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Despite the progress in the management of COVID-19, effective oral antiviral agents are still lacking. In the present review, the potential beneficial effects of molnupiravir in the management of COVID-19 are discussed. A literature search in Google Scholar, Scopus, PubMed and clinicaltrials.gov for the relevant articles regarding the pharmacokinetics, pharmacodynamics and clinical trials of molnupiravir in the management of COVID-19 is conducted. Most of the preclinical studies and available clinical trials showed a favorable short-term safety profile of molnupiravir; however, given its possible genotoxic effects, further trials are required to confirm the long-term efficacy and safety of molnupiravir in patients with COVID-19.

In the current pandemic of coronavirus disease 2019 (COVID-19), antiviral drugs are at the center of attention because of their critical role against severe acute respiratory disease syndrome coronavirus 2 (SARS-CoV-2). In addition to designing new antivirals against SARS-COV-2, a drug repurposing strategy is a practical approach for treating COVID-19. A brief insight about antivirals would help clinicians to choose the best medication for the treatment of COVID-19. In this review, we discuss both novel and repurposed investigational antivirals, focusing on in vitro, in vivo, and clinical trial studies.

Background: Periprocedural myocardial injury (PMI) after percutaneous coronary intervention (PCI) is a substantial health issue with a high mortality rate. Inflammation and oxidative stress are major contributing factors to PMI. Allopurinol inhibits xanthine oxidase (XO)-induced oxidative stress and has potential cardiovascular benefits. Methods: This randomized clinical trial evaluated 110 patients admitted to elective PCI. Patients were assigned to receive either a 1200 mg loading dose of allopurinol 2 hours before the procedure (n = 55) or the standard pretreatment (n = 55). The creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) levels were measured in both groups at the baseline, 8, and 24 hours after PCI. Results: There were no significant differences in the CK-MB levels at baseline (P = 0.71), 8 (P = 0.26), and 24 hours (P = 0.88) after PCI between the two groups. No significant changes in the cTnI levels at baseline (P = 0.26), 8 (P = 0.80), and 24 hours (P = 0.89) after the PCI were also noted. The mean difference for CK-MB and cTnI changes was not different between the two groups. Conclusion: Our study revealed that allopurinol did not reduce cardiac-specific enzymes. Further studies are required to evaluate the impact of allopurinol on preventing PCI-related myocardial injury.

Currently, the world is recovering from the shock of the coronavirus disease 2019 (COVID-19) pandemic; however, this situation is still fragile. Health authorities recommend administering COVID-19 vaccines as the safest and most reliable tool for eliminating COVID-19. Subsequent to the extensive administration of the COVID-19 vaccines, a series of cardiovascular adverse effects have been reported. This comprehensive review aimed to provide an update on the etiology, pathophysiology, clinical features, and management of the cardiovascular adverse events associated with COVID-19 vaccines, including myocarditis, pericarditis, thrombosis with thrombocytopenia syndrome, myocardial infarction, cardiac arrhythmias, hypertension, and stress-induced cardiomyopathy. The benefits of COVID-19 vaccination far outweigh the reported adverse events. It would be clinically important to provide diagnostic scoring systems to differentiate COVID-19-related cardiovascular adverse events from other causes and develop therapeutic approaches for their management. Further evaluation of cardiovascular adverse events of the COVID-19 vaccines is crucial for implementing vaccination programs and developing safer and more reliable vaccines.

Background: Medication errors (MEs) frequently occur in intensive care unit (ICU) admittedpatients. The present study aimed to evaluate the frequency and types of MEs in an open heartsurgery heart ICU and clinical pharmacists’ role in the management of them. Methods: This cross-sectional, observational study was performed from October 2016 toMarch 2017 in the Shahid Madani Heart Center. A clinical pharmacist reviewed patients’ files,laboratory data, and physician orders during morning hours. All of the MEs and the clinicalpharmacies’ recommendations for the management of them were analyzed. Results: A total of 311 MEs were observed in the medical files of 152 patients. The rate of MEswas 2.04 errors per patient and 0.19 errors per ordered medication. The acceptance rate of MEswas 72.6%. The most type of MEs was ‘forgot to order’ (75 cases, 24.1%) followed by "wrongfrequency" and "adding a drug" in 56 (18%) and 49 (15.8) patients, respectively. Most MEs wereinsignificant. Conclusion: MEs occur at different stages of the therapeutic process in the postoperative cardiacintensive care unit, and clinical pharmacists play an essential role in detecting and managingMEs.

