Search

Background: Acute lymphoblastic leukemia (ALL) has a high prevalence at early age and in children and regard to life expectancy index this disease cause to losing many years of life in these patients. Two well-known European protocols called United Kingdom (UK-ALL) and Berlin-Frankfurt-Munster (BFM-ALL) protocols are used to treat the disease in most countries of the world and in Iran, so the objective of this study is modelling of the treatment process using both protocols to estimate more ‎cost-effectiveness method. Methods: A decision tree model was applied to depict the real treatment process to calculate costs per quality-adjusted life-year (QALY). Total costs were included to the model. Results: The cost effectiveness ratio of UK-ALL is lower than BFM-ALL (1145.52 USD /3.87 QALY for UK-ALL and 1942.35 USD /3.02 QALY for BFM-ALL). Therefore, the UK-ALL is dominant and BFM-ALL is dominated.‎ Conclusions: The modeling results showed a double difference between the two studied options so to better cancer management, policymakers and oncologist ‎should advocate the economic evaluation methods and modeling to select a real option in the treatment of patients to save resources like UK-ALL.

Context: Cigarette smoking is a global public health concern, particularly in developing countries. Saudi Arabia has a high prevalence of smoking among young individuals, highlighting the need for interventions to address this issue. Aims: This study aimed to evaluate the awareness, attitude, smoking rates, and perception of health risks among young individuals in the Jazan region of Saudi Arabia. The goal was to identify areas for improvement and develop effective strategies to combat smoking and promote healthier lifestyles. Methods and Materials: A cross-sectional survey was conducted at the out-patient department of the College of Dentistry, Jazan University, over a 3-month period. A questionnaire consisting of 15 open-ended questions was administered to eligible patients. Statistical Analysis Used: Statistical analysis was performed using the Chi-squared test with a P- value of

Introduction: The COVID-19 pandemic has led to a significant number of patients requiring ICU admission. Survivors of COVID-19 who have been treated in the ICU may experience a decrease in their quality of life (QOL) due to physical, psychological, and social consequences. This review study aims to evaluate the QOL of ICU survivors of the COVID-19 pandemic. Methods: To conduct this review, a systematic literature search was performed using the PubMed, Scopus, and Cochrane Library databases. Studies published between January 2020 and July 2023 were included in this review. The search strategy included keywords such as COVID-19, Intensive Care Units, Survivors, Quality of Life, Outcome Measures. Results: The initial search identified 113 studies, of which 16 met the inclusion criteria and were included in this review. The QOL of ICU survivors of the COVID-19 pandemic was found to be significantly lower than that of the general population, with physical, psychological, and social impairments being the most commonly reported consequences. The use of rehabilitation interventions, such as early mobility and exercise, were found to improve QOL in ICU survivors of the COVID-19 pandemic. Conclusion: COVID-19 patients who require hospitalization and ICU admission may experience short-term and long-term physical, cognitive, emotional, and societal complications and effects after hospital discharge. These complications can significantly impact the patients' health-related quality of life, physical functioning, and psychological well-being.

Abstract Background:: Examining the results of the treatment of patients after discharge from the hospital is an important question in measuring the effectiveness of the treatment of COVID-19 for health systems. Therefore, the purpose of this study is to investigate the Quality of Life of cured patients with covid-19 using the well-known EQ-5D scale. Methods: A systematic search was conducted in known databases including PubMed, Scopus, Web of Science, and EMBASE from the beginning of January 2019 to the beginning of July 2022. After three stages of screening, studies related to the quality of life of COVID-19 survivors were included in the study. Results: Data were categorized and extracted based on the 5 dimensions of the EQ-5D questionnaire. Finally, the analysis of the results of the studies indicated that the utility score was above 70% so, in more than half of them, the most complaint among the dimensions of the questionnaire was related to disruption in usual activities and self-care. Next, mobility and pain had the greatest impact on reducing the quality of life of recovered patients. The least complaints of the discharged patients were related to anxiety/depression. Conclusion: Considering that the symptoms of the disease are present in the cured patients, therefore, it is necessary to follow up these symptoms in order to prevent them from getting worse by simple and important actions. So, an organized follow-up structure in health centers is very important to improve the quality of life for the survivors of COVID-19.

