Medication Adverse Reactions Research Articles

AI-powered Solutions for Casualty Assessment in Drug Safety and Patient Care

Objective: An adverse drug reaction is defined as “an appreciably harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product, which warrants prevention or specific treatment, alteration of the dosage regimen, or withdrawal of the product, as it predicts hazard from future administration.” Methodology: Currently used to report such responses, the International Classification of Diseases will soon incorporate WHO's Adverse Reaction Terminology. A medication's bad effects can fall into one of six types, each having its own mnemonic: withdrawal, therapeutic failure, dose-and time-related, non-dose-related, weird, increased withdrawal, and withdrawal overall (time-related). Factors such as timing, illness pattern, investigation findings, and retesting the medicine could be useful in pinpointing the reason for a suspected adverse drug reaction. Management includes treating the effects of the medication specifically as well as, if feasible, stopping it altogether. Results: Reporting suspected adverse medication reactions is important. Monitoring techniques are able to identify responses and establish connections. There is many software that is used to report and monitor adverse drug reaction responses. Various Pharmacovigilance companies use AI technology to utilize this method to record signals, communicate, and solve new issues in order to limit or avoid harm because of large data size.

Assess Incidence and Presentation of Cutaneous Adverse Drug Reactions in Patients Presenting at Jeddah's Tertiary Care Facilities

Background: It is often necessary to differentiate cutaneous signs of adverse medication reactions from other similar appearances. Because patients frequently fail to recognize the connection between drug consumption and ensuing cutaneous manifestations, early detection of these responses is imperative. Purpose: Investigating the prevalence of Cutaneous Adverse Drug Reactions (CADRs) at a teaching hospital for tertiary care is the goal of this study. Methods: A self-reporting technique was used to select cases in a prospective, observational trial that lasted six months in Saudi German hospital in Jeddah . The following categories applied to Cutaneous Adverse Drug Reactions: definite, potential, and probable. Results: The most common cutaneous manifestation of ADRs (42.85%) was maculopapular rash, which was linked to antimicrobials (48.30%) and nonsteroidal anti-inflammatory drugs (21.90%) during the study period, which resulted in 91 cases of Cutaneous Adverse Drug Reactions. Conclusion: Since cutaneous adverse drug reactions are common, raising awareness of them is crucial to diagnosing and preventing them.

Prospective Approaches of Herbal Novel Delivery System with Special Reference to the Herbal Nanosciences

: Medicinal and culinary uses of plants date back centuries. Projects on a global scale are conducting laboratory research to identify plants with therapeutic properties, with the ultimate goal of developing such compounds into medicines with acceptable drug delivery mechanisms and bringing them to market. Non-synthetic medications derived from plant or herbal sources have attracted a lot of interest because of their high tolerability and low likelihood of adverse medication reactions. All diseases, the theory goes, can be cured by something found in nature. Medicines can be taken in a wide variety of forms, including tablets, capsules, powders, semi-liquid extracts, tinctures, decoctions, medicinal teas, solutions, and more. Longer release, patient adherence, and other objectives necessitate adjustments to herbal medications. Researchers into novel drug delivery systems had hitherto overlooked herbal remedies due to a lack of scientific validation and the challenges inherent in processing, standardizing, extracting, and identifying them. Transdisciplinary research and cuttingedge isolation, purification, and identification techniques have led to the development of novel herbal compositions. Bioactive plant extracts and phytoconstituents are used in a wide variety of Nano- Emulsions, microspheres, transferosomes, implants, and ethosomes. Compared to herbal remedies, novel formulations fared better. Among these advantages are increased solubility, bioavailability, toxicity, pharmacological activity, stability, delivery duration, and resistance to physical and chemical degradation. As a result, the pharmacokinetic and pharmacodynamic properties of herbal medications can be enhanced by the use of novel drug delivery systems, making them safer and more effective. : This article aims to provide a concise description of the many new drug delivery techniques that have been created for the administration of herbal medications. The ultimate goal is to increase the efficacy of therapies and to learn more about their significance and worldwide appeal.

