Common Drug Groups Research Articles

Enhancing sulfamerazine degradation via peroxymonosulfate with Fe-doped Mo2C materials: Catalytic performance and mechanistic insights

Sulfonamide antibiotics are a common group of drugs that have the potential to induce the generation of resistance genes even at low concentrations. Herein, a novel Fe3Mo3C/Mo2C/Mo composite (Fe-Mo2C-1.0) was prepared by modifying the synthesis process of Fe-doped Mo2C and used to activate peroxymonosulfate (PMS) to degrade sulfamerazine (SMR). The optimal performance catalyst was obtained at Fe/Mo = 1.0 and a calcination temperature of 900 ℃. Fe-Mo2C-1.0 achieved 98.8 % SMR removal in 20 min, which was 4.5 and 44.3 times higher than that of Fe-Mo2C-0.5/PMS and Mo2C/PMS systems, respectively. In Fe-Mo2C-1.0, multiple low-valent forms of the element Mo, including Mo, Mo(II) and Mo(IV), which are highly reductive, participated in and contributed to the regeneration of Fe(II). The proportion of Fe(II) on the surface of Fe-Mo2C-1.0 before and after the reaction was maintained at a stable level. In addition, the high Fe content and sp2 hybridized carbon in Fe-Mo2C-1.0 promoted the role of mediated electron transfer during catalysis process. Electrochemical characterization indicated that Fe-Mo2C-1.0 had better redox properties, smaller electron transfer resistance and a faster corrosion rate than Fe-Mo2C-0.5 and Mo2C. Other SMR oxidation mechanisms included SO4∙-, O2∙- and 1O2, with 1O2 contributing the most. Finally, three possible degradation pathways of SMR were proposed. This work provided thoughts on the synthesis of Fe/Mo bimetallic carbide catalysts as well as reference for the removal of SMR by PMS activation.

Characteristics of Drug Hypersensitivity Reactions in Children: A Retrospective Analysis in an Allergy Outpatient Clinic

Objective: Confirmation of drug hypersensitivity reactions (DHRs) is crucial—as various nonallergic reactions, such as viral infections, in children can mimic such reactions. This study aimed to evaluate the characteristics of children with suspected DHRs applying to an allergy outpatient clinic. Material and Methods: This study involved children who visited our hospital’s pediatric allergy outpatient clinic between April 1 and December 31, 2023, with suspected DHRs . The data of patients analyzed retrospectively. Patient demographics, reaction characteristics, culprit drugs, diagnostic procedures (including skin and/or provocation tests), and final diagnoses were recorded. Results: The study included 163 reactions of 140 patients with 176 suspected drugs. The median age was 7.7 years (interquartile range [IQR]; 5.1–12 years), with an equal gender distribution. Notably, 27.1% of the patients presented with concurrent atopic diseases. The median age at the onset of reaction was 72 months (IQR; 34.5–108 months), with 16% of reactions occurring within hospital settings and the remainder at home. Oral administration accounted for 84.7% of the reactions, with antibiotics being the most common culprit drug group (75.5%). Immediate reactions constituted 41.1% (n = 67) of reactions, while delayed reactions accounted for 58.9% (n = 96). Skin symptoms were predominant (97.5%). DHRs were excluded in 75.5% (n = 123) of reactions but confirmed by diagnostic drug allergy tests in 4.9% (n = 8). Conclusion: A through evaluation of suspected DHRs in children is essential. Despite high suspicion rates, confirmation via diagnostic tests was low, emphasizing the need for referral to specialized clinics and appropriate diagnostics for accurate management.

