RESUMEN
Allopurinol is a xanthine oxidase inhibitor used in management of chronic gout. It acts by reducing the amount of uric acid by inhibiting purine metabolism. A middle-aged hypertensive female who was on allopurinol for 7 months presented with generalized weakness and exertional dyspnea. Investigations revealed pancytopenia: normocytic normochromic anemia (Hb-3.2g/dL, TLC-3400/mm3) and severe thrombocytopenia (Platelets-1000/mm3) with mild hepatosplenomegaly and grade 2 medico renal disease with normal cardiac status. Nutritional, hemolytic and infective causes were ruled out. She was transfused with fresh whole blood, platelets, administered empirical antibiotics and started on steroids. Initially, she responded to treatment but later developed an episode of convulsions with anuria and succumbed to leukopenic sepsis secondary to hypo/aplastic anemia probably due to allopurinol. Allopurinol is used extensively in the management of chronic gout and is well tolerated due to its safety profile. But we here report a case of allopurinol induced aplastic anemia leading to the demise of a patient. Allopurinol though safe needs careful monitoring.
RESUMEN
BACKGROUND: The health of oral tissues is known to be related to salivary flow and its composition which may be altered in diabetic patients. The purpose of this study is to correlate mixed salivary glucose levels and oral candidal carriage and to assess the prevalence of candidal carriage in diabetics and controls. METHODS: Thirty adults with type-2 diabetes and 30 without diabetes (control subjects), aged 30-60 yr, participated in the study. Unstimulated saliva was collected and investigated for glucose levels (using glucose oxidase method) and colony-forming units (CFU) of Candida, this was stained with two stains, periodic acid-schiff stain and Grocott Gomori stain. RESULTS: In the present study mixed salivary glucose concentration in diabetics was significantly higher (p<0.01) compared to the controls. Diabetics with intraoral candidal carriage had higher salivary glucose levels (mean = 12.76±5.85 mg/dl) compared to cases where Candida was not isolated. The diabetics without intraoral candidal carriage had lower salivary glucose levels (mean = 5.36±2.24 mg/dl). This relationship could be seen in controls (non-diabetics) also. Diabetics showed an oral candidal carriage rate of 80% which was significantly higher compared to nondiabetics who showed an oral candidal carriage rate of 40%. CONCLUSION: Mixed salivary glucose levels were significantly higher in diabetics. The possible high salivary glucose level could predispose to oral candidal infection. So saliva can be used as a quick, non-invasive tool to assess the oral candidal status and possible infection.