BackgroundEmerging evidence suggests that statins may decrease the risk of cancers. However, available evidence on prostate cancer (PCa) is conflicting. We therefore examined the association between statin use and risk of PCa by conducting a detailed meta-analysis of all observational studies published regarding this subject.MethodsLiterature search in PubMed database was undertaken through February 2012 looking for observational studies evaluating the association between statin use and risk of PCa. Before meta-analysis, the studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects model (DerSimonian and Laird method). Subgroup analyses, sensitivity analysis and cumulative meta-analysis were also performed.ResultsA total of 27 (15 cohort and 12 case-control) studies contributed to the analysis. There was heterogeneity among the studies but no publication bias. Statin use significantly reduced the risk of both total PCa by 7% (RR 0.93, 95% CI 0.87–0.99, p = 0.03) and clinically important advanced PCa by 20% (RR 0.80, 95% CI 0.70–0.90, p<0.001). Long-term statin use did not significantly affect the risk of total PCa (RR 0.94, 95% CI 0.84–1.05, p = 0.31). Stratification by study design did not substantially influence the RR. Furthermore, sensitivity analysis confirmed the stability of results. Cumulative meta-analysis showed a change in trend of reporting risk from positive to negative in statin users between 1993 and 2011.ConclusionsOur meta-analysis provides evidence supporting the hypothesis that statins reduce the risk of both total PCa and clinically important advanced PCa. Further research is needed to confirm these findings and to identify the underlying biological mechanisms.

BackgroundTo prevent medication errors in prescribing, one needs to know their types and relative occurrence. Such errors are a great cause of concern as they have the potential to cause patient harm. The aim of this study was to determine the nature and types of medication prescribing errors in an Indian setting.MethodsThe medication errors were analyzed in a prospective observational study conducted in 3 medical wards of a public teaching hospital in India. The medication errors were analyzed by means of Micromedex Drug-Reax database.ResultsOut of 312 patients, only 304 were included in the study. Of the 304 cases, 103 (34%) cases had at least one error. The total number of errors found was 157. The drug-drug interactions were the most frequently (68.2%) occurring type of error, which was followed by incorrect dosing interval (12%) and dosing errors (9.5%). The medication classes involved most were antimicrobial agents (29.4%), cardiovascular agents (15.4%), GI agents (8.6%) and CNS agents (8.2%). The moderate errors contributed maximum (61.8%) to the total errors when compared to the major (25.5%) and minor (12.7%) errors. The results showed that the number of errors increases with age and number of medicines prescribed.ConclusionThe results point to the establishment of medication error reporting at each hospital and to share the data with other hospitals. The role of clinical pharmacist in this situation appears to be a strong intervention; and the clinical pharmacist, initially, could confine to identification of the medication errors.

The results show that PIM prescribing is common among hospitalized elderly Indian patients. It is feasible to reduce this practice through the provision of appropriate unbiased information to healthcare professionals.

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*Background: In view of the multiple co-morbidities, the elderly patients receiving drugs are prone to suffer with drug interactions since they receive a greater number of drugs. Objective: The study was undertaken to determine the prevalence of drug interactions, as well as their predictors. Method: The prescriptions of a total of 1510 inpatients were collected prospectively for 1.5 years from inpatients wards of public tertiary care teaching hospital. All the prescriptions were checked for drug interactions using the Micromedex® Drug-Reax database-2010 and Stockley's Drug Interactions. Regression analyses sought to determine predictors for the drug interaction. Results: The patients, with the average age of 67.2 ±0.2 years, were prescribed an average of 9.15 ±0.03 medications. It was found that out of 1510 prescriptions of inpatients, 126 (8.3%) prescriptions had one or more than one drug interaction. All the identified interactions were severe in nature. The top most interacting drugs were acetylsalicylic acid and anticoagulant (n=59). The second top most interacting drug combination was clopidogrel and proton pump inhibitors (n=51). The most commonly involved drugs in interactions were C (cardiovascular system) and A (alimentary tract and metabolism). Using multivariate binary logistic regression, multiple drugs (Odds Ratio=4.5; 95% Confidence Interval: -2.38 -9.47) and multiple diagnoses (Odds Ratio=2.6; were found to be significant predictors for drug interaction. Conclusion:The results of this study substantiate the occurrence of severe drug interactions among Indian elderly inpatients. In order to provide safer pharmaceutical care, the active involvement of clinical pharmacists is a potential option.

In EP without organ dysfunction, a trial of conservative management may be successful.

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Background: Malnutrition is one of the most serious complications of chronic kidney disease due to its devastating consequences in terms of quality of life, morbidity, hospitalization and mortality. This study aims to evaluate the prevalence of malnutrition among chronic kidney disease patients globally and its contrast with India. Methods: Articles reporting the prevalence of malnutrition associated with CKD patients were retrieved from PubMed/Medline, ScienceDirect, Cochrane library & Google scholar. The quality assessment of studies was performed by using Newcastle-Ottawa scale. The pooled prevalence was reported with effect size considering the random effect model using comprehensive meta-analysis version 2.0. Results: The results from 61 observational studies containing 21119 patients are presented. The global prevalence of malnutrition associated with CKD was found to be 42.7%. The prevalence of malnutrition in peritoneal dialysis group was found to be (45.3%, 95%CI; 29.5-62.1) higher as compared to hemodialysis group (43.1%, 95% CI; 32.2-54.7) followed by non-dialysis group (38.5%, 95% CI; 24.0-55.3). The prevalence of malnutrition in India was found to be 56.7% (95% CI: 42.4-70.0%). Males were predominantly affected with malnutrition as compared to females. The prevalence in India was reported to be higher as compared to all the included countries, except Mexico and Jordan. Conclusions: Globally, India occupies the highest share of prevalence studies followed by Brazil. The geographical stratification of results revealed that the highest prevalence of malnutrition was observed in India except Mexico and Jordan. Given the high prevalence of malnutrition among CKD patients, evaluation of interventions for malnutrition with patient centered outcomes are warranted.