Abstract: Severe psychosis is an important issue to prescribers, often leading to polifarmacy. In some cases, association between two or more anti-psychotics is required. However, there is little research regarding which associations are both safer an effective, and which might lead to unwanted and potentially life threatening side effects, such as malignant neuroleptic syndrome. In the present case, a successful association between clozapine and aripiprazole is displayed.

Abstract: We report a 46-year-old immunosupressed man who developed cervical spondylodiscitis, right coxofemoral septic arthritis and osteomyelitis of the right acetabulum secondary to a Streptococcus pneumoniae bacteremia in spite of being properly immunized according to the standard vaccination schedule. Recent studies have found no evidence of protection for high-risk patients immunized with the polysaccharide vaccine. Thus, the role of the vaccination schedule is also discussed.

Abstract: The emphasis of the extant investigative research was on tracking patients with the most dangerous iatrogenic error in severe toxicological emergencies. The very first reported instance was that of a female patient with a dangerous intoxication that was caused due to caustic ingestion with a prescribed mega dose of methyl-predinisolone 30 mg/kg; she who visited the ER post seven days with a severe haematemisis attack. The next case was that of a severe atropine toxicity reported in a boy 4 years old reportedly suffering from a bout of food poisoning which was incorrectly diagnosed to be that a severe organophosphate toxicity and who was medically injected with five ampoules of atropine in a span of 20minutes. The third case comprised of seven instances of severe organophosphate poisoning who were rushed to the ER due to mixed atropine toxicity that was due to the acceleration of the procedure of complete atropinization without controlling the dosage/time schedule. The fourth case was a typical referral instance of mass food poisoning accident in five members of the family that was simultaneously identified to be a pure case of accidental toxicity due to leakage of carbon monoxide gas from their domestic bio gas system. The fifth case was an unsure choice to perform haemodialysis in five different cases of individuals reporting dangerous methanol consumption resulting in extreme diagnosis of irreversible blindness and grave worsening condition while sick. The sixth iatrogenic instance was an erroneous diagnosis in the strength of ethanol (10% or 100%) administered orally which resulted in a serious diagnosis in a 25 year old pharmacist who deliberately consumed 100 ml of pure methanol. The seventh case was that of a 51 year old female farmer who was not carefully observed and discharged untimely in a case of suspected snake bite after 4 hours; this led to her being re-admitted in the ER after 18 hours due to extreme progressive descending neuroparalytic symptoms.The eight case was a strict one that followed the intended dosage mentioned on the antivenin vial "One ampoule given intramuscularly" which resulted in a serious diagnosis of Disseminated Intravascular Coagulation by collaburdiae snake bite. The ninth case was that of a suicidal 37 year old female patient who had iatrogenic induction of vomiting due to consumption of the Zinc Phophite tablets which resulted in acceleration of the release of phophine gas and a quickly deteriorating deadly worsening of the inebriated condition. The last case was of cases of neuroleptic malignant syndrome prescription of medication to alter the neurotransmitter disturbance that was the due to the antipsychotic medicines that may result in more disturbance and dangerous result from anticholinergic medications that was due to paralytic ileus in a lady aged 46 years.

Abstract: Febuxostat is a non-purine xanthine oxidase inhibitor for which the metabolic pathway extensively differs from that for allopurinol. Since little information is available about the use of this agent in patients with chronic kidney disease (CKD), we investigated the effects of oral febuxostat for 2 months in patients with CKD, stage G3b-G5, and asymptomatic hyperuricemia. We found that the degree of serum uric acid decrease (ΔUA) after febuxostat administration was significantly larger in patients who had not been previously administered allopurinol or angiotensin receptor blockers. Furthermore, we found a significant positive correlation between ΔUA and baseline UA concentration. Finally, we found a weak negative correlation between ΔUA and baseline estimated glomerular filtration rate, suggesting that febuxostat could efficiently decrease UA levels in patients with severe renal dysfunction. These results suggest that we can prescribefebuxostat more safely and efficiently than allopurinol, for which the dosage has to be carefully reduced in patients with relatively advanced CKD.

Abstract: Solid lipid nanoparticles (SLNs) formulated using one type of lipid (homolipid) suffer from low drug encapsulation and drug bursting due to crystallization of the lipid into the more ordered b modification, thus leading to decreased drug entrapment and faster drug release. This study assessed the feasibility of using nanostructured lipid matrices (NLM) for ocular delivery of levofloxacin hemihydrate adopting heterolipids composed of mixtures of lipid and stabilized by surfactant. The systems were prepared using the modified solvent injection method followed by ultrasonication. The NLM were characterized by entrapment efficiency percentages EE %), mean particle size (PS), polydispersity index (PDI), and zeta potential (ZP). The in vitro drug release was studied using dialysis bag method. Decreasing gelucire concentration was accompanied by an increase in drug entrapment followed by an increase in particle size. The best formula, composed of Compritol: Gelucire in 1:1 ratio, 10 mg stearylamine, and 1% poloxamer, with EE% of 69.41%, PS of 220.1 nm, PDI of 0.202, and ZP of 24.3 mV, showed in vitro sustained release properties for 24 hours.

Abstract: Drug transporters are increasingly recognized for their role in organ-specific drug entry. Among a group of transporters known as uptake transporters which mediate the cellular influx of substrate compounds, members of the Organic Anion Transporting Polypeptide (OATP) family are of particular relevance to targeted drug delivery. Certain members of the OATP transporters have broad substrate specificity. Indeed, structurally divergent compounds ranging from anionic, neutral, zwitter ionic, as well as cationic compounds have been noted to be efficiently transported by OATPs. Moreover, certain members of the OATP transporters such as OATP1B1 and 1B3 are known for their liver-enriched expression pattern. They have already been demonstrated to be of relevance to efficacy and toxicity for the HMG-CoA reductase inhibitor class of lipid lowering drugs. A number of OATPs are expressed in organs such as the brain, kidney, and certain cancer cells.
For this review, a search of the literature regarding past and current concepts in OATP transport was carried out. Herein, a focused discussion of specific OATP isoforms was conducted where the expression, function, and substrate selectivity of OATPs provide the basis for considering how such transporters may be used to facilitate drug delivery. Potential benefits as well as challenges that face OATP-mediated drug targeting and delivery are also outlined.