January 1988, Volume 38, Issue 1

Case Reports

SELECTED ABSTRACTS FROM NATIONAL MEDICAL JOURNALS

Fatema Jawad  ( Sughrabai MilIwailla Hospital, Karachi. )

A STUDY OF INFECTIVE HEPATITIS WITH SPECIAL REFERENCE TO TREATMENT WITH CORTICOS­TEROIDS. Khan, N., Choudhry, N.A., Master, A., Shiva, F.H. The Medicus, 1971; 42 13 - 20.
A study carried out over a period of 12 months from November, 1968 to November, 1969 to assess the role of corticosteroids in the manage­ment of acute viral hepatitis is presented. 40 patients diagnosed as acute viral hepatitis were selected for the trial. All received a diet with high carbohydrates, a fair amount of proteins and low fats. Every other patient was also given 60 mg of prednisolone daily orally. The remaining 20 cases acted as controls. LFTs were conducted every week till normal results were obtained. There appeared to be no relationship between the degree of rise of serum biirubin level and SGPT levels at the onset of the disease. Similarly no correlation was found between the duration of recovery and the degree of increase of SGPT. A definite relationship between the level of serum Biirubin initially and the duration of the illness was determined. Administration of Prednisolone made no significant difference either in the speed of recovery or the duration of the disease when corn pared with the control group. It was thus agreed upon that corticosteroids do not alter the degree of liver necrosis, accelerate the rate of healing or assist in increasing immunity in viral hepatitis. On the contrary if the patient has a latent pul­monary tuberculosis, the administration of steroids can lead to flaring up the lesion. 4 cases of fulminating viral hepatitis not included in the study died inspite of receiving prednisolone 60 mg daily.
CORTWOSTEROIDS IN STATUS ASTHMATICUS. Anwar, M.A. The Medicus, 1971; 42: 159-161.
The therapy of 29 patients admitted with status asthmaticus over a period of one year in the Medical Unit of Civil Hospital, Karachi is reviewed. There were 15 males and 14 females with the age ranging between 15 and 55 years. The history of asthma dated from one month to 40 years and the duration of the present attack ranged from one to 20 days. All cases were given Injection Aminophyl­lin 250 mg diluted in 25% glucose i/v, Injection Chlôrpromazine 50 mg i/m followed by tablet Chlorpromazine 25 mg thrice daily and a mixture containing potassium iodide, ephedrine hydro­chloride and phenobarbitone. 25 individuals found relief in 8 to 24 hours. 4 patients were given Steroids of which one had already been on the therapy prior to admission and the other 3 because they had shown no improvement. Relief was obtained in 12 to 24 hours and prednisolone was tapered off and discontinued in 5 days. It was thus concluded that most of the status asthmaticus cases found relief without the use of corticosteroids. As pulmonary tuberculosis cannot be excluded without X-ray facilities, then by reserv­ing the use of Steroids, the risk of flaring up of tuberculous infection can be avoided.
COMMON URINARY TRACT PATHOGENS AND THEIR SENSITIVITY. Anwar, S.M. The Medicus, 1971;42: 202-205.
One hundred consecutive cases, fifty males fifty females admitted between June, 1970 June, 1971 with a positive urine culture were and studied and presented. E.   Coli was isolated in 85 specimens with 65 as solitary and 22 in combination. Proteus group was found in 19, Staphylococcus aureus in 2 and Klebsiella in one case. The sensitivity tests carried out proved nitrofurantoin to be the drug of choice to which 87% of E. Coli, 90% of Proteus, 85% of Staphy­lococcus aureus and both strains of Klebsiella were found to be sensitive. The next drug in order of merit was trimethoprin suiphamethoxazole to which 80% E. Coli, 85% Proteus, 60% Staphylo­coccus aureus and both strains of Kiebsiella were sensitive.
TRIMETHOPRIN - SULPHAMETHOXAZOLE (SEP­TRAN) IN P.FALCIPARUM AND P.VIVAX MALARIA. Minhas, A.L., Siddiq, K.Y. The Medicus, 1971; 42:310-314.
46 cases diagnosed as malaria by the presence of parasitaemia were treated with Tablet Trimethoprin - Suiphamethoxazole successfully. There were 22 males and 24 females with the ages ranging between 15 and 50 years. Thick and thin blood films showed the malarial parasite of which 22. were Plasmodium falciparum and 24 Plas­modium Vivax. The drug was administered in a dose of 2 tablets twice daily for 5 days. Each tablet contained trimethoprin 80 mg and sul­phamethoxazole 400 mg. All cases became negative for parasitaemia within 48 to 96 hours and the fever subsided in all but 5 individuals within 12 to 48 hours. These five had to be given an extended course of the drug. No sub­jective or haematological side effects were noted. Gametocytes were observed in 7 of the falciparum group while the asexual forms had disappeared within 48 hours. Like the other antimalarials, trimethoprin — suiphamethoxazole does not possess a gametocidal effect. This drug can thus be considered as a blanket therapy in those areas where Malaria is endemic and laboratory facilities are not available for diagnosis of fever cases.

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