Bone regeneration and repair are complex processes in the adult skeleton, and current research has focused on understanding and controlling these processes. Magnetic nanoparticle (MNP)-based platforms have shown potential in tissue engineering and regenerative medicine through the use of magnetic nanomaterials combined with remotely applied dynamic fields. Previous studies have demonstrated the ability of MNP-induced mechanoactivation to trigger downstream signaling and promote new bone formation. In this study, we aimed to compare the osteogenic induction achieved using the mechanoreceptor targets, Piezo1, Fzd1, Fzd2, and integrin alpha-5. We compared the binding efficacy of different types of agonists (antibodies vs. aptamers) to these receptors. Moreover, we optimized the aptamer concentration (2.5, 5, and 10 μg/mg) for the selected receptor to determine the optimum concentration for promoting bone formation. Our data demonstrated that the mechanoactivation of integrins (CD49e) significantly upregulated the RUNX2 and LEF1 genes compared to other selected receptors. Furthermore, comparing the mechanoactivation of cells using MNPs conjugated with CD49e antibodies and aptamers revealed that MNP–aptamers significantly enhanced the upregulation of LEF1 genes. This suggests that aptamer-mediated mechanoactivation is a promising alternative to antibody-mediated activation. Finally, our results showed that the concentration of the aptamer loaded onto the MNPs strongly influenced the mechanoactivation of the cells. These findings provide valuable insights into the use of MNP platforms for bone regeneration and highlight the potential of aptamers in promoting signaling pathways related to bone formation. The novelty of our study lies in elucidating the unique advantages of aptamers in mediating mechanoactivation, presenting a promising avenue for advancing bone regenerative strategies.

Background: Studies have shown that medication errors and adverse drug reactions are among the main causes of adverse events in hospitals leading to disability and death. Errors occur in the process of drug prescribing, dispensing, and administration. errors are most often made on the patient care units with various risk factors. The aim of the study was to evaluate medication errors in preparation and administration of intravenous medications in two Intensive Care Units of two university hospitals in Tabriz.Methods: An observational and single-blinded study was carried out in the pulmonary ICU of Imam Reza hospital and the ICU of Shohada hospital using general and mono-drug checklists of error-prone situations. 14 different error categories were studied.Results: Total of 367 administrations for 26 different drugs were observed. among 4558 opportunities for errors, 640 errors were identified. Error rate of 15.99 % and 10.96 % were reported in Imam Reza and Shohada hospital, respectively. Wrong rate error and controls during administration had the highest rate of errors in Imam Reza and Shohada hospitals, respectively. Streptokinase in Imam Reza hospital and ceftazidime in Shohada hospital were the drugs with highest error rate. Midnight and 10 PM administration rounds had the highest error rate in Imam Reza and Shohada hospitals, respectively. Error rate in Imam Reza hospital was significantly higher.Conclusion: It is concluded that medication errors occur in all stages like preparation and administration mostly related to rate of administration and controls needed while administration; Strict controlling, training programs, and presence of clinical pharmacists are highly recommended.

