Evaluation of microalbuminuria in type-2 diabetes mellitus under oral hypoglycemic agents: Association with age, sex, BMI, and renal clearance.

Background: Diabetes mellitus (DM) is increasing drastically and affecting the individuals globally, especially in the low- and middle-income countries like India. The poor glycaemic control results in micro-vascular and macro-vascular complications, leading to dysfunction of multiple organs. This study aimed to evaluate the association between the risk factors and microalbuminuria levels among patients with type 2 DM on oral hypoglycaemic agents. Materials and Methods: Hundred type 2 DM patients fulfilling the inclusion and exclusion criteria were selected by convenient random sampling. Demographic details, biochemical markers, and anti-diabetic medication details were collected. The findings were analyzed statistically using Chi-square test and one-way analysis of variance (ANOVA) with SPSS software 21.0. Results: Among the different combination therapies, 59% were commonly using metformin and teneligliptin. There was a significant association noted between microalbuminuria and risk factors like age, duration of disease, body mass index (BMI) (25.5 ± 2.9), fasting blood sugar (151 ± 53.2 mg/dL), post prandial blood sugar (227.01 ± 70.9 mg/dL), blood urea (24.42 ± 9.3 mg/dL), and serum creatinine (1.5 ± 0.2 mg/dL) (P < 0.001). One-way ANOVA showed statistical significance between microalbuminuria and the different treatment groups (P < 0.0001). Conclusion: Microalbuminuria was associated with age, duration of diabetes, glycaemic control, and BMI. In contrast, there was no significant difference noted between the genders and microalbuminuria. Microalbuminuria is an early indication of nephropathy in diabetes patients. The early identification of the risk factors is important, and it is always recommended to screen for microalbuminuria in all the diabetic patients for early detection and prevention of diabetic nephropathy and their associated complications.

Azithromycin-Induced Generalized Nonbullous Fixed-Drug Eruption.

Azithromycin-induced severe cutaneous reactions occur rare. We report a case of azithromycin-induced generalized nonbullous form of fixed-drug eruption (FDE). A 19-year-old male consulted the dermatology department for multiple painful oval-shaped, sharply defined, and hyperpigmented patches on his chest, abdomen, and upper limbs after consuming oral azithromycin tablets for his sore throat. The generalized nonbullous form of FDE was diagnosed, and the offending drug was stopped immediately. He was treated with antihistamines and steroids, and recovered on follow-up. This FDE is reported due to the spareseness of documentation from South India and to improve the awareness among the prescribing physicians about this severe cutaneous reaction (FDE) for a commonly used drug. This case report gives insight to the clinicians and health-care workers on rare side effects caused by the commonly used antimicrobial agent, azithromycin.

Monoclonal Antibodies Against Infectious Microbes: So Long and Too Little!

Monoclonal antibodies (mAbs) as alternatives or more often as complementary to the conventional antimicrobials have been developed for the management of infectious conditions for the past two decades. These pharmacotherapeutic strategies are inevitable as the burden of antimicrobial resistance is far-reaching in recent times. MAbs are part of the targeted pharmacotherapy armamentarium with a high degree of specificity - hence, exert comparatively superior efficacy and tolerability than the conventional polyclonal antisera. So far, only five mAbs have been approved for the management of infectious states, since the marketing authorization (1998) given to palivizumab (Synagis®) for the prophylaxis of lower respiratory tract disease caused by a respiratory syncytial virus in pediatric patients. Ibalizumab-uiyk (Trogarzo™) used for the management of multidrug-resistant HIV-1 infection not yielding to at least 10 antiretroviral drugs, was approved recently. Among the three antibacterial mAbs, raxibacumab (ABthrax®/ Anthrin®) and obiltoxaximab (Anthim®) are indicated for the treatment and prophylaxis of inhalation anthrax due to Bacillus anthracis; bezlotoxumab (Zinplava®) is used to reduce the recurrence of Clostridium difficile infection. There are also around 30 and 15 mAbs in different phases of development for viral and bacterial conditions. As alternatives to the traditional antivirals and antibacterials, the antimicrobial mAbs are the need of the hour. These mAbs are more relevant to the management of conditions like emerging viral outbreaks wherein there is a lack of prophylactic vaccines. The current cutting-edge engineering technologies revolutionizing the production of mAbs include phagedisplayed antibody libraries, cloning from single-memory B cells or single-antibody-secreting plasma B cells, proteomics-directed cloning of mAbs from serum clubbed with high-throughput sequencing techniques. Yet, the cost of manufacture continues to be the main limiting factor. In this review, the different therapeutic monoclonal antibodies directed against the microbial pathogens are discussed.

