Journal of Research in Pharmacy Practice

Abstract The nature of performing a scientific research is a process that has several different 
components which consist of identifying the key research question(s), choices of scientific 
approach for the study and data collection, data analysis, and finally reporting on results. 
Generally, peer review is a series of procedures in the evaluation of a creative work or 
performance by other people, who work in the same or related field, with the aim of 
maintaining and improving the quality of work or performance in that field. The assessment 
of the achievement of every scientist, and thus indirectly determining his reputation in the 
scientific community of these publications, especially journals, is done through the so‑called 
impact factor index. The impact factor predicts or estimates that how many annual citations 
article may receive after its publication. Evaluation of scientific productivity and assessment 
of the published articles of researchers and scientists can be made through the so‑called 
H‑index. The quality of published results of scientific work largely depends on knowledge 
sources that are used in the preparation, which means that it should be considered to serve 
the purpose and the very relevance of the information used. Scientometrics as a field of 
science covers all aforementioned issues, and scientometric analysis is obligatory for quality 
assessment of the scientific validity of published articles and other type of publications.

Abstract Despite the classic role of Vitamin D in skeletal health, new aspects of Vitamin D have been 
discovered in tissues and organs other than bones. Epidemiological and observational 
studies demonstrate a link between Vitamin D deficiency and risk of developing 
respiratory diseases including asthma, chronic obstructive pulmonary disease(COPD), and 
tuberculosis (TB). To review the literature, we searched the terms “Vitamin D”(using the 
set operator) and “asthma,” “COPD” and “TB” in electronic databases, including PubMed/
MEDLINE, Scopus, and Google Scholar until July 2015. Non‑English articles or articles with 
unavailable full text were excluded. Both in vivo and in vitro studies were included. All the 
reviewed articles state that Vitamin D deficiency is very common among patients with 
respiratory diseases. The present data regarding Vitamin D and asthma is still controversial, 
but data about COPD and TB are more encouraging. The relevant studies have been 
conducted in different populations therefore it is not particularly possible to compare the 
data due to genetic variations. In order to point out a role for Vitamin D, large clinical trials 
with Vitamin D deficient subjects and sufficient Vitamin D supplementation are needed.

Abstract Objective: The purpose of the present study was to evaluate the efficacy of 
midazolam‑ondansetron combination in prevention of postoperative nausea and 
vomiting (PONV) after middle ear surgery and its comparison with using midazolam 
or ondansetron alone.
Methods: One hundred and forty patients were enrolled in four groups to receive 
midazolam 0.75 mg/kg in group M, ondansetron 4 mg in group O, midazolam 0.75 mg/
kg and ondansetron 4 mg in group MO, and saline 0.9% in group S intravenously just 
before anesthesia. Assessment of nausea, vomiting, rescue antiemetic, and side effects 
of study drugs such as headache and dizziness was carried out postoperatively for 24 h.
Findings: The incidence of PONV was significantly smaller in groupMO than groupM and 
groupO, while there was no significant difference between group M and groupO during 
the first 24 h postoperatively. Requirement to the additional antiemetic was significantly 
more in group S (71.4%) compared to other groups, while in group MO (11.4%) was 
lower than group M (31.4%) and group O (34.3%).
Conclusion: Our study showed that prophylactic administration of midazolam 
0.75 mg/kg combined with ondansetron 4 mg was more effective than using midazolam 
or ondansetron alone in prevention of PONV after middle ear surgery.

Abstract Objective: The aim of this study is to evaluate the effect of zinc and omega‑3 supplements as 
adjunctive drugs in the treatment of attention‑deficit/hyperactivity disorder (ADHD) of children.
Methods: This study is a randomized, double‑blind clinical trial conducted on 150 
children aged 6–15 years old that diagnosed as new cases of ADHD. Study subjects 
were evaluated for 8 weeks. Besides of drug of choice (methylphenidate) for the ADHD, 
patients received placebo in the control group (n = 50), zinc sulfate in second group 
(n = 50), and omega‑3 (n = 50) in third group. Clinical improvement was checking 
by Conners’ Parent and Teacher Rating Scales before and in 2nd, 4th, and 8th week of 
treatment. Results were analyzed with SPSS version 16 software.
Findings: In this study, mean scores of Conners’ scale showed significant improvement 
during treatment in the zinc group compared to control group in children that affected 
to attention‑deficit disorder subtype of ADHD (P = 0.02). Moreover, in omega‑3 group, 
better clinical response was seen than other groups (P < 0.05). However, there was no 
significant difference between omega‑3 group compared to placebo group in the mean 
scores of Conners’ scale (P = 0.89).
Conclusion: Zinc supplementation accompanied by the main treatment significantly 
improves symptom of attention‑deficit disorder subtype of ADHD. However, omega‑3 
supplementation was superior to zinc and placebo in the clinical improvement of ADHD.

