Evaluation of hepatoprotective effect of silymarin among under treatment tuberculosis patients: a randomized clinical trial

Hepatic toxicity is the most serious adverse effect of anti tuberculosis drugs. This study was performed to evaluate efficacy of silymarin as a hepatoprotective herbal agent. In a randomized double blind clinical trial 70 new cases of pulmonary tuberculosis were divided into two groups. The intervention group was assigned to receive silymarin and the control group received placebo. Tuberculosis was treated by classic regimen consisting isoniazid, rifampin, pyrazinamide and ethambutol. No statistically significant difference was found between the two groups concerning the frequency of drug induced liver injury or mild elevation of liver enzymes. Silymarin was safe without any major side effect. Our results showed no significant hepatoprotective effect of silymarin among patients on tuberculosis treatment

rate of physicochemical incompatibilities, administration errors. Factors correlating with nurses' errors

Medication errors are commonly encountered in hospital setting. Intravenous medications pose particular risks because of their greater complexity and the multiple steps required in their preparation, administration and monitoring. We aimed to determine the rate of errors during the preparation and administration phase of intravenous medications and the correlation of these errors with the demographics of nurses involved in the process. One hundred patients who were receiving IV medications were monitored by a trained pharmacist. The researcher accompanied the nurses during the preparation and administration process of IV medications. Collected data were compared with the acceptable guidelines. A checklist was filled for each IV medication. Demographic data of the nurses were collected as well. A total of 454 IV medications were recorded. Inappropriate administration rate constituted a large proportion of errors in our study [35.3%]. No significant or life threatening drug interaction was recorded during the study. Evaluating the impact of the nurses' demographic characteristics on the incidence of medication errors showed that there is a direct correlation between nurses' employment status and the rate of medication errors, while other characteristics did not show a significant impact on the rate of administration errors. Administration errors were significantly higher in temporary 1-year contract group than other groups [p-value < 0.0001]. Study results show that there should be more vigilance on administration rate of IV medications to prevent negative consequences especially by pharmacists. Optimizing the working conditions of nurses may play a crucial role

Increasing the number of adverse drug reactions reporting: the role of clinical pharmacy residents

Detection of adverse drug reactions [ADRs] in hospitals provides an important measure of the burden of drug related morbidity on the healthcare system. Spontaneous reporting of ADRs is scare and several obstacles to such reporting have been identified formerly. This study aimed to determine the role of clinical pharmacy residents in ADR reporting within a hospital setting.Clinical pharmacy residents were trained to report all suspected ADRs through ADR-reporting yellow cards. The incidence, pattern, seriousness, and preventability of the reported ADRs were analyzed. During the period of 12 months, for 8559 patients, 202 ADR reports were received. The most frequently reported reactions were due to anti-infective agents [38.38%]. Rifampin accounted for the highest number of the reported ADRs among anti-infective agents. The gastro-intestinal system was the most frequently affected system [21.56%] of all reactions. Fifty four of the ADRs were reported as serious reactions. Eighteen of the ADRs were classified as preventable. Clinical pharmacy residents' involvement in the ADR reporting program could improve the ADR reporting system

Effect of a combination of omeprazole plus sustained release baclofen versus omeprazole alone on symptoms of patients with gastroesophageal reflux disease [GERD]

Previous studies have reported the efficacy of baclofen in the treatment of Gastroesophageal Reflux Diseases [GERD]. The objective of present study is to evaluate the effect of co-administration of omeprazole 20 mg/d plus sustained Release baclofen [SR baclofen] vs. omeprazole 20 mg/d plus placebo on alleviation of symptoms in patients with a diagnosis of GERD. A prospective, double blind, placebo controlled trial included 60 patients with diagnosis of GERD have been done. Patients were randomly selected to receive either SR baclofen or a placebo in addition to omeprazole 20 mg/d for a period of 2 weeks. Patients were questioned regarding heartburn, regurgitation, chest pain and hoarseness at the base line and after 2 weeks. All patients tolerated the medications and no patients failed to complete the study due to adverse drug reactions. A total of 53 patients completed the study, 25 in SR baclofen and 28 in placebo group. After 2 weeks, 1 patient [4%] in SR baclofen group reported heartburn and regurgitation. However 13[46.4%] and 15 [53.6%] of patients in the placebo group had heartburn and regurgitation respectively. The analysis of the data shows that there is a significant difference between the two groups in heartburn and regurgitation [p < 0.0001, p < 0.0001 respectively]. Statistical analysis revealed a significant difference in two groups regarding total GERD score [p <0.0001]. The results of the present study suggest that a combination of SR baclofen and omeprazole may be a more effective treatment for heartburn and regurgitation than omeprazole alone

effect of amlodipine and sildenafil on the NT-ProBNP level of patients with COPD-induced pulmonary hypertension

