Adalimumab

Sir, Fixed drug eruptions (FDEs) represent the most common cutaneous adverse drug reaction which is seen in the Indian scenario [1]. FDE is a distinctive drug-induced dermatosis with a characteristic recurrence at the same sites of the skin or mucous membrane, which occurs after repeated administrations of the causative drug [2]. It was first described by Bourns in1889; five years later, it was termed by Brocq as “eruption erythemato-pigmentee fixee” [3]. The most common drugs which cause FDE are antibiotics, followed by nonsteroidal anti-inflammatory drugs (diclofenac, aspirin, naproxen, and ibuprofen) [2]. Fluconazole is one of the most common drugs which is used in dermatology practice. We are reporting an FDE which occurred secondary to fluconazole intake. A 22-year-old woman received five doses of fluconazole (150 mg) orally, once a month, for recurrent vaginal candidiasis. A red erythematous macule which measured approximately 2 (two) centimetres in diameter, with well-defined and raised margins, appeared on the medial side of her right popliteal fossa, that was associated with burning and itching, four hours after she had taken her second dose of fluconazole. It faded, but a violet pigmentation developed after a week. A month later, she again developed two macules of similar dimensions within four hours of intake of another fluconazole dose. One of the lesions developed on exactly the same site where another had developed in the earlier episode and the other developed in the left popliteal fossa. After one week, the patches faded and hyperpigmented areas developed on the affected areas. Our differential diagnosis included fixed drug eruption and erythema multiforme. Although fixed drug eruption is primarily a clinical diagnosis, we conducted an oral challenge test. An oral challenge test with fluconazole (150 mg) was conducted 4 weeks later and it showed similar signs, three hours after intake of the drug. A local provocation test was performed with 10% fluconazole in petrolatum on the left pigmented area and with 10% fluconazole in ethanol on the right pigmented area. For comparison, the same compounds were tested on normal skin of her back. After 15 hours, two red patches developed on both sides of her legs and none developed on her back. A skin biopsy specimen taken from the left popliteal area revealed a lichenoid infiltrate, a basal cell vacuolization, dermal melanophages and a superficial perivascular lymphocytic infiltrate, which were consistent with features of FDE. The drug was dechallenged and the patient was treated antihistaminics and steroids. Contrary to this case, most of the previous studies done on FDEs caused by drugs had demonstrated higher occurrences in men as compared to those seen in women [4]. In the previous studies, all female patients were prescribed fluconazole for vaginal candidiasis, while male patients were prescribed fluconazole for Candida balanitis [5]. Cross-reactions may occur with structurally related agents such as itraconazole [6]. In almost all the cases, eruptions had occurred after a couple of drug administrations [7,8]. The only common medication which was used by the patients was fluconazole. The sites which were most affected for eruptions were limbs, palmar and plantar areas, as well as the oral cavity and lips [5–8]. Fluconazole is a commonly used antifungal agent, and a fixed drug eruption should be considered as a possible adverse effect of its use. This case highlights the importance of taking a comprehensive history of medication use and construction of a medication diary by the patient, to ascertain the occurrence of the eruptions after self-administering doses of fluconazole, when cutaneous adverse reactions are being examined.

Assessment of a natural grass carp reovirus genotype II avirulent strain GD1108 shows great potential as an avirulent live vaccine

The efficiency of cabergoline vs pyridoxine for lactation inhibition—a randomized controlled trial

