Medications probably are the single most important health care technology in preventing illness, disability, and death in the geriatric population. Age-related changes in drug disposition and pharmacodynamic responses have significant clinical implications; increased use of a number of medications raises the risk that medicine-related problems may occur. The relationship between increased use of drugs including the prescription medication and elderly is well established. Majority of ADRs (80%) causing admission or occurring in hospital are type A reactions. Although less common occurring in elderly, type B ADRs may sometimes cause serious toxicity. Studies have correlated the integral association between old age and increased rate of adverse drug reactions arising out of confounding association between age and polypharmacy contributed by age-related changes in pharmacodynamics and pharmacokinetics at least for some medical conditions. A drug combination may sometimes cause synergistic toxicity which is greater than the sum of the risks of toxicity of either agent used alone. But, strategies to increase opportunities for identifying ADRs and related problems have not been emphasised in current international policy responses especially in India to the increase in elderly population and chronic conditions. Careful epidemiological studies that encompass large numbers of elderly drug users are required to obtain this information as increased knowledge of the frequency and cost of adverse drug reactions is important in enabling both more rational therapeutic decisions by individual clinicians and more optimal social policy.
Background: An adverse drug reaction (ADR) is defined by World Health Organization (WHO) as 'Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy'. ADRs associated with cancer chemotherapy warrant analysis on their severity and preventability. The outcome would create awareness among health care providers and prevent their recurrence. We have performed a hospital-based prospective observational study designed to analyze the pattern of ADRs to chemotherapeutic agents in cancer patients of a tertiary care hospital. Methods: A total of 119 cancer patients were monitored for suspected ADRs during the course of chemotherapy from November 2014 to December 2015. Clinical events were recorded and analyzed with regard to the demographics and drug details of the patients. Results: A total of 106 ADRs were recorded from 119 cases. The ADRs commonly encountered included constipation, nausea, vomiting, alopecia and hematological changes. Cisplatin, cyclophosphamide, paclitaxel and 5-FU were used for the treatment of commonly found cancers in this region affecting the lungs, esophagus and lymphomas. Naranjo's causality assessment showed 86.7% possible (score 4) and 13.2% probable (score 5-6). Severity of adverse reactions showed 77.4% mild, 18.9% moderate and 3.8% severe. A total of 45.3% of ADRs were preventable reactions such as nausea, vomiting and constipation. Conclusions: This study highlights the role of active monitoring as an important tool for early detection, assessment and timely management of ADRs in patients undergoing cancer chemotherapy. The observed ADRs were preventable although ADRs such as hiccough, anemia, neutropenia and alopecia were not preventable.
Tramadol is a weak mu (µ) opioid receptor agonist that acts by inhibiting serotonin and norepinephrine uptake. Tramadol undergoes extensive hepatic metabolism by a number of pathways, including CYP2D6 and CYP3A4, and by conjugation with subsequent renal excretion. The maximum recommended dose is 400 mg/day. One of the most important adverse effects of tramadol is a seizure, which usually occurs at high doses and is often generalized tonic–clonic type and self-limiting. Here, we present a case of a patient with inflammatory low backache who developed seizures while on low-dose oral tramadol. After 1 h of taking the first tablet of tramadol, he developed morbilliform rashes all over the body. One day later, he developed generalized tonic–clonic seizures followed by a loss of consciousness for 5 min. The patient was admitted to the hospital and managed conservatively with injection lorazepam and tramadol was stopped. In general, if applied in overdose, tramadol can only incite seizures in patients already suffering from some sort of disorder related to seizures or if it is administered along with antidepressants, alcohol, etc. But here, only with the use of 37.5 mg oral application, the incidence of seizure happened.
Introduction: People most at risk of acquiring the disease are those who are in contact with or care for patients with COVID-19. This inevitably places health care workers (HCWs) at high risk of infection, especially when there is a breach in the personal protection while managing patients for categorization of risk in exposure to COVID-19 in health care workers, a risk assessment tool in the form of questionnaire has been devised by The Ministry of Health & Family Welfare (MoHFW), Directorate General of Health Services after the risk assessment of HCWs as high or low risk, management is done according to the recommendations. Materials & Methods: We analyzed the data collected by the Risk Assessment Committee members of Health care workers exposed to COVID 19 for a period of 1year from June 2020 to June 2021. After the interview of HCWs, they were categorized as high or low risk. Results: Risk assessment committee(RAC) members interviewed a total of 1660 HCW contacts of 144 index cases in one year period from June 2020 to June 2021. Our contacts include doctors, nurses, technicians, sanitation worker and other staffs. Index cases were mostly HCWs except few, who were patients. On an average, we used to receive a list of 8-12 contacts for each index case from the Contact Tracing Committee. Out of 1660 contacts, we found 241(14.5%) were high risk and 1419 (85.4%) low risk. Conclusion: Risk assessment of HCWs not only reduces the burden of disease in HCWs, but also prevents unnecessary quarantine of low risk category and shortage of man power as more scientific evidence on COVID- 19 becomes available, more accurate validated risk prediction scores will facilitate more precise estimates of individual risk.
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