Pulmonary hypertension [PH] is an important cause of heart failure in chronic obstructive pulmonary disease [COPD]. The pro brain natriuretic peptide N-terminal [NT-proBNP] has been suggested as a noninvasive marker to evaluate ventricular function. However, there is no evidence to support the use of NT-proBNP in monitoring the benefits of vasodilators in COPD induced PH. Thus, we used NT-proBNP as a biomarker to evaluate the effect of oral vasodilators on cardiac function in COPD-induced PH. Forty clinically-stable PH patients were enrolled with history of COPD, normal left ventricular ejection-fraction [LVEF], right ventricular systolic pressure [RVSP] > 45 mmHg and baseline blood NT-proBNP levels >100 pg/mL. Patients were randomized into two groups, one group received sildenafil and second group were given amlodipine for two weeks. NT- proBNP and systolic pulmonary arterial pressure [systolic PA-pressure] were measured at the beginning and the end of study. Mean NT-proBNP level in the first group was 1297 +/- 912 pg/mL before therapy and 554 +/- 5 pg/mL after two weeks drug therapy, respectively. Similarly, in second group NT- proBNP level was 1657 +/- 989 pg/mL and 646 +/- 5 pg/mL before and after treatment. Amlodipine or sildenafil significantly reduced NT-proBNP levels in COPD-induced PH patients [p < 0.05]. Our study shows that amlodipine and sildenafil have a similar effect on NT-proBNP levels. In both groups NT- proBNP levels were significantly reduced after treatment. Therefore, our findings support the potential benefits of treatment with vasodilators in COPD induced PH

effect of Garcin[registered sign] in preventing antiTB-induced hepatitis in newly diagnosed tuberculosis patients

Adverse effects of antituberculosis agents such as hepatotoxicity may reduce treatment effectiveness, because they significantly contribute to nonadherence and eventually result in treatment failure, relapse or the emergence of drug resistance. Garlic is an ancient herbal substance, which its effectiveness on isoniazid and rifampicin-induced hepatic injury in animal models has been demonstrated [1]. In the present study a randomized, double blind, placebo-controlled, parallel group clinical trial was designed to assess the effect[s] of garlic tablets [1000 mg daily] administered for two weeks orally. Fifty eight newly diagnosed, smear positive pulmonary tuberculosis patients, with age ranges between 18-65 years old, were randomly allocated into two groups. Each patient received either garlic or placebo tablets for the first two weeks of tuberculosis treatment. Of total 58 patients, 31 received garlic tablets while 27 received placebo. No significant difference was found between the two groups regarding age, sex, nationality, smoking, underlying diseases and opium usage. During 8 weeks of anti-TB [antituberculosis] treatment, 8 [13.0%] patients developed drug-induced hepatotoxicity [DIH]. Of them, 6 [75%] occurred in the first two weeks of treatment. Fifty percent of the patients who developed DIH were in garlic group. Results indicated no significant difference between groups in developing DIH [p=1.000]. We could not show a significant role in preventing DIH by 1000 mg daily garlic administration

pilot study of polymorphism of adrenergic beta-2 receptor and mild zsthma: z clinical and pharmacogenetic study

Glycine allele at codon 16 has previously been associated with the increase in asthma severity, bronchial hyperresponsiveness and also the increase in inhaled corticosteroid dependence. This study was designed to evaluate the genetic alleles in mild asthma

Thirty-four patients with diagnosis of mild asthma [FEV[1] >/= 80%, positive methacholine test] and body mass index [BMI

Among all, 20 [58.8%] Arg/Gly, 14 [41.2%] Arg/Arg and no Gly/Gly genotype were detected at codon 16. Genotyping at codon 27 revealed 2 [5.9%] Glu/Glu, 13 [38.2%] Glu/Gln and 18 Gln/Gln [52.9%].Based on the obtained results, Arg/Gly mutation had a higher rate among the studied subjects compared to Arg/Arg polymorphism. This is a pilot study which shows a probable usefulness of genotyping for predicting of asthma severity

Vancomycin utilization evaluation in a teaching hospital: a case- series study in Iran

