Objective — A “demonstration” scheme for adverse drug reaction (ADR) reporting by United Kingdom community pharmacists began in April, 1997. The objective of this study was to investigate community pharmacists' attitudes to and knowledge of ADR reporting and the “yellow card” scheme. Method — Structured face‐to‐face interview with community pharmacists, using a prepiloted questionnaire. Setting — Randomly selected community pharmacies within one demonstration scheme area. Key findings — Almost all of the pharmacists (28, 93 per cent) were aware that they were able to report ADRs but only one had done so. Just under half recalled receiving the official information pack and half of these had read it. Reasons given for not submitting reports were lack of information or time, and that most reactions seen were already well‐recognised. Although most pharmacists knew that serious reactions to established drugs should be reported, fewer recognised the need to report unusual reactions to established drugs and reactions to herbal medicines. Few participants knew the reporting criteria for “black triangle” drugs. Reporting on over‐the‐counter (OTC) products was an area specifically identified where it was expected that community pharmacists could “add value” to the previous, yellow card, scheme. It was thus of some concern that 21 pharmacists (70 per cent) agreed that they would be unlikely to report an ADR to a product they had counter‐prescribed for a patient. Few respondents had negative attitudes to the scheme. Most agreed that ADR reporting is important, and a professional role in which pharmacists should be involved. Conclusion — Community pharmacists are supportive of their involvement in ADR reporting. Their concerns about reporting need to be addressed and further publicity given to the scheme if reporting is to increase. Our findings suggest that more research is needed to identify the factors which encourage and inhibit reporting, and that further efforts may be needed to promote ADR reporting.

We describe a male patient who presented with sudden onset severe headache and right sided ptosis that was diagnosed to be secondary to pituitary apoplexy on the background of diabetes mellitus. This was complicated by left ventricular failure and acute coronary syndrome. The case highlights the importance of considering hypocortisolism/hypopituitarism as an important and rare precipitant of an acute coronary event as occurred in the case.

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BackgroundDiffuse alveolar haemorrhage (DAH) is a feature of several immune and nonimmune disorders. Failure to diagnose and treat DAH syndromes in their early stages may lead to acute respiratory failure, CKD and death. Prognosis is poor with in-hospital mortality ranging from 20% to 100%. Immune related DAH is monophasic and if treated early and achieved remission, long term outcome is good.ObjectivesTo evaluate the therapeutic response and long term outcome in patients with Immune related (AAV & SLE) DAH.MethodsA retrospective review of medical records of patients admitted under Rheumatology and Clinical immunology department with Immune related DAH was made with regards to their presentation, treatment & response, mortality, morbidity and long term outcome. Study was performed after approval and ethical clearence from IRB.ResultsFrom June 2012 to Augst 2016, 18 patients (15 were AAV related & 3 as SLE related) were admitted. Amongst AAV patients, PR3 positive were 11 & MPO positive were 4. Fourteen patients were females and 4 males, age ranged from 14 – 68 yrs (median=54.5 yrs). Mean duration of disease before onset of DAH was 3 months. Nine (50%) patients had associated kidney and musculoskeletal involvement. Eleven (61.11%) patients were admitted under ICU care requiring artificial ventilation. Pulse methylprednisolone injections were given in 15 (83.33%), Cyclophosphamide in 13 (72.22%), IVIg in 2 (11.11%), plasmapheresis in 7 (38.88%) patients. Time from first consultation to pulse methylprednisolone was in range from 1 to 5 days. Out of 18, 11 patients achieved remission. In hospital mortality was seen in 5 (27.77%) patients, all were AAV (MPO+=3, PR3+=2), all were complicated with sepsis with MODS before death. Out of 7 who received plasmapheresis, 2 patients (28.4%) died, 2 patients developed CKD (dialysis independent). Duration of ICU& hospital stay in days ranged from 3 to 28 days & 2 to 40 days respectively. Mean follow up was 16 months (range 11–42 months) on OPD visits. Two had relapse on follow up (1 nephritis, 1 persistant cavities with episcleritis) who were given Rituximab. Total 5 (38.46%) received Rituximab out of which 2 were refractory to Cyclophosphamide, 2 had relapse & 1 concomitantly. Eight patients (44.44%) developed morbidity in the form of dialysis independent-CKD in 4 (PR3+ in 2, MPO+ in 1 and Lupus nephritis in 1) with concomitant cataract in 1, ILD in 2, hearing loss in 1 and finger amputation in 1). All 13 patients who survived are in remission. Ongoing maintenance treatment is Azatjioprine in 5, Mycophenolate mofetil in 3 and Rituximab in 3 patients.ConclusionsHigh index of suspicion with early diagnosis and treatment results in low mortality and better long term outcome. All mortality was because of delay in diagnosis. Rituximab is effective in achieving remission in refractory as well as relapsed casesReferences Yi Lin, MD, et al. J Clin Rheumatol. 2009 Oct;15(7):341–4.Diffuse alveolar hemorrhage in systemic lupus erythematosus: risk factors and clinical outcome: results from ...

