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Ohta M, Miyawaki S, Yokota S, Yoshimoto M, Maruyama T, Koide D, Moritoyo T, Saito N. Causality Assessment Between Drugs and Fatal Cerebral Haemorrhage Using Electronic Medical Records: Comparative Evaluation of Disease-Specific and Conventional Methods. Drugs Real World Outcomes 2024; 11:221-229. [PMID: 38321346 PMCID: PMC11176114 DOI: 10.1007/s40801-023-00413-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION A new algorithm for causality assessment of drugs and fatal cerebral haemorrhage (ACAD-FCH) was published in 2021. However, its use in clinical practice has not been verified. OBJECTIVES This study aimed to explore the practical value of the ACAD-FCH when applying information available in clinical practice. METHODS The medical records of patients who died at the University of Tokyo Hospital in 2020 were reviewed, and cases with intracranial haemorrhage were selected. Two evaluators independently assessed these cases using three methods (the ACAD-FCH, Naranjo algorithm, and WHO-UMC scale). The number of 'Yes', 'No', and 'No information/Do not know' responses to each question by both evaluators were summed and compared. Inter-rater reliability was evaluated for each method using agreement rates and kappa coefficients with 95% confidence intervals (CI). RESULTS Among 316 deaths, 24 cases with intracranial haemorrhage were evaluated. The proportion of ‛No information/Do not know' responses for each question was 35.6% (95% CI 31.4-40.6%) for the ACAD-FCH and 66.9% (95% CI 62.5-71.1%) for the Naranjo algorithm. The respective agreement rates and kappa coefficients were 0.917 (0.798-1.00) and 0.867 (0.675-1.00) for the ACAD-FCH, 0.708 (0.512-0.904) and 0.139 (-0.236 to 0.513) for the Naranjo algorithm, and 0.50 (0.284-0.716) and 0.326 (0.110-0.541) for the WHO-UMC scale, respectively. CONCLUSION Our findings suggest the utility of the ACAD-FCH when assessing death cases with intracranial haemorrhage. However, larger studies including intra-rater assessments are warranted for further validation of this algorithm.
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Affiliation(s)
- Miki Ohta
- Clinical Research Promotion Centre, The University of Tokyo Hospital, Tokyo, Japan.
| | - Satoru Miyawaki
- Department of Neurosurgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinichiroh Yokota
- Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Yoshimoto
- Clinical Research Promotion Centre, The University of Tokyo Hospital, Tokyo, Japan
| | - Tatsuya Maruyama
- Clinical Research Promotion Centre, The University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Koide
- Clinical Research Promotion Centre, The University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Moritoyo
- Clinical Research Promotion Centre, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Schroeder JW, Napoli C, Caputo V, Bonoldi E, Rongioletti F. Unraveling the complexities of drug reaction with eosinophilia and systemic symptoms (DRESS): Insights into clinical, laboratory, and histopathologic features of a case series from an Italian tertiary center. Clin Dermatol 2023; 41:721-728. [PMID: 37730074 DOI: 10.1016/j.clindermatol.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe and potentially life-threatening drug hypersensitivity reaction. The diagnosis and management of DRESS are complicated due to its heterogeneous clinical and pathologic presentations, delayed onset of signs and symptoms, and unpredictable outcome. This retrospective study aimed to analyze cases of DRESS from a single Italian referring tertiary hospital center (Grande Ospedale Metropolitano Niguarda, Milan, Italy) with a focus on clinical features, causative drugs, histopathologic findings, and treatment. We have included 18 of 32 patients with a probable or definite diagnosis of DRESS. The study observed a slight predominance of women, with antimicrobials and allopurinol identified as the main causative drugs. Clinical manifestations varied, with a monomorphic maculopapular eruption being the most common, whereas facial edema and mucosal involvement were less frequently observed. Multiple organs were commonly affected, with liver and kidney involvement being prominent. Cardiac involvement was associated with the severity of eosinophilia. Laboratory evaluations showed elevated eosinophil levels and increased eosinophil cationic protein levels, supporting the role of eosinophils in DRESS pathogenesis. Histopathologic analysis revealed various patterns often coexisting in the same biopsy in 83% of cases, with interface dermatitis being the most frequent, followed by the perivascular pattern and the spongiotic/eczematous pattern. We observed eosinophils in the biopsy samples in about 50% of patients, and the relationship between peripheral eosinophilia and eosinophils in skin biopsies was not significant. In addition to the RegiSCAR score, age may play a role in predicting disease severity, as older patients with lower scores had poorer outcomes. The prognosis of DRESS depended on early identification, discontinuation of the causative agent, and appropriate therapy. Systemic corticosteroids were the primary treatment option.
