An Epidemiological and Clinical Analysis of Cutaneous Adverse Drug Reactions Seen in a Tertiary Care Outpatient Clinic in Cairo, Egypt

A cutaneous adverse drug reaction (CADR) is any undesirable change in the structure or function of the skin, its appendages, or mucous membranes caused by a drug. The frequency of CADRs is variable, with only few studies evaluating it. Our aim was to identify the clinical spectrum of CADRs and document the epidemiological data of different types of drug eruptions among Egyptian patients attending a tertiary care center. An observational hospital-based analytical study was planned for a period of six months (January-June 2015). All patients attending the outpatient Dermatology Clinic at Kasr El Aini hospital were examined to detect patients with CADRs, who were subjected to a detailed questionnaire with a detailed drug history. A skin biopsy was taken to confirm the diagnosis and to detect the type of CADRs. The primary incidence of CADRs reported in our study was 0.28% (78 patients) from a total number of 27,093 patients. The most common CADRs were SJS/TEN in 12 patients (15.3%) and lichenoid drug eruptions in 12 patients (15.3%), followed by exanthematous drug eruptions in 11 patients (14.1%) and vasculitic drug eruptions in 9 patients (11.5%). The most common drug incriminated was ibuprofen in 6 patients (7.6%), followed by penicillin in 4 patients (5.1%) and aspirin in 3 patients (3.8%). In conclusion, incidence of CADRs in our study was similar to incidence reported in different countries; however, the incidence of life-threatening reactions such as SJS/TEN was higher compared with studies conducted abroad.</p

Disclosure and adverse effects of complementary and alternative medicine used by hospitalized patients in the North East of England

Objectives: This study aimed to investigate the prevalence, disclosure and adverse effects of complementary and alternative medicine (CAM) use in hospitalised patients, and to explore the associations between patients’ perceived side-effects and relevant factors. Methods: Patients who were admitted to a district general hospital and met the eligibility criteria were interviewed using a semi-structured questionnaire. Their medications and pertinent details were verified from the medical notes. All quantitative and qualitative data were collated and analysed. A chi-squared test was performed to test the associations of the perceived CAM side-effects with the significance level determined at a=0.05. Results: A total of 240 in-patients completed the study. They were mostly white British (98.8%). The prevalence of CAM use within two years was 74.6% and one month 37.9%. Only 19 of 91 patients (20.9%) using CAM within one month disclosed their current CAM applications. Nearly half of patients (45.8%) who used CAM within two years experienced various CAM side-effects that tended to resolve after discontinuation. Slightly more than half (57.6%) perceived CAM side-effects and their perceptions were significantly associated with gender (P=0.048) and consideration for future CAM use (P=0.033). Potential interactions between herbal remedies/dietary supplements and prescribed drugs, such as garlic with lisinopril or aspirin, were assessed in 82 patients (45.8%). Conclusion: Most in-patients used CAM and experienced some adverse effects. The disclosure of CAM use and its adverse outcomes should be encouraged by healthcare professionals

Pharmacogenetics : the science of predictive clinical pharmacology

The study of pharmacogenetics has expanded from what were initially casual family-based clinical drug response observations, to a fully-fledged science with direct therapeutic applications, all within a time-span of less than 60 years. A wide spectrum of polymorphisms, located within several genes, are now recognised to influence the pharmacokinetics and pharmacodynamics of the majority of drugs within our therapeutic armamentarium. This information forms the basis for the new development of pharmacogenetic genotyping tests, which can be used to predict the therapeutic and/or adverse effects of a specific drug in a particular patient. Pharmacogenetic-guided, patient targeted therapy has now become the developing fulcrum of personalized medicine, as it provides the best means to optimize benefit/risk ratio in pharmacological management.peer-reviewe

Prevalence of drug-herb and drug-supplement interactions in older adults : A cross-sectional survey

© British Journal of General PracticeBackground Polypharmacy is common among older adults, with increasing numbers also using prescription drugs with herbal medicinal products (HMPs) and dietary supplements. There is no reliable evidence from the UK on concurrent use of HMPs and dietary supplements with prescription drugs in older adults. Aim To establish prevalence of concurrent prescription drugs, HMPs, and dietary supplements among UK community-dwelling older adults and identify potential interactions. Design and setting Cross-sectional survey of older adults registered at two general practices in South East England. Method A questionnaire asking about prescription medications, HMPs, and sociodemographic information was posted to 400 older adults aged ≥65 years, identified as taking ≥1 prescription drug. Results In total 155 questionnaires were returned (response rate = 38.8%) and the prevalence of concurrent HMPs and dietary supplements with prescriptions was 33.6%. Females were more likely than males to be concurrent users (43.4% versus 22.5%; P = 0.009). The number of HMPs and dietary supplements ranged from 1 to 8, (mean = 3, median = 1; standard deviation = 1.65). The majority of concurrent users (78.0%) used dietary supplements with prescription drugs. The most commonly used dietary supplements were cod liver oil, glucosamine, multivitamins, and Vitamin D. Others (20.0%) used only HMPs with prescription drugs. Common HMPs were evening primrose oil, valerian, and Nytol Herbal® (a combination of hops, gentian, and passion flower). Sixteen participants (32.6%) were at risk of potential adverse drug interactions. Conclusion GPs should routinely ask questions regarding herbal and supplement use, to identify and manage older adults at potential risk of adverse drug interactions.Peer reviewe

