A case of idiopathic edema after opioid abuse cessation: can failed aldosterone escape be implicated?

Edema is a recognized complication of ongoing heavy opioid use, regardless of the means of delivery or the specifics of the drug in question. The mechanism responsible remains incompletely understood. Hypotheses currently offered include increased Anti-Diuretic Hormone (ADH) secretion, histamine-mediated permeability changes, independent opioid-receptor mediated fluid retention and an exacerbation of pre-existing vascular compromise. Authors report a case of a 39yr old lady in whom edema emerged 7 months after cessation of opioid abuse. All secondary causes of edema were excluded by an exhaustive battery of investigations. The edema failed to recede with loop diuretics, and resolved only on institution of spironolactone, on which she maintained improvement. This case study reinforces hypotheses of ADH likely mediating opioid associated edema and suggests that aldosterone receptor antagonists are probably a superior class of drugs in opioid-associated edema. It also suggests that the physiological changes caused by opioid use that are responsible for edema are likely stable and persist well beyond the period of actual use. Reformed opioid abusers who never received OST are a huge population whose unique physiological status is likely to yield valuable insights into not just the pathology of opioid-abuse related edema, but the pathology of opioid use as a whole

Activity limitation and participation restriction in veterans of Indian Armed Forces: A cross-sectional study

Introduction: The armed forces provide lifelong medical benefits to all their veterans. As most of them are older, their health needs are quite different from those of serving personnel. Having led a relatively active and disciplined life in the services, their general health might also be better than that of their civilian counterparts. Unfortunately, there are no data available on the health of Indian military veterans. This study was planned to ascertain the level of activity limitation (AL) and participation restriction (PR) and determine factors affecting AL and PR. Material and Methods: This community-based, cross-sectional study was conducted among 406 veterans and their spouses aged 60 years and above residing in an urban housing society. House-to-house surveys were conducted. The study was done over 6 months (July–December 2016). Ethical clearance and informed consent were taken. The questionnaire used in the study was designed by incorporating elements from the International Classification of Functioning, Disability, and Health questionnaire and the WHO Disability Assessment Schedule. Results: Of the 406 veterans and their spouses surveyed, 188 (46.3%) were male and 218 (53.7%) were female. The majority of them were in the age groups of 61–70 years (175, 43.1%) and 71–80 years (173, 42.6%). Most of them were living with other family members with only 59 (14.5%) living alone. AL score was good or average in most of them (263 and 124, respectively), and it was bad or very bad in only a small number (11 and 8, respectively) Similarly, the PR score was good or average in 316 and 78 participants, respectively. Only 12 (2.8%) had a bad PR score. PR score increased significantly beyond the age of 80 years (P = 0.00). AL was more in males as compared to females. PR was more in those who were not married/divorced/single (P 0.05). The most common ailments reported by males were body aches and pains, hearing defects, and problems related to micturition. Complaints of feeling low or depressed were significantly higher in females (P < 0.05). The top five causes of morbidity in the study population were hypertension (209, 51.5%), diabetes (125, 30.8%), defective vision (116, 28.6%), cataract (105, 25.9%), and dental problems (102, 25.1%). Conclusion: This study provides an insight into the magnitude of disease, impairment, and disability among veterans. Hypertension was the most common morbidity. Assessment of the AL and PR is useful planning geriatric care and educating caregivers and families to improve the quality of life of the elders

Benign joint hypermobility syndrome with postural orthostatic tachycardia syndrome and acrocyanosis

Benign joint hypermobility syndrome (BJHS) and postural orthostatic tachycardia syndrome (POTS) are two common conditions which are frequently overlooked. While patients with BJHS are known to attend rheumatology, orthopedic, and medical outpatient departments for years with polyarthralgia; POTS is commonly misdiagnosed as anxiety neurosis or panic attack. Described first in 1940, POTS is one of the common causes of orthostatic symptoms in females. POTS is defined as orthostatic intolerance associated with tachycardia exceeding 120 beats/min (bpm) or an increase in the heart rate (HR) of 30 bpm from baseline within 10 min of changing the posture from a lying to standing position, in the absence of long-term chronic diseases and medications that affect the autonomic or vascular tone. Classified as primary and secondary, the underlying pathophysiological mechanism is assumed to be a failure of peripheral vascular resistance to increase sufficiently in response to orthostatic stress, and consequently, venous pooling occurs in the legs resulting in decreased venous return to the heart. This is compensated by an increase in HR and inotropy. We present a case of BJHS, who reported to us with recurrent episodes of syncope and presyncope and was diagnosed to have POTS secondary to his hypermobility syndrome. Although the tilt-table test is the gold standard for diagnosis of POTS, this case highlights the importance of bedside tests in evaluation of orthostatic symptoms and in diagnosis of relatively common but frequently overlooked syndrome

