taher entezari-maleki

 Percutaneous Coronary Intervention (PCI) is a fundamental procedure for coronary artery disease management, yet the risk of adverse events such periprocedural myocardial injury (PMI) persists. This double-blind, randomized clinical trial aims to assess the efficacy of empagliflozin in preventing myocardial injury during PCI procedure.

 A total of 90 patients were randomly assigned to two groups A and B; Group A as the intervention group received empagliflozin 25 mg 24 hours before and empagliflozin 10 mg 1-2 hours before coronary intervention and group Bas the control group received placebo at similar intervals. The primary outcome involved comparing baseline, 8-hour, and 24-hour cTnI and baseline and 24-hour hs-CRP levels after PCI in both groups to measure the incidence of periprocedural myocardial injury (PMI) and anti-inflammatory effects of empagliflozin.

 Baseline cTnI levels with P=0.955, 8 hours after PCI with P=0.469, and 24 hours after the intervention with P=0.980 were not statistically different in the two groups. Baseline levels of hs-CRP in both intervention and control groups were not statistically significantly different (P=0.982). Also, there was no statistically significant difference in hs-CRP levels 24 hours after PCI in two groups (P=0.198). Finally, the results showed that MACEs did not occur in any of the groups.

 The results of this trial could not express the advantages of acute pretreatment with empagliflozin in preventing PCI-related myocardial injury.

 Since there is a bi‐directional interaction between hypertension and depression, we aimed to evaluate the effects of citalopram administration in the management of hypertension.

 A randomized clinical trial was conducted on 72 patients with concomitant depression and hypertension. The intervention group (n=41) received citalopram 20 mg daily plus anti-hypertensive standard treatment, while the control group (n=31) received only the standard treatment. The study’s primary endpoint was in-office blood pressure (BP) measurement at baseline and home BP monitoring in the first and second months after entering the study.

 There were no significant differences in baseline systolic BP (163.3±19.6 vs.164.2±20.3 mm Hg; P=0.910) and diastolic BP (94.5±13.8 vs. 88.2±14.4; P=0.071). After one month, diastolic BP (82.7±11.7 vs. 77.09±12.2; P=0.023) was significantly higher in the control group compared to the intervention group. Two months after the intervention, systolic BP (133.8±16.5 vs. 124.5±12.4; P=0.009) and diastolic BP (80.7±10.3 vs. 73.7±9.7; P=0.002) were significantly decreased in the intervention group compared to the control group.

 This study supported the beneficial effects of citalopram in lowering BP in patients with concomitant depression and hypertension.

It is well-established that oxidative stress is deeply involved in myocardial ischemia-reperfusion injury. Considering the potent antioxidant properties of coenzyme Q10 (CoQ10), we aimed to assess whether CoQ10 supplementation could exert beneficial effects on plasma levels of oxidative stress biomarkers in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPIC).

Seventy patients with the first attack of STEMI, eligible for PPCI were randomly assigned to receive either standard treatments plus CoQ10 (400 mg before PPCI and 200 mg twice daily for three days after PPCI) or standard treatments plus placebo. Plasma levels of oxidative stress biomarkers, including superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), total antioxidant capacity (TAC), and malondialdehyde (MDA) were measured at 6, 24, and 72 hours after completion of PPCI.

The changes in plasma levels of the studied biomarkers at 6 and 24 hours after PPCI were similar in the both groups (P values>0.05). This is while at 72 hours, the CoQ10- treated group exhibited significantly higher plasma levels of SOD (P value<0.001), CAT (P value=0.001), and TAC (P value<0.001), along with a lower plasma level of MDA (P value=0.002) compared to the placebo-treated group. The plasma activity of GPX showed no significant difference between the groups at all the study time points (P values>0.05).

This study showed that CoQ10 has the potential to modulate the balance between antioxidant and oxidant biomarkers after reperfusion therapy. Our results suggest that CoQ10, through its antioxidant capacity, may help reduce the reperfusion injury in ischemic myocardium.

Periprocedural myocardial injury (PMI) after percutaneous coronary intervention (PCI) is a substantial health issue with a high mortality rate. Inflammation and oxidative stress are major contributing factors to PMI. Allopurinol inhibits xanthine oxidase (XO)-induced oxidative stress and has potential cardiovascular benefits.

