Adverse drug reactions to ibuprofen: a case report

Ibuprofen is a commonly used drug available by prescription and over the counter for treatment of fever, joint pain, headache, migraine, inflammatory states. It is available in combination with paracetamol and various other drugs. Side effects associated with aspirin & non-steroidal anti-inflammatory drugs (NSAIDs) are rash, gastrointestinal ulcers, hepatic toxicity, Steven Johnson syndrome, respiratory skin rashes, acute exacerbation of asthma and anaphylaxis. We have reported here severe distress hypersensitive reaction with ibuprofen induced hypersensitivity syndrome. Within two hours of consumption of ibuprofen patient developed severe bronchospasm, throat & laryngeal oedema leading to respiratory distress. He was treated with salbutamol, hydrocortisone, deriphylline and supportive oxygen, but did not respond and went into coma. Unlike acetaminophen, ibuprofen does not have any antidote hence managing adverse drug reactions (ADR) due to ibuprofen is big challenge. Therefore understanding pathophysiology of ADR to Ibuprofen is necessary to manage the patient. Literature in the field of allergic drug reaction shows that epinephrine, a physiological antagonist of histamine is the first drug of choice for the treatment of allergic or drug induced angioedema, laryngeal oedema and bronchospasm due to its direct action on target organs. Such reactions should therefore be managed by epinephrine without loss of time. ADR due to ibuprofen could be prevented by (a) avoiding unnecessary intake of drug, (b) educating patients / families and public about adverse drug reactions (c) surveillance and monitoring of drug reactions (d) record keeping (e) drug audit and (f) reporting of ADR to state/central pharmacovigilance agency. We do observe doctors having misconception about adrenaline, its actions, usage & side effects especially cardio-vascular, hence are reluctant to use. But in severe violent adverse drug reaction we have to use our wisdom and judgement and see whether usage of adrenaline overweighs the ADR or not. In acute drug reaction like this where respiratory system is compromised use adrenaline could have been helpful. We therefore suggest adequate teaching of the field of adverse drug reactions, early diagnosis of drug reactions and judicious use of epinephrine if warranted

Meditation as primary intervention strategy in prevention of cardiovascular diseases

Heart diseases especially Hypertension, Coronary Artery Diseases (CAD) and stroke are the leading causes of death all over the world. Hostility, anxiety, depression and increased reactivity to mental stress have been strongly associated with hypertension and CAD. Mental stress or anxiety causes increased sympathetic activation and poor vagus nerve control over heart.  Imbalance between sympathetic and parasympathetic nervous system leads to vasospasm and has been associated with Hypertension, Coronary Artery Disease and Myocardial Infarction. Psychosocial stress has also been found to be responsible for imbalance in autonomic nervous system, causing sympathetic dominance over parasympathetic leading to acute coronary events. Meditation is a process of self-contemplation and purification of mind. Practitioner of meditation brings about desirable changes in their behaviour and lifestyle. During Meditation sympathetic activity is reduced and there is parasympathetic dominance over sympathetic. During meditation and after meditation person feels calm, quiet and relaxed. Meditation causes decrease in metabolic rate. The blood pressure may come to normal or falls, pulse rate comes to normal or low, vascular spasm if any, is reduced and myocardial perfusion increase. Thus meditation helps in preventing hypertension, coronary artery disease and other cardiac events.  This may be beneficial before a person gets coronary event and post-myocardial infarction.   In view of the beneficial effects of meditation, it may be introduced as primary intervention strategy in preventing Cardio-vascular Diseases. We did this review study to find out: (1) Can meditation bring about desirable changes in human mind and body in post-intervention group compared to control group? (2) Its effectiveness in prevention of heart diseases like hypertension, coronary events and post-MI complications. This review included all randomised controlled trials on patients above 18 years, both sexes, any setting with medication & meditation or meditation, Controlled group was on medication alone. Clustered and crossover studies were excluded

