CORTICOSTERIODS INDUCED ECCHYMOSIS

Corticosteroids are the steroid hormones which are mainly used in the treatment of various diseases like rheumatoid arthritis, osteoarthritis, rheumatic fever, gout, allergic reactions, renal diseases and haematological diseases. Prolonged use of corticosteroids causes a number of undesirable effects. Major adverse drug reaction (ADR's) includes ulcers/gastrointestinal bleeding, osteoporosis, increased risk of heart diseases and decreased in bone density. Here we report a case of male patient of 72years old who was confirmed with cervical osteoarthritis and using oral corticosteroid (OCS) (methylprednisolone) since 6 y. While the patient was on therapy ecchymosis was noticed. The relation between suspected drug and ADR was established by performing ADR assessment scale, whereas both de-challenge and re-challenge was done, and ADR assessment scales like Naranjo's scale, WHO UMC scales showed probable ADR, it can be managed by stopping the drug or using alternative days. Close monitoring of blood cortisol levels in a patient using oral corticosteroids (OCS) should be done

A prospective and observational study on complications of type 2 diabetes mellitus in correlation with body mass index

Background: The aim of this study is to observe the prevalence of complications of diabetes mellitus (Type 2) among patients and to minimize their occurrence through patient education. The study helps to assess the clinical data of patients with diabetes mellitus (Type 2) along with the analysis of patterns, frequencies and predictive factors of microvascular, macrovascular complications and to educate and minimize the complications of diabetes mellitus among patients.Methods: Prospective and observational study was conducted among the type 2 diabetes mellitus patients at Sree Diabetes Clinic for a period of 6 months. The patients were interviewed using the patient data collection form which included demographic details, chief complaints and different diagnostic tools to detect type of complications. Both micro and macrovascular complications were evaluated.Results: A total of 150 type 2 diabetic cases were collected. Out of these 38(25.33%) patients were having BMI <25, and 112(74.67%) were having BMI ≥25 (overweight and obese). Out of 150 diabetic cases collected, a total of 131 diabetic complications were found. Out of these, 64(42.6%) were neuropathy, 3(2%) were nephropathy, 20(13.3%) were retinopathy and 17(11.3%) were having cardiovascular complications. Out of 112 patients with BMI ≥25, 60(54%) were found to have diabetic complications and out of 38 patients with BMI <25, 18(47%) were found to have diabetic complications. 90 out of 150 patients had a history of hypertension and 17 out of 150 patients had an abnormal lipid level.Conclusions: In this study, author found that obesity is a major risk factor for the development of diabetes mellitus and its complications

POLYPHARMACY INDUCED DRUG INTERACTIONS, ADVERSE DRUG REACTIONS (ADR) AND MEDICATION ERRORS IN TERTIARY CARE SOUTH INDIAN HOSPITAL

Objective: To study the pattern of drug interactions (DI) in our hospital and to identify whether it is associated with polypharmacy. To determine the level of severity of potential drug-drug interactions (PDDI), to detect, monitor and prevention of ADRs in the hospitalized patients and to identify the medication errors (ME). Methods: A prospective interventional study was conducted in a 300 bedded tertiary care South Indian hospital for a period of 6 mo. Prescriptions were analysed for PDDI using Micromedex software 2.2. The causality and severity of ADRs were assessed by using Naranjo’s, WHO UMC Scales and Hart wigs severity scales. ME was identified by review of patient drug charts. Results: Total 190 prescriptions were analyzed, in which 1028 drug interactions were seen. Out of which 718 were DDI, 198 DFI, 100 DEI, and 12 DTI were observed. More number of DI was seen in cardiovascular drugs, antibiotics followed by antacids and antiulcer agents. A total of 52 ADRs were identified in 43 patients. Diuretics, cardiovascular drugs were associated with a higher incidence of ADRs followed by Anti-Diabetic agents. 58 ME was seen in 190 prescriptions, among them omission error, prescribing errors and Wrong dose error was seen. Conclusion: Clinical pharmacist plays a potential role in the health care system in assisting the physician i.e. modifying the number of drugs taken, number of doses taken, medication adherence, identification of drug interactions, preventing, monitoring and detection of ADRs and identifying the medication errors

Fuzzy Clustering with Multi-Constraint QoS Service Routing in Wireless Sensor Networks, Journal of Telecommunications and Information Technology, 2019, nr 1

This paper presents a fuzzy logic-based, service differentiated, QoS aware routing protocol (FMSR) offering multipath routing for WSNs, with the purpose of providing a service differentiated path meant for communication between nodes, based on actual requirements. The proposed protocol initially forms a cluster by fuzzy c-means. Next, the building of a routing follows, so as to establish multiple paths between nodes through the modified QoS k-nearest neighborhood, based on different QoS constraints and on optimum shortest paths. If one node in the path fails due to lack of residual energy, bandwidth, packet loss, delay, an alternate path leading through another neighborhood node is selected for communication. Simulation results show that the proposed protocol performs better in terms of packet delivery ratio, delay, packet drop ratio and throughput compared to other existing routing protocols

Fuzzy Clustering with Multi-Constraint QoS Service Routing in Wireless Sensor Networks

This paper presents a fuzzy logic-based, service differentiated, QoS aware routing protocol (FMSR) offering multipath routing for WSNs, with the purpose of providing a service differentiated path meant for communication between nodes, based on actual requirements. The proposed protocol initially forms a cluster by fuzzy c-means. Next, the building of a routing follows, so as to establish multiple paths between nodes through the modified QoS k-nearest neighborhood, based on different QoS constraints and on optimum shortest paths. If one node in the path fails due to lack of residual energy, bandwidth, packet loss, delay, an alternate path leading through another neighborhood node is selected for communication. Simulation results show that the proposed protocol performs better in terms of packet delivery ratio, delay, packet drop ratio and throughput compared to other existing routing protocols