A 22-year-old male who presented with complaints of swelling in the right side of neck and cough with mucoid expectoration was diagnosed to have Hodgkin's lymphoma, stage 2B and was started on 6 cycles of ABVD (Adriamycin, Bleomycin, Vincristine, Dacarbazine) regimen from January 2004 to June 2004, followed by IFRT (Involved Field Radiotherapy). Patient was in complete remission post radiotherapy and was kept under regular follow up.After 10 years, he again presented with right inguinal lymphadenopathy and biopsy was suggestive of Hodgkin's lymphoma. Staging evaluation showed involvement of bone marrow and hence was diagnosed as having relapsed Hodgkin's lymphoma stage 4A. He was started on COPP/ABV regimen (Cyclophosphamide, Oncovin, Prednisone, Procarbazine, Adriamycin, Bleomycin, Vinblastine) with the dose of the offending drug Bleomycin being 15 IU in 100ml 0.9% normal saline. Two weeks after the last chemotherapy cycle 4, patient presented with complaints of breathlessness on exertion which was insidious and progressive and hence was admitted in intensive care unit. High Resolution Computed Tomography (HRCT) thorax showed septal thickening with interspersed areas of ground glass attenuation predominantly in basal and pleural aspects with an associated impression of interstitial lung disease [Table/ Fig-1]. In view of above presentation and computed tomography (CT) findings and drop in saturation, patient was started on non-invasive ventilation, steroids ABSTRACTHodgkin's lymphoma is one of the curable cancers and the standard treatment regimen involves combination chemotherapy involving bleomycin. One of the fatal side effect of bleomycin is pulmonary toxicity. Here we present three cases of Hodgkin's lymphoma treated with ABVD chemotherapy who had pulmonary toxicity. All three developed bleomycin induced pulmonary toxicity in the form of pulmonary fibrosis during treatment of the disease. Mode of treatment, severity of the condition and the treatment outcome varied among the three. Two recovered following treatment and one patient died due to irreversible pulmonary damage. Causality assessment using Naranjo's scale gave a score of 7 for case one and three and a score of 6 for case two, both indicating the adverse drug reaction to be a probable bleomycin induced Lung fibrosis.

Objective: Idiopathic thrombocytopenic purpura (ITP) is an immuunological disorder characterized by the production of antibodies targeted toward platelets. Corticosteroids and intravenous immunoglobulins were the mainstay of immediate treatment after 1950s with splenectomy for more than 100 years remains the only option with curative potential. The aim of this study was to analyze the incidence, age and sex distribution among adults, various modes of presentation, correlation between thrombocytopenia and bleeding manifestations, and various modalities of treatment of ITP in a tertiary care hospital in India.. Methods:A prospective study included 40 cases of ITP admitted to Kasturba Medical College Hospital, Manipal, from November 2005 to March 2007. Patients above 14 years of age admitted with thrombocytopenia in this institution were screened based on detailed clinical history, physical examination, and laboratory investigations. Results:The maximum incidence was in the 3 rd decade of life accounting for 27.5% of the patients. Male-to-female ratio was 1:1.9 with female preponderance. Females in the 3 rd decade had maximum incidence while males in the 4 th decade have maximum incidence. The majority (12, 85.71%) of male patients and 15 (57.69%) female patients developed purpura during the course of disease. The mean count was 17.8×10 Among the remaining patients, 3 (7.5%) had a relapse of symptoms within next 6 months and responded to repeat prednisolone started at 1 mg/kg. 2 (5%) patients were given steroids tapering dose with IV immune globulins for initial 5 days as therapy to which they responded. Conclusion:Idiopathic thrombocytopenia is 1.9 times more common in females than males. Most common presentation is bleeding spots over body. Bleeding manifestations are more common with thrombocytopenia <30000/mm 3 . Corticosteroids are the mainstay in treatment. Complete remission is seen in up to 57.5% of the patients. Splenectomy is the second modality of treatment in ITP. Complete and sustained remission is seen 75% of patients.

