Browsing by Author "Upinder Kaur"

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A prospective observational pilot study of adverse drug reactions in patients admitted in the geriatric ward of a tertiary hospital in north india
(Bentham Science Publishers B.V., 2018) Upinder Kaur; Sankha Shubhra Chakrabarti; Bhanupriya Singh; Indrajeet Singh Gambhir
Background: Adverse Drug Reactions (ADRs) form one of the leading causes of morbidity and mortality particularly in the elderly population. Alterations in pharmacokinetics and pharmacodynamics with ageing results in increased ADRs which may be novel in respect to the young and may also vary from one older individual to another. These may hence be invaluable in personalized medicine. Objective: The primary objective of this pilot study was to find the occurrence of ADRs in north Indian elderly patients admitted in the Geriatric ward, to analyze its epidemiological attributes and to draw conclusions regarding its implications in designing individualized treatment regimens and plan for larger multi-centric studies. Methods: Elderly patients (>50 years age) admitted in the Geriatric ward were enrolled in this hospital-based, prospective observational study done during the period of September 2014 to September 2015 and June 2016 to October 2017. Adverse drug reaction data was collected based on self-reporting by patients or attendants and/or physician diagnosis. Results: Out of 658 patients (M=388; F=270) admitted in the geriatric ward, 149 ADRs were reported in 103 patients (22.6%). 28 patients (4.2 % of all patients) experienced more than one ADR. Polypharmacy was seen in 98% cases of ADRs. Most commonly reported individual ADR was hypokalemia (13.4%) followed by diarrhea (8.7%). Electrolyte and metabolic abnormalities were the most common ADRs (27.5%) followed by the involvement of gastrointestinal system (18%) and central nervous system (13.4%). 120 (80.5%) ADRs were dose related i.e. Type A ADR and 22 ADRs (14.8%) were immunologic or type B ADRs. In addition, there were 2 cases of ADRs due to drug withdrawal (type E). Category wise, antibiotics were involved in maximum (32.2 % of ADRs) cases followed by diuretics (11.4 % of ADRs), intravenous fluids (10% of ADRs) and anti-hypertensives (9.4% of ADRs). The Naranjo scale was not applicable in 12.75% of ADRs; mostly due to multiple drugs or interactions being suspected. 55% ADRs were of moderate severity while 11% ADRs were of severe category. ADRs were found to increase the hospital stay by an average of 2 days. Mortality was seen in 4 cases with ADRs. 63% of ADRs were avoidable. Conclusion: A higher than described incidence of ADRs was seen in our study. Polypharmacy was observed as a universal association. Antibiotics and diuretics were the common culprits. A greater fraction of ADRs is avoidable by proper vigilance and adequate monitoring. Awareness about the culprit drugs and associated regional variations may help in avoiding them in the older patients of specific ethnicities. The study highlights the incidence, severity and type of ADRs in the north Indian elderly population and gives platform for large-scale studies in future. © 2018, Bentham Science Publishers.
