Identification and Assessment of Potential Drug-Drug Interactions in Intensive Care Unit Patients.

CONTEXT: Intensive care unit (ICU) patients suffer from various comorbidities and usually receive complex pharmacotherapy which increases the risk of drug-drug interactions (DDIs). AIM: To identify and assess potential DDIs (pDDIs) in ICU patients. SETTINGS AND DESIGN: A prospective observational study conducted in ICU of a tertiary care hospital for a period of 6 months. MATERIALS AND METHODS: Patient information was noted in the data collection form and pDDIs were assessed using Micromedex®database. STATISTICAL ANALYSIS USED: Chi-square test was used to find correlation of pDDIs with patient parameters. p value was calculated keeping the significance level 0.05. RESULTS: Total 400 subjects were included; having an average age of 55.99 ± 15.62 years with a higher percentage of males (61.75%). About 305 (76.25%) patients were found with pDDIs, showing an average of 2.93 pDDIs/patient. The findings of this study were as follows: Total interactions = 1171, contraindicated = 6 (1%), major = 715 (61%), moderate = 428 (36%), and minor = 22 (2%) pDDIs. Further, majority of pDDIs had onset of action "not specified" documentation "fair" and probable mechanism "pharmacodynamic" in nature. Significant association of occurrence of pDDIs was found with number of drugs prescribed to patients in ICU. CONCLUSION: This study demonstrated a high prevalence of pDDI in ICU due to the complexity of pharmacotherapy which showed major pDDIs as the most evident (61%) while contraindicated were 1%. Further studies are needed to better explore this area which may help in realizing the goal of good clinical practice and may offer a methodology to further increase drug safety. KEY MESSAGES: "Monitoring and assessment of DDIs is needed for better patient care". HOW TO CITE THIS ARTICLE: Wagh BR, Godbole DD, et al. Identification and Assessment of Potential Drug-Drug Interactions in Intensive Care Unit Patients. Indian J Crit Care Med 2019;23(4):170-174.

Interstitial lung disease probably caused by imipramine.

Drugs are rarely associated with causing interstitial lung disease (ILD). We report a case of a 75-year-old woman who developed ILD after exposure to imipramine. To our knowledge, this is one of the rare cases of ILD probably caused due to imipramine. There is need to report such rare adverse effects related to ILD and drugs for better management of ILD.

Evaluation of Quality of Life in Type 2 Diabetes Mellitus Patients Using Quality of Life Instrument for Indian Diabetic Patients: A Cross-Sectional Study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease with major impact on the quality of life (QoL) in terms of various domains such as social, physical, and mental well-being. AIM: This study aimed to study the factors determining the QoL in T2DM patients. MATERIALS AND METHODS: A prospective, observational study was conducted in a tertiary care hospital for 6 months. Patients of age ≥18 years and diagnosed with T2DM for ≥6 months (with and without comorbidities) were enrolled for the study. The sociodemographic and clinical characteristics were noted in the self-designed pro forma. The QoL was assessed by the Marathi-translated version of QoL Instrument for Indian Diabetes Patients questionnaire of 34 items and 8 domains. The reliability was validated by Cronbach's alpha. The differences were analyzed by Mann-Whitney U-test and Kruskal-Walis test. RESULTS: Out of 153 T2DM patients, majority were elderly males with mean age of 61.23 ± 11.4 years, married (83%), lower-middle income (57%), urban (51.6%), primary education (46.4%), had diabetes for 5 years or less (42.5%), had positive family history of diabetes (32.6%), and were treated by intensive therapy mainly insulin (41.2%). Statistically significant (P < 0.05) association was found between different domains of QoL and family history, hypertension, body mass index, educational status, marital status, income status, treatment, and complications. The domains of diet satisfaction and general health with the least mean estimates of 7.70 ± 2.62 and 8.25 ± 3.08, respectively, were predominantly affected. CONCLUSION: QoL is an important parameter in diabetes treatment modality. Different factors affected QoL in diabetics in our study. Further studies are definitely needed for better data generation at national level.

Clinical pharmacists: The major support to Indian healthcare system in near future.

