ABSTRACT
Background: Cutaneous adverse drug reactions (CADRs) range from mild-to-severe types and occasionally can become fatal. Hence, these incur additional financial burden both to patients and community. Aim and Objective: The aim of the study was to describe the characteristics of CADRs reported to ADR monitoring center (AMC) of a tertiary care center. Materials and Methods: CADRs reported to the AMC over a period of 2 ½ years were retrospectively studied. This study mainly focused on affected age group, gender, various pattern of CADRs, the group and name of drugs causing CADRs, and severity and causality assessment. Results: CADRs contributed 31.6% of the total ADRs reported to the AMC. Among these, 51.7% were females and 40% were of 51–60 years age group. About 37.9% of CADRs were pruritus. Antibacterial drugs were the most common cause of CADRs and beta-lactam antibiotics were responsible for 30% of CADRs. Stevens Johnson syndrome (SJS) constituted 4.9% of CADRs and 20% of this was due to Paracetamol. Drugs were withdrawn in 89% of cases and 85% cases recovered. On causality assessment, 94% were of probable category. Conclusion: Pruritus was the most commonly observed CADR and antibacterial drugs were the most common cause. Beta lactam antibiotic was the most frequent antibacterial drug to cause CADRs. The most common serious CADR was SJS and Paracetamol was the most frequent culprit drug.
ABSTRACT
Abstract Background and objectives Postoperative delirium is common in critically ill patients and is known to have several predisposing and precipitating factors. Seasonality affects cognitive function which has a more dysfunctional pattern during winter. We, therefore, aimed to test whether seasonal variation is associated with the occurrence of delirium and hospital Length Of Stay (LOS) in critically ill non-cardiac surgical populations. Methods We conducted a retrospective analysis of adult patients recovering from non-cardiac surgery at the Cleveland Clinic between March 2013 and March 2018 who stayed in Surgical Intensive Care Unit (SICU) for at least 48 hours and had daily Confusion Assessment Method Intensive Care Unit (CAM-ICU) assessments for delirium. The incidence of delirium and LOS were summarized by season and compared using chi-square test and non-parametric tests, respectively. A logistic regression model was used to assess the association between delirium and LOS with seasons, adjusted for potential confounding variables. Results Among 2300 patients admitted to SICU after non-cardiac surgeries, 1267 (55%) had postoperative delirium. The incidence of delirium was 55% in spring, 54% in summer, 55% in fall and 57% in winter, which was not significantly different over the four seasons (p= 0.69). The median LOS was 12 days (IQR = [8, 19]) overall. There was a significant difference in LOS across the four seasons (p= 0.018). LOS during summer was 12% longer (95% CI: 1.04, 1.21; p= 0.002) than in winter. Conclusions In adult non-cardiac critically ill surgical patients, the incidence of postoperative delirium is not associated with season. Noticeably, LOS was longer in summer than in winter.
Subject(s)
Humans , Delirium/etiology , Delirium/epidemiology , Emergence Delirium , Seasons , Retrospective Studies , Critical Illness , Intensive Care UnitsABSTRACT
Abstract Leishmaniasis is transmitted by sandfly which carries the intracellular protozoa in their midgut. Among visceral, cutaneous and mucocutaneous leishmaniasis, visceral type that is caused by Leishmania donovani is the most lethal one. Findings of leishmanial structure and species took place in 19th century and was initiated by Donovan. Leishmaniasis is still a major concern of health issues in many endemic countries in Asia, Africa, the Americas, and the Mediterranean region. Worldwide1.5-2 million new cases of cutaneous leishmaniasis and 500,000 cases of visceral leishmaniasis are reported each year. Leishmaniasis is endemic in nearly 90 countries worldwide and close to 12 million new cases of leishmaniasis are reported worldwide annually. Studies on antileishmanial drug development is of major concern as leishmaniasis are the second largest parasitic killer in the world and the available drugs are either toxic or costly. The major surface GP63 protease, also known as Zinc- metalloproteases present on the surface of leishmanial promastigotes, can be targeted for drug development. Protease inhibitors targeting such surface proteases show promising results. Different protease inhibitors have been isolated from marine actinobacteria against many infectious diseases. Metabolites produced by these actinobacteria may have greater importance for the discovery and development of new antileishmanial drugs. Hence, this review discusses the background, current situation, treatment, and protease inhibitors from marine actinobacteria for drug development against GP63 molecules.