A prospective observational safety study on ChAdOx1 nCoV-19 corona virus vaccine (recombinant) use in healthcare workers- first results from India
(Elsevier Ltd, 2021) Upinder Kaur; Bisweswar Ojha; Bhairav Kumar Pathak; Anup Singh; Kiran R. Giri; Amit Singh; Agniva Das; Anamika Misra; Ashish Kumar Yadav; Sangeeta Kansal; Sankha Shubhra Chakrabarti
Background: We provide the first post-approval safety analysis of COVISHIELD in health care workers (HCWs) in northern India. Methods: This continuing prospective observational study (February 2021 to May 2022) enrolled participants ≥18 years receiving COVISHIELD vaccination. Primary outcome was safety and reactogenicity. Categories (FDA toxicity grading) and outcomes of adverse events following immunization (AEFIs) were recorded, causality assessment performed, and risk factors analysed. Findings: We present the results of an interim analysis of 804 participants. AEFIs following first dose were reported in 321 (40%; systemic involvement in 248). Among 730 participants who completed a 7-day follow-up post second dose, AEFIs occurred in 115 (15.7%; systemic in 99). Majority of AEFIs were mild-moderate and resolved spontaneously. Serious AEFIs, leading to hospitalization was noticed in 1 (0.1%) participant with suspicion of immunization stress related response (ISRR). AEFIs of grade 3 severity (FDA) were recorded in 4 participants (0.5%). No deaths were recorded. Regression analysis showed increased risk of AEFIs in younger individuals, a two times higher odds in females, those with hypertension or with history of allergy; and three times higher odds in individuals with hypothyroidism. Interpretation: COVISHIELD carries an overall favourable safety profile with AEFI rates much less than reported for other adenoviral vaccines. Females, those with hypertension, individuals with history of allergy and hypothyroidism may need watchful vaccine administration. This being an interim analysis and based on healthcare workers who may not reflect the general population demographics, larger inclusive studies are warranted for confirming the findings. Funding: No funding support. © 2021 The Author(s)
A Prospective Observational Study on BBV152 Coronavirus Vaccine Use in Adolescents and Comparison with Adults: Interim Results of the First Real-World Safety Analysis
(Adis, 2022) Upinder Kaur; Anju K.L; Mayank Chauhan; Aditi Joshi; Agniva Das; Sangeeta Kansal; Vaibhav Jaisawal; Kishor Patwardhan; Sankha Shubhra Chakrabarti
Introduction: The BBV152 coronavirus disease 2019 (COVID-19) vaccine (COVAXIN) has recently been approved for adolescents. Objective: We provide the first real-world safety data of COVAXIN use in adolescents and compare with adults. Methods: A prospective observational study was initiated in January 2022. Enrolled adolescents and adults were contacted by telephone after 14 days of receiving the BBV152 vaccine. The primary outcome was vaccine safety assessed as rate of adverse events following immunization (AEFIs). Severity grading of AEFIs was done using the Food and Drug Administration (FDA) scale. Interim results are presented. Results: A total of 698 adolescents and 326 adults were enrolled. AEFIs after the first dose developed in 243 out of 670 adolescents (36.3%), with 21% reporting only local AEFIs and 15.2% reporting systemic AEFIs. Among 340 adolescents who had received the second dose of vaccine, 129 (37.9%) developed AEFIs, with only local involvement in 20.3% and systemic involvement in 17.6%. Injection site pain and fever were the common AEFIs. The majority of AEFIs were mild-moderate. Nearly 0.9% of adolescents receiving the first dose reported severe AEFIs. Atypical AEFIs were observed in 0.6–0.9% of adolescents. The majority of the AEFIs resolved in 1–2 days. AEFIs were persistent in > 2% of adolescents at day 14 after the second dose, and also in 3.7% of adults overall at follow-up. No difference was observed in AEFI incidence and patterns between adolescents and adults. Regression analysis showed females and those with a history of allergy to be, respectively, at 1.6 times and 3 times increased risk of AEFIs among adolescents. Conclusions: COVAXIN carries an overall favorable short-term safety profile in adolescents. The observed AEFI rates in adolescents are much lower than that reported with mRNA vaccines, but head–head comparisons in the same population are required to generate relative vaccine safety data. Female adolescents and those with a history of allergy need watchfulness for severe and persistent AEFIs. With some AEFIs persisting at 14 days, a longer follow-up is recommended to strengthen the safety data of COVAXIN. © 2022, The Author(s), under exclusive licence to Springer Nature Switzerland AG.
A Real-world Pilot Observational Study of Neuropathic Pain Medications in Older Adult Patients in North India
(Bentham Science Publishers, 2022) Upinder Kaur; Vandana Dwivedi; Alok Singh; Amit Singh; Arun Raj Pandey; Kumudini Acharya; Sankha Shubhra Chakrabarti
Aims: This pilot study aimed to make head-to-head comparisons of multiple classes of drugs used in the management of neuropathic pain in North Indian older adult patients pre-senting to the geriatric clinic of a tertiary medical institution. Background: Chronic neuropathic pain is a condition affecting nearly one third of older adults. There is paucity of data on head-to-head comparisons of drugs used in neuropathic pain in older adults. Real world studies may be a useful tool to study diverse neuropathic pain medications in this population. Objectives: The study objective was to measure NPRS (numeric pain rating scale), GDS (geri-atric depression scale), IADL (instrumental activities of daily living), HMSE (Hindi mental state examination) scores at baseline, and 4-and 12-week follow-ups in all older adult patients receiving neuropathic pain medications. Methods: A prospective observational study was conducted involving older adult patients ≥ 50 years of age with painful peripheral neuropathy of any etiology (n=60; mean age 63±8.4 years). The patients received either gabapentin, pregabalin, duloxetine, amitriptyline, or me-thyl-cobalamin complex. NPRS, GDS, IADL, and HMSE scores were measured at baseline and post-therapy. Results: All groups except amitriptyline showed statistically significant improvement in NPRS at 4 weeks and 12 weeks compared to baseline. 30% response rate at 4 weeks was maximum for pregabalin (72%) and 50% response rate at 12 weeks was maximum for gabapentin (58%). Numerically maximum improvement in depression was seen with duloxetine. There was no statistically significant difference in the measured parameters between the drug groups across time. Mean daily dose was 172 mg (gabapentin group), 75 mg (pregabalin group) and 20 mg (duloxetine group). The adverse drug reaction rate was 10.5%. Conclusion: All drug groups showed beneficial effects on neuropathic pain at much lower doses than those described in the literature. The effectiveness at these low doses and the lower rates of adverse effects sets the foundation for larger studies in the future in diverse ethnic and aged populations. © 2022 Bentham Science Publishers.
Acute Cardiac Events After ChAdOx1 nCoV-19 Corona Virus Vaccine: Report of Three Cases
(Lippincott Williams and Wilkins, 2022) Rohit Singh; Sankha Shubhra Chakrabarti; Indrajeet Singh Gambhir; Ashish Verma; Ishan Kumar; Soumik Ghosh; Ashutosh Tiwari; Gourav Chandan; Sasanka Chakrabarti; Upinder Kaur
[No abstract available]
Alpha-synuclein, proteotoxicity and parkinson's disease: Search for neuroprotective therapy
(Bentham Science Publishers B.V., 2018) Upasana Ganguly; Sankha Shubhra Chakrabarti; Upinder Kaur; Anwesha Mukherjee; Sasanka Chakrabarti
Background: There is a growing body of evidence in animal and cell based models of Parkinson's disease (PD) to suggest that overexpression and / or abnormal accumulation and aggregation of α-synuclein can trigger neuronal death. This important role of α-synuclein in PD pathogenesis is supported by the fact that duplication, triplication and mutations of α-synuclein gene cause familial forms of PD. Methods: A review of literature was performed by searching PubMed and Google Scholar for relevant articles highlighting the pathogenic role of α-synuclein and the potential therapeutic implications of targeting various pathways related to this protein. Results: The overexpression and accumulation of α-synuclein within neurons may involve both transcriptional and post-transcriptional mechanisms including a decreased degradation of the protein through proteasomal or autophagic processes. The mechanisms of monomeric α-synuclein aggregating to oligomers and fibrils have been investigated intensively, but it is still not certain which form of this natively unfolded protein is responsible for toxicity. Likewise the proteotoxic pathways induced by α-synuclein leading to neuronal death are not elucidated completely but mitochondrial dysfunction, endoplasmic reticulum (ER) stress and altered ER-golgi transport may play crucial roles in this process. At the molecular level, the ability of α-synuclein to form pores in biomembranes or to interact with specific proteins of the cell organelles and the cytosol could be determining factors in the toxicity of this protein. Conclusion: Despite many limitations in our present knowledge of physiological and pathological functions of α-synuclein, it appears that this protein may be a target for the development of neuroprotective drugs against PD. This review has discussed many such potential drugs which prevent the expression, accumulation and aggregation of α-synuclein or its interactions with mitochondria or ER and thereby effectively abolish α-synuclein mediated toxicity in different experimental models. © 2018 Bentham Science Publishers.
