Assessment of drug-induced electrolyte disorders in intensive care units: a multicenter observational study.

Objective: Electrolyte disorder (ED) is frequently encountered critically ill patients during admission or admission to the intensive care unit (ICU). This study aimed to determine the frequency of ED encountered in ICU patients to evaluate the relationship of ED with drugs. Methods: This prospective, multicenter study was conducted in the medical and anesthesiology ICUs of two training and research hospitals and included patients with at least one ED during admission or hospitalization in the ICUs. The relationship between ED and the drug was evaluated by calculating the logistic probabilistic method scale (LPMS) and the expert panel's evaluation. The correlation between EDs and LPMS was determined using Kendal tau. A binary logistic regression model was preferred in the analysis of factors related to ED. Statistical significance was set as p < 0.05. Results: A total of 117 patients were included in the study. A total of 165 EDs were detected, including at least one in 88 (75.2%) patients. According to the expert panel, 61 (21.7%) of EDs were drug-related, whereas according to the LPMS, 111 (39.6%) (p < 0.001). Mortality (50% vs. 13.7%) and mechanical ventilation rates (52.2% vs. 17.2%) were significantly higher in patients with ED (p < 0.001). Patients with ED had 8.352 times higher odds of exhibiting mortality (OR: 8.352, %95 CI: 1.598-43.648, p: 0.012) and need mechanical ventilation with higher odds of 3.229 (OR: 3.229 95% CI: 0.815-12.787 p: 0.045). Patient who required enteral or parenteral feeding were associated with an increased likelihood of exhibiting ED (respectively OR: 30.057, %95 CI: 2.265-398.892, p: 0.01, OR: 5.537, %95 CI: 1.406-21.800, p: 0.014). Conclusion: EDs are very common in the ICU. Dysnatremia was detected more commonly in other EDs. It has also been found that patients with ED are more often under mechanical ventilation, have more prolonged hospitalizations, and have higher mortality rates than patients without ED. The suitability of LPMS for assessing ED-drug relationships in the ICU context is questioned.

An Assessment of Different Decision Support Software from the Perspective of Potential Drug-Drug Interactions in Patients with Chronic Kidney Diseases.

Chronic kidney disease (CKD) is a multifaceted disorder influenced by various factors. Drug-drug interactions (DDIs) present a notable risk factor for hospitalization among patients with CKD. This study aimed to assess the frequency and attributes of potential DDIs (pDDIs) in patients with CKD and to ascertain the concordance among different Clinical Decision Support Software (CDSS). A cross-sectional study was conducted in a nephrology outpatient clinic at a university hospital. The pDDIs were identified and evaluated using Lexicomp® and Medscape®. The patients' characteristics, comorbidities, and medicines used were recorded. The concordance of different CDSS were evaluated using the Kendall W coefficient. An evaluation of 1121 prescribed medications for 137 patients was carried out. The mean age of the patients was 64.80 ± 14.59 years, and 41.60% of them were male. The average year with CKD was 6.48 ± 5.66. The mean number of comorbidities was 2.28 ± 1.14. The most common comorbidities were hypertension, diabetes, and coronary artery disease. According to Medscape, 679 pDDIs were identified; 1 of them was contraindicated (0.14%), 28 (4.12%) were serious-use alternative, and 650 (9.72%) were interventions that required closely monitoring. According to Lexicomp, there were 604 drug-drug interactions. Of these interactions, 9 (1.49%) were in the X category, 60 (9.93%) were in the D category, and 535 (88.57%) were in the C category. Two different CDSS systems exhibited statistically significant concordance with poor agreement (W = 0.073, p < 0.001). Different CDSS systems are commonly used in clinical practice to detect pDDIs. However, various factors such as the operating principles of these programs and patient characteristics can lead to incorrect guidance in clinical decision making. Therefore, instead of solely relying on programs with lower reliability and consistency scores, multidisciplinary healthcare teams, including clinical pharmacists, should take an active role in identifying and preventing pDDIs.

Evaluating the Clinical Significance of Diazepam Binding Inhibitor in Alzheimer's Disease: A Comparison with Inflammatory, Oxidative, and Neurodegenerative Biomarkers.

