Shatavisa Mukherjee

Pedal edema associated with atypical antipsychotics.

This study describes a patient diagnosed as a case of bipolar affective disorder complaining of bothersome incidence of pedal edema 1 month after the initiation of atypical antipsychotic regimen with risperidone and quetiapine. All hematological and biochemical profiles were found to be normal. On discontinuation of risperidone, the condition remained unresolved even after 2 weeks, and the edema progressed reaching her calves. On tapering the dose of quetiapine, she started showing gradual improvement in edematous condition. Quetiapine was slowly discontinued. No further recurrence of edema occurred, and hence, no further medication changes were implemented. Pedal edema was found to be resolved within weeks of dechallenge of the regimen. Naranjo adverse drug reaction probability scale gave a score of 7 which denotes “probable” adverse drug reaction with quetiapine.

Zika virus disease: Global concerns and making way through it

The recent upsurge of Zika virus infection has alarmed public health officials because of its possible association with thousands of suspected cases of microcephaly, thereby sparking a public health emergency. This mosquito-borne arboviral disease majorly remains asymptomatic. Unavailability of specific prophylaxis or vaccines or treatment necessitates the need to advocate preventive personal measures to get protected from these daytime bitters. Prevention and control measures should be aimed at reducing the vector density and minimizing the vector-patient contact.

Impact on behavioral changes due to chronic use of sertraline in Wistar albino rats.

Aim: Despite having better tolerability and a wide range of clinical applications over other antidepressants, selective serotonin reuptake inhibitors (SSRIs) are also known to be associated with serious adverse effects like suicidal ideation on chronic use. The present study had explored the impact of the chronic use of sertraline, an SSRI, on the behavioral changes in Wistar albino rats. Materials and Methods: The study was conducted on 30 Wistar albino rats of either sex; divided into five groups. Four groups were subjected to chronic mild stress induced by using various stressors randomly scheduled in a week and continued for a period of 3 weeks. The stressed rodents were subjected to sertraline treatment for 9 weeks in different human therapeutic doses extrapolated to animal doses. Behavioral changes were monitored, assessed, and evaluated throughout the treatment phase with the help of tests such as locomotor activity test, forced swim test, tail suspension test, antianxiety test, and sucrose preference test (SPT). Results: All tests except SPT, demonstrated significant (P < 0.05) reduction in depressive-like activity in the stressed rodents by the mid-treatment phase, followed by an abrupt onset of the depressive state by the end of the treatment phase. SPT showed a significant (P < 0.05) increase in sucrose consumption throughout the treatment phase. Conclusion: Behavioral changes following chronic sertraline administration conferred gradual remission of depression state on initial treatment phase, followed by a reversal of effect on chronic use.

Orofacial pain: A critical appraisal in management

Depression is a disorder of major public health importance, in term of its prevalence and the suffering, dysfunction, morbidity and economic burden. The study aims to assess the prevalence of depression among rural population of selected village. Subjects (N=92) who volunteered to participate in the study were recruited. The research design adopted for the study was descriptive survey design. Depression was assessed by using a self reported depression scale (CES-D). result shown majority of them were between 16 -60 yrs. The overall mean score of depressive affect is 17.04 and it was higher in illiterates. Among the dimensions somatic symptoms has mean score of 19.82 and it was higher in females. In association with demographic characteristics illiterates, females, married, nuclear family, middle class and laborers shows statistically significant association with depressive symptoms. The sudy concludes that prevalence of depression among the rural population is common especially in females, nuclear families and low socio economics due to variety of emotional and physical problems hence there is clear need to increase mental health services and to integrate this with general health services.Orofacial pain (OFP), a highly debilitating and prevalent pain condition, is a major concern of national public health. OFP can arise from different regions and etiologies. This intractable pain condition, arising from oral structures innervated by trigeminal nerves, represent a challenge to the clinician as the pain has multiple sources of origin and range of etiologies, thus making the diagnosis very challenging. Odontalgia, temporomandibular disorders (TMD), trigeminal neuropathy and migraines are some common disorders for which patients seek treatment. Owing to its diverse classification and etiologies, proper identification of the condition and subsequent treatment approaches has become a necessity. A multidisciplinary treatment approach comprising patient education, pharmacological, non-pharmacological means and psychosocial interventions can be considered essential for this enfeebling condition.