Background: Drug utilization review is defined as an authorized, structured, ongoing review of prescribing, dispensing and use of medication. Vancomycin is a narrow-spectrum glycopeptide anti-infective with activity against many gram-positive organisms such as Staphylococci, group A

Background: Pharmacotherapy in elderly patients has become a major concern due to their physiological changes, pharmacokinetic and pharmacodynamics variations, poly-pharmacy, etc. Objective: According to the global population ageing, we aim to evaluate the effect of “Beers Criteria” education on prescribing medications for elderly patients by GPs. Method: 30 General practitioners (GPs) with the highest number of prescriptions were included in this pilot study and their prescriptions for geriatric patients selected randomly during three months. Then the physicians trained on appropriate prescription by prepared pamphlets and booklets which were equipped based on Beers 2015 explicit criteria. In order to evaluate the effect of education, appropriateness of prescriptions was analyzed before and after training GPs. Results: Among 15,447 prescriptions in the first step, 1281 prescriptions related to geriatrics and the prevalence of inappropriate drug prescription was 37.3%. The most inappropriate medications were Bisacodyl, Alprazolam and Hyoscyamine. While, in the next step 1055 of 15,154 prescriptions were related to elderly people and inappropriate drug prescription was 23.6% of total prescriptions. The most common inappropriate medications include Alprazolam, Amitriptyline and Hyoscyamine. Conclusion: According to the results, prevalence of prescribing potentially inappropriate medications for elderly patients is high among GPs and educating “Beers Criteria” significantly reduces prescription of inappropriate medications.

Background: Considering the high prevalence and risk of Deep Vein Thrombosis (DVT) and pulmonary thromboembolism (PTE) in hospitalized patients and the existence of different prophylaxis methods in these patients, the necessity of evaluating the rational administration of heparin or enoxaparin and mechanical prophylaxis is one of the important priorities. The present study aimed to evaluate the consistency of the Heparin/Enoxaparin administration in comparison to guidelines in patients admitted to Imam Reza Hospital. Methods: In this prospective study drug use evaluation (DUE), 300 hospitalized patients receiving venous thrombosis prophylaxis were enrolled, of which 150 patients were selected from surgical wards and 150 patients from internal wards. The demographic and clinical data of patients were collected using clinical records of them. We used the checklists based on the Geneva System for patients admitted to internal wards and the Caprini Questionnaire for patients in surgical wards to evaluate whether patients had received heparin/enoxaparin prophylaxis and mechanical DVT prevention according to guidelines. Results: In the surgical ward, prophylactic treatment for venous thrombosis was administered in 85 (56.6%) patients admitted to surgical wards in accordance with the clinical guideline and in the internal ward, in 42 (28%) patients, with a significant difference between two sections (P: 0.0001). Mechanical prophylaxis, including compressive socks, was performed in 99 (66%) patients in the surgical ward and in the internal ward only in 56 (37.4%) patients, according to the guideline. Drug prophylaxis was administered in surgical wards in 116 (77.3%) patients and in internal wards, in 79 (52.6%) patients according to the guideline.Conclusion: Intravenous thrombosis prophylaxis, according to the guidelines, is more common in patients admitted to surgical wards than in internal wards. But in both sectors, statistics are far from international standards.

Background: The inappropriate use of antibiotic leads to microbial resistance, nosocomial infections and increased hospital costs. The broad-spectrum antibiotics, such as cefepime and piperacillin/tazobactam play an important role in the empiric therapy of serious infections. Methods: Demographic data, duration of prescription, dose, dosage adjustment in renal impairment and accompanied prescribed antibiotics were extracted from medical files. UpToDate and AHFS drug information 2012 were considered as standards of rational prescribing. Data analysis was performed by SPSS 18 software. Results: Drug dosage and indication were appropriate in 16 (23%). The most common antibiotic administered with cefepime was ciprofloxacin (37 cases). In 21 patients, cefepime dosage should have been adjusted according to renal impairment, whereas it has done only in 16 (22.9%) patients. Culture was done in 60 (85.8%) cases. Culture ordered before starting of antibiotics took place in 3(4.2%) patients. In 22(31.4%) patients, the result of culture was negative. Drug dosage and indication were appropriate in 34 (48%). The most common antibiotic administered with tazocin was vancomycin (45 cases). In 9 patients, tazocin dosage should have been adjusted according to renal impairment and it has done. Culture was done in 53 (75.8%) cases. Culture ordered before starting of antibiotics took place in 6(8.57%) patients. In 9(12.8%) patients, the result of culture was negative. Conclusion: The results showed that there was an injudicious use of cefepime and piperacillin/tazobactam at Sina hospital, evidenced by the significant number of inappropriate empiric prescriptions and inappropriate drug modifications, based on the results of microbial cultures and antibiograms.

