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

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On Sep 2018




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On Sep 2018




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"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."



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Lucknow
On Sep 2018




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On Aug 2018




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"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.
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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.
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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
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : FC11 - FC14 Full Version

Pharmacovigilance in Geriatric Patient-A Prospective Observational Study done in a Tertiary Care Hospital of Odisha, India


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51321.15893
Satyabrata Sahoo, Suhasini Dehury, Kaliprasad Pattnaik, Namita Mohapatra, Dhirendra Nath Maharana

1. DM Clinical Pharmacology Resident, Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, India. 2. Associate Professor, Department of Pharmacology, Scb MCH, Cuttack, Odisha, India. 3. Associate Professor, Department of Pharmacology, Scb Mch, Cuttack, Odisha, India. 4. Associate Professor, Department of Medicine, Scb Mch, Cuttack, Odisha, India. 5. Retired Professor, Department of Geriatric Medicine, Scb Mch, Cuttack, Odisha, India

Correspondence Address :
Dr. Suhasini Dehury,
Associate Professor, Department of Pharmacology, SCB Medical College, Cuttack, Odisha, India.
E-mail: drsuhasinidehury@gmail.com

Abstract

Introduction: Geriatrics is a speciality that focuses on healthcare of elderly people. Geriatric population is defined as people above 60 years of age. Geriatric population constitute 8.14% of total population in India. They have diverse physiological and pathological profiles which have an impact on the pharmacokinetic and pharmacodynamic properties of the administered drug. Very often they are under polypharmacy due to multisystem involvement and thereby subjected to numerous drug interactions and Adverse Drug Reactions (ADRs). There are few studies conducted in India regarding ADRs in Geriatric Patients and none in Odisha, India.

Aim: Pharmacovigilance study in Geriatric patients was taken up in a tertiary care hospital to assess the spectrum, cause, severity and preventability of ADRs.

Materials and Methods: This prospective, observational study was conducted in Department of Pharmacology in collaboration with Departments of Geriatric Medicine, Medicine and Skin and Venereal Disease (VD) of SCB Medical College and Hospital, Cuttack, Odisha, India. All geriatric patients (aged ≥60 years) diagnosed with ADR, from September 2016 to September 2018, were included. The detailed information of type of ADR and its characteristics were filled up in Suspected ADR Reporting Form. The prevalence and profile of ADRs in geriatric patients were studied. Their causality, severity and preventability were assessed by World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) System, Modified Hartwig’s Severity Scale and Schumock and Thornton Preventability Scale, respectively.

Results: A total of 236 geriatric ADRs were reported in two years, out of which, the most common ADRs were cutaneous 100 (42.4%), followed by metabolic 68 (28.8%) and Gastrointestional (GI) involvement 26 (11%). Out of the geriatric ADRs, 128 (54.2%) ADRs were possible, 65% were moderate in intensity and 70.3% ADRs were probably preventable.

Conclusion: Cutaneous and metabolic ADRs were most common in geriatric patients in present study. Majority of ADRs were possibly caused due to the drug used, were of moderate intensity and probably preventable.

Keywords

Adverse drug reactions, Cutaneous, Geriatric population

Pharmacovigilance is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem (1). ADR is defined as a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modifications of physiological function (2).

ADRs rank as one of the top leading causes of death and illness in the developed world (3). Recent data of US Food and Drug Administration (USFDA) shows that ADRs now ranks the 4th to 6th most common cause of death (4),(5),(6). Detection and prevention of ADRs at the earliest is very important to reduce the morbidity and mortality keeping in view the high healthcare cost involved in the management of ADRs.

The Pharmacovigilance Program of India (PvPI) is a National programme of Government of India and was launched with a broad objective to safeguard the health of 1.27 billion people of India. ADRs are reported from all over the country to National Coordinating Centre-Pharmacovigilance Programme of India (NCC-PvPI), which also works in collaboration with the Global ADR Monitoring Centre at WHO-UMC in Sweden to contribute in the global ADRs database (1). NCC-PvPI monitors the ADRs among Indian population and helps the regulatory authority of India i.e., Central Drugs Standard Control Organisation (CDSCO) in taking decision for safe use of medicines. The PvPI is a national programme and SCB Medical College Cuttack, Department of Pharmacology is a designated ADR Monitoring Centre under this national programme and ADRs are collected from most of the departments of our college. After doing the causality assessment of the ADRs they are entered in vigiflow for onward transmission to National Coordinating Centre (NCC) at Ghaziabad. Statistical analysis is carried out and a signal is generated. Signal information is transmitted to CDSCO and UMC for ADR database.

