A Prospective Analysis of Adverse Drug Reactions in a South Indian Hospital

Adverse drug reactions are a great cause of concern to the medical profession, the patients and the pharmaceutical industry. However ADR reporting and monitoring is yet to catch up in India. Hence we undertook a study to record and analyze adverse reactions among all patients admitted to the medical wards of a tertiary care. Centre patients admitted to all medical wards over one year were assessed for ADRs throughout their admission. Suspected ADRs were recorded and analyzed for i) the type of reaction ii) severity iii) Consequence on treatment that is if the drug was continued, or stopped, or needed to be treated with other drugs, iv) Physiological system involved and the v) group of the drugs associated with ADRs. Among 1250 patients admitted during the study period, 250 adverse events were observed. Majority (76.8%) were of mild type, 66% were severe requiring intensive care and 3 patients died. Antimicrobials were responsible for maximum (42.4%) ADRs followed by drugs acting on CNS (20%). When we analyzed the systems affected, CNS side effects were more common in our study. While in many other studies Cardiovascular and gastrointestinal side effects were the most common. Combination of drugs was responsible for a large percentage of ADRs. Inadvertent use of antipsychotics with sedatives led to respiratory failure in 4 patients of which 1 died. Contaminated IV fluids are suspected to be the cause of death in another fatal ADR. In conclusion there is a need for vigilant ADR monitoring to be done by all doctors to prevent morbidity and mortality from ADRs

IS RENAL IMPAIRMENT CONCEALED IN ELDERLY DIABETICS????

Objective: To compare and evaluate the renal profile of elderly and younger diabetics.Methods: This cross sectional study was conducted in a tertiary care teaching hospital. Patients with type-2-diabetes were grouped into elderly (age≥60years) and younger diabetics. Patients' demographics, duration of diabetes and serum creatinine were recorded. Cockcroft-Gault formula was used to calculate creatinine clearance (Clcr). Statistical analysis was done using Students'‘t' test and Pearson's correlation. Regression analysis to adjust for covariables was done wherever required.Results: A total of 477 diabetics were included (elderly n=320, young n=157). Body mass index (BMI) was significantly lower (p=0.003) and duration of diabetes was significantly longer (p=0.001) among elderly. Significant difference was noted in serum creatinine (1.06±0.32 vs 0.95±0.29 mg/dl; p=0.0002) and Clcr (57.82±17.41 vs 88.07±24.60 ml/min; p=0.001) between elderly and younger diabetics. Only 4.7% of elderly, whereas 47.8% of young had normal Clcr. Clcr showed a negative correlation with age in elderly (r=-0.389, p<0.001) and young (r=-0.396, p<0.001) and positive correlation with BMI in elderly (r=0.401, p<0.001) and young(r=0.337, p<0.001). Regression analysis of Clcr in elderly and young showed a positive correlation for BMI and inverse relationship for age and duration of diabetes mellitus.Conclusion: Almost 95% of the elderly and 50% of younger diabetics had impaired creatinine clearance. Renal impairment was concealed in most of them since mean serum creatinine was 1 mg/dl. Indian elderly diabetics should be considered renally impaired and drugs for all conditions need adjustment for creatinine clearance

PREDOMINANCE AND INFLUENCE OF VITAMIN D DEFICIENCY ON GLYCEMIC AND LIPID INDICES IN TYPE 2 DIABETES SUBJECTS: A CASE CONTROL STUDY

Objective To investigate the existence of vitamin D deficiency (VDD) among type 2 diabetes, non-diabetes subjects and its effect on both glycemic and lipid profiles.MethodsA case control study was conducted on 200 subjects of both gender (100 type 2 diabetes and 100 non-diabetes individuals) aged 40 to 60 years. Fasting serum 25(OH) D levels, Fasting Blood Sugar (FBS), HbA1C, lipid profile including total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein TC/HDL and very low density lipoprotein were estimated. Atherogenic Index of Plasma (AIP) was calculated. Group comparisons were done by one way ANOVA followed by post hoc Tukey's test and Student's independent T test. Chi-square test was performed for categorical variables. Correlation was done by Pearson's analysis. P < 0.05 was considered significant.Results The average serum 25(OH) D levels were significantly (p<0.001) low in diabetes group. The prevalence of VDD and the percentage of insufficient and sufficient categories was significantly (p<0.001) high and low respectively in diabetes group. In the deficient category diabetes group had severe VDD with significantly low HDL and elevated triglycerides and there was an insignificant but negative association between serum vitamin D levels, FBS, HbA1c, TC, TG, LDL, TC / HDL and AIP among diabetes subjects.ConclusionThe occurrence of severe vitamin D deficiency coupled with the independent association of the same with the glycemic and lipid profiles in type 2 diabetes may further add to the aggravation of complications Keywords: Vitamin D deficiency, Type 2 diabetes, Glycemic and lipid indice

IS DOSE TITRATION REQUIRED FOR ANTIHYPERTENSIVE AGENTS IN GERIATRIC DIABETIC PATIENTS?

