Dolutegravir (DTG) is the most recently introduced integrase inhibitor for the treatment of HIV infection and is preferred for its superior tolerability and efficacy in both new and pre-treated patients, and infrequent drug interactions. Since January 2017, Botswana has adopted a ‘treat-all’ approach with a DTG-based antiretroviral (ARV) regimen as first-line treatment. We report a 29-year-old man with clinical stage 1 HIV infection who had been started on DTG, tenofovir and emtricitabine eight months prior, and who was admitted following a suicidal overdose of 1500 mg of DTG. He reported only minor symptoms including vomiting, epigastric pain and dizziness; which promptly resolved following supportive treatment. On admission, full blood count, liver function tests and electrocardiography were unremarkable. However, there was a non-progressive increase in serum creatinine. After a month off ARVs, he was successfully restarted on antiretroviral therapy without any serious adverse effect.
To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. Methodology: This cross-sectional study was undertaken on 351 patients with diabetes at a specialised public diabetes clinic in Gaborone between July 2017 and October 2017. Clinical, anthropometry and laboratory data were collected. Vitamin B12 deficiency was defined by levels < 150 pmol/l. Results: The mean (SD) age of the participants was 57 ( 15) years, two-thirds (67.2%) were females, and the majority (92.9%) had Type 2 diabetes. Most (89.5%) participants were on metformin. The prevalence of vitamin B12 deficiency was 6.6%. Compared with participants with normal Vitamin B12 levels, deficient participants were significantly older (64 vs. 56 years, p = 0.014) and had a longer duration of metformin use (7 vs. 4 years, p = 0.024). The use of acid blockers was also associated with vitamin B12 deficiency (p = 0.012). There was no difference in the prevalence of peripheral neuropathy between those with normal and deficient vitamin B12 levels. Conclusion: Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. Regular vitamin B12 assessment may be beneficial, especially among diabetes patients who are old, those taking metformin over a long duration and patients on acid blockers.
Background: Pernicious anaemia (PA) describes megaloblastic anaemia resulting from cobalamin deficiency that is due to the absence of intrinsic factor (IF). Most cases are autoimmune in origin, with antibodies to parietal cells, IF or the cobalamin -IF complex. Methods: We report the clinical features, investigation and treatment of a patient in whom the first presentation of PA was demyelinating brain lesions. The patient presented with clinical features initially of neurological impairment and subsequently anaemia. Imaging studies were consistent with demyelinating lesions extending from the cortex to the midbrain. Peripheral blood and bone marrow findings were consistent with megaloblastic anaemia, which were confirmed by subnormal serum cobalamin levels. The patient was treated with parenteral cobalamin and oral folic acid. Results: The patient responded with complete resolution of anaemia and complete clinical neurological response. Conclusion: Clinical, laboratory and radiologic findings are important in the screening of patients presenting with demyelinating lesions, as these may help in the diagnosis of rare cases of PA. These tests are just as relevant even in the young African female population.
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