Ropivacaine: An Unusual Cause of Neuroleptic Malignant-Like Syndrome

Ropivacaine is commonly used for post-operative pain management. We describe a case of neuroleptic malignant-like syndrome in a woman administered ropivacaine delivered using a drug infusion balloon. The presenting symptoms were confusion, agitation and fever. Blood analysis showed elevated C-reactive protein, leucocytosis and increased creatine phosphokinase. As intoxication was suspected, ropivacaine was suspended and the patient gradually improved. Possible leakage of ropivacaine into the intrathecal space may have resulted in central nervous system toxicity.

Targeted Chemotherapy Delivery via Gold Nanoparticles: A Scoping Review of In Vivo Studies

In the field of oncology, a lot of improvements in nanotechnology creates support for better diagnosis and therapeutic opportunities, and due to their physical and chemical properties, gold nanoparticles are highly applicable. We performed a literature review on the studies engaging the usage of gold nanoparticles on murine models with a focus on the type of the carrier, the chemotherapy drug, the target tumoral tissue and outcomes. We identified fifteen studies that fulfilled our search criteria, in which we analyzed the synthesis methods, the most used chemotherapy conjugates of gold nanoparticles in experimental cancer treatment, as well as the improved impact on tumor size and system toxicity. Due to their intrinsic traits, we conclude that chemotherapy conjugates of gold nanoparticles are promising in experimental cancer treatment and may prove to be a safer and improved therapy option than current alternatives.

Ethanolic Artichoke Extract improves outcome in a rodent model of 5- Fluorouracil Induced Cardio toxicity

Background: During treatment, many drugs may become cause of cardiac system toxicity, cytotoxic drugs therapy cause cardiac toxicity, including 5- Fluorouracil (5- FU). It is regarded as antimetabolite which cause its toxic effects during S phase of the cell cycle and got its activation by conversion of thymidine phosphorylase into fluorodeoxyuridylate (5 fluoro 2'deoxyuridine 5'monophosphate, 5-FdUMP) which cause inhibition of thymidylate synthase, which ultimately cause prevention of synthesis of DNA. Aim: To focus on evaluation of ethanolic artichoke extract (Cynara scolymus L) with respect to its cardio protective properties against 5-fluorouracil (5-FU) induced cardio-toxicity in rabbits by estimation of Alanine aminotransferase, creatine kinase and aspartate aminotransferase enzymes in serum. Methods: 4 groups consisting of 8 rabbits each were made for collected 32 rabbits who were albinos. Group I: (negative control) administered dimethyl sulfoxide (DMSO) (2 ml/kg /day) orally on daily basis for duration of 10 days. Group II: (positive control) administered DMSO (2 ml/kg /day) daily via oral route for duration of 10 days and subsequently received dose of 5-FU (150 mg/kg) (single) by intraperitoneal injection, on day 8th day in connection with DMSO. Groups III: administered ethanolic artichoke extract (200 mg/kg/day) orally on daily basis for duration of 10 days. Groups IV: administered ethanolic artichoke extract (200 mg/kg/day) daily on oral basis for 10 days with subsequently single intraperitoneal dose of 5-FU (150 mg/kg) on day 8th day. Results: Before intoxication via 5-FU, treatment of ethanolic artichoke extract note worthily reduces the increase serum levels of AST,CK & ALT enzymes due to cardio toxicity induced via 5-FU- in case of rabbits . Conclusions: With respect to present scenario, extracts of ethanolic artichoke serve as powerful modulator in reducing or masking cardiac toxicity cause by induction of 5-FU in case of rabbits. Keywords: Artichoke Extract, Fluorouracil Induced Cardio toxicity, Ethanolic

Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients

Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.

Long-term Implication of Metronidazole Induced Reversible Cerebellar Toxicity and Peripheral Neuropathy- A Case Report

Metronidazole Induced Encephalopathy (MIE) is rare and serious central nervous system toxicity. A 40-year-old male, on long-term self treatment with metronidazole (cumulative dose: 102 gm) presented with dysarthria, nystagmus, unsteadiness, and numbness in both legs. A Magnetic Resonance Imaging (MRI) scan of the brain revealed a symmetric hyperintensity in both the dentate nuclei of cerebellum on both T2 weighted and Fluid-Attenuated Inversion-Recovery (FLAIR) imaging. Discontinuation of metronidazole resulted in resolution of the imaging findings and clinical improvement occurred within one month. Metronidazole-induced neurotoxicity should be considered in patient who present with cerebellar symptoms and characteristic lesion on MRI in close temporal relation with metronidazole intake and drug should be discontinued to prevent permanent neurological deficit.

