Perception regarding COVID-19 vaccine and COVID appropriate behavior among adolescents at a tertiary hospital, West Bengal: A longitudinal survey.

Background: Vaccination against COVID 19 and observing COVID appropriate behavior are effective measures to control, manage and prevent COVID-19 infection. With India starting its adolescent vaccination program, this study aimed to explore the adolescents' perception of vaccination, their COVID-appropriate behavior, compliance with two doses of COVID-19 vaccines and the experienced side effects following vaccination. Methods: A longitudinal survey was conducted among 440 adolescents visiting the COVID Vaccination Center (CVC) of a tertiary hospital in West Bengal. In the survey, adolescents were asked about family socio-demographic characteristics, their opinions on COVID-19 vaccines, and COVID-19 Appropriate Behavior (CAB) practices. Voluntary participants were given a questionnaire to fill and a telephonic interview was taken regarding side effects experienced following the vaccination and their compliance to both doses of vaccine. Results: The majority of adolescents (99.3%) had taken vaccines by their own wish. The reason for willingness to take the vaccine was the fear of being infected with COVID-19 infection (50.5%). Maximum adolescents got information regarding the COVID vaccination program through the internet (41.8%) followed by family members (30.5%). The majority of adolescents (70.9%) had a good perception of COVID-19 vaccination. A significant number of adolescents (44.8%) strongly disagreed with the statement that they don't need to follow COVID appropriate behavior after vaccination. Conclusion: The majority of adolescents had a good perception regarding COVID-19.

Cutaneous Hypersensitivity Reaction After Phenytoin Therapy in a Neonate: A Case Report and Review of Literature Elucidating the Potential Pharmacological Plausibility and Preventive Strategies.

BACKGROUND: Drug-induced hypersensitivity reaction is a potentially life-threatening condition reported among patients of different age groups. Phenytoin is a prototypic drug prescribed for the treatment of a variety of seizure disorders. Allergic reaction to phenytoin therapy in a newborn is relatively a rare clinical manifestation that is not frequently reported. OBJECTIVE: The objective of this study is to report a suspected case of hypersensitivity reaction in a newborn possibly due to phenytoin and the strategies to prevent these immune-mediated reactions. CASE REPORT: An early term newborn on the 4th day of life developed erythematous rashes over the abdominal region following phenytoin treatment for recurrent generalized tonic-clonic seizures. Prenatal history was uneventful except for the mother had preeclampsia during the third trimester of pregnancy. The suspected phenytoin was replaced with phenobarbitone to control seizure episodes. Subsequently, the rashes disappeared. The baby had also suffered from skin discolouration after phototherapy. Radiological investigations and cerebrospinal fluid culture were performed to detect the etiology of seizures. CONCLUSION: Hypersensitivity reaction to phenytoin in newborns is a rare clinical entity but may lead to serious lethal complications. Thus, stringent clinical monitoring of patients on phenytoin therapy is mandatory, especially in the pediatric population.

Anaphylaxis to Pantoprazole: A Case Report and Prerequisite for Vigilant Prescribing Practises for Proton Pump Inhibitors.

BACKGROUND: Pantoprazole is a Proton Pump Inhibitor, commonly used by clinicians all over the world as a gastric acid synthesis inhibitor for a wide variety of gastrointestinal disorders. The efficacy and the safety of the drug are unsurmountable. PPIs are being prescribed nowadays for unapproved indications. It is one of the widely used medications in the world. Consequently, adverse events are commonly reported nowadays with proton pump inhibitors, and it is essential to improve physician awareness regarding judicious prescribing practice. OBJECTIVE: To report a case of anaphylaxis to pantoprazole, that occurred in a patient admitted with gastrointestinal complaints. CASE SUMMARY: Within few minutes of intravenous infusion of pantoprazole, a 75-year-old female developed anaphylaxis. The adverse drug reaction was promptly diagnosed, and the patient was resuscitated. CONCLUSION: It is imperative that clinicians should be aware of this adverse effect that might occur with pantoprazole and hence be more cautious while prescribing the drug, especially in the elderly.

Clinical Pattern and Causality Assessment of Drug-induced Cutaneous Reactions in a Tertiary Care Hospital in India: A Prospective Study.