In Geriatric population (adults over 60 years), physiological and pathological changes are observed which modulates the effects of drugs. In older people, there occur alterations in the number of receptors, changes in signal transduction, and differences in intracellular response. Renal and hepatic functions can also be altered and can affect both the pharmacokinetics and pharmacodynamics of administered drugs (7). In the older patients, the multiplicity of disorders necessitates the use of numerous drugs. In addition, their modified pharmacokinetics and pharmacodynamics result in an increased sensitivity to many drugs. Studies from abroad as well as India have expressed that polypharmacy is common and is directly correlated with raised potential for ADRs, inappropriate prescription and drug interactions (8),(9),(10),(11). As the benefits of medications are always accompanied by harmful effects, it is not surprising that older people are at increased risk of developing ADRs (4). This may explain why in older people there is sometimes a greater sensitivity to the effects of certain drugs and sometimes a diminished response to therapy. Several studies have been conducted on ADRs as a cause of admission to hospital in older population (12),(13),(14),(15).

But very limited studies on ADR in Geriatric population have been conducted in India (16) and no similar study was conducted in the state of Odisha, India. The present study was aimed to study geriatric ADRs in our tertiary care teaching hospital with following objectives- to determine socio-demographic profile of geriatric ADRs, to assess causality assessment by WHO-UMC scale and Naranjo ADR probability scale, to assess severity of ADR using Hartwig’s severity scale and to assess preventability by Schumock and Thornton scale.

Material and Methods

The present study was a prospective, observational study done in Department of Pharmacology, SCB Medical College, Cuttack in collaboration with Departments of Geriatric Medicine, Medicine and Skin and VD of SCB Medical College and Hospital, Cuttack, Odisha, India. Our Institution is a tertiary care teaching hospital and has an approved ADR Monitoring Centre (AMC) under the PvPI. The study was approved by the Institutional Ethics Committee (IEC), SCB Medical College and Hospital, Cuttack with IEC NO.-583/26.02.18 and was conducted for a period of two years from September 2016 to September 2018.

Inclusion criteria: Geriatric patients presenting in Geriatric Medicine Department, Medicine Department and Skin and VD Department with all types of suspected ADRs. Patients aged ≥60 years, of both gender and who gave consent were included in this study.

Exclusion criteria: Patients with drug abuse and with intentional or accidental poisoning were excluded.

Study Procedure

Geriatric patients of both sexes were evaluated in detail (both by clinical examinations and laboratory investigations). The following laboratory investigations like complete blood count, blood sugar, serum sodium, serum potassium, urine routine microscopy, liver function test, serum urea, serum creatinine and other investigations were done as per the requirement of the treating clinician. The detailed information was entered into the Suspected ADR Reporting Form of IPC and information regarding pre-existing diseases and other co-morbidities of the patients, details of all the medications including prescribed and self-medications were entered into the predesigned study format. The causality assessment was done by using WHO-UMC scale and Naranjo scale; the severity was assessed by Hartwig’s scale. Preventability was assessed by Schumock and Thornton scale (1).

Statistical Analysis

Details of ADRs obtained in present study for the geriatric patients were analysed statistically (using Microsoft Excel) with special reference to age groups (60-69 years, 70-79 years and ≥80 years) and gender. Ultimately the extents (severity) of ADRs in Geriatric populations attending to our hospital were assessed. Then analysed statistically by using excel and most data are expressed in percentages.

Results

Demographic characteristics revealed most of the patients 172 (72.9%) were in the age group 60-69 years followed by age group 70-79 years in 58 (24.5%) (Table/Fig 1). The median (IQR) for age was found to be 67 year (63-70) years. Males constituted the majority i.e., 158 of all ADRs (67%) while females comprised 78 cases (33%) of ADRs. In this present study, most common ADR was cutaneous ADRs (42.4%), followed by metabolic i.e., 68 (28.8%) ADRs (Table/Fig 2).

(Table/Fig 3) shows the percentage of ADRs attributed to different categories of both WHO-UMC and Naranjo scales. In WHO-UMC scale, no definite, unclassifiable, certain and other categories of ADRs were found. Naranjo scale shows 120 (50.8%) ADRs in possible category and 116 (49.2%) ADRs in probable category. No definite, doubtful etc., categories of ADRs were found according to Naranjo Scale in the present study.

(Table/Fig 4) shows Hartwig’s severity scale, according to it 46 (20%) ADRs were of mild intensity, 154 (65%) ADRs were of moderate intensity and 36 (15%) ADRs were of severe intensity. (Table/Fig 5) shows preventability by Schumock GT and Thornton AP scale.

