Journal of Research in Pharmacy Practice最新文献

Objective: In severe cases, COVID-19 can lead to a hyperinflammatory state, resulting in devastating outcomes. Immune modulation using steroids or other immune modulators can regulate the intensity of the inflammatory response; however, this theory has not been adequately assessed in practice. The current study aims to investigate the use of corticosteroids alone or in combination with tocilizumab to treat patients with severe COVID-19.

Methods: This cross-sectional study was conducted on 166 Iranian patients with severe COVID-19 infection at Al-Zahra Hospital, who were treated with the standard treatment for severe COVID-19 infection, as per the 11^th version of the Iranian guideline for COVID-19 treatment. Patients were categorized into three treatment groups based on the dose of corticosteroid treatment and tocilizumab therapy: (a) high-dose methylprednisolone (>1 mg/kg) alone, (b) low-dose methylprednisolone (<1 mg/kg) followed by one dose of tocilizumab (8 mg/kg); and (c) high-dose methylprednisolone (>1 mg/kg) followed by one dose of tocilizumab (8 mg/kg). Mortality of patients as our primary outcome, laboratory parameters, length of hospitalization, intensive care unit (ICU) admission requirement, and drug-related adverse events were compared between groups.

Findings: The second group showed significantly better outcomes, including shorter ICU stays, lower C-reactive protein and lactate dehydrogenase levels, and higher oxygen saturation and platelet counts than the other groups. Logistic regression revealed increased risks of mortality, nosocomial infection, and adverse effects, including hepatic and renal dysfunction and gastrointestinal bleeding, in Groups B and C compared with Group A.

Conclusion: In all evaluated parameters, a low-dose steroid followed by tocilizumab was superior to a high-dose steroid alone or combined with tocilizumab. Although this combination treatment has been assessed worldwide, few studies have focused on its application in Iranian patients with severe COVID-19.

Objective: Immunocompromised patients are at increased risk of bacterial and viral respiratory infections and related complications. Available vaccines against these infections are the most effective tools in preventing complications. Community pharmacist vaccination service is evolving in many countries, and they could present an opportunity to improve vaccination coverage in this population. This study aims to describe how community pharmacists are involved in vaccinating high-risk (immunocompromised) populations.

Methods: This retrospective study included vaccination information of patients who received chronic immunosuppressive therapy among those who were taking selected chronic medications from community pharmacies in Montreal, Canada, from January 2020 to September 2023. Immunosuppressive therapy was categorized as either corticosteroids or immunosuppressive drugs or the combination of corticosteroids with one or two immunosuppressive drugs. Data were available from all private pharmacies through the Quebec Association of Pharmacists Owners database. Descriptive statistics are used for data analysis.

Findings: Of the total number of 4,114,528 patients who were taking selected chronic medications from community pharmacies, 611,789 (14.8%) were taking immunosuppressives. Prednisone/prednisolone was the most commonly administered drug in this population (345,744 [8.4%]). Most of these patients are aged over 50 years (484,827 [79.2%]). A total of 409,171 (66.8%) co-administered at least one other drug. The vaccination rate was highest for influenza (142,877 [23.3%]) and lowest (23,532 [3.8%]) with the pneumococcus vaccine. Patients younger than 25 had the lowest vaccination rate with three respiratory vaccines. Vaccination rate decreased after the pandemic with all three vaccines in our study population.

Conclusion: Vaccination rates of patients taking chronic immunosuppressive drugs in community pharmacies are low. These rates are worse than rates for other high-risk groups from the same database. This represents a missed opportunity for pharmacists to encourage this high-risk population to vaccinate proactively.

Objective: The traditional approach to pharmacy practice offers standard medications based solely on physicians' decisions or existing treatment guidelines, not accompanying patients in their health status. On the other hand, patient-centered pharmacies provide tailored care to each individual's particular needs and concerns. As the patient-centered approach has gained significant importance in modern healthcare systems, including pharmacies, this study investigates how community pharmacies in Tehran are implementing such an approach.

Methods: A descriptive-analytical cross-sectional study was conducted using a validated questionnaire in the general population visiting pharmacies. The data were analyzed using SPSS 30.0.

Findings: The results show that 45% of the pharmacies were patient centered. The average rating of their patient-centeredness was 4.03 (out of 5). Regarding the patient-centeredness aspects of pharmacies, the most decisive points were the confidentiality of personal information and respect for the rights and dignity of the patients.

Conclusion: Our study shows that most pharmacies are patient centered. There was also a significant positive correlation between patient-centeredness and disease-centeredness. This means that improving the level of patient-centeredness in pharmacies also enhances the status of disease-centeredness in pharmacies, increasing patient satisfaction and loyalty.

Objective: Uremic pruritus (UP) is a prevalent and debilitating condition experienced by patients undergoing hemodialysis, influenced by multiple underlying mechanisms. Despite the availability of various treatment options, many patients still endure significant pruritus. This double-blind, placebo-controlled clinical trial aims to assess and compare the safety and efficacy of mirtazapine and hydroxyzine in treating UP and improving sleep quality in hemodialysis patients.