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ABSTRACT Juvenile hormone (JH) analogues and mimics regardless of synthetic or of plant/animal origin are potent pest control agents and are popularly referred to as &apos;third generation pest control agents&apos;. ω-formyl longifolene oxime propargyl ether (NL13), an oxime ether of carbonyl compounds derived from longifolene, a tricyclin sesquiterpene from Indian turpentine oil extracted from the chir pine, Pinus longifolia (Roxb., Pinaceae) and bakuchiol, isolated from the medicinal weed, Psoralea coryllifolia (Linnaues) (Papilionaceae) are proven biopesticides against Culex quinquefasciatus and Dysdercus Koenigi, respectively. These two compounds show JH mimicking activities and disrupt the regular developmental pattern and thus identified as potential biopesticides. Since the larvae of silkworm Bombyx mori L. are known to respond positively to administration of exogenous JH analogues and mimics in terms of enhanced silk production, minute quantities of these two compounds were administered to fifth instar larvae based on the results of previous broad spectrum dose response studies. Emulsions containing 2.5, 5 and 10 ppm of NL13 and 0.625, 1.25 and 2.5 ppm of bakuchiol were administered to the fifth instar larvae of bivoltine silkworm hybrid, KA x NB 4 D 2 at 24, 48, 72 and 96 h at the rate of 12.5 ml/100 larvae, 30 minutes prior to feeding at about 10 am. The compounds elicited notable positive response in silkworm in terms of improved economic traits such as larval and cocoon characters. In the case of NL13, 5 ppm and in the case of bakuchiol, 1.25 ppm of the compounds at 48 h of 5 th instar showed the maximum improvement in the cocoon traits in the range of 10~15%. The physiological impact of the compounds on silkworm growth and development and the resultant impact on the commercial traits are discussed

Projecting prescribing issues and patient patterns on the way to therapeutic appropriateness at the community level through elderly hypertensives

Introduction: Despite treatment, up to 50% of older hypertensives have poorly controlled blood pressure in the community. Possibly, the management advice does not reach the intended. Who stands responsible; the prescriber, the system (social dynamics) or the patients themselves? The study aims to showcase various prescribing practices and patient behaviours that influence therapeutic delivery and thus patient care. Appropriate redressals to such practices and behaviours as and when required during health planning/practice could result in the percolation of the best possible care unto all socioeconomic strata within a community. Materials and Methods: Older patients on antihypertensives (n = 143) were interviewed by visits to various urban slums of a district in Western Maharashtra, India, between December 2018 and October 2020 for this cross-sectional, descriptive study. Demographic and clinical data were recorded on a predesigned pro forma with reasons for the patient's behavior concerning disease/treatment. Finally, available prescriptions and the latest blood/urine evaluations were recorded. Prescribing practices were recorded with available tools and data was analysed. Results: The mean age of the study population was 68 ± 7.39 years. Optimal control of the blood pressure was not achieved in 72.03% of patients (P < 0.0001%; 95% confidence interval [CI]: 32.94–53.54%), whereas adverse drug reactions (ADRs) occurred in 35.66% of patients. Physician's prescription was available in 101 patients for prescription quality assessment; however, 12 patients had never been prescribed and 30 lost their prescriptions. Even patients under regular follow-up with a physician failed to achieve the blood pressure targets or prevent an ADR. Finally, the patients' behavior was studied, wherein 41.22% became lost to follow-up and 64.13% of patients had old prescriptions. Forty-two patients could explain such behaviors. Conclusions: Both physicians and patients were responsible for poor blood pressure control. The means of assisting a physician on physician-patient communication would reduce physician workload (thus increasing efficiency) and reduce confusion/misconception (about drug/disease etc) that patient upholds (thus addressing counterproductive patient behaviours)

Ecthyma gangrenosum like lesions in disseminated mycobacterial tuberculosis infection in a renal transplant recipient

Ecthyma gangrenosum (EG) is a relatively rare skin manifestation that is most commonly described in Pseudomonas aeruginosa bacteremia. It is more frequently seen in immunocompromised individuals. We report a case of 60-year-old renal transplant recipient on triple immunosuppressants and diabetes mellitus type 2 on insulin therapy who developed EG-like lesions due to disseminated mycobacterial tuberculosis (MTB) infection. To the best of our knowledge, this is the first case report of EG-like lesions associated with disseminated kochs

Hormetic influence on silkworm, bombyx mori L., of the phytojuvenoid ω-formyl longifolene oxime propargyl ether

The hormetic influence on silkworm, Bombyx mori L. (Lepidoptera; Bombycidae) of the juvenile hormone mimic ω-formyl longifolene oxime propargyl ether (NL13) was assayed. Emulsions containing 2.5, 5.0 and 10.0 ppm of the compound were administered topically as a single dose, to two popular commercial silkworm hybrids, viz. KA × NB4D2 and PM × NB4D2, at 24, 48, 72 and 96 h into the 5th instar, and economic characters of the larvae and resultant cocoons measured. A medium and absolute control were maintained in parallel. It was found that administration of 5 ppm of NL13 to 48-h-old 5th instars resulted in the maximum improvement in commercial traits. The possible role of exogenous JH-like compounds in eliciting this response in silkworm is discussed