Search

Background: Polypharmacy and inappropriate prescriptions are the most highlighted health issues among geriatric population, as they have multiple comorbidities. The objective of this study was to assess prescriptions using the World Health Organization (WHO) core indicators and Beers Criteria to discover polypharmacy and inappropriate prescriptions. Methods: This was a prospective, cross-sectional study of geriatric patients (65 years and above) who were attending the medicine outpatients clinic of a tertiary care teaching hospital hospital from May to December, 2016. World Health Organization (WHO) indicators and updated Beers Criteria were used to assess the drug utilization pattern and the prevalence of potentially inappropriate medications (PIMs), respectively. Results: The prescriptions of 250 geriatrics patients with a distribution of 57.6% male and 42.4% female were assessed for this study. The total numbers of drugs recorded from the prescriptions were 1635 drugs, with an average of 6.54 drugs per person. According to the Beers Criteria, it was found that nearly 23.05% of the total prescribed drugs were potentially inappropriate. Conclusion: Polypharmacy and use of inappropriate medicines presents a health risk to the geriatric population. Causes could include healthcare practitioner shortage, lack of awareness of PIMs, not understanding drug interaction, and the need for multiple drugs. Prescriber training and retraining is needed. [ABSTRACT FROM AUTHOR]

Medication error (ME) is an adverse preventable event which happens due to the inappropriate use of medication that leads to patient harm. Such events may be related to professional practice, health-care products, procedures, and systems including prescribing, communication, product labeling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use. A major ME is the one, which results in either permanent harm or transfer to the intensive care units or death. When an error is identified, it shall be reported immediately. It must also be nonpunitive so that staff does not have to be afraid of repercussions. An error shall be reported to the concerned consultant immediately. Continuous monitoring and frequent assessments shall be done for the patient. A root cause analysis shall be done for all serious MEs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study is to determine the nature and severity of adverse drug reactions (ADRs) in pediatric patients. MATERIALS AND METHODS: In this retrospective cohort study, we extracted the data from all the available pediatric ADR forms submitted to ADR monitoring center (AMC) from May 2014 to December 2016. The data including nature, frequency, causality (World Health Organization [WHO] causality scale), and the severity (Hartwig and Siegel scale for severity) of ADR were extracted. We also assessed the preventability of the event on modified Schumock and Thornton scale of ADR preventability. RESULTS: There were a total of 20 pediatric ADRs reported during this period. Nearly two-thirds of the ADRs occurred in patients who were receiving multiple drugs (polytherapy). Antimicrobial agents were the most commonly implicated drugs. The most common ADRs were skin rash (maculopapular, erythematous, and urticaria, itching, etc.). The severity and preventability scales indicated that most reactions (18/20) were moderate in nature and all were preventable. Four reactions were "certainly" and ten ADRs were "probably" related to the suspected drug as determined by the WHO causality assessment. CONCLUSION: Frequency of ADR increased with number of medications patient was receiving. Health-care providers (HCPs) involved in the care of children must be aware of this fact and should use additional drugs when absolutely necessary. They should be involved in pharmacovigilance program by exchanging and updating each other through sharing constructive information, communication, and education concerning the appropriate use of drugs in children. Pediatric pharmacovigilance is the need of the hour and should be given utmost importance for monitoring the safety of drugs in children. Motivating HCPs for voluntary reporting of ADRs for preventing the morbidity and mortality in this vulnerable population could be of immense importance. [ABSTRACT FROM AUTHOR]

Gingival overgrowth (GO) is one of the common findings in clinical practice. There could be several causes including drugs associated with the GO. Carbamazepine (CBZ) and amlodipine are the drugs which are infrequently documented as a cause in inducing the gingival hyperplasia. Certain drugs in the body fluid might limit the population of plaque bacteria and alter their metabolism that in turn induce the inflammatory mediators and also activate the genetic and biochemical factors responsible for gingival fibroblast growth. Drug-induced GO is a side effect with a multifactorial etiology that seems to orchestrate the interaction between drugs and fibroblasts in the gingiva. We describe a case of trigeminal neuralgia with hypertension treated with multiple drugs including amlodipine and CBZ. Although amlodipine is known to be infrequently associated with GO, an association of CBZ with GO is even rarer. Causality analysis on the World Health Organization Uppsala Monitoring Centre's scale indicates a probable association with offending drugs. [ABSTRACT FROM AUTHOR]

