Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study.

Background: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, ‘‘concurrent use of five or more different prescription medication’’. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center. Methods: A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University Hospital April 2012 to March 2013. One thousand geriatrics patients (age $65 years) visiting ambulatory clinics were identified. They were divided on the basis of exposure (polypharmacy vs. no polypharmacy). We followed them from the time of their enrollment (day zero) to six weeks, checking up on them once a week. Incidence was calculated and Cox Proportional Hazard Model estimates were used. Results: The final analysis was performed on 1000 elderly patients. The occurrence of polypharmacy was 70% and the incidence of ADRs was 10.5% among the study cohort. The majority (30%) of patients were unable to read or write. The use of herbal medicine was reported by 3.2% of the patients and homeopathic by 3%. Our Cox adjusted model shows that polypharmacy was 2.3 times more associated with ADRs, con-current complementary and alternative medicine (CAM) was 7.4 times and those who cannot read and write were 1.5 times more associated with ADRs. Conclusion: The incidence of ADRs due to poly pharmacy is alarmingly high. The factors associated with ADRs are modifiable. Policies are needed to design and strengthen the prescription pattern

Incidence of polypharmacy among emergency patients at a tertiary care hospital in Karachi: An ignored paradigm for quality drug therapy

Introduction: A prescription containing five or more drugs is likely to result in adverse consequences that may involve hospital admission or falls. Increasing incidence of Polypharmacy among Emergency patients calls for a more judiciary and cautious approach to prescribing with a focus on long term as well as short term health. Objective: To estimate the incidence of polypharmacy and its strength of association with respect to medication regimen among patients (pediatric and adults) visiting ED of a tertiary care hospital in Karachi Pakistan. Methods: Data will be collected retrospectively of all patients, who visited the Emergency Department (ED) of Aga Khan University Hospital, Karachi (AKUH) during January, 2012 to December, 2012. The detailed clinical records on medication prescribing from admission through discharge of all patients will be reviewed. Results: Total 51,000 patients visited ED during January 2012 till December 2012, out of those polypharmacy was common in 40% of patients. Male were 56.6%(9,837) while 43.4% (7,553) were females. Peadiatric patients were 17.9% (3,145) while 79% (14,279) were adults. The most common triage category for patients with was P3 with 37.2% (6,483). Most of these patients were those who were recommended admission in other wards 59.6% (10,146), 26.5% (4,514) discharged patients and 9% (1,536) LAMA patients. Conclusion: The perils and problems associated with Poly pharmacy are a subject of interest as polypharmacy was significant finding among all ED patients. Keywords: Polypharmacy, Emergency, Karachi, Pakista

Child injury prevention short course in Karachi, Pakistan – lessons learnt

Introduction: Department of Emergency Medicine (WHO Collaborating Center for Emergency and Trauma Care) in collaboration with Department of Continuing Professional Education, Aga Khan University organised a two day course “WHO Prevention of Child Injury”. The purpose of this course was to describe epidemiologic trend and understand principles of child injury prevention methodology. Pretest and posttest were taken to assess the impact of course in improving knowledge. Methods: The two day workshop was organized on 17th and 18th March the topics/ presentations were followed by different group and individual activities. The Wilcoxon signed rank test was applied to see the difference in pre and posttests. Result: There were a total of 25 participants in the course. Most of them were from Karachi while seven participants were from other cities including Islamabad, Peshawar, Lahore, Umerkot and Sukkur. The participants included master candidate in epidemiology and biostatistics (n=5), research officers (n=4), police officer (n=1), pediatrician (n=2), health department administrators (n=6), forensic expert (n=2), and public health professionals (n=5). The mean score in pretest was 54.6% ±14.1% while posttest revealed a mean score of 66.8% ±12%. (p -value of \u3c0.029). On a scale of 1-5, 60% and 70% of the participants evaluated this workshop on 4 points. Conclusion: This workshop had a positive impact on knowledge of participants related to injury prevention principles and methodology. Such trainings/ course should be held on regular basis or incorporated in master level course to highlight the neglected injury area. Keywords: Injury, Emergency, Karachi, Pakista

Characteristics of chest pain and its acute management in a low-middle income country: Analysis of emergency department surveillance data from Pakistan

© 2015 Paichad et al. Background: Chest pain is one of the most frequent causes of emergency department (ED) visits in high-income countries. Little is known about chest pain patients presenting to EDs of low- and middle-income countries (LMICs). The objective of this study was to describe the characteristics of chest pain patients presenting to emergency departments (EDs) of Pakistan and to determine the utilization of ED resources in the management of chest pain patients and their outcomes. Methods: This study used pilot active surveillance data from seven major EDs in Pakistan. Data were collected on all patients presenting to the EDs of the participating sites to seek emergency care for chest pain. Results: A total of 20,435 patients were admitted to the EDs with chest pain. The majority were males (M 60%, F 40%) and the mean age was 42 years (SD+/- 14). The great majority (97%, n = 19,164) of patients were admitted to the EDs of public hospitals compared to private hospitals and only 3% arrived by ambulance. Electrocardiograms (ECGs) were used in more than half of all chest pain patients (55%, n = 10,890) while cardiac enzymes were performed in less than 5% of cases. Chest X-rays were the most frequently performed radiological procedure (21%, n = 4,135); more than half of the admitted chest pain patients were discharged from the EDs and less than 1% died in the ED. Conclusion: Chest pain is a common presenting complaint in EDs in Pakistan. The majority received an ECG and the use of diagnostic testing, such as cardiac enzymes, is quite uncommon

Adjusted Multivariable Analysis Showing Relative Risk of Adverse Drugs Reactions Along With 95% CI.

<p>Adjusted Multivariable Analysis Showing Relative Risk of Adverse Drugs Reactions Along With 95% CI.</p

Characteristics of Eligible Participants Attending Tertiary Care Center, According To Exposure Status.

<p>Characteristics of Eligible Participants Attending Tertiary Care Center, According To Exposure Status.</p

Descriptive and Univariate Cox Analysis Along With 95% Confidence Intervals of Eligible Geriatrics Attending Tertiary Care Center.

<p>Descriptive and Univariate Cox Analysis Along With 95% Confidence Intervals of Eligible Geriatrics Attending Tertiary Care Center.</p

Incidence of Adverse Drug Reactions According To Drug Exposure.

<p>Incidence of Adverse Drug Reactions According To Drug Exposure.</p

Flow of Study Participants.

<p>Flow of Study Participants.</p