Background Although almost a year has passed since the Coronavirus disease 2019 (COVID-19) outbreak and promising reports of vaccines have been presented, we still have a long way until these measures are available for all. Furthermore, the most appropriate corticosteroid and dose in the treatment of COVID-19 have remained uncertain. We conducted a study to assess the effectiveness of methylprednisolone treatment versus dexamethasone for hospitalized COVID-19 patients. Methods In this prospective triple-blinded randomized controlled trial, we enrolled 86 hospitalized COVID-19 patients from August to November 2020, in Shiraz, Iran. The patients were randomly allocated into two groups to receive either methylprednisolone (2 mg/kg/day; intervention group) or dexamethasone (6 mg/kg/day; control group). Data were assessed based on a 9-point WHO ordinal scale extending from uninfected (point 0) to death (point 8). Results There were no significant differences between the groups on admission. However, the intervention group demonstrated significantly better clinical status compared to the control group at day 5 (4.02 vs. 5.21, p = 0.002) and day 10 (2.90 vs. 4.71, p = 0.001) of admission. There was also a significant difference in the overall mean score between the intervention group and the control group, (3.909 vs. 4.873 respectively, p = 0.004). The mean length of hospital stay was 7.43 ± 3.64 and 10.52 ± 5.47 days in the intervention and control groups, respectively (p = 0.015). The need for a ventilator was significantly lower in the intervention group than in the control group (18.2% vs 38.1% p = 0.040). Conclusion In hospitalized hypoxic COVID-19 patients, methylprednisolone demonstrated better results compared to dexamethasone. Trial registration The trial was registered with IRCT.IR (08/04/2020-No. IRCT20200204046369N1).

Currently, the world is facing the pandemic of a novel strain of beta‐coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Acute respiratory distress syndrome (ARDS) is the most devastating complication of SARS‐CoV‐2. It was indicated that cytokine release syndrome (CRS) and dominantly IL‐6 play a central role in the pathophysiology of ARDS related to the novel 2019 coronavirus disease (COVID‐19). Despite the global emergency of the disease, at this time, there are no proven therapies for the management of the disease. Tocilizumab is a potential recombinant monoclonal antibody against IL‐6 and currently is under investigation for the management of ARDS in patients with COVID‐19. Given these points, we reviewed the current evidence regarding the potential therapeutic role of tocilizumab and its important clinical issues in the treatment of ARDS related to COVID‐19. This article is protected by copyright. All rights reserved

Background: The respiratory distress syndrome (RDS) is a common pulmonary disorder that usually occurs as a result of preterm labor and is associated with lack of surfactant. The aim of this study was to evaluate the pattern of surfactant prescription in Alzahra teaching hospital in Tabriz, Iran. Methods: This drug use evaluation (DUE) study was conducted in the neonatal intensive care unit (NICU) of Al-Zahra Hospital, Tabriz, Iran. The demographic and clinical data collection was performed using clinical records of patients. The pattern of surfactant replacement therapy was evaluated and compared with the European Consensus Guideline on the management of respiratory distress syndrome in 2016. Results: A total of 252 premature infants who received surfactant between August 2017 and March 2018 were included. 80.8% of neonates were born by cesarean section. The most used surfactant was Curosurf®, which was used in 82.1% of cases. Only 34.9% of the infants received within 8 hours of birth. Moreover, 79% of infants received the standard dose of surfactant, while 9.5 % and 11.5% were given high and low doses of surfactant, respectively. Conclusion: The pattern of surfactant replacement therapy was not completely according to the guidelines, particularly regarding the time of administration. Considering the importance of dose and timely administration of surfactant, providing strategies to decrease these errors are important.