Long-term Implication of Metronidazole Induced Reversible Cerebellar Toxicity and Peripheral Neuropathy- A Case Report

Metronidazole Induced Encephalopathy (MIE) is rare and serious central nervous system toxicity. A 40-year-old male, on long-term self treatment with metronidazole (cumulative dose: 102 gm) presented with dysarthria, nystagmus, unsteadiness, and numbness in both legs. A Magnetic Resonance Imaging (MRI) scan of the brain revealed a symmetric hyperintensity in both the dentate nuclei of cerebellum on both T2 weighted and Fluid-Attenuated Inversion-Recovery (FLAIR) imaging. Discontinuation of metronidazole resulted in resolution of the imaging findings and clinical improvement occurred within one month. Metronidazole-induced neurotoxicity should be considered in patient who present with cerebellar symptoms and characteristic lesion on MRI in close temporal relation with metronidazole intake and drug should be discontinued to prevent permanent neurological deficit.

Neuroanatomy and Sampling of Central Projections for the Visual System in Mammals Used in Toxicity Testing

Visual system toxicity may manifest anywhere in the visual system, from the eye proper to the visual brain. Therefore, effective screening for visual system toxicity must evaluate not only ocular structures (ie, eye and optic nerve) but also multiple key brain regions involved in vision (eg, optic tract, subcortical relay nuclei, and primary and secondary visual cortices). Despite a generally comparable pattern across species, the neuroanatomic organization and function of the visual brain in rodents and rabbits exhibit appreciable differences relative to nonrodents. Currently recognized sampling practices for general toxicity studies in animals, which are based on easily discerned external neuroanatomic landmarks and guided by extant stereotaxic brain atlases, typically will permit histopathologic evaluation of many brain centers involved in visual sensation (eg, optic chiasm, optic tract, dorsal lateral geniculate nucleus, primary and secondary visual cortices) and often some subcortical brain nuclei involved in light-modulated nonvisual activities needed for visual attention and orientation (eg, rostral colliculus in quadrupeds, termed the superior colliculus in bipeds; several cranial nerve nuclei). Pathologic findings induced by toxicants in the visual brain centers are similar to those that are produced in other brain regions.

Environmental and Nutritional Challenges With Down's Syndrome

Background Down's syndrome patients are suffering from such gastrointestinal and metabolic complications which affect their prolongation for survival and this could be attributed to the malnutrition system. To reduce the risk factors for mortality, the paper has focused on the assessment of the socioeconomic, clinical, physical, biophysiological, and biochemical characteristics of them which can be affected by the type of nutrition system, toxicity, and ecological footprint. Methods Patients were males with trisomy 21 diagnosed by karyotype test and assessed by clinical examinations. The clinical observations, medical interventions, and oral diseases associated with DS have been defined and oral treatment is explored. Samples collected from different biofluids. The physicochemical analyses of the biomatrix samples were performed and these properties had compared to findings of healthy males and age-matched controls. In specific, trace elements which could be originated from environmental resources were assessed in saliva, blood, urine, and hair. Results Duraphat application was proved effective for their oral treatment and saliva was the optimum biomarker for detecting malnutrition. The patients were hypersensitive to Cu while the Mn content in blood and hair was considered an expression to the degree of epileptic condition and chronic seizure development. The ecological footprint was 5.6 gha and carbon footprint was recognised in food poverty habits. These can be reduced by eating more plant-based proteins and fibre-rich foods with low saturated fats and sodium. Conclusion The current findings provide an up-to-date reference for expected developmental outcomes in children with DS in terms of biophysicochemistry. The genetically sensitive intervention is affected by heredity factor and sensitivity to toxics. Down's syndrome is encouraged to live green-hipster life. Besides, doctors are recommended to order the physicochemical analyses for early detection of this special intervention.