Potential effect of coenzyme Q10 (Ubiquinone) on serum NGAL biomarker and kidney function following Coronary Artery Bypass Grafting surgery

Background: Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) surgery, and is associated with major adverse outcomes. Effect of preoperative administration of coenzyme Q10 was evaluated in order to realize that whether it could prevent the occurrence of AKI following elective CABG surgery. Materials and Methods: Two hundred and fifty patients who were candidate for elective CABG surgery between September 2017 and August 2018 were randomly assigned to intervention group (receiving coenzyme Q10, 300 mg BID for 2 days before surgery) and control group. Serum NGAL (neutrophil gelatinase-associated lipocalin) was measured at baseline, 6 and 24 hours after surgery. Serum creatinine (sCr) and urine output (UO) were also measured at baseline and after surgery. Results: Fifty patients completed the study. The total incidence of acute kidney injury was 32%. There were no significant differences in the incidence of AKI (p=0.07) between the two groups. Serum NGAL was shown no significant difference at 6 (p=0.13) and 24 (p=0.22) hours after surgery compared to the baseline level between the two groups, whereas, the significant difference in the hospitalization duration was shown between them (p=0.02). Conclusion: CoQ10 supplementation did not significantly decrease the incidence of AKI in patients undergoing elective CABG

Effect of bromhexine in hospitalized patients with COVID-19

Background: Bromhexine is a potent inhibitor of transmembrane serine protease 2 and appears to have an antiviral effect in controlling influenza and parainfluenza infection; however, its efficacy in COVID-19 is controversial. Methods: A group of hospitalized patients with confirmed COVID-19 pneumonia were randomized using 1:1 allocation to either standard treatment lopinavir/ritonavir and interferon beta-1a or bromhexine 8 mg four times a day in addition to standard therapy. The primary outcome was clinical improvement within 28 days, and the secondary outcome measures were time to hospital discharge, all-cause mortality, duration of mechanical ventilation, the temporal trend in 2019-nCoV reverse transcription-polymerase chain reaction positivity and the frequency of adverse drug events within 28 days from the start of medication. Results: A total of 111 patients were enrolled in this randomized clinical trial and data from 100 patients (48 patients in the treatment arm and 52 patients in the control arm) were analyzed. There was no significant difference in the primary outcome of this study, which was clinical improvement. There was no significant difference in the average time to hospital discharge between the two arms. There were also no differences observed in the mean intensive care unit stay, frequency of intermittent mandatory ventilation, duration of supplemental oxygenation or risk of death by day 28 noted between the two arms. Conclusion: Bromhexine is not an effective treatment for hospitalized patients with COVID-19. The potential prevention benefits of bromhexine in asymptomatic postexposure or with mild infection managed in the community remain to be determined.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

The The potential role of clinical pharmacist in the practice of heart transplantation

Due to the complexity of heart transplant procedure and risk of organ rejection, most heart transplant patients receive multiple medications such as antibiotics, antifungals, and immunosuppressants. Since some medications have narrow therapeutic indexes, more attention is needed by the clinical pharmacists to solve and reduce medication-related problems. Pharmacists can play an essential role in assisting patients and physicians in receiving better treatment with the lowest risk of medication errors. The purpose of this study was to investigate the types and quality of clinical pharmacist recommendations, the recommendations acceptance rate, and the outcomes related to clinical pharmacist interventions in heart transplant patients. The study was conducted at National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Dr.Masih Daneshvari Hospital, a university affiliated hospital, Tehran, Iran. Main outcome measures included determination of the quality of clinical pharmacist recommendations, physician acceptance rate and the effects of recommendations on patients’ clinical outcomes. Clinical pharmacist recommendations were divided into ten categories, and physicians’ acceptance rate for each recommendation was recorded. The quality of pharmacist recommendations was also classified into six categories. The total number of recommendations that were recorded for 46 patients was 344, about 7.47 recommendations per patient. Dose adjustment recommendations were the most recommendations that were made (n=100, 29.06 %). However, this type of recommendation had the lowest physician acceptance rate (62%). Antibiotics had the least acceptance rate in dose adjustment recommendations (40%). Clinical pharmacist recommendations in the drug interaction category prevented 265 moderate and 28 severe interactions, respectively. Clinical pharmacist made 27 (7.84%) extreme significant recommendations and 88 (25.58%) significant recommendations. Clinical pharmacists could have a critical role in optimizing medication regimens and minimizing drug interactions as well as adverse reactions in transplant patient care and their treatment programs

بررسی باورهای دارویی در بیماران مبتلا به آسم و عوامل مرتبط با آن: باورهای دارویی در بیماران مبتلا به آسم

