Uday Venkat Mateti

Drug–drug Interactions in Hospitalized Cardiac Patients

Drug-drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. DDI in patients receiving multidrug therapy is a major concern. The aim of the present study was to assess the incidence and risk factors of DDIs in patients admitted in cardiology unit of a teaching hospital. A prospective, observational study was carried out for a period of 3 months (April-July 2009). During the study period, a total of 600 prescriptions were analyzed and it was found that 88 patients had at least one DDI. The percentage of DDIs was higher in females compared to males (56.82% vs. 43.18%). DDIs were observed more in the age group of 60 years and above (57.96). Patients with more than 10 prescribed drugs developed DDIs more frequently [58 (65.91%)]. Heparin [55 (62.25%)] and aspirin [42 (47.72%)] were the most common drugs responsible for DDIs. Bleeding was the commonest clinical consequence [76 (86.63%)] found in this study population. On assessment of severity of DDIs, majority of the cases were classified as moderate in severity (61.36%). Aging, female gender and increase in concurrent medications were found to be associated with increased DDIs. Patients having these risk factors can be actively monitored during their stay in the cardiology department to identify DDIs.

Preparation, validation and user-testing of pictogram-based patient information leaflets for hemodialysis patients.

Background: Patient information leaflets are universally-accepted resources to educate the patients/users about their medications, disease and lifestyle modification. Objectives: The objective of the study was to prepare, validate and perform user-testing of pictogram-based patient information leaflets (P-PILs) among hemodialysis (HD) patients. Methods: The P-PILs are prepared by referring to the primary, secondary and tertiary resources. The content and pictograms of the leaflet have been validated by an expert committee consisting of three nephrologists and two academic pharmacists. The Baker Able Leaflet Design has been applied to develop the layout and design of the P-PILs. Results: Quasi-experimental pre- and post-test design without control group was conducted on 81 HD patients for user-testing of P-PILs. The mean Baker Able Leaflet Design assessment score for English version of the leaflet was 28, and 26 for Kannada version. The overall user-testing knowledge assessment mean scores were observed to have significantly improved from 44.25 to 69.62 with p value <0.001. Conclusion: The overall user opinion of content and legibility of the leaflets was good. Pictogram-based patient information leaflets can be considered an effective educational tool for HD patients.

Drug utilization pattern in South Indian pediatric population: A prospective study

Background: Studies on the process of drug utilization focus on factors related to prescribing, dispensing, administering and taking of medication and its associated events. Aims: The aim of this study is to assess the prescribing patterns of medicines, apply the World Health Organization (WHO) core indicators and to assess the appropriateness of prescribed medicines in a pediatric unit. Materials and Methods: A prospective observational drug utilization study was carried out in a pediatric unit of a super specialty hospital in South India for a period of 9 months. Patients who attended the pediatric unit with the age newborn to 18 years were included in the study and patients who were not willing to participate in the study were excluded and the data collected from the pediatric unit were analyzed. Results: Out of 209 patients, the average number of drugs per patient was 4.56. The percentage of drugs prescribed with the generic name was found to be 19.16%. Among 209 prescriptions 49.78% of the drugs were essential drugs. Among the antibiotics 33.33% prescribed, cephalosporin group were the most commonly prescribed followed by amino glycoside and penicillin. Nearly, 21.80% of the medicines were given as intravenous and the prescriptions without drugs were 1.43%. Only 75.6% of patients have knowledge about their dosage schedule and almost all the prescriptions were appropriate. Conclusion: The assessment of WHO core indicators helped to improvise the prescribing pattern, identify significant problems involved in the knowledge gap of patients or caretakers understanding of instructions provided by consultants and even to minimize the cost burden on patient.

Predictors of warfarin-induced bleeding in a South Indian cardiology unit.

Objectives: Warfarin-induced bleedingresults in increased morbidity and mortality and higher cost of healthcare. The objective of the study is to identify the predictors of warfarin-induced bleeding in the Cardiology Unit of a teaching hospital. Materials and Methods: A cross-sectional study was carried out for a period of six months in a tertiary care teaching hospital. A total of 235 patients were enrolled in the study, to identify the predictors of warfarin-induced bleeding. Only prescriptions with warfarin were selected for the study. The chi square test was used to find the association between demography and risk factors. Results: Out of 235 patients, 61 (25.95%) had developed warfarin-induced bleeding and the majority were in the age group of 41 – 61 years (60.65%), and it was also found to be higher in women (62.29%). The length of stay was > 14 days (65.57%) and the number of drugs prescribed was in the range of 6 – 12 (52.45%). Aspirin (40.98%), Heparin (36.06%), Clopidogrel (22.95%), and Streptokinase (14.75%) were the most common drugs involved, and other comorbid conditions like diabetes (37.70%), hypertension (32.78%), smoking (57.37%), and alcohol (32.78%) were found to be major predictors of warfarin-induced bleeding in this study. The severity of warfarin-induced most of the bleeding reactions were moderate (44.26%) and the most common site of bleeding was gastrointestinal system (34.42%). Conclusion: Predictors of warfarin-induced bleeding were found to be female gender, length of stay, number of medications, drugs like aspirin, heparin, and clopidogrel, and other comorbidities like smoking, alcohol, and hypertension.