Antiepileptic drug therapy in the elderly: a clinical pharmacological review
(Springer-Verlag Italia s.r.l., 2019) Upinder Kaur; Indal Chauhan; Indrajeet Singh Gambhir; Sankha Shubhra Chakrabarti
Seizure disorder is the third most common neurological disorder in the elderly after stroke and dementia. With the increasing geriatric population, the situation of clinicians seeing more and more elderly epilepsy patients is very likely. Not only is the diagnosis of epilepsy tedious in the elderly, its management raises many challenging issues for the treating physicians. Altered physiology, age-related decline in organ function, and plasma protein binding and altered pharmacodynamics make the elderly patients with seizure disorder a difficult group to treat. This is further complicated by the presence of comorbidities and polypharmacy which increase the chances of drug interactions. The adverse effects that might be tolerated well in younger populations may be disastrous for the aged. Although the newer antiepileptic drugs are found to have a favorable safety profile, there is relative scarcity of randomized-controlled trials involving older and newer antiepileptics in the geriatric population. This review tries to compile the available literature on management of epilepsy in the elderly population including evidence of safety and efficacy of newer and older antiepileptics with special reference to the ‘geriatric giants’. It also deals with the interactions between antiepileptic medications and other commonly prescribed drugs in the elderly such as anti-hypertensives and antiischemic agents. The recommended guidelines of various international bodies are also analyzed from the perspective of elderly with seizure disorder. © 2019, Belgian Neurological Society.
APOE4 allele in north Indian elderly patients with dementia or late onset depression-a multiple-disease case control study
(Shiraz University, 2019) Anamika Misra; Sankha Shubhra Chakrabarti; Indrajeet Singh Gambhir; Upinder Kaur; Shukla Prasad
The objective of the study was to analyze the frequency of APOE4 allele in elderly patients with Alzheimer's or vascular dementia or depression; compare these to age/sex matched controls; compare the results with established literature and highlight new findings. A single center, multiple disease, case-control study was performed with three case groups-probable AD patients (n=36), vascular dementia patients (n=29) and depression patients (n=20) and with a control group (n=32). APOE genotyping was performed in whole blood samples collected from patients and controls by restriction isotyping using the enzymes AflIII and HaeII. There was significant difference in frequency distribution of E4 allele between the AD (12/72; 16.7%) and control groups (3/64; 4.7%) (P=0.03). However, no significant difference was found in any of the other comparisons. The current study demonstrates absence of a significant association between APOE4 positivity and presence of late-onset depression in the north Indian elderly and reinforces the higher APOE4 prevalence in LOAD patients but not in VD patients. It is the first study of its kind from the northern part of India involving multiple disease groups and lays the framework for larger cohort studies. © 2020, Shiraz University.
Aripiprazole-induced Parkinsonism with pregabalin as a confounder
(Springer Science and Business Media Deutschland GmbH, 2021) Upinder Kaur; Bisweswar Ojha; Bhairav Kumar Pathak; Amit Singh; Indrajeet Singh Gambhir; Sankha Shubhra Chakrabarti
[No abstract available]
Atypical extrapyramidal manifestation of a typical antipsychotic with serotonergic antidepressant
(Springer Science and Business Media Deutschland GmbH, 2024) Rohit Singh; Sankha Shubhra Chakrabarti; Upinder Kaur
Introduction: Typical antipsychotics are known to produce extrapyramidal side effects such as drug induced parkinsonism, acute dystonia, akathisia, tardive dyskinesias and rabbit syndrome. Rabbit syndrome is characterized by vertical rhythmic motion of the mouth and lips, resembling chewing movements of a rabbit. Reason for the report: Rabbit syndrome seen in patients on antidopaminergic therapies is characterized by vertical rhythmic movements of perioral region, has a late onset, and characteristically spares the tongue. The main aim of the report is to highlight atypical manifestation of antipsychotic associated Rabbit syndrome in the presence of a serotonergic antidepressant. Case summary: An elderly patient presented with atypical rabbit syndrome with relatively acute onset, horizontal movements of jaw and marked tongue involvement after haloperidol-escitalopram initiation. Outcome: The patient improved with discontinuation of antipsychotic. The tongue involvement was believed to be secondary to escitalopram use. Graphical Abstract: (Figure presented.) © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023.
