Correlation between serum isoniazid concentration and therapeutic response in patients of pulmonary tuberculosis in Central India: A prospective observational study.

BACKGROUND: Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis is one of the top ten causes of death worldwide. Isoniazid (INH) is an important component of anti-tuberculosis therapy (ATT). Low isoniazid levels can serve as a risk factor for the development of treatment failure, relapse of disease and acquired secondary resistance. Hence, serum level of isoniazid becomes a critical factor in determining the treatment outcome of patients on ATT. This study aimed to evaluate the correlation between serum isoniazid concentration and therapeutic response in patients of pulmonary tuberculosis in Central India. METHODS: This was a prospective single cohort observational study conducted at a tertiary care hospital. Therapeutic response in newly diagnosed patients of pulmonary TB was determined based the microbiological, clinical and radiological parameters. Serum INH levels were estimated based on a spectrophotometric method using nano-spectrophotometer. RESULTS: In this study, patients had a significant improvement in treatment outcome as evident by a significant decrease in the TB score I at end of IP (p = 0.001) and a significant decline in the Timika score at end of CP (p = 0.001). Although all patients converted to sputum negative at end of CP, 20% remained positive at end of IP. Lower INH levels were seen in 13.3% of the study population. Higher INH levels were observed in sputum converters, patients with low TB score I and low Timika score, although no statistically significant difference was noted (p > 0.05). CONCLUSION: In this study, we could not find any statistically significant association between serum INH levels and therapeutic outcome of the patients. Further studies on a larger population could provide better understanding about the prevalence of low serum isoniazid levels among the Indian population and establish its relationship with therapeutic outcome. Also, the usage of a comparatively less expensive spectrophotometric method of analysis makes this feasible in almost every district hospital without the need of high-performance liquid chromatography which is costlier and needs more expertise.

Angiotensin Receptor-Neprilysin Inhibitor in Acute Myocardial Infarction.

In patient with symptomatic heart failure sacubitril valsartan has been found to reduces the risk of hospitalization and death from cardiovascular causes more effectively then angiotensin converting enzymes inhibitor trail comparing the effect of these drugs in acute myocardial infarction is lacking. MATERIAL: We randomly assigned patient with acute myocardial infarction complicated with reduced LVEF, or pulmonary congestion to recieve sacubitril 97mg-valsartan 103mg and ramipril 5mg twice daily the primary outcome was death from cardiovascular causes or incident heart failure, outpatient symptomatic heart failure or heart failure leading to hospitalization whichever occure first. OBSERVATION: Total 566 patient was taken in randomization 283 receive sacubitril-valsartan and 283 receive ramipril over a median of 22 months total outcome occure in 138 patient in sacubitril-valsartan group and in137 patient with ramipril group(hazard ratio 0.90: 95%confidence interval death from cardiovascular causes or hospitalization for heart failure occure i 10.9% patient reciveing sacubitril-valsartan and in 11.8%patient with ramipril group death from cardiovascular causes is 5.9 and 6.7% respectively death from anyother causes is 7.5 and 8.5 % respectively in both sacubitril-valsartan and ramipril group. CONCLUSION: Sacubitril-valsartan was not associated with significantly lower incidence of death from cardiovascular causes or incidents heart failure then ramipril in patients with acute myocardial infarction.

Spondyloepihyseal Dysplasia Congenita.

We describe a case of Spondyloepiphyseal Dysplasia Congenita (SEDc) who presented to our rheumatology clinic with complaints of painful swelling of bilateral elbow, knee, distal and proximal interphalangeal joints (DIP and PIP) of hands and small joints of foot. Patient also complained of restriction during extension of bilateral wrist joint and lateral rotation of neck on both sides. He was also unable to walk without support.

Pachydermoperiostosis.

A case of Pachydermoperiostosis (PDP) presented to us in rheumatology clinic with complaints of enlargement and broadening of bilateral hands and feet, grade IV digital clubbing, coarsening of facial features, excessive sweating of the palms, soles during summers.

Alkaptonuric Ochronosis.

Alkaptonuria is an autosomal recessive metabolic disorder characterized by joints and spine involvement, ochronosis and presence of homogentisic acid in urine and its deposition in cartilage, intervertebral disc and other connective tissues, leading to disabling arthritis in elderly individual.

The Association of Left Ventricular Mass Index with Metabolic Syndrome in Comparison to Hypertensive Patients.

BACKGROUND AND OBJECTIVES: The metabolic syndrome (MS) is a condition associated with the clustering of risk factors including high blood pressure (BP), abdominal obesity, glucose intolerance, and dyslipidemia; which increases cardiovascular morbidity and mortality. High burden of subclinical disease component of MS contributes to the increased risk by causing left ventricular (LV) hypertrophy, thereby affecting long-term prognosis. This cross-sectional study uncovers the role of LV hypertrophy (LVH) and LV mass index (LVMI) in patients with MS in comparison to hypertensive patients. SUBJECTS AND METHODS: A total of fifty North Indians, out of which 25 subjects were cases with the MS (obesity, dyslipidemia, glucose intolerance/diabetes with hypertension) and rest of the 25 subjects were control with hypertensive patients were included in the study and assessed for LVH and LVMI by two-dimensional echocardiography. Data were analyzed by SPSS version 21.0 based program. RESULTS: MS cases had a significantly higher mean LVMI (49.60 ± 21.23 g/m2.7) (P < 0.05), also higher exposure rate of LVH with 11 cases (44%) and relative risk of 1.38 (odds ratio 1.67, 95% confidence interval 0.53-5.29) than controls with hypertensive patients. Among LVH patients, mean LVMI was highest in MS cases with males (50.31 ± 26.03 g/m2.7), high body mass index >30 kg/m2 (51.14 ± 22.08 g/m2.7), FBS ≤ 140 mg/dl (53.72 ± 27.91 g/m2.7), high TG > 150 mg/dl (50.00 ± 22.09 g/m2.7), and low HDL (male <40, female <50 mg/dl) (57.22 ± 27.23 g/m2.7) than controls with hypertension; respectively (P > 0.05, not significant). CONCLUSION: MS, as a clustering of cardiovascular risk factors, is associated with higher LVM and prevalence of LVH. Therefore, high BP, increased waist circumference, dyslipidemia, and hyperglycemia separately and additively contributes to LVH suggesting that optimal BP control along with weight loss, lipid lowering agents, and euglycemic state may contribute to regression of LVH and LVM.

Risperidone induced periorbital oedema.

Antipsychotic medications are associated with adverse cutaneous reactions (ACRs) in approximately 2-3% of patients. We present three cases of possible risperidone induced periorbital oedema in the absence of any other systemic or local cause responsible for the oedema. The development of periorbital oedema after the initiation of risperidone therapy, and disappearance after the discontinuation of this drug, suggests a possible causal relationship between periorbital oedema and risperidone. To our knowledge, there are very few reports of risperidone therapy and development of periorbital oedema. Risperidone is a valid and effective choice amongst antipsychotic medications, but these cases call for caution regarding ACRs at the time of prescribing.