A study on clinical profile of patients presenting with adverse drug reaction: a hospital based prospective observational study

Background: The aim of the study was to study the clinical profile of patients presenting with adverse drug reaction.Methods: The study was conducted in the Department of Medicine, IGMC Shimla from 01 July 2015 to 30 June 2016. A total of 129 patients were included in this study. A detailed history was taken followed by examination of patients. The routine investigations were done and special investigations as per need. For analysis patients detail, suspected drugs and the adverse drug reactions caused by them were used.Results: Bleeding from various sites was the most common event (39.5%), followed by symptomatic hypoglycemia 22.5% of events and symptomatic hyponatremia in 16.3% events. Amongst various drug classes anticoagulants were the most commonly involved drug class followed by oral hypoglycaemic agents, diuretics and antiplatelets. Type A was predominant ADR constituting (97.7%) of total ADRs and only (2.3%) of ADRs were of type B. After causality assessment, majority 86 (66.6%) were probable related and large number 127 (98.3%) of ADRs were serious which recovered after hospitalization.Conclusions: Our study revealed that ADRs are frequent and are easily recognized in clinical practice and are mostly preventable. Most ADRs are due to the use of drugs with high toxicity for example, warfarin often results in bleeding. It also shows that careful drug monitoring in hospitals  may lead to reduction of many such ADRs, suggesting that some type A, ADRs may be due to inadequate monitoring of therapies and doses. This study will aid the development of interventions to reduce the impact of ADRs in hospital in-patients

Pneumothorax and Pneumomediastinum in a Sputum Positive Tuberculosis Patient: The Continuous Diaphragm Sign

Secondary pneumothorax is a very common medical emergency. At times it is associated with pneumomediastinum, which could be fatal at times if not identified. We present a case of a 11 years old sputum positive child who presented with both these conditions and was diagnosed on chest x ray

Giant intra-abdominal hydatid cysts with multivisceral locations

The disseminated intra-peritoneal hydatid disease is a very rare finding. A case of disseminated intra abdominal hydatid disease is presented along with a review of literature and various therapeutic modalitie

Sporotrichosis in Sub-Himalayan India

Sporotrichosis is endemic in the Sub-Himalayan belt, which ranges from the northern to the north-eastern Indian subcontinent. Similar to many parts of the developing world, sporotrichosis is commonly recognized clinically in this region however consolidated epidemiological data is lacking. We report epidemiological, clinical and microbiological data from a hundred culture positive cases of sporotrichosis. Out of 305 clinically suspicious cases of sporotrichosis, a total of 100 isolates were identified as Sporothrix schenckii species complex (S. schenckii) on culture. Out of the culture proven cases 71% of the cases presented with lymphocutaneous type of lesions while 28% had fixed localized type and 1% had disseminated sporotrichosis. Presentation with lesions on hands was most frequently seen in 32% with arm (23%) and face (21%) in that sequence. The male to female ratio was 1∶1.27. Age ranged from 1 ½ years to 88 years. Mean age was 43.25 years. Disease was predominantly seen in the fourth to sixth decade of life with 58% cases between 31 and 60 years of age. Since the first report from the region there has been a steady rise in the number of cases of sporotrichosis. Seasonal trends reveal that most of the patients visited for consultation in the beginning of the year between March and April. This is the first study, from the most endemic region of the Sub-Himalayan belt, to delve into epidemiological and clinical details of such a large number of culture proven cases over a period of more than eighteen years which would help in the understanding of the local disease pattern of sporotrichosis

Claude's Syndrome Associated with Neurocysticercosis

Claude's syndrome is a distinctive brainstem syndrome characterized by ipsilateral third cranial nerve palsy with contralateral hemiataxia and is due to an intrinsic or extrinsic lesion in the midbrain. We report a case of Claude's syndrome caused by neurocysticercosis infection. A 68 year-old Asian man was admitted to our hospital because of ataxia, left ptosis, and diplopia. Brain magnetic resonance imaging (MRI) showed a cystic lesion in the midbrain, which was surrounded by ring enhancement and peripheral edema. Neurocysticercosis infection was diagnosed by the cerebral spinal fluid study. The patient was treated with albendazole and steroids. A follow-up brain MRI three months later demonstrated the disappearance of a surrounding brain edema and rim enhancement. The most common cause of Claude's syndrome is cerebrovascular disease and malignancy. However, there is no report caused by neurocysticercosis infection. Therefore, if we encounter Claude's syndrome, we should consider neurocysticercosis infection as one of the etiologic factors

Lipohipertrofia: conhecimento e educação ao tratamento com insulina na diabete mellitus

