This case report describes a 28-year-old female patient who presented with hypersensitivity reactions after being treated with ceftriaxone (a third-generation cephalosporin antibiotic) for a bacterial infection. The patient developed urticaria (hives) after a few days of ceftriaxone therapy. Tests ruled out other potential causes, and causality assessment scales determined the reactions were probably caused by ceftriaxone. The antibiotic was stopped and the patient recovered from the hypersensitivity reactions after 10 days. The report discusses how cephalosporins can rarely cause immediate IgE-mediated allergic reactions like urticaria.
This presentation deals with important pathophysiological steps involved with HIV infection, the various classes of drugs used in treatment of this condition, along with WHO-guidelines for treatment regimen(depending on various ages & conditions).
Newer drugs have also been mentioned and emphasized upon.
Anti Tubercular Drugs - Mechanism of Action and Adverse effects Thomas Kurian
A brief outline of the mechanism of action and adverse effects of anti tubercular drugs
Only First line and second line drugs are dealt with.First line drugs may be useful for MBBS students and the rest is directed for postgraduate students.
Hope you find it useful.
This presentation deals with important pathophysiological steps involved with HIV infection, the various classes of drugs used in treatment of this condition, along with WHO-guidelines for treatment regimen(depending on various ages & conditions).
Newer drugs have also been mentioned and emphasized upon.
Anti Tubercular Drugs - Mechanism of Action and Adverse effects Thomas Kurian
A brief outline of the mechanism of action and adverse effects of anti tubercular drugs
Only First line and second line drugs are dealt with.First line drugs may be useful for MBBS students and the rest is directed for postgraduate students.
Hope you find it useful.
Dengue fever- clinical features,investigations, diagnosis, treatment and prev...DeepakBhosle
This presentation is for medical students and general practitioner It contains detailed account of epidemiology, causation, clinical features, investigations,diagnosis, treatment of dengue fever. contains pictures. useful latest and comprehensive information about Dengue. It also contains dengue case definitions of WHO.It also lists the complications of dengue. It enumerates the warning signs for more severe form of dengue fever. Includes risk factors for dengue shock syndrome and dengue hemorrhagic fever.It includes a list if clinical markers of dengue. Also details about the habits of the dengue vector , aedes aegypti mosquito
synthetic antimicrobials having a quinolone structure that are active primarily against gram-negative bacteria, though newer fluorinated compounds also inhibit gram-positive ones.
Definition
History
Chemistry
Properties
Classification & its Generation
Pharmacokinetics
Mechanism of action
Indication
Contraindication
Therapeutic use
Adverse effect
Resistance
Comparison with penicillin
Market preparation
Introduction TO VOMITING,Pathophysiology of vomiting,Emetics,Anti emetics,classification,pharmacology,Drug treatment in selected circumstances FOR EMETICS were included.
Dengue fever- clinical features,investigations, diagnosis, treatment and prev...DeepakBhosle
This presentation is for medical students and general practitioner It contains detailed account of epidemiology, causation, clinical features, investigations,diagnosis, treatment of dengue fever. contains pictures. useful latest and comprehensive information about Dengue. It also contains dengue case definitions of WHO.It also lists the complications of dengue. It enumerates the warning signs for more severe form of dengue fever. Includes risk factors for dengue shock syndrome and dengue hemorrhagic fever.It includes a list if clinical markers of dengue. Also details about the habits of the dengue vector , aedes aegypti mosquito
synthetic antimicrobials having a quinolone structure that are active primarily against gram-negative bacteria, though newer fluorinated compounds also inhibit gram-positive ones.
Definition
History
Chemistry
Properties
Classification & its Generation
Pharmacokinetics
Mechanism of action
Indication
Contraindication
Therapeutic use
Adverse effect
Resistance
Comparison with penicillin
Market preparation
Introduction TO VOMITING,Pathophysiology of vomiting,Emetics,Anti emetics,classification,pharmacology,Drug treatment in selected circumstances FOR EMETICS were included.
