ABSTRACT
Introduction: Acute pancreatitis is a potentially lethal disease with wide variation in severity ranging from mild and self-limiting to a rapidly progressive illness leading to multiorgan failure. In accordance with this wide variation in clinical presentation, the treatment of acute pancreatitis requires a multidisciplinary approach. Mild acute pancreatitis causes disturbance in the homeostatic mechanism of the body is minimal; the treatment is aimed at supporting the native reparative processes of the body. One of the main supportive mechanisms is adequate and safe nutritional supplementation. Objectives: To assess the occurrence of infective and non-infective complications in cases of acute pancreatitis on early enteral nutrition. Materials & Methods: This is a prospective study conducted on patients who were admitted to SSIMS AND RC Davangere with symptoms suggestive of acute pancreatitis from July 2019 to July 2021. Patients with a clinical picture consistent with the diagnosis of acute pancreatitis, along with more than a 3-fold elevation of serum amylase and elevated serum lipase were considered to have acute pancreatitis. After initial diagnosis and assessment, patients were duly informed regarding the study and consent was obtained. A 16-gauge nasogastric Ryle’s tube was inserted for all patients included in the study. The feeding patterns were initiated depending upon the severity of acute pancreatitis. Feeding was started after calculating the nutrition requirement. In the early feeding group, patients were given a protein powder to achieve a target nutrition in a stepwise manner. The tolerance to feeds, infective and non-infective complications and the time taken to start on an oral diet were noted and analysed. Results: The incidence of infective complications in our study was found to be 2% with none of the infections involving the pancreas itself. The incidence of non-infective complications in our study was found to be 30% with 13% involving the pancreas proper. Conclusions: The use of early enteral feeding does not influence the incidence of infective and non-infective complications in mild and moderate acute pancreatitis. Early enteral feeding delivers nutrition, in a simpler and more cost-effective. Nasogastric and oral feeding reduces the morbidity of the patient by accelerating the return to normal activities.
ABSTRACT
Background: Diabetes mellitus (DM) and Hypertension (HTN) are the two major chronic disorders frequently coexisting, with increased incidence with age. HTN is about twice as common in patients with DM. Prescribing pattern are powerful tools to ascertain the role of drugs in society. There are many variations in prescribing patterns of antihypertensive drugs in patients with HTN and DM. Since these patients requires lifelong treatment it has enormously increased the burden of patients particularly in developing countries like India. Physician needs to be more concerned while choosing drugs for the patients with HTN and DM. In a tertiary care hospital, there is a real need for drug utilization study to determine the appropriate, more safe and effective patterns of drug therapy among diabetic hypertensive patients.Methods: A Cross sectional observational study was conducted in Maharajah’s Institute of Medical Sciences from December 2016 to May 2018. A total of 360 prescriptions of the patients with hypertension and coexisting diabetes were analyzed. The prescriptions prescribed to these patients were collected, assessed and the following parameters were noted. The treatment pattern of different group of drugs for HTN with co-existing DM was evaluated. The intended work was divided into three steps: Step 1: To collect the prescriptions of hypertensive patients with DM. Step 2: To separate the prescriptions prescribing anti hypertensive Drugs. Step 3: To statistically analyze the prescriptions. Relevant information was recorded in a structured proforma & data was evaluated.Results: In this study it was found that 36% of the patients were in the age group of 51-60 years with female preponderance among diabetic hypertensive patients. 77% of patients were treated with single antihypertensive drug and 23% of patients were treated with antihypertensive drug combinations. In monotherapy, telmisartan was most commonly prescribed. In combination therapy, amlodipine and telmisartan followed by amlodipine and atenolol were used.Conclusions: In this study monotherapy was preferred compared to combination therapy and adherence to the JNC 7 guidelines was good except in case of usage of diuretics.
ABSTRACT
Background: Diarrheal disorders in childhood account for a large proportion (18%) of childhood mortality. Among diarrheal diseases, dysentery is a major cause of childhood morbidity and mortality, especially in developing countries.Methods: This is an open labelled, prospective, randomised, comparative study carried out at Dr. B. R. Ambedkar Medical College Hospital, Bangalore from November 2014 to November 2015 after Institutional Ethics Committee approval. A total of 80 Paediatric patients who met the inclusion criteria were included in the study after taking written informed consent from parents and assigned into two groups, Group A- Inj. Ceftriaxone (50-100mg/kg/day) and Group B- Inj. Cefotaxime (100 mg/kg/day) in divided doses for a period of 3-5 days based on requirement.Results: In this study, Cefotaxime was non inferior to Ceftriaxone as the Mean Duration of Hospitalisation was 3.30±0.72 days in Group A and 3.30± 0.72 days in Group B with p value of 1.000, showing no statistically significant difference. Both were well tolerated without any reports of ADR (Adverse Drug Reaction).Conclusions: In this study shows that Inj. Cefotaxime is equally efficacious and well tolerated as Inj. Ceftriaxone in the treatment of Acute Bacillary Dysentery in paediatric patients.