Australasian Medical Journal
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Muscle fatigue secondary to hyperlactatemia and B2 agonists use in severe asthma crisis
Get PDFThe definition and approach of hyperlactatemia classically has been related to tissue hypoperfusion, hepatic insufficiency, and anaerobic metabolism. Nonetheless, there are few aetiologies known which could produce it. Muscle fatigue in patients with chronic obstructive pulmonary disease (COPD) or asthma, as well as the use of inhaled B2 agonist, is associated with hepatic noradrenaline release, activation of glycolysis (converting glucose to pyruvate or lactate), and consequently, an increase in lactate
Capsaicin 8% patch in trigeminal neuralgia: Case reports
Get PDFCapsaicin 8% patch has a verified analgesic effect in post herpetic neuralgia, diabetic neuropathy, surgical neuropathy and other cases of peripheral neuropathic pain.We report two cases of trigeminal neuralgia, idiopathic and post-herpetic, with cold and pinprick hyperalgesia and with poor response to antiepileptic drugs and sympathetic blockade of the stellate ganglion, treated with capsaicin 8% patch for 60 minutes covering the area of pain.In both cases observed: Repeated treatments have had similar efficacy, significant reduction in the pain area and reduction of the concomitant medication.Cold and pinprick hyperalgesia may be correlated with effective response to capsaicin 8% patch as in other studies
Tethered oral tissues as a differential diagnostic tool in infants and toddlers presenting with obstructive sleep apnea and air induced reflux
Get PDFBackgroundPaediatric dentists treating infants presenting with symptoms of gastroesophageal reflux or sleep apnoea can see a clinical improvements of symptoms of over 90% in both air induced reflux and OSA. AimsThe purpose of this paper is to open the eyes of the medical profession and health care community on need to understand that the ankylosed tongue needs to be included a differential diagnosis when evaluating infants having symptoms suggesting gastroesophageal reflux and obstructive sleep apnoea. Methods Surgical revisions using the 9300nm Carbon Dioxide Laser without the need for general anaesthetics in the dental office.Results Resolution or reduction of these problems often related to the tethered oral tissues can be seen in over 90% of infants within 24-48 hours. ConclusionAir induced reflux and Obstructive sleep disordered breathing are often the consequence of the ankylosed tongue and if allowed to go untreated can allow developmental problems which can last a life time. This may be a factor in the development of attention deficit disorder and attention-deficit/hyperactivity disorder (ADD and ADHD) in children. Early intervention can potentially intercept this from occurring
Would acetazolamide inhibit progression of atheromatous calcification?
Get PDFBackgroundVascular calcification is a recognised source of morbidity among mid-age and elderly subjects. Its development follows classical mineralisation pathways, inhibited by acidosis.AimsTo examine the argument for using acetazolamide to retard vascular calcification.ResultsThe final mechanism of tissue mineralization involves three processes, all of which are highly pH dependent. Calcium interacts with phosphate in its trivalent form, but this step is inhibited by pyrophosphate, the substrate for alkaline phosphatase. Separately, matrix vesicles create nucleation sites and indirectly disrupt vascular smooth muscle cells. Metabolic acidosis acts at every point to delay mineralization. The diuretic acetazolamide creates a sustained mild acidosis and phosphate loss and, though usually ineffective in the experimental model, has been used with success in certain clinical conditions.ConclusionWe suggest that acetazolamide, well studied and tolerated, could be trialled in selected subjects to offset the progression of vascular calcification, through its dual action of lowering tissue pH and phosphate concentration
Spontaneous coronary artery dissection with hypothyroidism in a 45-year-old man: A case report
Get PDFSpontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome in young persons, rarely found in men. There are currently no known direct causes of this condition, although some correlations have been found. We report the case of a 45-year-old man with unstable angina pectoris secondary to spontaneous diffuse spiral dissection in the right coronary artery. In addition, the patient was diagnosed with other autoimmune related diseases, for example hypothyroidism, chronic atrophic gastritis, lung emphysema, which suggesting that autoimmune mechanism is an important mechanism for the occurrence of SCAD
Amelanotic melanoma of the skin – detailed review of the problem