Comparative study on the measurement of learning outcomes after powerpoint presentation and problem based learning with discussion in family medicine amongst fifth year medical students

Background: Learning outcomes after traditional teaching methods were compared with problem-based learning (PBL) among fifth year medical students. Six students participated each in traditional teaching and PBL methods, respectively. Traditional teaching method involved PowerPoint (PPT) presentation and PBL included study on case scenario and discussion. Both methods were effective in improving performance of students. Postteaching, we did not find significant differences in learning outcomes between these two teaching methods. Aims: (1) Study was conducted with an intention to find out which method of learning is more effective; traditional or PBL. (2) To assess the level of knowledge and understanding in anemia/zoonotic diseases as against diabetes/hypertension. Settings and Design: All the students posted from February 3, 2014, to March 14, 2014, participated in this study. Six students were asked to prepare and present a lecture (PPT) and subsequent week other six students were asked to present PBL. Both groups presented different topics. Since it was a pre- and post-test, same students were taken as control. To maintain uniformity and to avoid bias due cultural diversity, language etc., same questions were administered. Materials and Methods: After taking verbal consent, all 34 students were given pretest on anemia and zoonotic diseases. Then lecture (PPT) by six students on the same topic was given it followed by posttest questionnaire. Subsequent week pretest was conducted on hypertension and diabetes. Then case scenario presentation and discussion (PBL) was done by different six students followed by posttest. Both the methods were compared. Statistical Analysis: Analysis was done manually and standard error of means and students t-test was used to find out statistical significance. Results: We found statistically significant improvement in performance of students after PPT presentation as well as PBL. Both methods are equally effective. However, Pretest results of students in anemia and zoonotic diseases (Group A) were poor compared to pretest results of students in hypertension and diabetes (Group B). The students who participated in presentation did not influence their performance as they were covering a small part of the topic and there were no differences in their marks compared to other students. Conclusions: We did not find significant differences in outcome after teaching between PBL and traditional methods. Performances of students were poor in anemia and zoonotic diseases which need remedial teaching. Assessment may influence retention ability and performance

Meditation as primary intervention strategy in prevention of cardiovascular diseases

Heart diseases especially Hypertension, Coronary Artery Diseases (CAD) and stroke are the leading causes of death all over the world. Hostility, anxiety, depression and increased reactivity to mental stress have been strongly associated with hypertension and CAD. Mental stress or anxiety causes increased sympathetic activation and poor vagus nerve control over heart.  Imbalance between sympathetic and parasympathetic nervous system leads to vasospasm and has been associated with Hypertension, Coronary Artery Disease and Myocardial Infarction. Psychosocial stress has also been found to be responsible for imbalance in autonomic nervous system, causing sympathetic dominance over parasympathetic leading to acute coronary events. Meditation is a process of self-contemplation and purification of mind. Practitioner of meditation brings about desirable changes in their behaviour and lifestyle. During Meditation sympathetic activity is reduced and there is parasympathetic dominance over sympathetic. During meditation and after meditation person feels calm, quiet and relaxed. Meditation causes decrease in metabolic rate. The blood pressure may come to normal or falls, pulse rate comes to normal or low, vascular spasm if any, is reduced and myocardial perfusion increase. Thus meditation helps in preventing hypertension, coronary artery disease and other cardiac events.  This may be beneficial before a person gets coronary event and post-myocardial infarction.   In view of the beneficial effects of meditation, it may be introduced as primary intervention strategy in preventing Cardio-vascular Diseases. We did this review study to find out: (1) Can meditation bring about desirable changes in human mind and body in post-intervention group compared to control group? (2) Its effectiveness in prevention of heart diseases like hypertension, coronary events and post-MI complications. This review included all randomised controlled trials on patients above 18 years, both sexes, any setting with medication & meditation or meditation, Controlled group was on medication alone. Clustered and crossover studies were excluded