Anaphylactic reaction induced by intravenous diclofenac: A case report.

Among the immune-mediated reactions, anaphylaxis is the most severe form. As a postoperative analgesia, diclofenac sodium, and nonsteroidal anti-inflammatory drug is commonly used. Intravenous (IV) diclofenac sodium-induced anaphylaxis is very rare. We are presenting a case of IV diclofenac-induced anaphylactic reaction, occurred during the surgery in a female patient of 21 years of age. The sign and symptoms of the reaction resembled an anaphylactic reaction. Temporal relationship with IV diclofenac administration and development of the clinical features of the reaction found to be probable. The health-care professionals should be aware of such rare and serious reactions so that it can be diagnosed and treated early. The clinical importance associated with the case encouraged us to report this rare complication of IV diclofenac.

Impact of immediate feedback on the learning of medical students in pharmacology.

INTRODUCTION: Providing feedback to students is an essential component in medical education and has been shown to improve the students' learning. The purpose of this study is to evaluate the effect of computer-based immediate feedback on the medical students' learning in a pharmacology course. METHODS: In this prospective intervention study some feedback modules in pharmacology (FMP) were prepared in two topics: the cardiovascular system (CVS) and chemotherapy, using blank templates on "Hot Potatoes" software. The FMP included MC-based questions and two versions were developed: one with feedback (FMP-1) and the other without feedback (FMP-2). The FMP-1 module provided immediate feedback for each option the student chose. The students (n=48) were randomized by computer generated random number table to two groups A and B to receive the module in CVS, i.e., FMP-1 and FMP-2, respectively. A cross-over design was adopted to expose all students to immediate feedback modules. The test scores were compared and feedback was obtained from students and faculty using a validated questionnaire. A focus group discussion was conducted to clarify the issues raised by the students. RESULTS: The module with immediate feedback was much better appreciated by the students than the module without feedback. The students spent more time on FMP-1 (42±7.00 minutes vs 27±12.36 minutes; p<0.001 in chemotherapy and 40±12.11 minutes vs 24±6.01 minutes; p<0.001 in CVS). However, there was no statistically significant difference in mean test scores. The qualitative data collected provided important information on the value of immediate feedback. The students believed that immediate feedback was an excellent way for self-assessment and improved their deeper understanding of content areas. They also felt that it supplemented their traditional learning habits and stimulated them to read more. The students enjoyed its non-threatening nature. CONCLUSION: Immediate feedback improved the deeper understanding of pharmacology and its relevance to medicine for the two topics although immediate feedback did not improve test scores. Overall, immediate feedback had a positive impact on the students' self-directed learning.

Bupropion as an augmenting agent in patients of depression with partial response.

The objective of this study is to evaluate the effects of bupropion as an add-on therapy to selective serotonin reuptake inhibitor (SSRI) on patients of major depressive disorder with partial response. This prospective, randomized, controlled and single-blind study was conducted in sixty patients suffering from major depressive disorder as per Diagnostic and Statistical Manual (DSM)-IV TR criteria, who were having Hamilton depression rating scale (HDRS) score ≥16 after 4 weeks of treatment with SSRIs. Group A received SSRI plus placebo and group B received SSRI plus bupropion. Evaluation was performed based on changes in HDRS score, Montgomery and Asberg depression rating scale (MADRS), Amritsar depressive inventory (ADI) and spontaneously reported adverse effects. There was a significant decrease in the HDRS, MADRS and ADI scores as compared to baseline in both groups. However, the mean decrease in depression score was more in group B than in group A. The percentage decrease of remitters was also significantly more in group B (60% as per HDRS score and 63% as per MADRS score), as compared to group A (24% as per HDRS score and 27% as per MADRS score) (p < 0.05), at the end of treatment. In conclusion, bupropion add-on can act as augmenting agent in patients of depression with partial response to SSRIs.