Exhaled Volatile Organic Compounds for Asthma Control Classification in Children with Moderate to Severe Asthma: Results from the SysPharmPediA Study

RATIONALE

Early identification of children with poorly controlled asthma is imperative for optimizing treatment strategies. The analysis of exhaled volatile organic compounds (VOCs) is an emerging approach to identify prognostic and diagnostic biomarkers in pediatric asthma.

OBJECTIVES

To assess the accuracy of gas chromatography-mass spectrometry based exhaled metabolite analysis to differentiate between controlled and uncontrolled pediatric asthma.

METHODS

This study encompassed a discovery (SysPharmPediA) and validation phase (U-BIOPRED, PANDA). Firstly, exhaled VOCs that discriminated asthma control levels were identified. Subsequently, outcomes were validated in two independent cohorts. Patients were classified as controlled or uncontrolled, based on asthma control test scores and number of severe attacks in the past year. Additionally, potential of VOCs in predicting two or more future severe asthma attacks in SysPharmPediA was evaluated.

MEASUREMENTS AND MAIN RESULTS

Complete data were available for 196 children (SysPharmPediA=100, U-BIOPRED=49, PANDA=47). In SysPharmPediA, after randomly splitting the population into training (n=51) and test sets (n=49), three compounds (acetophenone, ethylbenzene, and styrene) distinguished between uncontrolled and controlled asthmatics. The area under the receiver operating characteristic curve (AUROCC) for training and test sets were respectively: 0.83 (95% CI: 0.65-1.00) and 0.77 (95% CI: 0.58-0.96). Combinations of these VOCs resulted in AUROCCs of 0.74 ±0.06 (UBIOPRED) and 0.68 ±0.05 (PANDA). Attacks prediction tests, resulted in AUROCCs of 0.71 (95% CI 0.51-0.91) and 0.71 (95% CI 0.52-0.90) for training and test sets.

CONCLUSIONS

Exhaled metabolites analysis might enable asthma control classification in children. This should stimulate further development of exhaled metabolites-based point-of-care tests in asthma.

Exhaled volatile organic compounds associated with risk factors for obstructive pulmonary diseases: a systematic review

Background

Asthma and COPD are among the most common respiratory diseases. To improve the early detection of exacerbations and the clinical course of asthma and COPD new biomarkers are needed. The development of noninvasive metabolomics of exhaled air into a point-of-care tool is an appealing option. However, risk factors for obstructive pulmonary diseases can potentially introduce confounding markers due to altered volatile organic compound (VOC) patterns being linked to these risk factors instead of the disease. We conducted a systematic review and presented a comprehensive list of VOCs associated with these risk factors.

Methods

A PRISMA-oriented systematic search was conducted across PubMed, Embase and Cochrane Libraries between 2000 and 2022. Full-length studies evaluating VOCs in exhaled breath were included. A narrative synthesis of the data was conducted, and the Newcastle-Ottawa Scale was used to assess the quality of included studies.

Results

The search yielded 2209 records and, based on the inclusion/exclusion criteria, 24 articles were included in the qualitative synthesis. In total, 232 individual VOCs associated with risk factors for obstructive pulmonary diseases were found; 58 compounds were reported more than once and 12 were reported as potential markers of asthma and/or COPD in other studies. Critical appraisal found that the identified studies were methodologically heterogeneous and had a variable risk of bias.

Conclusion

We identified a series of exhaled VOCs associated with risk factors for asthma and/or COPD. Identification of these VOCs is necessary for the further development of exhaled metabolites-based point-of-care tests in these obstructive pulmonary diseases.

Prophylactic Agents for Preventing Cardiotoxicity Induced Following Anticancer Agents: A Systematic Review and Meta-Analysis of Clinical Trials

BACKGROUND

Anthracyclines can improve survival in many types of malignancies, but dose-dependent and irreversible results following the use of anthracyclines have been associated with cardiomyopathy. This meta-analysis aimed to compare the effects of prophylactic agents for preventing cardiotoxicity induced following anticancer agents.

