ABSTRACT
Background: Hepatic encephalopathy [HE] is among the commonest complications to present in the medical emergencies due to chronic liver disease [CLD]. Multiple regimens have been tried and newer antibiotic like Rifaximin is under extensive discussion regarding its management. Objective: To determine the efficacy of rifaximin in cases of chronic liver disease presenting with hepatic encephalopathy
Methodology: In this descriptive cases series study, which was conducted at Department of Medicine, Services Hospital, Lahore from 1st July to 31st December 2016. The cases of both genders with age range of 30-70 years, having CLD [Child Pugh Class B and C] and acute hepatic encephalopathy of grade II or more irrespective of the cause were included in this study. The cases with other co morbid conditions like DM, hypertension, renal or cardiac failure and those taking sedative, were excluded from this study. Hepatic encephalopathy was labeled according to the West Haven Criteria. The cases of HE were given Rifaximin in a dose of 550 thrice a day for 7 days and complete resolution of hepatic encephalopathy at 7th day was labeled as positive efficacy. Data was analyzed by using SPSS 20
Results: In this study, there were total 300 cases out of which 170 [56.67%] were males and 130 [43.33%] females. There were 150 cases in each child pugh class B and C and 114 [38%] cases had grade IV hepatic encephalopathy. Efficacy of rifaxamin was seen in 164 [45.33%] cases. The efficacy was significantly high in cases that had Child Pugh Class B where it was seen in 104 [69.33%] cases as compared to 60 [40%] in class C with p value of 0.03. Efficacy was also significantly better in grade III encephalopathy 70 [72.91%] cases in contrast to 34 [29.82%] cases with grade IV with p= 0.001
Conclusion: Rifaximin is good antibiotic for gut flora but it relieves hepatic encephalopathy in only half of cases. It is significantly better in cases with Child pugh class B and with encephalopathy grade III
ABSTRACT
Tuberculosis meningitis [TBM] is a serious public health problem in developing countries as it leads to significant mortality and residual neurological squeal. The estimated mortality due to TBM in Asia is 1.5 per 100,000 populations
Objectives: To determine the frequency of hydrocephalus in cases of TBM
Methodology: This was a cross sectional study conducted during July 2016 to December 2016 conducted at Department of Medicine Services Hospital, Lahore. The detailed demographic data was collected. Cases fulfilling the criteria of TBM underwent CT scan of brain [with IV contrast] for confirmation of TBM at the Department of Radiology, Sheikh Zayed hospital Rahim Yar Khan
Results: In this study there were 93 cases, out of which 54 were males and 39 females with mean of 34.13 +/- 9.45 years. Hydrocephalus was seen in 61 [65.59%] out of 93 cases of TBM. It was seen significantly higher in male group where it caused it in 40 out of 54 males [74.1%] with p value of 0.04 [table 1]. In context of age groups with respect to hydrocephalus it was seen maximum in patients with age group of 31 to 40 years affecting 12 [80%] out of 15 of its respective group. It was followed by 41 to 50 years affecting 28 [68.3%] of 41 cases, though this difference was not found statistically significant with p value of 0.24. Hydrocephalus was observed maximum in stage I of TBM where it affected 4 out of 5 cases followed by stage II with 36 of 52 cases and then stage III with 21 of 36 patients. This difference was also not significant with p= 0.44
Conclusion: Hydrocephalus is an important and deadly complication of tuberculous meningitis and is noted in every 2 [65.59%] out of 3 cases. There is significant association of male gender with hydrocephalus