Increasing antimicrobial resistance is now a critical point of human being in the world. Especially wide spectrum antibiotics resistance germs like vancomycin-resistant enterococci [VRE] should be dealt as soon as possible as an emergency conflict. Our study tries to reveal the amount of irrational use of vancomycin in a teaching hospital in Iran. We elected the whole inpatients that received vancomycin between February 2007 and May 2008. Forty four out of those 45 patients had inappropriate indication and dosing regimen of vancomycin [97.7%]. The most use of vancomycin was recorded in hematology - oncology ward and then Intensive Care Unit [ICU]. Culture responses were negative despite great clinical evidence of infection. Vancomycin irrational use was high compared to other countries and it could be concerned as a major health problem by health policy makers and physicians to deal. However more detailed researches are needed to reveal the other aspects of this problem. Implementation of antibiotic protocols and standard treatment guidelines are recommended

Evaluation of the pattern of human albumin utilization at a university affiliated hospital

Albumin is a protein colloidal solution that possesses great value in the clinic, particularly for the resuscitation of critically ill patients. It has accounted for a high percentage of the cost in our center. This study evaluates the appropriateness of albumin usage at Masih Daneshvari Hospital, Tehran, Iran. This study evaluated 69 patient charts. Data included patient demographics, ward of admission, primary reasons for prescribing albumin, and details of albumin use. Possible correlations between the appropriateness of albumin usage, the number of albumin vials, and mortality rate were analyzed. Albumin was prescribed appropriately in 63.8% of patients. Cardiac surgery accounted for 37.3% of all indications. The most prevalent inappropriate indication of used albumin was for mild hypoalbuminemia and nutritional support. There was a significant correlation between the number of used albumin vials and mortality rate. In conclusion, the albumin use in Masih Daneshvari Hospital was not completely in accordance with the accredited references. Albumin is an expensive medication prescribed unnecessarily for many patients. Using the clinical pharmacist's prepared guideline could minimize the situations where its administration is not needed

rate of antibiotic dosage adjustment in renal dysfunction

The purpose of this study was to determine the number of prescribed antibiotics being appropriately adjusted and to assess antibiotics with the highest incorrect dosing based on the patient's renal function according to distinguished guidelines. The study was conducted at a 446-bed university hospital. One hundred and fifty patients admitted through different wards of the hospital were included in the study. Demographic data were extracted and creatinine clearance was calculated using either Cockcroft-Gault [CandG] or Modification of Diet in Renal Disease [MDRD] formula. In patients with creatinine clearances less than 50 mL/min, antibiotic dosages were compared with guideline dose recommendations to judge whether they were correctly adjusted. Two hundreds and ninety-one instructions [79.9%] of 364 antibiotic prescriptions required dosage adjustment based on the patient's renal condition. These adjustments were rationally performed in 43.7% and 61.4% of prescriptions, according to the two guidelines used. Ciprofloxacin [29.1% of cases], and vancomycin [33.6% of cases], were the most inappropriate prescribed antibiotics in terms of dose administration. Drug dosing adjustments should be emphasized in patients with renal dysfunction. Failure to do so may lead to higher morbidity and mortality as well as therapeutic costs. Estimating creatinine clearance prior to drug ordering and use of a reliable dosing guideline is highly recommended

Physical and chemical stability of mycophenolate mofetil [MMF] suspension prepared at the hospital

To evaluate the physical and chemical stability of a suspension of mycophenolate mofetil [MMF] prepared in the hospital from commercially available MMF capsules and tablets. Extemporaneous pharmacy was used as a feasible method in this experimental study to prepare suspension form of MMF. Suspension formulations were prepared from both tablets and capsules forms of MMF. Thereafter the stability parameters such as pH, microbial control, thermal and physical stability and particle sizes were evaluated. The amount of MMF, in the suspension was measured at various time points by HPLC. The HPLC method showed that concentration of suspensions prepared from tablets and capsules were 49 mg/mL and 50 mg/mL at time 0, respectively. The effective amount of suspensions prepared from capsules was 101% at time 0, 100% after 7 days, 98% after 14 days, and less than 70% after 28 days. According to the obtained results in this study, capsule-based suspension was stable for as long as 14 days at 5°C. This formulation appears to be clinically acceptable and provides a convenient dosage form for pediatric patients and for adults during the early postoperative period

Methacoline challenge test as an evaluator of response to statins in bronchial hyperresponsiveness

