Evaluation of immediate reactions to β lactam antibiotics using a comprehensive diagnostic protocol

Background: β lactam antibiotics are commonly prescribed groups of antibacterial drugs for various infections however the prevalence of its allergic effects is not clear in our country, hence the need for an effective diagnostic protocol to determine immediate hypersensitivity reactions. The objective was to formulate a diagnostic protocol for evaluating immediate drug hypersensitivity to β lactam antibiotics.Methods: A prospective study was conducted at a tertiary care hospital. Adults who were prescribed any class of β lactam antibiotic were included. Non irritating concentrations of the antibiotic as per The European Network on drug Allergy were used. A strict three step diagnostic algorithm with skin prick test followed by intradermal test and drug provocation test, with 20 minutes observation period between each step, to determine cutaneous allergic reactions was followed.Results: The most commonly prescribed drug was cefazolin, followed by ceftriaxone, and cefoperazone + sulbactam combination. The culprit drugs were ceftriaxone in 4 (4.7%) patients, followed by piperacillin + tazobactam combination in 3 (3.5%), amoxicillin + clavulanic acid in 2 (2.3%) and 1 (1.1%) each for cefotaxime and cefepime + tazobactam combination. No patients were positive for skin prick test; 2.4% were positive for intradermal test and 10.6% were positive for drug provocation test.Conclusions: This diagnostic protocol is apt to adequately diagnose immediate reactions to β lactam antibiotics and henceforth can be used effectively in India. However, the skin prick test may be excluded but the intradermal test and drug provocation test is crucial to identify these immediate reactions

Comparison of self-medication practice for dysmenorrhoea in medical, nursing and dental students

Background: Dysmenorrhea is common in adolescent and young adult females and is responsible for impaired daily activities and significant absenteeism from college among female students. The self-treatment strategy varies among the students. Hence, the present study was done to analyse and compare the self-medication practice for dysmenorrhoea among medical, nursing and dental students.Methods: This was a cross-sectional study conducted among 188 female students with dysmenorrhoea in M. S. Ramaiah College Campus, Bangalore which included 62 medical, 63 nursing and 63 dental students. Data was collected with prevalidated questionnaire related to various aspects like demographic data, severity and duration of dysmenorrhoea and pattern of management in the three groups. Data collected was analysed using SPSS version 20.Results: The mean age of female students with dysmenorrhoea was 19.12±0.87 years. 28% students perceived hormonal changes as causative factor for dysmenorrhoea. About 92 (48.9%) were on self-medication and 46 (24.5%) of students used home remedies for dysmenorrhoea. Among 92 students drugscommonly used for self-medication were mefenemic acid+dicyclomine  (67.4%) followed by paracetamol (20.7%), ibuprofen (5.4%), dicyclomine (4.3%), and diclofenac (2.2%). NSAIDS such as mefenamic acid, paracetamol, ibuprofen, diclofenac were used commonly by students in the three groups.Conclusions: Dysmenorrhoea is a common cause for self-medication among young females. Self-medication practice for dysmenorrhoea was seen more in medical students where as non-pharmacological remedies in nursing and dental female students. NSAIDS like mefenamic acid and paracetamol are the mainstay of self-medication for dysmenorrhoea

Neuropsychological side effects of anti-epileptic drugs in epilepsy patients: a cross sectional study

Background: Epilepsy is the fourth most common neurological disorder in world. Managing an epilepsy with anti-epileptic drugs (AEDs) either as monotherapy or polytherapy is necessary to reduce the deleterious effect of the disease and to provide neuroprotection. AEDs exert their negative effects on cognition by suppressing neuronal excitability or enhancing inhibitory neurotransmission. These neuropsychological side effects are found to be modest when the drug level is within the therapeutic concentration and used as monotherapy. Objectives were to assess the prevalence of neuropsychological side effects among epilepsy patients who were on antiepileptic drug therapy. Methods: An open label, cross-sectional, clinical study was conducted at a tertiary care hospital, 126 participants were recruited. Participants demographic data, detailed medical and seizure history followed by neuropsychological tests was performed. The prevalence was assessed based on the number of participants scoring <15th percentile in one or more tests. Results: Out of 126 participants who were recruited, 82 participants were on monotherapy and 44 participants were on polytherapy. Levetiracetam was the most commonly prescribed drug as monotherapy, followed by phenytoin, carbamazepine and valproate; whereas in polytherapy levetiracetam, clobazam followed by phenytoin were the commonly prescribed AED. The most common adverse effect was drowsiness, followed by headache, hypersensitivity reaction, giddiness, tremors, anxiety etc. The prevalence of neuropsychological side effects was 77.8%. The prevalence of impairment between monotherapy and polytherapy was statistically insignificant (p=0.727). Conclusions: In this study, levetiracetam was the most commonly prescribed drug and the most common adverse effect was drowsiness due to AEDs. The subgroup analyses between monotherapy and polytherapy did not show any statistically significant neuropsychological impairment when compared based on the gender, age groups, duration of epilepsy with medication and duration of current therapy