This randomized clinical trial evaluated 110 patients admitted to elective PCI. Patients were assigned to receive either a 1200 mg loading dose of allopurinol 2 hours before the procedure (n = 55) or the standard pretreatment (n = 55). The creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) levels were measured in both groups at the baseline, 8, and 24 hours after PCI.

There were no significant differences in the CK-MB levels at baseline (P = 0.71), 8 (P = 0.26), and 24 hours (P = 0.88) after PCI between the two groups. No significant changes in the cTnI levels at baseline (P = 0.26), 8 (P = 0.80), and 24 hours (P = 0.89) after the PCI were also noted. The mean difference for CK-MB and cTnI changes was not different between the two groups.

Our study revealed that allopurinol did not reduce cardiac-specific enzymes. Further studies are required to evaluate the impact of allopurinol on preventing PCI-related myocardial injury.

Background &

Heart failure refers to a malfunction of the heart. This disease is actually a clinical syndrome that manifests with shortness of breath (active and at rest), fatigue and weakness, persistent cough or wheezing, and fluid retention. Currently, 64.3 million people worldwide suffer from heart failure. In 2012, 2.4% of Americans had heart failure. Meanwhile, with increasing age, this percentage also increases, so that it reaches nearly 12% of people over 80 years old. Total HF costs (direct and indirect costs) in the US are projected to increase from $30.7 billion in 2012 to $69.8 billion in 2030. Diseases that increase the risk of heart failure include male gender, sleep apnea, diabetes, coronary artery disease, heart valve disease, anemia, high blood pressure, hyperthyroidism, hypothyroidism, and emphysema. Also, people's lifestyle plays a significant role in contracting this disease; smoking, lack of enough exercise, drinking too much alcohol, and being overweight or obese all increase the risk of heart failure. Therefore, among the preventive measures for heart failure, we can mention lifestyle modification and control of the underlying diseases that cause it. The mortality rate in heart failure patients with reduced ejection fraction is higher than those with preserved ejection fraction. Recurrence of the disease after discharge is one of the main challenges in patients with heart failure, which leads to re-hospitalization and a higher mortality rate. Effective and sufficient training for patients to comply with the prescribed drugs is an important part of the treatment of heart failure patients and leads to a reduction in the exacerbation of the disease and re-hospitalization. Non-adherence of patients to drug treatment leads to exacerbation of heart failure, reduced physical performance, high risk of hospitalization, and death.
Among the most important drugs that cause exacerbation of heart failure are non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, class 1 antiarrhythmic drugs, some antidiabetic drugs such as pioglitazone, chemotherapy drugs such as anthracyclines. This study aimed to evaluate the risk factors of rehospitalization of patients with heart failure in Tabriz Shahid Madani Heart Hospital during a 6-month period.

This study is a descriptive-cross-sectional and prospective study that was conducted over a period of 6 months on patients with uncompensated heart failure who were admitted to Shahid Madani Hospital in Tabriz. The amount of the sample is equal to the number of examined patients in the period of 6 months. This study was approved by the ethics committee of the university with the number IR.TBZMED.REC.1400.423 and was conducted based on ethical protocols. The conditions for patients to enter the study include all patients with uncompensated heart failure and a history of hospitalization (at least once) and those over 18 years of age who had completed the ethical consent form. Exclusion criteria include patients' lack of satisfaction, mental disability insufficient understanding of the ethical consent form, and deficiencies in the patients' information. In this study, after evaluating the inclusion and exclusion criteria, eligible patients were included. The clinical information of the patients was recorded in a special data collection form. The first part includes the characteristics and demographic information of the patients (name and surname, file number, sex, age, height, weight, underlying disease history, smoking or drug use, symptoms at the time of visit and family history of cardiovascular diseases). The second part includes the rate of ejection fraction, drugs prescribed in the hospital, drugs prescribed after the last hospitalization, the patient's compliance with the drugs prescribed by the doctor, the history of taking non-prescription drugs, and the history of taking drugs that aggravate heart failure. The third part includes the history of severe activities harmful to the heart, eating salty or fatty foods, drinking a lot of fluids, pregnancy, influenza and coronavirus vaccine injections. Finally, the fourth part includes the patient's routine tests (creatinine, blood cell count, CBC). The source of information included patients' files, drug cardex, laboratory reports, and findings from the patient's history. All the obtained data were entered and analyzed in SPSS software version 23. First, the Kolmogrov-Smirnov test was used to evaluate the normal distribution of the data. T-tests or Mann-Whitney tests were used to compare the mean of continuous data between the two groups. Chi-square tests or Fisher's direct test were also used to compare the mean of non-continuous (ranked) data between two groups. Spearman and Logistic Regression tests were used to check the relationship between the data. In this study, p-values less than 0.05 were considered statistically significant. Descriptive statistics were used to summarize the data including percentage for discrete variables and standard deviation for continuous variables. Parametric data were presented as Mean ± SD.

