A CLINICAL STUDY OF PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

OBJECTIVE To study the incidence, age and sex distribution among adults, various modes of presentation, correlation between thrombocytopenia and bleeding manifestations and various modalities of treatment of Idiopathic Thrombocytopenic Purpura in a tertiary care hospital in India.MATERIALS AND METHODSProspective study consisting of 4o cases of ITP admitted to Kasturba Medical College Hospital, Manipal from November 2005 to March 2007. Patients above 14 years of age admitted with thrombocytopenia in this institution were screened based on detailed clinical history, physical examination and laboratory investigations.RESULTSThe maximum incidence was in the 3 rd decade of life accounting for 27.5% of the patients. Ratio of male to female was 1:1.9 with female preponderance. Females in 3 rd decade had maximum incidence while males in 4th decade have maximum incidence. Majority 12 (85.71%) of male patients and 15(57.69%) of female patients  developed purpura during the course of disease. The mean count was 17.8X109/L with range between 2.0 X109/L to 76 X109/L. Cutaneous bleeding spots were found to be assosiated with counts above 25000X109/L and hematuria with lowest counts around 4000 X109/L. 20 (50%) of the above 40 patients responded to corticposteroids alone and did not have any further relapse. Among the remaining patients 3 (7.5%) had a relapse of symptoms within next 6 months and responded to repeat prednisolone started at 1mg/kg. 2 (5%) patients were given steroids tapering dose with IV Immune globulins for initial 5 days as therapy to which they responded.CONCLUSIONIdiopathic thrombocytopenia is 1.9 times more common in females than males. Most common presentation is bleeding spots over body. Bleeding manifestations are more common with thrombocytopenia less than 30000/mm3. Corticosteroids are the mainstay in treatment. Complete remission is seen in up to 57.5% of the patients. Splenectomy is the second modality of treatment in ITP. Complete and sustained remission is seen 75% of patients. Â

Silver triflate catalyzed synthesis of 3-aminoalkylated indoles and evaluation of their antibacterial activities

An efficient, one-pot synthesis was developed for 3-aminoalkylated indoles by three-component coupling reaction of aldehydes, N-methylanilines, and indoles using AgOTf as a catalyst. A series of twenty 3-aminoalkylated indoles was evaluated for their antibacterial activities against both Gram negative and Gram positive bacteria. Compounds 4b and 4r showed good antibacterial activity against both Gram positive and Gram negative strains. However, inversing the property of substituent (from 4r to 4q) resulted in the significant fall in the magnitude of antibacterial activity against Escherichia coli

ASSOCIATION OF POSTPRANDIAL BLOOD SUGAR WITH HYPERCOAGULABILITY IN COMPARISON TO FASTING BLOOD SUGARS IN DIABETIC AND HEALTHY PATIENTS: A CROSS-SECTIONAL STUDY

Objective: The aim of this study was to find the association of postprandial blood glucose with hypercoagulability in comparison to fasting blood sugars(FBS) in diabetic and healthy patients.Methods: The present study involved a total of 156 patients, of which 78 were taken as cases (diabetics) and other 78 as controls (non-diabetics). Laboratory analysis included prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen assay done along with fasting, and postprandial sugars.Results: Platelets in diabetics and healthy controls were in normal range. Decrease in PT and partial thromboplastin time was noted in diabetics compared to non-diabetic controls. Fibrinogen levels were increased in cases compared to controls. Changes in PT values were more significant with postprandial blood sugar (PPBS) levels when compared to FBS levels, and APTT follows the same pattern with more in PPBS levels and FBS levels in diabetics. PPBS showed elevated fibrinogen when compared to FBS in diabetics as well as non-diabetics.Conclusion: Type 2 diabetes mellitus is a hypercoagulable state as proven by the following results of our study

BORTEZOMIB INDUCED SUBCONJUNCTIVAL HEMORRHAGE

Many drugs are used in the treatment of multiple myeloma but Thalidomide, Lenalidomide, Bortezomib, dexamethasone and their combination remains the main stay of treatment. The molecular formula of bortezomib is C19H25BN4O4 and its chemical IUPAC name is [3-methyl-1-(3-phenyl-2-pyrazin-2-ylcarbonylamino-propanoyl) amino-butyl] boronic acid. Mechanisms by which it acts is usually by 26 SProteasome inhibition leading to degradation of anti-apoptotic proteins. Bortezomib is known to cause many side effects. So hence we report a rare case of Bortezomib induced subconjunctival hemorrhage in our tertiary care hospital.KEYWORDS: Bortezomib, Adverse effect, Proteosome inhibition, Subconjunctival Hemorrhag

