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Background: Methadone is used for the pain management worldwide. Its special characteristics make it a potential alternative for pain management in critically ill and geriatric patients. Due to lack of studies in this population, we aimed to compare the pharmacokinetic behavior of Methadone following intramuscular and intravenous administration in geriatric ICU patients and with previously reports in healthy volunteers.
Methods: According to the limitations in ICU setting, we could include 11 patients over 65 years old, who required opioid for pain relief in this study. Patients were randomized to receive 5 mg of Methadone IM or IV injection every 8 hours for 6 days. The Methadone plasma level detected with LC-mass tandem mass spectrometry, and pharmacokinetics parameters were evaluated for each subject in both 1^st and 6^th days of treatment.
Results: Based on our results, bioavailability of intramuscular Methadone in geriatric ICU patients was low and less than 40% of the dose was absorbed within first 12 hours. The volume of distribution of Methadone in the first day was significantly lower than the previously reported values in healthy subjects and significantly increased during these 6 days. The Methadone half-life in this population also significantly increased through this period.
Conclusion: Pharmacokinetic behavior of Methadone in geriatric ICU patients is unpredictable. Reduced volume of distribution and half-life may be observed initially, following with an increase to the normal range. It seems that IM administration of Methadone in geriatric critically ill patients may not provide target analgesic Methadone serum levels.

Backgrounds: Hypomagnesemia is a common electrolyte disturbance among critically ill patient which is associated with increased morbidity and mortality. In this study, correlations between serum and intra-cellular magnesium concentrations at the time of intensive care unit (ICU) admission with ICU complications and mortality were evaluated.
Methods: This cross-sectional study included 70 consecutive adult patients admitted to the intensive care unit of a tertiary referral teaching hospital during a six-month period. Serum and intra-cellular magnesium levels were measured on admission. Clinical information, morbidity, and mortality were followed and recorded during ICU stay until discharge or death.
Results: On admission, 37.14% of patients suffered hypomagnesemia. Low intra-cellular magnesium level was observed in 44.28% of patients. Cardiovascular complications and mortality were significantly higher in patients with lower serum and intra-cellular magnesium levels when compared to patients with normal levels (P < 0.05). There was a significant correlation between serum magnesium level on ICU admission and Acute Physiology and Chronic Health Evaluation (APACHE II) score (r = ˗0.39, P < 0.001).
Conclusion: Particular attention should be reserved to possible prognostic and therapeutic consequences of magnesium depletion in critically ill patients. Magnesium deficiency was associated with a higher APACHE II score on admission, higher cardiovascular complications, and increased mortality.

Background:  Preparation of a new product with the goal of reducing chlorhexidine’s side effects without decreasing (and even increasing) its effectiveness is a desirable goal for researchers in the field of oral hygiene. The aim of this study was to evaluate the efficacy of Chlorhexidine 0.2% and Cetylpyridinium 0.05% combination in reducing oral bacteria in comparison with Chlorhexidine 0.2%, Cetylpyridinium 0.05% and Persica mouthwashes.
Methods: 100 healthy volunteers aged between 18 and 30 years were randomly assigned to 5 groups. The first group received Chlorhexidine 0.2%, the second group received Cetylpyridinium 0.05%, the third received Persica, the fourth received Chlorhexidine 0.2% plus Cetylpyridinium 0.05%, and the fifth group received Chlorhexidine 0.05% plus Cetylpyridinium 0.05%. Samples were obtained at baseline and thirty minutes after oral rinsing with the mouthwashes. The number of colony-forming units (CFU/mL) before and after mouthwash administration was compared for each sample.  
Results: The preparation with the most bacterial count reduction was found to be Chlorhexidine 0.2% and Cetylpyridinium 0.05% combination. However, the difference between efficacy of Chlorhexidine 0.2% plus Cetylpyridinium 0.05% and Chlorhexidine 0.05% plus Cetylpyridinium 0.05% was found not to be statistically significant.
Conclusions: A new mouthwash preparation including chlorhexidine 0.05% and cetylpyridinium 0.05 % combination is the most desirable due to the increased efficacy and fewer side effects.

Background: Antibiotic resistance is a worldwide issue due to rise of antibiotic consumption and wide variation in antibiotic prescribing practices. Crystalline penicillin is the most highly consumed antibiotics by hospitalized pediatrics patients in Dessie Referral Hospital and its utilization pattern is not known in the study area. The objective is to assess the appropriateness of crystalline penicillin use in pediatrics ward of Dessie Referral Hospital, Northeast Ethiopia.
Methods: A hospital based cross-sectional study was used for evaluating medication records of hospitalized pediatric patients who received crystalline penicillin from October to December 2018.
Results: A total of 262 hospitalized pediatrics patient records were included in the study. All the 262 (100%) cases were consistent with guidelines for contraindication and drug interaction to use the drug. Crystalline penicillin use was consistent with guideline recommendations in 93.8%, 92.8%, 89.6%, 66.7% and 39.4% of the cases with regard to, indication, outcome, frequency, dose and duration of treatment, respectively. The observed value of all drug utilization evaluation parameters except drug interaction and contraindication showed statistically significant difference from the set threshold in nonparametric binomial test.
Conclusion: The result of the current study especially with regard to dose and duration is much below the recommended threshold and needs scheduled trainings and necessary interventions to tackle the problem.

