Evaluation of time in therapeutic range (TTR) in patients with non-valvular atrial fibrillation receiving treatment with warfarin in Tehran, Iran: A cross-sectional study

Introduction: Anticoagulant control is assessed by Time in Therapeutic Range (TTR). For a given patient, TTR is defined as the duration of time in which the patient�s International Normalized Ratio (INR) values were within a desired range. Aim: To assess TTR in patients receiving treatment with warfarin for non-valvular atrial fibrillation at a referral center for cardiovascular diseases in Tehran, Iran. Materials and Method: Over 6 months, we enrolled eligible patients presenting to Shaheed Rajaie Hospital in Tehran for regular INR testing. Demographic data, medical history, and current medications were determined for all participants. TTR was assessed by the Rosendaal method. Results: A total of 470 patients (mean age 58.0±14.2 years, 60.2 women) underwent 1450 INR measurements. The mean TTR was calculated as 54.9±11.9. Of the sample patients, 37.3 were in the good control category (TTR > 70), 24.6 were in the intermediate category (50 < TTR < 70), and 38.1 were in the poor control category (TTR < 50). The number of current medications above four was a significant predictor of poor control (OR = 2.06; 95 CI, 1.87, 2.23). The mean TTR of the studied patients (54.9) was below the good control range. Conclusion: The quality of anticoagulant therapy with warfarin in Iranian patients is poorer than that reported in European countries. Based on these results, research considering the causes of poor TTR among Iranian patients is recommended. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved

Plasma oxytocin level and sexual dysfunction in depressed women treated by either fluoxetine or citalopram: A pilot clinical trial

Sexual dysfunction is a common cause of selective serotonin reuptake inhibitor (SSRI) withdrawal. Various studies indicate that decreased oxytocin is involved as a mechanism of delayed ejaculation induced by SSRIs. The aim of the present pilot study was to evaluate and compare sexual dysfunction and oxytocin levels in women being treated with either fluoxetine or citalopram. Thirty-nine women with the diagnosis of major depressive disorder were enrolled in the study. A baseline blood sample was collected and each participant was given either fluoxetine 20 mg/d or citalopram 20 mg/d. After 1 month, a second blood sample was collected and sexual dysfunction was evaluated via the Female Sexual Function Index (FSFI) questionnaire. Twenty-three women completed the study (12 and 11 in the fluoxetine and citalopram groups, respectively). After 1 month, the FSFI scores were 22.8 ± 7.8 and 22.5 ± 4.8 in the fluoxetine and citalopram groups, respectively. The oxytocin levels were 187.8 ± 38.8 pg/mL and 214.6 ± 23.1 pg/mL in the fluoxetine and citalopram groups, respectively. Statistical analysis did not reveal any difference in the FSFI score between the two groups after 1 month (p = 0.89). However, the oxytocin levels were significantly lower in the fluoxetine group than in the citalopram group (p = 0.05). We also observed a positive relationship between the FSFI score and oxytocin level at 1 month after starting fluoxetine or citalopram (r = 0.43, p = 0.04).A positive relationship between the oxytocin level and FSFI score supports the hypothesis that the oxytocin level plays a role in sexual dysfunction induced by SSRIs. © 2018 by School of Pharmacy Shaheed Beheshti University of Medical Sciences and Health Services

Role of vitamin C and rectal indomethacin in preventing and alleviating post-endoscopic retrograde cholangiopancreatography pancreatitis: a clinical study

Background/Aims This study aimed to determine whether vitamin C in addition to indomethacin decreases the occurrence and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) occurrence and severity. Methods This randomized clinical trial included patients undergoing ERCP. The participants were administered either rectal indomethacin (100 mg) plus an injection of vitamin C (500 mg) or rectal indomethacin (100 mg) alone just before ERCP. The primary outcomes were PEP occurrence and severity. The secondary amylase and lipase levels were determined after 24 hours. Results A total of 344 patients completed the study. Based on intention-to-treat analysis, the PEP rates were 9.9% for indomethacin plus vitamin C plus indomethacin and 15.7% for indomethacin alone. Regarding the per-protocol analysis, the PEP rates were 9.7% and 15.7% in the combination and indomethacin arms, respectively. There was a remarkable difference between the two arms in PEP occurrence and severity on intention-to-treat and per-protocol analyses (p=0.034 and p=0.031, respectively). The post-ERCP lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively). Conclusions Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity

Plasma oxytocin level and sexual dysfunction in depressed women treated by either fluoxetine or citalopram: A pilot clinical trial

