Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2008 | Month : February | Volume : 2 | Issue : 1 | Page : 600 - 604

Adverse Drug Event (ADE) related Medical Emergency Department visits and hospital admissions: a prospective study from a North Indian Referral Hospital

SAHA L, PANDHI P, MALHOTRA S, SHARMA N*

Department of Pharmacology and *Department of Internal Medicine. Postgraduate Institute of Medical Education and Research, Chandigarh,India 160012.

Correspondence Address :
Dr Lekha Saha, Senior lecturer, Dept of Pharmacology, Govt Medical College, Chandigarh.India. Ph –91-0172-2645262. Email-lekhasaha@rediffmail.com

Abstract

Objective: To analyse the contribution of adverse drug events to the overall number of visits, to the emergency medical outpatient department(EMOPD) of a tertiary care centre. The aim of the present study was also to characterise the different causes of drug related visits or admissions and the consequences of it on the cost of health care.
Patients and methods: All visits to the medical emergency were recorded in a prospective, non-interventional design study, over a period of 6 months. In order to maximize uniformity and minimize interpersonal variability and bias, the correlation of suspected drug(s) causing the problem that led to the EMOPD visit and hospital admission, was assessed by using the Naranjo probability scale. The cases of suspected ADEs were followed-up to find out whether they were discharged from the EMOPD itself, or whether they subsequently required hospitalisation.
Results: A total of 1200 patients were included in the study .Fifty patients (4.2%, 95% CI: 1.21 – 6.53) were considered to be related to adverse drug events. Half of all the adverse effects could be attributed to three drugs: NSAIDS associated GI bleeding (22%), antitubercular drug associated hepatitis (20%),and beta-lactam associated hypersensitivity reactions (8%). In the present study, we found that 10% of ADEs were life threatening, and 30% were serious to warrant hospitalisation .The hospital admissions that were related to adverse drug events accounted for US$6712 or US $134 per admission.
Conclusion: ADEs account for a sizable proportion of all visits to a medical emergency unit, and some are serious enough to require hospitalisation .A large number of ADE related visits and admissions are preventable, which highlights the importance of public education on the proper use of drugs, and also, the need for regulation of the practice of unregistered medical practitioners in developing countries.

Keywords

adverse drug events, medical emergency visits,hospital admission, cost.

How to cite this article :

SAHA L, PANDHI P, MALHOTRA S, SHARMA N. ADVERSE DRUG EVENT (ADE) RELATED MEDICAL EMERGENCY DEPARTMENT VISITS AND HOSPITAL ADMISSIONS: A PROSPECTIVE STUDY FROM A NORTH INDIAN REFERRAL HOSPITAL. Journal of Clinical and Diagnostic Research [serial online] 2008 February [cited: 2019 May 24 ]; 2:600-604. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2008&month=February&volume=2&issue=1&page=600-604&id=192

Adverse drug reactions (ADRs), including interaction, are a common cause of admission to a hospital, and are an important cause of increased morbidity and mortality(1),(2). Adverse events during drug therapy are believed to contribute significantly to rising health costs(3),(4).

Previous studies of drug-related visits to hospitals and emergency departments demonstrated that 1-4% of all visits were due to inappropriate use of medications(5),(6). However, all these studies had the methodological limitation of being performed retrospectively. In retrospective studies, non-recorded facts and missing information can lead to underestimation of the prevalence of possible drug-related emergency department visits. So, the true prevalence of ADRs leading to medical emergency department visits may actually be higher than indicated in earlier retrospective studies. We have earlier reported the proportion of drug-related visits to the medical emergency to be 5.9%(7). Since then, a number of new drugs have been introduced. Their contribution towards emergency visits or hospital admissions remains unknown.

The studies on drug-related visits to the medical emergency department and hospital can contribute to a more comprehensive evaluation of drug-related problems that arise from prescriptions of general practitioners. The information generated from such prospective studies can be utilized in such a manner, to try and establish as to what proportion these events are avoidable, so that an intervention can be carried out in future.

So, the aim of the present study was to analyse the contribution of adverse drug events to the overall number of visits to the emergency medical outpatient department (EMOPD) and hospital admissions. We also intended to characterise the different causes of drug related visits and the consequences on health care costs.

