Causative Drug Research Articles

A Rare Case of Recurrent Pancreatitis Secondary to Rifampicin in a Patient with Disseminated Tuberculosis

<i>Background</i>: Anti-tuberculous drug (ATD) induced pancreatitis is a rare complication of ATDs, but it has serious consequences if it is not managed promptly. Early recognition of ATD induced pancreatitis and identification of the culprit ATD are important approach with subsequent causative drug withdrawal, while at the same time, not impeding the ATD treatment of tuberculosis infection are unquestionably challenging. The objective of this clinical case report is to highlight an unusual case of Rifampicin induced pancreatitis to avoid future delayed diagnosis and management. <i>Case Report</i>: A 38 year-old male presented with acute dyspnea and cough. He was diagnosed to have smear positive disseminated tuberculosis infection with pulmonary and urinary system involvement. The intensive regime of ATDs (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) was started immediately. Nonetheless, he developed acute pancreatitis with severe abdominal pain after 1 week of ATDs therapy initiation. Usual etiologies of pancreatitis were eliminated. He demonstrated clinical improvement and his serum amylase reduced after his ATD regimen was withheld. Once his pancreatitis resolved, he was re-challenged with individual ATD one at a time in order to form an effective ATD regime. However, he developed another 3 episodes of pancreatitis in the following weeks with failed attempts to re-challenge with Rifampicin, which is an important core drug of ATD. Eventually, he succumbed to his severe tuberculosis illness. <i>Conclusion</i>: This clinical case is a rare case of Rifampicin induced pancreatitis with an unfavourable outcome. It is essential for clinicians to have a high index of suspicion for ATD induced acute pancreatitis in the patients with active tuberculosis infection and to identify the offending agent promptly without compromising the intensive phase of ATD treatment.

Skin testing and drug challenge in the evaluation of drug hypersensitivity reactions.

Immediate hypersensitivity to drugs is characterized by symptoms such as hives, swelling, and wheezing. To prevent a negative impact on care, assessment by an allergist is important. Evaluation requires a clear clinical history, but it is often lacking or vague, which makes a diagnosis difficult. Allergists instead can use skin testing and drug challenge to evaluate drug hypersensitivity reactions, which help the patient and provider understand the causative drug(s) and, more importantly, enables the use of the exonerated drug(s). Although penicillin skin testing is standardized, well described, and widely used, skin testing for most other drugs requires the use of a nonirritating skin testing concentration that can have a low negative predictive value. Drug challenges are the criterion standard for confirming tolerance. The allergist must obtain an in-depth clinical history and then follow with skin testing and/or drug challenges when indicated to determine which drugs can be de-labelled and which should be avoided. In this review, we focused on the evaluation of drug hypersensitivity reactions to antibiotics, perioperative agents, biologics, and chemotherapeutics.

Psychotic Episode following Treatment with Hydroxychloroquine in a 17- Year-Old Female Adolescent with Cutaneous Lupus Erythematosus: A Drug Causality Supported by a Literature Review and a Worldwide Pharmacovigilance Database Search

Psychotic Episode following Treatment with Hydroxychloroquine in a 17- Year-Old Female Adolescent with Cutaneous Lupus Erythematosus: A Drug Causality Supported by a Literature Review and a Worldwide Pharmacovigilance Database Search

Clinical Spectrum of Cutaneous Adverse Drug Reactions in Pediatric Population in East Coast of Andhra Pradesh: An Observational Study

Context: Cutaneous adverse drug reaction (CADR) among pediatric population is underappreciated and often misdiagnosed in clinical settings. Furthermore, epidemiologic data on only cutaneous adverse reactions among this population are limited. Aim: The aim of this study is to analyze the CADRs with reference to the pattern, causative drugs, its subgroup analysis, and other clinical characteristics among children. Settings and Design: This was an observational, hospital-based study over a period of 12 months. Materials and Methods: The CADRs occurring and referred to the inpatient and outpatient department of dermatology were actively monitored and the collected reports were analyzed for CADR pattern, drug groups, clinicodemographic profile, and severity of adverse drug reaction (ADR). Statistical Analysis Used: Data were documented in Microsoft Excel and analyzed using SPSS Version 20.0. Results: A total of 33 CADRs were documented. Most of the ADRs (40%) occurred between the age of 11 and 15 years. Antimicrobials comprised the major group of drugs causing ADRs (42.4%). Maculopapular rash (54.5%) and urticaria (15.2%) were the most common type of ADR. A single case of death due to anticonvulsant-induced toxic epidermal necrolysis had been observed in the study period. There were more occurrences of ADRs with multiple drugs compared to single-drug therapy. About 80% of reactions were of mild to moderate. Conclusion: Knowledge of the pattern and the offending drug helps in better diagnosis, management, reduced complications in this population, and also helps in preventing recurrences, thereby helps in promoting the safe use of drugs, which can overall impact the quality of health care among children positively.

Antithyroid Drug-Induced Lupus Erythematosus and Immunoglobulin A Deficiency

Patient: Male, 32-year-oldFinal Diagnosis: Drug induced lupus erythematosusSymptoms: Lymphadenopathy • proteinuria • rashMedication: —Clinical Procedure: Renal biopsySpecialty: Endocrinology and Metabolic • Immunology • General and Internal MedicineObjective:Rare co-existance of disease or pathologyBackground:Antithyroid drugs, namely methimazole, are well-known causes of drug-induced lupus erythematosus. This is, however, an infrequent adverse effect. Selective Immunoglobulin A (IgA) deficiency, in contrast, is the most common primary immunodeficiency. Patients with IgA deficiency are at risk of developing infectious diseases, but also autoimmune diseases such as Grave’s disease or systemic lupus erythematosus.Case Report:We report a case of methimazole-induced lupus erythematosus in a 32-year-old man with renal involvement and concomitant selective IgA deficiency. Symptoms promptly resolved after treatment with hydroxychloroquine and corticosteroids after discontinuation of methimazole. Lupus nephritis required treatment with cyclophosphamide followed by maintenance therapy with mycophenolate mofetil.Conclusions:Drug-induced lupus erythematosus usually develops after a few months or years of exposure to the causative agent. No specific symptoms exist. The diagnosis is not based on particular specific tests, but relies on a set of arguments evoking the role of the medication inducing the condition. The first step in treatment is to stop the causative drug. The therapeutic management of the various manifestations does not differ from that of idiopathic systemic lupus erythematosus. We briefly discuss the relationship between drug-induced lupus erythematosus, Grave’s disease, and IgA deficiency, and suggest that IgA deficiency may act as a potential risk factor. Testing for IgA deficiency could be helpful in patients being treated with drugs known to be associated with drug-induced lupus erythematosus.

Granulysin-Based Lymphocyte Activation Test for Evaluating Drug Causality in Antiepileptics-Induced Severe Cutaneous Adverse Reactions

Aromatic antiepileptic drugs (AEDs) are common causes of cutaneous adverse drug reactions, which range from morbilliform drug eruption to life-threatening severe cutaneous adverse reactions, including drug reaction with eosinophilia and systemic symptoms, Stevens‒Johnson syndrome, and toxic epidermal necrolysis. Different invitro methods for identifying the culprit drugs have been developed; however, it is particularly challenging for Stevens‒Johnson syndrome-toxic epidermal necrolysis. In this study, we enrolled 63 patients (39 with Stevens‒Johnson syndrome-toxic epidermal necrolysis, 13 with drug reaction with eosinophilia and systemic symptoms, and 11 with morbilliform drug eruption) and 30 tolerant controls to examine the performance of lymphocyte activation tests by measuring the expression of granulysin, granzyme B, and IFN-γ. Granulysin-based lymphocyte activation tests displayed the best sensitivity and specificity to identify the causality: 73.9% sensitivity and 96.7% specificity for carbamazepine and 68.2% sensitivity and 96.7% specificity for phenytoin. Oxcarbazepine and lamotrigine show weak antigenicity. Granulysin-based lymphocyte activation tests expanded predominantly memory cytotoxic T lymphocytes with characteristics of drug-specific T-cell receptor, major histocompatibility complex I dependence, and cross reactivity to different aromatic AEDs. Among 29 follow-up patients, 28 alternatively used nonaromatic AEDs, and none developed cutaneous adverse drug reactions. Our data suggest that granulysin-based lymphocyte activation tests represent invitro cytotoxic T-lymphocyte memory response to offending drugs and are useful to confirm drug causality of AED-induced severe cutaneous adverse reactions. Implementing these tests will improve the AED-induced severe cutaneous adverse reactions prevention and clinical care.

