فهرست مطالب tahereh eteraf-oskouei
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برگه ی راهنمای بیمار یا بروشور دارویی، رایج ترین فرمت قابل دسترس اطلاعات نوشتاری برای بیماران محسوب می شود که توسط کارخانجات داروسازی و تحت نظارت سازمان غذا و دارو تهیه و در داخل بسته بندی دارویی قرار داده می شود تا اطلاعات موثق در مورد دارو و دستورالعمل های لازم برای مصرف آن را در اختیار مصرف کننده قرار دهد. کاتالوگ های دارویی نیز برگه ی اطلاعات دارویی دیگری هستند که به دلیل محدودیت های زمانی و مشغله ی زیاد پزشکان، برای به روزرسانی دانش پزشکان در دسترس آنان قرار داده می شود تا در جریان آخرین تحولات دارویی قرار بگیرند. البته امروزه دنیای دیجیتال، ارایه ی خدمات دارویی را با تغییرات شگرفی مواجه کرده است. فناوری های نوین همچون اینترنت اشیاء، هوش مصنوعی، زنجیره ی بلوکی و رایانش ابری تکنولوژی های جدیدی هستند که آینده ی دارودرمانی را بسیار متحول خواهند کرد. تحول دیجیتال منجر به دارودرمانی دقیق، کاهش هزینه ها، صرفه جویی در زمان و نیروی انسانی، دسترسی به انعطاف بیشتر و کارآمدی بهتر در تمام فرایندها می شود. مقاله ی مروری حاضر در مورد وضعیت فعلی، چالش ها و ارتقاء اطلاعات برگه های راهنمای دارویی و اهمیت فناوری های نوین در عرصه ی اطلاع رسانی دارویی نگارش شده است.
کلید واژگان: بروشور دارویی, کاتالوگ دارویی, فناوری اطلاعات, برگه ی راهنمای دارویی بیمار}Background The Patient package inserts are officially published by pharmaceutical companies and authorized by the food and drug administration. The purpose of the package inserts is to provide complete, reliable and safety information about the drug to the consumer. Drug catalogues are another drug information sheet that is made available to physicians due to time constraints and busy schedules to update their knowledge about the existing and novel drugs. Of course, today the digital world has faced tremendous changes in the provision and consumption of pharmaceutical services. Internet of things, artificial intelligence, block chain and cloud computing are new technologies that will revolutionize the future of drug therapy. Digital transformation will lead to accurate drug therapy, cost reduction, saving time and manpower, access to more flexibility and better efficiency in all processes. This review article was about the current situation, challenges and promotion of information provided in the patient package inserts, also the importance of new technologies in the field of medication information.
Keywords: Drug labeling, Pamphlets, Consumer health informatics, Patient education handout} -
Cancer was predicted as the leading cause of death and the most important obstacle to the increased life expectancy in the 21st century worldwide. The World Health Organization (WHO) estimated number of new cases of cancers in 2020 about 19 million, and this number is estimated to be more than 295 300 000 people up to 2040 (more than 55% increase during next 20 years). Standard treatments for cancer include surgery, radiotherapy, and chemotherapy. However, all of these methods have dangerous side effects, so researchers are more interested in finding novel and less risky therapies. In recent years, there has been a great deal of interest in the development of anticancer agents obtained from foods or natural products. The relative safety of natural and food-derived compounds makes them attractive alternatives to conventional cancer treatment drugs. As a result, the majority of people are advised to use complementary and alternative medicine to treat and prevent cancer. In recent years, honey, as a natural product, has attracted many researchers’ attention as an alternative to conventional anticancer drugs. Natural honey has long been used as a medicine and nutrient and its beneficial effects on various diseases in animal and human models have been studied. It was found that it has a wide range of therapeutic properties, including antioxidant, antibacterial, antiviral, anti-fungal, anti-diabetic, anti-inflammatory, anti-hypertensive, antiarrhythmic, wound healing, and liver protection benefits. This article aimed to review the role of natural honey in the prevention and treatment of a number of important cancers and their subsequent complications
Keywords: Natural honey, Human diseases, Cancer prevention, Cancer treatment} -
فصلنامه سالمند، پیاپی 62 (تابستان 1400)، صص 274 -287اهداف
تجویز دارو برای سالمندان یک موضوع مهم بهداشتی است. در این مطالعه، وضعیت تجویز داروهای نامناسب برای سالمندان در نسخ پزشکان عمومی مورد بررسی قرار گرفت.
مواد و روش ها:
تعداد 16842 نسخه از نسخ تجویز شده توسط پزشکان عمومی شهرستان تبریز در سال 1398-1397 مربوط به بیمه تامین اجتماعی و بیمه سلامت انتخاب شده و 1500 نسخه متعلق به سالمندان 65 سال و بالاتر مورد بررسی گرفت. نامناسب بودن تجویز داروها با استفاده از معیار Beers ویرایش 2019 تعیین شده و در صورت وجود داروهای مناسب، جایگزین آنها پیشنهاد گردید.
یافته هامیانگین تعداد اقلام دارویی در هر نسخه 5/1±93/3 قلم و میانگین تعداد داروی نامناسب در هر نسخه 0/8±0/74 بود. فراوانی بیش دارویی (پلی فارماسی) در 32/6 درصد نسخ مورد مطالعه مشاهده شد و 53/9 درصد نسخ نیز حاوی حداقل یک داروی نامناسب برای سالمندان بودند. داروهای ضدالتهاب غیراستروییدی، ضددردها و آنتی هیستامین ها به ترتیب با 24/2، 21/4 و 10/9 درصد بیشترین گروه های دارویی تجویزی نامناسب برای سالمندان بودند. شایع ترین داروهای نامناسب تجویزی نیز به ترتیب شامل Adult cold، Diclofenac، Glibenclamide، Ketorolac و Diphenhydramine بودند.
