Journal of Research in Pharmacy Practice

Outcome evaluation of a subcutaneous immunoglobulin clinical management program

Julia Zhu; Gretchen Ayer; Heather S Kirkham; Chi-Chang Chen; Rolin L Wade; Swapna U Karkare; Chester H Robson; Jordan S Orange

Volume 8, Issue 2 , April 2019, , Pages 52-63

Abstract

  The aim of this study is to compare clinical and cost outcomes of patients undergoing subcutaneous immunoglobulin (SCIG) therapy who were managed by a clinical management program to ...  Read More The aim of this study is to compare clinical and cost outcomes of patients undergoing subcutaneous immunoglobulin (SCIG) therapy who were managed by a clinical management program to the matched controls in the United States. Methods: This was a retrospective cohort study using administrative claims data from the PharMetrics Plus™ (PMTX+) database. The patients from a high-touch SCIG clinical management program were matched to nonprogram patients in PMTX+ database using 1:4 propensity score matching without replacement. All patients were followed for 1 year during the study from September 1, 2011, to June 30, 2014, and both clinical and cost outcomes were compared between the two cohorts using the generalized estimating equation model. Findings: The clinical outcomes were measured by infection- and infusion-related adverse events (AEs). Most of them were not significantly different (P > 0.05) between the intervention group and matched controls. Although the proportion of patients who had a mild less common AE was higher (4.4% vs. 0.0%;P = 0.04), it could be due to increased reporting among the intervention group. The annual adjusted mean total health-care costs of patients in the program (n = 45) were $20,868 lower compared to matched controls (n = 180), representing a 24% lower costs ($66,450 vs. $87,318;P = 0.009). Conclusion: This study may demonstrate that clinical management programs for SCIG may be associated with lower health-care costs and comparable infection and severe AE rates. The limitations of this study included a small sample size and a reliance on administrative claim data.

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The content of plasma selenium in early admitted septic patients

Omid Moradi Moghaddam; Mohammad Niakan Lahiji; Azadeh Moghaddas; Maryam Farasatinasab; Somayyeh Nasiripour

Volume 6, Issue 1 , January 2017, , Pages 52-55

Abstract

  Selenium depletion has been reported in critical illness correlates with an increase in mortality and morbidity. In this study, we aimed to access the selenium plasma levels of septic ...  Read More Selenium depletion has been reported in critical illness correlates with an increase in mortality and morbidity. In this study, we aimed to access the selenium plasma levels of septic patients early at the Intensive Care Unit (ICU) admission in order to compare with reference range.Methods: We conducted a cross-sectional study in a university affiliated hospital aiming to assess the early plasma level of selenium in ICU admitted patients. eighty patients diagnoses with sepsis were included and considered for characteristic evaluation, monitoring criteria assessment and also blood sampling. All blood sampling was performed during 48 hours of the ICU admission in order to determined the plasma Selenium level by atomic absorption method.Findings: The mean plasma levels of selenium in male and female was 98.14 ± 23.52 and 78.1 ± 24.46 μ/L, respectively. Although selenium plasma levels was higher in the ICU male patients significantly, both had near normal range (80 μ/L).Conclusion: In this study we found that in early admitted Iranian ICU patients in Tehran, selenium deficiency has not routinely seen but probably will happen during ICU hospitalization. Keywords: Critical ill patients, intensive care unit, Seleniu

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Adherence to prescribed medications of Iranian traditional medicine in a group of patients with chronic disease

. Fataneh Hashem Dabaghian; . Maryam Rassouli; . Jila Sadighi; . Roshanak Ghods

Volume 5, Issue 1 , January 2016, , Pages 52-57

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 ...  Read More 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.

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Effect of phentolamine mesylate on duration of soft tissue local anesthesia in children

. Nosrat Nourbakhsh; . Farzaneh Shirani; . Mahdi Babaei

Volume 1, Issue 2 , November 2012, , Pages 55-59

Abstract

  Objective: Addition of vasoconstrictors to local anesthesia results in prolonged pain control. However, associated soft‑tissue anesthesia (STA) of the lips and tongue typically ...  Read More Objective: Addition of vasoconstrictors to local anesthesia results in prolonged pain control. However, associated soft‑tissue anesthesia (STA) of the lips and tongue typically lasts 3‑5 hours which is longer than required time for pain control after routine dental procedures can lead to inadvertent biting of the soft tissue, particularly in children. The present study aimed to evaluate phentolamine mesylate (PM) effect on duration of STA and incidence of soft‑tissue trauma after mandibular block injection.Methods: This randomized, double‑blinded, controlled clinical trial included 54 patients with the age of 4‑11 years. In group 1 at the first visit, the children received ordinary local anesthetic (LA) consisting of lidocaine 2% and epinephrine 1:80,000 and the PM injection was performed 30 minutes later. At the second visit, the contralateral side received LA injection then the dental procedure was done and a sham injection was performed. In group 2 at the first visit, patients received control injection and at the second visit received PM injection. Then the reversal time for normal sensation of soft tissue, the vital signs, and the incidence of soft‑tissue trauma in a period of 3‑5 hours after injection were evaluated.Findings: There was a statistically significant difference (P < 0.001) in recovery time of normal lip sensation between case and control groups and also between two groups (P < 0.003). Incidence of soft‑tissue trauma between case and control groups showed a statistically significant difference (P < 0.039).Conclusion: PM can be considered as a safe and effective drug for reduction of reversal time of STA after dental procedures.

