Quality Of Medicines Research Articles

Standardization of Myristicin in Nutmeg (Myristica fragrans Houtt.) Fruit using TLC-Densitometric Method

Background: Myristica fragrans Houtt. (Myristicaceae family), with the main content of myristicin, has been immensely used in herbal medicine. Standardization is essential to ensure the safety of natural extracts and the quality of herbal medicines using various chemical analysis techniques. Method validation is necessary to ascertain the reliability and reproducibility of the method. Myristicin is a member of the phenylpropene group, a natural organic compound found in small amounts in nutmeg fruit, which has pharmacological effects. Objective: This study aims to determine the myristicin content in nutmeg fruit using TLC-Densitometry. Methods: Determination of myristicin in nutmeg fruit extract was performed using TLC-Densitometry with silica GF254 as stationary phase, mobile phase n-hexane: ethyl acetate (8:2 v/v), and spot visualized at 285 nm. In this study, the content of myristicin in nutmeg fruit was determined using compendial methods (AOAC), thus requiring method verification with parameters including selectivity, linearity, precision, LOD, and LOQ. Results: The validation of this method showed good linearity and selectivity with y = 0.0001x + 0.0226 (r = 0.9996) and 1.53 (>1.5), respectively. The LOD and LOQ results were low with values of 0.11 μg/spot and 0.33 μg/spot, respectively. The percentage coefficient of variation for precision was below the requirement value of not more than 4%. The average myristicin content in nutmeg fruit extract was approximately 0.0017 ± 0.0003% (w/w). Conclusion: The developed method was valid and sensitive for the quantification of myristicin content in nutmeg fruit.

Analysis of The Use of Implicit Nursing Knowledge in The Teaching of Cardiovascular Internal Medicine Nursing

Objective: To explore the utilization of implicit nursing knowledge in the teaching of cardiovascular internal medicine nursing and to provide a reference for improving the quality and efficiency of cardiovascular internal medicine nursing work. Methods: Thirty-six trainee nurses working in the cardiovascular internal medicine department of our hospital from September 2022 to September 2023 were selected and randomly divided into a control group and an observation group of 18 trainees each. The control adopted the traditional teaching methods while the observation group adopted the implicit nursing knowledge in their clinical practice work. The assessment scores and teamwork ability of the two groups were analyzed and compared. Results: The performance of the observation group was better than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). The teamwork ability of the observation group was significantly better than that of the control group in teamwork ability (P < 0.05). Conclusion: Implicit nursing knowledge teaching is conducive to the cultivation of high-quality nursing talents and meets the development needs of hospitals. Therefore, the importance of implicit nursing knowledge should be strengthened in the teaching of cardiovascular internal medicine nursing and it should be comprehensively organized to improve the quality of nursing services.

Formulation and standardization of lohasava: an ayurvedic aasava formulation Man

Background: Plant solutions or decoctions are fermented with added sugar to create alcoholic remedies like arishta and aasava. Standardizing ayurvedic formulations is essential to assessing the quality of medicine. Objective: Standardisation of Lohasava, which contains iron as a metal and is used as hematinic, has been carried out in the current study. Methods: The standard ayurvedic procedure was used to prepare the aasava formulation. Modern scientific control processes have standardized the formulation for the final products. Organoleptic analysis, phytochemical assessment, and physicochemical characteristics such as pH, specific gravity, viscosity, acid values, total solid content, alcohol content, heavy metal content, and stability studies were used to standardize asava. Additionally, formulations were examined for the presence of pesticides. Using UV-visible spectrophotometric analysis, the iron content was determined. Animal studies were carried out to evaluate pharmacological activity. Results: Physical and chemical parameters were found within limits. The alcohol content of formulations was within limits and indicated good fermentation. Conclusion: The study's findings have revealed good formulation quality and provide a standard for aasava and ayurvedic formulations.

