Objectives: To identify and categorize types of Drug Related Problems (DRPs), assess various risk factors for developing DRPs and delineate if drugs with narrow therapeutic index or non-narrow therapeutic index drugs cause greater number of DRPs. Methods: Patients from General Medicine, Surgery, Psychiatry, Cardiac and Intensive Care Unit (ICU) departments of a tertiary care teaching hospital were included. Data was collected prospectively over eight months from medical history, medication charts, case notes and laboratory data. Only those patients prescribed at least five drugs were included. Pediatric and Oncology patients and pregnant women were excluded from the study. Narrow therapeutic index (NTI) drugs (Insulin, digoxin, warfarin, levothyroxine, aminoglycoside antibiotics, carbamazepine, lithium and phenytoin) were compared with non NTI-drugs to delineate patterns of DRPs between both groups. Results: A total of 200 patients were enrolled in the study, and 172 DRPs were identified. The most common DRPs were: drug interactions (63%), inappropriate drug use (10.5%) and adverse drug reactions (10.5%). Polypharmacy and duration of hospitalization were established as significant risk factors for developing DRPs. NTI-drugs had a greater risk of developing DRPs (0.22) versus non-NTI drugs (0.08). Two categories of DRPs were found to be more significantly associated with NTI-drugs: ADRs and inappropriate drug use. Conclusion: While ADR and inappropriate drug use were more common with NTI-drugs, in clinical practice other non NTI-drugs: Anti-psychotic drugs (quetiapine, amisulpride etc.) and NSAIDs (aspirin) showed a high tendency for interactions and needed frequent monitoring.
Cytomegalovirus (CMV) disease caused by genetically resistant CMV poses a major challenge in solid organ transplant recipients, and the development of resistance is associated with increased morbidity and mortality. Antiviral resistance affects 5%-12% of patients following ganciclovir (GCV) therapy, but is more common in individuals with specific underlying risk factors. These include the CMV D+R-serostatus, type of transplanted organ, dose and duration of (Val)GCV ([V]GCV) prophylaxis, peak viral loads, and the intensity of immunosuppressive therapy. Guideline recommendations for the management of GCV resistance (GanR) in solid organ transplant recipients are based on expert opinion as there is a lack of data from controlled trials. Second-line options to treat GanR include foscarnet (FOS) and cidofovir (CDV), but these drugs are often poorly tolerated due to high rates of toxicity, such as renal dysfunction and neutropenia. Here, we report seven cardiothoracic transplant recipients with GCV resistance CMV infection from our centre treated with CMV immunoglobulin (CMVIG) +/leflunomide (LEF) and reviewed the literature on the use of these agents in this therapeutic setting.
The authors present the case of a 12-year-old boy with a history of chronic upper abdominal pain. Based on ultrasonography, endoscopic retrograde cholangio-pancreatography, and computerized tomography, a diagnosis of chronic calcific pancreatitis with dilation of the main pancreatic duct and a pseudocyst of the proximal pancreas was made. At surgery, in addition to confirmation of the above findings, a pseudoaneurysm arising from the splenic artery was found in the head and body of the pancreas. Pancreaticoduodenal resection including the pseudoaneurysm was performed. Postoperatively the child developed diabetes, which is easily managed with small doses of insulin.
We report a case of a diamond polisher where FDG-PET/CT was helpful in identifying active inflammation in hard metal lung disease (HMLD) caused by cobalt exposure.
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