EFFECT OF SODIUM VALPROATE AND DOCOSAHEXAENOIC ACID ON INFLAMMATION IN RATS

Objective: To evaluate the anti-inflammatory activity of sodium valproate and docosahexaenoic acid (DHA) supplementation using various experimental models in albino Wistar rats.Method: A total of 48 adult Wistar albino male rats were divided into 8 groups of 6 rats each. Group I was control (distilled water 1 ml/kg), Group II received intraperitoneal (i.p.) injection of indomethacin (10 mg/kg), Groups III-V were injected (i.p.) with sodium valproate 100, 200, and 400 mg/kg water, and Groups VI-VIII were given sodium valproate 100, 200, and 400 mg/kg plus DHA 300 mg/kg (i.p.), respectively. Anti-inflammatory activity was assessed using carrageenan induced paw edema and the cotton pellet granuloma models.Results: We found that higher doses of sodium valproate (400 mg/kg) used either alone or with a combination of DHA (300 mg/kg) showed a significant anti-inflammatory activity when compared to control in both the models of inflammation.Conclusion: Combination of sodium valproate along DHA has shown promising anti-inflammatory activity.Keywords: Anti-inflammatory drugs, Sodium valproate, Rat model

A RARE INSTANCE OF LEVOSULPIRIDE–INDUCED GALACTORRHOEA

Antipsychotics are well known to affect prolactin secretion, resulting in hyperprolactinemia and its consequent manifestations like amenorrhoea, galactorrhoea, gynaecomastia, etc. Levosulpiride is a novel antipsychotic drug with additional antidepressant, antiemetic and antidyspeptic actions. The authors report a case of levosulpiride-induced hyperprolactinemia, presenting as galactorrhoea in a female patient with dyspepsia at Kasturba Hospital, Manipal, in South India.Keywords: Hyperprolactinemia, Prolactin, Dyspepsia, Antipsychotic, Dopamin

ACENOCOUMAROL OR WARFARIN: WHICH IS THE CLINICIAN'S ALLY?

ABSTRACTWarfarin and acenocoumarol are commonly prescribed oral anticoagulant drugs that are used in the prevention and treatment of thromboembolicdisorders across the world. Although both these drugs act by a similar mechanism, there are significant differences between them, especially in termsof their half-lives, and more importantly, in their variability in response pharmacogenetically. This case report highlights an instance wherein warfarinproved to provide a much more stable anticoagulant cover, as compared to that provided by acenocoumarol.Keywords: Thrombosis, Bleeding, Antiphospholipid antibody syndrome, Anticoagulant, International normalized ratio

HEMICHOREA: AN UNUSUAL MANIFESTATION OF THYROTOXICOSIS

ABSTRACTChorea is usually associated with neurological diseases. However, it can also be seen in patients with systemic lupus erythematosus (SLE), rheumaticfever (Sydenham's chorea), polycythemia vera, and thyrotoxicosis. Here, we report an interesting case of hemichorea in a 32-year-old lady, whopresented with acute onset of jerky, non-repetitive involuntary movements of the left upper and lower limbs. After detailed evaluation, she was foundto have thyrotoxicosis. Thyroid Tc-scan showed diffuse uptake suggesting Grave's disease. A magnetic resonance imaging of the brain was normal.Other causes of chorea like SLE and rheumatic fever were excluded. She was started on carbimazole. On follow-up after 6 weeks of therapy, there wasthe complete disappearance of chorea, and her thyroid hormone levels were normal.Keywords: Extrapyramidal syndrome, Hyperthyroidism, Corpus striatum, Dancing movements

PHENYTOIN-INDUCED ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS

ABSTRACTPhenytoin is the first line antiepileptic for generalized tonic-clonic seizures. It is still the go to†drug despite the availability of newer antiepileptics,chieflybecause of its lowcost and highefficacy.Phenytoinis associatedwith toxicitiesinvolvingmultiple organsystemssuch asbrain,blood, and skin. One of the most common adverseeffectsis the developmentof skin rashes.It can rangefrommild tolife-threateningskineruptions.This is a case reportof a younggirlwhodevelopedacutegeneralizedexanthematouspustulosis followingphenytointherapyforposttraumaticseizures.Keywords: Drug-induced rash, Anti-epileptic, Type-4 hypersensitivity, Hydantoi