3-hydroxy-3-methylglutaryl-CoA reductase inhibitors [statins], are effective serum cholesterol-lowering agents which also have anti-inflammatory properties. The objective of this study was to evaluate the effect of atorvastatin on bronchial hyperresponsiveness. Adult patients [age 14 to 65 years] with bronchial hyperresponsiveness [BHR] diagnosis based on the spirometry with methacholine challenge test were entered into the study. The study was conducted in the National Research Institute of Tuberculosis and Lung Disease. Patients were randomized to receive either atorvastatin 20 mg/day or placebo for 4 weeks. Spirometric parameters were determined at baseline and at completion of the study. Twenty two patients with the age of 32.95 +/- 10.30 years completed the trial. Changes in airway responsiveness categories [moderate to severe, mild, borderline, normal] after the intervention were not significant in atorvastatin group as in placebo group [p-value= 0.131 for atorvastatin group and p-value = 0.305 for placebo group]. Also, changes in methacholine solution number [different concentrations of methacholine] which caused at least 20% decrease in FEV1 were not significant between groups [p-value = 0.089]. Although we could not find a significant difference, the patients' fall in FEV1 in atorvastatin group was observed in higher concentrations of methacholine. Median before treatment versus after treatment in atorvastatin group was 1 versus 4 mg/mL, while those were 2 versus 1 mg/mL in placebo group. This study showed a better but not significant hyperresponsiveness control in the treatment group. The result might be presented more pronounced, if we could increase the sample size

Transcription errors observed in a teaching hospital

Medication errors are among the most common medical errors in the hospitals. Transcription error is a specific type of medication errors and is due to data entry error that is commonly made by the human operators. This study was designed to detect transcription errors in a teaching hospital in Tehran. Direct observational method was used in this study. Error was defined as any deviation in transcribing medication order from the previous step [order on the order sheet, administration nursing note and/or cardex, documentation of the order in the pharmacy database]. A total of 287 charts with 558 opportunities for error were reviewed. Of those opportunities for error 167 [29.9%] resulted in an error. Omission [the patient did not receive the medication that was ordered] was the highest [52%] transcription error type seen in this study. The evaluation clearly showed that errors at transcription stage were not infrequent. To cut these errors down we suggest implementation of surveillance systems, which might help to decrease medication errors

Spirometric improvements with two commonly used spacers in asthmatic patients

Pressurized metered dose inhalers [pMDIs] are commonly used in patients with asthma. However, the need to coordinate inhalation with inhaler actuation means that they are not suitable for use per se. Spacer devices were developed to overcome some of the problems of pMDIs. Several types of holding chambers of different sizes are available in Iran. This study was designed to compare spirometric parameters between Asmyar and Damyar spacers in asthmatic patients. Materials and This was an observational comparative study. Patients with mild to moderate asthma were entered in this study. The ease of use, convenience, and portability of the mentioned spacers were evaluated using a visual analogue scale [VAS]. Lung function was assessed by using a portable spirometer [Spirolab Italy] and spirometric parameters of FEF50%, FEF25-75%, PEF, FEV1, FVC and FEV1/FVC were measured. Forty patients [25 females, 15 males] with a mean age of 43.10 +/- 12.99 years were studied. Mean +/- SD changes of FVC, FEV1, PEF, FEF25-75%, FEF50% and FEV1/FVC [as percentage of the predicted values] before and after using Asmyar were not significantly different from those of Damyar. However, patient satisfaction was significantly higher with Damyar [P<0.0001]. Lung response after using salbutamol with either Damyar or Asmyar spacers was not significantly different

Management of community acquired pneumonia in a teaching hospital: the role of established guidelines

In spite of established guidelines developed by the American Thoracic Society [ATS], Infectious Disease Society of America [IDSA] and Centers for Disease Control [CDC], there is no consensus among physicians regarding hospitalization and choice of antibiotics for management of community-acquired pneumonia [CAP]. This study was conducted to determine the percentage of patients appropriately assessed for admittance and the antibiotic treatment selections that were in accordance with the established guideline criteria. This retrospective chart review study was conducted at the National Research Institute of Tuberculosis and Lung Disease [NRITLD], Masih Daneshvari Hospital during 2005-2006. Patients with a definite diagnosis of CAP were selected and entered the study. The previous IDSA, ATS and CDC guidelines and the more recent IDSA/ATS CAP guidelines were all used to evaluate the management of patients admitted with CAP. Patients were excluded if information was not sufficient. A total of 31 patients were reviewed. Of the 31 patients included in the study, 24 [77%] could have been treated with outpatient regimens. Six of 31 cases [19%] had been treated with regimens consistent with all three [IDSA, ATS, and CDC] guidelines. Twelve of 31 cases [39%] had corresponded to the previous treatment recommendations from ATS. The management of the remaining 13 patients [42%] had not corresponded to any of the mentioned guidelines. When compared to the recently published joint guidelines of ATS/IDSA, 12 of 31 cases [39%] had appropriately corresponded to the treatment recommendations. According to this study only one fifth of the cases reviewed could have been treated on an inpatient basis. Considering the standard guidelines 42% of the patients did not follow the recommendations from evidence-based guidelines. The enforcement of guideline usage through education and surveillance in university hospital settings may be required. We suggest the use of evidence-based medicine in the treatment of CAP