فهرست مطالب elham pourheidar

According to the increasing trend of antibiotic consumption all over the world, a rising concern is the emergence of resistant pathogens due to the inappropriate use of antibiotics, which increases the risk of treatment failure and mortality. Antibiotic Order Form (AOF) is an antimicrobial stewardship program protocol recommended to improve rational antibiotic use. We aimed to compare the antibiotic consumption rate, i.e., vancomycin and carbapenems, before and after preprinted AOFs were implemented. This study also evaluated physicians' compliance with AOFs as a secondary outcome. This prospective descriptive study was conducted from July to December 2015 in a 570-bed teaching hospital in Tehran, Iran. AOF includes demographics, microbiological, and clinical data on infection designed for vancomycin and carbapenems, including imipenem and meropenem. Prescribers were asked to fill out predesigned forms after prescribing the selected antibiotics and deliver them to the pharmacy on July 1, 2015. Collected data during this 6-month study period were compared with the same period times years 2011 to 2016 (4 years before and one year after implementation of AOF) to determine the effect of AOFs on the selected antibiotics consumption that had been calculated based on Daily Doses per 100-patients day (DDD/100-bed days). This study showed that although vancomycin had an increasing trend from 2011 to 2014, implementing the AOF program could stop this trend in 2015. vancomycin consumption significantly decreased compared to the previous year (P = 0.039). This effect of the program was not the same on the use rate of carbapenems, and their use was increased nonsignificantly in 2015 (P = 0.606). The acceptance of prescribers in filling out the forms for vancomycin increased from 5.12% in the first month to 57.75% in December. This increase was from 4.20% to 37.26% for carbapenems. According to the increasing trend of antibiotic consumption in hospitals, we recommend improving utilization surveillance of antibiotics by choosing an appropriate antibiotic, optimal dosing, and desired duration of treatment that are important in decreasing the risk of developing resistant microorganisms due to misuse. The forms are much more effective when accompanied by the acceptance of prescribers.

Augmented renal clearance (ARC) is a common phenomenon among critically ill patients and creates sub-therapeutic concentrations of antibiotics, due to an increase in renal clearance of them. We evaluated the Pharmacokinetic and Pharmacodynamic (PK/PD) properties of recommended doses of meropenem in critically ill patients with ARC. Adult critically ill patients with confirmed ARC, based on 12-hour Creatinine Clearance (CrCl) (≥130 ml/min/1.73 m2), who received standard doses of meropenem enrolled in this study. Two blood samples were gathered from each participant, at the steady-state time, to determination of peak and trough concentrations. Serum concentrations of meropenem were measured by high-performance liquid chromatography (HPLC) with an ultra-violet (UV) detector. From eighteen paired samples (peak and trough concentrations) that were obtained from 16 critically ill patients, peak concentrations were significantly lower in group 1 (received meropenem 1g every 8 hours) than in group 2 (received meropenem 2g every 8 hours) (mean ±SD, 5.95 ±3.39 µg/mL vs. 11.93± 4.18 µg/mL, respectively, p=0.005). Trough concentrations were sub-threshold (< 2 µg/mL) in 10 patients of group 1 (83.3%) and 3 patients of group 2 (50%). ft > MIC ≥ 50% was achieved in 83.3% of patients in both groups whereas 16.6% of patients of group 1 and 33.3% of patients of group 2 had ft> MIC= 100%. Augmented renal clearance is an essential cause of sub-therapeutic concentrations of meropenem in critically ill patients, and higher than the recommended doses of meropenem administered as an intermittent infusion may be necessary to achieve the PD targets and improve efficacy.

Posterior Cerebral Artery (PCA) aneurysms are a rare group of intracranial aneurysms. Pediatric aneurysms account for approximately 4% of all aneurysms and commonly are associated with an underlying predisposing disorder such as trauma. In contrast to traumatic aneurysms, spontaneous dissecting aneurysms are pointed out as a rare cause of pediatric aneurysms. aimed to present one case of a spontaneous dissecting aneurysm in a 10-month-old female infant.

Augmented Renal Clearance (ARC) reflects a measured creatinine clearance (CrCl) of more than 130 ml/min. Also, there are two scoring systems for the prediction of the ARC phenomenon i.e., the ARC score (ARCS) and the Augmented Renal Clearance in Trauma Intensive Care score (ARCTICs). The objectives of the current study were the evaluation the effect of using both scoring systems, on the chance of identifying this phenomenon and evaluating the accuracy of the three commonly used formulas for estimating glomerular filtration rate (eGFR) in ICU patients.

  In this prospective cross-sectional study, the CrCls of all patients admitted to the ICU were evaluated by using ARCS and ARCTICS, and for high-risk subjects based on scoring systems, a 12-hour urine sample was collected to measure CrCl. Besides, daily serum creatinine was recorded to estimate the daily eGFR.

  During the study period, 810 subjects were evaluated and 145 were categorized as high-risk using scoring systems. The ARC phenomenon was confirmed in 79 patients on the recruitment day and 81.01 and 18.98% of them were recruited by ARCS and ARCTICS, respectively. The ROC curves showed AUCs > 0.5 for CockcroftGault (C-G) and CKD-EPI with the cut-off of 100.48 and 107.05 mL/min/ 1.73m2, respectively; to detect the ARC phenomenon.

We recommend using ARCS and ARCTICS simultaneously to assess critically ill patients regarding the possibility of the ARC phenomenon which should be confirmed by using urinary CrCl, as none of the formulas could accurately detect the ARC phenomenon, neither the 12-hour CrCl.

Proton pump inhibitors (PPIs) are the most effective medications in acid-related disorders. Inappropriate use of Intravenous (IV) pantoprazole can cause unwanted consequences like hypersensitivity reactions, prolonged duration of treatment, and increased treatment cost. This study aimed to evaluate the effect of the utilization of a preprinted protocol for the use of IV pantoprazole on its appropriate administration.

This prospective, cross-sectional, two-phase study was conducted on the four departments of a tertiary teaching hospital. In the first phase, December 22, 2018, to March 19, 2019, all older than 18-year old patients who were admitted to internal medicine, general surgery, and neurosurgery, and received IV pantoprazole were included in the study. In the second phase of the study, April 4, 2019, to July 6, 2019, the neurology ward was added to the study according to the high consumption of IV pantoprazole. We evaluated the effect of the utilization of a preprinted protocol for the appropriate of IV pantoprazole on its consumption, and the frequency of appropriate administration based on the approved protocol, the need to change the patient's medication regimen, and the physician's feedback on the changes. The consumption of IV pantoprazole was compared with the same period times at the last year of intervention as the pre-intervention phases.

Four hundred forty-six prescriptions of IV pantoprazole were screened during the 2 phases of the study. The utilization of the approved protocol consequent decrease in IV pantoprazole consumption in intervention phases compared with pre-intervention phases in all departments. This difference was statistically significant in the general surgery  (p= 0.016) and neurosurgery (p= 0.012) wards in phase 2. Related data to the comparison of the IV pantoprazole consumption between two phases of the intervention also showed a significant decrease in the neurosurgery ward (p= 0.011). In the total of the two phases, the use of the protocol led to an 8.3% decrease in consumption in comparison with pre-intervention periods. During these six months, we detected that the administration of IV pantoprazole was not based on the protocol in 81.2% of patients and the use of the protocol led to correct 63.89% of physician's orders.

This study showed that the majority of IV pantoprazole prescriptions were inappropriate. Using the preprinted forms to administer the IV pantoprazole could improve its appropriateness in terms of indication for use, dose, and duration of treatment and decrease consumption.

Viral infections play an important role in the pathogenesis of diabetes mellitus (DM). The association between some viral infections, including cytomegalovirus (CMV) and the development of DM was reported by some articles, but about T. gondii data is limited. We aimed to evaluate the correlation between antiCMV and anti-Toxoplasma gondii (T. gondii) antibodies with the plasma level of glycosylated hemoglobin (HbA1C).

This is a cross-sectional retrospective study conducted on the medical records of women who tested for pre-pregnancy checkups and had antibody levels against CMV and/or T. gondii, and plasma level of HbA1C.

During 4 years, data from 117 patients with anti-CMV IgG, and 186 with anti-T. gondii IgG was finally analyzed. According to the data, we did not detect any correlation between the plasma levels of HbA1C and IgG levels against CMV (Correlation Coefficient 0.150, p = 0.108) and T. gaondii (Correlation Coefficient 0.076, p = 0.300).

In conclusion, we recommended a large-scale controlled clinical trial to compare the plasma level of HbA1C between patients with confirmed CMV or T. gondii infection and the control group.

Diabetes mellitus (DM) can influence various aspects of the immune system that may alter the immune response to vaccines. Data about altering the immune response to the rubella vaccine in the presence of diabetes are not enough. We aimed to evaluate the association between the level of glycosylated hemoglobin (HbA1C) and the immunogenicity of the rubella vaccination.

This cross-sectional retrospective study was conducted on the medical records of women who were tested to pre-pregnancy to check their antibody levels against rubella and had plasma levels of HbA1C.