METHODS

In this meta-analysis, Scopus, Web of Science, and PubMed were surfed for articles published by December 30th, 2020. The keywords were angiotensin-converting enzyme inhibitor (ACEI), enalapril, captopril, angiotensin receptor blocker, beta blocker, metoprolol, bisoprolol, isoprolol, statin, valsartan, losartan, eplerenone, idarubicin, nebivolol, dihydromyricetin, ampelopsin, spironolactone, dexrazoxane, antioxidants, cardiotoxicity, n-acetyl-tryptamine, cancer, neoplasms, chemotherapy, anthracyclines, doxorubicin, daunorubicin, epirubicin, idarubicin, ejection fraction or a combination of them in the titles or abstracts.

RESULTS

A total of 17 articles out of 728 studies examining 2,674 patients were included in this systematic review and meta-analysis. Ejection fraction (EF) values in the baseline, 6-month, and 12-month follow-up in the intervention group turned out to be 62.52 ± 2.48, 59.63 ± 4.85, and 59.42 ± 4.53, whereas in the control group appeared to be 62.81 ± 2.58, 57.69 ± 4.32, and 58.60 ± 4.58, respectively. Through comparison of the two groups, EF was found to increase in the intervention group by 0.40 after 6 months (Standardized mean difference (SMD): 0.40, 95% confidence interval (CI): 0.27, 0.54), thus proving higher than that of the control groups following the cardiac drugs.

CONCLUSION

This meta-analysis showed that prophylactic treatment with cardio-protective drugs, including dexrazoxane, beta blocker, and ACEI drugs in patients undergoing chemotherapy with anthracycline, have a protective effect on LVEF and prevent EF drop.

The Utilization Evaluation of Intravenous Pantoprazole for Stress Ulcer Prophylaxis in a Major Teaching Hospital

Background: Proton pump inhibitors (PPIs) are one of the first-line drugs for acid-dependent diseases. Inappropriate use of PPIs, especially the Intravenous (IV) formula of pantoprazole, can result in excessive cost. This study aimed to evaluate IV pantoprazole usage's appropriateness and optimize its use in accordance with guidelines at Razi educational and remedial center, Rasht, Iran. Methods: This cross-sectional study was executed in five months among 344 patients of Razi hospital who received IV pantoprazole for stress ulcer prophylaxis (SUP). Demographic data, route and doses of pantoprazole, risk factors for stress ulcer, and other related medical data were recorded. In addition, the appropriate use of IV pantoprazole was measured according to recommendations arranged by this center and the American Society of Health-System Pharmacists. Results: Out of 197 patients who received SUP with an appropriate indication, 183 patients (92.9%) were able to tolerate the drug orally, and only 14 patients (7.1%) had an indication for receiving IV pantoprazole. There was a significant difference between patients who received SUP with an indication regarding having or not having an indication for IV pantoprazole (P = 0.007). 5029 vials (96.5%) with a cost of 17,822 US dollars were used inappropriately and imposed an additional cost on the health care system. Conclusion: This study presented that the majority of IV pantoprazole use in this center was not well-matched with guidelines in most cases, containing appropriate indication and right dosing. In order to prescribe this drug as SUP, it is necessary to be more careful about the criteria for prescribing and conforming the prescribed drug and the prescribed dose to the relevant instructions.

Evaluation of Potential Drug-Drug Interactions among Patients of the Nephrology and Kidney Transplant Wards of a Major Teaching Hospital in Iran

Aims: This study was aimed to find the prevalence of potential DDIs in patients and identify factors associated with these interactions. Study design:  All patients' medication regimens were screened for potential DDIs through Lexi-Interact® Online application. Place and Duration of Study: This study was conducted for five months in 2017-2018 at the nephrology and kidney transplant ward of Razi hospital, Rasht, Iran. Methodology: Each potential DDI was characterized based on severity, onset, mechanism, risk rating and reliability rating.  The patient's comorbidity was assessed with the Charlson comorbidity index. The quality of patients' life was assessed with the Kidney Disease Quality of Life Instrument-SF36TM questionnaire. Results: The study included 191 patients (109 [57.07%] males and 82 [42.93%] females) with a mean age of 58.09 ± 17.76 years. The analysis revealed that 29.4 % of potential DDIs had good and 13.5% had excellent evidence. There was a statistically significant association among the number of prescribed medications (polypharmacy), hospital ward, age, Body Mass Index, education, history of drug addiction, length of hospitalization, dyslipidemia, and hypothyroidism. Conclusion Potential DDIs are common in patients of the nephrology and kidney transplant wards, so proper patient monitoring is essential for minimizing and preventing potential adverse outcomes of DDIs.

