Objectives: Drug Related Problems (DRPs) and prescriptions with polypharmacy may lead to increased health care cost, morbidity, mortality and decreased quality of life. The objective of the study was to assess the pattern of DRPs associated with polypharmacy. Methods: It is a hospital based prospective interventional study carried out for 6 months in the Department of General Medicine. The DRPs were identified by researchers during ward rounds by reviewing the patient case reports. Problems identified and recognized was documented and discussed with the concerned health care team. Results: During the study period, 150 patient case sheets were reviewed to identify 213 DRPs. The most common DRP was found to be Adverse Drug Reactions (ADRs) (45%) followed by needs additional drug therapy (26.8%), untreated indication (13.6%) and Drug-Drug Interactions (DDIs) (11.7%). Binary logistic regression was performed to identify the predictors of DRPs. It was observed that number of comorbidities (Adjusted odds ratio (AOR) = 3.68 (p < 0.001)), geriatric population and polypharmacy were the major predictor. Conclusion: The study highlights the importance of drug therapy review to minimize DRPs, ADRs, polypharmacy, framing of new deprescribing guidelines and algorithms for drugs which are utilized inappropriately, deprescribing of redundant drugs during routine clinical practice and appointment of clinical pharmacist in hospitals to achieve better therapeutic outcomes and improved patient care.

The current study was a prospective observational study. All poisoning cases admitted in the emergency care unit of M.S. Ramaiah Hospital and Memorial Hospital were included in the study. A total of 101 patients were included in the study. The pattern, severity and outcome of poison case were assessed using suitable scales. The common agent involved in poisoning was drugs. It accounted for 38.60% of total poisoning cases. This was followed by organophosphorous (OP) compounds, corrosive agents, rat poison, bedbug solutions and insecticides. According to APACHE II the estimated mortality was found to be 10.71. The mean Glasgow coma scale was 13.75±2.25. Out of 101 patients, 100 (99.01%) recovered and 1 (0.99%) died. Analysis of 101 poison cases revealed that most poisonings are due to over dose of drugs and also due to consumption of OP compounds. Establishment of strict policies against the sale and availability of agriculture field products and over the counter drugs are an effective way to control OP and drug poisoning. Accidental poisoning by paediatric groups can be minimized by conducting educational programs for the population in the rural regions.

Background: Farmers are extensively using pesticides for pest control in agriculture. Their precarious handling practices may lead to higher exposure resulting in adverse health effects. Aim: Current study was aimed to evaluate the knowledge, attitude and practices regarding pesticide usage and its toxic effects by farmers. Settings and Design: Cross sectional, Study Setting: Rural village in south Karnataka. Materials and Methods: Sample size: 171 farmers, Data collection: face to face standardized validated questionnaire. Statistical Analysis: Chi-square test. Results: A total of 118 males and 53 females participated in this study with median age of 40 years. About 61% of the farmers knew the harmful effects of pesticides. However, 22% of them were mixing the pesticides using their bare hands and 26% were not wearing any protective clothing during spraying pesticides. Around 67% were carelessly disposing the leftover pesticides in the open fields. Skin problems and neurological system disturbances were the most common pesticide related health symptoms. Equipment washing practices ( P < 0.05) and protective clothing ( P < 0.03) were significant predictors of health related problems. Significant associations were found between the occurrence of headache and equipment washing practices ( P < 0.03), storage of pesticide remains ( P < 0.02) and protective clothing ( P < 0.01). Conclusion: These findings showed that knowledge level is adequate among farmers but this did not reflect in their practice. There is a need for continuous pesticide safety education along with training to the farmers regarding use of personal protective devices, personal hygiene and sanitation practices during and after application of pesticides.

Background: Notoriety bias is defined as “a selection bias in which a case has a greater chance of being reported if the subject is exposed to the studied factor known to cause, thought to cause, or likely to cause the event of interest.” This study aimed to determine the existence of notoriety bias in the FDA Adverse Event Reporting System (FAERS) database and estimate the impact of potential notoriety bias induced by safety alerts on signal estimation using disproportionality analysis. Methods: Publicly available FAERS data were downloaded and used for analysis. Thirty-one drugs which had label change/safety alert issued by FDA from 2009 to 2013 were considered. These drugs were reviewed 4 quarters before and after the safety alert notification for the existence of notoriety bias. The impact of notoriety bias induced by safety alerts was analyzed by comparing the signal strength using reporting odds ratio (ROR) and proportional reporting ratio (PRR), 2 years before and after the safety alert. Wilcoxon signed rank test was used to determine whether there were a statistically significant difference before and after the safety alert. Results: There was increased reporting for 11 drugs after the safety alert/label change by the FDA. The reporting of 20 drugs decreased or remained unchanged after the safety alert/label change by the FDA. Wilcoxon signed rank test showed that there is no statistically significant difference with respect to the number of reports before and after the safety alert ( P = .330, Z = −0.974). Fourteen (45.16%) drugs had an increase in ROR, while 17 (54.83%) drugs had a decrease in ROR after safety alert issued by FDA ( P = .953, Z = −0.059). Fourteen (45.16%) drugs had an increase in PRR, while 17 (54.83%) drugs had a decrease in PRR after safety alert issued by the FDA ( P = .914, Z = −0.108). Conclusion: Although few FDA safety alert/warnings had a strong and immediate impact, many had no impact on reporting of AE and signal strength. This study found that overreporting due to notoriety bias does not exist in the FAERS database and the overall disproportionality in signal estimates is not altered by the safety alert.

Objectives:The present study evaluates the hepatoprotective activity of N-acetyl cysteine (NAC) against carbamazepine (CBZ)-induced hepatotoxicity.Materials and Methods:Rats were treated with CBZ (50 mg/kg p.o.) and CBZ supplemented with NAC 50, 100 and 200 mg/kg for 45 days, after which blood samples were collected and subjected to liver function tests. Animals were killed, liver was separated, weighed and the levels of antioxidants and liver enzymes were estimated. In addition, histopathological investigation was also performed.Results:Serum glutamate pyruvate transaminase (SGPT), serum glutamate oxaloacetate (SGOT) transaminase, alkaline phosphatase (ALP), bilirubin, lipid peroxidation, absolute and relative liver weights were significantly (P < 0.05) elevated, whereas serum levels of albumin, total protein and body weight were decreased in the CBZ-treated animals. CBZ also produced vacuolar degeneration, centrilobular congestion and hepatic necrosis as evidenced from histopathological report. NAC significantly reduced the levels of serum transaminase, ALP, bilirubin and liver weight and increased the levels of total protein, albumin and body weight.Conclusion:It was observed that NAC increased the glutathione (GSH) content, reduced lipid peroxidation and reversed the CBZ-induced histopathological abnormalities. CBZ-induced hepatotoxicity may be due its toxic epoxide metabolite-induced oxidative stress.