Ahmadinejad Z, Mobaen A.r, Kariminia A, Afhami Sh, Hatmi Zn, Torkabadi E, Yalda A,
Volume 65, Issue 2 (3-2008)
Abstract
Background: Sepsis is the leading cause of death in critically ill patients throughout the world. The incidence is increasing despite the major advances in the development of antimicrobial agents and other supportive treatments. Based on multiple studies, it has been shown that patient outcome depends on Th1 and Th2 cytokine response. Moreover, whenever the Th2 response is predominant, the sepsis is more severe. The aim of this study was to evaluate the correlation between cytokine levels and the severity of sepsis in patients.
Methods: A cross-sectional study on the cellular levels of several pro-inflammatory cytokines was carried out in patients with sepsis and severe sepsis. The study included 37 patients (24 men and 13 women), 26 of them had sepsis and 11 had the severe form of sepsis Thirty-seven healthy volunteers served as controls. The average age of the patients was 57 years (±23.3 years), with a range of 21 to 92 years. From the whole blood of the subjects, we separated the monocytes and leukocytes, which were then cultured. Using an ELISA method, we measured levels of IFN- and IL-12 (associated with Th1), and IL-4 and IL-10 (associated with Th2) in the cultured cells with and without cell stimulation.
Results: No correlation was found for IFN- production in the cells of patients with sepsis and severe sepsis, regardless of whether the patients had died or survived. However, IL-12 levels were significantly decreased in severe sepsis compared with those of sepsis patients (P=0.048). Furthermore, the cells of expired patients also had significantly decreased IL-12 levels compared with those of surviving patients (P=0.028). We also found that the levels of IFN-, IL-4, and IL-10 were decreased in patients compared with those of controls, which correlated to their production. However, there was no correlation for IL-12 production between the cells of the patients compared with those of the controls. There was also no correlation for cytokine production between men and women with sepsis and in adults compared with that of elderly patients (>55 years old).
Conclusion: We have shown that the predominating T helper cell subset in patients with severe sepsis, as well as expired patients, is Th2. In conclusion, the correlation of Th1 cytokine production and progression of sepsis was demonstrated. Most probably IL-12 levels would be significantly lower in patients with severe sepsis and those who expired.
Mosleh A, Darbooy Sh, Khoshnevis Ansari Sh, Mohammadi M,
Volume 65, Issue 14 (3-2008)
Abstract
Background: Rationalize of drug use in societies is one of the main responsibilities of
health policy makers. In our country irrational use of dugs has increased in the recent
years, for example one study in 1998 has shown that average number of medicines per
prescription was 3.6, percentage of prescriptions containing antibiotics was 43% and
percentage of prescriptions containing Injections was 39%. One of the best tools for
evaluation of drug use is the WHO guideline for calculating prescribing indicators. In this
study, we had an assessment about prescribing patterns in South of Tehran, Islamshahr
and Rey Health Centers.
Methods: In order to evaluating prescribing indicators in Tehran University of Medical
Sciences region 35 facilities which had pharmacy were selected according to WHO
gridline and 4190 prescription from these facilities were studied. Indicators were
calculated according to formulas has explained in article.
Results: The average number of drug per prescription was 2.58, percentage of drug
prescribed by generic name: 99.8%, percentage of encounters prescribed Antibiotics:
62.39% percentage of encounters prescribed Injection: 28.96% & the percentage of drugs
prescribed from PHC formulary 99.46%. These findings were almost similar in the three
Health Centers.
Conclusions: Health facilities are one of the most important bases to improve rational
use of Drugs and general practitioners are the major chain in RUD cycle. Results show
that we need to design intervention especially educational interventions to improve two
WHO prescribing indicators, percentage of encounters prescribed Antibiotics &
Injections in this region. For reaching this goals we need to design educational programs
for physicians, pharmacists and people too. These educations can be as workshops,
seminars, conferences or printed materials such as books, leaflets and etc
