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In adults with acute and chronic end-stage liver disease, liver transplantation (LT) is the only treatment option for these patients. On the other hand, one of the substantial causes of death in these patients is bacterial infection after transplantation, which should be considered as well as appropriate antibacterial treatment. For this reason, this study was designed to provide a multi-faceted review of different types of infections after transplantation and their treatment options during one year of experience in the largest LT center for adult patients in Iran. In this retrospective cohort study, records from all individuals over 18 years of age candidates for liver transplantation in Abu-Ali Sina hospital, Shiraz, Fars, Iran from 2018 March to 2019 March , were assessed. Demographic, laboratory, and clinical data were extracted in addition to the antimicrobial therapy. In this study, 412 patients included. 15.77% of patients were infected after transplantation, of which 61.17% of the isolated pathogens were gram-negative and 38.83% were gram-positive. The most common isolated gram-positive and gram-negative microorganisms include staphylococci (27.69%) and Klebsiella (27.69%), respectively. Urinary tract infection was the most common type of infection after transplantation in adult liver transplant recipients, and length of stay in ICU, length of hospital stay, length of mechanical ventilation are among the risk factors affecting bacterial infection after LT.

Stroke-related atrial fibrillation (AF), deep vein thrombosis (DVT), and pulmonary thromboembolism (PE) are among the most common thromboembolic events. recently, direct oral anticoagulants (DOACs) have been slowly replacing warfarin. Rivaroxaban is a DOAC frequently prescribes to control thrombotic events. The safety and efficacy of Rivaroxaban are dependent on appropriate prescription, dosage, and other factors. This study is aimed to evaluate the Rivaroxaban utilization based on the standard protocol in both inpatient and outpatient settings. This cross-sectional/observational study was conducted for six months from 1st August 2018 to 1st February 2019 at a private hospital and also an outpatient clinic in Shiraz, Iran. First, a clinical pharmacist defined a standard protocol for Rivaroxaban utilization and several indexes (9 indexes for Non-valvular AF (NVAF) patients and 10 indexes for DVT/PE patients). Second, participants were classified into three groups (NVAF inpatients, NVAF outpatients, and DVT/PE patients). Finally, the adherence of Rivaroxaban utilization indexes in each group to was evaluated accordingly. Two hundred and forty one eligible patients were recruited into this study. Most patients (N=208), were NVAF. Rivaroxaban utilization was appropriate in 71.9%, 65.8%, and 50.6% of patients within groups 1, 2, and 3, respectively. Although medication interaction, administration regarding time/meal, and dose adjustment based on renal function showed the lowest compliance, the monitoring laboratory data and considering the underlying disorders were completely matched with the protocol. This study showed some critical errors in both settings, especially in DVT/PE patients (49.4% no match). Hence, the most productive collaboration must be developed between clinical pharmacists and clinical practitioners.

In December 2019, the coronavirus disease-2019 (COVID-19) outbreak emerged in Wuhan, China. The World Health Organization officially declared it a pandemic on March 11, 2020. Reports indicated that the associated mortality of the infection is quite higher in the elderly, individuals with specific comorbidities (such as diabetes mellitus), and generally the ones with a compromised immune system. A cohort study in Wuhan, China, reported a dysregulated immune response in 452 patients with laboratory-confirmed COVID-19. As a result of this suppressed immune response, an increase in neutrophil to lymphocyte ratio, T lymphopenia, and a decrease in CD4+ T cells were all common laboratory findings, especially in severe cases.On the other hand, there is substantial evidence of T cell exhaustion in critically ill patients. Accordingly, the immune system seems to play an important role in the prognosis and pathogenesis of the disease. Therefore, this study aims to review the evidence on the immune response dysregulation in COVID-19 infection and the potential role of immunoregulatory treatments such as immune checkpoint inhibitors, interferons, and CD200 inhibitors in altering disease prognosis, especially in critically ill patients.

