Metoclopramide-induced Acute Dystonia Misdiagnosed as an Epileptic Seizure in a Lupus Patient

Acute dystonic reactions are the most prevalent extrapyramidal adverse effects associated with metoclopramide. It could be mistaken for a variety of other conditions, such as seizures, tetanus, and encephalitis, to name a few possibilities. We present a case of a 26-year-old female misdiagnosed as having an epileptic seizure who was rushed to the emergency unit with an involuntary bilateral upward deviation of the eyes, spasm, stiffness, lateral deviation of the neck, and protrusion of the tongue. Symptoms occurred 36 hours after the commencement of metoclopramide, used to treat nausea and vomiting in the referring hospital. All the laboratory work was normal. The drug was discontinued and 5 mg of intravenous biperiden was administered. The symptoms subsided in about 10 minutes with no recurrence. Metoclopramide-induced acute dystonia not only creates an anxious environment for patients but may also be life-threatening. Due to the high probability of misdiagnosis, detailed drug history and a high index of suspicion are critical in making the correct diagnosis.

CODCA – COVID-19 ONTOLOGY FOR DATA COLLECTION AND ANALYSIS IN E-HEALTH

Coronavirus (Covid-19) pandemic is one of the most deadly diseases that cause the death of millions around the world. Automatic collection and analysis of Covid-19 patient data will help medical practitioners in containing the virus. For this purpose, Semantic Web technologies can be utilized, which allows machine-processable data and enables data sharing, and reuse across machines. In this paper, we propose a Covid-19 ontology (named CODCA) that helps in collecting, analysing, and sharing medical information about people in the e-health domain. In particular, the proposed ontology uses information about medical history, drug history, vaccination history, and symptoms in order to analyse Covid-19 risk factors of people and their treatment plans. In this way, information about Covid-19 patients can be automatically processed and can be re-usable by other applications. We also demonstrate extensive semantic queries (i.e. SPARQL queries) to search the created metadata. Furthermore, we illustrate the usage of semantic rules (i.e. SWRL) so that treatment plans for individual patients can be inferred from the available knowledge.

Equus roundworms (Parascaris univalens) are undergoing rapid divergence due to host and environment factors

Background The evolution of parasites is often directly affected by the host's environment. Studies on the evolution of the same parasites in different hosts are extremely attractive and highly relevant to our understanding of divergence and speciation. Methods Here we performed whole genome sequencing of Parascaris univalens from different Equus hosts (horses, zebras and donkeys). Phylogenetic and selection analysis was performed to study the divergence and adaptability of P. univalens. Results At the genetic level, multiple lines of evidence support that P. univalens were mainly separated into two clades (Horse-derived and Zebra & Donkey-derived). This divergence began at 300-1000 years ago, and we found that most of the key enzymes related to glycolysis were under strong positive selection in zebra & donkey-derived roundworms, but lipid related metabolism system was under positive selection in the horse-derived roundworms, indicating that the adaptive evolution of metabolism may drive the divergence in past few centuries. In addition, we found that some drug-related genes have a significantly higher degree of selection in different populations. Conclusions This work reports evidence that the host’s diet drives the divergence of roundworms for the first time, and also supports that divergence is a continuous and dynamic process, and continuous monitoring of the effects of differences in nutritional and drug history on rapid evolution of roundworms are conducive to further understanding host-parasite interactions.

EP.TH.289Diagnosis of the aetiology of acute pancreatitis at a district Hospital: A retrospective audit

Introduction The correct diagnosis of acute pancreatitis should be made in all patients within 48 hours of admission. According to recently published NICE (NG 147) guidelines for diagnosis of aetiology of acute pancreatitis should be determined in at least 80% of cases and no more than 20% should be classified as idiopathic. We aim to overview our current practice compared to guidelines. Early identification of aetiology is essential. Materials and Methods Patients diagnosed to have pancreatitis presenting to surgical assessment unit from March 1st 2019 to December 31st 2019. Sample size audited 291. The diagnosis of acute pancreatitis is made with a combination of history, physical examination and laboratory evaluation. Further investigations were done for the ethology. These patients were identified from their discharge information. They had raised amylase along with history suggestive of pancreatitis and were analysed retrospectively. Results Of all the pancreatitis patients admitted in SAU, 88 (30%) were due to biliary, 40 (16%) alcohol related, 20 (7%) other causes whereas 134 (46%) were classified as idiopathic. 3 patients self-discharged. Conclusion In our trust it seems that aetiology of acute pancreatitis is not adequately investigated. Most of other blood investigations were not performed in index admission and relevant drug history was not elicited. This failure of non-identification of gallstones could be attributed to operator dependant and they didn’t have second USS as advised. We formulated an action plan with detailed history with adequate step wise investigations which will benefit the patients.

100 Assessing the Admission Proforma: A Multi-Cycle Audit Evaluating the Quality of Documentation of The Burnsadmission Proforma At the Regional Mersey Burn Unit

Introduction A thoroughly completed Burns Proforma can provide vital information for the effective management of a burn and enables the sharing of information with other members of the multidisciplinary team. Aim We aimed to assess the quality of record-keeping of the new Burns Proforma, compared it with the previous cycle, and identified areas of improvement. Method Data on 76 fields on version 4.0 of the Mersey Burns Proforma was collected for 92 patients between January and February 2020. The data was compared to cycle 1of the audit collected in July 2019. Results Assessing the 61 comparable fields between audit cycles, 58 fields (95%) improved while 3 (5%) deteriorated. 21 fields achieved a completion rate greater than 80%. Vital information such as history, comorbidities, and drug history achieved 100% completion, up from 94%, 94%, and 95%, respectively. Total body surface area (TBSA) increased to 93% from 83%, the use of the Lund & Browder chart remained the same, treatment plan documentation increased to 95% from 91%, documentation of admission increased from 24% to 51%, consultant confirmation of TBSA increased to 10% from 5%, but this requires further improvement. Comments stated the proforma was clearer and provided a flowchart layout which made documentation easier. Conclusions The Burns Admission Proforma has made significant improvements. Working with the nursing staff and consultant body, we aim to improve our completion rates of vital information further. It sets a high standard for data collection and presents itself as a useful tool for other Burns Units across the United Kingdom.

