Background Albumin is a protein colloidal solution with limited availability and high cost. It should be used in such approved indications as paracentesis, extensive burn, spontaneous bacterial peritonitis, and nephrotic syndrome. Objectives The aim of this study was to evaluate and compare the appropriateness of albumin usage before and after an evidence-based guideline. Setting Four wards of Imam Reza Hospital, Mashhad, Iran. Method An interventional pre-post design study was performed on 2 groups of patients; in gGroup 1 as a preparation phase group in 6 months from February 2015 to July 2015 and Group 2 as an interventional group from September 2015 to February 2016. A guideline for proper indications of albumin, designed and finalized based on the physicians' comments, was implemented in Group 2. Main outcome measure The pattern of albumin consumption. Results Fifty patients were evaluated in each group. The implementation of the guideline resulted in reduction of improper albumin use from 62 to 57.5%, which was not statistically significant; however., it reduced inappropriate dose and duration of albumin therapy (55.5-16.7%), the number of consumed albumin vial, and the average cost for each patient (317.78 ± 3.15-149.81 ± 1.91 USD) significantly, as well. Conclusion This study illustrated that in this hospital in most cases, albumin was used inappropriately and at an alarming rate. This improved after the introduction of an evidence-based guideline. Moreover, guideline implementation resulted in significant cost reduction.

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The antinociceptive effect of cyanocobalamin (Vit B12) has been reported in animal models and human studies. Our previous study showed the effect of Vit B12 on morphine tolerance. The dependence and tolerance were induced in male mice using subcutaneous morphine injections, 3 times a day (50, 50 and 75 mg/kg/day) for 3 days. Mice also received Vit B12 (100, 250 and 500 µg/kg), clonidine, memantine and saline intraperitoneally before morphine administration. On fourth day mice received only 7 mg /kg morphine just before tail-flick test. To determine the expression of morphine dependence and tolerance, all compounds were injected once intraperitoneally on the day of experiment. The tolerance was evaluated by the tail-flick test. The effect of Vit B12 and other agents on dependence were evaluated by counting the number of jumps (induced by naloxone 5 mg/kg). Co-administration of Vit B12 (100-500 µg/kg) and morphine in 3 days reduced the development of tolerance to morphine analgesic effect (8.2±0.5 and 7.83±0.5 s. vs. normal saline, 3.57±0.3 s). Repeated administration of Vit B12, also, diminished the reduced naloxane withdrawal signs of naloxone withdrawal test (100-500 µg/kg: 5±1.9 and 1.2±0.8 jumps vs. normal saline 72.6±12.2). However, Vit B12 had no effect on the expression of morphine tolerance and physical dependence. It is concluded that co-administration of Vit B12 and morphine could reduce tolerance to analgesic effect of morphine chronic administration and also reduce its withdrawal symptoms.

Urolithiasis is a common problem worldwide manifested with recurrent intermittent pain episodes, which today is increasing due to changes in lifestyle patterns, including sedentary and consumption of protein, fat, and fiber-free foods, as well as stress. Today, the role of nutrition in the formation of kidney stones as well as in its prevention is recognized as a key factor. Dolichos Biflorus is one of the most famous plants that are known as a useful food in the prevention and treatment of kidney stones. In this review study, electronic databases of PubMed, Scopus, Cochrane, Google Scholar, and Web of science and Persian medicinal books such as Al- Hawi, Al-Shamel fi-Alsenaat Altebbiah, Makhzan-al-Advia, and Tohfat al Momenin were searched to identify all the studies reporting the effects of Dolichos Biflorus on kidney stones. Dolichos Biflorus seeds contain effective substances in preventing kidney stones formation. These substances include Citrate, Magnesium, Potassium, and Vitamin B6. A protein has been identified in Dolichos Biflorus grain that has antiseptic and inhibitory stone formation properties. In several studies, the effect of Dolichos Biflorus extract on the dissolution of kidney stones and their prevention has been investigated. Dolichos Biflorus seeds can be used as a useful and effective food in patients with kidney stones, in addition to its nutritional role, as a harmless drug to prevent stone production.