Coronavirus can negatively affect the immune system. This complication can be exaggerated in pregnant women with micronutrient and elemental deficiencies. Also, coronavirus itself can induce micronutrients malabsorption and result in their severe deficiencies that can lead to increased risk of infection in these groups of patients. Serum calcium, zinc, iron, and selenium values have a positive correlation with PO2 values and a negative correlation with severe COVID-19 infection, lung involvement, fever, and C-reactive protein (CRP) concentration. In this mini-review study, the safety and efficacy of different suggested micronutrients including zinc, selenium, iron, vitamin A, C, D, E, and myo-inositol in pregnant women with COVID-19 have been discussed. According to the clinical practice findings and previous reports, administration of essential micronutrients including zinc, selenium, and iron and vitamins including vitamin A, B8, C, D, and E with optimum recommended dietary allowances (RDAs) during pregnancy would be promising and suggestive to improve maternal/neonatal complications during COVID-19 infection due to the enhanced immunity system against viral infection and COVID-19 pneumonia.

Purpose: Proper diagnosis of the corneal ulcer is one the most important efforts in the eyes medical urgencies. The aim of this study was to determine the bacteriological profile and in vitro antibiotic resistance of the bacteria isolated from the eyes of patients with infectious corneal ulcers Methods: In this study, 94 patients with corneal ulcer disease participated. After differential diagnosis of potentiated corneal ulcer infection and sampling of the active area of the wounds, the sample was transferred to the laboratory for cultivation in the suitable culture medium and finally incubatedin proper temperature. In cases of positive culture, the type of bacteria and antibiotic sensitivity test of the broth micro-dilution method was performed and evaluated for five antibiotics including ciprofloxacin, levofloxacin, gentamycin, erythromycin, and chloramphenicol. Results: our results indicated that patients consisted of 55% male and 45% female, 51% of whom were positive and the most common bacterium was staphylococcus negative coagulase with 48% prevalence. The isolated bacteria sensitivity for levofloxacin, ciprofloxacin, gentamycin, erythromycin and chloramphenicol was 94%, 79%, 67%, 33%, 27%, respectively.In vitro study for levofloxacin and ciprofloxacin showed ahigher percentage of antibiotic sensitivity in patients with corneal infectious ulcers in comparisonto other antibiotics. However, Erythromycin and chloramphenicol were not suitable for the bacterial corneal ulcer treatment due to the high microbial resistance. Conclusions: Accurate and precise training of physicians in the prescribing of ocular antibiotics as well as the prevention of arbitrary use of these drugs is important for reducing the microbial resistance.

Background: Medication errors may prolong hospitalization period, enhance its costs and make harmful impacts on health. Inappropriate drug history taking is a type of medication errors which may occur on admission, resulting in medication discrepancies. Objective: This work presents a report of discrepancies between the drug history acquired by pharmacists and the drugs administered by the physicians at a teaching hospital in Shiraz, Iran. Method: This prospective study was conducted from October 2016 to March 2017 in 7 wards of Namazi hospital affiliated to Shiraz University of Medical Sciences. Both the physicians/nurses and pharmacists obtained medication history from patients recruited in this study during the first 24 hours of their admission. The medications were classified according to the ATC classification.Results: Totally, 103 patients were recruited and 557 medications were recorded in this study. The mean±standard deviation age of patients was 58.52±18.75 years. Comparing pharmacist drug history with medication lists obtained by nurses or physicians revealed 353 discrepancies. On average, 3.42 discrepancies were identified per patient (ranged from 0 to 12). Most (85.8%) of medication discrepancies were related to omission errors. Metformin and aspirin were the most common medications involved in omission errors.Conclusion: The rate of medication discrepancies at admission in our hospital was high. Active contribution of pharmacists and providing accurate medication histories at the time of hospital admission can be considered as possible solutions for this problem.

