Papers by Parveen Malhotra
Advanced research in Gastroenterology and Hepatology, 2025
We are reporting a thirty-five-year-old male of chronic hepatitis B who was in active phase thus ... more We are reporting a thirty-five-year-old male of chronic hepatitis B who was in active phase thus was put on Tenofovir disoproxil fumarate (TDF) 300 mg daily once for last three months. He developed gradually progressive falling of hair after two months of starting of TDF. He had no other general or systemic symptoms or intake of any other drug during this period. All his biochemical labs were normal and HBV DNA quantitative showed declining trend. He was very dogmatic of hair loss after starting of TDF and attributed the same to it. Hence, immediately he was switched from TDF to Entecavir 0.5 mg, as he was non-cirrhotic. After few days of switching of these drugs, his hair loss stopped, and density of his scalp hairs became normal within a month. There are very few reports of Alopecia areata (AA) with TDF, more commonly it is seen with Tenofovir alafenamide (TAF) or with TAF when it is used in combination with other drugs as an antiretroviral therapy for Human immunodeficiency virus (HIV) infection.
Introduction: Chronic hepatitis C Virus (HCV) infection is responsible for almost one third cases... more Introduction: Chronic hepatitis C Virus (HCV) infection is responsible for almost one third cases of cirrhosis which require liver transplantation as the definitive treatment which in developing country like India, is not easily accessible due to limited centres and specialists for the same. The awareness regarding HCV is required in patients, family members and society at large. Aims and Objectives: The aim was to study awareness about their disease in confirmed patients of Hepatitis C. Materials and Methods: The present study was a hospital based, prospective, observational study conducted at PGIMS, Rohtak for ten years i.e. 01.01.2015 to 31.12.2024, for determining awareness about hepatitis C in confirmed patients of hepatitis B. In ten years, total 25,000 hepatitis C patients were enrolled. Out of them, in 1000 patients in whom HCV RNA was not detected in quantitative test on Polymerase chain reaction test (PCR) were excluded. Hence, final analysis was done on data obtained of 24,000 patients. All of these patients were evaluated on basis of detailed questionnaire regarding awareness about their HCV infection. Results: Out of total pool of 24,000 patients, only 980 patients were having complete awareness about different aspects related to HCV infection. One hundred patients, in addition to these 980 patients had partial knowledge about HBV. Conclusion: There is urgent need of increasing awareness regarding mode of transmission, spread of disease, precautions and available treatment regarding their disease in hepatitis C patients.
International journal of advanced research, 2025
ntroduction: It isimportant to determinethe epidemiological factors
like etiology, age, sex, mode... more ntroduction: It isimportant to determinethe epidemiological factors
like etiology, age, sex, mode of clinical presentation of fatty liver and
development of complications like chronic liver disease, so as to design
optimal and cost effective preventive and treatment strategies for the
same.
Aim: To determine spectrumof Fatty Liver at tertiary care centerof
Northern India.
Material and Methods:This was a prospective study conducted at
Medical Gastroenterology Department, PGIMS,Rohtak , over a period
of seven years i.e. 01.11.2017 to 31.10.2024, on 582confirmed patients
of Fatty Liver.
