ABSTRACT
The human body requires equilibrium to assume the vertical posture and balance for walking which is maintained by righting reflexes and supporting reactions, respectively. Postural movements around the ankle is responsible for maintaining forward and backward leaning in an upright posture. We report a case of postural sway and bobblehead movement following bilateral tendo-Achilles rupture.
Subject(s)
Achilles Tendon , Humans , Movement , PostureABSTRACT
OBJECTIVES: Carbamazepine (CBZ) is a commonly used anti-epileptic in rural hospitals in India. These hospitals lack the facilities to measure CBZ concentration; however, in larger hospitals this is performed using high performance liquid chromatography (HPLC). Dried blood spot (DBS) represents a feasible matrix for safe transportation by post/courier. This study was to determine whether the concentration of CBZ in serum can be predicted from that measured in DBS using an inexpensive HPLC method and inexpensive standard filter paper. METHODS: CBZ in serum and DBS from 80 epileptic patients were measured using a validated HPLC assay. The data was then randomly divided into two groups; simple Deming regression was performed with the first group and validation was performed using the second. RESULTS: There was a good correlation between the serum and DBS concentrations (r = 0.932) in the first group. The regression equation obtained was: predicted serum concentration = DBS concentration x 0.83 + 1.09. In the validation group, the correlation between the predicted and actual serum concentrations was also good (r = 0.958), and the mean difference between them was only 0.28 µg/ml (p = 0.8062). The imprecision and bias in both the groups were acceptable. CONCLUSION: Using inexpensive materials, serum CBZ concentrations can be accurately predicted from DBS specimens. This method can be recommended for the therapeutic drug monitoring of CBZ in resource-limited settings.
Subject(s)
Anticonvulsants/blood , Carbamazepine/blood , Drug Monitoring/methods , Adolescent , Adult , Anticonvulsants/therapeutic use , Carbamazepine/therapeutic use , Child , Chromatography, High Pressure Liquid , Cross-Sectional Studies , Epilepsy/drug therapy , Female , Humans , Male , Middle Aged , Young AdultSubject(s)
Brain Death/diagnosis , Coma/diagnosis , Insecticides/poisoning , Phorate/poisoning , Adult , Atropine/therapeutic use , Cholinesterase Inhibitors/poisoning , Coma/chemically induced , Diagnosis, Differential , Female , Gastric Lavage , Humans , Muscarinic Antagonists/therapeutic use , Poisoning/drug therapy , Poisoning/therapyABSTRACT
The objective of the study was to describe the clinical characteristics and course of delayed-onset organophosphate (OP) poisoning. In our clinical experience, we have noticed patients with onset of deep coma 4-7 days after hospital admission, clinical features that have not been previously described. We set up a prospective observational study over 1 year to formally characterize this observation. Thirty-five patients admitted to the intensive care unit (ICU) with severe OP poisoning and treated with atropine and supportive therapy were followed up. Oximes were not administered. Three patients developed delayed-onset coma after presenting with normal or near normal Glasgow coma score (GCS). They developed altered conscious state rapidly progressing to deep coma, 5.0+/-1.0 (mean+/-S.D.) days after OP ingestion. The GCS persisted at 2T for 4.3+/-2.1 days despite the cessation of sedative drugs at the onset of coma. During this period, the patients had miosed non-reacting pupils and no clinically detectable cortical or brainstem activity. Computed tomography of the brain and cerebrospinal fluid analysis were normal. Electroencephalogram showed bihemispheric slow wave disturbances. Two patients required atropine during this period to maintain heart rate and reduce secretions. In all three patients, no metabolic, infective or non-infective cause of altered conscious state was identified. With supportive therapy the GCS improved to 10T in 8.0+/-2.0 days. All patients survived to hospital discharge. Three other patients who developed a reduction in GCS (3T-7T) by 4.7+/-1.2 days but not progressing to coma and recovering (GCS 10T) in 3.3+/-0.6 days may have manifested delayed-onset encephalopathy. Delayed-onset coma appears to have a distinct clinical profile and course with complete resolution of symptoms with supportive therapy. Although persistent cholinesterase inhibition is likely to have contributed to the manifestations, the mechanism of coma and encephalopathy need to be explored in further trials. The good outcomes in these patients suggest that therapy should not be limited in OP-poisoned patients developing profound coma or encephalopathy during hospitalization.
