Pattern and incidence of adverse drug reactions observed in cardiac clinic of tertiary hospital, Hakeem Abdul Hameed Centenary Hospital, Jamia Hamdard, New Delhi

Background: The aim of the present study was to monitor the incidence and pattern of adverse drug reactions (ADRs) in cardiac care unit at Hakeem Abdul Hameed (HAH) Centenary Hospital.Methods: Study was conducted with the permission of Institutional Ethics Committee. Patients visiting medicine outpatient department, cardiac clinic, medical ward, and emergency departments over a period of 15 months were recruited. ADRs were recorded on the prescribed form. Causality assessment was done using Naranjo probability scale. 223 patients of hypertension and stable coronary artery disease were enrolled of which 48.9% were males and 51.1% females. The most common prescribed drugs were ace-inhibitors, angiotensin receptor blocker, and beta-blockers. Other prescribed drugs were calcium channel blockers, statins, nitrates, and antiplatelets.Results: A total of 44 ADRs were recorded. 26 ADRs were seen in females and 18 in males. Statins were the commonest drug associated with ADRs (29.5%) in our study. The most common organ system associated with ADRs in the present study was central nervous system followed by skin 15.9% each. The incidence of ADRs was about 20% of which 20% ADRs were probable, and 80% were possible. Maximum ADRs occurred in patients prescribed statins followed by beta-blockers and angiotensin receptor blockers.Conclusion: There is a need for conducting such studies in more and more patients to see the pattern of ADRs in cardiac patients. More information will help in reducing the ADR occurrence and making drug use more rational and safe for patients.

A SIMPLE INDEX OF SMOKING

Background: Cigarette smoking is implicated in a large number of diseases and other adverse health conditions. Among the dimensions of smoking are number of cigarettes smoked per day, duration of smoking, passive smoking, smoking of filter cigarettes, age at start, and duration elapsed since quitting by ex-smokers. The practice so far is to study most of these separately. We develop a simple index that integrates these dimensions of smoking into a single metric, and suggest that this index be developed further. Method: The index is developed under a series of natural assumptions. Broadly, these are (i) the burden of smoking monotonically increases with the cigarette-years but it is more severe in the beginning, (ii) start of smoking early in life is more burdensome than a late start, and (iii) the burden gradually reverses as the duration elapsed since cessation by ex-smokers increases. Result: The index so arrived is: S = (3 – a/15)*1/2*sqrt[sumof(pi*ni*xi) – 0.5] - y for S greater than equal to 0, and sumof(pi*ni*xi) greater than equal to 0.5; otherwise zero (use a =30 for a\u3e30); where i = 1, 2, …, I, and I is the number of segments in life with different smoking pattern and a is the age at start of smoking, pi is the proportion of smoke inhaled in case of passive smoking (or adjustment for filter cigarettes or for other forms of smoking), xi is the number of cigarettes smoked for ni years, and y is the number of years elapsed since cessation by ex-smokers. Negative values of S are to be considered equal to zero. Examples are given that demonstrate the use of this index. Conclusion: Just as almost any other composite index, our index too could be good as a comprehensive measure of burden of smoking but not to study its individual dimensions. This measures the present burden in absolute sense and not the risk of smoking-related diseases. Like body-mass index, the smoking index may have good correlation with the risk of some diseases and poor for many others, depending upon the extent to which the risk of disease agrees to our postulations

Right Ventricular Endomyocardial Fibrosis Presenting With Ventricular Tachycardia And Apical Thrombus - An Interesting Presentation

Endomyocardial fibrosis is a progressive disease of unknown origin affecting children and young adults. It involves inflow portion of right and/or left ventricle and apex. It may be associated with thrombus. Literature regarding right ventricular endomyocardial fibrosis with thrombus is scarce. Here we report a rare case of right ventricular endomyocardial fibrosis presenting as ventricular tachycardia and echocardiographic evidence of apical thrombus. Interestingly there was no pulmonary involvement or evidence of deep venous thrombosis. This case also underscores the importance of urgent echocardiography in diagnosis of obscure cases of ventricular tachycardia

Role of Family Milieu in Tobacco Addiction: A Study in a Tertiary-care Institution in India

Use of tobacco is singularly responsible for most cases of cancer and coronary artery disease (CAD). Efforts to stop tobacco-use need to be guided by social circumstances. It is believed that family milieu may play a role in tobacco addiction. We studied the prevalence and pattern of tobacco-use in families of 50 consecutive tobacco-user patients who presented to a tobacco-cessation clinic and compared with age- and gendermatched controls (non-users of tobacco). The tobacco-use rates were significantly higher in the family of patients with tobacco-use compared to the control group. We conclude that problems of tobacco-use are not related to individual phenomenon, and efforts for control of tobacco addiction must be focused on entire family

Cutaneous markers of coronary artery disease

Coronary artery disease (CAD) is rapidly increasing in prevalence across the world and particularly in south Asians at a relatively younger age. As atherosclerosis starts in early childhood, the process of risk evaluation must start quite early. The present review addresses the issue of cutaneous markers associated with atherosclerosis, and the strengths and weaknesses of the markers in identifying early coronary atherosclerosis. A diligent search for such clinical markers, namely xanthelasma, xanthoma, arcus juvenilis, acanthosis nigricans, skin tags, ear lobe crease, nicotine stains, premature graying in smokers, hyperpigmented hands in betel quid sellers, central obesity, and signs of peripheral vascular disease may prove to be a rewarding exercise in identifying asymptomatic CAD in high risk individuals

Lipoma disseminatum

A middle aged male patient came with multiple swellings over his body which were gradually increasing in number. He was asymptomatic for any other disease and was worried for cosmetic reasons. His examination was unremarkable except xanthelesma on all of his four eyelids and multiple swellings of varying size all over his body. His blood investigations including lipid profile, ECG and X-ray chest were normal. As this patient had xanthelesma it was presumed that the swellings on other parts of his body were a part of the same etiology namely xanthomas. However FNAC of the swellings surprisingly proved it to be lipoma. This case reports an uncommon distribution of lipomas all over the body in the presence of xanthelesma