Considering the recent controversies regarding the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in Coronavirus disease 2019 (COVID-19) patients, and due to the limited published data in this field, we reviewed currently available evidence for the use of NSAIDs in viral respiratory tract infections to help make decisions in this area. Currently, there is insufficient evidence to judge the safety and efficacy of NSAIDs in patients with COVID-19. According to the current evidence, acetaminophen is the choice treatment for symptomatic relief. If the patients’ symptoms are not controlled by acetaminophen, naproxen may be used as an alternative therapy.

Objective: Current literature indicates that the presence of clinical pharmacists in hospitals results in improved patient care, rational drug therapy, and treatment costs. This study assessed the clinical pharmacy services in the intensive care unit (ICU) of a tertiary hospital at Tabriz University of Medical Sciences, Iran. Methods: During a 9-month cross-sectional study (2014–2015), the clinical pharmacy interventions in 27 sessions and educational activities for patients and health-care professionals were randomly assessed based on the Australian guideline and standard of practice for clinical pharmacy. The interventions of clinical pharmacist were evaluated in terms of their clinical importance. Findings: In this study, a total of 832 interventions on 242 patients were performed by the clinical pharmacist, and approximately 93.6% of the interventions were approved by the attending physician. Most interventions concerned adding a new medication to a drug regimen or switching to a needed new medication. Each patient received an average of three interventions. The clinical pharmacist provided drug information to employees and medical staff in 108 of the total 832 interventions (13%). Medical residents who were surveyed indicated that the quality of education, research, and patient care was improved by the attendance of a clinical pharmacist. Conclusion: The results of this study show that the collaboration of a clinical pharmacist with the medical staff of an ICU can improve pharmacotherapy approach and increase the quality of education.

Background: Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in children, often prevalent in children between the age of 2 and 6 years. However, it can lead to a loss of many years of life in these patients. Therefore, considering the importance of quality of life (QOL) for patients during treatment or after treatment discontinuation, and the extent of the therapeutic protocols, tools, and methods used to measure the QOL of children, we have undertaken a comprehensive review of the QOL of these patients. Methods: In designing a review of the outcomes, consultation with internal clinical experts was implemented first to identify relevant keywords and outcomes. We reviewed all English-language studies from 2000 to 2015 based on the Web of Science, PubMed, and Scopus databases. Results: 2621 studies were first identified in relevant electronic databases. However, only 10 studies met our inclusion criteria. Most of the selected studies used Health Utilities Index Mark 2 (HUI2) and 3 (HUI3) for assessing children's QOL. Some were interviewed by proxy, such as parents and even doctors and nurses involved in the treatment process. Most of the studies reported improvement of utility from 0.67% to 0.96% that in survivors varied from 0.71% to 0.94%. Conclusion: The results of this study illustrated that the treatment of patients with ALL in recent years has developed dramatically in different countries; and consequently, the QOL of these patients improved both during and after treatment.

