Objective The aim of this study was to validate the Turkish version of the ‘Medication
Regimen Co... more Objective The aim of this study was to validate the Turkish version of the ‘Medication Regimen Complexity Index’ (MRCI). Methods This validation study has been conducted in prescriptions of the first 100 elderly patients who had visited the pharmacy for their prescription refill to evaluate convergent and divergent validity of the Turkish version. The reliability of the Turkish version was assessed with inter-rater and test-retest analysis after its translation and cultural adaptation. Results The mean age of the 100 patients (53 women) was 74.9 years (SD = 7.58, 65–95). The scale showed high inter-rater reliability and test-retest reliability for the total and subscale scores (p < 0.05). A strong and positive correlation between the number of medications in a prescription and the total Medication Regimen Complexity Index scores (r = 0.930, p < 0.001) was determined. There were no statistically significant differences between age, gender and MRCI scores (p > 0.05). Conclusion These results show that the Turkish version of MRCI is a reliable and valid tool in elderly patients.
Introduction: A large number of systematic reviews resulted in claims on drug-drug interactions
(... more Introduction: A large number of systematic reviews resulted in claims on drug-drug interactions (DDIs) with proton pump inhibitors (PPIs). Such a large number begs for a consensus on clinical significance of findings. Areas covered: We critically evaluated the safety of PPI use with respect to DDIs with a metareview of systematic reviews, published between 1978 and 2015. We assessed the evidence by their reliability, repeatability, transparency, and objectivity according to the Assessment of Multiple Systematic Reviews (AMSTAR) criteria. Expert opinion: Clinicians must assess risks for each PPI individually as well as certain comorbid conditions. DDIs don’t substantiate a class effect for PPIs. Each PPI could induce unique DDIs. Concomitant use of PPIs with thienopyridines (i.e.; clopidogrel) could be justified in patients without strong affinity to cytochrome CYP2C19 and with high risk of bleeding (i.e.patients with prior upper gastrointestinal bleeding, Helicobacter pylori infection, advanced age, steroid treatment, and non-steroidal anti-inflammatory drug use). DDIs could occur in AIDS subpopulation treated with highly active antiretroviral therapy (HAART). DDIs exist for cancer patients under targeted therapy. Hypomagnesemia could increase with DDIs in the backdrop of advanced age and polypharmacy. Omeprazole poses high risks due to its pharmacokinetic DDI profile. Future systematic reviews should incorporate these additional risks for better clinical guidance.
The emergence of multidrug-resistant bacteria as a cause of ventriculoperitoneal (VP) shunt infec... more The emergence of multidrug-resistant bacteria as a cause of ventriculoperitoneal (VP) shunt infection is a disconcerting phenomenon that often requires the use of alternative antimicrobial agents due to resistance against commonly used medications. Linezolid, a member of a new class of antimicrobial agents, has good activity against virtually all important gram-positive pathogens, including multidrug-resistant gram-positive pathogens. The object of this article is to report a single-center experience with linezolid treatment in 6 young patients with VP shunt infections caused by drug-resistant strains. The authors reviewed the records of 6 pediatric patients who developed VP shunt infection and in whom initial antimicrobial treatment regimens, including vancomycin, either failed or were associated with vancomycin-resistant enterococcus. All 6 patients were treated at their hospital between July 1, 2008, and June 29, 2009. The patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; demographic and clinical characteristics, underlying diseases, clinical manifestations, laboratory results, and various treatment modalities used before linezolid therapy were evaluated. The 6 patients included were 2 boys and 4 girls with a mean (+/- SD) age of 11.83 +/- 12 months (range 4-36 months). Five patients had acquired an infection within 4 months (mean 7.50 +/- 13.51 months, range 1-35 months) after shunt insertion. Four patients were treated with external ventricular drainage. Two patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; parents refused to allow shunt removal and placement of an external ventricular drain. The CSF was clear of bacterial growth within a mean of 3.67 +/- 1.36 days (range 2-6 days) after initiation of linezolid treatment. The mean duration of linezolid treatment was 18.17 +/- 3.31 days (range 14-21 days). Microbiological clearance of CSF and clinical cure were achieved in all patients. No laboratory or clinical side effects were observed during the treatment period. The mean length of hospital stay was 22.8 +/- 4.96 days (range 17-28 days). Linezolid could be an appropriate treatment alternative in children with ventriculostomy-related CSF infections caused by drug-resistant strains, including cases in which shunt removal is not an option. Well-designed prospective studies providing additional information on linezolid levels in plasma and CSF are necessary to confirm the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; observations.