Results:The most common etiology seen was Non-Alcoholic Fatty
liver disease (82.47%), followed by Chronic HBV infection (11.37%),
Chronic Hepatitis C (3.60%) and Alcoholic Liver Disease (2.57%),
Conclusion:The present study reveals that Nonalcoholic Fatty liver
disease is most common causeof Fatty liver in Northern India
International journal of advanced research, 2025
Introduction: Chronic hepatitis C virus (HCV) infection is important cause for cirrhosis of liver... more Introduction: Chronic hepatitis C virus (HCV) infection is important cause for cirrhosis of liver all over the world and many patients suffering from this deadly disease require liver transplantation as the definitive treatment. The oral directly acting antiviral for treatment has changed management of its treatment in a significant way, as these drugs like interferon can be used even in decompensated cirrhotic stage. Aims and Objectives:To determine the fear and apprehensions in Chronic HCV patients who have been successfully treated and achieved sustained virological response (SVR) on oral antiviral drugs compliance among patients who were treated with directly acting oral antiviral drugs (Sofosbuvir 400 mg, Daclatasvir 60 mg, Velpatasvir 100 mg). Materials & Methods:It was prospective study conducted at
International journal of advanced research, 2025
ntroduction: Hepatitis C virus (HCV)causes chronic infection in
majority of cases but in few can ... more ntroduction: Hepatitis C virus (HCV)causes chronic infection in
majority of cases but in few can also present as acute hepatitis and has
already impacted170 million people worldwide which amounts to 3%
of total world population and they are atfuture risk of developing
cirrhosis and liver cancer.
Aim: To assess the effectiveness of self-instructional module on
knowledge and awareness regarding prevention and control of hepatitis
C among B.Sc. Nursing 4th year students of College of Nursing at
PGIMS Rohtak.
Methodology: The study was done on 70 students of B.Sc. Nursing 4th
year students of College of Nursing, PGIMS Rohtak from 1st Jan.2020
to 8th Feb.2020, to assess the effectiveness of self-instructional module
on knowledge and awareness regarding preventive measures of HCV.
Results: The administration of self-instructional module in posttest
leads to more knowledge in students about HCV, thus enabling them,
to take care of themselves, their family and patients in better way.
There is partial significant association between knowledge with
selected demographic variables.
International journal of advanced research, 2025
Hepatocellular Carcinoma (HCC) is one of the most common
malignant tumours in the world. It is a ... more Hepatocellular Carcinoma (HCC) is one of the most common
malignant tumours in the world. It is a heterogeneous group of a
tumour which varies in risk factor, genetic and epigenetic alteration
event. The mortality rate due to it is increasing with time. The various
risk factors include hepatitis B &C viruses, alcohol, metabolic
syndrome including diabetes mellitus, chemicals, and inborn and
acquired metabolic disease. HCC is closely associated with hepatitis B
and C virus because liver injury caused by viral factor affects many
cellular processes such as cell signalling, apoptosis, transcription, DNA
repair which in turn induce important effects on cell survival, growth,
transformation and maintenance. The molecular mechanisms of
hepatocellular carcinogenesis vary depending on different factors thus
leading to different mechanisms associated with these tumours. Our
study shares the experience of various aetiological factorsresponsible
for HCC at tertiary care centre of Northern India
International Journal Of Advanced Research, 2025
Hepatitis B virus (HBV) infection has widespread implications and has already generated 350 milli... more Hepatitis B virus (HBV) infection has widespread implications and has already generated 350 million chronic carriers which can further progress to liver cirrhosis & hepatocellular carcinoma 1. Out of total pool of chronic carriers, half have got infected vertically from their mothers, i.e. through mother-to-child transmission (MTCT). Vertically-acquired HBV infections become chronic in 90% of cases 2 .HBV can be transmitted Vertically during pregnancy, delivery or postpartum. HBV has the ability of placental transfer and reach the fetus but the exact impact of this mode is unclear. Transmission during delivery is the most common mode of MTCT, thus, the neonatal administration of HBIG with vaccination is able to prevent newborn HBV infection in more than 85 % of cases. In postpartum period the close contact between mother and baby is responsible for HBV transmission and includes breastfeeding which has potential either through ingestion of the virus or by contact with skin lesions on the mother's breastAll Pregnant women should undergo mandatory screening for Hepatitis B.If HBV viral load or HbeAg is found to be significantly high, then antiviral treatment tenofovir 300 mg should be started. Caesarean section should be performed only for obstetric indications only and not solely due to HBV infection.Every new born of hepatitis B mother should be mandatory given 0.5 ml hepatitis B immunoglobulin, along with zero dose Hepatitis B vaccination within twelve hours of birth and later on full course of HBV should be completed.Breast feeding is allowed for the new born.
