Nicolau Syndrome: A Rare Event Following Intramuscular Diclofenac

Nicolau Syndrome (Embolia cutis medicamentosa) is a rare complication occurs after parenteral administrationof drugs. It has been reported in association with intramuscular, intravenous or rarely subcutaneous injections.We hereby report a case of Nicolau Syndrome in a 60-year-old male patient.

A retrospective study of clinical profile and outcome of patients with rodenticide poisoning in tertiary care teaching hospital, Mandya, Karnataka, India

Background: Poisoning is the major health problem in developing countries like India. Rodenticides are one of the commonest substances used for poisoning in India. Rodenticides are the substances used to kill rats. They differs from chemical composition and toxicity profile. Prognosis mainly depends on chemical content of poison.Methods: This retrospective record-based study was conducted between October 2018 to September 2019 at MIMS tertiary care teaching hospital, Mandya, Karnataka, India. Data regarding age, sex, marital status, occupation, socioeconomic status, type of poison, route of exposure, clinical presentation, complications and outcome of poisoning and associated comorbid conditions were collected from the hospital records and documented in the pre-structured proforma. Descriptive analysis was carried out by the mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results: Out of 126 study subjects, 77 (61.11%) were female, 49 (38.89%) were male. Most common age group was 21 to 30 years (45.23%), followed by 31 to 40 years (26.19%) group. Most common poison was zinc phosphide (52.39%), followed by yellow phosphorous (30.16%). Mode of poisoning was suicidal (94.4%) followed by accidental (5.6%).Most common symptom at presentation was nausea, vomiting (62.6%) followed by pain abdomen (52.4%).Most common complication was hepatitis 34 (26.98%) patients, followed by hepatic encephalopathy in 6 (4.76%) and cardiogenic shock in 6 (4.76%) patients. Total mortality was 8 (6.3%).Conclusions: Among rodenticides zinc phosphide was most common consumed poison in present study. Yellow phosphorous was most toxic poison and Aluminium phosphide was most lethal poison. Even though there is no specific antidote, early symptomatic treatment is the key in reducing the mortality.

Analysis of medication errors in medicine ward of medical college teaching hospital, Mandya

Background: Medication errors are one of the most common types of medical error that is seen in hospitalised patients. Since medication error is one of the growing concerns of healthcare issue and have implications on patient safety, the purpose of this study was to identify medication error and in turn would help to create awareness among healthcare professionals and provide safety to the patients.Methods: Study was initiated after obtaining approval from the Institutional Ethics Committee. The study was done for a period of 1 year between June 2016 and May 2017. Clinical data and data regarding the medication that was prescribed, transcribed, dispensed, administered was collected and was analysed for various types of medication errors during the different stages of medication use process.Results: A total of 351 subjects were recruited in the study for assessing medication error. About 2,283 drugs were prescribed among 351 patients. Maximum number of drugs was administered through parenteral route (50.3%). Medication error was most common during the prescribing stage (51.4%) followed by transcribing stage (39.1%), administration stage (6.9%), and dispensing stage (2.6%). On an average 6 drugs were prescribed per patient. Total of about 5411 errors have occurred out of which 98.8% of errors were preventable, 1.2% of errors were non-preventable. Cardiovascular system (21.9%) and endocrine and renal system (21.9%) was commonly affected due to the medication errors.Conclusions: Medication errors are one of the commonest problems of the healthcare system should be identified and documented and their causes should be studied in order to develop systems that minimize the recurrence.

Repurcussions of Concurrent Chemoradiotherapy for Head and Neck Cancers

Cancer is a potentially lethal disorder with abnormal cell growth and metastasis, warranting multimodal treatment owing to its diversity and complexity. Head and neck cancers are physically and emotionally devastating disease, with profound impact on the most fundamental activities of the subjects’ daily life such as the ability to speak, breathe, eat, drink, and socialize. The side-effects of radiotherapy and chemotherapy get superimposed on the existing problems and cause new problems resulting in significant morbidity and suffering. Methods: This Prospective Observational study was conducted at the Department of ENT, Southern Railway Headquarters Hospital, Chennai, India. All subjects were evaluated for toxicities using RTOG/EORTC toxicity criteria and Common Toxicity Criteria (CTC). Results: Hypopharynx was the most common site of malignancy observed (31.6 %). Pain (90%) and appetite loss (84.2%) secondary to Mucositis and Xerostomia were the most predominant, serious and lasting adverse effects noted. Subjects also experienced markedly altered smell (63%) and taste (78%). Skin changes and alopecia was observed in all the subjects. Overall treatment duration was prolonged in 78.9% owing to severe toxicities, which necessitated withholding of last few cycles of chemotherapy. Conclusion: Subjects receiving concurrent Chemo-Radiotherapy experience a substantial number of treatment related adverse events, which had considerable effect on their Quality of life.