Case Report: Isoniazid-Associated Delirium in an Elderly Female with Spinal Tuberculosis
(American Society of Tropical Medicine and Hygiene, 2022) Upinder Kaur; Rohit Singh; Amit Singh; Sankha Shubhra Chakrabarti
Isoniazid is an important component of first-line antitubercular therapy. The drug at its therapeutic dose is known to cause hepatitis and peripheral neuropathy. The association of isoniazid with pure delirium is rare. Here, we present an interesting case of new-onset delirium associated with isoniazid in an elderly female with spinal tuberculosis. Remarkable improvement was noticed in the patient following drug discontinuation and pyridoxine augmentation. Copyright © 2022 by The American Society of Tropical Medicine and Hygiene.
Case Report: Nocardia amamiensis Infection Leading to Worsening of Chronic Obstructive Pulmonary Disease Symptoms in an Elderly Man
(American Society of Tropical Medicine and Hygiene, 2023) Ahalya Kanakan; Amit Kumar; Upinder Kaur; Prity Narwade; Zinnu Rain; Nidhi Yadav; Ishan Kumar; Deepak Kumar; Sankha Shubhra Chakrabarti
Nocardiosis is a rare opportunistic infection mostly affecting the lungs, brain, or skin of immunocompromised individuals. Most pulmonary nocardiosis patients present with nonspecific clinical features such as productive cough, exertional dyspnea, and fever. The disease is uncommonly suspected, especially in tuberculosis-endemic regions, and clinical diagnosis is often delayed, resulting in high mortality. Pulmonary nocardiosis in apparently immunocompetent individuals is uncommon. Here, we present the case of an elderly gentleman with a background history of poorly controlled diabetes but no history of systemic steroid use who presented with worsening symptoms of chronic obstructive pulmonary disease in the form of productive cough and dyspnea. The patient had diffuse crepitations in bilateral lung fields and an arterial oxygen saturation of 86% at admission. Sputum microscopy revealed gram-positive filamentous bacteria that could be successfully cultured and identified as Nocardia amamiensis on 16S ribosomal RNA sequencing. Contrast-enhanced computed tomography of the lungs revealed cavitary nodules and consolidation. The patient responded well to treatment with specific antibiotics based on sensitivity patterns. Because of the nonspecific clinical and radiological findings in pulmonary nocardiosis, a high index of suspicion is required, especially in tuberculosis-endemic regions. © 2023 American Society of Tropical Medicine and Hygiene. All rights reserved.
Case Report: Rhino-orbital Mucormycosis Related to COVID-19: A Case Series Exploring Risk Factors
(American Society of Tropical Medicine and Hygiene, 2022) Sushil Kumar Aggarwal; Upinder Kaur; Dolly Talda; Akshat Pandey; Sumit Jaiswal; Ahalya Kanakan; Anshuman Singh; Sankha Shubhra Chakrabarti
There has been a surge of rhino-orbital mucormycosis cases in India in the wake of the second wave of the COVID-19 pandemic. It has been widely suggested that dysglycemia resulting from diabetes which is a common comorbidity in COVID-19 patients, and indiscriminate steroid use has resulted in this surge. We report a series of 13 cases of rhino-orbital mucormycosis in COVID-19 patients admitted to our center between mid-April and early June 2021. The cases showed a male preponderance, two patients had loss of vision, and four of them showed intracranial extension of disease. Twelve patients had received steroids and 12 had preexisting or newly diagnosed diabetes, both steroid use and diabetes being the most common identified risk factors. Considering other possible risk factors, immunosuppressed state, antiviral or ayurvedic (Indian traditional) medications, and oxygen therapy were not associated with a definite risk of mucormycosis, because they were not present uniformly in the patients. We propose that COVID-19 itself, through molecular mechanisms, predisposes to mucormycosis, with other factors such as dysglycemia or steroid use increasing the risk. © 2022 American Society of Tropical Medicine and Hygiene. All rights reserved.