Material and Methods

The present study was a prospective and a non-interventional study. All visits to the EMOPD and Internal Medicine in-patient department of the Nehru Hospital attached to the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, were recorded over a period of 6 months (April, 2003 to September, 2003). The PGIMER is a 1500-bed tertiary care hospital, and its emergency department has a multi-disciplinary structure (Internal Medicine, Cardiology, Pulmonary Medicine, Intensive Care, etc.). The residents on round-the-clock duty in the EMOPD and Internal Medicine indoor department were informed about the study objectives. They were asked to elicit information from all patients regarding whether the patient’s visit was due to an ADR, drug interaction, or patient non-compliance. This was further subjected to verification by a consultant from the EMOPD. Medical records of all the patients visiting the EMOPD were then reviewed by two clinical pharmacologists. Also, all patients (relatives, if patients were unconscious) were interviewed to elicit more information and reassess the causes for the EMOPD visit and hospital admission. Correlation of suspected drug(s) causing the problem that led to the EMOPD visit and hospital admission was assessed by using the Naranjo probability scale. (8) For each patient, the following information was recorded: demographic characteristics, diagnosis, drug history, type of ADE and clinical condition.

The cases of suspected ADEs were followed-up to find out whether they were discharged from the EMOPD itself, or whether they subsequently required hospitalisation.

Definitions
The definitions used in this study, as described in similar studies, were (7) (1) Adverse Drug Event (ADE): Injury or adverse events resulting from medical intervention related to drug. (2)Adverse Drug Reactions (ADRs): ADRs were defined as any “noxious and unintended reaction, and occurs at doses used in humans for prophylaxis, diagnosis, therapy or modification of physiologic functions”. (3)Drug-Drug Interactions: A drug interaction was considered to have occurred when the effects of one drug were modified by the presence of another drug. (4)Patient non-compliance: Determining whether a patient’s history of non-compliance was attempted in a non-judgemental way. The question was asked as follows “Many patients that are taking different medications over long periods of time will occasionally not take one or more of their medications. How often do you? Do you ever take more or less of the prescribed amount for any reasons?” (5) Accidental or intentional drug overdose: This information was obtained from the patients themselves or relatives, and was further confirmed from the resident concerned. Plasma concentrations were measured for the poisoning cases, wherever possible.

Definitions used in assessing causality were(9) (1) Definite or probable: The reaction commonly known to occur, with clear cut temporal association or laboratory confirmation, signs and symptoms were improved by dose adjustment, stopping or reinstating the drug; the signs and symptoms could not reasonably be explained by the known characteristics of the patient’s clinical condition or by the effects of other drugs. (2) Possible: Reaction known to occur with less clear-cut temporal relationship; other causes also possible; the signs and symptoms were improved by dose adjustment, stopping or reinstitution of the drug therapy. (3) Contributing factor: There is a definite or probable link between drug treatment and the diagnosis at admission. However, there are other complications that are unrelated to drug treatment, which are also a cause of admission. The total hospital cost of all drug related admissions (including ADRs, patient non-compliance, drug-interaction and over-dose), was calculated by calculating the cost of admission, drug-cost, cos

Results

(Table/Fig 1),(Table/Fig 2),(Table/Fig 3)

A total of 1200 patients were included in the study. The median (IQR) age range was 18 to 80 years, and the male to female ratio was 0.93.

Among 1200 patients who visited the Emergency OPD and were admitted in Internal Medicine Ward during six months duration, 50 patients (4.2% ,95% CI: 1.21 – 6.53) were considered to be related to adverse drug events, and 24 (2%) were admitted due to poisoning. The mean age of these patients was 47.3+ 18.9 years, and the male to female ratio was 0.85. The average number of drugs prescribed to the patients who visited the EMOPD was 6.01 + 1.9. At the time of emergency visits, patients whose visit was due to ADEs, were consuming more drugs (7.7 + 3.1 vs 3.5 + 2.1; p<0.01). The highest percentage of ADEs was seen in the more than 80 years age group (42%), and in the less than 20 years age group (26%), both being statistically significant when compared with other age groups (p<0.05)(Table/Fig 1).

The 50 ADEs were associated with 21 different drugs. The most frequent sub-group of ADE related visits were ADRs (90%) and patient non-compliance (6%), followed by overdose (2%) and drug interaction (2%), and the duration of hospital stay with ADE was longest with ADR (Table/Fig 2). The most frequent ADRs were NSAIDs-induced gastritis and upper GI bleeding (22%), followed by antitubercular drug-induced hepatitis (20%) and betalactam antibiotic-induced hypersensitivity (8%) reactions.

