Self-assumed Neurologic Related Condition Deviated Metoclopramide-Induced Acute Dystonic of Oculogyric Crisis in a Woman of Childbearing Age: A Case Report

A 26-year-old Malaysian woman (childbearing age) attended a private primary care clinic with a known case of gastroesophageal reflux disease (GERD) and complained of persistent nausea and a few episodes of vomiting. She had no known drug allergy, no surgical history, no hospitalization in the last two years, was a non-smoker, and no history of drug or alcohol abuse. The patient was prescribed Tab metoclopramide 10 mg TDS and Tab ranitidine 150 mg BD for five days. About 30 min after oral administration of both medicines, her eyes rolled involuntary upward, leading to lateral deviation of the eyes, and mouth jaws clenched as if “dislocated jaws.” The patient was immediately brought into an emergency department (ED) of a public tertiary care hospital. A drug challenge test was done which resulted in the withdrawal of metoclopramide. The accompanied sister later disclosed that the patient had taken metoclopramide and ranitidine from a private clinic earlier in the day. The patient self-assumed to have a sudden seizure, due to excessive hot weather and dehydration. A slow intravenous infusion of 50 mg/mL diphenhydramine hydrochloride in 0.9% w/v NaCl 100 mL was administered stat. Consequently, the symptoms vanished after approximately 30 min of the therapy, devoid of relapse. The patient was discharged from ED post 8 hours of monitoring with complete recovery. Physicians frequently prescribe metoclopramide to treat nausea and vomiting, which may cause adverse drug reaction of acute dystonic oculogyric crisis (OGC). Due to its unwanted and unpredictable extrapyramidal symptoms, metoclopramide should be prescribed and dispensed with caution. Thorough history taking at ED is imperative for correct early diagnosis and treatment, as metoclopramide-induced dystonic OGC has a high probability of confusion with other causes of dystonia such as conversion and seizures, encephalitis, tetanus, and hypercalcemic tetany.

A cross-sectional e-survey to map clinical practice of electrocardiogram use as a screening tool in outpatient department: India office electrocardiogram e-survey

Background:Early detection of electrocardiogram (ECG) abnormalities in high risk cardiovascular patients with routine ECG screening is the need of the hour. The aim of the e-survey was to understand the use of ECG in high risk cardio-metabolically deranged patients at outpatient departments (OPDs) by Indian physicians.Methods:A cross-sectional India office ECG (IOECG) e-survey was conducted using Google form questionnaire from November 2021 to December 2021 among Indian physicians. Survey results were collected and analysed using Google form survey tool.Results:We received total of 1863 responses. The results of the survey showed that while 90% of physicians agreed to the necessity of doing 12 lead ECG of cardio-metabolically deranged patients, only 61% of all physicians could perform ECG screening in less than 40% of high risk cardio-metabolic patients mainly, due to several practical challenges. Among physicians, 40.2% physicians believed that 12 lead ECG was too time consuming, 35.8% physicians believed that the unavailability of ECG device was common reason while 27.5% physicians believed that there was a lack of trained staff. Majority of physicians (69.7%) agreed to use point of care ECG device which can be a solution for more screening of such patients whether symptomatic or asymptomatic. According to the survey, 88.7% physicians would appreciate if a portable handheld ECG device was made available to facilitate screening in their practice.Conclusions:There is a need of the portable handheld ECG device which helps physicians to screen large number of cardio-metabolically deranged patients in their busy OPDs.