Cross-cultural adaptation, validation and reliability of the South Indian (Kannada) version of the kidney disease and quality of life (KDQOL-36) instrument

Health-related quality of life is an essential aspect concerned with the treatment outcomes. The main objective of the study is to evaluate the validity and reliability of the South Indian (Kannada) version of the Kidney Disease and Quality of Life-36 (KDQOL-36) instrument for hemodialysis (HD) patients. The KDQOL-36 instrument was validated by the committee of experts consisting of healthcare providers such as nephrologists (three), senior HD staff nurse (one) and clinical pharmacist (one). The measurement properties such as variability, reliability and validity were determined by administering the questionnaire to 82 patients on HD who were randomly selected from the HD units of three hospitals. The test and retest methods were used for reliability. Test-re-test reliability was assessed with a subsample of 45 patients by two administrations of the KDQOL-36 seven days apart. Data were collected through a face-to-face interview. It was evaluated computing intraclass correlation coefficients (ICC) and internal consistency estimated by computing Cronbachs-alfa. Reliability of each Kannada version of the KDQOL-36 sub-scale (symptoms/problems, burden of kidney disease, effects of kidney disease, physical component score [PCS] and mental component score [MCS] was good (Cronbachs-alfa >0.7, ranging from 0.72 to 0.77). The ICC ranged from 0.83 to 0.99 and the 95% confidence interval was 0.76-0.99 for test-retest of the KDQOL-36. The reliability measured with Cronbachs alfa, which was more than 0.72 and ICC ranged from 0.83 to 0.99, indicating that the Kannada version of the KDQOL-36 is reliable and valid for evaluating the health-related quality of life in Kannada-speaking HD patients.

Pharmaceutical Care for Dialysis Patients

The incidence of end stage renal disease (ESRD) is increasing worldwide. Dialysis centers are overwhelmed by the increased number of patients. When a patient becomes aware that his/her kidneys are nonfunctional, he/she is likely to be confused and depressed. The counseling of the patient in the matter of drugs, disease, and lifestyle forms an important necessity, which can help the patient′s confidence and motivate the patient for self-care of his/her condition. The counseling of the patient and dispelling the myths regarding ESRD and dialysis is vital for all patients on a continuous basis. This can be achieved by practicing the pharmaceutical care in ESRD patients on dialysis. In this article, the knowhow and the significance of self-management of ESRD patients on dialysis is discussed.

Pattern of Angiotensin-converting enzyme inhibitors induced adverse drug reactions in South Indian teaching hospital.

Background: Adverse drug reactions (ADRs) occur frequently with cardiovascular drugs leading to change in therapy, increasing morbidity, and mortality. Aim: The study was conducted to evaluate the incidence of ADRs due to angiotensin-converting enzyme Inhibitors in cardiology department. Materials and Methods: A cross-sectional observational study was carried out for a period of 6 months. The data were assessed for the pattern of the ADRs with respect to patient demographics, nature of the reaction, outcome of the reactions, causality, severity, and preventability. Results: Among 692 patients, 51 (7.36%) had developed 60 ADRs, and majority of cases (56.66%) were in the age group of >61 years and most of them were developed in female (80%). The common ADRs observed were cough, hypotension, hyperkalemia, and acute renal failure. In 21.66% cases the dose of the suspected drug was altered and in 78.33% cases the drug was withdrawn. Considering the outcome, 93.33% of cases recovered from ADRs, whereas in 6.66% cases were continuing. Causality assessment showed that majority of ADRs was probable and were found to be moderately severe. Conclusion: Our study concludes geriatrics and female patients have higher incidence of ADRs. So early identification and management of ADRs are essential for this population.

Insulin chewing gum: Need of the day for diabetic patients.

Chewing gum is an excellent drug delivery system for self medication as it is convenient, can be administered discreetly without water and offers the removal of ‘needle fear’ for the patients. As it releases insulin orally, it helps in tackling of the deprivation of insulin by digestive enzyme without adding digestive enzyme inhibitor. This can be done by binding of vitamin B12 and insulin. The vitamin B12 is protected with haptocorrin which is a salivary protein. Another chemical pathway takes over to help vitamin B12 pass into the bloodstream as haptocorrin reaches the intestines. The binding of vitamin B12 and insulin molecules makes the insulin to be protected on this supply chain. The insulin could ride all the way into the bloodstream, where it is released to do its work. By stimulating the brain, chewing gum also increases the releases of insulin. Finding simpler ways to deliver insulin into the blood stream is one important avenue for tackling the diabetes epidemic that is sweeping the developed world. The conditions in gastrointestinal tract may damage the bodys protecting and absorbing mechanisms for the valuable molecules. Chewing gum would be a better delivery method in humans.

Pharmacoeconomic evaluation of hospitalised pre-dialysis and dialysis patients: A comparative study.

BACKGROUND The progression of chronic kidney disease (CKD) can be attributed to various factors, including lack of medical services, delayed referral, lack of awareness about the disease, drugs, and financial support. AIMS To compare the pharmacoeconomic-related direct medical and non-medical costs among hospitalised pre-dialysis and dialysis patients. METHODS A prospective observational study was conducted on the inpatients admitted to the Department of Nephrology. Patients undergoing maintenance dialysis or initiated on renal replacement therapy were included in the dialysis patients group and other CKD patients in the pre-dialysis group. The data pertaining to the pharmacoeconomic-related direct medical and non-medical costs were collected from the patient records, medical bills, and other relevant sources. RESULTS Out of 100 patients, 43 were in the pre-dialysis group and 57 were in the dialysis group. The median direct medical costs (INR 4,731.62, USD

Risk factor assessment of stroke and its awareness among stroke survivors: A prospective study.

76.47) for dialysis group patients were significantly higher than for the pre-dialysis group (INR 1,820.95, USD