iman karimzadeh

Kidney transplant recipients are at higher risk of developing coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the pattern, pharmacotherapy, drug interactions, and clinical outcome of COVID-19 in kidney transplant recipients at a referral center in Iran. This retrospective, observational study was conducted in Abu Ali Sina Organ transplantation center in Shiraz, Iran. All adult kidney transplant patients diagnosed with COVID-19 and hospitalized for at least 48 hours were included. Required data were collected by reviewing medical charts and health information system of patients at hospital. Potential drug-drug interactions were identified using Lexi-Interact online as well as the Liverpool interactions online website. A total of 108 patients were included. Fever, cough, and shortness of breath were the most common clinical symptoms. About three-fourth (74%) of patients had non-severe COVID-19. Remdesivir was the most widely used antiviral agent. mTOR inhibitors and anti-metabolites were either dose reduced or discontinued in 100% and 80.2% of cases, respectively. Age (odds ratio [OR] = 1.06, 95% [Cl] = 1.02-1.09), calcineurin inhibitor adjustment (OR = 0.26, 95% Cl = 0.09-0.75), baseline white blood cell count (OR = 1.13, 95% Cl = 1.01-1.28), baseline serum lactate dehydrogenase level (OR = 1.32, 95% Cl = 1.03-1.69), administration of tocilizumab (OR = 0.06, 95% Cl = 0.07-0.54), and the severity of COVID-19 disease (OR = 0.03, 95% Cl = 0.00-0.03) had significant association with mortality.  The present investigation found that COVID-19 infection in kidney transplant patients may be severe and require hospitalization and even, critical care.

The inappropriate use of antimicrobials in outpatient and inpatient settings has led to the spread of microbial resistance, reduced clinical effectiveness of antimicrobial drugs, and significant direct and indirect costs. Various programs have been implemented to improve antimicrobial usage patterns. The study examined how the Health Transformation Plan (HTP) affected prescribing injectable antibiotics and costs at a referral teaching hospital.

  A retrospective observational study was conducted covering the periods 2011 to 2014 (pre-HTP period) and 2014 -2017 (post-HTP period) at Namazi Hospital in Shiraz, Iran. Forty-four injectable antimicrobial drugs were categorized into antifungals, antibacterials, and antivirals based on their Anatomical, Therapeutic, and Chemical codes.  Changes in prescribing practices were assessed annually based on total consumption rate, per capita consumption, total cost, and per capita cost. Required data were extracted from the hospital pharmacy database.

   Following the implementation of HTP, there were increases in total consumption (13.31%), numerical per capita consumption (1.39%), total cost (142.63%), and per capita cost (146%) of injectable antimicrobial drugs. The increases in per capita consumption, total cost, and per capita cost were statistically significant (P <0.05).

  In conclusion, changes in antimicrobial consumption patterns following the implementation of HTP may be partially attributed to increased demand facilitated by easier and faster access to requested antibiotics by pharmacists and physicians in hospitals.

Despite the need to use prophylactic antimicrobials to prevent infection at the surgical site, in many cases the use of prophylactic antibiotics is inappropriate. The aim of this study was to determine the pattern use of surgical site infection antibiotics prophylaxis based on standard guidelines in a teaching hospital in Shiraz. In this observational study, information of 338 patients from May to October 2020 received prophylactic antibiotics before surgery at Shahid Faghihi Hospital affiliated to Shiraz University of Medical Sciences was reviewed. Type of antibiotics, combination of antibiotics, dose and duration of treatment for each patient were defined based on both the American Society of Health-System Pharmacists (ASHP) and the National Ministry of Health and Medical Education of Iran guidelines for antimicrobial prophylaxis in surgery. Of the total 338 patients included in this study, only 27.5% received antibiotic prophylaxis according to standard guidelines. The most commonly used antibiotic class for surgical site infection prophylaxis was the first generation cephalosporins. The highest rate of antibiotic prophylaxis appropriateness was identified in the urology ward (11.53%). Few cases of antibiotic prophylaxis have shown complete compliance with the standard guidelines in this preliminary report.