Objective: Acute myocardial infarction (AMI) is one of the main leading causes of mortality and morbidity. Reteplase is a fibrin-specific thrombolytic which is used in the treatment of AMI. There is a limited number of studies reporting the postmarketing adverse drug reactions (ADRs) induced by reteplase. This study was aimed to examine the reteplase pattern of ADR and its associated risk factors in patients with acute ST-elevation myocardial infarction. Methods: A cross-sectional, prospective study in an 8-month period was done at the University affiliated referral cardiovascular center. The Naranjo probability scale and World Health Organization criteria for severity of ADRs were used for assessing the ADRs. The linear regression and logistic regression tests were used to evaluate the correlation between ADRs and risk factors. Findings: The all 20 patients who received reteplase during the study period were entered. The majority of patients (n = 17) experienced at least one ADR. The results showed that the incidence of ADRs was mainly associated with gender and age, and the number of ADRs was associated with the history of diabetes and taking anti-diabetic agents. The gender was the main predictor in the occurrence of ADRs (odds ratio: 32, 95% confidence interval: 1.38–737.45; P = 0.030). Conclusion: The results showed that gender, age, diabetes mellitus, and using of anti-diabetes medications are the risk factors associated with the incidence of ADRs by reteplase.

Objective: Considering the inability of neonates to swallow oral drugs in the form of solid tablets, the lack of appropriate dosage forms for infants, and the necessity to prepare some pills for neonates, the current study investigated dosage accuracy in drugs for neonates prepared from tablets by analyzing the concentrations of final products. Methods: Captopril and spironolactone, oral dosage forms that are not suitable for infants, were chosen as the drug model for this study. Demographic characteristics of nurses providing medications and tablet preparation methods were documented in a random observational method. To determine concentrations of final solutions, 120 drug samples (60 captopril and 60 spironolactone samples) prepared by Neonatal Intensive Care Unit nurses of the Children Cure and Health Hospital of Tabriz University of Medical Sciences were analyzed using high performance liquid chromatography (HPLC) and spectrophotometry. Findings: There was a significant error rate in the concentration of captopril in prepared solutions compared with the ordered dosage. No differences were observed in the demographic characteristics of the nurses and the method of preparation between the two drugs. The only difference related to the preparation technique was that in most cases (70.8%), one whole spironolactone tablet was used, whereas in around 50% of samples in captopril group, half or a quarter of one captopril tablet was utilized for the intended dosage (P = 0.009). Conclusion: This research suggests that the use of a whole tablet instead of a divided tablet in the manual preparation of medication dosage forms for neonates is the most appropriate approach.

Background: It is necessary that we have more information about the quality of life (QOL) of diabetics, their special characteristics and socioeconomical characteristics that affect QOL in type II diabetic patients. The aim of this study was to investigate the QOL in type II diabetic patients and relationship of QOL in type II diabetic patients with socioeconomical and treatment factors in Bojnord City, Iran. Methods: This study was a cross-sectional study. The subjects, in this study, were patients with type II diabetes referring to the diabetes clinic in the city of Bojnord, sampling was done randomly, according to the formula of samples and resources, 218 samples were estimated. For data collection, a two-part questionnaire containing demographic and disease characteristics and QOL questionnaire SF36. After collecting the information and entering data in the software SPSS using χ2 statistics test, one-way ANOVAs, t-test, and correlation coefficient were analyzed. Results: In this study, 218 patients with type II diabetes were analyzed of which 77 (35.3%) were male and 141 (64.7%) were female and most of the cases were married (96.3%). The mean age of the participants was 55.45 ± 11.44 years and also the average weight, body mass index, and duration of disease were 71.94 ± 12.17 kg, 27.18 ± 4.53, and 2720.78 ± 2504.63 days, respectively. The highest average among the eight dimensions of QOL is in physical function. The total score of the QOL was 55.94 ± 18.63. Furthermore, the findings showed that QOL of 66 people (30.3%), 56 people (27.7%), 59 people (27.0%), and 37 people (17.0%) is undesired, poor, good, and desirable, respectively. The results of t-test and ANOVA showed between gender, education, type of treatment and QOL in type II diabetic patients studied; there was a statistically significant difference (P ≤ 0.050). Conclusion: To increase the QOL for diabetics, attention to the self-care training programs and continuous monitoring and regular of patients have an important role.

