Access to Megadoses of Vitamin D, Insufficient Knowledge of People and Poor Practice of Community Pharmacists, Made a Vicious Circle in the Direction to D Hypervitaminosis in Iran.

Background: Due to emergence of antimicrobial-resistant healthcare associated infections (HAIs), the implementation of antimicrobial stewardship programs (AMSP) is the need of hour at institutional and national levels. We conducted an assessment of the current status of infrastructure, manpower, and education and training (E&T) in relation to Antimicrobial Stewardship (AMS) in the tertiary care hospitals of India. Methods: Healthcare professionals from 30 tertiary care hospitals in North-western India (public & private) were invited to participate in online survey from Nov 2022 to Apr 2023 by sending a pre-designed questionnaire about the current existing antimicrobial stewardship (AMS) practices at their hospitals through email. The answers received on various parameters of AMS were analyzed using descriptive statistics. Results: 72 healthcare professionals from 30 hospitals responded to the survey. 63% of the respondents had received education and training (E&T) on AMS during undergraduate or postgraduate training. 65% had not received any E&T at induction to the hospital. The positive responses were 36%, 47% and 33% for leadership support, accountability and availability of drug expertise in form of pharmacologist/pharmacist respectively. A policy to support optimal antibiotic use was present in 25% of respondents. Broad interventions to improve antibiotic use were scored as 28%, 7% and 6% for antibiotic time out, pre-authorization and prospective audit with feedback respectively. Conclusion: The findings reveal the enablers and barriers to implementation of antimicrobial stewardship and highlighted the need for establishing a framework for stricter implementation and monitoring of antimicrobial stewardship in Indian tertiary care hospitals. Few key areas which require immediate attention are: need for government level endorsement and leadership support of antimicrobial stewardship (AMS) activities; lack of AMS programs in hospitals; and lack of undergraduate/ postgraduate/at induction education and training in AMS for staff.

Background: Licorice is proposed as a treatment option for coronavirus disease-19 (COVID-19) by inhibiting the virus binding, penetration and replication; it also modulates various cellular signaling pathways. In this double-blind randomized-controlled trial, efficacy of Licorice hydroalcoholic extract oral formulation has been evaluated in patients with mild–moderate COVID-19in an outpatient clinic. Methods: A total of 40 mild to moderate outpatient Covid-19cases were randomly assigned into either Licorice or placebo groups (n=20 in each). Patients in Licorice group were given 700 mg capsules of hydroalcoholic extract of Licorice, trice a day for 2 weeks, while controls were given placebo capsules that were filled with Avicel (microcrystalline cellulose). Blood samples were collected from all participants before starting the medication and on days three, seven, and 14 for laboratory parameters including quantitative C-reactive protein (CRP), WBCs, lymphocytes, and neutrophils counts. The clinical symptoms were also recorded. Results: Our results showed that Licorice extract significantly decreased the frequency of cough on day seven (P=0.004) and the frequency of dyspnea on day three (P=0.02). No significant differences were found in the frequency of nausea, diarrhea, body pain, sore throat, runny nose, dizziness, lethargy, and loss of taste or smell between the two groups. Patients in Licorice group showed significantly higher oxygen saturations on days three, seven, and 14. Other laboratory parameters did not show any changes between the two groups. Conclusion: licorice extract improved some clinical symptoms such as cough and dyspnea while only increased the oxygen saturation. Further studies with larger sample sizes at different stages of Covid-19are suggested.

Background: One of the FDA-approved treatments for COVID-19 is remdesivir. In this study, we investigated adverse drug events (ADEs) of remdesivir in COVID-19 patients who contacted 13-Aban pharmacy's drug and poison information center (DPIC). Methods: In this study, data of patients receiving remdesivir who contacted the 13-Aban pharmacy's DPIC between April 2021 and May 2022 were extracted. For the evaluation of potential ADEs, we reviewed all contacts related to remdesivir recipients. Results: Out of 223 patients enrolled, 108 (48.40%) developed 120 ADEs. Elevated liver transaminase levels (26.67%) were the most common ADE, followed by weakness (7.5%), nausea, and vomiting (7.5%). The causality assessment of ADE using the Naranjo scale revealed that 41.67% were probable and 58.33% were possible. Conclusion: Based on the results of this study, hepatic dysfunction was the most prevalent ADE among remdesivir recipients; thus, in order to ensure safe use of remdesivir, patients should be closely monitored for this ADE.