A cross sectional study of depression during pregnancy and its risk factors among pregnant women attending a tertiary care hospital in Puducherry, India

Background: Depression during pregnancy is a recognized global health issue which can lead to wide range of maternal and neonatal complications to extremes like maternal suicide to infanticide. This study was done to estimate the magnitude of depression during pregnancy and its risk factors among pregnant women attending a tertiary care hospital in Puducherry.Methods: A descriptive cross sectional study was done among 220 pregnant women attending routine antenatal checkup in outpatient department of a tertiary care hospital in Puducherry, using a systematic random sampling technique. A semi structured questionnaire using Patient Health Questionnaire-9 was used to screen the mothers for antenatal depression.Results: 220 pregnant women were evaluated for antenatal depression. Mean age of the study participants was 25.02±3.13 years. Using PHQ-9 authors found that 19.5% pregnant women were having risk for antenatal depression, of which the mild, moderate and moderately severe levels of depression were 16.4%, 1.4% and 1.8% respectively. The risk of antenatal depression was statistically significant among the women age more than 30 years, husband’s educational status as higher secondary and below, residence in rural area, multigravida, having a male child, strained relationship, no support during pregnancy and pressure for a male child. Logistic regression analysis revealed age ≥30 years (aOR 3.03, 95% CI 1.04-8.82), and no support during pregnancy (aOR 3.30, 95% CI 1.10-9.90) were the significant factors.Conclusions: Since the risk for antepartum depression is huge in this region, there is a need for screening for antepartum depression as a routine antenatal checkup in the out patient department. Reinforcing the importance of appropriate for conception and support for the mother during pregnancy plays a vital role in reducing the magnitude of this depression.

A cross sectional study on screening for depression among elderly in rural areas of Puducherry, India

Background: Depression among elderly has been a neglected health issue. Various factors hinder its early diagnosis. The objectives of this study are to screen for depression among elderly using geriatric depression scale-15 and to determine its influencing factors.Methods: A community based cross sectional study on geriatric depression was done in villages catered by a primary health centre in Puducherry. Permanent residents of the study setting, aged ≥60 years consenting for the study were included. Line listing of elderly individuals in the study setting was done and subjects were selected by simple random sampling. A pretested structured questionnaire was used to collect socio-demographic and clinic-psychological variables. Hindi mental state examination scale was used to screen for cognitive impairment (score <23). Geriatric Depression Scale (GDS-15) was used to screen for depression (score >5) among geriatric individuals. Appropriate statistical tests of significance were done.Results: Among the 360 elderly individuals screened using GDS-15 tool, 41.4% of them were found to be at a higher risk of developing depression. Significant factors for risk of depression in univariate analysis include being female, illiterate, unemployed, widow/single, having sleep problems, dependency in activities of daily living and cognitive impairment. Predictors for risk of depression evident by multivariate analysis include presence of unemployment, sleep problems and cognitive impairment.Conclusions: A higher proportion of elderly was observed to be at risk of depression.  Primary care physicians may consider screening for depression in elderly with identified risk factors and act accordingly.

Management of early years of simple and mucopurulent chronic bronchitis with pre-defined Homoeopathic medicines ­ a Prospective Observational Study with 2-Years Follow-Up

Background Simple and mucopurulent chronic bronchitis (SMCB) is characterized by recurrent mucoid or mucopurulent expectoration in absence of localized suppurative disease. This observational open label study was undertaken to evaluate the effects of homeopathic medicine in SMCB. Methods 1902 patients were screened from 07 centres out of which 1305 were excluded. 597 patients were enrolled as per the inclusion and exclusion criteria. A total of 14 pre-defined homeopathic medicines were shortlisted for prescription after repertorizing the pathological symptoms of SMCB. Outcomes were assessed through chronic bronchitis symptom scale (CBSS) and FEV1/ FVC ratio with spirometry for over a period of two years. Appearance of any change (relief/ worse)/ status quo was immediately followed by placebo/ change in dilution/ change in remedy. Statistical analysis was done using SPSS version 20. Results: 532 patients were analyzed based on the intention to treat principle using last observation carry forward method. Mean CBS score reduced from 29.86±4.5 at baseline to 12.33±7.6 at completion of 2 years. Repeated measures ANOVA, at time points 0 (baseline), 3, 6, 9, 12 ,15, 18, 21 and 24 months, showed significant reduction in CBS scores [Wilk's Lambda 0.104, F=564, df 524; p=00001]. The FEV1 and FEV1/FVC was maintained within normal limits. 86% prescriptions included Lycopodium, Arsenicum album, Pulsatilla, Phosphorus, Stannum metallicum, Calcarea carbonica, Silicea, Bryonia alba. Conclusion: The result suggests effectiveness of homeopathic treatment in early years of SCMB patients. Controlled trials are warranted. (AU)

