Clinico etiological study of adverse cutaneous drug reactions

Background: Adverse cutaneous drug reactions (ACDR) are the most frequent ADRs (30-45%) and are responsible for about 2% of hospital admissions and few can result in significant morbidity, health care costs, hospitalization, and death. To study different clinical patterns of ACDR, assess the cause and identify the offending drug and to study the relationship of ACDRs to age and sex among patients referred to the department of DVL, NRI General Hospital.Methods: This is a retrospective study of 70 cases of colorectal carcinoma analysing incidence, clinicopathological features and outcome after different therapies including surgery, radiotherapy and chemotherapy. It was a descriptive hospital-based case series study. All out-patients and in-patients referred to the department of DVL, NRIGH, Chinakakani and in whom a diagnosis of ACDR is made, form the subjects for this study. The study was conducted over a period of two years.Results: 100 patients with adverse cutaneous drug reactions were included in the study. 42 (42%) were males and 58 (58%) were females. The age group ranged from 6 to 80 years with a maximum (43) belonging to 21 to 40 years. Maculopapular rash was most common followed by urticarial drug reaction, FDE, acneiform eruptions, EMF, erythroderma, DRESS, SJS, SJS/TEN, TEN and drug-induced hyperpigmentation. NSAIDs were the commonest culprits followed by antibiotics, antiepileptics and ATT.Conclusions: The commonest ACDR was maculopapular rash followed by urticaria, FDE and acneiform eruption. Antimicrobials as a group were the most common offending agents followed by individual drugs like diclofenac (13%), isoniazid (11%), efavirenz (9) and prednisolone (8%).

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A study of cutaneous adverse drug reactions in the outpatient department of Dermatology at a tertiary care center in Gujarat, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20171661 ◽

2017 ◽

Vol 6 (5) ◽

pp. 1115

Author(s):

Dinesh A. Chavda ◽

Satish D. Suthar ◽

Shradhanand Singh ◽

Jayesh D. Balat ◽

Sailesh P. Parmar ◽

...

Keyword(s):

Hospital Admissions ◽

Care Center ◽

Tertiary Care ◽

Maculopapular Rash ◽

Drug Reactions ◽

Female Ratio ◽

Drug Eruptions ◽

Male Preponderance ◽

Cutaneous Drug Reactions ◽

A Prospective Study

Background: The data for adverse cutaneous drug reactions (ACDRs) is limited in Gujarat. The ACDRs are one of the frequent ADRs and cause of significant morbidity and mortality in patients of all areas of healthcare today. They are responsible for significant number of hospital admissions. Thus, the present study emphasises on the need and importance of an effective pharmacovigilance programme.Methods: A prospective study was undertaken in a 183 cases tertiary care teaching hospital of India. Male to female ratio, most common class of drug, individual drug causing ACDR, common types of ACDRs Parameters were studied. Other Parameters like Causality, preventability and severe or non-severe reactions were analyzed.Results: Majority of the patients (48%) with CADR belonged to the age group 25-44 followed by 45-64 (28%). Most frequent adverse cutaneous drug reactions reported were Urticaria (40%), Maculopapular rash (25%) & Fixed drug eruptions (21%) in decreasing order of frequency. Majority of reactions (96%) were Bizarre/Unpredictable in nature. As a group, antimicrobials (46%) were most frequently associated with CADR followed by NSAIDs (31%) and antiepileptics (11%). Most of the reactions (93%) were mild-moderate and probable (77%) in nature. Approximately 60% of ACDRs reported in this study were preventable.Conclusions: There was slight male preponderance except acneiform eruptions. Cotrimoxazole being the most common offending drug then after Ibuprofen, Phenytoin among the anti-inflammatory, analgesics, antiepileptics class. Causality assessment resulted in high score 77% of probable category.

