Avicenna Journal of Pharmaceutical Research
Volume:3 Issue: 1, Jun 2022

Drug use evaluation (DUE) helps to investigate and modify the pattern of drug administration with the aim of improving patient care and cost saving. Considering the important indications for intravenous immunoglobulin (IVIG) and its high cost, assessment of its prescription pattern could be helpful in increasing the efficiency of the health system.This study aimed to investigate the pattern of IVIG use in a tertiary teaching hospital.

This retrospective study included all inpatients who received IVIG in spring and summer 2020. The needed information was extracted from patients’ files. Data were analyzed using SPSS and compared with the standard guidelines.

A total of 72 patients received IVIG. The indications were “FDA-approved” and “CEDITacknowledged” in 33.3% and 61.1% of the cases, respectively, and 45.8% adhered to the “red” indications of the UK protocol. Moreover, all prescriptions were in accordance with the approved indications of the FDO (Iranian Food and Drug Organization) guideline. Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy, and COVID-19 were the three most common causes of IVIG administration. Additionally, 66.7% had received the recommended dose regimen and 51.3% experienced drug side effects requiring some measures.

The occurrence of adverse drug reactions in more than half of the studied patients and related costs substantiate the need for enhancing physicians’ refrain from the unnecessary prescription of the IVIG, nursing staff’s knowledge, and the inclusion of a clinical pharmacist in the healthcare team.

Antibiotic prophylaxis is often used by surgeons to prevent surgical site infection (SSI) following operations. Despite the availability of several national guidelines for proper antibiotic prophylaxis, adherence to guideline recommendations, especially in developing countries, is still sub-optimal. This study aimed to assess adherence to the American Society of Health-System Pharmacists (ASHP) guidelines for prophylactic antibiotic use among surgeons in a referral hospital in western Iran.

This prospective cross-sectional study was conducted in surgery wards of a tertiary hospital affiliated with Hamadan University of Medical Sciences, Hamadan, Iran, for six consecutive months from February 1 to July 31, 2019. The records of 264 patients who were randomly chosen from patients admitted to surgery wards were reviewed. The appropriateness of parameters of surgical antibiotic prophylaxis, including indication, antibiotic choice, dose, timing of the first dose, and duration of prophylaxis, was assessed against ASHP guidelines.

A total of 248 patients (93.94%) received antibiotic prophylaxis. Only in 32.2% of the procedures, full adherence to all parameters of the AHSP guidelines was achieved. In a significant percentage of procedures, prophylactic antibiotics were administered inappropriately for more than 24 hours (59.21%). Regarding the antibiotic selection (92.1%), dose (88.6%), and timing of administration (89.9%), the rate of adherence to guidelines recommendations was relatively satisfactory in our hospital.

Our survey demonstrated that the adherence of surgeons to antibiotic prophylaxis guidelines was inadequate in our hospital, and there is still considerable room for improvement, especially in the process of discontinuation of antimicrobial prophylaxis.

Hepatotoxicity is one of the most important side effects of anticonvulsant drugs. This study compared the hepatotoxicity of sodium valproate, carbamazepine, phenytoin, lamotrigine, and vigabatrin in male rats.

Based on the results, 56 rats were randomly divided into seven groups of eight and treated intraperitoneally for four weeks. Groups 1 and 2 received 500 mg/kg of carbamazepine and sodium valproate, and groups 3, 4, and 5 were injected with 200 mg/kg of phenytoin, 200 mg/kg lamotrigine, and 500 mg/kg vigabatrin, respectively. As control groups, the sixth and seventh received distilled water and sesame oil. Biochemical parameters such as alanine aminotransferase (ALT), aspartate transaminase (AST), and γ-glutamyl transferase (GGT) in the serum samples, as well as malondialdehyde (MDA) and glutathione (GSH) contents in liver homogenates, were measured at the end of the experiment.

MDA levels in carbamazepine and phenytoin groups were significantly higher than that in sodium valproate, lamotrigine, vigabatrin, and control groups (P<0.05). GSH levels in carbamazepine and phenytoin groups were meaningfully higher compared to the groups that received sodium valproate (P<0.05), vigabatrin, and control groups (P<0.001). Based on the results, the GGT level in the carbamazepine group was remarkably higher in comparison with the other groups (P<0.01). ALT and AST represented considerably higher levels in the phenytoin group compared to the vigabatrin, sodium valproate, and control groups (P<0.01).

Overall, carbamazepine-induced hepatotoxicity caused the most significant changes in GSH, GGT, and AST. The induction of hepatotoxicity with sodium valproate had the least effect on enzymes and was significantly different compared to carbamazepine and phenytoin groups. Because of no hepatic metabolism, the level of biomarkers did not demonstrate a considerable difference between vigabatrin and the control groups.

Metabolic disturbances, including hyperlipidaemia, are risk factors for brain ischemia. Despite all research, no definitive treatment has yet been found for brain ischemia. Thus, this study investigated the effect of cinnamon on ischemic tolerance and the expression of matrix metalloproteinase (MMP) 2 and 9 genes, as well as levels of interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) proteins in rats receiving a high-fat diet (HFD).

