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Background: More than 80% of patients with hematologic  malignancies will develop fever during more than one chemotherapy cycle combined with neutropenia. We aim to evaluate empiric antibiotic strategies in Febrile Neutropenic (FN) cancer patients.
Methods: This is a concurrent study performed in the “Shahid Ghazi” teaching hospital, hematology-oncology center of Tabriz, Iran during the period of December 2011 to September2012. During this period, patients with FN were evaluated in view of antibiotics utilization based on Infectious Disease Society of America (IDSA) and National Comprehensive Cancer Network (NCCN) instructions.
Results: Seventy patients had a total of 91 episodes of FN in the duration of this study. Among them 63 (90%) patients were the cases of acute leukemia. For 88 (96.7 %) patients, imipenem was used as the initial empirical antibiotic regimen. It was changed to piperacillin/tazobactam in 8 (8.8%) of them without indication. Cultures didn’t obtain before the initiation of empirical therapy in 19 (20.9%) episodes. Empiric vancomycin didn’t discontinue after 3 days even if it was not warranted in 23 episodes. In 16 cases vancomycin was switched to teicoplanin. The fluconazole dosages generally given to patients were all suboptimal. Adjusting the dosages of vancomycin or imipenem was not done correctly in 13 (14.29%) episodes.
Conclusion: The results of this study showed that choosing antimicrobial agents and their dosing for prophylaxis and treatment of FN patients and discharge antimicrobial planning of FN patients do not follow the evaluated guidelines. Drug Usage Evaluation studies need to be done regularly in such a center.

Background: Oral aphthous is one of the most common oral mucosal inflammatory disorders which are very painful. There is no definite medical strategy up to now for aphthous treatment. Recently, some researchers have focused on immunomodulatory drugs such as tacrolimus and pimecrolimus in preventing aphthus recurrences. The aim of this study is to assess the effect of pimecrolimus cream against placebo in management of oral minor aphthous.
Methods: The study is a randomized clinical trial, was done in “Shariati” hospital and Isfahan Skin Research Center. 62 patients with minor aphthuos were included and divided randomly to two groups (31 in each). In experimental group, pimecrolimus cream was applied for two weeks and cold cream for the same duration in control group. Patients were followed for 3 and one week; results were assessed in recovery after drug administration. Compared variables between two groups were including: the size of lesions, the time to recovery and pain intensity.
Results: Results showed that mean size lesion in experimental and placebo group after complete recovery reduced (23.6 ±15.3 and 24.8 ±15 mm respectively) but it was not significant (P: 0.1). Mean time for recovery in both groups was 8±2.2 and 9.5±2.5 respectively which was significant in pimecrolimus treated patients (P: 0.014). Also mean degree for pain intensity measured by pain scale method was reduced significantly in test group (6 ± 1.2 before treatment and 5.3 ± 1.1 after treatment, P<0.001).
Conclusion: This study stated that pimecrolimus cream has an appropriate effect in reduction of recovery time and pain in minor aphthous compared to placebo but more clinical studies are needed to better conclusion.

Background: Diabetes mellitus is a chronic disease with a worldwide prevalence and its complications can be prevented with close monitoring of blood glucose. Quality of blood glucose monitoring utilizing glucometers in Iranian hospitalized patients has not been well published in the literature. We evaluated the accuracy and consistency of the results of two devices compared with the standard laboratory method used for measuring glucose levels in a teaching hospital.
Methods: In this study 100 patients with the average age of 57.5 ±17.7 years were randomly selected from 19 wards and their blood glucose were simultaneously measured using Accu-Chek Active®(1) and Cleverchek®(2) (commonly used in the wards) and the conventional laboratory method. Calibration was performed on both devices.
Results: Absolute Mean Difference of the devices 1 and 2 from the laboratory values were 24.3±2.4,and 38.5±4.5, respectively (P: 0.003). Correlation coefficient of the obtained values by glucometers1 and 2 with lab, were 0.82 and 0.52, respectively. Calibration of the devices showed that device 1 was the most consistent device with the laboratory values, and Pearson correlation coefficient between the obtained values as a result of four reiterations for each sample in each device showed that the highest coefficient belonged to the device 1 and the least belonged to the device 2 used in the Ear, Nose, and Throat Departments.
Conclusion: The device 2 used in different wards of the hospital must be calibrated periodically. Furthermore, the device 1 generated closest results to the ones obtained through the laboratory.