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Effects of the COVID-19 Epidemic on Hospital Admissions for Non-Communicable Diseases in a Large Italian University-Hospital: A Descriptive Case-Series Study

Journal of Clinical Medicine ◽

10.3390/jcm10040880 ◽

2021 ◽

Vol 10 (4) ◽

pp. 880

Author(s):

Caterina Caminiti ◽

Giuseppe Maglietta ◽

Tiziana Meschi ◽

Andrea Ticinesi ◽

Mario Silva ◽

...

Keyword(s):

Hospital Admissions ◽

Case Series ◽

Communicable Diseases ◽

University Hospital ◽

Negative Consequences ◽

Non Communicable Diseases ◽

Case Series Study ◽

And Gender ◽

Long Term Impact ◽

Series Study

Background: Concern is growing about the negative consequences that response measures to the COVID-19 epidemic may have on the management of other medical conditions. Methods: A retrospective descriptive case-series study conducted at a large University-hospital in northern Italy, an area severely hit by the epidemic. Results: Between 23 February and 14 May 2020, 4160 (52%) COVID-19 and 3778 (48%) non-COVID-19 patients were hospitalized. COVID-19 admissions peaked in the second half of March, a period characterized by an extremely high mortality rate (27.4%). The number of admissions in 2020 was similar to 2019, but COVID-19 patients gradually occupied all available beds. Comparison between COVID-19 and non-COVID-19 admissions in 2020 revealed significant differences concerning all age classes and gender. Specifically, COVID-19 patients were older, predominantly male, and exhibited more comorbidities. Overall, admissions for non-communicable diseases (NCDs) in 2020 vs. 2019 dropped by approximately one third. Statistically significant reductions were observed for acute myocardial infarction (−78, −33.9%), cerebrovascular disease (−235, −41.5%), and cancer (−368, −31.9%). While the first two appeared equally distributed between COVID-19 and non-COVID-19 patients, chronic NCDs were statistically significantly more frequent in the former, except cancer, which was less frequent in COVID-19 patients. Conclusions: Prevention of collateral damage to patients with other diseases should be an integral part of epidemic response plans. Prospective cohort studies are needed to understand the long-term impact.

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A Review of Adverse Cutaneous Drug Reactions Resulting from the Use of Interferon and Ribavirin

Canadian Journal of Gastroenterology ◽

10.1155/2009/651952 ◽

2009 ◽

Vol 23 (10) ◽

pp. 677-683 ◽

Cited By ~ 42

Author(s):

Nisha Mistry ◽

Jonathan Shapero ◽

Richard I Crawford

Keyword(s):

Side Effects ◽

Drug Reactions ◽

Drug Induced ◽

Common Cause ◽

Injection Site Reactions ◽

Drug Eruptions ◽

Fixed Drug ◽

Life Threatening ◽

Cutaneous Drug Reactions ◽

Systemic Drug

Drug-induced cutaneous eruptions are named among the most common side effects of many medications. Thus, cutaneous drug eruptions are a common cause of morbidity and mortality, especially in hospital settings. The present article reviews different presentations of drug-induced cutaneous eruptions, with a focus on eruptions reported secondary to the use of interferon and ribavirin. Presentations include injection site reactions, psoriasis, eczematous drug reactions, alopecia, sarcoidosis, lupus, fixed drug eruptions, pigmentary changes and lichenoid eruptions. Also reviewed are findings regarding life-threatening systemic drug reactions.

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Bibliometric analysis of adverse drug reactions and pharmacovigilance research activities in Nepal

Therapeutic Advances in Drug Safety ◽

10.1177/2042098620922480 ◽

2020 ◽

Vol 11 ◽

pp. 204209862092248

Author(s):

Sunil Shrestha ◽

Krisha Danekhu ◽

Bhuvan KC ◽

Subish Palaian ◽

Mohamed Izham Mohamed Ibrahim

Keyword(s):