Purpose/Background Sugammadex and neostigmine are two common drugs used to reverse neuromuscular blockade in anesthesia, but they differ in mechanism of action, side effects, and cost. Sugammadex provides rapid reversal, has fewer side effects, and has a lower risk of bradycardia than neostigmine. This scoping review examines the frequency of bradycardia in adult surgical patients receiving sugammadex versus neostigmine. Methods A scoping review was completed of peer-reviewed articles comparing the incidence of bradycardia in adult surgical patients after the administration of sugammadex and neostigmine for neuromuscular blockade reversal. Findings indicate that sugammadex resulted in fewer adverse events, including bradycardia, than neostigmine. Articles were critically appraised for quality and relevance, and results were synthesized to evaluate clinical outcomes and complications. Results The scoping review included ten articles assessing the safety profiles of sugammadex and neostigmine for neuromuscular blockade reversal, focusing on the incidence of bradycardia. High-quality evidence from randomized controlled trials and meta-analyses consistently demonstrated that sugammadex was associated with a lower incidence of bradycardia and adverse effects than neostigmine. Sugammadex showed particularly favorable outcomes in patients at high cardiovascular risk, such as those undergoing cardiac surgery. While some Level IV studies reported mixed results, including occasional increases in bradycardia with sugammadex, the majority of evidence highlighted its superior safety and efficacy. These findings support the administration of sugammadex as a safer alternative to neostigmine, though patient-specific considerations remain essential. Implications for Nursing Practice The findings of this scoping review suggest that using sugammadex for neuromuscular blockade reversal reduces the incidence of bradycardia compared to neostigmine, enhancing patient safety. Effective implementation of sugammadex in clinical practice requires standardized protocols and ongoing evaluation to ensure optimal patient outcomes. Further studies are necessary to explore long-term safety, cost-effectiveness, and broader clinical applications of sugammadex.

Common medications and drugs: how they affect male fertility

Objective: This study was designed to develop and prospectively validate a machine learning based algorithm that could predict patient response to the most common biologic drug classes used in the management of psoriasis patients. This type of tool would allow clinicians to have greater confidence that a given patient will respond to a specific drug class, which could lead to improved health outcomes and reduced wasted healthcare spend. Methods: Patients were enrolled into one of two observational studies (STAMP studies) where dermal biomarker patches (DBPs) were applied at baseline prior to drug exposure, followed by clinical evaluations at 12 weeks after exposure. PASI measurements were made at baseline and 12 weeks to evaluate clinical response to a clinical phenotype. Responders were defined as those who reached PASI75 at 12 weeks. The transcriptomes obtained from the DBPs were sequenced and analyzed to derive and/or validate classifiers for each biologic class, which were then combined to yield predictive responses for all three biologic drug classes (IL-23i, IL-17i, and TNFai). Results: A total of 242 psoriasis patients were enrolled in these studies, including 118 patients (49.6%) treated with IL-23i, 79 patients (33.2%) treated with IL-17i, 35 patients (14.7%) treated with TNFai, and 6 patients (2.5%) treated with IL-12/23i. The IL-23i predictive classifier was developed from the earlier enrolled patients and independently validated with the latter enrolled patients. IL-17i and TNFai predictive classifiers were developed using publicly available datasets and independently validated with patients from the STAMP studies. In the independent validation, positive predictive values for three classifiers (IL-23i, IL-17i, and TNFai) were 93.1%, 92.3% and 85.7% respectively. Over the entire cohort, 99.5% of patients were predicted to respond to at least one drug class. Conclusion: This study demonstrates the power of using baseline dermal biomarkers and machine learning methods as applied to the prediction of psoriasis biologic prior to drug exposure. Using this test, patients, physicians, and the health care system all can benefit in distinct ways. Precision medicine can be realized for individual patients as most will likely respond to their prescribed biologic the first time. Physicians can prescribe these drugs with increased confidence, and the healthcare system will realize lower net costs as well as greatly reduced wasted spend by significantly improving initial response rates to expensive biologic therapeutics.

84-Year-Old Man With Night Sweats, Weight Loss, and Diarrhea

Eating food items containing wheat flour fortified with iron alone may have little or no effect on anaemia and probably makes little or no difference in iron deficiency. We are uncertain on whether the intervention with wheat flour fortified with iron increases haemoglobin concentrations improve blood haemoglobin concentrations. Consuming food items prepared from wheat flour fortified with iron, in combination with other micronutrients, has little or no effect on anaemia, makes little or no difference to iron deficiency and may or may not improve haemoglobin concentrations. In comparison to fortified flour with micronutrients but no iron, wheat flour fortified with iron with other micronutrients, the effects on anaemia and iron deficiency are uncertain as certainty of the evidence has been assessed as very low. The intervention may make little or no difference to the average haemoglobin concentrations in the population. None of the included trials reported any other adverse side effects. The effects of this intervention on other health outcomes are unclear.

