Increasing the Number of Adverse Drug Reactions Reporting: the Role of Clinical Pharmacy Residents

Abstract 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 ADRreporting 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

Clinical pharmacy services in an Iranian teaching hospital: Type, severity, resolution, and accuracy

Objective: Clinical pharmacy services are improving in hospitals. For assessing the impact of these services, first it is important to exactly describe them by categorizing into types, severity, resolution, and accuracy. The objective of this study is to provide a detailed analysis of the clinical pharmacists′ services performed on in-patients in a teaching hospital during 28 months. Setting: Masih Daneshvari hospital, Tehran, Iran. Methods: This is a descriptive study. The authors retrospectively reviewed the notes of all services and entered them in a designed SPSS sheet. Documentation was carried out based on the "findings, assessment, resolution, and monitoring" method. The data were descriptively analyzed. Main outcome measure: Types, subtypes, severities, resolutions, and accuracies of services were defined, documented, and analyzed. Findings: In total 3152 records (2227 interventions and 925 visits with no intervention) were classified and analyzed in this study. Among all types of interventions, "improper medication use" (36.2%) was the most frequent intervention and among categories (subgroups) of "improper medication use," "untreated indication" was the most frequent (23.7%). From the aspect of severity, 75.4% of interventions were estimated as of minor potential inconvenience to the patient (severity degree 1). Most interventions (78%) were finally recommended to the prescriber and 97.6% of interventions were considered accurate on further evaluation. Conclusion: Clinical pharmacists′ interventions are highly demanded in the hospitals. Based on the results of this study, conditions needing medication to prevent later complications in the course of therapy are sometimes ignored, which emphasizes the positive role of the clinical pharmacists′ involvements in clinical teams to improve outcome

Physical and Chemical Stability of Mycophenolate Mofetil (MMF) Suspension Prepared at the Hospital

Abstract 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

Microbial contamination of single-and multiple-dose vials after opening in a pulmonary teaching hospital

OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36%) of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82%) were more significantly involved than gram-negative ones (9.09%) and fungi (9.09%), with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions

ارتباط غلظت ایزونیازید و آنزیم گلوتاتیون-اس- ترانسفراز با سمیت کبدی ناشی از داروی ضد سل

زمینه: سل یک بیماری عفونی شایع و گاه کشنده است. سمیت کبدی ناشی از داروهای ضد سل در بیماران از مهمترین عوارض این داروها است. هدف از این مطالعه بررسی ارتباط بین غلظت پلاسمایی ایزونیازید و گلوتاتیون اس-ترانسفراز با سمیت کبدی ناشی از داروهای ضد سل بود.  روش: 120 بیمار مبتلا به سل ریوی به روش مقطعی با ترکیب دوز ثابت داروهای ضد سل در تهران از مهر 1398 تا خرداد 1401تحت درمان قرار گرفتند.  برای اندازه گیری غلظت پلاسمایی ایزونیازید و استیل ایزونیازید از روش کروماتوگرافی مایع با کارایی بالا و غلظت پلاسمایی گلوتاتیون اس-ترانسفراز از روش اسپکتروفتومتری استفاده شد. داده‌های جمع‌آوری شده توسط نرم‌افزار SPSS نسخه 22 مورد تجزیه و تحلیل آماری قرار گرفت. به منظور تجزیه و تحلیل داده‌ها از آزمون t دو نمونه مستقل، آزمون مجذور کای و ضریب همبستگی پیرسون استفاده شد. سطح معنی داری در آزمون‌ها 05/0 در نظر گرفته شد. یافته ها: 40 بیمار گروه سمیت کبدی و بقیه را گروه بدون سمیت کبدی تشکیل دادند. درگروه سمیت کبدی، نسبت شانس ابتلا زنان به سمیت کبدی در مقایسه با مردان دوبرابر گروه بدون سمیت کبدی بود. هرچند سن در مقایسه این دو گروه تفاوت معناداری نداشت اما در گروه با سمیت کبدی اندکی بیشتر مشاهده شد. میانگین غلظت پلاسمایی ایزونیازید و گلوتاتیون اس- ترانسفراز در گروه با سمیت کبدی به طور معناداری نسبت به گروه بدون سمیت کبدی بالاتر بود اما میانگین غلظت پلاسمایی استیل ایزونیازید و نسبت استیل ایزونیازید به ایزونیازید به طور معناداری در گروه بدون سمیت کبدی نسبت به گروه با سمیت کبدی بالاتربود (P<0.001).  یک همبستگی مستقیم و متوسط بین غلظت پلاسمایی داروی ایزونیازید و آنزیم گلوتاتیون اس-ترانسفراز وجود داشت ( P<0.001 , r = 0.667 ). نتیجه‌گیری: بیماران دارای غلظت بالای ایزونیازید احتمال غلظت سرمی گلوتاتیون اس-ترانسفراز بالاتر و همچنین خطر سمیت کبدی را خواهند داشت.  بنابراین سنجش گلوتاتیون اس-ترانسفراز  در ترکیب با تست‌های کبدی به همراه تعیین غلظت ایزونیازید می‌تواند در شناسایی و درمان بیماران مبتلا به سل کمک شایانی به عمل آورد