Evaluation of cutaneous adverse drug reactions due to antimicrobial agents: A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Enoxaparin is extensively used in the treatment of venousthrombo-embolic disease (VTED) which inhibits blood clotting inside the blood vessels by the inhibition of factor Xa activity through antithrombin. Local hypersensitivity reactions are one of the rare adverse drug reactions (ADR) of enoxaparin which may lead to hospitalization and excessive burden to the patient. A 72 years male patient was admitted in general medicine department with retrosternal pain even at rest and was diagnosed with unstable angina pectoris. He was administered with anti-coagulantEnoxaparin 0.4ml (40 I.U)subcutaneouslyalong with other supportive medications. Patient have developed severe local hyper sensitivity reactions like erythema,pain,swelling,irritation at the site of injection, and suspected as an ADR of Enoxaparin and immediately drug was withdrawn, then it was confirmed through causality assessment and this ADR have shown +ve for rechallenge;patient was fallowed for improvement and the symptoms especially swelling and irritations were not subsidedeven on 9th day. By this case study we strongly recommend the testingof drug sensitivity before initiating Enoxaparin therapy,and need to collect past history comprehensively for safe and effective outcome of therapy.
Assessment of the Prevalence of Proactive Penicillin Allergy Testing in Patie...BRNSS Publication Hub
This study aims to promote penicillin allergy testing in an outpatient to penicillin allergy and educate both patients and clinicians about testing. Patients with a history of penicillin allergy were screened for penicillin allergy testing. The results of allergy testing and patient satisfaction after testing were the main outcomes. A total of 82 patients were recruited, although only 37 actually underwent testing. None of these 37 had a positive skin test and none of 36 had a positive oral challenge (one refused it). Following testing, 2 patients (5%) had subjective reactions within 24 h. Three (10%) were subsequently treated with a beta-lactam, and all reported that testing provided important information to their medical history. In conclusion, the penicillin allergy testing safely evaluates patients labeled as penicillin allergic. It is well tolerated and embraced by the patients who undergo testing. In our study, none of the patients tested had an allergic reaction, but we identified multiple barriers to developing a protocol for testing patients from the primary care setting.
Similar to Ceftriaxone induced hypersensitivity reactions (20)
Corticosteroids are the steroid hormones, which are mainly used in the treatment of rheumatoid arthritis, osteoarthritis, rheumatic fever, gout, allergic reactions, renal disease, haematological disorders and shock. The use of glucocorticoids in supra physiological doses for more than 2-3 weeks causes a number of undesirable effects. Most of the adverse effects are extension of pharmacological actions such as hyperglycaemia, Cushing syndrome, oedema, hypertension, CCF, steroid myopathy, glaucoma, various fungal infections etc. Diclofenac is a Non-Steroidal Anti Inflammatory Drug; it is high potent anti-inflammatory and analgesic drug. The mechanism of acute bronchitis due to the diclofenac still not known but increased production of leukotrienes may cause bronchitis. Here we report a 45 years old female patient was experienced moon face, pedal oedema, increased RBS, LDL, total cholesterol, abdominal striae, acute bronchitis and increased blood presser due to the prolonged using of corticosteroids and NSAIDs since 2 years regularly.
Amlodipine is a 4th generation dihydropyridine calcium channel blocker which is permitted for the treatment ofessential hypertension and angina pectoris. The main mechanism of calcium channel blockers are blocks the voltage sensitive L-type calcium channels by binding to alpha-1 subunit, so prevent the entry of calcium in to the cells finally no excitation-contraction coupling in the heart and vascular smooth muscles. It is absorbed slowly after oral administration. But its bioavailability is high. It has a longer duration of action than ahenefidipine. It dilates both peripheral as well as coronary vessels. It is an alternative anti-hypertensive drug for patients with Nefidipine induced pedaledema. This drug is expected to produce a more incidence of pedal oedema, as compared to Nefidipine and other calcium channel blockers, based on the limited data available from clinical trials. The common adverse effects of Amlodipine are nausea, abdominal pain, vomiting, dry mouth, constipation, gingival hypertrophy, dizziness, heartburn, photosensitivity, headache, light headedness and insomnia. We report a case of Amlodipine induced pedal edema.
