Abstract: Tea tree oil (TTO) is a very popular ingredient of many over-the-counter healthcare products known to be effective against a variety of infections. In topical products, it is used at a concentration of 5% to 10%.
A 33-year-old woman suffered TTO chronic intoxication as she improperly used 100% pure TTO for one year. She complained of symptoms of neurological toxicity: accompanied by nausea, diarrhea and severe weight loss. All clinical tests resulted negative. Her health improved when she stopped using TTO.
This is the first report on chronic TTO intoxication. The clinical presentation is similar to others described in literature could have been avoided with correct information on the use of this herbal remedy.

Abstract:
Purpose: We report a case in which lipid therapy successfully treated both immediate central nervous system toxicity and delayed cardiovascular collapse after ropivacaine administration.
Case Details: A 54 year old female with a history of hypertension, anxiety and sleep apnea was given bilateral paravertebral blocks with a total of 45 mL 0.5% ropivacaine. Approximately 15 minutes after the block, the patient became lethargic, exhibited facial dyskinesias, and immediately progressed to a tonic/clonic seizure. Local anesthetic systemic toxicity (LAST) was suspected and a 75mL bolus of 20% lipid emulsion was administered. The seizure resolved one minute after. She later received single oral doses of lorazepam and clonazepam for anxiety, and trazodone as per her home medications. Approximately 8 hours after the seizure, the patient became bradycardic and hypotensive, refractory to atropine and fluids. Another 75mL bolus of 20% lipid emulsion was administered over 2 minutes, followed by an infusion. Within 15 minutes of the infusion, the patient became hemodynamically stable.
Discussion: Cases of ropivacaine-induced LAST successfully treated with lipid therapy exist. However, there have been no previously reported cases involving such a prolonged delay in ropivacaine toxicity. Use of the Naranjo Adverse Drug Reaction Probability Scale resulted in probable associations for ropivacaine provoking both immediate and delayed toxicities. Lipid therapy was successful in both instances, further supporting ropivacaine as the inciting agent.
Conclusion: It is important for clinicians to continuously monitor patients with LAST for delayed effects, and to not overlook the need for maintenance lipid infusions after ropivacaine toxicity.

Abstract: Clopidogrel Lipid Suspension was formulated in lipid based aqueous system and characterized for morphology and particle size using physicochemical techniques. Transmission Electron Microscopy (TEM) cryo imaging analysis revealed the presence of predominantly spherical unilamellar liposome particles with 25-110 nm size and the product was found to be stable at 2-8°C for 2 years. Repeated dose toxicity study of Clopidogrel Lipid Suspension showed no signs of toxicity in rats and minimal toxicity in mice. Pharmacokinetic studies indicated a rapid metabolism of Clopidogrel following intravenous administration of Clopidogrel Lipid Suspension compared to oral administration of Clopidogrel bisulfate. Intravenous administration of 5, 10, 20, and 40 mg/kg Clopidogrel Lipid Suspension showed a dose dependent effect on the platelet aggregation in mice. An oral dose of 20 mg/kg of Clopidogrel was required to produce similar effects by intravenous administration of only 5 mg/kg in mice with Clopidogrel Lipid Suspension. Phase I clinical safety studies were also conducted in 48 healthy human subjects with dose escalation from 25 mg to 75 mg. All subjects who experienced adverse events during this study recovered completely and no serious adverse events were reported.

Abstract: In the US, organic dairy cattle cannot be treated with antibiotics and maintain their organic status. There are no alternate products approved by US FDA to treat bovine mastitis on organic farms. Therefore, herbal treatments must be investigated for mastitis control. National organic dairy regulations allow the use of herbal products to prevent and manage bacterial mastitis. Phyto-mast is one botanical phytoceutical, composed of five plant extracts in a canola oil base, commonly used on organic dairy farms to manage mastitis and maintain organic status.
Unfortunately, there are no data regarding in vitro bacterial activity of Phyto-mast®; therefore, five different potential mastitis-causing bacteria were tested for their susceptibility to Phyto-mast® in vitro according to the Clinical Laboratory Standards Institute techniques. Based on our results Phyto-mast® appears bacteriostatic to E. coli and S. agalactiae, but is ineffective in decreasing the growth of Staphylococcus species and S. bovis.

Abstract: Linezolid has a wide spectrum of activity against gram-positive organisms, but no clinical activity against gram-negative organisms. In a phase 3 study comparing linezolid with vancomycin in patients with intravascular catheter-related infections, a mortality imbalance occurred in patients with gram-negative bacterial infections. The hypothesis that this imbalance might be related to immunosuppressive effects of linezolid (impeding the ability of phagocytic cells to respond to gram-negative infections) was tested using in vitro and ex vivo approaches. Human whole blood was incubated with linezolid in vitro. Phagocytosis of Escherichia coli (E.coli) particles, cytokine (interleukin-1 receptor antagonist [IL-1ra], IL-8) secretion and mRNA synthesis by neutrophils in response to lipopolysaccharide (LPS) stimulation, were measured. Subsequently, in an ex vivo study, linezolid or placebo was administered to healthy subjects before measurements of phagocytosis of E. coli particles by neutrophils and monocytes, and cytokine (IL-1ra, IL-1ß, IL-6, IL-8, and tumor necrosis factor-a) secretion by total white blood cells in response to LPS stimulation. Linezolid and placebo group comparisons were based on individual baseline-corrected values. Linezolid had no effect on phagocytosis of E.coli particles by neutrophils or monocytes in vitro or ex vivo. Small to moderate decreases in IL-1ra and IL-8 secretions from neutrophils were observed at high linezolid concentrations (=16.5 µg/mL) in vitro, but cytokine gene expression was not affected. Linezolid had no significant effect on secretion of 5 cytokines evaluated ex vivo. There is no strong evidence suggesting that linezolid inhibits phagocytic cell functions in response to gram-negative pathogensat clinically relevant concentrations.

Abstract: A small proportion of the healthy population is lacking in plasma cholinesterase enzyme (ChE) due to a genotype aberration. Plasma (ChE) activity is reduced in liver dysfunction due to reduced synthesis. A prospective cross-sectional study was carried out at Dammam Regional Poison Control Center in cooperation with Dammam Medical Complex Hospital to measure ChE and establish its relationship with hepatic condition status in the studied cases. The studied cases were divided into the following groups: Group I comprised fifty age-matched male and female subjects, not exposed to pesticides, who were recruited randomly as a control group. All participants were from the same geographical setting. Group II comprised seventy-five patients with chronic liver diseases of different etiologies. Fibroscan and biochemical enzyme assays had been done including a ChE assay. From the current study, the researchers found that the activity of the ChE enzyme was significantly lower in the hepatic patients as compared to the control group (120.1 ± 69.3 and 167.1 ± 30.6 Ukat/l respectively). There was a significant decrease in plasma ChE as the fibroscan score increased. There was also a significant decrease in ChE level in Wilson & intrahepatic cholestasis regarding hepatitis B & C cases. There was a significant decrease in plasma (ChE) level with increase in age; a significant inverse relationship with variables hepatic profiles Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) and Gamma Glutamyl Transferase (GGT). Plasma (ChE) level had a significant negative correlation with plasma prothrombin time and INR ratio. In conclusion, the present study clarifies the non-interpretable plasma choline esterase enzyme in cases of suspected insecticide toxicity of hepatic patients.