Cerebellar dysfunction in an elderly male after a brief course of metronidazole
(Bentham Science Publishers B.V., 2019) Upinder Kaur; Ishan Kumar; Anup Singh; Mukesh Kumar; Sankha Shubhra Chakrabarti
Background: Metronidazole, a widely used antibacterial and antiprotozoal drug, is often the drug of choice in amoebic liver abscess. The drug, otherwise safe, can cause serious central nervous disturbances in rare circumstances. Case Report: Here, we report a case of cerebellar dysfunction in the form of slurring of speech and episodes of falls, in an elderly male following a three-week course of metronidazole therapy. Results and Conclusion: The patient manifested classic radiologic features of metronidazole neurotoxicity. Marked improvement in clinical symptoms was seen following drug discontinuation. © 2019, Bentham Science Publishers B.V.. All rights reserved.
Clinical outcomes with all-oral regimens in patients of drug-resistant tuberculosis: A prospective study in a tertiary hospital in North India
(Springer Science and Business Media Deutschland GmbH, 2025) Vijay Kumar; G. S. Sri Bharathi; Mohit Bhatia; Sankha Shubhra Chakrabarti; Upinder Kaur; Jai Krishna Mishra
The study aimed to analyze therapeutic outcomes with bedaquiline-based all-oral regimens for drug-resistant tuberculosis. A prospective observational study was conducted from August 2022 to March 2024 and patients of drug-resistant tuberculosis on all-oral regimens were enrolled. Among 100 patients enrolled (83 on longer-oral and 17 on shorter-oral), 73 patients from longer-oral regimens and 15 from the shorter-oral regimen were followed up at 6 months. Sixty-two (83.8%) patients of longer-oral, and 11 (64.7%) patients of the shorter oral regimen achieved microbiologic improvement in one sample. Clinical improvement occurred in the majority. Forty-five (60.8%) patients in the longer oral and six (35.3%) patients in the shorter-oral regimen required treatment modification, and the major reason was intolerability due to peripheral neuropathy. Skin pigmentation (43.2%), anemia (35.1%), and thrombocytopenia (25.7%) were other common adverse events in longer-oral regimen recipients. Optic neuritis occurred in two patients in the longer-oral regimen. Hepatitis and thrombocytopenia were common with regimens combining bedaquiline and delamanid. Linezolid dose was reduced in 44.6% and was replaced in 17.8% of the patients. Fluoroquinolone resistance emerged in 17.6% and 11.8% of patients in the longer-oral and shorter-oral regimens respectively. Interim microbiological outcomes with all-oral regimens of drug-resistant tuberculosis were favorable. Extended monitoring is needed to assess sustained treatment effect. Adverse events such as peripheral neuropathy are a major challenge and emphasize the need for a reduced dose of linezolid or newer regimens with better safety profiles. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.
COVID-19 in India: Are biological and environmental factors helping to stem the incidence and severity?