Distribution of Telomere Length in the Cord Blood of Chinese Newborns.

Aims: We studied the variability in telomere length in cord blood collected from newborns of different birth weights and gestational ages. Study Design: Prospective cohort study. Place and Duration of Study: Samples were collected from KK Women’s and Children’s Hospital between March 2011 and March 2012 and the terminal restriction fragment assays (TRF) were performed at the Department of Physiology, National University of Singapore. Methodology: Cord blood samples were prospectively collected in EDTA or heparin tubes for deliveries from Chinese parents. TRF assays were performed on genomic DNA extracted from whole blood. Data was collected for birth weight, gestational age, and maternal age. Variance analyses of telomere lengths and correlation coefficients were calculated using Statistical Package for the Social Sciences (SPSS). Results: The birth weight of the samples collected ranged from 0.61 kg to 5.18 kg with gestation age from 196 to 288 days. TRF results from 184 samples (96 males, 88 females) showed that there was a wide range from 6.6 kbp to 19.2 kbp. The mean TRF length was 12.64 kb (males: 12.33 kb ± 2.50; females: 12.99 kb ± 2.35). There was no statistically significant correlation of TRF with birth weight, gestation age or maternal age. There was highly significant correlation of birth weight with gestational age (P=0.00). Conclusion: Our results showed no correlation of either gestational age or birth weight with telomere length as measured by TRF assay.

Aspicularis tetraptera induced hematological parameters in infected and vaccinated mice

The present study deals with the effect of helminthic infection as Nematode parasite like Aspiculuris tetraptera on the haematological parameters of infected and vaccinated mice. Totally 15 mice were used. Five mice were used for positive control, 5 mice used for negative control and 5 mice used for experiment. The hematological parameters were studied viz. RBC, Hb, and serum protein values. The mice carrying heavy infection showed decrease in the Hb, RBC, and serum protein but in the vaccinated mice, all studied parameters were become on normal range. The level of immune response was assessed based on above studied hematological parameters in infected and vaccinated mice with Aspiculuris tetraptera. The increased value of RBC, Hb and Serum protein in infected and vaccinated mice compared to infected and non vaccinated suggested the involvement of blood parameters in immune response. This study also proves that somatic antigen of A. tetraptera was effective in imparting immunity in mice

Lymphocyte migration inhibition response in Trichuris muris infected and vaccinated mice

Immunological response of host and parasite play a key role in developing vaccination and immunization. The present study deals with the immune response and effecter mechanism, which was confirmed by migration inhibition factor [MIF]. The present work was conducted in Parasitological Lab of Postgraduate Department of Zoology, Government Holkar Science College, Indore [M.P.] during 2006-2007. For MIF assay, lymphocytes were separated from heparinized blood of experimental and control mice. Aliquots of cell suspension were placed in four wells cut in a preparation of agarose in a Petri dish. Two wells were filled with soluble test antigen, while rest two wells were filled with medium [control wells]. Petri dish was incubated overnight at 37°C in a humidified environment at 5% CO2 in air. Cells migrated under the agarose in a circle were fixed and stained. Diameters of the migration areas were measured with ocular micrometer. MIF reaction was maximum [44.2%] in the group IVEgESAg5 and minimum [10.8%] in the group IVASoAg1. The maximum MIF reaction was shown by eggs ES antigen and least by adult worm somatic antigen. The interesting observation was that migration inhibition increases as dose increased or we could say the reaction was dose dependent Increased value of MIF response in vaccinated mice suggested the involvement of lymphocytes in cell-mediated immunity. This study also proves that excretory-secretory [ES] antigen of eggs from Trichuris muris was more effective in imparting immunity in mice