saeed mohammad soleymani

It is known that in certain situations, such as heart failure, hypertonic saline can facilitate fluid removal by diuretics — especially loop diuretics — which improve the pathophysiological condition and reduce symptoms in hospitalized ICU patients.

Our study aimed to evaluate the effect of adding 5% NaCl solution to loop diuretics in managing edema and increasing urine volume in critically ill patients with edema.

This study was designed as a two-arm, parallel-group, randomized, open-label clinical trial with blinded outcome assessment. Critically ill adult patients with 2+ edema or greater were included in the study and randomly allocated into two groups: Intervention and control. In the intervention group, patients received 20 mg of furosemide plus 50 mL of hypertonic saline; in the control group, patients received 20 mg of furosemide plus 50 mL of normal saline. Both were infused over 30 minutes, three times daily for 48 hours. Changes in urine output and edema were assessed.

Twenty-eight patients were recruited and randomly allocated into intervention and control arms, with 14 patients in each group. The two groups were similar in terms of baseline demographic and laboratory characteristics. Urine volume increased significantly in both groups at 24 and 48 hours after the intervention; however, there were no statistically significant differences in edema changes, total urine output, or changes in urine volume between the two groups at 24 and 48 hours post-enrollment. After the trial, the percentage of patients with 4+ edema in the intervention group decreased from 21.43% to 0%, and in the control group from 7.14% to 0%. Edema graded 1+ increased from 0% to 28.57% and 42.86% in the intervention and control groups, respectively. Additionally, urine output in the control group increased from 1,550 mL to 4,450 mL per day, and in the intervention group from 2,025 mL to 3,600 mL per day, 48 hours after the start of the study.

The results showed that critically ill patients hospitalized in the intensive care unit (ICU) with edema respond well to diuretic therapy. However, adding hypertonic saline to loop diuretics does not demonstrate a synergistic effect in these patients. Further studies with a larger sample size or a higher dose of saline and diuretic are recommended.

Spinal surgery can be performed under either general anesthesia (GA) or regional anesthesia (RA).

This study compared outcomes between two groups of patients undergoing spinal neurosurgery with RA versus GA.

This randomized clinical trial was conducted in the Neurosurgery Ward of Imam Hossein Hospital, Tehran, Iran, from 2021-08-23 to 2022-08-23. Of 126 patients initially enrolled for spinal surgery, 26 were excluded. The remaining 100 patients were randomized into GA (n = 49) and RA (n = 51) groups. The primary outcome was operation duration. Secondary outcomes included blood loss, pain, hospital stay, and vital signs.

Baseline characteristics (mean age, gender, and surgery type) were similar between groups. Operation duration and anesthesia time were significantly shorter in the RA group [80.8 ± 27.9 vs 104.1 ± 43.7 minutes (P = 0.002) and 121.0 ± 30.6 vs 148.3 ± 43.8 minutes (P < 0.001), respectively]. Bleeding, nausea, and vomiting were higher in the RA group, while muscle relaxation was greater in the GA group (P < 0.05). Acetaminophen consumption was significantly higher in the GA group (P = 0.011). Both patient and surgeon satisfaction were significantly higher with RA (P < 0.05). Hemodynamics and headache incidence were comparable between groups.

Regional anesthesia resulted in shorter surgery times and was preferred by both patients and surgeons for spinal procedures. Additionally, RA significantly reduced the need for analgesic administration.

Prophylactic antibiotics can reduce post-surgical infection rates, but their improper use in surgery remains a significant concern. This misuse leads to adverse drug reactions, increased bacterial resistance, and unnecessary hospital costs.

This study aimed to examine and compare prophylactic antibiotic prescribing practices in general surgery departments at two Tehran university hospitals, in relation to established guidelines.

A cross-sectional study was conducted on 194 surgical patients. Data collection included demographic details, surgery type, and antibiotic prophylaxis protocols, covering medication type, dosage, pre-surgical timing, and prophylaxis duration.

The study included 27.8% clean surgeries and 72.2% clean-contaminated surgeries. Cefazolin was the primary antibiotic prescribed. According to the American Society of Health-System Pharmacists (ASHP) treatment guidelines, 10% of patients received antibiotics without proper indication. Among the 90 cases requiring antibiotic prophylaxis, appropriate antibiotic selection occurred in 39.0% of cases at Rasul Akram Hospital and 41.5% at Firouzgar Hospital. In these cases, errors were noted in dosing (79.8%), pre-operative timing (97.4%), and administration protocol (100%). Only 33% of cases followed the optimal prophylaxis duration.

These hospitals require an evidence-based antibiotic prescription program that adheres to clinical guidelines and includes close monitoring of implementation. Regular training and review of clinical guidelines are essential for all healthcare professionals.

 Pharmacists perform a diverse range of activities and services in the field of pharmaceutical care. Therefore, the quantitative and qualitative monitoring of these pharmaceutical services in hospital wards is essential. Since monitoring such services in hospitals requires a valid instrument, the aim of this research is to develop and conduct a scientometric evaluation of a questionnaire to quantify the quality of pharmaceutical care services in general hospital wards.

This methodological research was conducted between December 2023 and July 2024. To compile the questionnaire, the relevant areas were first identified. Subsequently, questions related to these areas were developed through a focused group discussion. Next, the appropriate scoring method was determined, and the initial questionnaire was constructed in two parts (technical and professional), formatted as a checklist. The content validity of the instrument was assessed in terms of clarity, simplicity, relevance, and necessity of each question. Internal consistency of the questionnaire was assessed using Cronbach's alpha.

The mean content validity ratio of the technical part was 0.84 and 0.88 for the professional part. Also, the content validity index was 0.85 for the technical and 0.84 for the professional part. The alpha values were 0.771 for the first part and 0.773 for the second part, indicating an acceptable internal consistency.

While introducing a practical instrument, our results revealed acceptable validity and reliability indices for it. This tool can be used to evaluate and quantify pharmaceutical care services in hospital wards, and also as an indicator to identify high-risk areas where medication errors could occur.

Recently, retrobulbar injection of liposomal amphotericin B has been explored as an alternative treatment of rhino-orbital-cerebral mucormycosis.

This study aims to measure amphotericin B concentration in the periocular fat tissue following intravenous, retrobulbar, and combined intravenous and retrobulbar injections.

In this study, 45 rats were divided into 15 groups, receiving either intravenous, retrobulbar, or combined intravenous and retrobulbar injections. Three groups received the same dose of liposomal amphotericin B. Rats were sacrificed at 4-, 6-, and 24-hours post-injection and the periocular fat tissue was analyzed for amphotericin B concentration using HPLC.

Results showed that amphotericin B concentrations after intravenous injection of 10 mg/kg were 0.0001, 0.1154, and 0.0693 μg/mL at 4, 6, and 24 hours, respectively; for 15 mg/kg, the concentrations were 0.0339, 0.3534, and 0.4209 μg/mL. Retrobulbar injection resulted in concentrations of 8.8965, 9.8124, and 9.4156 μg/mL. Combined injections (10 mg/kg IV + 0.25 mg/kg retrobulbar) yielded concentrations of 8.8401, 7.8869, and 8.6409 μg/mL, while the combined 15 mg/kg IV + 0.25 mg/kg retrobulbar yielded 8.1940, 8.5277, and 9.0889 μg/mL.

The findings indicate that retrobulbar injection of liposomal amphotericin B achieves suitable drug concentrations in periocular tissue, suggesting that for rhino-orbital-cerebral mucormycosis, retrobulbar injection alone may be sufficient, potentially eliminating the need for intravenous administration.

Cetirizine is a second-generation antihistamine with anti-allergy and anti-itching properties. The topical formulation of this medicine is used in androgenic alopecia treatment. Due to the hydrophilic nature of cetirizine, its skin absorption is negligible, so to increase its absorption, various enhancers were examined to see which can be used in the design of a topical formulation. First, the skin was exposed to enhancers, including eucalyptus, menthol, Tween 80, propylene glycol, and oleic acid, for 1 or 2 hours. Then, the permeability parameters of the cetirizine solution and the structural changes of the skin after exposure to enhancers were analyzed by differential scanning calorimetry (DSC) and Fourier-transform infrared spectroscopy (FTIR) techniques. The obtained results show that all used enhancers increased the permeability of the drug cetirizine compared to water. Various mechanisms, such as liquefaction of lipids, destruction of lipid structure, and irreversible denaturation of intracellular keratin, are involved in the increase in drug penetration caused by eucalyptus, mint, Tween 80, propylene glycol, and oleic acid. The results showed that among the studied absorption enhancers, eucalyptus and Tween 80 had the strongest, and propylene glycol had the weakest absorption enhancement effect after 2- and 1-hour pre-contact, respectively.