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Reduced weekly subcutaneous doses of bortezomib in combination with cyclophosphamide and dexamethasone for newly diagnosed multiple myeloma

Farzaneh Ashrafi; Azadeh Moghaddas; Ali Darakhshandeh

Volume 9, Issue 1 , January 2020, , Pages 56-59

Abstract

   A combination of bortezomib, cyclophosphamide, and dexamethasone is highly effective in the treatment of newly diagnosed multiple myeloma. Neuropathy is a dose-limiting adverse ...  Read More  A combination of bortezomib, cyclophosphamide, and dexamethasone is highly effective in the treatment of newly diagnosed multiple myeloma. Neuropathy is a dose-limiting adverse effect of this regimen. Subcutaneous and weekly injection instead of biweekly intravenous administration are used to reduce neuropathy. In this study, patients treated with subcutaneous weekly reduced the dose of bortezomib to reduce neuropathy and cost of treatment. Methods: This is an interventional study, including 16 patients. Enrolled patients received bortezomib 1 mg/m2 subcutaneously, cyclophosphamide 300 mg/m2 intravenously, and dexamethasone 40 mg intravenously days 1, 8, 15, and 22 of a 28 cycle. Findings: The overall response rate (≥partial response [PR]) was 93.8%. Thirteen of 16 patients (81.3%) were in an acceptable PR and complete response. Two patients (12.5%) achieving a PR. Meantime to achievement, the best response was 71 (55–87) days. Median progression-free survival was 33 (2–56) months, and autologous stem cell transplantation was performed for 68.8% of patients. Five patients (31.25%) experienced Grade I and one patient (6.25%) Grade III (no Grade 2 or 4) of peripheral neuropathy. Dose reduction and drug discontinuation was required in one patient (6.25%). Conclusion: A reduced subcutaneous, weekly dose of bortezomib in combination with cyclophosphamide and dexamethasone is effective with manageable profile toxicity and acceptable cost.

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A novel practical equation for treatment of emergent hypernatremia and dehydration phase in infants

Saba Ghaffary; Azadeh Moghaddas; Mehrnoush Dianatkhah

Volume 6, Issue 1 , January 2017, , Pages 56-59

Abstract

  Serum sodium (Na) concentration more than 145 mmol/L is defined as hypernatremia. Hypernatremia carries an acute morbidity and mortality, especially in neonates and infants. Rapid correction ...  Read More Serum sodium (Na) concentration more than 145 mmol/L is defined as hypernatremia. Hypernatremia carries an acute morbidity and mortality, especially in neonates and infants. Rapid correction of hypernatremia leads to severe cerebral damages, and seizure is the most common neurological complication of hypernatremia. Selection and calculation of an appropriate fluid and its amount is one of the tremendous challenges. It is important to choose the correct amount of suitable fluid and adjust rehydration rate. In this study, we have suggested practical equation to determine the amount of fluid that should be administered to the neonates and infants with hypernatremia. In this equation, the amount of infusate volume will be calculated from changes in serum Na and total body water. However, serum Na and infusate Na will play an important role in equation structure, too. Our suggested equation will help physicians to manage hypernatremic dehydrated patients in a suitable manner with an adjustable rate.

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Assessing health conditions and medication use among the homeless community in Long Beach, California

. Mok Thoong Chong; . Jason Yamaki; . Megan Harwood; . Richard d’Assalenaux; . Ettie Rosenberg; . Okezie Aruoma; . Anupam Bishayee

Volume 3, Issue 2 , April 2014, , Pages 56-61

Abstract

  Objective: Persons experiencing homelessness are a vulnerable population and are at increased risk for morbidity and all‑cause mortality compared to the general population. This ...  Read More Objective: Persons experiencing homelessness are a vulnerable population and are at increased risk for morbidity and all‑cause mortality compared to the general population. This study sought to evaluate medication use, regular physician visits, and identify health conditions among the homeless population of Long Beach, California.Methods: Two “brown bag” medication review events were held at homeless shelters in the Long Beach area. Demographic information, medication use, and comorbid disease states were obtained through surveys.Findings: Three‑fourths of the cohort (95 participants) consisted of males, and the average age of participants was 48 years. Psychiatric disorders and cardiovascular disease were the most common disease states reported at 32% and 46%, respectively and so were medications used in treating these chronic diseases. Medication adherence was found to be a significant problem in this population, where more than 30% of patients were nonadherent to medications for chronic diseases. Furthermore, foot problems, hearing and vision difficulties constitute the most commonly overlooked health problems within the homeless population.Conclusion: Based on this and other similar finding, we must accept that the homeless represent a vulnerable population, and that because of this fact, more programs should be focused at improving availability and access to health care among the homeless. Regarding the high number of reported health problems in the study, more studies are needed and more studies should incorporate screening for foot, hearing, and vision issues, both to increase awareness and to provide an opportunity for devising possible solutions to these highly preventable conditions.

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Effects of carnitine on nutritional parameters in patients with chronic Kidney disease: An updated systematic review and meta-analysis

Tahereh Gholipur-Shahraki; Awat Feizi; Mojgan Mortazavi; Shirinsadat Badri

Volume 7, Issue 2 , April 2018, , Pages 57-68

Abstract

  Protein energy malnutrition is a common problem in patients with chronic kidney disease (CKD). Scattered reports indicate that supplementation of Carnitine may improve patients' clinical ...  Read More Protein energy malnutrition is a common problem in patients with chronic kidney disease (CKD). Scattered reports indicate that supplementation of Carnitine may improve patients' clinical symptoms, with significant improvement in nutritional parameters. This systematic review was done to document the evidences of Carnitine effects in nutritional status of CKD patients. Peer-reviewed RCTs on Carnitine administration at any dose in CKD patients with at least four weeks of follow-up were including in the meta-analysis. Online databases (PubMed/Medline, ISI Web of Science, Embase, and Scopus) were searched to October 2017 using selected MeSH terms related to the study topic. Data was extracted independently by two reviewers using a standard form and then cross-checked. Statistical analyses were carried out with Comprehensive Meta-analysis software. Data are presented as standard mean difference (SMD) and 95% confidence interval (CI). According to the predefined criteria, a total of 14 randomized controlled clinical trials were included and screened for data extraction by two reviewers, separately. The preliminary results extracted from meta-analysis have shown that Carnitine can significantly increase the levels of albumin (SMD: -0.861; 95% CI: -1.321, -0.402), total protein (SMD: -0.418; 95% CI: -0.695, -0.141), total cholesterol (SMD: -0.350; 95% CI: -0.564, -0.135), LDL cholesterol (SMD: -0.362; 95% CI: -0.551, -0.173), transferrin (SMD: -1.465; 95% CI: -1.822, -1.108), and hemoglobin (SMD: -0.525; 95% CI: -0.732, -0.318); however there were no conclusive effects of Carnitine on body weight (SMD: -0.057; 95% CI: -0.404, 0.291) and BMI (SMD: -0.567; 95% CI: -1.548, 0.415), in pooled analyses. The results of this meta-analysis showed that there are considerable useful pieces of evidence so far about the effect of Carnitine on nutritional factors; however, there is still doubt about some evidences with this regard. It seems necessary to carry out clinical trials with stronger designs to evaluate the impact of these primary outcomes on the patients' clinical conditions. Having this evidences, the potential role of Carnitine in improving malnutrition consequences in CKD patients would be clearly defined.

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The comparative study of intravenous Ondansetron and sub-hypnotic Propofol dose in control and treatment of intrathecal Sufentanil-induced pruritus in elective caesarean surgery

. Anahita Hirmanpour; . Mohammadreza Safavi; . Azim Honarmand; . Akram Zavaran Hosseini; . Maryam Sepehrian

Volume 4, Issue 2 , April 2015, , Pages 57-63

Abstract

  Objective: Pruritus is a common and disturbing side effect of neuraxial opioids after cesarean section. The purpose of this study was to compare the efficacy of intravenous ondansetron ...  Read More Objective: Pruritus is a common and disturbing side effect of neuraxial opioids after cesarean section. The purpose of this study was to compare the efficacy of intravenous ondansetron and sub-hypnotic dose of propofol in control and treatment of intrathecal sufentanil induced pruritus in cesarean surgery.Methods: Totally, 90 parturient with American Society of Anesthesiology physical status grade I-II, undergoing spinal anesthesia with 2.5 µg sufentanil and 10 mg bupivacaine 0.5% were enrolled to this randomized, prospective, double-blind study. The women were randomly assigned to two groups who received 8 mg ondansetron or 10 mg propofol to treat pruritus grade ≥3. The patient was evaluated after 5 min and in the lack of successful treatment, the doses of two drugs repeated and if the pruritus is on-going, the exact treatment with naloxone was done.Findings: The incidence of pruritus was 69.3%. Both groups were well-matched. The peak time pruritus was 30–75 min after injection. The percentage of individuals consumed naloxone were 6.8% and 15.9% in ondansetron and propofol groups, respectively (P = 0.18). The mean score of satisfaction (according to visual analog scale criteria) was 9.09 ± 1.1 in ondansetron group and 9.3 ± 1.07 in the propofol group (P = 0.39).Conclusion: Ondansetrone and sub-hypnotic dose of propofol are both safe and well‑tolerated. Due to their same efficacy in the treatment of intrathecal sufentanil‑induced pruritus, they can be widely used in clinical practice.

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Development of a community pharmacy program in Iran with a focus on Logbook application

. Shadi Farsaei

Volume 5, Issue 1 , January 2016, , Pages 58-62

Abstract

  Objective: Community pharmacy educational program needs to be completed because of gradual transition in pharmacist responsibilities from traditional roles such as dispensing ...  Read More 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.

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Comparison of clinical manifestations of patients poisoned with tricyclic antidepressants alone or with benzodiazepine intoxication according to the dose of benzodiazepines

Gholamali Dorooshi1; Rasool Kermani; Ali Mohammad Sabzghabaee; Marjan Mansourian; Nastaran Eizadi-Mood

Volume 11, Issue 2 , April 2022, , Pages 59-63

Abstract

   Tricyclic antidepressants poisoning (TCA) is associated with cardiovascular complications, electrocardiographic abnormalities, and central nervous system toxicity. This study ...  Read More  Tricyclic antidepressants poisoning (TCA) is associated with cardiovascular complications, electrocardiographic abnormalities, and central nervous system toxicity. This study aimed to compare the clinical manifestations of poisoned patients with tricyclic antidepressants alone or with benzodiazepine (BZD) intoxication according to the dose of BZDs. Methods: In this case–control study, 120 patients with TCA poisoning were divided into four groups: the first group of TCA poisoning alone, the second group of TCA and BZD poisoning of <7.75 mg, the third group of TCA and B poisoning of 7.75 to 80 mg, and the fourth group of more than 80 mg of TCA and BZD poisoning. Patients' demographic, clinical, and cardiac information was extracted from their records at admission and 6 h after admission. Findings: Cardiac complications 6 h after referral and total cardiac complications between TCA and TCA low-dose BZD groups were significantly reduced in the low-dose BZD poisoning group. Comparison of TCA and TCA groups with a moderate dose of BZD showed a significant reduction in time six and total cardiac complications. However, due to the significant difference in TCA values between the two groups, the results are not significant. Comparing the two groups of TCA and TCA with a high dose of BZD, both 6-hour cardiac complications and total cardiac complications in the high-dose BZD group, it was significantly reduced. However, the loss of consciousness was also considerably greater in the high-dose BZD group than in the TCA group. Conclusion: Concomitant BZDs with TCA can reduce cardiovascular complications from TCA poisoning. However, with high doses of BZDs, there is a greater loss of consciousness.

