Cost, efficacy and safety of aminosidine [paromomycin] in the treatment of visceral leishmaniasis

To compare Aminosidine as a single agent in the treatment of visceral leishmaniasis with antimony compounds. Open non-randomized, interventional study of three drugs used in Pakistan for visceral leishmaniasis. Military hospitals at Muzaffarabad Azad-Kashmir and Rawalpindi [reservoir for visceral leishmaniasis in Pakistan] over a period of five years. Children up-to 12 years of age diagnosed as visceral leishmaniasis [LD-bodies positive]. Patients were divided into three groups of 30 patients each. Every patient received either sodium stibogluconate or meglumine antimonate @ 20 mg/kg/day for 28 days or the trial agent Aminosidine @15mg/kg/day for 21 days. Most patients were less than 36 months of age [82.2%] while there was male predilection [1.2:1]. Fever, hepatosplenomegaly and pancytopenia were seen in 100% cases with malnutrition in 71%, cough in 51%, lymphadenopathy in 23.3% and bleeding diathesis 40% being the other common features. Three agents were found to be effective [to a different degree] as regards defervesence, reduction in size of enlarged organs, recovery of bone-marrow function manifested by improvement in hematological parameters. No major side effects were detected clinically or by laboratory studies. Cost of therapy was also remarkably lower for aminosidine as compared to the antimonials. Aminosidine as a single agent is much cheaper, effective and a safe drug suitable for treatment of visceral Leishmaniasis in Pakistan

Role of strictureplasty in the management of tuberculous strictures of small intestine

To evaluate the outcome and assess the reliability of strictureplasty in the management of small intestinal strictures due to tuberculosis. A retrospective observational and descriptive study. PNS-Shifa, Karachi. Clinical data of cases of intestinal tuberculosis reporting over a period of five years-[Aug 1999-to-Aug 2004] was studied. Thirty patients with small intestinal tuberculosis who underwent strictureplasty alone or in combination with limited resection were selected for the study. In 20 cases [66.67%] the strictureplasty was performed in combination with limited resection. Remaining 10 cases [33.33%] were managed by strictureplasty alone. Anastomotic leakage with fistula formation occurred in 3 cases [10%], Burst abdomen occurred in 2 cases [6.67%]. Sub-diaphragmatic abscess formation occurred in 3 cases [10%]. On prolonged follow-up averaging two years, re-admission was required in 5 cases [16.67%]. Re exploration to relieve obstruction due to adhesions was required in 2 cases [6.67%]. Late incisional hernia was seen in 4 cases [13.33%]. There was no procedure related mortality. Strictureplasty is a simple, quick, and safe operative technique to manage tuberculous small intestinal strictures, in combination with limited resection or as a sole procedure