Serotonin toxicity is a common but often unrecognized toxicological condition. In most cases, a combination of two or more serotonergic drugs can cause serotonin syndrome. We describe a case of serotonin toxicity in a 17-year-old woman, secondary to suicidal ingestion of 1000 mg lamotrigine and 400 mg citalopram, which has been rarely reported. Our patient had a medical history of depression and was treated with lamotrigine and citalopram. She was brought to the emergency room with nausea, diaphoresis, agitation, shivering, tremor, vertigo, ataxia, mydriasis, nystagmus, hyperreflexia, myoclonus, tachycardia, tachypnea, and mild fever. The symptoms and signs were resolved within 3 days following hydration, sedation, and cyproheptadine. Minor cardiovascular symptoms are probably due to the less toxic dose of citalopram. Lamotrigine, especially in combination with other serotonergic drugs, should be considered a cause of serotonin toxicity.

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Selective serotonin reuptake inhibitors (SSRIs) are widely used in the treatment of many types of mental disorders. Citalopram is commonly used as a new generation of SSRIs in this regard; however, unfortunately, its overdose is associated with seizure and heart disorders. The reported case in the present study indicated recurrent seizures, nonspecific ST-T changes, and prolonged QT interval due to the overuse of citalopram. The patient had bilateral anterior shoulder dislocation along with right proximal humerus fracture that was occurred during the seizure. The dislocation was initially reduced and then fixed. Moreover, the seizure was controlled with diazepam without any problems, and cardiac monitoring continued for 2 days. Massive citalopram overdose may be associated with recurrent seizures and QT prolongation. Complications postseizures, such as shoulder dislocations, should be examined for and managed appropriately.

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Objective: Drug utilization studies provide information regarding the drug usage pattern in hospital settings, which can be used to promote cost-efficient uses of drugs. The present observational retrospective study was conducted to evaluate the drug utilization pattern in a tertiary care center in India and create a baseline consumption data for the drugs, simultaneously identifying targets for improving drug prescribing pattern. Methods: The current retrospective cross-sectional study was conducted at All India Institute of Medical Sciences Raipur, wherein the 217 medical records of different departments for August 2019 were chosen randomly (using systematic random sampling) for evaluation. The information was extracted from medical records regarding the basic demographic details, drug strength, route, and total amount, and eventually, the World Health Organization (WHO) core indicators were estimated. Drug utilization data were assessed using the WHO Anatomical Therapeutic Chemical/Defined Daily Dose (ATC-DDD) methodology. Potential drug–drug interactions were also analyzed. Findings: Most of the records analyzed were of male patients (56.2%). Drugs prescribed by their generic name were 50%. Prescriptions containing injection and antimicrobials were 68.1% and 83.6%, respectively. 49.3% of the patients had received a fixed-dose combination, and 60.9% of drugs belonged to the National List of Essential Medicines 2015. A total of 15 potential drug interactions were found. Conclusion: Calculated prescribed daily dose of most of the antimicrobials and other groups of drugs was close to the WHO-DDD. Trade name prescription and polypharmacy were very common. Antibiotics accounted for the majority of drug costs.

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Objective: This study was designed to evaluate the extent of inappropriate utilization of intravenous proton-pump inhibitors (IV-PPIs) and its financial burden in a Middle Eastern tertiary care university hospital. Methods: This was an observational, retrospective, cross-sectional study carried out in King Saud University Medical City, Riyadh, Saudi Arabia. During a study period of 6 consecutive weeks, all hospitalized adult patients (age ≥18) who received IV-PPI selected and mapped with their indications. The patient indications analyzed in comparison with the appropriate indications developed based on the evidence from published literature and guidelines. Findings: A total of 347 patients were identified, with a mean age of 51.5 years, of which 51.9% were male. Of all the patients who received IV-PPIs, 251 (72.3%), 66 (19%), and 30 (8.7%) received for stress ulcer prophylaxis (SUP), peptic ulcer disease (PUD) or gastroesophageal reflux diseases (GERDs), and upper gastrointestinal bleeding, respectively. Overall, only 110 (31.7%) of the 347 patients received IV-PPIs appropriately. The patients with SUP showed the highest percentage of inappropriate use of IV-PPI (80.59%) compared to PUD/GERD (19%). The total cost of inappropriate prescription of IV-PPI was 585,167 Saudi Riyal (SAR) (156,044 USD). Conclusion: There is a high tendency of IV-PPI's inappropriate prescription in our hospital setting. This large-scale inappropriate prescription of IV-PPI in the hospital setting not only may lead to increased financial burden but also expose patients to number of undesired effects.