A Case Report On Metoprolol Induced Nightmares And Hallucinations

Metoprolol is a cardioselective beta-1-adrenergic blocker. It is frequently prescribed for cardiovascular conditions but is associated with potential central nervous system adverse effects, including hallucinations and nightmares. We discuss the case of an 84-year-old female with mixed aortic valve disease who experienced hallucinations and nightmares after starting metoprolol medication. Her symptoms improved after she stopped using metoprolol, indicating a likely causative link. This example emphasizes the significance of rapidly diagnosing and addressing adverse medication reactions, especially in elderly patients who may have underreported symptoms. Understanding the pharmacological properties of lipophilic beta-blockers and their effects on neurological function is critical for improving patient care and reducing negative outcomes

Efficacy of a Multimodal Surgical Site Injection for Postoperative Pain Control in Pediatric Patients With Cerebral Palsy Undergoing Hip Reconstruction: A Randomized Controlled Trial.

One in 4 children with cerebral palsy (CP) will undergo orthopaedic surgery during their childhood. Despite its ubiquity, postoperative pain control has been poorly studied in this patient population. Moreover, poor pain management has been associated with adverse surgical outcomes. Multimodal analgesic injections have been well studied in the adult population, demonstrating safety and efficacy in reducing postoperative pain and narcotic consumption, but this modality has not been studied in pediatric patients undergoing similarly complex procedures. The objective of this study was to evaluate the efficacy of a multimodal surgical site injection for postoperative pain control following operative management of hip dysplasia in patients with CP. After obtaining IRB approval, a multicenter, randomized double-blind placebo control trial was completed. Patients below 18 years old with a diagnosis of CP who were scheduled for varus derotation osteotomy (VDRO) of the proximal femur were randomized to receive a surgical-site injection with either a combination of ropivacaine (3mg/kg), epinephrine (0.5mg), and ketorolac (0.5mg/kg) (experimental group) or normal saline (control). All included patients had identical postoperative care, including immobilization, physical therapy, and standardized, multimodal postoperative pain control. Pain scores and narcotic consumption were recorded at regular intervals and compared between groups utilizing two-tailed t test or a nonparametric Mann-Whitney test for quantitative variables and a Fischer exact test for categorical variables. Thirty-four patients were included, evenly divided between study arms. There were no significant differences in demographic variables, gross motor function classification system (GMFCS), comorbidities, preoperative radiographic parameters, or concomitant surgeries between groups. Patients in the experimental group required significantly lower narcotic medications at all postoperative time points from PACU until hospital discharge compared with controls (0.41 ± 0.42 vs. 1.87 ± 2.05 total morphine mEQ/kg, P =0.01). Similarly, patients in the experimental group were found to have significantly lower pain scores throughout their hospital stays compared with controls (1.0 ± 0.6 vs. 2.4 ± 1.1 mean pain score, P <0.001). There were no significant differences in operative time, OR time, blood transfusion requirements or hospital length of stay between groups. There were no adverse medication reactions or injection site complications in either group. In patients with CP undergoing hip reconstruction, surgical-site injection with a multimodal analgesic combination improves pain control and reduces narcotic consumption in the early postoperative period with no observed adverse effects. Local multimodal analgesic injections should be adopted as part of standard multimodal pain control in this patient population for all osseous surgeries. Level I-therapeutic.

Preparation, characterization, and anticancer evaluation of polydatin conjugated with zinc MOF and encapsulated by liponiosomes as a potential nanotool-induce apoptosis

Tumor is a serious worldwide issue that ranks as the second cause of mortality, regardless of the region's status. It is treated with a variety of techniques, including chemotherapy, radiotherapy, and surgery, however, there are drawbacks, such as adverse medication reactions. The investigation of stable and effective zinc metal-organic frameworks (ZMOFs) for medicinal applications has received increasing attention. Herein, we report the fabrication of our work has promised a drug delivery system (DDS) by polydatin (PD)-loaded ZMOF (PD-ZMOF) and encapsulated into liponiosomes (LNs) to form (PD-ZMOF@LNs) for increased drug targeting to tumor cells. The obtained compounds were characterized using XRD, SEM, TEM, FTIR, TGA, BET, PDI, zeta seizer, and zeta potentials (ZP) analysis. A computational approach based on Monte Carlo simulation was adopted to elucidate the PD loading mechanism into the ZMOF. Both ZMOF and PD-ZMOF@LNs showed no significant weight loss up to approximately 551⁰C, indicating their high thermal stability and the final weight decrease due to the full degradation of the ZMOF framework at that point. TEM images of ZMOF and PD-ZMOF@LNs NPs demonstrated a spherical-like and needle-like particles with an average diameter of 17.6 nm and 27.3 nm (*P < 0.05), respectively. The hydrodynamic size analyzer displayed an average particle size of 194.4 nm, with ZP of +23 mV. The encapsulation efficiency (EE), loading capacity (LC), drug release (DR), and drug-release kinetics of PD and PD-ZMOF@LNs were evaluated, and the results showed that PD was EE into ZMOF up to 91.27 ± 0.83 % (*P < 0.05). To understand the procedure of PD release at pH 6.9, four kinetic models were examined to identify which model best fit the obtained release data, and the Zero-order model demonstrated excellent release fitness with R2 = 0.9953. Anticancer activity of optimized free PD, ZMOF, and PD-ZMOF@LNs was evaluated in MCF-7 cells utilizing cell viability and flow-cytometric assays. Our samples demonstrate anti-tumor activity against MCF-7 cells with inhibitory concentrations (IC50) at 105 ± 1.5 µg/mL for PD-ZMOF@LNs. The surviving fraction and plating efficiency colony formation potential for PD-ZMOF@LNs were 32 % and 23 %, respectively (*P < 0.05). Flow cytometry analysis indicated that PD-ZMOF@LNs induced apoptosis in 77.39 % of MCF-7 cells.

