A 22-year-old woman who was on sertraline 50 mg oral tablets once daily for 2 years for treatment of major depression took 30 such tablets (1500 mg) in a fit of rage, with a suicidal intent. She presented to the Emergency Department of a Tertiary Care Hospital with tachycardia, tachypnea, hypertension, tremors, agitation, confusion, vomiting, and hyperthermia. The patient was admitted and treated symptomatically, and sertraline therapy was discontinued. The unwanted effects subsided within 48 h and she recovered uneventfully within 72 h. This case report describes an unsuccessful attempt of suicide with sertraline overdose in a patient on long-term sertraline therapy and underlines the importance of close monitoring of such patients.
Sir,Fixed drug eruptions (FDEs) represent the most common cutaneous adverse drug reaction which is seen in the Indian scenario [1]. FDE is a distinctive drug-induced dermatosis with a characteristic recurrence at the same sites of the skin or mucous membrane, which occurs after repeated administrations of the causative drug [2].It was first described by Bourns in1889; five years later, it was termed by Brocq as "eruption erythemato-pigmentee fixee" [3]. The most common drugs which cause FDE are antibiotics, followed by nonsteroidal anti-inflammatory drugs (diclofenac, aspirin, naproxen, and ibuprofen) [2]. Fluconazole is one of the most common drugs which is used in dermatology practice.We are reporting an FDE which occurred secondary to fluconazole intake. A 22-year-old woman received five doses of fluconazole (150 mg) orally, once a month, for recurrent vaginal candidiasis. A red erythematous macule which measured approximately 2 (two) centimetres in diameter, with well-defined and raised margins, appeared on the medial side of her right popliteal fossa, that was associated with burning and itching, four hours after she had taken her second dose of fluconazole. It faded, but a violet pigmentation developed after a week. A month later, she again developed two macules of similar dimensions within four hours of intake of another fluconazole dose. One of the lesions developed on exactly the same site where another had developed in the earlier episode and the other developed in the left popliteal fossa. After one week, the patches faded and hyperpigmented areas developed on the affected areas.Our differential diagnosis included fixed drug eruption and erythema multiforme. Although fixed drug eruption is primarily a clinical diagnosis, we conducted an oral challenge test. An oral challenge test with fluconazole (150 mg) was conducted 4 weeks later and it showed similar signs, three hours after intake of the drug. A local provocation test was performed with 10% fluconazole in petrolatum on the left pigmented area and with 10% fluconazole in ethanol on the right pigmented area. For comparison, the same compounds were tested on normal skin of her back. After 15 hours, two red patches developed on both sides of her legs and none developed on her back. A skin biopsy specimen taken from the left popliteal area revealed a lichenoid infiltrate, a basal cell vacuolization, dermal melanophages and a superficial perivascular lymphocytic infiltrate, which were consistent with features of FDE. The drug was dechallenged and the patient was treated antihistaminics and steroids.Contrary to this case, most of the previous studies done on FDEs caused by drugs had demonstrated higher occurrences in men as compared to those seen in women [4]. In the previous studies, all female patients were prescribed fluconazole for vaginal candidiasis, while male patients were prescribed fluconazole for Candida balanitis [5]. Cross-reactions may occur with structurally related agents such as itraconazole [6]. In almost all the cases, eruptions had o...
Objective: To assess the extent, pattern and determinants of non-prescription medicine use in an urban area of eastern India. Methods: A descriptive cross-sectional survey with total 392 subjects was carried out for 3 months by a structured questionnaire to assess the extent, pattern and determinants of non-prescription medicine use amongst the patients at a community retail medicine shop and a pharmacy running in Public-Private Partnership (PPP) model in a government hospital. Results: Our study found that 61.4% of the consumers indulged in the practice of self-medication. The commonest reason for self medication was a prevailing tendency in the community followed by cost-saving and convenience. The most commonly used medicines were antacids (43.4%) followed by analgesics-antipyretics (42.6%). It was found that only 12.5% completed an ongoing course of antibiotics. Consumption of ORS was commoner in diarrhoea than vomiting and only a few (13%) of the patients dissolved the ORS powder as directed. Only 9.7% of the subjects thought non-prescription medicine use is safe. Regarding the various types of medicine preparations used by them from the two types of pharmacy, a significant difference was noted only for eye drops (p = 0.003). This result might have been obtained due to prevailing ocular infections in the selected study population and underreporting at the Ophthalmology OPD of the nearest hospital. Conclusion: The current study has documented the extent of, factors associated with, and the pattern of non-prescription medicine use resulting in a surge of self-medication practice in urban area.Key words: Non-prescription medicine use, Self-medication, PPP model, Retail pharmacy, Survey. Key message: Given the increasing emphasis on self-care and empowering the public to manage their health with non-prescription medicines, the findings highlight the need for improved pharmacovigilance of these medicines to maximize benefits with minimal risk. Healthcare providers need to be aware of the potential for misuse, abuse and dependence, particularly in patients with long-term illness. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Glaucoma is a frequent, pathophysiologically heterogeneous ophthalmologic condition characterized by a typical visual field loss pattern from peripheral to central. As a chronic progressive optic neuropathy, it can lead to severe disability and blindness. Glaucoma is classified according to whether it is congenital or acquired. It is further sub-divided into open-angle or closed-angle, depending on how the aqueous outflow is impaired. Glaucoma is usually associated with an increase in intraocular pressure (IOP) above the normal value, which is usually estimated at 21 mm Hg (mean 15.5, range 10-21). Patients with statistically normal IOP who develop the characteristic changes associated with openangle glaucoma are said to have low tension or normal pressure glaucoma. Finally, primary or secondary types are identified depending on the presence of underlying contributory factors. The pathophysiology of glaucoma is not fully understood till date. The trabecular outflow pathway is the primary draining tissue for the aqueous humor in the eye. It consists of 3 structures, the trabecular meshwork (TM), juxtacanalicular tissue, and Schlemm's canal. In a healthy eye, IOP is maintained within a narrow range through dynamic regulation of trabecular outflow resistance. In a glaucomatous eye, elevated IOP is due to an abnormally high resistance to outflow in the trabecular outflow pathway.1 The causes of increased outflow resistance are not fully understood, but it has been hypothesized to involve an increase in the contractile tone and stiffness of the TM and changes in extracellular matrix composition and/or a change in the conductance of Schlemm's canal (Figures 1 and 2).2 There is a significant need for glaucoma drugs that specifically target the physiologic cause of elevated IOP and thereby enhance trabecular outflow. Currently, the management of glaucoma is focused on controlling the IOP by pharmacological and surgical measures to avoid these consequences. The tissues of the trabecular outflow pathway are avascular and rely on the aqueous humor to supply nutrients, growth factors, and antioxidants. The most widely prescribed glaucoma drugs, ABSTRACTThe purpose of this review was to discuss the major recent advances in the field of ophthalmology, particularly as it pertains to glaucoma. We reviewed literature using MEDLINE and PubMed databases with the following search terms: "glaucoma," "melatonin," "trabecular outflow pathway," "adenosine," "rho kinase," "norepinephrine," and "matrix metalloproteinases." We also reviewed pertinent references from articles found in this search. We looked at various studies concerning the clinical trials of glaucoma therapeutics, and therapeutic potential of putative ocular drug delivery systems in glaucoma. Challenges of assuring safety and efficacy of the newer medicines and techniques are pertinent in this regard. However, more research is needed to better elucidate the mechanism of various investigational drug products and drug delivery devices in glaucoma.
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