Postoperative Delayed Facial Nerve Palsy: A Surgeon's Nightmare.

The facial nerve supplies motor, sensory, and parasympathetic innervation to the head and neck, and its paralysis can have significant physical and psychological impacts. This study discusses a compelling case involving a 21-year-old male who developed delayed facial nerve palsy (DFNP) on the eighth day after cortical mastoid surgery. Through conservative management, the patient achieved a full recovery by the 52nd day. Our experience underscores the importance of approaching DFNP with patience, emphasizing the need for thorough counseling of both the patient and their family members.

A Routine over the Counter Phenylephrine Causing Rarer Drug Eruption as Adverse Drug Reaction - A Case Report.

BACKGROUND: Phenylephrine is a sympathomimetic, which means it acts analogous to adrenaline. Phenylephrine can be taken orally to treat nasal congestion symptoms. It is also frequently mixed with other medicines in products meant to relieve cough and cold symptoms. Given the widespread usage of phenylephrine, related drug eruptions appear to be uncommon. CASE PRESENTATION: Here we discuss a case of a 19-year-old female patient who reported to our hospital with blebs on the skin throughout her legs and torso. The drug eruption or adverse drug response was linked with itching, had a slow beginning, and progressed. Her medical history indicated that she had been taking phenylephrine 10 mg orally twice a day. On the sixth day, she experienced an adverse medication response caused by the medicine phenylephrine. Phenylephrine was stopped immediately and the other medications, such as levocetirizine, montelukast, and nasal spray, were continued. The patient was told not to use phenylephrine, either alone or in combination with FDCs. There are no other complaints. As a result, the patient was diagnosed with phenylephrine- induced eruption. CONCLUSION: We present this case to highlight the importance of inspiring a pharmacovigilance mindset among all clinicians providing care as a routine alert drug, phenylephrine-induced drug eruption.

Myocarditis manifestations in dengue cases: A systematic review and meta-analysis.

BACKGROUND: Dengue fever is a zoonotic viral infection that raises a global alarm in the tropics and subtropics, with the potentially escalating into newer geographical regions. Severe dengue may be associated with fatal complications such as myocarditis. There is a paucity of available data on the prevalence of dengue-associated myocarditis. The objective of this systematic review and meta-analysis was to estimate the global prevalence of dengue-associated myocarditis. METHODS: A systematic search was conducted utilizing the Cochrane library, PubMed, Scopus, ProQuest, Web of Science, and Preprint servers such as arXiv, medRxiv, bioRxiv, BioRN, ChiRN, ChiRxiv, and SSRN as of November 25, 2022. All primary studies (case series, cross-sectional, retrospective, and prospective) that reported confirmed cases of dengue myocarditis were included. The I2 statistic test assessed the heterogenic characteristics and publication bias was evaluated using Doi plot and Egger regression tests. RESULTS: A total of 12 studies conducted between 2007 and 2022 with 2795 laboratory-confirmed dengue patients were included. Of the included cases, 502 were positive for myocarditis, with a prevalence of 2.4-78%. The pooled prevalence of dengue-induced myocarditis in the studied population was 21.0% (95% CI, 9 - 38%). The prediction interval was estimated to be 0.00 - 0.81. CONCLUSION: Myocarditis in dengue patients is a significant and understudied complication in many aspects. To prevent dengue-associated myocarditis, appropriate measures such as early detection of cases and signs, symptoms-based diagnosis via electrocardiography and echocardiography, as well as relevant vector control policies must be implemented.

A Perspective into "TEL"-Tenofovir, Emtricitabine and Lamivudine Antileprotic Activities by Drug Repurposing and Exploring the Possibility of Combination Chemotherapy with Drug Rescued Molecules for a Leprosy Free Mankind.