Abstract Objective: This study was designed to compare the efficacy and safety of enteral 
supplementation of a prebiotic mixture (SCGOS/LCFOS) on faecal microbiota in very 
premature infants who fed exclusively with human-milk.
Methods: This double‑center randomized control trial was conducted from December 
2012 to November 2013 in the tertiary Neonatal Intensive Care Units of the Isfahan 
University of Medical Sciences. Fifty preterm infants (birth weight ≤1500 g who 
were not fed with formula) were randomly allocated to have enteral (tube feeding) 
supplementation with a prebiotic mixture (SCGOS/LCFOS; 9:1) or receive no prebiotics.
Findings: The primary outcome (e.g., the effect of the prebiotic mixture on fecal 
microbiota pattern) was clearly different between the two groups. Despite greater 
coliforms colony counts in first stool cultures in the prebiotic group (Group P)(P = 0.67), 
coliforms were significantly lower in the third stool cultures in the Group P (P < 0.001). 
Furthermore, despite the much higher Lactobacillus colony counts, in the first 
stool cultures, in the control group (Group C) (P = 0.005); there was a trend toward 
significantly increased Lactobacillus colony counts in the Group P during the study, 
but the difference between Lactobacillus colony counts, in the third stool cultures, 
between two groups was no longer statistically significant(P = 0.11). Interestingly, the 
median length of hospital stay was significantly less in the Group P (16 [12.50–23.50] 
vs. 25 [19.50–33.00] days; P = 0.003).
Conclusion: This suggests that it might have been “the complete removal of formula” which 
manifests a synergistic effect between nonhuman neutral oligosaccharides (prebiotics) 
and human oligosaccharides, which in turn, led to the rapid growth of beneficial 
Lactobacillus colonies in the gut of breast milk‑fed preterm infants, while decreasing 
the number of pathogenic coliforms microorganisms. Therefore, further studies with 
larger sample sizes are recommended to investigate the issue.

Abstract Objective: Pharmaceutical access for the poor is an essential factor in developing 
countries that can be improved through strategic purchasing. This study was conducted 
to identify the elements affecting price in order to enable insurance organizations to 
put strategic purchasing into practice.
Methods: This was a qualitative study conducted through content analysis with an 
inductive approach applying a five‑stage framework analysis (familiarization, identifying 
a thematic framework, indexing, mapping, and interpretation). Data analysis was started 
right after transcribing each interview applying ATLAS.ti. Data were saturated after 32 
semi‑structured interviews by experts. These key informants were selected purposefully 
and through snowball sampling.
Findings: Findings showed that there are four main themes as Pharmaceutical Strategic 
Purchasing Requirements in Iran as follows essential and structural factors, international 
factors, economical factors, and legal factors. Moreover, totally 14 related sub‑themes 
were extracted in this area as the main effective variables.
Conclusion: It seems that paying adequate attention to the four present themes and 
14 sub‑themes affecting price can enable health system policy‑makers of developing 
countries like Iran to make the best decisions through strategic purchasing of drugs by 
the main insurers in order to improve access and health in the country.

Abstract Objective: Antibiotic use pattern and emergence of resistant bacteria are major 
concerns in clinical settings. This study aimed to detect common bacteria and their 
antibiotic sensitivity patterns in nephrology and kidney transplant wards.
Methods: This 1‑year, observational study was performed in the nephrology and 
kidney transplant wards of Imam Khomeini Hospital Complex, Tehran, Iran. All patients 
treated with antimicrobial agents for confirmed or suspected infections were included. 
Their demographic, clinical, and laboratory data (including biological media used for 
microbial culture, growth organisms, and antibiograms) were collected. Adherence of 
antimicrobial regimen to standard guidelines was also assessed.
Findings: About half of the patients received antibiotic. The most common infecting 
bacteria were Escherichia coli followed by Enterococcus sp. and Staphylococcus aureus.
E. coli showed high rate of sensitivity to carbapenems and nitrofurantoin and high rate 
of resistance to co‑trimoxazole and ciprofloxacin. Enterococcus sp. in both wards had 
high rate of resistance to ampicillin and were all sensitive to linezolid. Unlike to the 
nephrology ward, more than 50% of Enterococcus sp. from kidney transplant ward 
was resistant to vancomycin. The most common type of S. aureus in this nephrology 
ward was methicillin‑resistant S. aureus (MRSA). Most commonly‑prescribed 
antibiotics were carbapenems followed by vancomycin, ciprofloxacin, and ceftriaxone. 
Antibiotic regimens were 75% and 83%, 85% and 91%, and 80% and 87% compatible 
with international guidelines in antibiotic types, dosages, and treatment durations, 
respectively, in nephrology and kidney transplant wards, respectively.
Conclusion: MRSA, fluoroquinolone‑resistant E. coli, and vancomycin resistant 
Enterococcus species are major threats in nephrology and kidney transplant wards. 
Most commonly‑prescribed antibiotics were carbapenems that necessitate providing 
internal guidelines by the teamwork of clinical pharmacist, infectious disease specialists, 
and nephrologists to avoid the widespread use of broad‑spectrum antibiotics.