ABSTRACT
Objectives@#Insulin degludec (IDeg)/insulin aspart (IAsp; IDegAsp) is a co-formulation of 70% IDeg and 30% IAsp. According to several randomized controlled trials, IDegAsp is effective and safe for patients with type 2 diabetes mellitus (T2DM). A subgroup analysis of the ARISE study was conducted to explore the safety and efficacy of IDegAsp among Malaysian patients with T2DM in real-world settings.@*Methodology@#ARISE, an open-label, multicenter, non-interventional, prospective study was conducted between August 2019 and December 2020. Adult Malaysian patients with T2DM who were enrolled from 14 sites received IDegAsp as per the local label for 26 weeks. The primary endpoint was change in glycated hemoglobin (HbA1c) levels from baseline to end of study (EOS).@*Results@#Of the 182 patients included in the full analysis set, 159 (87.4%) completed the study. From baseline to EOS, HbA1c (estimated difference [ED]: –1.3% [95% CI: –1.61 to –0.90]) and fasting plasma glucose levels (ED: –1.8 mmol/L [95% CI: –2.49 to –1.13]) were significantly reduced (p<0.0001). The patient-reported reduced hypoglycemic episodes (overall and nocturnal) during treatment. Overall, 37 adverse events were observed in 23 (12.6%) patients.@*Conclusion@#Switching or initiating IDegAsp treatment resulted in significant improvements in glycemic control and a reduction in hypoglycemic episodes.
ABSTRACT
Abstract Introduction: Schwannomas are tumous that arise from Schwann cells. Schwannoma is one of the differential diagnosis for lateral neck swelling. Objective: In this study, we aim to describe the incidence, presenting clinical features and management of extracranial, non-vestibular schwannomas of head and neck region, along with the review of the literature. Methods: Patients treated at our tertiary care hospital for head and neck schwannomas for the past 15 years were included in the study. A review of literature on the extracranial head and neck schwannoma was also done. Results: Twenty-five cases were assessed in this study. Nineteen cases presented as a neck swelling during the initial evaluation. Vagus nerve was the most common nerve of origin, followed by the cervical sympathetic plexus. A rare presentation arising from brachial plexus C5 nerve root was also encountered. A few rare cases of schwannomas arose from the nasal cavity, paranasal sinuses, and oral cavity. Surgical excision was done in all the cases with histopathology suggestive of schwannoma. The nerve of origin of the tumor was identified in nineteen patients. Among them, 11 (58%) were from the vagus nerve, 7 (37%) from the cervical sympathetic chain, and 1 (4%) from the brachial plexus C5 nerve root. Conclusion: A long-standing unilateral neck mass is the most common presenting complaint in head and neck schwannoma. The diagnosis is mainly based on clinical features and investigations such as imaging. The mainstay of treatment is complete surgical excision. The diagnosis is confirmed on the histopathological study after excision of the lesion. Due to the proximity of the tumor with the involved nerve, palsy may occur. Hence, an accurate preoperative diagnosis of schwannoma is essential.
ABSTRACT
The coronavirus disease 2019 (Covid-19) is a contagious disease caused by SARS-COV-2 that was fi rst identifi ed in Wuhan, China. The World Health Organisation (WHO) declared its outbreak as a public health emergency of international concern on 30 January 2020, and a pandemic on 11 March 2020. WHO announced Covid-19 as the new disease on 11 February 2020. According to World Health statistics as in November 2021, around 24.9 crore new cases, and 50.3 lakh deaths were reported. The global number of new cases reported seems to be plateauing after increasing for nearly two months since mid-June 2021.