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Assessing the performance of community pharmacies in iran by measuring responsiveness to non-medical needs: An application of who responsiveness framework

Saba Afifi; Amir Hossein Alizadeh Bahmani; Leila Zarei; Motahareh Mahi-Birjand; Mehdi Hoorang; Marziyeh Zare; Iman Karimzadeh; Farzad Peiravian; Mahtabalsadat Mirjalili; Payam Peymani

Volume 10, Issue 2 , April 2021, , Pages 59-64

Abstract

  Despite growing debates about the health systems' nonmedical performance, there has not been any empirical research on nonmedical performance and patients' rights consideration as a ...  Read More Despite growing debates about the health systems' nonmedical performance, there has not been any empirical research on nonmedical performance and patients' rights consideration as a driver of human rights in the pharmaceutical sector. This study's main objective was to assess the nonmedical performance of community pharmacies of Shiraz, Iran. Methods: A cross-sectional study was conducted using two self-administrated Likert-based questionnaires based on the World Health Organization (WHO) responsiveness framework and the legal charter communicated by the Ministry of Health and Medical Education of Iran. The population was patients older than 18 years who took a prescription from community pharmacies located in Shiraz and willing to answer the questions voluntarily, from 2018 to 2019. Considering the weights of subdimensions of responsiveness provided by the WHO framework, the total score of responsiveness was calculated ranging from 0 to 100. Findings: The response rate was 80.5%. The mean (standard deviation) overall score of responsiveness was 57.18 (21.61), with a median of 56.71. The mean score of client orientation was lower in respondents with a high education level than those with a diploma and under diploma (P = 0.028). Conclusion: Nonmedical pharmacy performance was considered either medium or high in more than half of the cases based on the participants' views. Regarding client, orientation was seen less often in patients with high education level compared to those with a lower education level.

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A survey on the factors influencing the pattern of medicine’s use: Concerns on irrational use of drugs

. Fatemeh Soleymani; . Fariba Ahmadizar; . Alipasha Meysamie; . Mohammad Abdollahi

Volume 2, Issue 2 , April 2013, , Pages 59-63

Abstract

  Objective: Pharmacists have a remarkable role in rational use of drugs by dissemination of drug information to guide patients, physicians, and policy makers. The present study ...  Read More Objective: Pharmacists have a remarkable role in rational use of drugs by dissemination of drug information to guide patients, physicians, and policy makers. The present study was undertaken to evaluate the pharmacists’ view point about the main factors affecting current drug use pattern regarding rational drug use and the most effective strategies for improving and promoting rational drug use among pharmacists.Methods: In a cross‑sectional survey, pre‑designed questionnaires were filled in convenient sampling by pharmacists who had attended the congress of rational drug use in Tehran, Iran.Findings: A total of 144 pharmacists with the average age of 40.78 years old were enrolled to the study. Data indicated that the most priorities in irrational use of drugs from pharmacists’ view point were lack of appropriate cooperation and communication between physicians and pharmacists(39%), pharmacists’ low tariff and economic issues (34%), lack of public knowledge about drug usage (45%), and lack of supervisory regulations on pharmacy practice (15.8%).Conclusion: In this study, lack of public knowledge and awareness about appropriate use of medicines was the most important element from pharmacists’ viewpoint in occurrence of irrational drug use. Dissemination of information and compiling of diverse strategies in education, management, regulation, and finance can be very efficient due to a strong relationship between drug policies and performance of regulations and supervisions as well as drug services.

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Does the intramuscular injection of vitamin D increase insulin resistance?

. Bijan Iraj; . Ashraf Aminorroaya; . Massoud Amini

Volume 1, Issue 2 , November 2012, , Pages 60-65

Abstract

  Objective: Considering the physiologic roles of vitamin D on insulin regulation, the effects of vitamin D treatment on insulin sensitivity and resistance indexes and beta cell ...  Read More Objective: Considering the physiologic roles of vitamin D on insulin regulation, the effects of vitamin D treatment on insulin sensitivity and resistance indexes and beta cell function in pre‑diabetic vitamin D deficient patients were investigated.Methods: In a randomized open clinical trial, 61 pre‑diabetic vitamin D deficient patients who were the first degree relatives of type 2 diabetic patients, were enrolled and randomized into three groups (A, B and C). GroupA (n = 21) were treated with intramuscular injection of 300,000 units of vitamin D at the beginning of the study and one month later. In group B (n = 20), injection of vitamin D plus 500 mg/d calcium and in group C (n = 20), just calcium was administered for two months. At baseline and two months later, oral glucose tolerance test was done. Homeostasis Model of Assessment-Insulin Resistance (HOMAIR), insulin resistance index, Homeostasis Model of Assessment-B (HOMA-B) which is a beta cell function index, and Matsuda index, an insulin sensitivity index, were calculated and compared before and after intervention and between three groups.Findings: In vitamin D treated groups (A + B), the mean (SD) of HOMA‑IR increased from 2.46 (1.36) to 3.1 (2.3) (P  =  0.02), and Matsuda index decreased from 11 (3) to 9.0 (2.3) (P = 0.001).Conclusion: Injection of vitamin D increased insulin resistance and decreased insulin sensitivity indexes.