Síndrome Neuroléptica Maligna: relato de caso

RESUMO&#x0D; Introdução: Síndrome neuroléptica maligna é uma doença rara, observada principalmente em homens de meia idade antes da 4ª década de vida, caracterizada por flutuação do nível de consciência, rigidez muscular intensa, disâutonomia (variação de pulso, pressão arterial (PA) e frequência respiratória) e hipertermia. O diagnóstico é clinico e laboratorial, devendo ser excluídas outras causas. Descrição: D.G.S., 43 anos, masculino, casado. Apresentou quadro de surto psicótico sendo medicado com haloperidol e prometazina, evoluindo posteriormente com quadro de rigidez muscular, sudorese, hipertermia, alteração neurológica e elevação de creatinina fosfoquinase (CPK), compatível com o diagnóstico de Síndrome Neuroléptica Maligna, provavelmente secundário a infusão de haloperidol. Conclusão: A Síndrome Neuroléptica Maligna se caracteriza por uma reação ao uso de neurolépticos e leva o indivíduo a apresentar múltiplas alterações orgânicas, possivelmente fatais. O diagnóstico é clínico e laboratorial. O tratamento primordial é a suspensão da droga causadora, não sendo ainda estabelecido um tratamento específico.&#x0D;

Adverse drug reaction monitoring in a teaching hospital Mandya

Objectives: 1. To assess and analyse adverse drug reactions (ADRs) according to reporting and presentation. 2. To describe causality and severity analysis. Materials and methods: After taking approval from the Institutional ethical committee study was undertaken over a period of one year. A prospective observational study was conducted to monitor the ADRs in all the clinical departments and emergency units of the hospital. The ADRs forms were distributed to all the departments and informed them to report any suspected adverse drug reactions. ADRs were monitored both actively and passively. Reported forms were collected by active surveillance and Causality assessment was done by pharmacologist using Naranjo’s & WHO scale and severity by Hartwig’s scale respectively. Results: Total 85 ADRs were reported over a period of year. Most of the ADRs were reported from the ART centers 70.6%. The most common system involved in ADR was haematological system about 29.4% of overall reaction followed by 24.7% dermatological. Zidovudine induced anaemia was the most common ADR. Causality assessed using Naranjo’s scale showed that most of reported ADRs were probable 49.4%, 27.1% were doubtful and 23.5% were possible. Conclusion: Study showed that there was under reporting of ADRs. Most of the cases were reported from ART center. There is a need to improve awareness among the clinicians to emphasize their role in voluntary reporting of ADRs, on generating quality reports, critically monitor the ADRs so as to prevent them further. Keywords: Adverse drug reaction, Causality assessment, Naranjo scale, WHO scale and Hartwig’s scale.

A study of cutaneous adverse drug reaction patterns with causality and severity assessment at a tertiary care centre

Introduction: Prescribed medications are intended to relieve sufferings during the course of illness. Occasionally due to the unpredictable pharmacological nature of the drug, the unique physiological condition of the patients and/or due to any other factors, drugs cause Adverse Drug Reactions (ADRs). Few of the ADRs are quite severe and if not adequately and promptly managed, may lead to serious complications and even death. Apart from this, the high frequency of obnoxious ADRs may also drive the patients to question the reliability of the given pharmacotherapy and that may further lead to medication nonadherance. Cutaneous ADRs are quite common and few of them are very severe which lead to significant comorbidities. Early identification of the condition as well as the culprit drug and omitting it at earliest holds the keystone in management and prevention of a more serious reaction. Thus, it is necessary to have a sound monitoring and reporting of cutaneous ADRs and also an adequate analysis and interpretation of their entire pattern of the occurrence. Aim: To study the patterns of cutaneous adverse drug reactions with causality and severity assessment in tertiary care hospital. Objective: To Identify, analyse and report cutaneous ADRs and drug classes responsible for the same. Materials and Methods: A Prospective study was carried out over a period of 5 months among the out-patients and in-patients in Department of Skin and Venereal Diseases. A total of 35 patients were enrolled as per selection criteria. Chi-square test was applied in order to investigate whether the distribution of categorical variables differ from one another. Result: Out of 35 patients enrolled in the study, 12 patients had maculopapular drug rash and the commonest causative drug was phenytoin. 9 patients in the study had fixed drug reaction, the commonest cause was nimesulide. 4 patients were of erythema multiforme, the commonest cause was NSAIDS. 3 patients each of Toxic Epidermal Necrolysi

