Escitalopram Induced Hyponatremia

National and international pharmacovigilance committee reports and case-control studies also implicate paroxetine, fluoxetine, sertraline. However, there have been only few reported cases of hyponatremia associated with escitalopram. The objective of this case report is to highlight a strong association of hyponatremia and SIADH (Syndrome of Inappropriate ADH secretion) in a middle-aged patient receiving escitalopram, a drug less commonly known to cause such side effects. Methods: We report a case of escitalopram induced severe hyponatremia in a middle-aged man where the association of hyponatremia with escitalopram is clearly established. Patient developed hyponatremia on the rechallenge with escitalopram (serum sodium = 94 mEq/L) within two days of initiation of treatment. The patient was free from other medical illnesses and was not taking other medications known to cause hyponatremia (confounders present in previous case reports suggesting an association between escitalopram and SIADH). Results: Our case suggests a strong association of escitalopram use and development of hyponatremia and SIADH in the absence of another drug use and medical comorbidity. Conclusion: Escitalopram, an SSRI is associated with hyponatremia and SIADH even in middle-aged individuals. There is a need for case-control studies especially involving a younger and middle age group. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Differences in the cell wall architecture of melanin lacking and melanin producing Cryptococcus neoformans clinical isolates from India: an electron microscopic study

Cryptococcus neoformans is an important opportunistic fungal pathogen that causes life-threatening infection of the central nervous system. A major virulence factor for C. neoformans is the production of melanin in the cell wall. Using transmission electron microscopy, we studied the cell walls of three pairs of isolates obtained from patients with dual cryptococcal infections, where a melanotic and an albino strain were isolated from the CSF of each patient. Transmission Electron Microscopy revealed that the albino strains lacked a melanin layer whereas a melanin layer was associated with the cell wall of the melanotic strains, comprising approximately 75 percent of the cell wall area. The cell wall size of the melanin producing cells was approximately double the size the albino isolates' cell walls (p value <= 0.003). In this study TEM revealed that the differences in the ultrastructure of the melanin lacking and melanin producing isolates were associated to the cell wall and the melanin layer.

Cryptococcus neoformans é um importante fungo oportunista patogênico que causa infecção no sistema nervoso central, e que pode levar o paciente à morte. Um dos principais fatores de virulência do C. neoformans é a produção de melanina na parede celular. Utilizando microscopia eletrônica de transmissão, nós estudamos as paredes celulares de três pares de isolados obtidos de pacientes com dupla infecção pelo fungo, onde um isolado melanizado e um albino foram isolados do líquor de cada paciente. A microscopia eletrônica de transmissão revelou que as cepas albinas não apresentavam a camada de melanina enquanto que uma camada de melanina estava associada com a parede celular de cepas melanóticas, constituindo aproximadamente 75 por cento da área da parede celular. O tamanho da parede celular das células produtoras de melanina foi aproximadamente o dobro do tamanho da parede celular dos isolados albinos (p < 0,003). Neste estudo, a microscopia eletrônica de transmissão revelou que as diferenças na estrutura dos isolados albinos sem melanina e dos isolados produtores de melanina estava associada à parede celular e a camada de melanina.