An analysis of adverse drug reactions to radiographic contrast media reported during a 3 year period in a tertiary care hospital in south india.

Aim : The aim of this study was to analyse the nature and incidence of adverse drug reactions to radiographic contrast media (ionic and non ionic) reported during a 3 year period in a tertiary care hospital in South India. Methods : Adverse Drug Reactions (ADRs) to radiographic contrast media (ionic and non ionic) reported during a 3 year period to the pharmacovigilance centre, JIPMER, Pondicherry were retrospectively analysed for demographic profile, frequency, severity, causality and the temporal relationship of contrast administration to the occurrence of ADR. Results : A total of 99 ADRs were spontaneously reported from 63 patients. It included 38 (60.3%) males and 25 (39.7%) females. The most common ADRs were nausea 26 (26.5%), vomiting 33 (33.7%) and rashes 30 (30.6%). As per Naranjo’s algorithm and WHO causality assessment, all reactions were ‘probable’. According to the Hartwig severity scale, 60 reactions were mild (60.6%), 34 (34.3%) were moderate and 5 (5.1%) were severe. There was no fatality reported. Adverse events required treatment in 38 (60.3%) patients. Most of the reactions (n=48, 76.2%) occurred immediately after contrast administration. Five (7.9%) reactions occurred during contrast administration and 10 (15.9%) reactions occurred within the next 30 minutes after contrast administration. Among the ADRs reported, the proportion of mild reactions were significantly higher in patients who received ionic contrast (n=42) than those who received non-ionic contrast (n=21) (p<0.05). Conclusion : The common adverse reactions to contrast were nausea, vomiting and rashes. Most of the reactions occur immediately after administration of contrast and are of milder severity.

Novel applications of nanotechnology in medicine.

Current modalities of diagnosis and treatment of various diseases, especially cancer have major limitations such as poor sensitivity or specificity and drug toxicities respectively. Newer and improved methods of cancer detection based on nanoparticles are being developed. They are used as contrast agents, fluorescent materials, molecular research tools and drugs with targeting antibodies. Paramagnetic nanoparticles, quantum dots, nanoshells and nanosomes are few of the nanoparticles used for diagnostic purposes. Drugs with high toxic potential like cancer chemotherapeutic drugs can be given with a better safety profile with the utility of nanotechnology. These can be made to act specifically at the target tissue by active as well as passive means. Other modalities of therapy such as heat induced ablation of cancer cells by nanoshells and gene therapy are also being developed. This review discusses the various platforms of nanotechnology being used in different aspects of medicine like diagnostics and therapeutics. The potential toxicities of the nanoparticles are also described in addition to hypothetical designs such as respirocytes and microbivores. The safety of nanomedicine is not yet fully defined. However, it is possible that nanomedicine in future would play a crucial role in the treatment of human diseases and also in enhancement of normal human physiology.

Drug therapy in elderly.

Population aging is considered as the most serious problem in developed countries and is going to be a threat for developing countries. Aging is associated with various physiological changes and multiple diseases like diabetes, hypertension, arthritis etc. which alter the pharmacological response to a drug. Moreover, elderly people are more sensitive to frequently used drugs like NSAIDs, benzodiazepines, opioids etc. All these factors alter the drug response resulting in adverse drug reactions (ADRs) and hospitalization, consuming 40% of health service expenditure in developed countries. Hence it is mandatory for physicians to be aware of normal age related physiological and pharmacological changes taking place in old people. This will help to avoid irrational prescribing, minimize ADRs and maximize benefits of drugs in elderly patients. Above all educating the old patients and their care providers regarding the importance and proper use of drugs to their well being is necessary to improve adherence. Hence setting therapeutic guidelines for treating elderly patients will enhance their quality of life.