INTRODUCTION: Alzheimer's disease (AD) is one of the pathologies that the scientific world is still desperate for. The aim of this study was the investigation of diazepam binding inhibitor (DBI) as a prognostic factor for AD prognosis. METHODS: A total of 120 participants were divided into 3 groups. Forty new diagnosed Alzheimer patients (NDG) who have been diagnosed but have not started AD treatment, 40 patients who diagnosed 5 years ago (D5YG), and 40 healthy control groups (CG) were included in the study. Levels of DBI, oxidative stress, inflammatory, and neurodegenerative biomarkers were compared between 3 groups. RESULTS: Plasma levels of DBI, oligomeric Aß, total tau, glial fibrillary acidic protein, α-synuclein, interleukin (IL) 1ß, IL6, tumor necrosis factor α, oxidative stress index, high-sensitive C-reactive protein, and DNA damage were found higher in D5YG and NDG as compared to CG (p < 0.001). On the contrary, plasma levels of total thiol, native thiol, vitamin D and vitamin B12 were lower in D5YG and NDG as compared to CG (p < 0.001). DISCUSSION: DBI may be a potential plasma biomarker and promising drug target for AD. It could help physicians make a comprehensive evaluation with cognitive and neurodegenerative tests.

Comparison of different decision support software programs in perspective of potential drug-drug interactions in the oncology clinic.

INTRODUCTION: One of the most intriguing situations for healthcare providers is cancer therapy. Drug-drug interactions (DDIs) account for 20-30% of all adverse effects. Cancer patients are more likely to have potential-DDIs since they are taking other drugs with anticancer treatments to prevent the side effects of chemotherapeutic agents. The purpose of this research is to compare various decision support software (CDSS) programs in terms of potential DDIs. METHODS: A cross-sectional study was carried out. A clinical pharmacist assessed the treatment regimens of 231 cancer patients. pDDIs were evaluated using three sources: Lexicomp®, Medscape®, and Micromedex®. The ethical approval was given in November 2017 with decision number 21/286. RESULTS: A total of 231 participants who were receiving therapy and had a median age of 61.5 ± 9.18 years were assessed. Almost half of the patients (49%) were female, and 155 had at least one comorbidity in addition to cancer. Medscape had a substantial pDDI ratio of 7.09%, Micromedex had a ratio of 11.15%, and Lexicomp had a ratio of 19.50%. The total number of pDDIs for major/X/contraindicated were 363-2716 (1.56-11.7 pDDI/patient) for Medscape®, 60-1723 (0.26-7.4 pDDI/patient) for Micromedex, and 145-984 (0.62-2.24 pDDI/patient) for Lexicomp®. One of the most common pDDI found was diclofenac and dexamethasone. Interactions between escitalopram and granisetron were also common, and different CDSSs made different recommendations. CONCLUSIONS: In this study, significant disparities in the quantity and severity of CDSS across distinct CDSS were discovered. One of the major finding of our study was suboptimal prescribing. To address this issue, regulatory organizations should establish and verify validation and reporting mechanisms.

Factors associated with Turkish pharmacists' intention to receive COVID-19 vaccine: an observational study.

Background Pharmacists have been taking part in vaccination services during the COVID-19 pandemic. However, research identifying pharmacists' intention to get COVID-19 vaccine is limited. Aim The objective of this study was to determine the intention to receive COVID-19 vaccine and to identify the factors related to it based on the Health Belief Model framework among Turkish pharmacists. Method This is an observational study conducted between December 2020 and January 2021. The online survey was sent to all hospital and community pharmacists working in Turkey. Transtheoretical Model of Behaviour Change and Health Belief Model were used for the development of the questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with the intention to receive COVID-19 vaccine. Results Among all participants (n = 961), 74.7% had an intention to receive the COVID-19 vaccine. In model 1, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers were associated with their intention to receive the COVID-19 vaccine (p < 0.05). In model 2, the intention to receive COVID-19 vaccine was associated with being male, years of experience in the professional field, not having contracted COVID-19, having a pharmacy staff who had contracted COVID-19, and having had received seasonal flu shot within the previous year (p < 0.05). Conclusion This study highlights the factors related to the intention of the pharmacists to receive COVID-19 vaccines. Health Belief Model is the strongest predictor for vaccination intention and could be used to develop behavioural change techniques to promote vaccination.

Investigation of drug-related problems in patients hospitalized in chest disease wards: A randomized controlled trial.