During 3 years, 112 women with anti-Rubella IgG data were finally analyzed. The mean age±SD of participants was 32.10±4.87. According to the data, we detected no correlation between the plasma levels of HbA1C and IgG levels against rubella (Correlation Coefficient 0.219, p = 0.020).

We revealed no correlation between the plasma levels of HbA1C and impaired immunogenicity of the rubella vaccination. We recommended a large-scale controlled clinical trial to evaluate the IgG levels against rubella in patients with high plasma levels of HbA1C compared to the control group.

Linalool is one of the main constituents of the essential oil of some aromatic plants, including Lavandula angustifolia. It is used in cosmetics and pharmaceutical industry. In this study, the cytotoxicity and genotoxicity of (±) linalool and its naturally occurring enantiomer, (R)-(-) linalool, were evaluated in neuronal PC12 cells.

PC12 cells were incubated with different concentrations of racemate linalool and (R)-(-) linalool for 12 and 24 h. Cytotoxicvity and genotoxicity were evaluated using MTT assay and single cell gel electrophoresis (comet) assay, respectively.

Findings showed that (±) linalool and (R)-(-) linalool (3200 μM) significantly reduced cell viability to 76.2% and 92%, compared to the control group (untreated cells) (P<0.001). IC50 values after 12 h and 24 h exposure to (±) linalool and (R)-(-) linalool were 2700 µM and 5440 µM, and 2600 µM and 3040 µM, respectively. Following treatment by (±) linalool or (R)-(-) linalool for 12 or 24 h, the DNA contents in the comets tail, as an indicator of genotoxicity, significantly increased to 21.36 ± 3.1%, 27.6 ± 2.3% and 15.2 ± 1.6% and 21.3 ± 2%, respectively (P<0.001).

In this study, racemate linalool and its enantiomer, (R)-(-) linalool, decreased the viability of PC12 cells via induction of genotoxicity. (R)-(-) linalool exhibited more cytotoxicity than (±) linalool.

Irrational consumption of antibiotics is one of healthcare problems and can lead to antibiotic resistance.vancomycin resistance be developing and has a huge cost burden to healthcare. Antimicrobial control programs is an essential strategy for optimal use of antibiotics and educational program is the main of these activities.

This study was aimed to evaluate the effects of educational programon vancomycin prescription pattern.

This pre-post interventional study was carried out between 2014 to 2016 in a university affiliated hospital,Tehran, Iran. In the first step, vancomycin usage protocol was prepared, then educational program delivered through workshops and physicians and assistants obligated to order vancomycin based on approved protocol. In the second step to assess the effectiveness of intervention, the prescription pattern of vancomycin assessed in Defined Daily Dose (DDD) per 100 patients days.

Vancomycin usage based on DDD per 100 patients days in post educational intervention period in comparison with period before intervention, December 2014 to March 2015, was decreased in all hospital departments but in comparison with three months period, September to December 2015, was decreased in all hospital departments with the exception of  intensive care department.

Despite the efforts to reduce the excessive use of antibiotics, irrational consumption is a main concern.Educational program will improve the consumption of antibiotics. The present study showed the antimicrobial educational programs has been effective in the utilization of vancomycin in a university affiliated hospital.

The purpose of this study was evaluating the efficacy and safety of intravenous (IV) ampicillin–sulbactam plus nebulized colistin in the treatment of Ventilator-Associated Pneumonia (VAP) caused by MDR Acinetobacter (MDRA)in ICU patients as an alternative to IV plus nebulized colistin. In this single-blinded RCT, one group received IV colistin and another group IV ampicillin–sulbactam (16 and 12 patients from total 28 patients, respectively) for 14 days or since clinical response. Both groups received nebulized colistin by mesh nebulizer. There were no statistically significant differences between the 2 groups in baseline characteristics and previous antibiotic therapy. In follow up period, no significant difference was observed between 2 groups in rate of microbiological eradication, clinical signs of VAP improvement, survival rate and length of hospital as well as ICU stays. Although we have found no significant differences in Acute Kidney Injury (AKI) incidence between two groups, comparison of cumulative patient-days with stages 2 and 3 AKI with days with no or stage 1 AKI, according to AKIN criteria, revealed significant difference in IV colistin versus IV ampicillin–sulbactam group (p = 0.013). The results demonstrated that the high dose IV ampicillin–sulbactam plus nebulized colistin regimen has comparable efficacy with IV plus nebulized colistin in the treatment of VAP caused by MDRA,withsensitivity to colistin only, with probably lower incidence of kidney injury.