Introduction: Diabetes mellitus type 1 is a chronic disease that, once diagnosed, generates changes in the patient's lifestyle. In order to achieve optimal treatment and avoid subsequent complications, such as lipohypertrophy caused by the increase in the use of insulin, it is vital that patients and medical personnel receive adequate education, so that they acquire knowledge and skills related to the application of the insulin injection. Lipohypertrophy occurs due to the accumulation of subcutaneous fat at the site where insulin is repeatedly injected. Objective: To describe lipohy subject. Methodology: A review of the literature in the databases SciELO, Ovid, Medline, PubMed, ScienceDirect, and Elsevier was carried out, from which 71 articles we identified, and of which 50 met the criteria and were relevant to the search. Results: The most complete and pertinent information was selected from the databases regarding lipohypertrophy, knowledge, education, and insulin treatment in diabetes mellitus. Conclusion: This research allowed us to determine that lipohypertrophy, a secondary complication of insulin treatment in diabetes mellitus, is caused by factors such as an inadequate application technique and inadequate rotation of the injection sites, as well as the lack of knowledge that patients have regarding the treatment, and the lack of education of health personnel when it comes to the use of insulin application techniques.Introducción: la diabetes mellitus tipo 1 es una enfermedad crónica que, una vez diagnósticada, genera cambios en el estilo de vida del paciente. Para lograr un tratamiento óptimo y evitar complicaciones posteriores, como lipohipertrofia por el aumento en el uso de la insulina, es de vital importancia que se brinde a los pacientes y el personal médico una adecuada educación, para que adquieran conocimientos y habilidades en la aplicación de la inyección de insulina. La lipohipertrofia se presenta por acumulación de grasa subcutánea en el sitio donde se inyecta constantemente la insulina. Objetivo: describir la lipohipertrofia en pacientes con diabetes mellitus, los conocimientos y educación que debe adquirir con respecto al tema. Metodología: se realizó una revisión de literatura en las bases de datos SciELO, Ovid, Medline, PubMed, ScienceDirect y Elsevier, que permitió identificar 71 artículos, de los cuales 50 cumplían con los criterios y pertinencia de la búsqueda. Resultados: se seleccionó la información más completa y pertinente de las bases de datos, respecto a la lipohipertrofia, conocimiento, educación y tratamiento con insulina en la diabetes Mellitus. Conclusión: esta revisión permitió determinar que la lipohipertrofia, una complicación secundaria del tratamiento con insulina en la diabetes Mellitus; se origina en factores tales como la técnica de aplicación y rotación inadecuadas de los puntos de inyección, el escaso conocimiento de los pacientes acerca del tratamiento y la falta de educación del personal sanitario con respecto al uso de las técnicas de aplicación de la insulina.Introdução. A diabetes mellitus tipo 1 é uma doença crônica que, uma vez diagnosticada, gera mudanças no estilo de vida do paciente. Para obter um tratamento ótimo e evitar complicações posteriores, como lipohipertrofia pelo aumento no uso da insulina, é de vital importância proporcionar aos pacientes e o pessoal médico uma adequada educação, para que adquiram conhecimentos e habilidades na aplicação da injeção de insulina. A lipohipertrofia se apresenta por acumulação de gordura subcutânea no lugar onde se injeta constantemente a insulina. Objetivo: descrever a lipohipertrofia em pacientes com diabetes mellitus, os conhecimentos e educação que deve adquirir com respeito ao tema. Metodologia: se realizou una revisão de literatura nas bases de dados SciELO, Ovid, Medline, PubMed, ScienceDirect, Elsevier, que permitiu identificar 71 artigos, dos quais 50 cumpriam com os critérios e pertinência da busca. Resultados: selecionou-se a informação mais completa e pertinente das bases de dados, com relação à lipohipertrofia, conhecimento, educação e tratamento com insulina na diabetes Mellitus. Conclusão: esta revisão permitiu determinar que a lipohipertrofia, uma complicação secundária do tratamento com insulina na diabetes Mellitus, origina-se em fatores tais como a técnica de aplicação e rotação inadequadas dos pontos de injeção, o escasso conhecimento dos pacientes sobre o tratamento e a falta de educação do pessoal sanitário com relação ao uso das técnicas de aplicação da insulina

A swinging heart

We present a case of young female presenting with clinical features of cardiac tamponade. On initial investigation, the etiology of cardiac tamponade could not be made. The presence of bradycardia with cardiac tamponade prompted us to perform thyroid function test which lead to the diagnosis of hypothyroidism

Catecholamine induced cardiomyopathy in phaeochromocytoma

International audienc