Linezolid induced psychosis and hallucination: Case report and literature review.

Introduction: Various classes of antibiotics have been linked to causing a wide range of neuropsychiatric symptoms. These manifestations range from psychosis and delirium to encephalitis and intracranial hypertension. The prevalence of psychosis adverse drug reactions (ADRs) for individual antibiotics ranges from 0.3 to 3.8%. We report a rare case of linezolid-induced psychosis and hallucination. Case presentation: We report a 52-year-old Asian gentleman who presented with an altered level of consciousness and hallucinations. He was treated for third-degree burns of 31% of the body for two months. Based on clinical and laboratory investigations, linezolid-induced psychosis and hallucination were diagnosed. His Naranjo probability score was +8. The drug was stopped, and the patient recovered successfully. Conclusion: On rare occasions, toxic blood levels of linezolid can lead to neuropsychiatric manifestations. Both linezolid-induced psychosis and hallucinations are manageable by suspension of the drug. Therefore, physicians should monitor the blood levels of this antibiotic to keep their patients safe from such serious adverse effects.

Temporal Changes in Extended Spectrum ß-Lactamase Producing Organisms in Acute Care Surgery.

BACKGROUND: Extended-spectrum ß-lactamase (ESBL) producing organisms are resistant to a wide range of broad-spectrum antibiotics, and their emergence is a significant driving force of antibiotic resistance. Most South-Asian countries have become hotspots for antibiotic resistance, so specifics of ESBL data are critical to tackling antibiotic resistance. We present the temporal changes in ESBL-producing organisms cultured in our tertiary care referral centre. METHODS: Over a year, a historical cohort analysis was carried out at our tertiary care referral centre in Southeast Asia. Samples from patients presenting with acute surgical conditions were sent for culture and sensitivity. The phenotype of all specimens was checked using the combination disc method. Antimicrobial susceptibilities to various antibiotics were also checked as per CLSI (Clinical and Laboratory Standard Institute) guidelines. RESULTS: Specimens from 170 patients were analysed. The mean age was 44.73±19.89 years, and there was a female predominance of 62%. The most common organisms were Escherichia coli (70%), Klebsiella pneumoniae (18%), and Pseudomonas aeruginosa (16%). The percentage of ESBL-producing organisms was 54.7%, which is significantly higher than in previous reports. Widespread resistance was found against commonly used antibiotics, including co-amoxiclav (81.9%), ceftriaxone (75%), ciprofloxacin (47%), and levofloxacin (35.7%). Sensitivities to combination antibiotics like piperacillin-tazobactam (79.2% sensitive), cefoperazone-sulbactam (84.3% sensitive), and imipenem-cilastatin (91.1% sensitive) were also noted to be falling. CONCLUSION: The incidence of ESBL-producing organisms continues to increase at an alarming rate, which mandates strict antibiotic stewardship and amendments to local guidelines.

Safety and Efficacy of Procedural Sedation and Analgesia in Pediatric Oncology Patients.

Objective Procedural sedation and analgesia are the standard of care for painful procedures in children that require immobility. The aim is to assess the safety and efficacy of procedural sedation and analgesia in pediatric oncological patients in a large tertiary care hospital. Method An observational study performed to review medical records of children who received procedural sedation and analgesia (PSA) for pediatric oncological procedures from July 2018 to September 2018. Patients undergoing oncology procedures (lumbar puncture, intrathecal chemotherapy, bone marrow aspiration +/- trephine) were included, and non-anesthesiologist (intensive care physician/emergency physician certified in pediatric advanced life support) provided PSA. Patients were assessed according to PSA protocol guidelines by the American Society of Anesthesiology (ASA). Low-dose ketamine (0.5 mg/kg) and propofol (2 mg/kg) were administered. Results A total of 565 children underwent 1216 procedures in whom the median age was 7.4 years, and the majority (65.1%) were males. The most common procedure was the lumbar puncture (n = 956; 78.6%) followed by bone marrow aspirate only (n = 137, 11.3%) and both (n = 123, 10.1%). Eight (0.7%) patients developed transient oxygen desaturation only as an adverse effect of ketamine-propofol drug combination with 50% procedures utilizing propofol 1 mg/kg for sedation. Conclusion According to the results of our study, the majority of the pediatric patients responded and reported no adverse events during the procedure with ketamine and propofol. Therefore, we conclude that ketamine and propofol are safe and effective as both sedative and an analgesic in procedures on pediatric oncology patients.

Maternal BMI mediates the impact of crop-related agricultural work during pregnancy on infant length in rural Pakistan: a mediation analysis of cross-sectional data.

