Objective: To assess factors associated with low adherence to pharmacotherapy in elderly patients. Methods: A prospective cross sectional observational study was conducted in Bharati Hospital and Research Centre, Pune over a period of 6 months. A total of 240 Elderly patients (≥60 years), taking 4 or more medications daily for any medical illness or illnesses were enrolled in the study. The details like age, gender, educational and employment status, physical activity, social history, past medical and medication history, current medications were noted in self pre designed patient pro forma. The medication adherence was assessed by using Brief Medication Questionnaire (BMQ). Results: The assessment of the patient's responses to the four scale BMQ showed that out of 240 patients, only 5.8% patients were adherent in regimen scale, 60% were adherent in belief scale, 15% were adherent in recall scale and 37.5% were adherent in access scale. Complexity of medication regimen (74.1%) was the main barrier to medication adherence. More than half of patients were unable to name their medications (68.3%). The main reason for non adherence would be related to patient related factors such as lack of knowledge about the disease (63.3%), inadequate knowledge regarding therapy (60%), taking so many pills at the same time (51.7%), forgetfulness (50.84%), difficulty in remembering to take all the pills (48.3%) and difficulty on refilling in time (20.0%). Conclusion: Various factors associated with medication nonadherence were complexity of medication regimen, lack of knowledge about the disease and therapy, difficulty in remembering to take medications and taking so many pills at the same time.

Abstract:Background:

Febrile neutropenia (FN) is the most common haematological toxicity associated with cytotoxic chemotherapy. Individual studies are available, but national estimates on FN are required. To describe chemotherapy-induced neutropenia, its associated infection-causing organisms, and the antimicrobials prescribed, a prospective cum retrospective study was conducted for a period of 9 months, which included 50 paediatric cancer patients less than 18 years. Patients having an absolute neutrophil count (ANC) less than 1500/mm 3 , having body temperature of above 38.5°C, and receiving anti-infectives as prophylaxis were included. Patient demographic details, presenting complaints, absolute neutrophil count, and laboratory findings were noted in a patient proforma. Out of the overall 584 episodes of CIN, 188 episodes (32.2%) were of febrile neutropenia. Majority of patients were boys (70%), aged between 1 and 6 years (66%), and diagnosed with acute lymphoblastic leukemia (64%). The mean ANC was 765.6 ± 235.7 × 10 9 /l. From a total of 188 episodes of FN, in 179 episodes, patients had ANC < 500 mm 3 , whereas in 9 episodes, patients had ANC < 100 mm 3. The predominant site of infection in these patients was bloodstream (27%), followed by urine (6%) and stool (1%). From the 51 episodes of blood culture done, the highest reported was of Staphylococcus species (49.01%). Anti-infective combinations of piperacillin/vancomycin (56%) and piperacillin/amikacin (42%) were given. Patients with positive fungal growth received Inj. amphotericin (18%) as therapy. Majority of the children undergoing chemotherapy, diagnosed with ALL, had FN. Low ANC led them susceptible to various bacterial and fungal infections. Introduction to antimicrobials and antifungals have all contributed to decreasing chemotherapy-related infections.

No abstract

Methotrexate (MTX) is an extensively prescribed antimetabolite especially in the treatment of several pediatric cancers, though managing toxicities associated with methotrexate in high dose continues to be a challenge. A prospective study was carried out from April 2017 to October 2018. Children of either sex below 18 years at the time of enrolment and receiving high dose Methotrexate intravenous infusion over 24 h as a 2 g/m 2 , 3 g/m 2 and 5 g/ m 2 dose was included in the study. The serum methotrexate level was estimated after the start of 48 h HDMTX infusion by using the ARCHITECT methotrexate assay. Toxicity due to HDMTX was assessed by Common Terminology Criteria for Adverse Events v.5.0. A total of 244 HDMTX infusions were delivered to 62 ALL patients. From the total of 244 cycles, serum methotrexate level in 35 cycles after the start of 48 h HDMTX infusion was found to be C 1.0 lmol/L with reported toxicities among 31 cycles (88.6%). In 209 cycles MTX level was found to be less than 1.0 is statistically significant as compared to other cycles (p \ 0.0001). Highest toxicities reported were in cycle I (38.8%). The toxicities such as oral mucositis, neutropenia, the elevation of liver enzymes, dermatological toxicities were found more in cycles whose methotrexate level are greater than 1.0 lmol/L. Dose reduction, increased the length of stay and treatment delay occurred in patients with severe toxicities. Severe toxicities of methotrexate can be interrelated with serum methotrexate levels at 48 h after the start of HDMTX infusion.