Rotavirus is the main cause of diarrhea-related illness and death in children worldwide. It is as... more Rotavirus is the main cause of diarrhea-related illness and death in children worldwide. It is associated with more than 2-3 million hospitalizations and up to 600 000 deaths in children aged <5 years; the vast majority occurring in developing countries (1). The clinical spectrum of ...
Management of multidrug-resistant Acinetobacter baumannii (MDRAB) meningitis/ventriculitis is a d... more Management of multidrug-resistant Acinetobacter baumannii (MDRAB) meningitis/ventriculitis is a difficult therapeutic problem owing to the limited penetration of antibiotics into cerebrospinal fluid (CSF). A 2-month-old girl with ventriculitis caused by MDRAB is reported. Despite therapy with intravenous (IV) colistin ventricular fluid, cultures remained positive for MDRAB. Institution of combination therapy with IV and intraventricular colistin resulted in a successful clinical and microbiological outcome. Intraventricular/intrathecal and IV colistin might be the best therapeutic option in the treatment of central nervous system infection caused by MDRAB. Further studies are required to evaluate pharmacokinetic and pharmacodynamic parameters of combined IV and intraventricular/intrathecal colistin administration, especially in children.
Objective of the study: To construct a simple model for an internal, retrospective cost-effective... more Objective of the study: To construct a simple model for an internal, retrospective cost-effectiveness analysis and to calculate the incremental cost-effectiveness of tissue plasminogen activator (TPA) over streptokinase (SK) in Turkey. Setting: Koşuyolu Heart, Education and Research Hospital, Istanbul, Turkey. Method: Among patients who were hospitalized for treatment of acute myocardial infarction (AMI), 196 were randomly selected. One-year mortality rates according to the treatment groups (TPA, SK, other) were determined. Among surviving patients, 28 from TPA and another 28 from SK group were randomly selected for the pharmacoeconomic analysis. Patient treatment data were taken from medical records while data regarding to costs were taken from hospital bills. Main outcome measures: Incremental cost-effectiveness ratio (ICER). The cost part of the ratio was considered as ‘the overall-costs’, while the effectiveness part was considered as ‘lives saved’ per treatment group. Results: With an increased one-year survival rate of 2.37% and an increased cost of €1120.8 ($1165.6) per patient in the TPA group, the ICER for the use of TPA instead of SK was €47,289 ($49,180.6) per life saved. Conclusion: This model can be a guide for similar analyses. The results of our study (the incremental cost-effectiveness of TPA over SK) will be informative for the decision-makers in Turkey, by whom the medical benefit for money spent would be assessed and judged. We believe that our results make a contribution to similar studies in the literature.
ABSTRACT The aim of the study was to evaluate the comparative effectiveness of Glycyrrhiza glabra... more ABSTRACT The aim of the study was to evaluate the comparative effectiveness of Glycyrrhiza glabra (liquorice) root decoction vs. omeprazole and misoprostol for the treatment of aspirin-induced gastric ulcers in rats. Animals were randomly assigned first to the &quot;prophylaxis&quot; and &quot;treatment&quot; groups and then to the test and the control groups. Liquorice decoction (25 ml/kg; i.g.); omeprazole (2.3 mg/kg; i.p.) and misoprostol (50 g/kg; i.g.) were administered for 3 consecutive days 30 min before aspirin (200 mg/kg, i.g.) administration, in the prophylaxis group. In the treatment group, aspirin (200 mg/kg, i.g.) was administered for 3 consecutive days, and then other drugs were administered at the same doses as the prophylaxis group daily for 4 weeks. According to histopathologic evaluation, misoprostol showed significant protection; however, liquorice decoction and omeprazole failed to protect. In the treatment group histopathological examinations showed no significant difference among liquorice decoction, misoprostol and omeprazole regarding aspirin-induced ulcer treatment; ulcers in all treatment groups were completely cured. The results of this study suggest that Glycyrrhiza glabra can be used for the treatment of NSAID-induced ulcers as an inexpensive alternative to misoprostol and omeprazole.