Bibliometric Analysis ◽

Adverse Drug Reactions ◽

Case Reports ◽

Research Performance ◽

Case Series ◽

Original Research ◽

Drug Reactions ◽

Drug Induced ◽

Scientific Publications ◽

Research Activities

Background: Bibliometric analyses have been used previously to study the measures of quality and impact of research performed in several health-related areas such as adverse drug reactions (ADRs) and pharmacovigilance (PV), etc. This method can assess the research performance of publications quantitatively and statistically. There is no evidence of bibilometric studies analyzing ADRs and PV from Nepal. Therefore, the present study aimed to assess scientific output on ADRs and PV-related research activities in Nepal using a bibliometric analysis of publications from 2004 January to December 2018, that is, 15 years. Methods: A systematic search was conducted in PubMed, Web of Science, Google Scholar, Scopus and Nepal Journal Online (NepJOL) databases. ‘Adverse Drug Reactions‘ or ‘ADRs‘ or ‘ADR‘ or ‘Adverse drug reaction‘ or ‘AE‘ or ‘Adverse Event‘ or ‘Drug-Induced Reaction‘ or ‘Pharmacovigilance‘ or ‘PV‘ and ‘Nepal‘. The search covered 15 years (January 2004 to December 2018) of study on ADRs and PV in Nepal. Only articles retrieved from databases were included, whereas published/unpublished drug bulletins, pharmacy newsletters and thesis were excluded. The articles thus retrieved were recorded, and thereafter analyzed. Word count code was used for the analysis of keywords used in the retrieved articles. Results: A total of 124 articles were retrieved, with the highest rate of publications in 2006 and 2007, with 16 papers each. Among the articles, 10 (8.1%) were published in Kathmandu University Medical Journal (KUMJ). Single papers were published in 38 different journals. Brief reports (1.6%), case reports (31.2%), case series (0.8%), education forums (0.8%), letters to the editor (5.6%), original research articles (41.9%), review articles (9.7%), short communications and short reports (8.1%) on ADRs and PV were recorded. Out of 124 papers, 52 (41.9%) were original research publications. The majority (74.1%) of research was done in the category of ADR incidence, types, prevention, and management, followed by policy and suggestions for strengthening national and regional pharmacovigilance centers of Nepal (14.5%). Conclusions: During the study years, there was an increase in scientific publications on drug safety. A total of 124 published articles were found during bibliometric analysis of ADRs and PV research activities in Nepal.

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Cutaneous Drug Reactions and Drug-Induced Pruritus

Pruritus ◽

10.1007/978-3-319-33142-3_23 ◽

2016 ◽

pp. 169-182

Author(s):

Jacek C. Szepietowski ◽

Adam Reich ◽

Franz Legat

Keyword(s):

Drug Reactions ◽

Drug Induced ◽

Cutaneous Drug Reactions

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Adverse drug reactions in SARS-CoV-2 hospitalised patients: a case-series with a focus on drug–drug interactions

Internal and Emergency Medicine ◽

10.1007/s11739-020-02586-8 ◽

2020 ◽

Author(s):

Giada Crescioli ◽

Valentina Brilli ◽

Cecilia Lanzi ◽

Andrea Burgalassi ◽

Alessandra Ieri ◽

...

Keyword(s):

