فهرست مطالب

  • Volume:8 Issue: 2, 2020
  • تاریخ انتشار: 1399/04/06
  • تعداد عناوین: 11
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  • Betul Ozdemir Pages 50-52
    Objective

    Congestive heart failure (HF) is a chronic disease that incidence is growing in the population. Vitamin D effects on directly myocardial cells. The aim of this study was to investigate the association between vitamin D levels with ejection fraction of left vetricule.

    Methods

    The study population consisted of 101 patients admitted with heart failure. Age, gender, and demographic characteristics (diabetes mellitus, hypertension, smoking-nonsmoking, coronary artery disease) of all patients were recorded. In all patients for blood analyses vitamin D, creatine, crp and lipid profile were studied. And all patients were studied echocardiography.

    Results

    HF patients, in our population 35 (34.7%) patient is female and 66 (65.3%) patient is male. The mean age of our patients was calculated as 67.4± 12.9 years. Our patients laboratory parameters mean were measured for vitamin D 24.3±17.3 ng/ml. LVEF mean was measured 31.8±9.5. In our study group LVEF and vitamin D was correlated with each other

    Conclusions

    Vitamin D and LVEF had a positive correlation in heart failure patients. It may be occured with the protective effect of vitamin D or consequence of hipovitaminosis.

    Keywords: Heart Failure, Stroke Volume, Vitamin D
  • Mostafa Alavi Moghadam*, Farhad Shahim, Mohammad Sistanizad, Elham Pourheidar, Rezvan Hassanpour Pages 53-56
    Background

    Irrational consumption of antibiotics is one of healthcare problems and can lead to antibiotic resistance.vancomycin resistance be developing and has a huge cost burden to healthcare. Antimicrobial control programs is an essential strategy for optimal use of antibiotics and educational program is the main of these activities.

    Objective

    This study was aimed to evaluate the effects of educational programon vancomycin prescription pattern.

    Methods

    This pre-post interventional study was carried out between 2014 to 2016 in a university affiliated hospital,Tehran, Iran. In the first step, vancomycin usage protocol was prepared, then educational program delivered through workshops and physicians and assistants obligated to order vancomycin based on approved protocol. In the second step to assess the effectiveness of intervention, the prescription pattern of vancomycin assessed in Defined Daily Dose (DDD) per 100 patients days.

    Results

    Vancomycin usage based on DDD per 100 patients days in post educational intervention period in comparison with period before intervention, December 2014 to March 2015, was decreased in all hospital departments but in comparison with three months period, September to December 2015, was decreased in all hospital departments with the exception of  intensive care department.

    Conclusion

    Despite the efforts to reduce the excessive use of antibiotics, irrational consumption is a main concern.Educational program will improve the consumption of antibiotics. The present study showed the antimicrobial educational programs has been effective in the utilization of vancomycin in a university affiliated hospital.

    Keywords: Inappropriate Prescribing, Vancomycin, Prescribing Pattern, Physician
  • Hananeh Baradaran, Mohammad Nasirpur, Hadi Hamishehkar* Pages 57-64
    Background

    Pharmacotherapy in elderly patients has become a major concern due to their physiological changes, pharmacokinetic and pharmacodynamics variations, poly-pharmacy, etc.

    Objective

    According to the global population ageing, we aim to evaluate the effect of “Beers Criteria” education on prescribing medications for elderly patients by GPs.

    Method

    30 General practitioners (GPs) with the highest number of prescriptions were included in this pilot study and their prescriptions for geriatric patients selected randomly during three months. Then the physicians trained on appropriate prescription by prepared pamphlets and booklets which were equipped based on Beers 2015 explicit criteria. In order to evaluate the effect of education, appropriateness of prescriptions was analyzed before and after training GPs.

    Results

    Among 15,447 prescriptions in the first step, 1281 prescriptions related to geriatrics and the prevalence of inappropriate drug prescription was 37.3%. The most inappropriate medications were Bisacodyl, Alprazolam and Hyoscyamine. While, in the next step 1055 of 15,154 prescriptions were related to elderly people and inappropriate drug prescription was 23.6% of total prescriptions. The most common inappropriate medications include Alprazolam, Amitriptyline and Hyoscyamine.

    Conclusion

    According to the results, prevalence of prescribing potentially inappropriate medications for elderly patients is high among GPs and educating “Beers Criteria” significantly reduces prescription of inappropriate medications.

    Keywords: Potentially Inappropriate Medication, General Practitioners, Geriatrics
  • Afsaneh Vazin, Mousavinasab*, Golnar Sabetian Pages 65-69
    Background

    One of the complications of critical ill patients admitted to intensive care unit (ICU) are stress-related mucosal damage. Stress ulcer prophylaxis (SUP) should be administered to all critically ill patients with at least one major risk factor and two or more minor criteria.

    Methods

    This study was performed during 6 months from October to December 2013 in Namazi Hospital intensive care units to assess the appropriate administration of SUP, according to American Society of Health-System Pharmacists (ASHP) protocol. Candidate for SUP according the ASHP guideline is considered if there is a at least one major risk factor or two or more minor risk factors.