Objective Despite the availability of various prevention guidelines on coronary artery disease, s... more Objective Despite the availability of various prevention guidelines on coronary artery disease, secondary prevention practice utilizing aspirin, beta-blockers, angiotensin converting enzyme inhibitors and statins still can be sub-optimal. In this study, we aimed to assess the guideline adherence of secondary prevention prescribing and the continuity of adherence for a 5-year period in a small cohort of patients angiographically diagnosed to have coronary artery disease. Method In this prospective study, 73 patients who were angiographically diagnosed to have CAD were followed up for 5 years. The baseline demographic and clinical data were collected just before angiography. The baseline drug data were collected at the day of discharge. The fifth year data were taken from the patients via face-to-face consultations or phone interviews. Results The ‘initial prescribing rate’ at discharge was found to be 82% for aspirin, 49% for statins, 44% for ACE inhibitors and 55% for beta-blockers. ‘Continuity of prescribing’ for 5 years was 45% for aspirin, 26% for statins, 17% for ACE inhibitors and 20% for beta-blockers. Conclusions Besides the sub-optimal prescribing of secondary prevention drugs, absence of continuity of prescribing seems to be a challenging issue in pharmaceutical care of coronary artery disease patients.
The aim of the study was to investigate antituberculous drugs effects on polymorphonuclear leukoc... more The aim of the study was to investigate antituberculous drugs effects on polymorphonuclear leukocyte (PMN) functions (phagocytic activity and intracellular killing activity) in vitro. PMNs obtained from healthy volunteers were incubated with antituberculous drugs (isoniazid [INH], rifampin [RIF], pyrazinamide [PZA], ethambutol [EMB], streptomycin [S], amikacin [A], ofloxacin [OFLX], prothionamide [PTH] and cycloserine [CyC]) and different combinations at therapeutic serum concentrations. Phagocytic activity of PMNs was significantly increased when compared with controls by PTH (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), A (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), OFLX (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), INH+RIF+S combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), A+OFLX combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05), A+OFLX+CyC combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and A+OFLX+CyC+PTH+EMB combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Intracellular killing activity of PMNs was significantly increased by OFLX when compared with the control (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). No significant difference was observed in functions of PMN for other drugs when compared with control (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Functions of PMN were significantly increased by OFLX when compared with A+OFLX combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Phagocytic activity of PMNs was significantly increased by A+OFLX+CyC combination and A+OFLX+CyC+PTH+EMB combination when compared with A+OFLX+CyC+PTH combination and A+OFLX+CyC+PTH+PZA combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). No significant difference was found in functions of PMN between the other groups (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). In conclusion, some antituberculous drugs alone or in combination enhanced PMN functions, although in combination no additive or synergistic effects were detected. Moreover, none of the antituberculous drugs alone or in combination significantly decreased PMN functions. The drugs having adverse effects on immune functions would better be replaced with equally effective drugs or drug combinations having positive effects on PMN functions.
Objective Diabetes mellitus is a serious health problem associated with an increased mortality an... more Objective Diabetes mellitus is a serious health problem associated with an increased mortality and morbidity. The association of improved glycemic control with sustained decrease in the rate of complications has been shown in randomized clinical trials. Pharmaceutical care is a relatively new concept in Turkey; yet, there are no recorded routine pharmaceutical care programs. Therefore, we aimed to assess the impact of a short pharmaceutical care program conducted in the community pharmacy setting, on the indices of diabetes care of type 2 diabetic patients, particularly those regarding glycemic control and high blood pressure management. Setting The study was carried out at eight community pharmacies in Pendik district of Istanbul. Method All patients who visited any of the eight pharmacies through the pre-determined 1-week period were questioned for the presence of type 2 diabetes. Patients who reported to be type 2 diabetic (n = 67) were informed about the study and invited to involve. During this prospective longitudinal study, pharmaceutical care was provided to the patients by the same clinical pharmacist. The 3 month pharmaceutical care period consisted of six pharmacy visits. Main outcome measure: The main outcome measures were the improvement in glycemic control and blood pressure control; while, weight control, self-monitoring of blood glucose, compliance and being under physician-control were also assessed. Results The study was conducted on 43 patients who accepted to involve. Fasting blood glucose was lowered by a mean of 23% over 3-months from an initial value of 167.2 mg/dl. Number of patients reaching the desired blood glucose goals increased from 16.3% to 39.5%. Systolic and diastolic blood pressures also significantly fell over 3 months (mean reductions were 10.9 mmHg for the systolic and 9.3 mmHg for the diastolic blood pressure). Number of patients reaching the desired blood pressure goal increased from 30.2% to 51.2%. Conclusion Our short-course pharmaceutical care program yielded measurable improvements in clinical indicators of diabetes and comorbidity management. The results suggest that the pharmacist is a beneficial key component of integrated care for patients with type 2 diabetes. We think that the positive results observed in this first reported pharmaceutical care program on diabetes in Turkey can be motivating and encouraging for all community pharmacists.
PurposeThe aim of this study is to evaluate the geriatric drug usage, assess the appropriateness ... more PurposeThe aim of this study is to evaluate the geriatric drug usage, assess the appropriateness of their drug treatment and identify their pharmaceutical care requirements.
