We developed a fast-dissolving nanofibrous film based on cyclodextrin (hydroxypropyl-β-cyclodextrin) inclusion complexes (ICs) incorporating a triple drug combination of acetylsalicylic acid (Aspirin), paracetamol, and caffeine (APC). The combination of these three drugs constitutes a multimodal analgesic widely used for the treatment of acute pain conditions, such as headache and migraine. Herein, the electrospun HPβCD/APC-IC nanofibrous film was fabricated with a total drug loading of ∼10 % (w/w), comprising ∼4.4/4.4/1.2 % (w/w) of each component (A/P/C), thereby matching the drug ratio found in the commercial analgesic formulation, Excedrin. 2D NMR (ROESY) analysis confirmed the IC formation between HPβCD and both acetylsalicylic acid and paracetamol. The powder form of HPβCD/APC-IC was also prepared as a control sample. XRD and DSC analyses revealed the amorphization of all three drug components within both the HPβCD/APC-IC nanofiber and powder forms. The HPβCD/APC-IC nanofibrous films exhibited significantly enhanced dissolution and disintegration performance in aqueous medium, along with improved drug release profiles, compared to their powder counterparts. HPβCD/APC-IC nanofibers demonstrate strong potential as a fast-dissolving drug delivery system, offering a promising alternative to conventional tablet dosage forms of this triple-drug combination.

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorder (MOGAD) is a central nervous system demyelinating disease in children, frequently induced by infection. We report the case of a 9-year-10-month-old boy with a 13-day fever and headache. He was admitted to our hospital for fever of unknown origin. He was diagnosed with bronchopneumonia via chest X-ray and encephalitis via cranial magnetic resonance imaging (MRI) and laboratory tests, which revealed increased white blood cells (WBC) (67 × 106/L) and a high proportion of segmented granulocytes (31%) in cerebrospinal fluid (CSF). Further examination showed positive serum MOG-immunoglobulin G (IgG). After treatment with high-dose methylprednisolone (20 mg/kg/day, 3 days) and gamma globulin (400 mg/kg/day, 5 days), the patient's temperature returned to normal with decreased CSF WBC count (11 × 106/L) and segmented granulocytes (5%). No abnormal bacterial growth was found in CSF. Oral methylprednisolone (32 mg/day), calcitriol soft capsules (1 capsule/day), and calcium carbonate D3 tablets (1 tablet/day) were prescribed after discharge, with a follow-up examination 1 week later. We present a rare case of a child with fever of unknown origin, diagnosed with MOG-IgG-associated encephalitis, bronchopneumonia, and MOG-IgG seropositivity despite negative infection screening. This report offers new insights into atypical MOGAD and a reference for MOGAD diagnosis and treatment in children. It highlights the importance of conducting MOG-IgG tests in children with encephalitis and bronchopneumonia despite negative infection screening.

Migraines represent one of the most prevalent and debilitating neurological disorders. In terms of quality-of-life impairment and the degree of disability incurred, severe migraine attacks align with the World Health Organization (WHO) level 7 disability, comparable to conditions such as tetraparesis, psychosis, and dementia. The severity of migraine attacks is influenced not only by the intensity of the headache but also by the severity of accompanying non-pain symptoms, which include nausea, vomiting, photophobia, phonophobia, dizziness, and cognitive impairment, as well as the frequency of recurrence. The presence of nausea or vomiting during a migraine attack is indicative of migraine-associated gastroparesis, which adversely affects the bioavailability and efficacy of oral medications. Consequently, these factors contribute to the limited effectiveness of standard tablet formulations in aborting migraine attacks. This article explores contemporary approaches to treating migraine attacks and new criteria for assessing therapeutic efficacy. Particular emphasis is placed on the effectiveness of orally disintegrating tablets (ODT) of rizatriptan compared with sumatriptan and zolmitriptan. Optimal management of a migraine attack necessitates an individualized approach that considers the severity of the condition, the spectrum of clinical manifestations, and the selection of an appropriate pharmaceutical formulation. Strong evidence supports the assertion that rizatriptan 10 mg ODT (Kaporiza) is one of the most rapid, effective, and convenient options for the abortive treatment of migraine attacks in the majority of patients.

Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disorder involving multiple systems. A 18-year-old female patient presented with complaints of headache, weakness, and tingling sensation in the left upper limb and lower limb. On magnetic resonance imaging (MRI), acute nonhemorrhagic infarct in right thalamo-capsular region was seen. The patient gave a history of malar rash and intermittent joint pains for which she had taken nonspecific treatment. Antineutrophilic antibody (ANA) by innumoflourescence and ANA blot was suggestive of SLE. Hence, the patient had central nervous system vasculitis and stroke due to SLE. The patient was started on antiplatelet therapy, tablet prednisolone 40 mg once daily, and tablet warfarin 5 mg once daily. The patient was readmitted after 2 weeks with menorrhagia and deranged INR. Tablet Warfarin was with-held, fresh frozen plasma transfusions were given. Repeat MRI did not show any new changes. Patient was given tablet nicoumalone and three doses of injection cyclophosphamide 800 mg. Hemiplegia has improved by 90%, her menstrual cycles are now regular.

Caffeine appears in breastmilk rapidly after maternal ingestion. Insufficient high-quality data are available to make good evidence-based recommendations on safe maternal caffeine consumption.[1] Fussiness, jitteriness and poor sleep patterns have been reported in the infants of mothers with very high caffeine intakes equivalent to about 10 or more cups of coffee daily. Studies in mothers taking 5 cups of coffee daily found no stimulation in breastfed infants 3 weeks of age and older. A maternal intake limit of 300 to 500 mg daily might be a safe level of intake for most mothers, although European authorities set a likely safe level at 200 mg.[2-4] Maternal doses of caffeine greater than 130 mg daily may decrease weight gain in their exclusively breastfed infants, but this needs further confirmation.[5] However, preterm and younger newborn infants metabolize caffeine very slowly and may have serum levels of caffeine and other active caffeine metabolites similar to their mothers' levels, so a lower intake level preferable in the mothers of these infants.[2,6,7] Coffee is thought to decrease milk supply in some cultures, but there is no scientific information on coffee and milk supply.[8] Other sources of caffeine, such as cola and energy drinks, yerba mate or guarana, will have similar dose-related effects on the breastfed infant. Coffee intake of more than 450 mL daily may decrease breastmilk iron concentrations and result in mild iron deficiency anemia in some breastfed infants.[9]

Acetaminophen is a good choice for analgesia, and fever reduction in nursing mothers. Amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare.