Patients In Department Of Medicine Research Articles

Potential Drug-Drug Interactions among Geriatric Patients in Medicine Department at a Tertiary Care Teaching Hospital - A Prospective Observational Study

Background Drug-drug interactions occur when therapeutic effect of one drug is altered by another drug during co-administration. These effects may result in increase or decrease in the action of either of the substances or it may cause adverse effect that is abnormally associated with either of the drugs. Data was collected from patients admitted in the Emergency Department.Aim The objective of the study was to identify evaluate and analyze the drug-drug interactions found in the prescriptions of elderly patients visiting the Medical department at a tertiary care teaching hospital.Methods This prospective observational study was undertaken in an Emergency ward for a period of six months to identify evaluate and analyze the drug-drug interactions. Ethical clearance was obtained from the Institutional Ethical Committee of SCS College of Pharmacy Harapanahalli. A total of three hundred and fifty cases were reviewed and details such as demographics past medical and medication history prescribed drugs and drug interactions were recorded.Results The data of 350 patients was included in the study. In our study a total of 405 drug-drug interactions were seen in 191 patients. The most commonly involved drugs were hydrocortisone and furosemide. Increased polypharmacy was observed in patients with co-morbid conditions leading to increased risk of potential drug-drug interactions PDDI.Conclusion Our study revealed that geriatric patients have higher risk for polypharmacy due to the presence of co-morbid conditions. Overall the incidence of PDDI was high and most interactions were pharmacodynamic in nature.nbsp

A Study to Evaluate Correlation of C-Reactive Protein and Glycosylated Haemoglobin in Patients of Diabetes Suffering from Acute Coronary Syndrome

Incidence of diabetes is increasing substantially worldwide. Cardiovascular disease is most prevalent cause of mortality and morbidity in diabetic populations. Cardiovascular risk factor including obesity, hypertension, dyslipidemia are common in patients with diabetes mellitus particularly with those of type 2 diabetes. Atherosclerosis has been described as an inflammatory disease. Aim: Study to evaluate correlation of C-Reactive Protein and Glycosylated Haemoglobin in Patients of Diabetes Suffering from Acute Coronary Syndrome. Material and Methods: A descriptive study after satisfying criteria was conducted in 115 patients in medicine department of a medical college and tertiary care hospital over a period of two years that included patients of diabetes suffering from acute coronary syndrome in the age group of 30 to 70 years. Evaluation and correlation was done by clinical profile. Results: Majority of patients were elderly age group of male of 51 to 60 yrs having mean BMI of 24 kg/m2. CRP level of >3 mg/dl was found in 77.39% and majority of patients had HbA1C >7%. CRP and HbA1C were significantly correlated (p<0.05). Majority of patients with elevated CRP were found in with killip class I. But CRP and killip classification were not significantly correlated in our study. Conclusion: Elevated C Reactive Protein and Glycosylated Haemoglobin are better correlated as poor prognostic marker for cardiovascular event in patients of diabetes suffering from acute coronary syndrome.

An evaluation of the appropriateness of prescribing and frailty in elderly patients using STOPP criteria and Frailty Index in tertiary care teaching hospital

People above 65 years of age would amount to 10.7% of total population of India by 2021. India has acquired the label of ‘an ageing nation’ with 7.7% of its population being more than 60 years old. Geriatric patients are exposed to potentially inappropriate medications (PIMs) thus strategies to improve quality of life and safety of prescribing is needed. One such explicit criteria tool is ‘Screening Tool of Older person’s Potentially inappropriate Prescriptions’ (STOPP) criteria. For older individuals, frailty plays a decisive role. Frailty assessment is useful for identification of risk stratifications to assist in clinical decision makings. Hence, this study is aimed to assess the percentage of PIM using STOPP criteria and correlation between PIMS and Frailty Index (FI) in elderly patients in our setting. An observational study was done in 60 patients in department of medicine at tertiary care teaching hospital. Demographic details, diagnosis and current medications were recorded in Microsoft excel 2016. PIMs based on STOPP criteria version 2 and FI suggested by Searle et al. was calculated and analyzed. Spearman rank correlation test was used to check the correlation between FI and PIM. Out of 60 prescriptions, 21 prescriptions with PIM were found. Most common drugs prescribed as PIM were Aspirin, calcium, ceftriaxone, multivitamin B complex and furosemide. FI was analyzed by using 34 variables. Value of FI was between 0.03 to 0.17. Spearman Rank correlation test showed direct low degree of significant correlation between FI and PIM with correlation (r) value of 0.1602 (P value=0.02). 35% of prescriptions were having at least one PIM in our study and we found that there was direct association between FI and PIM which will help us to reduce potential medication errors, drug interactions and adverse reactions.

