Use of proton pump inhibitors in dialysis unit in tertiary care hospital: a pharmaco-epidemiological study

Background: Proton pump inhibitors (PPI) are generally thought to be safer drug with fewer adverse effects. Though this class of the drug is thought to be well tolerated, a detail study about actual use of these agents in nephrology department is still awaited in many parts of India. There had been case reports and case series which were reporting PPIs producing acute interstitial nephritis progressing to acute renal failure. The risk of PPI treatment in haemodialysis patients remains unexplored. The aim of the study was to evaluate a drug utilization of PPI in patient undergoing haemodialysis procedure.Methods: In this study every day visit to the dialysis units of the hospitals was carried out. After taking consent from the patients, the information from the case-report form was noted like; age, sex, diagnosis, laboratory reports and drug prescried. No personally identifiable information about patient or physician was collected. After this an interview of patients was taken.Results: In this study, out of 126 patients 76.6% were male and 23.4% were female. Out of these 126 patients 88.89% patients were on PPI. Nearly 54% were using PPI for more than six months. Nearly 29% patients were using PPI for more than 12 months.Conclusions: As many case-reports and studies are suggesting, there is co-relation of PPI and acute interstitial nephritis from this study we suggest that especially in nephrology unit patients’, more caution must be exercised while using PPI.

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Cerebral Venous Thrombosis Case Series at a Tertiary Care Hospital: Exploring Treatment Safety and Efficacy of Direct Oral Anticoagulants

Blood ◽

10.1182/blood-2019-128406 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3658-3658

Author(s):

Mohammed Abdullah Alsheef ◽

Mukhtar Alomar ◽

Abdul Rehman Z. Zaidi ◽

Ghaydaa Juma Kullab ◽

Mohammed AlHazzaa ◽

...

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Tertiary Care ◽

Case Series ◽

Case Report Form ◽

Care Hospital ◽

Safety And Efficacy ◽

Number Of Patients

Background: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults and children. Initial treatment with heparin followed by wafarin is the mainstay of treatment. Only insufficient experience is available for direct oral anticoagulants (DOACs). Aims: The study aims to demonstrate the efficacy and safety of DOACs such as (Rivaroxaban and Dabigatran) in patients with objectively confirmed CVT. Methods: Data of 46 cases of CVT collected using a standardized case report form. Inclusion criteria were patients diagnosed with CVT, confirmed by CT or MRI imaging. Results: The total number of patients was 46 (9 males and 37 females). The mean age of the patients was 35.2± 5 years. The most common clinical manifestations among our patients were headache followed by seizure. 52% of cases were unprovoked, while 48% were provoked by pregnancy and oral contraceptive pills. Superior sagittal sinus (55%) and transverse sinus (44.9%) were the most common sites. Involvement of more than three venous sinuses was 34.8%. Thrombophilic abnormality was detected in 21.7% of patients. Initiation of anticoagulation (AC) was mostly low molecular weight heparin (LMWH) (80%), followed by unfractionated heparin (UFH) (17.7%) and fondaparinex (2%). Maintenance AC with Rivaroxaban after heparin (LMWH/UFH) was in 63% of our patients, the rest were switched from Warfarin to Rivaroxaban (34.8%), and one was treated by Dabigatran (2%). CVT recurrence was observed in one patient. Major bleeding (according to ISTH criteria) was not reported in our case series. Conclusions: DOACs demonstrated good safety and efficacy profile and can potentially replace warfarin in CVT patients. Disclosures No relevant conflicts of interest to declare.

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Over prescription of Proton Pump Inhibitors on discharge of Medical Inpatients

Journal of Medicine ◽

10.3329/jom.v18i1.31173 ◽

2017 ◽

Vol 18 (1) ◽

pp. 27-29 ◽

Cited By ~ 3

Author(s):

Sarmistha Biswas ◽

ABM Abu Sufian ◽

Prodip Kumar Sarkar ◽

Mostofa Kamal Chowdhury ◽

Joybaer Anam Chowdhury ◽

...