Left middle cerebral artery territory infarction due to intravitreal injection of ranibizumab

Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is increasingly used for the treatment of a wide variety of retinal diseases including age-related macular degeneration, diabetic retinopathy and retinal vascular occlusions, and retinopathy of prematurity. Despite encouraging results in halting the disease and improving the vision, intravitreal injection of anti-VEGF agents may be associated with marked side effects. The present case describes a 75-year-old female with known complications of hypertension, Type II DM, and hypothyroidism, who received intravitreal injections of Lucentis (ranibizumab) due to diabetic macular edema. After 10 days, the patient admitted with chief complaints of slurred speech. Further, radiological and clinical investigations conferred the case to be a left middle cerebral artery territory infarct with right-sided hemiparesis and aphasia. Although well-designed randomized clinical trials have shown the efficacy of these agents in visual improvement in various retinal diseases, each intravitreal injection poses the risk of postinjection- and drug class-associated adverse events. Clinicians should be more vigilant as patients receiving intravitreal injections are at a small risk of developing complications, which is often unrecognized or underreported.

Adverse drug reaction monitoring in patients on antiretroviral therapy in a tertiary care hospital in Eastern India

BACKGROUND: Besides unparalleled benefits, highly active antiretroviral therapy is also associated with wide range of potential adverse drug reactions (ADRs), which hinders treatment adherence. The present study was thus designed to monitor and explore the pattern of occurrence of ADRs to various antiretroviral therapy (ART) regimens in a tertiary care ART setup. MATERIALS AND METHODS: A prospective, observational clinical study was carried out in the outpatient setting of nodal ART center of Eastern India. A total of 610 patients on various ART regimens were studied for suspected ADRs over 12 months. Adverse event history, medication history, and other relevant details were captured. Causality and severity of each reported ADR were duly assessed. RESULTS: 32.45% patients of total study participants presented with a total of 330 ADRs. Patients from zidovudine-based regimens presented with majority of ADRs such as anemia (up to 36%), central nervous system (CNS), and gastrointestinal (GI) side effects. Tenofovir-based regimens were, however, found to be mildly safer. The combination with Efavirenz was associated with majorly CNS side effects while that of nevirapine was associated with rash and pigmentation of nails. Atazanavir boosted second-line regimens were notably associated with increased serum lipid levels followed by other GI and CNS adverse effects. Increased liver enzymes were found in atazanavir-based second-line ART. CONCLUSION: The study enables to obtain information on the incidence and pattern of ADRs associated with various antiretroviral regimens, thereby reducing its occurrence and protecting the patient population from avoidable harm. Need of intensive monitoring for ADRs in ARTs thus seems to be a mandate.

Botulinum toxin and its clinical aspects: An overview

Neurotoxins, an extensive class of exogenous chemical compound, adversely affect the functioning of both developing and mature nervous tissue through the inhibition of neuron cellular processes. These inhibitory processes usually range from membrane depolarization mechanisms to interneuron communication. By inhibiting the neuronal ability to perform their expected intracellular functions, or pass a signal to a neighboring cell, neurotoxins can induce systemic nervous system arrest as in the case of botulinum toxin (BTX), or even nervous tissue death. The time required for the onset of symptoms upon neurotoxin exposure can vary between different toxins, being on the order of hours for BTX and years for lead. Though neurotoxins are often neurologically destructive, their ability to specifically target neural components is important in the study of nervous systems.[1]

Divalproex-induced stuttering: A rare case report

This report describes development of stuttering with divalproex sodium in a patient of bipolar disorder. The treatment was started with twice a day regime which was well-tolerated and the patient started showing some improvement in symptoms. After a week, as the dosing was switched to three times a day, the patient experienced decreased and labored speech. His articulation altered as were the intensity and timings of utterance. Speech rhythm was also affected. Patient reported that such a problem he never experienced earlier. As he reverted to twice a day regime on advice of the doctor, there was improvement in his speech.

