose and duration of vancomycin therapy was according to ASHP and CDC guidelines in 74% and 59% of patients. Dose readjustments of antibiotics were necessary in 28 patients which were done in 12 of them. A total of 140 samples were collected from 60 patients. In 30% of patients, vancomycin use was continued without considering the culture results.
Conclusion: It is important to set practical pharmaceutical and therapeutic infection control committees in hospitals under the clinical pharmacists’ observation. Furthermore, educational programs for health care professionals regarding rational use of antibiotics can be helpful in improving antimicrobial medications utilization and monitoring.

Neurodegenerative disorders could be a most important health issue within the 21^st century. In the recent past; there has been a growing interest in medicinal plants. Chemical fruits and vegetables are said to decrease the possibility of many chief ailments, together with cardiovascular and cancer disorders as well as neurodegenerative ailments. Hence, who eat more fruits and vegetables may be less threaten for developing certain diseases caused by neurological dysfunction. The present review provides an overview of the about 14 most important plants used for neurological disorders and explores their neurological protection for the development of new pharmacological potential drugs. The data sources including the publications on Google Scholar, PubMed, and Science Direct. Publications searched with no particular time restriction in order to get a holistic and comprehensive view of the research done on this topic so far. Therefore, we present a systematic approach for herbal medicine as neuroprotective agent. From ancient time the herbal medicines are used to cure neurological symptoms. While the exact pharmacology of these herbs has not yet been set on, some of them have anti-inflammatory or antioxidant properties on different peripheral systems. The significant variety of medicinal plants makes it an essential source of healthy compounds compared to current therapeutic agents. In this review, the importance of phytochemicals for the function of neurological protection and other related disorders, in particular, the process mechanism and therapeutic prospective will be emphasize.

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Despite their adverse effects, fluoroquinolones continue to be commonly prescribed antibiotics. Ciprofloxacin remains the safest with remarkably few adverse effects of all fluoroquinolones. Here, we present a rare case of paroxysmal atrial fibrillation induced by ciprofloxacin intake in a 72-year-old woman. She was treated with ciprofloxacin and ceftriaxone for urinary tract infection caused by Klebsiella pneumonia and complicated with liver abscess. On the fifth day of ciprofloxacin intake, she suddenly complained of heart palpitations and epigastric pain. An electrocardiogram revealed supraventricular tachycardia type atrial fibrillation at 130 beats per minute. No QT interval prolongation was noted. Ciprofloxacin was stopped as it was the most incriminated to induce arrhythmia. A control electrocardiogram showed normal sinus rhythm. We continued ceftriaxone use solely for 3 weeks until the resolution of the liver abscess. Although rare, early detection of atrial fibrillation induced by ciprofloxacin may decrease the severity of complications and prevent death.

Epiploic appendagitis is natural fats at the anti-mesenchymal surface of the colon. EP is self- limited. Misdiagnosis can lead to unnecessary hospitalization, antibiotic therapy, and surgical intervention. The incidence reported 8.8 cases / million / year. Here, we report on 36-year-old female patient who presented with acute abdominal pain that was getting worse with the change of position. Based on these symptoms and double contrast computed tomography, she was diagnosed with epiploic appendagitis in adjacent to the sigmoid. The patient was treated successfully with conservative management and antibiotics. Since the signs and symptoms of epiploic appendagitis are nonspecific, but considering of this disease as one of the differential diagnoses of acute abdominal pain can prevent the disease from misdiagnosing.

Background: Increasing microbial resistance is a severe threat to global public health. One of the most common diseases in the intensive care unit is ventilator-associated pneumonia.
Methods: The method of this research was non-interactive and descriptive. This study was carried out from January to March 2018, at the Golestan Hospital of Ahvaz. Patients with ventilator-associated pneumonia (VAP) were included in the study. The prevalence of resistant gram-negative microorganisms was studied through reported laboratory antibiogram results of cultures.
Results: From 373 hospitalized patients, 38 (10.2%) were diagnosed with VAP. From the 57 respiratory cultures performed, overall 90 microorganisms were isolated, from which Enterobacter with 36 cases (39.5%) and E.Coli with 28 cases (30.7%) were most frequently compared to other organisms. From the 90 organisms responsible for the infection, 43 cases (47.2%) were Multiple drug-resistant (MDR)  microorganisms and 47 (51.6%) were Extensively drug-resistant (XDR) microorganisms. Enterobacter and E.Coli were the most prevalent MDR microorganisms with 17 cases (39.5%) and 13 (30.2%), respectively. Also, these two microorganisms were the most abundant XDR microorganisms with 19 cases (40.4%) and 15 (31.9%), respectively.
Conclusion:The results show the requirement of robust antibiotic monitoring and the optimization of antibiotic use in order to prevent the progression of antibiotic resistance in these units.