Safety profile of G?CSF in chemotherapy?induced neutropenia: A prospective observational study in Eastern India

Background: Granulocyte-colony stimulating factor (G-CSF) is used in cancer patients to treat chemotherapy-induced neutropenia (CIN). However, G-CSF poses few risks. Despite the regular use of G-CSF in CIN management, there is a paucity of published data on its safety profile in the management of CIN in India. Hence, the present study was designed to demonstrate the safety profile of G-CSF in patients with CIN. Methods: A prospective observational study was conducted over a period of 5 months enrolling 100 cancer patients aged from 18 years to 70 years. Patients with a diagnosis of CIN who received G-CSF were included. Patients were followed up for 15 days. Adverse events (AEs) were graded according to US National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The system organ class and preferred term of Medical Dictionary for Regulatory Activities (MedDRA) were used for reporting the AEs. Causality assessment was done by using the WHO-Uppsala Monitoring Centre scale. Results: The most frequently reported AEs were musculoskeletal and connective tissue disorders which included bone pain, myalgia, arthralgia, and pain in the extremity. Other AEs reported were general disorders and administration site conditions, and gastrointestinal disorders. The highest grade of toxicity reported was of grade 3 among all AEs. The majority of AEs had a “probable” type of causality relationship with G-CSF. Conclusion: G-CSF has a safety profile consistent with previous G-CSF studies.

Topical ciprofloxacin induced ocular toxicity: case report

Ciprofloxacin is a commonly used fluoroquinolone group of antimicrobial which is used for treating infective conditions like community acquired pneumonia and urinary tract infections. A patient of cataract was treated with ciprofloxacin eye drop as her pre-operative medication. She presented after four days with itching and redness in her right eye with swelling of the peri-orbital skin. We report this rare case where topical application of ciprofloxacin was responsible for the ocular symptoms.

Procedural Sedation in Paediatric Practice.

Introduction: Providing sedation techniques during the performance of diagnostic and therapeutic procedures on children decreases anxiety and discomfort. A number of drugs are available for the purpose. A retrospective record study in Paediatrics department of Burdwan Medical College & Hospital showed oral triclofos and per rectal diazepam were the two commonly used drugs for the purpose. However, intranasal midazolam is claimed to be a near ideal agent for procedural sedation. So, the above study was to compare efficacy and safety of intranasal midazolam over oral triclofos and per rectal diazepam. Methods: Participants having ASA score I or II having age group 1 to 6 years requiring non-invasive or minimally invasive procedure were divided into three groups- one group received oral triclofos sodium, second group received per rectal diazepam and third group received intranasal midazolam spray prior to the procedure. Levels of sedation and recovery were scored using Ramsey sedation score and modified Aldrete scoring system respectively. Induction of sedation was defined as attainment of Ramsey sedation score of at least 3. Complete recovery was defined as a minimum score of 10 of modified Aldrete scoring system. Results: Both times of induction and recovery were significantly higher in triclofos group when compared to other two groups. Level of sedation attained was higher in per rectal diazepam group, although there was no case of over sedation. Adverse effects were comparable except for nasal irritation which was exclusively limited to midazolam group. Cost of therapy was higher with intranasal midazolam therapy than with per rectal diazepam therapy. Conclusion: Per rectal diazepam appear to be a more ideal drug for procedural sedation over intranasal midazolam and oral triclofos.

Effect of dacryocystorhinostomy on systemic adverse effects of topical timolol maleate.

Purpose: To evaluate whether transformation of the naso-lacrimal passage as happens after dacryocystorhinostomy (DCR) operation has any effect on the systemic adverse effects of topically administered timolol maleate. Materials and Methods: Fifty otherwise healthy adult patients without any prior history of cardiac or pulmonary problems scheduled for elective DCR surgery received a drop of timolol maleate 0.5% on the healthy eye. This eye served as a control. Six weeks after successful DCR surgery, the operated eye received the same medication. Parameters compared included intraocular pressure (IOP), pulse rate, blood pressure and forced expiratory volume in the first second (FEV1) findings. Observations: Post DCR patients showed an increased incidence of reduced pulse rate and FEV1. Conclusion: Timolol maleate ophthalmic preparation should be used with caution in post-DCR patients.

Original research paper a study of rational use of drugs among the ophthalmic-in-patients of a government teaching hospital in view of forensic pharmacology.

Inappropriate, irrational and cost-ineffective practices of pharmaceuticals are worldwide phenomena. A retrospective study was conducted among the Ophthalmic-in-patients to investigate the nature of utilization of drugs in respect of rationality correlating the clinical and forensic pharmacology. Prescriptions in the Bed Head Tickets were the study samples which were analyzed according to the WHO/INRUD Indicators. Incurred cost per day per prescription was calculated. Commonly prescribed drugs were also studied. Result revealed that proportion of drugs from Essential Medicines List (EML) was 51.62%, while 54.05% was prescribed by generic names. Most commonly prescribed drugs were antibiotics (100%), analgesic-anti-inflammatory agents (100%) and mydriatic-cycloplegic agents (91.98%). Average number of drugs per prescription was 4.03±1.5 and average cost per day per prescription was 99.22 INR (Indian Rupees). Injectables were prescribed in 97.36% cases, and 10.81% of total drugs (37) prescribed. Prescribing practices were not always in accordance with the WHO criteria for rational use of drugs. It is suggested that there is a felt need to provide more inputs to the Ophthalmologists to promote rational use of drugs.

Animal study of silicosis in respect of morbidity and mortality.

Silica activates release of biochemical substances in lungs. To evaluate duration dependent toxic effects of silica by biochemical changes in Broncho Alveolar Lavage Fluid (BALF) and by post-mortem findings we developed a series of rat silicosis. Based on duration of exposures, single intratracheal injection of quartz dust in saline to acute models (n=3) and inhalation of quartz dust with air to chronic models (n=3) were administered. Control rats received vehicle only. Group wise BALF was collected on completion of exposure periods. Post-mortem examination was performed. Protein, hydroxyproline, elastase and Elastase Inhibitory Capacity (EIC) in BALF were measured. Post-mortem examination revealed progressive fibro-nodular changes in lungs. Biochemical parameters excepting EIC in both models showed significant (p< 0.001) gradual rise. Duration dependent biochemical changes in BALF due to silica were found responsible for progressive morbidity and may be considered as early markers for diagnosis, thereby, preventing increasing morbidity and death.

Conjunctival intra-epithelial neoplasia in a young Indian male with human immunodeficiency virus (HIV) infection.

Conjunctival intra-epithelial neoplasia is a disease of the elderly but recently this ocular surface tumour has been observed in younger age group specially who are serologically human immunodeficiency virus (HIV)-positive. Here a case of conjunctival intra-epithelial neoplasia of a 38-year-old male who was HIV-positive from Kolkata is reported. The patient presented with a growth at limbus in his left eye. Excision of the mass under local anaesthesia was done. Biopsy report confirmed conjunctival intra-epithelial neoplasia. The serological tests for HIV were found positive.

Review of ocular leprosy.

Leprosy, a chronic infectious disease caused by Mycobacterium leprae, affects peripheral nerves and skin. Eye is also frequently affected, partial or total loss of vision is especially tragic in leprosy. But ocular leprosy is still neglected by the leprosy workers due to lack of knowledge, and is also often overlooked even by the ophthalmologists. Here, an update review of ocular leprosy has been attempted regarding its epidemiology, clinical features, pathology, management and prevention under one umbrella.