Trastuzumab induced radiation recall dermatitis: an interesting case

Radiation recall dermatitis (RRD) is the appearance of skin reactions in previously irradiated skin which is triggered by the administration of certain drugs. Surgery, chemotherapy, and radiotherapy are the mainstay of treatment in breast cancer. RRD induced by trastuzumab has been rarely reported in India. This is a case report of a 56-year-old woman presented to the medical oncology outpatient department of our hospital with breast lump, and she was diagnosed to have human epidermal growth factor receptor 2 (HER-2/neu) positive invasive ductal carcinoma of left breast of stage T2N3cM0. She was treated with neoadjuvant chemotherapy, and she underwent modified radical mastectomy with axillary lymph node dissection. The treating oncologist was planned to start on adjuvant chemotherapy with injection trastuzumab for every four weeks, for 15 cycles. Patient received first dose of injection trastuzumab (450 mg) intravenously in the right (contralateral) arm and developed painful, swollen, erythematous blisters, and maculopapular rashes following the sharp linear borders of her previous radiation fields. She was reviewed by the medical oncologist and diagnosed as a rare case of RRD and treated with topical betamethasone cream. Causality assessment for RRD to trastuzumab was done using Naranjo and WHO-UMC scale and found to be in the category of probable and probable/ likely respectively

Assessment of knowledge, attitude and practice of insulin injection among subjects with diabetes mellitus

Background: Diabetes mellitus (DM) is a spectrum of common metabolic disorders whose management mainly lies in treating the patients with oral hypoglycemic drugs and insulin along with the dietary and lifestyle modifications. Insulin is administered most subcutaneously. As the insulin injection sites are relatively painless, patients tend to inject in the same area repeatedly rather than moving to a newer site and increase risk for development of injection site reactions like lipodystrophy and impairment of glycemic control. Hence, it is utmost important for every diabetic patient and their relatives who would inject the insulin injection to be aware of appropriate manner of insulin injection. This helps in maintaining adequate glycemic control in diabetic patients. The main objective of this study was to assess the knowledge, attitude and practice of insulin injection technique among the diabetic patients.Methods: A cross-sectional study was conducted in the department of Endocrinology on 250 diabetic patients taking insulin injections based on inclusion and exclusion criteria. A validated questionnaire was administered to patients to answer in order to assess their knowledge, attitude and practice about technique of insulin injection.Results: In this study, it was found that 90% of the patients were aware of rotating the injection site, whereas only 40% of the patients were aware of appropriate time duration (5-10 sec for syringes/counting 1-15 for releasing the pen) required for resting the syringe/pen needle inside the skin. Only 48% of the patients used to remove the air bubble prior to injection, 57% pinched the injection site before injecting, 20% rubbed the injection site after injection and 30% used to wash hands prior to injection. Hypoglycemia was the most common adverse effect noted in 54% of patients.Conclusions: It can be concluded from the present study that every patient and his/her attendant needs to be educated and trained appropriately regarding technique of injecting insulin injection for betterment of their health. 

Nanotechnology: a revolution in targeted drug delivery

Targeted drug delivery is a method of delivering medication in a unique way so that the concentration of the drug at the target site is optimized, burden of the drug to other tissues is reduced and toxicity minimized. There are various novel approaches to deliver drugs to the target sites in the form of nanocapsules, nanocrystals, nanoemulsions, dendrimers, polymeric micelles, nanotubes and monoclonal antibodies. They have the advantages of improved bioavailability, facilitated transport of drugs across difficult barriers to reach the target tissues for a specific action and providing protection to protect the drug against degradation. A number of anticancer drugs like Doxorubicin, Paclitaxel and 5-Fluorouracil have been formulated using nanoparticles. These innovative techniques have helped to overcome the limitations like resistance in the target cells and difficulty in movement across the barriers which are seen in the conventional drug delivery system. Apart from being a therapeutic tool, it also has brought revolution in early diagnosis of diseases and gene transfer. The surge of nanotechnology is now being translated into commercialized products. The future is exciting, and the promises are limitless as the application of nanotechnology in medicine will provide remarkable opportunities and newer perspectives for novel and effective treatment in various diseases.

