Silymarin (SMN) as an ancient plant has various therapeutic usage in many diseases. Almost all of its properties attributed to antioxidant and anti-inflammatory properties. Currently, infertility problems impose a heavy burden on many developing countries. As a result, effective infertility treatment is indicated. The role of oxidative stress in both male and female infertility has been revealed. Many studies have shown protective and antioxidative properties of SMN against adverse effects of chemotherapy medications and environmental toxins in sperms and oocytes. The antioxidative and clinical role of SMN in infertility has been reviewed. The use of antioxidants such as SMN can help to improve fertility rate by scavenging free radicals and inhibiting nuclear factor kappa B transcription factor. Animal studies in both male and female have indicated a beneficial effect of SMN on fertility recovery. Further clinical studies are needed considering the phytoestrogenic property of SMN, to determine the right dose and duration of treatment.

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Objective: There is increasing evidence to show that hyperuricemia may have a pathogenic role in the progression of renal diseases. We performed a prospective, randomized, controlled trial to investigate the renal effects of allopurinol treatment in hyperuricemic patients with end-stage renal disease (ESRD) who undergo peritoneal dialysis. Methods: This was a unicenter, randomized, controlled clinical trial conducted in “Alzahra Hospital, Isfahan, Iran.” Patients were randomly assigned into treatment or control group. Treatment-group patients were administered a starting allopurinol dose of 100 mg/day. The dose was adjusted according to serum uric acid level, aiming to maintain uric acid levels within the normal range. Participants were followed up for 6 months after receiving the medicine. Residual renal function (RRF) was assessed by measuring the renal component of Kt/V urea and estimating the patient's glomerular filtration rate (GFR) by calculating the mean of urea and creatinine clearance. In addition, systolic and diastolic blood pressure and serum level of creatinine were measured every 3 months during the follow-up period. Findings: Eighty patients were enrolled in the study and divided into two groups, including 40 ESRD patients receiving allopurinol and 40 ESRD did not receive allopurinol and considered as the control group. GFR measurements showed that there was not a significant difference between patients' RRF of two groups. However, allopurinol group had higher RRF than the control group during the follow-up period. Evaluating RRF by Kt/V showed the same results. Conclusion: Our study demonstrated significant effects of allopurinol on decreasing serum levels of uric acid in ESRD patients undergoing peritoneal dialysis. On the other hand, renal residual function of patients under treatment with allopurinol was better than the control group. We recommend that further studies should be conducted on the effects of allopurinol with greater sample size and longer time of follow-up.

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Objective: Pharmacokinetic and clinical studies recommend applying loading dose of colistin for the treatment of severe infections in the critically ill adults. Pharmacokinetic studies of colistin in children also highlight the need for a loading dose. However, there are no clinical studies evaluating the effectiveness of colistin loading dose in children. Methods: In a randomized trial, children with ventilator-associated pneumonia or central line-associated bloodstream infection (CLABSI) for whom colistin was initiated, were enrolled. Patients were randomized into two groups; loading dose and conventional dose treatment arms. In the conventional treatment arm, colistimethate sodium was initiated with maintenance dose. In the loading dose group, colistimethate sodium was commenced with a loading dose of 150,000 international unit/kg, then on the maintenance dose. Both treatment arms also received meropenem as combination therapy. Primary outcomes were overall efficacy, clinical improvement and microbiological cure. Secondary outcomes were colistin-induced nephrotoxicity and development of resistance. Findings: Thirty children completed this study. There was a significantly higher overall efficacy in the group received loading dose (42.9 vs. 6.3%, P = 0.031). There weren't any significant differences in the clinical and microbiological endpoints. In the subgroup of children with CLABSI, results illustrated a trend toward (though statistically nonsignificant) better clinical cure for patients receiving loading dose. Conclusion: This preliminary study suggests that colistin loading dose might have some benefits in critically ill children, specifically in children with CLABSI. Further trials are required to elucidate colistin best dosing strategy in critically ill children with severe infections.