НАЛОГОВЫЕ АСПЕКТЫ ИЗЪЯТИЯ АПТЕКАМИ ИЗ ОБРАЩЕНИЯ И УНИЧТОЖЕНИЯ ЛЕКАРСТВЕННЫХ СРЕДСТВ

Strict regulation of the quality of medicines, as well as the establishment of expiration dates for them, are risk factors for commodity and financial losses of pharmacies associated with the withdrawal from circulation and destruction of medicines that are unusable for further sale. As taxpayers of taxes in force in the Russian Federation, pharmacies must take these transactions into account when they determine their tax obligations. Understanding the tax aspects of the withdrawal from circulation and destruction of medicines allows, at the stage of organizing these procedures, to minimize tax risks, and, consequently, the financial losses of pharmacies associated with their implementation in the form of additional charges of taxes, fines and penalties. The purpose of the study was to identify possible tax risks arising when medicines are withdrawn from circulation and to identify possible ways to reduce them. To achieve this goal, an analysis of legislative requirements, explanations of authorized bodies and current judicial practice on the issue under consideration was carried out. The analysis showed that operations for the withdrawal from circulation and destruction of medicines are a source of tax risks for pharmacies in terms of income tax and VAT. It was revealed that tax risks for income tax are associated, first of all, with incorrect documentation of the withdrawal of medicines from circulation. They are also possible due to the refusal to identify those responsible for the damage or their absence, the failure to file claims against the guilty parties and their lack of compensation for losses, and write-off before the expiration date. Tax risks for VAT arise if a pharmacy does not have evidence of disposal of medicines for reasons beyond the will of the owner and without transfer to other persons. To help reduce tax risks will be the inclusion in the internal regulations on the withdrawal of medicines from circulation and their destruction of provisions that take into account the norms of tax legislation and arbitration practice, as well as monitoring their compliance.

Study of Fake Medicine Detection using Blockchain

The healthcare industry has grappled with the challenge of monitoring genuine medicines while counterfeit drugs continue to proliferate, posing significant risks to patient safety. These fraudulent pharmaceuticals not only have detri-mental effects on health but also result in substantial financial losses, with reports indicating annual losses of approximately 200 billion dollars for US pharmaceutical companies. Particu-larly concerning is the World Health Organization’s revelation that in underdeveloped nations, one in every ten medicines consumed by patients is counterfeit and of low quality. To address this critical issue, we use blockchain technology to track the supply chain, from the manufacturing stage to the end-user. Leveraging blockchain technology, our system enhances reliability, transparency, and security in healthcare data. This paper focuses on bolstering transaction security, safeguarding medicine quality, and fortifying data protection through the utilization of blockchain technology.

PROSOPIS AFRICANA EXTRACTS AS POTENTIAL NATURAL ALTERNATIVES TO SYNTHETIC ANTIBIOTICS AND A KEY FOR SUSTAINABLE BROILER PRODUCTION: A REVIEW

The chicken sector is more vulnerable to antimicrobial resistance, the buildup of toxic or dangerous residues in meat and eggs and environmental contamination as a result of the widespread and careless use of antibiotics in most nations. Natural solutions, such as medicinal plants, are required to address these issues. These plants have been shown to contain a variety of phytochemicals, including phenols, flavonoids, terpenoids, tannins, alkaloids and saponins. These chemicals endow plants with a multitude of medicinal qualities. One of the many alternatives to antibiotics is Prosopis africana extract, which includes stem bark, leaves, roots and their essential oils. Antioxidant, antibacterial, antifungal, anti-helminthic, antiviral, hepatoprotective, immune-stimulatory and antimicrobial properties are among the many pharmacological activity of P. africana preparations. They are also an abundant supplier of vital minerals and amino acids that support enzyme function and provide defense against the effects of oxidative stress. Using extracts from Prosopis africana is the way forward for effective chicken production, environmental sustainability and food hygiene.

Shankhpushpi (Convolvulus pluricaulis): Exploring its Cognitive Enhancing Mechanisms and Therapeutic Potential in Neurodegenerative Disorders

Abstract: Shankhpushpi (Convolvulus pluricaulis), also called C. pluricaulis Choisy (C. pluricaulis), is a longstanding shrub also known by the names C. microphyllus Sieb. as well as C. prostratus Forsk and it’s employed as a traditional people’s remedy for a number of illnesses such as memory enhancement in Ayurveda and Conventional Chinese Medicine system. It is primarily utilized as a memory enhancer and brain stimulant for the treatment of central nervous diseases like stress, depression, and sleeplessness. Traditional Indian medications are used. Anxiolytic, neurological (Alzheimer's, Huntington's, Epilepsy, but also Depressant) antioxidants, analgesics, immunomodulatory, antibacterial, antihyperlipidemic, and cardioprotective actions are just a few of the medicinal qualities of this herb that have been linked to them in historical publications. Therefore, identifying and scientifically validating herbal remedies helps advance Ayurvedic/ Unani studies. Various biological phytoconstituents, including the alkaloids (convolamine), flavonoids (kaempferol), and polyphenolic compounds (scopoletin, sitosterol, and ceryl alcohol), have been linked to the therapeutic benefits of this botanical. Several active substances, such as scopoletin, kaempferol phytosterol, as well as -sitosterol, which was extracted from flying sections of C. pluricaulis, have been demonstrated to work as GABAA agonists that might explain the antianxiety and CNS depressant properties of shankhpushpi. To compile data for this article, a Systematic Literature Review on C. pluricaulis was conducted.