Background Helicobacter pylori is the most important etiologic agent for development of peptic ul... more Background Helicobacter pylori is the most important etiologic agent for development of peptic ulcer, chronic gastritis and gastric carcinomas. It is now well established that H. pylori eradication treatment is more cost-effective than acid suppressing therapies alone for the treatment of peptic ulcer disease. However, the comparative cost-effectiveness of various H. pylori eradication regimens is still not clear. Objective This study was designed to make a pharmacoeconomic comparison of different H. pylori eradication regimens in patients with peptic ulcer disease or chronic gastritis, using real-world cost and effectiveness data. Setting Istanbul University Hospital and Marmara University Hospital. Method A total of 75 patients diagnosed as H. pylori (+) by endoscopy were randomized to receive one of the seven H. pylori treatment protocols. These protocols were as follows: (LAC) = ‘lansoprazole 30 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid’ for 7 days and (OCM) = ‘omeprazole 20 mg bid + clarithromycin 250 mg bid + metronidazole 500 mg bid’; (OAM) = ‘omeprazole 40 mg qd + amoxicillin 500 mg tid + metronidazole 500 mg tid’; (MARB) = ‘metronidazole 250 mg tid + amoxicillin 500 mg qid + ranitidine 300 mg hs + bismuth 300 mg qid’; (OAC) = omeprazole 20 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid’; (OCA) = omeprazole 40 mg bid + clarithromycin 500 mg bid + amoxicillin 1 g bid’; (OAB) = ‘omeprazole 20 mg bid + amoxicillin 500 mg tid + bismuth 300 mg qid’ each for 14 days. Only direct costs were included in the analysis. Effectiveness was measured in terms of “successful eradication”. The cost-effectiveness ratios of the regimens were calculated using these effectiveness and cost data. The perspective of the study was assumed as the Government’s perspective. Main outcome measure Cost-effectiveness ratios of eradication regimens. Results MARB and OCA regimens were found to be more cost-effective than the other treatment regimens. The eradication rates and cost-effectiveness ratios calculated for these protocols were 90% (€158.7) for MARB and 90% (€195.8) for OCA regimen. Conclusion This study confirms the importance of using local pharmacoeconomic data. Analyses such as this give decision-makers the tools to choose a better treatment option which is both highly effective yet and has a low cost.
Objective The aim of this study was to validate the Turkish version of the ‘Medication
Regimen Co... more Objective The aim of this study was to validate the Turkish version of the ‘Medication Regimen Complexity Index’ (MRCI). Methods This validation study has been conducted in prescriptions of the first 100 elderly patients who had visited the pharmacy for their prescription refill to evaluate convergent and divergent validity of the Turkish version. The reliability of the Turkish version was assessed with inter-rater and test-retest analysis after its translation and cultural adaptation. Results The mean age of the 100 patients (53 women) was 74.9 years (SD = 7.58, 65–95). The scale showed high inter-rater reliability and test-retest reliability for the total and subscale scores (p < 0.05). A strong and positive correlation between the number of medications in a prescription and the total Medication Regimen Complexity Index scores (r = 0.930, p < 0.001) was determined. There were no statistically significant differences between age, gender and MRCI scores (p > 0.05). Conclusion These results show that the Turkish version of MRCI is a reliable and valid tool in elderly patients.
Introduction: A large number of systematic reviews resulted in claims on drug-drug interactions
(... more Introduction: A large number of systematic reviews resulted in claims on drug-drug interactions (DDIs) with proton pump inhibitors (PPIs). Such a large number begs for a consensus on clinical significance of findings. Areas covered: We critically evaluated the safety of PPI use with respect to DDIs with a metareview of systematic reviews, published between 1978 and 2015. We assessed the evidence by their reliability, repeatability, transparency, and objectivity according to the Assessment of Multiple Systematic Reviews (AMSTAR) criteria. Expert opinion: Clinicians must assess risks for each PPI individually as well as certain comorbid conditions. DDIs don’t substantiate a class effect for PPIs. Each PPI could induce unique DDIs. Concomitant use of PPIs with thienopyridines (i.e.; clopidogrel) could be justified in patients without strong affinity to cytochrome CYP2C19 and with high risk of bleeding (i.e.patients with prior upper gastrointestinal bleeding, Helicobacter pylori infection, advanced age, steroid treatment, and non-steroidal anti-inflammatory drug use). DDIs could occur in AIDS subpopulation treated with highly active antiretroviral therapy (HAART). DDIs exist for cancer patients under targeted therapy. Hypomagnesemia could increase with DDIs in the backdrop of advanced age and polypharmacy. Omeprazole poses high risks due to its pharmacokinetic DDI profile. Future systematic reviews should incorporate these additional risks for better clinical guidance.