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Affiliation(s)
- Jan Walter Schroeder
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Valentina Caputo
- Unit of Surgical Pathology and Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Emanuela Bonoldi
- Unit of Surgical Pathology and Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Franco Rongioletti
- Vita-Salute San Raffaele University, Milan, Italy; Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
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Kim KI, Lee MC, Lee JH, Moon YW, Lee WS, Lee HJ, Hwang SC, In Y, Shon OJ, Bae KC, Song SJ, Park KK, Kim JH. Clinical Efficacy and Safety of the Intra-articular Injection of Autologous Adipose-Derived Mesenchymal Stem Cells for Knee Osteoarthritis: A Phase III, Randomized, Double-Blind, Placebo-Controlled Trial. Am J Sports Med 2023; 51:2243-2253. [PMID: 37345256 DOI: 10.1177/03635465231179223] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Intra-articular injection of autologous culture-expanded adipose-derived mesenchymal stem cells (ADMSCs) has introduced a promising treatment option for knee osteoarthritis. Although the clinical efficacy and safety of ADMSCs have been reported, the treatment remains controversial owing to the small sample sizes and heterogeneous osteoarthritis grades in previous studies. PURPOSE To assess the efficacy and safety of intra-articular injection of ADMSCs as compared with placebo in alleviating pain and improving functional capacity in a large sample of patients with knee osteoarthritis of Kellgren-Lawrence (K-L) grade 3. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This phase III multicenter clinical trial was a double-blind randomized controlled study that included 261 patients with K-L grade 3 symptomatic knee osteoarthritis who were administered a single injection of autologous culture-expanded ADMSCs or placebo. Clinical data were assessed at baseline and at 3 and 6 months after the injection. The primary endpoints were improvements in 100-mm visual analog scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for function at 6 months after the injection. The secondary endpoints included clinical and radiologic examinations and safety after injection. The changes in cartilage defects after injection were assessed by magnetic resonance imaging at 6 months. RESULTS The ADMSC and control groups included 125 and 127 patients available for follow-up, respectively. At 6 months, the ADMSC group showed significantly better improvements in 100-mm VAS (ADMSC vs control, 25.2 vs 15.5; P = .004) and total WOMAC score (21.7 vs 14.3; P = .002) as compared with the control group. The linear mixed model analysis indicated significantly better improvements in all clinical outcomes in the ADMSC group after 6 months. At 6 months, the ADMSC group achieved significantly higher proportions of patients above the minimal clinically important difference in 100-mm VAS and WOMAC score. Radiologic outcomes and adverse events did not demonstrate significant differences between the groups. No serious treatment-related adverse events were observed. Magnetic resonance imaging revealed no significant difference in change of cartilage defects between the groups at 6 months. CONCLUSION Intra-articular injection of autologous culture-expanded ADMSCs provided significant pain relief and functional improvements in patients with K-L grade 3 osteoarthritis. Long-term results are needed to determine the disease-modifying effects of ADMSCs, such as structural changes, and the duration of effect of intra-articular injection of ADMSCs in knee osteoarthritis. REGISTRATION NCT03990805 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea; Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Ju Hong Lee
- Department of Orthopaedic Surgery, Jeonbuk National University Hospital, Jeonbuk National University School of Medicine, Jeonju, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Institute of Health Science, Research Institute of Life Science, and School of Medicine, Gyeongsang National University, Jinju, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, Catholic University College of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Oog-Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Yeungnam University School of Medicine, Daegu, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Ki-Cheor Bae
- Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Al‐Antary ET, Ramiz S. Recurrent vincristine‐associated fever in a child with Wilms tumor. Cancer Rep (Hoboken) 2022; 5:e1673. [PMID: 35789542 PMCID: PMC9575493 DOI: 10.1002/cnr2.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Eman T. Al‐Antary
- Division of Pediatric Hematology‐Oncology, Department of Pediatrics Children's Hospital of Michigan Detroit Michigan USA
- College of Medicine Central Michigan University Saginaw Michigan USA
| | - Sarah Ramiz
- Division of Pediatric Hematology‐Oncology, Department of Pediatrics Children's Hospital of Michigan Detroit Michigan USA
- College of Medicine Central Michigan University Saginaw Michigan USA
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Kim JH, Kim KI, Yoon WK, Song SJ, Jin W. Intra-articular Injection of Mesenchymal Stem Cells After High Tibial Osteotomy in Osteoarthritic Knee: Two-Year Follow-up of Randomized Control Trial. Stem Cells Transl Med 2022; 11:572-585. [PMID: 35674255 PMCID: PMC9216209 DOI: 10.1093/stcltm/szac023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/20/2022] [Indexed: 02/02/2023] Open
Abstract
Intra-articular injection of adipose-derived mesenchymal stem cell (ADMSC) after medial open-wedge high tibial osteotomy (MOWHTO) would be a promising disease-modifying treatment by correcting biomechanical and biochemical environment for arthritic knee with varus malalignment. However, there is a paucity of clinical evidence of the treatment. This randomized controlled trial (RCT) was aimed to assess regeneration of cartilage defect, functional improvement, and safety of intra-articular injection of ADMSCs after MOWHTO compared with MOWHTO alone for osteoarthritic knee with varus malalignment. This RCT allocated 26 patients into the MOWHTO with ADMSC-injection group (n = 13) and control (MOWHTO-alone) group (n = 13). The primary outcome was the serial changes of cartilage defect on periodic magnetic resonance imaging (MRI) evaluation using valid measurements until postoperative 24 months. Secondary outcomes were the 2-stage arthroscopic evaluation for macroscopic cartilage status and the postoperative functional improvements of patient-reported outcome measures until the latest follow-up. Furthermore, safety profiles after the treatment were evaluated. Cartilage regeneration on serial MRIs showed significantly better in the ADMSC group than in the control group. The arthroscopic assessment revealed that total cartilage regeneration was significantly better in the ADMSC group. Although it was not significant, functional improvements after the treatment showed a tendency to be greater in the ADMSC group than in the control group from 18 months after the treatment. No treatment-related adverse events, serious adverse events, and postoperative complications occurred in all cases. Concomitant intra-articular injection of ADMSCs with MOWHTO had advantages over MOWHTO alone in terms of cartilage regeneration with safety at 2-year follow-up, suggesting potential disease-modifying treatment for knee OA with varus malalignment.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kang-Il Kim
- Corresponding author: Kang-Il Kim, M.D., Ph D., Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Republic of Korea. Tel: +82 2 440 6151;
| | - Wan Keun Yoon
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gandong, Seoul, Republic of Korea
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Alexandre Júnior RG, Lima PAD, Portela MP, Lima JLDF, Lima EC, Fonteles MMDF. Adverse reactions caused by antimicrobials in hospitalized pediatric patients: causality and avoidability analysis. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022000x20799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Kim KI, Lee WS, Kim JH, Bae JK, Jin W. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:586-596. [PMID: 35567774 PMCID: PMC9216498 DOI: 10.1093/stcltm/szac024] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/20/2022] [Indexed: 11/15/2022] Open
Abstract
Although successful short-term results of the intra-articular injection of mesenchymal stem cells (MSCs) for the conservative treatment of knee osteoarthritis (OA) have been reported, the mid-term results of the injection of adipose-derived (AD) MSCs remains unknown. We assessed the mid-term safety and efficacy of the intra-articular injection of ADMSCs in patients with knee OA. Eleven patients with knee OA were prospectively enrolled and underwent serial evaluations during a 5-year follow-up of a single intra-articular injection of autologous high-dose (1.0 × 108) ADMSCs. The safety profiles were assessed using the World Health Organization Common Toxicity Criteria. The clinical evaluations included visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain and function, respectively. The radiologic evaluations included chondral defect area and whole-organ magnetic resonance imaging scores (WORMS) by serial magnetic resonance imaging (MRI). Hip-knee-ankle axis (HKAA) and Kellgren-Lawrence (K-L) grades were assessed on simple radiographs. No treatment-related adverse events occurred during the 5-year follow-up. Both VAS and total WOMAC scores improved significantly at 6 months after the injection and until the latest follow-up. Total WORMS was significantly improved until 3 years after the injection. However, the chondral defect size on MRI or other radiologic evaluations did not change significantly. A single intra-articular injection of autologous, high-dose ADMSCs provided safe and clinical improvement without radiologic aggravation for 5 years. Furthermore, structural changes in the osteoarthritic knee showed significant improvement up to 3 years, suggesting a possible option for disease-modifying outpatient treatment for patients with knee OA.
