A comparative study of thyroid status of patients on phenytoin, carbamazepine and valproate monotherapy

Background: Anti-epileptic drugs are well tolerated, many effects on endocrine function have been reported, especially, the effect of long-term administration of anticonvulsant drugs on blood thyroid hormone levels.Methods: An analytical, cross sectional, non-randomized study conducted in Neurology Department over a period of twelve months from November 2012 to October 2013 where in 90 patients was enrolled in the study.Results: Of the 90 patients 56 were male and 34 were females. Baseline evaluation of the thyroid status of all patients were noted and showed all the 90 patients were clinically and Para clinically euthyroid. Patients on Phenytoin showed serum TSH value (Mean ± SD) to be statistically higher than the baseline and the normal reference value, whereas no significant difference was noted in the serum free T3 and T4 values. When patients on carbamazepine were evaluated, statistically significant difference was noted in the serum T3 and T4 level and was found to be lower than the reference value. No significant difference was seen in the serum TSH level. Patients receiving valproate showed no significant difference in the serum T3, T4 and TSH before and 6 month after prescription. All the patients were clinically euthyroid and showed no sign and symptoms of hypothyroidism.Conclusions: Valproate monotherapy does not alter serum levels of thyroid hormones. On the contrary, alterations of thyroid hormone function were seen in patients treated with carbamazepine and phenytoin. However, all the patients were euthyroid and were not associated with clinical or even subclinical hypothyroidism

A study to evaluate prescribing pattern of antibiotics among patients of urinary tract infection with preexisting renal disorders in a tertiary care hospital

Background: Urinary tract infection (UTI) is one of the most common bacterial infections encountered and treated worldwide. The objective was to determine the incidence, culture-sensitivity status, prescription pattern of antibiotics and response to various antibiotics and other therapeutic considerations in patients of complicated UTI (cUTI).Methods: The observational prospective analytical study conducted in Department of Nephrology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai.Results: A total percentage of patients having UTI was 13.08%. Of these 200 patients, 119 patients were female (60%) and 81 patients were male (41 %). Among male, the prevalence was seen more in geriatric age group and among female in adult group. Symptomatologically, fever was the most common symptom. Among male, diabetes mellitus was most commonly associated with cUTI whereas recurrent UTI were more common among female. Of the 200 patients, culture sensitivity was done in 133 patients. Escherichia coli was found to be the most common organism.Quinolones were the most commonly prescribed first line drug followed by beta-lactamase inhibitors. Combinations such as cefoperazone + linezolid were the most commonly prescribed second-line drug, followed by combination of ceftriaxone or cefoperazone with metronidazole.Paracetamol was the most common non antibiotic support given.Conclusions: The results of this study may not be representative of the general population; but UTIs are often treated empirically, and susceptibility tests are often carried out only when the patient has failed one or more courses of antibiotics

Drug-induced nephrotoxicity

Drug-induced nephrotoxicity is an extremely common condition and is responsible for a variety of pathological effects on the kidneys. Drug-induced acute renal failure (ARF) accounted for 20% of all ARF cases. Drugs showed to cause nephrotoxicity exert their toxic effects by one or more common pathogenic mechanisms. Although it is impossible to present all the drugs causing the nephrotoxicity, this article will summarize the mechanism of injury associated with particular common medications, discuss clinical presentations, renal markers, and evaluate strategies that prevent or minimize renal injury. Drug-induced nephrotoxicity tends to be more common among certain patients and in specific clinical situations. Therefore, successful prevention requires knowledge of pathogenic mechanisms of renal injury, patient-related risk factors, drug-related risk factors, and preemptive measures, coupled with vigilance and early intervention. General preventive measures include using alternative non-nephrotoxic drugs whenever possible; correcting risk factors, if possible; assessing baseline renal function before initiation of therapy, followed by adjusting the dosage; monitoring renal function and vital signs during therapy, and avoiding nephrotoxic drug combinations. Surprisingly, little information is available to guide us with respect to avoiding complications in critical illness; therefore, it is necessary to follow the guidelines

A comparative study of thyroid status of patients on phenytoin, carbamazepine and valproate monotherapy

Background: Anti-epileptic drugs are well tolerated, many effects on endocrine function have been reported, especially, the effect of long-term administration of anticonvulsant drugs on blood thyroid hormone levels.Methods: An analytical, cross sectional, non-randomized study conducted in Neurology Department over a period of twelve months from November 2012 to October 2013 where in 90 patients was enrolled in the study.Results: Of the 90 patients 56 were male and 34 were females. Baseline evaluation of the thyroid status of all patients were noted and showed all the 90 patients were clinically and Para clinically euthyroid. Patients on Phenytoin showed serum TSH value (Mean ± SD) to be statistically higher than the baseline and the normal reference value, whereas no significant difference was noted in the serum free T3 and T4 values. When patients on carbamazepine were evaluated, statistically significant difference was noted in the serum T3 and T4 level and was found to be lower than the reference value. No significant difference was seen in the serum TSH level. Patients receiving valproate showed no significant difference in the serum T3, T4 and TSH before and 6 month after prescription. All the patients were clinically euthyroid and showed no sign and symptoms of hypothyroidism.Conclusions: Valproate monotherapy does not alter serum levels of thyroid hormones. On the contrary, alterations of thyroid hormone function were seen in patients treated with carbamazepine and phenytoin. However, all the patients were euthyroid and were not associated with clinical or even subclinical hypothyroidism