Evaluation of the association between glycated hemoglobin levels and severity of coronary artery disease in nondiabetic patients

Introduction: Higher fasting blood glucose level plus raised glycated hemoglobin (HbA1c) levels is one of the major risk factors for cardiovascular (CV) events in nondiabetic population. HbA1c levels have low intra-individual variability especially in nondiabetic patients. Studies have shown that coronary artery disease (CAD) and HbA1c are predictors of CV mortality. In this study, we have evaluated the association between HbA1c and severity of CAD in nondiabetic patients. Materials and Methods: This is a hospital-based observational study done on 300 patients in Department of Medicine and Department of Cardiology, Mahatma Gandhi Medical College and Hospital, Jaipur. Prior approval was taken before the start of study from the Institute Ethics Committee. Gensini score was used to estimate the CAD severity. This score is based on the sum of scores for all 3 coronary arteries to assess the entire extent of CAD. Data were analyzed and appropriate statistical tests were used. P < 0.05 were considered statistically significant. Results: This study showed that the majority of cases (59.33%) were seen in 51–70 years of age group. The maximum number of patients (66.66%) had 5.6–6.5 HbA1c level and 29.36 ± 19.50 Gensini score in our study. Mean Gensini score showed a linear relationship with HbA1c. Conclusion: HbA1c level has a prognostic value for predicting the severity of CAD among nondiabetic patients and can act as a useful marker in risk stratification of nondiabetic patients presenting with acute coronary syndrome and indicated for angiographic evaluation.

Clinical and Bacteriological Profile of UTI Patients in Medicine Department in a Teaching Hospital of Bangladesh

Introduction: Urinary tract infections (UTIs) encompass a wide array of infections, accounting for a vast number of community as well as hospital acquired infections. This study was undertaken to evaluate the clinical presentations and bacteriological profile of UTI patients in indoor setting.
 Methods: This 6 months cross-sectional study enrolled 100 patients admitted in Medicine department of Sylhet MAG Osmani Medical College Hospital with symptoms and signs of UTI subsequently confirmed by compatible investigations including urine culture.
 Results: Among 100 patients of UTI, maximum were females (67%) and the male female ratio was 0.49: 1. The most common age group was 46–60 years (34%). Majority (68%) of the patients had upper UTI while lower UTI constitutes 32%.66% of the patients had complicated while 34% have uncomplicated UTI.18% of the patients had recurrent UTI. Most of the patients had fever (55%), followed by loin pain (37%) as their presenting symptoms. The most common risk factor was loss of host defense 38% (diabetes mellitus/ use of immunosuppressive drugs).Out of 100, 60 urine samples were positive for pathogenic organisms. Escherichia coli was isolated in 41 (68.3%) of the positive samples, followed by Klebsiella sp 13 (21.6%), Pseudomonas sp 3 (5%) Proteus sp 2 (3.3%) Staph. Aureus 1(1.66%).
 Conclusion: The most common clinical presentations of UTI in admitted UTI patients are fever and loin pain. Diabetes mellitus is the most important risk factor. Mainly Gram negative bacilli were found to be responsible for UTI and most frequent isolated bacteria was E-coli.
 J Bangladesh Coll Phys Surg 2021; 39(2): 106-113

