Eruptions in focus: cefadroxil and the uncommon realm of fixed-drug reactions: a case report

This case report explores a rare case of localized fixed-drug eruption (FDE) induced by cefadroxil, a first-generation cephalosporin. FDE, characterized by recurrent lichenoid lesions at specific sites upon drug exposure, is an immunological cutaneous adverse reaction. The incidence of FDE due to cephalosporins is infrequently reported, making this case noteworthy. We present a 51-year-old male who developed brownish-black patches and painful blisters on his extremities after initiating treatment with Cefadroxil for a minor toe injury. The patient's symptoms, clinical course, and subsequent recovery are detailed. Treatment involved corticosteroids, antibiotics, and topical agents. The report also provides immunological insights into FDE pathogenesis, involving CD8+ memory T cells, cytokine production, and the role of CD4+ regulatory T cells. While the exact pathogenesis of FDE remains elusive, this report sheds light on the mechanisms contributing to the self-limited nature of these eruptions. Causality assessment using the Naranjo algorithm categorized the association between cefadroxil and FDE as probable. This case report contributes to the limited literature on FDE caused by cephalosporins and underscores the importance of recognizing and managing such dermatological reactions. The broader implications of understanding FDE pathogenesis and the rarity of cephalosporin-induced cases provides valuable insights for clinicians and researchers

A retrospective study of drug prescribing pattern in burns patients in a tertiary care rural hospital

Background: To study and describe the prevailing prescription trend in burns patients in a tertiary care rural hospital.Methods: This was a retrospective observational study. Total 100 patients diagnosed with burn injury and admitted during Jan 2012 to Dec 2013 were included in the study. The demographic details, details of burn injury & treatment received were obtained from the medical record section of Dhiraj General Hospital, Piparia. Drug prescriptions were analyzed using Microsoft Excel for total number of drugs per prescription, various classes of drugs prescribed and group of antibiotics commonly prescribed.Results: Most common age group affected was 20-40 years. The female to male ratio was 1.8:1. Average number of drugs prescribed was 6.8 with a range of 4-9 drugs per prescription. All prescriptions (100%) contain antimicrobials, analgesics and antiulcer drugs. Among antimicrobials, ceftriaxone was most commonly prescribed followed by amikacin and amoxicillin + clavulanic acid. Only 18% patients were immunized against tetanus.Conclusions: Females are more vulnerable to burn injuries. Polypharmacy was observed in prescriptions. Systemic antibiotic should be used with caution to prevent emergence of resistant microorganisms. Results of the present study indicate that some aspects of drug treatment need to be rationalized in order to achieve better patient care.

Antenatal breast milk expression at term increases postnatal lactational performance

Background: Breast milk contains balanced nutrients for the complete growth of body and brain of neonates and infants. Breast feeding is rich in anti-infective factors and improves immune system, thus reducing the child mortality rate. Objective of present work was to study the effect of antenatal breast milk expression at term in improving lactational performance as compared to control group.Methods: The prospective, comparative study was conducted for 2 years to observe effects of antenatal expression of breast milk on postnatal lactational performance in a tertiary care centre   in Central India.  200 Subjects after 37 weeks of pregnancy divided in two groups of 100 each 1) study group 2) control group by systematic random sampling technique. Prior examination was done to exclude any inverted or cracked nipples and appropriate treatment instituted. The women with diseased breast and conditions, high risk pregnancy, congenitally anomalous fetus and drugs affecting lactation were excluded from study. Study group women were counselled to express milk 2-3 times every day preferably during bathing. All women were followed up in hospital and postnatal lactation performance was observed in both groups.Results: The study group did not find it difficult to initiate breast feeding after vaginal or caesarean delivery  and in 78% of patients time interval from initiation of lactation to establishment of lactation was less than half hour as compared to control group (38%) P value <0.001. Statistical analysis showed significant difference in the results of those groups.Conclusions: Daily antenatal breast milk expression after 37 weeks of pregnancy significantly reduced the time for establishing full breast feeding and reduced breast feeding failures

Amoxicillin induced toxic epidermal necrolysis (TEN): a case report

Each year many patients are hospitalized due to adverse drug reactions. Adverse reactions are the recognized hazards of drug therapy and they can occur with any class of drugs and many studies revealed that the incidence is more in case of antibiotics. Amoxicillin is a broad spectrum, bactericidal, beta lactam antibiotic, commonly used to combat various infections. Penicillin group of drugs are known to cause cutaneous drug eruptions especially in pediatric population. Most of the time, these eruptions are mild in nature, however, sometimes they represent the early manifestation of rare, severe drug-induced cutaneous reactions, such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Toxic Epidermal Necrolysis (TEN) is a rare, life threatening dermatological disorder that is usually induced by medications. Seventy percent of the cases of TEN are drug induced, most commonly implicated drugs being anticonvulsants, antibiotics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDS). Here, we report a case of toxic epidermal necrolysis induced by amoxicillin in a 16 year old female patient. Rigorous treatment with systemic corticosteroids and immunoglobulins helped in recovery of the patient. The case is being reported to emphasize the need for efficient pharmacovigilance in order to motivate adverse drug reaction reporting so as to gather more and more data regarding adverse drug reactions. Through this report, we also seek the support of everyone concerned to detect and, if possible, prevent adverse reactions to drugs

Collaborative Landscape and Knowledge Dynamics in IoT and Blockchain Research: A Bibliometric Analysis