Purpose: Considering the potential benefits of colchicine in coronary artery diseases, we aimed to carry out the present study to assess the impact of colchicine in the prevention of myocardial injury following elective percutaneous coronary intervention (PCI). Methods: A randomized, single-blinded, clinical trial was carried out on 102 patients undergoing elective PCI. All patients received the standard treatment prior to performing PCI. Moreover, the intervention group received 1, 0.5, 0.5 mg colchicine 12 to 18 hours before, 30-60 min before, and 12 hours after PCI, respectively. Serum concentrations of cardiac troponin I (cTnI) were measured before, 8, and 24 hours after the procedure to assess myocardial damage during PCI. Results: There were no significant differences in cTnI levels at baseline (P = 0.839), 8 (P = 0.729), and 24 hours (P = 0.398) after PCI between the intervention and the control groups. Likewise, no significant differences were seen regarding the mean differences of cTnI at baseline and 8 hours (P =0.190), at baseline and 24 hours (P = 0.780), and 8 and 24 hours after PCI (P = 0.680) in both groups. Conclusion: The study did not support the potential benefit of colchicine in the prevention of myocardial injury following elective PCI. Conducting well-designed randomized clinical trials with adequate sample size is recommended.

The acute loss of taste and smell following COVID-19 are hallmark symptoms that affect 20-85% of patients. However, the pathophysiology and potential treatments of COVID-19 smell and taste loss are not fully understood. We searched the literature to review the potential pathologic pathways and treatment options for COVID-19 smell and taste loss. The interaction of novel coronavirus with ACE-2 receptors expressed on sustentacular cells and taste buds results in direct damage to the olfactory and gustatory systems. Also, the invasion of the virus to the olfactory neurons and consequent local inflammation are other proposed mechanisms. Therefore, COVID-19 patients with smell or taste loss may benefit from neuroprotective, anti-inflammatory, or depolarizing agents. Based on the current evidence, phosphodiesterase inhibitors, insulin, and corticosteroids can be promising for the management of COVID-19 smell and taste loss. This review provided crucial information for treating COVID-19-related smell and/or taste loss, urging to perform large clinical trials to find optimum treatment options.

Since the early days of 2020, the severe acute respiratory syndrome coronavirus 2 pandemic has become a global health concern. Currently, some therapies and vaccines have received US Food and Drug Administration approval or emergency use authorization for the management of coronavirus disease 2019. According to the pathophysiology of the disease, several medications have been evaluated in different clinical conditions of the disease. Evidence‐based reviewing and categorizing these medications can guide the clinicians to select the proper medications according to each patient's condition. Therefore, we performed this review to categorize the coronavirus disease 2019 potential therapeutics and vaccines.

The coronavirus disease 2019 (COVID-19) pandemic has become a global health crisis. Considering the recent food and drug administration (FDA) approval of remdesivir as the first officially approved agent for COVID-19 treatment, we performed this systematic review and meta-analysis to evaluate the efficacy and safety of remdesivir administration in COVID-19 patients. A systematic literature search was done through MEDLINE, Google Scholar, Web of Science, Scopus, Science Direct, Cochrane Library, medRxiv, and bioRxiv from their inception to December 22nd, 2020. Five randomized controlled trials (RCTs) and five non-randomized studies of intervention (NRSI) were entered into the meta-analysis. The results showed that remdesivir administration was associated with a significant improvement in the 28-day recovery (RR = 1.09, 95%CI, 1.04-1.15), low flow oxygen support through days one to 14 (RR = 2.88, 95%CI, 1.80-4.60), and invasive mechanical ventilation or extracorporeal membrane oxygenation requirement through days 14-28 of the follow-up time (RR = 5.34, 95%CI, 2.37-12.05). The risk of experiencing serious adverse drug reactions (ADRs) was significantly lower (RR = 0.75, 95%CI, 0.63-0.90) in the remdesivir group than the comparison/control group. The pooled median difference of the time to clinical improvement was 2.99 (95%CI = 2.71-3.28), which did not remain significant during the sensitivity analysis. The clinical output comparison of the 5-day and 10-day remdesivir courses revealed that the 5-day regimen might provide similar benefits while causing fewer serious ADRs than 10-day. The current meta-analysis provided an updated evaluation of scientific evidence on the use of remdesivir in COVID-19 patients. Performing adequate well-designed RCTs are needed to show more accurate results.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic, caused by a newly discovered coronavirus (severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2), continues to spread all ar...