The Journal of Pediatrics, 2000
This document is intended to provide health related information so that you may be better informe... more This document is intended to provide health related information so that you may be better informed. It is not a substitute for a doctor's medical advice and should not be relied upon for treatment for specific medical conditions Celiac disease is a chronic digestive condition where the body reacts against a protein called gluten. Gluten is found in foods such as wheat, barley and rye. The body produces an immune reaction against gluten that affects a person's ability to digest nutrients. Read this handout to learn about how celiac disease is diagnosed in people with Down syndrome. In the typical population, up to 1 out of 100 people may have this condition. In people with Down syndrome, up to 10 out of 100 people may have this condition.
Case report:A male of fourteen years, having non-significant past
history, was detected to be suf... more Case report:A male of fourteen years, having non-significant past
history, was detected to be sufferingfrom acute hepatitis C virus (HCV)
infection, presented with acuteonset of gradually progressive bilateral
painful enlargement of parotid glands which was followed by bilateral
painful orchitis. His HCV RNA quantitative load was 765421 I.U./ml
with hyperbilirubinemia and transaminitis.The ultrasound abdomen
revealed mild hepatomegaly with gall bladder wall oedema suggestive
of acute hepatitis. He had no evidence of cirrhosis as evidenced by
normal Fibroscan score of 6.5. At the time of first consultation, his
mental status was normal without any fever but was having mild nausea
and generalized weakness. His bilateral parotid glands were enlarged
and painful for last one week. He also developed bilateral painful
orchitis after five days of developing parotitis. He was started on
antiviral treatment for hepatitis C for total of 12 weeks duration but his
bilateral parotitis and orchitis subsided within three weeks of starting of
treatment. He completed his 12 weeks antiviral treatment and later on
achieved 12 weeks sustained virological response (SVR), as evidenced
by complete absence of HCV RNA on polymerase chain testing (PCR)
report. He has been followed for one and half year and repeat HCV
RNA test and clinical examination for relapse is non-contributory.
Conclusion:Our case reportis an uncommon extrahepatic manifestation
of acute HCV case of bilateral parotitis in an acute hepatitis C patient.
There is paucity of data regardingparotitis and orchitis with acute
hepatitis C infection, hence merits vigil for the same by the treating
health care specialist.
Sulfasalazine, a commonly used medication in the treatment of ulcerative colitis, is associated w... more Sulfasalazine, a commonly used medication in the treatment of ulcerative colitis, is associated with various adverse
effects, including rash. Here, we present a case of a 22-year-old male with ulcerative colitis who developed a generalized
skin rash following the initiation of sulfasalazine therapy but there were no systemic symptoms or eosinophilia. The rash resolved promptly upon
discontinuation of sulfasalazine, highlighting the importance of recognizing and managing medication-induced adverse reactions in the
management of inammatory bowel disease
The blood is a lifesaving component which cannot be produced but has to donated by healthy donors... more The blood is a lifesaving component which cannot be produced but has to donated by healthy donors. The mandatory screening is done in every donated unit of blood for transfusion-transmitted infectious diseases such as HIV, hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis. Blood donation is blessing not only for recipient but for also donors, many of whom are incidentally detected to be suffering from chronic diseases like Hepatitis B and C which cause signicant morbidity and mortality. Despite knowing about the importance of blood donation, still a large section in society is averse for the same due to various kind of myths associated with it. Hence, there is strong need of developing new innovations for increasing awareness among general public for voluntary blood donation which has to be increased to hundred percent, as per National Viral Hepatitis Control Program (NVHCP).
