Spectrum of drug-induced liver injury in a tertiary hospital in southern India

BACKGROUND Anti-tuberculosis drugs are thought to account for about 50% of drugs that cause liver injury in India. We show that the spectrum of drugs is much wider than previously reported. METHODS We evaluated all patients with unexplained acute liver injury presenting during 2006–2016 using a structured proforma for drug-induced liver injury (DILI). The Roussel Uclaf Causality Assessment Method was used to assess causality. RESULTS DILI was found in 143 of 2534 patients with acute liver injury. Nineteen patients had probable ayurvedic DILI. The other common causes of DILI were statins (16 patients) and anti-tuberculosis drugs (11 patients). Eight patients had DILI post-liver transplant. Fluconazole was the most common cause of post-liver transplant DILI. Chronic DILI (abnormal liver function test after 12 months of stopping the suspected drug) was found in 2 patients. CONCLUSION In otherwise unexplained acute liver injury, DILI due to ayurvedic drugs should be sought. DILI should be considered in post-liver transplant patients. Patients with DILI should be monitored for at least 12 months to exclude progression to chronic DILI.

Suboptimal knowledge of hepatitis B infection and concerns regarding HBV vaccination among blood donors in Lao People’s Democratic Republic (PDR) / Lao Medical Journal

Background@#There is a high prevalence of HBsAg in adults in Lao PDR, as seen in first-time blood donors. The high positive rate is also detected in repeat donors although the cause is unclear. By surveying blood donors, this study examines the general population’s knowledge level of HBV infection and assesses the public’s perception of vaccination.@*Objective@#The aims of this study were to assess knowledge, attitude and practices (KAP) of blood donors regarding HBV infection. @*Methodology@#We conducted a cross-sectional study to collect the KAP information among consenting students of high school and university in March-September, 2018. A self-answered questionnaire was also utilized among blood donors in Vientiane Capital, Luang Prabang and Khammuan Provinces. The questionnaires were distributed and completed in the classroom setting with investigators proctoring. Descriptive analysis was performed on the socio-demographic characteristics, Student’s T-test were performed to examine the difference of mean and linear regression models the association between dependent and independent variables. @*Results@#Among 625 blood donors (132 health science students and 477 non-health science students), all had a positive attitude towards blood donation, but they had low knowledge towards hepatitis infection and prevention. Multivariable analysis showed that x factors were significantly associated with HBV vaccination. This included gender, level of education, being a health science student, HBV positivity status and awareness not to donate blood and knowledge towards vaccination. HBV vaccination hesitation was observed in blood donors who did not know that vaccination can prevent infection, and most blood donors (76.9%) answered that they were healthy so did not see the need for the vaccine and did not understand this vaccination method as prevention. A fear of injections, belief that they would not be able to drink alcohol for two weeks surrounding vaccination and that it was not necessary to prevent HBV infection were reasons given to not seek HBV vaccination.@*Conclusion@#Blood donors had overall poor knowledge on hepatitis B infection and prevention, particularly among the non-health student donors. Blood donors should be aware of and understand their HBsAg testing status and broaden their perception and knowledge on HBV infection and prevention.

Management of simple plantar ulcers by home based self-care.

Seeking a solution to bring down the prevalence of simple plantar ulcers in the field, Damien Foundation India Trust (DFIT), Chennai, developed a curriculum to teach the field staff of all its projects. The purpose was to make patients self-reliant in the care of their plantar ulcers in their homes. The strategy used was to make patients take care of their ulcers using tools found in their homes and surroundings and become responsible for the care of their limbs. This strategy was implemented in eight projects of DFIT and the programme was followed regularly for one year. Regular monitoring and evaluation showed that under this strategy the prevalence of plantar ulcers was reduced by about 50%.

A study on the effect of patient and community education in prevention of disability programme.

The effect of self-care learning by leprosy patients in prevention of disabilities was studied by adapting two strategies in two subcentres of a project in South India, one through patient education by trained field staff and the other through community education involving trained animators and health committees. One of the subcentres was taken as control where neither of the strategies was employed. In terms of results, though both the strategies were found to be effective in containing occurrence of new deformities among high risk patients and healing of trophic ulcers in hands and feet, strategy I i.e. self-care education of patients by concerned field personnel without prejudice to their routine work is recommended because of ease in diffusion of strategy.