The Bioavailability of Salbutamol in Urine via Volumatic and Nonvolumatic Valved Holding Chambers

Purpose Pressurized metered dose inhalers 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. Valved holding chamber devices were developed to overcome some of the problems of pressurized metered dose inhalers. Several types of holding chambers of different sizes are available in Iran. This study was designed to compare the effects of 2 commonly used valved holding chambers (Asthm Yar and Dam Yar) in Iran on bioavailability of salbutamol spray and also spirometric parameters in asthmatic patients.Methods This was a comparative experimental crossover study. Patients with mild to moderate asthma were entered in this study. Lung function was assessed using a portable spirometer (Spirolab, Progetti, Italy). Spirometric parameters of forced expiratory flow (FEF)50%, FEF25-75%, peak expiratory flow (PEF), forced expiratory volume in the first second of expiration (FEV1), forced vital capacity (FVC), and FEV1/FVC were measured. Urinary concentration of salbutamol as an index of pulmonary bioavailability was assayed with high-performance liquid chromatography.Results Forty patients (25 women and 15 men) with the mean age of 43.10 ± 12.99 years were studied. Mean ± SD changes of spirometric parameters before and after using Asthm Yar were not significantly different from those of Dam Yar. The relative bioavailability after inhalation with Asthm Yar was significantly higher than after inhalation with Dam Yar (P = 0.002).Conclusions Although the results indicate that relative bioavailability to the lung after inhalation with Asthm Yar was significantly higher than after inhalation with Dam Yar, its clinical importance should be tested. Keywords: asthma, valved holding chamber, urinary concentration, salbutamol, spirometr

The relevance of magnesium homeostasis in COVID-19

International audiencePurpose In less than one and a half year, the COVID-19 pandemic has nearly brought to a collapse our health care and economic systems. The scientific research community has concentrated all possible efforts to understand the pathogenesis of this complex disease, and several groups have recently emphasized recommendations for nutritional support in COVID-19 patients. In this scoping review, we aim at encouraging a deeper appreciation of magnesium in clinical nutrition, in view of the vital role of magnesium and the numerous links between the pathophysiology of SARS-CoV-2 infection and magnesium-dependent functions. Methods By searching PubMed and Google Scholar from 1990 to date, we review existing evidence from experimental and clinical studies on the role of magnesium in chronic non-communicable diseases and infectious diseases, and we focus on recent reports of alterations of magnesium homeostasis in COVID-19 patients and their association with disease outcomes. Importantly, we conduct a census on ongoing clinical trials specifically dedicated to disclosing the role of magnesium in COVID-19. Results Despite many methodological limitations, existing data seem to corroborate an association between deranged magnesium homeostasis and COVID-19, and call for further and better studies to explore the prophylactic or therapeutic potential of magnesium supplementation. Conclusion We propose to reconsider the relevance of magnesium, frequently overlooked in clinical practice. Therefore, magnesemia should be monitored and, in case of imbalanced magnesium homeostasis, an appropriate nutritional regimen or supplementation might contribute to protect against SARS-CoV-2 infection, reduce severity of COVID-19 symptoms and facilitate the recovery after the acute phase