We wanted to figure out how pharmacists make their judgments about the efficacy of natural products in urolithiasis and how they make suggestions about these products.

A self-made descriptive questionnaire was designed, evaluated, and performed to assess pharmacists’ knowledge, attitude, and practice (KAP) about natural products in urolithiasis in 46 young pharmacists and final year pharmacy students in Shiraz.

In all of the KAP sections, Rowatinex®, Cystone®, and Sankol® were the most known, believed to be effective, and preferred pharmacist products. Respondents had received different education hours. About 54% of them believed their education was averagely adequate. Brochures (63.0%), web-search (60.9%), and applications (45.7%) were the primary resources used by pharmacists, mainly to check the instruction of use. About 80% of pharmacists were unaware of the mechanism of action of at least 5 of 14 products. Generally, respondents had a positive view of natural products. In addition, they thought price and advertisements were effective in patients’ and physicians’ choice of products. More than half of pharmacists preferred to use clinical trials (52.2%) rather than systematic reviews (19.6%).

Providing a vast amount of information in the education process is not the best solution for preparing pharmacists for their role in community pharmacies. Besides the need for increasing clinical trials about complementary and alternative medicines and developing evidence-based databases, we need to train pharmacy students in professional ways to gain knowledge about complementary and alternative medicines.

Kidney stone as a third important disease of the urinary tract is a common disease affecting 10-15% of the world population. Effective medical treatment for the disease is not yet well established. On the other hand, there is an increasing global demand to manage and control various diseases with natural medicine and medicaments originating from Complementary and Alternative Medicine. Traditional Persian Medicine (TPM) is one of the most popular schools in the field of complementary and alternative medicine. There are numerous natural and clinical interventions for kidney stones, reported in TPM medical and pharmaceutical manuscripts. This review provides various related compound formulations for kidney stones from the standpoints of Persian scholars. These remedies have been cited in a series of traditional pharmaceutical manuscripts of Persian medicine, namely Qarābādin or prescription. With a view to the positive pharmacological or biological activities of the constituents of filtered formulations, many of those can be re-formulated and either experimentally or clinically evaluated to be introduced as new natural remedies in this field.

Stroke-related atrial fibrillation (AF), deep vein thrombosis (DVT), and pulmonary thromboembolism (PE) are among the most common thromboembolic events. recently, direct oral anticoagulants (DOACs) have been slowly replacing warfarin. Rivaroxaban is a DOAC frequently prescribes to control thrombotic events. The safety and efficacy of Rivaroxaban are dependent on appropriate prescription, dosage, and other factors. This study is aimed to evaluate the Rivaroxaban utilization based on the standard protocol in both inpatient and outpatient settings. This cross-sectional/observational study was conducted for six months from 1st August 2018 to 1st February 2019 at a private hospital and also an outpatient clinic in Shiraz, Iran. First, a clinical pharmacist defined a standard protocol for Rivaroxaban utilization and several indexes (9 indexes for Non-valvular AF (NVAF) patients and 10 indexes for DVT/PE patients). Second, participants were classified into three groups (NVAF inpatients, NVAF outpatients, and DVT/PE patients). Finally, the adherence of Rivaroxaban utilization indexes in each group to was evaluated accordingly. Two hundred and forty one eligible patients were recruited into this study. Most patients (N=208), were NVAF. Rivaroxaban utilization was appropriate in 71.9%, 65.8%, and 50.6% of patients within groups 1, 2, and 3, respectively. Although medication interaction, administration regarding time/meal, and dose adjustment based on renal function showed the lowest compliance, the monitoring laboratory data and considering the underlying disorders were completely matched with the protocol. This study showed some critical errors in both settings, especially in DVT/PE patients (49.4% no match). Hence, the most productive collaboration must be developed between clinical pharmacists and clinical practitioners.