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Objective: Uncontrolled hypertension negatively impacts on mortality. This study aimed to evaluate the impact of a pharmacist-led patient counseling and education model to empower hypertensive patients on chronic medication. Methods: This was an operational research project with a quasi-experimental design including an intervention group (55 patients) and a control group (31 patients) of chronic hypertensive patients. The data were collected with interview-administered questionnaires, and were analyzed using SAS^® version 9.4. Pharmacist interventions included an educational diary on hypertension management and patient counseling. Findings: A 34.7% improvement was observed in patients' understanding of what normal blood pressure (BP) is in the intervention group compared to the control group (P < 0.001), whereas a 9.1% improvement was also observed in the intervention group in their knowledge about the fact that systolic BP and diastolic BP are both important in controlling hypertension, with no change in the control group. After the intervention, 40.0% of patients in the intervention group versus 17.9% in the control group had adequate knowledge (≥75% correct answers) about hypertension and its management. Pharmacist interventions were well received by the majority of patients (>90%). Conclusion: A pharmacist-led patient counseling and education model can help improve patients' hypertension knowledge and BP control. These should increasingly become routine, aiming to improve chronic disease management.

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Objective: Increased risk of infection following hyperglycemia has been reported in hospitalized patients. Sliding-scale insulin protocol is an out-of-date method; therefore, it is necessary to examine new approaches in this regard. This study aimed to evaluate the efficacy of sliding-scale protocol versus basal-bolus insulin protocol, which supervised by clinical pharmacists in an infectious disease ward. Methods: In this prospective randomized clinical trial, 90 hyperglycemic patients who hospitalized in Loghman Hakim Hospital Infectious Disease Ward (Tehran, Iran) were randomized into two groups: sliding-scale insulin protocol (the control group) and the basal-bolus protocol groups that were under supervision clinical pharmacists. Some demographic, laboratory, and clinical variables, as well as patient's blood glucose were measured four times daily. Findings: The results indicated significant improvement among the patients in the intervention group. General indicators including fever, blood glucose level, the duration of hospitalization, incidence of hypoglycemia, days to achieve normal blood glucose, and leukocyte count improved in intervention group. Conclusion: According to this study, basal-bolus insulin protocol, which supervised by clinical pharmacy service, showed better blood glucose control and infection remission compared to the sliding-scale protocol.

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Objective: Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among under-fives. However, self-medication and “self-care” care practices remain common, especially among informal settlements in Namibia. Consequently, we sought to ascertain the rationale for this to guide the future activities. Methods: Mixed method approach among residents in an informal settlement in Namibia to determine the extent of health-seeking behaviors and the rationale for any self-medication. Findings: Of the 100 everyday households surveyed, 60% used self-medication for ARIs in children under five including cold/flu medication, paracetamol, and decongestants. There was no self-purchasing of antibiotics. The main drivers of self-medication were a perceived diagnosis of ARI as “minor or mild” as well as long waiting times and queues to receive care at public health facilities. Conclusion: The majority of households in this settlement self-medicate their children for ARIs. There are needs for outreach primary health care services in the future in townships to screen and appropriately manage ARI to address concerns. This can include increasing pharmacy services.

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Objective: The majority of patients who receive antihypertensive treatment do not achieve adequate blood pressure (BP) outcomes. Adherence to antihypertensive therapy contributes to adequate control of BP and is a substantial reason for therapeutic success. This study aims to evaluate the role of clinical pharmacists in improving patient adherence to pharmacological treatment and in improving BP outcomes. Methods: A pre- and postpharmaceutical care interventional study was provided to hypertensive patients in the Cardiovascular Health Program of the Family Health Community Hospital in rural Coelemu, Chile. Patients received pharmaceutical care in three individualized sessions over 6 months. Written educational materials including basic information on high BP were provided to each patient in every session using easy-to-understand language. BP was measured at the beginning and end of each session using an electronic tensiometer, and patients reported their adherence to therapy using indirect, self-reported measures. Findings: Over the study period, patients experienced average decreases in systolic and diastolic BP of 7.68 mmHg (P < 0.001) and 2.91 mmHg (P < 0.001), respectively. Patient adherence to medication, according to self-reported measures, increased from 22% to 60% over the study period. Conclusion: Pharmaceutical care, including education about hypertension, healthy lifestyle habits, and adherence, was associated with improved adherence to antihypertensive drug treatment and control of BP in hypertensive patients at a rural hospital in Chile.

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