Introduction : The purpose of the study was to evaluate Intensive Care Unit nurses’ knowledge, attitude, self-reported practice, and observed practice regarding medication administration via enteral feeding tube.Method:in this cross sectional study, a questionnaire and a checklist was developed for evaluating the nurses' knowledge, attitude, self-reported practice and real practice regarding medication administration via enteral feeding tube. Mean score of knowledge, and the percentage of different domains of attitude and practice was reported.Results: 53 nurses were included in this study. The mean number of medications which were prescribed for each patient was 15.8±4.5. From these medications, 5.5±2.8 drugs were administered via enteral feeding tube. There were few nurses (5%) with proper knowledge regarding correct dosage forms selection. About half of the nurses had proper knowledge regarding tube flushing and drug dilution,however according to direct researcher’s observation, 11% of nurses flushed the tubes before medication administration.Conclusion:The current study showed the disparity between the nurses' knowledge, self-reported practice, and proper performance in drug administration through enteral feeding tube. The most important problems in knowledge and attitude of nurses included crushing the dosage forms and in real practice in diluting medications and tube flushes domain.

Purpose: children are a large group of patients receiving medications. Since pediatric dosageforms are generally not available, adult dosage forms have to be used for children instead, which leads to large amounts of drug wastage, and high costs are imposed on the healthcare system. This study was carried out to evaluate the amount of medication waste and the cost in pediatric wards of two major pediatric referral centers in southern Iran. The results were compared with an adult ward in the same hospital.Method: This comparative cross-sectional study was carried out during a three-month period, from April to June 2014, assigning one month to each ward. A trained pharmacist collected the data using direct observational method during morning shifts. All the drug preparation processes were evaluated by direct visual observation. During this supervision, factors involved in medication waste and also the dose of drug prescribed and wasted were evaluated.Results: The percent of medication waste in pediatric wards of Nemazee and “Shiraz Ghadir Mother and Child” hospital was 17.4% and 18.05%. The cost of wastage was estimated to be 568.11 USD and 368.11 USD for each hospital during one-month. According to the results, in pediatric wards of “Nemazee” and “Shiraz Ghadir Mother and Child” hospitals 101 out of 290 and 45 out of 80 prescriptions consisted of at least one antibiotic. In both hospitals the most prescribed antibiotic was vancomycin.Conclusion: The results indicated that medication waste in pediatric ward of Nemazee hospital was not significantly different in comparison with pediatric ward of Shiraz Ghadir Mother and Child hospital, but the waste was calculated to be more in the pediatric ward in comparison with the adult ward of Nemazee hospital. The most wasted group of medication was reported to be antibiotics. Vancomycin was reported to have the highest consumption and gentamicin was the leading wasted medication.

Medication Errors (MEs) play a significant role in mortality and morbidity of hospitalized patients. Therefore, it seems advisable to determine types and consequences of such errors when addressing patient safety. The aim of this study was to determine the incidence, types, outcomes of errors in a 10 bed pediatric Intensive Care Unit at a large teaching hospital from September 2013 to February 2014 in southern Iran.The occurrence of errors was detected with direct observation method. A trained pharmacist selected 41 patients randomly in forty one working shifts. No patient arrived the study twice. In each shift, patient’s medications were observed from prescription, administration, transcription, and dispensing. The pharmacist would intervene only if the ME could cause substantial harms to a patient. All data were reviewed by a clinical pharmacist and a pediatric intensivist to confirm the type of the errors.Of the 512 drug dosages observed, 48.8 errors/100 orders were detected, Administration errors occurred on 148 occasions, with 28.9 chances to occur in each 100 orders. Prescription, transcription and dispensing errors came next with 14.25, 4.88 and 0.78 chance in each 100 orders, respectively. Wrong time, wrong technique, and wrong preparation were among the commonest types of administration errors with 14.1%, 5.7% and 4.9%, respectively. Monitoring errors group with 11.3% was the most common type of prescribing errors.The results of this study highlights the high medication error rates in pediatric ICU under the study, with administration and prescription errors marked the highest share of them. Hence implementing the effective strategies to reduce them are needed.