Glucocorticoids are pivotal components of immunosuppressive regimens in solid organ transplantations. This study aimed to assess the possible association between the ER22/23EK, N363S, and Bcl1 polymorphisms, and short-term clinical outcomes, including acute rejection and delayed graft function (DGF), in kidney transplantation recipients.

A case-control study was conducted in a two-year period on adults with transplanted kidneys, comprised of subjects without rejection (n=50, control) and those with documented rejection within one year after transplantation (n=50, case), between April 2017 and September 2018, in Shiraz, Iran. Demographic characteristics and clinical and paraclinical findings were gathered. The genotyping of the ER22/23EK, N363S, and Bcl1 polymorphisms was carried out via polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The association between the genotypes and DGF as well as rejection types was evaluated using either the Chi square test or Fisher exact test. A stepwise logistic regression analysis was conducted to determine the independent factors of acute rejection within the first year after transplantation.

The study population consisted of 64 men and 36 women. The frequency of mutated alleles was 0.32 for G (Bcl1), 0.02 for S (N363S), and 0.065 for A (ER22/23EK). There was no significant association either between the studied polymorphisms and acute rejection or between the Bcl1 (P=0.17), N363S (P=0.99), and ER22/23EK (P=0.99) genotypes and DGF. The length of hospital stay after kidney transplantation was slightly more in N363N and ER22/23EK wild allele carriers. However, this difference was not statistically significant.

Our data suggested no statistically significant association between the genotypes of the studied polymorphisms and early clinical outcomes after kidney transplantation.

Hepatitis C virus (HCV) could lead to increased mortality, disability, and liver transplant if left untreated, and it is associated with a possible increase in disease burden in the future, all of which would surely have a significant impact on the health system. New antiviral regimens in the treatment of the disease are effective yet expensive.

To performe a cost-effectiveness analysis of three medication regimens, namely, ledipasvir/sofosbuvir (LDV/SOF), velpatasvir/sofosbuvir, and daclatasvir/sofosbuvir (DCV/SOF) in HCV patients with genotype 1 in Iran.

A Markov model with a lifetime horizon was developed to predict the costs and outcomes of the three mentioned medication therapy strategies. The final outcome of the study was quality-adjusted life-years (QALYs) which was obtained using the previously published studies. The study was conducted from the perspective of the Health Ministry; therefore, only direct medical costs were estimated. The results were provided in the incremental cost-effectiveness ratio (ICER) per QALY. Ultimately, the one-way and probabilistic sensitivity analyses were used to measure the strength of study results.

The results showed that the QALY for LDV/SOF, DCV/SOF, and VEL/SOF were 13.94, 13.94, and 14.61, and the costs were 4807, 7716, and 4546$, respectively. The VEL/SOF regimen had lower costs and higher effectiveness than the LDV/SOF and DCV/SOF regimens, making it a dominant strategy. The tornado diagram results showed that the study results have the highest sensitivity to CHC and CC state costs. Moreover, the scatter plots results showed that VEL/SOF was the dominant therapeutic strategy in 73% of the simulations compared to LDV/SOF and in 66% of the simulations compared to DCV/SOF; moreover, it was in the acceptable region in 92% of the simulations and below the threshold. Therefore, it was considered the most cost-effective strategy. Moreover, the results showed that DCV/SOF was in the acceptable region below the threshold in 69% of the simulations compared to LDV/SOF. Therefore, DCV/SOF regimen was more cost-effective than LDV/SOF.

According to the present study results, it could be recommended that the VEL/SOF regimen be used as the first line of therapy in patients with HCV genotype 1. Moreover, the second-line medication regimen was DCV/SOF.

