A case of phenobarbitone induced Stevens-Johnson syndrome-toxic epidermal necrolysis along with its causality assessment

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse drug reaction, which are mainly caused by drugs; and these are usually associated with high degree of morbidity and mortality. They are characterized by mucocutaneous tenderness and typically haemorrhagic erosions, erythema and more or less severe epidermal detachment as blisters and areas of denuded skin.  High risk drugs for the development of SJS-TEN include phenobarbitone, phenytoin, carbamazepine, lamotrigine, nevirapine, NSAIDs, allopurinol, and cotrimoxazole. A 33 years old female patient came to skin and venereal diseases (VD) outpatient department (OPD) with complaints of painful skin lesions. She was apparently symptom free 15 days back. Then she took tablet phenobarbitone 60 mg, BD as her anti-epileptic treatment. After 12-13 days of taking the drug, she developed erythematous papules associated with itching over her both forearm, face, chest, abdomen, back and lower limbs bilaterally which rapidly progressed to fluid-filled blisters that ruptured to form painful erosions and desquamation of skin all over the body. The patient was managed by withdrawal of phenobarbitone and conservatively, and the patient recovered successfully. The causality of phenobarbitone in this reaction was “probable” as per Naranjo scale. Seriousness of the reaction was “prolonged hospitalization”. Phenobarbitone is one of the most common causative agents of SJS and TEN. The main stay of treatment is immediate withdrawal of causative agent along with supportive care

Efficacy of structured teaching programme on home care management of pregnancy induced hypertension in primigravida mothers: a tertiary hospital study

Background: Hypertensive disease of pregnancy is one of the major causes of maternal mortality in India. 7.1% of maternal deaths are attributed to hypertension disorder of pregnancy. Early identification of modifiable and non-modifiable risk factors of hypertensive disorders of pregnancy is essential for effective management of hypertensive disease of pregnancy. The study assesses the knowledge of primigravida women regarding home care management of pregnancy induced hypertension before and after administering structured teaching programme.Methods: It is a pilot study with pre-experimental study design. 30 study participants were recruited with non-probability purposive sampling of primigravida women attending antenatal clinic of maternity hospital of Petlaburj, Hyderabad. A pretested and standardized survey instrument was used for collecting socio-demographic characteristics and knowledge, attitude and practices regarding home care management of pregnancy after obtaining informed consent before and after structured teaching intervention programme with audio-visual aids for home management of pregnancy induced hypertension.Results: 43.3% of primigravida women were 21-24 years old and 43.3% of primigravida women were 20-24 years of gestation. Mean pre-test and post-test knowledge assessment score increased by 155.2% from 13.4 to 34.2 after administration of structured teaching programme and paired-t test was carried out to test difference of means. The test reports t-test statistic of -20.7 with p-value of <0.001 is highly significant.Conclusions: Evidence based guidelines adopted by Government of India should be implemented by health facilities by upgrading infrastructure, capacity building and community engagement for early identification of complications of pregnancy to seek health care services

Curvature dominance DE-model in f(R)f(R)-gravity

We have probed a cosmological model in $f(R)$-gravity, which is a cubic equation in scalar curvature $R$. The terms arise due to nonlinear $f(R)$ function are treated as energy due to curvature inspired geometry. As a result, we find accelerating expansion in the universe, which creates an anti-gravitating negative pressure in it. Some of the physical parameters are solved using numerical methods. The evolution of the model are examined by the latest observational Hubble data (46-data points) and Pantheon data (the latest compilation of SNIa with 40 binned in the redshift range $0.014 \leqslant z \leqslant1.62$). Some important features of the model have been discussed by analyzing the plots of various dynamical parameters. The plots of deceleration parameter $q$ and the Hubble parameter $H$ describe the accelerating expansion in the evolution of the Universe at the present epoch. The transition from deceleration to acceleration for our model is obtained at redshift $z_{tr} \simeq 0.694069$, which is in good agreement with $\Lambda$CDM. We have also carried out state finder analysis for our model. The analysis of specific features of the model confirms that our model is consistent with $\Lambda$CDM in late times.Comment: 9 pages, 10 figure

An FLRW accelerating universe model in Weyl type f(Q)f(Q) gravity and Observational Constraints