نتیجه گیری:
نتایج نشان داد که حدود 54 درصد نسخ حاوی داروی نامناسب برای سالمندان بوده و پلی فارماسی نیز در حدود یک سوم نسخ وجود داشت. برای بهبود این شرایط ضرورت دارد شیوه های آموزشی دانشجویان پزشکی اصلاح شده و دوره های آموزشی و بازآموزی متناسب طب سالمندی برای آنان و پزشکان عمومی به صورت مستمر برگزار گردد. نظارت های وزارت بهداشت و سازمان نظام پزشکی نیز می تواند نقش مهمی در اصلاح وضع موجود ایفا نماید.
کلید واژگان: داروهای نامناسب, سالمندان, پزشکان عمومی, معیار Beers, تبریز}ObjectivesPrescribing medication for the elderly is an important health issue. In this study, the status of prescribing inappropriate drugs for the elderly in general practitioners prescriptions was investigated.
Methods & Materials:
The sample size consisted of 16842 prescriptions of general practitioners belongs to two insurance systems (Social Insurance and Health Insurance Organizations) in Tabriz city during 2019. Among the sample, 1500 prescriptions were evaluated for adults 65 years and older. The Beers criterion (version 2019) was used to assess inappropriate medications and suggestion of their alternatives if needed.
ResultsThe mean number of drugs in each prescription was 3.93±1.5 and the average of inappropriate drugs in each prescription was 0.74±0.8. Polypharmacy was 32.6%, and 53.9% of the prescriptions had at least one inappropriate medication. Non-steroidal anti-inflammatory drugs, analgesics and antihistamines were the most inappropriate prescribed drug groups for the elderly (24.2, 21.4 and 10.9%, respectively). The most common inappropriate prescription medications were Adult cold, Diclofenac, Glibenclamide, Ketorolac and Diphenhydramine, respectively.
ConclusionThe results showed that about 54% of the prescriptions by general practitioners for elderly people contained inappropriate medications and polypharmacy was present in about one third of the prescriptions. In order to improve this condition, it is necessary to modify the educational methods of medical students and appropriate training and continuous retraining courses in the elderly medicine field will be provided for the students and general practitioners. Moreover, supervisions by Ministry of Health and Medical Council of Iran can play an important role in improving the current situation.
Keywords: Inappropriate drugs, Elderly, General practitioners, Beers criterion, Tabriz} -
سابقه و هدف
بروشور دارویی ورقه کاغذی است که با هدف فراهم کردن اطلاعات ضروری جهت استفاده موثر و ایمن از دارو، در داخل بسته دارویی قرار می گیرد. از آن جایی که بروشورها از منابع اصلی کسب اطلاعات در مورد داروها هستند، باید برای عموم مردم قابل درک باشند. مطالعه حاضر با هدف بررسی میزان آگاهی و رضایت مندی بیماران مراجعه کننده به داروخانه های آموزشی دانشکده داروسازی تبریز از بروشورهای دارویی ایرانی، انجام پذیرفت.
مواد و روش هادر این مطالعه توصیفی- مقطعی (1398-1397)، 200 نفر از بیماران مراجعه کننده به داروخانه های آموزشی دانشکده داروسازی به طور تصادفی انتخاب شدند. برای تعیین آگاهی و رضایت مندی بیماران در مورد اطلاعات بروشورهای دارویی ایرانی، پرسشنامه نظر سنجی محقق ساخته به صورت طیف لیکرت پنج گزینه ای طراحی شد. روایی پرسشنامه توسط متخصصان مربوطه تایید شد و تایید پایایی آن از طریق محاسبه ضریب آلفای کرونباخ با استفاده از نرم افزار SPSS نسخه 17 بررسی گردید. نتایج آزمون آلفای کرونباخ به میزان 81/0 به دست آمد.
یافته هابراساس نتایج به دست آمده میانگین آگاهی بیماران از بروشورهای دارویی ایرانی 50 درصد برآورد شد. اگر چه بیش ترین رضایت مندی در رابطه با «هشدارهای بارداری و شیردهی» و بعد از آن «هشدارهای مربوط به کودکان» بود اما در مجموع میزان رضایت بیماران از بروشورهای دارویی در حد متوسط ارزیابی شد (57 درصد).
استنتاجبراساس نتایج به دست آمده میزان آگاهی و رضایت مندی بیماران مراجعه کننده به داروخانه های آموزشی دانشکده داروسازی تبریز از بروشورهای دارویی ایرانی در حد مطلوب نبوده و باید ساز و کارهای مناسبی در مقررات مربوط به تهیه بروشورها و همچنین نظارت های سازمان غذا و دارو اتخاذ گردد.
کلید واژگان: بروشورهای دارویی, آگاهی, رضایت مندی, بیمار, تبریز}Background and purposeA drug brochure or Patient Package Insert (PPI) is a folded sheet of paper in drug package that provides necessary information for effective and safe use of the drug. PPIs are one of the main sources of drug information, so, they should be clear and easily comprehensible to the general public. The purpose of this study was to determine the awareness and satisfaction of patients with Iranian PPIs.
Materials and methodsIn this cross-sectional study, 200 patients attending pharmacies of the Tabriz University of Medical Sciences were selected using simple random sampling in 2018-2019. A questionnaire was designed as a five-point Likert scale to determine the patients’ awareness and satisfaction with the Iranian PPIs. Content validity of the questionnaire was confirmed and internal consistency was confirmed by Cronbach’s alpha coefficient in SPSS (V. 17). The Cronbach’s alpha
was 0.81.ResultsAccording to findings, the average awareness of patients about Iranian PPIs was 50%. The highest satisfaction with PPIs was for “pregnancy and lactation warnings” and “warnings for children”. The overall satisfaction of patients with PPIs was found to be moderate (57%).
ConclusionThe current study reported a moderate level of patients’ satisfaction with the Iranian PPIs in Tabriz, Iran. Therefore, appropriate mechanisms should be adopted in the regulations relating to preparation of PPIs and more supervision on pharmaceutical companies by Iran Food and Drug Administration.