Breast cancer is the leading cause of death in women. Epirubicin and cyclophosphamide (EC) is one of the chemotherapeutic regimens used for the treatment of breast cancer. We describe a case treated with EC regimen and who presented to us with symptoms suggestive of diabetes mellitus postchemotherapy. Absence of family history of diabetes and normal blood sugar level, prechemotherapy points toward drug-induced hyperglycemia. These chemotherapeutic agents capable of altering immune response and might act synergistically to cause immunological damage to the islets of pancreas which might precipitate diabetes mellitus. Causality analysis on Naranjo's scale indicates a possible association with regimen. [ABSTRACT FROM AUTHOR]

Summary: Cohort studies have shown that both overweight and obesity have their impact by increasing hospitalization with COVID‐19. We conducted a systematic literature search in PubMed, Google Scholar, and MedRxiv databases following the PRISMA guidelines. Statistical analyses were performed using STATA software version 16 MP (Stata Corp, College Station, TX, USA) and Med Calc software version 22.009(Med Calc software Ltd, Ostend, Belgium). The primary outcome was to measure the prevalence of overweight and obesity and their impact on the risk of hospitalization among COVID‐19 patients under and above 50 years of age. In total, 184 studies involving 2,365,377 patients were included. The prevalence of overweight was highest among those younger than 50 years of age over those older than 50 years of age, (26.33% vs. 30.46%), but there was no difference in obesity (36.30% vs. 36.02%). Overall, the pooled prevalence of overweight and obesity among hospitalized COVID‐19 patients was 31.0% and 36.26%, respectively. Compared with normal weight, the odds of hospitalization with overweight (odds ratio [OR] 2.186, 95% confidence interval [CI] [1.19, 3.99], p < 0.01) and obesity (OR 3.069, 95% CI [1.67, 5.61], p < 0.001) in those younger than 50 years and obesity (OR 3.977, 95% CI [2.75, 5.73], p < 0.001) in the older than 50 years age group were significantly high. The increased prevalence of overweight and obesity among the under 50 years age group and obesity among the older than 50 years age group significantly increased the rate of COVID‐19 infections, severity and hospitalization. [ABSTRACT FROM AUTHOR]

Gout is a metabolic disorder that usually presents as recurrent episodes of acute arthritis due to deposition of crystals in joints and cartilages. Despite the availability of several drugs for gout, its management is still less than adequate. There is always a search for newer, safer, and more potent urate-lowering therapies for treating patients inadequately controlled with available drugs. Lesinurad in combination with a xanthine oxidase inhibitor provides an effective mode of therapy in the management of hyperuricemia associated with gout. Lesinurad is a selective uric acid transporter 1 (URAT1) inhibitor. URAT1 is responsible for the majority of uric acid absorption from kidneys to the circulation. Lesinurad was granted marketing approval based on three randomized, double-blind, placebo-controlled; phase III clinical trials. It is devoid of interaction with organic anion transporters (OATs) such as OAT1 and 3, responsible for drug-drug interactions, an undesirable property associated with probenecid. On-going research is more focused on reducing inflammation consequent to deposition of crystals rather than production and excretion of urate. Various targets are being explored, and interleukin-1 beta inhibition seems to be one of the most promising approaches. [ABSTRACT FROM AUTHOR]

Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a severe cutaneous drug reaction with a high mortality. Immune response is the possible cause in its pathogenesis. Levofloxacin is one of the most commonly used quinolones and has been reported to cause of TEN. On the other hand, furazolidone was proposed to augment the action of immediate hypersensitivity of levofloxacin by its cytotoxic effect and by the generation of free radicals. Here, we present a case of TEN where, levofloxacin and furazolidone were the probable cause of these adverse drug reactions. [ABSTRACT FROM AUTHOR]