A study on adverse drug reactions to non-ionic contrast medium in an Indian population: a 1-year experience.

Background: To the best of our understanding, very few studies focusing on the adverse drug reaction (ADR) profile of non-ionic contrast medium (NICM) has been carried out until date among the Indian population. Hence, this study was planned. We sincerely believe that the knowledge gathered from this study can improve safer usage of these agents among the patients of Indian origin. The objective was to evaluate the incidence and severity of ADRs of non-ionic radio contrast media (CM) used in tertiary care hospital in Eastern India. Methods: For the duration of 1-year from July 2011 to July 2012, we prospectively recorded all the ADRs associated with the administration of NICM (iohexol and ioversol) in 3708 patients of Indian origin undergoing computed tomography scan at the hospital. The average median age, weight, dose used; types of ADRs, concomitant medication, final diagnosis, reasons for use were recorded and analyzed with appropriate statistical tools. Causality assessment was performed using Naranjo scale. Results: Eleven of 3708 patients who received either ioversol or iohexol developed ADRs (i.e. 0.3% of patients). The most common ADR was rigor. The incidences of mild, moderate and severe reactions were 55%, 36% and 9%, respectively. Average median age, weight, and dose used were 35 years, 66 kg and 70 ml, respectively. All the ADRs were early (occurred within 1 hr of CM administration). Due to logical constraints, the follow-up of these patients was not possible and hence late ADRs were not captured. The common concomitant medication used was pantoprazole (63.63% of patients). The difference in the incidence of ADRs by age distribution (Group 1 - Iohexol, Group 2 - Ioversol) and weight distribution was not statistically significant (p=0.75 and p=0.18, respectively). Causality analysis revealed that all the ADRs were possible (Score of 4). Interestingly, the incidence of reactions was noted to be higher in patients with a history of gastro intestinal disorders (45.45%). Conclusions: This pilot study reveals that adverse reactions to NICM are rare and severe reactions are less common among the patients of Indian origin. However, a larger multicentric study across the country should be carried out to understand the safety profile of these CM better among the Indian population.

Blood transfusion is associated with increase resource utilization and bacterial infection

To observe the association of blood transfusion and clinical outcome in cardiac surgery patients. Forty patients underwent cardiac surgery during a period of two months in a single institution. Coronary artery bypass surgery [CABG] was performed in 21 [52.5%] patients, Mitral valve replacement [MVR] in 15 [37.5%] patients, aortic valve replacement [AVR] in 2 [5%] patients and Atrial septal defect [ASD] was closed in 2 [5%] patients. The mean age of the patients were 41.7 +/- 18 years, 80% were male. Twenty five [62.5%] patients required blood transfusion. Transfusion group showed chest wound infection [7.5%], pulmonary oedema [12.5%] and shortness of breath [10%]. Total leukocyte count and platelets count were significantly lower in transfusion group. We conclude that blood transfusion is associated with increased rate of infection and pulmonary oedema, with high cost and resource utilization. Blood transfusion should be used with appropriate caution

Fine needle aspiration cytology; evaluation in the diagnosis of lymphadenopathy in children

Lymph nodes are frequently enlarged in children in a wide spectrum of diseases, some are of great concern while others are trivial from clinical or diagnostic point of view. To evaluate the diagnostic role of fine needle aspiration cytology in lymphadenopathy in pediatric age group. Jan2001 to Aug 2005. The material was obtained by FNA from children of the region, stained with H and E, papaniculau, giemsa and Z.N Stain. History, physical examination and other pertinent clinicopathological parameters were noted before the FNA procedure. The biopsy material where available was subsequently correlated with FNA diagnosis. A total number of 120 cases were included in the study. Out of these 64 were females and 56 were males. Out of non malignant cases the most common diagnosis in our cases was reactive lymphadenitis. Fine needle aspiration cytology is a reliable easy and economic technique of diagnosis. It should particularly be adopted in children to avoid unnecessary stop of surgery and mental trauma as fairly accurate cytodiagnosis is possible especially when majority of the cases of lymphadenopathy are inflammatory in nature

Left atrial myxoma: a clinical rarity in paediatrics

Primary cardiac tumours are very rare in paediatric age group and myxoma is the rarest among them. In young age group the symptoms and signs are variable and can make the diagnosis difficult. We present a case of left atrial myxoma in a nine year old boy, which remained undiagnosed for many days after the onset of symptoms of congestive cardiac failure. Two dimensional echocardiography enabled us to arrive at correct diagnosis

Serum bilirubin levels in neonates and children from Basrah

Serum bilirubin levels were estimated in normal healthy newborns [199]; full term babies [70] aged between 24 and 120 hours and 199 children aged between 1 month and 15 years. The mean [and standard deviation] of cord blood serum bilirubin was 1.3 [0.54] mg/dL. Serum bilirubin from full term babies and children was 4.68 [2.0] mg/dL and 0.71 [0.34] mg/dL respectively. There was no significant differences between males and females in all age groups, except in full term babies at the fifth day of life [p = 0.01]. These data could be used as initial values for the concentration of serum total bilirubin in Iraqi newborns, infants and children

Plasma cholesterol and triglycerides level in patients with sickle cell disease in Basrah

To determine the effect of anemia due to genetic red cell defects on the value of plasma lipids, the level of plasma cholesterol and triglycerides was estimated in a group of 74 patients with sickle cell disease [39 Hb AS and 35 Hb SS] and 50 age and sex matched control group with normal haemo-globin [Hb AA]. The level of plasma cholesterol was lower in sickle cell patients as compared with the normal control group and the difference was found to be statistically significant [P < 0.001]. The possible role of hypocholesterolaemia in those patients was discussed