Foroud Shahbazi

Pressure ulcers are common in critically ill patients and can delay recovery. Heparin improves blood flow and reduces inflammation, which may help wound healing. This study compared an optimized heparin hydrogel with a standard hydrocolloid dressing for treating Stage II pressure ulcers in critically ill patients. Eighteen heparin hydrogel formulations were prepared; eight met key physicochemical and stability criteria, and one optimized 1% formulation based on release profile, stability, and microbiological safety was selected for clinical testing. Patients were randomly assigned to receive either the heparin hydrogel or a hydrocolloid dressing every 3 days alongside standard wound care. Wound length, width, and surface area, as well as the Pressure Ulcer Scale for Healing (PUSH) score at baseline and on days 3, 7, and 14 after enrollment. Eighty-four patients were enrolled in the study, and 56 completed the trial (26 in the heparin hydrogel group and 30 in the hydrocolloid control group). The two groups were similar in baseline demographic and clinical characteristics. Both groups improved wound healing over time, but patients who received the heparin hydrogel had greater reductions in PUSH scores, wound length, width, and surface area by day 14 (p < 0.05). The median healing time was 7 days (95% CI 5.8-8.2) in the heparin group and 10 days (95% CI 8.8-11.2) in the hydrocolloid group (p < 0.001). No local or systemic adverse events were reported during the study. Heparin hydrogel treatment was well-tolerated and effectively accelerated wound recovery in patients with stage II pressure ulcers. Nonetheless, further research is warranted to elucidate the role of heparin hydrogel in pressure ulcer management.

Background: This study aimed to compare the efficacy and safety of herbal mixture versus chloral hydrate for sedation induction in the pediatric population undergoing echocardiography.Patients and Methods: Seventy pediatric patients referred to the echocardiography clinic were randomly allocated to receive either the herbal mixture or chloral hydrate for sedation induction. Sedation adequacy, echocardiography completion, onset and duration of action, and adverse effects were compared between the two groups from April 2022 to July 2022.Results: Over a 4‐month period, 70 patients received chloral hydrate (50 mg/kg) or an herbal admixture based on the company leaflet. The mean age of the patients was 20.95 ± 16.63 months, with the majority being male (58.3%). Adequate sedation was similar between the two groups. A Ramsay sedation score of ≥ 4 was achieved in 90% of the patients in the herbal product group and in 96.7% of the patients in the chloral hydrate group (OR: 0.31, relative risk 95% CI: 0.03–3.16, p:0.32). Oxygen desaturation and blood pressure fluctuations were not observed during the procedure or recovery. Chloral hydrate had a shorter onset of action and a longer duration of action (p = 0.029, p < 0.001), respectively and was associated with higher adverse effects (p < 0.001).Conclusions: The results of our study suggest that an herbal mixture can be effectively used for procedural sedation during echocardiography in children.Trial Registration: IRCT20200202046335N2

Introduction: Serotonin syndrome is a potentially life-threatening condition that can occur as a result of the therapeutic use of serotonergic medications or drug interaction. In this study, we describe two cases of serotonin syndrome-associated hypertensive crisis following linezolid use. Case Presentation: The first patient was a 52-year-old female who was admitted due to a diabetic foot infection and pneumonia associated with a decreased consciousness level. Serotonin syndrome occurred 24 hours after starting the linezolid use. Resistant hypertension was the main hemodynamic finding. It could not be controlled with amlodipine, valsartan, prazosin, and nitroglycerin infusion. Resistant hypertension and other symptoms of serotonin syndrome were resolved about 48 hours after discontinuation of linezolid use. The second case was a man with a history of kidney transplant, diabetes, and hypertension. He was admitted to the ICU due to severe COVID-19. Broad-spectrum antibiotics [linezolid, cefepime], and remdesivir was initiated. Following intubation, continuous infusion of fentanyl was used for sedation. Within 24 hours after fentanyl and linezolid initiation, severe agitation, eye clonus, hyperreflexia, hypertension [160-186 /90-110 mmHg], and tachycardia [>100/min] were noted. With the possible diagnosis of serotonin syndrome, fentanyl was discontinued, and morphine was initiated. The patient’s symptoms improved 48 hours after discontinuation of fentanyl. Conclusion: Both patients had a history of well- controlled hypertension. Hypertensive crisis has occurred after recent or concurrent use of serotonergic agents with linezolid. A thorough evaluation of the patient’s medical history and current condition can help clinicians prevent this syndrome in critically ill patients.

Linezolid, an oxazolidinone antibiotic, is used to treat gram-positive infections. However, it may also lead to serious adverse effects, including bone marrow suppression, optic neuropathy, peripheral neuropathy, hyponatremia, and lactic acidosis. This review evaluates the existing evidence concerning the adverse effects of linezolid in patients undergoing treatment with this medication, both in the short and long term. The objective of this review is to summarize the most significant adverse effects associated with linezolid. A search of PubMed was conducted for articles related to linezolid and its potential adverse effects, which include thrombocytopenia, anemia, neutropenia, lactic acidosis, optic neuropathy, and peripheral neuropathy. Thrombocytopenia frequently develops within the first two weeks of therapy, whereas anemia is more likely to manifest during prolonged treatment courses. Risk factors for linezolid-induced thrombocytopenia include elevated trough concentrations (>8 mg/L), renal impairment, low body weight, and severe liver dysfunction. Patients with multidrug-resistant tuberculosis and bone infections are at an increased risk for anemia, peripheral neuropathy, and optic neuropathy. Additionally, lactic acidosis and hyponatremia can occur at any stage during treatment.

Drug-induced thrombocytopenia can occur in hospitalized patients and complicate their antithrombotic treatment. Several medications can associate thrombocytopenia with immune and non-immune mechanisms. Thrombocytopenia can occur at any time from a few hours to months after a new medication initiation. In this study, we have described the case of a female patient with acute-on-chronic kidney injury following a non-steroidal anti-inflammatory agent use, who developed catheter-related thrombosis and was treated with heparin without any complication for 5 days. She was discharged after 5 days and prescribed to use apixaban 2.5 mg twice daily. However, she was readmitted after 24 hours with fatigue, petechiae, and severe thrombocytopenia (7000/mm3). The workup was negative for other reasons of thrombocytopenia. With a possible diagnosis of drug-related thrombocytopenia, apixaban was discontinued. Following the treatment with the intravenous immunoglobulin, her platelet counts increased and stabilized around 40-50,000/mm3. Anticoagulation was thus continued with adjusted doses of rivaroxaban (10-15 mg/day). 17 days after apixaban discontinuation and treatment with prednisolone, her platelet count increased to 108,000/mm3. With reference to this case, a brief review on refractory heparin-induced thrombocytopenia and the association of direct oral anticoagulants with thrombocytopenia is presented.

Toxicity associated with low doses of methotrexate (MTX) is low, but it may be fatal. Bone marrow suppression and mucositis are among the common side effects of low dose MTX toxicity. Different risk factors have been reported for toxicities associated with low doses of MTX, including accidental use of higher doses, renal dysfunction, hypoalbuminemia, and polypharmacy. In this paper, we present a female patient who had mistakenly used 7.5 mg of MTX daily instead of the same dose of MTX on Thursday and Friday. She was presented with mucositis and diarrhea to the emergency department. Moreover, we searched the databases Scopus and PubMed for available studies and case reports on toxicities associated with MTX dosing errors. The most frequently observed toxicities included gastrointestinal lesions, nausea, vomiting, skin lesions, and bone marrow suppression. Leucovorin, hydration, and urine alkalinization were among the most frequently used treatments. Finally, we summarize the data on the toxicities of low doses of MTX in different diseases.

Background: The similar efficacy of rivaroxaban and warfarin in thromboembolic events was recognized in clinical trials. But there are a few studies about the comparison of these medications in real world. This study was designed with the aim of comparing the efficacy and safety of the rivaroxaban and warfarin. Materials and ...

: Contrast-induced nephropathy (CIN) is the third cause of hospital-acquired acute kidney injury. The CIN prophylactic strategies adopted to date, although not highly efficient, are mostly based on antioxidant activity and hydration therapy. This study was designed and conducted to evaluate crocin’s efficacy in the prevention of CIN in chronic kidney disease (CKD) patients undergoing coronary angiography/angioplasty. In this randomized clinical trial, a total of 110 eligible CKD stage 3 patients requiring contrast agent administration for coronary angiography/angioplasty were enrolled and randomly assigned to either crocin (n = 57) or control (n = 53) group. The patients in both groups received standard hydration therapy; nevertheless, in the crocin group, the patients were also orally administered three consecutive oral doses of 30 mg crocin tablets 1 day before up to 1 day after contrast media (CM) exposure. The primary endpoint was CIN incidence defined as an increase in serum creatinine (SrCr) level by ≥ 0.3 mg/dL or any change in urinary neutrophil gelatinase-associated lipocalin (NGAL) from the baseline within 48 hours of CM exposure. During 4 months, 130 patients were recruited. The mean age of the patients was 65.62 ± 9.05 years, and the majority of them were male (64.54%). The SrCr in the crocin group did not significantly increase within 48 hours of angiography/angioplasty. The changes in the urinary NGAL level were not significant in both groups. The CIN incidence was significantly lower in the crocin group than in the control group (1.75% and 13.2%; P = 0.028). Crocin administration plays an important nephron-protective role in the prevention of CIN.

Background: Acute kidney injury (AKI) commonly occurs in critically ill patients. Estimation of renal function and antibiotics dose adjustment in patients with AKI is a challenging issue.Methods: Urinary creatinine clearance was measured in a 6-hour urine collection from patients with acute kidney injuries. The correlations between different formulas including the modified Cockcroft-Gault, modification of diet in renal disease, chronic kidney disease-epidemiology collaboration, Jelliffe, kinetic-glomerular filtration rate (GFR), Brater, and Chiou formulas were considered. The pattern of the prescribed antimicrobial agents was also compared with the patterns in the available resources.Results: Ninety-five patients with acute kidney injuries were included in the research. The mean age of the participants was 63.11±17.58 years old. The most patients (77.89%) were in stage 1 of AKI according to the Acute Kidney Injury Network criteria, followed by stage 2 (14.73%) and stage 3 (7.36), respectively. None of the formulations had a high or very high correlation with the measured creatinine clearance. In stage 1, Chiou (r=0.26), and in stage 2 and 3, kinetic-GFR (r=0.76 and r=0.37) had the highest correlation coefficient. Antibiotic over- and under-dosing were frequently observed in the study.Conclusions: The results showed that none of the static methods can predict the measured creatinine clearance in the critically ill patients. The dynamic methods such as kinetic-GFR can be helpful for patients who do not receive diuretics and vasopressors. Further studies are needed to confirm our results.

Antibiotic prescription is a challenging issue in critical care settings. Different pharmacokinetic and pharmacodynamic properties, polypharmacy, drug interactions, and high incidence of multidrug-...