Keywords: Patient Package Inserts, Awareness, Satisfaction, Patient, Tabriz} -
Introduction
Due to the increasing resistance to synthetic antifungal drugs, the use of drugs with a natural origin, with low side effects and low prices is a priority. This study was performed to evaluate the effect of topical honey gel and clotrimazole cream in treatment of signs of vaginal candidiasis.
MethodsThis randomized clinical trial was conducted to evaluate the topical use of honey and clotrimazole in the signs of vulvovaginal candidiasis in clinics and medical centers in Tabriz. The study was performed on 106 non-pregnant women (18 to 45 years old) who had clinical signs of candidiasis. Patients were randomly divided into two groups receiving honey gel and clotrimazole vaginal cream (53 people per group). Each group was treated for 8 days. Before, 4, and 8 days after the intervention, patients recorded the sings of disease and possible side effects of drugs using a researcher-made questionnaire. The results were analyzed using SPSS software ver. 22. Inter-group comparison was carried out using McNemar, Cochran Q and independent t tests. P value < 0.05 was considered statistically significant.
ResultsIn the three evaluation periods, a significant reduction in the sings was observed compared to the before starting of treatment regimes. The results of the cultures were similar and there was no significant difference between the two honey gel and clotrimazole cream groups.
ConclusionOur results may suggest that honey gel could have promising benefits in the treatment of vulvovaginal candidiasis as the main drug or as an adjunct to other antifungal drugs.
Keywords: Honey, Clotrimazole, Vulvovaginal candidiasis, Signs} -
Background and purpose
Research on new drugs with a natural source and low side effects is a priority in pharmacology studies. The present study was conducted to investigate the anti-inflammatory and anti-angiogenesis effects of bee pollen extract in the air pouch model of inflammation.
Experimental approach: To achieve this goal, male rats were moderately anesthetized and then 20 and 10 mL of sterile air were subcutaneously injected into the intrascapular area of the back of the rat on first and third days, respectively. On day 6, inflammation was induced by intrapouch injection of carrageenan. Normal saline in the control group and bee pollen methanolic extract (50, 100, and 200 mg/pouch) were administered at day 6, simultaneously with carrageenan, and then for 2 consecutive days only normal saline and the extracts were injected. Following sacrificing the rats the pouch was opened and the exudate volume, leukocyte accumulation, granulation tissue weight, vascular endothelial growth factor (VEGF), interleukin 1beta, and tumor necrosis factor alpha (TNF-α) concentrations were determined 3 days after induction of inflammation. In order to investigate the angiogenesis, the granulation tissue was removed, homogenized in the Drabkin's reagent, and then centrifuged. The supernatant was filtered and the hemoglobin concentration was determined using a spectrophotometer.ResultsBee pollen extract significantly decreased the exudate volume, leukocyte accumulation, granulation tissue weight, angiogenesis, VEGF, and TNF-α concentration.
Conclusion and implicationsThe findings of the current study revealed that bee pollen methanolic extract has an anti-inflammatory and anti-angiogenesis effect, which could be attributed to the inhibition of VEGF and TNF-α production in the inflammatory exudates.
Keywords: Air pouch, Angiogenesis, Bee pollen, Inflammation, TNF-α, VEGF} -
مقدمه
برگه ی راهنمای دارو (بروشور دارو) یک سند رسمی تایید شده می باشد که همراه با دارو عرضه می گردد و هدف آن، فراهم کردن اطلاعات ضروری جهت استفاده ی موثر و ایمن از دارو است. اطلاعات ارایه شده در بروشورها، همیشه مناسب و کامل نیستند و این امر، می تواند باعث بروز خطاها و عوارض دارویی شود. هدف از انجام این مطالعه، بررسی تبعیت بروشور آنتی بیوتیک های پرمصرف کودکان از استانداردهای سازمان غذا و داروی ایران بود.
روش هادر این مطالعه ی توصیفی- مقطعی، تعداد 51 بروشور متعلق به 13 آنتی بیوتیک پرمصرف کودکان، از 21 شرکت داروسازی ایران، بر اساس معیارهای سازمان غذا و دارو در 6 حیطه ی «اصول نگارش، توصیف دارو، هشدارها و احتیاطات، تداخلات، عوارض جانبی و منابع به کار رفته»، ارزیابی و امتیازبندی شدند.
یافته هادر مجموع، 2652 معیار مربوط به 51 بروشور ارزیابی شد. مطابقت بروشورها با استانداردهای سازمان غذا و دارو چندان مطلوب نبود (8/54 درصد). در بین 6 حیطه ی مورد بررسی، هشدارها و احتیاطات با 359 معیار (3/70 درصد)، بیشترین انطباق و منابع با 76 معیار (6/18 درصد) کمترین انطباق را با استانداردها نشان دادند.
نتیجه گیریبر اساس یافته های مطالعه ی حاضر، مشخص گردید که بروشورهای آنتی بیوتیک های پرمصرف کودکان، بر اساس استاندارهای وزارت بهداشت، درمان و آموزش پزشکی، کیفیت مناسبی ندارد. از این رو، ضرورت انجام اصلاحات، به روزرسانی و منطبق نمودن آن ها با استانداردها به صورت جدی وجود دارد.
کلید واژگان: بروشور دارویی, اطلاعات دارویی, ضوابط برگه ی راهنمای دارو, آنتی بیوتیک ها, کودکان}BackgroundPatient package inserts (PPIs) are the most important and accessible source of information for patients which is expected to contribute with the safe and efficient use of medicines. However, the information in the PPIs is not always appropriate and complete, and may lead to medication errors. The purpose of this study was to evaluate the conformity of pediatric antibiotics’ PPIs with the standards of Iran’s Food and Drug Administration (FDA).
MethodsThis descriptive cross-sectional study evaluated 51 PPIs related to 13 best-selling pediatric antibiotics in Iran based on the criteria approved by Iran’s FDA. Six categories of criteria as writing and formatting, drug description, warnings and precautions, side effects, interactions, and references were considered in evaluating the extent of conformity.
