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A metabolic encephalopathy brought on by dangerously low blood glucose levels is called hypoglycemic encephalopathy. Transient hypoglycemic episodes are frequent, particularly in diabetic patients. This complication is seen in diabetes patients who are taking insulin/insulin secretagogues. Severe persistent hypoglycemia can result in seizures, a protracted state of coma, and a wide range of other global and focal neurologic impairments. The main pathological alterations in hypoglycemic encephalopathy include widespread denaturation and necrosis of the neurons as a result of a lack of energy, which is accompanied by a significant number of glial cells entering the brain. In our case, the patient had recurrent hypoglycemic episodes, which led to the development of hypoglycemic encephalopathy caused by insulin. It is important for clinicians to be aware of this potential complication and to closely monitor patients with diabetes who are being treated with insulin. [ABSTRACT FROM AUTHOR]

Background: SARS-Cov-2(covid-19) infection is associated with Systemic Hyercoagulability and Thrombo-Embolic Complications. Anticoagulants play a key role in their management. Despite anticoagulants we have observed five case of RBBB MI in our ICU which co-relates with the thrombotic complication. And hence, Efficacy of the anticoagulants is debatable and requires meticulous APTT monitoring. Efficacy of thrombolysis is also not clear. A current guideline gives more emphasis on PCI over thrombolysis in RBBB MI patients. BUT unfortunate turn of events into catastrophe happened in these cases due to non-feasibility of cathlab interventions in covid-19 pandemic scenario. Material and Methods: This is A case series of five patients that were COVID-19 positive admitted to the ICU and Developed RBBB MI during their ICU stay despite on anticoagulant therapy. Data was collected retrospectively from hospital indoor records. Positive case of COVID-19 was confirmed by RT-PCR assay of nasopharyngeal or oropharyngeal swab specimen. Conclusion: Development of RBBB MI in covid-19 patients on anticoagulants co-relates with the thrombotic complication of SARS-CoV-2 infection and failure of the therapeutic management. PCI can be considered as a gold standard intervention compared to thrombolysis. BUT unfortunate turn of events into catastrophe happened in these cases due to non-feasibility of cathlab interventions in covid-19 pandemic scenario. [ABSTRACT FROM AUTHOR]

Background: Emergency department (ED) being the most crucial part of hospital, where adverse drug reactions (ADRs) often go undetected. Trigger tools are proficient ADR detection methods, which have only been applied for retrospective surveillance. We did a prospective analysis to further refine the trigger tool application in healthcare settings. Objective: To estimate the prevalence of ADRs and prospectively evaluate the importance of using trigger tools for their detection. Materials and methods: A prospective study was conducted in the ED for the presence of triggers in patient records to monitor and report ADRs by applying the Institute for Healthcare Improvement (IHI) trigger tool methodology. Results: Four hundred sixty-three medical records were analyzed randomly using 51 trigger tools, where triggers were found in 181 (39.09%) and ADRs in 62 (13.39%) patients. The prevalence of ADR was 13.39%. According to the World Health Organization (WHO)-Uppsala Monitoring Centre (UMC) causality scale, 47 (75.8%) were classified as probable and 15 (24.2%) as possible, wherein 39 (62.9%) were predictable and 8 (12.9%) were definitely preventable. Most common triggers were abrupt medication stoppage (34.98%), antiemetic use (25.91%), and time in ED >6 hours (17.49%). The positive predictive values (PPVs) of triggers such as international normalized ratio (INR) > 4 (p = 0.0384), vitamin K administration (p = 0.002), steroid use (p = 0.0001), abrupt medication stoppage (p = 0.0077), transfusion of blood or blood products (p = 0.004), and rash (p = 0.0042) showed statistically significant results, which make the event detection process more structured when these triggers are positive. Presence of five or more triggers has statistically significant chances of developing an ADR (p < 0.05). Conclusion: Trigger tool could be a viable method to identify ADRs when compared to the traditional ADR identification methods, but there is insufficient data on IHI tool and its use to identify ADRs in the general outpatient setting. Healthcare providers may benefit from better trigger tools to help them detect ADRs. [ABSTRACT FROM AUTHOR]

Drug induced Parkinsonism is common with neuroleptics drugs, antiemetic drugs but it is uncommon with antiepileptic drug such as Valproate (VAL). Neurological adverse effects of VAL are ataxia, tremor, sedation, lethargy, confusion, and more rarely encephalopathy and coma, have rarely been reported. Very rare cases of VAL induced Parkinsonism features associated with cerebral atrophy have been reported. The mechanism of these is currently unknown, but several hypotheses have been proposed. Possible mechanism can be, in vitro VAL can stimulate the activity of the GABA and Glutamate which can lead to Parkinsonism feature. Hence we reported a case of Parkinsonism developed after 6months of VAL treatment and also recovered after withdrawal of VAL. [ABSTRACT FROM AUTHOR]