Pancytopenia in Carbamazepine Therapy: A Rare and Serious Entity with Simple Prevention.

Carbamazepine is a commonly used drug in psychiatric settings used for indications such as partial seizures, generalized tonic-clonic seizures, mixed seizure patterns, pain associated with trigeminal neuralgia, acute manic, and mixed manic states. However, this drug comes with its own series of adverse effects such as nausea, vomiting, diarrhea, dizziness, hyponatremia, headaches, and dry mouth. One serious side effect which is rarely documented includes "carbamazepine-induced pancytopenia." In this case report, we wish to highlight a known case of schizophrenia, who was taking tablet carbamazepine as adjunctive treatment and subsequently developed pancytopenia. On removing the offending agent, her counts gradually returned to normal. By reporting this case, we wish to emphasize regarding the importance of regular monitoring of complete blood count, which often gets neglected. Furthermore, psychoeducating patients regarding regular blood monitoring and the importance of adherence holds considerable importance in enhancing their compliance. By ensuring such simple preventive measures, such serious and unusual side effects may be averted through early detection of warning signs.

Comparative Evaluation of Harmless Acute Pancreatitis Score (HAPS) and Bedside Index of Severity in Acute Pancreatitis (BISAP) Scoring System in the Stratification of Prognosis in Acute Pancreatitis.

Acute pancreatitis is a common disease in patients presenting to the emergency room in any hospital. The most common causes are alcohol ingestion and gallstone disease. Diagnosis is usually based on clinical findings and elevated serum amylase and lipase levels. Imaging is often not necessary but may be used to confirm the diagnosis or rule out any other pathology or to evaluate for any complications. The majority of patients will have a mild, self-limiting disease but others may develop a severe fulminant course with organ failure. These patients are at high risk of developing complications, morbidity or mortality. Treatment of acute pancreatitis includes supportive treatment with antibiotics, fluids, analgesics and early enteral feeding. Several scores have been developed to predict the course of pancreatitis and help make informed decisions, monitoring and timely intervention. The majority of them are complicated, require extensive and expensive interventions or require time. Harmless acute pancreatitis score (HAPS) is one such score that is easy to calculate and is done at the time of admission, bedside index of severity in acute pancreatitis (BISAP) is another one requiring more parameters. The parameters used to calculate it are easily available and can be done at a majority of healthcare facilities in developing countries. HAPS thus seems to be a good option in aiding doctors in assessing acute pancreatitis. It may be considered as a standard scoring for acute pancreatitis for early and effective management. We have tried to study and compare the superiority of HAPS over BISAP in predicting prognosis in acute pancreatitis.

Usability Comparisons of Head-Mounted vs. Stereoscopic Desktop Displays in a Virtual Reality Environment with Pain Patients.

Researchers have shown that immersive Virtual Reality (VR) can serve as an unusually powerful pain control technique. However, research assessing the reported symptoms and negative effects of VR systems indicate that it is important to ascertain if these symptoms arise from the use of particular VR display devices, particularly for users who are deemed "at risk," such as chronic pain patients Moreover, these patients have specific and often complex needs and requirements, and because basic issues such as 'comfort' may trigger anxiety or panic attacks, it is important to examine basic questions of the feasibility of using VR displays. Therefore, this repeated-measured experiment was conducted with two VR displays: the Oculus Rift's head-mounted display (HMD) and Firsthand Technologies' immersive desktop display, DeepStream3D. The characteristics of these immersive desktop displays differ: one is worn, enabling patients to move their heads, while the other is peered into, allowing less head movement. To assess the severity of physical discomforts, 20 chronic pain patients tried both displays while watching a VR pain management demo in clinical settings. Results indicated that participants experienced higher levels of Simulator Sickness using the Oculus Rift HMD. However, results also indicated other preferences of the two VR displays among patients, including physical comfort levels and a sense of immersion. Few studies have been conducted that compare usability of specific VR devices specifically with chronic pain patients using a therapeutic virtual environment in pain clinics. Thus, the results may help clinicians and researchers to choose the most appropriate VR displays for chronic pain patients and guide VR designers to enhance the usability of VR displays for long-term pain management interventions.

Mycoflora and natural aflatoxin contamination in dried quince seeds from Jammu, India.

Eighty two samples of dried quince seeds, obtained from the markets of Jammu province, were examined for mycoflora by different isolation techniques. A total of 27 fungal species belonging to 11 genera were recovered and identified from these samples. The predominant fungal genera encountered were Aspergillus, Penicillium and Fusarium. In view of the predominance of Aspergillus flavus, a known producer of aflatoxins, screening of the fungal contaminated samples was carried out for total aflatoxin levels using high performance liquid chromatography (HPLC). Twenty one aflatoxin positive samples contained 8.07-33.45 µg g(-1) and 0.05-3946.97 µg g(-1) AFB1 and AFB2 respectively. These results suggest that biochemical composition of dried quince seeds, along with climatic conditions of the region seem to be very favourable for aflatoxin production by toxigenic strains of A. flavus. Therefore, monitoring of aflatoxins in dried quince seeds is recommended for this region.