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General Practitioners' Sections
 
Three Causes of Jaundice Plus Haemolysis

OP Kapoor
 
The following are the three causes, where a patient having jaundice develops haemolysis, which increases the depth of jaundice:-
  1. Viral Hepatitis: The virus of this illness is the most common cause of producing haemolysis in a patient having G6PD deficiency. If a patient having G6PD deficiency develops viral hepatitis, he may also develop very high levels of bilirubin due to additional haemolysis.
  2. Falciparum Malaria: In this condition, the patient can develop Malarial Hepatitis. In addition, unconjugated bilirubin may add to the level of jaundice due to haemolysis produced by the malarial parasite.
  3. Zieves Syndrome has been described years back, where a patient having mild jaundice due to alcoholic liver disease develops severe jaundice over the weekend following an alcoholic binge, which may produce haemolysis.
Finally, in practice if a patient having liver disease also shows evidence of mild haemolysis in the blood, it favours the diagnosis of Wilson’s disease.

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
 
SUPPLEMENTS DON'T PROTECT THE ELDERLY FROM INFECTIONS

Multivitamin and multimineral food supplements don't seem to protect elderly people living at home from infections or improve their quality of life. In a pragmatic double blind controlled trial. Avenell and colleagues randomised 910 people aged over 64 to supplementation or placebo. They found no significant differences in frequency of attending primary care for infection, antibiotic prescriptions, hospital admissions, adverse events, compliance, self reported days of infection, and quality of life.

BMJ, 2005; 331 : 324.



REDUCED ANTIBIOTIC PRESCRIBING DID NOT RESULT IN MORE COMPLICATIONS

Antibiotic prescribing for childhood upper respiratory infections halved between 1993 and 2003 in the United Kingdom, but hospital admissions for peritonsillar abscess and rheumatic fever have not increased. Sharland and colleagues extracted data from drug prescribing and hospital admission databases. Admission rates for mastoiditis and simple mastoidectomy increased in the observed period by 19%, but the general practice research database did not show an increase in mastoiditis or referral for mastoidectomy.

BMJ, 2005; 331 : 328.
 
 
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