Cetirizine-Induced Fixed Drug Eruption.

Cetirizine, a piperazine-derivative second-generation antihistaminic, is used for a wide variety of disorders such as urticaria, eczema, and allergies. Adverse reactions due to this drug are usually rare, especially fixed drug eruption (FDE), a delayed cell-mediated hypersensitivity reaction, is scarce. Here, we report a case of cetirizine-induced FDE. A 34-year-old female developed hyperpigmented, itchy patches over both forearms, legs, feet, and right side of the chest after taking tablet cetirizine for dry cough with similar episode 2 years back on the same sites. The patient responded slowly with conservative treatment and the lesions disappeared after 10 days. She was advised to avoid the causative in near future. This case report highlighted FDE due to an antihistaminic which themselves will be prescribed to treat allergies.

Study of drug-Drug interactions among the hypertensive patients in a tertiary care teaching hospital.

AIM: Drug-drug interactions (DDIs) are one of the major but preventable cause of adverse drug reaction. Study of prevalence and prediction of DDIs will make the physician easier to provide better patient care and mitigate patient's harm. Hence, the study was planned to evaluate the potential DDIs among medication prescribed to hypertensive patients in our hospital. MATERIALS AND METHODS: A prospective, cross-sectional study was conducted among the hypertensive patients in medicine (outpatient/inpatient) department over the period of three months in a tertiary care hospital. Adult hypertensive patients of either sex with comorbidities were included in the study. The prescriptions were collected and analyzed for DDI using Medscape interaction checker. Data were analyzed using SPSS (version 16.0) software and expressed in percentage. Pearson's correlation and regression analysis were done. RESULTS: Among 125 patients, 48% were exposed to at least one DDI. Totally 123 DDI were identified and majority of them were significant (85.36%). No serious interactions were identified. Pharmacodynamic and pharmacokinetic drug interactions were found to be 37.39% and 28.76%, respectively. Logistic regression analysis showed advanced male gender and polypharmacy was associated with increased risk of DDI. About 51 interacting pairs of DDI were identified and most frequently occurring pair was amlodipine with atenolol. Aspirin was found to have commonly involved in DDI with enalapril, atenolol, frusemide, spironolactone, carvedilol, and metoprolol. CONCLUSION: The study highlighted that patients with hypertension are particularly vulnerable to DDI. The comorbidities, advanced age, and polypharmacy are the important factors associated with the occurrence of DDI.

Carbamazepine-induced angioedema.

Angioedema is a rare adverse reaction of carbamazepine, which causes localized tissue edema in submucosal and subcutaneous tissue mediated by histamine, serotonin, and kinins (bradykinin). We report a case of 34-year-old female who developed angioedema, 24 h after administration of carbamazepine for treating bipolar disorder. Patient's symptoms responded rapidly with antihistamine therapy and with the withdrawal of carbamazepine, the offending drug. Carbamazepine-induced angioedema is a life-threatening reaction which requires immediate treatment and monitoring in order to avoid morbidity and mortality.

Effect of antiepileptic drug therapy on thyroid hormones among adult epileptic patients: An analytical cross-sectional study.

OBJECTIVE: The objective of the study was to evaluate and compare the effect of conventional and newer antiepileptic drugs (AEDs) on thyroid hormone levels in adult epileptic patients. METHODS: A hospital-based, analytical cross-sectional study was conducted among the adult epileptic patients receiving conventional AEDs (Group 2) or newer AEDs (Group 3) for more than 6 months. Serum thyroid hormone levels including free triiodothyronine (fT3), free thyroxine (fT4), and thyroid stimulating hormone (TSH) were analyzed and the hormonal status was compared with healthy control subjects (Group 1). FINDINGS: Sodium valproate and phenytoin were commonly used conventional AEDs; levetiracetam and topiramate were common among the newer drugs. There was a statistically significant decrease in serum fT4 and increase in serum TSH levels (P < 0.0001) in patients on long-term therapy with conventional antiepileptic agents than in the control group. No significant change in thyroid hormone levels (fT3, fT4, and TSH; P = 0.68, 0.37, and 0.90, respectively) was observed with newer antiepileptics-treated patients when compared to control group. One-way analysis of variance followed by post hoc Dunnett's test was performed using SPSS version 17.0 software package. CONCLUSION: The present study showed that conventional AEDs have significant alteration in the thyroid hormone levels than the newer antiepileptics in adult epileptic patients.

Neuroprotective Effect of Lercanidipine- A Novel Calcium Channel Blocker in Albino Mice.