< p>Coronavirus disease 2019 (COVID-19) management in patients with predisposing psychiatric disorders would be challenging due to potential drug-drug interactions (PDDIs) and precipitation of their disease severity. Furthermore, COVID-19 itself might precipitate or induce unpredicted psychiatry and neuropsychiatry complications in these patients. In this literature review study, the psychological impacts of COVID-19 and major psychiatric adverse drug reactions (ADRs) of COVID-19 treatment options have been discussed. A detailed Table has been provided to assess potential drug-drug interactions of COVID-19 treatment options with psychotropic medications to avoid unwanted major drug-drug interactions. Finally, potential mechanisms of these major drug-drug interactions and possible management of them have been summarized. The most common type of major PDDIs is pharmacokinetics. Hydroxychloroquine/chloroquine and lopinavir/ritonavir were the most involved anti-COVID-19 agents in these major PDDIs.

The purpose of this study was to document the demographic data, to assess the proportion of consumed medicines and the amounts and types of drugs available to households, and to to estimate the probable prevalence of certain diseases in the southern region of Iran.

In this cross-sectional population-based study carried out in Shiraz (the central city in the Southern part of Iran), we documented and evaluated the drug usage details in a random sample of 1000 households during 2018–2020. We analyzed the usage of drug categories based on the anatomical therapeutic chemical classification, which the World Health Organization recommends.

In the studied population, the average age (± standard deviation) was 45.54 ± 15.82, ranged 18–91 years. More than 90% had medical insurance coverage. About 81.8% of the participants had individual family medicine practitioners, and most of them (93.8%) received medications with a physician’s prescription. The most frequently used medications were cough and cold preparations (12.9%), nervous system drugs (12.6%), and cardiovascular system drugs (11.6%).

Despite the easy access to medications for most participants, few individuals (about 6%) received their medications without a prescription. The most frequently prescribed medicines were the common cold, acetaminophen, and metformin. Common cold, gastrointestinal (GI) disorder, and diabetes were the most commonly used medication classes. Furthermore, we have found a probably higher than average prevalence of cardiovascular, GI, and endocrine disorders. This information could be used by the local policymakers as a basis for the estimation and allotment of health-care resources.

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.

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.

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).

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.

Patients’ complain regarding pharmaceutical services at community pharmacies is a fundamental issue as it can directly affect people’s service utilization. For the first time in Iran, this survey aimed to investigate the experience of people regarding declare a complaint against the pharmacy sectors as a community-based study.

In this cross-sectional study, over 100 samples based on postal codes were randomly selected from the city of Shiraz in 2017– 2018. The data collection instrument was designed in two parts (demographic and social profile which record the complaint experiences against pharmacists, pharmacy services, etc.). The data were analyzed by SPSS.

All 1035 eligible participants had a mean age of 45.54 ± 15.82 years (ranged from 14 to 91). Nearly 70% of the participants were female. Around 81.8% had a family physician coverage, whereas 7.4% of them had no medical insurance coverage. The frequency of complaints from the pharmacies was 35.6%. Nearly 55% of the complaints were related to governmental pharmacies. Homemakers were 1.36 times more likely to have experienced complaints in comparison with their employed female counterparts. Health status had an inverse association with complaints. Those participants who had received prescription medication were about two times more likely to have filed a complaint in comparison with those who received medication without a prescription. In addition, females aged 40–59 and above 60 and unemployed participants were more satisfied with respect to complaint follow-up process.

Low level of satisfaction with respect to the complaint process is a concerning issue; hence, strategies are warranted to improve the quality of services provided in the pharmacies.

 Iran has welcomed a large population of immigrants and refugees, which has led to new demands and priorities in many aspects of life, such as healthcare services.

 For the first time in Southern Iran, in Shiraz City, population-based research was conducted on the patterns of medication use in native non-Iranian residents.

 The present cross-sectional study was conducted amongst Shiraz citizens from 2017 to 2018. The population consisted of 43 migrants. Data were collected using a multipart data form. All statistical analyses were performed using SPSS.

 A total of 43 Afghan migrants were included in the study. Most of them were female (72.1%), aged under 40 years (67.4%), and homemaker (62.8%) with an education level of non-completed high school diploma (97.7%). The majority of the subjects did not have insurance or family physician coverage (93%), and 85.7% got medications without prescription. The three most common medications used by the subjects were iron supplements, acetaminophen, and cold medicines.

