Evaluation of adverse drug reactions in patients with Type II diabetes mellitus in tertiary care hospitals, Bhopal

Background: Pharmacovigilance is the science which deals with adverse drug reactions (ADRs) appear after long and short drug treatment. ADRs monitoring is essential to gain knowledge of drugs reaction for betterment of mankind. In the present study, observation of ADRs in Type II diabetic patients was conducted in tertiary care hospitals, Bhopal. ADRs reported in the present study were diarrhea, myalgia, flatulence, palpitations, rash, itching, etc., in patients receiving oral hypoglycemic agents. So through this observation, we want to acknowledge the various adverse effects occurred by oral hypoglycemic agents for reduction of morbidity and mortality in Type II Diabetic patients. Aims and Objectives: (1) The objectives of the study were to ADRs monitoring in Type II Diabetic patients receiving oral anti-diabetic agents and (2) to compare ADRs in conventional versus newer anti-diabetic agents therapies in Type II Diabetic patients. Materials and Methods: 150 patients were enrolled for evaluating adverse effects with oral antidiabetic agents. All patients were followed up by medical history, history of drugs, and any severity of ADR. Causality was graded by Naranjo scale. Results: 45 patients (30%) with mean age of 64.6 year (SD = 2.41) complained adverse effects and out of which 17 (11.3%) patients were reported to the physician. The most common adverse effect was found with sulfonylureas, biguanides, and thiazolidinediones such as hypoglycemia, weight gain, gastrointestinal (GI) disturbances allergic reactions, and dizziness probability of adverse effects more common in females (64.17%) in comparison to male (35.29%) patients. Conclusion: In Type II Diabetic patients receiving oral antidiabetic agents provides a fruitful information about a ADRs and enhance knowledge about pharmacovigilance to health-care providers. However, predominance of adverse effects in female diabetic patients was reported. Hypoglycemia, weight gain, and GI tract disturbances were observed frequently with oral antidiabetic agent in middle age diabetic patients. By this information, we can prevent drug related complications and improve quality of life of a person

Giant cell lesion of the jaw: A case report in a child.

Giant cell lesions of the jaw include cherubism, central giant cell granuloma (CGCG) peripheral giant cell granuloma (PGCG) aneurysmal bone cyst, traumatic bone cyst and jaw tumour of hyperparathyroidism. The histological, radiographic and clinical diagnosis is particularly difficult in these types of lesions due to their variable clinical behavior and identical histological presentation with abundant giant cells. We present the case of a 12-year-old boy, who developed a painless swelling of approximately 4 cm, in the left angle of the mandible. The lesion demonstrated slow, progressive and continuous growth. The patient was surgically treated by a conservative approach. The histopathology confirmed the suspected diagnosis of central giant cell granuloma.

Oral myiasis caused by chrysomya bezziana: A case report.

Myiasis is caused by members of the Diptera fly family that lay eggs on food, necrotic tissue, open wounds, and unbroken skin or mucosa. Although myiasis is primarily a problem of cattle and livestock in tropics, human infestation is uncommon and occurs accidentally in persons at extremes of age, who are debilitated or not able to ensure basic hygiene and wound cleanliness. The oral cavity is an uncommon site of infestation as was seen in the case reported here.

Extraskeletal osteogenic sarcoma: a rare entity.

A 25-year-old female presented with a rapidly increasing painful swelling around right lower thigh and knee for the last 5 months with distant metastasis in the form of lung involvement. X-ray of the part showed only soft tissue swelling without any bony involvement. A diagnosis of extraskeletal osteosarcoma was made which was confirmed by immunohistochemistry.

Immunopathology of skin lesions.

