Clonazepam associated hypothyroidism: Aforethought on a concealed dilemma.

Subclinical hypothyroidism or mild thyroid failure is a familiar problem, with a prevalence of 3-15% in a population without any known overt thyroid disorder. The prevalence increases with age and is relatively higher among females. Subclinical hypothyroidism is defined as serum thyroid stimulating hormone (TSH) levels above the upper limit of normal (4 mU/L) while the triiodothyronine (T3) and thyroxine (T4) enduring within the normal range. Additionally, there exists a log-linear relationship between TSH and circulating T3 and T4; hence, measurement of serum TSH becomes mandatory for diagnosing mild thyroid failure when free T3and T4 are lying within normal limits. Though, autoimmune thyroid disease is the most common cause for elevated TSH; thyroid functions can be afflicted by long-term consumption of drugs like lithium, amiodarone. The causal relationship between benzodiazepine class of drugs, particularly clonazepam and subclinical hypothyroidism has never been established clinically, yet there are some pre-clinical studies to claim the effect of benzodiazepine on thyroid functions; operating at various levels – hypothalamus, thyroid gland, peripheral cells and nuclear receptors. Henceforth, we would like to report a rare occurrence of subclinical hypothyroidism in an elderly female receiving clonazepam for her underlying psychiatric illness.

A Case of Accidental Formic Acid Poisoning.

Formic acid is a commonly available compound, available commercially for the purpose of coagulating rubber. It is a highly corrosive agent. Consumption of this pungent liquid has resulted in dire consequences, based on the available literature. There have been a few reports of accidental/suicidal consumption of formic acid in the past. This is one such case report of an accidental poisoning with formic acid, with successful management and recovery.

A Rare Case of Tamoxifen-Induced Thrombocytopenia.

Breast cancer is a commonly encountered cancer in women. Tamoxifen is a frequently used drug in breast cancer. It is a selective estrogen receptor modulator (SERM). It is used for both chemoprevention and for palliative care in these patients. Drug-induced thrombocytopenia is a common diagnosis these days. Moreover, this condition can be life threatening or even fatal. It can either be due to increased platelet destruction or reduced formation. Either way, early diagnosis followed by discontinuation of the offending agent is the key to successful management. Here, we present a rare case of tamoxifen-induced thrombocytopenia

Amlodipine -Atenolol Overdose Management: A Physician’s Nightmare.

The author reports a case of a 22-year-old female, daughter of a known hypertensive patient, who happened to consume her mother’s medicine. Her mother was on a fixed drug combination (FDC) of amlodipine and atenolol. The patient was brought to the emergency department with drowsiness following ingestion of 15 tablets of amlodipine-atenolol FDC (5+ 50 mg). On evaluation, she had refractory bradycardia and hypotension along with hyperkalemia. She was managed initially with gastric lavage with activated charcoal, and subsequently with supplementation of atropine, inotropes, anti-hyperkalaemic measures, pacemaker and levosimendan.

Anticonvulsant activity of gap-junctional blocker carbenoxolone in albino rats.

Background: Gap junctions (GJs) are clusters of channels that connect the interiors of adjoining neurons and mediate electrical/electrotonic coupling by transfer of ions and small molecules. Electrotonic coupling between principal neurons via GJs is increasingly recognized as one of the mechanisms in the pathogenesis of the abnormal neuronal synchrony that occurs during seizures. Carbenoxolone the succinyl ester of glycyrrhetinic acid obtained from liquorice has been shown to have the property of blocking gap junctional intercellular communication. The objectives were to study if carbenoxolone has in-vivo anticonvulsive activity in pentylenetetrazole (PTZ) and maximal electroshock (MES) seizure models and to probe the functional role of GJs in seizures. Methods: Carbenoxolone was tested for anticonvulsive effect in albino rats subjected to seizures by the PTZ and MES at three doses 100 m/kg, 200 m/kg, 300 m/kg. In the PTZ model parameters observed were seizure protection, seizure latency and seizure duration. In the MES model parameters observed were seizure protection and seizure duration. Results: The results showed that the carbenoxolone has anticonvulsant activity in both PTZ and MES induced seizures with better protection in the PTZ induced seizures. In the PTZ model carbenoxolone produced a statistically significant increase in seizure latency, decrease in seizure duration and seizure protection. In the MES model carbenoxolone produced a statistically significant decrease in seizure duration. Conclusions: Carbenoxolone has in-vivo anticonvulsive effect and could be useful in both petitmal (absence) seizures and grand mal (generalized tonic-clonic epilepsy) seizures. The protective effect of carbenoxolone could be due to blockade of GJ channels that mediate electro tonic coupling and thereby prevent the neural synchronization that is characteristic of seizures. The study also supports the view that GJs have a functional role in the electrophysiology of seizures and GJ blockers have potential as a new class of antiepileptic drugs.

Students’ attitude toward didactic lecture versus problem-based learning in pharmacology: a questionnaire based study.

Background: The study was conducted to assess student attitude toward learning by didactic lectures versus problem-based learning (PBL). Methods: A questionnaire containing 11 statements was distributed to the students. Statements ranged from general information on lectures and PBL to benefits of lecture-based learning (LBL) over PBL and vice versa. The students were asked to score each individual statement. The median total scores and median with interquartile range of individual statements was calculated. A comparison between questions that support LBL or PBL was performed. Student t-test was employed to compare the mean scores of different groups. Results: Two hundred and seven students participated in this questionnaire study. The individual median total score was 42 when compared with possible total score of 55. There was a statistically significant (p<0.05) difference between the total score (mean±standard deviation) for the questions related to LBL (3.2391±0.05120) and those related to PBL (4.0640±0.05688). Conclusion: The score for PBL was significantly higher than LBL showing that students liked PBL more than LBL.