Metrondazole-induced neurotoxicity.

A 50 year old male with history of prolonged intake of metronidazole for treatment of liver abscess developed acute ataxia, disorientation, distal symmetrical sensory and proximal motor neuropathy. Patients being treated with metronidazole particularly those on high doses for prolonged period should be monitored for neurotoxicity.

Concomitant Gilbert's syndrome and thalassemia trait.

A 23 years old male presented with fluctuating jaundice since age of five years. He was diagnosed to have thalassemia trait along with Gilbert's syndrome. He had disproportionately higher bilirubin concentration for either disorder alone. The importance of the concomitance of these disorders is highlighted.

Profile of hypertension in elderly subjects.

OBJECTIVE: To study clinical profile of hypertension in elderly subjects. METHODS: Two hundred and five consecutive subjects aged 60 years and above reporting to preventive cardiology clinic with cardiovascular disorders were studied. One hundred fifty six subjects (76.09%) were found to have essential hypertension (HTN). Newly detected hypertensives were classified as per JNC-VI classification. Detailed clinical examination and laboratory investigations were carried out to find evidence of associated ailments with HTN. RESULTS: Most of the patients belonged to 60-70 years age group. Mean age was 67.36 +/- 6.23 years (range 60 to 90 years) and male to female ratio was 1.44:1. Out of hypertensives 99 (63.46%) had HTN for long period, while 28 (17.94%), 17 (10.89%) and 12 (7.67%) belonged to mild, moderate and severe HTN categories, respectively. Out of newly detected hypertensives 14 (24.56%) were having isolated systolic HTN. Associated clinical conditions in hypertensives were coronary artery disease (CAD), non-insulin dependent diabetes mellitus (NIDDM), cerebrovascular disease (CVD), left ventricular hypertrophy (LVH) and chronic obstructive pulmonary disease (COPD) in 69 (57.05%), 49 (31.41%), 37 (23.71%), 20 (12.80%) and 10 (6.4%) subjects, respectively. HTN alone was found in 31 (19.87%) subjects only. Since most of these patients had other concomitant illnesses such as CAD. NIDDM etc. therapy was initiated accordingly. Four (20%) patients with LVH died within short period of 1 to 12 weeks. CONCLUSION: HTN is the commonest cardiovascular disorder in elderly subjects. CAD, NIDDM and CVD are commonly associated clinical conditions. Patients with associated LVH have very high short term mortality.

Antianginal and cardioprotective effects of Terminalia arjuna, an indigenous drug, in coronary artery disease.

The effect of bark powder of Terminalia arjuna, an indigenous drug, on anginal frequency, blood pressure, body mass index, blood sugar, cholesterol and HDL-cholesterol was studied in 15 stable (Group A) and 5 unstable (Group B) angina patients before and 3 months after T. arjuna therapy. Tread mill test (TMT) and echocardiographic left ventricular ejection fraction was evaluated in some cases. There was 50% reduction in anginal episodes in Group A cases (P < 0.01). TMT performance improved from moderate to mild changes in 5 patients and one with mild changes became negative for ischemia. The time to the onset of angina and appearance of ST-T changes on TMT after T. arjuna was delayed significantly. However, in patients with unstable angina there was an insignificant reduction in anginal frequency. These patients also needed diltiazem, B-blockers and nitroglycerine in addition to T. arjuna. The drug lowered systolic blood pressure and body mass index to a significant level (p < 0.05) and increased HDL-cholesterol only slightly along with marginal improvement in left ventricular ejection fraction in stable angina patients. There were no deleterious effects on liver or kidney functions. Our results suggest that monotherapy with T. arjuna is fairly effective in patients with symptoms of stable angina pectoris. However, it has a limited role in unstable angina.

Acute lymphatic leukemia and pregnancy.

Acute lymphatic leukemia (ALL) was diagnosed in a pregnant patient after she presented with features of superior vena cava obstruction. Patient received chemotherapy during the course of pregnancy. A premature but normal female child was born. A brief review of literature with respect to the toxicity of cytostatic drugs to fetus and mother is made. Although adults with ALL frequently achieve a complete remission, the decision about conception and pregnancy need to be individualized because of unpredictable course.

Cranial nerve palsies in benign intracranial hypertension.

Benign intracranial hypertension may occasionally be associated with various cranial nerve palsies. A case with multiple cranial nerve involvement is presented.