Medication errors made by nurses are common in general practice and can lead to harm in patients. The aim of this study was to evaluate the impact of pharmacist-led educational implementations in reducing medication errors made by nurses in an emergency hospital in Cairo, Egypt. A prospective pre-post-interventional study was conducted in an emergency hospital using direct observation for the detection of errors. The rate and severity of medication errors were determined before and after the implementation of educational tools. In total, 1025 and 1024 patients were examined pre- and post-intervention, respectively. Pharmacist interventions resulted in a significant reduction in the medication error rate from 351 (34.2%) in the pre-intervention phase to 157 (15.3%) in the post-intervention phase (P < 0.001). In both the pre- and post-intervention phases, none of the medication errors were associated with harm/death. Furthermore, all types of medication errors declined as a result of the interventions. Clinical pharmacists' interventions focusing on improving nurses' drug knowledge and awareness of errors were shown to be effective in reducing the rate and severity of medication administration errors among nurses in an emergency hospital environment.

Metabolic dysfunction-associated steatotic liver disease (MASLD) includes patients with hepatic steatosis and at least one of five cardiometabolic risk factors. Xanthine oxidase (XO) represents a treatment target for MASLD. We aimed to evaluate the effect of two xanthine oxidase inhibitors, allopurinol and febuxostat, plus lifestyle modifications compared to lifestyle modifications alone on improving steatosis. Ninety MASLD patients were assigned to one of three groups for three months. Patients with hyperuricemia were given either allopurinol 100 mg or febuxostat 40 mg daily, along with lifestyle modifications. The third control group was only given lifestyle modifications, excluding all patients with hyperuricemia due to ethical concerns. The primary outcome was to measure the change in the controlled attenuation parameter (CAP) score as an indicator of steatosis from baseline after three months. The secondary outcome was to measure the change in serum uric acid (SUA) three months from baseline. The study found that the CAP score decreased significantly in the allopurinol group (p = 0.009), but the decline in the febuxostat or lifestyle groups was non-significant (p = 0.189 and 0.054, respectively). The SUA levels were significantly reduced in both the allopurinol and febuxostat groups (p < 0.001), with no statistical difference between the two groups (p = 0.496).

Background. Critically ill patients have an increased requirement for vitamin C in sepsis and these patients have low levels of vitamin C. The researchers validated the efficacy of high-dose vitamin C intravenous infusion (IVI) in patients with sepsis requiring mechanical ventilation. Methods. Forty patients were randomly assigned to 2 groups (20 each) in a 1 : 1 ratio in accordance with the vitamin C treatment regimen: Group I (GI): patients received 1.5 g/6 h vitamin C in 50 ml of dextrose 5% in water (D5W) IVI over 30 minutes for 4 consecutive days; Group II (GII): patients received 100 mg vitamin C/day as a first single dose in 50 ml of D5W IVI over 30 minutes and the other three subsequent doses were 50 ml of plain D5W IVI over 30 minutes for 4 consecutive days. Primary outcomes were the change in sequential organ failure assessment (SOFA) score at day 7, the incidence of ventilator-associated pneumonia (VAP), and the plasma vitamin C level. The glutathione peroxidase (GPX) activity, C-reactive protein (CRP) level, duration of vasopressor therapy, and 28-day mortality were secondary outcomes. Results. The change in SOFA score at day 7 showed a significant difference between GI and GII ( $p<0.001$ ). The incidence of early VAP was significantly lower in GI ( $p=0.044$ ). Vitamin C levels showed a significant rise in GI at day 1 and day 4 ( $p<0.001$ and $p<0.001$ , respectively). GPX activity of day 4 and day 7 was significantly higher in GI ( $p=0.005$ and $p=0.014$ , respectively). CRP levels of day 4 and day 7 were significantly higher in GII ( $p<0.001$ and $p<0.001$ , respectively). There was a significant difference in 28-day mortality ( $p=0.038$ ) and duration of vasopressor therapy ( $p=0.033$ ) in GI compared to GII. Conclusion. The early use of high-dose vitamin C intravenous infusion in patients with sepsis requiring mechanical ventilation in combination with the standard treatment for sepsis lowered the incidence of VAP, increased the antioxidant status, and improved the illness severity. Trial Registration. This trial is registered with ClinicalTrials.gov Identifier (NCT04029675).

E19510 Background: Clarithromycin an oral active antibiotic used for H Pylori (HP) eradication, an effect that leads to regression of HP induced gastric MALT NHL. Angiogenesis is associated with NHL tumor growth (Ribatti et al, Neoplaisa 2013). Reports show that CL has direct anti neoplastic activity that can be partly attributed to an anti angiogeneic effect (Aoki et al, Anticancer Res 2005) (Ohe and Hashino, KJIN 2013). This study was designed to evaluate the efficacy and safety of CL plus CVP in indolent NHL pts and to understand the association between NHL response to CL therapy and serum(s)VEGF level. Methods: Pts (aged ≥18 yrs, histological proven indolent NHL, HP negative in case of MALToma, stage III/IV & chemo naive) were randomized to receive either CVP (cyclophosphamide 750mg/m² IV D1, vincristine 1.4mg/m² IV D1 and prednisone 40mg/m² oral (D1- D5) (arm A) or CVP plus CL 500 mg bid (D5-D18) (arm B) every 21 days. Response was evaluated every 2 cycles; toxicity was assessed using NCI CTCAE v4. Baseline and after 2 cycles, sVEGF levels were measured by ELISA. The primary endpoint was progression free survival (PFS), and secondary endpoints included overall response rate (ORR), overall survival (OS), safety and differential changes in sVEGF levels between the 2 arms of the study. Results: Overall, 60 pts with FL (45%), MZL (16.7%) and SLL (38.3%) were enrolled and 55 pts were eligible for evaluation. CR and ORR % in arms A and B were 18.5% (95%CI [CI]; 8, 37) vs 32.1% (CI; 18, 51) and 70.4% (CI; 52, 84) vs 92.8% (CI; 77, 98), respectively; P=0.04. Two years, PFS and OS rates were (46.2% vs 75%) P=0.02 and (85.4% vs 89.5%) P=0.636, respectively. The most common Grade ≥3 toxicities were anemia (14.9%, 3.6%), neutropenia (15.6 % 10.7%), thrombocytopenia (3.8%, 0%), mucositis (14.9 vs. 17.9%), respectively. Differential reduction in sVEGF level after 2 cycles was (20.5% vs 38.4%), P<0.001 respectively. Conclusions: CL plus CVP is active and safe in pts with previously untreated stage III/IV indolent NHL. Increased differential reduction in sVEGF level with CL suggests that anti angiogenesis may contribute to its anti neoplastic activity.