Methods: Twenty-seven patients in the mirtazapine group received 15 mg/night (7.5 mg for the first two nights) with a hydroxyzine placebo, while 28 patients in the hydroxyzine group received 25 mg/night (12.5 mg for the first two nights) with a mirtazapine placebo for 2 weeks. UP was assessed using the 5D-itch scale, and sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) at baseline, weeks 2, 3, and 4. Adverse effects were recorded using the Antidepressant Side Effect Checklist at each visit from baseline to week 2.

Findings: UP ratings based on the 5D-itch scale decreased for both groups, with a more significant reduction in the mirtazapine group (P = 0.04). The mirtazapine group also showed a significant improvement in the PSQI compared to hydroxyzine (P = 0.01). Dry mouth was the only notable adverse effect, occurring more frequently in the mirtazapine group (P = 0.02).

Conclusion: This study suggests that short-term treatment with mirtazapine is more effective than hydroxyzine in reducing the severity of UP and improving sleep quality for patients undergoing hemodialysis.

Objective: Statins, recognized for their lipid-lowering properties, are being studied in clinical studies for potential benefits in treating coronavirus disease 2019 (COVID-19). This clinical trial evaluated the efficacy of a moderate dose of atorvastatin in influencing the clinical response among critically ill COVID-19 patients.

Methods: This investigation involved adult individuals diagnosed with laboratory-confirmed COVID-19 and experiencing critical illness. Patients meeting the eligibility criteria and receiving atorvastatin were allocated to continue treatment at a daily dosage of 20 mg (PHA). In contrast, the remaining eligible patients were randomly assigned to the atorvastatin intervention (AIN: administration of 20 mg atorvastatin daily) and control groups. Patients followed up for 14 days for the primary endpoints of the COVID-19 severity and APACHE II scores. The secondary endpoints and different biochemical parameters were also assessed.

Findings: Finally, 116 people completed the study. The studied groups had no significant differences regarding the demographic and basic clinical data. C-reactive protein on the 7^th and 14^th days in the AIN and PHA groups was significantly lower than in the control group (P = 0.008 and P = 0.018). IL6 on the 7^th day (P = 0.04) showed a significant decrease in AIN compared to PHA and control groups. However, no significant differences in APACHE-II score and disease severity were detected between the groups.

Conclusion: Atorvastatin could effectively reduce inflammation in intensive care unit (ICU) patients admitted for COVID-19 management, but it could not influence the clinical outcomes. We suggested investigating its effect on COVID-19 in larger sample sizes, nonICU patients, and from the beginning of the diagnosis for a longer duration.

Objective: Poor medication adherence, drug interactions, and adverse drug events occur frequently in patients with bipolar I disorder (BD-I), affecting their treatment outcomes. Due to limited research regarding the impact of pharmaceutical care (PC) services in the management of patients with BD-I, this study was designed to assess the role of clinical pharmacist-led interventions on outcomes of BD-I patients.

Methods: A prospective randomized clinical trial was designed, and 59 patients were randomly assigned to the intervention group and 48 patients to the control group. Patients in the intervention group were provided with medication therapy management and follow-up services by the clinical pharmacist, whereas the control group only received routine care. Outcomes which were assessed at baseline (before discharge), 1 month, and 3 months after discharge were the Medication Appropriateness Index (MAI), Beck Depression Inventory-II (BDI-II), Young Mania Rating Scale, and World Health Organization Quality of Life, Brief version (WHOQOL-BREF).

Findings: Endpoint mean changes in MAI scores from baseline were -5.25 ± 5.19 and 2.02 ± 3.98 points for the intervention and control groups, respectively (P < 0.001). Depressive symptoms, measured by the BDI-II, also showed significant improvement in the intervention group; the mean change from baseline to 2^nd follow-up assessment was -1.47 ± 7.73 in the intervention group and 1.66 ± 6.42 in the control group (P = 0.02). Furthermore, the mean change from baseline to 2^nd follow-up in the psychological health domain of the WHOQOL-BREF questionnaire was significantly higher in the intervention group (4.59 ± 17.79) compared with the control group (-3.90 ± 12.55) (P = 0.005).

Conclusion: Our findings reveal that clinical pharmacist-provided services could positively affect outcomes in BD-I patients.

Objective: This study investigated the efficacy of adding the oral N-acetyl cysteine (NAC) supplement to the cystic fibrosis (CF) treatment regimen compared to adding a placebo. It also studied the quality of life and respiratory indicators of patients aged 6-18 with mild-to-moderate pulmonary involvement.

Methods: This clinical trial was a randomized, quasi-experimental pilot and add-on therapy controlled with a placebo for 3 months. The case group received 200 mg of oral NAC three times a day. In contrast, the control group had a placebo in the same way. From the 2021 fall to the summer of 2022, 38 CF patients referred to Imam Hossein Children's Hospital Clinic were finally examined. They were clinically stable with a forced expiratory volume in the first second (FEV₁) level of more than 50% and no history of underlying cardiovascular and renal diseases.

