Metoclopramide and domperidone are dopamine antagonists that can cause an acute dystonic reaction. Metoclopramide is a rare but major contributor to serotonin syndrome, particularly when used with other serotonergic agents. Serotonin syndrome is a rare, potentially life-threatening adverse reaction characterized by a triad of altered mental status, autonomic dysfunction, and neuromuscular hyperactivity that typically results from exposure to serotonergic agents. Herein, we report a previously healthy 9-year-old girl who was brought to the emergency department with an alteration in the level of conscious and involuntary repetitive movements after approximately 24 hours of receiving a therapeutic dose of metoclopramide and domperidone. Physical examination showed tachycardia, hyperthermia, and a Glasgow Coma Scale score of 11, as well as mydriasis and hyperreflexia. In addition to resolving the symptoms after administering midazolam and diphenhydramine, the diagnosis of serotonin syndrome was made based on the classical symptoms and signs, which met the Hunter criteria. This case indicates the need for clinical awareness of the life-threatening syndrome and caution with medications having potential interactions with metoclopramide.

BACKGROUND: Mesenchymal stem cells (MSCs) and/or biological scaffolds have been used to regenerate articular cartilage with variable success. In the present study we evaluated cartilage regeneration using a combination of bone marrow (BM)-MSCs, Hyalofast™ and/or native cartilage tissue following full thickness surgical cartilage defect in rabbits. METHODS: Full-thickness surgical ablation of the medial-tibial cartilage was performed in New Zealand white (NZW) rabbits. Control rabbits (Group-I) received no treatment; Animals in other groups were treated as follows. Group-II: BMMSCs (1 × 10⁶ cells) + Hyalofast™; Group-III: BMMSCs (1 × 10⁶ cells) + cartilage pellet (CP); and Group-IV: BMMSCs (1 × 10⁶ cells) + Hyalofast™+ CP. Animals were sacrificed at 12 weeks and cartilage regeneration analyzed using histopathology, International Cartilage Repair Society (ICRS-II) score, magnetic resonance observation of cartilage repair tissue (MOCART) score and biomechanical studies. RESULTS: Gross images showed good tissue repair (Groups IV>III>Group II) and histology demonstrated intact superficial layer, normal chondrocyte arrangement, tidemark and cartilage matrix staining (Groups III and IV) compared to the untreated control (Group I) respectively. ICRS-II score was 52.5, 65.0, 66 and 75% (Groups I–IV) and the MOCART score was 50.0, 73.75 and 76.25 (Groups II–IV) respectively. Biomechanical properties of the regenerated cartilage tissue in Group IV closed resembled that of a normal cartilage. CONCLUSION: Hyalofast™ together with BM-MSCs and CP led to efficient cartilage regeneration following full thickness surgical ablation of tibial articular cartilage in vivo in rabbits. Presence of hyaluronic acid in the scaffold and native microenvironment cues probably facilitated differentiation and integration of BM-MSCs.
Animals ; Bone Marrow ; Cartilage* ; Cartilage, Articular ; Chondrocytes ; Cues ; Hyaluronic Acid ; Mesenchymal Stromal Cells* ; New Zealand ; Osteoarthritis ; Rabbits* ; Regeneration*

BACKGROUND: Administering oxygen therapy (OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%–98% in most cases. This study aims to evaluate knowledge, attitude and practice (KAP) of nurses, paramedics, emergency medical technicians (EMTs) and Emergency Medical Services (EMS) physicians working at emergency departments (ED) in Riyadh, Saudi Arabia. METHODS: In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1–5, whereas practice was assessed as a yes/no categorical variable. RESULTS: A total of 444 emergency health-care workers (EHCWs) participated, of which 225 (50.7%) were male, with the majority (77%) in the age group of 20–35 years. Over half of the sample were nurses (266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was significantly better among paramedics – nurses group and EMT – nurses group. CONCLUSION This study demonstrates that there is a gap in EHCWs' KAP, particularly regarding when to provide OT to a patient. This gap can affect patients' safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers.