Hand Foot Syndrome Induced by Lenvatinib - A Case Report.

INTRODUCTION: Hand-Foot Syndrome (HFS), also known as palmar-plantar erythrodysesthesia, is a common reaction to Tyrosine Kinase Inhibitors ( TKIs), which can often lead to discontinuation of the drug. Lenvatinib is a recently approved drug for the treatment of endometrial carcinoma, which has been proven to provide a better overall survival rate and longer duration of progression-free survival among patients with advanced endometrial cancer. Herein, we have reported a case of carcinoma endometrium with metastasis who had to discontinue the use of lenvatinib due to the adverse drug reaction. CASE REPORT: A 60-year-old female patient with carcinoma endometrium with metastasis, post radical hysterectomy with bilateral salpingo-oophorectomy with omentectomy, was started on tablet lenvatinib 8 mg once daily orally for 15 days. After 12 days of treatment, the patient noticed painful lesions with reddish-black discoloration over the left forearm and dorsal aspect of the left hand and fingers, and was diagnosed with lenvatinib-induced hand-foot syndrome. Lenvatinib was discontinued and tab. prednisolone 30mg was taken orally. The reaction subsided after five days. CONCLUSION: Hand-foot syndrome is one of the commonest ADRs due to the use of lenvatinib. Lenvatinib is an oral formulation that patients can take at their homes. Hence, educating patients regarding the HFS is important so that they report it to the treating physicians on time. It is also essential to educate patients regarding the precautions to be taken to avoid hand-foot syndrome. This will help the physicians with the early discontinuation and appropriate treatment with corticosteroids, which will help in improving the quality of life of the patients already suffering from cancer.

Dog Bite Injury: Rusk Became a Risk - A Case Report.

BACKGROUND: Dog bites are a worldwide problem that disproportionately affects children. It might be difficult to keep in mind that even a man's closest buddy can be dangerous to people. In light of the significant morbidity and mortality associated with dog bites, we report, herein, an intriguing case in which a two-year-old boy appeared with eyelid facial lacerations as a result of a dog bite. CASE PRESENTATION: A two-year-old boy presented with bleeding around the right and left eyes. Local examination of the eyes revealed laceration and disfiguration of the left orbit and abrasion around the right eye. Preoperatively, parenteral antibiotics were started and continued postoperatively. Dressing was done for the right eye. Lid reconstruction surgery for the left eye was scheduled and it was carried out under general anaesthesia. The child was monitored for a month and showed satisfactory wound healing with no visible scars or complications. DISCUSSION: The standard treatment for bites is direct suture, grafting, or local flaps, depending on the type of wound and the surgeon's preference, regardless of the time since the attack. Crush wounds are difficult to treat because the damage to the tissues is often so profound that amputation is unavoidable. CONCLUSION: The global injuries caused by dog bites are the consequence of uncommon illnesses and often manifest as peri-orbital and ocular lesions. Most rabies cases occur in underserved rural and urban areas, with a high frequency of stray dogs without immunisation.

Kisspeptin and its Current Clinical Status- A Systematic Review.

BACKGROUND: Kisspeptin was initially known as metastin for its role in suppressing metastasis in melanoma and breast cancer. Later, based on its ability to stimulate GPR54, its importance in maintaining an intact hypothalamic-pituitary-ovarian axis was recognised, which is the basis for the widespread application of the drug in several conditions such as secondary amenorrhea, regulation of puberty onset, ovarian function, trophoblast invasion, fertility regulation, parturition, and lactation. This systematic study aims to evaluate the current status of kisspentin in clinical trials. METHODS: The keywords 'kisspeptin' or 'metastin' were used in the clinicaltrials.gov website and Clinical Trial Registry of India (CTRI) to find eligible clinical trials or records carried out without time constraints until February 26, 2023. RESULTS: A total of 33 records were identified through clinical trial databases. All records were screened, and four trials were rejected as they failed to meet the inclusion criteria. Finally, 29 (87.9%) reports of interventional clinical trials with kisspeptin were reviewed. CONCLUSION: Kisspeptin can be viewed as a multipurpose drug with considerably fewer side effects due to its effects simulating normal physiological processes in our body.

