Interferon-induced central retinal vein thrombosis

A middle-aged lady presented with sudden onset of unilateral central retinal vein thrombosis after completing 6 months course of interferon and ribavirin for chronic hepatitis C infection. She had no risk factors and all her thrombophilia workup was normal, however, she was found to be dyslipidemic which may have contributed to atherosclerosis and predispose to thrombosis. Despite anticoagulation, her visual acuity deteriorated. This case illustrates the possibility of unpredictable visual complication of interferon. Frequent eye examination should be undertaken in patients having underlying risk factors like diabetes, hypertension or dyslipidemia undergoing interferon therapy

Diabetic autonomic neuropathy: frequent life disabling complication of diabetes-mellitus in low socioeconomic group

To determine the frequency and pattern of au-tonomic neuropathy in diabetic patients belonging to low socio-economic group of Korangi industrial area, Karachi. A selective group of 400 [168 male and 232 female] were investigated for the pattern of autonomic neuropathy. Thorough history, detailed physical examination, ECG monitoring and all baseline investigations were done. Complete evaluation of cardiovascular, gastrointestinal, urogenital, vasomotor and central nervous system was carried out. Data was analyzed in SPSS ver.14. There were 42% male and 58% females in the study. All of the patients had poor glycemic control. Orthostatic hypotension [43% abnormal], Hand-grip test [20% abnormal] and Valsalva maneuver [46% abnormal] were performed to assess cardiovascular autonomic neuropathy. While gastrointestinal, urogenital, vasomotor and central nervous system was assessed on clinical grounds. Prevalence of 40% is high at an average diabetic duration of 5-10 years and is of considerable concern. Physicians can evaluate autonomic as well as peripheral nerve dysfunction among diabetics through simple tests. Therefore stress on patient's education and awareness about the disease, its complication, treatment modalities and glycemic control is important

Mushroom poisoning in children: clinical presentation and outcome

A variable clinical picture characterizes mushroom poisoning. The Amatoxin, the main toxic component of these fungi, are responsible for gastrointestinal symptoms as well as hepatic and renal failure. As acute gastroenteritis is extremely common in our set up, so every patient presenting with these symptoms is treated as gastroenteritis of viral aetiology. The authors present the clinical picture of the phalloid syndrome, its treatment and immediate outcome. All children age less than 16 years admitted in Saidu Hospital Swat from January to December 2006 with mushroom poisoning were included in the study. Patients with doubtful history or with associated illness were not included. The diagnosis was based on the clinical picture of the patient, history and the laboratory data. In addition to maintenance of fluid and electrolyte balance and treating sepsis, oral Silymarin and intravenous penicillin was started. Liver function tests, renal functions tests, serum electrolytes and coagulation profile was done in all the patients. The severity of poisoning was graded according to hepatic transaminase elevations and prolongation of prothrombin time. Of the 18 patients, fifteen were above five years of age. Female were twice in number. Fifteen patients developed hepatic failure and three patients developed renal failure. Thirteen patients expired. To start timely management, Mushroom poisoning should be considered in the differential diagnosis in patients presenting with food poisoning particularly coming in groups. Delay in diagnosis is associated with high mortality