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   Table of Contents - Current issue
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October-December 2018
Volume 7 | Issue 4
Page Nos. 171-212

Online since Thursday, December 6, 2018

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REVIEW ARTICLE  

The clinical efficacy of imiglucerase versus eliglustat in patients with Gaucher's disease Type 1: A systematic review Highly accessed article p. 171
Azita Nabizadeh, Bahman Amani, Maliheh Kadivar, Mahdi Toroski, Akbar Abdollahi Asl, Yahya Bayazidi, Mahdi Mojahedian, Majid Davari
DOI:10.4103/jrpp.JRPP_18_24  
Gaucher's disease (GD) is one of the most common lysosomal diseases in humans. It results from β-glucosidase deficiency and leads to necrosis, especially in macrophages with the accumulation of glucosylceramidase in cells. Most of the deleterious effects of the disease are seen in the liver, spleen, and bone marrow. The aim of this study was to compare the efficacy of Imiglucerase with Eliglustat in treating patients with GD. PubMed/Medline, Cochrane Library, Scopus, Web of Science, Embase, and Google Scholar were searched from inception to August, 2018. Predefined inclusion criteria for included studies were based on search methodology and are as follows: All randomized, quasi-randomized controlled, and cohort studies about patients with GD Type 1 that Imiglucerase was compared with Eliglustat were included. Two authors independently choose the papers based on the inclusion criteria. From 2979 recognized studies, three studies including two randomized clinical trials and one cohort study were recognized to meet the inclusion criteria. The primary outcomes were hemoglobin level, platelets count, liver, and spleen size, and the secondary outcomes were the immunological side effects of the medicines and bone complications. The results showed that there is no meaningful difference between the two medicines in terms of increasing blood hemoglobin, platelets count, and reducing the liver and spleen size. The findings of this review showed that both medicines are effective in the treatment of GD Type 1 and there is no statistically significant difference between their efficacies.
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ORIGINAL ARTICLES Top