A Very Rare Disease of Patent Urachus Cyst With Vesico-Umbilical Urinary Fistula in Adults: A Case Report and Short Review.

Rare developmental anomalies known as urachal remnants are brought on by flaws in the foetal developmental process. However, depending on the location and degree of incomplete obliteration, the urachus can undergo a variety of urachal anomalies. An umbilical fistulogram and a voiding cystourethrogram both supported the existence of the adult urachal cyst in this case. To treat the sepsis, we provided the patient with antibiotics first, then a surgical procedure. The entire vesico-umbilical tract with the urachal cyst was removed using the open approach. The excised specimen's histology revealed a foreign body giant cell reaction without any indication of malignancy. The presentation and diagnosis of vesico-umbilical urinary fistula (VUUF) in adults can occasionally be difficult. They happen very rarely. So we began putting forward this case for the same reason.

Burden of non-communicable diseases among adolescents and young adults aged 10-24 years in the South-East Asia and Western Pacific regions, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.

BACKGROUND: Although non-communicable diseases (NCDs) remain the leading causes of mortality and disability worldwide, little comprehensive or recent evidence of the burden of NCDs among adolescents and young adults in the South-East Asia and Western Pacific regions is available. We aimed to report population shifts in people aged 10-24 years and their NCD burden from 1990 to 2019 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS: We retrieved data from GBD 2019 for people aged 10-24 years in the South-East Asia and Western Pacific regions from 1990 to 2019. We presented population shifts and analysed deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for NCDs. We also quantified the associations of deaths and DALYs with the Socio-demographic Index (SDI) and Universal Health Coverage (UHC) effective coverage index using Spearman correlation and linear regression analyses. Percentages are reported to 1 decimal place and rates are reported to 2 decimal places. FINDINGS: In 2019, there were 559·2 million young people aged 10-24 years in the South-East Asia region and 335·0 million in the Western Pacific region; India and China remained the countries with greatest number of this age group. In 1990-2019, India had an absolute increase of 139·4 million adolescents, while China had a decrease of 134·3 million. In 2019, NCDs accounted for 27·3% (95% uncertainty interval 25·1 to 29·2) and 34·6% (33·5 to 36·1) of total deaths, and 49·8% (45·3 to 54·4) and 65·1% (60·6 to 69·3) of total DALYs in the South-East Asia and the Western Pacific regions, respectively. Neoplasms, cardiovascular diseases, and mental disorders were the leading causes of NCD burden in 42 countries. Kiribati had the highest rates of deaths (62·82 [50·77 to 76·11] per 100 000 population), YLLs (4364·73 [3545·04 to 5275·63] per 100 000 population), and DALYs (9368·73 [7713·65 to 11340·99] per 100 000 population) for NCDs, whereas Australia (6976·51 [5044·46 to 9190·01] per 100 000 population) and New Zealand (6716·81 [4827·25 to 8827·69] per 100 000 population) had the largest rates of YLDs due to NCDs. From 1990 to 2019 across both regions, the rate of death due to NCDs declined by over a third (-32·8% [-41·1 to -22·9] in the South-East Asia region and -40·0% [-48·6 to -30·4] in the Western Pacific region), and DALYs decreased by about 12% (-12·0% [-16·8 to -7·7] in the South-East Asia region and -12·8% [-17·7 to -8·7] in the Western Pacific region), whereas the proportion of NCD burden relative to all-cause burden increased (45·7% [32·9 to 61·7] for deaths and 41·2% [35·2 to 48·8] for DALYs in the South-East Asia region; 11·8% [7·1 to 21·5] for deaths and 18·2% [14·6 to 22·0] for DALYs in the Western Pacific region). The rate of deaths and DALYs due to NCDs decreased monotonically alongside increases in SDI (rs=-0·57 [95% CI -0·81 to -0·32] for deaths and rs=-0·30 [-0·61 to 0·03] for DALYs). The rate of deaths (rs=-0·89 [95% CI -0·97 to -0·80]) and DALYs (rs=-0·67 [-0·93 to -0·41]) due to NCDs also decreased alongside increases in the UHC effective coverage index. INTERPRETATION: Specific preventive and health service measures are needed for adolescents and young adults in countries with different levels of socioeconomic development to reduce the burden from NCDs. FUNDING: National Natural Science Foundation of China. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Efficacy and safety of sufentanil sublingual tablet system in postoperative pain management: a systematic review and meta-analysis.