Background/Aims: Physical exhaustion is not always peripheral, and it is the brain that causes the sensation of fatigue either due to decrease of metabolic resources or due to central activation process that regulates attention and performance. This study was undertaken to observe the variations in event-related potentials (ERPs) and cognitive performance after an exhausting physical exercise. Methods: A total of 60 healthy young adult subjects were included in the study. The study was conducted in 2 phases with at least a week gap between the phases. The participants answered a Multidimensional Fatigue Inventory (MFI-20) questionnaire before and after trials in each phase to measure the induced physical exhaustion. In phase I (control trial), the ERP data were processed using P300, Standard auditory “oddball paradigm,” on computerized evoked potential recorder (RMS EMG MK-2) using 10/20 system to know the engagement of attention after which participants were given to perform cognitive tasks such as “Stroop Test, Trial Making Test and Mini Mental State Examination.” In Phase II (exercise trial), the participants were instructed to cycle as hard as they could, till they could not continue anymore, which was followed by recording of P300-evoked potentials and performance of cognitive tasks as in Phase I. Paired t test was used to compare between any dependent variables. Results: Fatigue-related subjective measures (MFI-20) showed that both mental and physical exhaustion were significantly greater in the exercise-involved cognitive trial than in the control trial. Lower P300 latencies reflect faster reaction time; however, their response accuracies were poorer resulting in poorer cognitive performances. Participants subjected to control trial performed better in terms of higher percentage accuracy but with slow reaction time. Conclusion: The participants experienced more fatigue physically and mentally during the exercise that involved cognitive tasks. An apparent decrease in attention based on decreased percentage accuracy of response was evident, implying that fatigue, performance, and attention are interdependent.

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Penfluridol is a long acting oral antipsychotic agent taken once a week for the treatment of schizophrenia and other psychotic disorders. The weekly dosage regimen of the drug makes it an ideal drug in non-compliant patients, which is commonly seen in 50-75% of psychotic disorder patients. Better compliance may be associated with fewer relapses, better quality of life, fewer crises and less or shorter hospitalizations, leading to lower costs. As a part of pharmacovigilance program of India, we hereby report a case of Penfluridol induced extrapyramidal symptoms in a patient with refractory schizophrenia who developed EPS even at the least possible dose of the drug. Relevant data was collected from case record as per Central Drug Standard Control Organisation form and causality, severity and preventability assessment was done as per Naranjo's, Hartwigs and Schumock and Thornton scales respectively.

A 48-year-old thin-built (BMI of 18.2 kg/sq.m.) female was admitted with history of recurrent episodes of cough with expectoration for the past 10 years, dyspnoea and fatiguability for the past 5 years, and pedal oedema for the past 10 days. There was no history of fever, postnasal drip, gastro-oesophageal reflux, anorexia, weight loss, chest pain, paroxysmal nocturnal dyspnoea, orthopnoea or palpitations. Also, there was no history of tuberculosis in the past. The patient was not a smoker.On general examination, her vitals were stable. The patient had bilateral pitting pedal oedema, coarse crepitations in the right mammary area, loud S2 and ejection systolic murmur in the pulmonary area.Basic laboratory evaluation showed complete blood profile, renal and liver functions to be normal. Chest X-ray showed evidence of right middle lobe bronchiectasis [Table/ Fig-1]. Sputum culture showed no growth, and stain for acid-fast bacilli (AFB) was negative. The patient was also negative for HIV and hepatitis serological tests. Pulmonary function test showed evidence of small airway obstruction. Bronchoscopy findings were normal, except for secretions in the right middle lobe bronchus.

Many drugs are used in the treatment of multiple myeloma but thalidomide, lenalidomide, bortezomib, and dexamethasone and their combination remain the main stay of treatment. The molecular formula of bortezomib is C 19 H 25 BN 4 O 4 and its chemical name is (3-methyl-1-(3-phenyl-2-pyrazin-2-ylcarbonylamino-propanoyl) amino-butyl) boronic acid. Mechanisms by which it acts is usually by 26 SProteasome inhibition leading to degradation of anti-apoptotic proteins. Bortezomib is known to cause many side effects. Hence, we report a rare case of bortezomib-induced subconjunctival hemorrhage in our tertiary care hospital.