Antiseizure adverse drug reaction and associated factors among epileptic patients at Jimma Medical Center: a prospective observational study

A growing body of evidence suggests that adverse drug reactions (ADRs) are a major cause of morbidity and mortality in the healthcare system. Fifteen to twenty-five percent of patients with epilepsy discontinued antiseizure drugs (ASDs) within 6 months of therapy owing to intolerable adverse drug reactions. In Ethiopia, the prevalence of antiseizure adverse drug reactions and associated factors was not extensively conducted in advanced settings like Jimma Medical Centers. Hence, the objective of this study is to assess patterns of adverse drug reactions and associated factors among ambulatory epileptic patients at tertiary hospitals in Ethiopia. A hospital-based prospective observational study was spanned for 1 year. Two hundred ninety patients were consecutively recruited into the study from all epileptic patients attending the ambulatory clinic. Relevant data were collected through patient interviews and medical chart reviews. The causality assessment was done by using the Naranjo Probability Scale. Epi-Data manager version 4.6.0.4 was used for data entry and statistical analysis was performed by Statistical Package for Social Science version 25.0 (SPSS). Stepwise backward logistic regression analysis was done to identify factors that increase the risk of antiseizure adverse drug reactions. The mean (± SD) age of the participants were 29.91(± 11.26) years. The overall prevalence of ADR was 33.8% (95% CI 29.2–39.9%). A total of 110 adverse drug reactions were identified among 98 patients with an average of 1.12 per patient. ADRs were frequently reported with phenobarbital (52.04%) and phenytoin (34.70%). The commonly identified adverse drug reactions were epigastric pain (27.55%) and central nervous system drowsiness (23.46%). Comorbidity (AOR = 5.91, 95% CI (2.14–16.32), seizure-free period of fewer than 2 years (AOR = 1.94, 95% CI (1.18–3.19), and polytherapy (AOR = 1.35, 95% CI (1.80–2.26) were significantly associated with adverse drug reactions. This trial had a comparatively high percentage of adverse medication reactions. Adverse medication reactions were more common in patients with polytherapy, comorbidities, and seizure-free durations less than two years. Therefore, medical practitioners should advise patients who exhibit these traits on how to reduce or avoid bad drug responses or provide comfort in the event of small incidents.

Role of clinical pharmacist in drug utilization evaluation, medication adherence and pharmacovigilance

A series of systematic, criterion-based drug evaluation known as Drug utilization review are conducted on a regular basis to ensure that medication is utilized appropriately. It’s a mean of learning more about the issues brought on by drug usage, if done properly, may help to solve the issues. Medication adherence generally refers to a patient’s ability to take prescription drugs as directed and their continued use of those drugs. The increasing body of research linking medication non adherence to unfavorable outcomes and increased healthcare cost has raised concerns among clinicians, healthcare institutions, and other stakeholders. Pharmacovigilance, in which the procedures keeping an eye on the assessing adverse medication reactions, is essential to clinical practice, public health and efficient drug regulating system. Aim of the study was wo study about the role of pharmacist in drug utilization review, medication adherence and pharmacovigilance.