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Affiliation(s)
- Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Woo-Suk Lee
- Department of Orthopaedic Surgery, College of Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, South Korea
| | - Jun-Ho Kim
- Corresponding author: Jun-Ho Kim, Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, South Korea. Tel: +82-10-7170-0409;
| | - Jung-Kwon Bae
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gandong, Seoul, South Korea
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Efficacy of Acupuncture Combined with Rehabilitation Training for Intensive Care Unit-Acquired Muscle Weakness: A Protocol for a Randomized, Sham-Procedure-Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3539651. [PMID: 34721629 PMCID: PMC8550834 DOI: 10.1155/2021/3539651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/22/2021] [Indexed: 01/20/2023]
Abstract
To evaluate the efficacy of acupuncture combined with rehabilitation training in patients with intensive care unit (ICU)-acquired muscle weakness (ICUAW), a single-blinded, randomized, sham-controlled clinical trial is designed for execution. In total, 56 participants with ICUAW will be randomly assigned to the treatment and control groups with 28 participants in each group. The participants will be treated with acupunctures or sham procedures at LI15, LI11, ST36, GB34, and ST31, 5 times per week for a total of 20 sessions in 4 weeks while they will receive rehabilitation training. Patients will be followed up every month for 3 months after treatment. The primary outcomes include changes in quadriceps femoris muscle area, thickness, vastus intermediate muscle thickness, subcutaneous tissue thickness, and ultrasonic intensities of the rectus femoris. The secondary outcomes consist of the modified Barthel index score and the Medical Research Council total score. Participants' mechanical ventilation, the rate of detachment at the second week, the 28-day survival rate, and the occurrence of adverse reactions will be measured, and any side effects will be reported and recorded. Patient outcomes between the treatment and control groups will be compared and statistically tested. We anticipate that the therapeutic regimen of acupuncture combined with rehabilitation training would be more effective than the rehabilitation training alone for the treatment of the ICUAW. The findings of this study could help develop a better strategy for the treatment of the ICUAW disease and explore a clinical application of an acupuncture technique. Trial registration: Chinese Clinical Trial Register ChiCTR2000038779. Registered 30 September, 2020, https://www.chictr.org.cn/showproj.aspx?proj=62284.
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Sivagourounadin K, Rajendran P, Selvarajan S, Ganesapandian M. Agreement among different scales for causality assessment in drug-induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Curr Drug Saf 2021; 17:40-46. [PMID: 34126908 DOI: 10.2174/1574886316666210611160123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/03/2021] [Accepted: 04/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Identification of the offending drug is crucial and challenging in cases of severe cutaneous adverse drug reactions (CADR) like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Poor reproducibility and varying levels of agreement have been observed among different causality assessment tools (CATs) in assessing severe CADRs. This study was conducted to examine the agreement among four different CATs in assessing cases of drug-induced SJS, TEN and SJS/TEN overlap. METHODS All cases of drug-induced SJS, TEN and SJS/TEN overlap, which were reported between January 2012 and January 2020 were identified from the ADR register at an ADR monitoring center. Causality assessment was done in these reported cases using the following CATs: The World Health Organization-Uppsala Monitoring Centre (WHO-UMC) scale, Naranjo algorithm, Liverpool algorithm and Algorithm of drug causality for epidermal necrolysis (ALDEN). Weighted kappa (κw) test was used to calculate the agreement among four CATs. RESULTS A total of 30 cases of drug-induced SJS, TEN and SJS/TEN overlap were included in our analyses. The most common offending group of drugs were anticonvulsants (46.7%), antimicrobials (40%) and nonsteroidal anti-inflammatory drugs (13.3%). Of the anticonvulsants, phenytoin (13.3%), carbamazepine (10%) and valproate (10%) were the commonly reported offending drugs. Poor agreement was observed among the four different causality assessment scales. CONCLUSION Discrepancies were observed among four different CATs in assessing drug-induced SJS and TEN. A CAT that is more specific to drug-induced SJS and TEN, simple, user-friendly with limited subjective interpretation, incorporating new immunological and pharmacogenetic markers is necessary.
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Affiliation(s)
- Kiruthika Sivagourounadin
- Department of Pharmacology, Sri Manakula Vinayagar Medical college and hospital, Puducherry-605017, India
| | - Priyadharsini Rajendran
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry-605006, India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry-605006, India
| | - Mahalakshmi Ganesapandian
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry-605006, India
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Causality and avoidability of adverse drug reactions of antibiotics in hospitalized children: a cohort study. Int J Clin Pharm 2021; 43:1293-1301. [PMID: 33656658 DOI: 10.1007/s11096-021-01249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adverse drug reactions are a problem in healthcare systems worldwide. Children are more susceptible than adults, especially when exposed to specific drug classes, such as antibiotics. OBJECTIVE To assess the incidence, causality, severity, and avoidability of antibiotic-associated adverse drug reactions in hospitalized pediatric patients. SETTING Pediatric ward of a high-complexity public hospital in northeast Brazil. METHODS A prospective cohort study was conducted over six months, including children aged between 28 days and 12 years, hospitalized for more than 48 h, and receiving antibiotics. Liverpool's causality and avoidability assessment tools were used. Primary outcome measures: Incidence of adverse drug reactions, causality, severity, and avoidability, major antibiotics implicated, risk factors. RESULTS A total of 183 patients were followed, and 35 suspected adverse drug reactions were recorded overall incidence equal to 14.7%. Most adverse drug reactions were classified as moderate severity (76.7%), probable (57.1%) and defined (28.6%) causality, and unavoidable (66.7%). The affected organs were the gastrointestinal system (74.1%) and skin (25.9%). Major antibiotics implicated were ceftriaxone (40.7%), azithromycin (25.9%), and crystalline penicillin (11.1%). The number of antibiotics prescribed per patient during hospitalization and the length of stay were the risk factors identified. CONCLUSION Causality and severity assessment indicated that most adverse drug reactions were probable and moderate. Possibly avoidable reactions occurred due to inappropriate prescribing when preventive measures were not implemented. Monitoring the use of antibiotics in children is essential to ensure the safety of these patients.