There are numerous studies that report anemia and hematological
abnormalities in patients with human immunodeficiency virus (HIV) infection
and acquired immunodeficiency syndrome (AIDS). Highly Active Antiretroviral
therapy (HAART) is the best suited regimen that is potent enough to reduce the
viral load in patients with HIV/AIDS. On the other hand, this regimen has the
tendency to cause anemia and bone marrow suppression. We report a case of 26
years female patient confirmed with HIV infection since 6 months and is on
Zidovudine, Lamivudine and Nevirapine therapy for the past 4 months. While the
patient was in this regimen it leads to severe anemia and acute gastritis. The
relationship between the suspected drug and reaction was established by
performing casualty assessment. There is a need of close monitoring at regular
intervals to find the development of bone marrow toxicity and other
complications which help in prevention and better management of disease and
therapy problems
The intention with the suicidal thoughts, hair dye (super vasmol-33) poisoning cases are increasing in many parts of world to free their souls. Hence we felt it as a social need to conduct this type of study. Objective to understand the prevalence of ―Vasmol‖ poisoning cases and to analyze the presenting features, clinical course and their outcome in general medicine and emergency units of a tertiary care teaching hospital. This is a Prospective observational Study conducted for a period of six months. Any adult individual who consumed the vasmol poison intentionally were included as the study subjects. A total number of 380 vasmol poisoning cases have been collected. Out of them, 168(44.21%) cases were in the age group of 11-20 years, 120 (31.57%) were in between 21-30 years. 347 (91.31%) patients were illiterates. Out of 380 cases, 258 (67.89%) were recovered with the supportive therapy, 14 (3.68%) were died and 83 (21.84%) were referred to higher institution for better treatment. The death rate was found to be 1:27 i.e. out of every 27 cases 1 death was observed. Out of 14 deaths, 8 were due to cardio-respiratory failure, 3 were due to Myocarditis, 1 due to cardiac arrest, and 2 were due to acute renal failure. Vasmol hair dye ingestion is a life threatening condition and is a serious social issue to be addressed immediately. Early recognition, prompt referral, and supportive therapy are the factors on which clinical outcomes depend.
Candidiasis is a fungal infection caused by yeasts from the genus Candida. It is commonly called oral candidiasis or thrush when it affects the mouth. It is one of the common side effects associated with the long term use of steroid inhalers. Nebulizing therapy with corticosteroids is widely accepted treatment approach for patients with acute exacerbations of Chronic Obstructive Pulmonary Disease. The other side effects of steroid inhalers include hoarseness of voice and dysphonia, which are usually ignorable. We report this case of 74 year old male patient who was on metered dosage inhaler and nebulizer therapy with corticosteroid and presented with oral candidiasis. If oral thrush develops, treatment with oral fluconazole or nystatin mouth wash is beneficial. Proper patient education by the clinical pharmacist to the patient regarding safe and effective usage of inhalers and nebulizers especially corticosteroids can minimize these drug related problems.
The trend of consuming hair dyes intentionally to free their souls is increasing day by day especially among rural indian population. Among them super vasmol 33 is a well known emulsion base type hair dye brand. The main content in vasmol is paraphenylenediamine (PPD).the major toxic effects of this chemical were found to be cervicofacial edema, rhabdomyolysis and renal failure. Quick recognition and immediate supportive therapy helps to recover completely. We report a case which highlights the toxic effects upon vasmol ingestion.
Number of people exposed to traumatic events is on rise
day by day. Despite of this increased rate of exposure, little
is known about the disease, treatments available for
preventing/relieving PTSD symptoms. As research is a
continuous process and huge body of evidence is being
added to the existing literature, it is very important to
update ourselves. All the conclusions made by various
researchers are the result of experiments performed in
their set up which is different from ours. The applicability
of those conclusions in our kind of population has to be
evaluated and build our own body of evidence.