 Iran is now hosting Afghan nationals as one of the largest population of refugees in the world. The health conditions of the Afghan population need more attention in order to improve the health status of their community in Iran.

Acute lymphoblastic leukemia is as the most common childhood cancer. The definite etiology of childhood ALL is unknown. The pathogenesis of ALL is described as the disruption of lymphocyte proliferation and differentiation. The most common signs and symptoms of ALL are fever, hepatosplenomegaly, lymphadenopathy, pallor, and bleeding. Diagnosis is based on conducting complete blood cell, peripheral blood smear, bone marrow aspirate, immunophenotype, and cytogenetics tests. A number of demographic, clinical, and paraclinical characteristics of patients have been determined as prognostic factors. To select the appropriate treatment protocol, patients are risk stratified. In induction therapy, vincristine, corticosteroid, and asparaginase are given for the low- and standard risk groups and a four-drug induction therapy including vincristine, corticosteroid, asparaginase, and anthracycline are given for high- and very high-risk group for B cell ALL. The induction phase follow with post-induction courses including consolidation, interim maintenance, delayed intensification, and maintenance phases. ALL in pediatrics has a good prognosis and high cure rate.

Vancomycin is a glycopeptide antibiotic which is the drug of choice against methicillin-resistant Staphylococcus aureus</em>. It has a narrow therapeutic index, and thus therapeutic drug monitoring (TDM), and clinical pharmacokinetic assessment are necessary in order to prevent adverse drug reactions such as nephrotoxicity. In this study, we aimed to develop a simple and validated HPLC method for vancomycin assay in order to establish a TDM center for patients admitted to the ICU of Nemazee Hospital in southern Iran.

In this study, a brief review of different parameters and variables which could affect the sensitivity, selectivity of the validated HPLC method for vancomycin determination were considered. According to the previous studies a simple, fast, and the relatively low-cost method was established for vancomycin determination in plasma samples.

 The developed HPLC assay indicated a calibration curve with R-square of > 0.999, acceptable selectivity, the accuracy of 90-105%, CV% of less than 15%, the limit of quantification of 1 µg/mL, and limit of detection of 300 ng/mL. Vancomycin trough level, the area under the curve, renal clearance, the volume of distribution,, and elimination constant were measured in patients using this validated method.

 Validated method for assay of vancomycin plasma levels was used to quantify vancomycin levels of four patients who were admitted to the ICU of Nemazee Hospital. According to the results, two of these patients showed lower levels than recommended therapeutic purposes while one of them showed a toxic level. According to the results, the TDM assessment of vancomycin is strongly recommended for patients who are hospitalized in ICU. 

The most important adverse reaction of amphotericin B (AmB) is nephrotoxicity. The aim of this study was to assess the potential effectiveness of intravenous saline + sodium bicarbonate versus intravenous sodium chloride hydration in preventing or attenuating AmB nephrotoxicity. 

Experimental approach:

A randomized, non-placebo-controlled, single-blinded clinical trial was conducted in two adult hematology-oncology wards of Namazi hospital. Eligible patients were randomly assigned into either the normal saline or normal saline + sodium bicarbonate groups by the ratio of 1:2. In the normal saline group, 1000 mL of sodium chloride 0.9% (154 meq sodium) was given intravenously as two equal 500 mL volumes before and during the infusion of AmB. Patients in the saline + sodium bicarbonate group received 500 mL sodium chloride 0.9% (72 meq sodium) before and 500 mL isotonic sodium bicarbonate (72 meq sodium) intravenously during AmB infusion. 

Findings/ Results:

The rate of AmB nephrotoxicity was comparable between normal saline and sodium bicarbonate groups (54.2% and 41.6%, respectively; P = 0.3). This difference did not reach the level of statistical significance after considering AmB dose and duration of the treatment. The frequency of hypokalemia and hypomagnesemia did not differ significantly between the two groups even after adjusting the results according to AmB dose and treatment duration.

