Sukanta Sen

Status of zinc and magnesium levels in type 2 diabetes mellitus and its relationship with glycemic status

Diabetes mellitus (DM) is associated with alterations in the metabolism of zinc (Zn) and magnesium (Mg). The aim of the present study was to estimate the serum levels of these trace elements in patients with type 2 diabetes in relation to their glycemic status. Eighty seven type 2 diabetics & 30 apparently healthy sex and age matched control subjects were selected for the study. S-Zn and S-Mg levels were significantly low in type 2 diabetes patients. The serum levels of glucose were negatively correlated with serum levels of Zn and Mg of diabetic subjects. The low serum levels of Zn and Mg in diabetics compared to control subjects may be due to the poor glycemic control. Our study shows S-Zn & S-Mg levels are inversely related to glycemic status (HbA1C) of type 2 diabetics.

A questionnaire-based survey to ascertain the views of clinicians regarding rational use of antibiotics in teaching hospitals of Kolkata

Objectives: The objective was to assess the views of clinicians in teaching hospitals of Kolkata regarding the use of antibiotics in their own hospitals, focusing on perceived misuse, reasons behind such misuse and feasible remedial measures. Materials and Methods: A total of 200 clinicians from core clinical disciplines was approached in six teaching hospitals of Kolkata through purposive sampling. A structured, validated questionnaire adopted from published studies and modified to suit the responding population was completed by consenting respondents through face-to-face interaction with a single interviewer. Respondents were free to leave out questions they did not wish to answer. Results: Among 130 participating clinicians (65% of approached), all felt that antibiotic misuse occurs in various hospital settings; 72 (55.4% of the respondents) felt it was a frequent occurrence and needed major rectification. Cough and cold (78.5%), fever (65.4%), and diarrhea (62.3%) were perceived to be the commonest conditions of antibiotic misuse. About half (50.76%) felt that oral preparations were more misused compared to injectable or topical ones. Among oral antibiotics, co-amoxiclav (66.9%) and cefpodoxime (63.07%) whereas among parenteral ones, ceftriaxone and other third generation cephalosporins (74.6%) followed by piperacillin-tazobactam (61.5%) were selected as the most misused ones. Deficient training in rational use of medicines (70.7%) and absence of institutional antibiotic policy (67.7%) were listed as the two most important predisposing factors. Training of medical students and interns in rational antibiotic use (78.5%), implementation of antibiotic policy (76.9%), improvement in microbiology support (70.7%), and regular surveillance on this issue (64.6%) were cited as the principal remedial measures. Conclusions: Clinicians acknowledge that the misuse of antibiotics is an important problem in their hospitals. A system of clinical audit of antibiotic usage, improved microbiology support and implementation of antibiotic policy can help to promote rational use of antimicrobial agents.

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.

Allopurinol induced stevens - johnson syndrome - a case report.

A 43-year old female from rural area was admitted in a tertiary care hospital complaining of sudden development of rash all over the body since last four days. Initially rash developed over abdomen and chest followed by spreading to rest of the portion of the body including palm and soles. Skin rashes were initially erythematosus and maculopapular and extremely itchy followed by painful blister formation, affecting mucous membrane of mouth [Table/Fig-1], anal canal, and vaginal area also. There was denudation with raw ulceration at places over face following rupture of blisters during hospital stay [Table/Fig-1,​,2].2]. Patient was unable to eat due oropharyngial painful ulceration and crusting over lips. Then purpuric macules or blisters appeared over trunk, abdomen and back [Table/Fig-3]. There was no history of similar sort of episode in the past. [Table/Fig-1]: Shows oedema and crusting of the lips with erythematous purpuric macular lesions, which typically first appear on the face and thorax before spreading to other areas [Table/Fig-2]: Atypical target-like or targetoid lesions in a patient with SJS characterized by purpuric macules or blisters [Table/Fig-3]: Healed purpuric macules or blisters on the back On examination, the patient was alert and appeared dehydrated. Her body temperature was 38°C, blood pressure was 114/70 mm Hg, pulse rate was 96 beats per minute, and respiratory rate was 20 breaths per minute. Nikolsky’s sign was positive. The body surface area involvement of the patient at the time of presentation was 9%. Patient was suffering from multiple joint pains since last one month for which she was taking allopurinol 100 mg thrice daily for last ten days prior to development of skin rash. Patient’s body temperature was also increased to 39.4°C intermittently which diminished on paracetamol administration following three days after admission. The patient’s complete blood count was within normal limits except slight decreased haemoglobin concentration 10.4 g/dL. Erythrocyte sedimentation rate (ESR) was normal. Her C-reactive protein was increased to 7.6 mg/dL. The serum levels of total protein, albumin, blood urea nitrogen, creatinine and elevated random blood glucose were within normal limits. Serum total IgE and ECG were normal. The sodium and potassium levels were slightly decreased. There was no evidence of eosinophilia and levels of liver enzymes and serum bilirubin were within the normal range. Blood culture was negative. The serological titers for HSV was within normal limits, exclude the possibilities of HSV infection in etiopathogenesis in this particular case. Skin biopsy was advised in order to rule out differential diagnoses such as autoimmune blistering diseases like pemphigus vulgaris, bullous fixed drug eruption, erythema multiforme acute generalised exanthematic pustulosis and TEN. Treatment was started conservatively with oral antihistaminic 25 mg, antipyretics, intravenous dexamethsone and intravenous fluid therapy. The patient was started antibiotic inj. cefotaxime 1gm i.v. to reduce the risk of secondary infection, skin lesions were treated with topical therapy and local anaesthetic creams. Chlorhexidine rinse was given to maintain good oral hygiene and white-soft paraffin was applied on the lips to relieve pain. The lesions gradually diminished and healed up in about 15 days [Table/Fig-4] and resolved with mild hypo/ or hyperpigmented spots. The causality assessment as per the Naranjo algorithm [1] revealed the ADR to be Probable (Naranjo score 7). Assessment of causality by using the algorithm of drug causality for epidermal necrolysis (ALDEN) [2] was ‘very probable’. Severity-of-illness and prognosis was assessed by using the SCORTEN criteria. We did not seek to test the effects of re-challenge in our patient. Patient and relatives was properly counselled. [Table/Fig-4]: Healed purpuric macules or blisters on the face and trunk

