Potential Drug Interactions in Terminally-Ill Cancer Patients, a Report from the Middle East.

This study aims to evaluate the epidemiology of potential drug interactions in terminally-ill cancer patients receiving exclusively supportive care. In this cross-sectional study, during a 6-month follow-up, we considered the medical record of terminally-ill cancer patients referred to palliative care at the cancer center in Isfahan, Iran. Potential drug-drug interactions (DDIs) were assessed by Lexi-Interact ver.1.1 online software. During the study period, 133 terminally-ill cancer patients were recruited. We detected 1678 DDIs with moderate or major severity levels. Among them, 330, 219, 32, 1075, and 51 interactions were categorized in B, C, D, and X drug interactions categories, respectively. One hundred and twenty-two patients (91.73%) encountered at least one potential drug-drug interaction during the end of life care. Mechanistically, most drug-drug interactions (64.5%) were pharmacodynamics. The most frequent pharmacological class of drugs responsible for DDIs were quetiapine (91 cases), oxycodone (87 cases), and sertraline (55 cases). Interaction between oxycodone and sertraline was found to be in the top 10 detected DDIs (13.7%). Our results showed that potentially moderate or major drug-drug interactions often occur among terminally-ill cancer patients and the clinical significance of DDIs should be considered meticulously in the palliative care cancer setting.

Multiple Hydatid Cysts in Rare Locations Treated with Albendazole: A Case Report.

Hydatid cyst is a common disease between humans and animals. Foods that are contaminated with eggs of echinococcal species are the cause of hydatid disease. Although this parasite affects different organs, the liver and lungs are very susceptible but the cardiac hydatid disease is very rare. We report the case of a 33-year-old man admitted because of chest pain. Echocardiography had shown suspected round cyst in the myocardium. More diagnostic managements had demonstrated cystic lesion in the liver, spleen and lungs. There were also multiple cystic lesions in both lungs. He refused surgery and was taken to medical therapy. Myocardial involvement by hydatid cysts occurs very rarely. The main treatment approach for cardiac hydatid disease in patients should be surgery. The alternative treatment was done to those who refused surgical removal, adjuvant therapy such as albendazole for at least 1-6 months. Because myocardial involvement by hydatid cysts is uncommon, we decided to report this rare case.

A Case of Pneumoperitoneum after Colonoscopy without Frank Perforation.

Benign pneumoperitoneum can happen after colonoscopy, which shows itself as free air in the abdomen without symptoms or pneumoperitoneum without peritonitis. In this case, we reported a rare case of an elderly man who had acute abdominal stiffness after colonoscopy and observation of free air under the diaphragm that no perforation was observed in the intestine during laparoscopy and only one tiny intestinal tumor was randomly reported. There is no consensus on the treatment of pneumoperitoneum after colonoscopy. Patients with peritonitis benefit from laparoscopy but patients with micro perforation and asymptomatic patients benefit from intravenous antibiotic treatment and bowel rest.

New-onset lung sarcoidosis, an adverse event by COVID-19 or a sign of convalescence; a case report.

Key Clinical Message: Sarcoidosis is a systemic inflammatory disease able to affect any organ within the body. Sarcoidosis may be the body's secondary response to COVID-19 infection and a sign of rehabilitation. Early response to the treatments reinforces this hypothesis. The majority of sarcoidosis patients require immunosuppressive therapies, including corticosteroids. Abstract: Most studies so far have focused on the management of COVID-19 in patients suffering from sarcoidosis. Nevertheless, the current report aims to present a COVID-19-induced sarcoidosis case. Sarcoidosis is a systemic inflammatory disease with granulomas. Still, its etiology is unknown. It often affects the lungs and lymph nodes. A previously healthy 47-year-old female was referred with the following chief complaints: atypical chest pain, dry cough, and dyspnea on exertion within a month after COVID-19 infection. Accordingly, a chest computed tomography revealed multiple conglomerated lymphadenopathies in the thoracic inlet, mediastinum, and hila. A core-needle biopsy from the nodes revealed non-necrotizing granulomatous inflammation, sarcoidal type. The sarcoidosis diagnosis was proposed and confirmed by a negative purified protein derivative (PPD) test. Accordingly, prednisolone was prescribed. All symptoms were relieved. A control lung HRCT was taken 6 months later, showing the lesions had disappeared. In conclusion, sarcoidosis may be the body's secondary response to COVID-19 infection and a sign of disease convalescence.

