No Abstract

Background: Most adherence studies are based on self-report measures. There are limited studies on medication refill adherence (MRA) conducted in Malaysia, especially on bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). The study aimed to investigate the MRA for inhalers with fixed dosing indicated for BA or COPD, prescribed from paediatric and medical clinics in Hospital Tuanku Fauziah and the factors that may affect MRA of COPD/BA inhalers.
Methods: A cross-sectional study was conducted on repeat prescriptions (fixed-dose inhalers dispensed as the units of analysis) collected from 1st January 2015 to 31st December 2015 from the specialist clinic pharmacy. Descriptive analysis was conducted based on satisfactory MRA which was set as the dispensed refill of inhalers covering 80-120% of the prescribed treatment time. Logistic regression analysis was used to explore each variable (diagnosis, gender, ethnicity and age) in relation to MRA: overall satisfactory MRA (≥80% MRA) with undersupply (<80% MRA) as the reference group.
Results:  Out of the repeat prescriptions analysed (n=199), the majorities were COPD (n=118; 64.3%), male (n=122; 61.4%), Malay (n=175; 88.0%), and aged 60-69 years old (n=56; 28.3%). 44.5% of repeat prescriptions (n=57) for COPD showed satisfactory MRA, compared to only 25.4% (n=18) in BA. Repeat prescriptions for fluticasone/salmeterol accuhalers showed the highest satisfactory MRA at 18.1% (n=36). Diagnosis, gender and ethnicity did not significantly influence the overall MRA while age marginally influenced the overall MRA.
Conclusion: More than half of the repeat prescriptions for BA and COPD inhalers showed undersupply and oversupply: patients may not be compliant nor using the inhaler correctly.

Backgrounds: One of the most frequent complications of high-dose chemotherapy regimen before hematopoietic stem cell transplantation (HSCT) is oral mucositis (OM). Vitamin D (VD) has well-known immunoregulatory, anti-inflammatory, and antioxidant properties.
Objectives: This study aimed to evaluate the association of baseline VD levels with OM as well as neutrophil and platelet engraftments in patients with multiple myeloma, Hodgkin’s and non-Hodgkin’s lymphoma after autologous HSCT.
Methods: A sample of 71 patients was included after obtaining informed consent. Serum samples were collected in the morning prior to the administration of conditioning regimen to measure the baseline 25-OH-D. OM was examined daily during hospital stay. The WHO scale was used for scoring the OM. Absolute neutrophil count and platelet count were determined daily from transplantation until engraftment.
Results: Patients aged between 18 to 65 years. Mean length of hospital stay was 15.8±5.7 days. OM was detected in 44/71 (62.0%) of patients. Mean time to the engraftment of neutrophils and platelets were 11.8±4.0 and 17.2±7.3 days, respectively. Mean level of baseline 25-OH-D was 17.5±14.0 ng/ml. VD deficiency (<20 ng/ml) was diagnosed in 51/71 (71.8%) of patients. No association between baseline 25-OH-D levels and the incidence of OM (P=0.69) or OM grade 3-4 (P=0.46) was found. No significant correlations were detected between the baseline 25-OH-D and engraftment time of neutrophils (P=0.46) or platelets (P=0.17).
Conclusions: The prevalence of VD deficiency was high among adult HSCT patients at the time of transplantation. No association was found between low baseline VD with post-HSCT OM and engraftment time.

Objectives: To investigate the on-labeled and off-labeled indications of rituximab according to available evidence and the cost in our center.
Methods: This retrospective cross-sectional study was conducted between August 2016 and August 2017 at a teaching hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. Patients’ demographic data and disease, indication for rituximab use, its dosage and treatment regimen and previous and concurrent treatments was assessed. The collected data were compared with the current criteria for the pattern of rituximab use. The last version of Lexicomp® acquired by Wolters Kluwer was used as the reference for on-labeled and off-labeled indications of the prescribed drug and its dosage. Level of evidences for applied indications and cost has also been evaluated.
Results: A total of 85 patients received rituximab during the study period. The most frequent reasons for rituximab prescription were: multiple sclerosis (50.58%), systemic sclerosis (10.58%), rheumatoid arthritis (7.05%) and Idiopathic inflammatory myopathies (4.70%). Rituximab was used in 8 (9.4%) cases according to on-labeled indications. There was level C evidence for rituximab use in off-labeled indications in 47 (55.29%) cases according to available evidences which accounts for the highest calculated cost.
Conclusion: Based on our results, rituximab was frequently administrated for off-labeled indications most of which are not supported by established levels of evidence. The total cost was higher for level C evidence indications of off labeled rituximab than for indications with a higher level of evidence (A and B). So, strong evidence is necessary for decision making regarding its effectiveness and its cost benefit.

