ABSTRACT
Objective: To assess the patterns and predictors of pharmacotherapy and QOL in DFS patients in an Indian tertiary care hospital. Methods: A cross-sectional study was conducted among inpatients with DFS. Data on sociodemographic and clinical factors, pharmacotherapy, clinical outcomes, and QOL were analyzed using the chi-squared test, independent sample t-test, and binary logistic regression. Results: We screened 3284 inpatients and included consecutive 87 (2.7%) DFS patients. The mean age was 56.08 ± 11.05 years, with a male preponderance (75.8%). Mean HbA1c was 9.9 ± 2.483. About 75% of patients received insulin, and polypharmacy was noticed in 82.7%. About 67.8% of DFS patients had other vascular complications of diabetes, with diabetic retinopathy being the most common in 89%. Amputations were noticed in 32.1% of patients. Overall, poor QOL was seen in 79.3% of patients. The mean scores for different domains were as follows: physical, 41.51 ± 14.15; psychological, 42.90 ± 11.16; social relationships, 43.06 ± 19.36; and environment, 47.17 ± 13. The presence of complications from diabetes was a significant predictor of the utilization of antihypertensives (OR: 2.92, CI [1.09, 7.79], P = 0.03) and poor QOL (OR: 4.54, CI [0.965, 21.41], P = 0.05). Conclusion: DFS patients in this study were found to be younger with poor glycemic control and other vascular complications of diabetes. The presence of other complications of diabetes in DFS patients was found to be a predictor of pharmacotherapy and poor QOL.
ABSTRACT
Pharmacotherapy in critically ill is complicated by altered physiology, presence of multi organ system failure and utilization of multiple medications. The present study assessed the utilization pattern of gastrointestinal drugs among the inpatients of the intensive care unit. This prospective study was carried out in medical intensive care unit [ICU] of a tertiary care hospital. Case records of all inpatients of ICU were reviewed over a period of 12 months. The demographic data, clinical data, and drug details were recorded. Descriptive statistics was carried out. values are expressed as percentage, mean + SD and range. Of the 728 inpatients, a total of 695 patients received gastrointestinal drugs. Male to female ratio was 1:9. The mean age was 49.21 +/- 15.84 years with a range of 18-90 years. Drugs for gastrointestinal system and drug metabolism [ATC-A] [23.3%] were most commonly utilized drug class of all the drugs prescribed in the ICU. Among the anti-peptic ulcer agents, pantoprazole [A02BC02] [87%] and ranitidine [A02BA02] [9.7%] were the frequently prescribed drugs. Metoclopramide [A03FA01] [19.5%] was the most frequent prokinetic agent and ondansetron [A04AA01] [15%] anti-emetic agents. Lactulose [A06AD11] [11.7%] was the most common laxative given while Glycopyrrolate [A03BA01][6.3%] most frequent anti-secretory agent prescribed. Gastrointestinal drugs were the widely prescribed drug class among the critically ill prescribed both as prophylactic as well as therapeutic indications. Proton pump inhibitors were the acid suppressant therapy of choice, which require revision based on its recent findings on safety and efficacy in critically ill
ABSTRACT
BACKGROUND: Adverse drug reactions (ADRs) are important causes of hospital admissions and inpatient complications. Renal dysfunction has a role in occurrence of ADRs. AIMS: (1) To study the characteristics of ADRs among inpatients in Nephrology ward of a tertiary care hospital and (2) to compare these characteristics between patients with renal dysfunction and patients with normal renal function in same population of patients with ADRs. MATERIALS AND METHODS: A retrospective study of inpatients with ADRs (July 2005-June 2006) in Nephrology ward of a tertiary care hospital. STATISTICAL ANALYSIS: ADR characteristics were analyzed using descriptive statistics. Comparisons were made between normal renal function group and renal dysfunction group by t-test and Chi-square test. RESULTS: Of 1,464 case records, 244 (17%) patients were included. Two hundred sixty-seven drugs contributed to 294 ADRs. Serious ADRs accounted for 12% of the total ADRs. Renal/ electrolyte system (44%) was the most common organ system involved. Major clinical spectrum of ADRs included acute renal failure (22%), hypo/ hyperglycemia (13%), hyper/ hypokalemia (13%), bone marrow suppression (5%) and hepatic injuries (4%). Prednisolone (12%) was the most commonly implicated drug. Mean time to revert was 13+/-7.2 days. Three patients died. On comparing patients with normal renal function (n=80) with those suffering from renal dysfunction (n=164), polypharmacy, serious ADRs, multiple ADRs, longer time to recover, longer period of hospitalization were found to be more frequent among the renal dysfunction group (P CONCLUSIONS: High incidence of ADRs, especially serious and life-threatening ADRs, was noticed. A wide spectrum of ADRs was observed. Renal dysfunction showed a significant impact on various characteristics of ADRs.