Rats were divided into control, sham, model, lovastatin, vehicle, and cinnamon 130 mg (Cin130) and 260 mg (Cin260). All groups, except for the control group, received a high-fat diet for 6 weeks. Then, the last four groups received the corresponding treatment for 6 weeks. The stroke was induced by middle cerebral artery occlusion (MCAO). Twelve hours later, the animals were evaluated for the extent of neurological defects, lipid profiles, tissue damage, and gene expression of MMP-2,9, as well as IL-6 and TNF-α protein level.

The results showed that Cin130 has been highly successful in improving neurological defects. Cin130 was effective in reducing serum cholesterol and triglyceride. Further, Cin260 effectively reduced serum LDL. Moreover, Cin130 and Cin260 could reduce tissue damage volume, blood-brain barrier (BBB) integrity, and down-regulation of IL-6, TNF-α proteins and MMP-2,9 levels.

Overall, cinnamon, in addition to its lipid-lowering effect, may also have a neuroprotective effect that may be related to the down-regulation of MMPs and cytokines. The two may be independent events or related to a third event; in any case, appropriate experiments should be performed in future studies to determine whether altering the MMPs reduces the effectiveness of cinnamon.

 Physicians generally prescribe disease-modifying drugs (DMDs) to reduce the frequency and severity of relapses in multiple sclerosis (MS). The frequency and severity of side effects are important factors that can affect drug choice. The main purpose of this analysis was to evaluate the side effects of different types of first-line injectable DMDs and determine which drug has more complications, and which drug has the most drug discontinuation rates due to severe side effects.

 Four groups of injectable DMDs were compared in 386 relapsing-remitting MS (RRMS) patients in the range of 15-60 years who were controlled with these drugs for at least two years (2017-2019) and had the Expanded Disability Status Scale (EDSS) from 0 to 5 without underlying heart and liver diseases. Eventually, the frequency of side effects was determined for each group, and the collected data were compared in each treatment group.

 In the present study, 31% of patients had no complications. Most of the reported complications (68.25%) were mild in severity, and only 15.5% of the patients discontinued their therapy.

 The findings recommend that the side effects of different DMDs used for RRMS should be studied more comprehensively in clinical and post-marketing trials. Additionally, physicians should take note of these side effects of DMDs in their prescriptions to increase patients’ adherence to therapy.

 Peucedanum chenur Mozaff has been used by local people as a spice and for the treatment of urinary infections. The chemical constituent and biological activities of the essential oil (EO) and the extract of P. chenur Mozaff were evaluated in this study.

 The EO components were qualitatively and quantitatively identified by gas chromatography/ mass spectrometry (GC/MS) and gas chromatography/flame ionization detector. The phytochemical analyses, total flavonoids, and phenolic contents of the extract were determined, and then the phenolic compounds of the extract were quantified by reverse-phase high-performance liquid chromatography.

 Based on the results, 36 compounds were identified in the volatile oil, accounting for 94.7% of the total oil. The major components were α-pinene, limonene, γ-terpinene, β-pinene, and sabinene. The EO exhibited significant antibacterial activity on Bacillus cereus, Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae, whereas it exerted no effect on Pseudomonas aeruginosa. The antioxidant activity of the volatile oil had a half maximal inhibitory concentration value of 122±2.1 (μg/mL). Rutin, caffeic acid, naringenin, apigenin, and quercetin (183.6, 132.8, 38.4, 13.1, and 3.5 mg/100 g of the plant, respectively) were quantified in the methanolic extract.

 The various bioactive compounds and the antibacterial and antioxidant activities of P. chenur Mozaff confirmed the potential of this plant for use in the food, pharmaceutical, and cosmetic industries.

Multiple sclerosis (MS) is an acquired inflammatory and neurodegenerative immuno-mediated disorder of the central nervous system (CNS) characterized by inflammation, demyelination, and primary or secondary axonal degeneration. Epidemiological studies have suggested that both genetic and non-genetic risk factors are involved in the etiology of MS. Non-genetic factors include infections, vaccinations, nutritional habits, hormonal factors, and physical and chemical agents. Toxic environmental factors have been proposed to play a considerable role in MS pathogenesis. This review explored pieces of evidence and potential mechanisms of action for some toxic factors such as heavy metals, organic solvents (OSs), tobacco smoking, plastic monomers, additives, and pesticides. The obtained findings provide us with the potential for prevention, especially for people at greater risk such as individuals exposed to these toxic factors. It should be noted that further investigations are needed to find precise mechanisms of causality in humans and to develop defensive approaches.

According to the World Health Organization (WHO), the number of unintentional acute poisoning cases is between 3.5 and 5 million cases worldwide. Among these, 3 million cases were severe, leading to the death of 20000 people per year. In addition, 7.4 million years of life had lost every year due to diseases caused by agricultural toxins (1). Based on the previous evidence, the development of unauthorized supply stores and lack of proper monitoring of the permissible limit of poisons, as well as the sale of poisons without a prescription, the ignorance of farmers, the indiscriminate planting of products not resembling traditional agriculture, can be due to various factors related to the improper and indiscriminate use of pests. Pesticides and agricultural poisons have short- and long-term health effects. Globally, it is recommended that a policy brief be compiled for decision-making cases based on evidence. Therefore, to demonstrate evidence-based policy options, taking into account the existing obstacles and opportunities, it seems necessary to use strategies and intervention plans to reduce the consumption of pesticides while increasing the level of protection of farmers.