Susceptibility testing of Helicobacter pylori: Comparison of E-test and Disk Diffusion for Metronidazole and Mutations in rdxA gene sequences of Helicobacter pylori strains

Metronidazole is a main stay of modern multidrug therapies for Helicobacter pylori [H. pylori] infection. Metronidazole resistance reduces the effectiveness of these combination therapies. Various methods have been used for the determination of the sensitivity of H. pylori to metronidazole, that have shown conflicting results. The aims of this study are: 1] Comaring E-Test and disk diffusion methods for determining the susceptibility of H. pylori to metronidazole; and 2] As metronidazole resistance in H. pylori has been found to be associated with mutations in rdxA, the role of this gene in metronidazole resistance in H. pylori has been examined in this study. A total of 46 H. pylori strains from 223 consecutive patients were examined. The E-Test was performed according to the manufacturer's guidelines, and the disk diffusion test, according to standard procedure, using 5 micro g metronidazole disks. Extraction of DNA was done from all H. pylori isolates by boiling and the use of phenol-chloroform methods, and afterwards Polymerase Chain Reaction [PCR] was performed. Metronidazole resistance as determined by E-test and disk diffusion methods, was 64.3% and 47.6% respectively. None of the resistant or sensitive samples possessed rdxA gene deletion. Disk diffusion method is not reliable in determining metronidazole resistance in H. pylori. An intact rdxA gene has also been reported in metronidazole-resistant H. pylori, suggesting that additional metronidazole resistance mechanisms exist in H. pylori and even molecular methods are not reliable for the detection of this resistance

Assessment of cyclosporine serum concentrations on the incidence of acute graft versus host disease post hematopoietic stem cell transplantation

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.

Study of potential drug-drug interactions in prescriptions of university- based pharmacies

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

Bibliographic search of publication patterns in rational use of drugs in Iran: a systematic approach

Inappropriate use of drugs is a widespread problem with serious consequences such as increased adverse drug reaction and antimicrobial resistance. Proper interventions would have important financial and public health benefits. Several studies have been performed about Rational Drug Use [RUD] in Iran. To provide a picture of researches were done about RUD and highlight the existing gaps in practice in Iran, a systematic search was conducted by reviewing all papers [English and Persian] found by searching keywords in Pubmed, Web of Science, Google Scholar, CINAHL, Proquest, International Pharmaceutical Abstract [IPA], SID, Iran Medex and MagIran. Retrieved articles were extracted in Access form and exported to Excel for further analysis. After excluding duplicate and irrelevant articles, 466 related articles were remained. Number of publications increased dramatically after 2001. About 73% of studies were cross-sectional. Evaluation of prescribing pattern [15%], self-medication [11.3%] and adverse drug reaction [9.1%] were among the top topics which were studied. Despite an increasing trend in RUD publications in Iran, still large gaps remain to be investigated. Knowing the existing gaps is crucial for policy makers to make investments to solve the problems

Comparison of the effects of enoxaparin and heparin on inflammatory biomarkers in patients with ST-segment elevated myocardial infarction: a prospective open label pilot clinical trial

Heparin and enoxaparin possess anti-inflammatory properties. We compared the effects of these drugs on inflammatory biomarkers in patients with ST-segment Elevated Myocardial Infarction [STEMI]. Thirty four patients with STEMI randomly separated in two groups and received standard doses of heparin and enoxaparin. The serum concentration of Serum Amyloid A [SAA], C-Reactive Protein [CRP], Interleukin [IL]-6. ferritin and Myeloperoxidase [MPO] were measured at baseline ,12 .24 and 48 hours after drug administration. Serum concentrations of SAA [P: 0.02], CRP [P: 0.02] and ferritin [P: 0.01] significantly reduced in heparin group during measurements compared to baseline, circulating levels of IL-6 [P: 0.002], SAA [P: 0.009], CRP [P: 0.01] were significantly decreased in enoxaparin group. The overall difference in inflammatory biomarkers between heparin and enoxaparin group was not significant. Both heparin and enoxaparine reduced serum levels of inflammatory biomarkers in patients with STEMI. This effect may provide additional clinical benefit of these drugs in the treatment of STEMI patients

Drug utilization evaluation of imipenem and intravenous ciprofloxacin in a teaching hospital

Drug Utilization Evaluation [DUE] studies are designed to assess drug usage appropriateness. We aim to evaluate the drug utilization of intravenous ciprofloxacin and imipenem, two of the broad spectrum antibiotics that consume a significant proportion of our hospitals' outlay, in different wards of a teaching hospital in Zabol. During a 5 months period [December 2010 to May 2011], 263 patients who received imipenem or intravenous ciprofloxacin were assigned to this study. Retrospective review of patient's records was carried out. Data were converted to Defined Daily Dose [DDD] and the ratio of prescribed daily dose per DDD was calculated. Among these records, 100 patients received either imipenem or ciprofloxacin. The ratio of prescribed daily dose to DDD was 1.5 for both antibiotics. Almost all patients received empiric therapy in both groups. Only 13 patients [26%] in ciprofloxacin group and 4 patients [8%] in imipenem group received their antibiotics consistent with American Hospital Formulary System [AHFS] mentioned indication. Baseline Blood Urea Nitrogen [BUN] and serum Creatinine were ordered for only 37 patients [74%] in both groups with 15 abnormal results but dose adjustment performed just in one case with decreased renal function. In conclusion, the majority of courses with both drugs were empirically selected and continued and required lab tests for drug monitoring and dose adjustments were not performed in most cases. Educational interventions, developing a local formulary and a strict antibiotic prescribing policy for example by prior approval by an infectious disease consultant can help significantly to overcome these problems

Vasopressin and septic shock

Septic shock continues to be one of the leading causes of death in the Intensive Care Units. When the shock state persists after adequate fluid resuscitation, vasopressor therapy is required to improve and maintain adequate tissue/organ perfusion in an attempt to improve survival and prevent the development of multiple organ dysfunction and failure. Various studies have suggested that exogenous administration of arginine vasopressin may be an effective adjunctive therapy to traditional catecholamines for the management of hypotension during septic shock. Vasopressin is both a vasopressor and an antidiuretic hormone. It also has hemostatic, gastrointestinal and thermoregulatory effects, and is an adrenocorticotropic hormone secretagogue. Vasopressin is released from the axonal terminals of magnocellular neurons in the hypothalamus. Vasopressin mediates vasoconstriction via VI-receptor activation on vascular smooth muscle and mediates its antidiuretic effect via V2-receptor activation in the renal collecting duct system. Vasopressin infusion of 0.01 to 0.04 U/min in patients with septic shock increases plasma vasopressin levels. Current guidelines from the Surviving Sepsis Campaign recommend arginine vasopressin 0.03 unit/minute may be added to norepinephrine with the anticipation of an effect equal to higher doses of norepinephrine alone. Clinicians must be knowledgeable about the use of vasopressin in septic shock, including controversial areas where guidelines do not always provide solid recommendations