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

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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

Letter to Editor
Year : 2009 | Month : August | Volume : 3 | Issue : 4 | Page : 1713 - 1716

Pattern Of Potential Drug-Drug Interactions In The Intensive Care Unit Of A Teaching Hospital In Nepal: A Pilot Study

BISTA D*, SAHA A**, MISHRA P ***, PALAIAN S ****, PATHIYIL R S*****

*,**,***,****,*****Lecturer, Deptt of Clinical Pharmacology Nepal Medical College Teaching Hospital Kathmandu, (Nepal). ***,****Deptt of Pharmacology,Manipal College of Medical Sciences,Pokhara, (Nepal). Deptt of Hospital and clinical pharmacy Manipal Teaching Hospital,Pokhara, (Nepal).

Correspondence Address :
Durga Bista B.Pharm, M.Sc Pharmacology
Lecturer, Department of Clinical Pharmacology
Nepal Medical College Teaching Hospital
Kathmandu, Nepal.
E-mail: durgabista40@hotmail.com

Dear Editor,

With the increase in the number of patients with multiple diseases and complex therapeutic regimens, polypharmacy becomes unavoidable (1). When more than one drug is used, the risk for Drug-Drug Interactions (DDIs) increases. The consequences of DDIs are often not considered seriously, though they are a preventable cause of morbidity and mortality (1),(2),(3). A drug interaction (DIs) is said to occur when the effects of one drug are changed by the presence of another drug, food, drink or an environmental chemical agent. The result of DIs may be an additive effect, antagonism, alteration of an effect or idiosyncratic effects (4). Studies about DDIs are lacking in Nepal. A retrospective study from Nepal showed a high prevalence of polypharmacy. During the hospital stay, 73% of patients received more than five drugs concurrently (5).

The present study was conducted with the objective of identifying the potential DDIs in the Intensive care unit (ICU) of Manipal Teaching Hospital (MTH), to categorize the potential DDIs based on their severity, onset, and documentation and to study the association, if any, of potential DDIs with various parameters like age, sex, smoking, alcohol consumption, disease state and the number of drug prescribed.

A prospective, cross sectional study was conducted in the ICU of MTH, a 700 bedded tertiary care teaching hospital located at Pokhara city in the Western region of Nepal. The study was conducted for a period of fifteen days (Jan 1- 15, 2006). All patients admitted to the ICU of MTH were included in the study. Out patient department (OPD) patients, patients admitted to wards other than the ICU, patients taking only one drug, patients not taking any drugs and also patients on herbal drugs and multivitamins were excluded from the study. A self developed structured patient profile form was used for the collection of patient details in the study. The Micromedex (6) electronic source for integrated drug information was used to categorize the DDIs based on severity (major, moderate, minor), onset (rapid, delayed, not specified) and documentation (excellent, good, fair, poor and unlikely). It also gives information on the mechanism of DDIs, clinical outcomes and ways to manage them.

Among the 26 patients admitted during the study period, 15 (57.7%) encountered at least one DDI during their stay in the ICU. The average number of drugs prescribed among the patients who were at the risk of developing DDIs was 10.67 (n=15) and for the patients who were not at risk for DDIs was 8.23 (n=26). A higher incidence of potential DDIs was observed among the age group of 51-60 years at 40%. Male patients encountered more number of potential DDIs 9 (60%). Smokers (11.53%) and alcoholics (23.07%) were found to be at a risk of developing potential DDIs than those who were not taking these drugs.

According to the Micromedex electronic database classification, most of the potential DDIs encountered, were of ‘Moderate’ severity [39 (72.23%)] and of ‘Good’ documentation [35 (64.82%)]. Cardiovascular drugs were the most common therapeutic category at high risk for DDIs [50 (46.3%)]. (Table/Fig 1) shows the details regarding the therapeutic category at a higher risk for DDIs.

Aspirin was the most common high risk drug responsible for interaction in both the phases. (Table/Fig 2) has the list of the top thirteen high risk drugs prescribed during the study period.

(Table/Fig 3) shows the commonest high risk interactions found during the study period.

The incidence of potential DDIs during our study was 57.7%. A review of nine epidemiological studies reported an incidence of 0% to 2.8% (7). Similarly, a study from USA reported DDIs to be responsible for nearly 2% of adverse events in acute hospital in-patients (8). Another study from South India, carried out in a community pharmacy, reported an incidence of 26% (9).Our study had a higher incidence of potential DDIs. The difference might be due to the inclusion of patients from the ICU, where usually various chronically ill patients with multiple drugs are admitted.

We found that the incidence of potential DDIs was higher in the age group of 51-60 years. In conformation with other studies (9),(10). our study has also shown an increase in the number of potential DDIs with the patient’s increasing age. Similarly, a study from Sweden reported that 31% of the DDIs were found in elderly patients (11). In general, it has been observed that elderly patients use more medications and hence, they are at an increased risk of developing DDIs. Moreover, they also have impaired homoeostatic mechanisms that might otherwise counteract some of the unwanted effects. In these patients, the consequences of DDIs are likely to be serious (1). It has been stated that potential DDIs are common in elderly people who use many drugs and are part of a normal drug regimen (12).

