Amiodarone-Induced Hyponatremia in An Elderly Patient: A Rare Case Report

Amiodarone is an antiarrhythmic drug belonging to Vaughan-Williams Class III with additional Class IV effects, which is known to cause many adverse drug reactions (ADRs) necessitating close monitoring. In about 20% of patients, their therapy is discontinued due to adverse effects such as hepatic impairment, thyroid dysfunction, and several pulmonary complications. Although dyselectrolytemia is a common adverse reaction reported with many cardiac medications, the incidence of hyponatremia associated with amiodarone intake is not reported widely in the literature. We are reporting a case of a 73-year-old female patient, with hypertension and ischemic heart disease (IHD) receiving oral amiodarone, presenting with severe hyponatremia, requiring recurrent hospitalization. Amiodarone was found to be responsible after evaluating for the possible causes of hyponatremia. As the incidence of amiodarone-associated hyponatremia is unknown, and not many cases are reported, this case report serves to sensitize the clinician to consider amiodarone-induced hyponatremia as one of the differential diagnoses in cases of unexplained hyponatremia.

Covishield vaccine experience in a health care setting

Background: SARS-CoV-2 pandemic has affected the whole world and India is one among the most affected countries. Vaccination is the most important tool to halt this pandemic and vaccine hesitancy unfortunately derails vaccination drive. Vaccine hesitancy among people is mainly due to concerns about vaccine safety! This study was done to assess adverse effects of Covishield vaccine among health care workers in a single health care organization.Methods: All the vaccine recipients were requested to answer a questionnaire with demographic details and various side effects following both the doses of Covishield vaccination.Results: About 665 employees responded to the questionnaire and the most common adverse reaction following Covishield vaccine was injection site pain, which was reported by 63% of vaccinees after first dose of vaccine.Conclusions: Covishield vaccine is relatively safe and incidence of major adverse events are rare following vaccination.

Effects of diabetes on the development of radiation pneumonitis

Radiation pneumonia (RP) is a common adverse reaction to radiation therapy in patients with chest tumors. Recent studies have shown that diabetes mellitus (DM), which can cause systemic multisystem damage, specifically targets lungs, and the incidence of RP in patients with a history of diabetes is higher than that in other patients with tumors who have undergone radiotherapy. DM is an important risk factor for RP in tumor patients undergoing RT, and patients with DM should be treated with caution. This article reviews research on the clinical aspects, as well as the mechanism, of the effects of diabetes on RP and suggests future research needed to reduce RP.

Apheresis-Adverse Events in Man and Machine Individualities

Adverse events due to platelet pheresis are not unheard of citrate related reactions being the most common. Most of these events are mild and self limiting. The current study describes adverse events in platelet pheresis using modern apheresis systems. This prospective study included 1455 platelet pheresis procedures done from July 2016 to December 2017. Procedures were performed on Hemonetics MCS+, Trima Accel and Cobe spectra cell separators. The endpoint of each procedure was a yield of 3 × 1011 platelets (PLTs) per unit. Donor adverse reaction if any was managed, reported, and documented. The median age of donors was 31 years with male to female ratio of 13:1. The median body surface area and body mass index were 1.64 m2 and 22.4 kg/m2, respectively. The mean PLT count of donors was 199.8 × 103/uL with a mean hemoglobin value of 13.6 g/dl. ACD infusion was significantly more in the Hemonetics MCS+, (P< 0.01). Donation time was least with the Trima compared to Hemonetics MCS+ (P< 0.01) and Cobe (P< 0.001). Total whole blood volume processed was higher in Hemonetics MCS+, (P< 0.01). Paresthesia due to citrate toxicity was the most common adverse reaction (65.3%), and vascular injury was observed in only five donors. The overall incidence of adverse reaction was 3.4%. Serious adverse events were not observed. The modern generation apheresis machines are more donors friendly and cause less adverse reactions compared to the older versions. Good donor screening, optimized donor physiognomic and hematological values and skilled operators are the key factors in reaction reduction by apheresis. Faridpur Med. Coll. J. Jan 2019;14(1): 27-30

Pollen-Food Allergy Syndrome: A not so Rare Disease in Childhood

Seasonal allergic rhinoconjunctivitis (SAR) affects millions of people worldwide, particularly in childhood and adolescence. Pollen food allergy syndrome (PFAS) is a common adverse reaction occurring few minutes after the consumption of vegetable foods in patients with pollen-induced SAR. PFAS has rarely been investigated in the pediatric population, as it has been mainly examined as an adult disease. Recent studies suggested that PFAS might be more frequent in childhood than previously recognized. The present review aims to give an overview of the epidemiology, pathophysiology, diagnosis, management and prognosis of PFAS in children with SAR-induced by pollens.

Adverse drug reactions of non-opioid and opioid analgesics reported to Croatian national authority from 2007 to 2014