FindingsIn total, 2652 items from 51 PPIs were evaluated. The PPIs content was insufficient in various aspects of conformity with standards in each category (54.8%). Among the six categories, the best match was found in warnings and precautions with 359 items (70.3%). The lowest conformity was found in the reference category with 76 items (18.6%).
ConclusionThe PPIs of Iranian pediatric antibiotics do not fully meet Iran’s FDA standards. It is strongly recommended that the drug leaflets must be updated based on the standards of Iranian Ministry of Health and Medical Education to overcome this problem.
Keywords: Drug package inserts, Patient education handout, Brochures, Anti-bacterial agents, Pediatric} -
مقدمه
این مطالعه، با هدف بررسی اثرات نئوستیگمین بر روی شاخص های التهابی و تغییرات هیستوپاتولوژی بافت گرانولوماتوز انجام شد.
روش هامدل Air pouch در شش گروه از موش های صحرایی نر نژاد Wistar ایجاد شد. در ناحیه ی پشتی حیوان بیهوش شده، هوای استریل (10 و 20 میلی لیتر) به ترتیب در روزهای اول و سوم تزریق شد. جهت القای التهاب، در روز ششم 2 میلی لیتر کاراژنین (1 درصد) به داخل Pouch تزریق شد. هم زمان با کاراژنین، نرمال سالین به عنوان شاهد و نئوستیگمین با دزهای 35، 70، 140، 200 و 310 میکروگرم بر کیلوگرم به داخل صفاق تزریق شد. بعد از 6 ساعت، موش ها کشته شدند و مایع داخل Pouch برای تعیین حجم اگزودا و شمارش لکوسیتی جمع آوری شد. بافت گرانولوما خارج شد و پس از تعیین وزن، خصوصیات هیستوپاتولوژیک آن مورد بررسی قرار گرفت.
یافته هادز 70 میکروگرم بر کیلوگرم نئوستیگمین میزان تجمع لکوسیتی (050/0 > P)، حجم اگزودا (001/0 > P) و وزن بافت گرانولوماتوز (001/0 > P) را در مقایسه با گروه شاهد کاراژنین، با تفاوت معنی داری کاهش داد. در عین حال، دز 200 میکروگرم بر کیلوگرم دارو باعث افزایش مقادیر شاخص های التهابی پیش گفته گردید (050/0 > P). نتایج مطالعات هیستوپاتولوژیک بافت گرانولوماتوز نشان داد که دزهای بالاتر نئوستیگمین اثرات ضد التهابی بیشتری در مقایسه با گروه شاهد ایجاد می کنند.
نتیجه گیریبا وجود اثرات متفاوت نئوستیگمین در مدل التهابی Air pouch، در مجموع دزهای پایین نئوستیگمین اثرات ضد التهابی بیشتری بر روی شاخص های التهاب محیطی نشان دادند. با توجه به مکانیسم های متنوع پیشنهادی، احتمال می رود این اثرات به واسطه ی عملکرد مجموعه ای از اثرات تنظیمی نئوستیگمین بر سیستم ایمنی ایجاد می شود.
کلید واژگان: نئوستیگمین, التهاب, کاراژنین, موش صحرایی}BackgroundThe aim of this study was to evaluate the effects of neostigmine on inflammatory parameters and histopathological changes of granulation tissue.
MethodsThe Air Pouch model was developed in six groups of male Wistar rats. Briefly, the rats were anesthetized, and then 20 ml and 10 ml of sterile air were injected subcutaneously (SC) on the back of the animals on days 0 and 3, respectively. On day 6, inflammation was induced by injection of 2 ml of carrageenan 1% into pouches. Normal saline as control and neostigmine (35, 70, 140, 200, and 310 µg/kg) was administered intraperitoneally (IP) concurrently with carrageenan. After 6 hours, the rats were sacrificed; pouch fluid was collected to determine exudate volume and the number of accumulated cells. The pouches were dissected out and weighed, and histopathological characteristics were evaluated.
FindingsNeostigmine (70 µg/kg) reduced leukocyte accumulation (P < 0.050), exudate volume (P < 0.001), and granulation tissue weight (P < 0.001) compared to the carrageenan control group. Inflammatory parameters were increased by neostigmine 200 μg/kg (P < 0.050). The results of histopathological studies of granulation tissue showed that higher doses of neostigmine provided more anti-inflammatory effects.
ConclusionFrom this study, it may be concluded that in the air pouch inflammatory model, neostigmine at different doses has different effects on peripheral inflammation. These effects are likely mediated by regulatory effects of the agent on the immune system.
