clinical trial to investigate the role of clinical pharmacist in resolving/preventing drug related problems in ICU patients who receive anti-infective therapy

To highlight the role of the clinical pharmacist in resolving/preventing drug related problems and to measure the acceptance of the pharmaceutical care plan for patients who receive anti-infective therapy in the intensive care unit. Two groups of patients were randomly selected from general intensive care unit ward of the King Hussein Medical Center. Royal Medical Services, Amman, Jordan ; Intervention group, n=52 and control group. n=50. The intervention group received complete pharmaceutical care services. Consult notes were written to identify drug related problems according to a pharmacy care plan. Clinical pharmacist's recommendations for the intervention group were submitted to and discussed with physicians. Acceptance rate of the recommendations was then measured. A total of 251 drug related problem were identified for both groups. For the intervention group, the physicians' acceptance rate of the submitted recommendations was very high [around 98%]. Clinical pharmacist plays a key role as member of multidisciplinary team as he is able to assess the patient's medication treatment from different aspects during intensive care unit stay; consequently, physicians are increasingly accepting the clinical pharmacist recommendations regarding drug related problems for patients in intensive care unit

randomized control trial evaluating the prevalence of obstetrical anal sphincter injuries in primigravida in routine versus selective mediolateral episiotomy

To evaluate the prevalence of obstetrical anal sphincter injuries [OASIS], which include third and fourth degree perineal tears in primigravida in routine versus selective mediolateral episiotomy. Secondly, to determine the rate of episiotomy in local settings. This randomized control trial was carried out in the labor ward of a tertiary hospital of the Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia between May and October 2009. The trial included 171 primigravida beyond 38 weeks gestation who achieved vaginal delivery, and randomly assigned to selective and routine episiotomy groups. The type of perineal injuries following childbirth among 171 women were evaluated. The overall episiotomy rate from both groups was 76.6%. The prevalence of third degree perineal tears was 3.7% in the routine compared with selective mediolateral episiotomy at 1.1%. There was no occurrence of fourth degree tears in both groups. However, selective mediolateral episiotomy was associated with an increased risk of periurethral and labial injury compared with the routine group [4.5% versus 0%]. Routine mediolateral episiotomy in primigravida is associated with a higher prevalence of obstetrical anal sphincter injuries. As anal sphincter injuries are known to have morbidities, selective mediolateral episiotomy in primigravida is therefore recommended in the implementation of new delivery practice, and in an attempt to reduce our high episiotomy rate

Predictors of outcome for non-traumatic intracerebral hemorrhage

To evaluate the prognosis, neurologic outcome, and predictors of survival in patients with non-traumatic intracerebral hemorrhage. We evaluated prospectively a cohort of 96 Saudi adult males and females with stroke during the month of July 2005 at Arar Central Hospital, Riyadh, Kingdom of Saudi Arabia. Out of 103 patients, 96 patients, who were diagnosed as having intracerebral hemorrhage [ICH] presenting to the emergency department for initial evaluation, were included, except those with recurrent intracerebral hemorrhage, arteriovenous malformation, subarachnoid hemorrhage, traumatic brain injury, hemorrhagic infarctions, and patients receiving anticoagulant therapy. No patient underwent any neurosurgical procedure. The results of 96 patients were analyzed. The mean age at ICH was 67.2 [ +/- 14.7] years [range, 30-100 years], and mean Glasgow coma scale [GCS] score on admission was 8.42 [ +/- 1.73] and [range, 4-13]. Mean ICH volume on initial CT scan was 10.61 [ +/- 14.01] ml3 [range, 1-63]. Mean pulse pressure on hospital arrival was 81.9 [ +/- 22.8] mm Hg [range, 70-120 mm Hg]. In uni-variate analysis, GCS score [p = 0.0005], ICH volume [p = 0.001], mass effect [p = 0.001], and presence of intraventricular hemorrhage [p = 0.0005] were all associated with 30-days mortality, while in multivariable analysis, the most significant independent predictors of 30-day mortality were, GCS score and the intraventricular extension of hemorrhage. This model may aid in making decisions quickly and easily regarding the appropriate level of care for such patients with intracerebral hemorrhage