Analysis of drug-impregnated paper samples seized in English prisons between 2018 and 2020

Novel psychoactive substances (NPS) in the form of impregnated papers delivered to prisoners are of particular concern in prison settings, where they are commonly used by vaping. The purpose of this study was to create a qualitative method for identifying the various emerging NPS impregnated onto paper samples sent to prisoners. It helps to demonstrate that these findings can be used to predict drug prevalence and trends in prisons. Between 2018 and 2020, 1250 non-judicial paper samples seized from 12 English prisons were analysed to determine the NPSs being circulated. Approximately 1 cm2 paper were cut and added to 50 % (v/v) methanol in LCMS-grade water. Vortex-mixing was used to prepare extracts (30 min). Q-TOF LC/MS was used to screen the extracts. This study showed that synthetic cannabinoid receptor agonist (SCRA) was the most common drug group detected in impregnated paper seizures in English prisons between 2018 and 2020, followed by cocaine, heroin type drugs (A) and amphetamine, ketamine type drugs (B). Male prisons had a higher prevalence of SCRAs, whereas female prisons had a higher prevalence of A drugs. Furthermore, lower security prisons were found to have a higher prevalence of B drugs, pregabalin, gabapentin type drugs (C), and abused and prescription drugs than higher security prisons which unveiled a higher prevalence of nicotine. The findings of this study have revealed new information about drug use in prisons. This study will also aid in the identification of drug smuggling routes into jails, keeping prison staff up to date with the trends.

Evaluation of Knowledge, Attitude and Practice of Self-Medication among Pharmacy University Students: A Cross-Sectional Study in Zawia, Libya

Background: The term "self-medication" describes the practice of using pharmaceuticals to address illnesses that the patient has self-diagnosed without seeking medical advice. Self-medication and excessive drug usage have detrimental effects on the economy and public health. Objective: the objective of this study is to assess the prevalence of self-medication practices and to evaluate the current knowledge, attitude, and behavior regarding self-medication among Pharmacy School students in Zawia- Libya. Method: A cross-sectional study was conducted on Pharmacy School students. Participants were asked to answer closed-ended questions to evaluate their knowledge, attitude, and practice of self-medication. Result: This study comprised of 254 students. The students were divided into five groups according to their grades. This research comprised of 254 students. The students were divided into five groups according to their grades. The majority of students (93.70%) utilized self-medication, and the rest of the students (6.30%) didn't use it. The majority of students (N=171, 71.84%) who self-medicated offered arguments for when going to the doctor wasn't necessary for mild ailments. Headache accounted for 183 cases (76.89%) of symptoms for which self-medication was used, followed by cough, cold, and sore throat in 157 cases (64.96%) and hyperthermia in 107 cases (44.95%). Analgesics (74.70%), and antibiotics (51.2%) were the most common self-medicated drug groups. A large percentage of students stated that they were aware of the need to read labels and package inserts and adhere to any directions that were included 199 (83.61%). Conclusion: Students at Pharmacy School have a good knowledge and great perspective on self-medication and practice the right behaviors in self-medication.

Uncovering forensic evidence of drug-facilitated sexual assault: Toxicological findings from Eastern Denmark from 2015–2022

In drug-facilitated sexual assault (DFSA), the victim is unable to provide consent or resists sexual activity due to substance intoxication by voluntary or covert consumption. Obtaining forensic evidence of the assault is challenged by rapid drug metabolism and late sample collection. The objective of this study was to present toxicological findings and associated demographics from police reported sexual assault cases in Eastern Denmark from 2015 to 2022. A total of 369 sexual assault cases were submitted for analysis and a subgroup of 268 cases were categorized as suspected DFSA cases. The majority of the total sexual assault victims were women at the age 15–25 and the perpetrators were often unknown or an acquaintance. Time from assault to sample collection was slightly longer for suspected DFSA cases (12–24 h) compared to non-DFSA (<12 h). Positive toxicology was observed in 86 % of cases and the most common drug groups included alcohol (45 %), drugs of abuse (38 %), antidepressants (14 %), antihistamines (12 %), and benzodiazepines (11 %). Hypnotics were detected to a smaller extent (7 %). A total of 77 drugs were detected and the most commonly observed were cocaine, tetrahydrocannabinol (THC), cetirizine, amphetamine, diazepam and sertraline. The high level of observed alcohol and drugs of abuse indicated that most DFSA cases in Eastern Denmark were of an opportunistic approach rather than proactive.

