We evaluated the effects of human immunodeficiency virus (HIV) disease on pharmacokinetics of antituberculosis medications by measuring concentrations of isoniazid and rifampin in blood and of pyrazinamide and ethambutol in urine. Peak concentration and exposure were reduced for rifampin, and rapid acetylators of isoniazid had lower drug levels. HIV and HIV-tuberculosis patients who have diarrhea and cryptosporidial infection exhibit decreased bioavailability of antituberculosis drugs

Few studies from various countries have reported decline in Acute Coronary Syndrome (ACS) admissions to hospital during COVID-19 pandemic. We studied the impact of COVID-19 strict lockdown on ACS admission in a tertiary referral hospital in India. This showed 43% decline in admissions (n=104 vs mean n=183) and even in those who got admitted, there was a delay in presentation compared to previous year, which was reflected in the outcome of patients. Government and health organizations should educate the public early-on during the pandemic about the consequences of ignoring other acute medical problems such as ACS.

Background Malabsorption of drugs from the gastro‐intestinal tract due to HIV enteropathy and concurrent infections could lower the bioavailability of anti‐tuberculosis (TB) drugs in HIV infected individuals. Our aim was to study the pharmacokinetics of rifampicin (RMP), isoniazid (INH), pyrazinamide (PZA) and ethambutol (EMB) in HIV infected Indian subjects. The D‐xylose absorption test was also performed in all the patients. Method We studied 13 patients with smear positive pulmonary TB, 13 with HIV & diarrhoea and 14 with HIV & TB. Rifampicin (450mg), INH (600mg), PZA (1500mg) and EMB (1200mg) were administered orally. The plasma levels of RMP and INH at different time points and urinary levels of all drugs/metabolites were estimated. Results A significant decrease in peak concentrations of RMP in HIV & diarrhoea and HIV & TB patients was observed when compared to patients with TB, the values being 3.23, 3.27 & 8.27μg/ml respectively (P<0.001). Significant decrease in AUC of RMP was also observed in HIV patients. The bioavailability of INH was reduced in rapid acetylators in HIV patients with and without TB. The urinary excretion of all four drugs/metabolites and D‐xylose was reduced in both HIV groups of patients. Conclusion Patients with HIV & TB and/or diarrhoea have decreased bioavailability of first line anti‐TB drugs. This could have implications for TB treatment of HIV infected patients. Clinical Pharmacology & Therapeutics (2004) 75, P29–P29; doi:

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In patients in early childhood, secondary causes are underlying in 70-85% of cases. [2] The most common causes are renal causes. Reflux AbstractBackground: Hypertension in most cases is primary, the exact etiology not known but there may be risk factors such as salt excess, obesity, lack of physical activity, genetic factors, metabolic syndrome, and diabetes. However, there exists a subgroup of patients with hypertension with underlying etiology, referred to as secondary hypertension, and constitutes about 5-10% of patients with hypertension. The importance of diagnosis of the secondary causes of hypertension is to detect a potentially reversible etiology. Some of these causes are rare and unless looked for, can be easily missed. Methods: A review of age-specific causes, approach, rare diseases of the aorta, endocrine, renal, iatrogenic, and substance abuse have been discussed. The importance of suspecting unusual causes in patients with uncontrolled hypertension, hypertension in the young, in the presence of target organ damage is emphasized. Case reports of rare cases have been included. Conclusion: A systematic approach and knowledge of various rare causes will help suspect and lead to the correct diagnosis in many cases of secondary rare causes of hypertension. It gives a unique opportunity to cure hypertension in some cases and if the underlying cause is undiagnosed may result in morbidity and even prove fatal in some cases. R e v i e w A r t i c l eRare and unusual causes of hypertension Mahilmaran