Metronidazole-induced Metallic Taste: A Systematic Review and Meta-Analysis

Aims: This study aimed to estimate the incidence rate of metallic taste side effects in a patient who received metronidazole versus tinidazole and link it to the safety profile for metronidazole. Study Design: Systematic Review and Meta-Analysis. Place and Duration of Study: This study where written and revised in the pharmaceutical care department at general network for healthcare providers Hospital, Jeddah, Saudi Arabia. between Mar 2021 and Dec 2021. Methodology: Literature searches were conducted in the following databases: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Statistical analysis was performed using Review Manager (RevMan) Version 5.4 software. Results: Our meta-analysis of randomized controlled trials studies confirm that there is a slight increase in the rate of metallic taste adverse effects. Around one-fifth of patients who were treated with tinidazole had developed an incidence rate (5.1%) higher than the patient who treated with metronidazole. Our data shows that the incidence rate of metallic taste adverse effects in patients who received metronidazole was 15.5% (58/373) while the incidence rate in patients who received tinidazole was 20.6% (104/505). But the overall rate of metallic taste adverse effects was not statistically significantly different (RR, 1.07; 95% CI, 0.45 to 2.55; P = 0.87). also, there was statistical heterogeneity in the included studies (I2 = 75%). Conclusion: In our meta-analysis, the incidence rate of metronidazole-associated metallic taste adverse effects was slightly lower than the incidence rate of tinidazole-associated metallic taste adverse effects. It is not statistically significant as the result shows but still shifting the patient to metronidazole instead of tinidazole may decrease the incidence rate of metallic taste by (5.1%) and give good coverage for the microbial than tinidazole.

Local Anesthesia Systemic Toxicity (LAST) Treated as Anaphylaxis

Local anesthesia systemic toxicity (LAST) and anaphylaxis are the life-threatening adverse effects of lignocaine. Both have different presentations and treatments. We report a case of 35-year-old female who came to our Emergency Department (ED) with symptoms of lethargy, drowsiness, and difficulty breathing with foreign body sensation and a metallic taste in the throat which started 15 minutes after a right shoulder injection with 250 mg of lignocaine mixed with Triamcinolone in the Orthopedic Clinic. She was pushed to the resuscitation bay and was treated as anaphylaxis. Upon further evaluation, the blood pressure was never hypotensive, no sign of compromised airway, no gastrointestinal symptom, and no mucosal involvement which directs to the diagnosis of LAST rather than anaphylaxis. Surprisingly, she was gradually improving and was discharged home after six hours of observation in the ED. This is the first case report that LAST had been effectively treated as anaphylaxis.

THE EFFECT OF SMOKING STEAM COCKTAILS ON THE HARD TISSUES OF THE ORAL CAVITY

The aim of the study was the current problem of studying the impact of smoking steam cocktails on human health, as well as the development of methods for the prevention of diseases that were caused by the action of this habit is one of the main directions of the development of health protection, both in Russia and around the world. The study of dental status was carried out by means of a questionnaire, a detailed survey and a clinical examination of patients. The questionnaire was used to determine the level of evaluation of motivation to quit smoking. During the survey of patients, the subjective state of the oral cavity was determined, namely, the presence of dryness of the oral cavity, unpleasant smell, burning sensation, pain in the tongue, impaired taste sensations, and whether there was a metallic taste. Then an external examination was carried out, an examination of the vestibule of the oral cavity, an examination of the dentition itself. The intensity of dental caries was determined. According to the results of the survey, it is clear that the motivation to quit smoking is low. Data from the study in patients who use and do not use smoking mixtures showed that the intensity of caries sharply worsens depending on the length of smoking. The obtained data indicate an increase in inflammatory and destructive changes in the hard tissues of the teeth.

Case Report: A 73-year-old suspected COVID-19 patient with severe dyspnea fully recovers after reciting nine true words from Falun Gong

Background: The most common severe symptoms of coronavirus disease 2019 (COVID-19) are breathing difficulty and respiratory failure. Unfortunately, mortality of COVID-19 patients with severe breathing difficulties is high. Clinical finding and diagnosis: This report describes the case of a woman in her seventies, who could not taste anything except a metallic taste, had pains all over, low-grade fever, and who soon developed severe breathing difficulties in 15 days. At the time, her doctors described her as having suspected COVID-19 and advised her to self-quarantine at home. Interventions and outcomes: When the patient had her initial symptoms, her treating physician prescribed Tylenol which she took for 13 days. The patient initially felt better, but then developed severe fatigue, achiness within a week, and then severe breathing difficulties. The patient was sometimes unable to breathe and could not walk from her bed to the bathroom. She started feeling fearful of death after 15 days had lapsed. She then started to recite the nine Chinese characters "Fa-Lun Da-Fa Hao, Zhen-Shan-Ren Hao” daily. After she started reciting these nine true words (NTW) frequently and sincerely, the patient felt her lungs opened and she was able to breathe longer and deeper. Within three days of constantly reciting the NTW, her breathing returned to normal and all symptoms ceased. Conclusions: This suspected COVID-19 patient gained significant clinical benefits after sincerely reciting the nine-character true words from Falun Gong.