Background: The inappropriate use of antibiotic leads to microbial resistance, nosocomial infections and increased hospital costs. The broad-spectrum antibiotics, such as cefepime and piperacillin/tazobactam play an important role in the empiric therapy of serious infections.
Methods: Demographic data, duration of prescription, dose, dosage adjustment in renal impairment and accompanied prescribed antibiotics were extracted from medical files. UpToDate and AHFS drug information 2012 were considered as standards of rational prescribing. Data analysis was performed by SPSS 18 software.
Results: Drug dosage and indication were appropriate in 16 (23%). The most common antibiotic administered with cefepime was ciprofloxacin (37 cases). In 21 patients, cefepime dosage should have been adjusted according to renal impairment, whereas it has done only in 16 (22.9%) patients. Culture was done in 60 (85.8%) cases. Culture ordered before starting of antibiotics took place in 3(4.2%) patients. In 22(31.4%) patients, the result of culture was negative. Drug dosage and indication were appropriate in 34 (48%). The most common antibiotic administered with tazocin was vancomycin (45 cases). In 9 patients, tazocin dosage should have been adjusted according to renal impairment and it has done. Culture was done in 53 (75.8%) cases. Culture ordered before starting of antibiotics took place in 6(8.57%) patients. In 9(12.8%) patients, the result of culture was negative.
Conclusion: The results showed that there was an injudicious use of cefepime and piperacillin/tazobactam at our hospital, evidenced by the significant number of inappropriate empiric prescriptions and drug modifications.

Background: Errors in drug prescriptions are the most common preventable medication errors encountered in clinical practices worldwide. The purpose of this study is to examine the pattern of prescriptions and drug use in the Kurdistan region and to determine whether prescription patterns are based on rational therapeutic considerations.
Methods: A cross sectional-observational study was conducted in the Kurdistan region of Iraq over a period of five months. A total of 1000 prescriptions were selected randomly from different pharmacies and data obtained from each prescription. In these prescriptions a total of 2878 medications were prescribed. After collection, excel software was then used to perform calculations.
Results: The average number of drugs per prescription was calculated to be 2.8. Drugs prescribed by generic name were 27% and more than 98 percent of prescriptions were handwritten. The duration of therapy was mentioned in 56.5% of prescriptions. However, the dose and dosage form of medications were recorded 62% and 87.3% respectively. The percentage of prescriptions containing a signature was 88.1%. Furthermore, the percentage of antibiotics, supplements, non-steroidal anti-inflammatory drugs and other painkillers were prescribed at a rate of 51.8%, 44.2%, 31.8%, and 21.8% per prescription.
Conclusion: Whilst observing the data we can conclude that the rate of drugs written per prescription is much higher than the suggested World Health Organization (WHO0 average. Prescribing errors are one of the most common preventable causes of medication errors and the use of electronic prescriptions may play a huge role in ameliorating this fact.

Various medicinally uses of the natural foods as well as edibility of them caused attraction a huge attention for several pharmacological activities include antioxidants, antibiotics and antineoplastic activity. Aging is a major risk factor in the change of convert skin structure and function might also directly affect skin appearance. Age-related disorders in the skin health are a consequence of the accumulation of cellular damage and reduced activity of protective stress response pathways leading to low-grade systemic inflammation and oxidative stress. There is increasing evidence that consumption of a variety of phenolic compounds present in natural foods may lower the risk of serious health disorders because of their antioxidant activity, amongst other mechanisms. This mini review reports the importance of the natural foods and nutritional status in the maintenance of healthy skin in human.

Fluoroquinolones have many adverse effects include the gastrointestinal tract and the central nervous system, phototoxicity, and dermal toxicity. Levofloxacin has favorable adverse reaction profiles compared to other fluoroquinolones. Among the reported dermal toxicity there are few reports of toxic epidermal necrosis (TEN) in association with levofloxacin usage. However, there is no published study on levofloxacin induced stomatitis. Stomatitis is characterized by pain, infl ammation, and ulceration in the oral cavity. A 36-year-old man was referred to the hospital for ‘painful oral swelling and ulceration’. Before the admission due to fever and productive cough, 750 mg levofloxacin were prescribed for him. After 2 days of consumption, the patient experiences painful ulcerative and erythema lesions in the oral cavity that consistent with stomatitis. Due to the possibility of a drug reaction, levofloxacin was discontinued and no other antibiotic was used. Oral lesions were managed with a mouthwash and after 5 days, lesions recovered. To the best of our knowledge, this is the first case who developed stomatitis after two dose of levofl oxacin and recovered just with topical therapy and without any systemic treatment. Caution is advised while administering these drugs.

Myocardial infarction can be complicated by Ventricular septal rupture which is a rare fatal grim mechanical complication of MI which is a surgical emergency due to its incredibly high mortality rate. We depict a case of Anterior wall MI which was complicated by Ventricular septal rupture post fibrinolytic therapy.