Hepatotoxicity with antituberculosis drugs: the risk factors

To assess the severity and frequency of hepatotoxicity caused by different antituberculosis [ATT] drugs and to evaluate whether concurrence of risk factors influence the antituberculosis drug induced hepatotoxicity. This prospective cohort study was conducted in Medical Unit-V and OPD department of Civil Hospital Karachi from July 2004 to July 2005. A total of 339 patients diagnosed of active tuberculosis infection with normal pretreatment liver function were monitored clinically as well as biochemically. Their data were collected on proforma and patients were treated with Isonized, Rifampicin and Pyrazinamide. Duration after which derangement in function, if any, occurred and time taken for normalization was noted. Treatment was altered as needed, with exclusion of culprit drug. Finally data was analyzed by SPSS version 10.0. ATT induced hepatotoxicity was seen in 67 [19.76%] out of 339 patients. Females were more affected as compared to males [26.3% vs. 19.7%]. BMI [kg/m2] of 91% of diseased group were less than 18.5 [p<0.01] most of them were anemic having low albumin level suggestive of lean body mass. Hepatotoxicity was more severe in AFB smear positive patients. Concomitant use of alcohol, paracetamol and low serum cholesterol were proved as predisposing factors. Isoniazid [37 patients [55.21%], p<0.01] was the main culprit followed by Rifampicin [23 patients, 34.21%] and Pyrazinamide [7 patients, 10.5%]. Most of the patients [61%] developed the hepatotoxicity within two weeks of starting antituberculosis therapy with mild to moderate alteration in ALT and AST. ATT-induced hepatitis is significantly more frequent and more severe in patients with hepatotoxicity risk factors

Falciparum malaria: various presentations

This study was conducted to evaluate the modes of clinical presentations of falciparum malaria. Descriptive study. Medical Unit 5, Civil Hospital Karachi and Ankle Sria Hospital Karachi from August 2003 to December 2005. A total of 348 patients admitted with fever were screened with peripheral blood smear for malarial parasite. One hundred and twenty two patients were smear positive. One hundred and eight were positive for plasmodium falciparum, which were included in this study. Eleven patients were positive for plasmodium vivax and three patients had co-infection with plasmodium falciparum and P.vivax which were excluded. Critically ill patients were given injectible Quinine sulphate, rest of them were given either Halofantrine or Artemether orally. Out of 108 P. falciparum smear positive patients, males were 74 [68.51%] and females were 34 [31.48%]. Fever was present in all patients. Jaundice was observed in 39 [36.11%], vomiting in 32 [29.62%], abdominal pain in 23 [21.29%], altered state of consciousness in 26 [24.07%], diarrhea in 9 [8.33%], cough in 8 [7.40%] and seizures in 2 [1.85%] patients. Out of 108 patients 22 [20.37%] patients presented with cerebral malaria, 8 [7.40] with picture of respiratory tract infection, 9 [8.33%] patients presented with acute gastroenteritis, 9 [8.33%] with acute abdomen simulating the picture of acute pancreatitis but serum amylase and ultrasound abdomen excluded the diagnosis of acute pancreatitis. Six [5.55%] presented with the picture of acute hepatitis and 4 [3.70%] presented with fulminant hepatic failure with raised serum ammonia levels and hepatocellular jaundice with negative viral markers for hepatitis B, C and E. Three [2.77%] patients presented with a picture of acute renal failure. Apart from these, many patients were seen with various presentations of acute abdomen, clinical picture of lower respiratory tract infection, acute hepatitis with Fulminant hepatic failure being notorious. Falciparum malaria should be considered as a possibility in all febrile patients even with various presentations for malaria

Hypokalemic quadriparesis with normotensive primary hyperaldosteronism

This case report describe a 45 years old female who presented with hypotonia, hyporeflexia, and motor weakness of all four limbs with bilateral flexor planter response due to severe hypokalemia. The patient was finally diagnosed as a case of normotensive primary aldosteronism. Her CT scan abdomen was done which excluded adrenal adenoma. Aldosterone antagonist led to excellent response and recovery