Objective: The objective of this study is to evaluate the antihypertensive drug usage and dosage differences between geriatric and non-geriatric diabetics with reference to the duration of hypertension and creatinine clearance (Crcl).Methods: In this observational study, patients with type 2 diabetes mellitus were grouped into geriatric (age ≥60 years) and non-geriatric (age <60 years). Patients' demographic data, duration of hypertension, drugs prescribed, and serum creatinine were recorded after the patients had a stabilized antihypertensive dose for 6 months. Crcl was calculated using Cockcroft–Gault formula. The dosages of antihypertensives were converted into equivalent doses for easy comparison within a group. For angiotensin-converting enzyme inhibitors (ACEIs), enalapril was considered as prototype, and for angiotensin receptor blockers (ARBs) losartan, beta-blocker atenolol, and calcium channel blockers (CCBs), amlodipine was considered as prototype. Univariate analysis was done for comparison of drug doses between groups.Results: A total of 336 diabetics with hypertension were included, of which 252 were geriatric and 84 non-geriatric. Duration of hypertension was expectedly longer in the geriatric group (8.40±7.26 vs. 5.46±5.67; p=0.001). Systolic blood pressure was higher in geriatrics (137.14±13.51 vs. 133.38±12.49; p=0.01). When adjusted for the duration of hypertension and Crcl, there were no significant differences in the mean converted equivalent doses of beta-blockers, CCBs, ARBs, and hydrochlorothiazide between geriatrics and non-geriatrics. However, statistically significant lower converted equivalent doses of all ACEIs were needed in geriatrics compared to non-geriatrics, when adjusted for duration of hypertension and Crcl. Enalapril required 20.57% and ramipril required 18.36% dose reduction in geriatrics compared to non-geriatrics.Conclusion: A 20% dosage reduction is needed for ACEIs in the elderly

Evaluation of appropriateness of prescription and polypharmacy in the geriatric population: a cross sectional study at a comprehensive geriatric clinic in a tertiary care hospital

Objective: To assess the prescription quality in a comprehensive geriatric clinic and to determine the frequency of inappropriate prescription and polypharmacy.Methods: Both males and female patients above the age of 60 y attending a comprehensive geriatric clinic of a tertiary care hospital were included in the study. Medications taken by the patients, excluding vitamins, minerals and herbal medications were counted in each patient and analyzed by considering their medical history and using universally accepted tools like medication appropriateness index, START, STOPP & Beer's criteria. In this study, polypharmacy was considered as having 6 or more medications per prescription. Results: A total of 120 patients were included in the study. Around 82 (68.33%) patients had less than 6 prescribed medications and 38 patients (31.66%) were on 6 or more than 6 medications. The number of medications used by the patients is 4.37±2.33. Around 21 (17.5%) were on medications that are not indicated, 25 patients (20.83%) were receiving medications which are to be avoided in elderly as per the Beer's and STOPP criteria. Medication was underused in 24 patients (20%) as per START criteria. When both overused drugs and drugs to be avoided were considered for assessment of inappropriateness, 39 patients (32.5%) were found to be receiving inappropriate medication. Among the drugs to be avoided in elderly, amitriptyline was the most common drug and was used in 15 (12.5%) patients. Antihypertensives were the most common potential prescribing omissions in geriatric patients.Conclusion: Polypharmacy is seen in a significant proportion of geriatric patients. Inappropriate prescription and potential prescribing omissions were observed in a significant proportion of geriatric patients.Keywords: Polypharmacy, Geriatrics, Beer's criteria, STOPP criteri

Human Salmonella and Concurrent Decreased Susceptibility to Quinolones and Extended-Spectrum Cephalosporins

For complicated infections, decreased susceptibility could compromise treatment with drugs from either antimicrobial class

Geriatric health care in India - Unmet needs and the way forward

India has nearly 120 million elderly people with various physical, psychosocial, economic, and spiritual problems. While the functionally and cognitively fit can access usual health-care facilities provided by the government, these people need active aging program to keep them independent. Health ministry has created geriatric centers and geriatric clinics in most of the states; however, these centers may not serve the functionally and cognitively impaired elderly. There is great need for mobile units, day-care centers and hospices, and need for training of personnel in home nursing. Routine care clinics cannot handle the burden of geriatric population to address their multimorbidity and several other age-related problems. There is a need for a rapid training of health-care professionals of various disciplines in geriatric care. Government must support nongovernmental organizations and other agencies which provide day care, home care, and palliative care so that these services become affordable to all the elderly

Hyperpigmentation of the skin following chloroquine treatment - case series report

In this article, we are collectively presenting case reports of 15 patients who developed pigmentary changes of the skin and mucus membrane during the course of chloroquine therapy for connective tissue disorders. These female patients developed hyper pigmentation of the skin, largely on the exposed parts of the body. The pigmentary changes varied from brownish/ grayish/ bluish-black in color, patchy or diffuse, intense or mild. The shortest time lag between onset of chloroquine therapy and development of pigmentary changes was 3 months. The patients should be informed about this cosmetically important toxic effect of chloroquine and advised to avoid direct exposure to sunlight