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Background: Pneumonia is one of the common infectious diseases in the community and hospital, which can cause complications and death if not treated. Correct treatment of this disease is important. Therefore, in this study, we aimed to evaluate antibiotic stewardship for pneumonia with the American Thoracic Society (ATS) guidelines in Loghman Hakim Hospital in 2021. Materials and Methods: In this descriptive study, all patients admitted to Loghman Hakim Hospital in 2021 with pneumonia were evaluated. Age, gender, type of pneumonia (healthcare-associated pneumonia, community-acquired pneumonia, community-acquired aspiration pneumonia, early-onset and late-onset hospital-acquired pneumonia, ventilator-associated pneumonia, and hospital-acquired aspiration pneumonia), antibiotic type and dose, and renal dose adjustment of antibiotics were recorded. Then, the antibiotic prescription protocol in patients with pneumonia was compared with the ATS guidelines. Results: 72 people were included in the study; 11 (15.28%) had healthcare-associated pneumonia (HCAP), 24(33.33%) community-acquired pneumonia (CAP), 20(27.78%) community-acquired aspiration pneumonia (CAAP), 7(9.72%) hospital-acquired pneumonia (HAP), 4(5.56%) hospital-acquired aspiration pneumonia (HAAP), and 6 (8.33%) patients had ventilator-associated pneumonia (VAP). 31.94% did not receive antibiotics according to the protocol. 13.88% of patients received antibiotics correctly, but with the wrong dose, and in 18.06% of patients, the type of antibiotic was wrong (P-value=0.102). Conclusion: Monitoring antibiotic stewardship in the hospital for patients with pneumonia is necessary.

Background: Imaging and PCR each have a role in detecting and implementing precautionary measures in isolating individuals with a history of close contact, which helps limit the COVID-19 pandemic. Due to developing countries' difficulties, PCR is limited in Iran. This study seeks to determine the feasibility of early low-dose chest computed tomography (CT) scans substitution with PCR. Materials and Methods: Asymptomatic participants with a history of close contact with a confirmed case of COVID-19 were enrolled and followed for one week, receiving 2 PCR tests within one week. Initially, a chest CT scan was performed. The second CT scan was performed within one week on two participants. Participants with an initially negative CT scan and participants with a first CT scan compatible with COVID-19 who became symptomatic. Results: All Participants had an RT-PCR and at least one CT scan. Positive RT-PCR results were reported in 6 and 9 participants initially and within one week, respectively. Chest CT scans favoring COVID-19 infection were initially reported in 4 and 6 participants within one week, respectively. Seventeen participants showed neither symptoms nor positive RT-PCR or chested CT scans favoring COVID-19. Thirteen participants either had positive RT-PCR, a COVID-19 chest CT scan or became symptomatic. Conclusion: Rapid detection of COVID-19 and subsequent quarantining is crucial in the global fight against this pandemic. Our results showed lower sensitivity for chest CT scans compared to COVID-19 PCR, suggesting that chest CT scans are unsuitable for COVID-19 PCR tests.

Purpose: Vancomycin is a narrow therapeutic window glycopeptide antibiotic that acts against Gram-positive bacteria. As it is renally eliminated, therapeutic drug monitoring is recommended for vancomycin, especially in case of kidney function alteration. Augmented renal clearance (ARC), defined as a creatinine clearance of more than 130 ml/min, is a risk factor for sub-therapeutic concentrations of vancomycin. This study aimed to evaluate the vancomycin pharmacokinetics following the administration of two different regimens in ARC patients.Methods: A randomized clinical trial (IRCT20180802040665N1) was conducted on patients in need of vancomycin therapy. Eight hours of urine was collected and 56 patients divided into two groups with creatinine clearance of more than 130 ml/min were included in the study. The first group received 15 mg/kg of vancomycin every 12 h and the second group 15 mg/kg every 8 h. After four doses, the peak and trough concentrations were measured from two blood samples. The primary outcome was the percentage of patients who attainted AUC more than 400. The occurrence of acute kidney injury also was evaluated after seven days.Results: The mean age of patients in the every 12 h and every 8 h groups was 44.04 ± 16.55 and 42.86 ± 11.83 years, respectively. While neurosurgical issues were the most common causes of hospitalization, central nervous infections were the most common indications for vancomycin initiation. Urinary creatinine clearance was 166.94 ± 41.32 ml/min in the every 12 h group and 171.78 ± 48.56 ml/min in the every 8 h group. 46.42% of patients in the every 12 h group and 82.14% of patients in the every 8 h group attained AUC/MIC of more than 400 mg × hr/L. None of the patients in the every 12 h group reached more than 15 mcg/ml concentration. At the 7-day follow-up, 10.7% patients in the BD group and 28.6% patients in the TDS group developed acute kidney injury (p = 0.089).Conclusion: Administration of vancomycin at a dose of 15 mg/kg every 8 h is associated with higher pharmacokinetic attainment in ARC patients. The occurrence of acute kidney injury also was not significantly higher in this therapeutic regimen. AUC/MIC monitoring is necessary in this population.