Development and validation of a quantitative minilab system for quality evaluation of selected medicines: Albendazole, arthemether-lumefantrine combination (Co-artem®), and mebendazole finished pharmaceutical products

AbstractThe current technologies for substandard and counterfeit drug detection are either too expensive for low-resource settings or only provide qualitative or semi-quantitative results. GPHF minilab™ is one of them based on thin layer chromatography(TLC) principles with a semi-quantitative capability by visual observation of the spot area and intensity for medicine quality analysis. Thus, its use as a quality control tool for pharmaceutical products has limitations as spot area and intensity visual observation by the naked eye highly varies from analyst to analyst. As such, in this study, the semi-quantitative technique has been transferred to a quantitative approach by capturing the developed TLC plate image using an Android-based mobile phone inside a simple carton box. Then, the spot area was quantified using justTLC software. The quantitative results were compared with the-high performance liquid chromatography (HPLC) method as the golden standard. Accordingly, linearity was observed in the assayed range (80–120% label claim), and the correlation coefficients found were (R2 = 0.958, 0.997, 0.941, and 0.956 for Albendazole, Mebendazole, Artemether, and Lumefantrine, respectively.). The values are satisfactory. The %RSDs found were less than 2% for all drugs [intraday (n = 6) (RSD = 1.17, 1.61, 1.87, and 1.64), and interday (n = 18) (RSD = 1.16, 0.72, 1.12, and 1.18) for Artemether, Lumefantrine, Mebendazole, and Albendazole, respectively]. Moreover, comparisons of results obtained from the sophisticated CAMAG UV cabinet (R2 =0.991, 0.971, 0.946, and 0.967) and the developed simple carton box (R2 = 0.958, 0.997, 0.941, and 0.956) for Albendazole, Mebendazole, Artemether, and Lumefantrine, respectively. The values are comparable and reveal the accuracy of the method. Robustness testings' that were performed under different altered conditions revealed the robustness of the method (RSD less than 2% for all factors). Additionally the deviations from the golden HPLC results were on average −8.62% for albendazole, −3.79% for artemether, and −4.52% for lumefantrine samples. The developed method shows a satisfactory performance capability to utilize the GPHF minilab™ as a quantitative technique for medicine quality control purposes. It will be a very useful tool in a resource-limited setting. The target method profile, which encompasses a simple, low-cost, linear, precise, robust, accurate, and quantitative GPHF minilab™ system, was obtained for Albendazole, Mebendazole, and Arthemeter lumefantine combinations (Co-artem). The proposed method was successfully applied to analyze the content of the marketed medicines in the above mentioned tablets and offered acceptable deviations from the golden HPLC method. Automation of quantitative GPHF minilab™ was highly recommended to enhance the appropriateness and use of this system.

COUNTERFEIT DRUGS SET ALARM BELLS RINGING: COMPARATIVE ANALYSIS OF DRUG POLICIES

The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. To improve the effectiveness of the public pharmacy, resources should be switched towards areas of need, reducing inequalities and promoting better health conditions. Medicines are financed either through cost sharing or full private. The role of the private services is significant. A review of reform of financing medicines in Sudan is given in this communication. Also, it highlights the current drug supply system in the public sector, which is currently responsibility of the Central Medical Supplies Public Corporation (CMS). In Sudan, the researchers did not identify any rigorous evaluations or quantitative studies about the impact of drug regulations on the quality of medicines and how to protect public health against counterfeit or low quality medicines, although it is practically possible. However, the regulations must be continually evaluated to ensure the public health is protected against by marketing high quality medicines rather than commercial interests, and the drug companies are held accountable for their conduct.

