Classic Raymond syndrome

Classic Raymond syndrome presents with abducens nerve palsy on the ipsilateral side with contralateral hemiparesis and facial nerve paralysis. A 60-year gentleman presented with deviation of left angle of mouth and right sided weakness. Examination showed that he had left sided abducens nerve palsy, with contralateral central facial paralysis and paresis. MRI of brain confirmed left pontine infarct. These findings were consistent with classic Raymond syndrome. Till now, only a few cases have been reported worldwide, this being the first case reported in South Asia. This case confirms that classic Raymond syndrome is different from the common type of Raymond syndrome in terms of sparing of coritcofacial fibers in the latter type

Parvo B 19 myocarditis in immunocompetent patient

Parvo B19 virus can cause different diseases in human. It can cause myocarditis which if not treated in time can prove fatal. Here we are presenting a case of 43 years old immune-competent male who was found to be infected with Parvo B 19 virus, which was diagnosed by positive serology and PCR technique. He was successfully treated and ison regular follow up. Every clinician should consider the possibility of PVB 19 in any patient presenting with acute myocarditis

Gastrointestinal and hepatotoxic side effects of coamoxiclav in adults

Background: Co-amoxiclav which is a combination of Amoxicillin and Calvulanic acid is one of the most commonly prescribed antibiotics so there was need to study the side effects of this drug

Objectives: This study was done to enlist the adverse reactions especially the gastroinstestinal and hepatotoxic adverse reactions in patients who were prescribed co-amoxiclav

Patients and Methods: This cross-sectional study was conducted on 200 patients, both indoors and out-doors in the Department of Medicine of Khyber Teaching Hospital [KTH], Lady Reading Hospital [LRH] and Hayatabad Medical Complex Peshawar, in months of August-October of 2013. The individuals included in the study were those treated as inpatient or outpatient with the diagnoses of uncomplicated UTIs, RTIs including Sinusitis and Pneumonia and the Skin infection. Those who were below the age of 18 years, requiring more than one antibiotic, having previously known chronic disease especially the liver disease or on any long-term medications, alcoholics and pregnant ladies were excluded from the study. A detailed questionnaire mentioning the age, sex and ethnicity of the patients, indications for the use of co-amoxiclav, duration of the treatment, base line LFTs including Bilirubin, SGPT and Alkaline Phosphatase and use of any concomitant drugs was devised. The patients were asked for follow up at weekly intervals for eight weeks after the course of treatment and assessed clinically and biochemically and LFTs recorded. This study which was approved by the Ethics Committee of our hospital was self-funded by the authors and informed consent was taken from every patient. The data was processed using SPSS version 16

Results: Amoxicillin- Calvulanate combination was seen to be well tolerated by most of the patients in our study subjects and adverse reaction were noted only in 36 [18%] of the patients. The commonest side effect was diarrhea seen in 24 [12%] of the patients which was more severe in patients getting higher doses and for more than a week. Side effects were commonly seen in old patients 16 [8%] and in chronic smokers. Hepatotoxic side effects were seen in 6 [3%] of the participants mainly cholestatic type of derangement on LFTs was seen and the toxicity was Mild i.e. Grade 1 in five of them as per National Institute of Cancer's, "Common Toxicity Criteria for Adverse Events, version 4.0 [CTCAEv4]" while one developed Grade 2 Hepatocellular type of Liver injury secondary to Co-Amoxiclav. Only 2% of the patients were discontinued with the drug when they developed signs and symptoms of allergy on the 1[st] day of treatment while Oral candidiasis was seen in only 1% of the study subjects

Conclusion: Gastrointestinal and hepatic side effects are uncommon with Co-Amoxiclav and the commonest adverse reaction is diarrhea. Clinically obvious jaundice along with biochemically deranged LFTs is pretty remote possibility and can be reverted on stopping the drug and commencing the supportive treatment

Pattern of prescription of anti-hypertensive drugs and their effect on blood pressure

Background: Hypertension, one of the most common diseases, with medical treatment ranging from monotherapy to combination of drugs

Objective: This study was conducted to determine the pattern of prescription of antihypertensive agents and their effect on blood pressure control among hypertensive patients with BMI above or below 25

Patients and Methods: This cross-sectional study was conducted on 150 hospital admitted hypertensive patients from 1[st] April to 30[th] June 2012, in the department of Medicine, in Khyber Teaching Hospital, Leady Reading Hospital, Peshawar and Ayub Teaching Hospital, Abbottabad. In the study were included only the previously known hypertensive patients with or without the complications of hypertension whereas, those who were either newly diagnosed cases or treated as outdoor patients, having white coat hypertension or having vague history of hypertension were excluded from the study. A detailed questionnaire including biographic details, BMI, BP record, associated comorbidities, baseline biochemical profile including RBS, antihypertensive drug or drugs combination used, and any adverse effects, was used. The data was processed using SPSS Version 20

Results: Amlodipine was only calcium channel blocker prescribed in our study, which was given to 43 [28.7%] of all the cases, ACEi were prescribed to 45 [30%] of cases [lisinopril 20%, enalapril 2.6%, ramipril 7.3%]. ARBs were given to 7 [4.6%], diuretic were given to 48 [32%] of all the cases and beta blockers were given to 7 [4.6%] patients. Combination was given to 48 [32%] of the patients seen and as a second line therapy when one of the fore mentioned drug failed. It was noted that 125 [67%] of the patients achieved target BP of less than 140/90 mmHg, with the used of antihypertensive medication whereas, 33% of all the patients failed to achieve the target BP. It was noted that 54% of the study subjects were having DM and were obese, with 10% having nephropathy and protinurea. It was noted that 13% where having history of MI and 5% having history of strokes

Conclusion: It is concluded that Amlodipine, lisinopirl and diuretic are leading drugs used in tertiary care hospitals of Khyber Pakhtunkhawa. It was noted that antihypertensive drugs gradually lose their effectiveness in controlling BP as the BMI increases