Discussion

The present study was aimed to determine socio-demographic profile of geriatric ADRs, to assess causality assessment by WHO-UMC scale and Naranjo ADR probability scale, to assess severity of ADR using Hartwig’s scale, to assess preventability by Schumock and Thornton scale. A 72.9% of collected ADRs belong to age group 60-69 years (Table/Fig 1). A study conducted by Pauldurai M et al., revealed a result of 69% of ADRs in the above mentioned age group (2). Age wise occurrence of ADRs was 25% within the age group 70-79 years and 2% above 80 years of age group. Such findings may be due to less number of patients aged more than 70 years visit geriatric, medicine and skin and VD department. Gender distribution of ADRs revealed a male preponderance (i.e., 67% in males). This finding was consistent with findings obtained by Pauldurai M et al., ADRs in male was 73.19% and in female was 26.81%. Another study by Shree Lakshmi Devi S et al., revealed ADRs in male 55.31% and female 44.69% (17). Another study by Jayanthi CR et al., revealed ADRs in male was 62.9% and females were 37.1% in elderly (18).

The ADRs were categorised according to system involved as cutaneous, metabolic, GI, Central Nervous System (CNS), respiratory, haematological, renal and musculoskeletal type obtained in this present study (19). Cutaneous ADRs contributes to 42.4% of total ADRs (Table/Fig 3). Next to cutaneous was metabolic which comprised to 28.8%. Least was of renal type (1.7%) ADRs, in contrast to most common ADRs in GI system (29.89%) by Pauldurai M et al., (2). In this present study, 45.8% geriatric ADRs were in probable category and 54.2% were in possible category according to WHO-UMC scale in contrast to 70.10% geriatric ADRs in probable category, 27.83% ADRs in possible category and 2.06% in certain category by Pauldurai M et al., (2). In this present study, depicted 50.8% geriatric ADRs were possible category and 49.2% of ADRs probable according to Naranjo ADR probability scale in contrast to 29.89% ADRs in possible category and 70.10% ADRs in probable category by Pauldurai M et al., (2).

Severity assessment of ADRs according to Hartwig’s scale, 65% geriatric ADRs were moderate in intensity and nearly corroborate to the findings of 74/97 study done by Pauldurai M et al., (2). According to Schumock and Thornton preventability scale 70.3% ADRs were probably preventable, 19.5% ADRs were definitely preventable and 10.2% were not preventable (Table/Fig 6). Due to unavailability of data the finding could not be compared. Another study by Nagaraju K et al., (19) revealed 83 (68%) of moderate ADRs, 30 (25%) mild and 9 (7%) severe ADRs. This present study revealed 154 cases (65%) were of moderate in intensity and 46 cases (20%) were of mild in intensity and 36 cases (15%) were of severe in intensity that is corroborated with Jayanthi CR et al., study in which 46 (51.68%) were found to be mild, 35 (39.32%) moderate and 8 (8.98%) severe (18). In this present study, 70.3% ADRs were probably preventable which is corroborated with Jayanthi CR et al., that revealed 92.1% ADRs as probably preventable (18). Another study Rukmangathen R and Brahmanapalli VD shows 48.3% probable and 51.7% possible ADRs according to WHO-UMC scale which was not corroborated with the present study (20).

Limitation(s)

Only three clinical departments involved in this present study. There are limited studies on pharmacovigilance in geriatric patients.

Conclusion

This extensive pharmacovigilance study conducted in a tertiary care hospital showed varied ADRs with higher reports in males compared to females and more reports were obtained in young-old age group of geriatric patients. Dermatological ADRs had highest incidence among all geriatric ADRs. Most of the ADRs were probably caused due to the drug, were moderate in intensity and probably preventable. Hence, this study further emphasises need of pharmacovigilance to reduce incidence of geriatric ADRs and increasing awareness among healthcare professionals, patients and public.

References

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Geneva: World Health Organisation. Looking at the Pharmacovigilance: Ensuring the safe use of medicines. WHO Policy Perspectives on Medicines. Geneva: WHO; 2004. Available from website-http://www.whqlibdoc.who.int/hq/2004/WHO_EDM_2004.8.pdf. [Cited on 2009 Dec 15].
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Pauldurai M, Kannaaiyan D, Rao R. Adverse drug reaction monitoring in geriatric patients of rural teaching hospital. Der Pharmacia Lettre. 2015,7(12):187-19. (http://scholarsresearchlibrary.com/archive.html).
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Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalised patients, a meta-analysis of prospective studies. JAMA. 1998;279(15):1200-05. [crossref] [PubMed]
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Amin S, Shah S, Desai M, Shah A, Maheriya KM. An analysis of adverse drug reactions in extremes of age group at tertiary care teaching hospital. Perspectives in Clinical Research. 2018;9(2):70-75. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/51321.15893

Date of Submission: Jul 10, 2021
Date of Peer Review: Sep 02, 2021
Date of Acceptance: Dec 09, 2021
Date of Publishing: Jan 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 19, 2021
• Manual Googling: Dec 07, 2021
• iThenticate Software: Dec 13, 2021 (16%)

ETYMOLOGY: Author Origin

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