A Monte Carlo simulation-based decision support system for radiation oncologists in the treatment of glioblastoma multiforme.

In the present research, we have developed a model-based crisp logic function statistical classifier decision support system supplemented with treatment planning systems for radiation oncologists in the treatment of glioblastoma multiforme (GBM). This system is based on Monte Carlo radiation transport simulation and it recreates visualization of treatment environments on mathematical anthropomorphic brain (MAB) phantoms. Energy deposition within tumour tissue and normal tissues are graded by quality audit factors which ensure planned dose delivery to tumour site thereby minimising damages to healthy tissues. The proposed novel methodology predicts tumour growth response to radiation therapy from a patient-specific medicine quality audit perspective. Validation of the study was achieved by recreating thirty-eight patient-specific mathematical anthropomorphic brain phantoms of treatment environments by taking into consideration density variation and composition of brain tissues. Dose computations accomplished through water phantom, tissue-equivalent head phantoms are neither cost-effective, nor patient-specific customized and is often less accurate. The above-highlighted drawbacks can be overcome by using open-source Electron Gamma Shower (EGSnrc) software and clinical case reports for MAB phantom synthesis which would result in accurate dosimetry with due consideration to the time factors. Considerable dose deviations occur at the tumour site for environments with intraventricular glioblastoma, haematoma, abscess, trapped air and cranial flaps leading to quality factors with a lower logic value of 0. Logic value of 1 depicts higher dose deposition within healthy tissues and also leptomeninges for majority of the environments which results in radiation-induced laceration.

Quality metrics for same day emergency care—Consensus of a multi-professional panel of experts using a modified Delphi process

Same Day Emergency Care (SDEC) services are at the heart of recovery plans for Emergency Care in the National Health Service. There are no validated metrics for the quality of care in SDEC.The Society for Acute Medicine's Quality Improvement Committee invited to a three-stage modified Delphi process to gather metrics used by clinicians. Proposed metrics were ranked and further explored by 33 participating experts from a broad range of backgrounds including clinicians, data scientists and operational managers.Experts ranked five system-based metrics highest. These focus on optimisation of the proportion of patients receiving same day care in and out of SDEC units. Patient and staff experience metrics were ranked low, possibly due to present lack of viable examples.The paper adds a glossary with the rationale for ranking of metrics and their use for the improvement of quality and safety of clinical care.

Exploring Allied Health Models of Care for Children with Developmental Health Concerns, Delays, and Disabilities in Rural and Remote Areas: A Systematic Scoping Review.

Access to appropriate healthcare is essential for children's healthy development. This is lacking in rural and remote areas, impacting health outcomes. Despite efforts to improve access for these communities, to date, no review has systematically mapped the literature on allied health models of care for children with developmental needs. This scoping review seeks to address this knowledge gap. Adhering to the PRISMA-ScR and Joanna Briggs Institute guidelines, a systematic search was conducted. A total of 8 databases (from inception to May 2023) and 106 grey literature sources were searched. Two reviewers independently undertook a two-stage screening process. Data were extracted using customised tools and narratively synthesised utilising the Institute of Medicine's quality domains. This review is registered a priori via Open Science Framework. Twenty-five citations were identified within the literature. Varied models of care were reported from five mostly Western countries. Models of care identified in these areas were classified as screening services, role substitution, consultative services, or online-based services. Positive impacts on quality of healthcare were reported across all quality domains (apart from safety) with the domain of effectiveness being the most commonly reported. Multiple models of care are currently in operation for children with developmental needs in rural and remote areas and appear to improve the quality of care. Due to complexities within, and limitations of, the evidence base, it is unclear if one model of care is superior to another. This review provides a basis for further research to explore why some models may be more effective than others.

