Evaluation of potential drug-drug interactions in intensive care unit.

OBJECTIVE: Potential drug-drug interactions (pDDIs) and adverse drug reactions (ADRs) may be frequently observed in critically ill patients because of multiple drug use. It is important to identify pDDIs before their progression to ADRs. This study aimed to determine the prevalence and effect of pDDIs and possible ADRs in intensive care patients. PATIENTS AND METHODS: In this retrospective cross-sectional study, the medical records of patients in the intensive care unit (ICU) of Bursa Uludag University Faculty of Medicine Hospital between January 1, 2018, and December 31, 2018, were examined. Medication orders were recorded on days 2, 5, and 10. pDDIs, defined using the lexi-interact (UpToDate, 2020), were classified based on the significance level. RESULTS: A total of 144 patients were included in this study, and from the 395 medication orders, 1,776 had pDDIs. Of these interactions, 23.5% were major (n = 418), 71.4% were moderate (n = 1268), and 5.1% (n = 90) were minor. The majority of patients (96.9%) had at least one pDDI. There was a strong correlation between the number of drugs on days 2, 5, and 10 and the number of pDDIs (p < 0.001, ρ = 0.7; p < 0.001, ρ = 0.72; p < 0.001, ρ = 0.73, respectively). No significant correlation was found among the number of pDDIs, the APACHE II score, and the duration of ICU stay. CONCLUSIONS: The prevalence of pDDIs was high and there was a strong correlation between the number of drugs and pDDIs. Detection of potential interactions through clinical decision support systems and checker tools should be used to increase patient safety.

HMGCR and ApoE mutations may cause different responses to lipid lowering statin therapy.

Coronary artery disease (CAD) and its complications are the major causes of death in the world. Although statins have been used to lower lipid levels in CAD patients, this goal can not be attained in 1/3 of the patients. The objective of this study was to investigate whether common variations in HMG-CoA Reductase(HMGCR) and Apolipoprotein E (ApoE) genes involved in lipid and statin metabolism modify the effect of statins on serum lipid and lipoprotein concentrations in CAD patients.A hundred  CAD patients were enrolled into the study. At the beginning of the study biochemical measurements were performed to determine the baseline levels performed. Patients were treated with 40 mg atorvastatin for 2 months and biochemical measurements were repeated. According to the post-treatment, LDL-c levels,  patients were divided into 2 groups as non-responders and responders, respectively. The information regarding the risk factors such as smoking, alcohol consumption etc. were also obtained. DNA was isolated from peripheral blood. The presence of rs17244841 ve rs17238540 mutations in HMGCR and ε2, ε3 and ε4 variants of ApoE were determined by using RT-PCR. Results were evaluated statistically. HMGCR mutatations were mostly found in responders and ε4 variant of ApoE was mostly found in non-responders. It was also found that presence of HMGCR mutations causes a significant reduction in total cholesterol and LDL-c levels. Also presence of ε2 variant of ApoE causes a statistically significant increase in trigliseride levels. Our findings should be investigated with other researchers to clarify the mechanism.

[Ethnic rhinoplasty - type changing or type preserving?]. / Ethnische Rhinoplastik - typverändernd oder typerhaltend?

INTRODUCTION: We observe an annual augmentation of rhinoplasties to patients with migration background. This article illustrates the special features of the design and procedure of the operation considering the ethnic factors. METHODS: We present a review of patients with Middle Eastern origin, their nasal characteristics, their psychological specificities, specific expectations and some surgical concepts referring to a selective literature review. RESULTS: The Middle Eastern nose with a few exceptions offers a combination of specific characteristics. This requires detailed discussions and a thorough preoperative evaluation. More-over, both the psychological specificities and the expectations of patients should not be disregarded. The treatment of patients with a Middle Eastern background requires a particular empathy. In addition to the anatomic characteristics, expectations, role models and the ethnic behaviour in the pre- and postoperative period must all be considered. In the expectations of the patients the surgeons should be familiar with the Middle Eastern role models. The possibilities and the surgical limits can be discussed in detail with the patient and unrealistic expectations should be avoided. CONCLUSION: The increased mix of ethnic groups requires a new approach to aesthetic rhinoplasty, which aims primarily to provide individual solutions. Middle Eastern noses represent one of the most demanding challenges in rhinoplasty which lead to dramatic changes and to deeply grateful patients for which a lot of experience is required. Therefore the surgeon has to be highly specialised in Middle Eastern Nose rhinoplasty.