Keywords: Neostigmine, Inflammation, Carrageenan, Rat} -
PurposeIn the present study, postconditioning effect of fructose against ischemia/reperfusion (I/R)-induced arrhythmias and infarct size were investigated in isolated rat heart.MethodsThe isolated hearts were divided into 7 groups, mounted on a Langendorff apparatus at constant pressure then subjected to 30 min zero flow global ischemia followed by 120 min reperfusion. In the control group, normal KrebsHenseleit (K/H) solution was perfused into the hearts throughout the experiment. In two separate sets of experiments, the treatment groups received 12, 24 and 48 mM of fructose with/without normal glucose in K/H solution for 20 min at the beginning of reperfusion. Cardiac arrhythmias including number of ventricular tachycardia (VT), total ventricular ectopic beats, incidence and duration of VT, reversible and irreversible ventricular fibrillation were recorded and analyzed during the first 30 min of reperfusion. Computerized planimetry method was used to determine volume and percentage of infarct size.ResultsAdministration of fructose as a postconditioning agent clearly reduced volume and percentage of infarct size in the all treatment groups. The effect was statistically significant especially in the hearts that treated by fructose plus glucose (PConclusionThe results showed that perfusion of high concentration of fructose alone or coincident with glucose in globally ischemic-reperfused isolated rat hearts can reduce infarct size without inhibitory effect against reperfusion arrhythmias. Probably, fructose by providing adequate ATP for cardiac functions may inhibit necrosis and death of cardiomyocytes during I/R.Keywords: Fructose, Postconditioning, Ischemia, Reperfusion, Isolated heart}
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داروسازان، به عنوان عضوی از تیم سلامت، در انجام وظایف حرفه ای خود با چالش های اخلاقی زیادی روبه رو می شوند. هدف این پژوهش، بررسی وضعیت رعایت اخلاق حرفه ای داروسازی در داروخانه ها و تعیین چالش های اخلاقی موجود و ارائه ی راه حل هایی برای بهبود آن بود. پژوهش حاضر مطالعه ای توصیفی تحلیلی است که در سال های 1394 تا 1395 با به کارگیری پرسش نامه ی استانداردشده برای سنجش میزان رعایت اصول کد اخلاق حرفه ای داروسازی و با نظرخواهی از استادان و دانشجویان دانشکده ی داروسازی تبریز انجام گرفت. امتیاز به دست آمده برای هر یک از اصول کد اخلاق حرفه ای داروسازی نمایانگر رعایت هر یک از این اصول در سطح متوسط و بالاتر بود؛ اما در ارائه ی مطلوب مشاوره ی دارویی به بیماران، تعامل با پزشکان، تحویل دارو بدون نسخه ی معتبر و پذیرش مسئولیت حرفه ای از سوی داروسازان، کاستی هائی وجود دارد. همچنین، 5/71 درصد استادان و 5/75 درصد دانشجویان، درآمد ناکافی داروساز، مشکلات اقتصادی داروخانه، ایرادهای نظام بیمه، عدم فرهنگ سازی درباره ی جایگاه داروساز، آموزش ناکافی مسائل اخلاق حرفه ای در دانشگاه، پزشک سالاری نظام سلامت و اعطای هدایا از سوی شرکت های دارویی را از عوامل اثرگذار در رعایت اخلاق حرفه ای اعلام کردند. بنابراین، برای بهبود هرچه بیشتر وضعیت اخلاق حرفه ای داروسازی، مدیریتی جامع ضروری است و باید آموزش اخلاق حرفه ای و نهادینه کردن آن، توجه به مشکلات اقتصادی داروسازان و داروخانه ها، اصلاح عملکرد سازمان های بیمه، فرهنگ سازی برای ارتقای جایگاه داروساز و نظارت جدی متولیان نظام سلامت بر عملکرد داروخانه ها و شرکت های دارویی مورد توجه قرار گیرند.کلید واژگان: اخلاق حرفه ای, داروخانه, دانشکده ی داروسازی تبریز, دیدگاه استادان داروسازی, دیدگاه دانشجویان داروسازی}Pharmacists, as a member of the health team face a lot of ethical challenges in performing their professional duties. This study was aimed to evaluate status, challenges and improvement strategies of pharmacy professional ethics in drugstores. It was a descriptive-analytic study carried out in 2015-2016. Data was collected using a standardized questionnaire related to principles of pharmacy professional ethics’ code from the viewpoint of qualified faculty members and students of Tabriz faculty of pharmacy. The overall score obtained for each principles of professional ethics code indicated moderate and high level status for each of the principles. However, there are some shortcomings in counseling to patients, consulting and interacting with physician, delivery of non-OTC drugs without any prescription, and accepting professional responsibility among the pharmacists. In addition, 71.5% of the professors and 75.5% of the students believed that inadequate income of pharmacists, the economic problems of drugstores, defects in the insurance systems, lack of proper culture for pharmacist's position, insufficient training of professional ethics at universities, priority of physician in Iran health system and giving gifts by some pharmaceutical companies are the main factors influencing professional ethics in pharmacies. Thus, comprehensive management is essential for improving professional ethics in pharmacies. In this regard, promoting professional ethics education, paying attention to economic problems of pharmacists and pharmacies, improving the performance of insurance organizations, developing culture to promote the position of pharmacists and serious supervision of health system officials on drugstores and pharmaceutical companies are necessary.Keywords: Professional ethics, Drugstore, Pharmacy faculty members' viewpoint, Pharmacy students' viewpoint, Tabriz}
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PurposeIn the present study, the effects of verapamil on inflammation and angiogenesis in air pouch model were studied.MethodsTo create a model of inflammation in the rats, on days 1 and 3 sterile air, and on the sixth day, carrageenan was injected into the pouch subcutaneously. Normal saline as control, diclofenac sodium and dexamethasone as standards and verapamil (0.05, 0.1 and 0.2mg/rat) was injected into the pouch simultaneously with carrageenan and as well as 24 and 48 hours later. After 72 hours, volume of exudate, the leukocytes count, concentration of VEGF and IL-1ß, granulomatous tissue weight, histopathological changes and angiogenesis were considered.ResultsVerapamil significantly reduced leukocyte accumulation in all doses, but effect of 0.1mg/rat was more significant (PConclusionVerapamil has significant anti-inflammatory and anti-angiogenesis effects in the air pouch model probably due to attenuation effects of verapamil on IL-1β and VEGF.Keywords: Verapamil, Air, Pouch, Inflammation, Angiogenesis, VEGF, IL, 1β}