BackgroundSLE is characterised by excessive production of various autoantibodies and correlation of these antibodies with organ involvement may help to evaluate disease severity and long term prognosis. NBTE is a rare cardiac manifestation of SLE with prevalence rate varying from 6%–11%. Many, but no all, studies have shown association of NBTE with anti phospholipid antibodies, but, except this association, data regarding clinical, laboratory and serological characteristics of NBTE is sketchy. We designed this study to evauate profile of patients having NBTE in SLE.Objectives1. To study the prevalenence of NBTE in SLE patients.2. To study association of NBTE with clinical and laboratory characteristics and serological profile.MethodsAll consecutive SLE inpatients and outpatients attending the department of Rheumatology from September 2015 to December 2017 were enrolled. Patients subjected to 2D Echo were included and their demographic, clinical, laboratory and serological profile were recorded. Serological profile was studied with Blue diver kit which is an immunodot blot assay measuring autoantibodies against 25 ENA. Anti cardiolipin and anti beta 2 glycoprotein antibody were tested by ELISA. Study was approved by an independent ethics committee [ECR/282].ResultsTotal number of patients enrolled in study were 355 out of which 213 had undergone 2DEcho. NBTE was found in 33 (15.49%) patients. Among all autoantibodies studied, we found that the presence of anti-Nucleosome antibody, LAC, ACL and B2GP1 were significantly associated with NBTE (p<0.05). Myocarditis, valvular lesions and Pulmonary Hypertension were more common in NBTE group (p value: 0.012,<0.0001 and 0.013 respectively).We also noticed that there is a statistically significant association between presence of NBTE with APLA syndrome and Thrombotic events (p value<0.0001 and 0.005 respectively).Tab.1 Significant Serological association of SLE patients with NBTE.AntibodiesSLE With NBTE-33 (15.49%)SLE without NBTE-180P value Anti-nucleosome27 (81.8)32 (17.7)<0.0001LAC16/30 (53.3)31/149 (20.8)0.0002ACL (Ig M and IgG)9/303013/128 (10.1)0.004B2GP-1(Ig M and IgG)6/22209/103 (8.73)0.033APLA profile was available in 30 patients of NBTE and 147 patients not having NBTE. Out of this, positivity for APLA antibodies were seen in 17 (56.6%) and 36 (24.4%) patients respectively [p:0.005]. 82.3% patients with Anti phospholipid antibodies had APLA syndrome in NBTE group while in NBTE group 48.5% patients having Anti phospholipid antibodies had APLA syndrome. Thus, presence of NBTE increased the possibility of developing APLA syndrome in patients having positive serology for anti phospholipid antibodiesTab.2 Significant Clinical and laboratory characteristic of SLE patients with NBTE.Organ involvementSLE with NBTE-33SLE without NBTE-180p- value Myocarditis11270.012Valvulopathy104<0.0001PAH9210.013Thrombotic events8160.005APLA syndrome1417<0.0001ConclusionsPresence of Anti nucleosome antibody, LAC, Anti cardiolipin and anti beta 2 glycoprotein antibodies may predict presen...