The emergence of multidrug-resistant bacteria as a cause of ventriculoperitoneal (VP) shunt infec... more The emergence of multidrug-resistant bacteria as a cause of ventriculoperitoneal (VP) shunt infection is a disconcerting phenomenon that often requires the use of alternative antimicrobial agents due to resistance against commonly used medications. Linezolid, a member of a new class of antimicrobial agents, has good activity against virtually all important gram-positive pathogens, including multidrug-resistant gram-positive pathogens. The object of this article is to report a single-center experience with linezolid treatment in 6 young patients with VP shunt infections caused by drug-resistant strains. The authors reviewed the records of 6 pediatric patients who developed VP shunt infection and in whom initial antimicrobial treatment regimens, including vancomycin, either failed or were associated with vancomycin-resistant enterococcus. All 6 patients were treated at their hospital between July 1, 2008, and June 29, 2009. The patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; demographic and clinical characteristics, underlying diseases, clinical manifestations, laboratory results, and various treatment modalities used before linezolid therapy were evaluated. The 6 patients included were 2 boys and 4 girls with a mean (+/- SD) age of 11.83 +/- 12 months (range 4-36 months). Five patients had acquired an infection within 4 months (mean 7.50 +/- 13.51 months, range 1-35 months) after shunt insertion. Four patients were treated with external ventricular drainage. Two patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; parents refused to allow shunt removal and placement of an external ventricular drain. The CSF was clear of bacterial growth within a mean of 3.67 +/- 1.36 days (range 2-6 days) after initiation of linezolid treatment. The mean duration of linezolid treatment was 18.17 +/- 3.31 days (range 14-21 days). Microbiological clearance of CSF and clinical cure were achieved in all patients. No laboratory or clinical side effects were observed during the treatment period. The mean length of hospital stay was 22.8 +/- 4.96 days (range 17-28 days). Linezolid could be an appropriate treatment alternative in children with ventriculostomy-related CSF infections caused by drug-resistant strains, including cases in which shunt removal is not an option. Well-designed prospective studies providing additional information on linezolid levels in plasma and CSF are necessary to confirm the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; observations.
Rotavirus is the main cause of diarrhea-related illness and death in children worldwide. It is as... more Rotavirus is the main cause of diarrhea-related illness and death in children worldwide. It is associated with more than 2-3 million hospitalizations and up to 600 000 deaths in children aged <5 years; the vast majority occurring in developing countries (1). The clinical spectrum of ...
Management of multidrug-resistant Acinetobacter baumannii (MDRAB) meningitis/ventriculitis is a d... more Management of multidrug-resistant Acinetobacter baumannii (MDRAB) meningitis/ventriculitis is a difficult therapeutic problem owing to the limited penetration of antibiotics into cerebrospinal fluid (CSF). A 2-month-old girl with ventriculitis caused by MDRAB is reported. Despite therapy with intravenous (IV) colistin ventricular fluid, cultures remained positive for MDRAB. Institution of combination therapy with IV and intraventricular colistin resulted in a successful clinical and microbiological outcome. Intraventricular/intrathecal and IV colistin might be the best therapeutic option in the treatment of central nervous system infection caused by MDRAB. Further studies are required to evaluate pharmacokinetic and pharmacodynamic parameters of combined IV and intraventricular/intrathecal colistin administration, especially in children.
Objective of the study: To construct a simple model for an internal, retrospective cost-effective... more Objective of the study: To construct a simple model for an internal, retrospective cost-effectiveness analysis and to calculate the incremental cost-effectiveness of tissue plasminogen activator (TPA) over streptokinase (SK) in Turkey. Setting: Koşuyolu Heart, Education and Research Hospital, Istanbul, Turkey. Method: Among patients who were hospitalized for treatment of acute myocardial infarction (AMI), 196 were randomly selected. One-year mortality rates according to the treatment groups (TPA, SK, other) were determined. Among surviving patients, 28 from TPA and another 28 from SK group were randomly selected for the pharmacoeconomic analysis. Patient treatment data were taken from medical records while data regarding to costs were taken from hospital bills. Main outcome measures: Incremental cost-effectiveness ratio (ICER). The cost part of the ratio was considered as ‘the overall-costs’, while the effectiveness part was considered as ‘lives saved’ per treatment group. Results: With an increased one-year survival rate of 2.37% and an increased cost of €1120.8 ($1165.6) per patient in the TPA group, the ICER for the use of TPA instead of SK was €47,289 ($49,180.6) per life saved. Conclusion: This model can be a guide for similar analyses. The results of our study (the incremental cost-effectiveness of TPA over SK) will be informative for the decision-makers in Turkey, by whom the medical benefit for money spent would be assessed and judged. We believe that our results make a contribution to similar studies in the literature.