Development and In vitro Evaluation of a Nanoemulsion Containing Piroxicam for Topical Drug Delivery

ABSTRACT Background: A specific type of emulsion with a compatible droplet size of 20–500 nm and a submicron size range is termed nanoemulsion (NE), often referred to as mini emulsion. Nonsteroidal anti-inflammatory drugs such as piroxicam are employed to treat discomfort after surgery, acute gout, degenerative arthritis, and arthritis with inflammation. Objectives: With the aim of minimizing adverse medication reactions as well as enhancing compliance among patients, the study intends to develop and assess a piroxicam NE that includes oleic acid and Tween 80. It will do this by investigating the impact of the oil phase, surfactants, and cosurfactants on the product’s chemical and physical characteristics. Materials and Methods: After being homogenized, Tween 80, oleic acid, and paraffin oil are emulsified with ethanol and water. Zeta potential, drug entrapment efficiency, spreadability, viscosity, pH evaluation, and scanning electron microscopy (SEM) are being employed for the characterization of the dosage form. The procedure involves the dropwise addition of ethanol and continuous mixing. Results: According to accelerated experiments, four of the six formulations displayed good stability, suggesting their stability. This strategy is viable for NE formulations, with the entrapped drug percentage varying from 99.51 to 101.01. The range included additional factors such as drug release, texture, entrapment efficiency, spreadability, SEM zeta sizer, and polydispersity index value. Conclusions: Because of its potential negative effects, the study aimed to develop a stable NE of piroxicam for topical use by combining oleic acid, tween, paraffin, and ethanol. Because of their repelling characteristics, the charges strengthen stability, and the pH’s modest acidity helps to prevent skin infections. The study promotes spontaneous emulsification as the most suitable technique for producing NEs.

An Educational Intervention to Improve Adverse Drug Reactions Reporting Among Healthcare Practitioners in Selected Pediatric Hospitals in Iraq

Background: Pharmacovigilance is getting a lot of attention lately because it plays a crucial role in managing effective medication use in clinical settings. The main goals of pharmacovigilance are to protect and enhance public health and reduce the harm caused by drugs by ensuring their justified use. This study aimed to create a pharmacovigilance education program, record adverse medication reactions, and assess the impact of the program on the knowledge, attitudes, and practices (KAP) of healthcare professionals in several Iraqi pediatric hospitals. In a three-phase study, healthcare professionals were asked to complete a KAP questionnaire before and after the educational program. Results: The educational program significantly improved participants' knowledge about adverse drug reactions (ADRs) and pharmacovigilance (PV). Similar improvements were observed in attitudes and practices. Conclusion: Ongoing education programs are essential to assess their impact on achieving and maintaining the desired outcomes of the ADR reporting system and enhancing inter-professional practices.

Intravenous immunoglobulin alteration in response to adverse reactions in neurological conditions: A retrospective cohort study.

Intravenous immunoglobulin (IVIg) is an important treatment in a range of neurological conditions. There is currently limited evidence regarding the frequency and management of IVIg-associated adverse reactions (AR) in neurological disorders. A single-centre 18-month retrospective cohort study was conducted for all patients at a single tertiary hospital receiving IVIg as an inpatient or the medical day unit. Electronic medical record AR and alerts were reviewed for entries relating to IVIg, and prescribing records associated with recent IVIg administration were reviewed for the use of premedications. Case note review was undertaken to identify AR associated with alterations in IVIg treatment (such as reduction in rate, use of premedications or cessation of IVIg). Demographic, patient, and treatment factors were analysed for associations with AR necessitating alteration in IVIg treatment. This study included 98 individuals who received IVIg during the study period. Of these, 12 (12.1%) patients required an alteration in their IVIg treatment. In total, 3 (3.1%) of the 98 included patients required a reduced rate of IVIg, and 10 (10.2%) patients received premedication. The most common premedications were normal saline at the time of the infusion, cetirizine, and hydrocortisone. No demographic factors, indications or comorbidities were found to be associated with an increased likelihood of AR. However, an IVIg daily dose of >35 g and >45 g were associated with an increased likelihood of requiring IVIg treatment alteration due to AR. Alterations to IVIg treatment due to AR are commonly required in neurology patients, and may be associated with higher daily doses of IVIg.