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Said MA, Silva LSTE, de Oliveira Rocha AM, Alves GGB, Piotto DGP, Len CA, Terreri MT. Adverse drug reactions associated with treatment in patients with chronic rheumatic diseases in childhood: a retrospective real life review of a single center cohort. Adv Rheumatol 2020; 60:53. [PMID: 33153496 DOI: 10.1186/s42358-020-00154-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) are the sixth leading causes of death worldwide; monitoring them is fundamental, especially in patients with disorders like chronic rheumatic diseases (CRDs). The study aimed to describe the ADRs investigating their severity and associated factors and resulting interventions in pediatric patients with CRDs. METHODS A retrospective, descriptive and analytical study was conducted on a cohort of children and adolescents with juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). The study evaluated medical records of the patients to determine the causality and the management of ADRs. In order to investigate the risk factors that would increase the risk of ADRs, a logistic regression model was carried out on a group of patients treated with the main used drug. RESULTS We observed 949 ADRs in 547 patients studied. Methotrexate (MTX) was the most frequently used medication and also the cause of the most ADRs, which occurred in 63.3% of patients, followed by glucocorticoids (GCs). Comparing synthetic disease-modifying anti-rheumatic drugs (sDMARDs) vs biologic disease-modifying anti-rheumatic drugs (bDMARDs), the ADRs attributed to the former were by far higher than the latter. In general, the severity of ADRs was moderate and manageable. Drug withdrawal occurred in almost a quarter of the cases. In terms of risk factors, most patients who experienced ADRs due to MTX, were 16 years old or younger and received MTX in doses equal or higher than 0.6 mg/kg/week. Patients with JIA and JDM had a lower risk of ADRs than patients with JSLE. In the multiple regression model, the use of GCs for over 6 months led to an increase of 0.5% in the number of ADRs. CONCLUSIONS Although the ADRs highly likely affect a wide range of children and adolescents with CRDs they were considered moderate and manageable cases mostly. However, triggers of ADRs need further investigations.
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Affiliation(s)
- Manar Amanouil Said
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil.
| | - Liana Soido Teixeira E Silva
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Aline Maria de Oliveira Rocha
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Gustavo Guimarães Barreto Alves
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Daniela Gerent Petry Piotto
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Claudio Arnaldo Len
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
| | - Maria Teresa Terreri
- Division of Pediatric Rheumatology, Department of Pediatrics, Federal University Sao Paulo (Unifesp), Rua Borges Lagoa, 802, Sao Paulo, ZIP CODE: 04038-001, Brazil
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Danjuma MIM, Almasri H, Alshokri S, Khir FK, Elmalik A, Battikh NG, Abdallah IMH, Elshafei M, Fatima H, Mohamed MFH, Maghoub Y, Hussain T, Kamal I, Anwer Z, Bidmos MA, Elzouki AN. Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score. BMC Geriatr 2020; 20:346. [PMID: 32928134 PMCID: PMC7489200 DOI: 10.1186/s12877-020-01732-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/24/2020] [Indexed: 01/10/2023] Open
Abstract
Background Drug-induced liver injury (DILI) represents an increasing morbidity in the general population, but more so in the elderly cohort of patients. Despite this, the concept of its prevention through prospective analysis has largely remained unexamined. We evaluated the utility of recently validated adverse drug reactions (ADR) avoidability tool in a cohort of elderly patients with DILI. Methods We examined 38 DILI-drug pairs from n=38 patients in a prospective cohort of patients presenting with adverse drug reactions to a Weill Cornell-affiliated tertiary hospital between February 2019 and January 2020. DILI outcomes were adjudicated by the updated Roussel Uclaf Causality Assessment Method (RUCAM). Two clinical pharmacologists and two general physicians utilized the Liverpool adverse drug reactions avoidability tool (LAAT) and the modified Hallas tools to rate the preventability of DILI-drug pairs. Inter-rater, exact agreement proportions, as well as intraclass correlation coefficients were generated and expressed as ordinal outcomes. Results The cases examined for the determination of DILI avoidability had probability likelihood of “probable” or “highly probable” by the updated RUCAM scale. Examination of the 38 DILI-drug pairs (n= 38 patients) resulted in a total of 152 ordinal outcome decisions. We found about 32.3% (50/152) and 34.2% (52/152) of DILI-drug pairs were rated as “avoidable” (“probable” or “definite”) by the LAAT and the modified Hallas tools respectively. The overall median Krippendorf’s kappa with the LAAT was 0.61 (SE 0.12, CI 0.36, 0.85) and for modified Hallas tool was 0.53 (SE 0.18; CI 0.16, 0.89). The inter-rater correlation coefficient (ICC) for the LAAT and modified Hallas were 0.50 [0.32, 0.65] and 0.63 [0.48, 0.76] respectively. Exact pairwise agreement was present in 30/38 (IQR 29.5, 34.5), and 28/38 (IQR 27.5-35.5) of DILI-ADR pairs using the LAAT and modified Hallas tools respectively. Conclusion We found a significant proportion of drug-induced liver injury adjudicated by the updated RUCAM scale in elderly hospitalized cohort of patients were avoidable with significant implication for therapeutic commissioning as well as cost effectiveness interventions in this cohort of patients.
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Affiliation(s)
- Mohammed Ibn-Mas'ud Danjuma
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. .,Weill Cornell College of Medicine, New York and Doha, Qatar. .,College of Medicine (QU Health), Qatar University, Doha, Qatar.
| | - Hussam Almasri
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shaikha Alshokri
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell College of Medicine, New York and Doha, Qatar
| | - Fadi Khazahia Khir
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Elmalik
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Naim Ghazi Battikh
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ibtihal Mahmoud Hassan Abdallah
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Elshafei
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Haajra Fatima
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mouhand Faisal Hamad Mohamed
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yahya Maghoub
- Department of Diabetes and Endocrinology, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Road, Upton, Wirral, CH49 5PE, Liverpool, United Kingdom
| | - Tanweer Hussain
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Acute Medicine Unit, Derbyshire Hospitals Foundation Trust, Derby, England, United Kingdom
| | - Ijaz Kamal
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zubair Anwer
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdel-Naser Elzouki
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell College of Medicine, New York and Doha, Qatar.,College of Medicine (QU Health), Qatar University, Doha, Qatar
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Bergmann MM, Caubet JC. Role of in vivo and in vitro Tests in the Diagnosis of Severe Cutaneous Adverse Reactions (SCAR) to Drug. Curr Pharm Des 2020; 25:3872-3880. [PMID: 31696801 DOI: 10.2174/1381612825666191107104126] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022]
Abstract
Severe cutaneous adverse reactions (SCAR) are life-threatening conditions including acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS). Diagnosis of causative underlying drug hypersensitivity (DH) is mandatory due to the high morbidity and mortality upon re-exposure with the incriminated drug. If an underlying DH is suspected, in vivo test, including patch tests (PTs), delayed-reading intradermal tests (IDTs) and in vitro tests can be performed in selected patients for which the suspected culprit drug is mandatory, or in order to find a safe alternative treatment. Positivity of in vivo and in vitro tests in SCAR to drug varies depending on the type of reaction and the incriminated drugs. Due to the severe nature of these reactions, drug provocation test (DPT) is highly contraindicated in patients who experienced SCAR. Thus, sensitivity is based on positive test results in patients with a suggestive clinical history. Patch tests still remain the first-line diagnostic tests in the majority of patients with SCAR, followed, in case of negative results, by delayed-reading IDTs, with the exception of patients with bullous diseases where IDTs are still contra-indicated. In vitro tests have shown promising results in the diagnosis of SCAR to drug. Positivity is particularly high when the lymphocyte transformation test (LTT) is combined with cytokines and cytotoxic markers measurement (cyto-LTT), but this still has to be confirmed with larger studies. Due to the rarity of SCAR, large multi-center collaborative studies are needed to better study the sensitivity and specificity of in vivo and in vitro tests.