A probable case of collapse due to hyoscine patch

This case report highlights the potentially serious side effects of hyoscine and how a seemingly innocuous patch may confound patients and doctors alike. It demonstrates how easy it is to miss an obvious diagnosis when in fact a thorough medical history including an exhaustive drug history can easily point us in the direction of the diagnosis fairly quickly. Finally, hyoscine may cause potentially serious side effects and patients who are taking it, either orally or transdermally, should be made aware of these.

Serum testosterone levels and clinical signs of hypogonadism in men with type 2 diabetes

Background: Diabetes mellitus is a common metabolic disease that its association with low level of testosterone has already been shown in many studies. Considering the role of testosterone hormone in impotency, fatigue, and bone mass deficiency this study aimed to evaluate the total and free testosterone levels and clinical signs of hypogonadism in male patients with type 2 diabetes.Methods: In this descriptive-cross sectional study, sixty-five diabetic male patients aged 35-70 years were randomly selected and enrolled to the study. The necessary information such as patient demographics, BMI, past medical history, drug history, and history of smoking, education level and employment were completed by a checklist. Then, the patients were evaluated for total and free testosterone levels and symptoms related to decreased testosterone, hypogonadism symptoms by ADAM questionnaire. Finally, the data were statistical analyzed by spss version 21.Results: The mean age of patients was 57.12±4.7 years with age range of 38-69 years. According to the ADAM questionnaire, 51 (78.4%) of the patients were positive and 14 (21.6%) were negative. 16 (24.6%) of all patients had hypogonadism. Among ADAM positive patients, 46 (90.1%) had erectile dysfunction and 33 (64.7%) had decreased libido. Most people (75%) with hypogonadism had BMI more than 30.Conclusions: Testosterone levels are commonly found low in diabetic men, most of whom have symptoms of hypogonadism. Body mass index is known as an independent risk factor for hypogonadism in T2D men. There was also a significant correlation between free testosterone levels and hypogonadism.

Assessment of Interactions of Drugs Prescribed for Pediatric Patients in Bangladesh

Drug-drug interactions (DDIs) represent an important clinical problem. During inpatient admissions, infants, children, and adolescents are typically exposed to different medications, increasing their risk of potential drug-drug interactions (pDDIs). While drug interactions are reported to be common, there are only few publications of the prevalence of such interactions among pediatric patients in Bangladesh. The present study tries to estimates the prevalence and characteristics of pDDI exposure of pediatric patients treated in children’s hospitals. This observational retrospective study was carried out on 155 patients admitted to a children’s hospital located at Dhaka during January 2019 to August 2019. The medications of the patients were analyzed for pDDIs by using Medscape drug interaction checker. The prescriptions were analyzed for demographic characteristics, medical and detailed drug history. Drug-drug interactions (DDIs) were evaluated for total numbers, types and severity of DDIs. Total 155 prescriptions with mean age 2.12±2.08 years were analyzed and a total of 25 pDDIs were recorded. The prevalence of pDDI was 17%, of which 12 (48%) were pharmacodynamic interactions, 10 (40%) were pharmacokinetic interactions and 3 (12%) of unknown mechanism. According to the severity of interaction, 4 (18%) cases were categorized as serious, 15 (55%) cases as moderate and 6 (27%) cases as minor. The occurrence of DDIs were significantly associated (r=0.912, p<0.05) with the number of drugs prescribed. The present study has identified pDDIs and also documented interactions in pediatrics patients. It has highlighted the need for screening prescriptions of pediatric patients for pDDIs and proactive monitoring of patients who have identified risk factors in order to promote detection and prevention of possible adverse drug interactions. Bangladesh Pharmaceutical Journal 24(2): 91-98, 2021

Evaluation of Patients with Syncope in the Emergency Department: How to Adjust Pharmacological Therapy

The rate of syncope in the Emergency Department ranges between 0.9 and 1.7%. Syncope is mostly related to a underlying reflex or orthostatic mechanism. A bradycardic or a hypotensive phenotype, may be identified. The latter is the most common and could be constitutional or drug induced. Consequently, obtaining an accurate drug history is an important step of the initial assessment of syncope. As anti-hypertensive medication might be responsible for orthostatic hypotension, managing hypertension in patients with syncope requires finding an ideal balance between hypotensive and cardiovascular risks. The choice of anti-hypertensive molecule as well as the therapeutic regimen and dosage, influences the risk of syncope. Not only could anti-hypertensive drugs have a hypotensive effect but opioids and psychoactive medications may also be involved in the mechanism of syncope. Proper drug management could reduce syncope recurrences and their consequences.

A Cross-sectional Study of Acneiform Eruptions at a Tertiary Center

Background: Acneiform eruptions represent 1% of all drug-induced skin reactions following exposure to drugs such as hormones, vitamins, halogens, anti-tubercular drugs, neuropsychotherapeutic drugs, immunomodulating agents, and other miscellaneous drugs. Aim: The aim of the study was to identify the topical, inhalational, intralesional, and systemic drugs causing acneiform eruptions. Materials and Methods A total of 46 patients presenting with acneiform eruptions were studied with detailed drug history. Conclusions: Acneiform eruption is a relatively common and often misdiagnosed entity. Systemic steroids are the most common cause of acneiform eruption.