This research article presents a bibliometric analysis of the intersection between Internet of Things (IoT) and Blockchain, utilizing data sourced from the Web of Science database. The analysis employs the VOSviewer tool to investigate cocitation, co-occurrence, and bibliometric correlations among the publications. The findings indicate a surge in publications, with the highest number recorded in 2022, reflecting the growing interest and significance of this research area. Moreover, the analysis reveals China as the leading country in terms of research output, underscoring its active involvement in IoT and Blockchain research. Additionally, the study identifies IEEE Access as the leading publisher, indicating its prominence in disseminating relevant research. Notably, the analysis of keywords reveals "blockchain" as the most frequently occurring term, highlighting its central role in the field. These findings contribute to a better understanding of the research landscape in IoT and Blockchain, providing insights into collaboration patterns, influential countries, leading publishers, and the prominence of blockchain as a research topic

Adverse drug reaction profile of anticancer agents in a tertiary care centre of rural Maharashtra: a cross-sectional study

Background: The present study was undertaken to analyse the clinical spectrum, pattern of ADR reported, most common suspected drugs, timing of reporting of suspected ADR, outcome, severity and causality assessment of adverse drug reactions among oncology patients reported at our ADR monitoring Centre. Methods: The descriptive cross-sectional study was carried out for two months in the oncology department of a tertiary care rural hospital. ADR reporting form Version 2.4 was used for recording information of all patients of any gender and age who were suspected cases of adverse drug reactions receiving chemotherapy. Results: Total 83 ADRs were reported within the duration of two months. The number of males and females were 21 and 62, respectively with mean age 56.9±11.6 years for males and 59.6±8.8 years for females. The age group most commonly reported with suspected ADR was 61-70 years (28.9%). Of the 83 ADR reported, the most common suspected drug was Paclitaxel (47, 56.6%). The most common indications for the use of these anticancer drugs was reported to be CA breast (43, 51.8%). Most of the ADRs (38, 45.8%) were reported immediately. On applying Naranjo’s Causality Assessment Scale, 61 and 22 ADRs fell in the category of Probable and Possible, respectively. Conclusions: The occurrence of ADR among patients on chemotherapy is high. The reported ADR were common and predictable. Hence diligent monitoring in ADR may help manage and prevent morbidity associated with anti-cancer drugs

Structural Constraint of Osteopontin Facilitates Efficient Binding to CD44

Since the original description in 1996, the interaction between the cytokine osteopontin (OPN) and the homing receptor CD44 has been extensively studied in cancer, inflammation, bone remodeling, and various other conditions. Alternative splicing and extensive posttranslational modifications by both binding partners, as well as the possibility for lateral recruitment of additional membrane receptors or soluble co-ligands into a complex have left the exact molecular requirements for high-affinity OPN-CD44 binding unresolved. We now report that there is a moderate engagement between the unmodified molecules, which results in curved double-reciprocal plots for OPN titration, suggesting the existence of two binding sites or two binding conformations. Structural constraint of OPN, by immobilization or by addition of heparin, is required for its strong ligation of CD44. Prior literature provides evidence that heparin binding to OPN prompts the unfolding of a core element in the protein. This conformational adjustment may be essential for efficient CD44 interaction. The integrin α9β1 seems to compete with the OPN-CD44 engagement, while the integrin αVβ3 reflects additive binding, suggesting that the CD44 contact sites on OPN are downstream of the RGD motif but overlap with the SVVYGLR domain. Hyaluronate has no effect, placing the relevant domain on CD44 downstream of the N-terminus

Complement Evasion Strategies of Viruses: An Overview

Being a major first line of immune defense, the complement system keeps a constant vigil against viruses. Its ability to recognize large panoply of viruses and virus-infected cells, and trigger the effector pathways, results in neutralization of viruses and killing of the infected cells. This selection pressure exerted by complement on viruses has made them evolve a multitude of countermeasures. These include targeting the recognition molecules for the avoidance of detection, targeting key enzymes and complexes of the complement pathways like C3 convertases and C5b-9 formation – either by encoding complement regulators or by recruiting membrane-bound and soluble host complement regulators, cleaving complement proteins by encoding protease, and inhibiting the synthesis of complement proteins. Additionally, viruses also exploit the complement system for their own benefit. For example, they use complement receptors as well as membrane regulators for cellular entry as well as their spread. Here, we provide an overview on the complement subversion mechanisms adopted by the members of various viral families including Poxviridae, Herpesviridae, Adenoviridae, Flaviviridae, Retroviridae, Picornaviridae, Astroviridae, Togaviridae, Orthomyxoviridae and Paramyxoviridae

Comparative evaluation of efficacy of subgingivally delivered simvastatin and placebo gel in the treatment of stage ii periodontitis as an adjunct to scaling and root planing and its effect on porphyromonas gingivalis : A clinico-microbiological study

Aim: To evaluate the clinical efficacy of subgingivally delivered SMV and Placebo gel and compare in the treatment of stage II periodontitis when used as an adjunct to SRP and their antimicrobial effect on the Porphyromonas gingivalis bacteria. Materials &amp; Methods: In a split mouth study design, 10 systemically healthy patients with stage II periodontitis were included in this study based on the inclusion and exclusion criteria. Two sites with deepest pockets were selected. Plaque samples were collected from these pockets at baseline followed by full mouth scaling and root planning, In Group I 1,2% SMV gel and in Group II Placebo gel was placed in the subgingival pockets. Microbiological analysis for Colony Forming Units of P.g was done at baseline after 3 months, Clinical parameters (GI, PI, PD, CAL, mSBI) were evaluated at baseline (before SRP), 1 month and 3 months. Result: Both the groups showed significant reduction in GI, PI, PD, CAL, mSBI and CFU of Pg but Group I showed more significant reduction than Group II