Customized And Cost Effective Specimen Retrieval Bag In Laparoscopic Cholecystectomy: Study In 150 Cases

Minimally invasive surgery has undergone rapid development in last decade and it has many advantages but it has a few drawbacks also like difficulty in removing specimen, spillage of contents intraperitoneally and port site infection. Specimen retrieval through trocar site by using laparoscopic retrieval bag is the solution but cost is a barrier in government setups. So our major concern is to make customized Specimen retrieval bags for easy removal of specimen and reducing the rate of port site infection

Comparison of the outcomes of home based and supervised individually designed exercise programme amongst the patients in chronic phase after guillain barre syndrome: study protocol for a randomized control trial

Background: Guillain barre syndrome (GBS) is an immune mediated polyneuropathy characterized by progressive weakness and variety of symptoms including muscle paralysis, autonomic dysfunction and respiratory involvement that affect one or two persons in 100,000 population. Although immunotherapies including therapeutic plasma exchange (TPE), immunoglobulins (IVIg) and corticosteroids are the available beneficial modes of treatment, the residual symptoms are disabling and long lasting and require long term rehabilitation. Observational studies and RCT on multi-disciplinary care has proven exercises to be an answer to residual long lasting disability. Supervised individually designed exercise prescription after physiotherapy assessment may play a major role in minimizing disability.Methods: The present study is an open-level, parallel, superiority randomized control trial with blinding of outcome assessors to evaluate the results of the individually designed exercise programme over home based exercise programme. 74 adult referred GBS patients will be recruited and randomize in two groups either to receive 12 weeks individually designed exercise programme or home based exercise programme. The primary outcome shall be assessed as functional independence in activities of daily living and secondary outcomes shall be evaluated in terms of muscle strength, fatigue, pain, and quality of life at baseline, six months and twelve months duration.Conclusions: This is the first randomized control trial to compare the effect of supervised individually designed exercise over home based exercise programme on pwGBS.Trial registration: Currently the trial is ethically approved, prospectively registered CTRI/2016/08/007150 and in the process of recruiting its first subjects.

Counterfeit drugs in India: significance and impact on pharmacovigilance.

Counterfeit drugs have emerged as a major global problem. This issue has been brought to the centre of the Indian media due to the death of 15 women attending a sterilization camp in Chhattisgarh. India’s pharmaceutical industry exports drugs worth 15 billion dollars, which means a high prevalence of counterfeiting in India’s drug industry has global repercussions. However, accurate figures on the extent of counterfeit drugs in India are not available. The scientific literature as well as media reports often quotes figures of 10-35%, though studies done by the Indian Government dispute this. Counterfeit drug numbers have been known to be under represented by Governments due to fear of undermining their economy and health systems. On the other hand, rival companies in other countries may have an incentive to over hype India’s counterfeit problem to dent India’s growing status as the leading global supplier of generic medicines. Lack of clear definitions and differences between laws of countries further complicate reporting. A high prevalence of counterfeit drugs has a large impact on both health and economic indicators. Additionally, counterfeit drugs provide significant challenges to Pharmacovigilance programmes. Hence, here we discuss the significance of use of counterfeit drugs in India and challenges faced by Pharmacovigilance due to the extensive use of counterfeit drugs.

Effect of slump stretching on pain and disability in non-radicular low back pain.

Introduction: Non-radicular back pain is defined as pain, muscle tension, or stiffness in lumbosacral region; without leg pain (sciatica). Non-radicular symptoms lack the nerve root involvement. Slump test which is used for an assessment of altered neurodynamics is recently suggested as an intervention to potentially resolve sites of neural compression, excessive friction or tension,antidromically evoked impulses within nervous system. Objective: The study was aimed to find the effect of slump stretching on pain, disability in non-radicular low back pain. Material and methods: A quasi-experimental study was conducted at College of physiotherepy, Ahemdabad. 60 patients with non-redicular low back pain, aged 20-50 years with positive slump test and negetive straight leg rise (SLR) test were invited to take part in this study and a written consent was taken. While patients with positive neurological sign or symptom, positive SLR test ,spinal condition like infection, tumour, osteoporosis, fracture, previous spinal surgery, pregnancy were excluded. Then the patients were dividend into two groups: Experimental group; which received hot pack, slump streching and exercise and control group; which received hot pack and exercises. Total 6 sessions were given. The outcome measures: NPRS (numerical pain rating scale), MODI (modified oswestry disability index), AKE (active knee extension test) were taken pre and post treatment. Results: Wilcoxon test was applied for within group analysis. There was significant difference pre and post intervention within both case and control group. Values for group A NPRS, MODI, AKE/R, AKE/L are W=4.794, 4.802, 4.360, 4.589, p=<0.001, group B W=4.802, 4.132, 3.508, 3.372, p=<0.001 respectively. While Mann-Whitney U test was applied for in between group analysis there is a significant difference, values for NPRS, MODI, AKE/R, AKE/L are U=65.0, 103.0, 30.0, 37.0,p=<0.001. Conclusion: Slump stretching has an additional effect on pain, disability range of knee extension motion in patients with non- radicular back pain along with exercises and hot pack.

