A study of adverse drug reactions to iodinated contrast agents in tertiary care teaching hospital

Background: Contrast agents have long been used for the imaging of anatomic boundaries and to explore normal and abnormal findings in X-ray based imaging technique. These agents are not completely devoid of risk. Adverse effects from administration of contrast media vary from minor physiological disturbance to rare life threatening situation.Methods: A cross-sectional retrospective observational study over one-year duration from 1st August 2015 to 31st July 2016 was conducted at radiology department of a Pandit Deendayal Upadhyay Government Medical College and Teaching hospital, Rajkot, Gujarat. Adverse drug reactions were analyzed to study the nature of reactions caused by iodinated contrast agents. The temporal relationship of time of administration of contrast agents to the occurrence of adverse reaction was analyzed and classified as immediate or delayed type of reaction.Results: Out of 868 patients that were analysed 15 out of 497 male patients and 11 out of 371 female patients developed adverse reaction. Age range of patients that developed reactions was 20-55 years. Most common adverse drug reaction occurred in our study was nausea and vomiting which was treated by parenteral Ondansetron. All the reactions were found to be ‘probable’ in causality as per WHO causality assessment scale and Naranjo’s algorithm.Conclusions: Physicians performing diagnostic or therapeutic procedures with contrast agents must be aware of the risk, preventability & treatment so that reactions can be prevented. Sensitization of physicians is required to increase reporting of adverse drug reactions occurred due to radiocontrast agents

CHRONIC KIDNEY DISEASE – A MULTI-CENTER STUDY IN KARACHI, PAKISTAN

Objective: Chronic kidney disease is growing at alarming rate in developing countries like Pakistan. The aim of the study was to find out the major factors leading to this disease and to carry out the comparative analysis of the effectiveness of allopathic and homoeopathic medicines in treatment of chronic kidney disease.Methods: A multi-center study was carried out in five different centers from 2009-2014. The study was carried out by interviewing the patients, noting down their vitals and reviewing their records. Evaluation of the data was done considering age, sex and co-morbidities associated with renal failure.Results: Significant results were observed. Patients of age groups 46 to 60 (48%) and 30 to 45 (21%) were found to suffer more from chronic kidney disease. Hypertension was found as the most frequently occurring co-morbidity along with chronic renal failure followed by diabetes.Conclusion: The current study will be beneficial in bringing awareness in general public and thereby reducing the increasing burden of end-stage kidney disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Maternal health care utilisation among the urban poor of Maharashtra, India

Previous studies have shown that the uptake of maternal health care in developing countries has significant consequences for the state transition of the mother through pregnancy and childbirth (Khan 1987). The Indian National Family Health Survey (1992/93) shows that the utilisation of pre-natal care in India is low at only 63% and that the care received is often characterised by an insufficient number of visits timed late into the pregnancy. Furthermore, the delivery care utilised in India is dominated by home births, often performed by untrained local midwives.India contains a significant proportion of the world's births, and like other developing countries, has experienced a rapid growth in its urban population, and a subsequent increase in the numbers of urban poor. Maharashtra in particular, which contains the megacity of Mumbai (formerly Bombay) and the Pune-Thane-Nagpur belt has rapidly developing urban populations and the commensurate diversities of morbidity, mortality and service use. Women living in poorer areas of Maharashtra's urban settlements often have a choice of maternal and child health services that are not available to their rural counterparts.This thesis examines the patterns and prevalence of maternal health care utilisation among the urban poor, and explores the range of motivational factors behind the decision to uptake antenatal care and deliver a child in a formal medical institution. Factors influencing health care utilisation are multifaceted. Therefore, a combination of quantitative and qualitative methodologies are employed. The Indian National Family Health Survey of Maharashtra (1992) is used to examined the timing of the first antenatal visit, the number of visits made and the place of delivery. Multinomial regression analyses are applied to the data to identify socioeconomic and demographic determinants of maternal health care use. A composite index (Standard of Living Index) is created using information on the type of household, amenities and ownership of goods.</p

Poverty and maternal health care utilisation in Maharashtra: associated influences on infant mortality and morbidity

This paper explores the effects of poverty on access to maternal health care services (MHC), linking the use of MHC to two outcomes for the infant; mortality and nutritional status. The paper therefore falls under the overall theme of the international health strand; eliminating disparities in health outcomes. The paper establishes disparities in health outcomes between socio-economic groups in both urban and rural areas. Previous literature has documented an urban-rural dichotomy in infant survival and utilisation of MHC in India but little is known about the variations among socio-economic groups within urban areas. Rates of infant mortality are much higher in poorer sectors of the urban areas, suggesting that some differential utilisation of MHC exist between socio-economic groups. In this paper the Indian National Family Health Survey (1992/93) for Maharashtra is used to model use of antenatal and delivery care and associated influences on infant mortality and morbidity. A composite index is created to examine the influence of standard of living on use of MHC. Findings show that those living in poorer households in rural and urban areas have a lower utilisation of MHC services than those in the higher socio-economic strata. The low level of use of these services is associated with increased neonatal mortality. In addition, infants living in lower socio-economic groups in rural and urban areas have an increased risk of poor nutritional status and neonatal mortality. Learning Objectives: By the end of this session, the participant will be able to: 1. Create a standard of living index based upon socio-economic data collected in standard cross-sectional surveys such as the demographic and health surveys(DHS). 2. Compare maternal and child health outcomes across socio-economic groups within rural and urban settings in Maharashtra. 3. Recognise the barriers to health care utilisation by the poorest socio-economic groups in urban areas. 4. Understand how standard of living influences use of maternal health care and its associated influences with infant nutrition and mortality outcomes in Maharashtra