Evaluation of Albumin Utilization in a Major Teaching Hospital in Iran Before and After Guideline Implementation

Background: Inappropriate use of drugs is one of the major issues in health care system. Rational drug utilization based on the appropriate guidelines has an important role in management of use of expensive medications. We aimed to evaluate albumin usage's appropriateness based on evidence-based indications before and after implementing albumin prescription guideline in a teaching hospital. Methods: This study was performed in two phases. During two-month periods, all the patients who were ordered to receive albumin were evaluated. The first phase was done in November and December of 2017, during which, based on physicians' comments, the guideline was finalized and then implemented. Phase two was performed in May and June 2018. Results: Albumin was prescribed appropriately in 33 patients (55%) in the first phase and 43 (70%) patients in the second phase. 299 vials in the first phase and 456 vials in the second phase were prescribed which 198 vials (66%) and 394 (86%) vials were used with appropriate indications, respectively. The number of vials consumed with inappropriate indication decreased significantly from 101 vials (34%) in the first phase to 62 vials (14%) in the second phase (P-value=0.01). The average cost of the inappropriate indication per patient decreased from $197.3 ± 131.6 in the first phase to $183.5 ± 126.8 in the second phase (P-value=0.52). Conclusion: This study showed implementing a DUE program and designing a guideline for rational prescribing of albumin and interventional methods can optimize treatment duration, significantly decrease inappropriate usage, and avoid unnecessary hospital costs.

Evaluation of Medication Package Inserts in Iran

Objective:

Package inserts (PIs) provide information for the safe and effective use of medication. There is no study on the evaluation of PIs in Iran. The purpose of this study was to evaluate the completeness of PIs supplied with the 100 top-selling medications in Iran.

Methods:

This cross-sectional observational study was conducted during 3 weeks in January 2017. One hundred medications were chosen from a list supplied by the Iran Food and Drug Administration (IFDA). The PIs were assessed for the presentation and completeness of quality criteria, which was consisted of two parts. The first part was the criteria required by the IFDA, mentioned in Chapter 16 of the Pharmaceutical Regulations and Instructions provided by the IFDA. The second part of the criteria was defined according to the critical comments of clinical and industrial pharmacists.

Findings:

Thirty-seven out of 100 medications included no PIs. None of the PIs met all the criteria required by the IFDA. The highest score for completeness was 18 out of 21 (85.7%). Medication name, description, and adverse reaction were mentioned in all PIs. Other items such as patient counseling information (98%), warnings (95.2%), precautions (95.2%), pregnancy/lactation (95%), and storage condition (90.5%) have been mentioned in a high percentage of PIs.

Conclusion:

PIs have improved in recent years in Iran, but there is an absolute need for more accurate and up-to-date information. The IFDA should supervise pharmaceutical companies more strictly in this regard and should revise its regulations requiring PIs to conform to the FDA regulations.

Investigation of phenolic compounds and antioxidant activity of leaves extracts from seventeen cultivars of Iranian olive (Olea europaea L.)

The leaves of seventeen cultivars of olive growing in the north of Iran were investigated for total phenol content and antioxidant activity. The identification and quantification of main phenolic compounds were performed by reverse phase high performance liquid chromatography with diode array detector. The cultivars Kalamon, Gordal, and Coratina contained the highest concentration of phenolic compounds (190.65 ± 0.03, 184.72 ± 0.001, and 155.91 ± 0.06 mg GAE/g extract, respectively). The maximum radical scavenging activities were found in Gordal, Coratina, and Kalamon extracts (IC₅₀ 20.66, 22.95, and 26.74 µg ml^-1, respectively). The extracts of Mishen, Fishomi, and Arbequina (1971.37 ± 0.007, 1794.57 ± 0.001, and 1760.57 ± 0.005 µmol Fe II/g dried extract, respectively) showed highest antioxidant activity in FRAP assay. The identification analysis demonstrated the present of vanillin, rutin, luteolin 7-O-glucoside, oleuropein, and quercetin. The highest oleuropein concentrations were detected in cultivars Mishen, Beleidi, Kalamon, and Roghani while it was not detected in cultivars Conservolea, Amigdalolia, Leccino, and Fishomi.