DoE Approach: A Stability Indicating RP-HPLC Method for Simultaneous Estimation of Methylparaben, Mometasone furoate and Eberconazole nitrate in Topical Formulations.

A rapid and sensitive stability indicating RP-HPLC method is developed for the simultaneous estimation of Methylparaben, Mometasone Furoate and Eberconazole Nitrate in topical formulations. Chromatographic separation was achieved on Waters Xterra C18 (150 × 4.6 mm, 5μm) using a mobile phase constituted of water and methanol (35:65, v/v) at a flow rate of 1.50 mL/min and column temperature of 30˚C. All three components were measured with uv detection at 235 nm. Force degradation study was conducted to determine Methylparaben, Mometasone Furoate and Eberconazole Nitrate in the presence of degradants and excipients peaks. Developed method was validated for method precision, specificity, linearity, accuracy, robustness and solution stability as per ICH guidelines. Method is showing linearity in the range of 0.25-188, 0.50-75 and 2.0- 750 μg/mL for Methylparaben, Mometasone Furoate and Eberconazole Nitrate respectively. The method was proved to be robust by conducting DOE study. The method is suitable for stability studies, routine analysis and quality control of topical formulations containing these components, either alone or in combination.

Drug utilization pattern of antimicrobial agents in dental outpatients of a tertiary care teaching rural hospital.

Aim: To study drug utilization pattern of antimicrobial agents in various outpatient departments of a tertiary care teaching rural dental hospital. Methods: A prospective-observational study was carried out in 200 patients from January 2014 to March 2014. Relevant information was obtained from the interview as well the hospital case record. Structured and pre-tested format was used for compiling the data. Results: The majority of the patients (51.5%) were in age group 41 to 60 years. Common conditions for antibiotic use included periodontal diseases (46.5%), endodontic diseases (38.5%) and dental caries (21.5%).Five antimicrobial drug formulations were used leading to a total of their 253 drug uses. Amoxicillin alone (64%) was the most commonly prescribed antimicrobial formulation followed by amoxicillin plus clavulanic acid (31.5%), metronidazole (26.5%), ofloxacin plus ornidazole (3%) and doxycycline (1.5%). The average number of antimicrobials prescribed per patient was 1.61. The average duration of antimicrobial was found to be minimum 3 days to maximum 5 days. Except ofloxacin plus ornidazole, all of the prescribed antimicrobials have been included in the WHO Model List of Essential medicines. 50.59% and 49.40% of total antimicrobial drug formulations were prescribed by generic and brand names respectively. Conclusions: Drug utilization data can help to formulate appropriate clinical guidelines for drug use and facilitate rational use of medicines in population.

Development of pH-independent matrix type sustained release drug delivery system of propranolol hydrochloride.

