Pharmacovigilance study of angiotensin-converting enzyme inhibitors in patients visiting Department of Medicine of a Tertiary Care Hospital, Surendranagar, Gujarat

Background: The objective of this study was to evaluate incidence, patterns, and severity of angiotensin-converting enzyme inhibitor (ACEI) induced adverse drug reactions (ADR).Methods: A total of 500 hypertensive patients taking ACEI was enrolled in the study by taking an informed consent. Reporting of all ACEI-induced ADRs was done by filling CDSCO ADR form. All ADR reports were evaluated according to WHO-UMC causality assessment scale.Results: A total of 53 ADRs (31 males and 22 females) was observed in 500 hypertensive patients taking ACEI. Of 53 ADRs, 22 (41.51%) were mild, 28 (52.83%) were moderate, and only 3 (5.66%) were classified as severe. 7 ADRs (13.21%) were classified as certain, 30 ADRs (56.60%) were in probable category, 8 (15.09%) were in possible category, 4 (7.55%) in unlikely category, 3 (5.66%) in conditional category (unclassified), and 1 ADR was in unassessable (unclassifiable) category. Among 53 ADRs, 24 (4.80%) patients developed dry cough, 8 (1.60%) hypotension, 2 (0.40%) headache, 2 (0.40%) dizziness, 3 (0.60%) nausea/bowel upset, 3 (0.60%) rashes, 2 (0.40%) developed angioedema, 3 (0.60%) dysgeusia, hyperkalemia, acute renal failure, proteinuria are rare.Conclusions: Incidence of ADRs by ACEIs is 10.60% with cough as the most common ADR followed by hypotension. As enalapril is most frequently used ACEI, ADRs due to enalapril are more common

Spinal intramedullary tuberculoma: A rare cause of paraparesis

Spinal intramedullary tuberculoma is a rare cause of paraparesis. Clinical presentation is often nondistinctive in the absence of systemic tuberculosis. Magnetic resonance imaging reveals intramedullary granuloma with relatively distinct pattern with peripheral gadolinium enhancement resembling "target sign." Histolopathological evaluation is essential to differentiate it from other intramedullary lesions to offer curative treatment augmented by surgical excision. Early surgical intervention combined with anti-tubercular drugs yields good prognosis