Objective: Ventilator-associated pneumonia (VAP) described as a secondary and preventable consequence in mechanically ventilated patients, emerges 48 h or more after patients intubation. Considering the high morbidity and mortality rate of VAP and the fact that VAP is preventable, it seemed necessary to evaluate care bundle compliance rate and effect of education on its improvement. Methods: This observational study was conducted on 10 Intensive Care Units (ICUs) of four university affiliated hospitals in three steps. In the first step, VAP care bundle compliance including head of bed (HOB) elevation, endotracheal cuff pressure (ETCP), mouthwash time, utilizing close suction systems, subglottic secretion drainage, type of suction package, and hand wash before suctioning was evaluated. In the second and third steps, ICU staffs were trained and its effect on VAP care bundle compliance was investigated. Finally, an inquiry from nurses was conducted to evaluate the obtained results. Findings: A total of 552 checklists consisting of 294 observations in the pre-education group and 258 observations in the posteducation group were filled. Mean VAP care bundle compliance in pre-education and posteducation stages was 36.5% and 41.2%, respectively (P > 0.05). Except for patients′ mouth washing, there were no improvement in HOB elevation (>30΀), hand washing and ETCP after education. Based on the results of questionnaire received from nurses at the end of study, more than 90% of nurses believed that lack of rigid monitoring of VAP care bundle is a main reason of low adherence for VAP care bundle compliance. Conclusion: The adherence to VAP care bundle was inappropriate. Education seems to be ineffective on improving VAP care bundle compliance. Frequent recall of the necessity of the VAP care bundle and the continuous supervision of ICU staffs is highly recommended.

Objective: Phenytoin is an antiepileptic drug used widely for prophylaxis and treatment of seizure after neurotrauma. Phenytoin has a complex pharmacokinetics and monitoring of its serum concentrations is recommended during treatment. Total phenytoin concentration is routinely measured for monitoring of therapy. In this study, we evaluated the correlation between phenytoin total and free concentrations in neurotrauma critically-ill patients to determine whether the phenytoin total concentration is a reliable predictor of free drug, which is responsible for the therapeutic effects. Methods: A total of 40 adult head trauma patients evaluated for free (unbound) and total serum phenytoin concentrations. Patients were divided into two groups. Group A consists of 20 unconscious patients with severe head injury under mechanical ventilation and Group B consists of 20 conscious self-ventilated patients. Correlation and agreement between total and free phenytoin plasma concentrations were analyzed. Findings: Pearson correlation analysis and Bland-Altman test showed weak to moderate correlation (r = 0.528) and poor agreement between free and total phenytoin concentrations in patients with severe trauma and higher Acute Physiology And Chronic Health Evaluation II (APACHE II) scores (Group A) and good correlation (r = 0.817) and moderate agreement in patients with mild to moderate trauma and lower APACHE II scores (Group B). Conclusion: Our results indicated that total phenytoin serum concentration is not a reliable therapeutic goal for drug monitoring in severely-ill head trauma patients even in the absence of hypoalbuminemia, renal and hepatic failure. It seems justifiable to measure free phenytoin concentration in all severely ill neurotrauma patients.

Enteral feeding tube is employed for feeding of critically ill patients who are unable to eat. In the cases of oral medication administration to enterally fed patients, some potential errors could happen. We report a 53-year-old man who was admitted to intensive care unit (ICU) of a teaching hospital due to the post-CPR hypoxemic encephalopathy. The patient was intubated and underwent mechanical ventilation. A nasogastric (NG) tube was used as the enteral route for nutrition and administration of oral medications. Oral medications were crushed then dissolved in tap water and were given to the patient through NG tube. In present article we report several medication errors occurred during enterally drug administration, including errors in dosage form selection, methods of oral medication administration and drug interactions and incompatibility with nutrition formula. These errors could reduce the effects of drugs and lead to unsuccessful treatment of patient and also could increase the risk of potential adverse drug reactions. Potential leading causes of these errors include lack of drug knowledge among physicians, inadequate training of nurses and lack of pharmacists participation in medical settings.

