ABSTRACT
The aim of this study was to determine the incidence and causes of fever as a major problem contributing to transplantation related mortality among patients undergoing hematopoietic stem cell transplantation [HSCT] and evaluation of antibiotic use, according to reliable guidelines.We retrospectively reviewed hospital records of 195 adult patients who underwent HSCT between 2009-2011 at hematologyoncology and bone marrow transplantation research center. Baseline information and also data related to fever and neutropenia, patient's outcomes, duration of hospitalization and antibiotic use pattern were documented.A total of 195 patients were analyzed and a total of 268 febrile episodes in 180 patients were recorded [mean 1.5 episodes per patient]. About 222 episodes [82%] were associated with neutropenia which one-fourth of them were without any documented infection sources. Microbiologic documents showed that the relative frequencies of gram positive and gram negative bacteria were 62.5% and 37.5%, respectively. The hospital stay duration was directly related to the numbers of fever episodes [P<0.0001].The rate of febrile episodes in autologous stem cell transplantation was significantly higher compared to allogeneic type [P<0.05].It is necessary to determine not only the local profile of microbiologic pattern, but also antibiotic sensitivities in febrile neutropenic patients following hematopoietic stem cell transplantation, and reassess response to antibiotic treatment to establish any necessity for modifications to treatment guidelines in order to prevent any fatal complications from infection
Subject(s)
Humans , Male , Female , Hematopoietic Stem Cell Transplantation , Incidence , Anti-Bacterial AgentsABSTRACT
Medication error [ME] is the most common preventable cause of adverse drug events which negatively affects patient safety. Inadequate, low-quality studies plus wide estimation variations in ME from developing countries including Iran, decreases the reliability of ME evaluations. To clarify sources, underreporting reasons and preventive measures of MEs, we reviewed Iran current available literature. We searched Scopus, WOS, PubMed, CINAHL, EBSCOHOST and Persian databases [IranMedex, and SID] up to October 2012. Two authors independently selected and one reviewed and extracted data. Results reported by more than 30% of studies considered as the most important topics. Finally 25 articles were included. All study designs were cross-sectional [except for two interventional studies] and in hospital settings. Nursing staff and students were the most observed populations. Individual factor, with "inadequate knowledge of medication" as its most frequent reason, were the mostly reported source of MEs. Fear and reporting process were two most important reporting barriers. The sense of being reprimanded and ignoring to report respectively were their most frequent factors. Anti-infectives were the most frequent drugs involved in MEs. Preventive measures were varied and reporting of their effectiveness was inconsistent. There are still many research gaps which need to be explored by further studies. Based on our findings, further researches may be focused on design, implementation, and evaluation of a ME reporting system as groundwork, assessing systems-related factors to ME alongside individual factors and evaluating the effectiveness of preventive measures for MEs in trials
ABSTRACT
Allogeneic hematopoietic stem cell transplantation [HSCT] is a curative treatment option for hematological disorders. Cyclosporine [CsA] is one of the major immunosuppressive agents for the prophylaxis against graft versus host disease [GvHD]. In this retrospective study, we evaluated the effects of CsA serum levels on the incidence of acute GvHD and transplant outcomes. 103 adult patients received Hematopoitic Stem Cell Transplantation[HSCT] in the Hematology-Oncology, Bone Marrow Transplantation center at Shariati Hospital in Tehran, Iran. All participants received prophylactic regimen of cyclosporine plus methotrexate. CsA dose titration was done according to patients' serum levels and drug toxicity. Serum levels tested on the twice weekly basis in first 4 weeks after transplantation.Acute GvHD [grades II-IV] developed in 44 patients [43%, 95%CI: 33%-52%]. The median time to ANC and PLT recovery was 13 days [range: 9-31 days] and 16 days [range: 0-38 days], respectively. Univariate analysis of risk factors related to aGvHD [grade II-IV] development showed a higher risk of incidence of aGvHD [grades II-IV] for patients having the lowest blood CSA concentration [<200ng/ml] in the third weeks after transplantation [36% vs. 12%, P=0.035]. The only risk factors related to incidence of aGvHD grades III-IV was also blood CsA concentration at 3rd week post transplant [15% vs. 3%, P=0.047]. The CsA concentration at 3rd week was not related to disease free survival and overall survival [P=0.913 vs. P=0.81] respectively. Higher CsA serum levels in the third week post HSCT significantly decreased incidence of acute GvHD.
