ADVERSE DRUG REACTION PROFILE OF DRUGS PRESCRIBED IN CORONAVIRUS DISEASE - 19 PATIENTS – A CROSS-SECTIONAL STUDY

Objective: The objective of this study is to assess adverse drug reaction (ADR) profile of the drugs prescribed to treat Coronavirus Disease (COVID-19) positive patients and to determine whether ADRs are associated with any comorbidities. Methods: A cross-sectional study was done with Laboratory confirmed COVID-19 positive patients who experienced ADRs during their admission period at tertiary care center, Rajkot from April 2020 to March 2021. All the necessary information including ADRs information was obtained from patient’s case record file and filled in suspected ADR reporting form. Suspected ADRs were assessed for demographic parameters and causality, preventability, and severity using World Health Organization (WHO) scale and Naranjo algorithm, modified Schumock and Thornton’s criteria, and modified Hartwig’s criteria, respectively. Results: Out of the 100 patients there were 60 males. The mean age of the patients was 52.65±13.95 year. Fourty-six patients had comorbidities. The most common type of ADR was GI disorders. Among the single suspected medication, most common drug was methylprednisolone and among the two drugs, azithromycin was common. According to the WHO and Naranjo scale, Probable ADRs were 70% and 36%, respectively. The percentage for mild, moderate and severe ADRs were 44%, 39%, 17%, respectively. Eighty-six percent ADRs were definitely preventable. Fifty-one patients were recovered from adverse reactions. Conclusions: Seriousness of reactions is mainly associated with co-morbid conditions. This indicates that patients with comorbidity should be closely monitored to avoid harmful consequences. These ADRs monitoring and reporting program will help physicians to choose their therapy sensibly and decrease chances of mortality in this pandemic era

Multiple hepatosplenic abscesses in an immunocompetent host

Sphingomonas paucimobilis, a gram-negative organism, mainly infects immunocompromised hosts due to its low virulence. Patients with such an infection usually have contact with healthcare. Meningitis, peritonitis, visceral abscess, septic arthritis, septicemia, post-traumatic endophthalmitis, and keratitis are among the documented complications of Sphingomonas paucimobilis infection. Such an infection is rarely seen in the literature as the one causing splenic and liver abscess and that too in an immunocompetent host. We present a case of a 23-year-old immunocompetent male, who presented with fever and other constitutional symptoms with recent onset of abdominal pain and fullness. Splenic and liver abscesses were detected on radiology with the growth of only Sphingomonas on blood culture and negative reports for other organisms excluding the differentials, proving S.mobilis being the cause of the abscesses. The patient was managed on broad-spectrum antibiotics and additional medications for symptomatic relief. The patient gradually improved over 7 days of hospitalization. This case report mainly focuses on Sphingomonas paucimobilis infection, which is rarely seen and documented, and surprisingly in an immunocompetent host causing life-threatening infections and abscesses. Even though it’s a rare and a low virulence organism, such a presentation must not be overlooked. A regular and focused laboratory workup for detection and management, with adequate antibiotic treatment, is a must to avoid a poor prognosis

A case report on retrieval of retained guidewire- a rare complication after central venous catheterization

Central venous catheterization (CVC) is a routine technique which is widely used in fluid resuscitation, parenteral nutrition, haemodialysis and continuous invasive hemodynamic monitoring. CVC via the Seldinger technique is a minimally invasive procedure which is increasingly and widely performed. Popularity of the Seldinger technique of vascular cannulation has resulted in widespread use of spring guide wires. Though employed to make vascular cannulation easier and safer, guide wires are not without potential hazard. While the complication rate of inserting CVC catheters is approximately 11.8%, the intravascular loss of the guide wire during CVC placement is a rare but serious complication which is completely avoidable by appropriate care.

EFFECT OF AMLODIPINE AND ENALAPRIL ON WOUND HEALING IN DIABETIC WISTAR ALBINO RATS

Objective: A number of structural and functional mechanisms have been identified in the pathogenesis of impaired wound healing in diabetes. Diabetes promotes endothelial dysfunction as evidenced by decreased nitric oxide (NO) production. NO deficiency and resultant impaired angiogenesis have been implicated in impaired wound healing in diabetes. The objective of this study was to evaluate the effects of amlodipine and enalapril on wound healing in streptozotocin induced diabetic rats based on previous observations that amlodipine increases NO bioavailability and enalapril promote angiogenesis.Methods: Four groups for each wound model (n=6 in each group; total 8 groups) were used and served as diabetic control, active control (glibenclamide), amlodipine, and enalapril groups. Wound closure rate and re-epithelialization were studied in the excision wounds. Incision wounds were studied for wound breaking strength while dead space wounds were studied for granulation tissue weight, hydroxyproline content, and histological changes in granulation tissue.Results: Amlodipine and enalapril significantly (P<0.05) increased re-epithelialization in excision wound model. Amlodipine significantly improved incision wound breaking strength while enalapril increased granulation tissue formation. None of the study agents had a significant effect on wound granulation tissue histology.Conclusion: Amlodipine and enalapril enhance the re-epithelialization in the diabetic wound. Choosing amlodipine or enalapril as antihypertensive in diabetic patients may help to improve impaired wound healing in these patients. Further human trials are needed to demonstrate similar benefits in diabetic patients with wounds.Keywords:Antihypertensive drugs, Diabetic ulcers, Re-epithelization, StreptozotocinÂ