Pharmacy practice is still in the initial stages of development in India, but launching of Doctor of Pharmacy (PharmD) study program has brought serious discussions about clinical pharmacy in the country. As the profession is in budding stage in the country, the patients, physicians, nurses, other healthcare providers, recruiters in pharmaceutical industries, prospective students, and their parents have numerous questions about this profession and study course. The objective of this article is to create awareness about clinical pharmacy services (CPS) and to introduce the role of clinical pharmacists (CPs). After reading this article, one will know about the usefulness of CPs in the Indian healthcare system against the current flaws in the system. The article describes the role of CPs in the hospitals, in research, in pharmaceutical/contract research companies, in community service and it also tells about the related myths and facts. Prospective job opportunities for CPs, present challenges and the possible solutions are elaborated as well. In conclusion, CPs are going to be the major support to the Indian healthcare system in near future; the reasons being (1) CPS are beneficial in many ways to improve healthcare; CPS have already proved their importance in western countries (2) India was never officially and efficiently exposed to CPS; so launching of CPS shall revolutionize the country's healthcare scenario.

Patient-reported quality of life outcomes in Indian breast cancer patients: importance, review of the researches, determinants and future directions.

Breast cancer is a leading problem in developing world and India can be considered as one of the major contributors for incidence of breast cancer. In this article authors have reviewed quality of life studies on Indian breast cancer population. There are many factors which may hear common but cannot be neglected in case of Indian population. Policies and future directions to be implemented for breast cancer are also discussed.

Patient-reported outcomes: A new era in clinical research.

Now-a-days there is significant discussion about patient-reported outcomes (PRO) in medical world. The following article covers almost all the areas of PRO including-their importance, important concepts for understanding of PRO, significance, ideal properties, types, development and evaluation of PRO instruments. It is useful for physicians, pharmacists and patients for the assessment and improvement of the therapy.

Atorvastatin-induced acute pancreatitis.

Atorvastatin-induced acute pancreatitis (AP) is one of the rare adverse effects available in the literature. We report a case of 53-year-old patient developed AP after treatment with atorvastatin monotherapy which resolved after drug withdrawal. Extensive workup on AP failed to reveal any other etiology for it. To our knowledge, this is one of the rare case reports of AP caused due to atorvastatin monotherapy and it further strengthens the fact that statins may cause AP. There is need of continued reporting of such a rare adverse effect of atorvastatin for increasing awareness and to manage and avoid the same.

Impact of chronic disease assistance program on the retail pharmacy sector: A retrospective study.

OBJECTIVE: To assess the impacts of chronic disease assistance program (CDAP) on economic parameters, human resource and pharmacy structure and pharmaceutical care on the retail industry in Trinidad and Tobago. MATERIALS AND METHODS: A partially perceptual retrospective investigation was carried out in 60 pharmacies from all regions (North East, North West, Central and South) in Trinidad. Questionnaires were distributed to all pharmacists of the each pharmacies indicated above. The validated questionnaires were distributed, over a period of approximately 2 weeks. Pharmacists employed at each pharmacy were asked to complete the questionnaire which consisted of 11 questions based on the three aspects of investigation. A five-point Likert scale (1 = strongly disagree, 5 = strongly agree) was used. Information from the completed questionnaires was tabulated in Microsoft Excel and the respective percentages and proportions were generated. RESULTS: From the 60 pharmacies, 61% (n=37) believed that there was a decrease in sale of original brands while more than half of the respondents [53% (n=32)] believed there was an increase in sale of generics. The 60% (n=36) respondents viewed that there was compromised dispensary sale of original brands while 65% (n=39) felt there was increased orders for generic drugs. Of the CDAP prescriptions, it was disclosed that there was an overall increase in CDAP prescriptions from the year 2005-2008. A medium-scale pharmacy disclosed 1801 prescriptions in 2005, 2265 prescriptions in 2006, 3002 prescriptions 2007 and 3344 prescriptions in 2008 with overall increase in each year. CONCLUSIONS: The implementation of CDAP can explain the phenomenal increase in sale of generics drugs and the decrease in the sale of brands. There is a need for such a program in the developing countries.