Adverse drug reactions & their risk factors among Indian ambulatory elderly patients.

Background & objectives: Several studies have reported adverse drug events ranging from 5 to 35 per cent in all age group from outpatient setting. However, adverse drug reactions (ADRs) particularly among a large sample of ambulatory elderly patients in India has not been reported. This study has attempted to identify ADRs and assessed their causality, preventability and severity, and also their risk factors in Indian ambulatory elderly patients. Methods: A 2 year long term prospective study included 4005 ambulatory elderly patients (60 yr or above; either sex) at a public teaching hospital. Suspected ADRs were assessed for causality, preventability and severity using Naranjo's probability scale, modified Schumock and Thornton's criteria, and modified Hartwig's criteria, respectively. Results: Of the total 4005 prescriptions, 406 were identified with ADRs, giving the occurrence of 10 per cent ADRs in elderly. The total number of ADRs was 422 in 406 prescriptions. Type A ADRs accounted for 46 per cent of the total ADRs. Majority of the ADRs (88.6%) were classified as ‘probable’. The definitely preventable reactions were 22 per cent. The percentage of moderate reaction was 16 per cent. Only 1.6 per cent ADRs was severe in nature. The most common type of ADR was peripheral oedema. The most commonly offending class of drug was cardiovascular drugs (57.6%). Using logistic regression analysis, the risk factors which contributed to ADRs were age above 80 yr (OR=1.7), prescription of multiple drugs (OR=1.8), longer duration of treatment (OR=2.28) and multiple diagnoses (OR=1.8). Interpretation & conclusions: In this study, 10 per cent ambulatory elderly patients were found to have ADRs. This indicates that the elderly patients should be closely monitored for ADRs, to avoid clinically significant harmful consequences. The awareness of risk factors of ADRs would help physicians to identify elderly patients with greater risk of ADRs and, therefore, might benefit from ADRs monitoring and reporting programme.

Heart involvement in disseminated cysticercosis- a case report and review of literature.

Heart involvement in cysticercosis is uncommon but is well described in literature. Most of the reports are in the form of autopsy studies. Here we describe a young female with asymptomatic involvement of the heart, diagnosed by echocardiography.

Achalasia cardia in mother and son.

Familial occurrence of achalasia cardia is rare. Most associations are among siblings or in monozygotic twins. Parent-child association is even rarer and only six such instances have been reported till date. We report a 29-year-old man with achalasia cardia and his mother who had the same illness two and half years later. Both of them were successfully treated with balloon dilatation.

Disseminated Cryptococcosis Mimicking Lymphoreticular Malignancy in a HIV Negative Patient

Disseminated cryptococcosis, a life threatening mycosis, usually presents with respiratory tract, central nervous system and skin involvement. Herein we report a case of disseminated cryptococcosis presenting with hepatic, lymph nodal and bone marrow involvement in addition to the central nervous system and lung involvement in a previously healthy, HIV negative individual. The unique presenting manifestation highlights the need for careful consideration of this entity in conditions mimicking disseminated tuberculosis and lymphoreticular malignancy.

Isolated nocardial subcapsular and perinephric abscess.

We report a rare presentation of Nocardia infection in a 60 years old diabetic and cirrhotic patient who had perinephric and subcapsular renal abscess. This localized type of infection was successfully treated with oral cotrimoxazole.

Comparative analysis of duodenal biopsy tissue orientation supported on vegetable matrix versus filter paper.

BACKGROUND: Biopsy tissue may get disoriented if filter paper is used as a supporting medium. Use of vegetable matrix (cucumber) as a supporting medium may obviate the need of lifting the tissue while making blocks and thus avoid disorientation that occurs during this step. OBJECTIVE: To compare the orientation of duodenal biopsy tissue supported on vegetable matrix (cucumber) and on filter paper. METHODS: Over one year, 40 patients (20 with large-volume diarrhea, 20 with dyspepsia) were included in the study. Two pairs of duodenal biopsy tissues were obtained during gastroscopy; one pair was placed on filter paper, the other on vegetable matrix. Tissue and vegetable matrix were embedded together while making blocks, whereas the tissue had to be lifted off in case of filter paper. Sections were stained and assessed for crypt-villous alignment, parallel orientation of crypts and presence of visible muscularis mucosae with the help of a scoring system. RESULTS: Compared to biopsy tissue supported on filter paper, vegetable matrix-supported tissues were better oriented. Scores were rated as bad, good and very good in 8, 11 and 21 vegetable matrix-mounted tissues and in 21, 11 and 8 filter paper-mounted tissues, respectively. CONCLUSION: Duodenal biopsy tissue supported on vegetable matrix (cucumber) is better oriented than that on filter paper.