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In the present study, effects of salbutamol on the inflammatory parameters, angiogenesis, interleukin-1 beta (IL-1β) and vascular endothelial growth factor (VEGF) levels were investigated in an air pouch model of inflammation. Inflammation was induced by intrapouch administration of 1% solution of sterile carrageenan in male Wistar rats. Salbutamol (125, 250 and 500 µg/rat) and salbutamol (500 µg/rat) plus propranolol (100 µg/rat) were injected intrapouch. After 6 and 72 h, fluid inside the pouches was collected to measure volume of exudates, leukocytes number and IL-1β levels. To determine angiogenesis, the granulation tissues were dissected out and weighed 3 days after carrageenan injection, then hemoglobin concentration was assessed using a hemoglobin assay kit. In addition, amount of VEGF in the exudates was measured 72 h after induction of inflammation. Leukocyte accumulation and the volume of exudates were significantly inhibited by salbutamol administration. In addition, salbutamol decreased the production of VEGF and IL-1β. Moreover, all used doses of salbutamol significantly inhibited angiogenesis. Interestingly, effects of salbutamol on the attenuation of angiogenesis and inflammatory parameters was similar to diclofenac sodium. Co-administration of propranolol with salbutamol clearly reversed anti-inflammatory effects of salbutamol. Salbutamol can decrease acute and chronic inflammation by β2-adrenergic receptors activation. The observed IL-1β and VEGF inhibitory properties of salbutamol may be responsible for anti-inflammatory and anti-angiogenic effect of the agent.Keywords: Salbutamol, Inflammation, Angiogenesis, Air pouch, Carrageenan, VEGF, IL-1β}
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مقدمهاین مطالعه، با هدف بررسی اثرات داروی ال-کارنیتین (L-Carnitine یا L-car) بر روی پارامترهای التهابی و آنژیوژنز در مدل التهابی Air pouch انجام شد.روش هادر ناحیه ی پشتی موش های صحرایی نر نژاد Wistar، پس از بیهوشی به ترتیب 20 و 10 میلی لیتر هوای استریل در روزهای 1 و 3 به صورت زیر پوستی تزریق شد. در روز 6، کاراژنین به داخل Pouch تزریق گردید. نرمال سالین به عنوان شاهد و L-car با دزهای 250، 500، 1000 و 2000 میکروگرم به ازای هر موش، هم زمان با تزریق کاراژنین و همچنین 24 و 48 ساعت بعد از آن به داخل Pouch تزریق شد. بعد از 72 ساعت، مایع داخل Pouch برای تعیین حجم اگزودا و شمارش لکوسیتی و اندازه گیری غلظت Vascular endothelial growth factor (VEGF) و Interleukin-1 beta (IL-1ß) جمع آوری و بافت گرانولومای تشکیل شده از بدن حیوان جدا و توزین گردید. برای تعیین آنژیوژنز در بافت گرانولوما، از روش سنجش غلظت هموگلوبین استفاده شد.یافته هاL-car با تمام دزهای به کار رفته، تجمع لکوسیتی را در اگزودا کاهش داد (001/0 > P)، اما وزن بافت گرانولوما فقط با دز 2000 میکروگرم کم شد (001/0 > P). حجم اگزودا نیز با تمام دزها و سطح IL-1ß با دزهای 250 و 500 میکروگرم دارو به صورت معنی داری کاهش یافتند. L-car، نه تنها اثرات مهاری بر روی VEGF نداشت، بلکه دز 1000 میکروگرم آن سطح VEGF را افزایش داد (010/0 > P).نتیجه گیریL-car، اثرات ضد التهابی دارد، اما با دزهای به کار رفته، فاقد اثر ضد آنژیوژنز در این مدل بود. احتمال می رود اثرات ضد التهابی L-car با اثر مهاری آن بر روی IL-1ß مرتبط باشد.کلید واژگان: ال, کارنیتین, التهاب, آنژیوژنز, عامل رشد اندوتلیال عروقی}BackgroundIn this study, effects of L-carnitine on inflammatory parameters and angiogenesis were evaluated in the rat air pouch model of inflammation.MethodsMale Wistar rats were anesthetized; 20 and 10 ml sterile air was injected subcutaneously on the back of rats at first and 3rd day. To induce inflammation, carrageenan 2% was injected intrapouch at 6th day. Saline as control and L-carnitine (250, 500, 1000 and 2000 µg/rat) were administrated intrapouch at the same time as the carrageenan injection, 24 and 48 hours after inflammation induction. After 72 hours, the pouches were opened and pouch fluids were collected to determine exudate volume, leukocyte counts, vascular endothelial growth factor (VEGF), and interleukin-1ß (IL-1ß) levels. The granulated tissue was dissected out and weighed. Angiogenesis in the granulation tissues was measured based on the hemoglobin concentration method.
Findings: All used doses of L-carnitine reduced the leukocyte accumulation in the pouch fluid (PConclusionResults of this study showed that the used doses of L-carnitine have anti-inflammatory effects without anti-angiogenesis activity in this model of inflammation. The anti-inflammatory effect of L-carnitine maybe related to its inhibitory effect on IL-1ß.Keywords: L-carnitine, Inflammation, Angiogenesis, Vascular endothelial growth factor} -
IntroductionPharmacology is one of the specific courses of the medical sciences students. Multiplicity of drugs and a lot of similarities in their characteristics make the learning of this lesson difficult and no common methods of teaching have been able to fix this problem so far. This study aimed to examine the effect of observing the dosage forms appropriate to each training session on enhancing learning pharmacology and comparing it with other traditional teaching methods.MethodsFifty six Health Care Management and Family Health students in Tabriz University of Medical Sciences participated in this descriptive study. Each session was held using lectures and PowerPoint during half of educational classes and the other half was conducte d using whiteboard and at the same time the teaching pharmaceutical dosage forms, their functions and properties were shown. A standardized questionnaire based on Likert scale was given to the students and the level of learning was reviewed by self-assessment method. The data were analyzed using SPSS and descriptive statistical parameters.ResultsTeaching pharmacology through showing pharmaceutical dosage forms had significant effect on improving students learning in both fields based on their self-assessment, so that more than 95%of students were satisfied with the teaching methods. From point view of students, the understanding of pharmacology using whiteboard and showing pharmaceutical dosage forms was significantly more than PowerPoint.ConclusionThe students believe that the level of the learning pharmacology through using whiteboard along with observing the dosage forms appropriate to each training session is outstanding.Keywords: Teaching Method, Pharmacology, Pharmaceutical dosage forms}
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Honey is a by-product of flower nectar and the upper aero-digestive tract of the honey bee، which is concentrated through a dehydration process inside the bee hive. Honey has a very complex chemical composition that varies depending on the botanical source. It has been used both as food and medicine since ancient times. Human use of honey is traced to some 8000 years ago as depicted by Stone Age paintings. In addition to important role of natural honey in the traditional medicine، during the past few decades، it was subjected to laboratory and clinical investigations by several research groups and it has found a place in modern medicine. Honey has been reported to have an inhibitory effect on around 60 species of bacteria، some species of fungi and viruses. Antioxidant capacity of honey is important in many disease conditions and is due to a wide range of compounds including phenolics، peptides، organic acids، enzymes، and Maillard reaction products. Honey has also been used in some gastrointestinal، cardiovascular، inflammatory and neoplastic states. This review covers the composition، physico-chemical properties and the most important uses of natural honey in human diseases.Keywords: Honey Human Diseases Traditional Medicine Modern Medicine}