ASSOCIATION OF SERUM MAGNESIUM LEVEL WITH RESISTANT HYPERLIPIDEMIA IN DIABETIC AND HYPERTENSIVE PATIENTS

Introduction: Both diabetes mellitus and hypertension are aspects of metabolic syndrome. Objectives: The aim of this study was to determine the relationship between serum magnesium level with resistant hyperlipidemia in a group of diabetic and hypertensive patients. Patients And Methods: The present cross- sectional study was carried out on 90 hypertensive and diabetic patients in Medicine Department of DMCH, Laheriasarai, Bihar, (45 hypertensive and 45 diabetic patients). Included patients had high triglyceride levels despite 8 weeks of treatment with lipid-lowering agents. Results: There was an inverse signicant relationship between serum magnesium and triglyceride levels in diabetic patients (P=0.002, r=-0.458), however, this correlation was not signicant in hypertensive patients (P=0.754, r=0.048). Conclusion: This study showed, serum magnesium may affect triglycerides levels in diabetic patients, however, our nding requires further investigation with larger population

Identification and Treatment of Hypovitaminosis-D among in-patients setting of Cavan General Hospital, Ireland and its implication on different health perspectives and quality of life

Aim: People who are at risk of developing vitamin D deficiency are not usually tested for vitamin D when present to hospital. The aim of this study was to explore the incidence of Hypovitaminosis-D and its treatment in admitted patient category of Cavan General Hospital, Ireland. Methods: This is a cross sectional study which was conducted randomly among admitted patients in medicine department at CGH from August 2016 to August 2017. A random data was collected from total of 100 patients. All blood samples were stored and labeled properly in the CGH Hematology lab till further blood profile analyzed. Data was statistically analyzed through using DSAASTAT (Onofri, Italy). Results: Selected population of 100 patients expressed almost equal numbers in gender distribution including males and females at 51% and 49% respectively. The data was analyzed on the basis of age and gender distribution. Selected Population was divided in 3 age groups. There were 9 patients under the age-group of 30-50 years, 47 of 51-80 years and 44 of >80 years age-group. Among these patients, males comprised of 57% with hypovitaminosis D (vitamin D deficiency) and females were 43% respectively. Out of these 100 patients, 33 people were recorded with normal vitamin D level and 67 patients found to have low vitamin D level. These 67 patients with low vitamin D levels were selected for treatment with vitamin D as per guidelines. Out of these 67 patients, unfortunately 3 people died, 11 lost their follow up, so remaining 53 patients participated in receiving treatments. Out of those 53 patients with low vitamin D, there were 29 males and 24 females. After receiving treatment with vitamin D, 40 people ± 0.0001 recovered, showing vitamin D level >30 nmol/L, 9 patients ± 0.0002 found mildly deficient with vitamin D levels between 21-30 nmol/L and 4 patients ± 0.0003 were severely deficient with levels of <10 nmol/L. All those people with severe deficiency were more than 80 years-of-age and also were not sure about their compliance with medications. The probability value was p ≤ 0.05. Conclusion: This study was conducted to determine hypovitaminosis D (Vitamin D deficiency) in population, admitted to hospital with previous comorbid medical conditions which are prone to develop its deficiency. This study showed that 67% population has hypovitaminosis D with almost equal percentage in both genders. After receiving treatments with Vitamin D replacement, almost majority (>90%) showed recovery of vitamin D levels with very small number (8%) showed persistent severely low levels.

Preventable Drug Harms in Renal Injuries: A Prospective Observational Study in OPD and IPD Patients in Medicine Department of Civil Hospital, Nashik

Preventable Drug Harms in Renal Injuries: A Prospective Observational Study in OPD and IPD Patients in Medicine Department of Civil Hospital, Nashik

Aetiology and Short-term Outcome of Altered Level of Consciousness among Patients in Medicine Department of a Tertiary Hospital