Serum cystatin C for evaluation of acute kidney injury in adults treated with colistin p. 178
Rozina Abbasi Larki, Bahareh Jamali, Mohsen Meidani, Sarah Mousavi
DOI:10.4103/jrpp.JRPP_18_53  
Objective: Recent studies have shown that serum cystatin C (Cys C) is a better marker for measuring the glomerular filtration rate and may rise more quickly with acute kidney injury (AKI). The purpose of this study was to evaluate the clinical application of serum Cys C to predict colistin-induced nephrotoxicity in comparison with serum creatinine (SCr). Methods: Thirty-two adult patients with no history of acute or chronic kidney injury having been planned to receive intravenous colistin for an anticipated duration of at least 1 week for any indication were recruited. At baseline and 5 days after colistin treatment, serum Cys C as well as creatinine levels were measured. The incidence of colistin-induced acute renal failure was defined according to the AKIN criteria for SCr. Rise in concentration of Cys C by more than 10% from baseline considered as AKI. Findings: Colistin-induced nephrotoxicity (defined as SCr ≥0.3 mg/dl) occurred in 6 patients (18.8%). A Cys C increase concentration ≥10% after 5 days of colistin treatment was detected in 15 patients (46.9%). There was a poor agreement between the presence and absence of any SCr-AKI and Cys C-AKI (κ = 0.28, P = 0.04). Conclusion: Serum Cys C is a better marker of renal function in early stages of AKI and predictive of persistent AKI on colistin treatment.
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Impact of protocol implementation on rationalization of albumin use in a tertiary care teaching hospital in Tehran, Iran p. 182
Sholeh Ebrahimpour, Marzieh Nosrati, Mehdi Mohammadi, Haniyeh Kamyab, Amir Sarayani, Habibollah Mahmoodzadeh, Zahra Jahangard-Rafsanjani, Kheirollah Gholami
DOI:10.4103/jrpp.JRPP_18_38  
Objective: With respect to the high cost and limited availability of albumin, its use must be restricted to indications strongly supported by solid scientific evidence. It was anticipated that with the implementation of the National Health Reform Plan (NHRP), the consumption of albumin would increase as the result of decreasing patients' out-of-pocket costs. This study aimed to evaluate the efficacy of protocol implementation on the rationalization of albumin use in surgery wards of Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran. Methods: This pre-post interventional study was conducted in 32-month phases from January to November 2014 in an Iranian University hospital. The first phase was before the implementation of NHRP, the second phase was after NHRP, and the last one was after the intervention. The first and second phases were conducted retrospectively. Data extraction was performed by a hospital pharmacist. During the third phase, the physicians were mandated to adhere to a local albumin protocol which had been prepared by clinical pharmacy service and approved by drug and therapeutic committee. Appropriateness of prescriptions regarding indication, dose, and duration based on local guideline was compared among groups. Findings: Although hospital bed-days of care remained consistent among phases, albumin was prescribed for 40, 45, and 8 patients during first, second, and third phases, respectively. This shows about 80% reduction of drug prescriptions in the last phase. The mean duration/dose of albumin in inappropriate indications reduced significantly from 11.3 ± 8.2 days/24.7 ± 21.2 vials in the second phase to 2.6 ± 1.7 days/5.6 ± 3.5 vials in the third phase, respectively (P = 0.001 and P = 0.003). Conclusion: Interactive collaboration through guideline implementation seems effective in rationalizing the use of high-cost medications such as albumin.
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Predicting factors for the pattern of intravenous immunoglobulin utilization in a middle eastern university hospital p. 188
Zeinab Fakhari, Shadi Farsaei, Ali Mohammad Sabzghabaee
DOI:10.4103/jrpp.JRPP_18_73  
Objective: The dramatic increase in the consumption of intravenous immunoglobulin (IVIG) products in nonapproved indications, its high cost, and the severe shortage has developed the concerns of its irrational utilization, especially in the Middle East countries. Therefore, this clinical study attempts to describe the pattern of IVIG administration in one of the largest hospitals in Iran and find the variables associated with inappropriate IVIG utilization. Methods: This cross-sectional medication utilization study was conducted in one of the largest referral hospitals in Iran. Random IVIG administrations were assessed from different wards for 9 months. Different data were collected to evaluate the pattern of IVIG administration and find variables, which could predict this behavior. Findings: IVIG was prescribed for approved indications in 72% of 201 patients recruited in our study. Although, the rate of drug administration was appropriate in most of the study population, hydration and pre-medication were unsuitable in more than one-third of the patients. Among the variables analyzed to find the factors affecting the misuse of IVIG, female gender, older age of patients, and longer time to start IVIG administration due to hospital admission were statistically significant in the multivariate model. Conclusion: Despite the fact that inappropriate use of IVIG was confirmed in less than 30 % of its utilization for the studied patients, it caused a potential risk of treatment complications and a notable and unjustifiable burden of unnecessary costs for this University hospital.
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Omega-3 supplementation improves pruritus in continuous ambulatory peritoneal dialysis patients: A crossover randomized pilot clinical trial p. 195
Arian Pourmehdi Lahiji, Mojgan Mortazavi, Shahnaz Amani Tirani, Firouzeh Moeinzadeh, Ehsan Zarea Bidaki, Afsoon Emami Naini, Gita Faghihi, Arash Toghyani, Ziba Farajzadegan
DOI:10.4103/jrpp.JRPP_18_64  
