The effect of medication costs on physicians' drug selection.

BACKGROUND: To determine the physicians' knowledge of medication costs and its effect on drug selection. METHODS: The study was conducted between April 2007 and June 2007 on 245 physicians providing healthcare at outpatient clinics of different institutes at the city center of Ankara, Turkey. The data were collected by using questionnaires designed to obtain demographic characteristics of physicians, and assess factors affecting their drug selection based on knowledge of substances, producers and costs of five commonly prescribed commercial drugs. RESULTS: A total of 245 physicians responded, while 53 (21.6 %) were general practitioners, 145 (59.2 %) were resident physicians and 47 (19.2 %) were specialists. Of 1,225 medications that were commonly prescribed, the physicians knew the substance of 1,072 (87.5 %) medications and producers of 565 (46.1) medications. The costs of all drugs were overestimated or underestimated by physicians with a difference of 21.9 %. The factor most significantly affecting the drug selection was drug efficiency (39.4 %) whereas its cost had little effect (11.6 %). A significant difference was found among physicians in respect of the effect of insurance/legal limitations and producer of medication on drug selection (p=0.002, p=0.004, respectively). There were also significant differences in drug selection among institutes. CONCLUSIONS: It was determined that the physicians did not pay attention to the cost of drugs, were unaware of their prices, and prescribed expensive drugs instead of cheap ones even though the latter were available (Tab. 3, Ref. 16). Full Text in free PDF www.bmj.sk.

Colchicine intoxication and infection risk: a case report.

Colchicine is widely used, primarily for the treatment of gouty arthritis and familial Mediterranean fever. Colchicine intoxication is a rare but potentially life-threatening event. Herein, we reported a 26-year-old woman who presented to the emergency department after ingesting 27.5 mg of colchicine in a suicide attempt. She exhibited signs typical of colchicine-poisoning and developed infectious complications but with subsequent complete recovery. This paper discusses the role of colchicine poisoning in increasing susceptibility to infections. This aspect is usually under-appreciated in the clinical picture of colchicine overdose.

Is there any effect of Ramadan fasting on acute coronary heart disease events?

OBJECTIVE: We investigated whether Ramadan fasting, which concerns billions of Muslims in the world, has a negative effect on coronary heart disease patients. METHODS: Patients who were hospitalized at Emergency Center of Ankara Numune Hospital were evaluated retrospectively between the years 1991 and 1997. Patients with acute coronary heart disease events, who were hospitalized and those who died of this disease within the period of before, during, and after Ramadan were evaluated and the ratio of these cases in the total number of patients was determined along with mortality rates. RESULTS: In all the years of the study the number of cases with acute coronary heart disease events was significantly lower in Ramadan than before or after Ramadan (P=0.03). But, the ratio of this population to all patients was not statistically significant between the periods (P>0.05). In conclusion, we speculate that Ramadan fasting does not increase acute coronary heart disease events. We believe that further prospective studies should provide an opportunity to examine the relation of fasting to coronary events.

Effect of Ramadan on peptic ulcer complications.

BACKGROUND: Fasting during the month of Ramadan provides researchers with a good opportunity to study experimental hunger. METHODS: The case histories of patients brought to Ankara Numune Hospital and hospitalized there because of peptic ulcer complaints during the period 1987-92 were retrospectively studied. RESULTS: The ratio of peptic ulcer complications was in all the years of the study higher during Ramadan than during the periods before Ramadan (0.05 > p > 0.01) and after Ramadan (0.1 > p > 0.05). Female patients tended to develop more haemorrhage and perforations during Ramadan. In the peptic ulcer perforation group the average age of women was significantly higher during Ramadan, whereas it was significantly lower in men. CONCLUSIONS: A type of partial hunger during Ramadan increased peptic ulcer complications.