Journal of Advances in Medicine and Medical Research

Formoterol is a long-acting β2 agonist used in the management of asthma and chronic obstructive pulmonary disease (COPD). Oral ingestion of sympathomimetic aerosol preparations is unlikely to cause systemic toxicity as most of these agents are poorly absorbed via ingestion. Oral ingestion of inhaler formoterol capsule form is rare. Twenty six year old male admitted to the emergency department after a suicide attempt by swallowing 60 capsules of formoterol fumarate (12 mcg/capsule, total 720 mcg). With the oral ingestion of high doses caused nausea, vomiting, vertigo and palpitation in our patient. It is important to know the effects of the oral ingestion of inhaler formoterol capsule.

Aim: The aim of this case report is to present an unusual case of multidrug- resistant Bacteroides fragilis from a patient with pyopneumothorax who had a blunt injury to the thorax and got admitted in a tertiary care hospital, South India.

Presentation of Case: The patient developed pyopneumothorax after a blunt injury and on admission was treated empirically with piperacillin-tazobactam and metronidazole. Following antibiotic sensitivity testing the B. fragilis strain isolated showed multidrug resistance including metronidazole. Imipenem was initiated replacing empiric therapy with a successful clinical outcome.

Discussion: Bacteroides species are obligate anaerobic bacteria that are usually found in the gastrointestinal tract of the human body. Bacteroides species are the most commonly isolated anaerobic organisms from intra-abdominal lesions and rarely from intrathoracic disease conditions like pyopneumothorax. Pyopneumothorax caused by Bacteroides species is associated with high treatment failure and mortality rates in antibiotic-resistant cases. Though metronidazole is the mainstay of treating anaerobic infections, attention has to be given to the possibility of multidrug resistance when treating critical diseases.

Conclusion: This case report summarizes the multidrug- resistance in Bacteroides fragilis strain isolated from a case of pyopneumothorax. The situation calls attention to the possibility of multidrug-resistance being underestimated when given as empirical therapy and institution of appropriate and timely antibiotic policy measures to prevent mortality.

Objective: Cholelithiasis is one of the topical issues of the modern medical science. The aim of the study was to discover the prevalence of cholelithiasis among patients with occupational COPD and vibrational disease.

Methods: We monitored 1331 patients with chronic occupational pathology. 410 of them were engaged in mechanical engineering and were affected by occupational COPD, 327 patients with vibrational disease from the same type of manufacturing, and 594 metal workers and clinchers with vibrational disease but engaged in aircraft industry. This study followed the ethical criteria recommended by the Resolution N 248 of 14.08.1998 of Ministry of Health of the Russian Federation.

Results: The highest incidence rate of cholelithiasis development was registered among patients with pulmonary pathology (23.6% of women and 14.4% of men). The least incidence rate was registered among patients occupied in foundry engineering (4.5% of women, 0.5% of men).

Conclusions: The possible cause of incidence rate of cholelithiasis development reduction among patients with vibrational disease is the absence of hypoxaemia and systemic inflammation. The second essential aspect is that the vibrational influence on bile prevents aggregation of bile components into calculi.

Aim: The study of results of Total Knee Arthroplasty based exclusively on the use of models Posterior stabilized (PS) or Cruciate retaining (CR) may be insufficient if we do not analyse other factors. Our objective is to analyse the interaction of certain factors as age, sex, BMI, prior deformity and use of navigation  on the  follow-up.

Materials and Methods: Multicenter study of 415 Total Knee Arthroplasty (TKA). In 298 cases, the CR model was implanted and the PS in 117. The results were evaluated with the scales WOMAC, AKS and SF-12 v2. The average age of the series was 71 years (SD 7.8). The mean BMI was 31.7 (SD 4). In 294 cases, the frontal deformity of the mechanical axis of the knee was greater than 3°, particularly varus. Surgical navigation was used in 38.5% of patients as a helper in the implant of arthroplasty.

Results: PS implanted joints demonstrated better results in all subscales than CR implanted joints. However,the study of the interaction between type of technique and preoperative deformity, sex, age, and BMI, showed that prior deformity and BMI influenced more on results than the use of one model or another. Navigation improved the results in the three scales, although these cases started with lower scores.