Effect of Patient Counseling in Improving Physical and Mental Health of Type-...Gangula Amareswara Reddy
The present study concluded that chronic diseases like diabetes affect the quality of life of patients.As the main goal of any medical care is the improvement of the patients’ overall quality of life, the clinical pharmacist imparted patient education through counseling has a major role in improving the physical as well as mental health outcomes.
A PILOT STUDY ON DRUG - DRUG INTERACTIONS AMONG THE SCHIZOPHRENIA PATIENTS IN...Gangula Amareswara Reddy
As the improvement in schizophrenia patients is seen with only long term therapy, being adhered to the regimen all the way is very important. Development of drug-drug interactions among prescribed agents is the main reason for drug non adherence.Hence prior assessment of prescriptions is mandatory for the prescriptions with multiple drug therapy.The study opens door for larger studies to emphasize the role of pharmacist in identifying and preventing drug-drug interactions.
Digoxin is extensively used in the treatment of congestive heart failure
(CHF). It improves blood circulation to peripheral tissues by increasing
contractility of myocardial cells by binding to Na+-K+ ATPase pump.
Arrhythmias are the major Adverse Drug Reaction (ADR) of Digoxin which
may lead to hospitalization, morbidity and even mortality. A 60 years male
patient was admitted with breathlessness, pedal edema and was diagnosed as
CHF. He was prescribed with Digoxin 5 day therapy along with other
medications, on 5th day we observed Electro Cardio Gram (ECG) changes
indicating ventricular tachycardia as a suspected ADR of Digoxin and was
confirmed by causality assessment, immediately suspected drug was stopped,
patient was monitored for progression and on 9 th day ECG showed no
tachycardia changes. We strongly recommends to monitor the patients receiving
digoxin (especially those aged > 60years of age) for safe and effective outcome
of therapy.
ASSESSMENT OF SELF MEDICATION AMONG RURAL VILLAGE POPULATION IN A HEALTH SCRE...Gangula Amareswara Reddy
THE STUDY AIMS AT IDENTIFYING SELF MEDICATION PATTERN AMONG RURAL POPULATION AND VARIOUS FACTORS INFLUENCING IT LIKE OCCUPATION, HABITS, LITERACY RATE, EXTENT OF AWARENESS, SOURCE FOR DRUG INFORMATION ETC.......
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Arjun Kumar et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-3(2) 2015 [82-84]
82
IJAMSCR |Volume 3 | Issue 2 | April-June- 2015
www.ijamscr.com
Case report Health research
A case report on Ceftriaxone induced Hypersensitivity Reactions (Urticaria)
A Arjun Kumar1
, R Siddarama*2
, M Javeed Baig2
, Gangula Amareswara Reddy2
1
MD Associate Professor, General Medicine, Rajiv Gandhi Institute of Medical Sciences, (RIMS),
Kadapa, India- 516003
1
Department of Clinical Pharmacy, P Rami Reddy Memorial College of Pharmacy, kadapa, India –
516003.
*Corresponding author: R Siddarama
E-mail id: siddaramapharmd22@gmail.com
ABSTRACT
Ceftriaxone is a third generation cephalosporin group of broad spectrum anti-biotic. It active against the gram
positive and gram negative organisms. Which is commonly used antibiotic in patients with various infections like
respiratory tract infection, urinary tract infection, enteric fever and meningitis. Hypersensitive reactions subsequent
ceftriaxone therapy is unusual but is potentially life-threatening. It is rapidly occurring reactions, hence called
immediate hypersensitivity reactions. Whenever the patient exposure to certain drugs (penicillin, cephalosporin's
and aspirin ) production of IgE antibodies – fix to mast cells then again re-exposure to the same drug antigen-
antibody reaction occurs on the mast cell surface then release of inflammatory mediators like histamine, 5-HT, PGs,
LTs, PAF these mediators cause the hypotension, bronchospasm, angioedema, urticarial, rhinitis and anaphylactic
shock. The management of hypersensitivity reactions which include inj.Adrenalin 0.3 to 0.5ml, intramuscularly,
inj.Hydrocortisone 100 to200 mg, intravenously, inj. Pheniramine 45 mg intravenously. Here we report a 28 years
female who presented with the hypersensitivity reactions with ceftriaxone therapy.