Background: Chemotherapy induced nausea and vomiting is an added distress to patients burdened by the illness. In an effort to tackle the emetogenic potential of the agents, guidelines have been proposed to maintain uniformity in prescription and improvement in patient tolerance; but their utility and practice is not consistent. The aim of this clinical audit was to assess the antiemetic.practice and investigate the adherence to antiemetic clinical practice guideline
Methods: We performed an audit of the antiemetic practices in our tertiary referral centre. A.questionnaire based interview was completed at the outpatient visit to tabulate the data
Results: 99 (81.8%) patients received chemotherapy of at least low emetogenic risk. 83 (84%) patients received prophylaxis which was appropriate in 65% based on the our centre’s antiemetic regimen. This was however inappropriate in 76% of patients based on the international practice.parameters
Conclusions: Guidelines are not uniformly representative of all populations and modifications toguidelines based on local data are required to ensure success of such policies. There exist evidence-.practice gaps in antiemetic policies

Backgrounds: All of Long-acting β2-agonists are beneficial in maintenance treatment of asthma but their use in relieving acute asthma attacks is not well known. The aim of this study was to compare rapid bronchodilatory effects of Salmeterol and Formoterol in patient with moderate to severe asthma.
Methods: It was a randomized, double blind, cross-over study on 60 patients with moderate to severe asthma. Patients randomly received 50 micrograms of salmeterol or 18 micrograms of formoterol  and  after  one-week  washed  out  period  exchanged  their  medications. All  patients undergone spirometry for four times (before receiving the drugs, as well as 3, 30 and 60 minutes after drug inhalation) and Forced Expiratory Volume in 1 second (FEV1), Forced Vital Capacity (FVC), FVC percentage predicted value, FEV1/FVC, Peak Expiratory Flow Rate (PEFR) and PEFR percentage predicted value were measured.
Results: Both medications could significantly increase FEV1/FVC and PEFR at 3, 30 and 60 minutes after inhalation (P<0.001 compared to baseline).Three minutes after inhalation of salmeterol and formoterol, FEV1 increased by 8.7% and 12.2% respectively. Formoterol was associated with more increase in the amounts of FEV1 compared to Salmeterol.
Conclusion: This study showed that fromoterol has a more rapid onset of bronchodilating action compared with salmeterol at 3 minutes after inhalation. Both agents had significant increases in FEV1/FVC and PEFR compared to baseline with no significant differences between two drugs.

Background: Pharmacy education has been changed in recent years. Pharmacy students need more practical and clinical skills which come from direct interaction with patients and other health care providers. To achieve this, students need more effective courses and clerkships. In this paper we describe our method to design and evaluate clinical pharmacy clerkship for the first time in Ahvaz Jundishapur University of Medical Sciences (AJUMS).
Methods: To  determine  the  most  beneficial way  of  education  we  designed  a  pilot  study  in educational hospital of AJUMS. After analyzing the conclusions from pilot study, 40 fifth year pharmacy student divided in ten groups and each group had a six week rotation in three different wards under supervision of medical residents. Each student was asked to provide evaluations during six total weeks of three different rotation sites.
Results and Discussion: Clinical pharmacy clerkship led to successfully improved clinical skills for students such as being familiar with different practice environments, direct communication whit patients and medical team and participation in direct patient care activities. All the students participate in the course could pass the final exam and 85% of students believed this would be a necessary education course in their clerkship programs. Although there were some problems but pharmacy students benefited from this course and it gives them advantages in clinical knowledge and professional communication skills.

Polyunsaturated fatty acids (PUFAs) particularly ω-3 PUFAs showed great assure in prevention of cardiovascular diseases (CVD). The evidence for CV benefits of PUFA comes from eicosapentaenoic acid (EPA) with or without docosahexaenoic acid (DHA) in primary prevention, after myocardial infarction (MI), with heart failure (HF). The epidemiologic studies and trials showing the benefits of PUFA, specifically EPA and DHA, in CV prevention and provide potential mechanisms. The target EPA and DHA consumption should be at least 500 mg/day for individuals without basic evident CV disease and at least 800 to 1,000 mg/day for individuals with known coronary heart disease (CHD) and heart failure (HF) and optimal dosing and relative ratio of DHA and EPA ω-3 PUFA that provides maximum cardio-protection at risk of CVD as well in treatment of atherosclerotic, arrhythmic, and primary myocardial disorders.

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