A study was conducted on 130 patients suffering from skin lesions which included psoriasis, lichen planus, DLE, pemphigus, vitiligo and alopecia areata. Forty age-and-sex-matched healthy individuals served as control. Serum IgG, IgM, and circulating immune complexes (CIC) were estimated. Significant increase in serum IgG (1937.2 +/- 1030.43 mg%) and IgM (232.12 +/- 136.98 mg%) was observed in all the skin lesions when compared with controls except in lichen planus where they were significantly lowered, values being 580.61+/- 77.35 mg% and 66.88 +/- 6.59 mg% respectively. CIC levels were significantly raised (P< 0.00 1) in various skin lesions (40.49+/-23.29) when compared with controls (17.68+/- 3.21), but no significance was observed in lichen planus( 17.72 +/- 4.28). Serum IgG, IgM and CIC were statistically significantly altered depending on the extent of the lesion and lowered significantly to almost normal values following treatment, thereby confirming the role of immunity in the pathogenesis of these skin disorders.

Recurrent infantile digital fibromatosis--a rare entity.

We present here a rare case of Infantile Digital Fibromatosis in a six year old female child who presented with recurrent swelling over the phalanx of left middle finger.

Influence of smoking and hypertension on left ventricular mass.

OBJECTIVE: The present study was designed to observe the influence of smoking and hypertension on left ventricular mass (LVM), both individual and the combined effect. METHODS: This study was conducted in the Department of Medicine, SMS Medical College Hospital, Jaipur. Hundred patients were included in the study. They were divided into four groups--non smoker normotensives, non-smoker hypertensives, smoker normotensives and smoker hypertensives. They were also divided into smokers and nonsmokers and hypertensives and normotensive. Patients of age group 31-65 years of both sexes were chosen. Patients with secondary hypertension, diabetes mellitus, dyslipidemia, cardiomyopathies, valvular heart disease women on oral contraceptives were excluded from the study on the basis of history and relevant laboratory tests. An M-mode echocardiography was done and the LV mass was calculated by the formula proposed by Devereux et al. LV mass = 0.8 [1.04 (IVSd + LVIDd + LVPWd)3 - (LVIDd)3] + 0.6 gms RESULTS: The mean LV mass (in gms) in the four groups of nonsmoker normotensives, nonsmoker hypertensives, smoker normotensives and smoker hypertensives are 106.77 +/- 25.78, 165.3 +/- 42.55, 154.53 +/- 24.6 and 228.78 +/- 56.88 respectively. The comparison of mean LV mass (in gms) of smokers and nonsmokers were 191.66 +/- 40.74 and 136.04 +/- 36.16 (P < 0.001) respectively. The comparison of the mean LV mass (in gms) of hypertensives and nonhypertensives were 197.25 +/- 49.72 and 126.29 +/- 25.19 (P < 0.001) respectively. Comparison of the mean LV mass (in gms) of patient with two risk factors i.e., smokers hypertensives with patients without any risk factor i.e., nonsmoker normotensive were 228.78 +/- 56.88 and 106.77 +/- 25.78 (P < 0.001) respectively. While comparison of the mean LV mass (in gms) of patients with one risk factor each i.e., smoker normotensives and nonsmoker hypertensives were 165.3 +/- 42.55 and 154.53 +/- 24.6 (P < 0.05) respectively. CONCLUSION: Both smoking and hypertension cause an increase in LV mass, hypertension causing a more increase, than smoking, individually. Both smoking and hypertension combine together to increase the LV mass, more than either of them individually. Smoking by itself can cause an increase in LV mass independent of hypertension.

Metastatic adenocarcinoma rib presenting as chondrosarcoma.

A case of chondrosarcoma rib which turned out to be a case of metastatic adenocarcinoma on histopathological examination is being presented.

Teratoma of the liver--a case report.

A case of primary teratoma of the liver in a 10 months old male child is being reported for its rarity. It is the first case report in Indian literature.

QT dispersion as a marker of left ventricular mass in essential hypertension.