This study was conducted for 6 months on 112 heart failure patients who were re-hospitalized. The average age of patients is 61.3 ± 12.98 years. In terms of gender, 79.5% (89 people) of patients are men and 20.5% (23 people) are women. The average number of hospitalizations in the studied patients is 6.41 ± 5.89; the minimum hospitalization is 2 times and the maximum hospitalization is 25 times.
The clinical and demographic information of the patients is summarized in Table 1. The average body mass index (BMI) was 26.67 ± 6.73. In terms of underlying diseases, blood pressure with 51 people (45.5%) and diabetes with 41 people (36%) were the most frequent. Also, 43 patients (38.4%) had a history of smoking. Regarding the use of heart failure aggravating drugs, about a quarter of patients used non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
Based on the Spearman correlation results, the number of readmissions of patients with age (rs = 0.254, p-value = 0.008), pacemaker implantation (rs = 0.287, p-value = 0.002), left ventricular ejection fraction (rs = 0.239, p-value = 0.03), patient compliance with prescribed drugs (rs = 0.222, p-value = 0.021), and cardiac ischemia (rs = 0.394, p-value = 0.001) have a significant relationship (refer to table number 2). Based on the results of linear regression analysis, a cardiac pacemaker with a beta coefficient of 2.3 and p=0.002 is related to the rate of re-hospitalization of patients.

This study showed the risk factors of rehospitalization of patients with heart failure in the largest heart hospital in the northwest of the country. More studies are suggested for more detailed investigations.

Thrombolytic therapy is a key in the management of ST elevated myocardial infarction (STEMI). Metformin implies a series of cardioprotective effects. We aimed to investigate how pretreatment with metformin could affect cardiac troponin I (cTnI) levels following reteplase therapy amid STEMI patients.

A pilot randomized clinical trial was carried out in 80 STEMI patients undergoing thrombolytic therapy with reteplase. The metformin group (n = 40) received a single dose of 1000 mg metformin orally before receiving reteplase, while the control group (n = 40) received only reteplase. The serum level of cTnI was measured at baseline, 8, 16, 24, and 32 hours after the admission to assess myocardial damage.

There was no significant difference in cTnI levels at baseline (p = 0.657), 8 (p = 0.93), 16 (p = 0.690), 24 (p = 0.217), and 32 (p = 0.517) hours after STEMI diagnosis between two groups. The mean differences were also not significant for changes of cTnI at baseline and other time frames.

The results of the present study demonstrated that early use of 1000 mg metformin prior to reteplase could not reduce the level of cTnI in STEMI patients.

Considering the potential benefits of colchicine in coronary artery diseases, we aimed to carry out the present study to assess the impact of colchicine in the prevention of myocardial injury following elective percutaneous coronary intervention (PCI).

A randomized, single-blinded, clinical trial was carried out on 102 patients undergoing elective PCI. All patients received the standard treatment prior to performing PCI. Moreover, the intervention group received 1, 0.5, 0.5 mg colchicine 12 to 18 hours before, 30-60 min before, and 12 hours after PCI, respectively. Serum concentrations of cardiac troponin I (cTnI) were measured before, 8, and 24 hours after the procedure to assess myocardial damage during PCI.

There were no significant differences in cTnI levels at baseline (P = 0.839), 8 (P = 0.729), and 24 hours (P = 0.398) after PCI between the intervention and the control groups. Likewise, no significant differences were seen regarding the mean differences of cTnI at baseline and 8 hours (P =0.190), at baseline and 24 hours (P = 0.780), and 8 and 24 hours after PCI (P = 0.680) in both groups.

The study did not support the potential benefit of colchicine in the prevention of myocardial injury following elective PCI. Conducting well-designed randomized clinical trials with adequate sample size is recommended.