Caffeine is an edible chemical compound obtained from various plants, such as tea and coffee. Caffeine is an alkaloid that is highly hydrophilic and has limited skin permeability. The lipophilic nature of the stratum corneum is a major barrier to the passage of this substance through the skin. Topical drug delivery systems can effectively transfer caffeine to the skin.

This study investigated the effect of pretreatment time with chemical enhancers on caffeine’s skin permeation.

The skin was subjected to additives such as sodium lauryl sulfate, sodium lauryl ethyl sulfate, tynoline, nanoxinol, and lecithin for 5, 15, and 30 minutes. Then, the parameters of caffeine permeability and structural changes in the skin due to additive adsorption were studied using Fourier Transform Infrared (FT-IR) spectrometry.

The enhancers increased the permeation of caffeine through the skin. There are different mechanisms for penetration enhancers, including lipid liquefaction, disruption of lipid bilayers, and irreversible denaturation of intracellular keratin.

Sodium lauryl sulfate can affect the skin permeability of caffeine.

Background and

Minoxidil is one of the agents that can treat hair growth disorders, including alopecia, by increasing the anagen period. Due to the nature of minoxidil, the permeability of the drug to the skin surface is negligible. Therefore, the purpose of this study was to design and evaluate microemulsion formulations in order to increase skin permeability of minoxidil.

Microemulsions containing 2% minoxidil were prepared with an appropriate amount of oil phase, surfactant, and co-surfactant. The medicinal substance was dissolved in the oily phase. The physicochemical properties of the microemulsions, including particle size, viscosity, release, skin permeation through rat skin as well as the rate of drug permeation through rat skin, were evaluated using Franz cells.

The particle size of microemulsions was in the range of 5.45-10.4 nm, viscosity was 113.2-199.2 centipoise. This study showed that the parameters of drug release percentage in the second hour, drug release percentage in the 24th hour, viscosity and Dapp were significantly related to independent variables(P<0.05). Increasing the percentage of water and the percentage of oil has increased the amount of drug release in 24 hours. Increasing the percentage of oil and decreasing the percentage of water can lead to an increase in viscosity, and increasing the percentage of water can increase the amount of Dapp in microemulsions.

The prepared formulations were able to significantly increase the skin permeability of minoxidil.

 Finasteride is a 5-alpha reductase inhibitor used to treat hair loss and acne. The skin permeation of finasteride is one of the main challenges associated with dermal drug delivery. One way to overcome the skin barrier is to use penetration enhancers. The purpose of this study was to investigate the effect of some penetration enhancers on finasteride permeability on the skin, as well as the effect of pretreatment time on their efficacy.

 In order to determine the effect of penetration enhancers on the skin permeability of finasteride, the skin was exposed to clove oil, urea, and lyophilized powder of grape seed extract (LPGSE) at different pretreatment times (2, 4 h), and then the permeability parameters were determined by passing the drug through the skin.

 The results of this study showed that clove oil, urea, and LPGSE increased the transfer of finasteride from the skin. The highest rate of permeation was observed with clove oil (4 h), and the least permeability was observed with urea (4 h).

 Increasing the pretreatment time with clove oil and LPGSE increases the permeability of finasteride. Meanwhile, the increase in pretreatment time with urea reduces the penetration of finasteride from the skin due to reversible effects.

 This study aimed to examine the uptake of the model therapeutic agent, minoxidil, through the skin, under the influence of different vehicles. Therefore, the effect of different penetration enhancers such as Propylene glycol, water, ethanol, transcutol P, caprylic acid, and Isopropyl alcohol were evaluated on skin permeability of minoxidil through rat skin.

