Phenytoin/albendazole induced exanthematous eruptions: a case report

Exanthematous drug eruptions, often called “drug rashes” or “maculopapular eruptions” by non-dermatologists are the most common form of cutaneous drug eruption. Cutaneous reactions are among the most common adverse effects of drugs, including penicillins, cephalosporins, sulfonamides, and allopurinol (with an incidence of up to 50 cases per 1000 new users), and particularly the aromatic amine anti-seizure medications, including carbamazepine, phenytoin, and lamotrigine (with an incidence of up to 100 cases per 1000 new users). Phenytoin is a hydantoin derivative anticonvulsant drug used primarily in the management of complex partial seizures and generalized tonic-clonic seizures. Albendazole is a benzimidazole medication used for the treatment of a variety of parasitic worm infestations. Carbamazepine and phenytoin are among the most common causes of antiepileptic drug-related cutaneous adverse reactions. Manifestations range from a mild erythematous maculopapular rash to life-threatening Stevens-Johnson syndrome and toxic epidermal necrolysis. Albendazole induced rashes and urticaria have been reported in less than 1% of the patients. Here we present the case of a 12-year-old male patient who came to the dermatology outpatient department with complaints of itching and maculopapular eruptions all over the body. The patient gave a history of taking tablet phenytoin and tablet albendazole for neurocysticercosis since 1-week. There was no fever or any other systemic manifestations. There was no history of any other drug intake. A diagnosis of phenytoin/albendazole induced exanthematous eruptions was made. Both the medications were discontinued, and the patient was advised to take syrup sodium valproate 200 mg BD. For the rashes and itching, the patient was advised to take tablet hydroxyzine HCl 10 mg OD, tablet prednisolone and tablet levocetirizine for 5 days. Improvement was seen and the itching reduced. Rechallenge was not done. In this event, casualty assessment using Naranjo adverse drug reaction probability scale revealed that phenytoin/albendazole were probable causes for the adverse drug reaction

Disulfiram induced hemoptysis: a case report

Disulfiram (tetraethylthiuram disulfide [TETD]) has been used for more than 50 years as a deterrent to ethanol abuse in the management of alcoholism. Approximately 200,000 alcoholics take disulfiram, or Antabuse, regularly in the United States. Haemoptysis is the expectoration of blood originating from the lower respiratory tract. It is a common alarming symptom accounting for 10 to 15% of all pulmonary visits. Here, we present the case report of a 39-year old male patient who came to the medicine OPD with complaints of coughing of blood in the early morning hours since one and a half months. During history taking, it was understood that the patient was administered disulfiram by his wife, without his knowledge to prevent him from consuming alcohol since one and a half months (the patient is a chronic alcoholic). There was no history of any other drug intake which could cause haemoptysis like anticoagulants, thrombolytics and non-steroidal anti-inflammatory drugs. Infections causing haemoptysis like tuberculosis, pneumonia and bronchitis were ruled out. Haemoptysis subsided once disulfiram was stopped. Thus, in this case, because of the temporal relationship between exposure to the drug and the onset of symptoms, disulfiram was considered as the most probable cause of haemoptysis. The adverse drug reaction was considered probable (score 5) according to the Naranjo adverse drug reaction probability scale

Cefotaxime-induced Stevens–Johnson syndrome: a case report

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis are two forms of a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes. The most well-known causes are certain medications, but it can also be due to infections, or more rarely, cancers. SJS usually begins with fever, sore throat, and fatigue, which is commonly misdiagnosed and therefore treated with antimicrobials. Ulcers and other lesions begin to appear in the mucous membranes, almost always in the mouth and lips, but also in the genital and anal regions. Conjunctivitis of the eyes occurs in about 30% of children who develop SJS. A rash of round lesions about an inch across arises on the face, trunk, arms and legs, and soles of the feet, but usually not the scalp. SJS is a medical emergency that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications. Recovery after SJS can take weeks to months, depending on the severity of the condition. If it was caused by a medication, then the medication and others closely related to it has to be avoided permanently.An 18-month-old male child was admitted to a private health setup in Kolar with the complaints of peeling and discoloration of the skin, ulcerations in the oral cavity, eyelids, and genitalia. The parents gave the history of cefotaxime injection being administered to the child for treating typhoid 20 days back. Seven days after the administration of cefotaxime, the child had developed maculo-papular lesions all over the body. Later on there was peeling and discoloration of the skin. Itching was present. Ulcerations in the oral cavity, eyelids and genitalia were also noticed by the parents, who then brought the child to the health care center. According to the Naranjo’s adverse drug reaction probability scale, there is a possible relation between this adverse drug reaction (SJS) and cefotaxime

