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Introduction: Medication‑related harm (MRH) has been recognized as a global public health issue., Objectives: This study aimed to assess the prevalence and causes of MRH in geriatric patients. Another objective of the study was to recognize how MRH and drugs prescribed after geriatric interventions affect survival., Patients and Methods: It was a cross‑sectional study of 301 geriatric patients admitted to the hospital for any cause, combined with a 2‑year survival analysis. Altogether, 71 drug items were included. Medication‑related harm was defined based on clinical reasoning. Logistic regression models were applied to identify the explanatory variables for each type of MRH. The Cox proportional hazards model was used to determine the association of MRH and postdischarge medications with patient survival., Results: Medication‑related harms were identified in 35.2% of the study patients. Those included, among others, hypotension (19.3%), hypoglycemia (13.3%), parkinsonism (4.3%), and benzodiazepine addiction (5.7%). Logistic regression, applied to estimate the impact of drugs before admission on MRH of any type, demonstrated an independent negative effect of typical neuroleptics, antidiabetic medication, benzodiazepines, and supplements, except vitamin D. After geriatric interventions, 4 drug classes showed a positive association with survival: thiazides (hazard ratio [HR], 0.45; 95% CI, 0.22-0.93), selective serotonin reuptake inhibitors (SSRIs; HR, 0.51; 95% CI, 0.34-0.75), paracetamol (HR, 0.54; 95% CI, 0.33-0.88), and angiotensin‑converting enzyme inhibitors (ACEIs; HR, 0.59; 95% CI, 0.4-0.89)., Conclusions: Geriatric-based deprescribing and drug optimization mitigate the negative impacts of MRH on patient survival and may decrease the rehospitalization rate and healthcare costs. Thiazides, ACEIs, SSRIs, and paracetamol, if indicated, were associated with better survival in geriatric patients.

INTRODUCTION    Multimorbidity in older adults leads to polypharmacy with all its hazardous outcomes and drug‑related problems. OBJECTIVES    We aimed to assess the difference in the number of drugs between admission to and discharge from a geriatric ward and identified the patient‑related factors associated with changes in the drug regimen. PATIENTS AND METHODS    This retrospective cross‑sectional study included 301 geriatric patients who underwent drug optimization in line with the Beers and STOPP/START criteria. The numbers of drugs per individual at hospital admission and discharge were compared using the Wilcoxon signed‑rank test. A multiple linear regression model was used to identify patient characteristics that influenced the observed difference in the number of drugs following geriatric hospitalization. RESULTS    A significant reduction of 1.29 in the number of drugs per patient, on average, was observed. The Spearman's correlation coefficient between the number of prescribed medications and the number of coexisting conditions per individual changed from 0.28 to 0.51. The patient‑related characteristics that jointly and independently explained (P <0.001) the difference in the number of drugs in the multiple regression model (R2 = 0.73) were the number of drugs on admission, number of coexisting conditions, age, fact of living alone, and the incidence of adverse drug reactions. CONCLUSIONS    Geriatric hospitalization results in deprescribing rather than prescribing medications, especially in individuals who were overtreated, older, undernourished, at risk of an adverse drug reaction, and living alone. Appropriate deprescribing may potentially lead to fewer drug‑related problems in the senior population as well as reduce health care costs.

A case is presented of a 30-year old man with long-term history of painful muscle cramps, episodes of tetany, general malaise and persistent hypokaliemia. On the ground of clinical appearance and biochemical data the Bartter's syndrome in Gitelman's variant was diagnosed. In differential diagnosis we considered renal tubular acidosis, other tubular defects (Liddle's syndrome), primary and secondary hyperaldosteronism. Other possible causes of hypokaliemia were excluded such as surreptitious diuretic and lexative abuse, persistent vomiting and diarrhea. Good therapeutic effect were achieve using spironolacton, indomethacin, propranolol and potassium supplementation.