Medication Errors Associated with Look-alike/Sound-alike Drugs: A Brief Review.

The existence of confusing drug names is one of the most common causes of medication errors. There are many types of medication errors: wrong drug, wrong dose, wrong route of administration, wrong patient etc. Misreading medication names that look similar is a common mistake. These look-alike medication names may also sound alike and can lead to errors associated with verbal prescriptions. Similar sounding drugs may produce confusion and may lead to unintended interchange of drugs causing harm to patients or even patient death. The main aim of the study was to evaluate medication errors related to look alikesound alike drug names and to find out the strategies to prevent these medication errors.

A 16-Year-Old Female with Peutz-Jeghers Syndrome.

Peutz-Jeghers syndrome is a rare autosomal dominant disorder of hamartomatous polyposis of the gastrointestinal tract, with pigmentation around lips and macules on the buccal mucosa that typically manifests itself as recurrent colicky abdominal pain and intestinal obstruction due to intussusception. Here we report a case of a 16-year-old girl who presented with abdominal pain, vomiting and previous history of laparotomy for intussusception. Multiple well demarcated black pigmented macules on lips, perioral region, buccal mucosa, digits, palms and soles were noted. She was diagnosed as a case of Peutz-Jeghers syndrome and managed conservatively.

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.

Tragedy in Savar: Management of Victims in Enam Medical College Hospital.

Background: Rana Plaza collapse is the worst and deadliest man-made industrial disaster in the history of garment sector in the world. Around 1200 people died and thousands more were injured. Most of the victims of the disaster were treated in Enam Medical College Hospital (EMCH). We conducted this study to give an overview on the disaster victims and services provided by EMCH. Objective: The study was done to observe the length of time between accident and admission in EMCH, length of time between admission and discharge, to observe the numbers, types and sites of injuries to the victims, medical measures given to the victims and finally to observe the status of the victims at the time of discharge. Materials and Methods: This descriptive type of observational study was carried out among the victims of Rana Plaza tragedy during the period of May to October 2013. All admitted patients in EMCH were included in the study. Purposive nonprobability sampling technique was applied in this research work. Data were collected from the hospital record. After collection, data were manually compiled, edited and analyzed. Results: Among 621 victims treated in different wards, 276 (44.45%) were admitted to the hospital on the day of accident. Among the admitted patients, 255 (41.06%) stayed in the hospital for 1--3 days,133 (21.42%) for 4--7 days and 88 (14.17%) for more than 10 days. Fracture and dislocation were present in 32.70% patients, lacerated injury in 18.20%, abrasion in 15.78%, bruise in 13.53%, incised wound in 15.45% and punctured wound in 4.34% patients. Single injury was present in 56.68% and rest had multiple injuries. Lower limbs were the most (33.01%) affected part of the body followed by head and neck (22.06%), upper limbs (18.52%), thorax (17.55%) and abdomen (8.86%). Two hundred seventy two patients (43.80%) were improved after treatment and 56 (9.02%) were fully cured; 23.83% of the victims were referred to higher medical centers for special measures. Conclusion: The collapse of Rana Plaza has fueled a greater call for reform and safety in garment industry. At the same time, all health care centers should adopt a broad-based approach to disaster-preparedness by providing a framework to ensure a well-coordinated response to mass casualty event.

Cough Variant Asthma in Medical Outpatient Department of a Tertiary Care Hospital in Bangladesh.

Background: Cough variant asthma (CVA) is a subset of asthma where the only symptom is chronic persistent cough. Many cases go unrecognized due to lack of proper evaluation. Response to asthma medication with features supportive of airway hypersensitivity helps in management of this disease. Objective: To find out the proportion of cough variant asthma among the patients attending medicine outpatient department of Enam Medical College, Savar, Dhaka. Materials and Methods: This cross sectional study was conducted in Enam Medical College Hospital, Savar, Dhaka over a period of two years from July 2009 to July 2011. Cough variant asthma was diagnosed mainly on clinical ground as chronic cough without wheezing, fever, weight loss, shortness of breath or sputum or any other apparent cause that persisted for more than eight weeks with absolutely normal physical examination of chest, normal chest radiography and blood count except raised eosinophil count and IgE level. Patients who met these criteria were given 2 weeks course of inhaler beclomethasone propionate and were assessed for improvement. Those who improved after steroid inhalation were categorised as having cough variant asthma. Results: Out of purposively selected 148 patients complaining only of chronic dry cough for more than eight weeks, 92 patients met the primary selection criteria for cough variant asthma. These 92 patients were given 2 weeks trial of 250 μgm beclomethasone inhalation twice daily. Seventy nine patients reported almost complete recovery from chronic cough after 2 weeks and were categorized as having CVA. Thirteen patients did not improve and were not categorized as CVA. Conclusion: These findings suggest that cough variant asthma is the most common among the patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of this disease.

Ice-on-Eyes Test in the Diagnosis of Myasthenia Gravis.

Myasthenia gravis is the most frequent autoimmune neuromuscular transmission disorder with incidence of 2-20 patients per million. Its pathophysiology is autoimmune, with acetylcholine receptor auto antibodies damaging the post-synaptic fold at the muscle membrane. The diagnostic confirmation of myasthenia gravis is often challenging. Ice-oneyes test can be used to diagnose this disease for its simplicity, safety and cost-effectiveness. Here we report a case of myasthenia gravis in Enam Medical College Hospital, Savar, Dhaka where ice-on-eyes test was done with improvement of ptosis of the patient. Aim of this case report is to make aware our physicians to apply this simple bed side test instead of common traditional edrophonium (tensilon test) test for confirmation of the diagnosis of ocular myasthenia gravis.

Pattern of Poisoning Cases in a Tertiary Hospital in Bangladesh.

Background: Poisoning with various substances is a global problem. It is one of the most important reasons for emergency admission in the hospital. The earlier the initial resuscitations, gastric decontamination and use of specific antidotes, the better is the outcome. Epidemiology of poisoning differs from region to region. This study was carried out to determine the pattern and severity of poisoning in a tertiary care hospital. Objective: To characterize the poisoning cases admitted in Enam Medical College Hospital. Materials and Methods: All cases admitted to the emergency department of Enam Medical College Hospital during the period of April to December, 2010 were evaluated retrospectively. We reviewed data obtained from the hospital medical records and included the following factors: demographic characteristics, etiology and outcome of the acutely poisoned patients. Total 84 poisoning cases were found and they were included in the study. Results: The overall case fatality rate was 3.5%. More detailed data from 2010 reveals that two-thirds of the patients were 20-30 years old, 53% male and 47% female. Organophosphorus was the most common cause (73.9%) followed by unknown poisoning (9.5%), sedative (5.9%), harpic (4.7%), aluminium phosphide (2.4%), savlon (1.2%), paracetamol (1.2%) and amitryptiline (1.2%). 90.5% cases were suicidal and 9.5% were homicidal. Conclusion: This study provides important information on the characteristics of the poisoning in this region. Community education about the danger of the drugs and reduction of exposure to pesticides are recommended.