Sushil Kumar Varma

Diclofenac induced acute renal failure in a decompensated elderly patient

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed drugs in post-operative period worldwide. Their nephrotoxic effects are documented and accounts for around 15.5% of all cases of drug induced renal failure. Acute renal failure following NSAIDs usage are reported in volume depleted patients which is further precipitated by co-morbid conditions like hypertension and various drug interactions that increase plasma level of NSAIDs and worsens the condition. This highlights the importance of hydration in post-operative period as well as assessment of co-morbid conditions before administration of NSAIDs to prevent acute renal failure.

Levofloxacin and furazolidone induced toxic epidermal necrosis.

Toxic epidermal necrolysis (TEN), also known as Lyells syndrome, is a severe cutaneous drug reaction with a high mortality. Immune response is the possible cause in its pathogenesis. Levofloxacin is one of the most commonly used quinolones and has been reported to cause of TEN. On the other hand, furazolidone was proposed to augment the action of immediate hypersensitivity of levofloxacin by its cytotoxic effect and by the generation of free radicals. Here, we present a case of TEN where, levofloxacin and furazolidone were the probable cause of these adverse drug reactions.

Magneto-convective and radiation absorption fluid flow past an exponentially accelerated vertical porous plate with variable temperature and concentration

A numerical analysis is carried out for an unsteady free convective, radiative, chemically reactive, radiation absorption, viscous, incompressible and electrically conducting fluid past an exponentially accelerated vertical porous plate in the presence of sink. The set of non-dimensional governing equations along with boundary conditions are solved numerically. The effect of various physical parameters on flow quantities are studied with the help of graphs. For the physical interest, the variations in skin friction, Nusselt number and Sherwood number are also studied through tables.

Fixed drug eruption due to fixed dose combination: A novel case

Fixed drug eruption is a well documented drug side effect and accounts for about 5-10% of cutaneous drug reactions. We describe a case of fixed drug eruption on lips and perioral region following consumption of a fixed dose combination in acute gastroenteritis. Fixed dose combination of Ofloxacin and Ornidazole is one of the most commonly used medications for acute gastroenteritis. Fixed drug reaction caused in this case was red, raised macule, which turned into blister and later followed by post-inflammatory hyperpigmentation. Delayed type IV hypersensitivity reaction is most probably the reason for the mechanism of fixed drug reaction.

Zotepine-induced convulsive seizures in a chronic case of treatment resistant paranoid schizophrenia

Adverse effects to antipsychotics are varied, frequently intolerable, often serious and sometimes fatal in clinical practice. Seizures are one of these adverse effects. Almost all first and second generation antipsychotics elicit dose-dependent lowering of seizure threshold, indicating increased seizure risk at higher drug dosages. The adverse event of zotepine induced seizure is published in few case reports. We report the occurrence of myoclonic seizure progressing to generalized tonic-clonic seizures with zotepine along with clear temporal association of dose dependent modulation evident in this case.

Hypersensitivity reactions to intravenous ferric carboxymaltose in a patient with iron deficiency anemia: a rare case report

Therapy for iron deficiency anemia (IDA) includes repletion of iron stores and, appropriate, correction of the underlying cause of iron loss. Oral iron is usually the appropriate initial treatment for anemia due to absolute iron deficiency, but a significant proportion of patients will not respond adequately. This may be due to poor compliance secondary to gastrointestinal side effects which include nausea, vomiting, and cramping. Also oral iron may be inappropriate in conditions of severe IDA in which oral iron may not be able to replenish iron stores rapidly enough to avoid blood transfusion. Intravenous (I.V) iron, is the preferred therapy for such patients. However, earlier-generation parenteral therapies have been associated with bioactive iron reactions characterized by ABSTRACT

A Cross-Sectional study of Drug Prescription Pattern in Urticaria patients attending Dermatology & Venereology Department in a Rural Tertiary Care Teaching Hospital

Background: Urticaria is a very common skin condition characterized by recurrent, pruritic (itchy), pink-to-red edematous (swollen) lesions that often have pale centers (wheals). Histamine is the main mediator of urticaria and H1 antihistamines represent the initial and mainstay treatment of urticaria. The newer second generation H1 antihistamines are preferred over the older first generation H1 antihistamines as the initial choice of therapy due to its less sedating and less cholinergic side effects. Although numerous treatments are available for urticaria, there is little information about the prescription pattern for the treatment of urticaria. Hence this study was conducted. Methods: This was a cross-sectional study conducted on 100 newly diagnosed and untreated patients of urticaria who attended Dermatology and Venereology outpatient department of a rural tertiary care teaching hospital. The prescriptions were collected for the duration of 18 months and details of prescription (particulars of the patient, diagnosis, name of the drugs, dose, route of administration, total duration etc.) were collected in case record forms. Results: Majority of the patients (34) belonged to the age group of 21-35years. The mean age of the patients was 34.35±15.26 years. Most of the patients were treated with oral antihistamines. Among oral antihistamines, most of the patients received 2nd generation antihistamines either as monotherapy or in combination with 1st generation antihistamines and H2 blockers. Among 2nd generation antihistamines, fexofenadine was prescribed highest either as monotherapy or in combination with levocetirizine and cetirizine. Patients with more severe form of disease were treated with combination of oral and parenteral therapy. Further long term study is required for proper assessment of prescription pattern in urticaria patients. Conclusion: Most of the patients with urticaria can be effectively treated with Oral antihistaminic medication, and additional parenteral therapy may be required only for severe cases of acute on chronic urticaria. Keywords: Urticaria, Oral medication, Parenteral therapy, Antihistamines

Drug-interaction-induced hemodynamically mediated acute renal failure in postsurgical patient

Acute renal failure is a life threatening condition. Nonsteroidal antiinflammatory drugs (NSAIDs) and cephalosporins are widely used postoperative drugs. NSAID-induced acute renal failure has been reported in the past. In this case, drug interaction and decompensated state of the patient precipitate the condition. NSAIDs inhibit prostaglandins synthesis and thus aggravate ischemia to the kidney that is already facing volume crisis due to surgery. Due to renal dysfunction, plasma ceftriaxone level increases due to decrease clearance and it also acts as nephrotoxic by unknown mechanism. On the other hand, ceftriaxone on its interaction with diclofenac for renal tubular clearance also increases the level of diclofenac and thus further aggravate the ischemia. It is a reversible condition with excluding diclofenac from the treatment regimen and giving adequate hydration to the patient. This highlights the importance of hydration and knowledge of drugs interactions in a postsurgical patient.

Bleomycin-induced flagellate hyperpigmentation: Clinical Image

Flagellate hyperpigmentation is a unique complication of systemic bleomycin sulfate therapy. It has an onset anywhere between 1 day and several months after administration for various indications and these eruptions are usually dose-dependent. The dose of bleomycin required to produce such an effect is usually more than 100 U but it can also occur at lower doses also. Herewith, we describe a case with clinical image of ovarian dysgerminoma that presented with typical linear and streaked pigmentation following a very low dose (30 U) of systemic bleomycin therapy which appeared within 24 h of administration and increased gradually after subsequent doses.