Sushil Kiran Kunder

A Rare Case of Tamoxifen-Induced Thrombocytopenia

Breast cancer is a commonly encountered cancer in women. Tamoxifen is a frequently used drug in breast cancer. It is a selective estrogen receptor modulator (SERM). It is used for both chemoprevention and for palliative care in these patients. Drug-induced thrombocytopenia is a common diagnosis these days. Moreover, this condition can be life threatening or even fatal. It can either be due to increased platelet destruction or reduced formation. Either way, early diagnosis followed by discontinuation of the offending agent is the key to successful management. Here, we present a rare case of tamoxifen-induced thrombocytopenia.

A Retrospective Study to Assess the Effect of Proton Pump Inhibitors on Renal Profile in a South Indian Hospital

INTRODUCTION Proton Pump Inhibitors (PPIs) are arguably among the most commonly prescribed drugs in clinical practice, either as part of treatment or prophylaxis. Many clinicians prescribe these drugs as part of any prescription, without a proper rationale. Recent studies done outside India have shown that these drugs are not entirely safe, and they can result in the development of acute renal injury. AIM To assess the effect of PPIs on blood urea and serum creatinine, when administered for at least seven consecutive days. MATERIALS AND METHODS The study was conducted in a retrospective manner, using data from the medical records department. Values of blood urea and serum creatinine were taken twice, first before start of therapy and then after at least one week of therapy. RESULTS A total of 175 subjects were selected for the study. When their case files were analysed, acute kidney injury was identified in 19 (10.86%) of them. Pantoprazole was the most common drug involved (84.21%). Renal injury was more common in the age group of over 50 years of age. CONCLUSION PPIs are not entirely free of adverse effects, as assumed by several practitioners. A vigilant eye has to be maintained on the patients renal profile so as to avoid any untoward decline in renal function, as evidenced in the current study.

Effect of Sodium Valproate and Docosahexaenoic Acid on Pain in Rats.

INTRODUCTION Analgesics are commonly prescribed medications used to alleviate pain of various aetiologies without affecting the patients consciousness. They interfere with the transmission of pain signals. A commonly used antiepileptic drug, sodium valproate has been used in various non-epileptic conditions like migraine prophylaxis and in the treatment of bipolar disorder because of the multiple mechanisms by which it acts. Docosahexanoic Acid (DHA), an omega 3 fatty acid, is known to possess analgesic activity. We planned a study to assess the effect of sodium valproate alone and in combination with DHA in rat models of pain. AIM To evaluate the analgesic activity of sodium valproate and DHA supplementation using various experimental models in albino Wistar rats. MATERIALS AND METHODS For analgesic activity, A total of 48 adult Wistar albino rats were divided into eight groups of six rats each. Group I was control (distil water 1 ml/kg), Group II received intraperitoneal injection of tramadol (10 mg/kg), Group III, IV, V were injected intraperitoneal sodium valproate 100, 200, 400 mg/kg with distil water respectively and Group VI, VII, VIII were given sodium valproate 100, 200, 400 mg/kg plus DHA 300 mg/kg (intraperitoneal) respectively. Analgesic activity was assessed using hot plate, tail flick and acetic acid writhing models. RESULTS We found that sodium valproate at higher doses (400 mg/kg) used either alone along with DHA (300 mg/kg) showed statistically significant analgesic activity in comparison to control in various experimental models for assessing pain. CONCLUSION Combination of sodium valproate along with DHA has shown promising analgesic activity.

A rare instance of levofloxacin induced myoclonus

Levofloxacin is a widely used fluoroquinolone, mainly as a respiratory antimicrobial agent. It is employed as a second line therapeutic modality in pulmonary tuberculosis as well. The drug has been in use for ages, and is known to be both efficacious and safe. However, it is not free of adverse effects. The most dangerous ones are those involving the Central Nervous System (CNS). Although rare, levofloxacin can cause involuntary movements like chorea and myoclonus. Here by, we present a case of an elderly male patient who developed reversible myoclonus/chorea after a course of levofloxacin (which was initiated as part of his anti-tubercular therapy) following the development of peripheral neuropathy secondary to isoniazid.