 The skin permeability of minoxidil on rat skin was analyzed through a Franz cell by evaluating the parameters, including Jss, ERflux, ERD, and ERp. The enhancement mechanisms were studied by comparing FT-IR peak intensities for asymmetric and symmetric C-H stretching, ester C=O stretching, and Amide peaks. The mean transition temperature (Tm) and their enthalpies (ΔH) were investigated by the DSC technique.

 Caprylic acid had the highest diffusion coefficient enhancement ratio (ERD), followed by propylene glycol and water. All solvents have ERD flux enhancement ratio. Solubility in the stratum corneum limited partitioning. All carriers enhanced drug permeability from rat skin, according to FTIR and DSC.

 Caprylic acid is an effective topical vehicle for minoxidil due to greater partitioning and diffusion through rat skin.

Tadalafil has gained wide clinical acceptance in treatment of erectile dysfunction due to its long treatment window and lower potential for visual impairment. Transdermal drug delivery prevents systemic elimination, drug-drug and food-drug interactions, and reduces side effects by reducing the dose of the drug. The aim of this study was to evaluate the effect of microemulsion formulation on dermatological drug delivery of Tadalafil in rat skin.

In this laboratory study, Tadalafil microemulsions were prepared using a phase-diagram method with an appropriate ratio of oil and water mixture. Factorial design with three variables in two levels was performed to prepare eight formulations. Microemulsions containing 0.05 Tadalafil were prepared with an appropriate amount of oil phase (Oleic acid, Transcotol P), surfactant (Tween 80 and Span 20), and co-surfactant (Propylene Glycol). The drug was dissolved in the oil phase. The physicochemical properties of these microemulsions were evaluated using Franz Cells.

The droplet size of microemulsions ranged less than 60 nm and the viscosity ranged between 114.2 and 239.2 cpz. Parameters, including pH, drug release percentage in two hour and 24 hours, viscosity, Tlag and Dapp were significantly associated with independent variables (P<0.05).

The release kinetics of the drugs in selected microemulsions showed that compared to the Tadalafil solution, release occurs over time. All microemulsions significantly increase the flux coefficient and skin permeability.

Piroxicam is a non-steroidal anti-inflammatory medication for treating fever, discomfort, and inflammation. In addition, piroxicam inhibits cyclooxygenase and lowers prostaglandin synthesis, resulting in analgesic and anti-inflammatory effects.

This study used Franz diffusion cells made from rat skin primed with sesame, eucalyptus, olive, menthol, clove, and sunflower oils.

Control was hydrated rat skin. Permeability measurements include steady-state flux (Jss), permeability coefficient (Kp), and diffusion coefficient (D). FT-IR was used to compare changes in peak position, differential scanning calorimeter (DSC), mean transition temperature, and the permeability enhancement methods of the penetration enhancer (Tm). The skin acted as a barrier to piroxicam permeability throughout the whole surface, indicating that drug flux was limited by diffusion into the skin.

The steady-state flux (Jss) of all penetration enhancers were not significantly different from control, except for clove and menthol oil (4 hours treated) and olive oil (2 and 4 hours treated).

Penetration enhancers improved drug permeability through rat skin. Sesame oil, menthol oil, and sesame oil were found to have higher ERflux, ERD, and ERP ratios than water-hydrated skin due to lipid fluidization, lipid structure disruption, and irreversible keratin denaturation.

Transdermal permeability refers to the delivery of medication to the body through the skin for local or systemic treatment. Transdermal drug delivery systems have not liver first pass effect and gastrointestinal adverse reaction. The use of chemical penetration enhancers and physical absorption systems are obsolete because there are expensive and changes of the skin structure, and the future look at the use of novel drug delivery systems. Nano-carriers is one of the most important new technologies in the field of novel drug delivery. Nanoparticle formulations have about 10 to 100 nanometers. Smaller particles are absorbing more easily than the surface of the skin.

In the present study, a review of previous studies on the use of Nano technology in transdermal drug delivery systems introduced them and their transdermal permeability was paid.

Nanotechnology in different routes and formulations has the ability to increase the permeability of therapeutic drugs depending on their characteristics, the physicochemical characteristics of the drugs, and the therapeutic goals one can choose.