ABSTRACT
Protamine is a routinely used safe antidote for heparin reversal in cardiovascular surgeries. Protamine was first introduced to prolong the action of insulin preparations. As protamine interacts with platelets and fibrinogen and has an anticoagulant effect of its own, minimal amount is given to neutralize heparin present in plasma. Although infrequent, protamine is associated with serious adverse drug reactions (ADRs), especially in patients with previous history of protamine hypersensitivity. Here, we report a case of protamine-induced pulmonary arterial hypertension and peripheral vascular collapse in a 60-year-old diabetic male patient who had undergone on-pump coronary artery bypass grafting in a tertiary care center. This was a definite, nonpreventable, severe ADR as per causality, preventability, and severity assessment scale. This patient had no previous history of protamine hypersensitivity and was not on any insulin preparations. Despite precise timely treatment and other resuscitative measures, the patient expired subsequent to these ADRs. This case report throws light on the grave requirement in urgent evolvement of pharmacogenetic and pharmacokinetic tools to detect patients who are at risk of precipitating these ADRs and thus to take precautions to prevent them
ABSTRACT
@#The presence of lobulated tumour arising from immature adipose tissue is called lipoblastoma when occurring as localised or discrete lesion, and lipoblastomatosis when spread diffusely. The purpose of this case study is to report a case of an 18 – year old man who presented with lipoblastoma in the left sublingual space which was found to be in close proximity with the left sublingual gland. Magnetic resonance imaging (MRI) was taken and showed the tumour was confined within the sublingual space and no penetration was noted inferiorly through the mylohyoid muscle. Tumour dimension measured clinically was 3 cm x 2 cm x 2 cm and the anterior margin of the tumour crossed the midline and entered into the right sublingual space. Complete excision with sparing of neurovascular bundle was performed under general anaesthesia. Follow-up of 2 months showed complete remission of the lesion without any complications.
ABSTRACT
Microsurgical procedures are time-consuming and sometimes fatigue-inducing. However, a skilled assistant and scrub nurse can help surgery be performed more smoothly and rapidly. Three microsurgical simulation courses were held for perioperative nurses at our institution. Each course consisted of two lectures and two practice microsurgical sessions, and was evaluated with a post-course survey. The respondents all felt that their knowledge of microsurgical instruments, sutures, microscope set-up, and microsurgical skills had improved following the course. Many felt that their ability to predict what the surgeon would request during a microsurgical case improved, and that they were able to handle instruments and sutures better. The nurses also reported improved confidence in assisting with microsurgical procedures and tolerance of the long operative time in some microsurgical cases. Based on our experience, a basic microsurgery course for nurses can play a significant role in training effective and competent microsurgical scrub nurses.
ABSTRACT
Microsurgical procedures are time-consuming and sometimes fatigue-inducing. However, a skilled assistant and scrub nurse can help surgery be performed more smoothly and rapidly. Three microsurgical simulation courses were held for perioperative nurses at our institution. Each course consisted of two lectures and two practice microsurgical sessions, and was evaluated with a post-course survey. The respondents all felt that their knowledge of microsurgical instruments, sutures, microscope set-up, and microsurgical skills had improved following the course. Many felt that their ability to predict what the surgeon would request during a microsurgical case improved, and that they were able to handle instruments and sutures better. The nurses also reported improved confidence in assisting with microsurgical procedures and tolerance of the long operative time in some microsurgical cases. Based on our experience, a basic microsurgery course for nurses can play a significant role in training effective and competent microsurgical scrub nurses.