Backgrounds: In recent years, low molecular weight heparin use has increased in children. Dose of enoxaparin to achieve target anti-Xa and time to achieve anti-Xa are evolving and efficacy outcome data in terms of laboratory and clinical response rate in children still remains to be elucidated. Thus, in this drug utilization and evaluation study, we assessed patterns of enoxaparin use, its concordance with guidelines and laboratory and clinical outcomes in pediatric patients in a Children’s teaching hospital.  
Methods: In a prospective observational study, all pediatric patients with a thrombotic event who underwent treatment with enoxaparin were included. Demographic data, clinical outcome data based on follow-up sonography results, laboratory response based on anti-Xa and concordance with guidelines in terms of initial daily dose, duration of treatment, performing sonography to evaluate response, anti Xa check and time of anti-Xa check were evaluated.
Results: During a 9-month period, 41 pediatric patients suffered a thrombotic event and received enoxaparin. Median age of participants was 18.5 months. The anti-Xa level became therapeutic on mean day 4.7 with a mean enoxaparin dose of 1.24 mg/kg. Among participants 42% achieved therapeutic anti-Xa with initial empirical dosing. Less than 25 % of participants had a follow-up sonography and among them, 77% demonstrated complete thrombosis resolution after 4-6 weeks of enoxaparin therapy. We observed one major bleeding event. Concordance with guidelines was low in the aspects of duration of treatment, performing sonography to evaluate response and anti-Xa check.
Conclusion: With initial empiric dosing, it may take several days before anti-Xa become therapeutic. Among half of the children, a higher than recommended 1 mg/kg dose was required to achieve therapeutic anti-Xa level. Educational processes are mandatory regarding enoxaparin use and monitoring among clinicians to improve concordance with guidelines.

Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. The pandemic outbreak of COVID-19 is rapidly spreading all over the world. This review aims to provide a relationship between the alteration of immune system during  COVID-19 infection and the risk of developing diabetes complications. The risk of COVID-19 infection in patients is due not only to the severity of the viral infection but also to the host's immune response. The risk of infection is one of the main complications of diabetics, as it has been suggested that diabetes inhibits the immune response which contributes to infection and progression to symptoms. also, The evidence of generation of oxygen free radicals and oxidative stress is a key process in the onset of diabetes mellitus which participate in the development of the systemic inflammatory response syndrome. In addition, chronic hyperglycemia during COVID-19 infection may increase the release of inflammatory cytokines, a high ability to bind to the virus ACE2 glycosylated, worsen the ketoacidosis and vascular complications that may explain the severity of the SARS-CoV-2 infection in diabetic patients.

A new corona virus disease (COVID-19) is affected more than 5 million people worldwide to date and has become a global pandemic. Since there is no definitive cure for this life threatening disease, many clinical studies are underway in this regard. Pathogen-associated molecular patterns (PAMP) prompting by coronavirus seems to generate cellular, structural, and functional derangement induced by immune dysregulation and many biological abnormalities including cytokine storm. The role of IL-6 in viral pneumonia and also the impact of its inhibition on the prevention of organ damage are not known yet.IL-6 seems to behave as a double blade evil cytokine, with a valuable role in cell to cell natural physiological communication. Tocilizumab as an inhibitor of interleukin (IL)-6, may interrupt the paracrine system while causing dissemination of bacterial, fungal, and other viral infections, especially COVID-19, who are at high-risk development of sepsis and life-threatening superinfection.

Background: Nosocomial infections are associated with increased morbidity, mortality, and medical burdens. Pseudomonas aeruginosa and Acinetobacter baumannii are not-fermentative gram-negative bacteria that considered as the most important nosocomial infection. In the current study, we have aimed to evaluate the sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa microorganisms to the colistin antibiotic.
Methods: In this descriptive cross-sectional study, patients admitted to the ICU ward of Firoozgar Hospital from July 2018 to March 2019 were evaluated, and 169 Patients infected with Acinetobacter baumannii, and Pseudomonas aeruginosa were included. Acinetobacter baumannii and Pseudomonas aeruginosa were isolated, and antibiotic sensitivity was determined by the disk diffusion method according to Clinical & Laboratory Standards Institute (CLSI) criteria. E test was also used to determine MIC-50 and MIC-90 of colistin.
Results: Acinetobacter baumannii was around 8 times more frequent than Pseudomonas aeruginosa. Colistin resistance was detected in only 4(2.4%). The mean age of patients infected by Acinetobacter baumannii was significantly higher than those infected with Pseudomonas aeruginosa. Moreover, the mean time of the hospitalization period did not show any significant differences in the different groups.
Conclusion: Our findings indicated that the majority of isolated Pseudomonas aeruginosa and Acinetobacter baumannii were sensitive to Colistin. Therefore, it could be effectively used for patients with a confirmed diagnosis of Pseudomonas aeruginosa and Acinetobacter baumannii.

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Prolactin is a polypeptide hormone secreted and released by lactotroph cells in the anterior pituitary gland in response to diverse physiological stimuli, principally via the inhibitory action of dopamine and serotonin. This paper describes a 44-year-old woman with depression and obsessive-compulsive disorder (OCD) who called the 13-Aban drug and poison information center (DPIC). She was being treated with fluoxetine (80 mg/day) for 10 months until risperidone was added to her regimen for augmentation therapy (0.5 mg/day). Her symptoms improved within less than two months without significant side effects until she experienced painful bilateral breast discharge along with spotting and menstrual irregularity, besides amenorrhea for the previous 2 cycles and serum prolactin level of 33.7 ng/mL, presenting hyperprolactinemia. After discontinuing risperidone, within two weeks, galactorrhea and breast pain disappeared and amenorrhea resolved. Further prolactin level measurement showed the significant reduction. This neuroendocrine effect observed with very low-dose risperidone plus fluoxetine is apparently exerted through both pharmacokinetic and pharmacodynamic augmentation of this combination therapy.