Keywords: Ceftrioxone, third generation cephalosporin, hypersensitivity reactions,
.
INTRODUCTION
Ceftriaxone is a long acting, third generation, broad-
spectrum cephalosporin group of beta lactom
antibiotic. Ceftrioxone bactericidal action is through
the inhibition of cell wall synthesis and it exerts in-
vitro activity against a wide range of gram-positive
and gram-negative microorganisms. Intravenous
administration of ceftriaxone is generally well
tolerated and used for the treatment of serious
bactericidal infections. Ceftrioxone is having the few
adverse effects, among that hypersensitivity reactions
are the most common one.1
The incidence of
ceftrioxone induced severe allergic reactions are 1-
3%, and the incidence of anaphylaxis reactions are
still lesser rat 0.1-0.0001%.2
In the same way, there
are inadequate reports regarding life threatening
anaphylaxis even after negative skin test given
through surgical prophylaxis3,4
. The mechanism of
hypersensitivity reactions in our patient may be IgE-
dependent conversely it is difficult to explain since
there was no history of previous exposure to
cephalosporin group of antibiotics or penicillin,
though the history was not dependable. Unlike for
penicillin's, skin testing for cephalosporin's is not
heterogeneous5
. And there is no skin test that can
constantly expect whether a patient will noticeable an
allergic reaction to ceftriaxone.6
The patients who are
an allergic reaction to a exact cephalosporin almost
certainly should not receive that cephalosporin group
again. Cross reaction between cephalosporin's
perform but at a lower rate7.
Detailed history of the
patient regarding prior antibiotic allergy should take
in full account of the symptoms such as urticaria,
respiratory difficulties, angioedema, purities, or
severity of reaction as well as the timing of reaction
after prescription treatment. The positive and
negative prognostic values of skin testing results for
cephalosporin group of antibiotics are not well
established8
. Drug allergies can be categorized into
IgE-mediated (type I immediate-type) and non-IgE
mediated hypersensitivity reactions. IgE-mediated
reactions include angioedema, anaphylaxis, urticaria
and broncho spasm occurs within 72 hours after
taking the cephalosporin anti-biotic. Non-IgE
mediated hypersensitivity reactions Include
interstitial nephritis, haemolytic, anemia,
thrombocytopenia, Stevens-Johnson syndrome,
serum sickness, drug fever, morbilliform eruptions,
erythematic, multiform, and toxic epidermal
necrolysis occur most commonly after 72 hours of
drug administration9
. Drug-induced Hypersensitivity
reaction is a life-threatening systemic reaction
categorized by cutaneous rash, internal organ
involvement, lymphadenopathy, fever, eosinophilia
and leukocytosis10
.
International Journal of Allied Medical Sciences
and Clinical Research (IJAMSCR)
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CASE REPORT
28 years female patient was admitted in general
medicine department with the chief complaints of
body pains since 1 week, insidious onset and
gradually progressed, aggregated by walk and relived
by rest, Fever since 1 week, weakness since 1 week.
She was not known a hypertensive and diabetes
patient. On general examination patient was
conscious and coherent and her vitals were found to
be, PR-80 bpm, BP-110/80 mm of Hg and her
systems examinations were found to be CVS-S1S2+,
CNS-not abnormalities, RS-BLAE+, RR-12cpm. On
physical examination, patient is found to have
hypersensitivity reactions on whole body, mainly
abdomen and chest region. (Shown in Fig:1.)
Laboratory examination of the patient was found to
be Hemoglobin-12gm%, RBS-110mgs/dl, HIV-
negative, HbsAg- negative, Malaria Parasite-negative,
Widal Test-negative.