Sexual dysfunction is a common cause of selective serotonin reuptake inhibitor (SSRI) withdrawal. Various studies indicate that decreased oxytocin is involved as a mechanism of delayed ejaculation induced by SSRIs. The aim of the present pilot study was to evaluate and compare sexual dysfunction and oxytocin levels in women being treated with either fluoxetine or citalopram. Thirty-nine women with the diagnosis of major depressive disorder were enrolled in the study. A baseline blood sample was collected and each participant was given either fluoxetine 20 mg/d or citalopram 20 mg/d. After 1 month, a second blood sample was collected and sexual dysfunction was evaluated via the Female Sexual Function Index (FSFI) questionnaire. Twenty-three women completed the study (12 and 11 in the fluoxetine and citalopram groups, respectively). After 1 month, the FSFI scores were 22.8 ± 7.8 and 22.5 ± 4.8 in the fluoxetine and citalopram groups, respectively. The oxytocin levels were 187.8 ± 38.8 pg/mL and 214.6 ± 23.1 pg/mL in the fluoxetine and citalopram groups, respectively. Statistical analysis did not reveal any difference in the FSFI score between the two groups after 1 month (p = 0.89). However, the oxytocin levels were significantly lower in the fluoxetine group than in the citalopram group (p = 0.05). We also observed a positive relationship between the FSFI score and oxytocin level at 1 month after starting fluoxetine or citalopram (r = 0.43, p = 0.04).A positive relationship between the oxytocin level and FSFI score supports the hypothesis that the oxytocin level plays a role in sexual dysfunction induced by SSRIs. © 2018 by School of Pharmacy Shaheed Beheshti University of Medical Sciences and Health Services

Efficacy and safety of propolis mouthwash in management of radiotherapy induced oral mucositis; A randomized, double blind clinical trial

Aim and BackgroundPropolis has been used for the management of oral mucositis in a number of studies. Due to lack of sufficient evidence especially in radiotherapy induced oral mucositis, the present study was designed to evaluate the efficacy and safety of propolis mouthwash in oral mucositis and dysphagia in patients undergoing head and neck radiotherapy.Materials and methodsThis study was a prospective, randomised, double-blind, placebo-controlled trial. The patients randomly divided into two groups receiving either the propolis or the placebo mouthwash. Patients were advised to rinse their mouth with 15 mL three times daily for four weeks. Severity of mucositis and dysphagia were evaluated by the National Cancer Institute Common Toxicity Criteria (NCI-CTC) and Common Terminology Criteria for Adverse Events (CTCAE), respectively.ResultsThirty patients completed the study. Each group consisted of 15 patients. Although, there is not any significant difference between two groups in the first week of radiotherapy, a significant difference was seen in the second, the third and the fourth week (p = 0.03, 0.02, 0.02, respectively). Dysphagia reported as a mild score in the propolis group only in the fourth week which is significant compared with the placebo group (p = 0.01). There is not any serious adverse effect related to propolis or placebo during the study.ConclusionIt seems that propolis mouthwash is an effective and safe medication for alleviation of oral mucositis and dysphagia in patients under head and neck radiotherapy

Detection and Management of Medication Errors in Internal Wards of A Teaching Hospital by Clinical Pharmacists

Any suboptimum treatment in the management of patients can lead to medication errors (MEs) that may increase morbidity and mortality in hospitalized individuals. By establishing well-designed patient care activities within the managed care setting, clinical pharmacists can cooperate with other health care professionals to provide quality care and maximize safety. The aim of this study was to evaluate the frequency and prevention of MEs by clinical pharmacists. This was a cross-sectional interventional study conducted in internal wards of a teaching hospital during a two-month period. During this period, patient records, and physician orders were reviewed by clinical pharmacists. Any prescription error identified was documented. Incorrect drug selection, dose, dosage form, frequency, or route of administration all were considered as medication errors. Then, the clinical pharmacist discuss about findings with the clinical fellows to change faulty orders. The frequency and types of MEs in different wards that were detected and prevented by clinical pharmacists was documented. During the study period, in 132 patients, 262 errors were detected (1.98 per each). Wrong frequency 71 (27%), forget to order 37 (14.1%), wrong selection 33 (12.5%), drug interactions 26 (9.9%), forget to discontinue 25 (9.5%) and inappropriate dose adjustment in renal impairment 25 (9.5%) were the most types of errors. Cardiovascular medications were the class with the highest detected errors (31.6%) followed by gastrointestinal agents (15.6%). Medication errors are common problems in medical wards that their frequency can be restricted by the intervention of clinical pharmacists

Patients' Adherence to Tenofovir for the Treatment of Hepatitis B: The Role of Clinical Pharmacists: Patients' Adherence to Tenofovir for the Treatment of Hepatitis B

Tenofovir is an antiviral agent prescribed for patients suffering from hepatitis B. It is associated with some side effects such as reduction in the level of patients’ adherence. The aim of this study was to evaluate the impact of clinical pharmacist consultation on patients’ adherence to the use of Tenofovir. In this prospective study, a total of 80 patients were enrolled into the study and were divided into two groups. Patients in group one, received their medication in a routine clinic manner, while patients in the second group, by clinical pharmacist intervention, received Tenofovir along with verbal and written tips about the drug dosage, side effects, drug interactions, food-drug interactions and administration. Finally, patients’ adherence to their medication was evaluated using a standard scale. Also, adverse drug reaction (ADR) occurrence and some laboratory parameters were recorded for further analysis. The patients' adherence to their medication was higher in case group than the control group in first three month of follow up. Moreover, lower ADRs were observed in patients who received clinical pharmacist consultation. It can be concluded that consultation provided by clinical pharmacist can lead to better adherence to Tenofovir usage, better therapeutic response and better tolerance of side effects