Abstract Objective: The extent to which a person’s health‑related behavior corresponds with 
medical instructions (adherence) is an important modifier of health system effectiveness. 
This study was designed to determine the patients’ adherence to Iranian traditional 
medicine in a group of patients with chronic disease.
Methods: Convenience sampling was used to enroll 320 patients with chronic diseases 
from January 2014 to January 2015 in clinics of traditional medicine affiliated with 
medical universities in Tehran. Morisky Medication Adherence Scale (MMAS) was 
used to measure the adherence. After describing the variables and the frequency of 
adherence, logistic regression analysis was used to determine the influencing factors.
Findings: Mean age was 40.8 (standard deviation [SD] =13) years. The mean of the 
duration of disease was 54.6 (SD = 56.1) months and mean of the duration of referring to 
the clinics 6.5 (SD = 6.9) months. Total score of MMAS was zero in 33 (10.3%) of patients 
(high adherence), one or two in 128 (40%) of patients (moderate adherence), and more 
than two in 159 (49.7%) of patients (low adherence). Forgetfulness, bad taste, not 
availability, and the high cost of the drugs were the most commonly reported causes of 
non‑adherence. Adherence was associated with age(odds ratio[OR] =1.05, 95% confidence 
interval [95% CI] 1–1.1), marriage (OR = 10.8, 95% CI 2.05–57.6), number of prescribed 
drugs (OR = 0.05, 95% CI 0.02–0.14), and duration of disease (OR = 1.01, 95% CI 1–1.02).
Conclusion: Considering the low adherence in users of medications of Iranian traditional 
medicine, health care practitioners need to be trained in adherence and the influencing 
factors and also to use some interventions to increase the adherence.

Abstract Objective: Community pharmacy educational program needs to be completed because 
of gradual transition in pharmacist responsibilities from traditional roles such as 
dispensing and compounding medications to give professional patient‑based care. To 
further develop the community pharmacy program, this study was designed to involve 
Logbook in pharmacy training courses.
Methods: For this study, at first, Logbook for community pharmacy practice was 
designed to develop educational program of this course in Isfahan University of Medical 
Sciences. Thereafter, in a 6‑month prospective study, this Logbook was incorporated to 
the pharmacy practice course of Doctor of Pharmacy (PharmD) educational program, 
and students’ feedbacks were gained after final examination to improve the Logbook 
accordingly. Students described their opinions about different sections of this program 
as unnecessary, necessary, and necessary with revision.
Findings: A total of 65 PharmD students were included in this study. More than 90% of 
the students gave complete answers to the evaluation of this pharmacy training program. 
The results showed that more than 70% of students considered this program of pharmacy 
training was necessary(with or without revisions) in PharmD courses. They recommended 
more time to be included for prescription reading and analyses during these courses.
Conclusion: Developing pharmacy training program by using Logbook which was 
presented in this study was considered necessary and efficient for PharmD students. 
However, it is a prototype system, and we are committed to using initial students and 
preceptors’ feedbacks to improve Logbook in future courses.

Abstract Objective: Opportunistic infections like cytomegalovirus (CMV) are among the 
primary causes of morbidity and mortality in patients undergoing hematipoetic stem 
cell transplantation (HSCT). This infection is frequently seen in early postengraftment 
period. So we determined to find the risk factors associated with CMV reactivation.
Methods: We retrospectively evaluated the medical records of 126 consecutive patients 
who underwent allogenic‑HSCT from peripheral blood stem cells from August 2011 to 
February 2013 in Shariati Hospital. We included HSCT patients with 15 years of age 
or older, who survived at least 100 days after transplantation. CMV reactivation was 
detected based on the weekly PP65 assessment. Patients with 10 or more positive cells 
per 50,000 cells were defined as having high‑level antigenemia.
Findings: From 126 patients which included in this study, 76 were male (60%). CMV 
antigenemia was documented in 43 patients (34%). The median time to CMV infection 
was 40 days (range: 3–77) after transplantation. The incidence of high‑level antigenemia 
during the first 100 days following HSCT was 11%.
Conclusion: We found that the significant risk factor for CMV antigenemia in multivariate 
analysis was prior graft‑versus‑host disease (GVHD) experience and higher donor age. For 
high‑level antigenemia, GVHD or duration of its treatment was significant determinant.

Abstract Drug reaction with eosinophilia and systemic symptom (DRESS) is a severe adverse 
drug‑induced reaction with a prolonged latency period which is characterized by a variety 
of clinical manifestations, usually fever, rash, lymphadenopathy, eosinophilia, and a wide 
range of mild‑to‑severe systemic presentations. Drugs are an important cause of DRESS in 
most of the cases. It is challenging to diagnose DRESS because of the diversity of cutaneous 
eruption and visceral organs involvement. We hereby report a 34‑year‑old female who 
developed DRESS syndrome following ingestion of nitrofurantoin for the treatment of 
urinary tract infection. She was managed conservatively and recovered after few weeks. 
Our aim of this study is to raise awareness to suspect DRESS syndrome in patients who 
present with unusual clinical features with skin involvement after initiating any drug.

Abstract