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The high prevalence of concomitant chronic illnesses and the resulting higher number of medications in the elderly population increase the risk of adverse drug reactions due to drug-drug interactions (DDIs) and potentially inappropriate medications (PIMs). Therefore, the aim of this study was to investigate the prevalence and factors associated with DDIs and PIMs in outpatient geriatrics. In this cross-sectional study, 1512 prescriptions belonging to patients aged ≥65 years from five public pharmacies in Tehran were evaluated. Clinically relevant (C, D, and X) and significant DDIs (D and X) were documented according to the Lexicomp®. Additionally, Zhan criteria were used to detect PIMs. At least one clinically relevant DDI was detected in 61.7% of the prescriptions containing ≥2 medications. The largest percentage of prescriptions with DDIs was prescribed by cardiologists (74.3%). The number of medications in prescriptions and the specialty of the prescriber significantly affected both clinically relevant and significant DDIs in a logistic regression model. At least one PIM was identified in 16.3% of the prescriptions. General practitioners (GPs) were the largest prescribers of PIMs. The mean number of medications was significantly higher in prescriptions with PIMs. In conclusion, clinically relevant DDIs are frequent in the elderly. In terms of PIMs, more attention should be paid to the education of GPs.

Introduction: High frequency of adverse drug reactions (ADRs) challenges multiple sclerosis (MS) treatment. This study aims to assess the nature and frequency of ADRs induced by MS medications in an observational cross-sectional study. Methods: ADRs of all outpatients who had seen a neurologist and had received at least one disease-modifying therapy (DMT) for MS during the last three months were investigated. Results: A total of 484 ADRs were detected in these patients. The preventability rate was 5.9%, and 0.61% of reactions were serious. Conclusion: The high frequency of adverse drug reactions in this study shows a strong need for strategy planning to increase patients' adherence to treatment. [ABSTRACT FROM AUTHOR]

Purpose: Oral mucositis (OM) is the most frequent side effect of radiation. Selenium deficiency leads to increased levels of free oxygen radicals and the selenium level tends to fall during radiotherapy. Hence, in this double-blind randomised controlled clinical trial, the effect of selenium was assessed in patients receiving radiation.Materials and Methods: Patients with head and neck cancer who were candidates to receive radiation were instructed to use selenium 200 mcg tablets twice daily. The grade of OM was evaluated by the World Health Organization (WHO) grading system on a weekly basis. The selenium level was measured at baseline and at the end of the radiation.Results: Seventy-one patients with head and neck cancer (37 in the selenium group, 34 in the placebo group) were enrolled in the study. The cumulative incidence of OM (grade 1-4) was 97.3% in the selenium and 100% in placebo group (p value: 0.79), and difference in the mean serum selenium level at the end of radiation was not statistically significant between the two groups (p value 0.24) Conclusion: Selenium supplementation does not appear to affect the selenium level as well as the severity and duration of OM. It is supposed that higher doses may be effective in the prevention of RT-mucositis. This trial was registered in the Iranian Registry of Clinical Trials accessible at www.irct.ir (ID No. IRCT2014072718612N1). [ABSTRACT FROM AUTHOR]

Introduction: Weight management is a new public health role for community pharmacists in many countries. Lack of expertise is one of the key barriers to counseling obese patients. We evaluated the comparative efficacy of three alternative continuing education (CE) meetings on weight management. Methods: We designed a randomized controlled trial comparing didactic lecture, lecture plus case discussion, and lecture plus small-group training. It was conducted in 2011 in Tehran. Pharmacists' knowledge, attitudes, and competence were evaluated immediately before, immediately after and one month after each meeting via standardized questionnaires and case vignettes. Participants' satisfaction was evaluated after each meeting. Data were analyzed using repeated measure analysis of variance and chi-squared tests. Results: Sixty pharmacists were randomly allocated to each study arm. There were no demographic differences between the arms at the baseline. The knowledge scores significantly improved for all interventions over time. At the follow-up, the small-group training arm obtained significantly higher knowledge scores (p less than 0.001, effect size = 0.54). The competence scores in lecture plus case discussion and lecture plus small-group training meetings improved over time (effect size 0.14 and 0.34; difference nonsignificant). Small-group training resulted in significantly higher satisfaction scores (p = 0.005). The interventions' effects on attitudes were similar. Discussion: This is the first study on the implementation and efficacy of various types of CE meetings for community pharmacists to provide weight management services. Lecture plus small group training resulted in better learning retention over time and higher satisfaction. Future studies should evaluate the effects of various types of CE meetings on pharmacists' behavior and their cost-effectiveness. (Contains 3 figures and 4 tables.)

Actinic keratosis (AK) is a pre-cancerous skin lesion, associated with development of squamous cell carcinoma. Current treatment options are limited. To compare the efficacy and safety of topical 5-fluorouracil cream (5-FU) and potassium hydroxide 5% (KOH) in the treatment of AK. Eighteen patients with AK applied KOH solution or 5-FU on each side of their scalp/face, randomly. The efficacy and safety of these treatments were compared. Thirteen (118 lesions) and ten (83 lesions) patients were successfully followed for one and three months, respectively. After one month, KOH showed a better clinical response (81% vs. 58%; p-value = 0.007) and dermoscopic response (KOH, 65% vs. 5-FU, 46%; p-value = 0.04); while no differences were noted after three months (clinical response, 83% vs.70%, p-value = 0.1; dermoscopic response, 76% vs. 59%, p-value = 0.1). No significant differences in the recurrence rate of the lesion between the two groups were noted at the end of the third month (p-value = 0.5). Regarding the safety of the treatments, the risk of developing erythema, scaling, sand swelling was higher in 5-FU group (p-value < 0.0001, for all), while more patients in KOH group had erosion and ulcer (p-value < 0.001 for both). KOH was up to 96% less expensive than 5-FU. Low number of patients and short-term follow-up limited the analysis. KOH solution offers a faster and less expensive resolution of AK lesions than does 5-FU. IRCT20180909040978N1 [ABSTRACT FROM AUTHOR]