Acetyl-L-carnitine for the prevention of taxane-induced neuropathy in patients with breast cancer: a systematic review and meta-analysis.

Background and purpose: Peripheral neuropathy is one of the most prevalent and undesirable side effects of taxane-containing chemotherapy regimens. This study aimed to investigate the effect of acetyl-L-carnitine (ALC) on the prevention of taxane-induced neuropathy (TIN). Experimental approach: MEDLINE, PubMed, Cochrane Library, Embase, Web of Science, and Google scholar were systemically applied as electronic databases from 2010 to 2019. The current systematic review was carried out based on the main considerations of PRISMA preferential reporting items for systematic review and meta-analyses. Since there was no significant discrepancy, the random-effect model was used for 12-24 weeks' analysis (I2 = 0%, P = 0.999). Findings/Results: Twelve related titles and abstracts were found during the search, 6 of them were excluded in the first phase. In the second phase, the full text of the remaining 6 articles was comprehensively evaluated and 3 papers were rejected. Finally, 3 articles complied with the inclusion criteria and pooled analyses. The meta-analysis showed a risk ratio of 0.796 (95% CI between 0.486 and 1.303), so, the effects model was used for 12-24 weeks' analysis (I2 = 0%, P = 0.999) since no significant discrepancies were observed. There was no evidence of ALC's positive effect on the prevention of TIN during 12 weeks, and it was revealed that ALC significantly increased TIN in 24 weeks. Conclusion and implications: According to our findings, the hypothesis that ALC had a positive effect on preventing TIN in 12 weeks has not been proved; however, ALC led to an increase in the TIN in 24 weeks.

The effectiveness of colistin/levofloxacin compared to colistin/meropenem in the treatment of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii: a randomized controlled clinical trial.

Background and purpose: The treatment of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) is still a great challenge. This study evaluated the effectiveness of the colistin/levofloxacin regimen compared to the usual colistin/meropenem regimen in the treatment of patients with VAP caused by CRAB. Experimental approach: The patients with VAP were randomly assigned to experimental (n = 26) and control (n = 29) groups. The first group received IV colistin 4.5 MIU every 12 h + levofloxacin 750 mg IV daily, and the second group received IV colistin with the same dose + meropenem 1 g IV every 8 h for 10 days. The clinical (complete response, partial response, or treatment failure) and microbiological responses at the end of the intervention were recorded and compared between the two groups. Findings/Results: The complete response rate was higher (n = 7; 35%) and the failure rate was lower (n = 4; 20%) in the experimental group than in the control group (n = 2; 8%, and n = 11; 44%, respectively), but the differences were not statistically significant. Even though the microbiological response rate was higher in the experimental group (n = 14; 70%) than in the control group (n = 12; 48%), the difference was not statistically significant. The mortality rate was 6 (23.10%) and 4 patients (13.8%) in the experimental and control groups, respectively (P = 0.490). Conclusion and implication: The levofloxacin/colistin combination can be considered an alternative regimen to meropenem/colistin in the treatment of VAP caused by CRAB.

Adult-onset still's disease and budd-chiari syndrome: A case report.

Adult onset still's disease (AOSD) is a rare autoinflammatory disease displaying with a wide range of non-specific symptoms and budd-chiari syndrome (BCS) is an uncommon disorder characterized by obstruction of hepatic venous outflow. We present the case of a young patient who presented with persistent fever, sore throat, elbow, hand fingers and knees arthralgia with abdominal pain. The patient's symptoms had started 7 days before the referral. Imaging and laboratory data led to the diagnosis of BCS in the context of AOSD. The patient treated with corticosteroid in combination of warfarin with favorable outcome and complete improvement of signs and symptoms. We came to this conclusion AOSD complicated with BCS is a rare but potentially life-threatening entity. Clinicians should be aware of this complication.

Toxicoepidemiology of Phosphide Poisoning in the Central Part of Iran.

