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Background: Urinary tract infection (UTI) is one of the most common diseases caused by bacteria in communities and hospital settings. With the irrational prescription of antibiotics and their misuse leads to constant increase in resistance. This study aims to evaluate the spectrum and antibiotic resistance pattern of uropathogens and to provide a basis for appropriate antimicrobial therapy in patients with UTI.Methods: A retrospective observational study was carried out for a period of 6 months from April 2018 to September 2018 at general hospital Kakinada. Data of 282 positive urine culture reports and their antibiotic susceptibility test results were collected from the records of the Microbiology department and were analyzed and depicted in percentages. Sample processing, identification of organisms, and pattern of antimicrobial sensitivity were carried out as per the Clinical and Laboratory Standards Institute guidelines.Results: Out of 282 positive reports, Escherichia coli was the most common isolated uropathogen with a total of 148 (52.4%) followed by Klebsiella 72 (26%), 20 (7.9%) each of Citrobacter and pseudomonas aeruginosa. E. coli were resistant to nalidixic acid (59.5%), cotrimoxazole (58.1%), ciprofloxacin (54%) amoxyclav (52.7%), ampicilin (45.9%), cefatoxime (37.8%), cefaperazone and salbactum (25.3%). Klebsiella were resistant to amoxyclav (77.7%), cotrimazole (50%), nalidixic acid (41.6%), ampicilin (44.4%), cefatoxime (27.7%), ciprofloxacin (25%). E. coli and Klebsiella were highly susceptible to nitrofurantoin, cefaperazone and salbactum, piperacillin and tazobactum, amikacin, imipenem, gentamicin.Conclusions: The majority of the isolated bacteria were resistant to many antibiotics commonly used in clinical practices. So prior culture reports and institutional antibiograms are necessary for prescribing antibiotics rationally.
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Background: P-drug is a personal or preferred or priority choice drug of a clinician. The aim of the study is to evaluate knowledge, awareness, practice of p-drug which helps the clinician to prescribe drugs rationally.Methods: The study was a prospective cross-sectional pre-validated questionnaire-based study conducted in Government General Hospital, Rangaraya Medical College, Kakinada. During the study period a total of 300 members were enrolled and instructed to fill the questionnaire forms. These filled forms were collected and data were analyzed.Results: Out of 300 members, 240 filled the questionnaire, and these forms were evaluated. Among them 16.6% were aware of p-drug, 27.5% were aware of P treatment, 32.5% were not including FDC抯 in their p drug list, 28.33% were aware of advantages of prescribing P drug and 82% felt that teaching programs were needed for preparing p drug list.Conclusions: For promoting and achieving rational use of medicine, P drug concept is one of the milestones. As few were aware of p-drug concept, institutional teaching review board should conduct teaching programs regarding p drug concept.
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Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.
ABSTRACT
Ventricular septal rupture [VSR] is a life threatening complication of myocardial infarction [MI]. The incidence of post-MIVSR varied from 1% to 3% in the pre-thrombolytic era. There is almost a 10-fold decrease in the reported incidences [0.2-0.3%] of MIVSR today. The mortality in such an event is as high as 50-90%. Prognosis of post-MIVSR depends on prompt echo diagnosis and proactive surgical therapy. The peri-operative challenges during management of such a case can be enormous