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global crisis with a growing number of mortalities and morbidities worldwide. Despite performing numerous researches, there are still considerable unrevealed details regarding the long-term complications and post-infection immunity of the coronavirus disease 2019 (COVID-19). Based on pathophysiological features, SARS-CoV-2 may act similarly as an oncovirus in the lung. This letter summarized three possible oncogenic mechanisms of SARS-CoV-2 that may be associated with lung cancer development.

About 55% of extremely-low-birth-weight (birth weight < 1000 g) and 23% of very low-birth-weight infants (birth weight < 1500 g) suffer from metabolic bone disease (MBD). There are limited data on the use of calcitriol (1, 25-dihydroxycholecalciferol) to prevent or treat MBD in preterm infants. Therefore, this study aimed to compare the preventive effect of calcitriol and cholecalciferol on the biochemical markers of MBD in preterm infants.

This study was a pilot randomized controlled trial conducted in the Alzahra teaching hospital of Tabriz University of Medical Sciences. we randomized 72 very-low-birth-weight infants in two groups of calcitriol 0.25 μg/day and cholecalciferol 400 IU/day. Biochemical markers, including serum 25-hydroxyvitamin D, alkaline phosphatase (ALP), phosphorus (P),calcium (Ca), parathyroid hormone (PTH), and tubular reabsorption of phosphate (TRP) levels were checked at baseline, three, and five weeks after medication, consecutively.

After three weeks of supplementation, infants in the cholecalciferol group had higher levels of serum 25-hydroxyvitamin D (P=0.001) and lower levels of urine phosphate (P=0.009); There were no significant differences in other biochemical markers. At the end of the fifth week, there was no significant difference between the two groups in terms of biochemical markers.

The study indicated that the use of cholecalciferol caused a lower urinary loss of phosphate in very-low birth-weight infants at a short time; however, these findings were not sustained during the study period.

Given the potential anti-ischemic effects of allopurinol, we aimed to assess whether allopurinol administration may reduce myocardial injury following non-ST elevation myocardial infarction (NSTEMI).

A randomized clinical trial (RCT) was conducted on 100 individuals with NSTEMI. The intervention group (n=50) received 600 mg oral allopurinol at the time of diagnosis of NSTEMI, followed by 300 mg every day for two next days and the standard treatment of NSTEMI, while the control group (n=50) received only the standard treatment. Serum concentrations of cardiac troponin I (cTnI) were measured at baseline, and 8, 16, 24, and 32 hours after the treatment.

The baseline demographic and clinical data of the patients were not statistically different between the intervention and control groups (all P > 0.05). The comparing estimated marginal mean ± standard error for cardiac troponin I (cTnI) levels revealed no significant difference between the study groups (2.93 ± 0.27, 2.25 ± 0.27; P=0.082). The linear mixed model results showed that the interaction of time and group was not statistically different (P=0.751). Moreover, there was a decreasing trend over time for cTnI in both groups (P=0.039).

The present pilot RCT did not support the potential cardio-protective benefits of allopurinol administration on decreasing myocardial injury following NSTEMI.

The coronavirus disease 2019 (COVID-19) outbreak has caused a public health crisis worldwide. However, data regarding the protective factors of the disease is limited. Consequently, preventive health measures that can decrease the risk of infection, progression, and severity are dreadfully required. It is well-documented that people with immunodeficiency, such as the elderly, people who already have comorbidities (e.g., diabetes mellitus, hypertension, respiratory and cardiovascular disorders), and underrepresented minorities, are placed in a group with a higher risk of getting infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A diet rich in vitamins, minerals, and antioxidants plays an essential role in strengthening the immune system and fighting against invading pathogens. The present comprehensive review has discussed published literature regarding the potential role of vitamins in strengthening the immune system and managing viral infections, particularly SARS-CoV-2 infection. Although there are controversial data regarding the plasma level of vitamin D and the severity of the disease, according to the limited evidence, vitamin D may lower the mortality rate. Moreover, vitamin C could reduce the development of inflammatory response; however, the results of ongoing clinical trials are required to confirm these primary findings.

Medication errors (MEs) frequently occur in intensive care unit (ICU) admittedpatients. The present study aimed to evaluate the frequency and types of MEs in an open heartsurgery heart ICU and clinical pharmacists’ role in the management of them.