Prevalence of insulin induced lipodystrophy in patients with diabetes mellitus in a tertiary care centre: a cross sectional study

Background: Diabetes Mellitus is a spectrum of common metabolic disorders whose management mainly lies in treating the patients with oral hypoglycaemic drugs and insulin along with the dietary and lifestyle modifications. Lipodystrophy is the most neglected adverse drug effect caused by injecting insulin. The main objective of this study was to assess the prevalence of lipodystrophy at the insulin injection sites in patients suffering from diabetes mellitus (Type 1 and Type 2).Methods: A cross-sectional study was conducted in the Department of Endocrinology on 250 diabetic patients taking insulin injections based on inclusion and exclusion criteria. The demographic features and anthropometric measurements were noted. Insulin injection sites were examined clinically by inspection and palpation for presence of swelling like lipodystrophy, injection marks and signs of allergy like erythema etc. Lipodystrophy was graded from 0-3 and denoted as lipohypertrophy or lipoatrophy. The results were tabulated and presented accordingly.Results: In this study, out of 250 patients 17 (6.8%) patients presented with insulin induced lipodystrophy. Lipohypertrophy was the most common presentation and only one case presented with lipoatrophy.Conclusions: It can be concluded from the present study that lipodystrophy which is an important adverse effect due to insulin injection needs to be monitored regularly in every patient taking insulin for better control of glucose levels

Evaluation of efficacy of palonosetron versus ramosetron in patients receiving emetogenic chemotherapy

Background: Chemotherapy induced nausea and vomiting is the most distressing side effect of cancer chemotherapy. It can seriously impact patient’s quality of life, influence the adherence to chemotherapy and progression free survival causing a delay or refusal of potentially life-saving therapy. The objective of this study was to compare the efficacy of palonosetron with ramosetron in achieving complete response to the chemotherapy.Methods: This was a prospective randomized open-label study conducted on 130 patients admitted in Medical Oncology ward of a Tertiary Care Hospitals, Bangalore, India. Patients were randomized to receive either palonosetron 0.25 mg or ramosetron 0.3 mg I.V. along with aprepitant and dexamethasone 30 minutes prior to chemotherapy and were followed up for a period of 5 days post chemotherapy. The observations such as number and severity of vomiting and nausea, the outcome was assessed at the end of 5 days. Pearson’s Chi-square test was used to demonstrate the difference between both the study groups with respect to various categorical data.Results: The complete response rate in delayed phase was more significant in patients who received palonosetron than patients who received ramosetron (72.3% vs 50.8%). Total control was achieved in 38.5% patients with palonosetron as compared to 15.4% patients with ramosetron.Conclusions: Palonosetron is more efficacious than ramosetron in controlling chemotherapy induced nausea and vomiting especially in delayed phase of emesis

Occurrence of linezolid induced thrombocytopenia and its association with the risk factors: a review article

Linezolid is the oxazolidinone group of antibiotic with wide range of activity against the gram positive bacteria including methicillin resistant staphylococcus aureus and penicillin resistant pneumococci and vancomycin resistant enterococci. Patients who are on linezolid were reported to have reversible myelosuppression especially thrombocytopenia and anaemia. Since there are less number of studies regarding the occurrence of thrombocytopenia and the risk factors associated with it, this study was undertaken to evaluate the occurrence of linezolid induced thrombocytopenia and its association with risk factors. It was a systematic review with synthesis of available literature in English language. Articles were retrieved using search terms included “linezolid”, “and”, “or”, “thrombocytopenia” from Clinical key and PubMed, published during 2000 - 2017. Out of 16 studies retrieved, only 7 studies were analysed based on inclusion and exclusion criteria; of them, 3 were found to be prospective and retrospective cohort each and only one was retrospective cross-sectional study. The occurrence of linezolid induced thrombocytopenia range from 18-50% with normal renal function and 57% of incidence associated with renal insufficiency patients. The risk factors were found to be dose of linezolid >18-27mg/kg, body weight of subjects <55kg, creatinine clearance <88.39 to 60ml/min/1.73m2 and baseline platelet count <200*103/mm3, serum albumin concentration, serum creatinine, concomitant caspofungin therapy and duration of linezolid therapy

Methimazole induced lichenoid eruptions: an unusual case

This is a case report of a 31-year-old male presented to the Endocrinology outpatient department of our hospital with hyperthyroidism and was prescribed tablet methimazole 30mg once daily and tablet propranolol 40mg once daily. After 3 months, the patient complained of violaceous papular lesions on both the extensor aspect of the arms and legs. Physical examination was remarkable for acute onset, raised, itchy, violaceous papular lesions over the defined areas. The drug methimazole was suspected to cause lichenoid drug eruptions and was withdrawn. This case illustrates methimazole otherwise an efficacious and widely used anti thyroid drug is an agent capable of inducing lichenoid eruptions. However in future the monitoring of methimazole is essential for such adverse reaction