Incidence of Suspected Serious Adverse Drug Reactions in Corona Virus Disease-19 Patients Detected by a Pharmacovigilance Program by Laboratory Signals in a Tertiary Hospital in Spain: Cautionary Data.

BACKGROUND: From March to April 2020, Spain was the center of the SARS-CoV-2 pandemic, particularly Madrid with approximately 30% of the cases in Spain. The aim of this study is to report the suspected serious adverse drug reactions (SADRs) in COVID-19 patients vs. non-COVID-19 patients detected by the prospective pharmacovigilance program based on automatic laboratory signals (ALSs) in the hospital (PPLSH) during that period. We also compared the results with the suspected SADRs detected during the same period for 2019. METHODS: All ALSs that reflected potential SADRs including neutropenia, pancytopenia, thrombocytopenia, anemia, eosinophilia, leukocytes in cerebrospinal fluid, hepatitis, pancreatitis, acute kidney injury, rhabdomyolysis, and hyponatremia were prospectively monitored in hospitalized patients during the study periods. We analyzed the incidence and the distribution of causative drugs for the COVID-19 patients. RESULTS: The incidence rate of SADRs detected in the COVID-19 patients was 760.63 (95% CI 707.89–816.01) per 10,000 patients, 4.75-fold higher than the SADR rate for non-COVID-19 patients (160.15 per 10,000 patients, 95% CI 137.09–186.80), and 5.84-fold higher than the SADR rate detected for the same period in 2019 (130.19 per 10,000 patients, 95% CI 109.53–154.36). The most frequently related drugs were tocilizumab (59.84%), dexketoprofen (13.93%), azithromycin (8.43%), lopinavir-ritonavir (7.35%), dexamethasone (7.62%), and chloroquine/hydroxychloroquine (6.91%). CONCLUSIONS: The incidence rate of SADRs detected by the PPSLH in patients with COVID-19 was 4.75-fold higher than that of the non-COVID-19 patients. Caution is recommended when using medications for COVID-19 patients, especially drugs that are hepatotoxic, myotoxic, and those that induce thromboembolic events.

An epidemiological and clinical analysis of cutaneous drug eruption: A cohort of 164 patients

Aim: Drug reactions are important and frequent complications of medical treatments. In this study we aimed to investigate the patients hospitalized with a diagnosis of cutaneous drug eruptions, implicated drugs, and related skin manifestations considering the literature. Methods: This retrospective cohort study was performed in Haydarpaşa Numune Training and Research Hospital, Dermatology and Venereology Department. The study comprised 164 patients that were diagnosed with cutaneous drug eruption between January 2010 and December 2016. Some parameters, such as demographic characteristics, type of the reaction, culprit drug groups, multiple drug usage, time between the onset of the drug intake and beginning of the eruption were recorded. Age, gender, symptoms, laboratory tests, diagnosis and treatment information were obtained through patient files. Causal relationship was assessed by Naranjo algorithm. Adverse drug reactions were categorized as definite, probable, possible, and absent. All values were expressed in percentages. The severity of the reaction caused by the drug was assessed with Hartwig's Severity Assessment Scale. Results: Among 164 patients, there were 104 females and 60 males with a mean age of 46.3 (18.8) years. The most commonly encountered type of drug reactions were urticaria and angioedema (42.1 %), followed by morbilliform drug eruption (31.7%). More cutaneous reactions were noted with NSAIDs (18.9%), antibiotics (15.2%) and the combination of NSAIDs and antimicrobial agents (9.8%). Time between the onset of eruption and the intake of the drug varied by hours to months. Some of these patients also described similar reactions related to drugs in the past. Conclusion: Knowledge of these drug eruptions, the causative drugs and the prognostic factors is important for clinicians. It is recommended to advise patients to carry a list in their wallets indicating their drug allergies and/or intolerances, especially if they had a severe reaction before. We conclude that a careful follow-up should be performed with NSAIDs, antibiotics and anti-epileptics. The combination of drugs, including NSAIDs and antibiotics should be avoided as much as possible.