Abstract Serotonin syndrome is a potentially life‐threatening adverse drug reaction typically caused by a single or combination of two or more medications with serotonergic properties due to increased serotonin release. Our case is a 60‐year‐old drug‐addict man who was admitted to the poisoning department of Loghman hospital with methadone poisoning. On the fifth day of hospitalization and after initiating the linezolid treatment for VAP, the patient began to run a fever with agitation, tremor, spontaneous clonus movement in the hands, and tachycardia. Due to patients' manifestations and after ruling out other diagnoses, serotonin syndrome was confirmed with the possibility of concomitant use of linezolid and methadone. Linezolid administration was promptly discontinued, and vancomycin therapy was initiated (1000 mg twice a day intravenously). Supportive therapies were performed. Finally, tremor, rigidity, and clonus movement disappeared within 48 h.

Abstract Datura spp. is a potentially poisonous plant that is widely spread and is simply accessible, which can yield poisoning with a central and peripheral anticholinergic effect. We reported cases of family poisoning caused by the herbal tea with refreshing effects that were identified as Datura spp.

Abstract Here, a case of Sputnik‐V vaccine‐induced panniculitis was reported. The patient developed erythema, induration, and local tenderness at the injection site after 13 days of the injection. Ultra‐sonography imaging showed inflammation in subcutaneous layers including fat tissue compatible with panniculitis. She received ibuprofen and warm compress, and all symptoms resolved.

Rheumatoid arthritis (RA) is considered as an autoimmune-related condition in which the overproduction of pro-inflammatory cytokines leads to an inflammatory cascade. N-acetylcysteine (NAC) is a potent anti-inflammatory and anti-oxidant agent. We aimed to explore the impact of oral NAC on cytokines activities and clinical indicators in RA patients. In this placebo-controlled randomized double-blind clinical trial, 41 active RA patients were allocated in either NAC (600 mg, twice a day) or placebo group, as add-on therapy to the routine regimen, for 8 weeks. Disease activity score with an erythrocyte sedimentation rate (DAS28-ESR), and serum concentrations of interleukin (IL)-1β and IL-17 were assessed at baseline and end of the trial for all participants in the test and control groups. The reduction of the DAS28-ESR was higher considerably in the NAC group compared to that of the control group. No statistically significant differences were seen in the reduction of IL-1β and IL-17 cytokines between the NAC and control groups. In addition, improvements in the patient global assessment, number of tender joints, number of swollen joints, and the ESR rates were in favor of the NAC group. Our findings reveal that NAC may have a beneficial effect on all of the clinical features of RA. However, non-significant variations in the IL-1β and IL-17 levels suggest an alternative way of NAC effectiveness without influencing the measured cytokines. Nevertheless, these results need to be confirmed by further investigations.

Background: Due to uncontrolled lymphocyte reaction, the overproduction of cytokines in COVID-19 patients can cause sepsis-like symptoms, suggesting sepsis, cytokine release syndrome (CRS), and secondary hemophagocytic lymphohistiocytosis (sHLH). Since different therapeutic approaches are used for each diagnosis, differentiation is essential. This study aims to use H-score as a possible prognostic tool in COVID-19 patients. Methods: A sample of 64 moderate and severe COVID-19 patients was enrolled in this study. Clinical and laboratory findings were assessed. H-score was initially calculated and reevaluated among severe cases 72 hours later and among moderate cases showing severe features of COVID-19. Results: Mortality of 31.3% was reported. Laboratory findings, including triglycerides (TG), ferritin, and aspartate aminotransferase (AST) showed significantly higher initial and follow-up laboratory assessment levels in severe cases than in moderate cases. Moreover, fibrinogen was significantly higher among severe cases than moderate cases at the initial assessment, but no significant difference was reported in the second fibrinogen assessment. Conclusion: In this study, H-score was useful as a predictive tool for the initial evaluation of severe cases of COVID-19. H-score is much lower in these patients than in non-COVID-19 HLH patients may be due to the different underlying immunologic pathophysiology of COVID-19; thus, each H-score criterion must be evaluated for sensitivity and specificity in COVID-19 patients. The H-score cut-offs, H-score may be useful for diagnosing immune overreaction and determining the need for more exclusive immunomodulatory treatments.

Objective: Increased risk of infection following hyperglycemia has been reported in hospitalized patients. Sliding-scale insulin protocol is an out-of-date method; therefore, it is necessary to examine new approaches in this regard. This study aimed to evaluate the efficacy of sliding-scale protocol versus basal-bolus insulin protocol, which supervised by clinical pharmacists in an infectious disease ward. Methods: In this prospective randomized clinical trial, 90 hyperglycemic patients who hospitalized in Loghman Hakim Hospital Infectious Disease Ward (Tehran, Iran) were randomized into two groups: sliding-scale insulin protocol (the control group) and the basal-bolus protocol groups that were under supervision clinical pharmacists. Some demographic, laboratory, and clinical variables, as well as patient's blood glucose were measured four times daily. Findings: The results indicated significant improvement among the patients in the intervention group. General indicators including fever, blood glucose level, the duration of hospitalization, incidence of hypoglycemia, days to achieve normal blood glucose, and leukocyte count improved in intervention group. Conclusion: According to this study, basal-bolus insulin protocol, which supervised by clinical pharmacy service, showed better blood glucose control and infection remission compared to the sliding-scale protocol.