Vision-related quality of life in Pakistani subjects with early or moderate glaucoma

Background: The aim of this study was to report the vision-related quality of life (QoL) in Pakistani subjects with early or moderate glaucoma. Methods: This case control study was conducted at Al-Shifa Trust Eye Hospital, Pakistan, from 1 January 2014 to 31 December 2015. All the patients having early or moderate glaucoma, with a disease duration of at least 6 mo, and presenting during the study period, were included. Subjects in the control group were recruited from the hospital volunteer staff, spouses and friends of patients. QoL assessment was done using the NEIVFQ25 questionnaire translated into the Urdu language. A two-tailed t-test was used to test the significance of difference between the mean QoL scores and a p-value of ≤0.05 was considered significant. Multiple linear regression was carried out to assess the predictors of QoL scores. Results: A total of 698 participants were enrolled, including 247 cases and 451 controls. The mean QoL score was higher in controls 81.31 (mean=81.31, SD=26.33) than in cases (mean=53.89, SD=30.32), p<0.001. The lowest NEIVFQ-25 scores for glaucoma patients were for mental health (mean=23.88, SD=28.80) followed by general vision (mean=27.73, SD=29.74). The difference in all the mean subscale scores of two groups was statistically significant (p<0.001). Conclusion: QoL scores are significantly reduced in Pakistani glaucoma patients with early and moderate glaucoma, with more pronounced effect on mental health and general vision

Clustering of motor and nonmotor traits in leucine-rich repeat kinase 2 G2019S Parkinson's disease nonparkinsonian relatives: A multicenter family study

Objectives: The objective of this study was to determine phenotypic features that differentiate nonparkinsonian first-degree relatives of PD leucine-rich repeat kinase 2 (LRRK2) G2019S multiplex families, regardless of carrier status, from healthy controls because nonparkinsonian individuals in multiplex families seem to share a propensity to present neurological features. Methods: We included nonparkinsonian first-degree relatives of LRRK2 G2019S familial PD cases and unrelated healthy controls participating in established multiplex family LRRK2 cohorts. Study participants underwent neurologic assessment including cognitive screening, olfaction testing, and questionnaires for daytime sleepiness, depression, and anxiety. We used a multiple logistic regression model with backward variable selection, validated with bootstrap resampling, to establish the best combination of motor and nonmotor features that differentiates nonparkinsonian first-degree relatives of LRRK2 G2019S familial PD cases from unrelated healthy controls. Results: We included 142 nonparkinsonian family members and 172 unrelated healthy controls. The combination of past or current symptoms of anxiety (adjusted odds ratio, 4.16; 95% confidence interval, 2.01-8.63), less daytime sleepiness (adjusted odds ratio [1 unit], 0.90; 95% confidence interval, 0.83-0.97], and worse motor UPDRS score (adjusted odds ratio [1 unit], 1.4; 95% confidence interval, 1.20-1.67) distinguished nonparkinsonian family members, regardless of LRRK2 G2019S mutation status, from unrelated healthy controls. The model accuracy was good (area under the curve = 79.3%). Conclusions: A set of motor and nonmotor features distinguishes first-degree relatives of LRRK2 G2019S probands, regardless of mutation status, from unrelated healthy controls. Environmental or non-LRRK2 genetic factors in LRRK2-associated PD may influence penetrance of the LRRK2 G2019S mutation. The relationship of these features to actual PD risk requires longitudinal observation of LRRK2 familial PD cohorts. © 2018 International Parkinson and Movement Disorder Society

Penetrance estimate of LRRK2

International audienceBackgroundPenetrance estimates of the LRRK2 p.G2019S mutation for Parkinson’s disease (PD) vary widely (24%–100%). The p.G2019S penetrance in individuals of Ashkenazi Jewish ancestry has been estimated as 25%, adjusted for multiple covariates. It is unknown whether penetrance varies among different ethnic groups. The objective of this study was to estimate the penetrance of p.G2019S in individuals of non-Ashkenazi Jewish ancestry and compare penetrance between Ashkenazi Jews and non-Ashkenazi Jews to age 80.MethodsThe kin-cohort method was used to estimate penetrance in 474 first-degree relatives of 69 non-Ashkenazi Jewish LRRK2 p.G2019S carrier probands at eight sites from the Michael J. Fox LRRK2 Cohort Consortium. An identical validated family history interview was administered to assess age at onset of PD, current age, or age at death for relatives in different ethnic groups at each site. Neurological examination and LRRK2 genotype of relatives were included, when available.ResultsRisk of PD in non-Ashkenazi Jewish relatives who carry a LRRK2 p.G2019S mutation was 42.5% (95% CI: 26.3 – 65.8%) to age 80 which is not significantly higher than the previously estimated 25% (95% CI: 16.7 – 34.2%) in Ashkenazi Jewish carrier relatives. The penetrance of PD to age 80 in LRRK2 p.G2019S mutation carrier relatives was significantly higher than the non-carrier relatives, as seen in Ashkenazi Jewish relatives.ConclusionsThe similar penetrance of LRRK2 p.G2019S estimated in Ashkenazi Jewish carriers and non-Ashkenazi Jewish carriers confirms that p.G2019S penetrance is 25–42.5% at age 80 in all populations analyzed