Drug related crisis in myasthenia gravis.

Myasthenia gravis is an autoimmune disorder where antibodies against the nicotinic Ach receptor resulting in impaired transmission at the NM junction. A number of drugs have been reported to cause neuromuscular blockade and/or to increase weakness in myasthenia gravis. We report a case of myasthenia gravis in which the calcium channel blocker-nifedipine caused the worsening of the symptoms.

Effect of granulocyte macrophage colony stimulating factor on hepatitis-B vaccination in haemodialysis patients.

OBJECTIVES: Haemodialysis patients often fail to respond to hepatitis B vaccination. There are various agents that can be used as vaccine adjuvant in chronic renal failure patients on haemodialysis. In this study, the adjuvant effect of granulocyte macrophage colony stimulating factor (GMCSF) is compared with that of control subjects. METHODS: In this study, eight patients were started on 150 mcg of GMCSF subcutaneously 24 hours prior to intramuscular hepatitis B vaccination (20 mcg of genetically engineered vaccine at the same site). The antibody response to surface antigen (anti HBsAg) in these patients were compared with those of eight control subjects who received standard three doses of monthly 40 mcg of same hepatitis B vaccine. RESULTS: In the control study, only two patients developed significant antibody response to surface antigen whereas seven of eight patients in GMCSF group developed significant antibody titres (> 10 IU/L). The sero-protection rate was 87.5% in GMCSF group and 25% in control group. CONCLUSION: This study shows that GMCSF offers significantly better seroprotection against hepatitis B compared to standard dose of vaccination in patients with chronic renal failure on haemodialysis.

Short term anti-tubercular drug therapy and hepatic microsomal enzyme activity. Antipyrine metabolism as an index.

The effect of short course chemotherapy on the drug metabolising capacity of the liver was studied in 7 newly diagnosed pulmonary tuberculosis patients, using antipyrine as a model drug. Antipyrine elimination half-life and plasma clearance rate were not significantly altered by 3 weeks of therapy. It is concluded that short course chemotherapy does not affect antipyrine metabolising enzyme activity.

Coxsackie virus and rheumatic fever. A correlative study.

Twenty-one patients of whom 13 had acute rheumatic fever and 8 had recurrence of rheumatic fever were studied for the evidence of coxsackie B viral infection using neutralisation test. A significant rise was noted in 17 cases (81%) and two cases had very high initial titre of neutralising antibodies to coxsackie B viruses type 1 to 6. Mixed infection with more than one serotype was seen in 11 cases. Coxsackie B2 was the commonest type and 14 patients had antistreptolysin 'O' anti-bodies. The high incidence of coxsackie B viral infection in rheumatic fever and the coexistent streptococcal infection and their relationship are discussed.

A comparative study of creatinine clearance rate in type I (IDDM) and II (NIDDM) diabetic patients.

The endogenous creatinine clearance test was done in 14 Type I and 15 Type II poorly controlled diabetic patients and compared with respective age matched healthy volunteers. Type I diabetics had significantly lower creatinine clearance rate, body mass index and serum albumin levels when compared to their control group. In Type II diabetics these values remained unaltered. Both Type I and Type II diabetics had significantly higher blood sugar and glycosylated haemoglobin levels. The creatinine clearance rate had significant positive correlation with patients' body mass index and serum albumin levels. This suggests that the undernutrition of Type I diabetics may be responsible for the decreased creatinine clearance.

Reaction time in clinical diabetes mellitus.

Visual and auditory reaction times were studied in patients suffering from diabetes mellitus and age matched normal control subjects. Auditory reaction times were shorter than visual reaction times in control subjects as well as diabetic patients. In diabetic patients, there was significant prolongation of visual as well as auditory reaction times. Further studies of reaction times for various modalities may provide a better insight into the neurological disturbances in diabetes mellitus.