Introduction 5-Fluorouracil is an antineoplastic agent generally used to treat various types of solid tumors. The common adverse drug reaction associated with 5-fluorouracil are myelosuppression, mucositis, diarrhea, and hand-foot syndrome. Neurological side effects such as headache, dizziness, convulsion, encephalopathy, and acute cerebellar syndrome are rare in nature. Case presentation We report a case of 5-fluorouracil induced cerebrovascular accident (CVA) in a patient with no risk factors for CVA before chemotherapy. A 37 years old female patient diagnosed with carcinoma rectum underwent six cycles of chemotherapy with 5- fluorouracil- calcium leucovorin- irinotecan (FOLFIRI regimen). After completing the last cycle, she developed headache, vomiting, and facial deviation along with high blood pressure (260/160 mmHg). MRI brain was done, and it revealed acute non-hemorrhagic lacunar infarct in the left half of pons. 5-fluorouracil induced CVA was suspected and was managed with dual antiplatelet, statin, and antihypertensives. Conclusion The clinicians and clinical pharmacists must be aware about the potential of 5-FU to induce rare side effects such as CVA even in low risk patients in order to avoid permanent harm to the patient

Introduction Steven–Johnson syndrome (SJS) is a serious mucocutaneous reaction, characterized by fever, influenza-like symptoms and followed by dermatological manifestations. Capecitabine is an oral fluoropyrimidine carbamate analogue of 5-Fluorouracil (5-FU). It is widely accepted for many malignancies because of its better safety profile and tolerability. Hand-foot syndrome is the common dermatological toxicity associated with Capecitabine and SJS is the rarest manifestation. Case presentation: We report a case of Capecitabine induced SJS in a 70 years old male patient with metastatic carcinoma pancreas. He was treated with intravenous Gemcitabine and Carboplatin initially and then switched to oral therapy with Capecitabine 1000 mg twice daily. After ten days of treatment with Capecitabine, he developed vomiting, mucositis, hyperpigmentation, itching and scrotal mucosal peeling. The clinical status of the patient was suggestive of SJS, which was confirmed by dermatologic consultation. According to Naranjo, WHO-UMC, and Hartwig’s scale, the reaction was found to be probable and severe. Pharmacological as well as supportive care measures were provided, but the condition progressively worsened, and the patient was deceased. Conclusion Capecitabine can cause severe hypersensitivity reactions which can be dangerous and life-threatening. Health care providers must be aware of all rare adverse effects, including SJS. Clinicians and clinical pharmacists should educate and counsel the patients regarding the likely adverse effects of their chemo drugs because the early identification of toxic symptoms is crucial to reduce further complications to the patient.

Background:The etiology of urinary tract infection (UTI) and their antibiotic sensitivity pattern vary from time to time and across different areas in India. This study is designed to analyse the resistance of uropathogens to commonly used antibiotics. Aim: To study antibiotic resistance trends of uropathogens and assess the antimicrobial utilization pattern according to the antimicrobial susceptibility test in the paediatric department of a tertiary care hospital. Materials and Methods: It was an ambispective observational cohort study conducted in 144 patients admitted with UTI for a period of one year and observed for recurrent UTI for the next one year.Results: E. coli (50%) was found to be the most common cause of UTI followed by Klebsiella (22.22%). E. coli and other isolates were more sensitive to Meropenem and Amikacin compared to other antibiotics tested. These isolates show increasing resistance to commonly used antibiotics. Most (74.31%) children were given single antimicrobial agent. Majority of the children were prescribed with Cephalosporins (60.41%), followed by Penicillin derivatives (29.17%) and Carbapenems (11.11%). Out of 144 children, antibiotics were prescribed according to culture sensitivity report in only 31.94%. Among children whose antibiotics were not selected based on the culture report, 40 had recurrent UTI in the following year. Conclusion: Recurrent UTI can occur if adequate antimicrobial therapy based on antimicrobial susceptibility test is not administered during the initial UTI episode. Close cooperation between physicians, microbiologists and pharmacists is essential to ensure that UTI patients receive antimicrobial therapy, if required based on local susceptibility data.

BACKGROUNDSepsis is responsible for 30-50% of the total neonatal deaths in developing countries and is considered the commonest cause of neonatal mortality. Neonatal sepsis has wide range of presentations with number of predisposing factors. Our study aims at detecting the risk factors of neonatal sepsis and to describe the clinical features and laboratory profile of neonates started on intravenous antibiotics for neonatal sepsis.METHODS 120 neonates (60 cases and 60 controls) admitted in the department of child health were enrolled in the present case control study and all cases were subjected to diagnostic evaluation and data was collected using restructured case record forms which included perinatal history, signs and symptoms associated with sepsis and laboratory investigations. Institutional Ethics Committee approved the study and written informed consent was obtained from all consenting mothers. Parameters are expressed as mean (SD) and as proportions. RESULTS52.5% neonates and 55% cases were males. 25% of cases were preterm deliveries and 21.7% cases were small for gestational age. Premature rupture of membranes (PROM), maternal urinary tract infections (UTI), and gestational diabetes mellitus (GDM) were seen in 16.7%, 10% and 28.3% cases. Hypothermia was a symptom of sepsis in 28.3% while fever was a symptom in 21.7% cases. CRP elevation and toxic granulations were seen in 75% and 33.3% cases. 6.7% cases had a positive blood culture. CONCLUSIONSManifestations of neonatal sepsis are non-specific. A high index of suspicion with or without laboratory evidences of sepsis is the key for early diagnosis. Prompt institution of antibiotic therapy and supportive care will save most of the cases of neonatal sepsis. HOW TO CITE THIS ARTICLE:Shaji SM, Devi S, Jemila J, et al. Role of maternal risk factors and neonatal clinical features in diagnosis of neonatal sepsis: a case control study.