Aim and objective: Geriatrics is a specialty that deals with the care of the aged. The term “geriatric population” refers to those over 60 years. In India, the elderly make up 8.14% of the population. The pharmacokinetic and pharmacodynamic aspects of the delivered medications are affected by their complicated physiological and pathological profiles. Polypharmacy can lead to various drug–drug interactions and adverse drug reactions (ADRs) in elderly. Gastrointestinal (GI) system ADRs are mostly found in hospitalized elderly. Gastrointestinal ADRs include upper gastrointestinal bleeding (UGI) bleed, diarrhea, etc.; these are the frequent causes of seriousness and hospitalization in geriatric patients. These ADRs are difficult to manage. To prevent ADRs, we need to understand the risk of potential inappropriate prescribing. Deprescribing in appropriate time can prevent medication-related atrocities. Clinical pharmacological reconciliation and review would help us understand anticholinergic burden associated with polypharmacy. Gastrointestinal system ADRs in geriatric patients have been the subject of a small number of research in India, but none have been undertaken in Odisha. Therefore, the aim of this study is to evaluate the GI ADRs that geriatric patients in Odisha experience. Materials and methods: This prospective, hospital-based observational study was carried out by the SCB Medical College and Hospital's Department of Pharmacology and Geriatric Medicine. From August 2016 to July 2018, all elderly patients (aged ≥60 years) with ADR diagnoses were included. The Suspected Adverse Drug Reaction Reporting Form of Indian Pharmacopoeia Commission Version 1.3 was filled out with the ADRs and their features. The prevalence and profile of GI system ADRs were observed. The WHO-UMC System rated their causation, the Hartwig's Severity Scale evaluated their severity, and the Schumock and Thornton Preventability Scale evaluated their preventability. Results: In 2 years, 236 geriatric ADRs were documented, 11% of which involved the GI system. Out of the GI system ADRs, 85% ADRs were found to be in possible category, 92.3% were found to be of moderate in intensity, and 84.6% were found to be probably preventable. The most frequent GI system ADR identified was UGI bleeding caused by nonsteroidal anti-inflammatory drugs (NSAIDs) (61.5%). Conclusion: Most of the ADRs were found to be of moderate intensity according to Hartwig's Severity Scale and probably preventable according to Schumock and Thornton Preventability scale. NSAID-induced UGI bleeding is the major type of GI system ADR found in this study.

The artery of Percheron (AOP), which is a rare anatomical variant, is characterized by a solitary common arterial trunk arising from the posterior cerebral artery (PCA). Occlusion of this artery is rare and may lead to a bilateral paramedian thalamic infarction with or without midbrain involvement. The AOP is a rare anatomical variant that is present in 4–12% of the population. The AOP stroke represents 0.1–2.0% of ischemic strokes and 4–18% of thalamic infarcts. This case series describes the varied clinical manifestations and the imaging findings of AOP infarct. The symptoms noted in the series are altered mental state, hypersomnolence, vertical diplopia, memory disturbances, hemiparesis, and ataxia. The magnetic resonance imaging (MRI) findings showed bilateral paramedian thalamic infarct with or without the involvement of the midbrain. The complexity and polymorphism of AOP stroke semiology explain why bilateral thalamic infarction is often misdiagnosed, lately detected, or even not detected. It is a real diagnostic challenge for clinicians to detect this condition in a timely fashion. Its diagnosis and treatment may be delayed because of the wide spectrum of its clinical features.

Despite the development of effective antibiotics, subphrenic abscess continues to be a significant clinical problem. The formation of the subphrenic abscess occurs after intestinal contents and gut bacteria contaminate the abdominal cavity. Here, we report a case of a bilateral subphrenic abscess mimicking a bilateral pleural effusion and the symptoms appeared 1 year after the last abdominal operation. The uniqueness of this case was its late presentation and bilateral distribution, mimicking a bilateral pleural effusion.

Myasthenia gravis is a well-known autoimmune disorder. Very few cases in literature showed association of myasthenia gravis, thymoma, and oral candidiasis. Here, we present a case of myasthenia gravis with thymoma, significant weight loss, extensive oral and esophageal candidiasis mimicking an immunodeficiency state which often creates a therapeutic dilemma in instituting immunosuppression.

This is a case report of an immunocompromised adult female presented with fever and reddish-colored spots all over the body along with bilateral swelling of parotid and submandibular glands. Hematological parameters revealed pancytopenia, and she was diagnosed with disseminated histoplasmosis by bone marrow trephine biopsy. The patient was treated with antimicrobials and other supportive therapy, but she rapidly deteriorated and succumbed to the underlying bone marrow infiltration and failure.

Pyomyositis is defined as the pyogenic infection of skeletal muscle, which leads to the formation of an abscess. It is difficult to diagnose in its early course, due to poor localizing signs and vague presentation. Diagnosing pyomyositis needs a high index of suspicion. Any delay in diagnosis will lead to sepsis, compartment syndrome, and ultimately death. We describe here a case of pyomyositis of the left thigh, with a relatively non-specific presentation, who was successfully managed with antibiotics and aspiration of pus.