CLOPIDROGEL INDUCED LEUKOCYTOCLASTIC VASCULITIS

Cutaneous adverse drug reactions are very common in a hospital setting while treating patients. Drug-induced vasculitis is a very common form of vasculitis affecting all age groups, and many drugs have been implicated in causing vasculitis. Clopidogrel is an antiplatelet drug used in the management as well as prevention of coronary artery disease. It is known to cause various side effects ranging from bleeding, gastrointestinal disturbances, to skin rashes. Leukocytoclastic vasculitis is a form of hypersensitivity vasculitis and is very rarely seen with clopidogrel. Hence, we report a case of clopidogrel-induced leukocytoclastic vasculitis in an old male patient after coronary stenting.Â

ACENOCOUMAROL OR WARFARIN: WHICH IS THE CLINICIAN'S ALLY?

ABSTRACTWarfarin and acenocoumarol are commonly prescribed oral anticoagulant drugs that are used in the prevention and treatment of thromboembolicdisorders across the world. Although both these drugs act by a similar mechanism, there are significant differences between them, especially in termsof their half-lives, and more importantly, in their variability in response pharmacogenetically. This case report highlights an instance wherein warfarinproved to provide a much more stable anticoagulant cover, as compared to that provided by acenocoumarol.Keywords: Thrombosis, Bleeding, Antiphospholipid antibody syndrome, Anticoagulant, International normalized ratio

HEMICHOREA: AN UNUSUAL MANIFESTATION OF THYROTOXICOSIS

ABSTRACTChorea is usually associated with neurological diseases. However, it can also be seen in patients with systemic lupus erythematosus (SLE), rheumaticfever (Sydenham's chorea), polycythemia vera, and thyrotoxicosis. Here, we report an interesting case of hemichorea in a 32-year-old lady, whopresented with acute onset of jerky, non-repetitive involuntary movements of the left upper and lower limbs. After detailed evaluation, she was foundto have thyrotoxicosis. Thyroid Tc-scan showed diffuse uptake suggesting Grave's disease. A magnetic resonance imaging of the brain was normal.Other causes of chorea like SLE and rheumatic fever were excluded. She was started on carbimazole. On follow-up after 6 weeks of therapy, there wasthe complete disappearance of chorea, and her thyroid hormone levels were normal.Keywords: Extrapyramidal syndrome, Hyperthyroidism, Corpus striatum, Dancing movements

PHENYTOIN-INDUCED ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS

ABSTRACTPhenytoin is the first line antiepileptic for generalized tonic-clonic seizures. It is still the go to†drug despite the availability of newer antiepileptics,chieflybecause of its lowcost and highefficacy.Phenytoinis associatedwith toxicitiesinvolvingmultiple organsystemssuch asbrain,blood, and skin. One of the most common adverseeffectsis the developmentof skin rashes.It can rangefrommild tolife-threateningskineruptions.This is a case reportof a younggirlwhodevelopedacutegeneralizedexanthematouspustulosis followingphenytointherapyforposttraumaticseizures.Keywords: Drug-induced rash, Anti-epileptic, Type-4 hypersensitivity, Hydantoi

HYPOKALEMIC PERIODIC PALSY AS THE PRIMARY PRESENTATION OF SJOGREN'S SYNDROME

ABSTRACTThe most common presentations of Sjogren's syndrome include dryness of eyes, oral cavity, and features of systemic scleroderma. When a patientwalks in with such classical features, it becomes easy for the clinician to diagnose and treat the patient. However, Sjogren's syndrome may presentatypically as experienced in the present case. Here, the authors present a case of Sjogren's syndrome, which presented as hypokalemic periodic palsy,secondary to distal renal tubular acidosis.Keywords: Scleroderma, Potassium, Sicca syndrome, Renal tubular acidosis

THORACIC EPIDURAL ABSCESS DUE TO COMMUNITY-ACQUIRED METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

ABSTRACTA spinal epidural abscess threatens the spinal cord or cauda equina by compression and also by vascular compromise. If left untreated, an expandingsuppurative infection in the spinal epidural space can impinge on the spinal cord, producing sensory symptoms and signs, motor dysfunction, andultimately paralysis, followed by death. Hence, early intervention undoubtedly improves the outcome. The authors report a case of a 27-year-oldfemale patient, who presented with paraplegia, and was found to have thoracic epidural abscess due to community-acquired methicillin-resistantStaphylococcus aureus.Keywords: Spinal cord, Cauda equina, Infection, Laminectomy, Drainage