Analysis of adverse drug reactions reported to national pharmacovigilance center of Bhutan

Introduction: Medicines prescribed for diseases often causes adverse drug reactions in patients ranging from mere inconvenience to permanent disability and death. This is because, most of the adverse drug reactions especially the serious and latent ones may not have occurred during the clinical trials and vulnerable populations like children, pregnant women and the elderly are not all included in clinical trial studies considering the ethical and safety issues. Objectives: To study the demographic characteristics, types of adverse drug reactions and common drugs causing these reactions from the adverse drug reaction reports received by the national pharmacovigilance of Bhutan. Methods: A total of 222 adverse drug reactions were received at the national pharmacovigilance center from January 2016 to May 2018 were analyzed retrospectively. The Drug Regulatory Authority is the national pharmacovigilance center of Bhutan and is a member to the International Drug Monitoring Program since 2014. Results: 73% of adverse drug reactions occurred in adults while 13.5% occurred each in children and elderly. 48.7% of the total adverse drug reactions reports were caused by antibiotics out of which penicillin was the most common causal drug (32.4%). The most commonly reported adverse drug reactions was rashes (36.5%) followed by gastro-intestinal system disorder (14.9%). Conclusions: Antibiotics are common causal drugs for adverse drug reactions. All categories of health professional must be encouraged to report adverse drug reactions. Active surveillance for drug safety monitoring especially for those of patients who are on antibiotics is recommended.

Changing spectrum of suspected drugs of epidermal necrolysis: A World Health Organization pharmacovigilance database analysis from 1997-2020

Changing spectrum of suspected drugs of epidermal necrolysis: A World Health Organization pharmacovigilance database analysis from 1997-2020

Drug-induced IgA vasculitis in children and adults: Revisiting drug causality using a dual pharmacovigilance-based approach.

IgA vasculitis (IgAV) is an immune complex small-vessel vasculitis. Drug-induced IgAV cases were rarely reported in the literature. Drug causality assessment is challenging as many other etiological factors can be involved. We performed a pharmacovigilance study to identify the main drugs reported to induce IgAV. We used the French pharmacovigilance database (FPVD) and the WHO global individual case safety reports database (VigiBase) to retrieve IgAV cases. Cases from the FPVD were reviewed by two investigators using predefined criteria. Disproportionality analyses (case - non-case approach) were conducted in VigiBase to identify drugs significantly associated with IgAV reporting. Of the 467 IgAV cases retrieved from the FPVD, 115 (47 children and 68 adults) have been assessed as definite or probable, reported with 178 suspected drugs. Overall IgAV cases were mainly male (58%), with a median age of 33.5 (8.0-63.3) years. No death was reported. Besides, we identified 1558 possible IgAV cases in VigiBase. Among them, 40 were associated with a disproportionality in IgAV reporting. Drugs were mainly vaccines, antibiotics and TNF-α blockers, these finding being consistent in both databases. IgAV reporting with TNF-α blockers was significantly associated with their use in inflammatory bowel diseases, psoriasis or ankylosing spondylitis compared to other indications. Our systematic study enables the identification of culprit drugs in drug-induced IgAV. These results strengthen the immune pathophysiology of IgAV and the role of underlying disease. The list of suspected drugs may be useful for physicians to manage patients with IgAV and consider appropriate drug discontinuation. What is already known about this subject? IgA vasculitis has multifactorial etiology. To date, possible culprit drugs have been reported only in case reports. What does this study add? Using a dual pharmacovigilance-based approach, we identified drugs associated with the occurrence of IgA vasculitis, such as all types of vaccines, major antibiotics and immunomodulatory agents, mainly TNF-α blockers. How might this impact on clinical practice or future developments? Physicians should be aware of drug-induced IgA vasculitis and we provide evidence on the most frequent implicated drugs.

