Subacute cutaneous lupus erythematosus (SCLE) is an autoimmune disease that may be induced by proton pump inhibitors (PPIs) in at-risk populations. The US FDA does not recognize SCLE as an adverse event associated with PPIs. We queried the FDA Adverse Event Reporting System database, which contains adverse event case reports submitted by the public as well as by industry, and analyzed the data to quantify passive pharmacovigilance signals for SCLE associated with PPIs. A disproportionality analysis of the signals yielded a significant association between SCLE and PPIs. Discontinuation of PPI resulted in remission, with PPI re-challenge causing SCLE to reoccur. A follow-up analysis also yielded a significant association between SCLE and H2 receptor antagonists. We conducted a brief literature survey of published case reports and studies to discern the validity of PPI-induced SCLE signals. Healthcare prescribers and patients should be made aware that SCLE can be induced by PPIs. In such cases, PPIs should be discontinued and alternative clinical treatment sought. Regulatory bodies such as the FDA should incorporate the adverse reaction in PPI prescription labels.

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Early clinical exposure as a part of vertical integration is an intervention that bridges the gap between the basic and clinical sciences. It can be achieved by exposing undergraduate medical students to clinical cases at an early stage. This study was conducted with an aim to introduce first professional MBBS students to clinical cases in Orthopaedics as a part of an early clinical exposure module in Anatomy and to analyse its impact and feasibility. Methodology: A prospective, cross over, intervention was conducted to introduce 139 first year MBBS students to patients in Orthopaedics OPD. Feedback and perceptions regarding the module were obtained both from the students and the participating faculty. Quantitative and qualitative analysis of the data was conducted. Result: Students perceived the early clinical exposure module very well. They agreed that it had helped them in understanding the applied anatomy of the topics and found it to be interesting and motivating. Students were motivated for self-directed learning and an overwhelming majority of respondents agreed that more topics should be covered in similar modules. Conclusion: Early exposure to clinical aspects of basic sciences provides a structured setting for clinical correlation of knowledge and learning the importance of communication skills. This is an innovative interactive teaching strategy which is feasible to conduct and improves learning outcomes.

The health care provider, including anesthetists, should be made aware that as with bupivacaine HCl, Local Anesthetic Systemic Toxicity, including seizures and cardiac arrest, could be induced by Exparel as well.