Baclofen is a centrally acting antispasmodic agent that is commonly prescribed to patients suffering from spinal cord problems. Nearly 85% of baclofen is excreted by the kidneys whereas the remaining 15% is metabolized by the liver. In patients with renal insufficiency, baclofen accumulates and causes central nervous system toxicity. Herein we report a case of baclofen induced neurotoxicity in a patient with end stage renal disease on maintenance haemodialysis. The patient had cervical spondylomyopathy and was started on baclofen 10 mg once daily which was subsequently increased to three times a day. Within 48 hours of the increased dose of baclofen, he developed drowsiness, confusion and became aggressive. Other causes of encephalopathy were excluded and baclofen was stopped. His confusion improved completely after three consecutive sessions of haemodialysis. Physicians should be aware of baclofen induced neurotoxicity in patients with renal insufficiency.
Background: Many strategies have been employed to improve compliances to antihypertensive medications but these efforts are not translated into good compliances with several patients leading to high cases of morbidity and mortality. The study probes into the medication compliance of patients in order to guide patient-focussed care.
Aims and Objectives: The objectives of the study are to identify compliance cases, their causes and factors influencing the pattern. The study also assesses the extent to which compliance problems are discussed with health professionals.
Methods: A total of 225 patients comprising 95 males and 130 females on clinic visit were studied. A cross-sectional descriptive design through questionnaires was used. Data were collected over a period of 48 clinic days.
Results: Primary non-compliance such as not filling prescription occurred in 8.0% proportion while non-conforming category of non-compliance such as taking incorrect doses (26.2%), taking medication at the wrong times (53.8%), altering the dosing frequency (19.1%) and failing to follow instructions (7.6%) were similarly identified. However, the major worrisome cases of concern are those showing non-persistence compliance such as stopping medication too soon (19.1%), taking drug holidays without medical advice (3.1%), partial filling of prescription (7.1%) resuming medication only when close to the clinic visits (3.1%). A total of 25 reasons were identified as the causes of non-compliance with forgetfulness accounting for highest (25.8%) followed by unavailability of drugs (16.4%). Perceived wellness and medication side effects were reported in 8.0% and 2.2% cases respectively. About 2.7% and 1.8% cases of unaffordability and perceived ineffectiveness of drugs were reported respectively. Preference for herbal agents (4.4%), drug holidays (3.1%) and incomplete prescription filling (7.1%) among others were similarly identified. Out of the 33 identified reasons for non-compliance, only in about 10 (less than one-third) cases recorded high number of patients above average reporting the problem to experts.
Conclusion: The category of non-compliance involves primary, non-conforming and non-persistent compliances. The reasons for non-compliance vary widely and diverse factors including those of healthcare system related, patients’ behaviour, environmental and socio-economic factors were identified. The patients who reported their compliance problems to health care were below average in all groups of cases.
Objectives: To evaluate the in vitro mutual interaction of ketorolac tromethamine with bovine serum albumin (BSA) using fluorescence spectroscopy under different conditions.
Materials and Methods: Different concentrations of ketorolac were mixed with 20 µM bovine serum albumin solution at pH 7.4 and stirred for 2 min at 298 K & 308 K temperatures. Finally different ketorolac-BSA complex at the excitation wavelength 280 nm & 293 nm was measured by the fluorescence spectrophotometer.
Results: In the experimental work, it was found that ketorolac is responsible for fluorescence quenching of BSA molecule where tryptophan and tyrosine both amino acid participated in the molecular interactions between BSA and ketorolac at excited state. Stern-Volmer equation is used to calculate fluorescence quenching constant. The thermodynamic parameters such as Gibb’s free energy (∆G), enthalpy change (∆H), and entropy change (∆S) at different temperatures were studied by using Van’t Hoff equation. The values of ΔG, ΔH and ΔS at 298K were -33.25 KJ/mol, 17.093 KJ/mol and 168.94 J/mol for ketorolac. The binding process for ketorolac had been found to be spontaneous, exothermic and entropy driven as indicated by thermodynamic analysis and hydrophobic forces playing a major role in the ketorolac-BSA association.
Conclusions: The interaction of ketorolac with BSA was successfully explored using a fluorescence spectroscopic technique.
Epilepsy is a chronic neurological disorder manifested as unpredictable, unprovoked recurrent seizures that affect a variety of mental and physical functions. Despite the use of current anti-epileptic drugs (AEDs) about 30% of patients remain refractory, while 30-40% have associated psychiatric disturbances. A gap in successful AED search has been the lack of understanding of the processes leading to the cascade of epilepsy. Thus we tried to focus on the role of inflammation and oxidative stress in epilepsy. Epileptic seizures result in extensive release of proinflammatory factors i.e cytokines, chemokines from glial cells, thereby increasing the influx of neuronal calcium, enhancing extra neuronal glutamate concentration and decreasing potassium, resulting in decrease in seizure threshold and neurodegeneration. Prolonged seizures produce sufficient cellular reactive oxygen species (ROS) and reactive nitrogen species (RNS) which initiate a cascade of events induced by increased firing from neurons, excessive release of glutamate, activation of N-methyl-D-aspartate (NMDA) receptor, influx of cytosolic and mitochondrial calcium, increased ATP consumption and mitochondrial damage, resulting in neuronal hyperexcitation and neurodegeneration.
Rational prescribing is vital to achieving rational drug use but limited studies exist on the prescription practices, causes, and types of prescription error in developing countries. Prescription error is one of the leading causes of morbidity and mortality globally. However, due to paucity of data, the figures could be alarming in developing countries. This narrative review described retrospectively the causes and types of prescription error in developing countries using Nigeria as a case study. A review of relevant literatures was carried out using PubMed, Medline, and Embase. It covered a period from January 1990 to December 2015. Hand searches of the references of retrieved literature; official search of libraries texts on literature reviews and discussions with experts in the field of reviews of the literature was conducted coupled with personal experience gathered from participating in and writing several reviews of literature.
Ethically approved studies written in English Language were used for the study. The study lasted from October 2015 to April 2016. Study revealed incomplete prescription information, poor knowledge of therapeutics and prescription writing poor working condition. Understanding the trends is the first step towards effective prevention and control of the scourge.