ABSTRACT
Amiodarone is a highly effective treatment in various cardiac arrhythmias however, with number of side effects. Recent studies and case reports found that chronic treatment with amiodarone can induce toxic changes in different parts of the eye. The aim of this work is to study ocular toxic manifestations induced by chronic administration of amiodarone in cardiac patients, its consequence on eyesight, and its correlation with the dose and the duration of treatment, by measuring visual acuity, visual field assessment, slit lamp and fundoscopic examinations. Control group [group I] was: 12 healthy volunteers. Twenty four cardiac patients on amiodarone therapy were classified into 2 groups, group II: receiving oral dose of amiodarone 200 mg/d, group III: receiving oral dose of amiodarone 400mg/d, for less than 1 month. All patients were submitted to ophthalmic examination every 3 months for 12 months. It was found that amiodarone [200 mg/d] after 3 months did not induce ocular changes. After 6 months, bilateral corneal deposits of grade 1 and 2 were noticed in 58.3% of patients. After 9 months, 75.0% of patients showed corneal lesions of grade 3. At the 12[th] month, 83.3% of patients were affected, with a non significant difference between the mean values of visual acuity as compared with the control group [P>0.05], normal visual field and absence of retinal toxic changes all through the study. 66.6% of patients received amiodarone [400 mg/d] had bilateral corneal deposits of grade 1 and 2, after 3 months. After 6 months, 91.6% of patients were affected. At the 9th month, 100% of patients had vortex verticillata of grade 3. At the 12[th] month, keratopathy of grade 3 and 4 was obviously detected in all patients [100%]. Regarding visual acuity, after 6 months of amiodarone administration, 2 patients had mild diminution of vision and visual field defect. Fundus examination revealed toxic retinopathy in the both patients. After 12 months, bilateral optic disc swelling was noticed in one patient and necessitated discontinuation of the drug. Follow up of those patients after discontinuation of amiodarone, showed slight improvement after 3 months. After 6 months, visual fields showed significant improvement with normal optic disc in one patient. The other patient showed complete resolution of the left optic disc swelling with minimal swelling in the right one. It was concluded that chronic administration of amiodarone induces reversible ocular toxic changes including retina and optic disc, can be detected at the first 3 months of therapy, increase by the dose and the duration of treatment that may necessitate discontinuation of the drug. Periodic ophthalmic examination is a valuable measure for early detection of ocular toxicity
Subject(s)
Humans , Male , Female , Retina , Papilledema , Corneal Opacity , Follow-Up Studies , Visual AcuityABSTRACT
Praziquantel [PZQ] is widely and effectively used in the control of bilharziasis which constitutes a major endemic health problem in Egypt. However, recent studies recommended that the drug must be re-evaluated because of its potential carcinogenicity and genotoxicity. Mirazid is a new natural anti-schistosomal drug formed of myrrh extract and considered to be a safe drug. This work was conducted to evaluate and compare hepatotoxic, genotoxic and carcinogenic effects of PZQ und mirazid on adult male albino rats by assessment of serum levels of ALT, AST and bilirubin, histopathological study of the liver and cytogenetic study of bone marrow cells. 100 adult male albino rats were equally divided into 4 groups: group I negative control, group II control rats received distilled water, group III received weekly single oral dose of PZQ [1500 mg/kg] for 6 weeks and group IV received daily oral dose of mirazid [500mg/kg] for 6 weeks. At the end of the study, 10 rats of each group were investigated by assessment of the levels of AST, ALT, and bilirubin. After scarification, liver sections were examined by light microscopy. Another 10 rats of each group were submitted to cytogenetic examination. It was found that praziquantel induced a significant increase in the mean values of AST, ALT and bilirubin with areas of hyaline degeneration, fatty changes, dysplasia and necrosis in the liver sections. It also induced a significant increase in the incidence of chromosomal aberrations as polyploidy, fragment, deletion and ring chromosome as compared with control group. Mirazid induced an insignificant increase in the mean values of AST, ALT and bilirubin with a normal hepatic tissue and an insignificant increase in the incidence of chromosomal aberrations as compared with the control group. On comparing both drugs, praziquantel induced a significant hepatotoxic, genotoxic and carcinogenic effects. It was concluded that praziquantel is considered to be a hepatotoxic, genotoxic and carcinogenic drug. On the other hand, mirazid seemed to be a safe and promising antiparasitic drug, free from hepatotoxic, genotoxic and carcinogenic effects