SAFETY REPORTING STUDY OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

Background: The nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently used drugs to treat pain and inflammation. Although NSAIDs are having enormous clinical use, but are not devoid of adverse drug reactions (ADRs) as peptic ulcer, gastritis, renal, neurological reactions etc. Methods: Total 500 Orthopaedic out-patients of SIMS, Hapur were enrolled in the study to observe the risk of ADRs due to NSAIDs. All the ADRs were further analysed in relation to age, sex, types of drug and its pattern etc. The causality was analysed by using Naranjo’s Algorithm and severity was analysed by using the Hartwing and Siegel scale. Results: In this study the incidence rate of the ADRs was around 5.6%. Among the 28 patients who had developed ADRs, a total 10 kinds of ADRs were observed. The reactions that affected the study subjects were gastritis, nausea, vomiting, abdominal Pain, diarrhoea, urticaria, pruritus, headache, rash, ankle oedema and dizziness. Majority (23 cases) of ADRs were mild in their severity and that 5 cases ADRs were moderate in nature. All the ADRs were treated symptomatically by using standard treatment protocols. Conclusion: In this study, incidence of adverse reactions to nonsteroidal anti-inflammatory drugs was 5.60% and the most common implicated drug for the ADRs were Diclofenac sodium. Most of the adverse effects were mild and tolerable. Keywords: Adverse drug reactions, Nonsteroidal anti-inflammatory drugs, Pharmacovigilance

Effusive-constrictive cholesterol pericarditis: a case report

Background Cholesterol pericarditis (CP) remains a rare pericardial disease characterized by chronic pericardial effusions with high cholesterol concentrations with or without the formation of cholesterol crystals. Effusions are often large and can cause ventricular compression and subsequent pericardial adhesion formation. CP can be idiopathic but has associations with rheumatoid arthritis (RA), tuberculosis and hypothyroidism. Case summary We present a case of a 72-year-old male with a background of seropositive RA with a finding of an incidental pericardial effusion on computed tomography thorax abdomen and pelvis. Transthoracic echocardiogram demonstrated a large effusion with echocardiographic features of tamponade. On review, he was breathless with a raised venous pressure, bilateral ankle oedema, and pulsus paradoxus was present. Pericardial drainage was performed with fluid analysis demonstrating a cholesterol concentration of 8.3 mmol/L and numerous cholesterol crystal formation. Interval imaging demonstrated recurrence of the effusion with pericardial thickening and progressive constriction. He remained asymptomatic and underwent a successful pericardial window. At present, he is under close clinical outpatient surveillance with symptoms guiding a future pericardiectomy if warranted. Discussion CP can present as an emergent situation with signs and symptoms of acute heart failure with prompt pericardiocentesis required in cases of clinical tamponade. However, the disease course is often one of chronicity with relapsing large effusions that tend to recur following drainage, with the development of pericardial constriction necessitating pericardiectomy for definitive management.

Glucocorticoids

Glucocorticoids still are the most effective, broadly applicable, and cheapest immunosuppressive drugs used in the treatment of rheumatic conditions. In rheumatoid arthritis (RA) they are applied for their symptomatic effects but also for disease-modifying properties. The risk of adverse effects of glucocorticoid therapy in RA is dependent on patient (age, comorbidity, and comedication), glucocorticoid dose, type and route of administration, and treatment duration. Toxicity is important in treatment decisions, but for low-dose glucocorticoids, overestimation of the risk of adverse effects should be avoided. Monitoring safety of this therapy only requires that good follow-up of rheumatic patients in daily practice is extended with screening for osteoporosis, and pretreatment assessments of fasting blood glucose levels, risk factors for glaucoma, and a check for ankle oedema.