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Herbal supplement use and herb–drug interactions among patients with kidney disease

Soroush Mohammadi; Gholamreza Asghari; Afsoon Emami-Naini; Marjan Mansourian; Shirinsadat Badri

Volume 9, Issue 2 , April 2020, , Pages 61-67

Abstract

  The prevalence of herb–drug interactions and herb's adverse effects may be serious in susceptible population such as patients with chronic kidney disease (CKD). In this study, ...  Read More The prevalence of herb–drug interactions and herb's adverse effects may be serious in susceptible population such as patients with chronic kidney disease (CKD). In this study, we planned to determine the usage prevalence of herbal products and herb–drug interactions in CKD patients. Methods: A cross-sectional prospective study was conducted on CKD and posttransplant patients with a history of using herbal supplements in Isfahan, Iran. The patients were subjected to a validated checklist, containing demographic and clinical information. The knowledge of herbal use, side effects, and herb–drug interactions was assessed based on patients' responses. Data were reported as prevalence (percent) of the occurrence. Findings: The prevalence of herbal supplement usage among CKD patients was 18.6% in this study. The study included 400 patients (261 males and 139 females). The majority of the study population were in the age range of 50–70 years (61.5%). Hypertension (34.36%) was the most common cause of kidney failure, while diabetes mellitus (21.80%) took the second place. The most frequently used unformulated medicinal herb was Echium (Echium amoenum) (15.27%), and the most commonly used formulated herbal products were anticough and mucolytic based on Thymus vulgaris (24.27%). Eighteen patients (4.5%) used herbal mix with unknown entity and sources. In this study, ginseng has the most possible interactions with prescription drugs (18 interactions), while this interaction (with clopidogrel, warfarin, and heparin) was severe in six cases. Conclusion: The present study provided the information on possible herb–drug interactions in CKD patients on herbal usage. Since the issue of using herbal products may be arbitrarily in the majority of the patients, and considering the importance of adverse reactions or major interactions, health-care providers should play an active role to identify these cases and inform the patients regarding herbal product safety, adverse effects, and possible interactions.

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Adherence to American society of health‑system pharmacists surgical antibiotic prophylaxis guidelines in a teaching hospital

. Mohammadreza Rafati; . Afshin Shiva; . Amirhosein Ahmadi; . Omran Habibi

Volume 3, Issue 2 , April 2014, , Pages 62-66

Abstract

  Objective: Surgical site infections are the second most common type of adverse events occurring in hospitalized patients, whereas an estimated 40-60% of these infections are thought to ...  Read More Objective: Surgical site infections are the second most common type of adverse events occurring in hospitalized patients, whereas an estimated 40-60% of these infections are thought to be preventable. Choice of regimen, administration timing or duration of antibiotic prophylaxis is reported to be inappropriate in approximately 25-50% of cases. We tried to evaluate an antibiotic administration pattern for surgical antibiotic prophylaxis in a teaching hospital.Methods: This study was conducted at the general surgery and orthopedic wards of a teaching hospital affiliated with Mazandaran University of Medical Sciences. The medical records of admitted patients who underwent different surgical procedures were reviewed. Compliance was assessed with the recommendations of the American Society of Health‑System Pharmacists’ guidelines for every aspect of antibiotic prophylaxis. All data were coded and analyzed by SPSS16 software using Student’s t‑test and Chi‑square test.Findings: During 1 year, 759 patients who underwent different surgeries were included in the study. Mean age of patients was 32.02 ± 18.79 years. Hand and foot fractures repair were the most frequent surgery types. About 56.4% of administered prophylactic antibiotics were in accordance with the American Society of Health System Pharmacists (ASHP) guidelines regarding prophylaxis indication. The most commonly antibiotic used was cefazolin and antibiotic choices were appropriate in 104 of 168 surgical procedures (62%). Gentamicin, metronidazole and ceftriaxone were the most frequently antibiotics that used inappropriately. Only in 100 of 168 procedures, duration was concordant with the ASHP guideline, whereas in 68 procedures, duration was longer than recommended time. In 98 procedures, the dose was lower and in one procedure, it was higher than recommended doses.Conclusion: Although such guidelines have been in place for many years, studies showed that much inappropriate antibiotic use as prophylaxis and poor adherence to guidelines are still major issues. It is essential for surgeons to be aware to consider the best antibiotic choices, dose and duration based on reliable guidelines for antibiotic prophylaxis.

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The risk factors for cytomegalovirus reactivation following stem cell transplantation

. Bahareh Valadkhani; . Mona Kargar; . Asieh Ashouri; . Molouk Hadjibabaie; . Kheirollah Gholami; . Ardeshir Ghavamzadeh

Volume 5, Issue 1 , January 2016, , Pages 63-69

Abstract

  Objective: Opportunistic infections like cytomegalovirus (CMV) are among the primary causes of morbidity and mortality in patients undergoing hematipoetic stem cell transplantation ...  Read More 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.