Increased left ventricular mass is an important risk factor in hypertension for various cardiovascular complications. We studied 49 patients of essential hypertension and the relationship between QT dispersion (defined as the difference between the maximum and the minimum QT interval in a 12-lead electrocardiogram) and M-mode echocardiographic left ventricular mass was analysed. Criterion of left ventricular hypertrophy was left ventricular mass index above 134 gm/m2 in men and above 110 gm/m2 in women. There were a total of 22 patients with left ventricular hypertrophy (15 men and 7 women). The mean QT dispersion was 82.66 +/- 35.34 milliseconds (ms) in men with left ventricular hypertrophy and 36.66 +/- 15.71 ms in men without left ventricular hypertrophy. The mean QT dispersion was 77.14 +/- 29.27 ms in women with left ventricular hypertrophy and 26.66 +/- 9.99 ms in women without left ventricular hypertrophy. The correlation co-efficient was 0.59 (p < 0.001) and 0.69 (p < 0.01) in men and women, respectively. Hence, we conclude that there is a direct, linear and positive correlation between left ventricular mass and QT dispersion in essential hypertension.

Soft tissue tumours of eyelid.

Soft tissue tumours of eyelid constituted 28.9% of all eyelid tumours. Morphologically they were either vascular 32 cases (49.23%), neural 24 cases (36.92%), fibrous 6 cases (9.23%) or adipose tissue tumours 3 cases (4.62%). The age ranged from 1-30 years, haemangiomas and neurofibromas were present since birth. Upper eyelid was involved in 81.54% cases. Neurofibroma was associated with generalized lesions in 13.6% cases.

Benign osteoblastoma mimicking malignancy of the spine.

A case of osteoblastoma of the spine in a sixty year old female is presented. These lesions usually get misdiagnosed as tuberculosis or malignancy of the spine. Salient diagnostic features have been discussed.

Tumours of eyelid: a clinicopathologic study.

A retrospective study of 207 cases of eyelid tumours and tumour like lesions, diagnosed histopathologically, was carried out for the period 1957 to 1991. There was a slight preponderance of males as the male/female ratio was 1.3:1. The age of the cases ranged from one to 80 years. Benign tumours were usually seen in the first two decades whereas the malignant tumours were common in the age group of 40 to 60 years. Malignancy was noticed in 85 cases (41.1%). Of these cases of malignant tumours, basal cell carcinoma was the commonest (38.8%) followed by sebaceous carcinoma (27.1%), squamous cell carcinoma (22.4%), basisquamous cell carcinoma (8.2%) and melanoma (3.5%). The ratio of basal cell carcinoma to squamous cell carcinoma was 1.74: 1. Of the 122 benign lesions common ones were vascular tumours (21.3%), neural tumours (18.0%), dermoid cysts (16.4%), squamous cell papilloma (13.1%) and naevi (12.3%).

Pleomorphic adenoma of skin (chondroid syringoma) involving the eyelid.

Lid tumours are fairly common. However, pleomorphic adenoma (chondroid syringoma) is quite rare. In a series of 207 eyelid tumours and tumour like lesions, pleomorphic adenoma was observed in a male aged 41 years; its incidence being 0.48%.

Present status of drug resistance in cases of enteric fever in Rajasthan.

Drug Sensitivity of Salmonella typhi isolated from 30 blood culture positive cases of typhoid fever who presented between Nov. '93 to Aug. '94 was tested to determine their in vitro susceptibility to various antimicrobiols. 56.6% showed resistance to chloramphenicol, 70% to amoxycillin, 50% to amikacin, 43.3% to gentamycin, 40% to ampicillin, 33.3% to cotrimoxazole, 30% to cephalexin and very low resistance (6.6% each) to ceftriaxone and cefotaxime. All the 30 cases were sensitive to ciprofloxacin and ofloxacin. 17 chloramphenicol resistant typhoid cases in whom chloramphenicol was initially started failed to respond to this drug even after 4-5 days therapy, indicating that in vivo response matched with the in vitro sensitivity. Clinical response to ciprofloxacin, whether given initially or following chloramphenicol failure was prompt and satisfactory. Ciprofloxacin thus appears to be a good choice in such cases.