Clozapine: why wait to start a laxative?

SUMMARYClozapine, the antipsychotic of choice for treatment-resistant schizophrenia, has a number of side-effects, some of which are potentially life-threatening. Historically viewed as a relatively minor side-effect, there is increasing awareness of the potentially severe sequalae of constipation secondary to clozapine-induced gastrointestinal hypomotility (CIGH). These include ileus, intestinal obstruction, bowel ischaemia, gastrointestinal necrosis, toxic megacolon and death. CIGH is significantly more common than clozapine-induced blood dyscrasias and has a higher mortality rate. Although strict criteria must be followed to assertively monitor, detect and treat blood dyscrasias in patients taking clozapine, no such framework exists for CIGH. We recommend that prescribing guidelines, regulatory agencies and information from manufacturers should more clearly highlight the risks identified in the literature. Furthermore, we recommend that, in people taking clozapine, constipation should be prevented by prophylactic treatment with laxatives rather than treated only when clinically identified.LEARNING OBJECTIVES:After reading this article you will be able to: •understand the mechanism of gastrointestinal hypomotility in those taking clozapine•improve the monitoring of clozapine-induced constipation•understand prophylactic laxative treatment and the use of less commonly prescribed laxatives in patients who experience clozapine-induced constipation.

Antimicrobial Properties of Rosa Indica (A New Start with Nature)

Plants have been played an important role as a resource of natural medicines for human health, from the long period of time. Some plants show antimicrobial properties. The most important merit of using plant derived medicines is that they are low priced, readily available and showing minor side effect. The present study deals with the antibacterial potential of crude extracts of petals of Rosa indica. Through agar disk diffusion method the antimicrobial potential of Rosa indica was examined. Petals were collected, dried and its crude extract was obtained. Methanol and acetone were used as the extraction solvent. These extract were examined against two gram-positive (Staphylococcus aureus, Bacillus cereus) and two gram-negative (E-coli, Salmonella typhi) bacteria. Extracts prepared by all solvents showed antimicrobial action and established zone(s) of inhibition. By performing phytochemical tests we have observed positive results for flavanoid, tannin and alkaloid. These phytochemical have capability to inhibit the growth of microorganism or can fight against microorganism. Rich source of compounds have been obtained in this particular plant. For inhibition of multiple drug resistant microorganisms, this extract can be tested. For making herbal drugs, extract of Rosa indica may prove to be useful as an advance step in future.

The Evaluation of Silicon Oil Evacuation Procedure In Cipto Mangunkusumo Hospital Indonesia

Background: Injection of Silicon oil is a standard procedure for vitreous replacement in vitrectomy procedure for retinal detachment cases. It acts as a great tamponading agent for reattachment of retinal breaks or retinal detachment. Despite its minor side effect, silicon oil could cause several complications such as cataract, endothelia decompensation, increased intraocular pressure, and secondary glaucoma. Thus needed to be evacuated after the retinal reattachment is stabilized. Following evacuation procedure, visual acuity are known to be significantly improved. However, some cases shows decreased of visual acuity due to retinal redetachment, optic nerve damage due to secondary glaucoma, hypotonym vitreous hemorrhage, expulsive hemorrhage, and cornea abnormality. Methods: A retrospective descriptive study of retinal detachment patients underwent silicon oil evacuation procedure in Cipto Mangunkusumo Hospital, Indonesia from September 2017 until Januari 2018. Results: There were seventy seven cases of retinal detachment undergoes silicon oil evacuation within period of September 2017-Januari 2018. There were improvement of visual acuity (greater than 6/60) after one month of silicon oil evacuation. Anatomical retinal reattachment was successfully observed in 91% patient. The most occuring complication after silicon oil evacuation includes secondary glaucoma and retinal redetachment. Conclusion: Silicon oil evacuation is a standard procedure following a vitrectomy in retinal detachment cases. The evacuation procedure yields in positive benefit for patient in term of visual acuity and anatomical structure.

Depression

Depression is one of the thoroughly evaluated diseases in psychiatry with regard to diagnosis as well as treatment variables. Like in other medical conditions, early treatment should be aimed and watchful waiting which is for instance also not done in the treatment of high blood pressure or diabetes, has not been proven to be a sophisticated approach based on neurobiological considerations. Like in other diseases, it is apparent that days of untreated depression may result in brain damage like reduced volume size of the hypocampus. The course of illness of depression shows that life events are less important in later stages of the illness than in earlier. The introduction of the group of selective serotonin reuptake inhibitors (SSRI) marked a revolution in the treatment of depression, since it was possible to treat patient for the first time effectively with a more minor side effect profile with this approach. Substantially more patients could be reached and the association with this phenomenon and the reduction of the suicide rates in different countries like Sweden, Austria and Hungary has been discussed. Dual reuptake inhibitors effecting both the serotonergic as well as the noradrenergic pathways and the dopaminergic noradrenergic medication bupropion have been introduced in the filed with specific angles of treatment goals like pain or somatic symptoms. With the introduction of agomelatine, a unique mechanism of action with the combination of melatonergic agonistic as well as serotonergic antagonistic activities has been achieved. With this approach a more potent influence on the circadian rhythm has been shown compared to other, previously used antidepressant properties. Deep brain stimulation and vagus nerve stimulation for treatment refractory depressed patients yield promising results. More thorough characterisation of the underlying pathophysiology of depression including brain imaging results as well as molecular biological variables will yield further inside of the understanding and treatment of depression.

Laser-assisted uvulopalatoplasty: an assessment of a technique

The Kamami technique of laser-assisted uvulopalatoplasty has recently been introduced into British practice as an office-based multistage procedure for the treatment of snoring and, in certain cases, for obstructive sleep apnoea. We have treated 50 patients with simple snoring, with a minimum follow-up of six months. Six-month telephone interview follow-up has assessed partner and patient satisfaction, as well as willingness to undergo the procedure again. We have found the procedure easy to perform with no serious intra-operative complications. Thirty-four (68 per cent) of patients' partners have been definitely satisfied with the results of treatment, with 11 (22 per cent) definitely unsatisfied. However, only 25 of these 34 satisfied patients (76 per cent) would be prepared to undergo the treatment again with postoperative pain and discomfort cited as the reason in those who would not. The failure rate doubled between one and six months post-operatively. There have been no serious complications but a 40 per cent minor side-effect rate is noted. These results are discussed in the context of previously reported results, with consideration of future strategies to improve outcome.