BACKGROUND: Since leprosy bacilli cannot grow in vitro, testing for antimicrobial resistance against Mycobacterium leprae or assessing the anti-leprosy activity of new drugs remains hard. Furthermore, developing a new leprosy drug through the traditional drug development process is not economically captivating for pharmaceutical companies. As a result, repurposing existing drugs/approved medications or their derivatives to test their anti-leprotic potency is a promising alternative. It is an accelerated method to uncover different medicinal and therapeutic properties in approved drug molecules. AIMS: The study aims to explore the binding potential of anti-viral drugs such as Tenofovir, Emtricitabine, and Lamivudine (TEL) against Mycobacterium leprae using molecular docking. METHODS: The current study evaluated and confirmed the possibility of repurposing antiviral drugs such as TEL (Tenofovir, Emtricitabine, and Lamivudine) by transferring the graphical window of the BIOVIA DS2017 with the Crystal Structure of a phosphoglycerate mutase gpm1 from Mycobacterium leprae (PDB ID: 4EO9). Utilizing the smart minimizer algorithm, the protein's energy was reduced in order to achieve a stable local minima conformation. RESULTS: The protein and molecule energy minimization protocol generated stable configuration energy molecules. The protein 4EO9 energy was reduced from 14264.5 kcal/mol to -17588.1 kcal/mol. CONCLUSION: The CHARMm algorithm-based CDOCKER run docked all three molecules (TEL) inside the 4EO9 protein binding pocket (Mycobacterium leprae). The interaction analysis revealed that tenofovir had a better binding molecule with a score of - 37.7297 kcal/mol than the other molecules.

Molecular Docking Analysis of Adhatoda vasica with Thromboxane A2 Receptor (TXA2R) (6IIU) and Antiviral Molecules for Possible Dengue Complications.

OBJECTIVE: The present study is an in silico model of platelet amplification potential of Adhatoda vasica, which can be used to treat thrombocytopenia in dengue complications. METHODS: Docking studies have proved to be an essential tool that facilitates the structural diversity of natural products to be harnessed in an organized manner. In the present study, vasicine containing natural anti-dengue potential was subjected to docking studies using Schrodinger glides software (ver.11.1). The docking study was carried out to find out the potential molecular targets for selected protein. The docking was carried out on different ligands, like vasicine, ramatroban, chloroquine, celgosivir, and standard eltrombopag downloaded from PubChem and retrieved to glide software and ligands prepared using lig prep wizard. Docking was performed using the ligand docking wizard of Glide-maestro 2018. RESULTS: The docking score of vasicine (-5.27) is nearly identical to the standard eltrombopag (-6.08), and both ligands bind with one hydrogen bond. The validation score of ramatroban is -12.39, binding with five hydrogen bonds, Celgosivir exhibited a docking score of -7.3 with three hydrogen bonds, and chloroquine displayed no hydrogen bond but had a docking score of -4.6. CONCLUSION: Vasicine was found to be the most suitable target of platelet amplification potential from Adhatoda vasica. However, the molecular docking results are preliminary, and it has been indicated that vasicine could be one of the potential ligands to treat the thrombocytopenia of dengue; experimental evaluation will be carried out in the near future.

Capecitabine and Hand-foot Syndrome: A Case Report.

Capecitabine, a prodrug of 5-fluorouracil, is an FDA-approved drug for adjuvant treatment of colon, metastatic colorectal, and breast cancer. A variety of mucocutaneous adverse effects has been recognized with capecitabine. The pathogenesis of such manifestations still remains an enigma though various theories have been proposed. Here, we report two such cases. A 59-year-old female with carcinoma of the sigmoid colon on palliative therapy developed localized cutaneous hyperpigmentation of the palms and soles secondary to capecitabine in her 2nd cycle. Another case was of a 42-year-old female with stomach adenocarcinoma, who developed similar adverse effects after administration of capecitabine in her 4th cycle. Since these drugs have been widely used in recent years due to their relative ease in administration, the relative unawareness of Hand-foot syndrome (HFS) caused due to this drug makes it a prudent topic to be reported.

Leprosy Reactions: Clinical Pharmacologist Perspective with Repurposed Medications.

The elimination of leprosy has been possible with the available anti-leprotic drugs. However, the lepra reactions usually occur months or years after multi-drug therapy completion, and continue to be a formidable challenge mainly owing to its role in causing nerve damage and disability. Corticosteroids are commonly used but they lead to systemic complications, and hence require dose reduction and adjunct therapy with a different target. Various drugs with different targets have been identified and are in practice to treat lepra reactions. The newer targets can include genetic and tissue targets in the skin and nerve. Thalidomide treatment reducing pentraxin-3, toll-like receptor antagonists, minocycline, apremilast, immunomodulators, and tenidap can be helpful in lepra reaction. Other modalities to manage lepra reactions include plasma exchange, intravenous immunoglobulins, and immunotherapy. Most of these treatments are based only on the pathological process of the reaction and tend to be incomplete leading to recurrence. Newer multimodal approaches are required based on various biomarkers (genetic, tissue, serological), which can be monitored to prevent the recurrence of reactions. Hence, there is a need for newer targets and drugs to be identified for the management of lepra reactions.