ABSTRACT The aim of the study was to evaluate the comparative effectiveness of Glycyrrhiza glabra... more ABSTRACT The aim of the study was to evaluate the comparative effectiveness of Glycyrrhiza glabra (liquorice) root decoction vs. omeprazole and misoprostol for the treatment of aspirin-induced gastric ulcers in rats. Animals were randomly assigned first to the &quot;prophylaxis&quot; and &quot;treatment&quot; groups and then to the test and the control groups. Liquorice decoction (25 ml/kg; i.g.); omeprazole (2.3 mg/kg; i.p.) and misoprostol (50 g/kg; i.g.) were administered for 3 consecutive days 30 min before aspirin (200 mg/kg, i.g.) administration, in the prophylaxis group. In the treatment group, aspirin (200 mg/kg, i.g.) was administered for 3 consecutive days, and then other drugs were administered at the same doses as the prophylaxis group daily for 4 weeks. According to histopathologic evaluation, misoprostol showed significant protection; however, liquorice decoction and omeprazole failed to protect. In the treatment group histopathological examinations showed no significant difference among liquorice decoction, misoprostol and omeprazole regarding aspirin-induced ulcer treatment; ulcers in all treatment groups were completely cured. The results of this study suggest that Glycyrrhiza glabra can be used for the treatment of NSAID-induced ulcers as an inexpensive alternative to misoprostol and omeprazole.
Objective Despite the availability of various prevention guidelines on coronary artery disease, s... more Objective Despite the availability of various prevention guidelines on coronary artery disease, secondary prevention practice utilizing aspirin, beta-blockers, angiotensin converting enzyme inhibitors and statins still can be sub-optimal. In this study, we aimed to assess the guideline adherence of secondary prevention prescribing and the continuity of adherence for a 5-year period in a small cohort of patients angiographically diagnosed to have coronary artery disease. Method In this prospective study, 73 patients who were angiographically diagnosed to have CAD were followed up for 5 years. The baseline demographic and clinical data were collected just before angiography. The baseline drug data were collected at the day of discharge. The fifth year data were taken from the patients via face-to-face consultations or phone interviews. Results The ‘initial prescribing rate’ at discharge was found to be 82% for aspirin, 49% for statins, 44% for ACE inhibitors and 55% for beta-blockers. ‘Continuity of prescribing’ for 5 years was 45% for aspirin, 26% for statins, 17% for ACE inhibitors and 20% for beta-blockers. Conclusions Besides the sub-optimal prescribing of secondary prevention drugs, absence of continuity of prescribing seems to be a challenging issue in pharmaceutical care of coronary artery disease patients.
The aim of the study was to investigate antituberculous drugs effects on polymorphonuclear leukoc... more The aim of the study was to investigate antituberculous drugs effects on polymorphonuclear leukocyte (PMN) functions (phagocytic activity and intracellular killing activity) in vitro. PMNs obtained from healthy volunteers were incubated with antituberculous drugs (isoniazid [INH], rifampin [RIF], pyrazinamide [PZA], ethambutol [EMB], streptomycin [S], amikacin [A], ofloxacin [OFLX], prothionamide [PTH] and cycloserine [CyC]) and different combinations at therapeutic serum concentrations. Phagocytic activity of PMNs was significantly increased when compared with controls by PTH (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), A (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), OFLX (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), INH+RIF+S combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), A+OFLX combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05), A+OFLX+CyC combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and A+OFLX+CyC+PTH+EMB combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Intracellular killing activity of PMNs was significantly increased by OFLX when compared with the control (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). No significant difference was observed in functions of PMN for other drugs when compared with control (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Functions of PMN were significantly increased by OFLX when compared with A+OFLX combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Phagocytic activity of PMNs was significantly increased by A+OFLX+CyC combination and A+OFLX+CyC+PTH+EMB combination when compared with A+OFLX+CyC+PTH combination and A+OFLX+CyC+PTH+PZA combination (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). No significant difference was found in functions of PMN between the other groups (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). In conclusion, some antituberculous drugs alone or in combination enhanced PMN functions, although in combination no additive or synergistic effects were detected. Moreover, none of the antituberculous drugs alone or in combination significantly decreased PMN functions. The drugs having adverse effects on immune functions would better be replaced with equally effective drugs or drug combinations having positive effects on PMN functions.