- Introduction: Visceral Leishmania represents a challenging diagnosis and treatment because the clinical picture of Visceral Leishmaniasis, so that the treatment outcome is compromised with many factors, thus study try to asses real picture of treatment outcome with determinants. Objective: To assess treatment outcome and determinant factors among patient with visceral Leishmaniasis in Arba Minch General Hospital Leishmania Research and Treatment Center. Methods: Institution-based, Cross-sectional, retrospective study was conducted among Leishmaniasis patients in Arba Minch general hospital. Patient charts that have been treated from January 2011-December 2015 were reviewed. A total of 348 charts were selected by Simple Random Sampling technique and included in the study. The data were entered and cleaned using Epi-info version 7.0 and analysis was carried out using SPSS-20 statistical packages. Multi-variate logistic regression analysis was carried out to identify the independent predictors of treatment outcome. Result: A total of 348 patient's charts were included in the study. The prevalence of poor outcome was found to be 8.6%. The presence of bleeding/Epsitaxis[AOR=5;95% CI:1.3,19.3], tuberculosis[AOR=3.7;95%CI:1.83,6.3], septic syndrome[AOR=4.3;95% CI: 6.1,32], and adverse drug side effect[AOR=4.5;95%CI:2.73,13.6] were the independent predictors of treatment outcome. Conclusion and recommendation: The prevalence of poor treatment outcome among patients with VL in the study area is high. Concomitant infection; bleeding/Epsitaxis, tuberculosis, septic syndrome and adverse side effect were independently associated with poor treatment outcome. The clinical management of VL in co-infected patients is a major challenge that requires new treatment approaches to improve its outcome.

Hypofractionated stereotactic radiotherapy combined with topotecan in recurrent malignant glioma

Watch your step: Helping patients avoid falls

Preliminary assessment of medical cannabis consumption by cancer survivors

Medicinal, Non-medicinal, Biopesticides, Color- and Dye-Yielding Plants; Secondary Metabolites and Drug Principles; Significance of Medicinal Plants; Use of Medicinal Plants in the Systems of Traditional and Complementary and Alternative Medicines (CAMs)

Introduction and aim of the work: Laryngopharyngeal reflux often occurs in daily otolaryngological clinical practice. Diagnostics and treatment of this disease are complex for clinicians. Proton pump inhibitors cause many adverse effects, so alternative therapeutic methods are required. This study aims to submit current medical knowledge about laryngopharyngeal reflux, including possible treatment options. Materials and methods: The literature review of medical articles published between 2014 and 2024 was performed. These papers were accessed from the PubMed and Springer Nature Link databases. To find relevant articles, the following keywords were used: “laryngopharyngeal reflux”, “reflux laryngitis”, “proton pump inhibitors”, and “baclofen side effects”. State of knowledge: Symptoms of laryngopharyngeal reflux can result in reduced quality of life. Laryngopharyngeal symptoms are not that specific. Patients often search for a reason for their complaints at different specialists. Treatment of this disease is usually based on the trial-and-error method and observing patients’ responses. Summary: The accurate incidence of laryngopharyngeal reflux is not known. Various factors influence the occurrence of this disease. There are disparate opinions about using 24-hour pH monitoring as a gold standard; thus, other methods are sought. Proton pump inhibitors are the most common drugs used in the therapy, but their effectiveness is doubtful. More research should be done on the different methods of laryngopharyngeal reflux treatment. Pepsin inhibitors seem like an auspicious alternative, but there are too few studies on this subject.

Pharmacologic management of cardiovascular problems in women