Assessing health-related quality of life of Chinese population using CQ-11D

PurposeThis study aimed to assess the health-related quality of life (HRQoL) of the Chinese population by using the Chinese medicine quality of life-11 dimensions (CQ-11D) questionnaire and to identify factors associated with HRQoL.MethodsThe data was derived from a survey conducted by the Institute of Pharmacoeconomics Evaluation at Beijing University of Chinese Medicine on the quality of life of the Chinese population. The sex and age of respondents were considered through quota sampling. Demographic, socioeconomic, and health indicators were collected using the structured questionnaire. We performed bivariate analyses first to examine the associations between the above factors and the HRQoL of respondents measured by the CQ-11D. Multivariate linear regression and ordinal logistic regression models were established to analyze the factors (demographic, socioeconomic, and health indicators) differences in HRQoL, as well as the risk of each group reporting problems across the 11 dimensions of CQ-11D.ResultsFrom February 2021 to November 2022, a total of 7,604 respondents were involved and 7,498 respondents were included. The sample approximated the general adult Chinese population in terms of age, sex, and district of residence, and each geographic distribution ranged from 9.71 to 25.54%. Of the respondents, 45.84% were male, and 89.82% were Han ethnicity. The mean utility score ranged from 0.796 to 0.921 as age increased. According to the respondents, most health problems were identified in the PL (fatigue) (70.16%) and SM (quality of sleep) (63.63%) dimensions. The CQ-11D index scores varied with the demographic and socioeconomic characteristics of respondents, except for ethnicity (p > 0.05) and income (p > 0.05). The multivariate analysis revealed significant negative associations between health utility scores and various factors. These factors include sex (female), age over 65, belonging to ethnic minorities, rural household registration, being widowed or divorced, having a primary school education or below, being a student or unemployed, having a low income of 0–1,300, engaging in smoking or drinking, limited participation in physical activities, experiencing changes in self-perceived health status compared to the previous year, and having chronic diseases. The odds of respondents reporting problems in 11 dimensions varied among different socio-demographic groups.ConclusionsThis study reports the first Chinese population norms for the CQ-11D derived using a representative sample of the Chinese general population. Self-reported health status measured by the CQ-11D varies among different socio-economic groups. In addition to participation a physical activity and the presence of chronic disease, smoking and drinking also significantly influence HRQoL.

Role of Herbal Active Compound in Cardiac Failure Treatment

The prevalence of cardiovascular diseases (CVDs) is constantly rising, making them a major health burden. In terms of global mortality and morbidity, they are still at the top. An alternate method of treating many illnesses, including CVDs, is the use of medicinal herbs. There is a current, unprecedented push to include herbal remedies into contemporary healthcare systems. The widespread conviction in their safety and the fact that they offer more effective treatment at a lower cost than conventional modern medicines are two of the main factors propelling this movement. However, there has not been enough testing of the purported safety of herbal remedies. As a result, people need to know that medical herbs can be toxic, have possibly fatal side effects, and can interact negatively with other drugs. Experimental evidence suggests that medicinal herbs may be useful in the treatment of cardiovascular diseases (CVDs) due to their ability to inhibit multiple risk factors for these conditions. So, in order to successfully use herbs in CVD therapy, there have been numerous initiatives to transition medicinal herb research from the lab to the clinic. Presented below are cardiovascular diseases (CVDs) and the variables that put people at risk for developing them. Next, we provide a synopsis of herbal medicine's role in the treatment of disease, with a focus on cardiovascular diseases. In addition, information is compiled and examined about the ethnopharmacological therapeutic possibilities and medicinal qualities against cardiovascular diseases of four commonly used plants: ginseng, gingko biloba, ganoderma lucidum, and gymnostemma pentaphyllum. The use of these four plants in the treatment of cardiovascular diseases (CVDs) including myocardial infarction, hypertension, peripheral vascular disorders, coronary heart disease, cardiomyopathies, and dyslipidemias has been well examined. We are also making an effort to describe the current in vitro and in vivo investigations that have attempted to examine the cellular and molecular underpinnings of the four plants' cardio-protective effects. Lastly, we highlighted the effectiveness, safety, and toxicity of these four medicinal herbs by reviewing and reporting the results of current clinical trials.
 GRAPHICAL ABSTRACT
 

EpMYB2 positively regulates chicoric acid biosynthesis by activating both primary and specialized metabolic genes in purple coneflower.

Chicoric acid is the major active ingredient of the world-popular medicinal plant purple coneflower (Echinacea purpurea (L.) Menoch). It is recognized as the quality index of commercial hot-selling Echinacea products. While the biosynthetic pathway of chicoric acid in purple coneflower has been elucidated recently, its regulatory network remains elusive. Through co-expression and phylogenetic analysis, we found EpMYB2, a typical R2R3-type MYB transcription factor (TF) responsive to methyl jasmonate (MeJA) simulation, is a positive regulator of chicoric acid biosynthesis. In addition to directly regulating chicoric acid biosynthetic genes, EpMYB2 positively regulates genes of the upstream shikimate pathway. We also found that EpMYC2 could activate the expression of EpMYB2 by binding to its G-box site, and the EpMYC2-EpMYB2 module is involved in the MeJA-induced chicoric acid biosynthesis. Overall, we identified an MYB TF that positively regulates the biosynthesis of chicoric acid by activating both primary and specialized metabolic genes. EpMYB2 links the gap between the JA signaling pathway and chicoric acid biosynthesis. This work opens a new direction toward engineering purple coneflower with higher medicinal qualities.