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Safety And Health ◽

Medical Inpatients ◽

Study Population ◽

Potential Risks ◽

The Mean

Background: Proton pump inhibitors (PPIs) are the drugs used to treat and prevent acid peptic conditions. Their efficacy and safety profile has led to injudicious prescription of these drugs exposing patients to various potential risks and increased healthcare expenditure.Methodology: A retrospective observational study was done from 10th January to 24th January, 2015 in Medicine Indoor in a tertiary care hospital to determine the trend of prescribing PPIs on discharge of Medical inpatients.Result: We found 117 patients were discharged in the study period; 83 were male and 34 were female. Among them 102 (87.17%) were prescribed PPIs on their discharge. Mean age was 44.79 years. Among the study population only 29 patients (28.5%) truly needed PPIs during their discharge. The mean duration of prescribed PPIs was 28 days.Conclusion: Amore rational prescription of PPI during discharge will have better impact on patient safety and health care expenditure.J MEDICINE January 2017; 18 (1) : 27-29

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Acute interstitial nephritis caused by two different proton pump inhibitors

British Journal of Hospital Medicine ◽

10.12968/hmed.2016.77.1.50 ◽

2016 ◽

Vol 77 (1) ◽

pp. 50-51 ◽

Cited By ~ 4

Author(s):

Frederick JA Torlot ◽

Duncan J Whitehead

Keyword(s):

Interstitial Nephritis ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Acute Interstitial Nephritis

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Proton Pump Inhibitors and Acute Interstitial Nephritis

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2005.11.004 ◽

2006 ◽

Vol 4 (5) ◽

pp. 597-604 ◽

Cited By ~ 101

Author(s):

Nimeshan Geevasinga ◽

Patrick L. Coleman ◽

Angela C. Webster ◽

Simon D. Roger

Keyword(s):

Interstitial Nephritis ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Acute Interstitial Nephritis

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Drug utility pattern of antiulcer agents used in osteoarthritis patients at tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20194111 ◽

2019 ◽

Vol 8 (9) ◽

pp. 2029

Author(s):

Syed Ubaid Razvi ◽

Shrikant B. Lahamate

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Ulcer Healing ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

H2 Blockers ◽

Antiulcer Agents ◽

Healing Agent ◽

Antiulcer Drugs

Background: Osteoarthritis is the most common form of joint disease and the leading cause of pain in elderly people. Osteoarthritis (OA) is a progressive and painful chronic disease that mainly affects knee, hand and hip joints.Aim of study was to evaluate current trend of antiulcer drugs and to assess the group of antiulcer agents use in osteoarthritis patient.Methods: A prospective observational study was conducted in a tertiary care hospital for period of twelve months in collaboration with department of orthopaedics. Patients data recorded in case report form and analysed to study prescription pattern and related information Results: Total of 630 cases were enrolled in this study. Prescribed antiulcer drugs in OA were ranitidine, omeprazole, pantoprazole, rabeprazole, sucralfate and esomeprazole. Most commonly prescribed drug was Ranitidine i.e. 80.79% followed by omeprazole i.e. 8.42% pantoprazole i.e. 3.97% rabeprazole i.e. 3.81%, sucralfate i.e. 2.53% and esomeprazole i.e. 0.48% respectively. In this study, the commonest group prescribed was H2 blockers i.e. 80.79% followed by proton pump inhibitors i.e. 16.68%, and ulcer healing agent i.e. 2.53% respectively.Conclusions: Most commonly prescribed drug was ranitidine followed by omeprazole, pantoprazole, rabeprazole, sucralfate and esomeprazole respectively. In this study, the commonest group prescribed was H2 blockers followed by proton pump inhibitors, and ulcer healing agent respectively.

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Proton pump inhibitors: acute interstitial nephritis and other renal effects

Clinical Nephrotoxins ◽

10.1007/978-0-387-84843-3_25 ◽

2008 ◽

pp. 567-577

Author(s):

Ursula C. Brewster ◽

Mark A. Perazella

Keyword(s):

Interstitial Nephritis ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Acute Interstitial Nephritis ◽

Renal Effects

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1030. Risk Predictive Model for Candida Endocarditis in Patients with Candidemia: A 12-year Experience in a Single Tertiary Care Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.867 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S307-S307

Author(s):

Kap Sum Foong ◽

Ryan Kronen ◽

Ana S Salazar ◽

Kevin Hsueh ◽

Charlotte Lin ◽

...