Background: Altered level of consciousness is a very common medical emergency resulting in considerable mortality &amp; morbidity. Accurate diagnosis &amp; prompt management can reduce the complications to a great extent. There are various aetiologies of impaired consciousness including infective &amp; metabolic causes as well as cerebrovascular accidents. This study described clinical outcomes of the patients relating to specific aetiologies of the illness.Objectives: To explore the common aetiologies of altered consciousness &amp; to determine the clinical outcomes of the patients after one month in a tertiary level hospital of Bangladesh.Methods: This hospital based prospective observational study was conducted in Medicine department of Dhaka Medical College Hospital (DMCH) from December 2013 to May 2014. Sample size was 100 &amp; the data was collected by structured questionnaire. Purposive sampling method was applied using inclusion &amp; exclusion criteria. Statistical analysis of the result was obtained by using SPSS-16.Results: The mean age of the study patients was found 48.7 years with range from 19-92 years. Majority (58%) of the patients were male. Stroke was identified as the commonest (39%) aetiology of impaired consciousness followed by meningo-encephalitis (19%), septicemia (10%) &amp; poisoning (10%). Among metabolic encephalopathy diabetic ketoacidosis was 3%, hypoglycemia 1% and hepatic, uremic &amp; hypertensive encephalopathy was 3%, 4% &amp; 1% respectively. Overall death rate was higher among patients with stroke (26%), ICSOL (50%), ADEM (50%) than those with meningoencephalitis (5.3%), septicemia (20%) &amp; poisoning (10%).Conclusion: Infective &amp; metabolic causes of impaired consciousness showed better outcome than structural &amp; vascular aetiologies of brain.J MEDICINE July 2017; 18 (2) : 80-85

RISK ELEMENTS AND DRUG UTILIZATION IN STROKE PATIENTS

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Cerebrovascular accident (CVA), formally called as stroke is the second leading cause of death worldwide. Recent studies in different parts of India also documented that the prevalence of stroke varies from 40 to 270 per 100,000 populations. Identifying the risk factors of the disease helps to improve the effectiveness of the therapy. Our present study aims in accessing the risk aspects and utilization of drugs in CVA patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective Interventional study was carried out on stroke patients in Medicine Department, Viswabarathi Hospital, Kurnool, AP from January to September 2015. Required demographic and laboratory data, along with general neurological evaluation and brain CT was analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 100 patients was analyzed. Among them, the incidence of ischemic stroke (96%) was greater compared to hemorrhagic stroke (4%). Prevalence of disease was higher in males (69%) than females (31%) with notable occurrence in the age group of 61-70 (26%). Higher percentage of patients were found to have&amp;gt;3 risk factors (34%), including hypertension (68%), age (58%), diabetes (39%), smoking (22%), alcoholism (21%), CAD (10%) and percentage with no risk element accounts7%. The prescribing pattern includes antihypertensives (16.25%), Gastrointestinal agents (12.2%), anti-platelets (9.16%), hyperlipidemic (8.4%), Nootropics (7.97%) followed by other classes and nitrates (0.62%) occupies the last place in prescribing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The present study emphasizes on the need to identify risk factors and providing awareness among the patients by a pharmacist in minimizing the disease burden. It also points the rationality in prescribing of drugs based on therapeutic guidelines.&lt;/p&gt;

Upper respiratory tract infection: drug utilization study

Background: One of the most common causes of visit to physician is upper respiratory tract infections (URTI). This infection is often considered to be of little value from a stand point of mortality but this infection is responsible for limited activity and absence from work and school in the general population of nation mainly in a developing country like India, when compared it with other infections. Methods: This study was conducted in Krishna Institute of Medical Sciences, Karad, India to see the prescription pattern of URTI patients in medicine department. It was a retrospective study record based, observational study and the data were collected from the medical record room. Results: Out of 212 patients, 53.30% were of URTI, 31.60% were sinusitis, pharyngitis and CSOM accounted for 11.79% and 3.30% respectively. Female accounted for 62.26% and male for 37.73% of total cases. In 8 cases culture and sensitivity was done and all were sterile. Only in 8 cases antimicrobial agents were not prescribed. Conclusions: Azithromycin was the most commonly used antimicrobial, followed by ceftriaxone. Apart from antibiotics the most frequently prescribed class was antihistamines followed by expectorants and bronchodilators. Paracetamol was the preferred antipyretic. Acid reducing agents were prescribed in 84.82% of Patients, might be used to check the acidity caused by antibiotics. The use of generic medicines should be promoted.