BACKGROUND: Cutaneous Adverse Drug Reactions (ADRs) are common and pose a serious challenge to physicians, especially in cases when the patient has many comorbidities, is polypharmacy, or self-administers over-the-counter medications. OBJECTIVE: The objective of this study is to analyze the clinical pattern and incidence of cutaneous ADRs and perform causality assessment using the WHO-UMC scale and Naranjo's scale. The severity of the reactions was determined by the Hartwig scale. METHODS: This was conducted as a prospective observational study in patients admitted to SRM Medical College, Kattankulathur, Tamil Nadu, India, between November 2016 to August 2018 after obtaining Institutional Ethics Committee clearance of all adverse drug reactions reported at the hospital. RESULTS: Of the 158 ADRs reported during the time period, 101 were cutaneous ADRs, of which the most common presentation was maculopapular rash (n=42; 41.58%). The most common drugs which produced cutaneous adverse reactions were antimicrobials (n=58; 57.42%) followed by NSAIDs (n=35; 34.6%). The causality assessment as per the Naranjo scale yielded 3.96% (4) cases as definite, 81.18% (82) as probable, and 14.85% (15) as possible, whereas the WHO scale yielded 9 (89.10%) certain, 64 (63.36%) probable and 28 (27.72%) possible cases. The severity of the cases determined as per the Hartwig scale yielded 82.17% cases as mild and 17.82% as moderate. CONCLUSION: It is important to recognise the ADRs at the right time and exert caution in future use. This can minimise harm to the patient both physically and financially and improve the outcome of the treatment.

The assessment of the quality of randomized controlled trials published in Indian medical journals.

AIM: In this retrospective cross-sectional study, we sought to evaluate if the published randomized controlled trials (RCTs) reported in the year 2017 among the Indian medical journals (IMJs) complied with the Consolidated Standards of Reporting Trials (CONSORT) guidelines and identify domains where reporting could be improved. METHODS: A literature search was performed using PubMed and Google Scholar to identify all the IMJs that published RCTs in the year 2017. In the archives of the identified journals, the number of published RCTs was identified and the full text was obtained. We selected articles that stated RCT in abstract and title and that evaluated the safety and efficacy of all therapeutic and preventive interventions. RESULTS: A total of seven IMJs comprising of the Indian Journal of Anesthesia, Indian Journal of Dermatology, Venereology and Leprology, Indian Journal of Pharmacology, Indian Journal of Ophthalmology, Journal of Obstetrics and Gynaecology, Journal of Pharmacology and Pharmacotherapeutics, and Indian Journal of Medical and Pediatric Oncology that published a total of 84 RCTs were included. The mean compliance score of all the RCTs was 13.7 ± 2.66 (57%). Most RCTs had serious reporting deficiencies in the methodology and result sections. DISCUSSION: In spite of journals making it mandatory for prospective authors to comply with the CONSORT guidelines, it is intriguing that there continues to be significant lacunae in reporting RCTs adequately in most IMJs. CONCLUSION: There is an urgent need to impart training to the medical community of our country in clinical research methods and reporting of RCTs.

Do ANGPTL-4 and galectin-3 reflect the severity of coronary artery disease?

BACKGROUND: Coronary artery disease (CAD) is one of the leading causes of mortality and morbidity worldwide. We thereby sought to investigate whether the biomarkers, angiopoietin-like 4 (ANGPTL-4) and galectin-3, reflect the severity of CAD. METHODS: Patients were screened based on inclusion/exclusion criteria and written informed consent was obtained from the patients. Serum ANGPTL-4 and galectin-3 was quantified using enzyme-linked immunosorbent assay (ELISA) and correlated with the Global Registry of Acute Coronary Events (GRACE) and GENSINI score using Spearman's rank correlation coefficient and multivariate analysis. RESULTS: A total of 226 patients consisting of ST-segment elevation myocardial infarction (STEMI), non-STEMI/unstable angina (USA), chronic stable angina (CSA) and normal controls (NCs) participated in the study. ANGPTL-4 and galectin-3 were significantly higher in CAD than the NC group. ANGPTL-4 showed significant negative correlation with GRACE score in acute coronary syndrome (ACS) ( r = -0.211, p = 0.03) patients. ANGPTL-4 showed significant positive correlation with serum creatinine ( r = 0.304, p = 0.056) and body mass index (BMI) ( r = 0.424, p = 0.009) in CSA patients. A modest positive correlation was observed between the serum galectin-3 levels and GRACE score ( r = 0.187, p = 0.055) in ACS patients. However, on multivariate analysis the positive correlation relationship between ANGPTL-4 and galectin-3 with the severity of CAD was not sustained. CONCLUSION: In conclusion, ANGPTL-4 and galectin-3 do not appear to have a promising role for assessing the severity of CAD. Nevertheless these biomarkers do warrant further exploration in improving the management of CAD.