Objective: According to the World Health Organization (WHO), chest diseases are among the 10 diseases that cause the highest mortality worldwide. Drug-related problems (DRPs), readmission, and antimicrobial resistance are critical problems in chest disease wards. Active involvement of clinical pharmacists (CPs) who are focused on reducing the risks of potential problems is needed. The aim of this study is to investigate the effects of pharmaceutical care (PC) services on the pulmonology service. Method: A randomized controlled trial at a university hospital in Istanbul was conducted between June 2020 and December 2021. The participants were randomized into the control group (CG) and intervention group (IG). In the CG, CPs identified and classified the DRPs according to Pharmaceutical Care Network Europe v9.0 (PCNE) and provided solutions to DRPs for the IG. The effect of PC services was evaluated by the number and classification of DRPs, and readmissions within 30 days were compared between the two groups. Results: Out of 168 patients, 82 were assigned to the IG. The average number of medicines administered per patient in the CG and IG was 14.45 ± 7.59 and 15.5 ± 6.18, respectively. In the CG and IG, the numbers of patients with DRPs were 62 and 46, respectively. The total number of DRPs was 160 for CG and 76 for IG. A statistically significant difference was found in favor of the IG, in terms of the number of patients with DRPs, the total number of DRPs, and readmission within 30 days (p < 0.05). Conclusion: In this study, CP recommendations were highly accepted by the healthcare team. Pharmaceutical care services provided by CPs would decrease possible DRPs and led to positive therapeutic outcomes. Cognitive clinical pharmacy services have beneficial effects on health care, and these services should be expanded in all settings where patients and pharmacists are present.

Community pharmacy cognitive services during the COVID-19 pandemic: A descriptive study of practices, precautions taken, perceived enablers and barriers and burnout.

OBJECTIVE: The objectives of this study were to identify community pharmacist (CP)-led cognitive services and CPs' precautions taken related to COVID-19, perceived enablers and barriers related to pharmaceutical services and burnout levels during the COVID-19 pandemic. METHOD: In this descriptive study, the survey was administered online to CPs in all regions of Turkey. The frequency of their provision of patient counselling, provision of medication information and practices towards precautions during the pandemic were evaluated based on CP self-reports. The Turkish version of the Burnout Measure Short Form was used, and a 30-item questionnaire based on the 12-domain Theoretical Domains Framework was developed to determine CPs' perceived enablers of and barriers to pharmaceutical service delivery during the COVID-19 pandemic. Data were collected using convenience sampling methods. Besides internal consistency reliability, principal component analysis, and correlation analysis, Mann-Whitney U-test was conducted in group comparisons. RESULTS: A total of 1098 complete responses were received, for a response rate of 4.11% among 26 747 CPs. The CPs' median burnout score was 3.3 (2.5-4.2). More than half of the CPs (54.5%) referred probable patients with COVID-19 to the hospital. Commonly delivered cognitive CP-led services included preventive health services (89.5%) and medication information services (86.3%). Perceived barriers to delivering pharmaceutical services were a lack of environmental resources and support and a lack of innovation in pharmaceutical services. Perceived enablers were CPs' knowledge, skills, self-confidence, actions, impacts, emotions and perceived behavioural control. CONCLUSION: To increase the preparedness of pharmacists for future pandemics or disasters, this study highlighted CP-led cognitive services, precautions taken related to COVID-19, perceived enablers and barriers and burnout during the COVID-19 pandemic. Pharmaceutical services guidelines that could be followed during a pandemic or other disaster should be designed by addressing these findings.

Attitudes of medicine, pharmacy, and dentistry students about psychostimulant use to enhance cognition.

INTRODUCTION: The use of psychostimulant drugs to increase academic success is common among young people. There is no study examining this issue in Turkish population. In this study, the prevalence, attitudes, knowledge, and ethical evaluations of Pharmacological Cognitive Enhancement (PCE) in university students were investigated. METHOD: A structured online survey was carried out with 1148 undergraduate and postgraduate (master, PhD and residency) students in different faculties of Medicine, Dentistry and Pharmacy in Turkey. Comparisons between groups, correlation and regression analysis about associated variables were made. RESULTS: The general prevalence of PCE in our study was found to be 7.4%. The highest prevalence was seen in the faculty of medicine (8.4%), among the residency students (15.5%). There was no significant difference prevalence of PCE between the faculties. Education level, smoking, study performance satisfaction, and knowledge level were found to be factors associated with PCE. Around 40% of PCE users stated that they used it with the recommendation of their friends. PCE users had a lower perception of harm and risk, and rated the use of it as more acceptable and normal behaviour. CONCLUSION: PCE is a method used by young with high knowledge, low study performance satisfaction, to increase their academic success, especially during exam periods. Peer effect is an important factor in increasing prevalence.

