Introduction Cisplatin-associated acute kidney injury (AKI) is the major limitation to the use of cisplatin-based chemotherapy regimens. Serum creatinine as a traditional marker did not increase in a timely enough fashion in AKI patients. Therefore, recently, the novel markers such as neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) were considered for early detection of AKI. The aim of this study was to compare the sensitivity and specificity of urinary NGAL and KIM-1 with serum creatinine in cisplatin related AKI. Methods Patients ≥18 years with solid tumors who received cisplatin-based chemotherapy were included. Urine samples were collected 0, 6 and 24 h after cisplatin infusion and the urinary NGAL, KIM-1, and creatinine concentrations were evaluated. NGAL and KIM-1 concentrations were adjusted based on urine creatinine to eliminate hydration effects. Serum creatinine levels were assessed at the base and 72 h after cisplatin administration. Results Seven out of the 35 recruited patients (20%) suffered from AKI defined by Acute Kidney Injury Network criteria. In AKI patients, the ratio of urinary KIM-1–creatinine at 24 h compared to baseline (24 h/baseline) and NGAL–creatinine 24 h/baseline were significantly higher than those of non-AKI group ( p = 0.037 and 0.047 respectively). The area under the receiver-operating characteristic curve for KIM-1–creatinine 24 h/baseline and NGAL–creatinine 24 h/baseline were 0.78 (0.59–0.96, p = 0.032) and 0.77 (0.57–0.97, p = 0.036) respectively. Conclusions Our findings showed that the changes in urinary NGAL–creatinine and KIM-1–creatinine ratios, 24 h after cisplatin administration can be utilized to predict AKI in cisplatin recipients.
Backgrounds: The pharmacists have a crucial role in providing pharmaceutical care to patients who receive anticoagulants. This study was conducted to evaluate the pharmacists’ confidence in pharmaceutical consultation in the field of anticoagulant therapy, identify their educational needs, and find their commonly used sources of medical information. In addition, their preferred method for future educations and specific areas of interest were assessed. Methods: This cross-sectional study was conducted between June 2018 and April 2019 among pharmacists involved in different areas of professional activity. They filled out an online questionnaire specifically developed to evaluate the aims of the study. The questionnaire was prepared in three parts including 6 questions about demographic information, 13 questions about confidence level, and 9 questions about the commonly used sources of medical information and educational needs of participants. Results: At the end of the study, 229 pharmacists completed the questionnaire. The pharmacists’ confidence was significantly higher when advising patients on warfarin versus non-vitamin K antagonists oral anticoagulants (NOACs) (P=0.0001). More than 98% of participants acknowledged that additional education is required in the field of anticoagulation. Among the different educational methods, electronic learning (e-learning) was more attractive than others (P=0.0001). Conclusion: Pharmacists’ confidence was lower in providing pharmaceutical support on NOACs compared with other anticoagulants. Our findings suggest that additional educational courses are needed to enable pharmacists on the provision of anticoagulation care, preferably via e-learning methods.
The COVID-19 pandemic continues to claim victims around the world, and Iran is no exception from this ravage. Vaccine development led to growing optimism regarding control of COVID-19. Vaccine acceptance by the majority of the population is important for the success in controlling COVID-19. This study assessed the attitude of Iranian population toward COVID-19 vaccination. Also, the adverse effects of the COVID-19 vaccines on vaccinated individuals were reported. This cross-sectional study was conducted from May to July 2021 among Iranian population. The data was collected using the online researcher-made questionnaire. The questionnaire contained 16 questions in 3 sections.The questionnaire was filled out by 916 people in total. The majority of participants had 40-65 years old (N:480, 52.4%). More than half of participants were from health care team (N:543, 59.3%). The majority of participants trusted the vaccine and said they would inject it (N:582, 63.5%). However more than 80% of participants preferred non-domestic vaccines over Iranian ones. Potential adverse effect following vaccination was the main concern of responders (N:576, 62.9%). The most common adverse effects reported by vaccine recipients were temporary fatigue and muscle pain (N:313, 71.95%). The level of education, academic area and area of practice in the health system were significantly associated with the positive response to COVID-19 vaccination (P-value 0.0001, 0.0001 and 0.004 respectively). According to the results of this study, Iranian health authorities should provide clear information about the safety and efficacy of COVID-19 vaccines, especially domestic types, to increase public confidence and awareness regarding vaccines.
Prolactin is a polypeptide hormone secreted and released by lactotroph cells in the anterior pituitary gland in response to diverse physiological stimuli, principally via the inhibitory action of dopamine and serotonin. This paper describes a 44-year-old woman with depression and obsessive-compulsive disorder (OCD) who called the 13-Aban drug and poison information center (DPIC). She was being treated with fluoxetine (80 mg/day) for 10 months until risperidone was added to her regimen for augmentation therapy (0.5 mg/day). Her symptoms improved within less than two months without significant side effects until she experienced painful bilateral breast discharge along with spotting and menstrual irregularity, besides amenorrhea for the previous 2 cycles and serum prolactin level of 33.7 ng/mL, presenting hyperprolactinemia. After discontinuing risperidone, within two weeks, galactorrhea and breast pain disappeared and amenorrhea resolved. Further prolactin level measurement showed the significant reduction. This neuroendocrine effect observed with very low-dose risperidone plus fluoxetine is apparently exerted through both pharmacokinetic and pharmacodynamic augmentation of this combination therapy.
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