BACKGROUND: Sufentanil sublingual tablet system (SSTS) is a recently approved formulation for postoperative pain management that has become popular due to its pharmacokinetic properties such as good bioavailability, rapid attainment of equilibrium and elimination without any metabolites, along with its pharmacodynamic properties such as rapid onset and effective pain reduction. It is also relatively well tolerated by patients. OBJECTIVE: This is a quantitative analysis of the efficacy and safety of SSTS in patients with moderate to severe postoperative pain. DESIGN: This is a systematic review and meta-analysis. Databases such as Cochrane Library, MEDLINE and EMBASE were searched for eligible articles. SETTINGS: Randomised controlled trials published after 2000 in English language and which assessed at least one of the outcome measures of interest with pain intensity difference between 12 hours and a maximum of 96 hours. PARTICIPANTS: Adults with moderate to severe postoperative pain and taking SSTS for pain management. METHODS: Data were analysed using Review Manager (RevMan) V.5.3. Risk of bias (RoB) assessment was done using RoB-2 scale, and overall grading of evidence of each outcome was done using GRADEpro Guideline Development Tool. RESULTS: Analysis of SSTS versus control indicates a statistically significant reduction in summed pain intensity difference at 12 hours (mean difference (MD)=-12.33 (95% CI -15.5 to -9.17), p<0.00001), summed pain intensity difference at 48 hours (MD=-43.57 (95% CI -58.65 to -28.48), p<0.00001), time-weighted total pain relief over 12 hours (MD=-4.77 (95% CI -6.28 to -3.27), p<0.00001) and pain intensity difference (MD=-0.73 (95% CI -1.00 to -0.46), p<0.00001) with SSTS, alongside high quality of evidence. Success of treatment as assessed by Patient Global Assessment (OR=4.01 (95% CI 2.74 to 5.89), p<0.00001) and Healthcare Professional Global Assessment (OR=4.46 (95% CI 3.03 to 6.56), p<0.00001) scoring at 72 hours was observed in a significantly high number of individuals using SSTS, with high quality of evidence. There was no difference in adverse events except for dizziness (RR=1.90, 95% CI 1.02 to 3.52). There was a significantly higher number of total adverse events in orthopaedic surgery in the SSTS group than in the comparator. CONCLUSION: SSTS is effective in postoperative pain management in patients with moderate to severe pain. It also has good tolerability and high patient satisfaction. PROSPERO REGISTRATION NUMBER: CRD42018115458.

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.

Pleural Effusion Induced by Systemic Consumption of Topical Minoxidil: A Rare Case Report.

INTRODUCTION: Pleural effusions can be caused by several conditions such as cancer, connective tissue disease, and infection. They are occasionally caused due to the adverse drug reaction. Most commonly, systemic minoxidil use can cause pleural effusions in patients with chronic kidney disease. CASE PRESENTATION: We present a case of a patient without chronic kidney disease who developed pleural effusion as a result of unintentional use of topical minoxidil orally. The patient's oxygen saturation was 90% on room air; there was dullness to percussion and asymmetrical chest expansion with diminished air entry on both sides. In chest x-ray there were bilateral pleural opacities. Minimal pleural effusions were shown in ultrasonography of the chest. The patient was managed with diuretics and airway management which resolved completely. CONCLUSION: Minoxidil is a commonly used drug by many people for the treatment of hair fall with or without doctor advice. We would like to stress that even though rare, physicians/pulmonologists should be aware of the rare side effects of topical minoxidil, and it should be kept in mind as a differential diagnosis for pleural effusion.