Journal of digestive endoscopy, Mar 1, 2024
Journal of gastroenterology & hepatology reports, Dec 31, 2023
Corrosive injury of the upper gastrointestinal tract has been commonly reported in medical litera... more Corrosive injury of the upper gastrointestinal tract has been commonly reported in medical literature. It can be due to ingestion of acid or alkali and may be accidental or suicidal. The extent of injury varies from involving the esophagus, stomach, and duodenum either individually or together but oral cavity is rarely involved. Case Report: We present a young male of twenty-six years who presented with complaint of dysphagia for last two months. He had history of incidental ingestion of corrosive six months back and was symptomatically treated for the same for one month by some local private practitioner. He remained asymptomatic after that and now developed inability to swallow solid food for last two months and was surviving on liquids only. He was seen by ENT specialist at our institute and was then referred to our department for opinion. On evaluating in detail, patient admitted that he is not able to swallow solid food into food pipe and it stucks in oral cavity and then he has to throw out the solid food but he is able to take liquid diet but in small amount and that too slowly. He was heamodynamically stable and his baseline routine investigations were essentially normal. He was subjected to upper gastrointestinal endoscopy which revealed a tight stricture in oral cavity at level of uvula and scope could not be negotiated beyond it. The patient underwent surgical intervention by parent ENT department and has now completely recovered. Rare presentations are rarely seen but merits vigil for timely diagnosis and proper line of management.
Mutation Research/Genetic Toxicology and Environmental Mutagenesis, 2014
Aflatoxin B1 is a carcinogen produced by Aspergillus flavus and a few related fungi that are ofte... more Aflatoxin B1 is a carcinogen produced by Aspergillus flavus and a few related fungi that are often present in many food substances. It interacts synergistically with Hepatitis B or C virus (HBV, HBC) infection, thereby increasing the risk of hepatocellular carcinoma (HCC). The G to T transversion at the third position of codon 249 (AGG) of the TP53 gene, substituting arginine to serine, is the most common aflatoxininduced mutation linked to HCC. This study examined mutations in TP53 by PCR-RFLP analysis and by measurement of an aflatoxin-albumin adduct as a biomarker for human exposure of aflatoxin B1 by indirect-competitive ELISA, in samples collected from healthy controls as well as patients with hepatitis in Hyderabad, Andhra Pradesh, India. A total of 238 blood samples were analyzed the presence of the G to T mutation. Eighteen of these samples were from HBV-positive subjects, 112 of these were from subjects who had HBV-induced liver cirrhosis, and 108 samples were taken from subjects without HBV infection or liver cirrhosis (control group). The G to T mutation was detected in 10 samples, 8 of which were from subjects positive to both HBV and aflatoxin-albumin adduct in blood (p = 0.07); whilst two were from individuals who were HBV-negative, but positive for the aflatoxin-albumin adduct (p = 0.14). The aflatoxin-albumin adduct was detected in 37 of 238 samples, 29 samples were from HBV-positive subjects and eight were from individuals who were positive for both HBV and the TP53 mutation (p = 0.07). The concentration of aflatoxin-albumin adduct ranged from 2.5 to 667 pg/mg albumin. Despite low incidence of the G to T mutation, its detection in subjects positive to aflatoxin-adducts is indicative of a strong association between the mutation and aflatoxin exposure in India.
Journal of clinical and experimental hepatology, 2023
Journal of clinical and experimental hepatology, 2022
The Indian practitioner, 2014
The Indian practitioner, May 1, 2015
Journal of clinical and experimental hepatology, Mar 1, 2013
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Papers by Parveen Malhotra
like etiology, age, sex, mode of clinical presentation of fatty liver and
development of complications like chronic liver disease, so as to design
optimal and cost effective preventive and treatment strategies for the
same.
Aim: To determine spectrumof Fatty Liver at tertiary care centerof
Northern India.
Material and Methods:This was a prospective study conducted at
Medical Gastroenterology Department, PGIMS,Rohtak , over a period
of seven years i.e. 01.11.2017 to 31.10.2024, on 582confirmed patients
of Fatty Liver.
