Background:Atorvastatin has a longer duration of action than other hydroxymethylglutaryl coenzyme A reductase inhibitors.Objectives:The objective was to evaluate the efficacy of alternate day vs. daily dosing of atorvastatin for the treatment of hyperlipidemia.Materials and Methods:In this prospective, open label, crossover study, 40 patients with plasma low-density cholesterol (LDL-C) of more than 130 mg/dl and total cholesterol (TC) more than 200 mg/dl were recruited. After baseline tests, they were randomly allocated to two groups. Group A received 20 mg atorvastatin on alternate days and group B received 20 mg atorvastatin daily for 12 weeks. After 4 weeks of washout period, the groups were crossed over to the other treatment regimen for another 12 weeks. Fasting plasma lipid profile and serum alanine transaminase (ALT) and aspartate transaminase (AST) were measured for both groups at 6th, 12th, 16th, 22nd, and 28th weeks. Results were pooled across the periods and data between the two groups were compared using unpaired t-test.Results:Among the 40 enrolled subjects, 38 completed the study. Both treatment regimens significantly reduced LDL-C and TC compared to baseline. There was no statistically significant difference between the two groups in terms of reduction of plasma LDL-C and TC at 6 and 12 weeks of treatment. Both the regimens were well tolerated.Conclusion:Alternate-day treatment with atorvastatin is comparable in efficacy and safety to the established daily treatment regimen, thus being a cost effective alternative.

Objectives:Magnesium historically has been used for treatment and/or prevention of eclampsia. Considering the low body mass index of Indian women, a low-dose magnesium sulfate regime has been introduced by some authors. Increased blood levels of magnesium in neonates is associated with increased still birth, early neonatal death, birth asphyxia, bradycardia, hypotonia, gastrointestinal hypomotility. The objective of this study was to assess safety of low-dose magnesium sulfate regimen in neonates of eclamptic mothers treated with this regimen.Materials and Methods:This was a cross-sectional observational study of 100 eclampsia patients and their neonates. Loading dose and maintenance doses of magnesium sulfate were administered to patients by combination of intravenous and intramuscular routes. Maternal serum and cord blood magnesium levels were estimated. Neonatal outcome was assessed.Results:Bradycardia was observed in 18 (19.15%) of the neonates, 16 (17.02%) of the neonates were diagnosed with hypotonia. Pearson Correlation Coefficient showed Apgar scores decreased with increase in cord blood magnesium levels. Unpaired t-test showed lower Apgar scores with increasing dose of magnesium sulfate. The Chi-square/Fisher's exact test showed significant increase in hypotonia, birth asphyxia, intubation in delivery room, Neonatal Intensive Care Unit (NICU) care requirement, with increasing dose of magnesium sulfate. (P ≤ 0.05).Conclusion:Several neonatal complications are significantly related to increasing serum magnesium levels. Overall, the low-dose magnesium sulfate regimen was safe in the management of eclamptic mothers, without toxicity to their neonates.

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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 o...

Introduction: The skill and quality of doctors largely depend on their academic performances. Examination scores of medical students can be impacted by their personality and Socioeconomic Status (SES). Identification of the effects of different personality traits and socioeconomic profile on the academic results of medical undergraduates can help to identify the vulnerable groups and consider possible support by counselling, financial aids and policy formulation. Aim: To assess the correlation of personality traits and SES with the academic performances of undergraduate medical student based on the marks scored in the second professional Bachelor of Medicine and Bachelor of Surgery (MBBS) examination. Materials and Methods: An observational cross-sectional study of 10 months duration from May 2017 to February 2018 was done on 143 students of sixth semester (Part I) of MBBS course, in a Government Medical College of Kolkata, West Bengal, India. Participants filled up the Big Five Inventory (BFI) questionnaire that evaluates dimensions like extraversion, agreeableness, conscientiousness, neuroticism and openness, and the Kuppuswamy’s SES scale form which considers education of the head of family, occupation of head and monthly family income. The examination marks were collected from the student’s section of the institution. Demographic parameters of the population like age, gender and religion were considered. Data was tabulated in MS Excel spreadsheet and a descriptive statistical analysis was performed. Any correlation of the study parameters with student’s academic performance was determined through statistical analysis using Spearman correlation coefficient and p≤0.05 was considered significant. Results: Among the participants of the study (n=143), a mean age of 21.53 years was observed with male:female ratio of 2.04; about 87.41% of the students were Hindu while rest were Muslim. The results showed conscientiousness (r=0.1842) and neuroticism (r=0.1799) were correlated with total academic score as well as openness to pathology (r=0.1783) and forensic medicine (r=0.2362). Higher SES positively affected the results in microbiology (r=0.1698). Occupation of the head of the family was correlated positively with total marks (r=0.1677) and performances in microbiology (r=0.2256) and pathology (r=0.1919). Conclusion: Conscientious behaviour, an attitude of openness and even neuroticism, can contribute to better grades. Higher occupation of the head of the family may also contribute positively. Appropriate counselling to nurture beneficial personality traits and adequate guidance by mentors may help students achieve better academically.