Multidisciplinary Management of COVID-Associated Mucormycosis Syndemic in India.

The study aimed to determine clinical presentation, contributing factors, medical and surgical management, and outcome of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM). A cross-sectional, single-center study was conducted on patients receiving multidisciplinary treatment for mucormycosis following the second wave of COVID-19 pandemic from April to June 2021 in India. Clinicoepidemiological factors were analyzed, 30-day overall survival and disease-specific survival were determined, and t-test was used to determine the statistical significance. A total of 215 patients were included in the study, the cases were stratified into sino-nasal 95 (44.2%), sino-naso-orbital 32 (14.9%), sino-naso-palatal 55 (25.6%), sino-naso-cerebral 12 (5.6%), sino-naso-orbito-cerebral 16 (7.4%), and sino-naso-orbito-palato-cerebral 5 (2.3%) based on their presentation. A multidisciplinary team treated patients by surgical wound debridement and medical therapy with broad-spectrum antibiotics and amphotericin B. Across all disease stages, cumulative 30-day disease-specific survival is 94% (p < 0.001, intergroup comparison, Breslow (generalized Wilcoxon) CI 95%) and overall 30-day survival is 87.9% (p < 0.001, intergroup comparison, Breslow (generalized Wilcoxon) CI 95%) (censored). Early identification, triaging, and proper multidisciplinary team management with systemic antifungals, surgical debridement, and control of comorbidities lead to desirable outcomes in COVID-associated mucormycosis. The patients with intracranial involvement have a higher chance of mortality compared to the other group. Supplementary Information: The online version contains supplementary material available at 10.1007/s12262-021-03134-0.

A review and case report of enigmatic superficial endometrial spread of cancer of the uterine cervix: Need for vigilance in the primary care setting.

Cervical cancer is a leading cause of cancer-related morbidity and mortality. It usually spreads via direct invasion and lymphatics. Few cases with superficial spread to the uterine endometrium, fallopian tubes, and ovaries have been observed. The staging of these cases, as well as management, is not yet clear due to limited data. The Federation of Gynecology and Obstetrics (FIGO) staging disregards uterine spread to upstage the disease, and it also fails to provide clear guidelines regarding the superficial extension to the ovaries and tubes which is not uncommon in these cases. A 63-year-old female with postmenopausal bleeding was diagnosed with squamous cell carcinoma on a pap smear. Ultrasound and magnetic resonance imaging revealed a predominant endometrial lesion. Histopathology after Wertheim's hysterectomy revealed a squamous cell carcinoma of the endocervix, stage 1B2, that had spread superficially to the endometrium. A total of 48 cases of cervical cancer with superficial spread were identified. The commonest complaint was postmenopausal bleed in 39.39%. In 50% of the cases, the disease was carcinoma in situ, and 70.45% of the women had disease of stage 1B or less. In many cases, the disease had reached the tubes, 36.66%, and ovaries 23.33%. All women with stage 2A or lesser disease except for one were alive at 6 months after surgery. Superficial spread of cervical cancer is a distinct entity. Endometrial pathology must be ruled out before planning management in these women, especially when managing early-stage disease with conservative therapy.

A study of risk factors and complications in elderly hypertensive subjects.