BACKGROUND: The available conventional antiepileptics do not afford cure or prophylactic treatment and henceforth there is always a quest to explore new targets for management of convulsions. In this perspective, dihydropyridine calcium channel blockers have been investigated in various animal models of epilepsy. Lercanidipine, a newer dihydropyridine calcium antagonist, is a potential candidate with its favourable lipid profile and longer duration of action. OBJECTIVE: (1) To evaluate the anticonvulsant effect of lercanidipine alone and in combination with standard drug in adult male Swiss albino mice. (2) To evaluate the muscle relaxant and spontaneous locomotor activity of lercanidipine in adult male Swiss albino mice. MATERIALS AND METHODS: Adult male Swiss albino mice weighing 20-30g were used to study the anticonvulsant, muscle relaxant and spontaneous locomotor activity using electroconvulsometer, rotarod and actophotometer apparatus respectively. The mice were divided into six groups of six animals in each group. Group 1 and 2 served as control (vehicle treated) and standard group respectively. Standard drug used to evaluate anticonvulsant effect is phenytoin sodium 25 mg/kg I.P. whereas muscle relaxant activity and locomotor activity is diazepam 4 mg/kg I.P., Group 3 and 4 received lercanidipine 1 and 3 mg/kg I.P., respectively. Anticonvulsant models included group 5 and 6 and they were given combination of phenytoin sodium 12.5 mg/kg I.P., with lercanidipine 1 and 3 mg/kg i.p, respectively. Abolition or reduction of tonic hind limb extension was considered as index of anticonvulsant activity whereas the balancing time of the animals in rod was recorded to asses muscle relaxant activity. The locomotor activity was recorded for 5 minutes. The data were analysed with one-way Analysis of Variance followed by post-hoc 'Dunnett t-test'. RESULTS: Lercanidipine given alone in a dose of 1 and 3 mg/kg had significantly reduced the tonic hind limb extension. Combination of lercanidipine (3 mg/kg) and phenytoin had offered 100% protection. The results also revealed that the test drug didn't impair the motor coordination and locomotor activity in mice. CONCLUSION: The present study had demonstrated that lercanidipine could be potential novel candidate for the treatment of convulsions.

Midazolam premedication for Ketamine-induced emergence phenomenon: A prospective observational study.

OBJECTIVE: Ketamine administration is known to induce hemodynamic pressor response and psychomimetic effects which could be attenuated by appropriate premedication. The present study was designed to evaluate the effect of midazolam on hemodynamic stability and postoperative emergence phenomenon following ketamine anesthesia. METHODS: This was a prospective observational study including 30 adult patients with American Society of Anesthesiologists physical grades I and II scheduled for elective short surgeries under ketamine anesthesia. Patients were premedicated with midazolam (0.02 mg/kg intravenously) before the ketamine induction (1 mg/kg intravenously). Demographic data and hemodynamic variables were observed during the perioperative period. Pain score by visual analog scale score and psychomimetic effects were recorded postoperatively. FINDINGS: The mean ± standard deviation of heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate were decreased postoperatively (85.3 ± 11.4, 120.7 ± 8.2, 79.2 ± 5.5, 13.5 ± 1.8, respectively) compared to intraoperative period (88.53 ± 14.1, 123.83 ± 13.8, 83 ± 9.1, 14.13 ± 2.0, respectively). There was statistically significant decrease in systolic (P = 0.03) and diastolic (P = 0.002) blood pressure, but not with heart rate and respiratory rate. Eighty percent of patients had no pain at ½ hour and 1 hour, while this increased to 90% at 2 hours postoperatively. Mild emergence delirium was noted in 13.3% and 16.7% at ½ hour and 1 hour, respectively, which decreased to 13.3% at 2 hours. Dreams were noticed in 20%, 27% and 10% of patients at ½ hour, 1 and 2 hours after surgery, respectively. CONCLUSION: Midazolam premedication in ketamine anesthesia effectively attenuated the hemodynamic pressor response and postoperative emergence phenomenon. Hence, the combination of midazolam with ketamine can be safely used for short surgical painful procedures in adults.

Fixed drug eruptions caused by cross-reactive quinolones.

Fixed drug eruptions (FDE) are the common dermatological adverse drug reaction accounts for 16-21% of all cutaneous drug reactions in India. Drugs most frequently implicated in FDE are antimicrobials, anticonvulsants, and nonsteroidal antiinflammatory drugs. Here, we report a rare case of bullous FDE due to ciprofloxacin followed by ofloxacin administration.