Use of antimicrobials and other medical products in an ethnic minority context of South-Central Vietnam: A qualitative study of vulnerability.

Despite the global threat of antimicrobial resistance (AMR), evidence on the use and quality of medicines at community level is limited, particularly in impoverished, rural areas where prevalence of (bacterial) infections is high. To better understand the processes that drive vulnerability to AMR' effects, this study aimed to assess social factors underpinning access to-and use of-medical products and healthcare, among people from the Raglai ethnic minority in Ninh Thuan Province, Vietnam. We conducted ethnographic research in eight villages in 2018-2019, using interviewing and participant observation methods for data collection. Different types of informants (including community members and healthcare providers) were selected using purposive sampling strategies and analysis was retroductive. Our findings show that, despite the existence of a government-funded health insurance scheme, Raglai people's flexible therapeutic itineraries did not systematically start with formal healthcare. Different types of care (private/informal, public, shamanic) were combined in parallel or in alternation, determined by distance to the provider, cost, workload, perceived diagnostic capacity, perceived severity and aetiology of the illness, and trust in the provider. Available medicines were often tablets dispensed in plastic bags containing labelled tablets, unlabelled tablets (in bulk) or tablets ground to powder. Treatment was often considered effective when it relieved symptoms, which led to abandonment of the treatment course. When symptoms did not speedily abate, the illness aetiology would be reinterpreted, and "stronger" medicines would be sought. The precarious socio-economic status of some Raglai drove them in cycles of severe poverty when additional unforeseen factors such as illness, animal disease or loss of crops arose, hampering access to (in)formal healthcare providers and/or appropriate diagnosis and treatment. We conclude that Raglai communities are structurally unable to buffer themselves against the threat and consequences of AMR. Despite this vulnerability, they are among the least targeted by efforts to optimize antibiotic use, which are concentrated in secondary and tertiary healthcare facilities targeted at urban populations.

Development of a Monoclonal Antibody-Based Indirect Competitive Enzyme-Linked Immunosorbent Assay for the Rapid Detection of Gallic Acid.

Gallic acid (GA) is closely related to the quality of herbal medicines and other agricultural products. In order to facilitate the rapid detection of GA, we developed a monoclonal antibody-based ic-ELISA method. Antigens with and without connecting arms were prepared. It was found that the introduction of connecting arms (linear carbon chain) was beneficial for immune response. By utilizing hybridoma technology, a specific mAb (anti-GA-M702) was screened and identified, which exhibited a 1:40,500 antibody titer and IgG2b antibody subtype. The ic-ELISA assay was established based on anti-GA-M702. The optimal working concentrations of the encapsulated antigen and antibody were 0.5 µg/mL and 0.67 µg/mL, respectively. The ic-ELISA method showed a linear detection range of 297.17-2426.61 ng/mL for GA with a sensitivity of 849.18 ng/mL. It displayed a good applicability for the determination of GA in Galla chinensis. In conclusion, the ic-ELISA method provides an efficient approach to the rapid detection of GA in products.

Super-refractory status epilepticus, rhabdomyolysis, central hyperthermia and cardiomyopathy attributable to spinal anesthesia: a case report and review of literature