    Results

    Ninety-four patients were enrolled (46 men and 48 women). The mean age of study subjects was 51.5 years. The most major risk factor to stress ulcer found to be mechanical ventilation more than 48 hours (53%). The most minor risk factor for stress ulcer was ICU admission for less than one week (23.5%). Most prescribed medication for stress ulcer prophylaxis was intravenous Pantoprazole (44.7%). Our results have shown that about 74% patients were candidate for SUP according the ASHP guideline. 13(13.8%) of patients had only major risk factors. 5 (5.3%) of patients received SUP while they did not have at least one major risk factor or two or more minor risk factors.

    Conclusion

    Our results have shown that 76.2% of the total SUP administrations were compliant with the ASHP guideline. Among the prescribed medication for SUP, intravenous pantoprazole had the highest percentage of administration (44.7%) and oral omeprazole had the lowest percentage of administration (7.4%). According to the results of our study, 72% of the route administrations are compliant with the ASHP guideline.

    Keywords: Stress Ulcer Prophylaxis, Critically Ill Patients, Cross Sectional Study
  • Sajad Khiali, Samira Eskandari, Hadi Hamishehkar, Parham Maroufi, Haleh Rezaee* Pages 70-74
    Background

    Vancomycin is a potent antibiotic and has central role in the managing of infections with known resistance to other antibiotics or in patients with allergy to beta-lactams. Irrational use of vancomycin is associated with increased morbidity and mortality as well as the antibiotic resistant.

    Methods

    The DUE was done in Imam Reza Hospital, Tabriz, Iran. A total of 100 patients were included during a 6-month period. We aimed to evaluate vancomycin administration pattern and assess its compliance with Centers for Disease Control and Prevention (CDC) and the American Society of Health-System Pharmacists (ASHP) protocols as the primary outcome and its adverse effects as the secondary outcome.

    Results

    The mean duration of hospitalization and antibiotic therapy were 22.11 ± 1.76 and 19.08 ± 1.51 respectively (mean ± SD). The most causes of vancomycin administration (51%) were for surgery prophylaxis. In 38% of patients, vancomycin administration was not in accordance to standard guidelines. Dose and duration of vancomycin therapy was according to ASHP and CDC guidelines in 74% and 59% of patients. Dose readjustments of antibiotics were necessary in 28 patients which were done in 12 of them. A total of 140 samples were collected from 60 patients. In 30% of patients, vancomycin use was continued without considering the culture results.

    Conclusion

    It is important to set practical pharmaceutical and therapeutic infection control committees in hospitals under the clinical pharmacists’ observation. Furthermore, educational programs for health care professionals regarding rational use of antibiotics can be helpful in improving antimicrobial medications utilization and monitoring.

    Keywords: Vancomycin, Drug Utilization Review, Drug Resistance, Bacterial
  • Arash Abdolmaleki*, Muhammad Akram, Muhammad Muddasar Saeed, Asadollah Asadi, Mahan Kajkolah Pages 75-82

    Neurodegenerative disorders could be a most important health issue within the 21st century. In the recent past; there has been a growing interest in medicinal plants. Chemical fruits and vegetables are said to decrease the possibility of many chief ailments, together with cardiovascular and cancer disorders as well as neurodegenerative ailments. Hence, who eat more fruits and vegetables may be less threat of developing certain diseases caused by neurological dysfunction. The present review provides an overview of the most important plants used for neurological disorders and explores their neurological protection for the development of new pharmacological potential drugs. The data sources included Pubmed and PMC Pubmed Central articles on the topic. Therefore, we present a systematic approach for Herbal medicine as neuroprotective agent. From ancient time the herbal medicines are used to cure neurological symptoms. While the exact pharmacology of these herbs has not yet been set on, some of them have anti-inflammatory or antioxidant properties on different peripheral systems. The significant variety of medicinal plants makes it an essential source of healthy compounds compared to current therapeutic agents. In this review, the importance of phytochemicals for the function of neurological protection and other related disorders, in particular, the process mechanism and therapeutic prospective will be emphasize.

    Keywords: Neurodegenerative Diseases, Herbal Medicine, Nervous System, Medicinal Plants
  • Saeed Mehralinejadian, Mandana Izadpanah*, Farhad Soltani, Sepideh Sayadi, Maryam Aghakouchakzadeh Pages 83-87
    Background

    Increasing microbial resistance is a severe threat to global public health. One of the most common diseases in the intensive care unit is ventilator-associated pneumonia.

    Methods

    The method of this research was non-interactive and descriptive. This study was carried out from January to March 2018, at the Golestan Hospital of Ahvaz. Patients with ventilatorassociated pneumonia (VAP) were included in the study. The prevalence of resistant gram-negative microorganisms was studied through reported laboratory antibiogram results of cultures.