Adverse Drug Reactions ◽

Case Series ◽

University Hospital ◽

Drug Reactions ◽

Case Evaluation ◽

Hospitalised Patients ◽

Number Of Patients ◽

Case Series Study ◽

Caucasian Patients ◽

Series Study

AbstractDue to the need of early and emergency effective treatments for COVID-19, less attention may have been paid to their safety during the global emergency. In addition, characteristics of drug–drug interaction (DDI)-related adverse drug reactions (ADRs) in COVID-19 patients have not yet been studied in depth. The aim of the present case-series study is to describe clinical and pharmacological characteristics of SARS-CoV-2 hospitalised patients, focusing on ADRs, particularly those related to DDIs. We evaluated all reports of COVID-19 medication-related ADRs collected within the COVID-19 Units of Careggi University Hospital, Florence (Italy), between January 1st and 31st May 2020. Information regarding COVID-19 medications, patients’ demographic and clinical characteristics, concomitant drugs, ADRs description and outcome, were collected. Each case was evaluated for the causality assessment and to identify the presence of DDIs. During the study period, 23 Caucasian patients (56.5% males, mean age 76.1 years) experienced one or more ADRs. The majority of them were exposed to polypharmacy and 17.4% presented comorbidities. ADRs were referred to cardiovascular, psychiatric and gastrointestinal disorders. The most frequently reported preferred term was QT prolongation (mean QT interval 496.1 ms). ADRs improved or resolved completely in 60.8% of cases. For all patients, a case-by-case evaluation revealed the presence of one or more DDIs, especially those related to pharmacokinetic interactions. Despite the small number of patients, our evidence underline the clinical burden of DDIs in SARS-CoV-2 hospitalised patients and the risk of unexpected and uncommon psychiatric ADRs.

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HLA-B*58:01 Genotyping to Prevent Cases of DRESS and SJS/TEN in East Asians Treated with Allopurinol—A Canadian Missed Opportunity

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475419867599 ◽

2019 ◽

Vol 23 (6) ◽

pp. 595-601 ◽

Cited By ~ 2

Author(s):

Marisa Grace Ponzo ◽

Monica Miliszewski ◽

Mark G. Kirchhof ◽

Paul A. Keown ◽

Jan P. Dutz

Keyword(s):

Screening Test ◽

East Asian ◽

Geographic Area ◽

Vancouver General Hospital ◽

Stevens Johnson Syndrome ◽

Drug Reactions ◽

East Asians ◽

Drug Induced ◽

Asian Descent ◽

Cutaneous Drug Reactions

Background and objective East Asians exposed to the urate-lowering drug allopurinol have a predilection for severe cutaneous drug reactions such as drug-induced hypersensitivity syndrome or drug reaction with eosinophilia and systemic symptoms (DRESS) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Screening is recommended in patients of East Asian descent for the presence of HLA-B*58:01 prior to allopurinol initiation to avoid these complications. Utilization rates of the HLA-B*58:01 predictive screening test within the Greater Vancouver area, which has a population composed of 40.1% people of East Asian descent, are unknown. Measures We identified cases of DRESS or SJS/TEN due to allopurinol using the Vancouver General Hospital dermatology consult service database. We next compared the frequency in which the HLA-B*58:01 screening test was ordered since 2012 to the estimated frequency of new prescriptions for allopurinol prescribed for the management of gout among the East Asians. Results We report 5 cases of East Asian patients exposed to allopurinol for management of gout between 2012 and 2016, who developed DRESS (4 patients) or SJS/TEN (1 patient). All were of HLA-B*58:01 genotype, representing preventable cases. The HLA-B*58:01 test was ordered 6 times in 2012, whereas the estimated number of new cases of allopurinol-prescribed gout among patients of East Asian descent during that time period was 13. For 2012, testing was ordered for only 46% of at-risk patients. Conclusion We continue to observe cases of severe cutaneous drug reactions among high-risk individuals due to allopurinol exposure. The HLA-B*58:01 screening test for allopurinol hypersensitivity is underutilized in our geographic area.

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Pharmacogenomics of Allopurinol and Sulfamethoxazole/Trimethoprim: Case Series and Review of the Literature

Journal of Personalized Medicine ◽

10.3390/jpm11020071 ◽

2021 ◽

Vol 11 (2) ◽

pp. 71

Author(s):

Ogechi Ikediobi ◽

Jeremy A. Schneider

Keyword(s):

Adverse Drug Reactions ◽

Drug Targets ◽

Case Series ◽

Human Leukocyte ◽

Hypersensitivity Syndrome ◽

Outpatient Setting ◽

Stevens Johnson Syndrome ◽

Review Of The Literature ◽

Drug Reactions ◽

Drug Induced

Severe cutaneous adverse drug reactions (SCAR) such as the Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome (DIHS) can be induced by a plethora of medications. The field of pharmacogenomics aims to prevent severe adverse drug reactions by using our knowledge of the inherited or acquired genetic risk of drug metabolizing enzymes, drug targets, or the human leukocyte antigen (HLA) genotype. Dermatologists are experts in the diagnosis and management of severe cutaneous adverse drug reactions (SCAR) in both the inpatient and outpatient setting. However, most dermatologists in the US have not focused on the prevention of SCAR. Therefore, this paper presents a case series and review of the literature highlighting salient examples of how dermatologists can apply pharmacogenomics in the diagnosis and especially in the prevention of SCAR induced by allopurinol and sulfamethoxazole/trimethoprim, two commonly prescribed medications.