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Affiliation(s)
- Marcel M Bergmann
- Pediatric Allergology Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland.,Centro Pediatrico del Mendrisiotto, Mendrisio, Switzerland
| | - Jean-Christoph Caubet
- Pediatric Allergology Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
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14
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Shou Y, Hu L, Zhang C, Xu S, Jin Q, Huang L, Li B, Yuan L, Xu S, Zhang K, Jiang H, Zhang B. Efficacy of acupuncture at three nasal acupoints plus acupoint application for perennial allergic rhinitis: A multicenter, randomized controlled trial protocol. Trials 2020; 21:110. [PMID: 31992367 PMCID: PMC6986062 DOI: 10.1186/s13063-019-4039-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Many studies have shown the potential therapeutic effect of acupuncture on allergic rhinitis. Most of these studies were limited by low-quality evidence. Preliminary experiments showed that the use of acupuncture at three nasal acupoints plus acupoint application (AAP) achieves a more persistent effect in the treatment of perennial allergic rhinitis than acupuncture alone. In this study, a multicenter, single-blind, randomized controlled trial will be performed, in which acupuncture at nonmeridian acupoints and sham AAP will be used as the control group to evaluate the effect of AAP through long-term observation. METHODS The trial is designed on the basis of the Consolidated Standards of Reporting Trials 2010 guidelines and Standards for Reporting Interventions in Controlled Trials of Acupuncture. A total of 120 participants with perennial allergic rhinitis will be randomly assigned to a treatment or control group. A specially appointed investigator will be in charge of randomization. The participants in the treatment group will be treated with acupuncture at EX-HN3, LI20, and EX-HN8 thrice per week for a total of 12 sessions. In addition, they will undergo AAP at DU14, BL13, EX-BI, and RN22. The participants in the control group will be treated with sham AAP. The primary outcome will be the change in the Total Nasal Symptom Score from baseline to the completion of 4-week treatment. Secondary outcomes include changes in visual analog scale and total non-nasal symptom scores from baseline to the second and fourth weeks of treatment, as well as 1, 3, and 6 months after the completion of treatment. Peripheral blood IL-4, IL-5, IL-6, IL-8, and IL-10 levels will be measured, and any side effects related to treatment will be observed and recorded. DISCUSSION It is expected that this randomized clinical trial will provide evidence to determine the effects of AAP compared with acupuncture at nonmeridian acupoints and sham AAP, particularly the long-term effect. These findings will help improve the clinical application of this technique. TRIAL REGISTRATION Acupuncture-Moxibustion Clinical Trial Registry AMCTR-ICR-18000179. Registered on 12 April 2018.
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Affiliation(s)
- Yin Shou
- Department of Acupuncture and Moxibustion, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Acumox and Tuina Research Section, College of Acumox and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Li Hu
- Acumox and Tuina Research Section, College of Acumox and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cuihong Zhang
- Shanghai Research Institute of Acupuncture and Meridians, Shanghai, China
| | - Shifen Xu
- Acupuncture Department, Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of TCM, Shanghai, China
| | - Qi Jin
- Acupuncture Department, Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of TCM, Shanghai, China
| | - Li Huang
- Acupuncture Department, Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of TCM, Shanghai, China
| | - Bingrong Li
- Department of Acupuncture and Moxibustion, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Long Yuan
- Department of Acupuncture and Moxibustion, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Siwei Xu
- Department of Acupuncture and Moxibustion, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kaiyong Zhang
- Department of Acupuncture and Moxibustion, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huiru Jiang
- Department of Acupuncture and Moxibustion, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bimeng Zhang
- Department of Acupuncture and Moxibustion, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Danjuma MIM, Shokri SA, Abubeker IY, Malik AE, Abdallah IMH, Shafei MNE, Fatima H, Mahmoud M, Hussain T, Maghoub Y, Sajid J, Zouki ANE. An investigation into the avoidability of adverse drug reactions using the LAAT and modified Hallas tools. Medicine (Baltimore) 2020; 99:e18569. [PMID: 31895800 PMCID: PMC6946216 DOI: 10.1097/md.0000000000018569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
An adverse drug reactions avoidability tool called the Liverpool ADR avoidability assessment tool (LAAT) was recently developed (for research purposes), and subsequently validated with mixed interrater reliability (IRR). We investigated the comparative IRR of this tool in an inpatient cohort to ascertain its practical application in this setting.The patient population was comprised of 44 ADR drug pairs drawn from an observational prospective cohort of patents with ADR attending a Weill Cornell Medicine-affiliated tertiary medical Centre in Doha Qatar (Hamad General Hospital). Using the LAAT, and modified Hallas tools, 4 independent raters (2 Clinical Pharmacologists, and 2 General Physicians) assessed and scored the 44 ADR-drug pairs. Agreement proportions between the rating pairs were evaluated as well individual/overall kappa statistics and intraclass correlation coefficients. We evaluated the weight of each of the 7 questions on the LAAT tool to ascertain its determinative role.Across 44 ADR-drug pairs, the overall median Fleiss kappa using the LAAT, and modified Hallas tools were 0.67 (interquartile range (IQR) 0.55, 0.76), 0.36 (IQR, 0.23-0.71) respectively. The overall percentage pairwise agreement with the LAAT and modified Hallas tools were 78.5%, and 62.2% respectively. Exact pairwise agreement occurred in 37 out of 44 (range 0.71-1), and 27 of 44 (0.53-0.77) ADR-drug pairs using the LAAT and modified Hallas tools respectively. Using the LAAT tool, the overall intraclass correlation coefficient was 0.68 (CI 0.55, 0.79), and 0.37 (CI 0.22, 0.53) with the modified Hallas tool.We report a higher proportion of "possible" and "definite" avoidability outcomes of adverse drug reactions compared with the modified Hallas, or that reported by developers of the LAAT tool. Although initially developed for research purposes, our report has suggested for the first time a potential applicability of this tool in clinical environment as well.
