ADVERSE REACTION DUE TO CLINDAMYCIN

ABSTRACTA 43-year-old patient was diagnosed of left sided empyema. He was started on injectable piperacillin-tazobactam combination and clindamycin.After 11 days, he developed itchy red lesions over different parts of the body. Both the drugs were immediately stopped in view of drug allergy.However, oral clindamycin with a lower dose was restarted, and patient tolerated the drug without any skin related episodes. Postdischarge he wasprescribed oral clindamycin for 2 more weeks. 2 days postdischarge he started developing rash. The patient continued the drug for next 10 daysand as a severity of rashes increased he reported to the hospital. He had itchy red lesions throughout the body. Clindamycin was stopped, and hewas prescribed clonate lotion and tablet cetirizine for 10 days. The lesions resolved. A patient was informed that he is allergic to beta-lactams andclindamycin.Keywords: Clindamycin, Skin rashes, Beta-lactams

The altered sputum microbiome profile in patients with moderate and severe COPD exacerbations, compared to the healthy group in the Indian population [version 4; peer review: 2 approved]

Background: Microbial culture-independent sequencing techniques have advanced our understanding of host-microbiome interactions in health and disease. The purpose of this study was to explore the dysbiosis of airway microbiota in patients with moderate or severe chronic obstructive pulmonary disease (COPD) and compare them with healthy controls. Methods: The COPD patients were investigated for disease severity based on airflow limitations and divided into moderate (50%≤FEV12) revealed that marker genera like Streptococcus and Rothia were abundant in moderate COPD. For severe COPD, the genera Pseudomonasand Leptotrichia were most prevalent, whereas Fusobacterium and Prevotella were dominant in the healthy group. Conclusions: Our findings suggest a significant dysbiosis of the respiratory microbiome in COPD patients. The decreased microbial diversity may influence the host immune response and provide microbiological biomarkers for the diagnosis and monitoring of COPD

Epigenetics: The New Frontier in the Landscape of Asthma

Over the years, on a global scale, asthma has continued to remain one of the leading causes of morbidity, irrespective of age, sex, or social bearings. This is despite the prevalence of varied therapeutic options to counter the pathogenesis of asthma. Asthma, as a disease per se, is a very complex one. Scientists all over the world have been trying to obtain a lucid understanding of the machinations behind asthma. This has led to many theories and conjectures. However, none of the scientific disciplines have been able to provide the missing links in the chain of asthma pathogenesis. This was until epigenetics stepped into the picture. Though epigenetic research in asthma is in its nascent stages, it has led to very exciting results, especially with regard to explaining the massive influence of environment on development of asthma and its varied phenotypes. However, there remains a lot of work to be done, especially with regard to understanding how the interactions between immune system, epigenome, and environment lead to asthma. But introduction of epigenetics has infused a fresh lease of life in research into asthma and the mood among the scientific community is that of cautious optimism

Review Article Statins in Asthma: Potential Beneficial Effects and Limitations

Asthma's sustenance as a global pandemic, across centuries, can be attributed to the lack of an understanding of its workings and the inability of the existing treatment modalities to provide a long lasting cure without major adverse effects. The discovery of statins boosted by a better comprehension of the pathophysiology of asthma in the past few decades has opened up a potentially alternative line of treatment that promises to be a big boon for the asthmatics globally. However, the initial excellent results from the preclinical and animal studies have not borne the results in clinical trials that the scientific world was hoping for. In light of this, this review analyzes the ways by which statins could benefit in asthma via their pleiotropic anti-inflammatory properties and explain some of the queries raised in the previous studies and provide recommendations for future studies in this field

Comparison of oral montelukast with oral ozagrel in acute asthma: A randomized, double-blind, placebo-controlled study