Results:The most common etiology seen was Non-Alcoholic Fatty
liver disease (82.47%), followed by Chronic HBV infection (11.37%),
Chronic Hepatitis C (3.60%) and Alcoholic Liver Disease (2.57%),
Conclusion:The present study reveals that Nonalcoholic Fatty liver
disease is most common causeof Fatty liver in Northern India
majority of cases but in few can also present as acute hepatitis and has
already impacted170 million people worldwide which amounts to 3%
of total world population and they are atfuture risk of developing
cirrhosis and liver cancer.
Aim: To assess the effectiveness of self-instructional module on
knowledge and awareness regarding prevention and control of hepatitis
C among B.Sc. Nursing 4th year students of College of Nursing at
PGIMS Rohtak.
Methodology: The study was done on 70 students of B.Sc. Nursing 4th
year students of College of Nursing, PGIMS Rohtak from 1st Jan.2020
to 8th Feb.2020, to assess the effectiveness of self-instructional module
on knowledge and awareness regarding preventive measures of HCV.
Results: The administration of self-instructional module in posttest
leads to more knowledge in students about HCV, thus enabling them,
to take care of themselves, their family and patients in better way.
There is partial significant association between knowledge with
selected demographic variables.
malignant tumours in the world. It is a heterogeneous group of a
tumour which varies in risk factor, genetic and epigenetic alteration
event. The mortality rate due to it is increasing with time. The various
risk factors include hepatitis B &C viruses, alcohol, metabolic
syndrome including diabetes mellitus, chemicals, and inborn and
acquired metabolic disease. HCC is closely associated with hepatitis B
and C virus because liver injury caused by viral factor affects many
cellular processes such as cell signalling, apoptosis, transcription, DNA
repair which in turn induce important effects on cell survival, growth,
transformation and maintenance. The molecular mechanisms of
hepatocellular carcinogenesis vary depending on different factors thus
leading to different mechanisms associated with these tumours. Our
study shares the experience of various aetiological factorsresponsible
for HCC at tertiary care centre of Northern India
history, was detected to be sufferingfrom acute hepatitis C virus (HCV)
infection, presented with acuteonset of gradually progressive bilateral
painful enlargement of parotid glands which was followed by bilateral
painful orchitis. His HCV RNA quantitative load was 765421 I.U./ml
with hyperbilirubinemia and transaminitis.The ultrasound abdomen
revealed mild hepatomegaly with gall bladder wall oedema suggestive
of acute hepatitis. He had no evidence of cirrhosis as evidenced by
normal Fibroscan score of 6.5. At the time of first consultation, his
mental status was normal without any fever but was having mild nausea
and generalized weakness. His bilateral parotid glands were enlarged
and painful for last one week. He also developed bilateral painful
orchitis after five days of developing parotitis. He was started on
antiviral treatment for hepatitis C for total of 12 weeks duration but his
bilateral parotitis and orchitis subsided within three weeks of starting of
treatment. He completed his 12 weeks antiviral treatment and later on
achieved 12 weeks sustained virological response (SVR), as evidenced
by complete absence of HCV RNA on polymerase chain testing (PCR)
report. He has been followed for one and half year and repeat HCV
RNA test and clinical examination for relapse is non-contributory.
Conclusion:Our case reportis an uncommon extrahepatic manifestation
of acute HCV case of bilateral parotitis in an acute hepatitis C patient.
There is paucity of data regardingparotitis and orchitis with acute
hepatitis C infection, hence merits vigil for the same by the treating
health care specialist.
effects, including rash. Here, we present a case of a 22-year-old male with ulcerative colitis who developed a generalized
skin rash following the initiation of sulfasalazine therapy but there were no systemic symptoms or eosinophilia. The rash resolved promptly upon
discontinuation of sulfasalazine, highlighting the importance of recognizing and managing medication-induced adverse reactions in the
management of inammatory bowel disease
like etiology, age, sex, mode of clinical presentation of fatty liver and
development of complications like chronic liver disease, so as to design
optimal and cost effective preventive and treatment strategies for the
same.