The results of the current preliminary clinical trial suggested that the combination of sodium bicarbonate and normal saline compared to normal saline alone appears to have no superiority in preventing or attenuating different studied aspects of AmB nephrotoxicity in patients with hematological malignancies.

Nephrotoxicity is one of the most important side effects of gentamicin (GEN). Accumulating evidence demonstrated the crucial roles of antioxidant compounds in the reduction of GEN-induced renal injuries. Silymarin (SM),an antioxidant agent,was demonstrated toimprove GEN-induced kidney damage. The aim of this clinical trial was to investigate the effect of SMon GEN-induced nephrotoxicity.

This randomized, double-blinded, placebo-controlled clinical trial was conducted from April 2017 to October 2019 on patients diagnosed with infectious diseases receiving GEN at least for 7 days. After approving the study and obtaining informed consents, 60 patients were included in this study. Patients in the treatment (30) and control (30) groups were given injectable GEN along with 140 mg of SM tablets or placebo orally three times a day, respectively. Demographic, laboratory, and therapeutic profilesof the patients were recorded. Urine and blood samples were collected before and on days 1, 2, 3, 5 and 7 after GEN administration and intervention.

Sex, age, GEN indication and baseline glomerular filtration rateswere found to haveno effect on GEN nephrotoxicity. SM- and placebo-treated groups exhibited no significant differencesbetweenthe indications and intervals of GEN administration. The overall rate of GEN nephrotoxicity in the SM group was significantly lower than that in the placebo group (16.7% and 53.3%, respectively; p: 0.003). In addition, the risk of GEN nephrotoxicity in patients receiving placebowas significantly higher than those receivingSM(OR:12.69, 95%, CI: 1.38-116.74; p:0.03). Serum creatininewasfound to be significantly higher in the placebo-treated group than that in theSM-treatedgroup (p<0.05). However, the frequency of acute tubular necrosis on days 2, 3, 5, and 7 after GEN administration exhibited no significant differences between SM- and placebo-treated patients.

This study demonstratedthat SM could attenuate renal injury in GEN-treated patients.

The aim of the present study was to determine the pattern of antimicrobial resistance of Gram-positive bacteria during three consecutive years at the nephrology ward of Namazi Hospital in Shiraz, Southwest of Iran.

During a 3-year period from 2013 to 2015, data of all biological samples of hospitalized patients at the adult nephrology ward of Namazi Hospital were sent to the central laboratory for identification of Gram‑positive microorganisms and subsequently, their antimicrobial susceptibility testing by Kirby–Bauer disc diffusion method were analyzed in a retrospective manner.

Coagulase-negative Staphylococci (CONS) (38.5%), Staphylococcus aureus (25.4%), and Enterococcus spp. (23.8%) were the most common isolated Gram-positive bacteria from all biological samples. All Enterococcus spp. isolates within the 3 years were resistant to oxacillin. The rate of vancomycin-resistant enterococci(VRE) increased from 40.63% in 2013 to 72.73% in 2015. Enterococcus spp. resistance rates to aminoglycosides during 3 years were above 85%. The frequencies of oxacillin-resistant S. aureus (ORSA) in 2013, 2014, and 2015 were 95.24%, 80.95%, and 36.36%, respectively. Two out of 11 (6.67%) S. aureus isolates were resistant to vancomycin. More than 90% of CONS were sensitive to vancomycin within the study period. The frequency of gentamicin-resistant CONS ranged from 40% to 57.14%.

The rates of ORSA, VRE, and aminoglycoside-resistant CONS as well as Enterococcus spp. in our clinical setting were considerably high and concerning. These may be due to the failure or lack of infection control activities and antimicrobial selection pressure

To assess and describe the call services delivered by drug and poison information call center (DPIC) of 13‑Aban pharmacy, which is closely operated by the Department of Clinical Pharmacy, College of Pharmacy affiliated to Tehran University of Medical Sciences.