BACKGROUND: Stunted growth in early infancy is a public health problem in low-and-middle income countries. Evidence suggests heavy agricultural work during pregnancy is inversely associated with maternal body mass index (BMI) and infant birth weight in low- and middle-income countries; but pathways linking agricultural work to length-for-age Z-scores (LAZ) in early infancy have not been examined. This study aimed to investigate the relationship between agricultural work during pregnancy, post-natal maternal BMI and LAZ among young infants in rural Pakistan; and explored whether maternal BMI mediated the relationship between agricultural work and infant LAZ. METHODS: A cross-sectional survey was conducted from December 2015 to January 2016 in rural Sindh, Pakistan. Mother-infant dyads were recruited via systematic random cluster sampling at 2-12 weeks' post-partum (n = 1161). Anthropometric measurements (maternal and infant height/length and weight) and questionnaire data were collected. Multivariable linear regression and structural-equation based mediation analyses were used to examine associations of agricultural work during pregnancy with maternal BMI and infant LAZ. RESULTS: During pregnancy, women reported engaging in livestock-related work (57.0%), crop-related work (42.7%), and cotton harvesting (28.4%). All three forms of agricultural work were negatively associated with maternal BMI (ß = - 0.67 [- 1.06; - 0.28], ß = - 0.97 [- 1.51; - 0.48]; and ß = - 0.87 [- 1.33; - 0.45], respectively). Maternal engagement in cotton harvesting alone was negatively associated with infant LAZ after controlling for confounding factors. The total negative effect of cotton harvesting on infant LAZ was - 0.35 [- 0.53; - 0.16]. The indirect effect of maternal BMI on infant LAZ was - 0.06 [- 0.08; - 0.03], revealing that 16% (- 0.06/- 0.35) of the relationship between cotton harvesting and infant LAZ, after adjustment, was mediated via maternal BMI. CONCLUSION: These results underscore a need to reduce labour-intensive agricultural workload demands during pregnancy, especially in cotton harvesting, to reduce risks of negative maternal energy balance and poor growth outcomes in early infancy.

Factors associated with catch-up growth in early infancy in rural Pakistan: A longitudinal analysis of the women's work and nutrition study.

The adverse health impacts of early infant stunting can be partially ameliorated by early catch-up growth. Few studies have examined predictors of and barriers to catch-up growth to identify intervention points for improving linear growth during infancy. This study aimed to estimate the prevalence of, and factors associated with, catch-up growth among infants in Pakistan. A longitudinal study of mother-infant dyads (n = 1,161) was conducted in rural Sindh province, with enrolment between December 2015 and February 2016 (infants aged 0.5-3 months), and follow-up (n = 1035) between November 2016 and January 2017 (infants aged 9-15 months). The outcome was catch-up growth (change in conditional length-for-age z-scores >0.67 between baseline and endline). Associated factors were examined using multivariable logistic regression analyses. The prevalence of stunting was 45.3% at baseline and 60.7% at follow-up. 22.8% of infants exhibited catch-up growth over this period. Factors positively associated with catch-up growth included maternal height (odds ratio (OR) = 1.08 [1.05-1.11]), household wealth (OR = 3.61 [1.90-6.84]), maternal (OR = 2.43 [1.30-4.56]) or paternal (OR = 1.46 [1.05-2.03]) education, and households with two or more adult females (OR = 1.91 [1.26-2.88]). Factors negatively associated with catch-up growth were two (OR = 0.64 [0.45-0.89]) or three or more (OR = 0.44 [0.29-0.66]) preschool children in the household and the infant being currently breastfed (OR = 0.59 [0.41-0.88]). Catch-up growth was exhibited among approximately a quarter of infants despite living in challenging environments associated with extremely high rates of early infant stunting. Several modifiable factors were identified that might represent suitable programme intervention points to off-set early infant stunting in rural Pakistan.

Synergistic interactions of polyphenols and their effect on antiradical potential.

The aim of the current study was to evaluate interactions among polyphenols from different plants and their effect on antioxidant potential. Different mixtures of plant extracts of Crataegus oxyacantha (C), Elettaria cardamomum (Cr), Terminalia arjuna (T) and Rauvolfia serpentina (R) were prepared and evaluated for total phenolics, flavonoid contents, and antioxidant activity. A correlation was also established between total phenolics, flavonoids and antioxidant activity. Comparative evaluation revealed that phenolics, flavonoids and antioxidant activity were found high in plant extracts mixtures than individual plants. Highest phenolics (580±1.12mg GAE/g), flavonoids (67.10±0.11mg CE/g) and antioxidant activity (IC50 0.109mg/ml) was observed with ratio 1:1:1:2 of plant mixture C, Cr, T, R. A weak linear positive correlation was found between antioxidant activity, total phenolic and flavonoid contents. A negative correlation was observed among IC50 value, total phenolics and flavonoid contents. Investigation through RP-HPLC revealed the presence of different potent phenolics in plants understudy. More antioxidant potential of extracts in combinations as compared to that of individual plants was clear corroboration of synergism. The ratio (1:1:1:2) of the studied plants in combination, that showed the highest free radical potential, was another expected better pharmacological prospect. This formulation can bring maximum relief against free radical-associated diseases.

Haemoperitoneum due to ruptured ovarian cyst in a 13-year-old girl with factor V deficiency- A case report.

Factor V deficiency is a rare autosomal recessive coagulation disorder. We are reporting a case of a 13 year old girl with factor V deficiency presenting as life threatening haemoperitoneum, following bleeding from ruptured ovarian cyst. Prolonged Prothrombin Time, Activated Partial Thromboplastin Time and a normal platelet count pointed towards a disorder of coagulation. Mixing study with factor V deficient plasma and coagulation factor assay revealed markedly reduced plasma factor V clotting activity.