BackgroundAdverse events (AEs) among HIV-infected patients with multidrug-resistant tuberculosis (MDR-TB) receiving anti-TB and antiretroviral treatments (ART) are under-researched and underreported. Hypothyroidism is a common AE associated with ethionamide, p-aminosalicylic acid (PAS), and stavudine. The aim of this study was to determine the frequency of and risk factors associated with hypothyroidism in HIV/MDR-TB co-infected patients.MethodsThis was a prospective, observational cohort study, using routine laboratory data in a Médecins Sans Frontières (MSF) clinic in collaboration with Sewri TB Hospital, Mumbai, India. Hypothyroidism was defined as a thyroid stimulating hormone (TSH) result >10 mIU/L at least once during treatment. Patients having a baseline result and one additional result after 3 months were eligible for enrolment.ResultsBetween October 2006 and March 2013, 116 patients were enrolled, 69 of whom were included. The median (IQR) age was 38 years (34-43) and 61% were male. By March 2013, 37/69 (54%) had hypothyroidism after at least 90 days of treatment. Age, gender, CD4 counts and stavudine-based ART were not associated with the occurrence of hypothyroidism in multivariate models. The co-administration of PAS and ethionamide was found to double the risk of hypothyroidism (RR: 1.93, 95% CI: 1.06-3.54).DiscussionHigh rate of hypothyroidism was recorded in a Mumbai cohort of MDR-TB/HIV co-infected patients on treatment. This is a treatable and reversible AE, however, it may go undiagnosed in the absence of regular monitoring. Care providers should not wait for clinical symptoms, as this risks compromising treatment adherence. Simple, affordable and reliable point-of-care tools for measuring TSH are needed, especially in high MDR-TB burden countries. Our findings suggest the need for TSH screening at baseline, three months, six months, and every six months thereafter for HIV-infected patients on MDR-TB treatment regimens containing PAS and/or ethionamide, until newer, safer and more efficacious MDR-TB regimens become available.

Abstract:Aim-to study CADRs

Aim:Traumatic dental injuries frequently occur in society and may occur at home. The ultimate prognosis of an avulsed tooth occurring in a child may depend on the parents’ knowledge of appropriate emergency measures. This study is aimed at evaluating the awareness level of a sample of Indian (Rohtak, Haryana) parents in the management of dental trauma.Materials and Methods:A total of 1500 parents were surveyed using a self-administered structured questionnaire. The questionnaire was divided into three parts. The tabulated data were statistically analyzed using the Chi-square test.Result:This study indicated a low level of knowledge regarding tooth avulsion and replantation procedures to be followed in emergency. The residing area and age of parent did not affect the knowledge and awareness of parents. Moreover, well-educated parents also had very little or no information about dental trauma first-aid. The lack of significance in correct answers between those with and without such experience indicated that past experience did not seem to have increase the knowledge of the correct emergency procedures. Very little or no information about tooth avulsion and replantation had been given to most of them.Conclusion:Dental injury prevention and management should be recognized as a major public health issue and adequate resources to be allocated for research in this area. Educational programs to improve the knowledge and awareness among the parents have to be implemented.

Psychosis with phenytoin use has earlier been reported only in the context of Vitamin B12 or folic acid deficiency. We report a rare case of phenytoin toxicity manifesting as psychosis in the absence of Vitamin deficiency. The importance of recognition of psychosis as a harbinger of phenytoin toxicity and implications for management are discussed.

Objective-To study the adverse drug reactions in paediatric age group in a tertiary care hospital.Methods-A retrospective study was undertaken to analyse adverse drug events in paediatric department of a tertiary care hospital.Medical record sheets were analysed and adverse event marked as ADR by the paediatrician was included in the study. Causality, preventability and severity were analysed by 2 Pharmacologists. Other parameters like male to female ratio, most common class of drug causing ADR, common types of ADRs, commonly involved systems, polypharmacy were studied. Results-64 cases of ADRs were identified in study duration(overall incidence 4.4%) of which 56% were females and infants the commonest age group. Antinfectives were the commonest drug class(68%) causing ADRs,with skin the commonest involved organ. 81% of ADRs were of moderate degree as compared to 1% of severe degree.76% cases fell in probable category of preventability where as 3% were definitely preventable.76.5% cases scored into probable category according to Naranjo's scale of causality assessment. 86% cases were prescribed polypharmacy. Conclusion-Incidence of Iatrogenic harm is rising and due to suboptimal ADR reporting practices only the tip of iceberg is seen. Though more vulnerable, paediatric age group is neglected in various aspects. To ensure safety we need to judiciously use drugs, strengthen ADR reporting and conduct more studies & awareness programmes.