(International Society on Aging and Disease, 2020) Sankha Shubhra Chakrabarti; Upinder Kaur; Anindita Banerjee; Upasana Ganguly; Tuhina Banerjee; Sarama Saha; Gaurav Parashar; Suvarna Prasad; Suddhachitta Chakrabarti; Amit Mittal; Bimal Kumar Agrawal; Ravindra Kumar Rawal; Robert Chunhua Zhao; Indrajeet Singh Gambhir; Rahul Khanna; Ashok K. Shetty; Kunlin Jin; Sasanka Chakrabarti
The ongoing Corona virus (COVID-19) pandemic has witnessed global political responses of unimaginable proportions. Many nations have implemented lockdowns that involve mandating citizens not to leave their residences for non-essential work. The Indian government has taken appropriate and commendable steps to curtail the community spread of COVID-19. While this may be extremely beneficial, this perspective discusses the other reasons why COVID-19 may have a lesser impact on India. We analyze the current pattern of SARS-CoV-2 transmission, testing, and mortality in India with an emphasis on the importance of mortality as a marker of the clinical relevance of COVID-19 disease. We also analyze the environmental and biological factors which may lessen the impact of COVID-19 in India. The importance of cross-immunity, innate immune responses, ACE polymorphism, and viral genetic mutations are discussed. © 2020 Chakrabarti S et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Cross-immunity and trained immunity in explaining variable COVID-19 mortality—Guidance for future pandemics
(John Wiley and Sons Inc, 2021) Sasanka Chakrabarti; Sankha S. Chakrabarti; Upinder Kaur; Bimal K. Agrawal; Upasana Ganguly; Kunlin Jin
[No abstract available]
Deep venous thrombosis associated with thalidomide use in a case of steroid dependent erythema nodosum leprosum-a management conundrum
(Bentham Science Publishers B.V., 2017) Upinder Kaur; Sankha Shubhra Chakrabarti; Rohit Singh; Indrajeet Singh Gambhir
Introduction: Thalidomide, previously banned owing to the issues of teratogenicity is being used and tested for a variety of dermatological and non dermatological conditions. The drug has been approved for the management of erythema nodosum leprosum [ENL] and multiple myeloma [MM]. The drug is commonly known to produce adverse effects like peripheral neuropathy and constipation. Deep vein thrombosis [DVT] is one of the serious adverse effects seen with thalidomide use, especially in malignancies and is relatively uncommon in non cancer settings like ENL. Method: Here we report a case of DVT occurring after 8 months of use of thalidomide in a young patient of 22 years age suffering from ENL. Result: The case highlights the problems faced in the management of refractory ENL and the treatment of DVT in the setting of multiple drug interactions and financial constraints. Conclusion: New guidelines are required regarding the prophylaxis and management of DVT associated with thalidomide use in non-malignant conditions. © 2017 Bentham Science Publishers.
Delayed neuroleptic malignant syndrome associated with the use of low dose risperidone in conjunction with cholinergic drugsthe dangers of polypharmacy in the elderly
(Bentham Science Publishers B.V., 2018) Upinder Kaur; Sankha S. Chakrabarti; Indrajeet S. Gambhir; Deepak K. Gautam
Background: Neuroleptic malignant syndrome (NMS) is an idiosyncratic reaction with systemic manifestations like fever, rigidity, altered sensorium and autonomic disturbances. The syndrome is often seen within days to weeks in patients being treated with antipsychotics. Though reported with the use of atypical antipsychotics, it is relatively uncommon to occur if patient is on a stable dose of antipsychotic for a long time. Objective: Here we report a case of delayed NMS with risperidone use at the lowest recommended dose. Method: Review of probable etiology including drug review was performed in a 60 year hypertensive female presenting with progressive limitation of movements and rigidity in upper and lower limbs along with bilateral hand tremors, fever, poor speech, difficulty in swallowing, agitated behavior, urinary incontinence and altered mental status. Results: NMS occurred in the patient of schizophrenia on the lowest possible therapeutic dose of risperidone of 0.5 mg/day, after 14 years of therapy. The case highlights the possible drug interaction between risperidone and cholinergic drugs resulting in the catastrophe. (Videos before and after therapy are part of submission) Conclusion: Physicians should be vigilant of the risk of NMS with atypical antipsychotics like risperidone particularly when administered along with cholinergic drugs. NMS can occur even after long term use of a stable dose of antipsychotic. Cholinergic drugs like donepezil, citicoline and piracetam should be used with caution in patients who are already on antipsychotics and if needed should be added one by one. © 2018 Bentham Science Publishers.
Delayed resistance to imatinib after 16 years of therapy in a patient with chronic myeloid leukaemia
(Blackwell Publishing Ltd, 2020) Upinder Kaur; Indrajeet Singh Gambhir; Vibhu Ranjan Khare; Amit Singh; Sankha Shubhra Chakrabarti
[No abstract available]