Ramanathan Kirthivasan

Anticoagulants are very useful medications but can also lead to haemorrhagic as well as thromboembolic complications when not used correctly or without proper medical attention. Anticoagulant’s complex pharmacology and pharmacokinetics contribute to its narrow margin of safety. Pharmacist’s unique knowledge of pharmacology, pharmacokinetics and interactions makes them well-suited to assist patients in maintaining safe and effective anticoagulation. Successful anticoagulation therapy implies fewer incidences of therapeutic failures and bleeding complications. The anticoagulation management service staffed by clinical pharmacists is a service established to monitor and manage oral and parenteral anticoagulants. In this research work, 40 patients each were included in the intervention and the control groups. In the intervention group, patient’s knowledge score on anticoagulation increased from an average of 5.6±3.2 to 13.8±0.94 (P=0.000) after clinical pharmacist’s counselling, whereas in the control group there was no significant improvement in patient’s baseline knowledge over the knowledge score at the end of the study (8.0±1.59 vs. 8.3±2.6) (P=0.218). In the intervention group, 73.45% of the international normalised ratio test results were within the therapeutic range, 8.45% supratherapeutic and 18.5% subtherapeutic during the 6 months data collection period. The corresponding data for the control group were 53.2 (P=0.000), 18.4 (P=0.000) and 28.4% (P=0.002), respectively. Forty four adverse drug reactions (ADRs) related to anticoagulants were identified in the intervention group as compared to 56 in the control group. These results revealed that the clinical pharmacist’s involvement in the anticoagulation management improved the therapeutic outcome of patients and demonstrate the benefits of clinical pharmacist guided anticoagulation clinics in India.

Moyamoya disease is a vasculopathy causing chronic progressive stenosis and occlusion of the large arteries of the circle of Willis that could lead to brain ischaemia. The condition may also present with haemorrhagic strokes. This is a case report of moyamoya disease in a 32-year-old woman presenting with ischaemic stroke. The report describes her inpatient stay and investigations and findings. The report reviews the main aspects of moyamoya disease definition, epidemiology, clinical features, diagnosis, classification and treatment. This case is interesting because her first presentation occurred after 3 months of her second delivery. Whether the different physiological stresses of pregnancy, child birth and puerperium have had some effect in accelerating the pathogenesis of her moyamoya disease remains unknown. 1

Background. The aim of our research was to examine the impact of depressive symptomatology and cognitive impairment on visual function and symptoms in patients with cataract. Material and methods. Demographic details, ophthalmological details, Snellen acuity, cataract symptoms, visual function, depressive symptomatology, cognitive impairment and quality of life were measured in 72 elderly subjects attending the pre-assessment cataract clinic at the Herts and Essex Hospital, Bishops Stortford, England. Results. Subjects with depressive symptomatology were significantly more affected by symptoms of cataract (Spearman = 0.039, p<0.05) and had poorer visual functioning (Spearman = 0.023, p<0.05) than their non-depressed counterparts, despite no significant difference in visual acuity between the two groups. There were no significant differences for subjects with cognitive impairment and cataract symptoms (Spearman = 0.700, NS) or visual functioning (Spearman = 0.158, NS). Conclusions. The study supports the hypothesis that depressive symptomatology is related to pre-operative cataract symptoms and visual functioning, but did not confirm that cognitive impairment was related to pre-operative cataract symptoms or level of visual function.

Results. Subjects with depressive symptomatology were significantly more affected by symptoms of cataract [Spearman = 0.039, p<0.05] and had poorer visual functioning [Spearman = 0.023, p<0.05] than their non-depressed counterparts, despite no significant difference in visual acuity between the two groups. There were no significant differences for subjects with cognitive impairment and cataract symptoms [Spearman = 0.700, NS] or visual functioning [Spearman = 0.158, NS]. Conclusions. The study supports the hypothesis that depressive symptomatology is related to pre-operative cataract symptoms and visual functioning, but did not confirm that cognitive impairment was related to pre-operative cataract symptoms or level of visual function.