Background: Health care section as an important social part of a community plays a determining role in people’s health and therefore all people must equally and purposefully enjoy health services and facilities; failure in this regard may lead to unpleasant consequences. Methods: The research is both applied and analytical which ranks the counties of Sistan and Baluchestan province in terms of entitlement to health structural indicators in 2011. Thus, 15 health structural indicators were selected and data were collected from Statistical Center of Iran. Experts’ opinions and FAHP technique were used to weight the indicators. Finally the counties ranked by TOPSIS technique. Data were analyzed using Excel, Expert Choice, and LINGO. Findings: FAHP’s results showed that indicator of health house workers (Behvarz) in health centers was more important and dentist indicator less important than other indicators. Besides, TOPSIS technique showed that Zahedan, Zabol, and Iranshahr were the highest and Delgan, Zaboli, and Sib and Suran were the least entitled counties, respectively. Conclusion: Based on our findings, there seems to be a huge gap between the counties of the province in terms of their entitlement to health structural indicators. It is therefore suggested that authorities of the health section set the priorities according to the counties’ entitlement to the indicators to remove inequalities in the province.

Background: Self-medication is one of the largest social, economic and health problems in developing communities such as Iran. It is considered as an unsafe treatment behavior. This study aimed to assess self-medication status among referring patients to Kashan pharmacies. Methods: This descriptive cross-sectional study was conducted in 2012; 12 pharmacies were selected randomly from 56 pharmacies in Kashan. The data was collected through observation, interviews and semi-structured questionnaire. The data were analyzed through SPSS v.18. Results: About 26% of patients requested drug without a prescription. Of 208 persons, 143 persons (%68.8) were men, and 65 (31.3%) women; 119 (57.2%) had high school or academic education. The most requested drugs were analgesics (36.5%), antibiotics (30.8%), cold remedies (16.8%), gastrointestinal (513.5%), tranquilizers and antidepressants (11.5%). Main excuses for self-medication were having previous experience of using the drug (46.7%) and low importance of the disease (25%). Conclusion: In Iran, the rate of self-medication is very high and analgesics and antibiotics are among the most without-prescription requested drugs. Clearly, providing help to raise public awareness on the over-the-counter (OTC) drugs and prescription-only medicines’ (POM) risks and side effects is needed. According to the reasons mentioned for self-medication immediate action for reducing nonprescription medicine request are essential.

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.

ABSTRACT This study was conducted to determine the antimicrobial susceptibility patterns among common pathogens in the intensive care units (ICUs) of a university hospital in northwestern Iran. A retrospective study was done on laboratory records of patients with nosocomial infection who were admitted to five ICUs of Imam Reza Hospital during a 21-month period from March 2010 to January, 2012. A total number of 556 isolates from 328 patients were evaluated. The most common sites of infections included respiratory (51.7%), urinary (24.8%), and blood (10.4%). The most frequently isolated microorganisms were Enterobacter aerogenes (50.6%) followed by Escherichia coli (16.7%) and Pseudomonas aeruginosa (7.5%). Staphylococcus aureus was the most frequent pathogen among gram-positives (39.7%). The rate of methicillin-resistant Staphylococcus aureus (MRSA) was 87.5%. Multidrug-resistant (MDR) gram-negative bacteria were documented in 25.8% of Acinetobacter, 20% of Klebsiella, and 16.6% of Pseudomonas. The most active antimicrobials were vancomycin (93.5%) followed by amikacin (71.5%) and gentamicin (46%). The overall antibiotic susceptibility was as follows: 36% ciprofloxacin, 19% imipenem, 20% trimethoprim-sulfamethoxazole, 20.5% ceftazidime, and 12% ceftriaxone. Due to the high rate of antimicrobial resistance in the ICU setting, more surveillance and control of the use of antimicrobials is needed to combat infections.