Abstract 16521: Using Electronic Health Record Data to Identify and Prioritize Patients With Heart Failure With Reduced Ejection Fraction for a Remote Medication Optimization Program

Introduction: Remote medication management programs (RMMP) might be effective in optimizing guideline directed medical therapy (GDMT) for HFrEF. Identification of patients that can be safely managed remotely and prioritization of those with the highest need for medication optimization is crucial, especially in the setting of constrained resources. Methods: We analyzed records from our institutional enterprise data warehouse to identify patients with HFrEF in whom GDMT can be safely optimized by an RMMP within the Mass General Brigham health system between May 2021 and May 2023. After identifying a population with HFrEF, we excluded patients with contraindications to GDMT and with higher risk of adverse medication reactions. Next, we identified active and past medications by using medication discontinuation data (Figure). We performed chart review on a random sample of 100 patients to validate our analysis. Results: We have identified 1771 patients with HFrEF who are actively receiving care and are eligible for remote medication optimization. Only 7% (129/1771) of patients were prescribed all four GDMT, however in 4% (78/1771) at least one of these prescriptions was discontinued. Of all patients, 45% (801/1771) had stopped at least one GDMT, including 50% of SGLT2i, 30% of MRA, and 46% of ARNI. Patients who were never prescribed GDMT were identified as top priority for the RMMP. Conclusion: EHR data can effectively identify and prioritize HFrEF patients for medication optimization. Similar to prior HFrEF registries, our study showed poor utilization of GDMT. However, it also revealed a significant number of patients who had their GDMT prescriptions discontinued. Investigating the reasons for discontinuations may elucidate barriers to GDMT optimization. This study can be expanded to patients with HFpEF and HFmEF, and refined further by using natural language processing, machine learning, and by incorporating data for medication refill, claims, and dosages.

Public Awareness Regarding Corticosteroid Use and Side Effects: A Cross-Sectional Study in Riyadh, Saudi Arabia.

The administration of corticosteroids may have possible hazards, ranging from minor adverse medication reactions to more serious considerations. We aimed to assess levels of public awareness concerning corticosteroid use, side effects, and predictors of its use. A cross-sectional study was conducted online throughout the period of May to July 2023. The present investigation utilized a previously developed questionnaire tool. The study encompassed a cohort of 732 individuals. Upon inquiry regarding the adverse effects of corticosteroid treatment, the participants predominantly reported weight gain, skin alterations, and fluid retention leading to breathing difficulties, constituting 44.4%, 30.3%, and 27.7% of the responses, respectively. The prevailing adverse effects observed in individuals using corticosteroids were weight gain, alterations in mood, and changes in skin characteristics, which accounted for 38.1%, 25.7%, and 21.8% of reported cases, respectively. Individuals within the age range of 41-50 years and those who are currently not working show a higher propensity for utilizing corticosteroids in comparison to other demographic groups (p < 0.05). The level of general public knowledge about corticosteroids and the side effects connected with them in Saudi Arabia was adequate. Demographic factors, such as age, gender, and education, have an impact on the use of corticosteroids.

Monitoring Adverse Medication Reactions: Aiding Pharmacovigilance at a Hospital Providing Secondary Care

Monitoring Adverse Medication Reactions: Aiding Pharmacovigilance at a Hospital Providing Secondary Care

Analysis of Prescribing Practices in the Dermatology Outpatient Department of a Tertiary Care Teaching Hospital.

Introduction The practice of appropriately prescribing and delivering pharmaceuticals to the right patient for the diagnosis, prevention, and treatment of diseases is referred to as "rational drug usage". Patients should receive pharmaceuticals that are appropriate for their clinical needs, given in doses that meet their needs, for long enough periods of time, and for the least amount of money possible. Minimizing drug therapy costs without sacrificing therapeutic effectiveness, avoiding unnecessary adverse medication reactions and drug-drug interactions, and improving therapeutic care while encouraging patient adherence are the main objectives of rational drug usage. The present study was planned to assess the current prescribing practices in the dermatology outpatient department of a tertiary care hospital. Materials and methods A prospective descriptive study was conducted in the department of dermatology at a tertiary care teaching hospital after receiving permission from the institutional ethics committee. The study was conducted from November 2022 to February 2023 and followed the WHO recommendation for sample size. A total of 617 prescriptions were analyzed thoroughly. Results Regarding the demographic profile of the 617 prescriptions, 299 were male and 318 were female. The patients had diverse diseases, with the most common being tinea infection (57 cases, 9%) and acne vulgaris (53 cases, 8.5%), followed by scabies (38 cases, 6%), urticaria, and eczema (30 cases, 5%). Twenty-six (4%) prescriptions were not written in capital letters, 86 (13%) prescriptions did not mention the route of drug administration, and the consultant's or physician's name and signature were missing in 13 (2%), and six (1%) prescriptions, respectively. None of the prescriptions were written using the generic names of the drugs. Polypharmacy was observed in 51 (8%) prescriptions. Moreover, potential drug-drug interactions were identified in 12 (1.9%) instances. The most prescribed drugs were antihistaminics, with 393 (23%) prescriptions. Antifungal drugs were the second most prescribed, with 291 (17%) prescriptions. Corticosteroids were also commonly prescribed, with 271 (16%) prescriptions. Antibiotics were prescribed in 168 (10%) cases; other drugs were prescribed in 597 (35%) cases, including retinoids, anti-scabies drugs, antileprotic drugs, moisturizers, sunscreens, etc. Conclusion The study highlighted the prescription errors in writing the drugs in capital letters, mentioning the dose, route, and frequency of drugs, etc. It provided insight into the common diseases in dermatology and routine prescribing patterns and addressed the frequency of polypharmacy and drug-drug interactions.

Patient Safety Management Practiced by Pharmacy Pharmacists Using Their Training at Oncology Hospital

Recent changes in the environment surrounding community pharmacists include "follow-up after dispensing" becoming mandatory, initiation of "certified pharmacy system with specific functions," with the discussions on post-graduate training, lifelong training and specialization, refill of prescriptions, as well as pros and cons of hospital pharmacies in preparation for the 2022 dispensing fee revision. In this regard, since 2019, I have been receiving training at The Cancer Institute Hospital of Japanese Foundation for Cancer Research (JFCR). In addition, to implementing community pharmacists' perspectives into collaboration between community pharmacists and hospital pharmacists, a tracing report model incorporating the Common Terminology Criteria for Adverse Events (CTCAE) ver. 5.0 has been created. And, a regimen of drugs and operation describing necessary supportive care has been published in The Cancer Institute Hospital of JFCR website. As a practice of patient safety management at pharmacies, we are working on the standardization of questionnaire criteria to assess the severity of adverse medication reactions in cancer patients and the measurement of health-related quality of life using EuroQol 5 dimensions 5-level (EQ-5D-5L), introduced with cooperation of universities, hospitals, and pharmacies. As medical care is advancing day by day, especially in cancer medication therapy, patient safety management by pharmacists becomes essential, when dealing with the complexity of administration schedule and the wide variety of side effects. For patient safety management, community pharmacists need to practice with pharmaceutical and medical knowledge, and have skills to acquire and convey information, with a researcher's perspective.

Prescribing Practices in Geriatric Patients with Cardiovascular Diseases.

Inappropriate prescribing (IP) increases the risk of adverse medication reactions and hospitalizations in elderly patients. Therefore, it is crucial to evaluate prescribing patterns among this population. This study was designed to assess the prevalence of potentially inappropriate medication (PIMs) use and potential prescribing omissions (PPOs) among geriatrics with cardiovascular diseases (CVDs). In addition, it determined the predictors for IP in this population. A multi-center study was performed retrospectively on 605 patients' medical records collected randomly from seven governmental hospitals in Kuwait. Three of these hospitals have specialized cardiac centers (tertiary care). Inclusion criteria were age ≥ 65 years, diagnosed with at least one CVD, and attended the outpatient clinic during the last 6 months before data collection. A total of 383 patients (63.3%; 95% CI: 59.3-67.1%) were found using at least one PIM or having PPO or both, based on STOPP/START criteria. Three hundred and ninety-one patients (64.6%; 95% CI: 60.7-68.4%) were prescribed PIMs categorized as C and/or D medicines according to the Euro-FORTA list. Over one-quarter (28.8%; 95% CI: 25.2-32.6%) of the patients had drug-drug interactions class D that require therapy modification and/or X that should be avoided. Patients taking ≥ five medications had significantly higher PIMs based on STOPP and FORTA criteria, drug-drug interactions (p &lt; 0.001), and significantly higher PPOs based on START criteria (p = 0.041). Patients with three or more chronic diseases had significantly higher PIMs based on STOPP and FORTA criteria and PPOs based on START criteria (p-values: 0.028, 0.035, and 0.005, respectively). Significantly higher PIMs based on STOPP criteria and PPOs based on START criteria were found in general hospitals compared to specialized cardiac centers (p= 0.002, p= 0.01, respectively). These findings highlight the need to develop and implement multifaceted interventions to prevent or minimize inappropriate prescribing among the geriatric population with CVDs in Kuwait.