The characteristics of a new Polyvinylacetate/Povidone based excipient, Kollidon® SR were evaluated for application in extended release matrix tablets. The effects of the following formulation and process variables on tablet properties and drug release were tested: Kollidon® SR concentration in the tablet, addition of external binder for wet granulation, presence of an enteric polymer in the matrix, method of manufacturing and compression force. The similarities in release profiles were evaluated by applying the model independent f2 similarity factor. It was found that Kollidon® SR is suitable for pH-independent extended release matrix tablets. A minimum concentration of 30% polymer was necessary to achieve a coherent matrix, able to extend the release of the incorporated drugs. Increasing the Kollidon® SR concentration in the tablet led to a slower drug release. Drug release followed square root of time dependent kinetics, thus indicating a diffusion-controlled release mechanism. The drug release was influenced by the aqueous solubility of the drug. The drug release rate was faster for wet granulation than direct compression, thus making direct compression the method of choice for manufacturing Kollidon® SR extended release systems. It was found that Kollidon® SR was the main release controlling agent in the presence of an external binder or enteric polymer in the matrix. A significant reduction in the dissolution rates associated with an increase in tablet hardness was observed during the stability test under accelerated conditions. The developed propranolol matrix tablets formulation was compared to the reference listed product (Inderal® LA capsules). It was concluded that Kollidon® SR is a potentially useful excipient for the production of pH-independent extended release matrix tablets.

Comparison effect of Pioglitazone and Glimepiride alone on renal function marker in experimentally induced renal damage in diabetic rats.

Present study was designed to evaluate in Renoprotective activity of Pioglitazone and Glimepiride on Ischemia/reperfusion (I/R) induced renal damage in diabetic rats. Ischemia/reperfusion injury, which is commonly seen in the field of renal surgery or transplantation in diabetic condition, is a major cause of acute renal failure. Type 2 Diabetes was induced in rats by a single intraperitoneal (i.p) injection of Streptozotocin (65 mg/kg, STZ) in overnight fasting rats followed by the i.p administration of Nicotinamide (110 mg/kg, NIC) after 15 minutes. After right nephrectomy, Piogltazone (10 mg/kg/day, p.o) and Glimepiride (0.5 mg/kg/day, p.o) were administered for 15 days. On the 16th day, ischemia was induced in contra lateral kidney for 45 min, followed by reperfusion for 24 hr. renal function marker and oxidative parameter were estimated at the end of 24 hr reperfusion. At the end of experimental period the level of malondialdehyde formation/ lipid peroxidation (LPO) in kidney tissue and serum marker Creatinine, Urea and Uric acids were significantly increased. Whereas, the activity of biomarkers of oxidative stress such as reduced glutathione (GSH), Catalase (CAT) and superoxide dismutase (SOD) were found to be decreased significantly compared to control rats. Pioglitazone improved the renal dysfunction and oxidative stress after renal ischemia/reperfusion injury in diabetic rats, but Glimepiride less improved the renal marker change compared to treatment of Pioglitazone. In conclusion, Pioglitazone shows potent may improve renal function marker and oxidative stress in kidney in I/R induced renal damage in type 2 diabetic rats.

Glimepiride reduces on experimentally induced ischemia/reperfusion in diabetic rats.

Hyperglycaemia is most probably a contributing factor in the development of ischaemic acute renal failure (ARF) in many patients. Both clinical and experimental data suggest that hyperglycaemia increases the risk of ARF. Present study was designed to evaluate in Glimepiride reduced on experimentally induced ischemia/reperfusion in diabetic rats. Type 2 Diabetes was induced in rats by a single intraperitoneal (i.p) injection of Streptozotocin (65 mg/kg, STZ) in overnight fasting rats followed by the i.p administration of Nicotinamide (110 mg/kg, NIC) after 15 minutes. After right nephrectomy, Glimepiride (0.5 mg/kg/day, p.o) was administered for 15 days. On the 16th day, ischemia was induced in contra lateral kidney for 45 min, followed by reperfusion for 24 hr. Renal function marker and oxidative parameter were estimated at the end of 24 hr reperfusion. At the end of experimental period the level of malondialdehyde formation/ lipid peroxidation (LPO) in kidney tissue and serum marker Creatinine, Urea and Uric acids were significantly increased. Whereas, the activity of biomarkers of oxidative stress such as reduced glutathione (GSH), catalase (CAT) and superoxide dismutase (SOD) were found to be decreased significantly compared to control rats. Glimepiride improved the Serum Uric acid and tissues parameter LPO after renal ischemia/reperfusion injury in diabetic rats. In conclusion, Glimepiride shows low may improve experimentally induced ischemia/reperfusion in type 2 diabetic rats.