Functional outcome of ischemic stroke in diabetics

Objective was to determine whether the outcome of ischemic stroke is different or not in diabetics than nondiabetics. Prospective observational. analytical study Study place and Duration; It was conducted in medical unit-2 Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College Bahawalpur from October I, 2004 to September 30. 2005. 132 patients of ischemic stroke, confirmed by CT scan, were enrolled during one year study period. The patients of hemorrhagic stroke, TlA, focal deficits of non-vascular origin and infratentorial lesions were excluded. Patients were devided into two groups; diabetics and nondiabetics and were studied regarding their in hospital outcome according to the modified Rankin Scale. The variables applied were age, sex, hypertension and type of infarct [lacunar/cerebral]. Out of 132 ischemic stroke patients 36 [27%] were diabetics and 96 were nondiabetics. Hjipertension was present in 83 [62%]. Overall mortality wa s 11.3%. Mortality was significantly more frequent in diabetics than nondiabetics [16.6% Vs 9.3% p<0.05]. Disability was also more frequent in diabetics [25% Vs 13.5% p<0.05]. In diabetic group good recovery [8.8% Vs 12.5%] as well as partial recovery [50% Vs 64.5%] was less frequent. Patients <40 years were few in number with good recovery in both diabetics as well as nondiabetics. Diabetics of 40-60 years were found to have significantly high number of deaths [15.3% Vs 7% p<0.05] and disability [15.3% Vs 10.7% p<0.05] than non-diabetics. Similar pattern was seen in patients >60 years. Increasing age was found to be associated with poor outcome in both the groups but poorer in diabetics. Sex did not discriminate the poor outcome in diabetics. The presence of hypertension worsened the out come in both the groups but more in the diabetic group both in term of mortality [20.8% Vs 11.8% p<0.05] as well as disability [33.3% Vs 15.2% p<0.05]. Lacunar infarct was found in few patient with good prognosis while cere bral infarct was associated with poor prognosis and put the diabetics at higher risk in term of mortality [17.6% Vs 9.8% p<0.05] as well as disability [26.4% Vs 14.2% p<0.05]. Diabetes Mellitus is associated with poor outcome of ischemic stroke patients both in terms of mortality and morbidity during acute hospitalization. Hypertension. increasing age and large infarct size further worsens the outcome

Frequency of hepatitis C infection in diabetes mellitus

The study was conducted at diabetic clinic B.V. Hospital/Q.A.M.C Bahawalpur from December 1st, 2004 to March 15th, 2005. Diabetes mellitus and hepatitis C infections are common and emerging problems of the society. Either diabetes mellitus is common in chronic hepatitis C patients as reported initially by Ellison and co-workers or hepatitis C infection is more frequent in diabetes mellitus. We want to study the frequency of hepatitis c infection in diabetes mellitus. To study the frequency of hepatitis C infection in diabetic patients and to note any risk factors of diabetic patients predisposing to hepatitis C infection. A cross-sectionalObservational-descriptive analytic study. A total of 250 consecutive diabetic patients of either sex were compared with 6574 blood donors for hepatitis c infection. They were evaluated for hepatitis C infection by using Enzyme Linked Immunosorbant Assay [ELISA-3] which is an anti-HCV anti body test. On basis of this test, the patients were divided into two groups, anti-HCV +ve and anti-HCV -ye. Different variables of these patients were studied and compared in these two groups Variables studied were as follows:- Age, Sex, BMI, Mode of therapy area of their residence[rural or urban] Duration of diabetes mellitus, Blood pressure, Nephropathy and Control of diabetes mellitus. Among a total of 250 patients, 120 [48%] were male and 130 [52%] were female. Two hundred and forty-four [97.6%] patients were of type-II DM and 06 [2.4%] patients were of type-I DM. 22 [8.8%] patients were on insulin therapy while 228 [91.2%] were on oral hypoglycemic agents. Anti-HCV test was positive in 69 [27.6%] diabetic patients as compared to blood donors 41 [0.62%]. In anti-HCV positive group, longer duration of diabetic mellitus [15yrs 15.94%], poor control of diabetic mellitus[87%], insulin therapy[17.39%] hypertension[91.3%] and nephropathy[94.2%] were the significant vari ables while BMI, age, sex and whether they were belonging to either rural or urban area were not significant in both the groups. Hepatitis C infection is common in diabetic patients as compared to control group [27.6% vs 0.62%]. Out of diabetic patients HCV infection is more common with longer duration of diabetic mellitus, poor control of diabetic mellitus, hypertension, nephropathy and insulin therapy

Feasibility Study of Dobutamine Stress Transesophageal Echocardiography

Transesophageal echocardiography(TEE) was performed during pharmacologic stress with dobutamine for evaluation of coronary artery disease in 15 patients (12 men, 3 women ; mean age, 70 years) with inadequate transthoracic echocardiographic images. In five patients, additional indications for TEE were present. Dobutamine was administered according to a standard protocol with a maximum dose of 40microg/kg per minute. Angina and an increase in simple ventricular ectopy were noted in one patient each, but no other complication or side effect was noted. Images (midesophageal four-and two-chamber views ad transgastric short-and long-axis views) were satisfactory for interpretation in 14 patients. In one patient, the apex could not be optimally visualized. Five patients (33%) had resting wall motion abnormalities. Wall motion abnormality developed in three patients(20%) and worsened in two(13%). Dobutamine stress TEE findings were normal in eight patients. Coronary angiography in two patients revealed significant stenosis corresponding to stress-induced wall motion abnormalities. Dobutamine stress TEE is a safe, feasible, well-toerated alternative to conventional stress echocardiography for detecting myocardial ischemia.

Primary anorectal melanoma. About one case

The authors report one observation of a primary anorecral melanoma, in a woman of 60 years, diagnosed by biopsy of a pigmented tumour, situated 4 cm above the anal margin. The evolution was fatal by a metastatic diffusion and an abundant rectum haemorrhage within the period of 5 months. Through our case and review of literature we try to bring out the characteristics, particularly the problem of diagnosis and therapeutics of this rare location and a very bad forecast of a primary melanoma