Sodium valproate is a commonly used antiepileptic drug (AED) for control of a broad range of seizures. Adverse drug reactions (ADR) due to sodium valproate range from sedation to nausea, vomiting, weight gain, idiosyncratic adverse effects like hepatotoxicity and life threatening conditions like pancreatitis. We present a case of sodium valproate induced enuresis in child. This ADR of valproate is an underreported ADR and requires special attention of pediatricians as it can interfere with the further treatment of the disease.
Objective: To assess the prescription pattern & Adverse Drug Reaction (ADR)) profile of Antiepileptic drug (AEDs) therapy in children of rural population. Materials and Methods: This prospective open label, observational study was carried out over one and half year duration on 142 newly diagnosed epileptic children below 12 yrs age receiving AEDs in pediatric department in a tertiary care rural hospital. Follow up was done every month for 6 months duration. Prescription pattern and incidence, causality and severity of ADRs due to AEDs were assessed at each visit. Results: Out of 142 patients on AEDs, 97.2% patients were on mono-therapy and 2.8% patients were on poly-therapy. Valproic acid was the most commonly prescribed drug (58) and Lorazepam was the least prescribed drug (1). Central nervous system related ADRs (50%) were most common followed by gastrointestinal system (14.7%). Sedation and gastrointestinal distress were among the most frequently reported ADRs and29.4% of probable category while 70.5% ADR's were possible category. 72% ADRs were mild, 22% were moderate and 5.8% of ADRs were severe. Conclusions: Children receiving AEDs should be closely monitored for the development of any ADRs, especially related to their behavior and cognition. as it can influence their learning and memory, Active surveillance can help in knowing the exact incidence of ADRs. This study emphasizes on the role of patient / parent education and importance of health care professionals in pharmacovigilance studies.
SummaryBackground: Many disorders can occur during pregnancy, labour, postpartum. Some women become normal, some seriously ill and some die. It is essential to know disorders' burden.Objectives: of present study were to know burden of disorders, which cause severe illnesses, during pregnancy, birth, post birth, profile of such cases.Material Methods: Analysis of profile of cases admitted over 5 years at rural referral institute was done. Criteria was admission to intensive care area with system for ventilatory support in obstetric department.Results: Majority of women were of 20-29 years, mean age 24 years, 2.6% adolescents. 39.7% were rural, 36.2% urban, 24.1% from urban settlements with low resources, 69.7% were antenatal, 18.5% intranatal, 11.8% postnatal. Sixty two percent were nullipara. Severe morbidity had 'U' curve in relation to age. Hypertensive disorders (53% of severely ill cases) were commonest basic disorder, next were medical disorders (26%)(severe anaemia, heart disease, malaria, infective hepatitis, pneumonia).Others were, late haemorrhage 12%, (antepartum and postpartum haemorrhage), early pregnancy complications(abortions, ectopic pregnancy, hydatiform mole) 5%, puerperal sepsis 2%, acute fatty liver of pregnancy 1.2%, rupture uterus 0.8%. Conclusion:Severe maternal morbidity with reference to age followed a 'U' curve. More cases were primigravida. Highest ratio was of cases from low resource urban settlements. Majority of severely ill cases were antenatal, some postnatal too. Commonest primary cause of severe illness was hypertensive disorders, followed by medical disorders, haemorrhage, complications of early pregnancy, puerperal sepsis, acute fatty liver of pregnancy, rupture uterus in descending order. Quality maternal care, at primary level, timely referral, quality maternal care at referral is essential. Also a lot of research is needed for prevention of some disorders, their severity.