Aim: To determine spectrumof Fatty Liver at tertiary care centerof
Northern India.
Material and Methods:This was a prospective study conducted at
Medical Gastroenterology Department, PGIMS,Rohtak , over a period
of seven years i.e. 01.11.2017 to 31.10.2024, on 582confirmed patients
of Fatty Liver.
Results:The most common etiology seen was Non-Alcoholic Fatty
liver disease (82.47%), followed by Chronic HBV infection (11.37%),
Chronic Hepatitis C (3.60%) and Alcoholic Liver Disease (2.57%),
Conclusion:The present study reveals that Nonalcoholic Fatty liver
disease is most common causeof Fatty liver in Northern India
majority of cases but in few can also present as acute hepatitis and has
already impacted170 million people worldwide which amounts to 3%
of total world population and they are atfuture risk of developing
cirrhosis and liver cancer.
Aim: To assess the effectiveness of self-instructional module on
knowledge and awareness regarding prevention and control of hepatitis
C among B.Sc. Nursing 4th year students of College of Nursing at
PGIMS Rohtak.
Methodology: The study was done on 70 students of B.Sc. Nursing 4th
year students of College of Nursing, PGIMS Rohtak from 1st Jan.2020
to 8th Feb.2020, to assess the effectiveness of self-instructional module
on knowledge and awareness regarding preventive measures of HCV.
Results: The administration of self-instructional module in posttest
leads to more knowledge in students about HCV, thus enabling them,
to take care of themselves, their family and patients in better way.
There is partial significant association between knowledge with
selected demographic variables.
malignant tumours in the world. It is a heterogeneous group of a
tumour which varies in risk factor, genetic and epigenetic alteration
event. The mortality rate due to it is increasing with time. The various
risk factors include hepatitis B &C viruses, alcohol, metabolic
syndrome including diabetes mellitus, chemicals, and inborn and
acquired metabolic disease. HCC is closely associated with hepatitis B
and C virus because liver injury caused by viral factor affects many
cellular processes such as cell signalling, apoptosis, transcription, DNA
repair which in turn induce important effects on cell survival, growth,
transformation and maintenance. The molecular mechanisms of
hepatocellular carcinogenesis vary depending on different factors thus
leading to different mechanisms associated with these tumours. Our
study shares the experience of various aetiological factorsresponsible
for HCC at tertiary care centre of Northern India
history, was detected to be sufferingfrom acute hepatitis C virus (HCV)
infection, presented with acuteonset of gradually progressive bilateral
painful enlargement of parotid glands which was followed by bilateral
painful orchitis. His HCV RNA quantitative load was 765421 I.U./ml
with hyperbilirubinemia and transaminitis.The ultrasound abdomen
revealed mild hepatomegaly with gall bladder wall oedema suggestive
of acute hepatitis. He had no evidence of cirrhosis as evidenced by
normal Fibroscan score of 6.5. At the time of first consultation, his
mental status was normal without any fever but was having mild nausea
and generalized weakness. His bilateral parotid glands were enlarged
and painful for last one week. He also developed bilateral painful
orchitis after five days of developing parotitis. He was started on
antiviral treatment for hepatitis C for total of 12 weeks duration but his
bilateral parotitis and orchitis subsided within three weeks of starting of
treatment. He completed his 12 weeks antiviral treatment and later on
achieved 12 weeks sustained virological response (SVR), as evidenced
by complete absence of HCV RNA on polymerase chain testing (PCR)
report. He has been followed for one and half year and repeat HCV
RNA test and clinical examination for relapse is non-contributory.
Conclusion:Our case reportis an uncommon extrahepatic manifestation
of acute HCV case of bilateral parotitis in an acute hepatitis C patient.