A study on coping skills of caregivers of patients with bipolar disorder

Background: Caregivers of people with bipolar disorder experience a different quality of burden than seen with other illnesses. A better understanding of their concerns is necessary to improve the training of professionals working with this population. The aim of this study was to study the level of family burden, coping skills and psychological wellbeing among caregivers of bipolar affective disorder.Methods: This was a prospective cross-sectional study conducted over a six months period from January 2014 to June 2014. Patients diagnosed as bipolar disorder as ICD-10 and their caregivers were included in the study. Purposive sampling technique was employed. Socio-demographic data were collected in preformed questionnaire. Disease burden was calculated using burden assessment schedule, psychological general well being index and brief COPE scale.Results: Around 63.4% of the caregivers were males, 38.5% were illiterate, 44.2% were unskilled labourers, 57.6% were spouses, mean BAS score was 86.03, mean coping score was 55.77 and BAS was inversely related to PGWBI. Male caregivers used self-distraction and substance use as coping strategies while females used religion and denial.Conclusions: The perceived burden was higher among caregivers of bipolar disorder. Coping strategies varied based on caregiver demographic characteristics. Higher the perceived burden, lower was the psychological wellbeing. Psycho-educational family intervention for caregivers has to be implemented along with pharmacological therapy in patients with bipolar affective disorder

A comparative study between first generation and second generation antipsychotics over the development of metabolic syndrome in persons with first episode drug naive schizophrenia

Background: Antipsychotic treatment for schizophrenia is prone for drug side effects. Both typical and atypical antipsychotics are prone for metabolic derangements. The aim of this study was to compare the emergence of metabolic syndrome with haloperidol and risperidone in drug naïve first episode schizophrenics.Methods: This was a prospective observational study conducted at the Institute of Mental health, Chennai, India from April 1, 2011 to November 15, 2011. 24 patients received haloperidol and 29 patients received risperidone and followed up for 6 months, after obtaining informed consent. PANSS score, AHA criteria for metabolic syndrome, plasma glucose, waist-hip ratio, body mass index and lipid profile were recorded at every two months interval.Results: PANSS score showed a decrease in both groups, systolic blood pressure showed an increase with Haloperidol and an initial decrease with risperidone while diastolic blood pressure increased with haloperidol. Weight gain, increase in waist circumference and hip circumference, rise in triglyceride levels and fall in HDL cholesterol were equally observed in both groups. Increase in plasma glucose was seen more with risperidone (93.1%). 18.86%  (n = 10) developed metabolic syndrome at the end of 6months with no difference in emergence between both groups.Conclusions: Risperidone may be considered equivalent to haloperidol in efficacy and with minimal changes in metabolic profile. Blood pressure lowering effect of risperidone is more marked in earlier months warranting patient education. Stringent guidelines are needed during antipsychotic treatment to prevent cardiovascular and cerebrovascular morbidity and mortality