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High-dose intravenous Vitamin C in early stages of severe acute respiratory syndrome coronavirus 2 infection: A double-blind, randomized, controlled clinical trial

Zohre Labbani-Motlagh; Shahideh Amini; Rasoul Aliannejad; Anahita Sadeghi; Gita Shafiee; Ramin Heshmat; Mohamadreza Jafary; Mona Talaschian; Maryam Akhtari; Ahmadreza Jamshidi; Mahdi Mahmoudi; Kourosh Sadeghi

Volume 11, Issue 2 , April 2022, , Pages 64-72

Abstract

  Based on previous studies in the sepsis population, Vitamin C could prevent injuries when administered in high doses and before the damage is established. This study aimed to evaluate ...  Read More Based on previous studies in the sepsis population, Vitamin C could prevent injuries when administered in high doses and before the damage is established. This study aimed to evaluate the protective potentials of high-dose Vitamin C in the progression of coronavirus disease 2019 (COVID-19). Methods: A double-blind, placebo-controlled clinical trial was conducted. Patients with moderate-to-severe disease severity based on the World Health Organization definition were enrolled and received 12 g/d Vitamin C (high-dose intravenous Vitamin C [HDIVC]) or placebo for 4 days. Sequential Organ Failure Assessment (SOFA) score as a primary outcome, National Early Warning Score, Ordinal Scale of Clinical Improvement, and cytokine storm biomarkers were recorded on days 0, 3, and 5. Survival was also assessed on day 28 after enrollment. Findings: Seventy-four patients (37 patients in each group) were enrolled from April 5, 2020, to November 19, 2020, and all patients completed follow-up. A lower increase in SOFA score during the first 3 days of treatment (+0.026 vs. +0.204) and a higher decrease in this parameter in the last 2 days (−0.462 vs. −0.036) were observed in the treatment group. However, these differences did not reach a significance level (P = 0.57 and 0.12, respectively). Other indices of clinical and biological improvement, length of hospitalization, and intensive care unit admission days were the same between the two groups. Treatment did not affect the 28-day mortality. Conclusion: Among patients with moderate-to-severe disease of COVID-19, the use of HDIVC plus standard care resulted in no significant difference in SOFA score or 28-day mortality compared to the standard care alone.

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Frequency and predisposing factors for drug-induced hypoglycemia in patients with type-2 diabetes mellitus

Atiqulla Shariff; Sathvik Belagodu Sridhar; Hana Rami Bittar; Ahed Hamad; Reem Ahmed; Ghaidaa Kadour

Volume 8, Issue 2 , April 2019, , Pages 64-68

Abstract

  Hypoglycemia is the most common complication of the treatment for diabetes mellitus. Various factors predispose an individual for drug-induced hypoglycemia. The aim of this study was ...  Read More Hypoglycemia is the most common complication of the treatment for diabetes mellitus. Various factors predispose an individual for drug-induced hypoglycemia. The aim of this study was to explore the relative frequency and likely predisposing factors for drug-induced hypoglycemia among type-2 diabetic patients in the United Arab Emirates (UAE). Methods: In this cross-sectional survey-based study which was conducted from February to April 2018 in two local community pharmacies in the UAE, diabetic patients underwent a structured interview on their diabetes mellitus status and management and specific open-ended questions related to hypoglycemic symptoms that they might have experienced and the occurrence of symptoms. Collected data were used to estimate the relative frequency of drug-induced hypoglycemia and to identify the probable predisposing factors and their contribution in causing hypoglycemia using relative risk, Chi-square test, and Fisher's exact test. Findings: The relative frequency of drug-induced hypoglycemia in our study was 46.25%. Patients' age of ≥65 years, duration of diabetes mellitus for more than 1 year, patients with more than one comorbid condition, and patients using more than one antidiabetic medication were predisposing for developing drug-induced hypoglycemia. Conclusion: The relative frequency of drug-induced hypoglycemia in a nontrial environment which lacks the special cares routinely provided in drug development clinical trials is high. We suggest that more attention should be paid to identify, prevent, and manage drug-induced hypoglycemia in type-2 diabetic patients who have more than 1 year of diabetes, more than one comorbidity, using more than one antidiabetic medication, and elderly.

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Comparison of Gabapentin with Estrogen for treatment of hot flashes in post‑menopausal women

. Zahra Allameh; . Safoura Rouholamin; . Sonia Valaie

Volume 2, Issue 2 , April 2013, , Pages 64-69

Abstract

  Objective: Various non‑hormonal agents have been used for the treatment of hot flashes in women with menopause. Some studies have reported that gabapentin appears to be an effective ...  Read More Objective: Various non‑hormonal agents have been used for the treatment of hot flashes in women with menopause. Some studies have reported that gabapentin appears to be an effective and well‑tolerated treatment modality. The aim of this study was to evaluate whether the treatment with gabapentin is effective in reducing hot flash frequency and severity and also to compare gabapentin 100 mg/day, 300 mg/day and conjugated estrogen in this regards.Methods: In this comparative clinical trial, 100 post‑menopausal women attending outpatient clinics of Isfahan University hospitals were included from April 2008 to February 2009. Participants randomly received gabapentin 300 mg/day, gabapentin 100 mg/day, or conjugated estrogen 0.625 mg/day for 12 weeks. Frequency and severity of hot flashes and adverse effects were compared among the three groups.Findings: From all, 16 participants dropped out. There were no significant differences among the groups before intervention in terms of age, body mass index and baseline hot flash frequency and severity. Hot flash diaries were used to record the frequency and severity of hot flashes. After the treatment period, there was a significant decrease in both severity and frequency of hot flashes in all three groups. Post‑hoc analyses showed that the frequency and severity of hot flashes were significantly lower in those who received gabapentin 300 mg/day or estrogen 0.625 mg/day compared to those who received gabapentin 100 mg/day. There was not statistically significant difference between those who received gabapentin 300 mg/day and those who received estrogen. Very few adverse effects, mostly gastrointestinal discomfort were observed in both gabapentin groups (8%).Conclusion: Gabapentin 300 mg/day could be useful to relieve hot flashes in women for whom hormone therapy is not suitable or when hot flashes do not respond to other therapies. Further researches are needed to determine the efficacy of gabapentin use for longer periods or at higher doses.

