Hypersensitivity reaction with metformin: a case report

Metformin is a biguanide derivative widely used for treatment of diabetic patients. The most common toxic effects of metformin are gastrointestinal (anorexia, nausea, vomiting, abdominal discomfort and diarrhoea). As with other drugs, allergic reactions can occur with metformin also, but these are very rare. A case of hypersensitivity reaction with metformin was reported in adverse drug monitoring centre. A 59-year-old female, newly diagnosed case of diabetes mellitus II, started on metformin tablet 500 mg twice daily, developed purpuric skin lesions on her arms, legs and back few days after starting the drug. metformin was stopped and patient was put on glimepiride tablet. The lesions slowly started subsiding after stopping metformin

Clonazepam induced maculopapular rash: a case report

Clonazepam is a benzodiazepine with prominent anticonvulsant action than other members of the group at equisedating doses. It especially blocks pentylenetetrazole-induced seizures. Other important actions include anxiolysis. Common adverse effects to Clonazepam include drowsiness and lethargy. In this submission we report a case of Clonazepam induced maculopapular rash in a 30 year old female treated for panic disorder

Efficacy of topical phenytoin in healing diabetic foot ulcer

Background: India is fast becoming world diabetes capital. Complications are a cause of hospitalization in patients with diabetes mellitus especially foot complications. Gauze moistened with saline has been the standard method.Methods: The study was done from June 2015 to June 2016. The objective of this study was to assess the efficacy of topical phenytoin compared to standard and conventional methods of wound care in improving the healing process. In this randomised control trial, the data from 70 patients with diabetic ulcers was collected, 35 patients underwent topical phenytoin dressing while remaining 35 underwent conventional wound care. Histopathological and Clinical examination were done and the following parameters were calculated: Granulation tissue formation in 2 weeks and Mean duration of hospital stay.Results: In this study, Mean hospital stay in days was 33.4 in Phenytoin treated group and in other group with use conventional materials, the mean hospital stay in days was 39.7 days. Granulation tissue formation was faster as compared to conventional materials of Dressings.Conclusions: In this study we conclude Topical phenytoin helps in faster healing of Diabetic Foot Ulcers and it also reduces the mean hospital stay of the patients

Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition)

In 2008 we published the first set of guidelines for standardizing research in autophagy. Since then, research on this topic has continued to accelerate, and many new scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Accordingly, it is important to update these guidelines for monitoring autophagy in different organisms. Various reviews have described the range of assays that have been used for this purpose. Nevertheless, there continues to be confusion regarding acceptable methods to measure autophagy, especially in multicellular eukaryotes. For example, a key point that needs to be emphasized is that there is a difference between measurements that monitor the numbers or volume of autophagic elements (e.g., autophagosomes or autolysosomes) at any stage of the autophagic process versus those that measure fl ux through the autophagy pathway (i.e., the complete process including the amount and rate of cargo sequestered and degraded). In particular, a block in macroautophagy that results in autophagosome accumulation must be differentiated from stimuli that increase autophagic activity, defi ned as increased autophagy induction coupled with increased delivery to, and degradation within, lysosomes (inmost higher eukaryotes and some protists such as Dictyostelium ) or the vacuole (in plants and fungi). In other words, it is especially important that investigators new to the fi eld understand that the appearance of more autophagosomes does not necessarily equate with more autophagy. In fact, in many cases, autophagosomes accumulate because of a block in trafficking to lysosomes without a concomitant change in autophagosome biogenesis, whereas an increase in autolysosomes may reflect a reduction in degradative activity. It is worth emphasizing here that lysosomal digestion is a stage of autophagy and evaluating its competence is a crucial part of the evaluation of autophagic flux, or complete autophagy. Here, we present a set of guidelines for the selection and interpretation of methods for use by investigators who aim to examine macroautophagy and related processes, as well as for reviewers who need to provide realistic and reasonable critiques of papers that are focused on these processes. These guidelines are not meant to be a formulaic set of rules, because the appropriate assays depend in part on the question being asked and the system being used. In addition, we emphasize that no individual assay is guaranteed to be the most appropriate one in every situation, and we strongly recommend the use of multiple assays to monitor autophagy. Along these lines, because of the potential for pleiotropic effects due to blocking autophagy through genetic manipulation it is imperative to delete or knock down more than one autophagy-related gene. In addition, some individual Atg proteins, or groups of proteins, are involved in other cellular pathways so not all Atg proteins can be used as a specific marker for an autophagic process. In these guidelines, we consider these various methods of assessing autophagy and what information can, or cannot, be obtained from them. Finally, by discussing the merits and limits of particular autophagy assays, we hope to encourage technical innovation in the field

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Acneform eruptions with use of minoxidil-a case report

A 32 year male patient resident of Andaman and Nicobar Islands presented to the dermatology OPD with the chief complaints of acneform eruptions since 1 month after the use of Minoxidil/Aminexil 5% solution for the treatment of Alopecia which he had since 6 months. Diagnosis of androgenic alopecia was made based on the clinical examination and hence treatment with tablet Finpecia (Finasteride) 1mg once daily and 5% Minoxidil/ Aminexil topical solution 1ml thrice daily local application was advised and patient was asked to come back for follow up after a period of 2 months, but the patient returned after 1 month of treatment with the complaints of comedonic eruptions on forehead