Left lateral parietal rTMS improves cognition and modulates resting brain connectivity in patients with Alzheimer's disease: Possible role of BDNF and oxidative stress.

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive neuromodulation technique which is increasingly used for cognitive impairment in Alzheimer's Disease (AD). Although rTMS has been shown to modify Brain-Derived Neurotrophic Factor (BDNF) and oxidative stress levels in many neurological and psychiatric diseases, there is still no study evaluating the relationship between memory performance, BDNF, oxidative stress, and resting brain connectivity following rTMS in Alzheimer's patients. Furthermore, there are increasing clinical data showing that the stimulation of strategic brain regions may lead to more robust improvements in memory functions compared to conventional rTMS. In this study, we aimed to evaluate the possible disease-modifying effects of rTMS on the lateral parietal cortex in AD patients who have the highest connectivity with the hippocampus. To fill the mentioned research gaps, we have evaluated the relationships between resting-state Functional Magnetic Resonance Imaging (fMRI), cognitive scores, blood BDNF levels, and total oxidative/antioxidant status to explain the therapeutic and potential disease-modifying effects of rTMS which has been applied at 20 Hz frequencies for two weeks. Our results showed significantly increased visual recognition memory functions and clock drawing test scores which were associated with elevated peripheral BDNF levels, and decreased oxidant status after two weeks of left lateral parietal TMS stimulation. Clinically our findings suggest that the left parietal region targeted rTMS application leads to significant improvement in familiarity-based cognition associated with the network connections between the left parietal region and the hippocampus.

Investigation of the Genotoxic, Cytotoxic, Apoptotic, and Oxidant Effects of Olive Leaf Extracts on Liver Cancer Cell Lines.

OBJECTIVES: Hepatocellular carcinoma (HCC) is the seventh most common cancer and the third leading cause of tumor-related deaths worldwide. Mechanisms underlying tumor onset, progression, and metastasis in the case of HCC have not been adequately studied. In this study, we aimed to investigate the genotoxic, cytotoxic, apoptotic and oxidant effects of olive leaf extract (OLE) on HCC cells. MATERIALS AND METHODS: H4IIE Rattus norvegicus hepatoma cells and Rattus norvegicus healthy liver clone-9 cells were treated with the increasing concentrations of OLEs (250-2000 ppm) in ethanol, acetone, dichloromethane, and methanol. ATP cell viability, intracellular reactive oxygen species generation levels, double staining test with acridine orange/ethidium bromide, comet assay, levels of interleukin 1-beta (IL-1ß), IL-6, and tumor necrosis factor alpha were measured. Significance was determined using ANOVA test. RESULTS: Apoptotic, genotoxic, cytotoxic, and oxidative effects of OLEs increased with the increasing concentrations as compared to controls in H4IIE cells (p<0.001). CONCLUSION: This is the first study to show a significant and selective cytotoxic activity of OLEs in the selected H4IIE cancer cell lines. OLEs could selectively increase the apoptotic damage and show anti-proliferative and pro-apoptotic properties against the H4IIE cells. They could be recommended as potential nutraceuticals in the prevention of cancer.

Investigation of the Effects of Biochemical Parameters on Alzheimer's Disease.

BACKGROUND: The most common type of dementia is an Alzheimer's disease which is a major concern in growing chronic diseases in the geriatric society, and its connection with biochemistry has not been sufficiently understood. OBJECTIVE: This study aims to evaluate the effects of blood biochemistry on Alzheimer's disease. METHOD: Eight participants aged 55+ with Alzheimer's disease were analyzed. A cross-sectional work has conducted. Eighty patients have been divided into 2 groups as group A and group B according to laboratory findings including glycosylated hemoglobin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TGA), vitamin D, folic acid, and vitamin B12. Mean Mini-Mental State Examination scores between these different 2 groups have been compared. RESULTS: High levels of HDL, vitamin D, and folic acid correlate with cognitive scores, whereas high levels of total cholesterol, HbA1c, LDL show a negative effect on cognition scores. CONCLUSION: High-density lipoprotein, vitamin D, folic acid, cholesterol, HgA1c, and LDL have an effect on dementia.