Deaths following methotrexate overdoses by medical staff

Methotrexate (MTX) is an effective disease modifying antirheumatic drug (DMARD) with a relatively safe profile, and it is widely used to treat neoplastic diseases and dermatologic and rheumatologic disorders. As indications for use of MTX increase, more accidental overdoses are noted to occur. Typical problems include deficiencies in labeling, instructions, or packaging, as well as erroneous use. We describe 5 fatal cases of repeated oral overdose of MTX prescribed by physicians in the treatment of rheumatoid arthritis to focus attention on the design of the underlying system and the organizational practices as sources of problems.     

Diabetic foot ulcers—where do we stand microbiologically?

Foot ulcers in diabetics are prone to polymicrobial infection by bacteria as well as fungi. Infection retards healing of ulcers leading to gangrene and ultimately, amputation of the extremity. The choice of empiric antibiotic therapy is extrapolated from results of studies from other regions, western literature or infection at other sites which may be inappropriate. Thus, a study was conducted to determine microbial aetiology of diabetic foot ulcers and their susceptibility patterns. Pus aspirates or wound swabs were collected from foot ulcers of 70 diabetics at the time of admission and processed for isolation of bacteria (aerobic and anaerobic) and fungi according to standard protocols. Organisms were identified upto species level. Antimicrobial susceptibility testing was performed by Kirby Bauer disk diffusion method as per CLSI standards. One hundred forty-seven organisms were isolated from 70 specimens. Seventy-three percent showed polymicrobial growth. The proportion of Gram negative bacilli, Gram positive cocci, anaerobes and fungi were 57 %, 27 %, 4 % and 12 % respectively. Enterobacteriaceae were the predominant Gram negative bacilli and S.aureus, the predominant Gram positive cocci. Clostridium and Candida species were the commonest among anaerobes and fungi respectively. Twenty-three percent of S.aureus were MRSA and 23 % of Enterobacteriaceae were ESBL producers. Ps.aeruginosa strains demonstrated good susceptibility to antipseudomonal antimicrobials and 16.5 % strains were meropenem resistant. Due to the associated risk of increased morbidity and mortality in infected diabetic ulcers, the wide spectrum of organisms associated with it and their differing susceptibility profile, treatment should be individualised based on microbial culture and antimicrobial susceptibility results.     

RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020

International Journal of Diabetes in Developing Countries -     

Aneurysmal Bone Cyst of the Jaws: Clinicopathological Study

Aim

The aim of the present study was to analyze clinical, radiological and histopathological features of aneurysmal bone cysts (ABCs) of jaws.

Materials and Methods

Archival data from 2009 to 2012 present in the Oral Pathology Department was retrieved and clinicopathological features of all the cases which had been previously diagnosed as ABC were analyzed in detail.

Results

Seven cases ranging in age from 10 to 50 years were included, in which maximum (5/7) cases were below 20 years. Ratio of presentation of lesion in male to female and in maxilla to mandible was 3:6 and 1:6 respectively. Swelling and pain were the most common presenting features. Variable presentation of the lesion was observed radiographically; although multilocular, well defined, bone expansion and perforation were the most common observations. Histopathological analysis revealed association of one case with ossifying fibroma and two cases with trabecular variety of juvenile ossifying fibroma. Predominance of solid variety was noted and other features like stroma, giant cells, nature of blood vessels, bone destruction and perforation and presence of any osteoid or calcified material was also accounted for. The current study showed association of two cases with trabecular variety of juvenile ossifying fibroma, which is a rare finding.

Conclusion

ABCs of jaws, thus have varying patterns of presentation which are diagnostically challenging. A thorough examination of the incisional/excisional tissue is thus required to confirm the association with any other lesion which will affect the treatment plan for the patient.