Ciprofloxacin induced erythema multiforme: a case report

Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction associated with certain infections, medications, and other various triggers like flavorings and preservatives, such as benzoic acid and cinnamon, immunologic disorders, such as transient selective C4 deficiency of infancy, collagen diseases, vasculitides, sarcoidosis, non-Hodgkin lymphoma, leukemia, multiple myeloma, myeloid metaplasia, and polycythemia, physical or mechanical factors, such as tattooing, radiotherapy, cold, and sunlight, foods, including salmon berries and margarine, malignancy, and hormonal. EM may be present within a wide spectrum of severity. EM minor represents a localized eruption of the skin with minimal or no mucosal involvement. According to a consensus definition, Stevens-Johnson syndrome (SJS) was separated from the EM spectrum and added to toxic epidermal necrolysis (TEN). The two spectra are now divided into the following: (1) EM consisting of erythema minor and major and (2) SJS/TEN. Ciprofloxacin is a second generation fluoroquinolone. Fluoroquinolones are rapidly bactericidal in vitro and are considerably potent against Escherichia coli and various species of Salmonella, Shigella, Enterobacter, Campylobacter, and Neisseria. Mainly used in urinary tract infections, prostatitis, sexually transmitted diseases, gastrointestinal and abdominal infections, respiratory tract infections, bone-joint and soft tissue infections. Metronidazole is a nitroimidazole antimicrobial medication used particularly for anaerobic bacteria and protozoa. It is on the World Health Organizations list of essential medicines, a list of the most important medications needed in a basic health system. Here we report the case of a 39-year-old male patient who presented with EM to the dermatology outpatient department, Adichunchanagiri Hospital and Research Centre. The patient gave a history of taking antimicrobials ciprofloxacin and metronidazole for the treatment of a non-healing wound on the right leg which he sustained in a road traffic accident. The review of the literature has revealed very rare associations of metronidazole and pantoprazole with EM, but cases of ciprofloxacin-induced EM have been reported. Hence, the reported adverse drug reaction has been attributed to ciprofloxacin. In this event, casualty assessment using Naranjo’s scale revealed that ciprofloxacin was a probable cause for the adverse drug reaction

Human otoacariasis: a common outbreak in rubber growing belt of Karnataka.

Background/Objective: Soft tick in the ear is a very common acute painful and distressing condition in the flowering months of October to March. It’s a common condition in the rubber growing belt of Sullia.The mouthparts of the tick grips firmly the skin of the external auditory canal or the tympanic membrane and sucks blood and swells up. Otoscopy and removal of the tick from the ear can be done in outpatients in adults and difficult in a frightened irritable child.Materials and methods: 312 cases of intra-aural ticks presenting to the opd and casualty which included 131 males and 181 females were included in the study.Results: Out of the 312 cases of intra-aural ticks, 170 cases were treated in the outpatient and 140 cases under short general anesthesia with oto-microscopy.Conclusion: Intra-aural tick infestation is an acute painful condition which needs prompt management by an experienced otolaryngologist. Proper visualization and instrumentation is necessary to avoid complications.

Examining resistance, accommodation and the pursuit of aspiration in the Indian IT‐BPO space: reflections on two case studies

This article is based on case studies of two organisations: an India-based information technology (IT) services company and a financial services company located in the UK and India. Although they operate in different sectors and have some notable contrasts, both can be seen as typifying aspects of India\u27s new economy. Our article explores the lived experience of working in this economy—a perspective that has been relatively neglected in the extant literature. Drawing on Homi Bhabha\u27s notions of ambivalence and mimicry, and V. S. Naipaul\u27s powerful illustrations of these concepts in his fiction and non-fiction works, we report on how respondents talked about their aspirations within India\u27s emerging economy, and examine their mobilisation of particular discursive resources as forms of accommodation and resistance to the demands they face at work

An Exploratory Study on Sustainable ICT Capability in the Travel and Tourism Industry: The Case of a Global Distribution System Provider

Climate change is one of the biggest challenges facing humanity today. Environmental values have spread globally and consumer beliefs are pressurizing firms in almost all industries to comply with green regulations. Sustainability has become such an important part of business strategy that almost every major company now has an executive with “sustainability” in their title. The travel and tourism industry produced 14 percent of global greenhouse gas emissions in 2010. Policy makers have responded with ambitious targets. The European Union aims to achieve a 60 percent reduction in transport sector emissions by 2050. This exploratory study draws on the sustainable ICT capability maturity framework (SICT-CMF) and the case of the Amadeus IT Group, a large travel and tourism industry corporate enterprise that specializes in IT solutions. The study investigates the current capability maturity level of sustainable ICT in the company. The findings suggest that the company is a market leader in terms of sustainability initiatives and that it demonstrates an “advanced” level of sustainability capability. We discuss the lessons learned from Amadeus’ experience