Some unusual and severe forms of adverse drug reactions: a call for setting adverse drug reaction monitoring centres

Thirty four patients aged 14 to 65 years (18 males and 16 females) admitted to the University Hospital with various unusual and severe forms of adverse drug reactions were studied. It comprised of toxic epidermal necrolysis in 8 patients, systemic vasculitis in 7 of which 3 patients had gangrene of fingers and/or toes, severe erosive gastritis in 9 patients, Stevens-Johnson syndrome in 7 patients, thrombocytopenic purpura in 2 patients and generalised convulsions in 1 patient. Various drugs responsible for causing these adverse drug reactions included antibacterials, antimalarials, anticonvulsants, antituberculars and nonsteroidal anti-inflammatory drugs. Most of the patients recovered. However, 5 of the 8 patients having toxic epidermal necrolysis died of which 2 patients had developed tetanus as a preterminal event. In view of ongoing addition of newer drugs to the therapeutic armamentarium and an increasing incidence of various unusual and severe forms of adverse drug reactions, it is our contention that a separate adverse drug reaction monitoring cell should be established in every hospital setting.     

A giant vascular hamartoma of the breast in a child

Vascular tumors of the breast are uncommon. Perilobular hemangiomas, the commonest histologic subtype of breast hemangiomas, constitute majority of microscopic, vascular mammary tumors. Macroscopic hemangiomas and vascular hamartomas of the breast are distinctly rare. We describe a giant, vascular hamartoma of the right breast in a five year old girl and discuss pertinent literature.     

A survey of technical considerations in the construction of intestinal stomas

Reported complications rates for the construction of intestinal stomas are high. Many of these complications result from improper construction, improper location, or other technical errors. In order to sample the techniques of stoma construction currently in use, a survey was conducted at the 69th Annual Clinical Congress of the American College of Surgeons in Atlanta in conjunction with our scientific exhibit "Complications of Intestinal Stomas." A total of 245 surgeons completed the questionnaire with a mean age of 47.8 years. The routine use of fascial-seromuscular tacking sutures and primary maturation of a loop colostomy in the presence of distal obstruction were among the most controversial technical points considered. Many other subtle but important principles of stoma construction were also discussed. In addition, the authors contend that many of the techniques currently in use result from an underemphasis on the importance of proper stoma construction in many surgical training programs.     

Liver profile in COVID-19: a meta-analysis

Journal of Public Health - Few studies have been performed to investigate multiorgan failure occurring with extrapulmonary symptoms like diarrhea, anorexia, and vomiting. There has been no attempt...     

Direct versus indirect transfer for traumatic brain injury to James Cook University Hospital: a retrospective study

IntroductionPatients with traumatic brain injury are referred to the neurosurgical unit at James Cook University Hospital, Middlesbrough, either from local accident and emergency departments (direct transfer from the scene) or from other hospitals (indirect transfer). This study looked at the outcome in both groups.Material and methodsThis was a retrospective observational study using trauma audit research network data for patients treated for traumatic brain injury at the neurosurgery department at the neurosurgical unit at James Cook University Hospital.ResultsA total of 356 patients with traumatic brain injury were admitted under the care of neurosurgeons; 143 (40%) of these patients had a neurosurgical procedure. Of the patients undergoing a neurological procedure, 111 patients were transferred directly while 32 were indirect transfers; 213 patients were managed conservatively. Of those managed conservatively, 165 were transferred directly while 48 were indirect transfers.We compared the length of hospital stay and Glasgow Outcome Scale score for the patients based on whether they were conservatively managed or required surgery in the direct and indirect transfer groups. The difference in the length of stay in the surgical and conservative groups following direct and indirect transfer was insignificant (p = 0.07). The time to the operation in direct and indirect transfer was also not statistically significant (p = 0.06).ConclusionPatients are as safe, if not safer, by reaching the nearest trauma unit with facilities for resuscitation and imaging.     

Enolase 1 of Candida albicans binds human CD4+ T cells and modulates naïve and memory responses

To obtain a better understanding of the biology behind life-threatening fungal infections caused by Candida albicans, we recently conducted an in silico screening for fungal and host protein interaction partners. We report here that the extracellular domain of human CD4 binds to the moonlighting protein enolase 1 (Eno1) of C. albicans as predicted bioinformatically. By using different anti-CD4 monoclonal antibodies, we determined that C. albicans Eno1 (CaEno1) primarily binds to the extracellular domain 3 of CD4. Functionally, we observed that CaEno1 binding to CD4 activated lymphocyte-specific protein tyrosine kinase (LCK), which was also the case for anti-CD4 monoclonal antibodies tested in parallel. CaEno1 binding to naïve human CD4⁺ T cells skewed cytokine secretion toward a Th2 profile indicative of poor fungal control. Moreover, CaEno1 inhibited human memory CD4⁺ T-cell recall responses. Therapeutically, CD4⁺ T cells transduced with a p41/Crf1-specific T-cell receptor developed for adoptive T-cell therapy were not inhibited by CaEno1 in vitro. Together, the interaction of human CD4⁺ T cells with CaEno1 modulated host CD4⁺ T-cell responses in favor of the fungus. Thus, CaEno1 mediates not only immune evasion through its interference with complement regulators but also through the direct modulation of CD4⁺ T-cell responses.     

Public perceptions of a rural emergency medical services system

INTRODUCTION: To determine the awareness of citizens and physicians concerning the capabilities of a rural emergency medical services (EMS) system. HYPOTHESIS: Citizens and physicians are unaware of the capabilities of the EMS system. METHODS: Residents were selected randomly from the local telephone directory and asked a series of structured questions about their EMS agency. A written survey was distributed to area physicians. Chi-square analysis was used to compare the proportion of respondents who knew the available interventions in their community with the proportion of those who did not. Statistical significance was inferred at p < 0.01. RESULTS: A total of 49% of the citizens were able to identify available skills, and 41.4% of the physicians were able to identify available skills. Physicians were less likely than were the citizens to be able to identify the skills performed by each provider (p < 0.001). CONCLUSION: This study indicates that both physicians and the lay public have little understanding of the capabilities of their EMS system.     

Postequatorial horizontal rectus recession in the management of congenital nystagmus

Postequatorial (12 mm) recession of all four horizontal recti was done in nine patients with congenital nystagmus. Fifteen of 18 eyes showed decreased amplitude of nystagmus while 12 eyes also showed an increase in visual acuity. Functionally, significant limitation of ocular motility was not encountered despite unconventionally large recessions.     

Retroperitonial, teratoma as fetus in fetu--a case report

We report a rare case of Retroperitonial teratoma containing Axial Skeleton long bone. Jaw, pelvis & scapula in a 27 yrs old male. Aberration in monozygotic twinning may rarely present as Fetus in Fetu. Rarer is presentation in Adult.