Clinical solid organ transplant (SOT) pharmacy services started half a century ago in United States (US). In 2004, United Network of Organ Sharing (UNOS) bylaws mandated all SOT programs to recognize pharmacist as a responsible for providing pharmaceutical care to SOT patients. Soon after that, SOT pharmacy services were implemented in Iran and nowadays SOT pharmacists are members of SOT multidisciplinary teams with various clinical, education, and research duties during pre-, peri-, and post-transplantation phases. Board Certification in Solid Organ Transplant Pharmacotherapy (BCTXP) was established in 2018 in the US. The aim of this postdoctoral program is providing SOT pharmacotherapy services for all patients from pre-transplantation era to decades after transplantation event in community and hospitals. Inspiring that, SOT pharmacotherapy fellowship has been programmed in Tehran University of Medical Sciences and is under consideration by National Board of Clinical Pharmacy and Ministry of Health and Medical Education of Iran. Hopefully, this program will be initiated with the first applicants among board certified clinical pharmacists from Fall 2024.

Background: Drug utilization studies are powerful exploratory tools for establishing the role of drugs in society and also effective methods for assessing the prescribing pattern of clinicians. Around 4-10% of children suffer at least one seizure episode at 16 years of age. Even after the availability of several Antiepileptic drugs (AEDs), choosing the correct drug with accurate dosing will produce seizure-free generation. Hence, this study aims to examine the prescription patterns of drugs in epileptic children. 

Methods: This study was a cross sectional observational study. Children <16 years old visiting neurology department with a history of epileptic seizures and already on antiepileptic drug therapy were included in the study. The data comprised of demographic details, disease history, type of seizure, diagnosis, investigations done, along with prescribed medication noted in case record form. The total study duration was 13 months. 

Results: In this study, the maximum epilepsy encountering age in male and female children was   below the 12-year age group, male predominance was higher than females (male 60.83% vs. female 39.16%). The majority of children were diagnosed with generalized tonic colonic seizures, 54.17%, followed by focal/or partial seizures, 39.17%. Sodium valproate 19.16%, carbamazepine 14.17%, oxcarbazepine 16.67%, and levetriacetam 13.33% were the most commonly prescribed single drug regimens for treating both types of seizures, followed by clobazam added as second and third adjuvant drug in resistant epilepsy to valproate 12.5%, oxcarbazepine 6.67%, and levetriacetam plus carbamazepine combination 5% respectively. 

Conclusion: Monotherapy was majorly followed in 70% of pediatric patients for maintaining better patient compliance. Both old and new AEDs regimens are prescribed for maintaining the quality of life in patients.

Background

During COVID-19, healthcare systems in underdeveloped nations had significant challenges and were unlikely to offer the necessary care. It appears that a new, reliable healthcare model that prevents hospitalization is necessary to reduce the pressure that COVID-19 is putting on healthcare systems and patients. More particularly, as Remdesivir's use as an outpatient treatment for mild to severe SARS-CoV-2 infection has rarely been examined; we aimed to investigate in-depth comprehension of the effects of Remdesivir in these cases.

Methods

In our two-month cross-sectional study, non-hospitalized patients with mild to moderate COVID-19 who were referred to the hospital for up to 5 days of Remdesivir treatment received 200 mg of Remdesivir intravenously on day 1, followed by 100 mg of Remdesivir once daily for the subsequent 4 days. Patients were divided into groups based on the time of starting Remdesivir treatment after the appearance of symptoms: group 1 less than and equal to 7 days, and group 2 more than 7 days. Two groups were evaluated for a correlation between Remdesivir administration time and clinical symptoms on days 1 and 14 (follow-up visits).

Results

The study enrolled 273 eligible patients with a mean age of 47.5 years, of whom 112 were males and 125 were females. Results showed that patients who received Remdesivir in the first 7 days had less dyspnea (P-value<0.0001) and lung involvement (P-value<0.0001) than those who received it after 7 days at the end of the study. Patients who came later to receive Remdesivir also showed higher fatigue, AST, and ALT levels on the first day.

Conclusions

Among patients with moderate COVID-19, those who received a 5-day course of Remdesivir within 7 days of the onset of symptoms had a statistically significant difference in clinical status compared with those who received their treatments later. However, the size of this finding has uncertain clinical importance.

