A rare case of fatal accidental dimethyl sulphate poisoning.

Accidental poisoning of workers occurs occasionally in chemical and pharmaceutical industries. Some of the chemicals involved in industrial poisoning are unique and rarely available to the general public. One such case of poisoning due to dimethyl sulphate fumes is described. Death due to this poison has been rarely reported in literature. The respiratory and gastrointestinal systems are its primary targets. The diagnosis and prevention of this poisoning is of paramount importance.

Serum nitrate levels in alcoholic patients: a study in an urban government hospital and de-addiction centre.

This study was designed to determine the nitric oxide metabolism measured as circulating nitrate levels in the serum of alcoholic patients. Nitric oxide (NO) plays a significant role in the inflammatory process and has been implicated in several autoimmune disorders. This study was carried out prospectively to estimate the levels of nitrate in the serum, as a surrogate marker of NO production, among alcohol-dependent patients. Serum nitrate concentrations as an index of plasma NO levels were assessed in alcohol-dependent patients attending the deaddiction centre of a major hospital. Total sample size comprised 450 males. Age- and sex-matched non-alcoholic control population (n=90) was compared with alcoholics (n=360) of similar socioeconomic status. Serum nitrate concentration was assayed spectrophotometrically. Stable metabolites of nitrates were significantly higher in alcoholics compared with their nonalcoholic controls (p<0.05). The results may support the involvement of oxidative damage due to high NO concentration, and may be linked to its excitotoxicity and cytotoxicity in neurons, glia, and myelin. Generation of NO has been linked to an increased tendency towards tolerance to alcohol.

Nicolau syndrome following intramuscular benzathine penicillin.

Nicolau syndrome (NS) is a rare complication of an intramuscular injection characterized by severe pain, skin discoloration, and varying levels of tissue necrosis. The case outcomes vary from atrophic ulcers and severe pain to sepsis and limb amputation. We describe a case of a seven-year-old boy with diagnosis of NS after intramuscular benzathine penicillin injection to the ventrolateral aspect of the left thigh. Characteristic violaceous discoloration of skin and immediate injection site pain identified it as a case of NS. The case was complicated by rapid progression of compartment syndrome of the lower limb, proceeding to acute renal failure and death. Associated compartment syndrome can be postulated as a poor prognostic factor for NS.

Death due to butorphanol ingestion: A case report.

Butorphanol poisoning is not common. A case is presented of ingestion of toxic dose of butorphanol, which proved fatal in a young adult. Although the exact amount ingested could not be ascertained, the circumstances and observations pointed clearly to death due to overdose by butorphanol.

Antimicrobial price variation: conundrum of medical profession!

Pharmacoeconomics plays a pivotal role in clinical practice. High medicine prices can adversely affect a patient's finances and compliance. The Indian pharmaceutical industry has become a cornucopia of medicines with wide variation in prices for the same medicine marketed under different brand names. Price list of available antimicrobial brands was procured from a commercial drug directory. Average price of widely prescribed oral antimicrobials was found and price variation between different brands was calculated. The variation in medicine prices was found to be from 95% lower to more than 350% higher than the average price. Implications of price variation in clinical practice are discussed and remedial measures suggested.

Accidental formaldehyde poisoning in aquaculture student.

Formaldehyde is an eye, skin, and respiratory tract irritant. Inhalation of vapour can produce narrowing of the bronchi and pneumonia. Liquid formalin causes corrosion of mucosa of the gastrointestinal tract. Systemic effects of formaldehyde are primarily due to conversion to formic acid and may include metabolic acidosis, circulatory shock, and acute renal failure. We report a case of accidental ingestion of formalin in an aquaculture research student.

Confusing brand names: nightmare of medical profession.

OBJECTIVE: India has more than 20,000 registered pharmaceutical manufacturers. Consequently, there is a flood of brand names to choose from. We conducted this study to analyse and sort out the multitudinous brand names thronging the Indian market, and identified those that could create a possible confusion. MATERIALS AND METHODS: Recent issues of drug formularies like Indian Drug Review, Drug Index, and Monthly Index of Medical Specialities-India were checked and all the brand names given were included. Some other brand names that are available with the pharmacists but are not included in these indexes were also included in the study for analysis. OBSERVATIONS: Potentially confusing brand names were sorted out and categorised according to the severity of damage they can cause if misinterpreted by the pharmacist or the patient. Subgroups were made according to the brand name, the generic name, and the manufacturers of the drug. CONCLUSION: Several brand names are strikingly identical, similar looking (orthographic), or similar sounding (phonological). Preventing this possible confusion is not the work of any one person involved. We describe the role of prescribing doctors, dispensing pharmacists, consumer patients, and the manufacturing companies to prevent "wrong prescribing" due to similarities in brand names.

Effect of antihypertensive drugs on ethanol induced gastric lesions: is there a correlation with mucosal blood flow?

We studied the effect of five antihypertensive drugs on ethanol-induced gastric haemorrhagic lesions in rats. While hydralazine aggravates these lesions, nifedipine and propranolol have a protective action. On the other hand, enalapril and prazosin have no effect. Thus the effects of antihypertensive drugs on ethanol-induced lesions do not always correlate with their reported actions on gastric mucosal blood flow.

Aggravating action of hydralazine on ethanol-induced gastric lesions.

Endogenous nitric oxide has been proposed as one of the mediators of gastric cytoprotection. We studied the effect of the vasodilator hydralazine which acts via nitric oxide and thus is expected to have a gastroprotective action. However, hydralazine aggravates ethanol-induced gastric lesions. This effect is not influenced by pretreatment with the selective alpha 1 adrenergic antagonist prazosin but is abolished by the angiotensin converting enzyme inhibitor, captopril suggesting the involvement of the renin-angiotensin system.

Protective effect of propranolol on ethanol-induced gastric lesions in rats: probable mechanism of action.

The non-selective beta-adrenoceptor antagonist, propranolol, has been reported to protect against gastric injury in mice, an effect only partly due to prostaglandin release. This study was designed to confirm the gastric cytoprotective effect of propranolol in another species of animal, the rat, and investigate further its mechanism of action. Our results show that propranolol prevents both ethanol-induced gastric lesions as well as ethanol-induced contraction of the circular muscle of rat fundic strip. The local anaesthetic, lignocaine also inhibited the effect of ethanol on circular muscle. However, timolol, another non-selective beta-adrenoceptor antagonist, failed to produce such an action. The effect of propranolol was abolished by the cyclooxygenase inhibitor, indomethacin and a high dose of the guanylate cyclase inhibitor, methylene blue. The results suggest that in addition to prostaglandins, endogenous nitric oxide and the membrane stabilising action of propranolol may also be involved in its gastroprotective action.