Objective: To evaluate whether clinical pharmacist's interventions have any impact on medication adherence of patients having inflammatory bowel disease and to assess the awareness of patients about their disease and the significance of medications they use. Materials and Methods: A prospective, interventional follow up study was conducted in the outpatients visiting Gastroenterology and Hepatology department of Amrita Institute of Medical Sciences, Kochi. To assess the level of medication adherence and patient's awareness, MMAS-8 and CCKNOW has been utilized. Once this baseline information's were collected, counselling was given to patients and they were supplemented with pill cards and patient information leaflets as educational material. During the follow up visit, all the above parameters were reassessed and compared with the baseline visit. Result: About 110 IBD patients have participated in this study. In baseline visit, 6.36% patients had low adherence, 62.73% patients had medium adherence, 30.91% patients had high adherence. During follow up visit, after intervention by clinical pharamcist, 3.64% patients had low adherence, 18.18% patients had medium adherence and 78.18 % patients had high adherence. From this study, it was notified that the average score of CCKNOW was only 8.15 in the beginning. Later on, it was escalated to 11.65 during the revisit periods. Conclusion: Knowledge of patients about their disease and medications were insufficient during baseline visit. Adherence to medication was found to be poor among IBD patients. Counselling provided by clinical pharmacist about the importance of medication adherence and provision of information leaflets and pill cards lead to an improvement in medication adherence and knowledge of IBD patients. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Leucovorin (LCV) acts as an essential coenzyme for nucleic acid synthesis and also it is an active metabolite of folic acid. LCV can be used to selectively "rescue" cells from the adverse effects of methotrexate (MTX). Here, we report a case of LCV-induced hypersensitivity reaction when used in combination with high dose MTX (HDMTX). We describe a 2-yearsold female baby diagnosed with B-cell acute lymphoblastic leukemia on chemotherapy with pediatric berlin-frankfurtmunster protocol; she is on HDMTX and injection LCV. After initiation of LCV (folinic acid) at 42 h she was noted to have hypersensitivity reaction. Despite reaction to LCV is uncommon, one should be aware of the reactions that can be caused by LCV.

ITP is a bleeding disorder which is not associated by a systemic disease caused by low platelet count or thrombocytes. However, use of dapsone is limited by adverse effects such as methemoglobinemia, reticulocyte increase, hemolysis, hemoglobin decrease, red cell life span shortened, agranulocytosis, anemia, leukopenia, and pure red cell aplasia. This report relates to an incident to methemoglobinemia after administration of dapsone as the second line agent for treatment of ITP in a tertiary care hospital. A 46-year-old male, with a case of immune thrombocytopenia and a family history of aplastic anemia in mother. Now presented with high grade fever associated with generalized weakness, cough with expectoration and shortness of breath and decreased urine output. He was admitted for further management. Initial laboratory investigations were done. Blood and urine cultures were sent. His arterial blood gas showed elevated methemoglobin (18.2). Peripheral smear revealed microcytic hypochromic anemia with polychromatophils, microspherocytes, and relative neutrophilia. Urine culture showed Escherichia coli and blood culture was sterile. Serum electrolytes were sent. He had elevated international normalized ratio (INR) value (5.93). Warfarin and dapsone were withheld.