<p><strong>Objective. </strong>Adverse drug reactions (ADRs) are commonly observed in the health services because of system weaknesses and individual errors. Analgesics are widely used and it can be expected that with the increased use one can expect increased number of ADRs of analgesics. The aim of this study was to analyze ADRs of non-opioid and opioid analgesics reported to the Croatian Agency for Medicinal Products and Medical Devices (HALMED) from 2007 to 2014. <strong>Methods. </strong>HALMED provided data on generic drug name, year of the ADR re- port, type of report, institution, reporting person, patient’s age, sex and ADR type. <strong>R</strong><strong>esults. </strong>In the analyzed period 796 ADRs of analgesics were reported, of which 367 (46%) were serious ADRs. Number of ADR reports was continuously increasing during the analyzed period. There were 20 analgesics that had ≥5 reports, making 597 (75%) of all ADR reports for analgesics. The most common adverse reaction re- ports of those 20 analgesics referred to individual drugs (n=16; 80%). Most of the ADR reports were filed by physicians (n=257; 43%), fol- lowed by pharmacists (n=252; 42%). Most side effects (n=572; 96%) were reported spontaneously through appropriate forms by patients or health professionals. ADRs were most commonly reported in wom- en (n=352; 59%) and most of them have occurred in adults (n=354; 59%). The most common ADRs of opioid and non-opioid analgesics have been reported on the skin and mucous membranes. Most serious ADRs were result of action of opioid analgesics. <strong>C</strong><strong>onclusion. </strong>Num- ber of ADR reports in Croatia is continuously increasing and a consid- erable number of them refers to serious ADRs. To keep better track of medications and ADRs it is necessary to educate and encourage health professionals and patients in reporting side effects</p>

Rate and Incidence of Adverse Reactions Associated With Ceftaroline Exposure: Importance of Cutaneous Manifestations

Background: Ceftaroline is a broad-spectrum, methicillin-resistant Staphylococcus aureus (MRSA)-active β-lactam approved for acute bacterial skin and skin structure infections (ABSSSIs) and community-acquired pneumonia. Because of its favorable spectrum and pharmacokinetics, ceftaroline is frequently utilized for infections such as osteomyelitis and endocarditis. Ceftaroline has been associated with neutropenia, but evaluation of other adverse events remains limited. Objective: To describe the rates and types of ceftaroline-associated adverse events and determine if patients’ baseline allergies affect the rates of an adverse event. Methods: A single-center, retrospective, observational analysis was conducted of all patients who received ceftaroline between November 4, 2011, and March 28, 2017, at the VA Saint Louis Health Care System. The Naranjo algorithm was utilized as a standardized method to evaluate likelihood that the adverse events were caused by ceftaroline therapy. Ceftaroline dose, duration, indication, and baseline allergy information were collected for all patients. Results: There were 75 patients who received 78 courses of ceftaroline identified for inclusion. The most common indications were osteomyelitis (51.3%) and ABSSSI (16.7%). Overall, 13/75 (17.3%) patients developed an adverse event, and 10/75 (13.3%) required discontinuation of ceftaroline. Rash was the most common adverse reaction and occurred in 7/75 (9.3%) patients, followed by neutropenia in 3/75 (4.0%) patients. There were no differences in baseline allergy characteristics between patients who experienced an adverse reaction to ceftaroline and those who did not. Conclusions: When compared with clinical trials, ceftaroline use appears to be associated with an increased rate of overall adverse events, which is driven by cutaneous reactions.

The Management of Anemia in Patients with HCV Treated with DAA

Hepatitis C virus (HCV) infection affects approximately 180 million people worldwide, which accounts for roughly 2% - 3% of the world’s population. Complications arising from chronic HCV infection include the development of cirrhosis, end stage liver disease, and hepatocellular carcinoma (HCV). Objective: The study analyses management of anemia with patients in administrating DAA treatment (Telaprevir for 12 weeks). Material and method: We conducted a study on 24 patients who have concluded the DAA administration period, being now in the period of finalization of standard therapy. Results: Anemia was the most common adverse reaction,17 patients ( 70.8% ),mild anemia 5 patients (20.8%),medium anemia 8 patients( 47% ), severe anemia 4 patients (24% ). Hemoglobin levels were recorded during therapy, mild Hgb (10.0-10.9g/dl),medium Hgb (9.99-9.9 g/dl),severe Hgb (7.0-8.9 g/dl ), and analyzed the management of anemia in these patients. In the first 3 months of therapy ( DAA+PegINF and RBV ), doses of DAA not changed. Any doses of RBV were not modified in patients with mild anemia, in patients with moderate anemia patients received lower doses of RBV, while those with severe anemia patients received lower doses of RBV and red blood cells mass. Conclusions: Anemia was common adverse reaction in patients with DAA compared with previous results, only PegINF end RBV. Lowering the dose of RBV in the first 3 months, when patients received DAA did not affect SVR.

Preventive Effects of a Chinese Herbal Formula, Shengjiang Xiexin Decoction, on Irinotecan-Induced Delayed-Onset Diarrhea in Rats

Irinotecan is a well-known chemotherapy drug for the treatment of various cancers. However, delayed-onset diarrhea is a common adverse reaction, limiting the application of the drug. The study presented was designed to evaluate the preventive effects of Shengjiang Xiexin decoction (SXD) on irinotecan-induced diarrhea and to explore the possible mechanisms of this action. We established a diarrhea rat model. The condition of the rats was observed. The proliferation and apoptosis of intestinal cells were measured using immunohistochemical assays and a caspase-3 activity assay, respectively. The expression of Lgr5 and CD44 staining were used to observe intestinal stem cells (ISCs). In addition, the activity ofβ-glucuronidase in the rats’ feces was measured. Our results showed that the number of proliferating intestinal cells in the SXD groups was obviously higher, while the activity of caspase-3 was lower. The expression of Lgr5 and the integrated option density (IOD) of CD44 stain were increased significantly by SXD. Additionally, SXD decreased the activity ofβ-glucuronidase after irinotecan administration. In conclusion, SXD exhibited preventive effects on irinotecan-induced diarrhea, and this action was associated with an inhibitory effect on intestinal apoptosis andβ-glucuronidase and a promotive effect on intestinal cell proliferation due to increased maintenance of ISCs.