Keyword(s):

Predictive Model ◽

Tertiary Care Hospital ◽

Hematologic Malignancy ◽

Case Reports ◽

Univariate Analysis ◽

Tertiary Care ◽

Case Series ◽

Valvular Disease ◽

Invasive Infection ◽

Care Hospital

Abstract Background Candida endocarditis (CE) is a rare but an invasive infection associated with a high mortality rate. The current understanding of this infection is poorly defined from case reports, case series and small cohorts. This study aimed to assess the risk factors for CE in patients with candida bloodstream infections (CBSI). Methods We conducted a retrospective analysis of all hospitalized patients diagnosed with CBSI at a large tertiary care hospital between 2002 and 2015. Data included demographics, comorbidities, laboratory parameters, and outcomes. Univariate and multivariable logistic regression analyses were used to build the predictive model. Results Of 1,873 cases of CBSI, 47 patients were identified to have CE. The most commonly isolated species were C. albicans (59.6%) followed by C. parapsilosis (16.2%). On univariate analysis, preexisting valvular disease (7.95, 95% CI [3.16, 20.02]) was associated with a higher risk of CE (P < 0.05). Factors such as isolation of C. glabrata (0.17, 95% CI [0.04, 0.68]), hematologic malignancy (0.09, 95% CI [0.01, 0.68]), and total parenteral nutrition (TPN) (0.40, 95% CI [0.17, 0.95]) were all associated with a lower risk of CE. In multivariable modeling, the factors of valvular disease (5.05, 95% CI [1.77, 14.43]), isolation of C. glabrata (0.19, 95% CI [0.05, 0.80]), hematologic malignancy (0.09, 95% CI [0.01, 0.66]), and total parenteral feeding (0.43, 95% CI [0.17, 1.09]) remained significant. The final model had a C-statistic of 0.82. The crude 90-day mortality for CE was 48.9%, similar to the overall CBSI mortality of 42.1%. Conclusion In a population of patients with CBSI, previous valvular disease was the only factor associated with a greater risk of development of CE. Use of TPN, hematologic malignancy, and isolation of C. glabrata were protective factors. A predictive model may reduce the need for expensive and sometimes invasive diagnostic imaging such as trans-esophageal echocardiography, as a subset of patients may be at low enough risk for CE not to warrant them. Disclosures All authors: No reported disclosures.

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Mucormycosis due to Apophysomyces species complex- 25 years’ experience at a tertiary care hospital in southern India

Medical Mycology ◽

10.1093/mmy/myz081 ◽

2019 ◽

Vol 58 (4) ◽

pp. 425-433 ◽

Cited By ~ 2

Author(s):

Umabala Pamidimukkala ◽

Sukanya Sudhaharan ◽

Anuradha Kancharla ◽

Lakshmi Vemu ◽

Sundaram Challa ◽

...

Keyword(s):

Necrotizing Fasciitis ◽

Amphotericin B ◽

Species Complex ◽

Case Reports ◽

Tertiary Care ◽

Case Series ◽

Chronic Alcoholism ◽

Care Hospital ◽

Amphotericin B Deoxycholate ◽

Progressive Necrosis

Abstract Apophysomyces elegans species complex is an important cause of cutaneous mucormycosis in India. However, majority of those cases are reported as case reports only. We desired to analyze our patients with Apophysomyces infection reported over 25 years (1992–2017) to understand the epidemiology, management, and outcome of the disease. During the study period 24 cases were reported, and the majority (95.8%) of them presented with necrotizing fasciitis following accidental/surgical/iatrogenic trauma. One patient presented with continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Healthcare related Apophysomyces infection was noted in 29.2% patients. In addition to trauma, comorbidities were noted in 37.5% patients (type 2diabetes mellitus-6, chronic alcoholism-2, and chronic kidney disease-1). Of the 24 isolates, 11 isolates starting from year 2014 were identified as Apophysomyces variabilis by molecular methods. Majority (95.8%) of the patients were managed surgically with or without amphotericin B deoxycholate therapy, while one patient was treated with amphotericin B deoxycholate alone. Among 24 patients, seven (29.1%) recovered, six (25%) patients could not afford antifungal management and left the hospital against medical advice, and 11 (45.9%) patients died.The present case series highlights that necrotizing fasciitis caused by A. variabilis is prevalent in India, and the disease may be healthcare related. Although diagnosis is not difficult, awareness among surgeons is still limited about the infection, leading to a delay in sending samples to the mycology laboratory. Apophysomyces infection must be considered in the differential diagnosis in apatient with progressive necrosis of a wound who is not responding to antibacterial therapy.

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