To find out the efficacy of sucralfate in preventing gastrointestinal side effects of non-steroidal anti-inflammatory drugs (NSAIDs) a prospective, randomised single blind study was conducted from 1989 to 1992. Patients with osteoarthritis, rheumatoid arthritis and other long standing painful conditions, who were expected to receive NSAIDs for over three months, were recruited into the study. All medicines were discontinued for a period of 10-15 days prior to initial endoscopic assessment. NSAID therapy was started and the patients were randomised to receive either placebo (group A) or sucralfate (group B) in addition. Patient were reassessed clinically every week and an endoscopic examination was repeated after 6-8 weeks of follow-up. A total of 176 patients were studied in group A (n=91) and group B (n=85). At the end of 8 weeks gastrointestinal symptoms were present in 30.6% and 26.4% patients of group A and B respectively. Endoscopic assessment showed superficial lesions in 36.5% and 18.7% while endoscopic ulcer in 2.4% and 1.1% patients of groups A and B respectively. Thus in patients receiving chronic NSAID therapy, simultaneous administration of sucralfate reduces the incidence of superficial gastric lesions but has no significant effect on symptoms or ulcer formation.
Eighty two patients of leukaemia consisting of 25 cases of acute lymphocytic leukaemia, 38 cases of acute myeloid leukaemia, 14 cases of chronic myeloid leukaemia and 5 cases of chronic lymphocytic leukaemia were evaluated for central nervous system (eNS) involvement. Speech disorders, cranial nerve palsies, encephalopathy, ataxia, intracranial haemorrhage, peripheral neuropathy and spinal cord involvement were the main neurological findings detected in 23 (28.1%) cases. All except one were subjected to autopsy after death. Leukaemic infiltrations (36.6%) and intracranial haemorrhage (26.8%) were the prominent CNS autopsy findings. In addition, demyelination with astrocytosis (9.7%) and gliosis (2.4%) were seen. In all, 45 (54.9%) of the patients showed CNS involvement at autopsy. Thus a large number ofCNS lesions were missed clinically and detected only on autopsy. MJAFI 1995; 51 : 161-164
To derermine if early ambulation was safe in acute viral hepatitis (AVH), 202 patients of uncomplicated AVH were prospectively randomised into two group. Group A (n=loo) received conventional treatment with bed rest while group B (n=102) patients were ambulated as soon as their clinical symptoms abated and progressive clinical and biochemical recovery was noted. While mean recovery time in two groups wu not significantlly different (28.8 VB 29.7 days), bed rest period in group B wu significantly less (28.8 vs 8.6 days). Natural history of the AVH, clinical and biochemical findings and relapse rate over a follow up period of14 to 18 months, were no different in the two groups. None of the patients developed chronic hepatitis. Early ambulation is there fore safe in uncomplicated AVH and can lead to enormous saving of manhours and hospital resources. MJAFI 1994; 50 : 15-18
Pulmonary embolism is considered a rare disease in India. The diagnosis is likely to be missed as its presentation is often enigmatic. Ten cases of pulmonary embolism are presented. Nine patients presented with acute pulmonary embolism, while one had chronic pulmonary emboli with cor pulmonale. The diagnosis was based on pulmonary angiography (1 case), lung perfusion/ventilation scan (2 cases), autopsy (2 cases) and characteristic ECG, X-ray chest and clinical features (5 cases). The initial diagnosis was often incorrect (7/10 cases). Common presenting clinical features were: sudden breathlessness (10/10), tachypnoea (10/10) and tachycardia (8/10); chest pain (3/10) was uncommon and hemoptysis was not seen in any patient. ECG revealed isolated sinus tachycardia in 2 cases, S Q T pattern in 2, and right axis with ST-T wave changes in 5 patients. X-ray chest showed either an area of oligemia or non-specific opacities in 7 patients and was normal in three cases. Advances in specific diagnostic modalities coupled with heightened awareness should contribute to an early detection of pulmonary embolism, rarity of which may be more apparent than real.
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