Modification of First-line Antiretroviral Therapy in Treatment-naive, HIV Positive Patients

Introduction: Modification of initial Antiretroviral Therapy (ART) program is an important issue in HIV infected patients as the number of ART regimens available is limited. Hence, there is a need to understand the factors that affect modification and therefore, the durability of the initial antiretroviral regimen. Aim: To study the type of modification of first line ART in treatment-naive HIV positive patients and factors influencing it. Materials and Methods: A retrospective observational study was carried out in the HIV clinic of a tertiary care hospital, using data obtained from the case records of the subjects who were initiated on ART between January 2012 to December 2014. Data on patient baseline characteristics, proportion of patients who required modification, type and time of modification was collected. The determinants of time to modification were analysed using Chi-square test. Binomial logistic regression was utilized to assess independent risk factors for change in regimen. Results: Out of 200 case records analysed, 54 patients had to undergo a modification in their initial regimen. The mean age of patients was 44.68 ± 11.31 years. Majority of the patients were males. The most common reason for modification was Adverse Drug Reactions (ADRs) (79.63%) followed by treatment failure (9.25%). In 85.18% cases, modification involved substitution. Occurrence of ADRs and non-tenofovir based first-line regimens were associated with higher likelihood of substitution in regimen (p<0.05). The median time (IQR) to modification was 173 (152.25, 293.50) days. Conclusion: ADRs and the use of non-tenofovir based regimens resulted in significantly higher rates of modification of antiretroviral therapy. There should be monitoring of patients on ART to detect ADRs at the earliest and to obtain increased use of single tablet containing tenofovir based regimen to improve durability of first line regimens.

A Study to Assess the Therapeutic Effect of Enalapril on Olanzapine Induced Metabolic Syndrome in Wistar Rats

INTRODUCTION Metabolic Syndrome (MS) is a complex of risk factors for the development of cardiovascular complications and Type 2 Diabetes Mellitus (DM). Pharmacological management of the condition is complex, as multiple drug groups have to be used, as the syndrome itself is multi faceted. Angiotensin Converting Enzyme Inhibitors (ACEIs) are chiefly used to manage the hypertensive component of the syndrome. However, recent studies have shown that these drugs may have a role in the non hypertensive aspects of the syndrome as well. AIM To evaluate the therapeutic effect of enalapril on total body weight, random blood glucose and serum lipid profile in a rodent model of olanzapine induced MS. MATERIALS AND METHODS Three different dosages (1 mg/kg/day, 10 mg/kg/day and 20 mg/kg/day) of oral enalapril were administered (for three weeks) in albino wistar rats, which received prior intra peritoneal olanzapine (for three weeks), and compared against control (normal saline) and standard (olanzapine only and enalapril only) groups. Parameters like total body weight, random blood glucose and serum lipid profile were measured at baseline, at three weeks and at six weeks. RESULTS Enalapril at 20 mg/kg/day was found to be effective in reversing the weight gain, hyperglycaemia and hypercholesterolaemia, without any changes in triglycerides, High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL). 10 mg/kg/day of enalapril prevented any further rise in body weight, blood glucose, total cholesterol and serum triglycerides, after olanzapine was stopped. 1 mg/kg/day of enalapril was ineffective. CONCLUSION High dose of enalapril may be considered as a component of therapeutic regimens to combat weight gain, hyperglycaemia and dyslipidaemia seen in MS, in addition to its antihypertensive utility. Further rodent and clinical studies may be required to ascertain the same.

A Case of Accidental Formic Acid Poisoning

Formic acid is a commonly available compound, available commercially for the purpose of coagulating rubber. It is a highly corrosive agent. Consumption of this pungent liquid has resulted in dire consequences, based on the available literature. There have been a few reports of accidental/suicidal consumption of formic acid in the past. This is one such case report of an accidental poisoning with formic acid, with successful management and recovery.

Cefoperazone: A Rare Cause of Thrombocytopenia

Beta lactam antibiotics are one of the most commonly prescribed antibiotic drug classes in medical practice. Cephalosporins differ from other beta lactam antibiotics in both their structure and spectrum of action. Beta lactam antibiotics, in general, may cause platelet deficiency owing to their interference with normal platelet function. Cefoperazone, belonging to the group of 3rd generation cephalosporins, has been reported to cause hypoprothrombinemia and hence, bleeding manifestations. However, it is not known to alter platelet function and count at the routinely used therapeutic doses. This case report highlights a rare case of cefoperazone-induced thrombocytopenia.