In the present study, we found the incidence of fatal ADEs to be 0.2%. Among them, 10% were life threatening, and 30% were serious (Table/Fig 3).

The hospital admissions that were related to adverse drug events accounted for US$ 6712.34 or US$ 134.25 per admission (Table/Fig 2).

According to the Naranjo probability scale, all the ADEs reported have been classified as definite or probable (40%), possible (34%), or a contributing factor (26%). Among 50 ADE-related visits, 15 cases (30%) were thought to have been preventable or avoidable.

Another important cause of hospital visits apart from ADEs in our hospital was poisoning with various non-therapeutic chemicals. During 6 months of duration (April 2003 to September 2003), 24 cases (2% of all admissions) that were admitted to the EMOPD, were due to poisoning and organophosphorus compounds.

Discussion

In large hospital based studies, the incidence of ADEs was 3.4 – 3.7%(10),(11). The leading cause of medical injury was use of drugs, accounting for 19.4% of these injuries, and therapeutic mishap occurred in 7.5%(12). A meta-analysis of 39 prospective studies, covering 32 years, revealed a 6.7% incidence of serious and fatal ADRs, and a 0.32% death rate among patients admitted to the hospital because of an ADR, and those having an ADR while in hospital. The study showed that a large number of serious ADRs occur, even when the drugs are properly prescribed and administered(13).

In the present study, we estimated the proportion of drug-related visits to be 4.2%, which is consistent with other studies.

In the present study, ADRs were seen with the highest frequency in the age group above 80 years and below 20 years. We had earlier reported that more than 14% of elderly admissions were due to drugs(14). In other studies, the incidence of drug-related adverse events in the elderly population was 28.2%,(9) whereas in our study, it was higher 42%. Elderly age group patients are at high risk of developing drug related adverse effects because of increased sensitivity to the unintended side effects or adverse drug reactions of medications that could result from incorrect dosing, and their use of more medications. In the present study, we estimated the incidence of ADEs in the age group < 20 years to be 26%, which was higher as compared to other age groups (p<0.05). This reflects two problems. Firstly, that of unregulated sale of drugs without prescription in the Indian market, a problem faced by many developing countries, and secondly, many cases of teenage depression may be going unrecognised.

The other aspect is that of non-compliance, especially the patient’s non-compliance. Compliance issues have been a major area of concern in many studies(15),(16). In the present study, 4% of patients were admitted to the EMOPD due to patient non-compliance. The causes of patient non-compliance were due to a majority of them switching over to alternative systems of medicine. In a country like India, superstitions, illiteracy, poverty, and certain deficiencies in the conventional medicine make patients seek alternative therapies.
In the present study, NSAIDs, antitubercular drugs and antimicrobials were the most commonly implicated drugs, which probably reflects their widespread use.

For the patient, economic consequences of drug related problems would include cost of medical care, loss of wages, impact on household services of the injured, and effects on quality of life (damages for pain and suffering)(17). The estimated annual cost of drug related problems in outpatient clinics in the US, is $ 76,600 million. The largest component of this cost was due to drug-related hospitalisation(17). In the present study, we estimated that the total projected annual cost of drug related visits and admissions in the EMOPD and the Internal Medicine in-patient department, was about US$ 6712.34 in our hospital. Since this was single centre study and limited to two departments only, the total costs across all the departments and all the hospitals in India is likely to be high.

Ours is a public sector institution and the costs of physician visits and nursing charges are negligible, while the costs of investigations and stay are highly subsidized. Thus, our costs are much lower than the costs, not only in developed countries(18), but also in comparison to the private sector institutions of our country.

Most studies reviewed above, suggest that a significant percentage of AEDs and DRPs are preventable(19). In our st

Acknowledgement

Residents and EMOPD staff who helped in this study.

References

1.
Mannesse CK, Derkx FH, de Rider MA, et al. Adverse drug reactions in elderly patients as contributing factor for hospital admission: cross sectional study. Br Med J 1997; 315: 1057-1058.
2.
Mannesse CK, Derkx FH, de Ridder AM, Manint Veld AJ, Vander commen TJ. Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 2000; 29: 35-39.
3.
Avorn J. Putting adverse drug events into prospective. JAMA 1997; 277: 341-342.
4.
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