The dilemma of hyperoxia following positive pressure mechanical ventilation: role of iron and the benefit of iron chelation with deferasirox

Abstract. -Background and Objective: Increased oxidative stress in patients under treatment with high concentrations of oxygen (hyperoxia) is considered to be one of the major mechanisms of lung injury, which is thought among different mediators, transition metal ion, iron, by generation of very reactive free radicals which play an important role. Disruption of normal iron homeostasis has been reported in hyperoxic conditions. We hypothesized that chelation of iron can reduce hyperoxia-induced lung injury. Methods: Mechanically ventilated patients, who received oxygen with FiO 2 >0.5 for at least 3 days, underwent bronchoscopy before and 72 hours after receiving "Deferasirox". Oxidative injury index and iron homeostasis markers were measured in lavage fluid and plasma. Results: In 12 patients, the concentrations of 8-isoprostane (p=0.005), 8-oxoguanine (p=0.04), carbonyl proteins (p=0.04) -as markers of oxidative stress -decreased significantly in lavage fluid after intervention. Levels of iron-related proteins, ferritin (p=0.04) and transferrin (p=0.005) also decreased significantly in lavage fluid. Conclusion: Deferasirox -as an iron chelator -decrease oxidative injury index in hyperoxic condition and it could be consider safe and beneficial agent, along with other supportive measures in hyperoxia-induced lung injury for better toleration of oxygen therapy

Vitamin E plasma concentration in osteoporotic patients

Background: The cause of osteoporosis is multifactorial and many dietary factors are important in the prevention of this disease. Antioxidants as free radical scavengers may influence osteoporosis by reducing the effects of oxidative stress that may be associated with bone loss. Vitamin E is an important antioxidant that protects polyunsaturated fatty acids (PUFA) in cell membranes from oxidation. There are only two studies regarding vitamin E plasma levels in subjects suffering from osteoporosis. The purpose of this study was to investigate the association between plasma vitamin E levels and bone mineral density (BMD) in Iranian patients. Methods: Subjects were consecutively recruited between May and September 2005 from among a total of approximately 1000 people referred for instrumental screening for osteoporosis to the Jami Clinic in Tehran. Inclusion criteria for the study group were: a femoral neck T-score of -1 or less, osteopenia, severe osteopenia and osteoporosis. A total of 137 subjects were enrolled. According to their femoral and spinal BMD scores, 54 persons were selected as a control group. The control group consisted of subjects with a femoral neck T-score and spine T-score of -1 or more. In selecting the case group, only the femoral BMD score was used. Plasma vitamin E was measured, after extraction with methanol, by HPLC with UV detection at 280 nm. Methanol, deionized water and butanol (90:4:6) was used as a mobile phase with a C8 column. The flow rate was 1.0 ml. min-1 and the acetate ester of vitamin E was used as an internal standard. Results: The results show no significant difference in plasma vitamin E between the control and case groups, however linear regression analysis does reveal a significant difference between the T-score and plasma vitamin E. Conclusion: Deceleration Femoral bone Density during osteoporosis will be Accelerated with Decrease of Vitamin E Antioxidant level

"Erythropoietin Utilization Evaluation And Two Brand Products Comparison, Eprex and Eposim "

Background and Aim: Anemia is one of the common problems in patients with chronic renal impairment. The most common cause of anemia in this patients is a decreased in erythropoietin hormone excretion, however other common cause include low life of red blood cells, loss of blood during dialysis, frequent blood sampling, uremia, iron, vitamin B12 and folic acid deficiency. Until introduction of erythropoietin in 1982, blood transfusion was an alternative for correction and maintaining hematocrit in normal range in dialyze patients. In current date, any dialyzed patient take rh-erythropoietin . Materials and Methods: The goal of this study is to evaluate erythropoietin utilization and comparing the effectiveness of the commercial product in the Iranian drugs market. The study was performed at nephrology and dialyze ward of Immam Khomeini hospital in a one year period. Results and Conclusion: Of the 30 patients' subject of study, 13 patients received eprex and 17 received epocim. Average dose of erythropoietin 2000IU was three times per week. The average plasma hemoglobin and hematocrit of patients prior to the treatment were 9.38 g/dl and 28% respectively. Increase in the hemoglobin and hematocrit in the group who received eprex was significantly higher than epocim group (p=0.001 and p=0.026 respectively). The incidents of side effects including hypertension, headache, pain at injection site, and influenza-like in eposim group were considerably higher than eprex

High Prevalence of Hypoparathyroidism in Patients with beta-Thalassemia Major

"nIntroduction: Hypoparathyroidism (HPT) is an irreversible but preventable disorder caused by an iron overload which can be considered a typical complication in patients with beta-thalassemia major. "nPatients and method: Parathyroid function was evaluated in 130 patients in Qom, Iran, who suffered from beta-thalassemia major. Their serum ferritin levels were checked for monitoring of chelation therapy effects. "nResults: The prevalence of HPT was 14.6% (19/130). The median age of patients with HPT was significantly higher than of patients without HPT (18 vs. 15 years; P=0.03). Serum ferritin levels was not significantly different between the two groups (median: 2709 vs. 1512; P=0.95). The prevalence of cardiac diastolic dysfunction in patients with HPT was significantly higher than in normal thalassemic patients (3.1% vs. 15.8%, P=0.04). Patients with hypoparathyroidism demonstrated abnormal glucose metabolism (0% vs. 15.8%; P=0.003). "nConclusion: the high prevalence of hypoparathyroidism demonstrated poor chelation therapy in these patients. Close monitoring of ferritin level was recommended. Also, the measurement of parathyroid hormone on a regular basis for all thalassemic patients was recommended

A systematic review of adherence to diabetes and cardiovascular medications in Iran: A call for patient education and reinforcement

Adherence to medications (AM) has been a major research priority for recent decades. Numerous factors including poor access to medicines have been identified to affect AM particularly in middle income countries (MIC). However, access to medicines seems to be addressed well in Iran as a MIC but little is known about the rate and the determinants of AM for Iranian patients. In the present study, we systematically reviewed the AM literature related to Iranian patients with diabetes (DM) and cardiovascular diseases (CVD). Methods We searched biomedical databases including Scopus, Web of Science, PubMed, CINAHL, and Google Scholar, Scientific Information Database, and IranMedex from inception to July 2012. Two independent researchers screened all abstracts. Studies were included if they reported rate of adherence to CVD or DM medications in Iran. We also included studies which had focused on AM determinants or AM improving interventions. Two teams of researchers reviewed full-texts of the relevant articles for quality appraisal and data extraction. We preferred qualitative synthesis of literature as the AM definitions and measurement tools were highly diverse among studies. Among 1003 citation, fourteen studies were eligible for review. Adherence rate for diabetic patients was 62.8-86.3% and for patients with CVD was 38.8-60.0%. Forgetfulness, lack of knowledge about medical condition and prescribed medications, and concerns about medications were consistently reported as barriers to AM. Patient education plus telephone or short message service follow-ups improved AM in diabetic patients. We found no high quality trials on AM improving interventions for patients with CVD. Non-adherence to medications may not be assured for accessible medicines in resource-limited settings. We strongly suggest for multidisciplinary policies and interventions on patient education and reinforcement strategies to address the issue of non-adherence to medications

A 3-Armed Randomized Controlled Trial of Nurses' Continuing Education Meetings on Adverse Drug Reactions

Introduction: Nurses' insufficient knowledge of adverse drug reactions is reported as a barrier to spontaneous reporting. Therefore, CE meetings could be utilized to enhance nurses' competencies. Methods: In a 3-armed randomized controlled trial, 496 nurses, working in a tertiary medical center, were randomly allocated to a didactic lecture, brainstorming workshop, or the control group (delayed education). Similar instructors (2 clinical pharmacists) prepared and delivered the educational content to all 3 groups. Outcomes were declarative/procedural knowledge (primary outcome), participation rate, and satisfaction. Knowledge was evaluated using a validated researcher-made questionnaire in 3 time points: immediately before, immediately after, and 3 months after each session. Participants' satisfaction was assessed immediately after each meeting via a standard tool. Data were analyzed using appropriate parametric and nonparametric tests. Results: Rate of participation was 37.7 for the lecture group and 47.5 for the workshop group. The workshop participants were significantly more satisfied in comparison with the lecture group (p <.05). Mean knowledge scores were similar at baseline in the 3 study groups (43-47). Immediately after the meeting, knowledge was significantly higher in the lecture group (79.1 ± 11.9 vs 73.7 ± 11.3; p =.01). At the follow-up, knowledge scores of the lecture and workshop groups were similar, while significantly higher than the control group. However, the reduction of knowledge score was significantly higher in the lecture group (-13.0 ± 15.9 vs -5.7 ± 15.1, p =.02). Discussion: Educational interventions can improve nurses' knowledge of adverse drug reactions. Short-term learning could be achieved with lecture, but the retention of knowledge will be enhanced by simple interactive techniques. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education

A community pharmacy-based cardiovascular risk screening service implemented in Iran

Background: Cardiovascular disease is a major health concern around the world. Objective: To assess the outcomes and feasibility of a pharmacy-based cardiovascular screening in an urban referral community pharmacy in Iran. Methods: A cross sectional study was conducted in a referral community pharmacy. Subjects aged between 30-75 years without previous diagnose of cardiovascular disease or diabetes were screened. Measurement of all major cardiovascular risk factors, exercise habits, medical conditions, medications, and family history were investigated. Framingham risk score was calculated and high risk individuals were given a clinical summary sheet signed by a clinical pharmacist and were encouraged to follow up with their physician. Subjects were contacted one month after the recruitment period and their adherence to the follow up recommendation was recorded. Results: Data from 287 participants were analyzed and 146 were referred due to at least one abnormal laboratory test. The results showed 26 patients with cardiovascular disease risk greater than 20%, 32 high systolic blood pressure, 22 high diastolic blood pressures, 50 high total cholesterol levels, 108 low HDL-C levels, and 22 abnormal blood glucose levels. Approximately half of the individuals who received a follow up recommendation had made an appointment with their physician. Overall, 15.9% of the individuals received medications and 15.9% received appropriate advice for risk factor modification. Moreover, 7.5% were under evaluation by a physician. Conclusion: A screening program in a community pharmacy has the potential to identify patients with elevated cardiovascular risk factor. A plan for increased patient adherence to follow up recommendations is required