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Identification of possible adverse drug reactions in clinical notes: The case of glucose-lowering medicines

. Pernille Warrer; . Peter Bjødstrup Jensen; . Lise Aagaard; . Lars Juhl Jensen; . Søren Brunak; . Malene Hammer Krag; . Peter Rossing; . Thomas Almdal; . Henrik Ullits Andersen; . Ebba Holme Hansen

Volume 4, Issue 2 , April 2015, , Pages 64-72

Abstract

  Objective: Through manual review of clinical notes for patients with type 2 diabetes mellitus attending a Danish diabetes center, the aim of the study was to identify adverse drug reactions(ADRs) ...  Read More Objective: Through manual review of clinical notes for patients with type 2 diabetes mellitus attending a Danish diabetes center, the aim of the study was to identify adverse drug reactions(ADRs) associated with three classes of glucose‑lowering medicines: “Combinations of oral blood‑glucose lowering medicines” (A10BD), “dipeptidyl peptidase‑4 (DDP‑4) inhibitors” (A10BH), and “other blood glucose lowering medicines” (A10BX). Specifically, we aimed to describe the potential of clinical notes to identify new ADRs and to evaluate if sufficient information can be obtained for causality assessment.Methods: For observed adverse events (AEs) we extracted time to onset, outcome, and suspected medicine(s). AEs were assessed according to World Health Organization-Uppsala Monitoring Centre causality criteria and analyzed with respect to suspected medicines, type of ADR (system organ class), seriousness and labeling status.Findings: A total of 207 patients were included in the study leading to the identification of 163 AEs. 14% were categorized as certain, 60% as probable/likely, and 26% as possible. 15 (9%) ADRs were unlabeled of which two were serious: peripheral edema associated with sitagliptin and stomach ulcer associated with liraglutide. Of the unlabeled ADRs, 13 (87%) were associated with “other blood glucose lowering medications,” the remaining 2 (13%) with “DDP‑4 inhibitors.”Conclusion: Clinical notes could potentially reveal unlabeled ADRs associated with prescribed medicines and sufficient information is generally available for causality assessment. However, manual review of clinical notes is too time-consuming for routine use and hence there is a need for developing information technology (IT) tools for automatic screening of patient records with the purpose to detect information about potentially serious and unlabeled ADRs.

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Metabolic acidosis in multi drug poisoning with antidepressants and antipsychotics

Nastaran Eizadi-Mood; Saba Dehghanzad; Ali Mohammad Sabzghabaee; Ziba Farajzadegan

Volume 10, Issue 2 , April 2021, , Pages 65-70

Abstract

   In this study, we evaluated the predictive factors for the occurrence of metabolic acidosis in patients with multi-drug poisoning, including antidepressants (Ad)/antipsychotics ...  Read More  In this study, we evaluated the predictive factors for the occurrence of metabolic acidosis in patients with multi-drug poisoning, including antidepressants (Ad)/antipsychotics (Ap). Methods: This cross-sectional study was carried out in the referral poisoning center, Khorshid University Hospital, affiliated with Isfahan University of Medical Sciences. All patients with multi-drug ingestion, including Ad/Ap, were included in the study. Patients were divided into two groups with and without metabolic acidosis. Demographic factors, time from ingestion to admission, clinical manifestations, length of hospital stay, and outcome were compared in two groups. Binary logistic regression was used to identify factors associated with the risk of metabolic acidosis occurrence. Findings: Among the 206 evaluated patients, 45 patients (21.8%) had metabolic acidosis whom the majority were female (73.3%) with intentional purposes (77.8%). 31.1% of the patients with metabolic acidosis had tachycardia on admission (P = 0.03). Among all variables, time from ingestion to admission (P = 0.02) and lengths of hospital stay (P = 0.002) were significantly different between patients with and without metabolic acidosis. Tachycardia on admission (adjusted odds ratio [OR], 2.24; 95% confidence interval [CI]: 1.05–4.76; P = 0.036) and time from ingestion to admission (adjusted OR, 1.06; 95% CI: 1.00–1.13; P = 0.04) were also the predictive factors in occurrence of metabolic acidosis. Most of the patients survived without any complications (94.6%), of whom 72.3% had no previous underlying somatic diseases (P = 0.05). Conclusion: Admission tachycardia and the time elapsed from ingestion to admission may be considered important factors for predicting metabolic acidosis in multi-drug poisoning, including Ad/Ap.

