Abstract: Methaemoglobinemia can occur due to a congenital enzyme defect or can be secondary to medication or drugs. Symptoms depend on the concentration of methaemoglobin in the blood and the existence of additional risk factors. Methaemoglobinemia can cause significant tissue hypoxia, with no reaction on oxygen therapy, leading to severe, potentially life-threatening clinical features and/or death. A discrepancy between the oxygen saturation, as measured by pulse oximeter and the arterial oxygen saturation can be indicative of methaemoglobinemia. The diagnosis is made by blood gas analysis. Here, we describe the clinical course of two male patients. One patient, aged 53, develops methaemoglobinemia after the ingestion of poppers (nitrite-containing recreational drugs). A 3-year old boy with a glucose-6-phosphate-dehydrogenase-deficiency develops methaemoglobinemia after treatment with rasburicase. The first patient was treated with methylene blue. In the second patient methylene blue was contra-indicated due to the glucose-6-phosphate-dehydrogenase-deficiency. He was treated with red blood cell transfusions. Both patients recovered without sequelae.

Abstract:
Introduction: Aluminium phosphide poisoning is one the commonest pesticide used in India and also the most lethal with mortality approaching almost 100%; majority in the first 24 hours. Its lethality is accentuated by its rapid toxicity, non-availability of an antidote and debilitating cardiac dysfunction.
Objective: We discuss here a case of aluminium phosphide induced severe cardiac dysfunction and shock managed aggressively and successfully with early initiation of VA-ECMO propelled by the belief, though scant literature, that the cardiac injury induced by this poison is reversible.
Case study: This report pertains to a young man, admitted with reported oral ingestion of a lethal dose of aluminum phosphide with suicidal intent. He presented in a critical state of cardiovascular collapse requiring prompt management with a modality used rarely for this kind of intoxication: ECMO
Conclusion: With this report, we would like to support the belief that cardio toxicity due to aluminium phosphide poisoning is reversible. With V-A ECMO emerging as an upcoming modality with increasing availability and acceptable risk-benefit ratio, we suggest that it should be further studied as a promising treatment option to tide over the acute phase and act as a "bridge" to recovery of the cardiac function before the onset of multi organ failure (MOF) in a specific subset of patients.

Abstract:
Severe isopropyl alcohol poisoning is usually manifested by central nervous system (CNS), respiratory depression and circulatory failure. Diagnosis is classically made based on the patient's history, clinical presentation and laboratory findings. Common findings include osmolal gap, ketonemia, and/or ketonuria with or without metabolic acidosis, accompanied by a fruity odour of the breath. Treatment predominantly consists of symptomatic supportive measures if the patient is not comatose and/or severely hypotensive; however haemodialysis increases the elimination of isopropanol and acetone substantially and should be considered in severely poisoned cases. Patients usually recover fully, on condition that they receive early proper supportive care, and were not complicated with coma or severe hypotension.

Abstract:
Objective: To assess the bioequivalence of single dose trazodone hydrochloride USP 100 mg tablets administered as an oral dose under fasting condition.
Methods: This study was an open-label, balanced, randomized, two-sequence, two-treatment, two-period, single oral dose, crossover bioequivalence study in healthy, adult, human subjects under fasting conditions. After an overnight fast of at least 10 hours, a single oral dose (100 mg) of either the test or the reference product was administered to the subjects with 240mL of drinking water at ambient temperature in sitting posture. The primary pharmacokinetic parameters, maximum plasma concentration (Cmax) and area under the plasma concentration–time curve (AUC) from time zero to last measurable concentration (AUC0-t) and extrapolated to infinity (AUC0-) were compared by an analysis of variance using log-transformed data. Bioequivalence was concluded if the 90% confidence intervals (CIs) of the adjusted geometric mean (gMean) ratios for Cmax and AUC were within the predetermined range of 80%-125%, in accordance with regulatory requirements.
Results: For the test formulation, the trazodone gMean Cmax was 2172.2 ng/mL (vs. 2031.2 ng/mL for reference), AUC0-t was 16631.6 ng·h/mL (vs. 16342.9 ng·h/mL) and AUC0- was 17460.6 ng·h/mL (vs. 17270.1 ng·h/mL). The 90% CIs for the ratio (test/reference) were 101.2-113.0% for Cmax, 98.5-105.1% for AUC0-t and 97.7-104.5% for AUC0-8. There were no deaths or serious adverse events during the conduct of the study.
Conclusion: Test product when compared with the Reference product meets the bioequivalence criteria with respect to the rate and extent of absorption of Trazodone under fasting condition.