ABSTRACT
Low plasma level of vitamin D is linked to the increased risk of cardiovascular diseases such as hypertension, diabetes, dyslipidemia and peripheral vascular diseases. Vitamin D deficiency is a worldwide problem that involves Iranian population. To the best of our knowledge, this was the first investigation on venous thromboembolism [VTE] subjects that assessed the correlation of vitamin D level with plasma P-selectin, hs-CRP, and risk factors of thrombosis. In this prospective study, patients with diagnosis of acute deep vein thrombosis and or pulmonary eboembolism were enrolled. All patients' clinical data, demographics and risk factors of thrombosis were evaluated. Plasma level of P-selectin and hs-CRP were measured by ELISA method. Radio immune assay method was used to determine plasma level of 25-hydroxy vitamin D. In this study, 60 subjects were included. The mean +/- SD plasma 25-hydroxy vitamin D level [25[OH] D] of participants was 21.4 +/- 14.6 ng/mL. The vitamin D deficiency was reported in 60% of patients. No significant relation was found between the plasma 25[OH]D level and P-selectin and hs-CRP. In multiple regression analysis, there was a significant relationship between the level of 25[OH]D and the patients' age [beta = 0.452; p = 0.001], diabetes [beta = 0.280; p = 0.036] and positive family history of cardiovascular diseases [beta = 0.373; p = 0.003]. Vitamin D deficiency is a frequent problem in Iranian VTE patients. Moreover, Plasma level of vitamin D is not associated with increase level of P-selectin and hs-CRP in VTE patients
ABSTRACT
Thalassemia along with hematopoietic stem cell transplantation [HSCT] can lead to major oxidative stress. Vitamins A and E are antioxidants which protect membrane from lipid peroxidation. We sought to determine for the first time, whether vitamins A and E supplementation is efficacious in maintaining or increasing plasma level of these vitamins in thalassemic children undergoing HSCT. A cross-sectional study was performed on 50 children with beta-thalassemia major hospitalized for HSCT. Patients took a daily multivitamin. Plasma vitamins A and E levels were measured at four different times: on admission, HSCT day [day 0], day 7 and day 14 after HSCT. Plasma vitamin A and E were abnormal on admission in most patients [62.0% and 60.0% respectively]. Ratio of patient with normal to abnormal plasma level of the vitamins improved from baseline to a peak on day 7 then deteriorated afterward until day 14. There was an increasingly positive correlation between daily oral intake and plasma vitamin A at different times, but plasma vitamin E showed inverse correlation at first which tended towards no correlation subsequently. In multivariate analysis, supplementation significantly changed plasma level of vitamin A at different measurement time [P=0.001] within study subjects. But, plasma level of vitamin E showed no significant difference [P=0.2]. Our findings suggest that oral supplementation could have beneficial effects due to increasing plasma vitamin A level and preventing plasma vitamin E depletion
ABSTRACT
Drug-Drug Interactions [DDIs] are adverse reactions caused by a combination of drugs; they are often predictable and therefore avoidable or manageable. The objective of this study was to evaluate the nature, type and prevalence of potential DDIs in prescriptions dispensed in university-based community pharmacies in Tehran, Iran. From July 2012 to February 2014, sample of 1260 prescriptions were collected from community and outpatient hospital pharmacies affiliated to Tehran University of Medical Sciences [TUMS], Iran. The prescriptions were assessed using the reference text "drug interaction facts". The identified DDIs were categorized according to their level of significance into three classes [minor, moderate, major]. At least one drug-drug interaction was present in 339 [26.9%] of prescriptions and a total of 751 cases of interactions were found in prescriptions. Major DDIs represented 7.3% of all DDIs detected, whereas moderate DDIs were 75% of all DDIs. The mean number of drugs per prescriptions was 3.2, with a median of 4 [range, 2-10].There was a positive association between number of prescribed drugs and occurrence of DDIs [OR: 2.14, 95% CI: 1.9-2.4]. The prescriptions of medical specialist had greater risk of occurrence of moderate severity DDIs than general practitioners [OR: 1.52, 95%CI: 1.08-2.15]. Despite the prescriptions were collected from university-based pharmacies, but the overall prevalence of potential DDIs were high among patients. Physicians should be aware of potentially harmful DDIs. Meanwhile Pharmacists can contribute to the detection and prevention of drug-related injuries. Appropriate education, collaborating drug selection and pharmaceutical care are strongly recommended for physicians and pharmacists
ABSTRACT