Get PDFBackgroundMalignant melanoma (MM) of the skin accounts for about one per cent of all malignancies in humans. Amelanotic melanoma is a rare tumour, diagnosed in eight per cent of all melanomas.AimsThe study aimed to analyse our clinical experience with amelanotic MM of the skin and the statistical data from a retrospective five year analysis of pigmented and amelanotic types of skin melanoma. Furthermore, we compare our results to those from other teams' studies. To reach the corresponding in-depth conclusions.MethodsThe study included 151 patients with malignant melanoma of the skin, diagnosed and treated at Dr. Georgi Stranski University in Pleven, Bulgaria, between 2012 and 2016. All the patients signed informed consent forms.ResultsOf the 151 patients we studied, 14 (9.3 per cent) were diagnosed with amelanotic melanoma. The average Breslow thickness in patients with amelanotic MM was 4.2mm, while in pigmented MM patients it 2.1mm. Local recurrence rates (35.7 per cent) were higher in patients with amelanotic melanoma. Distant metastases were found in 39 of all tested patients with melanoma. Of the 14 patients with amelanotic MM, eight had such metastases.ConclusionAmelanotic melanoma was diagnosed too late. Local recurrences were six times as many as the ones diagnosed in pigment melanoma. Distant metastases were twice as many, and mortality rates were three times higher
The association between depression and anti-Müllerian hormone in premenopausal women with secondary amenorrhea
Get PDFBackgroundMood disturbance has been described in women with menstrual abnormalities.AimsTo access the prevalence of depression in patients with secondary amenorrhea (SA), and investigate the relationship between depressive scores and serum anti-Müllerian hormone (AMH) levels among these women. Methods Sixty-six women with SA completed the Centre for Epidemiological Studies-Depression Rating Scales (CES-D) and Hamilton-Depression Rating Scales (HAM-D) in a university hospital. Clinical and biochemical parameters were measured in all individuals, and their associations with depressive scores were analysed.Results Among the 66 patients with SA, 42 (63.6 per cent) were diagnosed with polycystic ovarian syndrome, followed by 14 patients (21.2 per cent) with unexplained chronic anovulation, and the remaining 10 (15.2 per cent) were identified as primary ovarian insufficiency or low ovarian reserve. In the analysis of CES-D Scales, 21 (31.8 per cent) women had scores indicative of depression. Serum AMH levels and antral follicle counts were lower in patients with depressive symptoms than those in patients without depressive symptoms. (4.76±4.77ng/ml vs. 10.49±7.52ng/ml (P=0.003), 10.67±6.20 vs. 14.78±7.35 (P=0.030), respectively). The CES-D and HAM-D scores also correlated negatively with serum AMH levels after adjusting age, body mass index and androgen level (γ=-0.429, P=0.001 and γ=-0.428, P=0.001).ConclusionThis cross-sectional study showed that the prevalence of depression in SA patients was high and higher depressive scores were associated with lower serum AMH levels. This observation suggests that decreased AMH level may possibly be linked to a particular spectrum of depression in patients with SA
The patterns of abdominal trauma and factors associated with ICU admission in a major trauma center in Medina
Get PDFBackgroundTrauma is a significant health problem in Saudi Arabia. In polytrauma victims, the abdomen is the second most affected body region following the head. In the Middle East, abdominal trauma prevalence ranges from 15 per cent to 82 per cent. AimsThis study aims to assess the patterns of blunt and penetrating abdominal traumas and to assess the factors associated with ICU admission.MethodsThis is a retrospective analytical study conducted at a major trauma centre in Medina, Saudi Arabia. Admitted abdominal trauma patients from 2015 to 2018 were included. Paediatric and isolated extra-abdominal traumas were excluded. Descriptive analysis was used to identify patterns of abdominal trauma. Chi-squared test and independent t-test were applied to evaluate the association of the mechanism of injury, solid abdominal organs, associated extra-abdominal injuries, and type of injury. Multiple regression analysis was conducted to assess factors associated with ICU admission in abdominal trauma. ResultsWe included a total of 218 patients with a mean age of 32.7±13.9 years. Males (78.4 per cent) were predominantly greater in number than females (21.6 per cent). The primary mechanisms of injury were motor vehicle collisions (MVCs) (76.6 per cent), followed by stab wounds (12.4 per cent) and falls (7 per cent). The liver and spleen were the most injured organs (31 per cent and 30 per cent, respectively). Chest injuries were the most associated extra-abdominal trauma (47.2 per cent). The majority of MVC patients (88.6 per cent) had BTA, while stab wound was the main mechanism of injury in penetrating trauma (12 per cent) (P < 0.001). Penetrating trauma patients required laparotomy more than BTA patients (52.9 per cent and 8 per cent; P < 0.05). Eighteen percent of patients needed ICU admission. Factors positively associated with ICU admission (P < 0.05) were head and neck, musculoskeletal, and thoracic injuries and a moderate Revised Trauma Score (RTS).ConclusionBlunt abdominal trauma was the dominant type of abdominal injury in this study. The majority of patients were young adult males. MVCs and stab wounds were the predominant mechanisms of injury. The most affected organs were the liver and spleen. Chest injuries were the most associated extra-abdominal trauma. Factors positively associated with ICU admission were head and neck, chest, and musculoskeletal injuries and a moderate RTS