The present study observed the practice of polypharmacy (10.67 drugs per prescription). A study conducted at USA found an increase in the risk of ADIs to be 13% for patients taking two medications and 82% for those taking 7 or more medications (13).A retrospective study from Nepal showed a high prevalence of polypharmacy where during a hospital stay, 73% patients received more than five, 54% received more than eight, and 24% received more than nine drugs concurrently, predisposing them to DDIs (5). Our study was similar to these results with respect to the observation that the number of interactions increased with increase in the number of drugs prescribed.

The severity of the DDIs was graded as per the Micromedex (6) electronic database classification. We found 72.23% of the potential DDIs to be moderately severe. The ‘Major’ severity type accounted for 16.67% of DDIs and 11.12% were of ‘Minor’ severity. Our values are higher than the findings reported from a study conducted at USA, which reported 7.3% of Major DDIs in a surgical intensive care unit (14). A South Indian study found 15% of DDIs to be severe in nature and 12% to have a significance level of one (severe reaction and well-documented interaction), which is again higher than our values (8).

In our study, 51.86% of the potential DDIs had delayed onset as per the Micromedex electronic database. In general, DDIs usually have a specific time course i.e. onset and duration and this makes them more predictable and preventable than ADRs (15). This finding suggests that one should be careful while prescribing drugs that can cause the delayed type of DDIs. These patients should also be counseled for careful monitoring of symptoms suggestive of the occurrence of DDIs. There was no significant reduction in the type of onset after the intervention.

A study by Doucette and coworkers also found cardiovascular and psychotropic medications to be more frequently involved in DDIs (16). In general, the ICU had a significant number of cardiac patients from our hospital. This could be a reason attributable for the higher number of cardiac drugs in our study. We found aspirin (12.04%) followed by frusemide (11.11%), digoxin (8.33%), enalapril (6.48%) and omeprazole (4.63%) to be the drugs which were at a high risk for developing DDIs. A South Indian study identified antitubercular drugs, analgesics and antipyretics, bronchodilators, diuretics, antiplatelet drugs, H2-receptor blockers and proton pump inhibitors to be commonly responsible for causing DDIs (8). Though some of the drugs involved were similar, our study has focused on the pattern of the interaction of the drugs used in the ICU.

The commonest potential DDIs observed during the study were between aspirin-ACEIs (9.26%), followed by aspirin-LMWH (5.56%). Unlike in our finding, a study done in an elderly population found that the most common DDIs in them were between beta-blockers and antidiabetics, followed by potassium-sparing diuretics and potassium and between carbamazepine and dextropropoxyphene (10).

This study provided some basic information regarding the pattern of DDIs in the ICU setting in Nepal. Our findings suggest the need for further studies in this area.

References

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. Lee A, Stockley IH. Drug interactions In Walker R, Edwards C. Clinical Pharmacy and Therapeutics. 3rd edition. Churchill Livingstone, Philadelphia 2003: 21-31.
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. Seymour R.M, Routledge P.A. Important drug-drug interactions in the elderly. Drugs Aging 1998; 12: 485- 94.
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. Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug-drug interactions among elderly patients hospitalized for drug toxicity. J Am Med Assoc 2003; 289: 1652- 8.
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. Stockley I H. Drug interaction: a source book of adverse interaction, their mechanisms, clinical importance and management.5th ed. Pharmaceutical Press, London 1999.
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. Joshi MP, Sugimoto T, Santoso B. Geriatric prescribing in the medical wards of a teaching hospital in Nepal. Pharmacoepidemiol Drug Saf 1997; 6: 417- 21.
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. Klasco RK (Ed): DRUG-REAX® System. Thomson Micromedex, Greenwood Village, Colorado (Vol. 130 [Expires12/2006]).
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. Jankel C A, Fitterman L K. Epidemiology of drug-drug interactions as a cause of hospital admissions. Drug safety 1993; 9: 55- 9.
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. Leape L, Brennam T A, Laired N et al. The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. N Engl J Med 1992; 324: 377- 84.
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. Nagavi BG, Singhal R. Drug interactions in prescription from selected Indian community pharmacies. J Pharm Pract Res 2005; 35: 332.
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. Bergendal L, Friberg A, Schaffrath AM. Potential drug-drug interactions in 5,125 mostly elderly out-patients in Gothenburg, Sweden. Pharm World Sci 1995; 17:152-7.
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. Biorkman IK, Fastbom J, Schmidt IK, Bernsten CB. Drug-drug interactions in the elderly. Ann Pharmacother 2002; 36: 1675- 81.
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. Goldberg RM, Mabee J, Chan L, Wong S. Drug-drug and drug-disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med 1996; 14; 447- 50.
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. Oeser DE, Polansky M, Thomas NP, Varon J. Incidence of major drug interactions and associated adverse drug events in a surgical intensive care unit. Internet J Pharmacol 2003; 2.
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. Johnson MD, Newkirk G, Jr White JR. Clinically significant drug interactions: what you need to know before writing prescriptions. Postgrad Med 1999; 105:193- 5, 200, 205- 6.
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. 16.Doucet J,Chassagne P, Trivalle C et al. Drug-drug interactions related to hospital admissions in older adults: a prospective study of 1000 patients. J Am Geriatr Soc. 1996; 44: 944- 8.

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