Infections in neutropenic patients are considered as major causes of mortality and the emergence of drug resistance. Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including Methicillin Resistant Staphylococcus Aureus [MRSA]. In this study, we evaluated the appropriate utilization of this agent in bone marrow transplantation [BMT] patients. In a cross sectional study, all patients who received vancomycin in a seven months period at bone marrow transplantation research center in Shariati teaching hospital in Tehran, Iran, were entered to the study. Clinical and preclinical parameters such as serum creatinine, microbial culture, antibacterial sensitivity, WBC count and fever were collected and recorded for analysis. We also measured vancomycin trough level after administration of three doses. Fifty one patients were entered in the study and reviewed in two adult BMT wards. The age range was 18 to 65 years. Most patients received allogenic versus autologous transplantation [56.9%, 43.1%]. About 80% of the vancomycin used for the patients with febrile neutropenia was compatible with National Comprehensive Cancer Network [NCCN] guideline. 21.6% of patients received appropriate doses. Vancomycin trough serum concentration range was 15.0 +/- 11.9 microg/mL. Vancomycin is an antibiotic used to treat resistant gram-positive infections and must be prescribed by a specialist. Vancomycin wrong dosing or initiation prescribing with dose 1 gr/q12h increases the resistance and toxicity to drug, and cause an inappropriate response to the drug
ABSTRACT
The efficacy of amlodipine, a calcium channel blocker, in treating systemic hypertension is well established but the most efficacious brand of this drug is still uncertain. The cost of different brands of amlodipine is tremendously different which may affect decision-making in hypertension treatment. The purpose of this study was to compare the efficacy and safety of different brands of amlodipine [Amlodipine, Amlopress, and Norvasc] in the treatment of hypertension in adult patients. This was a double-blind, randomized, three-sequence crossover study. Ambulatory patients with hypertension who had the inclusion criteria were enrolled. Patients were randomized and entered into three groups to receive either brand of amlodipine in a crossover method. After every four weeks of treatment completed, the other brand of drug was prescribed. The total period of the study was 12 weeks for all three drugs including four weeks for each brand. A total of 20 patients entered to the study, 15 completed the 12-week treatment schedule. The absolute reductions in seated and supine systolic blood pressure [SBP] and diastolic blood pressure [DBF] were similar with all three brands during the 4 weeks of treatment. Headache, malaise and weakness were the most common reported adverse effects [AE] with all three drugs. Generic amlodipine had the most AE as compared with other brands. These AE were mild and did not require withdrawal of the drug. There is no statistical difference in lowering blood pressure by three different brands of amlodipine thus everyone which has the lowest price can be the first choice
Subject(s)
Humans , Male , Female , Hypertension/drug therapy , Treatment Outcome , Double-Blind Method , Cross-Over Studies , Blood Pressure/drug effectsABSTRACT
Isotretinoin [13-cis retinoic acid] is used for treatment of nodular cystic acne unresponsive to conventional therapy. It is an expensive, potent teratogenic drug with serious adverse drug reaction [ADRs]. Recently, use of this drug has increased in Iran. To date, there are no published data about the use of isotretinoin in Iran; therefore, this study aims to assess its use in this country. This was a prospective, drug utilization evaluation [DUE] study conducted in an institutional community pharmacy affiliated with Tehran University of Medical Sciences [TUMS]. Drug prescription, administration, and evaluation of appropriateness were recorded and compared with standard protocols. Collected data were analyzed by SPSS software. A total of 274 outpatients treated with isotretinoin enrolled in the study. Of these, 51.3% were prescribed isotretinoin under the usual recommended daily doses of 0.5mg/kg/day. Data also indicated that 33.5% of the patients were given total doses of less than 100 mg/kg [72.4 +/- 17.2 mg/kg] and 12.2% received more than 150 mg/kg. With regards to the teratogenic effects of isotretinoin, only 6.8% of couples simultaneously used two methods of contraception [P = 0.001]. In addition, we detected improper use of isotretinoin for mild and moderate acne in about 20% of cases. The most important finding of this study is that the doses of isotretinoin are incorrect in many cases. Incorrect dosages would decrease drug efficacy and increase the risk of relapse. In addition, patients have not been adequately counseled about isotretinoin's teratogenicity and the seriousness of its adverse effects
Subject(s)
Humans , Male , Female , Drug Utilization , Drug Utilization Review , Prospective Studies , Acne VulgarisABSTRACT
Bone is a dynamic tissue that is continuously renewed throughout life by the process of bone remodeling. Antioxidant system might be involved in the pathogenesis of bone loss, so the aim of this study was to evaluate the total antioxidant capacity [TAC], vitamin C and vitamin E levels of plasma besides measuring enzymatic antioxidants, superoxide dismutase [SOD], catalase [CAT] and glutathione reductase [GR] enzymes activity in Iranian osteoporotic women comparing to the control group. Bone mineral density [BMD] of the femoral neck and lumbar spine was measured by dual x-ray absorptiometry. The participants were divided into groups: a] total participants [-3.9 /= -1] including 76 women, c] the total patients [T-score < -1] including 76 women. Then, plasma TAC, vitamin C levels, SOD and GR activities, erythrocyte CAT were measured using spectrophotometrical methods separately, and for vitamin E by HPLC analysis. Comparing the control group and osteoporotic women showed that: a] plasma levels for vitamin C and erythrocyte CAT were markedly lower in the patients than in the controls, but plasma activity of TAC, SOC and GR were significantly higher, respectively. b] the differences were higher between control and patients with severe disease [T-score <-1.7] comparing to patients in the group with milder disease [-1.7