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

Uncomplicated bifid Meckle’s diverticulum mimicking recurrent appendicitis

Meckel’s diverticulum is the rare congenital anomaly in children. When inflamed it can mimic acute appendicitis. The distal end of the Meckel’s diverticulum is usually rounded and narrow. We present a case of partially bifid Meckel’s diverticulum in a young boy who presented with features of recurrent appendicitis. During appendectomy, a bifid Meckle’s diverticulum was found in therein the distal ileum. It was excised with V shaped ileal wall. Histopathology showed features of Meckel’s diverticulum without any Gastric or pancreatic tissue in mucosa. Clinicians should be wary of a bifid meckel’s diverticulum as a very rare anomaly that can be symptomatic mimicking appendicitis.Keywords: Bifid, Meckel’s, Diverticuliti

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

Solution decomposition of the layered double hydroxide of Co with Fe: Phase segregation of normal and inverse spinels

The nitrate-intercalated layered double hydroxide of Co with Fe decomposes on hydrothermal treatment to yield an oxide residue at a temperature as low as 180 °C. The oxide product is phase segregated into a Co3O4-type normal spinel and a CoFe2O4-type inverse spinel. Phase segregation is facilitated as decomposition in a solution medium takes place by dissolution of the precursor hydroxide followed by reprecipitation of the oxide phases. In contrast, thermal decomposition takes place at 400 °C. This temperature is inadequate to induce diffusion in the solid state whereby phase segregation into the thermodynamically stable individual spinels is suppressed. The result is a single-phase metastable mixed spinel oxide. This is rather uncommon in that a hydrothermal treatment yields thermodynamically stable products where as thermal decomposition yields a metastable product. © 2008 Elsevier Inc. All rights reserved

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

Optimal Cloning and Singlet Monogamy

The inability to produce two perfect copies of an unknown state is inherently linked with the inability to produce maximal entanglement between multiple spins. Despite this, there is no quantitative link between how much entanglement can be generated between spins (known as monogamy), and how well an unknown state can be cloned. This situation is remedied by giving a set of sufficient conditions such that the optimal Completely Positive map can be implemented as a teleportation operation into a standard, reference, state. The case of arbitrary 1 to N asymmetric cloning of d-dimensional spins can then be solved exactly, yielding the concept of `singlet monogamy'. The utility of this relation is demonstrated by calculating properties of Heisenberg systems, and contrasting them with the results from standard monogamy arguments.Comment: 4 pages, 1 figure. v2: conjecture upgraded to proof and generalized to arbitrary local hilbert space dimensions. v3: published versio

Consequences of Implementing Knowledge Management Initaitives in Different Organizational Subcultures

Organizations implementing knowledge management (KM) initiatives are concerned with promoting sharing and transferring of knowledge, within and across different organizational units. Thus, gaining a deeper awareness of the diverse viewpoints and attributes of the various organizational units is one of the important challenges facing organization-wide knowledge management (KM) interventions. It is imperative for large organizations to be sensitive to the inherent differences within different units and align their KM strategies so that the differences are suitably reflected and accommodated in the organization-wide KM strategy. In this context, this paper focuses on the KM strategies of Infosys Technologies, a leading Indian software services and products company recognised globally as a successful KM exponent. Adopting the case study methodology, we conducted an intensive two-month study at Infosys and looked at the consequences of initiating organization-wide KM in two different organizational Business units (BU). Evidence from the case highlights the unfolding of unintended and intended consequences in the two units, and organizational efforts to reconcile them. Taking a subcultural perspective of the two units offered useful insights into the consequences. The Theoretical and managerial contributions of the study to the KM arena are discussed