Figure :1 Ceftrioxone induced Hypersensitivity reactions (urticaria)
The patient was treated with following drugs on day
1, parental anti-biotic (ceftrioxone 1gm iv bd),
parenteral anti-ulcer drug (pantaprazole 40mg iv bd),
parenteral anti-pyretic (paracetamol 300mg im tid),
oral vitamins (B.complex vitamin 67.5mg od). This
treatment was continued up to 6 days. On day 2
patient developed mild hypersensitivity reactions, on
day 3 and day 4 patient developed hypersensitivity
reactions on whole body [Figure 1]. So on day5 we
intimate to the physician about hypersentivity
reactions caused by ceftriaxone and physician
immediately stopped that drug, patient recovered
from hypersentivity reactions after 10 days.
ADR analysis
After collecting past and current medication history
from the patient it was suspected that the patient had
developed drug induced hypersensitivity reactions.
After analyzing the ADR profiles of all the drugs, it
was found that the most suspected drug for producing
hypersensitivity reactions was Ceftrioxone. We have
further analyzed to establish the relationship between
the drug and the observed ADRs, through causality
assessment by using naranjo’s scale, WHO-UMC
ADR assessing scale as well as Karch and lasagna
scale, results were shown in Table 01. We have also
assessed the severity, predictability and
preventability as a part of management through
Modified Hartwig and Siegel severity scale,
Schumock and Thornton Preventability Scaleresults
were shown in Table 02
ADR Management
Generally, management of ADR includes
withdrawal/suspension, dose reduction of suspected
drug and administration of supportive therapy. Hear
the suspected drug was withdrawn from the
prescription, after 10 days patient was recovered
from that reactions.
Table 1: causality assessment of suspected ADRs
S.No Suspected Drug and Reaction (ADR) Nariño's scale WHO-UMC Karch & Lasagna scale
1 Ceftrioxone induced hypersensitivity reactions Probable Probable Probable
Table 02: Severity, Predictability, Preventability.
ADR Drug
involved
Severity Predictability Preventability
Ceftrioxone induced hypersensitivity
reactions
Cefrtioxone moderate
level 4
Predictable (Type-
B)
Probably
preventable
DISCUSSION
Pharmacovigilance is defined as the science and
activities involving to the detection, Understanding,
assessment, and prevention of adverse drug reactions
(ADRs) or any other drug related problems. ADRs
can occur due to the use of multiple or concurrent
drugs, drug interactions, and Possible in attention
etc11
. Drug explosion are common, comprising 10–
30% of all reported adverse drug reactions12
. B-
Lactam antibiotics like cephalosporin's, Penicillin's
and sulfonamides develop hypersensitivity reactions
more commonly. Ceftriaxone is a third generation
cephalosporin antibiotic, It is used commonly in adult
patients and children for serious infections.
Hypersensitivity reactions due to the ceftriaxone
therapy are potentially serious13
. Causality
3. Arjun Kumar et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-3(2) 2015 [82-84]
84
assessment was also done and correlation was
established by using Naranjo’s scale WHO-UMC and
Karch and Lasagna scale. Drug-induced urticaria
frequently occurs due to antibiotics of which
cephalosporin's were the mainly familiar causative
drugs14
. Cephalosporin induced hypersensitivity
reactions may be immediate or non-immediate.
Immediate reactions are IgE mediated reactions like
urticaria, bronchospasm, Anaphylaxis and angio
edema, which typically occurs within an hour of drug
experience15
. Non-immediate reactions are maculo
papular or morbilliform rashes and delayed
appearance of urticaria. Rashes or urticaria was the
most frequently happening adverse reaction of
intravenous Ceftriaxone16
.
CONCLUSION
Ceftriaxone which is used widely to treat various
infections has ability to cause severe allergic
reactions. Hence it is must to do skin test prior to
administration of ceftriaxone or other beta lactam
antibiotics.
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