Abstract:
Preeclampsia (PE) is a complex disorder, occurring during the third trimester of gestation characterized by hypertension with proteinuria, increased uterine artery resistance (UARI), elevated inflammatory cytokines and endothelial dysfunction during pregnancy. 17-hydroxyprogesterone caproate (17-OHPC), a synthetic hormone called progestogen or progestin, is already approved by US Food and Drug Administration (FDA)and used for the prevention of subsequent preterm labor not complicated by PE. There is limited information for the use of 17-OHPC to manage or treat preeclampsia. In fact, this progestin is not used in the management of PE and there are no studies, other than ours in recent years, evaluating the efficacy of 17-OHPC to improve symptoms of preeclampsia. Therefore, this mini review reflects on our preclinical experiments with the use of 17-OHPC for the management of preeclampsia (PE). We have recently published that PE is a state of progesterone deficiency. 17-OHPC administered on gestation day 18 (GD18) to Reduced UterinePerfusion Pressure (RUPP) rats reduced renal and placental endothelin-1 (ET-1), TNF-alpha and IL-6, most recently, increased vascular endothelial nitric oxide synthase (eNOS) expression and nitrate-nitrite levels while improving blood pressure in response to placental ischemia. These data suggest that 17-OHPC improves pregnancy outcomes during placental ischemia and should be considered for addition to the management of PE.

Abstract:
Objective: Cinnamon supplementation can increase insulin sensitivity and activate glucose transporter 4. These features make it an attractive supplement, particularly in populations seeking natural therapies, such as Native Americans with diabetes. The aim of this review is to discuss thepharmacology and evidence regarding cinnamon supplementation in type-2 diabetes (T2DM) and the possible rationale for use Native Americans.
Data Sources and Selection: PubMed and Ovid Medline databases were searched from 1946 through August 28, 2015 using the MESH terms "cinnamon" and "Diabetes Mellitus, Type 2"A total of 51 citations were generated, which were filtered to include only clinical trials and studies involving human subjects (n=11). Two of the 11 citations were excluded from review and three additional citations were identified from references.
Data Synthesis: A total of twelve studies met inclusion for review. Allstudies were randomized and placebo-controlled. Three trials evaluated cinnamon's effect on insulin sensitivity and nine trials investigated the influence of cinnamon supplementation on fasting blood glucose and/orHbA1C values.Of these, eight studies showed a benefit from cinnamon supplementation while four failed to demonstrate any clinical benefit. The cinnamon dose varied from 120-6000 mg per day for duration of 6 hours to 4 months. There was substantial heterogeneity in trials, making broad conclusive statements difficult.
Conclusion: Current evidence for the role of cinnamon in the general T2DMpopulation appears inconclusive. However, cinnamon may bean economical, safe, and potentially effective natural option for Native Americans with diabetes.

Abstract:
Aluminum phosphide is a powerful insecticide and rodenticide. It is commercially used for crop protection either during storage, or transportation. Nevertheless, it is considered as a highly toxic substance. Its detrimental effects may range from nausea and headache to renal failure and death. It is, therefore, important to ensure their cautious handling to avoid poisoning episodes. Its poisoning has a high mortality and recent years have seen a boost in the number of poisoning cases and deaths caused by suicidal ingestion. Diagnosis is typically reached based on the patient's history, clinical presentation and laboratory findings.