Chronic Lithium Toxicity in Old Age Patients Taking Angiotensin Receptor Blocker: A Case Report.

Chronic lithium toxicity is a potentially serious side effect on patients taking lithium for a prolonged period with the diagnosis of mood disorders. The toxicity is even higher in patients taking drugs that interfere with the metabolism of lithium like angiotensin receptor blockers and in older patients with reduced kidney function. In this report, we present the case of a 62-year-old woman who presented to the emergency department with symptoms including loose stools, generalised body weakness, slurred speech, coarse hand tremors, and dystonia persisting for fifteen days. She had been under lithium therapy for bipolar type 1 disorder for 15 years before experiencing these symptoms, which emerged shortly after the addition of telmisartan (angiotensinogen receptor blocker) for hypertension. Keywords: angiotensin receptor blocker; bipolar disorder; case reports; lithium; telmisartan.

Unmasking the Silent Threat: Cefepime-Induced Thrombocytopenia.

Cefepime, a commonly prescribed fourth-generation cephalosporin, is well-known for its broad-spectrum antibacterial activity. While adverse drug reactions associated with cefepime are well documented, thrombocytopenia as a rare complication has gained attention due to its potential severity. Symptomatic patients present with purpura (bruising), petechiae (small red or purple spots on the skin), and mucosal bleeding. Drug-induced thrombocytopenia can be initiated by myelosuppression by halting platelet formation in the bone marrow or by a drug-induced immune thrombocytopenia reaction. We present a case of a 71-year-old male who experienced thrombocytopenia secondary to cefepime use. We further discussed the underlying mechanisms of cefepime-induced thrombocytopenia, highlighting the need for increased vigilance in monitoring platelet counts during cefepime administration. This case underscores the importance of recognizing and managing this uncommon but potentially life-threatening adverse reaction in clinical practice.

Outcomes of Conventional External Dacryocystorhinostomy with and without Mitomycin C: Experience from Eastern Nepal.

INTRODUCTION: Dacryocystorhinostomy (DCR) is the commonest surgery for nasolacrimal duct obstruction. Inhibition of the scarring process within the anastomosis and rhinostomy site which has been attributed to the failure of this procedure, might improve the success rate of DCR. The objective of this study was to evaluate the outcomes of DCR with Mitomycin-C (MMC) and to compare the results of DCR with and without MMC. MATERIALS AND METHODS: A hospital based, prospective study was conducted in patients with primary acquired nasolacrimal duct obstruction. Standard conventional DCR was performed upto the level of creation of flaps. Application of MMC 0.2 mg/ml in and around the ostium and underneath the created flaps for two minutes was effected with cotton pledgets. The area was thoroughly washed with normal saline after removal of the pledgets. Rest of the surgery was completed as usual. The patients were followed up on the first postoperative day, one month and three months post surgery. RESULTS: A total of 60 cases, 30 in each group were allocated. The success rate of DCR with MMC was found to be 96.7% compared to 86.7% (p=0.35) in the DCR group at the end of three months duration. CONCLUSIONS: Intraoperative application of MMC during conventional DCR surgery provides a comparatively higher success rate than DCR without MMC without posing any extra financial burden and adverse drug reaction to the patient.