High Effectiveness of a 14-Day Concomitant Therapy for Helicobacter pylori Treatment in Primary Care. An Observational Multicenter Study

Background: The current cure rates with triple therapy combining a proton-pump inhibitor, amoxicillin and clarithromycin are unacceptably low. Aims: To evaluate the efficacy of a 14-day concomitant therapy as an empirical first-line treatment for curing Helicobacter pylori (Hp) infection in primary care. Methods: Patients from six primary care centers in Catalonia -Spain- were included consecutively. Hp status pre and post treatment was assessed according to local clinical practice protocol. A 14-day concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus omeprazole 20 mg, all drugs administered twice daily) was prescribed. Adherence to therapy and adverse events were assessed by personal interview. Results: 112 patients were enrolled. Mean age was 46.7 ± 16.1 years. Main indication for treatment was non-investigated dyspepsia (83%). Hp eradication was achieved in 100 of the 112 patients. Eradication rates were 89.3% (95% CI: 81.7–94.1) by intention-to-treat (ITT) analysis and 91.7% (95% CI; 84.6–95.9) per protocol (PP). No major side effects were reported; 104 (92.8%) patients complete the treatment. Forty-seven patients (42%) complained of mild side effects (metallic taste, nausea). Low adherence to treatment (p = 0.004) and significant adverse events (p = 0.004) were the variables associated with treatment failure. Conclusions: In primary care, a 14-day concomitant therapy is highly effective and well tolerated.

EXPANDING HORIZON IN CARIES PREVENTION WITH SILVER DIAMINE FLUORIDE- A REVIEW

Dental caries is the most common pandemic on the globe, affecting various age bars in all countries with varying degree of severity. Silver diamine fluoride provides an alternative care path for those patients in whom traditional restorative treatment cannot be done. Application of SDF to arrest dental caries is a non-invasive procedure that is quick and simple to use. Reports of available studies found no severe pulpal damage after SDF application. However, it has drawbacks like black discoloration of the carious teeth and an unpleasant metallic taste. But, the low cost of SDF and its simplicity in application suggest that SDF is an appropriate therapeutic agent for use in community dental health projects. Keywords: Silver diamine fluoride; Dental caries; Caries arrest

A STUDY ON EFFECT OF DRUG DURING IN CLINICAL MANAGEMENT OF DIABETES

Diabetes is defined as a state in which homeostasis of carbohydrate, protein and lipid metabolism is improperly regulated as a consequence of a relative or absolute deficiency of insulin secretion, resistance to insulin action or both at one or more center in tedious pathways of hormones activity. Diabetes is deadly disease in both developed and developing countries. In 2000, there were a probable 175 million people with diabetes universal and by 2030, the projected estimate of diabetes is 354 million. The most widely recognized unfavorable responses to insulin are weight addition and hypoglycaemia (Henry et al, 1993; Kudlacek et al, 1992). Weight increase in the wake of beginning insulin treatment for uncontrolled diabetes is an inescapable outcome and is the consequence of expanded truncal fat and muscle mass and severe side effects of biguanides include diarrhoea, abdominal discomfort, nausea, metallic taste, and anorexia. Keywords: Diabetes, Insulin, Biguanides and Hypoglycaemia

Neurologist, 29 years’ experience, USA

This chapter details how patients with Psychogenic Non-Epileptic Pseudoseizures present some of the more challenging cases brought to a specialist in clinical epilepsy or neurophysiology. One particular case taught a neurologist several important points about the evaluation of those who have psychogenic symptoms. First, an unreliable history is a finding. Second, examination techniques may help separate physiological from functional deficits. Third, despite these careful observations, the patient may not appreciate the efforts. The chapter then specifically looks at a case where a woman presented to the epilepsy monitoring unit with a several year history of paroxysmal events consisting of a metallic taste, bilateral scintillating scotomas, left arm posturing, and loss of consciousness with shaking. Postictal symptoms consisted of headache, amnesia, and severe fatigue. Injuries were also common. In fact, she had been intubated at least twice for status epilepticus. She was also deaf. Later, the neurologist found out that the patient had a history of sexual abuse and had seen a psychiatrist in the past for posttraumatic stress disorder (PTSD). The neurologist thus considered her history as unreliable.

Primary hyperparathyroidism on the example of a 33-year-old female patient with parathyroid adenoma

Parathyroid hyperactivity is the state of over-production and PTH secretion [1]. The most common cause of primary hyperparathyroidism is parathyriod adenoma - about 80% of cases, the remaining are parathyroid hyperplasia around 15%cases [2] [3], and in 1-5% of cases, cancer [2] [3] [4] [5]. The disease is diagnosed inabout 40 people in 100,000 [5] [6] [3] [7]. The most common cause of adenoma is the mutation in gene MEN 1. Less than 5% of cases are chronichyperparathyroidism, which is a component of the MEN 1 MEN 2a endocrine adenocarcinoma syndrome [1]. Excess PTH in the body leads to increased mobilization of calcium from the bones, and henceincreased osteolysis, what also increases the absorption of calcium from thedigestive system, as well as an increased amount of phosphate excretion in the urine. Clinical picture of the disease is multiform and often runs in a latent form. Most often the diseaseoccurs in the form of osteoporosis, chronic recurrent kidney stones, and is also commonpyelonephritis on the basis of urolithiasis. The disease may be accompanied by: dysphagia, abdominal pain, metallic taste in the mouth, persistent constipation. In addition, from the systemnervous: dizziness and headaches, disturbances of consciousness. Arrhythmia the form of additional contractions and paroxysmal tachycardia. Osteolysis, osteoporosis and pathological fractures [1]. The purpose of this article is to bring closer to the reader case of 33 years old woman with primary hyperparathyroidism on the adenoma.