Protocol for the effective feedback to improve primary care prescribing safety (EFIPPS) study : a cluster randomised controlled trial using ePrescribing data

High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions to improve care are attractive because they are relatively cheap to widely implement. There is good evidence that feedback has small to moderate effects, but the most recent Cochrane review called for more high-quality, large trials that explicitly test different forms of feedback. The study is a three-arm cluster-randomised trial with general practices being randomised and outcomes measured at patient level. 262 practices in three Scottish Health Board areas have been randomised (94% of all possible practices). The two active arms receive different forms of prescribing safety data feedback, with rates of high-risk prescribing compared with a ‘usual care’ arm. Sample size estimation used baseline data from participating practices. With 85 practices randomised to each arm, then there is 93% power to detect a 25% difference in the percentage of high-risk prescribing (from 6.1% to 4.5%) between the usual care arm and each intervention arm. The primary outcome is a composite of six high-risk prescribing measures (antipsychotic prescribing to people aged ≥75 years; non-steroidal anti-inflammatory drug (NSAID) prescribing to people aged ≥75 without gastroprotection; NSAID prescribing to people prescribed aspirin/clopidogrel without gastroprotection; NSAID prescribing to people prescribed an ACE inhibitor/angiotensin receptor blocker and a diuretic; NSAID prescription to people prescribed an oral anticoagulant without gastroprotection; aspirin/clopidogrel prescription to people prescribed an oral anticoagulant without gastroprotection). The primary analysis will use multilevel modelling to account for repeated measurement of outcomes in patients clustered within practices. The study was reviewed and approved by the NHS Tayside Committee on Medical Research Ethics B (11/ES/0001). The study will be disseminated via a final report to the funder with a publicly available research summary, and peer reviewed publications

Clinical Management of Adult Patients with a History of Nonsteroidal Anti-Inflammatory Drug-Induced Urticaria/Angioedema: Update

<p/> <p>In the large majority of previous studies, patients with a history of acute urticaria induced by nonsteroidal anti-inflammatory drugs (NSAIDs) seeking safe alternative drugs have undergone tolerance tests uniquely with compounds exerting little or no inhibitory effect on the cyclooxygenase 1 enzyme. In light of recently published studies, however, this approach seems inadequate and should be changed. The present article critically reviews the clinical management of patients presenting with a history of urticaria induced by a single NSAID or multiple NSAIDs and suggests a simple, updated diagnostic algorithm that may assist clinicians in correctly classifying their patients.</p

Social media mining for identification and exploration of health-related information from pregnant women

Widespread use of social media has led to the generation of substantial amounts of information about individuals, including health-related information. Social media provides the opportunity to study health-related information about selected population groups who may be of interest for a particular study. In this paper, we explore the possibility of utilizing social media to perform targeted data collection and analysis from a particular population group -- pregnant women. We hypothesize that we can use social media to identify cohorts of pregnant women and follow them over time to analyze crucial health-related information. To identify potentially pregnant women, we employ simple rule-based searches that attempt to detect pregnancy announcements with moderate precision. To further filter out false positives and noise, we employ a supervised classifier using a small number of hand-annotated data. We then collect their posts over time to create longitudinal health timelines and attempt to divide the timelines into different pregnancy trimesters. Finally, we assess the usefulness of the timelines by performing a preliminary analysis to estimate drug intake patterns of our cohort at different trimesters. Our rule-based cohort identification technique collected 53,820 users over thirty months from Twitter. Our pregnancy announcement classification technique achieved an F-measure of 0.81 for the pregnancy class, resulting in 34,895 user timelines. Analysis of the timelines revealed that pertinent health-related information, such as drug-intake and adverse reactions can be mined from the data. Our approach to using user timelines in this fashion has produced very encouraging results and can be employed for other important tasks where cohorts, for which health-related information may not be available from other sources, are required to be followed over time to derive population-based estimates.Comment: 9 page