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BackgroundAt the present time, teaching pharmacology for medical students mainly focuses on the basic principles of pharmacology. This study was conducted to assess the current situation of pharmacology teaching and the necessity of developing clinical pharmacology from the viewpoint of medical interns and externs in Tabriz University of Medical Sciences.MethodsThis descriptive cross-sectional study was conducted in 2009 on extern and intern medical students of Tabriz University of Medical Sciences. The subjects were a convenience sample of students. Each participant filled out a questionnaire and the data was analyzed by SPSS-16 software.ResultsThe mean obtained from student's viewpoints toward necessity of clinical pharmacology was 90 percent. The proper time section was provided during the internship training or at the end of the externship period. At present, the students’ satisfaction on teaching pharmaceutical dosage forms were approximately 30%, prescribing writing skills were 17% and teaching important drug interactions were 35%. The suitable contents of clinical pharmacology from the viewpoint of students were teaching the pharmaceutical dosage forms and their correct usages, important drug interactions and good prescription writing skills. Between the two groups of students, the satisfaction rate did not show any significant statistical difference except for the proper time section and teaching pharmaceutical dosage forms.ConclusionsRegarding the results, it seems that clinical pharmacology is a necessary course for medical students prior to starting their clinical training in the hospital wards.
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مقدمهاستفاده از شبیه سازی رایانه ای یکی از روش های جدید آموزش در علوم پزشکی است ولی تاکنون مطالعه ای در مورد بکارگیری این روش در آموزش فارماکولوژی در ایران انجام نیافته است. هدف این پژوهش، بررسی دیدگاه دانشجویان داروسازی پیرامون آموزش فارماکولوژی به کمک شبیه سازی رایانه ای بود.روش هادر این مطالعه توصیفی- مقطعی، تعداد30 نفر دانشجوی داروسازی دانشگاه علوم پزشکی تبریز که در سال تحصیلی 88-87 واحد فارماکولوژی عملی را انتخاب نموده بودند وارد شدند. بخشی از درس با نرم افزارهای شبیه سازی رایانه ای تدریس گردید. در پایان دوره نظرات دانشجویان با پرسشنامه ای محقق ساخته اخذ گردید. داده ها با آمار توصیفی تجزیه و تحلیل شد.نتایجنمره رضایت کلی دانشجویان از بکارگیری شبیه سازی رایانه ای 21/0±51/3 بود. کمک نرم افزارها به فهم بیشتر دروس نظری فارماکولوژی بیش از 75 درصد ارزیابی گردید. میزان یادگیری و مشارکت فعال دانشجویان به ترتیب 76 و 82 درصد بیشتر از جلسات برگزار شده در آزمایشگاه بود. حدود 80 درصد دانشجویان داروسازی شرکت کننده در پژوهش، خواستار ارائه 25 الی50 درصد فارماکولوژی عملی با این شیوه بودند. میانگین نمره رضایت مندی از روش ارزیابی پایان دوره نیز 24/0±54/3 به دست آمد.نتیجه گیرینتایج نشان داد که بکارگیری شبیه سازی رایانه ای میزان یادگیری و مشارکت فعال دانشجویان و فهم دروس تئوری فارماکولوژی را ارتقا می دهد. به نظر می رسد می توان روش آموزش این درس را بازنگری نموده و بخشی را با استفاده از نرم افزارهای شبیه سازی ارائه داد.
کلید واژگان: دیدگاه, آموزش, روش تدریس, فارماکولوژی, شبیه سازی رایانه ای, دانشجویان داروسازی}Introduction:Using computerized simulation is one of the new methods in medical education. However, there is no report on applying this technique for teaching pharmacology in Iran. This study was conducted to assess the attitude of pharmacy students toward using this method in the teaching of practical pharmacology.MethodsThis descriptive–cross sectional study was performed on pharmacy students (n=30) selecting practical pharmacology course in Tabriz University of Medical Sciences in 2008. A part of practical pharmacology was taught by computer simulation soft ware. Finally, students’ viewpoints were collected by a researcher made questionnaire. Data were analyzed by descriptive statistics through SPSS software.ResultsThe score of student's satisfaction with teaching practical pharmacology by computer simulation was 3.51±0.21. Effect of the simulation on better understanding of theoretical aspects of pharmacology was assessed more than 75%. Students’ learning and active participation were 76% and 82% more than the sessions held in laboratory respectively. About 80% of pharmacology students, attended in the research, asked for teaching 25-50% of the practical pharmacology course through computer simulation. The student's satisfaction means score with final exam assessment was 3.54±0.24.ConclusionThe results of the present study demonstrated that application of computer simulation was effective on improvement of deep and active learning of pharmacology in students of pharmacy. It seems that teaching methods of this course can be revised so that some parts of practical pharmacology can be taught by such computer simulation. -
IntroductionIn the present study, potential differences between the effects of L-carnitine (LC) and acetyl-Lcarnitine (ALC) on ischemia/reperfusion (I/R)-induced myocardial infarction size were investigated.MethodsMale Wistar rats were randomly divided into five groups and then anesthetized by sodium pentobarbital. Hearts of the animals were removed and quickly mounted on a Langendorff apparatus and perfused under constant pressure by a modified Krebs-Henseleit (K/H) solution. The hearts were perfused during 30 min regional ischemia followed by 120 min reperfusion by normal K/H solution (as control) or enriched solution with 1.5 and 3 mM LC (groups 2 and 3) or ALC (groups 4 and 5). At the end of the reperfusion cycle, 0.25 % evans blue solution was infused to stain the non-ischemic area, then the hearts were cut into slices and incubated by triphenyltetrazolium chloride solution and fixed by formalin. The infarction size was determined by using a computerized planimetry package.ResultsThe infarct size after perfusion of isolated hearts with 1.5 (26±4.5%) and 3 mM LC (20±4 %) showed a significant reduction compared to the control value (45.6±3.4 %, P<0.01 and P<0.001, respectively). The same concentrations of ALC significantly lowered myocardial infarction size to 23.8±4 % (P<0.01) and 15.8±2.9 % (P<0.001), respectively. When the effects of similar concentrations of LC and ALC on the infarction size were compared, there was no statistically significant difference (p>0.05). Among the potential protective mechanisms of the agents, increase of glucose oxidation, reduction of lactate production, toxic fatty acid metabolites and removing free radicals from the myocytes seem to be more relevant.ConclusionThe results of this study demonstrated the protective effects of LC and ALC against I/R injuries by reduction of infarct size in isolated rat hearts without any important difference between the agents.
