Comparison of calcium acetate with calcium carbonate as phosphate binder in patients on maintenance haemodialysis

Hyperphosphatemia is common in end-stage renal disease patients. Objective of this study is to compare the hypercalcaemic effect and phosphate binding power of calcium acetate and calcium carbonate in end-stage renal disease patients on maintenance haemodialysis. This randomised control trial was conducted in four phases with calcium acetate or calcium carbonate. Sixty-four patients on haemodialysis were randomly divided into 2 groups. After a washout period of 2 weeks, each group was given calcium acetate or calcium carbonate for 2 months. After another washout period the patients were crossed over and again received these drugs for 2 months. Serum Calcium, phosphate, and albumin were analysed on Selectra E auto analyser at completion of each phase of study. Hypercalcaemic effect was defined as serum calcium >2.54 mmol/l, and phosphate binding power as serum phosphate <1.61 mmol/l. Forty-one patients completed the study. Though lower dose of calcium acetate was used, it resulted in equally good control of hyperphosphatemia as compared with calcium carbonate therapy [1.37 mmol/l [SD 0.33] vs. 1.46 mmol/l [SD 0.34], p=0.16]. Incidence of hypercalcaemia was higher with calcium carbonate therapy [2.73 +/- 0.67 mmol/l vs. 2.32 +/- 0.28 mmol/l, p < 0.01]. Both drugs were well tolerated, but patients more frequently complained of muscle cramps while taking calcium acetate. It is concluded that calcium acetate has similar effect on serum phosphate levels as compared to calcium carbonate in patients on maintenance haemodialysis. However, calcium acetate results in lesser frequency of hypercalcaemia as compared to calcium carbonate. Tolerance to both drugs was similar, though patients complained of more muscle cramps while taking calcium acetate

case of chronic liver disease. HEV induced or cryptogenic?

Hepatitis E virus [HEV] infection is known to cause epidemic outbreaks as well as sporadic disease in many parts of the world. Clinical presentation of hepatitis E varies from acute icteric viral hepatitis to severe disease with fulminant hepatic failure, and anicteric infection [no jaundice but with ALT elevation]. According to available data HEV infection does not lead to chronic liver failure. We are reporting a case of 37 years old army soldier who was admitted as a case of HEV induced acute viral Hepatitis. Later he was found to have chronic liver disease [CLD] with persistence of HEV antibodies and absence of any other detectable cause of CLD

Stress hyperglycemia and mortality in patients with acute ischemic stroke

The objective of the study was to compare mortality and morbidity in patients of acute ischemic stroke presenting with and without stress hyperglycemia. A high proportion of patients suffering an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a preexisting diagnosis of diabetes. This study was carried out in neurology units of Military Hospital Rawalpindi, and in Combined Military Hospital Rawalpindi, both are tertiary referral hospitals. The duration of study was from 1st March to 25th August, 2004. In the hyperglycemic group, out of 50 patients, 22 [44%] died within 04 weeks of stroke. In the control group, 10 [20%] out of 50 patients expired. The study showed a statistically significant relative risk of 2.2 in case of hyperglycemics as compared to normoglycemics. In the study group, mortality rate was higher in males, 14 [63%] out of 22 as compared to females of 8 [36.36%]. Even in survivors, functional outcome at 01 month was worse in the hyperglycemic group. Patients with stress hyperglycemia were 0.4 times less likely to improve as compared to normoglycemics. In non-diabetic patients suffering from an ischemic stroke, moderately elevated glucose levels were associated with a more than 2-fold higher risk of short-term mortality compared with lower glucose levels. Even in survivors, stress hyperglycemia was associated with a poor functional outcome after acute ischemic strokes