Introduction Capreomycin is a second-line drug often used for multidrug-resistant tuberculosis which can result in nephrotoxic effects similar to other aminoglycosides. We describe a case of capreomycin induced Bartter-like syndrome with hypocalcemic tetany. Case Report 23-year-old female patient presented with carpopedal spasms and tingling sensations in hands. Patient was being treated with capreomycin for two months for tuberculosis. On further investigation, hypocalcemia, hyponatremia, hypomagnesemia, hypokalemia, and hypochloremic metabolic alkalosis were noted. Vitamin D and serum PTH levels were within normal limits. Hypercalciuria was confirmed by urine calcium/creatinine ratio. Calcium, potassium, and magnesium supplementation was given and capreomycin was discontinued. Electrolytes normalized in two days after cessation of capreomycin with no further abnormalities on repeat investigations. Discussion Aminoglycosides can result in renal tubular dysfunction leading to Fanconi syndrome, Bartter syndrome, and distal tubular acidosis. Impaired mitochondrial function in the tubular cells has been hypothesized as the possible cause of these tubulopathies. Acquired Bartter-like syndrome phenotypically resembles autosomal dominant type 5 Bartter syndrome. Treatment consists of correction of electrolyte abnormalities, indomethacin, and potassium-sparing diuretics. Prompt diagnosis and treatment of severe dyselectrolytemia are warranted in patients on aminoglycoside therapy.
Objective: Plasmodium vivax (P. vivax) infection has been considered for a long time a benign and self-limited disease. Percentage of complicated cases of vivax malaria is on the increasing trend, cerebral malaria being the most dreaded and a potentially life-threatening complication. Material and Methods: A prospective observational study was done after institutional ethics committee approval from July 2011 to February 2012 at tertiary care hospital in Mumbai. We studied the clinical profile and outcome of all the 48 patients above the age of 12 years diagnosed with Cerebral Malaria. Results: Incidence of neurological manifestations of vivax malaria in our hospital was 14.15%, with 32 (66.7%) out of 48 patients being males. The mean age of patients with neurological manifestations of vivax malaria was 29.66 years in discharged patients and 50.88 years in expired patients. Altered sensorium 37 (77.1%) followed by convulsion 28 (58.3%) were common findings, but focal neurological deficit, Bell's palsy, ataxia, psychosis were also seen. Mortality was higher (62.5%) in patients with premorbid conditions (p value <0.05) and that of with other system involvements (87.5%) including hepatic, renal, hepatorenal, pulmonary involvement (p value<0.05). Association between outcome with older age & high parasite index patients is significant (p value<0.001), however no such significant association was found in terms of gender distribution. Conclusion: Plasmodium vivax, as has been traditionally believed, is no longer a benign species and is causing presentations akin to P. falciparum. It is imperative that clinicians are aware of and ready to handle the complications caused by Plasmodium vivax.
INTRODUCTIONWarfarin is widely used anticoagulant in treatment and prevention of thrombosis, in chronic atrial fibrillation, mechanical valves, and pulmonary embolism. Despite its common use, warfarin can be associated with bleeding complications.1-3 Achieving a safe therapeutic response can be difficult because of its narrow therapeutic index (1-20mg/d) and great variability in dose required, which is mostly a consequence of individual genetic variants and environmental factors like age, gender, diet, drug interactions. To maintain a therapeutic level, warfarin therapy requires intensive monitoring via INR. Bleeding is most common effect of warfarin toxicity. 4,5 Major bleeding complications include GI haemorrhage, intracranial bleeding, and retroperitoneal bleeding. Minor bleeding complications include subconjuctival haemorrhage, haematuria, epistaxis, and ecchymoses. A review of many studies show average yearly rates of warfarin related bleeding as high as 0.5%, 4.9% , 15% for fatal, major, minor bleeding complications. In spite of ABSTRACT Background: Warfarin is widely used anticoagulant in treatment and prevention of thrombosis. Despite its common use, warfarin can be associated with bleeding complications because of its narrow therapeutic index. A review of many studies show average yearly rates of warfarin related bleeding as high as 0.5% , 4.9% , 15% for fatal, major, minor bleeding complications. The study is to determine age, gender, pharmacogenetics, drugs influencing warfarin toxicity in Indian patients. Methods: Observational and cross-sectional study was conducted over period of 1 year after obtaining institutional ethics committee permission. Written and informed consent was taken from patients admitted in tertiary care hospital who fulfilled inclusion and exclusion criteria. Results: Most common age for Warfarin toxicity in our study was between 30 to 39 years (22.5%) with mean of 42.9 years. Bleeding risk was higher in elderly with 14 out of 26 patients with age >50 years had bleeding manifestations. Toxicity was more prevalent in female (60%). 40% patients were on drugs interacting with warfarin; NSAIDS (Nonsteroidal Anti-Inflammatary Drug) and antibiotics were the most common interacting drugs. In our study, 17.5% patients had acute liver disease and one patient had deranged creatinine (2.6). 40% of patients had VKORC1 variants and 35% of patients had CYP2C9 variants. Maximum patients developed toxicity within 15-30 days of initiation of warfarin. Conclusions: Warfarin toxicity has multifactorial cause. Drugs and Genetic variation are most common factors influencing warfarin toxicity. Warfarin toxicity has low mortality rate, although it increases with (International Normalised Ratio) INR>10 and with increasing age.
Background: Supraventricular tachycardia is a clinical syndrome characterized by a rapid tachycardia with an abrupt onset and termination. The objective of our study was to determine and assess the clinical profile, electrocardiographic and echocardiographic of patients diagnosed with supraventricular tachycardia.Methods: This cross-sectional study was conducted in the department of general medicine, Dr DY Patil medical college and hospital, Navi Mumbai from April 2020 till October 2021, in which we included patients diagnosed with any type of supra-ventricular tachycardia and excluded hemodynamically unstable patients.Results: In the present study, of the 45 cases, atrial fibrillation was the most common mechanism of SVT, diagnosed in 47% of the patients. Next most common was AVNRT (22%) and AVRT (18%). In addition, atrial tachycardia was diagnosed in 9% of the patients and atrial flutter was diagnosed in 4%. Mean age of the patients was 34.5 years, ranging from 13 to 68 years and 56% were males. It was observed that palpitation was the most common symptoms (91%). On ECG, no abnormalities were detected in 64%, while left ventricular hypertrophy (18%) and prolonged corrected QT (18%) were the most common abnormalities. On echocardiography, no abnormality was detected in 78% of the patients. Furthermore, 49% of the patients achieved normal sinus rhythm with a single dose of adenosine infusion and 33% of the patients required another dose of adenosine infusion.Conclusions: Palpitation is common presentation symptom. Most of patients had good response to medication treatment especially adenosine therapy, additional treatment was required in few patients.
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