BACKGROUND: Hypertension among the elderly is a major, highly prevalent yet treatable cardiovascular disease. AIMS & OBJECTIVES: Study aims to highlight the risk factors for hypertension in the elderly in an urban setup for the benefit of improving quality of life and also reduce the incidence of the cardiovascular related complications. METHODOLOGY: This is a Cross-sectional observational study. Included 125 study subjects based on selection criteria. The selected patients were subjected to a preformed and pretested schedule of questions pertaining to the risk factors. RESULTS: Among the known hypertensive patients above 60 years of age, 125 subjects were included in the study. Smoking (62%), alcohol consumption (21%), family history of hypertension (26%), family history of diabetes (70%) were statistically significant risk factors observed for the development of hypertension. CONCLUSION: Sedentary lifestyle (physically less active) and anthropometric measures like overweight and obesity, abnormal waist circumference, and abnormal waist hip ratio were all identified as remarkable risk for hypertension. Myocardial infarction (20%), stroke (14%), and heart failure (12%) were the chart buster complications of hypertension in the vulnerable geriatric population.

Efficacy of green tea, its polyphenols and nanoformulation in experimental colitis and the role of non-canonical and canonical nuclear factor kappa beta (NF-kB) pathway: a preclinical in-vivo and in-silico exploratory study.

NF-kB plays a major role in the aetiopathogenesis of inflammatory-colitis. In this study, we evaluated the efficacy of green tea and its polyphenols and their nanoformulation in Tri-Nitro Benzene Sulfonic acid (TNBS) induced colitis in in-vivo system (Rat) and the involvement of non-canonical and canonical NF-kB pathway in green tea mediated protection (in-silico platform). We used the Wister rat model of TNBS-induced colitis. Rats were grouped into eleven groups (six animals each) and administered vehicle (ethanol), TNBS, Epicatechin (EC), Epigallocatechin (EGC), Epicatechin-gallate (ECG), Epigallocatechin-gallate (EGCG), sulfasalazine, green tea, EGCG + sulfasalazine, nano-EGCG and nano-EGCG + sulfasalazine for 14 days after induction of colitis. Colonic tissue was evaluated for the level of malondialdehyde, myeloperoxidase activity, catalase, reduced glutathione, glutathione peroxidase, IL-6, TNF-α, IL-1ß, NF-κB and morphological and histopathological evidence of damage. In the in-silico part, molecular docking and dynamic simulation study of EGCG was done against different targets in NF-kB for detailed evaluation of the role of non-canonical and canonical NF-KB pathway. In our study, EGCG reduced colonic inflammation, markers of oxidative stress, TNF-α, NF-κB, IL-1ß and IL-6. Nano-EGCG + sulfasalazine was more efficacious when compared to EGCG + sulfasalazine. In molecular docking and molecular dynamic simulation studies, EGCG showed a good binding profile to the inhibitor binding sites of IKK-beta, IKK-alpha and NIK. Thus, it can be concluded that EGCG showed protective action in experimental colitis acting through both non-canonical and canonical NF-kB pathway. Nano-EGCG + sulfasalazine combination showed better protection than nano-EGCG alone. Communicated by Ramaswamy H. Sarma.

Role of Dupilumab in Approved Indications of COVID-19 Patient: an Efficacy-Based Nonsystematic Critical Analysis.

With many drugs being tried in the management and treatment of COVID-19, dupilumab is one such monoclonal antibody that has come under the limelight for its possible role as an adjunct therapy in COVID-19 position. There are isolated case reports and series that document a milder course of COVID-19 infection in patients who have already been on dupilumab therapy for treatment of conditions such as atopic dermatitis and chronic rhino-sinusitis with nasal polyp. There is also an ongoing debate regarding the continuation of biologicals in the COVID patient. In this article, a non-systematic critical analysis of dupilumab was performed to delve into this hypothesis further.

Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports.

