Safety of Weekly Primaquine in Glucose 6 Phosphatase Dehydrogenase (G6PD) Deficient Children

Aim: To assess the Safety of weekly Primaquine in Glucose 6 Phosphatase Dehydrogenase (G6PD) deficient children, for radical treatment of Plasmodium vivax malaria Study Design: cross sectional study Place and Duration: Pediatrics Out Patient Department, Liaquat University of Medical and Health Sciences Hyderabad from 11 January 2018 to 31st August 2019 (total 20 months’ duration) Methodology: A sample of 40 patients was studied during study period. Male children between 4 years to 12 years of age having confirmed vivax malaria were included in the study. If G6PD result showed decreased level of G6PD level then, they were enrolled for study. MP was checked by thick and thin slide method. 5 ml blood was taken in anticoagulant bottle for G6PD, liver function test, creatinine, complete blood count, and reticulocyte count tests. Haemoglobin < 7 g/dL, reticulocyte count > 4, SGPT > 80, G6PD Level < 60% of normal and creatinine > 1.2 was considered significant. Treatment was given with Artemether and Lumefantrine for 3 days while Primaquine, 0 .75 mg base/kg body weights once a week was given for 8 weeks. Patients were followed at OPD initially on 3rd day of therapy then every week for 8 weeks for any hemolysis. Results: There was no hemolysis during the first week and 8 weeks after therapy. Most common side effect was abdominal pain 4 (10%). Mean hemoglobin was 11.8mg/dl. Plasmodium vivax was negative on 3rd day of therapy, it was also negative on 8 week of therapy. Reticulocyte count, Liver function test, creatinine were also normal on 8 weeks of therapy. Conclusion: Primaquine 0.75mg//kg/week for total eight weeks is highly effective for the radical cure of Plasmodium vivax in G6PD deficient children. There is no recurrence of Plasmodium vivax after 8 weeks of therapy. We found this regimen safe as there was no hemolysis demonstrated in children.

Management of a Suspected Case of Gallbladder Cancer with Individualised Homoeopathy: A Case Report

Background India has a highest incidence of gallbladder cancer (GBC) and contributes 10% of global GBC burden. The risk of GBC increases with age. The first peak of GBC occurs at 50 to 60 years and second peak at 70 to 80 years. In this article, the authors have presented a suspected case of GBC in a male patient of 65 years. Radiological reports also show presence of gallstones in this case. Studies show that four out of five persons with GBC have gallstones when they are diagnosed. The patient had pain in right upper abdomen, weight loss for few months, liver function test was highly altered and a space-occupying lesion was found in the gallbladder on radiological investigation. Patient was receiving treatment in a private medical college and hospital where computed tomography (CT) scan and magnetic resonance cholangiopancreatography detected gallbladder mass . Age of the patient, significant weight loss, presence of gallstones, abnormal liver function test and gallbladder mass have raised a suspicion of gallbladder cancer. Patient was advised for CT-guided biopsy by doctors of private hospital, but patient did not go for biopsy because of his belief that biopsy may worsen malignancy. Patient came to National Institute Homoeopathy for homoeopathic treatment to avoid biopsy and surgery. Method After proper case taking and repertorisation, a constitutional medicine Carcinosin was prescribed in Q-potency. Patient was kept under follow-up for more than a year and the patient is still under treatment. During treatment different potency of Carcinosin was prescribed in ascending scale. Results During the course of treatment, significant clinical, radiological and biochemical and pathological improvement has occurred. Conclusion Homoeopathy is among the commonly used alternative approaches in cancer. It is being widely used as palliative and curative care in patients suffering from cancer. Though studies on the use of homoeopathy in cancer after surgery, radiotherapy and chemotherapy have been reported, clinical trials on effects of homoeopathy in cancer are rare. In this case report, a suspected case of GBC was treated by higher homoeopathic dilution with significant improvement.