We propose to develop a cosmological model of the universe based on Weyl type $f(Q)$ gravity which shows the transition from decelerating in the past to acceleration at present by considering a particular functional form of $f(Q)$ gravity as $f(Q) = ({H_0}^2) (\alpha_1 + \alpha_2 \hskip0.05in log ({H_0^{-2}} Q))$. We have solved Weyl type $f(Q)$ gravity field equations numerically and have obtained numerical solutions to the Hubble and deceleration parameters, distance modulus, and apparent magnitudes of stellar objects like SNIa Supernovae. We have also obtained numerical solutions for the Weyl vector $w$, non-metricity scalar $Q$, and the Lagrangian multiplier $\lambda$ appearing in the action of $f(Q)$ gravity. We have compared our theoretical solutions with the error bar plots of the Observed Hubble data set of $77$ points, $580$ distance modulus SNIa data set, and $1048$ supernova Pantheon data sets of apparent magnitudes. It is found that our results fit well with the observed data set points. \bf{The model envisages a unique feature that although the universe is filled with perfect fluid as dust whose pressure is zero, still the weyl vector dominance f(Q) creates acceleration in it. }Comment: 13 pages, 5 figure

Metronidazole induced neurotoxicity: a case report

Metronidazole is a well-known antimicrobial agent, used for the treatment of anaerobic bacterial and protozoal infections. It is generally well tolerated with common side effects like nausea, dizziness, headache and metallic taste in the mouth. But prolonged use of metronidazole can cause neurotoxicity like ataxic gait, dysarthria, seizures and encephalopathy. Here, we are reporting a case of a 60 years old male patient who was a chronic alcoholic with liver abscess and he developed acute ataxia and dysarthria after four weeks use of metronidazole. The causality of metronidazole in this case was “probable” with score 7 as per Naranjo scale. The patient was managed by discontinuing the metronidazole and there was considerable improvement in his gait and speech after that. The case was recorded properly in adverse drug reaction reporting form and was sent to nearby adverse drug reaction (ADR) monitoring centre

A study to assess the knowledge and awareness regarding safe disposal of pharmaceutical wastes among 2nd year medical and para-medical students in a tertiary care teaching hospital in North India

Background: The use of pharmaceutical products in our day to day life is escalating and one cannot deny their presence in every household. Unfortunately not all the medicines that reach our homes get consumed. Unused, unwanted and expired drugs get accumulated over time and are generally disposed along with other household trash thus contributing to environmental pollution. This turns our attention towards the significance of eco-pharmacovigilance. Assessing the level of knowledge and awareness of students under training  as health care professionals  regarding safe disposal of pharmaceutical wastes can help us to partly assess the magnitude of the problem of inappropriate disposal methods and help us to plan and initiate steps to prevent the hazards caused by improper disposal of these items.Methods: A questionnaire based cross-sectional study was conducted among medical and paramedical students of a tertiary care teaching hospital using a pre-validated questionnaire from previous studies.Results: Majority of the participants were not aware of the possible hazards of improper disposal of pharmaceutical wastes. They expressed the need for awareness programs regarding the subject.Conclusions: The study revealed the practice of drug accumulation at home. The disposal methods opted by the participants were not the recommended methods. There is a need to address this issue through awareness programs at various levels

Immunosuppressive drugs in renal transplantation

A kidney transplant, sometimes known as a renal transplant, is the treatment of choice for kidney failure at end stage renal disease (ESRD). The renal transplant surgery is followed by a lifetime course of immunosuppressive agents, divided into initial induction phase and later maintenance phase. It is seen that the risk of acute rejection is maximum in the initial months after transplantation (induction phase) and then reduces later (maintenance phase). In induction phase there is use of high-intensity immunosuppression immediately after transplantation, when the risk of rejection is maximum and then the dose reduced for long- term therapy. The main challenge in the renal transplantation community is long- term transplant survival. Long-term graft loss is mainly due to acute and chronic graft rejection, and also due to complications of immunosuppressive therapy. Currently, there is triple therapy as conventional immunosuppressive protocol: a calcineurin inhibitor, an antimetabolite agent, and a corticosteroid. The main aim of development of new immunosuppressive agents is not only improvement of short- term outcomes but also to increase the long- term graft survival by less nephrotoxicity, and minimal side-effects