Anemia in Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in Bangladesh

Background: Chronic obstructive pulmonary disease (COPD) is usually associated with polycythemia. It is assumed that systemic inflammatory components of COPD can interfere with erythropoietin and can result in anemia of chronic disease which will impair the functional capacity of these patients and also increase morbidity and mortality. Objective: To evaluate anemia status in COPD patients. Materials and Methods: This cross-sectional study was conducted in clinically stable 50 COPD patients in the outpatient department of Medicine in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of July to December 2011. The demographic characteristics, smoking habit, duration of disease, types and severity of anemia, BMI and results of 6-minute walk test were recorded. Results: Out of 50 COPD patients, 76% were male and 24% were female. Among them 32% patients were anemic, 20% were polycythemic and 48% patients had normal hemoglobin. Among the anemic patients with COPD, 87% were male and 13% were female,75% were mildly anemic and 4% moderately anemic, 62.5% had normocytic and 37.5% had microcytic anemia. Conclusion: Anemia in COPD patients is often overlooked and underestimated. Clinicians should be aware of the presence of anemia in patients with COPD so that appropriate treatment could be initiated to improve the quality of life and prognosis DOI: http://dx.doi.org/10.3329/jemc.v4i3.20943 J Enam Med Col 2014; 4(3): 151-155

Study on relationship between stroke and kidney dysfunction based on estimated glomerular filtration rate (eGFR)

Background: Stroke is one of the commonest causes of severe disability and accounts for a large proportion of health care resources. Kidney diseases are related to stroke and reduced estimated glomerular filtration rate (eGFR) appears to be a significant independent prognostic factor for short as well as long term mortality in stroke patients. Objective: The present study has been designed to assess the relationship between stroke and kidney dysfunction based on eGFR. Methods: The present study was a case control study. The study was conducted in the Department of Physiology, Dhaka Medical College and Hospital (DMCH), Dhaka from 1st July 2010 to 30th June 2011. A total of 200 subjects were included with the age limit of 35–85 years. Out of them 100 apparently healthy subjects were selected as control(Group A) for comparison and 100 diagnosed stroke patients were selected as study group (Group B). On the basis of age, group A and group B were further subdivided into group A1(age 35-59 years) consisting of 47 normal persons and group A2(age 60-85 years) consisting of 53 normal person, group B1(age35-59 years) was consisting of 42 stroke patients and group B2(60-85 years) consisting of 58 stroke patients .The study subjects were selected from admitted patients in Department of Medicine, DMCH, Dhaka. Estimated GFR (eGFR) were measured by MDRD equation. The data was analyzed by computer based statistical software (SPSS version 12). Results: The result was expressed as Mean (+SD). The test of significance was calculated and p values &lt;0.05 was accepted as level of significance. The mean(±SD)of eGFR level was significantly(p&lt;0.001) lower in group B1 and B2 than that of group A1 and A2 respectively.Conclusion: From this study it can be concluded that, stroke patients suffers from kidney dysfunction than that of normal control group on the basis of measuring eGFR.http://dx.doi.org/10.3329/bjpp.v29i1-2.20062 Bangladesh J Physiol Pharmacol 2013; 29(1&amp;2) : 12-16

Study of prescribing pattern of antimicrobial agents in indoor patients of a tertiary care hospital

Background: To evaluate prescribing pattern of antimicrobial agents in indoor patients of medicine and surgery department of SBH Government Medical College, Dhule. Methods: This was a retrospective cross sectional study carried over a period of 3 months. The patients who were admitted and received antimicrobial therapy in department of Medicine and Surgery were randomly selected and included in the study. The case record sheet and drug chart were obtained from Medical Record Section of the Hospital. The data was collected using case record form specially prepared for the study. The cases were categorised according to slightly Modified Kunin’s Criteria. Results: Total numbers of patients receiving antimicrobial therapy were 130 in medicine department and 93 in surgery department. Most commonly prescribed antimicrobial agent was cefotaxime (21.7%) in medicine and metronidazole in surgery (30.6%) department. The average number of antimicrobials per patient was found to be 1.7 and 3.02 in medicine and surgery department respectively. The switch on therapy from parenteral to oral route was employed in 16.15% patients in medicine department and 11.82% patients in surgery department. As per Kunin’s modified criteria, 66.2% and 58.06% patients received antimicrobial therapy appropriately in Medicine and surgery department respectively. Conclusion: This study highlights the problem of over-prescription of antibiotics and a trend towards polypharmacy. The interventions to rectify the problem of inappropriate use of antimicrobial agents are needed to make therapy more rational and cost effective.