Objective Diabetes mellitus is a serious health problem associated with an increased mortality an... more Objective Diabetes mellitus is a serious health problem associated with an increased mortality and morbidity. The association of improved glycemic control with sustained decrease in the rate of complications has been shown in randomized clinical trials. Pharmaceutical care is a relatively new concept in Turkey; yet, there are no recorded routine pharmaceutical care programs. Therefore, we aimed to assess the impact of a short pharmaceutical care program conducted in the community pharmacy setting, on the indices of diabetes care of type 2 diabetic patients, particularly those regarding glycemic control and high blood pressure management. Setting The study was carried out at eight community pharmacies in Pendik district of Istanbul. Method All patients who visited any of the eight pharmacies through the pre-determined 1-week period were questioned for the presence of type 2 diabetes. Patients who reported to be type 2 diabetic (n = 67) were informed about the study and invited to involve. During this prospective longitudinal study, pharmaceutical care was provided to the patients by the same clinical pharmacist. The 3 month pharmaceutical care period consisted of six pharmacy visits. Main outcome measure: The main outcome measures were the improvement in glycemic control and blood pressure control; while, weight control, self-monitoring of blood glucose, compliance and being under physician-control were also assessed. Results The study was conducted on 43 patients who accepted to involve. Fasting blood glucose was lowered by a mean of 23% over 3-months from an initial value of 167.2 mg/dl. Number of patients reaching the desired blood glucose goals increased from 16.3% to 39.5%. Systolic and diastolic blood pressures also significantly fell over 3 months (mean reductions were 10.9 mmHg for the systolic and 9.3 mmHg for the diastolic blood pressure). Number of patients reaching the desired blood pressure goal increased from 30.2% to 51.2%. Conclusion Our short-course pharmaceutical care program yielded measurable improvements in clinical indicators of diabetes and comorbidity management. The results suggest that the pharmacist is a beneficial key component of integrated care for patients with type 2 diabetes. We think that the positive results observed in this first reported pharmaceutical care program on diabetes in Turkey can be motivating and encouraging for all community pharmacists.
PurposeThe aim of this study is to evaluate the geriatric drug usage, assess the appropriateness ... more PurposeThe aim of this study is to evaluate the geriatric drug usage, assess the appropriateness of their drug treatment and identify their pharmaceutical care requirements.
Background Helicobacter pylori is the most important etiologic agent for development of peptic ul... more Background Helicobacter pylori is the most important etiologic agent for development of peptic ulcer, chronic gastritis and gastric carcinomas. It is now well established that H. pylori eradication treatment is more cost-effective than acid suppressing therapies alone for the treatment of peptic ulcer disease. However, the comparative cost-effectiveness of various H. pylori eradication regimens is still not clear. Objective This study was designed to make a pharmacoeconomic comparison of different H. pylori eradication regimens in patients with peptic ulcer disease or chronic gastritis, using real-world cost and effectiveness data. Setting Istanbul University Hospital and Marmara University Hospital. Method A total of 75 patients diagnosed as H. pylori (+) by endoscopy were randomized to receive one of the seven H. pylori treatment protocols. These protocols were as follows: (LAC) = ‘lansoprazole 30 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid’ for 7 days and (OCM) = ‘omeprazole 20 mg bid + clarithromycin 250 mg bid + metronidazole 500 mg bid’; (OAM) = ‘omeprazole 40 mg qd + amoxicillin 500 mg tid + metronidazole 500 mg tid’; (MARB) = ‘metronidazole 250 mg tid + amoxicillin 500 mg qid + ranitidine 300 mg hs + bismuth 300 mg qid’; (OAC) = omeprazole 20 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid’; (OCA) = omeprazole 40 mg bid + clarithromycin 500 mg bid + amoxicillin 1 g bid’; (OAB) = ‘omeprazole 20 mg bid + amoxicillin 500 mg tid + bismuth 300 mg qid’ each for 14 days. Only direct costs were included in the analysis. Effectiveness was measured in terms of “successful eradication”. The cost-effectiveness ratios of the regimens were calculated using these effectiveness and cost data. The perspective of the study was assumed as the Government’s perspective. Main outcome measure Cost-effectiveness ratios of eradication regimens. Results MARB and OCA regimens were found to be more cost-effective than the other treatment regimens. The eradication rates and cost-effectiveness ratios calculated for these protocols were 90% (€158.7) for MARB and 90% (€195.8) for OCA regimen. Conclusion This study confirms the importance of using local pharmacoeconomic data. Analyses such as this give decision-makers the tools to choose a better treatment option which is both highly effective yet and has a low cost.