Conclusion: Analysis of results of TKAs based exclusively on the use of PS or CR models is insufficient. Characteristics of the patient, previous deformity and navigation aid influence more on the results than using one model or another.

Summary: Extradural hematoma (EDH) has been seen as a neurosurgical emergency since eighteenth century. Efforts have been on since then to reduce the mortality associated with this entity. The mortality has dropped from around 80% in late nineteenth and early twentieth centuries to below 20% in many centers now. Improving quality of care and, constant assessment of outcome and factors affecting outcome are the driving forces leading to reduction in mortality.

Objectives: To determine the functional outcome and the effect of level of consciousness on traumatic extradural hematoma patients who had surgery in our centers.

Patients and Methods: It was a prospective observational study carried out on forty three patients with traumatic extradural hematoma who had surgical evacuation of the hematomas in our centers over a five year period. Data were collected using structured proforma in accident and emergency, theater, intensive care unit, wards and in outpatient clinic. The data were analyzed using Environmental Performance Index (EPI) info 2007 software.

Results: Forty three patients had surgery for traumatic extradural hematoma during the five year period. There were thirty eight males (88.37%) and five females (11.63%). Road traffic accident was the most common aetiology. The functional outcome was 83.72% and mortality was 13.95%. Glasgow Coma Score prior to surgery and age significantly affected the outcome, P = .002 and P = .00 respectively.

Conclusion: The favorable functional outcome from our study (83.72%) was within the current range in the world. Level of consciousness prior to surgery and age significantly affected outcome.

Aims: To investigate if basal measures of serum prolactin correlate with biochemical and anthropometric data of Brazilian patients. 

Methodology: This study consists of a cross-sectional evaluation of basal serum prolactin levels and its correlations with biochemical (fasting glucose, lipid profile, uric acid, insulin, Homeostasis Model Assessment-Insulin Resistance - HOMA) and anthropometric data (body mass index - BMI, waist circumference - WC, Visceral Adiposity Index - VAI) in 356 patients who sought Endocrinological evaluation in order to lose weight (242 women, 114 men; age range 16-80 years). Most patients were obese (43.63%), 36.52% were overweight and 16.85% had normal BMI. Patients were divided among four quartiles according to the prolactin levels: The first containing the patients with the lowest, and the forth, those with the highest levels.

Results: The fourth prolactin quartile had significantly lower BMI (P= .02), WC (P= .003), glucose (P <.001), total cholesterol (P= .02), LDL (P= .04), triglycerides (P= .02), HOMA (P= .04), and VAI (P= .04), and fewer diagnostic criteria for the Metabolic Syndrome (P <.001). In addition, the fourth quartile had lower prevalences of obesity (P= .02) and Diabetes Mellitus (P= .02). There were correlations between PRL and BMI (r= -.17, P= .001), WC (r= -.21, P <.001), glucose (r= -.25, P <.001), total cholesterol (r= -.14, P= .01), HDL (r= .14, P= .01), LDL (r= -.12, P= .02), triglycerides (r=  -.17, P <.001), HOMA (r= -.13, P= .03), VAI (r= -.21, P <.001), and the number of diagnostic criteria for the Metabolic Syndrome (r= -.23, P <.001).

Conclusion: Patients with higher levels of prolactin had a more favorable anthropometric and biochemical profile. Basal levels of prolactin correlate well with anthropometric and biochemical data and may be a useful tool for the estimation of serotoninergic activity in patients who seek Endocrinological evaluation for weight reduction.

Introduction: Self-medication is a serious issue worldwide and its irrational use becomes a major cause of global concern.

Aims: The present study aimed to determine the knowledge of and attitude of students towards self-medication.

Methods: A descriptive cross-sectional study was conducted among all medical students enrolled in Al-Iraqia Medical College, 400 (> 90%) students were the respondent sample size and data was collected using self-administrated questionnaire.