Incidence, preventability, and causality of adverse drug reactions at a university hospital emergency department

PurposeTo investigate the characteristics of ADRs in patients admitting at the emergency room of a tertiary hospital.MethodsWe collected the patient records of 1600 emergency room visits of a university hospital in 2018. The patient files were studied retrospectively and all possible ADRs were identified and registered. Patient characteristics, drugs associated with ADRs, causality, severity, preventability, and the role of pharmacogenetics were assessed.ResultsThere were 125 cases with ADRs, resulting in a 7.8% overall incidence among emergency visits. The incidence was greatest in visits among elderly patients, reaching 14% (men) to 19% (women) in the 80–89 years age group. The most common causative drugs were warfarin, acetylsalicylic acid (ASA), apixaban, and docetaxel, and the most common ADRs were bleedings and neutropenia and/or severe infections. Only two of the cases might have been prevented by pharmacogenetic testing, as advised in Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines.ConclusionThe same ATC classes, antithrombotics and cytostatics, were involved in ADRs causing university clinic hospitalizations as those identified previously in drug-related hospital fatalities. It seems difficult to prevent these events totally, as the treatments are vitally important and their risk-benefit-relationships have been considered thoroughly, and as pharmacogenetic testing could have been useful in only few cases.

Pediatric drug reaction with eosinophilia and systemic symptoms: A systematic review of the literature, with a focus on relapsing cases.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction with systemic symptoms. This study aims to investigate clinical features, causative drugs, and available treatments for pediatric DRESS, particularly for relapsing cases. A systematic search of the English and French literature on pediatric DRESS was conducted using the Medline, Embase, and Cochrane collaboration databases. Confirmed cases of pediatric DRESS fulfilling the RegiSCAR diagnostic criteria with a probable or a definite diagnosis were included. After full-text article review, 144 articles were included, representing a total of 354 pediatric patients with a mean age of 8.8years. The mean time from the drug intake until the onset of the first symptom was 18.9days. Antiepileptic drugs were the main trigger, followed by anti-infectious agents. Relapsing DRESS was reported in 17 children. In comparison to non-relapsing cases, relapsing patients had more comorbidities. The initial clinical presentation was more commonly erythroderma. Facial edema, fever, and enlarged lymph nodes in more than two sites were more commonly found in relapsing cases. Systemic steroids were more frequently administered. Pediatric DRESS is a potentially severe adverse drug reaction. Antiepileptic agents are the most common causative agents. Fever, facial edema, lymph node enlargement, and pharyngeal and visceral involvement predicted DRESS reactivation in children. Corticosteroids were the mainstay of treatment.

A Drug-Induced Acute Pancreatitis Retrospective Study.

Background and Aims Drugs are considered a relatively rare and understudied cause of acute pancreatitis (AP). The lack of convincing and conclusive data on drug-induced AP (DIAP) complicates the diagnosis as well as the identification of the causative drug. The aim of this study is to document causes of DIAP cases that occurred in the Saguenay-Lac-Saint-Jean (SLSJ) population. Methods We have conducted a retrospective and descriptive population-based study of DIAP cases that occurred between 2006 and 2014 in the six hospitals serving the entire SLSJ population. Cases were selected from the Quebec Ministry of Health hospitalizations registry (MED-ECHO) administrative public database. A medical chart review was performed in an attempt to characterize DIAP hospitalizations and to identify the imputable drugs. Results During the studied period, 75 cases (30.7% male, 69.3% female) were included totaling 90 hospitalizations for DIAP. Among them, 50 causative drugs were identified and were distributed in 17 different drug classes. Recurrent DIAPs were documented in 13 cases, and among them, 6 cases have experimented a positive rechallenge. Six drugs (5-fluorouracil, atorvastatin, bortezomib, nilotinib, rosuvastatin, and triamcinolone) were associated with the highest degree of evidence. The most common causative drugs of DIAP hospitalization were azathioprine (n = 7), followed by atorvastatin (n = 6), hydrochlorothiazide (n = 5), rosuvastatin (n = 4), and codeine (n = 4). Conclusions This study has added new evidences about potentially pancreatitis-associated drugs in literature. This is the first study to report definite 5-fluorouracil- and triamcinolone-induced AP. An updated version of the evidence-based literature review is needed to support the clinicians in the identification of the causative drugs.

Toxic Epidermal Necrolysis (TEN)/Stevens-Johnson Syndrome (SJS) Epidemiology and Mortality Rate at King Fahad Specialist Hospital (KFSH) in Qassim Region of Saudi Arabia: A Retrospective Study.

Background Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are life-threatening conditions caused by drug reactions. There are multiple causative drugs and different risk factors associated with SJS/TEN. Objectives To study the epidemiology of SJS/TEN and associated mortality rate in Qassim region, Saudi Arabia. Methodology. A retrospective chart review of all patients with the diagnosis of SJS/TEN who were admitted to King Fahad Specialist Hospital (KFSH) in Qassim region, Saudi Arabia, for the period between Jan 2014 to Jan 2019. The Careware information health system is used at KFSH, and patients were identified searching the diagnosis SJS/TEN. Results Total of 10 patients with diagnosis of SJS/TEN were admitted to KFSH for the period from Jan 2014 to Jan 2019. Antibiotics were the culprit in 5 out of 10 patients. 9 out of 10 patients survived with good outcome. One patient with the diagnosis of TEN died, given extensive skin involvement complicated by sepsis. Conclusion Despite the limitation of this study given small sample size, this is the first study of its kind that discusses the epidemiology of SJS/TEN in Saudi Arabia. We found the estimated incidence rate of SJS/TEN in Qassim region to be 7.6 cases per million person-years. Antibiotics and antiepileptics were the culprits in 8 out of 10 patients.

In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs-a systematic review and meta-analysis.

the prevalence of adverse drug reactions (ADRs) in hospitalised older patients, their clinical presentations, causative drugs, severity, preventability and measurable outcomes are unclear, ADRs being an increasing challenge to older patient safety. we systematically searched PubMed, Embase, EBSCO-CINAHL, the Cochrane Library, 'rey' literature and relevant systematic review bibliographies, published from database inception to March 2020. We included any study reporting occurrence of in-hospital ADRs as primary or secondary outcomes in hospitalised older adults (mean age ≥ 65years). Two authors independently extracted relevant information and appraised studies for bias. Study characteristics, ADR clinical presentations, causative drugs, severity, preventability and clinical outcomes were analysed. Study estimates were pooled using random-effects meta-analytic models. from 2,399 abstracts, we undertook full-text screening in 286, identifying 27 studies (29 papers). Final analysis yielded a pooled ADR prevalence of 16% (95%CI 12-22%, I2 98%,τ2 0.8585), in a population of 20,153 hospitalised patients aged ≥65years of whom 2,479 patients experienced ≥ one ADR. ADR ascertainment was highly heterogeneous. Almost 48.3% of all ADRs involved five presentations: fluid/electrolyte disturbances (17.3%), gastrointestinal motility/defaecation disorders (13.3%), renal disorders (8.2%), hypotension/blood pressure dysregulation disorders/shock (5.5%) and delirium (4.1%). Four drug classes accounted for 57.8% of causative medications i.e. diuretics (19.8%), anti-bacterials (14.8%), antithrombotic agents (12.2%) and analgesics (10.9%). Pooled analysis of severity was not feasible. Four studies reported the majority of ADRs as preventable (55-95%). on average, 16% of hospitalised older patients experience significant ADRs, varying in severity and mostly preventable, with commonly prescribed drug classes accounting for most ADRs.

A prospective cross - Sectional investigation of the clinical characteristics features and management of lower limb ulcers

Aim: To determine the clinical features and management of ulcers of the lower limb. Methods: The Department of General Surgery conducted a prospective cross-sectional analysis. With the aid of computer-generated random numbers, 100 patients with chronic leg ulcers were chosen at random from those who visited the OPD or were admitted to the surgical ward. After determining the primary cause of leg ulcers, proper antibiotic coverage for gram positive, gram negative, and anaerobic organisms, proper glycaemic control, leg elevation, compression bandaging, total cessation of smoking and causative drugs, nutritional support, vasoactive agents to restore blood flow, nerve stimulation, and proper wound care with debridement slough excision are also recommended. Results: The leg ulcers were more prevalent in the age group 40-70 years. Test of proportion showed that proportion of males 85% was significantly higher than that of females 15% (Z=9.74; p