Effects of ethanolic extract of Jasminum grandiflorum Linn. flowers on wound healing in diabetic Wistar albino rats

Objective: To evaluate wound healing activity of ethanolic extract of Jasminum grandiflorum Linn. (J. grandiflorum) flowers in diabetic rats. Materials and Methods: Streptozotocin-induced diabetic Wistar albino rats were divided into six groups (n=6).Three groups – diabetic control, positive control (that received Glibenclamide) and treatment (that received J. grandiflorum Linn. Flower extract) were operated for excision wounds (EW). These groups were evaluated for wound contraction and re-epithelization. The other three groups were operated for incision wounds (IW) and dead space wounds (DW). Incision and dead space wounds were produced in the same rats. IWs were analyzed for wound breaking strength and the granulation tissues from DWs were analyzed for dry weight, hydroxyproline content, and histology. Results: IWs and DWs showed significant improvement in wound breaking strength (265.8±10.4 vs 332.5±8.2;

Drug-induced Stevens–Johnson syndrome in Indian population: A multicentric retrospective analysis

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening hypersensitivity reactions mainly caused by drugs. Data on incubation period, hospital stay, and outcome for HIV-positive patients are sparse. Role of corticosteroids in their management is still controversial.Methods: Indoor cases of SJS, SJS–TEN overlap, and TEN were analyzed for causative drugs, incubation period, a severity-of-illness score for toxic epidermal necrolysis (SCORTEN) score, HIV status, treatment, and outcome. Comparison of parameters between HIV and non-HIV cases was done. Utilization pattern of corticosteroids and their role in outcome were evaluated.Results: Four SJS, 15 SJS-TEN overlap, and 21 TEN cases were evaluated. Antimicrobials (27.1%), antiviral (23%), antiseizure drugs (8.4%), and analgesics (8.4%) were commonly associated drugs. Among 12 (30%) HIV-reactive cases, nevirapine (97.6%) and cotrimoxazole (41.6%) were common causative drugs. Males (75%) were affected more than females (25%) among HIV-positive individuals. Incubation period was significantly higher in HIV-reactive patients. Total 30 (75%) patients were treated with corticosteroids. Dexamethasone (90%) and prednisolone (26.6%) were most commonly used. No significant difference was found among cases treated with or without corticosteroids.Conclusions: Antimicrobial drugs are common to cause SJS/TEN. Among HIV-reactive patients, male have more risk, incubation period is more and severity of reaction is less. Effectiveness of corticosteroids for treatment of SJS/TEN is inconclusive.Keywords: Causative drugs, corticosteroids, HIV, Stevens–Johnson syndrome, toxic epidermal necrolysi

Analysis of Rainfall Characteristics for Crop Planning in North and South Saurashtra Region of Gujarat

Knowledge of the sequences of dry and wet spells as well as onset and withdrawal of monsoon season is necessary for successful planning and management of agricultural ecosystem. In this study, 21-year (1997-2017) rainfall data of the North and South Saurashtra region of Gujarat were analysed to understand and quantify the South-west monsoon characteristics. Analysis of the results revealed that the onset and withdrawal of rainy season occurred during the 26th Standard Meteorological Week (SMW) and 40th SMW, respectively, in the North and South Saurashtra region. The length of the rainy season was 15 weeks for South Saurashtra and 14.5 weeks for North Saurashtra region. The South - and North-Saurashtra region received 96.7 % and 95.1 % of the mean annual rainfall, respectively, during the monsoon season. The initial probability of the wet weeks (25th - 34th SMW) and the conditional probability of wet week, followed by another wet week in the Saurashtra region varied from 47.6 % to 66.7 %, and 20.0 % to 64.3 %, respectively. Results indicated that the land preparation and sowing of kharif crops should be undertaken during the 24th to 26th SMW. The sowing of dryland crops in rabi season may be completed between 40th and 41st SMW, as remaining weeks have less probability of getting sufficient rainfall