Fatal Nevirapine-Induced Toxic Epidermal Necrolysis in a HIV Infected Patient

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are the most Severe Cutaneous Adverse Reactions (SCARs) which mainly caused by exposure to drugs and having significant morbidity and mortality. TEN represents an immunologic reaction to a foreign antigen and is most often caused by drugs. Nevirapine (NVP), a non-nucleoside reverse transcriptase inhibitor (NNRTI) is an important component of Highly Active Antiretroviral Therapy (HAART). It is sometimes associated with life-threatening adverse reactions. Here, we report the fatal case of 72-year-old male who developed TEN secondary to intake of nevirapine. This fatal case report will increase awareness among treating physicians for careful monitoring of patients on NNRTI-based antiretroviral therapy and better counseling of the patient on NVP regimen for early identification and reporting of SCARs so that fatalities due to adverse drug reactions can be prevented with timely intervention.

Oxcarbazepine Induced Maculopapular Rash - A Case Report

Unlike carbamazepine, newer anti epileptic drug like oxcarbazepine, reports fewer side effects. In this report we describe a case of oxcarbazepine induced maculopapular rash probably happened because of a drug interaction with isoniazid, and a brief review of the existing literature is presented herewith. A 40-year-old male patient received oxcarbazepine 300mg twice daily along with other anti-tubercular drugs including isoniazid (300mg) once daily since two days. Extensive cutaneous rash with intense itching developed which subsided on discontinuation of oxcarbazepine. This case highlights the fact that there is a potential possibility of drug-drug interaction between oxcarbazepine and isoniazid and concomitant use of these two drugs should better be avoided during clinical practice.

Metronidazole-Induced Bullous Pemphigoid: A Case Report

Bullous pemphigoid is an autoimmune cutaneous blistering disorder, the exact pathogenesis of which is still not fully elucidated. Drug-induced bullous pemphigoid eruptions are rare but have been reported earlier with the use of frusemide, psoralens, ibuprofen, galantamine hydrobromide, ACE inhibitors like captopril, spironolactone, penicillin, ampicillin, levofloxacin, penicillamine. We hereby report a case of metronidazole induced bullous pemphigoid (BP) in a 52-year-old male patient suffering from liver abscess following 4 days of drug administration. The skin biopsy findings obtained from the patient were consistent with the diagnosis of bullous pemphigoid (BP). Metronidazole was discontinued and symptomatic treatment was offered to the patient. Following withdrawal of metronidazole, the bullae subsided in the next 7-10 days without any significant residual scarring. The causality assessment performed as per the Naranjo algorithm revealed the case to be probable (Naranjo score 7).

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.

Non-healing Scalp Ulcer Accompanying Chronic Arsenicosis: A Case Report

Arsenic, an environmental toxin, significantly contributes to the development of several health problems. Epidemiological studies done across the globe have reported that a prolonged arsenic exposure has been associated with characteristic skin lesions, neuropathy and an increased risk of skin, lung, liver (angiosarcoma), bladder, kidney and colon cancers. In present study, we are reporting a case of a 60-year-old male, who presented with a large (5cm x 4cm) painless ulcer in fronto-parietal area of scalp, with occasional oozing of blood. X-ray of skull (AP and lateral view) revealed granular well-outlined osteolytic lesions in right fronto-parietal skull vault, which raised a suspicion of malignancy. An incisional biopsy was taken and histopathology revealed no evidence of malignancy. A benign, non-healing skin ulcer is rarely seen in a setting of chronic arsenicosis. His skin examination showed characteristic fine freckles of spotted pigmentary changes i.e. classic rain-drop pigmentations which were present all over the body, particularly on trunk, palms and soles. Arsenic levels seen in hair and nail of the patient were 1.23 micrograms/gram and 3.26 micrograms/gram respectively, which were in accordance with WHO suggested diagnostic criteria of chronic arsenicosis.