Abnormal Liver Function Test and Statins

Introduction: Statins or 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors are one of the foremost commonly endorsed medications in cardiac patients. A bit like any other lesson of drugs, they have the potential to cause liver harm over time indeed with reasonable utilize. This drug induced liver harm (DILI) can be either coordinate (hepatocellular) or peculiar. As with multiple other hepatic pathologies, DILI may be asymptomatic or clinically quiet. Subsequently, it is judicious to carry out liver work tests (LFTs) from time to time. LFTs are an inexpensive, noninvasive, and fast first-line examination to monitor liver status. Be that as it may, the design of liver damage with statin utilize isn't particular and a relationship over time may not be clear. Objectives: To assess the derangements in Liver function test with regard to statin utilization and decide if there is any correlation exists. Method: Retrospective Observational study conducted in Punjab Institute of Cardiology, Lahore, from 31st July 2020 to 30 June 2021. Data Collection Procedure: This study is conducted at Punjab Institute of cardiology, Lahore, a total of 100 patients admitted from 1st July 2020 to 30 June 2021 with ischemic heart diseases were considered for inclusion as this was retrospective observational cohort study. The patients already taken statin were included in this study. LFTs were noted before the start of statin in their records then during the use of statin at 3rd and 6th month with great care. The collected data was analyzed by using SPSS version 23. Results: A total number of 100 patients were included in this study after inclusion exclusion criteria. The ratio male to female is 3:2.Patients using two types of statin i.e. Atorvastatin 20mg and Rosuvastatin 10mg were included. LFTs elevation was seen in the study. Conclusion: The use of statins clinically proved insignificant elevation of LFTs and hence it is safe to prescribe. Keywords: (HMG-CoA) reductase, Liver finction tests, Statin, LFTs

Warfarin‐induced Stevens–Johnson syndrome with severe liver injury

Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a life-threatening mucocutaneous disease that is predominantly drug-induced. Warfarin is the most commonly used drug for long-term anti-coagulant therapy; however, warfarin-induced SJS/TEN is seldom reported. In this study, we presented the case of a 61-year-old man who developed SJS after receiving multiple-drug therapy following aortic valve replacement surgery. The patient was diagnosed with drug-induced liver injury (DILI) based on significantly abnormal liver function test results. Warfarin was identified as the culprit drug using the algorithm of drug causality for epidermal necrolysis (ALDEN) score, enzyme-linked immunospot (ELISPOT) assay, and Roussel Uclaf Causality Assessment Method (RUCAM). After warfarin discontinuation and corticosteroid therapy, the lesions and liver function test findings improved. Human leukocyte antigen typing was conducted to detect the risk allele. To our knowledge, this is the first reported case of warfarin-induced SJS/TEN with DILI. This case suggests that commonly used and safe pharmaceutical agents such as warfarin can potentially cause serious adverse events, including SJS/TEN and DILI. The application of ALDEN, the ELISPOT assay, and RUCAM could be useful in identifying culprit drugs.

Comparative efficacy of protein creatinine ratio and calcium creatinine ratio in determining organ dysfunction in ante-natal patients with pre-eclampsia

Aim: To evaluate the biochemical parameters in determining the severity of pre-eclampsia andcompare the efficacy between protein creatinine ratio and calcium creatinine ratio in determiningorgan dysfunction in ante-natal women with pregnancy-induced hypertension. Material andMethods: 150 cases of pregnancy-induced hypertension admitted in the labour room were studiedin the Department of Obstetrics and Gynaecology, SRMSIMS and were divided into two groups mildand severe pre-eclampsia depending on blood pressure, clinical and biochemical parameters. Variousparameters for renal function and liver function were evaluated along with fundoscopy. Results: Onthe evaluation of various parameters of renal function test and liver function test, a statisticallysignificant p-value was observed with increase in grade of pre-eclampsia. When abnormal organfunctions were compared, it was observed that PCR ≥ 0.3 is associated with 85%, 75.6% and81.25% cases of abnormal fundoscopy, deranged renal function test and deranged liver function testcompared to CCR ≤ 0.04 which was associated with 77%, 78.6% and 65% cases of abnormalfundoscopy, deranged renal function test and deranged liver function test respectively. Conclusion:The degree of derangement among biochemical parameters increases as the disease progresses.Early determination by a single test helps to predict organ involvement and correlates with diseaseseverity.