ABSTRACT
Aims@#This study aims to isolate lactic acid bacteria (LAB) from various food sources to obtain a potent strain against Listeria monocytogenes. @*Methodology and results@#A total of 68 LAB isolates were selected to evaluate their antimicrobial activity against L. monocytogenes, a foodborne pathogen and a causative agent of listeriosis. The selected isolate was identified and characterized. The isolate C23 from cabbage showed the highest antimicrobial activity against L. monocytogenes ATCC 7644 with inhibition ability of 73.94%. The isolate was closely related to Lactobacillus brevis by 16S rRNA sequencing and subsequently deposited in GenBank with an accession number of MN880215, named as L. brevis C23. The cell free supernatant (CFS) of L. brevis C23 had high tolerance in low pH and was able to withstand up to 60 °C. The proteinaceous nature of the antimicrobial agent was also confirmed through the enzymatic test. The CFS was stable on different detergents as well as bile salts. Under transmission electron microscopy (TEM), the inhibitory effect of CFS against L. monocytogenes was proven by causing cell lysis.@*Conclusion, significance and impact of study@#Bacteriocin-like inhibitory substances (BLIS) of L. brevis C23 showed very promising potential in food industrial application.
Subject(s)
Lactobacillales , Listeria monocytogenes , Foodborne Diseases , Sprains and StrainsABSTRACT
Although prostate cancer can metastasize to any part of the body, laryngeal cartilage metastasis is extremely rare and few cases have been published so far. Here we present the case of a 65-year-old male patient, recently diagnosed with prostate adenocarcinoma, referred for staging with 68Ga-PSMA PET/CT. He was found to have extensive skeletal metastasis along with cartilage metastasis involving both thyroid and cricoid cartilages.
ABSTRACT
@#Background & Objectives: Malignant middle cerebral artery (MCA) stroke constituting 5% of all strokes carries a high mortality across the world. We aimed to study predictors of malignant MCA stroke outcome, especially decompressive surgery in a developing country scenario. Methods: This was a prospective study design where patients with malignant MCA stroke (defined as imaging-CT/ MRI showing infarct involving >2/3rd MCA territory) admitted within 7 days of illness to SCTIMST, between January 2010 and December 2014 (5 years) were recruited. Clinical and imaging data, surgical details, in hospital complications and discharge outcome were collected. Follow-up data was collected at 3 and 12 months post-stroke. Results: We had 74 patients of malignant MCA territory strokes, 42 operated and 32 non-operated, who were comparable at baseline, except for age and stroke severity. At 3 months, deaths were more among the non-operated group (63% in non-operated vs 23% in operated group, p=0.02), while functional outcome was comparable. At 1 year follow-up, age below 60 years, lower stroke severity at onset and decompressive surgery were found to be independent predictors of good outcome. (p=0.04). Delayed surgery group, albeit small had a better 1 year outcome in comparison to the medical arm. Conclusions: Early functional outcome in the decompression group did not differ from the medically treated patients, other than mortality benefit. However, at 1 year, patients with age<60 years, lower stroke severity and decompressive surgery had a better morbidity and mortality outcome, indicating long term benefit of this life saving procedure in developing country scenario as well.
ABSTRACT
Background: A higher incidence of occupational diseases has been reported recently compared to the past years. One of the industries where workers are remarkably exposed to dust is cement industry. Several studies have been conducted to evaluate pulmonary functions and biochemical parameters of workers exposed to cement dust in factories and construction sites, but few were concentrated among loading and unloading workers of warehouses. Hence the present study was undertaken to find out the effect of cement dust among loading and unloading workers of cement warehouses.Methods: This study was conducted among 82 exposed (cement dust) and 82 non-exposed individuals. Frequency of symptoms, biochemical parameters and spirometric values were taken from all subjects. Spirometric parameters recorded were, forced vital capacity (FVC), Forced expiratory volume (FEV1), FEV1/FVC% and Peak expiratory flow rate (PEFR).Results: Out of exposed group, 51.2% had cough, 46.3% had rhinitis 45.2% had breathlessness. FEV1 and FVC showed significant reduction while FEV1/FVC values were normal. No significant changes were seen in renal function tests or liver function tests. Mean value of erythrocyte sedimentation rate (ESR) was found to be significantly increased.Conclusions: Compared to normal healthy adults the loading and unloading workers in cement warehouses showed restrictive lung disease and an increase in ESR representing a non-specific inflammatory change. A continuous bio monitoring of health status must be initiated for these employees and awareness campaigns regarding the exposure and use of standardized protective devices must be mandated.