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Specific genes associated with adverse events of methylphenidate use in the pediatric population: A systematic literature review

Beinta Joensen; Morten Meyer; Lise Aagaard

Volume 6, Issue 2 , April 2017, , Pages 65-72

Abstract

  The aim of this study was to review empirical studies examining associations between candidate genes and adverse events (AEs) from methylphenidate (MPH) use in children and adolescents. ...  Read More The aim of this study was to review empirical studies examining associations between candidate genes and adverse events (AEs) from methylphenidate (MPH) use in children and adolescents. The PubMed, EMBASE, CINAHL, and Web of Science databases were searched from their inception until March 2017. We included empirically based articles on pharmacogenetic studies in 0–17-year-old patients that investigated associations between specific candidate genes, their polymorphisms, and reported AEs. We extracted information about study design, setting, type of AE reporter, studied genes and their polymorphisms, age and gender, administered doses, method of genotyping, outcome measures, and main findings. A total of nine articles reporting information about four double-blind, placebo-controlled, cross-over studies and five open-label cohort studies were eligible for inclusion. Studies were published from 2006 onward and included a total of 998 patients (3–17-year-olds) diagnosed with attention-deficit hyperactivity disorder (ADHD). Studies predominantly involved males and lasted from 1 to 12 weeks. Studies used polymerase chain reaction and single nucleotide polymorphism genotyping methodology. Reported AEs were significantly associated with the following genes: appetite reduction (CES1*G); buccal-lingual movements (T1065G); diastolic blood pressure (ADRA2A Mspl C/C-GC); emotionality (DAT1*9/9); irritability (SNAP25 T1065G); picking (DRD4*7/DRD4*4); social withdrawal (DRD4*7/DRD4*4); somatic complaints (DAT1*10/10); tics (5-HTTLRP*S/L*L/L; SNAP25 T1065G); sadness (CES1*rsl12443580); and vegetative symptoms (5-HTTLPR). In conclusion, only few MPH pediatric pharmacogenetic studies were located, and large between-study heterogeneity was found. Studies were of naturalistic design and of short duration. They included small patient samples, poorly standardized treatment regimens, and limited outcome assessments. In the future, more pharmacogenomic studies in ADHD are needed, preferably using randomized, controlled study designs and of longer duration (more than 6 months).

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Pharmaceutical care for asthma patients: A Developing Country's Experience

. Sriram Shanmugam; . Jane Varughese; . Manjuladevi Anandavalli Sukumaran Nair1; . Rajalingam Balasubramanian; . Shivashankar Velu; . Chitra Bhojan; . Vidhya Devarajan; . Ali Mohammad Sabzghabaee

Volume 1, Issue 2 , November 2012, , Pages 66-71

Abstract

  Objective: This study aims at the outcome of providing pharmaceutical care service for asthma patients through an active partnership between clinical pharmacist and patients, for an ...  Read More Objective: This study aims at the outcome of providing pharmaceutical care service for asthma patients through an active partnership between clinical pharmacist and patients, for an optimal pharmacotherapy and a better quality of life (QoL).Methods: In this controlled clinical trial, which was conducted for 8 months (2009) in the Institute of Pulmonary Medicine and Research Centre of a 550-bedded multispecialty tertiary care teaching hospital in India, all patients diagnosed with asthma at least 6 months before getting enrolled in this study were included (n = 66). Patients were divided into the intervention group who received pharmaceutical care through asthma education, medication counselling, instructions on lifestyle modifications, asthma care diary, etc., and the control group who were not provided any pharmaceutical care. Asthma control in the two groups was assessed using Asthma Control Test (ACT) at regular intervals. QoL in both groups was assessed at regular intervals using standardized Asthma Quality of Life Questionnaire (AQLQ). Findings: The mean AQLQ scores for the intervention group at the baseline were changed to significantly higher amounts in the final visit indicating overall, activity, symptoms, emotional, and environmental domains, respectively (P < 0.05). The mean ACT scores for intervention group at baseline were also increased in statistically significant amounts in the final visit for all the five ACT questions (P < 0.05). Conclusion: Our pharmaceutical care program showed a positive impact in improving patient’s asthma-related QoL, lung function, and asthma control. By providing structured pharmaceutical care, clinical pharmacists can help asthma patients to achieve desired health outcomes.

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Efficacy of a local‑drug delivery gel containing extracts of Quercus brantii and Coriandrum sativum as an adjunct to scaling and root planing in moderate chronic periodontitis patients

. Jaber Yaghini; . Mohammad Shahabooei; . Abolfazl Aslani; . Mozhgan Reza Zadeh; . Sima Kiani; . Narges Naghsh

Volume 3, Issue 2 , April 2014, , Pages 67-71

Abstract

  Objective: Recent advances in the field of alternative medicine introduced various herbal products for the treatment of periodontitis. The purpose of this study was to evaluate ...  Read More Objective: Recent advances in the field of alternative medicine introduced various herbal products for the treatment of periodontitis. The purpose of this study was to evaluate the effects of combined extracts from Quercus brantii and Coriandrum sativum on periodontal indices in adult periodontitis patients.Methods: In this randomized, double‑blinded clinical trial, performed in Isfahan Dental School in 2012, a new herbal medicament containing combined extracts from Q. brantii and C. sativum was formulated in the gel form for subgingival application. Following scaling and root planing (SRP), both herbal and placebo gels were delivered at the experimental and control sites, respectively. Periodontal pocket depth, clinical attachment level, papilla bleeding index, and plaque index were measured at baseline, 1 month and 3 months later. Both intra‑and inter‑groups changes were registered. The obtained data were analyzed by SPSS software, using repeated measure analysis of variance, paired t‑test, Mann-Whitney, Friedman, and Wilcoxon tests. Differences with P < 0.05 were considered to be significant.Findings: Both groups indicated statistically significant improvements in the periodontal indices (P < 0.05), but there were no significant differences between two study groups with this regard.Conclusion: The herbal gel does not have considerable advantages over SRP alone as an adjunct in periodontal treatment.

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