49 research outputs found

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

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    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 ‚Äúprobable‚ÄĚ as per Naranjo scale. Seriousness of the reaction was ‚Äúprolonged hospitalization‚ÄĚ. 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

    Metronidazole induced neurotoxicity: a case report

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    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 ‚Äúprobable‚ÄĚ 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

    Immunosuppressive drugs in renal transplantation

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    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

    Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

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    Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk‚Äďoutcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk‚Äďoutcome pairs, and new data on risk exposure levels and risk‚Äďoutcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk‚Äďoutcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46‚Äą749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34¬∑1 million (95% uncertainty interval [UI] 33¬∑3‚Äď35¬∑0) deaths and 1¬∑21 billion (1¬∑14‚Äď1¬∑28) DALYs were attributable to GBD risk factors. Globally, 61¬∑0% (59¬∑6‚Äď62¬∑4) of deaths and 48¬∑3% (46¬∑3‚Äď50¬∑2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10¬∑4 million (9¬∑39‚Äď11¬∑5) deaths and 218 million (198‚Äď237) DALYs, followed by smoking (7¬∑10 million [6¬∑83‚Äď7¬∑37] deaths and 182 million [173‚Äď193] DALYs), high fasting plasma glucose (6¬∑53 million [5¬∑23‚Äď8¬∑23] deaths and 171 million [144‚Äď201] DALYs), high body-mass index (BMI; 4¬∑72 million [2¬∑99‚Äď6¬∑70] deaths and 148 million [98¬∑6‚Äď202] DALYs), and short gestation for birthweight (1¬∑43 million [1¬∑36‚Äď1¬∑51] deaths and 139 million [131‚Äď147] DALYs). In total, risk-attributable DALYs declined by 4¬∑9% (3¬∑3‚Äď6¬∑5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23¬∑5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18¬∑6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

    Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition)