Use of Naloxone in 9-1-1 Patients without Respiratory Depression in Los Angeles County, California (USA)

Introduction:Along with an increase in opioid deaths, there has been a desire to increase the accessibility of naloxone. However, in the absence of respiratory depression, naloxone is unlikely to be beneficial and may be deleterious if it precipitates withdrawal in individuals with central nervous system (CNS) depression due to non-opioid etiologies.Objective:The aim of this study was to evaluate how effective prehospital providers were in administering naloxone.Methods:This is a retrospective study of naloxone administration in two large urban Emergency Medical Service (EMS) systems. The proportion of patients who had a respiratory rate of at least 12 breaths per minute at the time of naloxone administration by prehospital providers was determined.Results:During the two-year study period, 2,580 patients who received naloxone by prehospital providers were identified. The median (interquartile range) respiratory rate prior to naloxone administration was 12 (6-16) breaths per minute. Using an a priori respiratory rate of under 12 breaths per minute to define respiratory depression, only 1,232 (47.8%; 95% CI, 50.3%-54.2%) subjects who received naloxone by prehospital providers had respiratory depression.Conclusion:This study showed that EMS providers in Los Angeles County, California (USA) frequently administered naloxone to individuals without respiratory depression.

Programmed Labor in Gestational Diabetes Mellitus as a Reserve for Reducing the Frequency of Cesarean Section

The aim of this study was to investigate the perinatal outcomes of delivery by various methods in patients with gestational diabetes mellitus (GDM). Methods and Results: The study included 403 pregnant women (gestational age of 37.0–41.0 weeks) with GDM and 68 without disorders of carbohydrate metabolism, who gave birth from the second quarter of 2018 to the third quarter of 2020 in the maternity ward of the City Clinical Hospital No. 29 named after N.E. Bauman. All patients with GDM were divided into 2 groups. Group 1 included 187 patients receiving insulin therapy; Group 2 included 216 patients receiving a well-balanced diet. The main indicators of the health status of newborns in the early neonatal period were assessed taking into account the methods of delivery: programmed labor (PL), planned cesarean section (PCS), and spontaneous delivery. The 1-minute Apgar score in newborns from mothers of Groups 1 and 2 was higher at the PL, compared with PCS. The 5-minute Apgar score in newborns from mothers of Group 2 was also statistically significantly higher at the PL, compared with planned CS. The incidence of hypoglycemia in newborns from mothers of all groups was minimal at the PL, including a statistically significant low rate in newborns from mothers of Group 1. Symptoms of neonatal CNS depression were significantly more common in newborns born by abdominal delivery from mothers with GDM. Conclusion: PL in women with GDM reduces the incidence of the main complications of the early neonatal period: hypoglycemia and symptoms of neonatal CNS depression. PL may be considered more acceptable than abdominal delivery for women with GDM.

NEAR FATAL AMITRAZ: A NOT SO UNCOMMON POISONING

Background: Amitraz is a pharmaceutical, veterinary, and agricultural product which is used worldwide to control ectoparasites in animals. Its widespread use has led to increased cases of poisoning in rural parts of India. Aim: To study the clinical features, complications, laboratory abnormalities and outcome of the patients with acute amitraz intoxication. Methodology: The study is a retrospective case series study conducted in HSK hospital between the period of Feb 2019 and May 2020. Results: A total of 11 patients were analysed and results revealed CNS depression and vomiting in 8 of those patients with 1 patient with respiratory failure requiring mechanical ventilation. Conclusion: Amitraz poisoning appears to be severe with CNS depression being the most common symptom. But most patients stabilise and recover quickly. Patients should be monitored for respiratory failure as it is a dreadful complication. Treatment is symptomatic as no antidote is available.

CNS DEPRESSION POTENTIAL EVALUATION, FORMULATION AND CHARACTERIZATION OF LYOPHILIZED HERBAL ORAL CAKE OF TERMINALIA CHEBULA FRUITS

Objective: Terminalia chebula fruits are used as traditional herbal medicine from the ancient era but still now, the extract has not revealed any research data on CNS depression activity as well as its lyophilized herbal formulation. The present study was designed to evaluate CNS depression activity and develop lyophilized oral cake of Terminalia chebula fruit extract. Methods: CNS depression potential of Terminalia chebula fruit was examined using the hole board, hole cross, and thiopental sodium induced sleeping time test. The human equivalent dose was calculated based on US FDA guidelines of dose conversion between animals and humans. A novel lyophilized herbal oral cake of aqueous extract of Terminalia chebula fruits with additives was then formulated. The formulated cake was subjected to characterize its physicochemical properties such as appearance, residual humidity, drug content, dissolution, and drug release profile, extract-polymer compatibility by Fourier-transform infrared spectroscopy (FTIR) and stability. The prepared cake was further evaluated with the hole board and hole cross model in mice and compared with control to ensure its CNS depression activity. Results: Crude extract at the doses of 100, 150, 200, and 400 mg/kg body weight showed significant (p<0.01) dose-dependent inhibition of locomotor behavior. Crude extract dose of 200 mg/kg body weight in mice compared with standard diazepam dose (1 mg/kg) was used to calculate the human equivalent dose of 1000 mg/60 kg. The formulation presented a rapid drug release profile while drug content was approximately 99.5%. FTIR spectroscopy of formulation showed no drug-excipient interaction. The oral cake at the dose of 200 mg/kg body weight showed significant (p<0.01) CNS depression activity. Conclusion: CNS depression activity, FTIR, and stability analysis ensure the preservation of active ingredients in the lyophilized oral cake as in the crude extract.