THORACIC EPIDURAL ABSCESS DUE TO COMMUNITY-ACQUIRED METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

ABSTRACTA spinal epidural abscess threatens the spinal cord or cauda equina by compression and also by vascular compromise. If left untreated, an expandingsuppurative infection in the spinal epidural space can impinge on the spinal cord, producing sensory symptoms and signs, motor dysfunction, andultimately paralysis, followed by death. Hence, early intervention undoubtedly improves the outcome. The authors report a case of a 27-year-oldfemale patient, who presented with paraplegia, and was found to have thoracic epidural abscess due to community-acquired methicillin-resistantStaphylococcus aureus.Keywords: Spinal cord, Cauda equina, Infection, Laminectomy, Drainage

A STUDY TO ASSESS THE CLINICAL AND BIOCHEMICAL PROFILE OF PATIENTS DIAGNOSED WITH HEPATITIS E IN A LARGE TEACHING HOSPITAL OF SOUTHERN INDIA

ABSTRACTObjective: Hepatitis E has been identified as a major health problem in developing countries and recently developed countries. To study the profile ofpatients diagnosed with hepatitis E infection in a tertiary care hospital in south India.Methods: A cross-sectional record-based study with the records of patients diagnosed with hepatitis E infection over a 40-month period from ateaching hospital in southern India and fulfilling the following criteria was performed.Results: The cases were predominant in the age group of 21-30 years with relative sparing of children. No seasonal variation in the occurrence orsecondary cases was observed. Temporary derangement of liver function tests was recorded in all cases. The study showed a male preponderance. Asdocumented in previous studies, the disease proved fatal in a primigravida who developed fulminant hepatic failure. Another interesting feature wasthe presence of leptospirosis, scrub typhus, and hepatitis A as co-infection with hepatitis E.Conclusion: In India, the awareness of the disease is also low, therefore, the diagnosis is usually not made in the majority of cases. Hence, theavailability of data regarding the clinical pattern of presentation and biochemical profile is restricted. However, there are some questions stillunanswered like the preference of the virus to infect individuals in the age group of 20-40 years, sparing of children, and increased rate of infectionamong the males. The cause of the increased morbidity and mortality of this virus in pregnant women is still not known. A larger sample size and thedata on the seroprevalence of this disease in the population under study are necessary for a meaningful interpretation of its epidemiological pattern.Keywords: Alanine transaminase, Alkaline phosphatase, Aspartate aminotransferase, Bilirubin, Liver

A RARE INSTANCE OF DIASTASE/PEPSIN–INDUCED HYPERSENSITIVITY REACTION

Diastase/Pepsin combination supplements are very commonly prescribed in clinical practice, mainly in the adult population. The chief indication for such use is indigestion or dyspepsia, wherein concomitant medication with proton pump inhibitors and antiemetics is also advised. Hypersensitivity reactions, though theoretically plausible with the use of digestive enzymes, there are no cases reported in the medical literature, to the best of our knowledge. This is one such case of hypersensitivity secondary to the administration of digestive enzymes in an adult Indian male. Keywords: Digestive enzymes, Rash, Maculopapular, Allerg

Modification of First-line Antiretroviral Therapy in Treatment-naive, HIV Positive Patients

Introduction: Modification of initial Antiretroviral Therapy (ART) program is an important issue in HIV infected patients as the number of ART regimens available is limited. Hence, there is a need to understand the factors that affect modification and therefore, the durability of the initial antiretroviral regimen. Aim: To study the type of modification of first line ART in treatment-naive HIV positive patients and factors influencing it. Materials and Methods: A retrospective observational study was carried out in the HIV clinic of a tertiary care hospital, using data obtained from the case records of the subjects who were initiated on ART between January 2012 to December 2014. Data on patient baseline characteristics, proportion of patients who required modification, type and time of modification was collected. The determinants of time to modification were analysed using Chi-square test. Binomial logistic regression was utilized to assess independent risk factors for change in regimen. Results: Out of 200 case records analysed, 54 patients had to undergo a modification in their initial regimen. The mean age of patients was 44.68 ± 11.31 years. Majority of the patients were males. The most common reason for modification was Adverse Drug Reactions (ADRs) (79.63%) followed by treatment failure (9.25%). In 85.18% cases, modification involved substitution. Occurrence of ADRs and non-tenofovir based first-line regimens were associated with higher likelihood of substitution in regimen (p<0.05). The median time (IQR) to modification was 173 (152.25, 293.50) days. Conclusion: ADRs and the use of non-tenofovir based regimens resulted in significantly higher rates of modification of antiretroviral therapy. There should be monitoring of patients on ART to detect ADRs at the earliest and to obtain increased use of single tablet containing tenofovir based regimen to improve durability of first line regimens