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Commercial Cannabinoid Oil-Induced Stevens-Johnson Syndrome

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/6760272 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Han Y. Yin ◽

Nicholas Hadjokas ◽

Kanish Mirchia ◽

Robert Swan ◽

Samuel Alpert

Keyword(s):

Total Body Surface Area ◽

Supportive Therapy ◽

Maculopapular Rash ◽

Acute Onset ◽

Stevens Johnson Syndrome ◽

Drug Reactions ◽

Drug Induced ◽

Johnson Syndrome ◽

Eye Involvement ◽

Total Body

Purpose. To report an unusual presentation of commercial cannabidiol (CBD) oil-induced Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS-TEN). Methods. A 56-year-old woman presented with acute onset of a diffuse, blistering, maculopapular rash with over 30% total body surface area (BSA) involvement two days after taking CBD oil sublingually for chronic pain. Biopsy confirmed SJS-TEN. Ophthalmology was consulted and mild eye involvement was found. She was started on topical cyclosporine, prednisone, moxifloxacin, and erythromycin ointment to prevent progression, which was successful. She was otherwise treated with supportive therapy in the intensive care burn unit and ultimately passed away from septic shock. Conclusion. In this case, we described an unusual drug-induced SJS from a commercial, non-FDA-regulated cannabis product. The use of a commercial CBD product should be cautioned due to potential for series of drug reactions to the cannabis product and the risk for reaction to other unregulated other pharmacological components.

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Clinical presentation of Long QT Syndrome in a case series study in Iraq

Journal of the Faculty of Medicine Baghdad ◽

10.32007/jfacmedbagdad.6231753 ◽

2020 ◽

Vol 62 (3) ◽

Author(s):

AMAR Talib AL-HAMDI

Keyword(s):

Long Qt Syndrome ◽

Qt Interval ◽

Beta Blockers ◽

Case Series ◽

Long Qt ◽

Drug Induced ◽

Arrhythmic Death ◽

Case Series Study ◽

Qt Syndrome ◽

Series Study

Background: Long QT syndrome is an important cause of arrhythmic death, and it is characterized by electrocardiographic changes and a prolonged QT interval. Patients may present with sudden cardiac death, recurrent syncope, and palpitation.Objective: Clinical orientation for the Long QT syndrome and minimizing its misdiagnosis to achieve high diagnostic index.Patients and Methods: Patients presenting with ventricular arrhythmias, syncope, dizzy spells, and prolonged, non-drug-induced QT interval from 2004 uptil 2019 at Al Nasirya Heart Center , Al Sulaimanya Heart Hospital, and Al Nahrain Teaching Hospital were enrolled in this study. All aptients studied clinically and followed up. Management included beta blocker drug therapy and ICD implantation.Results: Forty-two patients were included within 15 years, comprising 22 pediatric and 20 adult patients (26 males, 16 females). Ventricular fibrillation reported in 18 patients and ventricular tachycardia in five patients. Thirty-eight patients received beta blockers, and 85% showed marked reduction in ventricular arrhythmia events. Implantable cardioverter-defibrillator (ICD) was implanted in 34 patients.The diagnosis of Long QT syndrome was missed in 85% of cases during the provisional medical contacts .Conclusion: In this case series study patients with LQTS presented with syncope, recurrent dizzy spells or palpitation. The diagnosis requires high index of diagnostic suspicion.This case study is intended to orient physicians to diagnosis this fatal problem.

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