Background: Pharmacological interventions sometimes carry inherent significant risks which include adverse drug reactions (ADRs), drug interactions (DIs) and other consequences of inappropriate medication use. An adverse drug reaction (ADR) is defined in this study as a response to a drug which is noxious and unintended that occurs at doses normally used in man for therapeutic purposes. Despite the extensive study and attention given to ADRs, they still represent a clinically significant problem and burden with high incidence and prevalence. Aim: The main aim of this study was to evaluate and highlight the pattern of medications most frequently involved in ADRs and the predisposing risk factors among adult medical in-patients in clinical practice setting with the goal of preventing them and improving their treatment outcome. Methods: The patients admitted into the adult medical wards of a Nigerian University Teaching Hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven (507) patients were evaluated during the study, out of which 269 (53.1%) of them were males and 238 (46.9%) were females. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). The drugs most frequently involved in ADRs were insulin in 14 (27.5%) patients, Non-steroidal Anti-inflammatory drugs in 10 (19.6%) patients, antihypertensives in 8 (15.7%) patients, antimalarials in 5 (9.8%) patients, herbal medications in 4 (7.8%) patients and antibacterials in 3 (5.9%) patients. Furthermore, four (4) fatal ADRs were observed during the study; in which herbal medications caused two (2) deaths, sulfadoxine/pyrimethamine combination (maloxine^®) caused one (1) death, and Iron dextran caused one (1) death. The most frequently affected body systems by ADRs were the central nervous system and the gastrointestinal system corresponding to the Antidiabetic drug-insulin use causing neuroglycopenic symptoms and Non-steroidal Anti-inflammatory drugs (NSAIDs) use causing NSAID-induced gastroenteritis/GIT bleeding, respectively. The elderly age group (≥ 65 years), presence of polypharmacy (taking more than 5 different pharmacologically active medications by a particular patient at the same time) and the presence of multiple comorbidities in a particular patient are clinically proven and significant risk factors found to be associated with and predisposed adult medical in-patients to ADRs in this study. Conclusion: The negative health burden and consequences of ADRs with the predisposing risk factors were significantly high among these adult medical in-patients. In this study, ADRs increase patients morbidity, mortality and length (duration) of hospitalization. Insulin and NSAIDs caused the highest number of ADRs which indicate that adequate caution, proper care and continuous monitoring must be implemented during the course of treating patients with these drugs in order to optimize their clinical efficacy and prevent the occurrence of ADRs in them.

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A substantial proportion of traumatology involves the maxillofacial region. Injuries to this region are associated with several complications, among them being the different syndromes. These syndromes may arise depending on not only the localization of the initial injury, but also from the treatment itself. This review article aims to bring into the attention of medical community different syndromes that may be associated with maxillofacial injuries.

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Background: The aim of this study is to evaluate retrospectively prognosis and auditory function after CyberKnife (CK) stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) and to determine the radiation effects on hearing loss/preservation. Materials and Methods: The records of forty-one41 patients (24 males, 17 females) with VS who had received CK-SRS treatment were enrolled and retrospectively analyzsed. All patients underwent SRS (18 Gy in 3 sessions) between 2007 and 2012 at Tri-Service General Hospital, Taipei, Taiwan. Audiograms had been obtained before and after radiosurgery, and magnetic resonance imagingMRI and computed tomographyCT had been repeated to evaluate the tumour control rate. Age, percent tumour coverage, conformality index, new conformality index, cochlear dose, and audiometric test results were collected and analyzsed for all patients. Results: There were 41 patients enrolled in this study. The mean follow-up period of imaging studies was 56.6 ± 15.5 mo. At the postoperative assessment, there are 13 patients (76%) of Gardner–Robertson (GR) hearing maintained in Grade I and four4 patients (23%) of GR hearing changed to Grade II within those levels after treatment. There are 15 patients (62%) of GR hearing had been maintained in Grade II, and 9 patients (37%) of GR hearing changed to Ggrade I within those levels after treatment. After CK-SRS radiotherapy, 22 patients (22/41, 53%) had GR Ggrade I hearing, and 19 patients (19/41, 46%) had GR Ggrade II hearing. The patients with hearing deterioration had larger tumour volumes, lower cochlear volumes, higher cochlear radiation doses, and poorer hearing beforeprior to radiosurgery. Conclusions: Excellent tumour control and hearing preservation rates were observed for VS patients treated by CK SRS, with rates consistent with those reported in the literature. Compared with therapeutic alternatives, CK SRS is an effective tool for VS treatment and preserves hearing well.