This cross-sectional, observational study was performed from October 2016 toMarch 2017 in the Shahid Madani Heart Center. A clinical pharmacist reviewed patients’ files,laboratory data, and physician orders during morning hours. All of the MEs and the clinicalpharmacies’ recommendations for the management of them were analyzed.

A total of 311 MEs were observed in the medical files of 152 patients. The rate of MEswas 2.04 errors per patient and 0.19 errors per ordered medication. The acceptance rate of MEswas 72.6%. The most type of MEs was ‘forgot to order’ (75 cases, 24.1%) followed by "wrongfrequency" and "adding a drug" in 56 (18%) and 49 (15.8) patients, respectively. Most MEs wereinsignificant.

MEs occur at different stages of the therapeutic process in the postoperative cardiacintensive care unit, and clinical pharmacists play an essential role in detecting and managingMEs.

Current literature indicates that the presence of clinical pharmacists in hospitals results in improved patient care, rational drug therapy, and treatment costs. This study assessed the clinical pharmacy services in the intensive care unit (ICU) of a tertiary hospital at Tabriz University of Medical Sciences, Iran.

During a 9‑month cross‑sectional study (2014–2015), the clinical pharmacy interventions in 27 sessions and educational activities for patients and health‑care professionals were randomly assessed based on the Australian guideline and standard of practice for clinical pharmacy. The interventions of clinical pharmacist were evaluated in terms of their clinical importance.

In this study, a total of 832 interventions on 242 patients were performed by the clinical pharmacist, and approximately 93.6% of the interventions were approved by the attending physician. Most interventions concerned adding a new medication to a drug regimen or switching to a needed new medication. Each patient received an average of three interventions. The clinical pharmacist provided drug information to employees and medical staff in 108 of the total 832 interventions (13%). Medical residents who were surveyed indicated that the quality of education, research, and patient care was improved by the attendance of a clinical pharmacist.

The results of this study show that the collaboration of a clinical pharmacist with the medical staff of an ICU can improve pharmacotherapy approach and increase the quality of education.

Pentoxifylline (PTX) is a xanthine derivative with the potential cardiovascular effects. This study was done to evaluate the impact of pentoxifylline on blood pressure when added to patients’ antihypertensive regimen.

A randomized control trial were carried out on 100 patients with primary hypertension for a three-month period. The intervention group received 1200 mg daily PTX in three divided doses plus the standard treatment of antihypertensive medications, whereas the control group received only the standard treatment of hypertension. Patients’ blood pressure was measured at baseline, 4, and 12 weeks after intervention. Patients were also followed up for major adverse cardiac events.

After 4 weeks and 12 weeks of study, no significant difference was observed in systolic blood pressure (SBP) (135 ± 16 vs. 136.2 ± 17.2 mmHg, p=.72; 134.8 ± 13.3 vs. 134.3 ± 14.7 mmHg, p=.85) and diastolic blood pressure (DBP) (81.5 ± 9.9 vs. 82.4 ± 12.9 mmHg, p=.69; 80.8 ± 9 vs. 80.4 ± 10.7 mmHg, p=.84) between two groups.

The result showed that PTX has not a significant effect on BP in patients with primary hypertension.

Despite the classic role of Vitamin D in skeletal health, new aspects of Vitamin D have been discovered in tissues and organs other than bones. Epidemiological and observational studies demonstrate a link between Vitamin D deficiency and risk of developing respiratory diseases including asthma, chronic obstructive pulmonary disease(COPD), and tuberculosis (TB). To review the literature, we searched the terms “Vitamin D”(using the set operator) and “asthma,” “COPD” and “TB” in electronic databases, including PubMed/ MEDLINE, Scopus, and Google Scholar until July 2015. Non‑English articles or articles with unavailable full text were excluded. Both in vivo and in vitro studies were included. All the reviewed articles state that Vitamin D deficiency is very common among patients with respiratory diseases. The present data regarding Vitamin D and asthma is still controversial, but data about COPD and TB are more encouraging. The relevant studies have been conducted in different populations therefore it is not particularly possible to compare the data due to genetic variations. In order to point out a role for Vitamin D, large clinical trials with Vitamin D deficient subjects and sufficient Vitamin D supplementation are needed.