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Papers by Mesut Sancar
Regimen Complexity Index’ (MRCI).
Methods This validation study has been conducted in prescriptions of the first 100 elderly
patients who had visited the pharmacy for their prescription refill to evaluate convergent
and divergent validity of the Turkish version. The reliability of the Turkish version was
assessed with inter-rater and test-retest analysis after its translation and cultural adaptation.
Results The mean age of the 100 patients (53 women) was 74.9 years (SD = 7.58, 65–95).
The scale showed high inter-rater reliability and test-retest reliability for the total and
subscale scores (p < 0.05). A strong and positive correlation between the number of
medications in a prescription and the total Medication Regimen Complexity Index scores
(r = 0.930, p < 0.001) was determined. There were no statistically significant differences
between age, gender and MRCI scores (p > 0.05).
Conclusion These results show that the Turkish version of MRCI is a reliable and valid
tool in elderly patients.
(DDIs) with proton pump inhibitors (PPIs). Such a large number begs for a consensus on
clinical significance of findings.
Areas covered: We critically evaluated the safety of PPI use with respect to DDIs with a metareview
of systematic reviews, published between 1978 and 2015. We assessed the evidence by
their reliability, repeatability, transparency, and objectivity according to the Assessment of
Multiple Systematic Reviews (AMSTAR) criteria.
Expert opinion: Clinicians must assess risks for each PPI individually as well as certain
comorbid conditions. DDIs don’t substantiate a class effect for PPIs. Each PPI could induce
unique DDIs. Concomitant use of PPIs with thienopyridines (i.e.; clopidogrel) could be justified
in patients without strong affinity to cytochrome CYP2C19 and with high risk of bleeding
(i.e.patients with prior upper gastrointestinal bleeding, Helicobacter pylori infection, advanced
age, steroid treatment, and non-steroidal anti-inflammatory drug use). DDIs could occur in
AIDS subpopulation treated with highly active antiretroviral therapy (HAART). DDIs exist for
cancer patients under targeted therapy. Hypomagnesemia could increase with DDIs in the
backdrop of advanced age and polypharmacy. Omeprazole poses high risks due to its
pharmacokinetic DDI profile. Future systematic reviews should incorporate these additional
risks for better clinical guidance.
Regimen Complexity Index’ (MRCI).
Methods This validation study has been conducted in prescriptions of the first 100 elderly
patients who had visited the pharmacy for their prescription refill to evaluate convergent
and divergent validity of the Turkish version. The reliability of the Turkish version was
assessed with inter-rater and test-retest analysis after its translation and cultural adaptation.
Results The mean age of the 100 patients (53 women) was 74.9 years (SD = 7.58, 65–95).
The scale showed high inter-rater reliability and test-retest reliability for the total and
subscale scores (p < 0.05). A strong and positive correlation between the number of
medications in a prescription and the total Medication Regimen Complexity Index scores
(r = 0.930, p < 0.001) was determined. There were no statistically significant differences
between age, gender and MRCI scores (p > 0.05).
Conclusion These results show that the Turkish version of MRCI is a reliable and valid
tool in elderly patients.
(DDIs) with proton pump inhibitors (PPIs). Such a large number begs for a consensus on
clinical significance of findings.
Areas covered: We critically evaluated the safety of PPI use with respect to DDIs with a metareview
of systematic reviews, published between 1978 and 2015. We assessed the evidence by
their reliability, repeatability, transparency, and objectivity according to the Assessment of
Multiple Systematic Reviews (AMSTAR) criteria.
Expert opinion: Clinicians must assess risks for each PPI individually as well as certain
comorbid conditions. DDIs don’t substantiate a class effect for PPIs. Each PPI could induce
unique DDIs. Concomitant use of PPIs with thienopyridines (i.e.; clopidogrel) could be justified
in patients without strong affinity to cytochrome CYP2C19 and with high risk of bleeding
(i.e.patients with prior upper gastrointestinal bleeding, Helicobacter pylori infection, advanced
age, steroid treatment, and non-steroidal anti-inflammatory drug use). DDIs could occur in
AIDS subpopulation treated with highly active antiretroviral therapy (HAART). DDIs exist for
cancer patients under targeted therapy. Hypomagnesemia could increase with DDIs in the
backdrop of advanced age and polypharmacy. Omeprazole poses high risks due to its
pharmacokinetic DDI profile. Future systematic reviews should incorporate these additional
risks for better clinical guidance.