Background: Due to the narrow therapeutic window of the AEDs prescription, their side effects and efficacy are the most important items that should be considered in epileptic patients. Objectives: This study aimed to investigate evidence-based pharmacotherapy in epileptic patients. Patients and Methods: Data were collected Cross-sectionally from patients (n = 24) registered at Kashani Epilepsy Ward in Isfahan. Demographic, clinical, hematology and biochemical data were recorded in d-base and analyzed using SPSS application for windows. Results: The frequency of polypharmacy was 79% in which 50% of epileptic patients received 3 to 4 AEDs. The onset of seizure was under 16 years old in 70% of patients. Fourteen varieties of AEDs were used, among them valproic acid (Depakote) was the most administered drugs. Prescriptions of two patients consisted of 4 and 6 AEDs: patient with code No. 575 (carbamazepine, topiramate, clobasam, lamotrigine) and another one with code No. 587 (oxcarbamazepine, phenytoin, gabapentin, valproic acid, clonazepam, lamotrigine). Red blood cell counts, hemoglobin and hematocrit in patients under more than one drug treatment were significantly lower than patients with AED monotherapy. Conclusions: AEDs are well-recognized to control seizure attacks. In clinical practice, the older generation of AEDs such as carbamazepine (CBZ), valporic acid (VPA), phenytoin (PHT), topiramate (TOP) and lamotrigine (LAMO) might need monitoring serum levels. Nonrational polypharmacy in terms of simultaneous using of both AEDs inducer and inhibitor could cause sedation, dizziness, and cognitive adverse effects. Further studies are needed to confirm these associations. Finally, to avoid polypharmacy that could arise side effects, a sufficient intervention for each AED to decide on its continuation, interruption or the number of drugs should be attempted. Combinations based on CBZ + VP, VP + TOP, CBZ + TOP, VP + LAMO, and TOP + LAMO could cause pharmacokinetic interactions.

Background: Liver cancer remains to grow worldwide. We aimed to describe the period prevalence (PP) and incidence rates (Irs) for liver cancer in Isfahan Province that is located in the center of Iran and ranked as the third province in terms of population.Methods: Information related to the Surveillance, Epidemiology, and End Results; (SEER) was collected from the Isfahan Cancer Registry. Period prevalence (PP) was calculated per 100,000 people. The cancer sites studied were defined according to the International Classification of Diseases (ICD-O; Third Edition) and recorded by topography code (C22).Result: Among all registered liver cancer patients, 57% of the 920 cases were male. The mean age of the patients was 65.9 ± 16.8 years. Reported age in 13% of the patients was less than 50 years and as high as 84% were in between 50 to 90 years. With a total PP of 18.5 per 100,000 people, this value was 24.4% higher in males when compared to females (16.8 vs. 20.9). In the previous years, incidences were 3.9 (2011-2012), 5.3 (2012-2013), 4.9 (2013-2014) and 4.2 (2014-2015) per 100,000 people. There were 89% reported deaths among the total population.Conclusion: The PP for liver cancer in male population was approximately 24.4% higher than females. There was a 7.7% increase in the Irs over the study period. Further study toward estimation of the proportion of the causes of liver cancer and deaths due to infection of hepatitis B and C virus, exposure to aflatoxin, alcohol drinking and smoking seem to be advantageous. Therefore, the plan of healthcare system should focus on greater effort toward strategic evidence-based pharmacotherapy in Isfahan province/Iran.

Background: Previous studies confirm that thyroid cancer, as the most common endocrine cancer, accounts for about 1% of new malignant diseases all over the world. Objectives: As thyroid cancer incidence in Iran has changed rapidly over the past years, therefore this study was designed to investigate period prevalence (PP) and incidence rate (Irs.) of thyroid cancer in Isfahan Province, Iran. Methods: Recorded data of thyroid cancer were obtained from the Isfahan Cancer Registry at the Deputy of Health. Continuous variables were reported as means ± SD and categorical variables as frequencies and percentages. In order to examine the relationship of PP with age and gender, the t-test and chi-squared test were used, respectively. The PP was defined as the proportion of the total cases over the study years to the population at risk during the same period ×100000. Results: 1545 patients were diagnosed with thyroid cancer, among which 3% were related to death events. The mean (± SD) age of the study subjects was 41.9 ± 15.4 years. For the total population, the PP was calculated as 31.0, accounting for 49.3 versus 13.3 per 100000 for females versus males (P < 0.001). The study of Irs. data showed an increasing trend (P < 0.001) in the number of patients from 2011 to 2015. With a minimum age of three-years-old, in 84% of the patients, the age ranged from 20 to 60 years old. Conclusions: In this study, not only was the period prevalence 3.7 times higher in females than in males but also there was an increase (61.9%) in the incidence of thyroid cancer from the year 2011 to 2015. Based on the findings, however, detection methods of thyroid cancer have improved recently all over of the world, but a well-established classification of the disorder, pharmacotherapy, and surgical plan in the Iranian population can improve the clinical outcome. Further study in these contexts seem to be useful in Isfahan, Iran.

Context: According to published articles, thrombosis is the main reason for death all over of the world. With stroke time missing is brain missing, therefore, the FDA-approved drug r-TPA, could be administered as initial IV bolus in less than 3 -4.5 hours from onset of Acute Ischemic Stroke (AIS). The aim of this review was to provide updated pharmacotherapy related to r-TPA in AIS. Evidence Acquisition: Searches for associated published articles were conducted in major databases until September 2015. The main terms used in the search were a combination of words and phrases such as ischemic stroke and tissue plasminogen activator. Results: Age, time of onset, systolic blood pressure, diabetes, stroke severity, co-morbidities and premorbid medical situation, stroke scale according to national institute of health and outcomes related to CT (head, angiogram and perfusion) were considered when determining successful treatment by endovascular thrombectomy. According to the 2015 guidelines, strategies related to successful pharmacotherapy management should be based on class I evidence-care on a stroke unit, IV-r-TPA within 3 -4.5 hours of stroke onset, aspirin commenced within 48 hours of stroke onset, and decompressive cranioctomy for supratentorial malignant hemispheric cerebral infarction. Hemorrhagic stroke (intraparenchymal, subarachnoid, intraventricular, intracerebral such as orolingual angioedema), hematoma (epidural and subdural) and head trauma are the absolute contraindications related to r-TPA prescription. Conclusions: Due to considerable inter-and intra-heterogeneity among studies performed by other centers such as differences in study project, background, and population features, determining a pharmacotherapy model based on Safe Implementation of Treatments in stroke or SITS seem advantageous.

No abstract