Acute myocardial infarction (AMI) is one of the main leading causes of mortality and morbidity. Reteplase is a fibrin‑specific thrombolytic which is used in the treatment of AMI. There is a limited number of studies reporting the postmarketing adverse drug reactions (ADRs) induced by reteplase. This study was aimed to examine the reteplase pattern of ADR and its associated risk factors in patients with acute ST‑elevation myocardial infarction.

A cross‑sectional, prospective study in an 8‑month period was done at the University affiliated referral cardiovascular center. The Naranjo probability scale and World Health Organization criteria for severity of ADRs were used for assessing the ADRs. The linear regression and logistic regression tests were used to evaluate the correlation between ADRs and risk factors.

The all 20 patients who received reteplase during the study period were entered. The majority of patients (n = 17) experienced at least one ADR. The results showed that the incidence of ADRs was mainly associated with gender and age, and the number of ADRs was associated with the history of diabetes and taking anti‑diabetic agents. The gender was the main predictor in the occurrence of ADRs (odds ratio: 32, 95% confidence interval: 1.38–737.45; P = 0.030).

The results showed that gender, age, diabetes mellitus, and using of anti‑diabetes medications are the risk factors associated with the incidence of ADRs by reteplase.

To assess and describe the call services delivered by drug and poison information call center (DPIC) of 13‑Aban pharmacy, which is closely operated by the Department of Clinical Pharmacy, College of Pharmacy affiliated to Tehran University of Medical Sciences.

All calls services including counseled and follow‑up calls provided by 13‑Aban DPIC to health care professionals and public were collected, documented, and evaluated in a 2 years period from July 2010 to June 2012 using the designed software. Data analysis was done by SPSS version 16.0.

Totally 110,310 calls services delivered during a 2 years period. Among healthcare professionals, pharmacists, general physicians, and nurses requested more call services respectively (P = 0.001). DPIC could detect 585 potential cases of adverse drug reactions (ADRs) and 420 cases of major drug‑drug interactions (DDIs).

This study by analyzing and reporting the two-years activities of one of the major DPICs in Iran, showed that DPICs can offer drug consultation for healthcare professional and public as well as detect and prevent ADRs and DDIs, and therefore can promote patients’ health regarding drug therapy.

Administrative and financial affairs are one of the most important activities in any organization. Determining the processes related to these affairs is necessary. Therefore, the present research was designed and implemented to improve the administrative and financial processes of Management and Medical informatics school of Tabriz University of Medical Sciences by action research methodology.
Material and This was a qualitative study with action research approach. After understanding about the lack of transparency and time consuming of administrative and financial processes, it was planned to resolve this problem. The correct form of the processes was determined and presented after reviewing the jobs description, interviewing with personnel and drawing the flowchart of the administrative and financial processes. Then, an evaluation was done by selecting 20 percent of the processes and examining personnel’s performance and timing.
Current situation analysis showed that administrative and financial processes are done mainly based on individual experience and interest. The lack of coordination with school's educational and research timetable prevents timely performance of tasks. After taking action research steps, 49 processes were identified and documented. (accounting: 13, secretariat: 2, public affair administration: 7, staffing: 16, property: 7, and procurement: 4). The results of the evaluation showed that 97% of the processes were in accordance with the standard and the time spent on implementing the processes was reduced between 30% to 100%.
Action research, as part of a collaborative process between researchers and process owners promoted administrative and financial processes. In order to increase the readiness level of the financial department of the faculty and coordination with the education and research departments, adjusting the administrative and financial calendar at the beginning of the year predicting the action time before receiving the request receipt of the units was suggested.

According to studies, a significant association exists between the low levels of vitamin D and cardiovascular diseases such as myocardial infarction (MI).
In a prospective, case control study, 88 patients with acute coronary syndrome (ACS) including ST elevation myocardial infarction (STEMI) and Non-STEMI were enrolled. The plasma level of 25-hydroxy vitamin D[25(OH)D] was obtained at the time of acute MI. To assess the association between study variables logestic regression analysis was used.
The overall rate of vitamin D deficiency was documented in 59.1% with the significantly higher prevalence rate in STEMI group (77.5% versus 43.7%; p = 0.001). In STEMI group, the plasma level of 25(OH) vitamin D significantly was lower than non-STEMI group (13.5 ±7.7 versus 24.3±14.9; p = 0.001). Vitamin D deficiency was the main predictor in occurring the ST elevation type of MI (Odd ratio: 8.1, 95% CI: 2.3 – 28.2; p = 0.001).
The results of present study demonstrated that vitamin D deficiency was associated with occurring of ST elevation type of MI among ACS patients. Large studies are needed to confirm these findings.