All calls services including counseled and follow‑up calls provided by 13‑Aban DPIC to health care professionals and public were collected, documented, and evaluated in a 2 years period from July 2010 to June 2012 using the designed software. Data analysis was done by SPSS version 16.0.

Totally 110,310 calls services delivered during a 2 years period. Among healthcare professionals, pharmacists, general physicians, and nurses requested more call services respectively (P = 0.001). DPIC could detect 585 potential cases of adverse drug reactions (ADRs) and 420 cases of major drug‑drug interactions (DDIs).

This study by analyzing and reporting the two-years activities of one of the major DPICs in Iran, showed that DPICs can offer drug consultation for healthcare professional and public as well as detect and prevent ADRs and DDIs, and therefore can promote patients’ health regarding drug therapy.

The aim of the current study was to determine various aspects of methylphenidate adverse reactions in children with attention deficit‑hyperactivity disorder (ADHD) in Iran.

During the 6 months period, all children under methylphenidate treatment alone or along with other agents attending a university‑affiliated psychology clinic were screened regarding all subjective and objective adverse drug reactions (ADRs) of methylphenidate. Causality and seriousness of detected ADRs were assessed by relevant World Health Organization definitions. The Schumock and Thornton questionnaire was used to determine preventability of ADRs.

Seventy‑one patients including 25 girls and 46 boys with ADHD under methylphenidate treatment were enrolled within the study period. All (100%) ADHD children under methylphenidate treatment developed at least one ADR. Anorexia (74.3%), irritability (57.1%), and insomnia (47.2%) were the most frequent methylphenidate‑related adverse reactions. Except for one, all other detected ADRs were determined to be mild. In addition, no ADR was considered to be preventable and serious.

Our data suggested that although methylphenidate related adverse reactions were common in children with ADHD, but they were mainly mild and nonserious.

Medication errors may prolong hospitalization period, enhance its costs and make harmful impacts on health. Inappropriate drug history taking is a type of medication errors which may occur on admission, resulting in medication discrepancies. This work presents a report of discrepancies between the drug history acquired by pharmacists and the drugs administered by the physicians at a teaching hospital in Shiraz, Iran. This prospective study was conducted from October 2016 to March 2017 in 7 wards of Namazi hospital affiliated to Shiraz University of Medical Sciences. Both the physicians/nurses and pharmacists obtained medication history from patients recruited in this study during the first 24 hours of their admission. The medications were classified according to the ATC classification. Totally, 103 patients were recruited and 557 medications were recorded in this study. The mean±standard deviation age of patients was 58.52±18.75 years. Comparing pharmacist drug history with medication lists obtained by nurses or physicians revealed 353 discrepancies. On average, 3.42 discrepancies were identified per patient (ranged from 0 to 12). Most (85.8%) of medication discrepancies were related to omission errors. Metformin and aspirin were the most common medications involved in omission errors. The rate of medication discrepancies at admission in our hospital was high. Active contribution of pharmacists and providing accurate medication histories at the time of hospital admission can be considered as possible solutions for this problem.

Introduction Nowadays, creatine is one of the most common oral supplements used by professional athletes for boosting their strength and muscle mass. In this review, we collect available experimental and clinical data about renal safety of both short-term and long-term use of creatine. Materials and Methods. Scientific literature was critically searched by keywords "creatine," "renal insufficiency," and "renal dysfunction" and their synonyms in medical databases (Scopus, MEDLINE, EMBase, and ISI Web of Knowledge). Overall, 19 relevant clinical and experimental articles were selected for this review. Results. Short- and long-term creatine supplementations (range, 5 days to 5 years) with different doses (range, 5 g/d to 30 g/d) had no known significant effects on different studied indexes of kidney function such as glomerular filtration rate at least in healthy athletes and bodybuilders with no underlying kidney diseases. In addition, although short-term (range, 5 days to 2 weeks) high-dose oral creatine supplementation (range, 20 g/d to 0.3 g/kg/d) stimulated the production of methylamine and formaldehyde (as potential cytotoxic metabolites of creatine) in the urine of healthy humans, there was currently no definite clinical evidence about their adverse effects on the kidney function. Conclusions . Although creatine supplementation appears to have no detrimental effects on kidney function of individuals without underlying kidney diseases, it seems more advisable to suggest that creatine supplementation not to be used by sportsmen or women with pre-existing kidney disease or those with a potential risk for kidney dysfunction