Findings: The differences between the groups were not significant. In the placebo group, key measures remained unchanged, whereas the NAC group had an improvement in the CF Questionnaire-Revised score but no notable changes in other indices. Overall, comparisons of forced vital capacity (FVC) between the groups showed no variation.

Conclusion: The indicators of FEV₁, FVC, FEV₁/FVC, forced expiratory flow between 25% and 75% of vital capacity, and the quality of life of the case group were not significantly different from those of the placebo group, and no significant differences were observed between this medicine and placebo.

Objective: Shivering is one of the most common complications due to disturbances in the thermoregulatory system after regional anesthesia, leading to adverse outcomes and decreased patient satisfaction. Ketamine and tramadol are considered mild analgesics that affect the thermoregulatory center. This triple-blind, randomized clinical trial aims to explore the comparative efficacy of intravenous ketamine and tramadol in reducing postspinal anesthesia shivering in high-risk urological surgeries.

Methods: A total of 90 patients undergoing urological surgeries under spinal anesthesia at Shahid Hasheminejad Hospital in Tehran in 2024 were randomized into three groups: ketamine (0.5 mg/kg), tramadol (0.5 mg/kg), and placebo (normal saline). Variables, including ambient temperature, patient demographics, surgery duration, and anesthetic techniques, were meticulously controlled. The primary outcome was the incidence of shivering, measured using the Crossley and Mahajan scale. Data were analyzed using the SPSS software Version 19, employing Chi-square tests, analysis of variance, and logistic regression.

Findings: The patients were homogeneous regarding demographic and surgical variables. No significant difference was found in patients' body temperature upon admission. The incidence of shivering was significantly lower in the tramadol group (23.3%) compared to the ketamine group (36.7%) and placebo group (60%) (P = 0.013). Tramadol demonstrated superior efficacy with minimal side effects. Logistic regression analysis confirmed that patients in the tramadol group were significantly less likely to experience shivering (odds ratio = 0.286; 95% confidence interval: 0.098-0.834, P = 0.022). Ketamine, while effective, had a higher incidence of hemodynamic fluctuations and psychotropic effects.

Conclusion: The incidence of shivering was significantly lower in the tramadol group compared to the ketamine and placebo groups. Tramadol demonstrated superior efficacy with minimal side effects. While effective, ketamine had a higher incidence of hemodynamic fluctuations and psychotropic effects.

Objective: The present study aimed to evaluate the efficacy of N-acetylcysteine (NAC) in preventing nephrotoxicity in critically ill patients receiving colistin.

Methods: In a randomized, controlled clinical trial, eligible participants receiving colistin were divided into two groups: the drug group (n = 24) and the control group (n = 24). In the drug group, 2 g of NAC was administered intravenously daily for 5 days, simultaneously with colistin. The patients in the control group received only colistin. Serum creatinine (SCr), blood urea nitrogen (BUN), and creatinine clearance (CrCl) at baseline and on each day, and the number of cases of acute kidney injury during the study were recorded. Urinary N-acetyl-beta-D-glucosaminidase (NAG) was determined before the start of treatment and on day 5. The study outcomes were the mortality rate, length of intensive care unit (ICU) stay, and NAG levels. Finally, the values were compared between the groups.

Findings: It was found that the 28-day mortality rate (P = 0.540) and length of ICU stay (P = 0.699) were not significantly improved by coadministration of intravenous N-acetylcysteine with colistin. SCr and BUN showed no significant reduction, and there were no changes in CrCl at the end of treatment. The changes in urinary NAG levels did not differ significantly between the two groups. There was also no difference in the stages of the RIFLE criteria (P = 0.641), and most patients were in the normal stage (58.3%).

Conclusion: Concomitant administration of intravenous NAC at a dose of 2 g daily does not prevent colistin-induced nephrotoxicity, 28-day mortality, and length of ICU stay in critically ill patients.

Objective: Treating ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) is still a significant challenge. This study evaluated the effectiveness of the colistin/rifampin regimen compared to the usual colistin/meropenem regimen in treating patients with VAP caused by CRAB.

Methods: In a randomized controlled clinical trial, the patients with CRAB-related VAP were randomly assigned to experimental (n = 21) and control (n = 24) groups. The first group received colistin 4.5 MIU IV infusion every 12 h and rifampin 300 mg PO every 12 h, and the second group received colistin with the same dose and meropenem 2 g IV every 8 h for 10 days. The clinical response (complete response, partial response, or treatment failure) and mortality rate at the end of the intervention were recorded and compared between the two groups.

Findings: The complete response rate was higher (n = 8; 66.70%), and the failure rate was lower (n = 4; 26.70%) in the experimental group than in the control group (n = 4; 33.30%, and n = 11; 73.30%, respectively), but the differences were not statistically significant. The mortality rate was three patients in both experimental (14.28%) and control (12.50%) groups; however, the difference was not statistically significant (P = 0.860; odds ratio: 1.143, 95% confidence interval: 0.258-5.067).

Conclusion: The colistin/rifampin combination can be considered an alternative regimen to colistin/meropenem in the treatment of VAP caused by CRAB.