Results: The study finding revealed the mean age of 400 enrolled students was 20.37, most of them were female (66.5%) aged more than 20 years old (53%), in third level (26.5%), single (97.5%), lived with family (74%) and with non-sufficient family monthly income (52.8%). More than half of the respondents found to have a good knowledge (55.25%) and positive attitude (67.25%) towards self self-medication with considerable effect of their socio-demographic characteristics.

Conclusion: Medical students have in general good knowledge and positive attitude towards self-medication with favor to practice it saying that it acceptable. Therefore, it is strongly recommended for raising the issue of orientation to enlighten the students about the problems that may arise from inappropriate medication use.

Introduction: Wearing a white coat is an accepted part of medical and dental practice. The actual use of white coats and how often they are changed varies greatly among individuals and their specialties. There has always been some concern that white coats may actually play a part in transmitting pathogenic bacteria.

Objectives: To assess the perception and attitudes of dental undergraduates and postgraduates towards wearing white coats in public.

Methods: 1146 structured, closed ended questionnaires were distributed to all undergraduates and postgraduates of two colleges in Davangere. Chi-square test was used to test associations between the responses among the genders and the responses within the educational levels of the participants. Binary logistic regression models were fitted to the data to calculate odds ratios (OR) for the responses among the genders.

Results: A response rate of 88.74% was obtained, 93.5% of subjects had seen doctors wearing white coats in public, 24% of participants agreed that the lack of provision for storage of aprons could be the possible reason for wearing white coats outside the clinical setting. 52.5% of students believed that white coats are potential source for spreading infection.

Conclusion: The present study highlights the fact that white coats are potential source of cross infection. Strict audit process and protocols should be set in workplace for preventing cross‑contamination from the white coats.

Aims: To investigate the effect of fansidar® and vitamin C co-administration on serum electrolyte and body weight indices of Wistar albino rats.

Place and Duration of Study: Department of Medical Biochemistry, Cross River University of Technology, Okuku Campus, between August 2013 and June 2014.

Methodology: Sixty (60) Wistar albino rats were divided into three groups I, II, III (n=20; 10 male, 10 female) weighing between 180-200 g. Group I was designated as the control and received distilled water, groups II and III were treated with 14.29 mg/kg body weight of fansidar® and 14.29 mg/kg body weight each of fansidar® + vitamin C respectively for 14 days. The animals were then sacrificed and blood collected for serum electrolyte analysis.

Results: The results obtained showed that the serum [Na⁺] was significantly (P<0.05) increased in group II females only compared with control. There was a significant (P<0.05) increase in the serum [K⁺] of groups II and III males and group III females compared with control. There was also a significant (P<0.05) elevation of [CO₂] in group II rats (irrespective of sex) compared with the control. The [Cl^-] of only the males in groups II and III was significantly (P<0.05) reduced compared with the control. The results of body weight indices investigated showed a significant (P<0.05) decrease in mean weight increase (MWI) and growth rate (GR) of all the test groups compared with the control, however, group III compared with group II was significantly (P<0.05) increased.

Conclusion: The alterations in serum electrolyte on fansidar® administration were pronounced in males than females except in the sodium electrolyte levels. The co-administration of vitamin C may reverse the adverse alterations in serum electrolyte and body weight changes caused by fansidar® administration.

Introduction: Thoracic trauma leading to multiple fractured ribs (MFR) remains common. The significant chest pain of multiple rib fractures can be difficult to manage and can lead to decreased pulmonary function, increased hospital stay, and increased health care expenditures.

Aims: To evaluate the treatment options available for pain control in blunt chest injury with multiple rib fractures.

Study Design: Internet research.

Methodology: Literature review on pain management of blunt chest injury associated with multiple rib fractures was done from 1970 to 2014 using manual library search, journal publications on the subject, and Medline.

Results: Various modalities have been in use including systemic modalities, regional modalities, transcutaneous modalities and cutaneous modalities.

Conclusion: The current research has shown differs modalities available for control of chest pain in blunt chest injury and multiple rib fractures in the ranges of systemic therapy, regional therapy and trans-cutaneous therapy. Summation of evidences favours regional therapy over others.