First Report of “Munchausen Syndrome by Proxy Variant” in an Injection Drug User with 12 New Organisms in Blood Cultures 17 Days after Admission to the Hospital

The term Munchausen syndrome is used to describe a situation where a person inflicts an illness or injury on self. Munchausen syndrome by proxy is when a person fabricates an illness on behalf of another. We report the case of an injection drug user admitted to the hospital for a spinal epidural abscess which was drained, treated with antibiotics and doing well, suddenly becoming very sick and febrile on day 17. The blood cultures grew a total of 12 organisms including 2 fungi. Someone who visited the patient in the hospital around this time was suspected to have injected a solution of drugs brought from home directly into the patient’s intravenous line used to administer antibiotics resulting in a polymicrobial bacteremia/fungemia. Presence of Lactobacilli in one blood culture raised the suspicion that the girl friend who was also a drug user, may have been responsible as Lactobacilli are more frequently found in hands of females. We caution physicians and nurses to be vigilant when handling injection drug users and other drug abusers admitted to hospital. Materials brought to the patient’s room from outside must be screened. New onset of unexpected symptoms should alert caregivers of the possibility of such abuse.

Ribonucleases and Immunoribonucleases as Potential Modalities of Anticancer Therapy

A novel approach of antitumor treatment, that involves targeting RNA either using specific antisense oligonucleotides or cytostatic/cytotoxic ribonucleases (RNases), is being promoted. Among recently described cytotoxic RNases, amphibian RNases, including ranpirnase (onconase; ONC) and Amphinase (rAmph), are promising anticancer agents. They manifest strong antitumor effects and act synergistically with several cytostatics. Recently, rapidly developed proteins by engineering of RNases, displayed cytotoxic activity against several types of malignant cells. Most recent data show the role of microRNAs in mediating tumor progression, opening a new field of possible molecular targets for RNases. This review summarizes the current status of those RNases and immunoRNases as promising novel anticancer therapeutics.

Oral Methadone for Cancer Pain Management at the End of Life: A Forgotten Drug

Background: Opioids are used for pain management in cancer patients. Morphine is considered the best option. For some patients with pain of difficult control management and adverse effects, an opioid rotation should be considered. Oral methadone is an opioid to which patients can be rotated safely and effectively and inexpensive for Mexico and Latin America. Our study describes the 9-year experience of opioid rotation to methadone, the population profile, efficacy of methadone in cancer patients of the palliative care service. Methods: Retrospective study of cancer patients rotated to oral methadone for pain control. Tables of frequencies, median and interquartile ranges were made, as well as overall survival. Results: 311 patients were rotated to methadone, predominantly males (58.5%), median age of 54 years with oncological diagnoses in cervix (10.3%), germinal tumors (8.4%), breast (8.0%), prostate (7.4%) and rectal (5.5%). These patients experienced visceral (17.6%) or other types of pain (68.6%), and a combination of different types of pain, the most prevalent pain was neuropathic (88.7%) and 50% received morphine, 21% buprenorphine or fentanyl 19% previously, with a median dose of 60 mg (30-120). The main reason for rotation was difficult pain control (54%), obtaining an efficacy of 70.0%. Conclusion: In this cohort at advanced disease stage, 54% suffered from difficult pain control, thus rotation became necessary, reducing pain and manageable adverse events, without major changes of the initial and final dose. Should be promoted more widely in the management of pain of difficult control by cancer in first position prescription.

New Validated Analytical Method for Determination of Simvastatin in Tablet Formulations by RP–HPLC

RP–HPLC method has been developed and validated for the determination of simvastatin (SVS) in pure form and in tablets. Fluvastatin sodium was used as internal standard. The determination was performed on Nucleodur column C8 (250×4.6 mm i.d., 5 µm particle size); the mobile phase consisted of a mixture of phosphate buffer solution (KH2PO4 0.05 M, pH 4.83) and methanol (20:80, v/v), pumped at a flow rate 1.0 mL min−1 . Analyte was monitored by UV detection at 230 nm. The mean retention times for fluvastatin and simvastatin were about 4.40 and 9.00 min, respectively. The method was proved linear in the range of 3.5– 550.0 µg mL-1 and exhibited good correlation coefficient (r>0.9998) and excellent mean recovery (100.71– 102.18%). Very good limit of detection of 0.63 µg mL-1 was found for SVS. The method was validated statistically and by recovery studies for linearity, precision, repeatability, and reproducibility. This method was successfully applied to the determination of simvastatin content in four marketed brands from Syria. A good agreement between this method with the pharmacopoeial method for the determination of simvastatin in some real samples demonstrates that the proposed method is suitable to quantify simvastatin in pharmaceutical formulations.

Drug Abuse Amidst COVID-19 Pandemic: A Dark Side of Online Pharmacy

Online pharmacy has been in the focus of heightened interest during this lockdown period due to COVID outbreak in Nepal and worldwide. This paper explains the issues relevant to online pharmacies that sell drugs with or without prescriptions to patients at the retail level online (through software apps or website). The online pharmacy industry has shifted its target abruptly during this pandemic period in developing as well as developed countries. The various aspects of online pharmacy practice are listed within this article. Issues like access, prescription, availability, misuse, and lack of awareness among the patients are described. The challenges and opportunities are discussed as well as the necessity of rules and regulation for online pharmacies on country level are elaborated. A proper advice to the patients and proper monitoring of online pharmacy should be offered for proper and safer way of purchasing drugs. The zero tolerance to the misuse or abuse of prescription and non-prescription drugs should be practiced.

Antibacterial Drugs Utilization among Patients Admitted to Medical Wards of Magway Regional Hospital

Background: Drug utilization studies are important elucidation tools for prescribing habits in particular therapeutic field and they play a key role in helping the healthcare personnel to understand, interpret and improve the prescribing, administration and use of medications. Objectives: This study was undertaken to identify amount of antibacterial drugs used and utilization patterns of antibacterial drugs in medical wards of Magway Regional Hospital. Methods: This study is a hospital-based, cross-sectional, descriptive study and was carried out for a period of four months. Data regarding antibacterial prescription during hospital stay were collected from medical record files of patients. The data were evaluated by Microsoft Excel software. Results: In this study, the most common indications for antibacterials were respiratory tract infections (43.34%) followed by gastrointestinal tract infections (16.27%). Out of 879 patients, 52.10% were prescribed by single antibacterial agent and in 47.90%, combination of antibacterials was necessary to be given. Antibacterials were prescribed by oral route in 29.58% and parenteral route were prescribed in 29.35% while 41.07% patients received antibacterials by both oral and parenteral routes. Antibacterials were prescribed with generic name in 64% and trade name in 36%. Cephalosporins were the most commonly prescribed drugs, 68.26%, followed by penicillin groups and quinolones, 53.58% and 16.27% respectively. In this study, 13 drugs included in DU90% segment were amoxicillin and β-lactamase inhibitor combination (22.26%), ceftriaxone (16.05%), cefuroxime (8.26%), levofloxacin (7.67%), amoxicillin and flucloxacillin combination (7.27%), metronidazole (6.89%),clarithromycin (4.74%), cefixime (4.68%), co-trimoxazole (4.24%), ceftazidime (2.6%), azithromycin (2.46%), cefoperazone and β-lactamase inhibitor combination (1.65%) and clindamycin (1.64%). Conclusions: The findings from this study will provide the documentary evidence regarding antibacterial utilization patterns in treatment of a variety of infections and antibacterial drugs include in DU90% segment. This information generally contributes data for making decision of purchasing medicines or preparing drug budgets.