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Background and Aim: Recurrent hemarthrosis results in synovitis and destructive arthropathy in hemophilic patients. The aim of our study was to investigate the efficacy and synovial changes with viscosupplementation therapy in treating hemophilic arthropathy of the knee. Subjects and Methods: Twenty hemophilic patients who had painful arthropathy of the knee with synovitis were enrolled. Patients received three weekly intra-articular injections of 2 mL hyaluronic acid (HA). The synovial thickness and vascularity determined by ultrasonography, visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form 36 (SF-36) were compared initially and at 1, 2, 3, and 6 months after the first injection. Statistical analysis was performed using SPSS version 20 software (Armonk, NY, USA: IBM Corp). Results: There were 19 hemophilia A patients and 1 hemophilia B patient. A total of 26 knees received viscosupplementation therapy. Significant improvement in VAS, SF-36, WOMAC score, hyperemia, and thickness of suprapatellar recess synovium from baseline was seen up to 6 months after intra-articular HA injection. No severe injection-related adverse event was observed. Conclusions: This study suggests that three weekly intra-articular HA injections are safe and effective in treating hemophilic arthropathy of knee with synovitis for a period up to 6 months. The treatment not only improved quality of life, pain and knee function but also reduced synovial thickness and hyperemia. HA viscosupplementation therapy could serve as an adjunctive therapy before arthroscopic synovectomy or total knee arthroplasty.

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Perirenal hematoma after extracorporeal shock wave lithotripsy (ESWL) is an unusual but underdiagnosed complication. Most hematomas are asymptomatic, but severe complications are possible, which may require intervention such as a blood transfusion. We present the case of a 41-year-old Asian man suffering from a symptomatic huge perirenal/subcapsular hematoma with scrotal hematoma after ESWL; we reviewed the literature and examined the possible risk factors and treatments. This case was a very rare presentation of hematoma extension into the scrotum region from an ipsilateral perirenal hemorrhage caused by shock wave lithotripsy treatment.

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Patent blue is the safest and most widely available blue dye for lymphatic mapping during breast cancer and cervical cancer surgeries. This paper reports an anaphylactic reaction to patent blue used for lymphatic mapping during breast cancer surgery where the patient presented with angioedema with bilateral eyelid and upper airway edema. Anesthesiologists should be aware of the possibility of anaphylactic reactions to any drug or substance administered during surgery.

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Spontaneous regression of an osteochondroma of the distal femur is unusual. This report highlights the spontaneous regression of a sessile osteochondroma of the distal femur in a 9-year-old boy which resolved over a 4-year period. The mechanism underlying regression of the tumor is discussed with a review of previous reports. Since this type of osteochondroma can spontaneously resolve, conservative treatment is always the first choice to avoid unnecessary surgery.

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Background: Infective endocarditis (IE) occurs with an incidence of about 3–10 per 100,000 person-years globally. Those with infective endocarditis complicated embolic events have worse outcomes. However, whether antiplatelet therapy could prevent the development of ischemic stroke and myocardial infarction remained unknown. Materials and Methods: We conducted a retrospective cohort study using Taiwan National Health Insurance Research Database to access the effect of prior antiplatelet therapy on major adverse cardiac events in patients diagnosed with infective endocarditis. Results: The clinical characteristics and the risk of subsequent major adverse cardiac events in 901 patients with infective endocarditis with prior antiplatelet therapy and a matched cohort without antiplatelet therapy were retrospectively analyzed. The majority (63%) of the patients with prior antiplatelet therapy were male and 568 (57.7%) had a high (≥3) Charlson Cormorbidity Index score. There was no significant difference in the risk of myocardial infarction, ischemic stroke, and major bleeding between the two groups. The tests of interaction showed the risk of myocardial infarction was contingent on heart failure. Conclusions: Prior antiplatelet therapy did not prevent the cerebral and myocardial infarction in those with infective endocarditis. Neither did them increase the risk of major bleeding in patients with infective endocarditis.

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Pelvic organ prolapse (POP) is the descent of the female organs that result in a protrusion of the vagina and/or uterus. Women often present with multiple complaints including bladder, bowel, and pelvic symptoms. Urinary retention was the symptom that woman presents uncommonly. Treatments of urinary retention were including removing the etiology of compression of the urethra and rescuing the normal position of pelvic organs. Surgery may be by abdominal, vaginal, or laparoscopic or robotic approach according to doctor's skillfulness, patient's need, and involving pelvic organs. Robotic technology has advantages of minimally invasive surgery such as reduced postoperative pain, shorter hospital stay, and quicker recovery times. It also has advantages of faster performance times, increased accuracy, enhanced dexterity, more accessible and more comfortable suturing, and a lower number of errors when compared to conventional laparoscopic instrumentation. Hence, it could be performed complex surgery such as this case. We present a case of multiple uterine myomas with compression symptoms and occult stress urinary incontinence. At the case of paravaginal wall defect with stress incontinence, she underwent robotic Burch colposuspension and paravaginal repair. Robotic pelvic reconstruction can be accomplished safely and efficiently and should be considered as an option for patients who had POP with urinary incontinence and who are prepared undergoing robotic surgery.

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