Background: Vancomycin is a glycopeptide antibiotic that is widely used for the treatment of gram-positive microorganisms, including methicillin-resistant Staphylococcus aureus. It is a valuable antibiotic in practice; unfortunately, its excessive use and mistakes in prescription have increased bacterial resistance. Hence, this study seeks to investigate the common errors related to the pharmacokinetics of vancomycin prescription in teaching hospitals in Iran. Methods: This study is an observational study that research orders with errors related to pharmacokinetics parameters of vancomycin. A total of 150 patients were enrolled in the study from May 2016 to September 2018 in teaching hospitals. Errors in drug prescription were identified based on literature resources. Results: About 22.7% of patients did not receive the loading dose. Also, 85.3% of patients were prescribed a fixed dose, instead of weight-based dosing. About 46% of patients had kidney problems (chronic kidney disease or acute kidney injury) and all of them had received a much lower dose than they needed according to guidelines. Another 46% of patients did not undergo therapeutic dose monitoring correctly. Finally, 69.3% of patients had not received consequent doses after encountering a nontherapeutic trough level correctly. Also, none of 22 obese patients with a body mass index of greater than 40 kg/m2, had received the proper dose. Conclusion: Since the incorrect use of vancomycin significantly increases the prevalence of resistant organisms and, consequently, the mortality rate of patients, it is necessary to define guidelines for its use in the hospital.

Background: Drug utilization evaluation (DUE) is an effective process in order to identifying variability in drug use and subsequent application of effective interventions for improving patient outcomes. In this study, appropriate uses of drugs were evaluated by pharmacy service. Methods: A prospective, interventional study was designed for determining frequency and type of clinical pharmacists’ interventions and medication errors occurred in the infectious disease ward of Loghman hospital, affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran during 8 months. Results: During the 8 months of the study period, 498 errors were detected among 419 patients that admitted to infectious disease ward of Loghman hospital. Most common errors were related to DVT prophylaxis, SUP and vancomycin monitoring. Discussion: Our result showed that clinical pharmacy interventions can have an important role in reducing adverse drug events and their activities can be effective for reducing of medication error.

Magnetic Resonance Imaging (MRI) contrast agents most commonly agents used in diagnosing different diseases. Several agents have been ever introduced with different peculiar characteristics. They vary in potency, adverse reaction and other specification, so it is important to select the proper agent in different situations. We conducted a systematic literature search in MEDLINE/PUBMED, Web of Science (ISI), Scopus, Google Scholar by using keywords “gadolinium” and “MRI contrast Medias”, “Gadofosvest”, “Gadobenate” and “Gadoxetate”. The most frequent contrast media agents made based on gadolinium (Gd). These are divided into two categories based on the structure of their chelating parts, linear agents and macrocyclic agents. All characteristics of contrast media factors, including efficiency, kinetic properties, stability, side effects and the rate of resolution are directly related to the structure of chelating part of that formulation. In vitro data has shown that the macrocyclic compounds are the most stable Gd-CA as they do not bind to serum proteins, they all possess similar and relatively low relaxivity and the prevalence of Nephrogenic Systemic Fibrosis (NSF) has decreased by increasing the use of macrocyclic agents in recent years. No cases of NSF have been recorded after the administration of any of the high-relaxivity protein interacting agents, the vascular imaging agent gadofosveset trisodium (Ablavar), the hepatic imaging agent gadoxetate meglumine (Eovist), and the multipurpose agent gadobenate dimeglumine (MultiHance). In pregnancy and lactating women, stable macrocyclic agent is recommended.

Any suboptimum treatment in the management of patients can lead to medication errors (MEs) that may increase morbidity and mortality in hospitalized individuals. By establishing well-designed patient care activities within the managed care setting, clinical pharmacists can cooperate with other health care professionals to provide quality care and maximize safety. The aim of this study was to evaluate the frequency and prevention of MEs by clinical pharmacists. This was a cross-sectional interventional study conducted in internal wards of a teaching hospital during a two-month period. During this period, patient records, and physician orders were reviewed by clinical pharmacists. Any prescription error identified was documented. Incorrect drug selection, dose, dosage form, frequency, or route of administration all were considered as medication errors. Then, the clinical pharmacist discuss about findings with the clinical fellows to change faulty orders. The frequency and types of MEs in different wards that were detected and prevented by clinical pharmacists was documented. During the study period, in 132 patients, 262 errors were detected (1.98 per each). Wrong frequency 71 (27%), forget to order 37 (14.1%), wrong selection 33 (12.5%), drug interactions 26 (9.9%), forget to discontinue 25 (9.5%) and inappropriate dose adjustment in renal impairment 25 (9.5%) were the most types of errors. Cardiovascular medications were the class with the highest detected errors (31.6%) followed by gastrointestinal agents (15.6%). Medication errors are common problems in medical wards that their frequency can be restricted by the intervention of clinical pharmacists.