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IntroductionThis study was aimed to investigate the effects of postconditioning by natural honey on cardiac arrhythmias in the ischemic isolated rat heart.MethodsMale Wistar rats were divided into four groups then anesthetized by sodium pentobarbital. The animal hearts were removed and quickly mounted on a Langendorff apparatus and perfused under constant pressure by a modified Krebs-Henseleit (K/H) solution that was previously equilibrated with 95% O2–5% CO2. The hearts were subjected to 30 min regional ischemia followed by 30 min reperfusion. In the control group, the hearts perfused by normal K/H solution, however in the postconditioning groups, they were perfused with natural honey (0.25, 0.5 and 1%) enriched K/H solution from 10 min before to 10 min after reperfusion. The ECGs were analyzed to determine the total number of ventricular ectopic beats (VEBs), ventricular tachycardia (VT), the incidence and duration of VT and ventricular fibrillation (VF) during last 10 min of ischemia and the first 30 min of reperfusion.ResultsDuring ischemia, honey (0.25, 0.5 and 1%) produced significant reduction in the number of VEBs and number, duration and incidence of VT (P<0.01). The incidence and time spent in VF were lowered by honey compared to the control group (P<0.05). During reperfusion time, all used concentrations of honey significantly reduced the number of VEBs (P<0.05). In addition, honey (0.5 and 1%) decreased the number and duration of VT (P<0.01 and P<0.05, respectively). Moreover, VF duration was lowered by perfusion of honey (0.25 and 0.5 %) versus the control group (P<0.05).ConclusionThe results showed protective effects of postconditioning by honey against ischemia-reperfusion injuries as anti-arrhythmic activities. Probably, antioxidant activity of honey, by scavenging of free radicals, and the presence of important energy sources such as glucose and fructose by improvement of cardiac function may involve in these protective effects.
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Objective(s)In this study, effects of chronic administration of oral natural honey against ischemia/reperfusion (I/R)-induced cardiac arrhythmias were investigated in isolated rat heart. Materials and MethodsMale Wistar rats were divided into four groups (n= 10-14 rats in each group) and fed with natural honey (1%, 2% and 4% dissolved in the drinking water) for 45 days except for the control group. After anesthesia, the rats’ hearts were isolated quickly, mounted on a Langendorff apparatus and perfused with a modified Krebs-Henseleit solution during stabilization, 30 min regional ischemia followed by 30 min reperfusion. The ECGs were recorded throughout the experiments to analyze cardiac arrhythmias based on the Lambeth conventions. ResultsIn the ischemic phase, honey (1%) significantly reduced (P<0.05) the number and duration of ventricular tachycardia (VT). Honey (1% and 2%) also significantly decreased number of ventricular ectopic beats (VEBs). In addition, incidence and duration of reversible ventricular fibrillation (Rev VF) were lowered by honey 2% (P<0.05). During reperfusion time, VT incidence was 73% in the control group, however natural honey (1%) decreased it to 22% (P<0.05). Honey also produced significant reduction in the incidences of total VF, Rev VF, duration and number of VT. ConclusionFor the first time, the results of present study demonstrated protective effects of chronic oral honey administration against I/R-induced arrhythmias in isolated rat heart. Antioxidant activity, the existence of energy sources such as glucose and fructose and improvement of some hemodynamic functions might be responsible for these effects.
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Objective(s)Air pouch is a well-established inflammatory model in which fluid extravasations; leukocyte migration, angiogenesis and other parameters involved in the inflammatory response can be measured. In this study, the influence of gender on inflammatory parameters has been examined in the air pouch model.Materials And MethodsTo induce air pouch, adult male and female Wistar rats were anesthetized, then 20 ml and 10 ml of sterile air were injected subcutaneously on the back on day 0 and day 3, respectively. On day 6, inflammation was induced by injection of 1 ml of carrageenan 1% into pouches. After 6 and 72 hr, the rats were sacrificed, pouch fluid was collected in order to determine exudates volume and the accumulated cells were counted using a hemocytometer. Pouches were dissected out and weighed. Angiogenesis of granulomatous tissue was assayed using hemoglobin kit.ResultsAnalysis of our data demonstrated a sexually dimorphic pattern in inflammation parameters both in acute and chronic forms (P<0.05). The value of angiogenesis in the air pouch model in male rat was higher than that female rats (P<0.001).ConclusionThe degree of inflammation and angiogenesis induced in Wistar rat air pouch model is gender-dependent, suggesting that gender may be a key consideration in the design of inflammation experiments.
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