Sadhana N Holla’s research while affiliated with Manipal Academy of Higher Education and other places

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Publications (3)


Pharmacotherapy of Opportunistic Infections in HIV Patients: A Review
  • Article

January 2016

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12 Reads

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2 Citations

Journal of Applied Pharmaceutical Science

S.N. Holla

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M.K.K. Kishore

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With the introduction of antiretroviral therapy, there is a dramatic decrease in the morbidity and mortality related to human immunodeficiency virus (HIV) infections. Due to varying degree of immunosuppression, patients are prone to various number of infections in their lifetime. Respiratory system, central nervous system, gastrointestinal tract and the skin are the most susceptible for opportunistic infections. Timely management of these microbial infections followed by chemoprophylaxis is essential as per the guidelines for the management of opportunistic infections in HIV. The development of drug toxicities and drug resistance in managing patients with HIV has always remained a clinical challenge. Consideration is given to the numerous pharmacokinetic interactions between drugs used to treat and prevent opportunistic infections and antiretroviral drugs, along with complications like immune reconstitution inflammatory syndrome. Clinicians must be aware about optimal strategies present for diagnosis, prevention and treatment of opportunistic infections in order to improve health and provide high quality of care for the patients.


Cycloserine Induced Late Onset Psychosis and Ethambutol Induced Peripheral Neuropathy Associated with MDR-TB Treatment in an Indian Patient- A Rare Case Report
  • Article
  • Full-text available

February 2015

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120 Reads

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14 Citations

Journal of Clinical and Diagnostic Research

Sadhana N Holla

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Rajeshkrishna Bhandarypanambur

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[...]

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Manju Janardhanan

Adverse reactions and toxicity inevitably accompany all treatment courses for drug-resistant TB. Our case underscores the importance of awareness regarding neuropsychiatric adverse reactions due to MDR-TB therapy and reversible nature of it. Cycloserine induced psychosis is most life threatening complication and sometimes could be fatal. A 42-year-old male on MDR-TB therapy got admitted for his persistent psychotic complaints like hallucinations, delusions and suicidal ideations, despite being treated with quetiapine/olanzapine. Eventually patient was rehabilitated, cycloserine was stopped and psychotic events regressed slowly. Other culprit drugs like ethambutol and levofloxacin causing psychosis was ruled out because there was no relapse of psychotic events despite being continued with these drugs. He also complained of tingling, numbness, swaying, pain and weakness. On examination, he had distal motor weakness in lower limbs, tandem gait positive, altered position sense, and tenderness over toes and positive Romberg’s sign with ataxia. He was diagnosed to have drug induced sensorimotor peripheral neuropathy. All these symptoms persisted after stopping cycloserine and patient continued to have neuropathy with ethambutol and ethionamide. Considering the nature of neuropathy which was mild, mixed sensorimotor and resolved completely after 2-3 weeks of stopping, it was more in favour of ethambutol. However, we could not rule out the possibility of ethionamide or (ethionamide + ethambutol) causing neuropathy or both could have accelerated the neurotoxic effects of cycloserine which remained elusive.

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Hypersensitivity Reaction Associated with Abacavir Therapy in an Indian HIV Patient – A Case Report

September 2014

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69 Reads

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4 Citations

Journal of Clinical and Diagnostic Research

The most important and unique adverse effect of abacavir (ABC) is fatal hypersensitivity reaction (HSR). The objective of this report is to describe a case of ABC induced HSR that occurred in an Indian HIV patient during treatment. Although this adverse effect is not uncommon, it is perhaps underreported or has never been reported so far in an Indian case scenario. A 44-year-old known case of HIV-1 was admitted in view of his worsening condition and very low CD4 cell counts 3 cells/μL. He was on anti-retroviral therapy since three years but not regular. On the basis of treatment failure, non-compliance and progressive low CD4 counts, the anti HIV regime was switched over to abacavir 600 mg+ atazanavir/ ritonavir 300mg/100mg Two weeks after ABC therapy he presented with maculopapular rash, headache and signs of hepatic damage (serum AST, ALP and ALT increased to 3-4 fold) suggestive of hypersensitivity reaction. As we know discontinuation of the drug is the ultimate litmus test to confirm diagnosis of drug induced adverse reaction. We did confirm ABC induced HSR by de-challenge wherein, rash disappeared within 2-3 days and LFT came back to normal within 5 days. However, no rechallenge was done. HSR was more in favour of ABC because atazanavir failed to produce any similar reaction after re-challenge.

Citations (2)


... A total of 20 articles [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] met the inclusion criteria and survived the quality process, encompassing 22 patients from eight different countries (Table 1) and most patients from India (10 patients, 45.45% of the cases included). One of the articles was published in Spanish [53] and another in Japanese [37], while the rest were published in English. ...

Reference:

Cycloserine-induced psychosis in patients with drug-resistant tuberculosis: a systematic review of case reports
Cycloserine Induced Late Onset Psychosis and Ethambutol Induced Peripheral Neuropathy Associated with MDR-TB Treatment in an Indian Patient- A Rare Case Report

Journal of Clinical and Diagnostic Research

... Systemic inflammation leading to death is believed to be the result of the cumulative inflammatory and immune responses in multiple organs. In fact, patients with AHS often exhibit elevated levels of serum markers associated with liver or kidney injury, including AST, ALT, ALP, lactate dehydrogenase, and creatinine [4,6,30,31]. Therefore, patients with AHS may have lesions in several tissues, such as liver and kidneys, even if they do not show any noticeable symptoms. ...

Hypersensitivity Reaction Associated with Abacavir Therapy in an Indian HIV Patient – A Case Report

Journal of Clinical and Diagnostic Research