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Objective: The present study aimed to assess the knowledge, attitude, and practice (KAP) of 3^rd- and 4^th-year medical, dental, and pharmacy students about hepatitis B (HB) infection at a private medical university, Malaysia. Methods: A cross-sectional, questionnaire-based study was conducted among 482 medical, dental, and pharmacy students of 3^rd- and 4^th-year degree program of Asian Institute of Medicine, Science and Technology University to assess their KAP about HB infection using 34 prevalidated questions by convenient sampling method. A questionnaire was administered to the students, and their responses were measured at “yes” and “no” scale. Students' responses were entered in SPSS version 22, and quantitative analysis was performed using descriptive statistics and nonparametric tests at P < 0.05. Findings: The medical, dental, and pharmacy students had good knowledge and practice with positive attitude about HB infection. Mann–Whitney U-test determined a significant difference in knowledge (P < 0.001) and practice (P < 0.001) scores between medical and pharmacy, attitude (P < 0.001) scores between medical and dental, and attitude (P < 0.001) and practice (P < 0.001) scores between pharmacy and dental students. Students' age was correlated with their attitude, practice, and KAP scores and family income with their knowledge, attitude, practice, and KAP scores. Conclusion: Although students' knowledge and practice were good with positive attitude, all the students did not participate in health education program, screening, and vaccination of hepatitis B virus (HBV) infection which makes them more vulnerable to occupational HBV infection. Hence, it is recommended to organize a regular health education program for the students on screening and vaccination against HBV to prevent its infection.

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Objective: Amphotericin B is an antifungal agent used to treat serious fungal infections mainly in critically ill patients. Despite its adverse effects including renal toxicity and electrolyte imbalances, amphotericin B remains one of the best choices for antifungal treatment. Information from animal studies has provided a strong scientific basis for the use of pentoxifylline as lowering nephroprotective agent. The present study was designed to evaluate the efficacy of pentoxifylline in preventing renal toxicity and electrolytes imbalances induced by amphotericin B. Methods: This study was conducted as a randomized controlled trial on 44 patients admitted to Sayyedoshohada Hospital, Isfahan, Iran, from October 2016 to August 2018. Patients were assigned to one of the two groups: Pentoxifylline, 400 mg twice a day, or matching placebo, from the 1^st day of amphotericin B therapy till minimum of 7 days. All patients' information including lab data (serum and urine levels of Mg, Na, and K, serum creatinine level, blood urea nitrogen [BUN] and urinary creatinine excretion) were gathered at the time of drug initiation and during the study period. The results were analyzed by SPSS v. 20 software and Repeated measures test was used to assess the differences between groups Findings: This study did not show any significant differences between the two groups in terms of all the assessed variables, including serum and urinary levels of electrolytes, and creatinine, as well as the number of cases presented acute kidney injury during the study period. Conclusion: Despite the positive effects of pentoxifylline in preventing renal complications in previous studies, this study could not show a definitive result in salt wasting or renal damage induced by amphotericin B. So, Designing robust studies with more included samples would be valuable.

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Objective: The treatment of hypertension requires special attention because of comorbidities and polypharmacy. In a previous study, polypharmacy has been associated with a high risk of drug-related problems (DRPs). This study aimed to analyze DRPs in Indonesian hypertensive patients focusing on drug therapy effectiveness and adverse drug reactions. Methods: A cross-sectional study was conducted using medical records' data, prescriptions, and nursing records to observe DRPs that occurred in outpatients with hypertension from February to April 2019. A total of 114 outpatients aged ≥23 years with a primary diagnosis of primary hypertension were included in this study. DRPs were reviewed based on literature, recent guidelines, and drug interaction software. Classification DRPs were done using Indonesian-translated Pharmaceutical Care Network Europe V6.02. The data obtained were analyzed using univariate descriptive analysis. Findings: Of all participants, 65 (57%) outpatients were found to have DRPs related to treatment effectiveness (54 cases) and adverse drug reactions (36 cases). The primary cause of the problems was an inappropriate drug (94.14%) and dose selection (2.86%). Potential drug interactions were found high (62.14%) in the combination of an antihypertensive agent with other drugs among patients. Overprescribing drugs without clear indications, untreated indications, and subtherapeutic dosage were also reported in this study. Conclusion: A significant percentage of outpatients being treated for hypertension experienced DRPs. The role of clinical pharmacists and physicians in monitoring drug therapy needs to be prioritized to prevent and resolve DRPs in outpatients with hypertension.

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Challenges faced by non-COVID-19 patients with chronic illness are limitless during the lockdown period. These patients are mostly immunocompromised and vulnerable to infection. The worst affected would be chronic disease patients with lower household income. Patients' fear of approaching medical facilities and also travel restrictions limit the patients to reach the healthcare team, and either of this leads to poor health outcome. Frequent communication with chronic disease patients by healthcare professionals is a key to encourage the patients to be adherent to the medications and manage their disease conditions.

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