Background This study examines the concept that elevated homocysteine levels are associated with sudden infant death syndrome. The study aimed to determine whether elevated serum homocysteine levels were related with an increased risk of iatrogenic stillbirths. Method In this retrospective case-control study, 100 women who had stillbirths for unknown reasons and 100 who had normal pregnancies served as cases and controls, respectively. The serum homocysteine levels were evaluated using enzyme assays, and other pertinent clinical and demographic information was also gathered. Result Significantly differing homocysteine levels were found between the case group (mean ± standard deviation: 12.5 ±2.1 units) and the control group (mean± standard deviation: 8.3± 1.5 units; p0.001). After adjusting for potential confounding factors Conclusion The results suggest that elevated serum homocysteine levels may be a biomarker for the unknown risk of stillbirth in women. Further research is required into potential treatments and prevention strategies for hyperhomocysteinemia-related pregnancy complications. This study supports the theory that elevated homocysteine levels induce sudden infant death syndrome. Significant therapeutic implications result from these findings, as systematic homocysteine monitoring throughout pregnancy may help identify high-risk patients and implement appropriate therapies to reduce stillbirths. Recommendation There is a need for additional research to validate these findings and investigate methods to reduce maternal homocysteine levels.uch as maternal age, smoking status, and gestational age, logistic regression analysis revealed a important association between elevated serum homocysteine levels and unexplained stillbirths (odds ratio: 2.90, 95% confidence interval: 1.70-4
Objective: To determine the frequency, severity and morphological pattern of ACDRs and their correlation with various risk factors. Methodology: A prospective, observational study was conducted in Muzaffarnagar Medical College & hospital, Muzaffarnagar Uttar Pradesh from Feb 2013 to Jan 2014 for one year. All patients of either sex and all age groups with suspected ACDRs attending/referred to Dermatology department were included. Results: Total of 90 cases were reported over a period of one year. ACDRs were observed with 0.5% incidence of patients attending OPD. ACDRs were commonly seen in adult age group (mean age 36.93 yrs) and have 3 or more drugs prescribed with equal gender distribution. As per Naranjo Algorithm, maximum number of ACDRs were of Possible type (74%), while 23 cases were of "Probable" category with female and male preponderance respectively. 71 of ACDRs were Moderate in severity (79%) followed by 11% of mild and 10% of severe category. Most common clinical pattern was Urticaria with 32 cases followed by 24 cases of Maculopapular Eruptions, 9 cases of Acneiform eruptions and 8 of fixed drug reactions and SJ Syndrome. Commonest Drug groups causing ACDRs were Antibiotics (38%) and Antiepileptics (30%).This was followed by NSAIDs induced ACDRs (9%). Phenytoin was the most common drug causing 12 ACDRs followed by 6 with Cabamazipine and Ceftrixone each and 5 cases with ATT. Conclusion: Incidence was low as compare to global incidence; better steps must be needed to strengthen the activity of pharmacovigilance in this state of the country.
Background: Pain and pyrexia are the warning signals, primarily protective in nature, that cause discomfort and suffering and may even be unbearable and incapacitating. The modern drugs (like opioids, NSAIDs, corticosteroids) currently used for the management of pain, fever and inflammatory conditions, present with many known adverse effects. Tinospora cordifolia known as Giloe, widely used in folk medicine due to its property to cure a number of diseases. Hence the present study was undertaken to explore the analgesic activity of water-soluble extract of stem of T. cordifolia in albino rats in experimentally induced pain.Methods: Present study was done in the department of pharmacology, albino rats were used to study the analgesic activity of T. cordifolia aqueous extract at the dose of 1.25g/kg,2.5g/kg and 5g/kg p.o. Various methods like Eddy’s hot plate, tail flick test and acetic acid induced writhing were used for the anti- nociceptive study.Results: In Eddy’s hot plate and tail flick test an increase in reaction time was observed with peak effect at 90min. Results were similar to the standard drug Tramadol in acetic acid induced writhing increase in time of onset, decrease in number and duration of writhing was observed.Conclusions: Aqueous extract of T. cordifolia was effective in all the three models of pain suggesting its possible action by central and peripheral mechanisms. Activity of T. cordifolia can be attributed to various phytoconstituents viz. protoberberine alkaloids, terpenoids, glycosides and polysaccharides. It can be developed as potent analgesic agent in future.