Management of Hypertension with Conventional and Herbals Drugs

In this article, we have discussed about Types (primary, secondary, isolated, white coat, malignant, resistant and pulmonary hypertension), classification, adverse drug reactions of antihypertensive drugs (beta-blocker induce psoriasis and calcium channel blocker cause peripheral oedema. ACE inhibitor produce ankle oedema and thiazide diuretics causes hypenatremia and also hyperglycaemia. These are some of the serious adverse drug reactions associated with patients who are being treated with these drugs), measurement, management, diagnosis and associated diseases (e.g. diabetes mellitus, heart disease, cerebrovascular disease) lastly concluded about the herbal approach for management of hypertension . Keywords: Hypertension, conventional drugs, Herbal drugs

Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study

Background: Chronic telogen effluvium (CTE) may be primary or secondary to various causes, including drug reaction, nutritional deficiency and female pattern hair loss (FPHL). Oral minoxidil stimulates hair growth, and topical minoxidil is used in the treatment of FPHL and male androgenetic alopecia. minoxidil has not been used to treat CTE. This study aimed to assess the treatment of CTE with once daily oral minoxidil. Methods: Women with a diagnosis of CTE based on >6 month history of increased telogen hair shedding, no visible mid frontal scalp hair loss (Sinclair stage 1) and no hair follicle miniaturization on scalp biopsy were treated with once daily oral minoxidil. Hair shedding scores (HSS) at baseline, 6 and 12 months were analysed using the Wilcoxon rank sum test for pair-wise comparisons. Results: Thirty-six women were treated with oral minoxidil (range, 0.25-2.5 mg) daily for 6 months. Mean age was 46.9 years (range 20-83), HSS at baseline was 5.64, and duration of diagnosis was 6.55 years (range 1-27). There was a reduction in mean HSS scores from baseline to 6 months of 1.7 (p<0.001) and baseline to 12 months of 2.58 (p<0.001). Five women who described trichodynia at baseline, noted improvement or resolution within 3 months. Mean change in blood pressure was minus 0.5 mmHg systolic and plus 2.1 mmHg diastolic. Two patients developed transient postural dizziness that resolved with continued treatment. One patient developed ankle oedema. Thirteen women developed facial hypertrichosis. For 6 patients this was mild and did not require treatment; 4 had waxing of their upper lip or forehead; 3 had laser hair removal. No patients developed any haematological abnormality. All 36 women completed 12 months of treatment. Conclusions: Once daily oral minoxidil appears to reduce hair shedding in CTE. Placebo controlled studies are recommended to further assess this response.

Primary care REFerral for EchocaRdiogram (REFER) in heart failure: a diagnostic accuracy study

BackgroundSymptoms of breathlessness, fatigue, and ankle swelling are common in general practice but deciding which patients are likely to have heart failure is challenging.AimTo evaluate the performance of a clinical decision rule (CDR), with or without N-Terminal pro-B type natriuretic peptide (NT-proBNP) assay, for identifying heart failure.Design and settingProspective, observational, diagnostic validation study of patients aged >55 years, presenting with shortness of breath, lethargy, or ankle oedema, from 28 general practices in England.MethodThe outcome was test performance of the CDR and natriuretic peptide test in determining a diagnosis of heart failure. The reference standard was an expert consensus panel of three cardiologists.ResultsThree hundred and four participants were recruited, with 104 (34.2%; 95% confidence interval [CI] = 28.9 to 39.8) having a confirmed diagnosis of heart failure. The CDR+NT-proBNP had a sensitivity of 90.4% (95% CI = 83.0 to 95.3) and specificity 45.5% (95% CI = 38.5 to 52.7). NT-proBNP level alone with a cut-off <400 pg/ml had sensitivity 76.9% (95% CI = 67.6 to 84.6) and specificity 91.5% (95% CI = 86.7 to 95.0). At the lower cut-off of NT-proBNP <125 pg/ml, sensitivity was 94.2% (95% CI = 87.9 to 97.9) and specificity 49.0% (95% CI = 41.9 to 56.1).ConclusionAt the low threshold of NT-proBNP <125 pg/ml, natriuretic peptide testing alone was better than a validated CDR+NT-proBNP in determining which patients presenting with symptoms went on to have a diagnosis of heart failure. The higher NT-proBNP threshold of 400 pg/ml may mean more than one in five patients with heart failure are not appropriately referred. Guideline natriuretic peptide thresholds may need to be revised.