BackgroundThere are only six past reports of super-refractory status epilepticus induced by spinal anesthesia. None of those patients have died. Only < 15 mg of bupivacaine was administered to all six of them and to our case. Pathophysiology ensuing such cases remains unclear.Case presentationA 27 year old gravida 2, para 1, mother at 37 weeks of gestation came to the operating theater for an elective cesarean section. She had no significant medical history other than controlled hypothyroidism and one episode of food allergy. Her current pregnancy was uneventful. Her American Society of Anesthesiologists (ASA) grade was 2. She underwent spinal anesthesia and adequate anesthesia was achieved. After 5–7 min she developed a progressive myoclonus. After delivery of a healthy baby, she developed generalized tonic clonic seizures that continued despite the induction of general anesthesia. She had rhabdomyolysis, one brief cardiac arrest and resuscitation, followed by stress cardiomyopathy and central hyperthermia. She died on day four. There were no significant macroscopic or histopathological changes in her brain that explain her super refractory status epilepticus. Heavy bupivacaine samples of the same batch used for this patient were analyzed by two specialized laboratories. National Medicines Quality Assurance Laboratory of Sri Lanka reported that samples failed to confirm United States Pharmacopeia (USP) dextrose specifications and passed other tests. Subsequently, Therapeutic Goods Administration of Australia reported that the drug passed all standard USP quality tests applied to it. Nonetheless, they have detected an unidentified impurity in the medicine.ConclusionsAfter reviewing relevant literature, we believe that direct neurotoxicity by bupivacaine is the most probable cause of super-refractory status epilepticus. Super-refractory status epilepticus would have led to her other complications and death. We discuss probable patient factors that would have made her susceptible to neurotoxicity. The impurity in the drug detected by one laboratory also would have contributed to her status epilepticus. We propose several possible mechanisms that would have led to status epilepticus and her death. We discuss the factors that shall guide investigators on future such cases. We suggest ways to minimize similar future incidents. This is an idiosyncratic reaction as well.Graphical

The status of nuclear medicine in China: the first official national survey.

The National Nuclear Medicine Quality Control Center of China conducted the first official survey to investigate the nationwide situation of nuclear medicine in 2020. The survey aimed to unveil the current nuclear medicine situation and its quality control in China. The web-based survey was conducted and the data was collected via the National Clinical Improvement System (NCIS) of China from 1st April to 31st May 2021. A total of 808 institutes across 30 provinces responded to the national survey. For human resources, there are 4460 physicians, 3077 technologists, 339 physicists, and 309 radiochemists. There are 887 single-photon imaging instruments, including 823 SPECT or SPECT/CT, and 365 PET instruments including 314 PET/CT. Six hundred twenty-four institutes perform SPECT examinations and 319 institutes perform PET examinations. 60% of SPECT scans are bone scintigraphy. A total of 97% of PET scans use an [18F]F-FDG tracer. Furthermore, 587 institutes provide radionuclide therapy services but only 280 institutes have admission rooms. The top three radionuclide therapies are [131I] therapy of hyperthyroidism with 546 institutes, [89Sr] therapy of bone metastasis with 400 institutes, and [131I] therapy of differentiated thyroid cancer with 286 institutes. Finally, for the frequency of equipment quality control per year, there are about 67 times self-test within the department for SPECT instruments and 111 times for PET instruments on average in each province. There are about three failures of SPECT and five failures of PET on average per year in each province. There are 408 institutes (of 624 SPECT institutes) performing quality control of SPECT radiopharmaceuticals, 216 (of 319) for PET radiopharmaceuticals, and 373 (of 587) for radionuclide therapy. These results of the first official survey towards current status of nuclear medicine in China are the foundation for the establishment of the quality control management system.

Occurrence and health risk of pesticide residues in Chinese herbal medicines from Shandong Province, China.

Pesticide residue was one of the stress factors affecting quality and safety of Chinese herbal medicines (CHMs). The present study was designed to investigate the occurrence and dietary exposure of 70 pesticide residues in 307 samples of CHMs, including 104 American ginseng, 100 Ganoderma lucidum (G. lucidum), and 103 Dendrobium officinale (D. officinale) in Shandong Province, China. The study revealed that a total of 29 pesticides were detected in the majority (92.5%) of samples, and the pesticide residues of 85 (27.7%) samples exceeded the maximum residue levels (MRLs). Particularly, the maximum concentration of chlorpyrifos was 23.8mgkg-1, almost 50 times of the MRLs in food in GB 2763-2021, while there's no standard restrictions specified in CHMs in China. The chronic, acute, and cumulative risk assessment results indicated that risk exposure of the three types of CHMs were unlikely to pose a health risk to consumers. However, more attention should be paid to the multiple residues with the presence of four or more pesticides in one sample and high over-standard rate of pesticides. The pesticide users and the government should pay more attention to the pesticides used in CHMs and regularly monitor the presence of these compounds. The study recommended the MRLs of these pesticides in CHMs should be established and perfected by the relevant departments in China.