Objective: Pruritus is a prevalent skin condition in end-stage renal disease patients. Omega-3 fatty acids have been shown to reduce pruritus in hemodialysis patients. Our objective was to assess the effect of 3 g/day omega-3 supplementation on pruritus among continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: In this two-period, two-sequence crossover randomized clinical trial, 40 eligible subjects (CAPD patients who complained of pruritus for more than 8 weeks) were randomized to 3 g of omega-3 (n = 20) or identical placebo capsules (n = 20) for 4 weeks. After a wash-out period of 6 weeks, patients were crossed over to the alternate treatment option. Pruritus intensity was assessed using the visual analog scale (VAS) at baseline, 2-and 4-weeks post-intervention in each study period. Both patients and investigators were blinded to the study protocol. Findings: No significant carry-over effect was detected. The mean pruritus score (VAS) in the omega-3 group compared with placebo group after the first (−3.02 vs. −0.48, P < 0.001) and second (−4.09 vs. −0.43, P < 0.001) intervention periods showed higher significant decrease. Conclusion: In summary, omega-3 supplementation is an effective treatment for pruritus alleviation in CAPD patients. Further studies are needed to determine the mechanisms underlying antipruritic effects of omega-3.
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Predictive factors of treatment outcomes for hospital care in children with acute methadone poisoning p. 200
Yasamin Atighi, Nastaran Eizadi-Mood, Marjan Mansourian, Amin Zamani, Ali Saffaei, Ali Mohammad Sabzghabaee
DOI:10.4103/jrpp.JRPP_16_141  
Objective: The trend of methadone toxicity in children and adolescents seems to be increasing in Iran since it is used as a legal measure of the treatment for opioids addiction in methadone maintenance therapy clinics. In the present study, we describe the clinical and demographical characteristics of acute methadone toxicity in a cohort of pediatric poisoned patients in Isfahan, Iran and discussed the predictive factors for their treatment outcomes. Methods: In this 4-year cross-sectional study which was performed from 2013 to 2016 in a referral university hospital (Isfahan, Iran), medical records of the demographic and admission time clinical characteristics of all in-patients aged <18 years with acute methadone poisoning were abstracted and analyzed. According to the outcomes of hospital care and treatment, patients were divided as survived without medical complication and patients survived with at least one medical complication or death. Findings: A total number of 157 (79 male) children and adolescents with a mean age of 105.4 ± 6.1 months were hospitalized and included in the study. A total of 145 (92.4%) patients survived and discharged from the hospital without any medical complication. Pupil size, respiratory rate, and level of consciousness were predictive factors for the outcome of death or medical complications. Conclusion: It seems that methadone poisoning in children and adolescents is more commonly accidental in school-aged boys (6–12 years old) and it occurs mostly with the syrup dosage form, especially when one of the parents or people who live with the child has an addiction history and if the patients' house located in lower socioeconomic class area of Isfahan city (Iran).
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Off-label prescribing of antipsychotics in a Danish child and adolescent mental health center: A register-based study p. 205
Kristine Tøfting Kornø, Lise Aagaard
DOI:10.4103/jrpp.JRPP_18_42  
Objective: We analyzed prescribing patterns of antipsychotics for children and adolescent affiliated with a Danish Child and Adolescent Mental Health Center) with respect to age, sex, medicine, diagnoses, off-label status, and time. Methods: We included all patients below 19 years of age prescribed antipsychotics during 2007–2008 and as of November 1, 2014. Prescription data included all antipsychotic prescriptions and prescriptions of concomitant psychotropic medications. We defined an antipsychotic user as a patient receiving at least one prescription during the study period, irrespective of any previous history of antipsychotic use. We defined off-label prescribing as prescriptions outside the licensed age group and approved indication. Findings: We analyzed 404 antipsychotic prescriptions that were located for 150 patients. The patients were between 7 and 18 years of age. Two-thirds of the prescriptions were for girls and two-thirds of prescriptions for olanzapine and quetiapine. Totally, 92% of all prescribed antipsychotics were used off-label. For typical antipsychotics, this share was 96% and for atypical antipsychotics 90%. As of November 1, 2014, the total share of off-label antipsychotic prescriptions was 96%, and 63% of these were for medications prescribed outside the approved age group, and 26% for nonlicensed indication(s). Conclusion: This study demonstrated a high level of off-label prescribing over time with respect to age and indication. The prescribing patterns underpin the need for further economic incentives for pharmaceutical companies to register pediatric indications, particular for off-patent products.
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CASE REPORT Top

Unstable angina: A rare presentation of minoxidil intoxication: A case report and literature review p. 210
Farzad Gheshlaghi, Shafeajafar Zoofaghari, Gholamali Dorooshi
DOI:10.4103/jrpp.JRPP_18_23  
Minoxidil is an antihypertensive direct vasodilator that can cause severe toxicity when sufficiently ingested. We report a case of accidental ingestion of 5 ml topical minoxidil solution 5% presented with chest pain and new-onset ST depressions. After giving IV saline and performing echocardiography/angiography, the patient fully recovered without any pharmacotherapy such as vasopressors and discharged 4 days after admission. The clinical toxicology, treatment, and previous case reports of minoxidil poisoning have been reviewed.
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