The use of traditional medicine as an important part of complementary/alternative medicine spread nowadays all around the world. Something that is due to the lack of effectiveness of modern medicine in treating some disease especially chronic disease. Since one of the most important theories beside traditional medicine is the concept of “temperaments” and this is very close to the concept of personalized medicine, which is taken into consideration nowadays. It is important to investigate what really temperament is and also reach a precise meaning and criteria for determining it. For reviewing all the researches that have been done on temperaments till today, the most popular database like PubMed, Scopus, Google scholar, science direct and etc. were searched for keywords Hot and cold, temperaments, hot and cold medicine, hot and cold nature, hot and cold parameters till September 2015. The results show that there are some physiological and metabolic criteria, genes and networks and metabolite that contribute in determining the temperaments not only in body but also in disease, foods and drugs. Despite the presence of all these detailed data the lack of a comprehensive practical criteria for temperament is still obvious, so we try to gather all data to reach that in its best way.

Drug and Poison Information Centers (DPICs) provide quick, easy, valid and reliable access to medication and toxin information for professionals, health workers and the public. The purpose of this study is to report the services provided by a university hospital DPIC within 1 year. This descriptive study reports all scientific questions asked from DPIC of Namazi hospital in Shiraz from the September 2016 to the August 2017. The information include the number of questions, the ward that ask the question, the questioner's profession, the method of asking questions, the method of responding, the type of question, and the resources used to answer them. After extraction of duplicates, data were analyzed by using the Excel software. The total number of contacts registered during the study period was 485. The most number of questions were received in July and the lowest in November. Major questions were asked from the health-care team working in Namazi hospital and mostly from the nursing group (44.7%). Most of the questions (79.6%) were asked and responses were provided (67.1%) by the telephone device. Of all incoming inquiries, drug indication (13.3%), adverse drug reactions (ADR) (13.3%), storage (11.8%), and the method of preparation as well as administration (11.7%) were among the most common types of questions. The most frequent ward in asking questions was the pediatric intensive care unit (13.1%). The most widely used drug information resource to answer questions was the UptoDate® (47.5%). DPIC services in the hospital settings can decrease or prevent ADRs as well as medication errors, improve the pattern of medication use, and result in cost saving

To evaluate colistin use according to global standard drug consumption in intensive care units of a referral hospital in Shiraz, Iran
A prospective, interventional study was performed during an 11 month period on 100 patients admitted to ICUs of a teaching hospital being treated with colistin for at least 3 subsequent doses. Required demographic, clinical, and paraclinical data were gathered by a pharmacist. Fifteen indexes were considered to evaluate colistin use. A clinical pharmacist reviewed indication and dose of colistin at the time of prescribing this agent.
In our study population, pneumonia (69%) was the main indication of colistin. In 87% of patients, colistin administration was based on microbiological laboratory evidence. Continuation of therapy was inappropriate in 5% of cases. By the intervention of the clinical pharmacist, colistin was discontinued in all patients in whom empirical therapy was continued incorrectly. None of the patients received loading dose of colistin. The maintenance dose, dose interval, and duration of treatment of colistin were appropriate in 76%, 71%, and 100% of patients, respectively. For none of the patients, the pharmacokinetic dosing method was used. In all patients, serum creatinine and WBC count were evaluated on daily basis. The sum indexes of colistin use were relevant to standard guidelines in 67.33% of the cases.
The results of this study highlight the necessity of the pharmaceutical care team participation in all stages of treatment with antibiotics. After pharmacist interventions, some criteria of colistin utilization were corrected and brought closer to standard values.