سابقه و هدف: باور دارویی مثبت در بیماران، خصوصاً بیماران آسمی، جهت دست یافتن به اهداف درمانی ضروری می باشد. مطالعه حاضر با هدف تعیین میزان باورهای دارویی در بیماران آسمی ایرانی و عوامل مرتبط با آن طراحی و اجرا گردید. مواد و روش ها: یک مطالعه از نوع توصیفی- تحلیلی و مقطعی  طراحی گردید. بیماران آسمی بالغ (بالای 18 سال) مراجعه کننده به درمانگاه بیماری های ریوی بیمارستان آموزشی مسیح دانشوری به روش نمونه گیری غیراحتمالی در فاصله زمانی فروردین تا اسفند ماه سال 1398 وارد مطالعه شدند. برای جمع آوری اطلاعات از فرم گردآوری اطلاعات سه قسمتی که شامل الف- اطلاعات دموگرافیک بیماران ب- سوابق دارویی و پزشکی آن ها، و ج- ترجمه فارسی پرسشنامه باور های دارویی (BMQ) می باشد، استفاده و آنالیز شد. یافته ها: در مجموع 191 بیمار مبتلا به آسم، شامل 108 زن (54/56%) و 83 مرد (46/43%)، با میانگین ± انحراف معیار سنی 53/15 ± 65/50 سال وارد مطالعه شدند. میانگین ± انحراف معیار امتیاز نگرانی دارویی و ضرورت دارویی بیماران به ترتیب 62/2 ± 86/13 و 39/2 ± 15/18 بود، و در کل امتیاز باور دارویی 29/3 ± 29/4 برای بیماران مورد مطالعه بدست آمد. آنالیز رگرسیون خطی چند متغیره نشان داد که 6 متغیر مصرف الکل، تعداد مراجعه روتین به پزشک در یکسال اخیر، سابقه ابتلا به آسم، سابقه فامیلی ابتلا به آسم، شهر محل سکونت و مالکیت خودرو دارای ارتباط معنی داری با میزان ضرورت دارویی می باشند (.(p<0.0001, r=0.49 نتیجه گیری: بر اساس نتایح این مطالعه بیماران مبتلا به آسم از باور دارویی پایینی برخوردارند. همچنین بیماران مجرد، بیماران فاقد آگاهی در خصوص داروهای مصرفی و بیماران فاقد توان مالی برای تأمین وسیله نقلیه شخصی، دارای باور دارویی پایین تری بودند. برنامه های ارتقاء خدمات مدیریت دارویی در بیماران آسمی باید بر روی این بیماران با خصوصیات سوشیودموگرافیک خاص تمرکز یابد تا به کاهش بار این بیماری در جامعه کمک نماید

Molnupiravir in Combination with Remdesivir for Severe COVID-19 Patients Admitted to Hospital: a Case Series

Since the start of the COVID-19 pandemic, a large number of trials have examined the efficacy of various medications as potential treatments for COVID-19, but a promising therapeutic option is still missing and under investigation. Molnupiravir is an investigational oral antiviral medication and a nucleoside analogue that suppresses SARS-CoV-2 replication and has been found to be active against common virus variations (including the Delta variant). Several phase 2 and 3 clinical trials have shown high efficacy for direct antiviral activity of molnupiravir as well as its favorable safety and tolerability in mild to moderate Covid-19 patients. The current study was done on five hospitalized, severe COVID-19 patients. It seems that in combination with remdesivir, this novel antiviral could exert a synergistic effect on reducing the severity of symptoms as well as the duration of hospitalization. However, further clinical studies on the use of molnupiravir in the treatment of severe COVID-19 are warranted

A Pregnant Woman with a Diagnosis of COVID-19 without Clinical Manifestations: A Case Report: A Pregnant Woman with a Diagnosis of COVID-19

A 41 year old woman, 38 weeks and 3 days pregnant, without any past medical history and gravida (G) 4, parity (P) 2 and abortion (Ab) 2, gave birth by Cesarean section. The patient did not have any fever, cough, and dyspnea and did not report any close contact with COVID-19 patients. She was extubated post-surgery in the recovery room. She had oxygen saturation (SpO2) of 87-93% with face mask and was transferred to medical ward. Six hours later, she experienced dyspnea and her SpO2 fell down to 83%. Ten hours after surgery, due to worsening of her dyspnea and SpO2 of 78%, cardiology consultation was conducted and patient was admitted to the intensive care unit (ICU) with the diagnosis of pulmonary thromboembolism (PTE). Cardiac consultation and echocardiography excluded PTE. In the ICU, her chest computerized tomography scan (CT-scan) showed bilateral ground glass opacity in favor of COVID-19. Reverse Transcription-Polymerase Chain Reaction (RT-PCR) for COVID-19 was also positive. The baby was born with an Apgar score of 9, a normal physical examination and a positive PCR test for COVID-19

Successful IgM-enriched immunoglobulin treatment in severe COVID-19 pneumonia: a case report

Coronavirus disease (COVID-19) pandemic has turned into one of the most considerable challenges worldwide. The optimal treatment strategy, particularly in severely ill patients, is still unrecognized. IgM-enriched immunoglobulin (Pentaglobin®, Biotest AG, Dreieich, Germany) contains IgM, IgA and IgG against a variety of pathogens representing passive immune protection for affected individuals and it may be effective in the treatment of COVID-19. On March 16, 2020, a 32-year-old woman presented to Masih Daneshvari Hospital, Tehran, Iran. On admission, the peripheral oxygen saturation (O2 Sat) was 84%. Spiral chest computed tomography (CT) scan revealed bilateral ground-glass opacification (GGO) involvement. On March 19, 2020, the clinical condition was deteriorated, and her O2 Sat decreased to 70% in ambient air. Treatment with IgM-enriched immunoglobulin was immediately initiated over the course of three days (total dose for the patient was calculated to be 1500 ml). On the seventh day of hospitalization, the patient was discharged with satisfactory general condition, without any complaints, and with stable vital signs and O2 Sat of 95% on room air. In conclusion, IgM-enriched immunoglobulin could be considered as a potential option for the treatment of severely ill patients with COVID-19