Background:This study aimed to determine whether severe pre-eclampsia is associated with an increased risk of birth-related complications based on serum lactate levels determined at hospital admission and to find potential markers that could be used to predict the occurrence of complications in pregnant women previously diagnosed with severe pre-eclampsia. Methodology:Patients diagnosed with severe pre-eclampsia in the Indian state of Bihar between January 1, 2022, and December 31, 2022, were subjected to a retrospective analysis of hospital admission information. The patients who participated in this study were female. At the time of admittance, a record of the mother's difficulties and a serum lactate analysis were obtained. The nature of the relationship between maternal issues and serum lactate levels was investigated using statistical methods such as association and logistic regression. Results:Seventy-five percent of the 200 female participants in the study encountered at least one problem while hospitalised. 45% of the patients developed eclampsia, 32% developed acute renal impairment, and 24% developed disseminated intravascular coagulation. Serum lactate levels and obstetric complications were found to have a significant positive correlation (r = 0.72, p 0.001 for both statements). A logistic regression analysis revealed an association between an increased risk of maternal difficulties and a higher odds ratio per unit increase in lactate level of 1.58 (95% confidence interval: 1.31-1.80, p 0.001). Conclusion:This study indicated severe pre-eclampsia admissions with high serum lactate levels were associated with maternal problems. Serum lactate levels may indicate complications in severe pre-eclampsia. Early detection of elevated lactate levels helps clinicians monitor high-risk patients for consequences. Recommendation:Further prospective research is needed to confirm these findings and determine the best lactate threshold for predicting severe pre-eclampsia problems.
OBJECTIVE: Knowing about complications, care sought by women is essential for understanding the risks, services, programs, and policies for abortion care. This study aimed to know the magnitude of abortion complications and to define the care sought by rural tribal women. STUDY DESIGN: Rural community-based cross-sectional study was carried out in villages near Sewagram Wardha and Melghat, Amravati, Maharashtra, India. RESULTS: Spontaneous abortions rate was 3.30% in villages around Sewagram and 0.32% in villages of Melghat. The reported complications rate for induced abortions was 1% in Sewagram villages and 0.1%in Melghat villages. In Sewagram villages, among 24 (4.3%) women who had complications with spontaneous abortions, the reported complications were: vaginal bleeding in 33.3% (1.4% of all spontaneous abortions), abdominal pain in 33.3%, weakness in 29.16% (1.2% all spontaneous abortions), backache in16.6% (0.7%of spontaneous abortions), fever in 12.5%(0.5% of spontaneous abortions), excessive vaginal discharge in 8.33% (0.3% of spontaneous abortions), and other complications in 8.33% (0.36% of spontaneous abortions) women. Among 7 women (3.9% of all 177), who reported complications after induced abortions, 57.1% (2.2% of all induced abortions) reported, vaginal bleeding and 28.5% (1.1% of induced abortions) reported abdominal pain. In Melghat villages only 4 women reported complications with spontaneous abortions (0.32% spontaneous abortions): two (0.16% spontaneous abortions) reported abdominal pain, one (0.08% spontaneous abortions) reported vaginal bleeding, and one (0.08% of spontaneous abortions) reported backache. In villages of Melghat 2 women (3.7%) out of 27 induced abortions cases had complications: one had vaginal bleeding, discharge, pain, weakness, another only vaginal bleeding. In villages of Melghat 2 of the total 6 sought health facility care, however, no one reported to specialists despite complications. Nevertheless, there was neither abortion-related mortality nor near-miss morbidity or severe morbidity during the same duration. CONCLUSION: Research is needed about traditional therapies, reverse pharmacology, socio-behavioral issues in addition to creating awareness in women about abortion complications, long-term squeal, and the necessity of care-seeking.
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