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Affiliation(s)
- Mohammed Ibn-Mas’ud Danjuma
- Weill Cornell Affiliated-Hamad General Hospital, Hamad Medical Corporation; Weill Cornell Medicine; College of Medicine, Qatar University
| | - Shaikha Al Shokri
- Division of General Internal Medicine, Weill Cornell Affiliated-Hamad General Hospital, Hamad Medical Corporation
| | | | - Ashraf El Malik
- Emergency Department, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation,
| | | | - Mohamed Nabil El Shafei
- Clinical Pharmacist, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation,
| | - Haajra Fatima
- Weill Cornell Affiliated-Hamad General Hospital, Hamad Medical Corporation
| | - Mohamed Mahmoud
- Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Tanweer Hussain
- Division of General Internal Medicine, Weill Cornell affiliated-Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Acute Medicine Unit, Derbyshire Hospitals Foundation Trust, Derby, England, United Kingdom
| | - Yahya Maghoub
- Wirral University Teaching Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Jamal Sajid
- Weill Cornell Affiliated-Hamad General Hospital, Hamad Medical Corporation
| | - Abdel Naser El Zouki
- Hamad General Hospital, Hamad Medical Corporation (HMC), Doha, Qatar, Department of Clinical Sciences, College of Medicine, Qatar University, Weill Cornell Medical College of Qatar, Doha, Qatar
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16
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Projective mechanisms subtending real world phenomena wipe away cause effect relationships. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2019; 151:1-13. [PMID: 31838044 DOI: 10.1016/j.pbiomolbio.2019.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/16/2019] [Accepted: 12/10/2019] [Indexed: 01/11/2023]
Abstract
Causal relationships lie at the very core of scientific description of biophysical phenomena. Nevertheless, observable facts involving changes in system shape, dimension and symmetry may elude simple cause and effect inductive explanations. Here we argue that numerous physical and biological phenomena such as chaotic dynamics, symmetry breaking, long-range collisionless neural interactions, zero-valued energy singularities, and particle/wave duality can be accounted for in terms of purely topological mechanisms devoid of causality. We illustrate how simple topological claims, seemingly far away from scientific inquiry (e.g., "given at least some wind on Earth, there must at all times be a cyclone or anticyclone somewhere"; "if one stirs to dissolve a lump of sugar in a cup of coffee, it appears there is always a point without motion"; "at any moment, there is always a pair of antipodal points on the Earth's surface with equal temperatures and barometric pressures") reflect the action of non-causal topological rules. To do so, we introduce some fundamental topological tools and illustrate how phenomena such as double slit experiments, cellular mechanisms and some aspects of brain function can be explained in terms of geometric projections and mappings, rather than local physical effects. We conclude that unavoidable, passive, spontaneous topological modifications may lead to novel functional biophysical features, independent of exerted physical forces, thermodynamic constraints, temporal correlations and probabilistic a priori knowledge of previous cases.
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17
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Jordan S, Banner T, Gabe-Walters M, Mikhail JM, Panes G, Round J, Snelgrove S, Storey M, Hughes D. Nurse-led medicines' monitoring in care homes, implementing the Adverse Drug Reaction (ADRe) Profile improvement initiative for mental health medicines: An observational and interview study. PLoS One 2019; 14:e0220885. [PMID: 31509537 PMCID: PMC6738583 DOI: 10.1371/journal.pone.0220885] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/25/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Preventable adverse effects of medicines often pass unnoticed, but lead to real harm. Intervention Nurse-led monitoring using the structured Adverse Drug Reaction (ADRe) Profile identifies and addresses adverse effects of mental health medicines. Objectives This study investigated the implementation and clinical impact of ADRe, and barriers to and facilitators of sustained utilisation in routine practice. Methods Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales. Results Residents were aged 60–95, and prescribed 1–17 (median 9 [interquartile range (IQR) 7–13]) medicines. ADRe identified a median of 18 [IQR 11.5–23] problems per resident and nurses made 2 [1–2] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors’ non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses’ concerns regarding residents’ welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation. Implications To our knowledge, ADRe is the only instrument that brings a full account of patients’ problems to medication reviews. This juxtaposition of signs and symptoms against prescriptions facilitates dose adjustments and de-prescribing and leads to: reduced pain and sedation; early identification of problems linked to ADRs, such as falls; and timely medication reviews e.g. for dyspnoea.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
| | - Timothy Banner
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Cardiff and Vale University Health Board, Wales, United Kingdom
| | | | - Jane M. Mikhail
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Gerwyn Panes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Sherrill Snelgrove
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Mel Storey
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Hywel Dda University Health Board, Wales, United Kingdom
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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18
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Lee WS, Kim HJ, Kim KI, Kim GB, Jin W. Intra-Articular Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Knee Osteoarthritis: A Phase IIb, Randomized, Placebo-Controlled Clinical Trial. Stem Cells Transl Med 2019; 8:504-511. [PMID: 30835956 PMCID: PMC6525553 DOI: 10.1002/sctm.18-0122] [Citation(s) in RCA: 259] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/08/2019] [Indexed: 12/12/2022] Open
Abstract
Mesenchymal stem cells (MSCs) have been the focus of an emerging treatment for osteoarthritis. However, few studies reported about outcomes of an intra-articular injection of autologous adipose-derived mesenchymal stem cells (AD-MSCs). This study aimed to assess the efficacy and safety of a single intra-articular injection of AD-MSCs for patients with knee osteoarthritis. It was a prospective double-blinded, randomized controlled, phase IIb clinical trial. AD-MSCs were administered for 12 patients (MSC group), and the group was compared with 12 knees with injection of normal saline (control group) up to 6 months. All procedures were performed in the outpatient clinic. Primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score. Secondary outcome measure included various clinical and radiologic examination, and safety after injection. Change of cartilage defect after injection was evaluated using magnetic resonance imaging (MRI). Single injection of AD-MSCs led to a significant improvement of the WOMAC score at 6 months. In the control group, there was no significant change in the WOMAC score at 6 months. No serious adverse events were observed in both groups during the follow-up period. In MRI, there was no significant change of cartilage defect at 6 months in MSC group whereas the defect in the control group was increased. An intra-articular injection of autologous AD-MSCs provided satisfactory functional improvement and pain relief for patients with knee osteoarthritis in the outpatient setting, without causing adverse events at 6 months' follow-up. Larger sample size and long-term follow-up are required. Stem Cells Translational Medicine 2019;8:504-511.
