No abstract

: Loperamide hydrochloride is an over-the-counter anti-diarrheal agent, acting via mu-opioid receptor agonist effects in the intestinal myenteric plexus. Although preclinical investigations suggested that abuse liability associated with loperamide use is low, there are increasing numbers of cases reported to the US Food and Drug Administration, of abuse, dependence, and withdrawal associated with loperamide use. A case of a patient with opioid use disorder, that is, in the form of protracted loperamide excess use, requiring management of withdrawal with methadone is presented. Management of withdrawal from abrupt loperamide discontinuation has not been discussed in the literature. Long-term treatment issues are also described.

Purpose: The number of deaths due to wheat pill poisoning is enormous and despite aggressive management only a fewpatients survive the fatal effects of the wheat pill poison. Despite the growing number of patients appearing in the emergency departmentswith this easily available poison in the market, very little effort has been put forth to study the subject scientifically and to prevent theongoing loss of precious lives. This is a narrative review of the wheat pill poisoning, highlighting the important steps in diagnosis andmanagement. Methods: Data sources include Pubmed, Scopus, Medline (1996 to date), Cochrane library and Google scholar. Weincluded all clinical trials, systematic reviews and ongoing cohort studies. Conclusions: Wheat pill (Aluminum Phosphide) poisoning is alethal toxin and its effective treatment requires prompt diagnosis and early, time-efficient management. Early transfer to a healthcarefacility, good resuscitation, diagnosis, monitoring, gastric lavage and supportive therapy are the hallmarks of management and may resultin improved outcomes. The governmental and legislative authorities must take appropriate steps towards limiting its availability at thegrass-roots level. Aluminum Phosphide poisoning must be a part of the medical students’ curriculum and long-term, well-designedcomprehensive research studies are required to discover new modalities of treatment.

Background: There is an overwhelming concern around the world regarding the increasing number of resistant strains of microorganisms in all sorts of wounds. There is hardly any information about the prevalence and incidence of such resistance pattern in our local hospitals Methods: This study was done to probe into the common microorganisms and their culture sensitivities to antibiotics in surgical wound infections in general surgery wards of Mayo hospital. The study material included the pus specimens sent to pathology lab from general surgical wards. There culture sensitivity results were interpreted to find out the prevalence of individual microorganisms in surgical wounds and sensitivities and resistance to different antibiotics. Results: Staphylococcus aureus was the most common organism cultured (54.87%), followed by E.Coli (10%), pseudomonas(10%), proteus (7.9%) and kleibsiella (5.3%). 20 percent of wounds had mixed growth of organisms. Mixed growth of microorganisms was seen in 20% of cases. Conclusion: Most of the bacteria cultured were resistant to routinely used antibiotics.

Xeroderma pigmentosum comprises of a heterogeneous group of autosomal recessive hereditary diseases, which are characterized by a number of clinical characteristics and abnormal DNA repair mechanism. These patients are prone to multiple cutaneous malignancies at an early stage in life. We present 2 cases of xeoderma pigmentosum with malignant melanoma and conclude that such cases must be identified at an early stage and properly educated to protect themselves from malignancies.