Data has shown that pharmacist-directed health services play a key role in the treatment of hypertension. We aimed to perform this study to compare two methods of the pharmacist-directed home blood pressure monitoring (HBPM) and the usual care. A total of 126 patients with uncontrolled blood pressure (BP) were randomized 1:1 into the pharmacist-directed HBPM and the usual care groups. In the intervention group, the patients were trained to measure their BPs and adjust their medications based on the designed protocol under the supervision of a clinical pharmacist. The primary endpoint of the study was the comparison of the BPs at baseline and months 1, 3, and 6. One month after the allocation, the baseline systolic BP (SBP) (150.5 ± 13.1 vs. 149.7 ± 11.2 mm Hg; P = 0.71) and diastolic BP (DBP) (97.2 ± 9.8 vs. 93.6 ± 14.5; P = 0.11) significantly dropped to the control range equally in 85.2% of the patients in two groups (SBP: 128.8 ± 6.4 vs. 125.6 ± 7.1 mm Hg; P = 0.01 and DBP: 89.1 ± 6.2 vs. 81.5 ± 6.0 mm Hg; P = 0.01). This pattern continued during the study period (month 6; SBP: 115.6 ± 10.1vs. 116.1 ± 9.6 mm Hg; P = 0.78; DBP: 79.0 ± 5.0 vs. 77.2 ± 5.8 mm Hg; P = 0.08). In this study, we did not observe any significant difference between the pharmacist-directed HBPM and usual care methods in decreasing BP.

Background: Vancomycin is a potent antibiotic and has central role in the managing of infections with known resistance to other antibiotics or in patients with allergy to beta-lactams. Irrational use of vancomycin is associated with increased morbidity and mortality as well as the antibiotic resistant. Methods: The DUE was done in Imam Reza Hospital, Tabriz, Iran. A total of 100 patients were included during a 6‐month period. We aimed to evaluate vancomycin administration pattern and assess its compliance with Centers for Disease Control and Prevention (CDC) and the American Society of Health-System Pharmacists (ASHP) protocols as the primary outcome and its adverse effects as the secondary outcome. Results: The mean duration of hospitalization and antibiotic therapy were 22.11 ± 1.76 and 19.08 ± 1.51 respectively (mean ± SD). The most causes of vancomycin administration (51%) were for surgery prophylaxis. In 38% of patients, vancomycin administration was not in accordance to standard guidelines. Dose and duration of vancomycin therapy was according to ASHP and CDC guidelines in 74% and 59% of patients. Dose readjustments of antibiotics were necessary in 28 patients which were done in 12 of them. A total of 140 samples were collected from 60 patients. In 30% of patients, vancomycin use was continued without considering the culture results. Discussion: It is important to set practical pharmaceutical and therapeutic infection control committees in hospitals under the clinical pharmacists’ observation. Furthermore, educational programs for health care professionals regarding rational use of antibiotics can be helpful in improving antimicrobial medications utilization and monitoring.

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global crisis with a growing number of mortalities and morbidities worldwide. Despite performing numerous researches, there are still considerable unrevealed details regarding the long-term complications and post-infection immunity of the coronavirus disease 2019 (COVID-19). Based on pathophysiological features, SARS-CoV-2 may act similarly as an oncovirus in the lung. This letter summarized three possible oncogenic mechanisms of SARS-CoV-2 that may be associated with lung cancer development.