Background: The need for more effective management of acute asthma has led to research on drugs which are otherwise approved for use in chronic asthma. Objective: To study and compare the effects of oral montelukast with oral ozagrel in acute asthma. Materials and Methods: One hundred and twenty patients with acute asthma were recruited for the study. Out of 120 study patients, forty each were randomized into placebo, montelukast, and ozagrel groups. After the first dose of the drug or placebo was administered, peak expiratory flow rate (PEFR), number of rescue medications and also vital signs were noted at 6 h, 12 h, 24 h, 48 h, and at discharge. In addition, same recordings were done on the morning (8 a.m. – 10 a.m.) following admission. The difference in mean PEFR of each group at above-mentioned time points was the primary endpoint whereas need for rescue medications the secondary end-point. Results: The respective mean PEFR recordings of the placebo, montelukast, and ozagrel groups at various time points were as follows: at 6 h (235.19 ± 3.18, 242.86 ± 3.26, 228.18 ± 3.25); at 12 h (254.37 ± 5.23, 265.62 ± 5.38, 242.99 ± 5.36); at 24 h (267.46 ± 7.41, 291.39 ± 7.61, 268.14 ± 7.58); and at 48 h (277.99 ± 7.35, 303.22 ± 7.56, 285.27 ± 7.53); and discharge (301.94 ± 7.07, 317.32 ± 7.27, 298.99 ± 7.23). The mean PEFR between the treatment groups were not statistically significant (P = 0.102). The mean PEFR in the three groups at 8–10 a.m. following admission was 257.60 ± 5.52, 264.23 ± 5.98, and 249.94 ± 5.96; P = 0.266. Total number of rescue doses needed were 7, 4, and 13, respectively (P = 0.67). Conclusion: Montelukast or ozagrel when added to the standard treatment of acute asthma does not result in any additional benefit

Critical appraisal of published literature

With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader′s work environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice

Herniation of unruptured tuberculous lung abscess into chest wall without pleural or bronchial spillage

A 22-year-old unmarried man presented to the chest outpatient department with a history of productive cough of two-month duration. He also complained of pain and swelling on the anterior aspect of right side of chest of one-month duration. Imaging studies of the thorax, including chest roentgenography and computerized tomography, revealed an unruptured lung abscess which had herniated into the chest wall. Culture of pus aspirated from the chest wall swelling grew Mycobacterium tuberculosis. He was diagnosed to have a tuberculous lung abscess which had extended into the chest wall, without spillage into the pleural cavity or the bronchial tree. Antituberculosis drugs were prescribed, and he responded to the treatment with complete resolution of the lesion

Bacterial isolates from the bronchoalveolar lavage fluid of patients with pneumonia not responding to initial antimicrobial therapy

Background: Patients with community-acquired pneumonia (CAP) who are admitted in a hospital but do not respond to initial antimicrobial therapy pose a challenge to the attending physician. The knowledge of the likely pathogens and their sensitivity pattern can help the clinicians to better manage such cases. Aims and Objectives: To study the spectrum of the bacterial isolates and to determine the antimicrobial sensitivity pattern obtained from the bronchoalveolar lavage (BAL) fluid of CAP patients who did not respond to initial antimicrobial therapy. Setting and Design: A retrospective study of 87 patients who were admitted in the medical wards of a tertiary care teaching hospital in South India with the diagnosis of CAP and were not responding to initial antimicrobial therapy. Materials and Methods: The patient-related data were obtained from the case records and entered on a pre-designed proforma. This included demographic characteristics and reports of relevant clinical tests. The BAL culture and sensitivity results were also noted on the proforma. Results: The mean age of the patients was 49.28 ± 16.61 years (mean ± SD, range 17-80 years). Fifty-seven patients (65.5%) of were male. Also, 98 bacterial isolates were obtained from the BAL fluid of 87 patients. The most prevalent bacterial isolates included Pseudomonas aeruginosa (n = 35, 35.7%), Klebsiella pneumoniae (n = 19, 19.4%), Staphylococcus aureus (n = 15, 15.3%) and Acinetobacter species (n = 11, 11.2%). Most bacterial isolates tested showed 100% sensitivity to meropenem except Acinetobacter species (25%). Conclusion: P. aeruginosa and K. pneumoniae were the most common bacterial pathogens isolated from the BAL fluid. The isolates tested showed 100% sensitivity to meropenem except Acinetobacter species. All the methicillin-resistant S. aureus isolates displayed sensitivity to vancomycin, linezolid and teicoplanin

Idiopathic Clubbing Confined to Lower Limb Digits and Idiopathic Pulmonary Fibrosis: An Unusual Association

A 62-year-old housewife presented to the chest outpatient department with a history of exertional breathlessness of four-month duration. On general physical examination, clubbing of toes was present with sparing of fingers. Chest examination revealed bilateral basal end inspiratory fine crepitations. A diagnosis of idiopathic pulmonary fibrosis was made on the basis of clinical, spirometric, and high-resolution computed tomography findings. Extensive evaluation could not reveal any cause for the differential clubbing. The unusual distribution of clubbing in a clinical condition, such as idiopathic pulmonary fibrosis, where generalized clubbing is expected can lead to a diagnostic confusion. This can lead to a further burden of investigations on the patient as clubbing being a significant finding cannot be ignored