A novel rapid - acting oral inhalation human insulin for diabetes mellitus: Afrezza.

Afrezza is rapid-acting oral inhalation insulin that is administered at the beginning of each meal. The U.S Food and Drug Administration has approved Afrezza (insulin human) inhalation powder, a rapid-acting inhaled insulin to improve glycemic control in adults ≥18 years of age with Type 1 or Type 2 diabetes mellitus (T1DM or T2DM). Afrezza must be used in combination with long-acting insulin in patients with T1DM. Afrezza may be used with either oral anti-diabetic drugs or basal insulin in patients with T2DM. Afrezza should be administered via oral inhalation using Afrezza inhaler. Dosage adjustment is needed when switching from injection insulin to oral inhalation Afrezza. It is contraindicated in individuals with chronic lung disease and smokers because of the risk of the acute bronchospasm. Before initiating, Afrezza, a complete medical history, physical examination and spirometry (forced expiratory volume 1 sec) results is required in all individuals to identify the potential lung disease. Common adverse reactions in individuals treated with Afrezza include hypoglycemia, cough, throat pain or irritation, headache, and diarrhea.

Evaluation of novel methods of assessments in pharmacology to develop new attitudes and skills in Caribbean Medical School.

Background: Assessment is said to drive student learning and define the curriculum. The problem-solving type of multiple choice questions (MCQs), which can be used to probe and assess medical students in pharmacology should have a clinical vignette containing presenting complaints, abstract history, physical examination and laboratory data, followed by a single or series of questions based on it. National Board of Medical Examination (NBME), USA has an extensive bank of problem-solving MCQs, and these questions are often regarded as similar in format and focus to MCQs of United States Medical Licensing Examination (USMLE). The objective assessment of teaching and curriculum in this study is done by comparison of students’ performance in pharmacology comprehensive exam of NBME, USA before and after curriculum changes. This study was designed to obtain an objective assessment of teaching and curriculum by comparison of students’ performance in terms of student mean grades, percentage of students passed, percentage of students failed, percentage of students with honors, and individual highest scores of five semesters before and five semesters after curriculum changes in pharmacology comprehensive exam of NBME, USA among the 5th semester students of American University of the Caribbean, School of Medicine, St. Maarten. Methods: We have compared the students’ performance of pharmacology comprehensive exam of NBME using five parameters like student mean grades, percentage of students passed, percentage of students failed, percentage of students with honor, and individual highest score of five semesters May 2009, September 2009, January 2010, May 2010 and September 2010 semester batches before the introduction of curriculum changes with subsequent semesters January 2011, May 2011, September 2011, January 2012 and May 2012 semesters after the introduction of curriculum changes. Results: The pre-curriculum student performances were compared with post-curriculum changes using the Student’s t-test. The students mean scores improved significantly from 50.76 before curriculum changes to 56.54, students passed (%) increased from 94.57% before curriculum changes to 96.93% after curriculum changes and students with honors (%) increased significantly from 64.72% before curriculum change to 75.51% after curriculum changes and also seem to have remained consistently better. The students failed (%) decreased dramatically from 5.43% to 3.07% after curriculum changes. The highest individual mean score also improved significantly from 72.4 to 80.8 after curriculum changes and have remained consistent in the following semesters. Conclusions: There seems to be obvious improvements in student performance as reflected by a significant increase in mean scores, students pass (%), and students with honors (%) probably due to inclusion of problem-solving MCQs in formative and summative assessments in new curriculum compared with declarative MCQs in old curriculum. The student failed (%) decreased dramatically, which could be attributed to the changes in teaching content and format brought by curriculum changes in pharmacology. The teaching of pharmacology principles as pathophysiology of drug therapy also seemed to have prepared students better for NBME comprehensive exam and also USMLE Step 1. The clinical pharmacology exercises in small groups as role playing sessions seem to have really improved students’ comprehension and retention of the basic sciences knowledge for clinical application based on students’ feedback.

Cerebral Venous Thrombosis Due to Abrin Toxicity: A Case Report.

Abrus precatorius (jequirity bean) is a common cause of accidental or intentional poisoning in the tropics. The data on exact incidence of abrus poisoning is largely insufficient in our country, due to lack of reporting. The estimated lethal dose for humans is 0.1-1 μg/kg. The toxic component is the protein abrin that causes widespread endothelial damage. Abrin causes a variety of manifestations like hemorrhagic gastroenteritis with erosions, hemolysis, acute renal damage, dyselectrolytemia, hepatotoxicity with elevated liver enzymes and seizures. Apart from the common manifestation of hemorrhagic gastroenteritis, patients experiencing mental status perturbations have been identified and documented earlier. There have been previous reports of elevated intracranial tension (ICT) in abrus poisoning, however, the exact cause for this phenomenon had not been elucidated. We herein report a case of intentional A. precatorius poisoning in a young girl that caused cerebral venous thrombosis (CVT).