There is paucity of data regardingparotitis and orchitis with acute
hepatitis C infection, hence merits vigil for the same by the treating
health care specialist.
effects, including rash. Here, we present a case of a 22-year-old male with ulcerative colitis who developed a generalized
skin rash following the initiation of sulfasalazine therapy but there were no systemic symptoms or eosinophilia. The rash resolved promptly upon
discontinuation of sulfasalazine, highlighting the importance of recognizing and managing medication-induced adverse reactions in the
management of inammatory bowel disease
predominantly ulcerative colitis followed by Crohn’s disease in India.
They affect predominantly gastro-intestinal area but extra-intestinal
involvement also occurs which include skin also, symptoms of which
can start before, simultaneously or later in the course of IBD.
Case Report-The presentcase report is of a30-year young male with
history of six months alopecia universalis and a history of intermittent
diarrhea associated with blood for three years. His Colonoscopy and
biopsy on histopathological examination confirmed ulcerative colitis.
Patient was on mesalamine, steroids and azathioprine. On follow up,
there was no regrowth of hair.
Conclusion-Thus,clinicians should recognize that various skin
manifestations, including alopecia, may be an extra-intestinal
presentation of IBD, particularly ulcerative colitis (U.C.)
Case report: This case report highlights the allergic reaction with the over-the-counter non-steroidal anti-inflammatory drug (NSAID) mefenamic
acid. Approximately 10% of individuals exposed to mefenamic acid can even experience DRESS syndrome, a severe and potentially fatal allergic
reaction characterized by fever, skin rash, lymphadenopathy, haematological abnormalities, and internal organ involvement. Leucocytosis with
eosinophilia (90%) and mononucleosis (40%) has been linked to certain cases, emphasizing the diversity of clinical presentations. The causative
medication must be promptly discontinued upon identification of DRESS syndrome, with documented evidence indicating improved prognosis
with early drug removal. We report a case of twenty-five-year-old male, not a known case of any chronic illness, presented with pain abdomen in
outdoor department. He was advised all routine tests and ultrasonogram abdomen and was started on symptomatic treatment which included
proton pump inhibitors and mefenamic acid. He reported next day with diffuse allergic patches all over body and immediately all the treatment
was stopped. At this point of time, he shared that he has got thrice same type of reaction in past after use of mefenamic acid. The allergic skin
patches resolved within three days without development of any systemic symptoms. On his medical record, note was put that he is allergic to
mefenamic acid and was advised not to use this salt in future and to make aware to all the treating health care in future also to safeguard from
use of mefenamic acid.
Conclusion: Our case report emphasizes the fact about need of strict vigil about drug reactions and making patients aware for sharing the same
every time they come in contact with health professionals.
Keywords: Allergic reaction; Rash; Eosinophilia; Mefenamic acid; NSAIDS
in genetically predisposed people and isdue to permanent intolerance to
wheat gliadins and other cereal prolaminsalso known as gluten-
sensitive enteropathy or non-tropical sprue. In 1888, it was first
described byDr. Samuel Gee and in Greek means koiliakaos-
abdominal. Dicke in1950 highlighted association between the
consumption of bread, cereals and diarrhea which improved after
stoppage of wheat intake. Thediagnosed cases of celiac disease
represent just a tip of iceberg and rest 90% are hidden and undiagnosed.
Celiac disease is confirmed by clinical symptoms, serology, endoscopy,
histopathological diagnosis and resolution of symptoms after gluten
restricted diet. Celiac disease requires life-long gluten restriction;thus,
compliance rate varies between 50% to 90%,and is slightly more in
elderly & females. As per available data, there is association between
coeliac disease and Down's syndrome. Therefore, while evaluating
associations of Down’s Syndrome, coeliac disease should not be
missed.
A known case of testicular tumour underwent bilateral orchiectomy under spinal anesthesia. He developed headache and altered sensorium postoperatively. CT scan head showed secondaries in the brain with intra-cerebral bleed. Typically the patient had no neurological symptoms in the past. The presented postoperative complication is of interest because the secondaries in brain, which must have been present for months, became symptomatic acutely in the post-operative period.