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Affiliation(s)
- Woo-Suk Lee
- Department of Orthopaedic Surgery, College of Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, South Korea
| | - Hwan Jin Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.,School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.,School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Gi Beom Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.,School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
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Jose J, Rafeek NR. Pharmacovigilance in India in Comparison With the USA and European Union: Challenges and Perspectives. Ther Innov Regul Sci 2018; 53:781-786. [PMID: 30554527 DOI: 10.1177/2168479018812775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pharmacovigilance (PV) is an integral part of the drug regulation system. PV plays an indispensable role in the identification, assessment, and publicizing of adverse drug reactions (ADRs) through various methods. ADRs account for serious harm to the patients and even lead to morbidity and mortality. The PV databases help in the promotion of safe drug use and protection of public health safety. This article compares the PV system in the USA, Europe, and India, highlighting the challenges and future perspectives to be adapted to widen the horizon of the existing PV structure in India. In India, PV programs are still at the dawning stage when paralleled to the other countries. The National Pharmacovigilance Program and the Pharmacovigilance Program of India are the most recent advancements in this field in the country. The USA and Europe have well-established PV systems in place thanks to technological progress and other resources. India is the largest producer of pharmaceuticals in the world and a major clinical research hub; hence, it requires a more stringent PV setup. With the increase in population and novel drugs in the market each day, there is a need for an effective PV system in India.
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Affiliation(s)
- Jobin Jose
- Department of Pharmaceutical Regulatory Affairs, NGSM Institute of Pharmaceutical Sciences, NITTE Deemed to be University, Mangalore, Karnataka, India
| | - Naziya Refi Rafeek
- Department of Pharmaceutical Regulatory Affairs, NGSM Institute of Pharmaceutical Sciences, NITTE Deemed to be University, Mangalore, Karnataka, India
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20
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Affiliation(s)
- Robin E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham B18 7QH, UK
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
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21
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Sundaran S, Udayan A, Hareendranath K, Eliyas B, Ganesan B, Hassan A, Subash R, Palakkal V, Salahudeen MS. Study on the Classification, Causality, Preventability and Severity of Adverse Drug Reaction Using Spontaneous Reporting System in Hospitalized Patients. PHARMACY 2018; 6:pharmacy6040108. [PMID: 30274320 PMCID: PMC6306913 DOI: 10.3390/pharmacy6040108] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 02/02/2023] Open
Abstract
Hospital-based adverse drug reaction (ADR) monitoring and reporting programs intend to identify and quantify the risks associated with the use of medicines. To examine the causality, preventability and severity of ADR in a hospital setting; a prospective cohort study on spontaneous ADR reporting was conducted from December 2015 to May 2016. Incidence of ADRs, causality, type, severity and preventability were assessed using necessary assessment scales. The study included 3157 hospitalized individuals, in whom 51 ADRs were detected among 49 patients. The overall incidence of suspected ADRs was found to be 1.6%. According to the causality assessment, most of the ADRs reported were probable (n = 26, 51.0%), and type A (augmented/pharmacological) reactions (n = 39, 76%) were the most common type of ADR found. The majority of ADRs were moderate to severe (n = 35, 68.6%), of which 37.3% were found to be potentially preventable. Predictability was observed in 28 (54.9%) reported ADRs. The prescribed medicines most frequently associated with ADRs were antibiotics, antiepileptics and antihypertensives. This feasibility study was able to highlight the clinical pharmacist's role in ADR monitoring service and create awareness about the way it could be done to promote safer medication use. Similar ADR reporting programs are necessary to educate and to improve awareness among healthcare professionals in some countries.
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Affiliation(s)
- Siraj Sundaran
- Devaki Amma Memorial College of Pharmacy, Kerala University of Health Sciences, Malappuram, Kerala 673634, India.
| | - Anjali Udayan
- Devaki Amma Memorial College of Pharmacy, Kerala University of Health Sciences, Malappuram, Kerala 673634, India.
| | - Keerthi Hareendranath
- Devaki Amma Memorial College of Pharmacy, Kerala University of Health Sciences, Malappuram, Kerala 673634, India.
| | - Basil Eliyas
- Devaki Amma Memorial College of Pharmacy, Kerala University of Health Sciences, Malappuram, Kerala 673634, India.
| | - Babu Ganesan
- Devaki Amma Memorial College of Pharmacy, Kerala University of Health Sciences, Malappuram, Kerala 673634, India.
| | - Ashik Hassan
- PVS Hospital Pvt Ltd., Calicut, Kerala 673002, India.
| | - Rajesh Subash
- PVS Hospital Pvt Ltd., Calicut, Kerala 673002, India.
| | - Vishnu Palakkal
- Devaki Amma Memorial College of Pharmacy, Kerala University of Health Sciences, Malappuram, Kerala 673634, India.