Protocol for a multicenter, double-blinded placebo-controlled randomized controlled trial comparing intravenous ferric derisomaltose to oral ferrous sulfate for the treatment of iron deficiency anemia in pregnancy: The IVIDA2 trial

BackgroundIron deficiency anemia (IDA) is common during pregnancy and associated with adverse maternal and neonatal outcomes. Treatment with iron supplementation is recommended during pregnancy, but the optimal delivery route is unclear. Oral iron risks has high risk of gastrointestinal side effects and low absorption. Intravenous iron is infused directly but is expensive. The American College of Obstetricians and Gynecologists currently recommends oral iron to treat IDA in pregnancy with intravenous iron reserved as second-line therapy, if needed. This approach is associated with persistent anemia, increasing the risk of peripartum blood transfusion. We aim to provide data on optimal route of iron repletion for IDA in pregnancy. MethodsIn IVIDA2, a double-blind, placebo controlled, multicenter randomized trial in the United States, 746 pregnant people with moderate-to-severe IDA (hemoglobin <10 g/dL and ferritin <30 ng/mL) at 24–28 weeks' gestation will be randomized 1:1 to either a single 1000 mg dose of intravenous ferric derisomaltose and oral placebo (1–3 times daily) or a single placebo infusion with 1–3 times daily 325 mg ferrous sulfate (65 mg elemental iron) tablet. The primary outcome is peripartum blood transfusion (blood transfusion from delivery to 7 days postpartum). Secondary outcomes include adverse medication reactions, maternal and neonatal hematologic indices, and offspring neurodevelopment. Ethics and disseminationA central ethical review board—Advarra—granted ethical approval (Pro00060930). Participating centers—Women & Infants Hospital of Rhode Island, University of Michigan Medical Center, Washington University School of Ethics and dissemination: A central ethical review board—Advarra—granted ethical approval (Pro00060930). Participating centers—Women & Infants Hospital of Rhode Island, University of Michigan Medical Center, Washington University School of.

Clinical utility of local over general anesthetic tonsillectomy using the BiZact™ device

PurposeTonsillectomy under general anesthesia may be viewed preferentially to local anesthesia, due to mitigation of potential airway compromise secondary to intraoperative hemorrhage, patient discomfort and anxiety. However, this is offset by risk of increased trauma (via the endotracheal tube and gag), adverse medication reactions and cost. Here we evaluated the case for use of local anesthesia in tonsillectomy using the BiZact™ (Medtronic) device by comparing surgical outcomes and cost factors across patients where either local or general anesthesia was employed. Materials and methodsRetrospective cohort study of 59 BiZact™ tonsillectomy patients (38 under local anesthetic, and 21 under general anesthetic) from a single surgeon at Tauranga Hospital (public) and Grace Hospital (private) in New Zealand; March 2018 to June 2021. ResultsNeither patient group had any primary postoperative hemorrhage and there was comparable incidence of secondary hemorrhage (one case in each cohort). Local anesthetic tonsillectomy was well tolerated with only 2 patients requiring conversion to general anesthetic secondary to anxiety. Local anesthetic proved to be cost-effective, with a halving of hospital length of stay and significant associated overall cost saving, and did not add significantly to operating or total theatre time. Local anesthetic tonsillectomies where perioperative sedation was not required were associated with additional reductions in recovery and overall hospital stay, and cost. ConclusionsLocal anesthetic BiZact™ tonsillectomy is evidently safe and cost-effective.

Angiotensin-Converting Enzyme Inhibitors; Their Efficacy, Adverse Effects, and the Genetic Influence on Cough They May Cause

Hypertension is a major health condition that increases the risk of a number of other diseases, including renal failure, myocardial infarction, stroke, and death. Angiotensin-converting enzyme inhibitors (ACE-I) are part of most of the protocols being used to manage hypertension and various other conditions, including congestive heart failure, and myocardial infarction. Despite the fact that these therapies are well tolerated, one out of every five individuals discontinues them due to adverse medication reactions, the most prevalent of which is a persistent dry cough. Heritability accounts for 30% to 50% of inter-individual variation in blood pressure. However, the genetic variation connected to ACE-I-induced cough remains contentious and requires additional investigation. Genetic variation may affect the incidence of ACE-I-related cough. This article examines the efficacy of ACE-I, their adverse effects, and pharmacogenetic studies on ACE inhibitors induced cough.