Background: Critically ill patients treated in the intensive care unit (ICU) are at risk of drug-related problems (DRPs), clinical pharmacists are specifically trained in pharmacotherapy evaluations with the abilities to identify and manage drug-related complications. This study aims to identify areas where clinical pharmacists can be effective in the ICU. The primary outcomes of this study were determining the clinical aspect of clinical pharmacists in the ICU, type, and number of clinical pharmacist interventions. Methods: This was a prospective, interventional study in a teaching hospital in Iran. A clinical pharmacist was dedicated to implement comprehensive medication management (CMM); All Pharmacotherapy Problems were categorized. Results: During the monitoring of 162 patients by the clinical pharmacist, 1524 interventions were conducted. The most frequent pharmacotherapy-related problems identified were drug selection (33.3%), dose adjustment (17.3%), and fluid and electrolyte management (12.9%). Conclusion: Clinical pharmacists’ interventions could reduce the rate of DRPs by pharmacotherapy evaluation and may have important role in many aspects of patient’s management.

Background: Coronary endarterectomy is an adjunctive treatment to coronary artery bypass grafting (CABG) in patients with multiple coronary involvements. The aim of the present study was to compare the efficacy and safety of the rivaroxaban versus warfarin in patients undergoing CABG endarterectomy in a prospective observational study. Methods: All the patients who had undergone CABG endarterectomy and had received rivaroxaban or warfarin during the period from January2019 until August 2020 were included in the study. Need for salvage CABG, major bleeding, and thromboembolic events were considered as primary outcomes. The secondary outcomes included all-cause mortality and minor bleeding. The patients all were followed for at least six months after their hospital discharge. Results: Out of the 73 patients recruited during the 18 months, 45 received rivaroxaban and the remaining people received warfarin along with at least one antiplatelet. During the follow-up, no salvage CABG was performed. The minor bleeding was comparable between the two groups (31.96 versus 13.27; p=0.21). There was no significant difference between warfarin and rivaroxaban in terms of major bleeding and thromboembolic events (p=0.38 and >0.99, respectively). The all-cause mortality rate was similar between the two groups (p>0.99). Conclusion: In this preliminary real-word study, rivaroxaban was comparable to warfarin in terms of efficacy and safety in the patients undergoing CABG endarterectomy. Further larger studies are needed to clarify safety and efficacy of such approach.

Acute myeloid leukemia (AML) is a heterogeneous disease with multiple mutations in hematopoietic stem cells characterized by abnormality increases in immature or dysfunctional white blood cells. The precise mechanisms of AML development have not been clear but there are many factors increase to developing leukemia such as familial history of leukemia, elderly, life style, genetics and some chronic disease like diabetic. Multiple mutilations happen in the hematopoietic stem cells, acquire some form of genetic instability lead to improve expression of some protein kinase and transduction protein following that increase ROS formation, which is associated with increased DNA damage. Nowadays, the use antioxidant drugs are growingly accepted in universal due to their safety and efficiency to diminish the adverse effects of free radicals and treatment of the many diseases such as cancer. In this article, we discussed the correlation between acute myeloid leukemia incidence and the oxidant biomarkers (oxidative stress), and more focusing on the great role of antioxidant biomarkers, whether the non-enzymatic or the enzymatic in the protection of the cells against harmful effects of free radicals in the acute myeloid leukemia patients.

Corona virus disease 2019 (COVID-19) is primarily an infectious disease of the respiratory system. COVID-19 might have unusual extra pulmonary clinical manifestations as initial symptoms. This systematic review included case reports published from January 2020 to June 2022 in English language that met the following criteria: unusual clinical manifestations as a sole or first initial manifestation of COVID-19, Confirmed positive Reverse Transcription Polymerase Chain Reaction (RTPCR) and real time RTPCR COVID-19 patients, no history of pre-existing co morbidities or any family, past, personal history and complete details of patients with their management. All the case reports were identified in PubMed and Sciencedirect database. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.  A total of 14537 studies were screened and 46 case reports were included in this review. In 46 case reports, there were 49 patients (three case reports had two patients) in which 32 were males and 17 were females. Majority of the patients experienced neurological manifestations followed by gastrointestinal manifestations, haematological manifestations and ocular manifestations.  Health care professionals should be aware and alert about unusual extra pulmonary clinical manifestations of COVID-19 patients; this would help in making timely diagnosis and accurate treatment of COVID-19 patients.

The outbreak of opportunistic fungal infections such as mucormycosis has been a critical issue following coronavirus disease 19 (COVID-19). Mucormycosis is happened by the fungal group Mucorales and commonly affects immunocompromised patients. To date, COVID-19-associated mucormycosis (CAM) is being reported in several countries. It should be noted that CAM has been started in patients approximately within two to three weeks after the onset of COVID-19. However, here, in one case, fungal symptoms appeared after just one week. In patients with mucormycosis due to this enigmatic infection, the sinuses were most commonly affected, followed by the orbit, nose, and finally the brain. All cases received glucocorticoids as a part of viral therapy. Diabetes mellitus (DM) was reported in all but one case in which COVID-19 was detected, without complications, and this may be the sole predisposing agent.  Therefore, in this manuscript, we reported eight cases of COVID-19-induced mucormycosis. Although one case experienced evacuation of the right eye, others discharge with promising outcomes after receiving surgical debridement and proper anti-fungal treatment including, amphotericin B, caspofungin, and posaconazole.