Acute myocardial infarction (AMI) is one of the main leading causes of mortality and morbidity. Despite the progress in the treatment of AMI, streptokinase is still being used in many countries. Because of the critical condition of patients with AMI and complications of streptokinase therapy, this study was performed to evaluate the pattern of adverse drug reaction (ADRs) induced by streptokinase and its associated risk factors in patients with acute ST elevation MI.
A prospective cross-sectional study in a 14-month period was done at the university affiliated referral cardiovascular center. The Naranjo probability scale and Food and drug administration (FDA) criteria for severity of ADRs were performed for assessing the ADRs. The linear and logistic regression tests were used to evaluate the correlation between ADRs and study risk factors.
During the study period, 217 patients who were received streptokinase were entered. The majority of patients (n = 191) experienced at least one ADR. Six patients died in-hospital mainly because of cardiac causes. The history of drug allergy was the main predictor in occurring of ADRs (Odds ratio: 3.26; 95% CI: 1.48-457.6; p = 0.026). The most serious ADR was hemorrhagic stroke with a 1.4% incidence. Hypotension was one of the most occurred ADR (n=75). Anaphylactic shock was not detected in this study.
In summary, our study showed that the history of drug allergy is the main predictor in occurring ADRs by streptokinase. Furthermore, streptokinase therapy was associated with a higher rate of hemorrhagic stroke in Iranian population.

In recent decades Procalcitonin (PCT) has been introduced to help physicians differentiate sepsis from SIRS. Its routine use in such specific settings as ICU, on the other hand, is very polemical owing to the variable results.
In this prospective observational study, we examined the accuracy of PCT levels in differentiating septic from SIRS in critically ill patients admitted to the general ICUs of two hospitals in Tabriz, Iran from September 2014 to May 2016. Further appraised was the effect of illness severity and organ failure on PCT value. We tried to answer this question that why there is controversial and wide range of findings pertaining to PCT in critical care settings.
One hundred and thirty two SIRS (Systemic Inflammatory Response Syndrome) positive critically ill patients admitted to the ICU were enrolled in the present research. Patients were divided based on their positive cultures into infectious and SIRS positive groups, in both of which, PCT was measured, severity of illness and organ failure were recorded, and the PCT sensitivity and specificity for the detection of sepsis and its relationship with disease severity and mortality were evaluated.
The optimal cut-off point for the PCT, determined 0.25μg/L with a sensitivity and specificity of 73 % and 39 %, respectively. PCT level was not able to significantly diagnose septic patients from SIRS positive ones and was significantly correlated with Cr and BUN concentrations.
These findings indicate that PCT may not differentiate between sepsis and SIRS in a heterogeneous population of critically ill patients admitted to the ICU; PCT measurements, nonetheless, can probably conduce to predicting the outcome of patients.

There is a relation between amounts of antibiotic uses and creation of resistant bacteria. Due to the critical role of antibiotics and increasing trend of resistance in developing countries, comprehensive methods of antibiotic use is necessary to limit the threat of resistant microorganisms. In this study we compare antibiotics consumption by Defined Daily Dose (DDD) per 100 bed-days in teaching and private hospitals during six months in Tabriz, Iran.
Four university hospitals and one private hospital were included in this study. Amount of their antibiotic consumption obtained from the hospital pharmacies. Anatomical Therapeutic Chemical (ATC) code J01 was explained as defined daily doses per 100 bed-days (DDD/100) according to the ATC/DDD classification. The amount of consumption was assessed with DDD per 100 bed-days in six months.
Total antibacterial consumption was higher in Emam reza (119.62 DDD/100) than other hospitals. Cephalosporins were the most widely used antibiotic in all five hospitals with the total DDD per 100 bed-days of 53.74, 58.51, 46.09, 19.75 and 15.16 for Emam reza, Shohada, Sina, Shahriar and Shahid madani ,respectively. Cefazoline had highest use among cephalosporins consumption in all hospitals except Shahriar. Ciprofloxacin was among the five most used antibiotics in all hospitals.
Although the pattern of antibacterial consumption was almost logical in different categories of hospitals, the total amount of DDD per 100 bed-days was dramatically more than developed countries. Specific strategies should be employed in infection control development and engage rational antibiotic utilization in order to reduce future resistant strains and increase antimicrobial efficacy.