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Jordan S, Banner T, Gabe-Walters M, Mikhail JM, Round J, Snelgrove S, Storey M, Wilson D, Hughes D. Nurse-led medicines' monitoring in care homes study protocol: a process evaluation of the impact and sustainability of the adverse drug reaction (ADRe) profile for mental health medicines. BMJ Open 2018; 8:e023377. [PMID: 30269073 PMCID: PMC6169755 DOI: 10.1136/bmjopen-2018-023377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/02/2018] [Accepted: 08/07/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Improved medicines' management could lead to real and sustainable improvements to the care of older adults. The overuse of mental health medicines has featured in many reports, and insufficient patient monitoring has been identified as an important cause of medicine-related harms. Nurse-led monitoring using the structured adverse drug reaction (ADRe) profile identifies and addresses the adverse effects of mental health medicines. Our study investigates clinical impact and what is needed to sustain utilisation in routine practice in care homes. METHODS AND ANALYSIS This process evaluation will use interviews and observations with the participants of all five homes involved in earlier research, and five newly recruited homes caring for people prescribed mental health medicines. The ADRe profile is implemented by nurses, within existing resources, to check for signs and symptoms of ADRs, initiate amelioration and share findings with pharmacists and prescribers for medication review. Outcome measures are the numbers and nature of problems addressed and understanding of changes needed to optimise clinical gain and sustain implementation. Data will be collected by 30 observations and 30 semistructured interviews. Clinical gains will be described and narrated. Interview analysis will be based on the constant comparative method. ETHICS AND DISSEMINATION Ethical approval was conferred by the National Health Service Wales Research Ethics Committee. If the ADRe profile can be sustained in routine practice, it has potential to (1) improve the lives of patients, for example, by reducing pain and sedation, and (2) assist in early identification of problems caused by ADRs. Therefore, in addition to peer-reviewed publications and conferences, we shall communicate our findings to healthcare professionals, policy-makers and sector regulators. TRIAL REGISTRATION NUMBER NCT03110471.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Timothy Banner
- Welsh School of Pharmacy, Cardiff University, Cardiff, UK
| | | | - Jane M Mikhail
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Jeff Round
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Mel Storey
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Douglas Wilson
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea, UK
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Comparison of different methods for causality assessment of adverse drug reactions. Int J Clin Pharm 2018; 40:903-910. [PMID: 30051231 DOI: 10.1007/s11096-018-0694-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 07/12/2018] [Indexed: 01/01/2023]
Abstract
Background The causality assessment of adverse drug reactions (ADRs) remains a challenge, and none of the different available method of causality assessment used for assessing adverse reactions has been universally accepted as the gold standard. Objective To examine the agreement and correlation among three broad approaches for causality assessment of ADRs viz. World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system, Naranjo algorithm, and updated Logistic method. Setting ADR monitoring centre (AMC) of a tertiary care teaching hospital in India. Method A total of 230 cases of ADR from April 2017 to August 2017 were retrospectively analyzed by each of these three methods. The agreement among the different methods was calculated by Cohen's kappa (κ), and Spearman's correlation was used to find the correlation among these methods. Main outcome measures Cohen's kappa value and Spearman's correlation coefficient for comparison among the different methods. Results The Cohen's κ used for analyzing the agreement between WHO-UMC system and Naranjo algorithm was 0.45, between WHO-UMC system and updated Logistic method was 0.405, and between Naranjo algorithm and updated Logistic method was 0.606. The Spearman's correlation coefficient was 0.793 for Naranjo algorithm vs. updated Logistic method, 0.735 for WHO-UMC system vs. Naranjo algorithm, and 0.696 for WHO-UMC system vs. updated Logistic method. Conclusion Causality assessment based on objective measurements (scores and probabilities) like updated Logistic method and Naranjo algorithm are less prone to subjective variations compared to the WHO-UMC system which is based on expert judgement.
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Use and Safety of Anthroposophic Medicinal Products: An Analysis of 44,662 Patients from the EvaMed Pharmacovigilance Network. Drugs Real World Outcomes 2017; 4:199-213. [PMID: 28965336 PMCID: PMC5684047 DOI: 10.1007/s40801-017-0118-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background There is a need for data on the clinical safety of anthroposophic medicinal products (AMPs). Objectives The main objective of this analysis was to determine the frequency of adverse drug reactions (ADRs) to AMPs, relative to the number of AMP prescriptions. Methods EvaMed (Evaluation of Anthroposophic Medicine) was a prospective pharmacovigilance study with the patients of 38 physicians in outpatient care in Germany. Diagnoses and prescriptions were extracted from the electronic medical records. All physicians documented ADRs of Grades III–IV and serious ADRs, seven ‘prescriber physicians’ also documented non-serious ADRs of any intensity. Patients were eligible for this analysis if they had one or more AMP prescription in the years 2001–2010, followed by one or more physician visit. Results A total of 44,662 patients with 311,731 AMP prescriptions, comprising 1722 different AMPs, were included. One hundred ADRs to AMPs occurred, caused by 83 different AMPs. ADR intensity was mild, moderate, and severe in 50% (n = 50/100), 43%, and 7% of cases, respectively; one ADR was serious. Among patients of prescriber physicians, ADRs of any intensity occurred in 0.071% (n = 67/94,734) of AMP prescriptions and in 0.502% (n = 65/12,956) of patients prescribed AMPs. In subgroup analyses according to age, specific AMPs or AMP groups, dosage forms, and concentrations (altogether 11 groups), the highest ADR frequency was 0.290% of prescriptions (for one specific AMP). Among all patients, serious ADRs occurred in 0.0003% (n = 1/311,731) of prescriptions and 0.0022% (n = 1/44,662) of patients. Conclusion In this analysis from a large sample, ADRs to AMP therapy in outpatient care were rare; ADRs of high intensity as well as serious ADRs were very rare. Electronic supplementary material The online version of this article (doi:10.1007/s40801-017-0118-5) contains supplementary material, which is available to authorized users.
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Gupta SK, Kumar KD. An assessment of reported adverse drug reactions in a Tertiary Care Hospital in South India: A retrospective cross-sectional study. Int J Pharm Investig 2017; 7:193-197. [PMID: 29692979 PMCID: PMC5903024 DOI: 10.4103/jphi.jphi_81_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: The primary objective of this study was to assess the causality of ADRs using World Health Organization-Uppsala Monitoring Centre (WHO–UMC), Naranjo and Liverpool ADR Causality Assessment Tool (LCAT). Other primary objective was to assess the agreement between the WHO-UMC criterion, Naranjo algorithm and LCAT. The secondary objective was to assess the reported adverse drug reactions in a tertiary care hospital in South India. Materials and Methods: This was a cross-sectional retrospective study. All the ADRs which were reported by the Pharmacovigilance Unit between July 2016 and March 2017 were assessed. Causality assessment was performed by two well-trained independent pharmacologists by applying the three methods–WHO, Naranjo and LCAT. Concurrence between the two algorithms was compared using the Cohen's weighted kappa statistic. Results: Causality assessment of adverse reactions according to Naranjo criteria shows that 81% cases were of probable type, 9.5% cases were possible and 9.5% cases were unlikely. Causality assessment of adverse reactions according to WHO-UMC criteria shows that 85.7% cases were of probable type, 4.8% cases were possible, 4.8% cases were unlikely and 4.8% cases were definite. Causality assessment of adverse reactions according to Liverpool criteria shows that 61.9% cases were of probable type, 4.8% cases were possible and 33.3% cases were definite. Cohen's kappa test shows that negative and poor concurrence was seen between WHO and Naranjo causality comparison (κ = −0.161). Positive but poor concurrence based on kappa values was seen between Liverpool and Naranjo's causality comparison (κ = 0.133). Negative and poor concurrence based on kappa values was seen between WHO and Liverpool causality comparison (κ = −0.161). Conclusion: The most frequent causality category observed by the WHO-UMC criteria, Naranjo as well as the Liverpool algorithm was “Probable.” Full concurrence was not found between any of two scales of causality assessment.
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Affiliation(s)
- Sandeep Kumar Gupta
- Department of Pharmacology, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - K Deva Kumar
- Department of Pharmacology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India
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