Vigilance Needed in Treating Leprosy Patients in Accordance with WHO's AWaRe.

BACKGROUND: Leprosy is a highly stigmatized disease that can range from a minor skin lesion to life-threatening conditions such as deformities and disability. The World Health Organization (WHO) has developed a tool called "Access, Watch, and Reserve" (AWaRe) to reduce antibiotic misuse and abuse. AIM: The purpose of this review is to determine whether the drugs used in the leprosy treatment regimen are complied with the AWaRe programme, in order to improve the quality of hospital antibiotic use and reduce the incidence of antimicrobial resistance (AMR). METHODS: We started by looking for antibiotics that are used in the treatment and chemoprophylaxis of leprosy, as defined by the WHO's AWaRe classification. Furthermore, we look for studies on antibiotics that showed sensitivity or less resistance after antimicrobial sensitivity testing (AST) on isolates from infected leprosy ulcers, as well as their AWaRe category. RESULTS: There were 32 studies found, but only 5 of them met the inclusion criteria. They consisted of four cross-sectional studies and one descriptive retrospective study. A total of 19 antibiotics were identified in 5 studies, with 9 (47.4%) antibiotics in the access category, 8 (42.1%) antibiotics in the watch group, and 2 (10.5%) antibiotics in the reserve group. CONCLUSION: As per our knowledge, this is the first study to explore antibiotics in leprosy treatment, chemoprophylaxis, and complications such as ulcer compliance with the AWaRe programme. Antimicrobial resistance is on the rise, which is a global issue that continues to pose challenges to clinical practices. This review may provide physicians with an overview of the current state of drug prescribing trends in leprosy, whether in accordance with the AWaRe classification in selecting the right drug when the use of antimicrobials is indicated and may also aid in rational drug prescribing.

Does Methylene Blue Satisfy an Option in COVID-19 ARDS.

BACKGROUND: In COVID-19, the respiratory tract is usually affected by SARS-CoV-2 infection. Due to viral transmission in the blood and an overwhelming inflammatory response, including cytokine storm, the condition can progress to acute respiratory distress syndrome and failure. Methylene blue is the only medicine that has been shown to reduce the excessive generation of reactive species and cytokines. CASE PRESENTATION: A 51-year-old male patient came to the hospital with shortness of breath. At room air, the patient was having 70% Spo2. The patient was treated with a noninvasive ventilator (NIV) and Standard of care (SOC). Due to prolonged hypoxia and respiratory distress, the patient was treated with NIV and the methylene blue (MB) was given in a humidifier for 5 days. RESULT: Methylene blue resulted in a significant decrease in respiratory distress and a steep rise in Spo2. CONCLUSION: We suggest trying methylene blue as an additional intervention in COVID-related acute respiratory distress to avoid the disease's devastating consequences.

The combined effect of Trigonella foenum seeds and Coriandrum sativum leaf extracts in alloxan-induced diabetes mellitus wistar albino rats.

Diabetes mellitus is a group of heterogeneous disorders commonly presenting with episodes of hyperglycemia and glucose intolerance, as a result of lack of insulin, ineffective insulin action, and/or both. It is our interest to study the effect of ethanolic extract of Trigonella foenum seeds (fenugreek) and Coriandrum sativum leaves (dhaniya) or its combination in alloxan induced diabetes mellitus wistar albino rats. Rats were randomly separated into six groups where group 1 animals received 2% acacia, group 2 animals received alloxan dose of 150 mg/kg, group 3 animals received glibenclamide dose of 0.5 mg/kg and group 4, 5 and 6 animals received ethanolic extracts of Trigonella foenum seeds, Coriandrum sativum leaves and combination of both extracts at the dose of 100mg/kg for 21 days. Different biochemical parameters such as hepatic and renal biomarkers and histopathology of pancreas were studied. Combination of both extracts showed significant decrease in blood glucose, cholesterol, triglycerides, LDL, VLDL levels, SGOT, SGPT, urea, creatinine and increase in HDL levels and body weight than individual extracts. Thus, we show the antidiabetic activity of poly herbal formulation using biochemical and histo pathological data.