Subcutaneous Erythropoietin Reverses Optic Neuropathy Induced by Methanol Poisoning: Three Case Reports

Background: Methanol is a highly toxic alcohol and causes such severe side effects as CNS depression, blindness, acute renal failure and even death. Methods: Patients were three male referrals (aged 29-56 years) to the poisoning center at Taleghani Hospital, Urmia, Iran, in 2020. They had unknowingly ingested methanol. Their chief problems were bilateral blindness and metabolic acidosis. Upon taking medical history and physical examinations, they were assessed by an ophthalmologist, while testing the arterial blood gases and standard laboratory tests. They were given standard treatments and antidotes 3-4 days, which did not reverse the blindness. Subsequently, each patient was injected with five doses of subcutaneous erythropoietin every second day. The visual acuity progress was monitored daily until their discharge from the hospital. Results: Following 3-4 days of ineffective standard treatments, patients were injected with low doses of subcutaneous erythropoietin, which gradually reversed the visual acuity to normal level over the next 7 to 9 days. The patients were discharged from the hospital 10-12 days post admission, with normal visual acuity and without having any side effects. Conclusion: The subcutaneous erythropoietin effectively relieved the acute optic neuropathy and reversed the blindness to normal vision. This study is the first to investigate the therapeutic effects of subcutaneous erythropoietin in the treatment of optic neuropathy secondary to methanol intoxication.

Poisons affecting the neurological system

The brain is susceptible to a variety of poisons. Sedating drugs and chemicals can cause central nervous system (CNS) depression while other substances can cause CNS stimulation, including seizures. These are of particular concern since intractable seizure activity may cause complications, with pyrexia resulting in secondary damage to other organs. The common poisons discussed here that cause neurological effects are metaldehyde and tremorgenic mycotoxins, which can cause rapid onset seizures; cannabis, which can cause prolonged sedation in companion animals; permethrin, which is associated with prolonged seizures, particularly in cats; and ivermectin, which can cause CNS depression, blindness and seizures. Treatment is supportive in most cases; care should be taken when considering the use of emetics since there is a risk of aspiration in seizuring animals. Control of seizure activity is a priority, while intravenous lipid emulsion may also be useful.

Effect of Caffeine at Different Concentrations on Behavior and Motor Activity in Mice

Aims: This article aimed to study the effect of different caffeine concentrations on behaviour and motor activity of mice. Place and Duration of Study: This study took place in Faculty of Pharmacy, University of Tripoli, and was conducted between 2017 to 2018. Methodology: The experiment was carried out using 24 male mice (25-30 gm). Plus maze was used for screening antianxiety effect of caffeine. While swimming maze was used to test the antidepressant effect. Descriptive statistics was performed using SPSS (version 22), followed by one sample Kolmogorov-Simirnov test. One-Way ANOVA was applied to compare between groups and Post Hoc test (LSD). Results: At a dose of 100 mg/kg, caffeine produce significant decrease in the duration of immobility using forced swimming maze; while the lower (25 mg/kg) and the higher (200 mg/kg) doses did not produce any changes compared to the control. In plus maze, Caffeine decreases the anxiety measure at the dose used of 100 mg/kg; but did not change the anxiety measure when lower (25 mg/kg) or higher (200 mg/kg) doses used compared to the control. The spontaneous motor activity was decreased significantly after administration of the higher dose of 200 mg/kg; the lower dose (25 mg/kg) showed insignificant increase, while the dose of 100 mg/kg produce insignificant decrease in the spontaneous motor activity. Conclusion: Caffeine has dose dependent effect, in a dose 100 mg/kg it produce anxiolytic and antidepressant like action, while lower (25 mg/kg) and higher (200 mg/kg) doses did not show any changes. Caffeine also produce dose dependent decrease in the spontaneous motor activity, this indicate that caffeine produce CNS depression with higher doses.

Poisons affecting the neurological system

The brain is susceptible to a variety of poisons. Sedating drugs and chemicals can cause central nervous system (CNS) depression while other substances can cause CNS stimulation, including seizures. These are of particular concern since intractable seizure activity may cause complications, with pyrexia resulting in secondary damage to other organs. The common poisons discussed here that cause neurological effects are metaldehyde and tremorgenic mycotoxins, which can cause rapid onset seizures; cannabis, which can cause prolonged sedation in companion animals; permethrin, which is associated with prolonged seizures, particularly in cats; and ivermectin, which can cause CNS depression, blindness and seizures. Treatment is supportive in most cases; care should be taken when considering the use of emetics since there is a risk of aspiration in seizuring animals. Control of seizure activity is a priority, while intravenous lipid emulsion may also be useful.

Neonicotinoid insecticides: an emerging cause of acute pesticide poisoning

Neonicotinoids are a new class of insecticides widely applied for crop protection. Information on human exposures to neonicotinoids is limited. The most common routes of exposure were ingestion (51%), dermal (44%), and ocular (11%). These insecticides act as agonists at nicotinic acetylcholine receptors, which cause insect paralysis and death the high specificity for receptors in insects was considered to possess highly selective toxicity to insects and relative sparing of mammals. However, an increasing number of cases of acute neonicotinoid poisoning have been reported in recent years. Present study report three cases presented to us with acute neonicotinoid poisoning with different manifestations including acute myocardial infarction, central nervous system (CNS) depression, and acute kidney injury, who recovered subsequently with supportive care. A detailed literature review found that respiratory, cardiovascular and certain neurological presentations are warning signs of severe neonicotinoid intoxication. Supportive treatment and decontamination are the practical methods for the management of all neonicotinoid-poisoned patients.