INTRODUCTION: Thalidomide is an anti- tumor necrosis factor alpha (TNF-a) drug used mainly in the management of moderate to severe form of Erythema Nodosum Leprosum (ENL). Because of its teratogenic potential it has to be used under proper supervision. Our critical analysis tries to look into the rationale with which it has been used by means of case reports on lepra reaction. METHODS: We looked for the case reports between December 2005 to June 2019 in databases like Pubmed, Embase and other relevant resources. We used search words like "erythema nodosum leprosum(ENL)", "thalidomide", "case report" in different combinations to get relevant reports that focus on thalidomide usage atleast once at any time point during management. The information extracted were indication of thalidomide use, dose, response, outcome, complication if any, along with all the demographic details and geographical distribution. RESULTS: We found 41 case reports eligible for analysis.The information was critically evaluated. From the analysis it was found that 7 of the case report mentioned the exact indication, 4 case report showed irrational use of thalidomide in the case of neuritis without use of steroids, 7 showed proper use of Clofazimine prior to thalidomide initiation, 26 case report showed case report of rationale dose range and in 4 case reports clofazimine was used prior to thalidomide along with the rational dose of thalidomide. CONCLUSIONS: This analysis helps to guide the rationale use of thalidomide focussing on few important points that anyone should keep in mind while managing a case of ENL.

Retrospective Analysis of Drug Prescription Statistics in a Tertiary Care Center in India: Recommendations for Promoting Prudent Utilization of Drugs.

OBJECTIVE: Drug utilization studies provide information regarding the drug usage pattern in hospital settings, which can be used to promote cost-efficient uses of drugs. The present observational retrospective study was conducted to evaluate the drug utilization pattern in a tertiary care center in India and create a baseline consumption data for the drugs, simultaneously identifying targets for improving drug prescribing pattern. METHODS: The current retrospective cross-sectional study was conducted at All India Institute of Medical Sciences Raipur, wherein the 217 medical records of different departments for August 2019 were chosen randomly (using systematic random sampling) for evaluation. The information was extracted from medical records regarding the basic demographic details, drug strength, route, and total amount, and eventually, the World Health Organization (WHO) core indicators were estimated. Drug utilization data were assessed using the WHO Anatomical Therapeutic Chemical/Defined Daily Dose (ATC-DDD) methodology. Potential drug-drug interactions were also analyzed. FINDINGS: Most of the records analyzed were of male patients (56.2%). Drugs prescribed by their generic name were 50%. Prescriptions containing injection and antimicrobials were 68.1% and 83.6%, respectively. 49.3% of the patients had received a fixed-dose combination, and 60.9% of drugs belonged to the National List of Essential Medicines 2015. A total of 15 potential drug interactions were found. CONCLUSION: Calculated prescribed daily dose of most of the antimicrobials and other groups of drugs was close to the WHO-DDD. Trade name prescription and polypharmacy were very common. Antibiotics accounted for the majority of drug costs.

Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports

Abstract INTRODUCTION: Thalidomide is an anti- tumor necrosis factor alpha (TNF-a) drug used mainly in the management of moderate to severe form of Erythema Nodosum Leprosum (ENL). Because of its teratogenic potential it has to be used under proper supervision. Our critical analysis tries to look into the rationale with which it has been used by means of case reports on lepra reaction. METHODS: We looked for the case reports between December 2005 to June 2019 in databases like Pubmed, Embase and other relevant resources. We used search words like "erythema nodosum leprosum(ENL)", "thalidomide", "case report" in different combinations to get relevant reports that focus on thalidomide usage atleast once at any time point during management. The information extracted were indication of thalidomide use, dose, response, outcome, complication if any, along with all the demographic details and geographical distribution. RESULTS: We found 41 case reports eligible for analysis.The information was critically evaluated. From the analysis it was found that 7 of the case report mentioned the exact indication, 4 case report showed irrational use of thalidomide in the case of neuritis without use of steroids, 7 showed proper use of Clofazimine prior to thalidomide initiation, 26 case report showed case report of rationale dose range and in 4 case reports clofazimine was used prior to thalidomide along with the rational dose of thalidomide. CONCLUSIONS: This analysis helps to guide the rationale use of thalidomide focussing on few important points that anyone should keep in mind while managing a case of ENL.