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Renal disease is a common complication in malaria infection. In acute falciparum malaria renal involvement is usually mild, but in severe disease acute renal failure is a major problem. Acute renal failure has been attributed to ischaemic tubular necrosis from hypovolaemia resulting from vasodilatation due to endothelial injury. Though myositis is recorded as a common manifestation in falciparum malaria, only 1 case with myositis and myoglobinuria with acute renal failure has been documented; but no renal biopsy was performed in the patient. In the present study we examined the case of a 17-year-old man with severe falciparum malaria with myositis and myoglobinuria who developed acute renal failure requiring dialysis. Muscle biopsy revealed severe myositis with macrophages and T lymphocytes including CD4+ cells. The kidney biopsy showed scanty T cells and macrophages in the glomeruli which were only mildly hypercellular. The renal tubules showed myoglobin casts in the lumen and foci of interstitial inflammatory cells, including macrophages and T lymphocytes but no CD4+ cells. Rhabdomyolysis induced by macrophages and T cells with myoglobinuria and acute renal failure is a problem in severe falciparum malaria infection.

Sixty patients were enrolled In a prospective, randomized study to evaluate the efficacy of two different regl mens for the empirical treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. At presentation, Group I received Intraperitoneal vancomycin (1 g) and oral pefioxacin (400 mg b.l.d.), and Group II Intraperitoneal vancomycin (1 g) and gentamicin (80 mg loading dose, followed by 15 mg/2 L). Treatment duration was 14 days. Despite randomization, Group I had significantly more patients with primary Candida peritonitis. When fungal peritonitis was excluded from analysis, there were no significant differences In the treatment success rate (Group I, 73.3% vs Group II, 80.0%, p=NS), number of relapses (Group 1,0 vs Group II, 1), and Tenckhoff catheter removal rates (Group 1,26.6% vs Group 11,16.6%, p=NS) between the two groups. The patients treated with pefioxacin had an increased incidence of nausea and vomiting. In selected situations oral pefioxacin may be a suitable substitute for intraperitoneal gentamicin as outpatient therapy for CAPD peritonitis.

Polypharmacy is common in hemodialysis patients. The objective of this study is to identify drug‐related problems (DRPs) in hemodialysis patients, intervene, and resolve them. All patients undergoing dialysis at a hemodialysis center were enrolled into the study. Patients who had been hospitalized during the study period were excluded. DRPs were identified after thorough review of the patients’ medication and clinical records. DRPs were classified into 8 categories and any DRP that did not fit into the 8 categories was classified under ‘Others.’ Appropriate recommendations for the resolution of the DRPs were presented to the nephrologist in‐charge of the center and action taken. Accepted recommendations were deemed as interventions and assigned a significance rank on a scale of 1 (adverse significance) to 6 (extreme significance). Where recommendations were accepted, monitoring was carried out 2 weeks later to assess the clinical outcome of the intervention. A total of 35 patients were studied. 31 patients completed the study, 4 were lost to follow‐up. In a 3‐month period, 83 DRPs were identified and 73 interventions (88%) made. A mean of 2.7 ± 1.1 DRPs were detected per patient. Drug underdose constituted the most common DRP accounting for 35% of all DRPs. 62% of the accepted recommendations were classified as significant and given a rank of 4/6. On follow‐up, 54% of the interventions showed improved clinical outcomes. DRPs are prevalent in hemodialysis patients. The introduction of clinical pharmacy services can potentially contribute to many aspects of healthcare in hemodialysis patients through the detection and resolution of DRPs. Where clinical pharmacy services are not available, clinicians should be vigilant regarding polypharamcy and the occurrence of DRPs.

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