Acute drug intoxication in childhood: a 10-year retrospective observational single-centre study and case reports.

Medication poisoning in children is a severe condition that can endanger a child's life. Although drug intoxications are easily preventable, awareness of the proper handling of drugs and their safe storage out of the reach of children is not widespread among the general public. In this work, we investigated the demographic and clinical data of children admitted to the Department of Pediatrics of the University Hospital Olomouc for acute drug-induced intoxication. We also selected several case reports to illustrate the wide range of both presentations and outcomes in individual patients. Cases of drug-induced intoxications were selected from a group of patients under the age of 19 years admitted to the hospital for poisoning between January 1, 2010, and December 31, 2019. Medical records of these patients were prospectively evaluated, and overview tables and graphs of predefined research objectives were created. During the given time period, 162 children with suspected drug intoxications were hospitalized at the Department of Pediatrics, University Hospital Olomouc. Of these, 108 cases were reported in girls and 54 in boys (66.7% vs. 33.3%). In 16 cases (9.9%), there was a severe intoxication requiring follow-up intensive care. There was also one case of fatal accidental intoxication. Most poisonings were seen in toddlers (65; 40.1%). Intoxication with suicidal ideation was found in 44 cases (27.2%), with a higher incidence of suicide attempts in girls (40 vs. 4). Repeated intoxication was recorded in nine cases. Analgesics were the most common drug group (61; 37.7%), with paracetamol (28; 17.3%) being the leading drug. In 154 cases (95.1%), the drugs were taken orally, most often in the form of tablets. Accidental drug intoxications most frequently occurred in the age group from one to three years old. The second highest incidence was among adolescents most of which were suicide attempts. Analgesics and psychoactive agents accounted for the majority of cases. Medications should be kept in places where children cannot reach them.

Severe Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Saudi Arabia.

Severe cutaneous adverse drug reactions (SCARs), although rare, are known to be associated with significant morbidity and mortality. SCARs include drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and acute generalized exanthematous pustulosis (AGEP). Studies on SCARs are limited in Saudi Arabia. This study aims to characterize SCARs at a tertiary care center in Saudi Arabia. A cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. All inpatient and emergency department consultations to dermatology were electronically reviewed during the period from January 2016 to December 2020. All patients who developed an adverse cutaneous drug reaction were enrolled. Detailed analysis was performed only for SCARs. The culprit medication was determined based on the latency period, history of previous intake of the medication, and drug notoriety. There were 3050 hospital consultations to dermatology during the study period. Cutaneous adverse drug reactions constituted 253 (8.3%) cases. A total of 41 patients with SCARs were identified, accounting for 16.2% of all cutaneous drug reactions. Antibiotics and anticonvulsants were the most common causative drug groups accounting for 28 (68.3%) and 9 (22%) cases, respectively. DRESS was the most common SCAR. The latency period was the longest for DRESS and shortest for AGEP. Vancomycin was responsible for approximately a third of DRESS cases. Piperacillin/tazobactam was the most common cause for SJS/TEN and AGEP. The majority of drugs causing AGEP were antibiotics. The mortality rate was the highest in SJS/TEN (5/11 (45.5%)), followed by DRESS (1/23 (4.4%)) and AGEP (1/7 (14.3%)). SCARs are rare in Saudis. DRESS appears to be the most common SCAR in our region. Vancomycin is responsible for most cases of DRESS. SJS/TEN had the highest mortality rate. More studies are required to further characterize SCARs in Saudi Arabia and Arabian Gulf countries. More importantly, thorough studies of HLA associations and lymphocyte transformation tests among Arabs with SCARs are likely to further improve patient care in the Arabian Gulf region.

Clinical and Laboratory Features and Factors Determining the Outcome in Poisoning Children in a Tertiary Pediatric Intensive Care Unit: Eleven Years of Experience.

This study aimed to evaluate the characteristics of patients admitted to a pediatric intensive care unit for poisoning and the factors associated with their outcomes. Patients who were admitted to the pediatric intensive care unit for poisoning over the 11-year period between January 2010 and December 2020 were retrospectively analyzed. The patients' demographic characteristics, poisoning agent, whether the poisoning was unintentional or intentional (suicide attempt), clinical findings at admission, indication for hospitalization, antidote administered, and supportive and extracorporeal treatments were examined. During the study period, poisonings accounted for 9.4% (436/4653) of pediatric intensive care unit admissions. Of these, 419 patients with complete records were included in the analysis. Drug poisonings accounted for 81.9% of cases (multiple drugs in 38.5%). The most common drug group was central nervous system drugs (47%). Of the symptomatic patients, 56.5% had central nervous system-related findings and 55% had gastrointestinal findings. Before pediatric intensive care unit admission, 52.7% of the patients received activated charcoal and 7.4% received antidote therapy. In the pediatric intensive care unit, 68.9% of patients received no medical treatment, while 71.5% of those who received medical treatment had organ involvement. Multivariate logistic regression analysis to predict whether patients will require treatment during the intensive care follow-up showed that antidote administration before pediatric intensive care unit admission was associated with the need for medical treatment (odds ratio: 25.6, 95% CI: 6.8-96, P < .05). Three patients died, and the mortality rate was 0.72%. Childhood poisoning is a widespread and important problem. Effective management in pediatric emergency and intensive care units contributes to patient survival without sequelae.

Adverse Cutaneous Drug Reactions at a Rural-Based Tertiary Health-Care Center in Gujarat: An Eleven Year Study.

An adverse cutaneous drug reaction (ACDR) is an undesirable change in structure and function of the skin, its appendages, or mucous membranes due to drugs. To study the demographic details, clinical patterns, mucocutaneous involvement, causality, and the offending drugs causing ACDR. In this observational study, we have seen 2,96,544 patients in the skin department at a rural-based tertiary health-care hospital, out of which 728 cases were diagnosed to have ACDR from a time span of April 2010 to March 2021. The causality assessment system WHO-UMC (World Health Organization Collaborating Centre for International Drug Monitoring, the Uppsala Monitoring Centre), the Naranjo probability scale, and Hartwigs score were calculated for patients. Out of 728 cases, males were 371 (50.96%); most common age group was 21-30 years (25.13%). The most common presenting complaint was erythematous rash (21.29%). Antimicrobials (n = 345, 47.39%) were the most common drug group. Most common mucosa involved was oral mucosa and most common pattern of reaction seen was maculopapular rash (25%) among these patients. In the causality assessment using WHO guidelines, there were 66 (9.1%) certain, 224 (30.83%) probable, and 436 (60%) possible cases. Naranjo score showed 73 (10%) definite cases, 255 (35%) probable cases, and 400 (55%) possible cases, while Hartwigs score showed level 2 in 122 (16.7%) cases and level 3 in 412 (56.7%) cases. Wide spectrum of drug reactions were observed in this study. Antimicrobials were the most common causative agents of ACDR.

ГЕПАТОТОКСИЧНОСТЬ НЕСТЕРОИДНЫХ ПРОТИВОВОСПАЛИТЕЛЬНЫХ СРЕДСТВ У ПАЦИЕНТОВ С ПОДАГРОЙ

Non-steroidal anti-inflammatory drugs (NSAIDs) are the second most common group of drugs leading to the development of drug-induced liver injury (DILI). Objective: to determine the clinical features of DILI in patients with gout when using NSAIDs. Material and methods. The study is monocentric, observational, retrospective. Performed in the period from 2012-01-01 to 2020-12-31 in the Rheumatology Department of the 11th City Clinical Hospital. The study included 527 patients with gouty arthritis (GA). The type of DILI was determined in accordance with the recommendations of EASL, 2019. An updated scale RUCAM (Roussel Uclaf Causality Assessment Method) was used to assess causal relationships. Results. DILI was detected in 91 patients (14.3%), in 80 – hepatocellular, in 11 - mixed type of DILI. The 1st category of DILI severity was stated in 88, the 2nd category – in 3 patients. We observed DILI more often in younger patients without severe comorbidity, but with an alcoholic surplus preceding a GA attack and, after, during attack an excess of the average therapeutic doses of NSAIDs was registered. Conclusions. Thus, we did not observe a severe course of DILI in patients taking NSAIDs for the relief of GA. However, NSAID hepatotoxicity in this category of patients is a social and medical problem.

Prescription pattern of depressive and anxiety disorders in patients attending Psychiatry outpatient department of a tertiary hospital in Telangana

Depression and anxiety are the most common mental illnesses encountered in patients visiting psychiatry outpatient clinics. The relative safety of majority of antidepressants and anxiolytics has increased their routine use. However, limited data is available on the prescribing patterns of these drugs, especially from the state of Telangana. The aim of this study was to assess the prescription pattern in depression and anxiety disorders in patients attending Psychiatry outpatient department of a tertiary care teaching hospital in Telangana. A prospective observational study was conducted in Psychiatry outpatient department in Government General Hospital (GGH), Nalgonda over a period of 6 months (March 2021 to August 2021). A total of 45 patients suffering from anxiety and depression, based on International Classification of Diseases-10th edition (ICD-10), were selected. Data was collected using a semi-structured proforma and analyzed. A total of 103 drugs were prescribed and the average number of drugs per prescription was 2.29. It was found that majority of patients were in 15-35 years age group (60%), female (62.22%), married (60%) and from urban background (82.2%). In the study population, 55.55% were suffering from anxiety disorders, out of which 31.11% had Generalized anxiety disorder. Among the depressive disorders (44.45%) majority had Severe depressive episode (26.67%) followed by Moderate depressive episode (17.78%). The duration of illness was less than 6 months in majority of patients (75.56%). Selective serotonin reuptake inhibitors (SSRIs) were the most common group of drugs prescribed. 41 prescriptions (91.11%) contained SSRIs, and Sertraline was the most common drug followed by Escitalopram. 93.33% of the prescriptions also included Benzodiazepines (Clonazepam). 35.55% of the prescriptions had fixed dose combinations, commonest being Escitalopram 10mg + Clonazepam 0.5mg.

A study of reporting pattern of adverse drug reactions in a tertiary care teaching hospital

Background: Adverse drug reactions (ADRs) are one of the prime causes of morbidity and mortality, increase in hospital stay and socioeconomic burden on the patients. Periodic monitoring aids in formulating methods for safe usage of medicines in hospitals. Identification of ADRs and their reporting pattern can provide useful information for their prevention. Hence this study was done to see the pattern of reported ADRs in Patna Medical College and Hospital, Patna in a 3 months of study.Methods: It was an observational and retrospective study carried out between July 2022 to September 2022. Both outpatients and inpatients were included in the study. The ADRs in the form of Individual Case Safety Reports (ICSRs) were sent to the nearby adverse drug reaction monitoring centre (AMC).Results: The occurrence of ADRs was more common in females (56.25%) as compared to males (43.75%). Patients of age-group 21-40 years (40.625%) were most commonly involved. Medicine department (34.375%) reported the maximum percentage of ADRs. Antimicrobials (37.50%) was the most common drug-group causing ADRs. Maximum reported ADRs (81.25%) were probable, 9.375% were possible, 6.25% were certain, while 3.125% were unlikely with the suspected drug as per Naranjo scale.Conclusions: The pattern of ADRs reported in our hospital is comparable with the results of studies conducted in hospital setup elsewhere, along with a few differences. The study results revealed opportunities for interventions in ADR management especially for the preventable ADRs to ensure safer drug use.

Public Knowledge and Belief Regarding Antibiotic Use and Antimicrobial Resistance in Qatar

Background: Antibiotics act as a therapeutic weapon in eradicating pathogens. Antibiotics are the most common group of drugs misused for self-medication. This is a global public health concern and is one of the major contributing factors to antibiotic resistance (ABR). Objective: This study aimed to assess the knowledge and beliefs of the public in Qatar regarding appropriate antibiotic use and antimicrobial resistance. Methods: A cross-sectional research design was used to collect the information from the participants based on an adapted questionnaire from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) between September – November 2018. The study enrolled 1000 participants who visited two large emergency departments (ED) of public hospitals in Qatar. Results: The mean knowledge and belief scores were 55.07±15.87 and 66.57±23.13 respectively. 42% of the participants had moderate knowledge regarding antibiotic and antimicrobial resistance. The majority of the participants (64.8%) believed that antibiotics fight against bacteria and viruses. The educational level significantly influences the belief of the participants. Graduates possess a higher belief score of 11.75±12.5 (P=0.001) compared to others. Conclusion: The key findings of this study highlighted the existing gap in knowledge among the public. A community-based health education program should be launched to raise citizen responsibility to use antibiotics judiciously.

Occurrence and removal of psychiatric pharmaceuticals in the Tehran South Municipal Wastewater Treatment Plant.

Psychiatric drugs released by humans in wastewater have received more attention because of their potential risks for aquatic organisms. In this study, the occurrence of the two most common groups of psychiatric drugs (sedatives-hypnotics-anxiolytics and antidepressants) were evaluated in the Tehran South Municipal Wastewater Treatment Plant. All the target sedatives-hypnotics-anxiolytics (alprazolam, phenobarbital, and thioridazine) and antidepressants (fluoxetine, citalopram, sertraline, and venlafaxine) were observed in influent and secondary clarification (SC) effluent. Thioridazine (164.25 ± 218.74ng/L) and citalopram (672.53 ± 938.56ng/L) had the highest mean concentrations in the influent, while alprazolam (5.09 ± 2.33ng/L) and citalopram (776.97 ± 1088.01ng/L) had the highest concentrations in the SC effluent. The higher concentrations of the psychiatric drugs, except thioridazine, were detected in the SC effluent compared to the concentrations in the influent. The increased drugs concentrations, with negative removal efficiencies, were more distinctive in the cold season samples. Psychiatric drugs processed in the chlorination unit followed a completely different pattern compared to the drugs in the biological treatment unit. All the drugs' concentrations, except thioridazine, decreased in the chlorination unit, ranging between 27 ± 14% for alprazolam and 75 ± 10% for citalopram. However, the mean concentrations of the detected drugs were as follows: sertraline (11.96 ± 11.62ng/L) and venlafaxine (184.94 ± 219.74ng/L) which could cause environmental and ecological concerns.

Childhood Obesity and Health Care Utilization: Empirical Evidence from Austrian Administrative Data.

Background: Increases in pediatric obesity have been associated with higher levels of health care utilization. There is currently a lack of knowledge on the therapeutic drivers of increased health care use. Objective: To examine the association between different measures of health care utilization and BMI among children. Methods: We linked cross-sectional administrative data from a regional health insurance fund in Austria with objectively measured BMI from routine school health examinations in 6-15-year-old children (n = 13,493). Differences in probabilities of annual health care utilization (drug prescriptions by therapeutic classification, physician visits by medical specialty, and hospitalizations) were compared between children with normal weight, overweight, or obesity using Probit regressions. Results: Children with obesity had a 1.6 and 8.6 percentage points (pp) higher probability of outpatient doctor visits and prescribed medication, respectively (all p < 0.05). Children with overweight were intermediate. There was a higher probability of consulting a general practitioner, pediatrician, or orthopedist, and higher levels of prescribing for children with obesity across most common drug groups. Children with obesity were ∼40% more likely to receive medication for musculoskeletal and for mental health problems. This was reflected in orthopedic clinic appointments but not in psychology clinics. There were no major differences by gender or age, or parental socioeconomic status. Conclusions: Our data show clear and objective evidence of higher health care utilization by children with obesity. This highlights the importance of policy interventions to curb obesity in children and young people.

Ophthalmic drug therapy in professional athletes-what is allowed, what is doping?

At first sight, ophthalmic drugs are not necessarily suspected of being used as performance-enhancing agents in competitive sports. However, there are some restrictions that must be noted, especially when certain drugs are taken orally. Astructured analysis of the doping relevance of ophthalmic drugs was performed on the basis of aliterature review, taking into account the current guidelines of the National Anti-Doping Agency of Germany and the World Anti-Doping Agency. Use of the most common ophthalmological drug groups is possible without restrictions, especially in the case of topical application. An exception is the oral use of diuretics, which is prohibited at all times. For glucocorticoids, topical application to the eye is allowed, but oral application is prohibited in competition. Asimilar restriction applies to the use of epinephrin, for which all forms of systemic application are prohibited in competition. When taking beta-blockers, the sport being played is the determining factor: use is prohibited in billiards, archery, darts, golf, motor sports, shooting sports, skiing/snowboarding, ski jumping, freestyle aerials/half pipe, snowboard half pipe/big air, and underwater sports. For shooting and archery, beta-blockers are also prohibited outside of competitions. Athletes with pre-existing ophthalmological conditions should seek comprehensive advice from an ophthalmologist before using any medication, and together they should choose apermissible active ingredient, consider the appropriate route of application, and, if necessary, apply for aTherapeutic Use Exemption. It is currently not known how many of the national and international athletes have to be treated with eye drops.

Impact of Antibiotics as Waste, Physical, Chemical, and Enzymatical Degradation: Use of Laccases.

The first traces of Tetracycline (TE) were detected in human skeletons from Sudan and Egypt, finding that it may be related to the diet of the time, the use of some dyes, and the use of soils loaded with microorganisms, such as Streptomyces spp., among other microorganisms capable of producing antibiotics. However, most people only recognise authors dating between 1904 and 1940, such as Ehrlich, Domagk, and Fleming. Antibiotics are the therapeutic option for countless infections treatment; unfortunately, they are the second most common group of drugs in wastewaters worldwide due to failures in industrial waste treatments (pharmaceutics, hospitals, senior residences) and their irrational use in humans and animals. The main antibiotics problem lies in delivered and non-prescribed human use, use in livestock as growth promoters, and crop cultivation as biocides (regulated activities that have not complied in some places). This practice has led to the toxicity of the environment as antibiotics generate eutrophication, water pollution, nutrient imbalance, and press antibiotic resistance. In addition, the removal of antibiotics is not a required process in global wastewater treatment standards. This review aims to raise awareness of the negative impact of antibiotics as residues and physical, chemical, and biological treatments for their degradation. We discuss the high cost of physical and chemical treatments, the risk of using chemicals that worsen the situation, and the fact that each antibiotic class can be transformed differently with each of these treatments and generate new compounds that could be more toxic than the original ones; also, we discuss the use of enzymes for antibiotic degradation, with emphasis on laccases.

Study of Clinicodemographic Profile of Adverse Cutaneous Drug Reactions in Indian Perspective

Background: Cutaneous adverse drug reactions are an important group of disorders which pose considerable amount of diagnostic and therapeutic challenges. The incidence of CADRs is estimated to be 1–2% in the general population. Newer insights have been developing in the field of factors affecting CADRs and the need for studies in the Indian population regarding the newer trends in cutaneous adverse effects. Materials and Methods: A prospective and observational study was conducted in the Department of Pharmacology and Collaboration with Department of Dermatology in MGM Medical College and LSK Hospital. All cases of suspected CADRs in patients with systemically administered drugs were actively screen by a senior dermatologist. Causality assessment was done by a Pharmacologist using WHO UMC scale. Only those cases where the causality was certain probable/likely were recorded. Results: This sampling comprised of 77 CADRs over a period of 1 year from June 2012 to May 2013. The clinical pattern and spectrum of CADRs were studied in 77 subjects. A wide clinical spectrum of CADRs ranging fixed drug eruptions to serious Stevens Johnson syndrome (SJS) was observed. The predominant pattern of reactions observed was fixed drug eruptions FDE (35.1%) followed by acneiform eruptions (23.4%), erythema multiforme (9.1%), and phototoxic drug reactions (7.8%). The antimicrobials causing FDE were macrolides, cephalosporins, and fluoroquinolones. Among the NSAIDs causing FDE, most were due to diclofenac (70%). CADRs were seen most commonly in the 31–40 (26%) years age group followed by 11–20 (24.7%) years and 41–50 (19.5%) years with mean age 32.09 years. Only 5.2% patients were more than 60 years, oldest being 67 years. Antimicrobials were the most common drug group incriminated in 34% patients followed by NSAIDs in 29% cases and steroids in 25% cases. Among NSAIDs, maximum number of CADRs were caused by ibuprofen (40.9%) followed by diclofenac (36.4%), paracetamol (9%), aceclofenac (9%), and nimesulide (4.5%). Serious reactions were infrequent. Conclusion: Most of the reactions were mild (53%) to moderate (42%) requiring no major medical intervention. However, a larger and multi-centric study needs to be conducted across the state to obtain more information about CADRs among the state population.

Hypertension Management in Primary Care in the Capital Area of Iceland

High blood pressure (HT) is one of the main risk factors for cardiovascular diseases which in 2010 caused one third of all mortality in the world. Untreated, HT can cause stroke, myocardial infarction, heart failure, dementia, kidney failure, atherosclerosis and eye diseases. The main aim of this study was to find out how HT is treated in primary care in the capital area of Iceland. The study is a descriptive retrospective cross-sectional study covering the years 2010, 2014 and 2019. Information about all patients over 18 years old diagnosed with HT were gathered from computerised medical records at every primary care center in the Capital area. The number of individuals diagnosed with HT increased during the study period and the mean age did also increase. The sex ratio changed with more men diagnosed than women. Of 25.873 patients diagnosed with HT in the year 2010, 63.4% received drug treatment. In 2019 this percentage had dropped 60.9% (p<0,001). Of those on antihypertensive drug treatment the proportion receiving one, two or three drugs remained same from 2010-2019. The most common group of drugs used were diuretics (C03), beta-blockers (C07), calcium channel blockers (C08) and renin-angiotensin-aldosteron-system (RAAS) inhibitors (C09). The proportion af these drug groups changed significantly during the study. Fever patients were treated by diuretics (p<0,001) or beta-blockers ((p<0,001) but the number treated by calcium channel blockers (p<0,01) or RAAS inhibitors increased (p<0,001). During the whole stud period 44.1% of the patients reached the target goals. The proportion of patients who reached the target goals in different health care center was specifically for the year 2019. Just over 41% of HT patients reached the targets goals. However, two health care centers achieved notably different results with only one third of the patients attaining the goals. As has recently been shown in epidemiologic studies hypertension in Iceland is both underdiagnosed and undertreated although the country ranks high on both counts in international comparison. Furthermore, the fact that under half of hypertensive patients in general practice in the capital area reach the targeted treatment goals, cannot be considered an acceptable. Thus, it is of immense importance to improve both the diagnosis and the treatment of HT.

Pharmacoeconomic analysis of the use of antibacterial preparations in the curative institution

Antibacterial preparations are some of the most common groups of drugs used in healthcare institutions that require significant financial resources, especially in the event of a dangerous increase in microbial resistance to antibiotics. The ABC / VEN pharmacoeconomic analysis will allow assessing the rationality of antibacterial drugs, redirecting financial resources for the purchase of effective preparations in the context of data on bacterial resistance in the curative institution, highlighting additional resources for inclusion in the pharmacotherapeutic form of more effective synthetic antibiotics and chemotherapeutics. The results of the analysis will contribute to the optimization of the use of antibacterial groups and preparations in the sections of the curative institution and the rational distribution according to the incidence of the treated pathologies.