Polypharmacy Induced Drug Interactions, Adverse Drug Reactions (ADR) And Medication Errors In Tertiary Care South Indian Hospital

Objective: To study the pattern of drug interactions (DI) in our hospital and to identify whether it is associated with polypharmacy. To determine the level of severity of potential drug-drug interactions (PDDI), to detect, monitor and prevention of ADRs in the hospitalized patients and to identify the medication errors (ME). Methods: A prospective interventional study was conducted in a 300 bedded tertiary care South Indian hospital for a period of 6 mo. Prescriptions were analysed for PDDI using Micromedex software 2.2. The causality and severity of ADRs were assessed by using Naranjo’s, WHO UMC Scales and Hart wigs severity scales. ME was identified by review of patient drug charts. Results: Total 190 prescriptions were analyzed, in which 1028 drug interactions were seen. Out of which 718 were DDI, 198 DFI, 100 DEI, and 12 DTI were observed. More number of DI was seen in cardiovascular drugs, antibiotics followed by antacids and antiulcer agents. A total of 52 ADRs were identified in 43 patients. Diuretics, cardiovascular drugs were associated with a higher incidence of ADRs followed by Anti-Diabetic agents. 58 ME was seen in 190 prescriptions, among them omission error, prescribing errors and Wrong dose error was seen. Conclusion: Clinical pharmacist plays a potential role in the health care system in assisting the physician i.e. modifying the number of drugs taken, number of doses taken, medication adherence, identification of drug interactions, preventing, monitoring and detection of ADRs and identifying the medication errors.

Microbiological and faunal soil attributes of coffee cultivation under different management systems in Brazil / Atributos microbiológicos e da fauna do solo com diferentes sistemas de cultivo de cafeeiro no Brasil

Abstract Brazil is the biggest coffee producer in the world and different plantation management systems have been applied to improve sustainability and soil quality. Little is known about the environmental effects of these different management systems, therefore, the goal of this study was to use soil biological parameters as indicators of changes. Soils from plantations in Southeastern Brazil with conventional (CC), organic (OC) and integrated management systems containing intercropping of Brachiaria decumbens (IB) or Arachis pintoi (IA) were sampled. Total organic carbon (TOC), microbial biomass carbon (MBC) and nitrogen (MBN), microbial activity (C-CO2), metabolic quotient (qCO2), the enzymes dehydrogenase, urease, acid phosphatase and arylsulphatase, arbuscular mycorrhizal fungi (AMF) colonization and number of spores and soil fauna were evaluated. The greatest difference between the management systems was seen in soil organic matter content. The largest quantity of TOC was found in the OC, and the smallest was found in IA. TOC content influenced soil biological parameters. The use of all combined attributes was necessary to distinguish the four systems. Each management presented distinct faunal structure, and the data obtained with the trap method was more reliable than the TSBF (Tropical Soils) method. A canonic correlation analysis showed that Isopoda was correlated with TOC and the most abundant order with OC. Isoptera was the most abundant faunal order in IA and correlated with MBC. Overall, OC had higher values for most of the biological measurements and higher populations of Oligochaeta and Isopoda, corroborating with the concept that the OC is a more sustainable system.

Resumo O Brasil é o maior produtor mundial de café e diferentes sistemas de manejo têm sido aplicados para melhorar a sustentabilidade e a qualidade do solo. Pouco se conhece sobre os efeitos ambientais desses sistemas de manejo, assim, o objetivo desse estudo foi utilizar parâmetros biológicos do solo como indicadores de mudanças nos sistemas. Foram amostrados, na região sudeste do Brasil, solos com cultivo convencional (CC), orgânico (OC) e sistema integrado de cultivo consorciado com Brachiaria decumbens (IB) ou com Arachis pintoi (IA) na entrelinha. Foram avaliados o carbono orgânico total (TOC), carbono e nitrogênio da biomassa microbiana (MBC e MBN), atividade microbiana (C-CO2), quociente metabólico (qCO2), as enzimas desidrogenase, urease, fosfatase ácida e arilsulfatase, a colonização e número de esporos de fungos micorrízicos arbusculares (AMF) e a fauna do solo. A maior diferença entre os sistemas de manejo foram verificadas no teor de matéria orgânica do solo. O maior teor de TOC foi encontrado no OC, e o menor teor encontrado no sistema IA. O teor de TOC influenciou os parâmetros biológicos e a diferenciação da fauna do solo. O uso combinado de todos os atributos foi necessário para diferenciar os quatro sistemas de cultivo. Cada manejo apresentou estruturas diferentes de fauna, e dados obtidos com o método de armadilhas tipo pitfall foi mais confiável do que o método TSBF (Solos Tropicais). A análise de correlação canônica mostrou que Isopoda foi correlacionado com TOC e a ordem mais abundante em OC. Isoptera foi a ordem da fauna mais abundante em IA e foi correlacionada com MBC. Em geral, OC apresentou os maiores valores para a maioria dos atributos biológicos, inclusive para abundância de indivíduos de Oligochaeta e Isopoda, corroborando com o conceito de que OC é um sistema mais sustentável.

Reiter's syndrome associated with the Acquired Immunodeficiency Syndrome: a case report

The association of Reiter's Syndrome (RS) with the Acquired Immunodeficiency Syndrome (AIDS) is seldom mentioned in the medical literature. This report illustrates this relationship in a 46 years old male patient suffering from AIDS (CD(4)(+) = 240 cells/mm(3), CD(8)(+) = 1,301 cells/mm(3) and viral load = 330,000 copies/ml), pulmonary tuberculosis (positive catarrhal bacilluscopy), and RS. The diagnosis of RS was based on the combination of dermatological and articular alterations. The patient s cutaneous lesions were characterized by exfoliation and the formation of crusts located on the face, scalp, genitals, hands, and feet; onychodystrophy with opacity; yellowish coloring; and hyperkeratosis of the nails. Articular lesions led to progressive deformity of phalangeal joints of the hands, and intensive arthralgia, mainly of the larger joints (shoulders, elbows, hips and knees). AIDS treatment was administered with anti-retroviral drugs (zidovudine and didanosine); for tuberculosis (isoniazid, rifampicine, and pyrazinamide); and (prednisone and inometacine) for the RS. The patient recovered with the improvement of articular symptoms; however, on the eighth day of treatment, the patient showed significant hemoptysis and hypovolemic shock, and died. The association of RS and HIV infection is reviewed.