    Results

    From 373 hospitalized patients, 38 (10.2%) were diagnosed with VAP. From the 57 respiratory cultures performed, overall 90 microorganisms were isolated, from which Enterobacter with 36 cases (39.5%) and E.Coli with 28 cases (30.7%) were most frequently compared to other organisms. From the 90 organisms responsible for the infection, 43 cases (47.2%) were Multiple drug-resistant (MDR) microorganisms and 47 (51.6%) were Extensively drug-resistant (XDR) microorganisms. Enterobacter and E.Coli were the most prevalent MDR microorganisms with 17 cases (39.5%) and 13 (30.2%), respectively. Also, these two microorganisms were the most abundant XDR microorganisms with 19 cases (40.4%) and 15 (31.9%), respectively.

    Conclusion

    The results show the requirement of robust antibiotic monitoring and the optimization of antibiotic use in order to prevent the progression of antibiotic resistance in these units.

    Keywords: Pneumonia, Ventilator-Associated, Gram-Negative Bacteria, Intensive Care Units, Drug Resistance
  • Zohre Labbani Motlagh, Simin Dashti Khavidaki* Pages 88-89

    Since first published guideline on the use of direct oral anti-coagulants (DOACs) in non-valvular atrial fibrillation on 2013 till latest update on 2018 (1), DOACs interactions with other drugs are one of the important challenges in their prescribing. By rapid growing number of solid organ transplant recipients the need for anticoagulant therapy among transplant patients is increasing. Based on in vivo studies (2, 3) and clinical reviews (4, 5) on concomitant administration of calcineurin inhibitors (CNIs) and DOACs, reassessing the color of interactions in the guideline (1) seems to be necessary. Using midazolam as CYP3A probe showed that cyclosporine inhibits CYP3A stronger than tacrolimus and there is no significant difference in CYP3A inhibition between tacrolimus and control group (2). Same pattern of inhibition is seen with P-glycoprotein (P-gp) pathway (3). Hence, considering cyclosporine as moderate to strong P-gp inhibitor and moderate CYP3A inhibitor and tacrolimus as mild to moderate P-gp and mild CYP 3A inhibitor might be considered. Based on current data higher rivaroxaban exposure and risk of bleeding has been reported while cyclosporine was used concomitant with rivaroxaban, but taking cyclosporine with apixaban increased apixaban exposure only modestly within its therapeutic range. Dabigatran is not metabolized by CYP3A, however, clinical experiences and reports on CNIs plus dabigatran regimen are limited and inconclusive. On the other hand, the competition effect of DOACs on CNIs metabolism (6) can be easily overcome by blood level monitoring of the CNIs about 5 to 7 days after DOAC initiation. In conclusion, considering acceptable safety of DOACs plus tacrolimus that is more frequently used CNIs among transplant patients, DOACs may be convenient anticoagulants in this population. We may suggest reconsidering the severity and color of CNIs-DOACs interactions as shown in the Table 1.

  • Fatma Hammami, Makram Koubaa*, Sahar Ben Kahla, Amal Chakroun, Khaoula Rekik, Fatma Smaoui, Mounir Ben Jemaa Pages 90-92

    Despite their adverse effects, fluoroquinolones continue to be commonly prescribed antibiotics. Ciprofloxacin remains the safest with remarkably few adverse effects of all fluoroquinolones. Here, we present a rare case of paroxysmal atrial fibrillation induced by ciprofloxacin intake in a 72-year-old woman. She was treated with ciprofloxacin and ceftriaxone for urinary tract infection caused by Klebsiella pneumonia. On the fifth day of ciprofloxacin intake, she suddenly complained of heart palpitations and epigastric pain. An electrocardiogram revealed supraventricular tachycardia type atrial fibrillation at 130 beats per minute. No QT interval prolongation was noted. Ciprofloxacin was stopped as it was the most incriminated to induce arrhythmia. A control electrocardiogram showed normal sinus rhythm. Although rare, early detection of atrial fibrillation induced by ciprofloxacin may decrease the severity of complications and prevent death.

    Keywords: Ciprofloxacin, Atrial Fibrillation, Drug-Related Side Effects, Arrhythmias
  • Touraj Asvadi Kermani, Farnaz Naeimzadeh, Haleh Rezaee* Pages 93-95
    Background

    Epiploic appendagitis is natural fats at the anti-mesenchymal surface of the colon. EP is self- limited. Misdiagnosis can lead to unnecessary hospitalization, antibiotic therapy, and surgical intervention. The incidence reported 8.8 cases / million / year.

    Case presentation

    Here, we report on 36-year-old female patient who presented with acute abdominal pain that was getting worse with the change of position. Based on these symptoms and double contrast computed tomography, she was diagnosed with epiploic appendagitis in adjacent to the sigmoid. The patient was treated successfully with conservative management and antibiotics.

    Conclusions

    Since the signs and symptoms of epiploic appendagitis are nonspecific, but considering of this disease as one of the differential diagnoses of acute abdominal pain can prevent the disease from misdiagnosing.

    Keywords: Case Reports, Epiploic Appendagitis, Acute Abdomen, Computed Tomography