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.

CYP450 enzymes are basics for the metabolism of several medications such as numerous AEDs. As AEDs polypharmacy could lead to hidden pharmacokinetic interactions due to CYP450, there fore, the aim of this study was to determine a proper guide line for AEDs prescription in Iranian epileptic population. A cross-sectional study of fifty-four patients' (n=23 females; n= 31 males with a mean age of 27 years) located in the Epilepsy Ward of Kashani Hospital of Isfahan University of Medical Sciences was carried out during the year 2011. Variables including sex, age, age of seizureonset, type and number of AEDs were recorded in d-Base. Results showed that the number of prescriptions based on AEDs polypharmacy was 77.8%. The most important drugs in prescriptions were carbamazepine (n=41) that is a potent inducer of CYP450 and valproic acid (n=31) that is a potent inhibitor of CYP450 simultaneously. Administration of AEDs was based on: three (n=17), four (n=7), five (n=4) or six (n=3) AEDs simultaneously. To avoid side effects, in prescribing AEDs that act as CYP450 inhibitors or inducers concomitantly, their spectrum of interactions should be predicted.

Implication for health policy/practice/research/medical education:Previous studies from the 12-th century B.C. up to modern times have focused on quality and quantity of life in transplant recipients. This review focuses on the history of transplant and immunosuppressive drug therapy.Please cite this paper as: Tolou-Ghamari Z. Nephro and neurotoxicity, mechanisms of rejection: A review on Tacrolimus and Cyclosporin in organ transplantation.

ObjectivesTo clarify period prevalence (PP), incidence rate (Ir), and reported mortality for patients with bladder cancer (BC) in Isfahan Province/Iran, as BC is the most common cancer of the urinary tract in Iran and other parts of the world.Patients and methodsData from 21 March 2011 to 3 March 2015 was obtained from the Isfahan Cancer Registry. BC was distinguished by the related established topography code (C67). Ir and PP were calculated and expressed per 100 000 persons.ResultsIn all, 279 females and 1376 males were identified. For the total population the PP was calculated as 33.2. This value corresponded to a PP of 54.4 for males and 11.4 for females (P < 0.001). Histologically, 63% of patients had invasive BC. Irs versus mortality rates were calculated for each year, i.e. 2011–2012, 2012–2013, 2013–2014, and 2014–2015, as 7.7 vs 0.56, 8.1 vs 0.74, 7.4 vs 0.98, and 9.9 vs 0.84, respectively. The mean (SD, range) age of the patients was 65.2 (13.9, 3–100) years. In relation to the age of the study population, BC occurred in 12% of patients aged <50 years and in 15% of those aged ≥80 years.ConclusionThe PP for BC in the male population was 4.8-times higher than females. There was a 28.6% increase in the Ir over the study period. Further study concerning environmental exposure, genetic factors, job-related exposure to various chemical carcinogens, and geographical distribution in Isfahan and its’ rural provinces would seem to be valuable.

The PP for lung cancer in male population was 2.5 times higher than females. There was a 3.2% increase in the Irs over the study period. To facilitate early diagnosis for better management associated to pharmacotherapy or surgical care, our findings emphasized the advantage of further research and greater effort toward environmental, job related exposure, genetic and geographical factors in Isfahan Province/Iran.

Context: Review of epidemiological studies of different geographical regions show a wide variation in the prevalence of multiple sclerosis (MS) worldwide. This study compares related geoepidemiological differences in prevalence of MS in the Middle East. Evidence Acquisition: Key words relevant to "prevalence of multiple sclerosis" were searched for with countries in the Middle East. Results: A prevalence of 31-55 per 100,000 individuals has been reported for Persian Gulf countries. The reported prevalence per Kuwait (n = 85.05) and United Arab Emirate (n = 54.4) seems to be high. The reported prevalence for Turkey and Jordan were 51 and 20, correspondingly. Within Iran, the highest and lowest prevalence seem to belong to Isfahan (n = 93.06) and Golestan (n = 18.0), respectively. Immunomodulating drugs such as Interferon-beta as a first-line therapy; and cyclophosphamide, methotrexate, mitoxantrone, and azathioprine have been considered as second-line therapies. Conclusions:The high prevalence of MS in the Middle East might be pointed toward the adverse effects of low vitamin D, individual daily life, smoking, Epstein-Barr virus infection, hereditary affects, and a history of depression.

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:Multiple sclerosis (MS) could be considered as one of the most common chronic disorders of the central nervous system. However, patient education tasks in this group are a challenge for health care provider team but due to increase in the incidence of MS, a new category of contact, care, and education seems to be useful. Hence, the aim of this study was to compare the effect of electronic education and illustrated booklet on knowledge of patients with MS.Methods:This was a quasi-experimental research was carried out on 120 patients with MS from January 2013 to July 2013. All patients attended MS clinic located at the Ayatollah Kashani Hospital conducted to Isfahan Neurosciences Research Center (INRC). Patients were divided randomly into two equal groups: (1) Electronic education (n = 60) and (2) illustrated booklet (n = 60). Participants’ knowledge score was collected according to the researcher-made questionnaire with 40 questions. Data were analyzed using Student's t-test and paired t-test through SPSS (version 11.5) with a significance level of P < 0.05.Results:Although there was not any significant difference between the knowledge score of electronic education and illustrated booklet group before intervention (18 ± 2.2 vs. 17.01 ± 3.4(, (P = 0.434, t = −5.64), but there was a significant difference after 2 weeks intervention (35.74 ± 1.4 vs. 33.74 ± 3.4), (P = 0.021, t = −6.64). Paired t-test showed a statistically significant difference in the knowledge level in both groups after intervention as follow: (1) Electronic education (18 ± 2.2 vs. 35.74 ± 1.4), (P = 0.024, t = −7.55) and illustrated booklet (17.01 ± 3.4 vs. 33.74 ± 3.4), (P = 0.003, t = −8.55).Conclusion:The electronic educational program applied in this study appears increased knowledge of patients with MS. Therefore, the conveyance of this program to earn time for patient and healthcare provider team is suggested as a valuable and appropriate teaching method.