Drug-Induced Deafness: A Rare Case of Bilateral Sensorineural Hearing Loss Following Speedballing.

Many users of recreational drugs use cocaine and opioids together, often called "speedballing." Hearing loss is a rarely reported adverse effect following recreational drug abuse. Only one case has been reported in history with hearing loss caused by speedballing. Here, we present the case of a 38-year-old female who presented with speedball abuse and new-onset bilateral hearing loss to the emergency department. A computed tomography scan of the head was unremarkable. She was treated with thiamine, folate, multivitamins, and intravenous fluids. The hearing loss improved without any acute intervention. The significance of sudden hearing loss due to recreational drug use is highlighted by this case. Apart from a few animal studies, there is no detailed research explaining the pathophysiology of speedball-induced hearing loss. Further studies and trials are needed to better understand the effects of combined and separate cocaine and opioid use on audiologic physiology.

Toxicity of Metformin and Hypoglycemic Therapies.

Metformin along with other antidiabetic medications provide benefit to patients in the treatment of type 2 diabetes mellitus, but caution is advised in certain scenarios to avoid toxicity in kidney disease. Renal dosing, monitoring of kidney function, and evaluating the risk of developing serious side effects are warranted with some agents. The available literature with regard to incidence of adverse events and toxicity of hypoglycemic therapies is reviewed.

Spinal Abscess Caused by Salmonella Bacteremia in a Patient with Primary Myelofibrosis.

BACKGROUND In Primary Myelofibrosis (PMF; a clonal disorder arising from the neoplastic transformation of early hematopoietic stem cells) patients, spinal cord compression (SCC) is a common complication or even a presentation symptom due to extramedullary hematopoiesis (EMH). However, a case of SCC caused by a spinal abscess is unusual. To the best of our knowledge, this is the first case report of this rare condition. CASE REPORT We are reporting the case of a 50-year-old male with primary myelofibrosis and long-standing splenomegaly with back pain as a presenting symptom who was found to have spinal cord compression. An MRI was performed, as EMH was suspected. The blood cultures revealed an infection with Salmonella, so the patient was placed on ceftriaxone, with no response. The patient demonstrated substantial clinical improvement after 2 weeks of neurosurgical intervention and pain management. CONCLUSIONS In PMF patients, back pain with fever or mild neurological symptoms needs to be investigated urgently because of the high risk of irreversible spinal cord damage leading to partial or complete loss of functional independence and shortened survival. The compression could be related to EMH or infections due to an immunodeficiency.