Objective: To evaluate whether clinical pharmacist's interventions have any impact on medication adherence of patients having inflammatory bowel disease and to assess the awareness of patients about their disease and the significance of medications they use. Materials and Methods: A prospective, interventional follow up study was conducted in the outpatients visiting Gastroenterology and Hepatology department of Amrita Institute of Medical Sciences, Kochi. To assess the level of medication adherence and patient's awareness, MMAS-8 and CCKNOW has been utilized. Once this baseline information's were collected, counselling was given to patients and they were supplemented with pill cards and patient information leaflets as educational material. During the follow up visit, all the above parameters were reassessed and compared with the baseline visit. Result: About 110 IBD patients have participated in this study. In baseline visit, 6.36% patients had low adherence, 62.73% patients had medium adherence, 30.91% patients had high adherence. During follow up visit, after intervention by clinical pharamcist, 3.64% patients had low adherence, 18.18% patients had medium adherence and 78.18 % patients had high adherence. From this study, it was notified that the average score of CCKNOW was only 8.15 in the beginning. Later on, it was escalated to 11.65 during the revisit periods. Conclusion: Knowledge of patients about their disease and medications were insufficient during baseline visit. Adherence to medication was found to be poor among IBD patients. Counselling provided by clinical pharmacist about the importance of medication adherence and provision of information leaflets and pill cards lead to an improvement in medication adherence and knowledge of IBD patients. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Trichosporon asahii is a rare opportunistic fungal pathogen that causes fatal systemic infection in immunocompromised patients. Neutropenia developing due to malignancies is an important risk factor for fungal infection. Invasive infections due to T. asahii can be divided into disseminated and localized forms. The disseminated form is more common and usually occurs in neutropenic patients. The patient typically has an acute febrile illness that progresses rapidly to multiorgan failure. Here, we are presenting a case of fungal sepsis by invasive T. asahii in a 1-year-old child with Wilms Tumor. To the best of our knowledge, this is the first time that fungal sepsis due to T. asahii has been reported in a Wilms tumor patient. The incidence of rare invasive fungal infections is increasing in immunocompromised patients in whom management becomes difficult due to their heterogenous antifungal susceptibility pattern and intrinsic resistance to the standard antifungal agents that are routinely given. The patient was admitted with high spiking fever, and his laboratory investigations suggested neutropenia. T. asahii was isolated from the blood culture, for which he was started on inj. voriconozole. After 14 days of treatment, the fungus was cleared out from the patient’s blood.
Valproic acid is commonly used in the treatment of both focal and generalized epilepsies and is often tolerated well. Valproic acid is usually tolerated well, but serious complications, including hepatotoxicity and hyperammonemic encephalopathy, may occur. Here, we report a case of valproic acidinduced hyperammonemic encephalopathy on concomitant use with lacosamide.
QT prolongation refers to the prolonged QT interval in electrocardiography (ECG) which can even lead to life-threatening events such as ventricular arrhythmias, torsades de pointes, etc., several drugs can cause QT prolongation which includes sotalol, quinidine, arsenic, disopyramide, procainamide, amiodarone, haloperidol, etc., Arsenic trioxide (ATO) is used as an effective treatment option in promyelocytic leukemia (PML). Acute myeloid leukemia (AML) is a cancer that affects the blood and bone marrow. Acute promyelocytic leukemia (APL) is the M3 subtype of AML that affects mainly the white blood cells. In APL, immature granulocytes accumulate abnormally to form promyelocytes. ATO helps in the apoptosis of these cancerous promyelocytic cells. In patients on arsenic therapy, ECGs must be monitored to ensure QT prolongation as it a major side effect of the drug. Here is the case of a 58-year-old female patient and was newly diagnosed with APL. She developed QT prolongation with arsenic therapy. Other confounding factors such as electrolytes and presence of other QT-prolonging drugs were also corrected.
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