Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

BackgroundAmoebic Liver abscess although fairly common in developing countries, yet, there is limited data on the clinical presentation to the emergency department. A retrospective analysis of 86 indoor cases of Amoebic Liver Abscess presenting to the emergency department over a 5-year period was carried out.FindingsThe mean age of patients was 40.5 ± 2.1 years (male-female ratio = 7:1). Fever, pain abdomen and diarrhea were seen in 94%, 90% and 10.5% respectively. Duration of symptoms less than 2 weeks was seen in 48% cases. Hepatomegaly was present in 16% cases only, a right sided pleural effusion in 14% cases and ascites in 5.7%. On ultrasound, a right lobe abscess was seen in 65%, a left lobe abscess in 13% and multiple abscesses in both the lobes in 22% cases. Seventy one cases underwent per-cutaneous pigtail catheter drainage for a mean period of 13.4 ± 0.8 days. The mortality rate was 5.8%. On multivariate regression and correlation analysis, a higher number of inserted pigtail catheters correlated to mortality.ConclusionsAmoebic liver abscess presents commonly to the emergency department and should be suspected in persons with prolonged fever and pain abdomen. Conservative management for uncomplicated amoebic liver abscess and insertion of single per-cutaneous pigtail catheter drainage for complicated amoebic liver abscess are efficacious as treatment modalities.

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This report documents the first presentation of seven human cases of poisoning with a compound used in poultry feed. The clinical presentation was a toxic polyneuropathy with rhabdomyolysis and acute renal failure. We describe the protracted clinical course of one of these victims along with a tabulated description of the clinical course and relevant laboratory investigations of the others. Maduramicin is a monoglycoside polyether derived from the fungus Actinomadura rubra. It is classified as an ionophor and predominantly used as an anticoccidial agent, which is mixed with poultry feed in the ratio of 5 ppm.1 There are numerous observational and experimental reports to show that this compound, if used for a long time, can be toxic to the animals fed on this mixture. 2-6However, toxicity data among humans inadvertently exposed to this compound has been lacking. We report seven victims with this unusual poisoning. We describe the protracted clinical course of one of these victims along with a tabulated description of the clinical course and relevant laboratory investigations of the others.The index case was a 30 year old male poultry farm worker who was admitted to the medical emergency room of the Nehru Hospital of the Postgraduate Institute of Medical Education and Research, Chandigarh, India, after consuming a pudding of maduramicin mixed with vegetable oil, which he mistook for porridge under the influence of cannabis at a religious function. He had consumed this concoction in the company of six other friends. The approximate quantity of maduramicin ingested was 450 g in total. Within two hours, all seven victims developed vomiting and weakness of all four limbs and truncal muscles. Two victims died over the next 48 hours at the primary health centre where they were admitted and the others, including the index case, were referred to our hospital after eight days.On arrival at our hospital, the index case complained of excessive sweating over the face and pain in the buttock area. On examination, the pulse rate was 80/minute, respiratory rate of 16/minute, blood pressure of 120/80 mmHg, and excessive sweating over the face was noted. There was no pallor, icterus, cyanosis, or dependant oedema. The examination of the lungs, heart, and the abdomen was normal but the neurological examination showed a grade IV muscle power with generalised areflexia.Upon investigation, the following were noted: the haemoglobin was 10 mmols/L, total leucocyte counts 8.8610 9 /L, and the differential counts and peripheral blood smears were normal. The serum biochemistry was normal and the electrocardiography, chest x ray, ultrasound examination, and echocardiography were also normal. On day two of hospital admission, the pain in the buttock area and back worsened and the patient noted a darkening in the colour of the urine. Investigations revealed rhabdomyolysis (creatinine phosphokinase MM levels 17 300 U/L, serum myoglobin present, alanine aminotransminase 1.25 mkat/L, and aspartate aminotransminase 0.60 mkat/L) following which al...

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