A 23-year-old human immunodeficiency virus (HIV)-infected Indian woman was admitted to a tertiary care hospital with generalized erythematosus rash all over her body with difficulty in swallowing for the previous 3 days. She also presented with swelling of the lips and redness of both eyes along with nausea, anorexia, slight headache, and fever, which appeared immediately after the initiation of a new regime of antiretroviral treatment with tenofovir (300 mg once daily), lamivudine (300 mg once daily), and efavirenz (600 mg once daily). Presumptive diagnosis of efavirenz-induced Stevens–Johnson syndrome was made after excluding other causes. Efavirenz was withdrawn, followed by tenofovir and lamivudine. Supportive care was provided to the patient during her hospital stay. She recovered after 2 weeks. Thus, strict vigilance of adverse drug reaction is required in patients on a highly active antiretroviral therapy regimen.

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Objective: To describe and analyze the demographic and pharmacological characteristics of self-medication trends among a geriatric urban population in a community. Materials and Methods: This structured interview-based, cross-sectional survey was conducted among elderly subjects of either sex in an urban community, who visited two pre-identified, retail pharmacies in a sub-urban locality, for procuring sundry medicinal products of their choice, without a valid prescription. Institutional ethics approval was duly obtained. Respondents (n=108) readily shared the information as sought regarding the encounter. The data were captured by trained field staff in a pre-designed data sheet, maintaining full confidentiality. Results: The subjects (n=108) were predominantly (64.81%) male, with an average age of 65.95 years. The subjects mostly retired from job. Only 21.29% of them asked for particular brands, whereas just 5.55% subjects asked for a generic product. Majority of the subjects (73.14%) sought for medical help and received it from the dispenser at the counter. Antibiotics, on most occasions, were dispensed for inappropriate indication and duration. On an average, the cost of the medicines procured in a single encounter by the employed and unemployed were Rs 51.86 and Rs 21.86 respectively. Conclusion: Self-medication trends in elderly are a disturbing problem that needs to be carefully addressed. Pilot study such as the present one is easy to carry out, and can rapidly yield information about the true nature of self medication trends among the elderly. This can help in designing effective and appropriately targeted interventions in the future.

Background: Lithium continues to be considered first-line therapy for treatment of acute mania, acute mixed bipolar disease and long-term prophylaxis of bipolar disorder. Present study was done to study the pattern of drug therapy in bipolar affective disorder patients with special reference to lithium in the routine psychiatric outpatients care setting of a tertiary care teaching hospital as well as to understand the prospect of therapeutic drug monitoring in optimization of lithium therapy based on outcome.Methods: It was a prospective, non-randomized, observational study of a cohort of subjects who are suffering from bipolar affective disorders and on lithium therapy. Patients were prospectively followed up three monthly for three visits with therapeutic drug monitoring of their plasma lithium level, as and when advised by the treating physician, and pre-formed questionnaires.Results: Results revealed there was significant improvement in symptoms of patients who were monitored with therapeutic drug monitoring and prescribed lithium therapy in accordance with clinical pharmacological consultation for optimal dosing resulting in optimal benefit to patients.Conclusions: With regular therapeutic monitoring, optimal target serum lithium levels can be achieved with dosage modifications thereby reducing the risk of toxicity with improved drug compliance. Thus, individualization of dosing and optimization of treatment can be achieved by dependable analytical laboratory services, better psycho-education, family support and overall a disease-based management team approach with the involvement of clinical Pharmacologist to meet the complexities of lithium therapy.

Arsenic is an element which occurs naturally in the earth's crust and in small quantities in rock, soil, water and air. Chronic arsenic toxicity produces various dermal and systemic manifestations including cancer. It may also cause different pulmonary diseases. Here, we have described a case series of three chronic arsenicosis patients having varied pulmonary involvements ranging from bronchiectasis to chronic obstructive pulmonary diseases. They all had classic raindrop pigmentations with one patient developing squamous cell carcinoma. Pulmonary manifestations were severe with more cutaneous manifestations as well as more arsenic levels in hair and nail samples of patients. Manifestations also seemed severe with increased duration of exposure and more amount of arsenic in their drinking water.