Prescribing Cascade � What, When, How and the Ways to Mitigate

Rational prescribing is essential for adequate patient compliance and proper therapeutic outcome. Often medicines are prescribed randomly to take care of the drug induced adverse reactions without changing the culprit drug or modifying it抯 dose, rather commonly by adding another drug towards amelioration of the presenting complain, ignoring it抯 drug related occurrence. This 慞rescribing Cascade� turns out to be a vicious cycle by promoting polypharmacy thus leading to it抯 adverse consequences. This can happen to any person at any age but elderly population are more vulnerable because of their age related physiological changes and co-morbidities. There are several ways to curb the vicious cycle down like anticholinergic burden assessment, selecting the right drug for the right person, medication reconciliation etc.

Symmetrical peripheral gangrene complicating ventricular pseudoaneurysm: a report of an unusual case and a brief review of the literature

Abstract Symmetrical peripheral gangrene is an ischemic necrosis simultaneously involving the distal portions of two or more extremities without any proximal arterial obstruction or vasculitis. It may occur as a result of a large number of infectious and non-infectious causes. A few cases of symmetrical peripheral gangrene associated with cardiac disease have been described in the literature. We describe a case of symmetrical peripheral gangrene complicating ventricular pseudoaneurysm, probably a hitherto unreported occurrence. In this report, we sought to emphasize the importance of cardiac evaluation while dealing with a case of symmetrical peripheral gangrene.