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2007| October | Volume 61 | Issue 10
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Adverse drug reactions in nephrology ward inpatients of a tertiary care hospital
Lisha Joshua, Padmini D Devi, Shoba Guido
October 2007, 61(10):562-569
Adverse drug reactions (ADRs) are important causes of hospital admissions and inpatient complications. Renal dysfunction has a role in occurrence of ADRs.
(1) To study the characteristics of ADRs among inpatients in Nephrology ward of a tertiary care hospital and (2) to compare these characteristics between patients with renal dysfunction and patients with normal renal function in same population of patients with ADRs.
Materials And Methods :
A retrospective study of inpatients with ADRs (July 2005-June 2006) in Nephrology ward of a tertiary care hospital.
ADR characteristics were analyzed using descriptive statistics. Comparisons were made between normal renal function group and renal dysfunction group by t-test and Chi-square test.
Of 1,464 case records, 244 (17%) patients were included. Two hundred sixty-seven drugs contributed to 294 ADRs. Serious ADRs accounted for 12% of the total ADRs. Renal/ electrolyte system (44%) was the most common organ system involved. Major clinical spectrum of ADRs included acute renal failure (22%), hypo/ hyperglycemia (13%), hyper/ hypokalemia (13%), bone marrow suppression (5%) and hepatic injuries (4%). Prednisolone (12%) was the most commonly implicated drug. Mean time to revert was 13 ± 7.2 days. Three patients died. On comparing patients with normal renal function (n=80) with those suffering from renal dysfunction (n=164), polypharmacy, serious ADRs, multiple ADRs, longer time to recover, longer period of hospitalization were found to be more frequent among the renal dysfunction group (P < 0.05), with no difference in mortality between groups.
High incidence of ADRs, especially serious and life-threatening ADRs, was noticed. A wide spectrum of ADRs was observed. Renal dysfunction showed a significant impact on various characteristics of ADRs.
Atypicality in presentation of neuroleptic malignant syndrome caused by olanzapine
Biswaranjan Mishra, Baikunthanath Mishra, Saddichha Sahoo, Manu Arora, C.R.J Khess
October 2007, 61(10):570-573
Neuroleptic malignant syndrome (NMS) is the most serious of acute neurological side effects produced by antipsychotic medication, characterized by hyperthermia, rigidity, altered consciousness and autonomic dysfunction, the prevalence of which varies from 0.4-1.4%. NMS is usually seen in treatment with high potency typical antipsychotics and very rarely with atypical antipsychotics. However, NMS cases have been reported with risperidone, clozapine, olanzapine and quetiapine. The presentations of NMS have often varied, and we report another atypicality in presentation of NMS due to olanzapine use.
Causes and pattern of mortality in HIV-infected, hospitalized patients in a tertiary care hospital: A fourteen year study
Vijay Dharma Teja, Talasila Sudha, Vemu Lakshmi
October 2007, 61(10):555-561
The introduction of highly active antiRetroviral therapy (HAART) in several centers in India has raised the expectation that many human immunodeficiency virus (HIV)-infected individuals will live longer. However, as most infected individuals remain undiagnosed till the late stage of infection; several continue to succumb to this infection even in the era of HAART.
Materials and Methods :
A retrospective study was conducted over a 14 year period on 2,050 HIV-infected, hospitalized patients to evaluate the pattern of mortality and to determine proportion, risk factors and causes of death.
A total of 145 deaths among HIV-infected patients were documented during hospitalization, with an overall mortality rate of 8.15%: 2.94% in the pre HAART era (1992-1996), 7.29% in the early HAART era (1997-2000) and 9.73% in the present HAART era (2001-2005). 11.7% (17/145) of deceased patients were aware of their HIV-infected status before getting admitted. Only five patients were on any antiretroviral treatment prior to admission. Ninety (62.07%) deaths were HIV-related (AIDS-defining conditions) and 55 (37.93%) were nonHIV-related.
Our study stresses the importance of early diagnosis of HIV infection to curb adult mortality, which will continue to rise unless effective treatment interventions are introduced.
LETTERS TO EDITOR
Antibiotic susceptibility profile of
serovars: Trend over three years showing re-emergence of chloramphenicol sensitivity and rare serovars
October 2007, 61(10):576-579
Outcome of coronary artery bypass grafting in patients without major risk factors and patients with at least one major risk factor for coronary artery disease
Younes Nozari, Ali Hashemlu, Zinat Nadia Hatmi, Mehrdad Sheikhvatan, Amir Iravani, Ali Bazdar, Nasir Babakhan, Nazanin Gholami Ghasri
October 2007, 61(10):547-554
Coronary artery bypass grafting (CABG) has become a safer procedure in recent years.
: We aimed to compare complications and early outcome of CABG in patients without history of general risk factors with those in patients with at least one general risk factor for coronary artery disease (CAD).
Settings and Design :
Materials and Methods
: Postoperative in-hospital complications, 30-day mortality rate and length of stay in hospital of 708 patients without preoperative general risk factors undergoing CABG in three university hospitals were assessed and compared with 10,844 patients undergoing CABG with at least one general risk factor as controls. In addition, the association of the studied variables with patients' early outcome was evaluated.
Statistical Analysis :
SPSS software with Pearson's χ
test; independent sample t test, Mann-Whitney test and univariate analysis were used.
All studied in-hospital complications were similar between the two groups. Thirty days mortality rate (0.7% in study group and 1.4% in control group) was similar between groups, whereas prolonged length of stay (>12 days) was more frequent in control group (61.33% vs. 71.36%, P < 0.0001). Atrial fibrillation (P < 0.0001) was a strong predictor for prolonged length of stay in hospital.
Most aspects of early complications after CABG, as well as 30-day mortality rate, were similar between patients with and without general risk factors for coronary artery disease undergoing CABG.
Melioidosis: A review of orthopedic manifestations, clinical features, diagnosis and management
Vijay Kumar Jain, Deepali Jain, Himanshu Kataria, Ajay Shukla, Rajendra Kumar Arya, Deepak Mittal
October 2007, 61(10):580-590
Melioidosis is an infectious disease caused by gram-negative soil-dwelling bacillus Burkholderia pseudomallei. Musculoskeletal melioidosis mimics other infections both clinically and radiologically. An extensive literature review has been performed over musculoskeletal melioidosis through various search engines such as Pubmed, Embase, Medscape, Altavista and Google. Diagnosis requires a high index of clinical suspicion and is dependent on microbiological confirmation. Prompt treatment with long-term combination antibiotics in high dosages and surgical drainage of abscesses improves survival
LETTERS TO EDITOR
Pharmacogenomics in clinical trials: An analysis
Mukta N Chowta, Prabha M Adhikari, KV Ramesh, Ashok K Shenoy
October 2007, 61(10):574-576
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