Octyl methoxycinnamate is one of the ingredients in sunscreen products. The main aim of this study was to investigate the effect of different enhancers of in vitro skin permeability of Octyl methoxycinnamate. Octyl methoxycinnamate permeability parameters were evaluated through the whole skin of the rat with and without chemical enhancers including eucalyptus oil, urea, menthol and olive oil by Franz cell diffusion. The effects of enhancers on skin structure were also studied using DSC and FT-IR techniques. The skin prevented the permeability of Octyl methoxycinnamate so that after 24 hours less than 3% of the substance passed through the skin. The results of this study showed that by increasing the time, it is possible to increase the skin permeation and the highest rate of skin absorption were corresponded to olive oil (ERflux=63.074), eucalyptus oil (ERflux=48.78) and menthol (ERflux=33.5), respectively while the least amount of skin absorption was related to urea (ERflux=29.53). Chemical penetration enhancers are substances that interfere with the complex structure of the skin and protein lipids. Two endothermic transitions were obtained at about 67 (Tm1) and 112 ° C (Tm2) in thermogram of the hydrated whole rat skin. Tm1 and Tm2 seems to be due to the melting of the lipids and the irreversible intracellular keratin or melting of the lipid-protein (keratin) complex, respectively. The amount of Tm1, ΔH1 and ΔH2 were decreased by all penetration enhancers compared to the hydrated skin. The FT-IR results suggested the mechanism of increasing absorption effect by lipid fluidization and lipid extraction. All of penetration enhancers used in this study significantly increased the skin permeability of Octyl methoxycinnamate.

Finasteride is a pharmaceutical agent that treats hair loss and acne with hormonalpatterns. Due to its poor water solubility, and the smaller surface area in comparison to totalskin surface area, penetration of the drug into hair follicles and skin is low. The aim of thisresearch was to formulate, characterize and evaluate in vitro skin permeability of finasteridemicroemulsions (MEs).

Finasteride MEs were prepared using a pseudo-ternary phase diagram method withan appropriate ratio of oil mixture, surfactant-co-surfactant mixture and water. MEs containing1% finasteride were prepared with a suitable amount of oily phase and surfactant and cosurfactant.The physicochemical properties of these MEs and in vitro skin permeability of MEswere evaluated.

The results showed that the mean droplet size range of ME samples was 5–17 nm andpH was 5.1–5.7. The viscosity of MEs ranged from 86.4–209.6 cps. The drug release profileshowed that 49.510% of the drug was released (ME-F-6) over the 24 hours of the experiment.The kinetics of drug release from all selected MEs were approximately described by Higuchiand first-order modeling. All ME formulations with different compositions and propertiessignificantly increased flux and permeability coefficient from rat skin. The selected MEs exhibit99.9% finasteride after six months of storage.

This study showed that any change in the content and composition of MEs couldchange the physical and chemical properties in addition to ME permeability parameters. TheMEs increased permeability of the skin to finasteride.

Thisstudy is aimed to design a tool for evaluating the quality and effectiveness of educational films in the field of medical sciences. By using the guidelines provided and implementing corrections, two questionnairesweredesigned to evaluate the film by technical and educational aspects, respectively.Then, content validity index of the questionnaires was determined based on the comments of 20 specialists in the field of filmmaking and educational points, the faculty members in the field of medical sciences, and by using the Lawshe method, and the coefficient of variation ratio. To assess the reliability of the questionnaires, the split-half method was carried out on 50 chosen individuals. The Cronbach's coefficient alpha and theintraclass correlation coefficient (ICC) test were used to calculate the repeatability of the forms in order to determine the internal consistency of the questionnaires. There was a suitable content validity for almost all questions of both forms (CVR = 0.99). Also, the Content Validity Index (CVI) was at least acceptable in most aspects of the theoretical teaching questionnaires (CVI = 0.789). Meanwhile, both of these forms had acceptable reliability. The reliability of the questionnaires was calculated using Cronbach's alpha coefficient of 0.89, which indicates the questionnaires have a high degree of internal correlation and high repeatability (ICC = 0.989). According to the results obtained in this study, questionnaires provided for using educational development systems in the medical sciences have a desirable and relatively reliable validity.