Objective: Aluminum phosphide (ALP) and zinc phosphide (ZnP) are toxic agrochemical pesticides, which are commonly used as an agent of self-harm in developing countries. Because of high toxicity of phosphides, we evaluated toxico-epidemiology ALP and ZnP poisoning in with respect to outcome. Methods: We performed a cross-sectional study with retrospective chart review including the records for patients admitted due to phosphide poisoning (ALP, ZnP) in a poisoning referral center in Khorshid Hospital, affiliated with Isfahan University of Medial Sciences, Isfahan, Iran. Demographic characteristics, clinical manifestations, outcome (survived or death), and length of hospital stay for the patients were recorded in a data collecting form. Binary backward stepwise logistic regression was used for outcome prediction. Findings: Sixty patients were evaluated in the study. The mean age of patients was 27.61. Thirty-nine patients were men. 96.7% of the patients ingested it intentionally. Most of the patients on admission were conscious (66.7%). Abnormality of EKG was noted in 8.3%. The mortality in ALP and ZnP poisoning was 39.2% and 22.2%, respectively. Serum bicarbonate and base excess in the venous blood gas analysis, systolic blood pressure, and serum sodium level were significantly different between patients with ALP and ZnP poisoning on admission time (P < 0.05). On admission, systolic blood pressure was an important predictive factor for mortality (odds ratio 4.87; 95% confidence interval: 1.5-15.45; P = 0.007). Conclusion: The rate of mortality in phosphide poisoning is high. Knowing predictive factors for mortality help physicians for selecting patients in intensive care unit admission and aggressive treatment.

Severe Ondansetron-associated Hypokalemia in a Patient Diagnosed with Aspiration Pneumonia.

This case report aims to introduce a patient with severe hypokalemia as one of the rare complications of ondansetron injection. The stroke patient was 56 years old and hospitalized in the emergency department with and purulent sputum. The symptoms and lung computed tomography scan confirmed the diagnosis of aspiration pneumonia. A nasogastric tube was inserted, and food gavage was performed for the patient. The treatment was started with meropenem to manage aspiration pneumonia. The patient could not tolerate the gavage. Consequently, ondansetron was prescribed, but severe hypokalemia of 2.5 mEq/l was developed. The causes of hypokalemia were evaluated. The hematological, biochemical, and liver function tests were done, and the potassium level was measured daily. Afterward, causes of hypokalemia was ruled out and with discontinuation of ondansetron the hypokalemia was resolved. Hypokalemia may be caused by ondansetron. It is required that potassium monitoring be always considered during administrating of this medicine.

Review of COVID-19 Treatment.

Many contagious diseases, such as plague or cholera, played a role in changing the pathway of history. In this respect, although coronavirus was not as dangerous as novel diseases such as swine flu and Ebola, the spread and the power of coronavirus infiltration caused public fear across the world. Three viruses among coronaviruses have been epidemic during the recent years, including severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 or new coronavirus. Respiratory droplets transmit the coronavirus through direct and indirect contact, and it can be transmitted through the contact in the case of remaining, the infected person's secretion on the surface. Based on the conducted studies on the treatment of COVID-19 disease, there is virtually no cure or vaccine for coronavirus infections yet. Those infected with Covid 19 are quarantined to prevent the outbreak of this disease. However, the researchers carried out different studies to investigate the impact of the various drugs on this virus, which in this study, we will examine the outline of this disease and the other conducted studies.

Pentoxifylline in Prevention of Amphotericin B-induced Nephrotoxicity and Electrolyte Abnormalities.

OBJECTIVE: Amphotericin B is an antifungal agent used to treat serious fungal infections mainly in critically ill patients. Despite its adverse effects including renal toxicity and electrolyte imbalances, amphotericin B remains one of the best choices for antifungal treatment. Information from animal studies has provided a strong scientific basis for the use of pentoxifylline as lowering nephroprotective agent. The present study was designed to evaluate the efficacy of pentoxifylline in preventing renal toxicity and electrolytes imbalances induced by amphotericin B. METHODS: This study was conducted as a randomized controlled trial on 44 patients admitted to Sayyedoshohada Hospital, Isfahan, Iran, from October 2016 to August 2018. Patients were assigned to one of the two groups: Pentoxifylline, 400 mg twice a day, or matching placebo, from the 1st day of amphotericin B therapy till minimum of 7 days. All patients' information including lab data (serum and urine levels of Mg, Na, and K, serum creatinine level, blood urea nitrogen [BUN] and urinary creatinine excretion) were gathered at the time of drug initiation and during the study period. The results were analyzed by SPSS v. 20 software and Repeated measures test was used to assess the differences between groups. FINDINGS: This study did not show any significant differences between the two groups in terms of all the assessed variables, including serum and urinary levels of electrolytes, and creatinine, as well as the number of cases presented acute kidney injury during the study period. CONCLUSION: Despite the positive effects of pentoxifylline in preventing renal complications in previous studies, this study could not show a definitive result in salt wasting or renal damage induced by amphotericin B. So, Designing robust studies with more included samples would be valuable.