More than 80% of patients with hematologic malignancies will develop fever during more than one chemotherapy cycle combined with neutropenia. We aim to evaluate empiric antibiotic strategies in Febrile Neutropenic (FN) cancer patients. This is a concurrent study performed in the “Shahid Ghazi” teaching hospital, hematology-oncology center of Tabriz, Iran during the period of December 2011 to September 2012. During this period, patients with FN were evaluated in view of antibiotics utilization based on Infectious Disease Society of America (IDSA) and National Comprehensive Cancer Network (NCCN) instructions. Seventy patients had a total of 91 episodes of FN in the duration of this study. Among them 63 (90%) patients were the cases of acute leukemia. For 88 (96.7 %) patients, imipenem was used as the initial empirical antibiotic regimen. It was changed to piperacillin/tazobactam in 8 (8.8%) of them without indication. Cultures didn’t obtain before the initiation of empirical therapy in 19 (20.9%) episodes. Empiric vancomycin didn’t discontinue after 3 days even if it was not warranted in 23 episodes. In 16 cases vancomycin was switched to teicoplanin. The fluconazole dosages generally given to patients were all suboptimal. Adjusting the dosages of vancomycin or imipenem was not done correctly in 13 (14.29%) episodes. The results of this study showed that choosing antimicrobial agents and their dosing for prophylaxis and treatment of FN patients and discharge antimicrobial planning of FN patients do not follow the evaluated guidelines. Drug Usage Evaluation studies need to be done regularly in such a center.

Low plasma level of vitamin D is linked to the increased risk of cardiovascular diseases such as hypertension, diabetes, dyslipidemia and peripheral vascular diseases. Vitamin D deficiency is a worldwide problem that involves Iranian population. To the best of our knowledge, this was the first investigation on venous thromboembolism (VTE) subjects that assessed the correlation of vitamin D level with plasma P-selectin, hs-CRP, and risk factors of thrombosis. In this prospective study, patients with diagnosis of acute deep vein thrombosis and or pulmonary eboembolism were enrolled. All patients’ clinical data, demographics and risk factors of thrombosis were evaluated. Plasma level of P-selectin and hs-CRP were measured by ELISA method. Radio immune assay method was used to determine plasma level of 25-hydroxy vitamin D. In this study, 60 subjects were included. The mean ± SD plasma 25-hydroxy vitamin D level (25(OH) D) of participants was 21.4 ± 14.6 ng/mL. The vitamin D deficiency was reported in 60% of patients. No significant relation was found between the plasma 25(OH)D level and P-selectin and hs-CRP. In multiple regression analysis, there was a significant relationship between the level of 25(OH)D and the patients’ age (beta = 0.452; p = 0.001), diabetes (beta = 0.280; p = 0.036) and positive family history of cardiovascular diseases (beta = 0.373; p = 0.003). Vitamin D deficiency is a frequent problem in Iranian VTE patients. Moreover, Plasma level of vitamin D is not associated with increase level of P-selectin and hs-CRP in VTE patients.

Drugs have been estimated to the cause of 10-15% of adverse events in hospitalized patients. Drug fever as the only manifestation or the most prominent clinical characteristics of an adverse reaction occurs in 3-5% of patients. Considering drugs as a cause of fever of unknown origin is important from clinical viewpoint. Drug fever is a febrile response coinciding temporally with the administration of a drug, subsides once the causative drug is disvontinued, and other probable causes of fever such as infection, malignancy,thromboembolic disease, cerebrovascular accidents, collagen vascular diseases, acute gout, surgery, and trauma have been ruled out by physical examinations and paraclinical investigations. A wide range of agents could induce fever by different mechanisms. Antibiotics have been considered as the most common offending agents among different drug classes causing fever. Antibiotics are associated with about one-third of drug-related fever episodes.Among antibiotics, drug fever has been mostly reported with betalactams, sulfonamides, and nitrofurantion. The sole effective approach to manage drug fever is to discontinue the offending agents(S).