Adverse drug reaction monitoring of antidepressants in the psychiatry out patient department at a tertiary care teaching hospital in India: A cross-sectional observational study

Background: Antidepressant drugs, though of great benefit in a range of psychiatric disorders, are associated with a wide range of potential adverse effects. There is growing concern among the healthcare personnel to assess these adverse drug reactions (ADRs) of newer psychotropic drugs, which have an impact on long-term compliance and achieving successful treatment. The present study was thus designed to monitor and analyze the pattern of occurrence of ADRs to antidepressant medications in Outpatient Department (OPD) of a tertiary-care hospital. Materials and Methods: A cross-sectional observational clinical study was carried out in the OPD of Psychiatry in Medical College, Kolkata. A total of 190 patients who received antidepressants were studied. 5-8 consecutive previously diagnosed depression patients attending follow-up per day, were screened for suspected ADRs, 2 days (one male OPD and one female OPD) in a week, over 6 months (October 2013 to March 2014). Adverse event history, medication history and other relevant details were captured in a format as adopted in the Pharmacovigilance Programme of India (PvPI). Causality of ADR was assessed by Naranjo′s ADR probability scale. The severity of each reported ADR was assessed using Hartwig and Siegel Scale. All the statistical analysis was done by using SPSS-version 20 (SPSS Inc). Results: A total of 190 patients were screened for the study of which males and females represented 43.68% and 56.31% of the cases respectively. The age-group presenting with maximum depressive problems was found to be 30-39 years. A total of 481 ADRs were noted of which dry mouth was the commonest, closely followed by nausea and tremor. Out of 130 ADRs assessed for causality, 89.23% of the ADR cases, were found to be ′probable′, while 10.77% were found to be ′possible′. According to Hartwig and Siegel′s Scale 83.99% of the cases were found to be mild, 14.97% moderate and 1.04% severe. Conclusion: The study enables to obtain information on the incidence and pattern of adverse drug reactions associated with antidepressants in the local population thereby reducing its occurrence and protecting the user population from avoidable harm.

Management of swine flu (H1N1 Flu) outbreak and its treatment guidelines

In its strongest resurgence since the pandemic of 2009, the influenza type A virus, known as H1N1, has broken out in different parts of India with deaths surpassing 1000 mark and number of affected cases exceeding 18,000 by the end of February 2015. Swine influenza spreads from person to person, either by inhaling the virus or by touching surfaces contaminated with the virus, then touching the mouth or nose. Symptoms occurring in infected human by H1N1 are like any other flu symptoms. Treatment is largely supportive and consists of bed rest, increased fluid consumption, cough suppressants, antipyretics and analgesics for fever and myalgias. Management largely includes the potential use of antiviral agents for patients presenting with illness due to influenza virus infection. If the illness is known or suspected to be due to a zoonotic influenza A virus, oseltamivir or zanamivir are treatment options. For known or suspected infection with avian influenza H5N1 virus, antiviral treatment should follow the World Health Organization (WHO) rapid advice guidelines on pharmacological management of humans infected with highly pathogenic avian influenza A (H5N1) virus. WHO also recommends vaccination of the high-risk group with seasonal influenza vaccine. Vaccination is recommended for health care workers working in close proximity to influenza patients are at higher risk of acquiring the disease. Since swine flu can directly be transmitted from one person to another through air droplets, people who fail to follow proper hygiene, especially in crowded places are at a high risk of contracting the virus. Proper preventive and control measures thus must be ensured. We have only limited treatment options, so rational use of the antiviral agent is very essential to avoid resistance and future complications. Health education and awareness among citizens should be transferred by proper mechanism.