Amitriptyline for pain control in scleritis may help to avoid excessive steroid use in selected cases: a case report.

INTRODUCTION: Pain in scleritis may be difficult to control with conventional immuno-suppressive regimes. Amitriptyline may be an effective option in those circumstances. CASE PRESENTATION: A 41-year-old woman presented with scleritis and eye pain that was refractory to treatment with steroid and immunosuppressive agents. Effective pain relief and reduction of steroid dose was only achieved after starting amitriptyline. CONCLUSION: Amitriptyline may be an effective option for pain control in case with scleritis which might otherwise require unnecessarily large doses of immunosuppression.

Beri-beri: the major cause of infant mortality in Karen refugees.

During a prospective evaluation of malaria prophylaxis in pregnancy in a refugee population on the north-western border of Thailand from 1987 to 1990, an extremely high infant mortality rate (18%) was documented despite good access to health care. Infantile beri-beri was recognized as the main cause of death accounting for 40% of all infant mortality. Thereafter, severe vitamin B1 deficiency in infants was diagnosed and treated promptly. The impact of this was assessed prospectively from 1993 to 1996 in a second cohort study. The case fatality of infantile beri-beri fell from almost 100% to 7%. The overall infant mortality rates declined from 183 to 78 per 1000 live births. Post-neonatal deaths fell by 79% (95% CI 65-87%) while neonatal mortality remained unchanged. Mortality resulting from acute respiratory infections did not change (15 and 11 per 1000, respectively), whereas mortality attributable to beri-beri decreased from 73 to 5 per 1000 (P < 0.0001). Before its recognition approximately 7% of all infants in this population died from infantile beri-beri. This lethal but preventable syndrome may be more common than hitherto recognized, particularly in refugee populations, in this populous region.