Background: Surgical site infection (SSI) is the most common reason for patient readmission after surgery. Because most cases of surgical site infection are preventable with antimicrobial prophylaxis, adherence to appropriate guidelines is critical. The aim of this study was to evaluate adherence to guideline recommendations for antimicrobial prophylaxis of surgical site infections at Shahid Chamran Heart Hospital, Isfahan, Iran. Methods: This cross-sectional observational study was conducted using prospective data collected from December 2021 to June 2022 in the cardiac surgery ward of Chamran Hospital. Adherence to "Clinical practice guidelines for antimicrobial prophylaxis in surgery (2013)" was assessed using data from patient records regarding the type, dosage, timing, and duration of antimicrobial prophylaxis. Results: A total of 363 patients were included in this study. The compliance rate with the guideline in terms of the type, dosing, initiation time, redosing and duration of the antimicrobial agent was 99.72%, 1.6%, 98.8%, 29.28%, and 0% respectively.Conclusion: The present study revealed relatively low adherence to the guidelines in terms of dosing, re-dosing and duration of antimicrobial prophylaxis at Chamran Heart Hospital. Based on the results, developing a local guideline is highly recommended.

Background: This study evaluated the current practices of opioid and non-opioid analgesic administration for postoperative pain management in gynecological surgeries, aiming to optimize pain relief while minimizing side effects.

Methods: A cross-sectional, prospective Drug Utilization Evaluation (DUE) study was conducted at Al-Zahra Hospital, Tabriz, Iran. Medical records of 100 patients undergoing gynecological surgery were reviewed over five months. Data on prescribed analgesics, pain scores, and adherence to APS2016 and ERAS2016 guidelines were collected and analyzed statistically.

Results: Meperidine (pethidine) and diclofenac were the most frequently prescribed analgesics. The average patient pain score was 2.48 units. A combination of meperidine, diclofenac, and acetaminophen was identified as the most effective regimen for pain control. Prescribed regimens demonstrated 41.4±27.3% theoretical and 60.60 ± 28.77% practical compliance with APS2016 and ERAS2016 guidelines. While achieving the primary objective of pain relief with minimal side effects, compliance with established guidelines could be further improved through educational interventions.

Conclusion: Optimizing analgesic regimens for postoperative pain management requires careful consideration of individual patient needs, including the benefits of opioid analgesics in achieving greater pain reduction. Adherence to evidence-based guidelines and ongoing educational programs for healthcare professionals are crucial for ensuring optimal pain relief with minimal side effects.

Background: In 2019 COVID became the cause of a pandemic, with approximately 500,000 deaths in six months worldwide. Remdesivir, the first drug approved by the U.S. Food and Drug Administration (FDA) for COVID-19 treatment, gained attention from numerous medical centers worldwide.
Objective:The consecutive waves of COVID-19 peaks in Iran, coupled with the lack of widespread vaccination, and high consumption leading to a shortage of Remdesivir in the country, prompted an investigation into the usage patterns of Remdesivir and its correlation with clinical indicators in hospitalized patients.
Method: A retrospective cross-sectional study was conducted using 390 patients' electronic records in seven different hospitals. Electronic records were reviewed and information was extracted under four categories: demographic data, lab test results at admission, medication information, and lab test results after completing treatment. Patients were classified into three time periods based on the date of their first Remdesivir injection. Outcomes were defined as final clinical status and length of stay in hospital.
Results: A total of 390 patients were enrolled, with 198 females and 192 males. The longest hospital stay was 88 days, with an average of 7.5 days. A total of 1,979 doses of Remdesivir were prescribed, with 224 doses being in accordance with the national protocol, 22 doses exceeding the protocol, and 144 doses below the protocol. The overall average dose consumption was 5.07 for each patient.
Conclusion: Overall pattern of Remdesivir utilization in the hospitals evaluated in this study (affiliated with Shahid Beheshti University of Medical Sciences) has been reasonable and in accordance with national protocols for COVID-19 infection.

Through a multi-level and multi-target treatment approach, herbal medicines, such as Traditional Chinese Medicine (TCM), have been identified as revolutionary medical treatment for IPF. Due to their natural properties, herbal medicines have shown to possess low adverse effects, stable therapeutic impact, and no obvious drug dependencies. Herbal medicines have also shown anti-inflammatory and anti-fibrotic effects, which make them a promising therapeutic target for IPF. A growing number of formulas, herbal components, and various forms of Chinese herbal medicine extracts are available for IPF patients in China. This review summaries the role of herbal medicines in the prevention and treatment of IPF.