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Background: Proton pump inhibitors are one of the most commonly used drugs worldwide. Often they are used for inappropriate indications too, imposing economic burden to patients and governments. Many studies have showed equipotent efficacy of oral and intravenous proton pump inhibitor therapy. Despite that, most of the hospitalized patients receive intravenous proton pump inhibitor without appropriate indications. This study aimed to assess use of proton pump inhibitors in government hospital.Methods: It was an observational cross-sectional study done in the general medicine department of a tertiary care teaching hospital in Eastern India, including 800 noncritical patients. Objective was to assess the use of proton pump inhibitors (indications, route of administration, dosing frequency).Results: 100% patient received intravenous proton pump inhibitor irrespective of diagnosis. 80% of them received it twice daily and 18% received it once daily. Majority of the patients received intravenous proton pump inhibitor despite taking other drugs by oral route.Conclusions: Most of the PPI administration was done without appropriate indication. All patients received Intravenous proton pump inhibitors, which may impose economic burden on a government hospital. Majority of the patients received proton pump inhibitors twice daily. These approaches are not cost effective and need to be rectified.
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Loss of all toes not only causes tremendous psychological impact but also causes a significant functional defect. There is no reported case of replantation ofen bloc amputation of all five toes and very few papers on single or double toe replantations hence we had to rely on our experiences and logic to salvage the amputated part. Here, we report the case of replantation of en-bloc amputation of all five toes in a 16-year-old male. The purpose of this report is to share the authors’ experience with en bloc toe replantation. Successful replantation goes a long way in mitigating the psychological and functional trauma of the patient
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Tuberculosis control can significantly be increased if more effort is given to improve knowledge and attitudes of physicians towards prevention and control of disease. This study aimed to assess the knowledge about recent change in RNTCP guideline (2016) for diagnosis and treatment of tuberculosis among medical students and interns. Sample size was 295, including students of 3rd Professional MBBS part 1, 3rd Professional MBBS part 2 and Interns of a Medical college in West Bengal. The study was done with the help of specially prepared questionnaires. Mean scores of different batches did not show any significant difference . mean score of 3rd Prof part 1 students was best. Overall response was not satisfactory as many questions had more than 50 percent wrong responses. 3rd Prof MBBS part 1 students , probably after passing microbiology and pharmacology in 2nd Prof MBBS examination fared better in the questionnaire than their senior fellows.
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Proximal arm replants are devastating injuries which leave significant disability for the patient. Replantation of proximal limb injuries is widely considered to have poor results, especially so of the proximal third of the arm due to the difficulty in anastomosis of the vessels in the axilla. Furthermore, crush avulsion injuries have a much worse prognosis than clean-cut injuries. Here, we present the successful replantation of a true proximal crush amputation of the upper limb at the level of proximal third arm with satisfactory results in a 19-year-old male
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Background: Antimicrobial agents are one of the most commonly used as well as misused drugs. Rational antibiotic use is thought to be the best way to control resistance. Awareness and practice about antimicrobial use and resistance among medical students of different years so that appropriate measures can be taken to educate them properly to prevent misuse of antimicrobial as far as possible.Methods: It was a cross sectional questionnaire-based study undertaken in a teaching hospital in Eastern India among 328 medical students in 4 different batches. their responses remained confidential. total correct and incorrect responses from each of the 4 batches of MBBS students. overall trend and batch wise difference in the responses were analyzed.Results: Most of them had idea about problem of antimicrobial resistance and most of the students answered majority of the questions correctly. While assessing difference in responses in different batches, result showed that there was very significant improvement in the response of 6th semester students than the response of 4th semester students, may be due to acquiring knowledge of antimicrobials from their pharmacology classes in that period.Conclusions: Overall knowledge of antimicrobial resistance and proper use of antimicrobials appears good among different batches of MBBS student of this institution, though some areas need to be improved. Knowledge improvement is most evident from 4th semester to 6th semester students. Pharmacology training appears to make students more aware of this problem. Regular education is important to make them more aware.
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La manifestación clínica más grave y potencialmente fatal de la abstinencia de alcohol es el delirium tremens (DT), cuadro observado en aproximadamente el 5% al 10% de los pacientes con trastorno por consumo de alcohol que requieren hospitalización. El diagnóstico adecuado del DT requiere conocer los factores de riesgo, el cuadro clínico típico y la evolución y la gravedad de los síntomas de abstinencia. Las benzodiazepinas son el tratamiento farmacológico de elección para los pacientes con DT. Su eficacia fue confirmada mediante numerosos estudios. Si bien hay drogas alternativas que también pueden ser efectivas, las benzodiazepinas son elegidas debido a su perfil farmacocinético y de seguridad favorable. Las drogas alternativas son utilizadas como complemento de las benzodiazepinas para el tratamiento de los pacientes con cuadros de abstinencia complicados o resistentes. Los esquemas que incluyen dosis de carga administradas por vía oral o intravenosa son los preferidos para los pacientes con DT. El aumento rápido de la dosis de benzodiazepinas de acuerdo con la gravedad de los síntomas evaluados mediante escalas estructuradas y el empleo de drogas adyuvantes alternativas permiten el control oportuno del DT. Cerca del 10% de los pacientes que presentan resistencia a las benzodiazepinas requieren tratamiento en unidades de terapia intensiva con dosis intravenosas elevadas de benzodiazepinas y otras drogas, evaluación minuciosa y, de ser necesario, ventilación mecánica. La suplementación vitamínica y la atención adecuada por parte del personal de enfermería también son componentes esenciales del tratamiento. Los psiquiatras de enlace deberían integrar equipos multidisciplinarios destinados al tratamiento agudo de los pacientes con DT. No obstante, solo los psiquiatras de enlace con capacidades y conocimiento que se desempeñan de acuerdo con los protocolos estandarizados pueden lograr que determinados pacientes con DT reciban tratamiento adecuado. El psiquiatra de enlace también debe procurar un periodo de abstinencia seguro que proteja la dignidad del paciente y lo prepare para resolver la dependencia
The most serious and potentially life-threatening manifestation of alcohol withdrawal is delirium tremens (DT) or alcohol withdrawal delirium, which occurs in about 5% to 10% of hospitalized patients with alcohol problems. A consideration of risk factors, the typical clinical picture, evolution of withdrawal-symptoms and their severity aid in the proper recognition of DT. Benzodiazepines are the mainstay of medication treatment of DT. Their efficacy has been established by a large body of evidence. Although alternative medications might be equally effective, benzodiazepines are preferred because of their favourable pharmacokinetic and safety. Alternative medications are used as adjuncts to benzodiazepines in the treatment of complicated and refractory withdrawal states. Oral or intravenous loading-dose regimens are preferred for treatment of DT. Rapidly escalating doses of benzodiazepines titrated to symptom-severity on structured scales and the use of adjunctive alternative medications ensures prompt control of DT. About 10% of patients who are benzodiazepine-resistant require treatment in intensive care units with massive intravenous doses of benzodiazepines and additional medications, careful monitoring and mechanical ventilation if necessary. Vitamin supplementation and adequate medical, nursing and supportive care are other essential components of management. Liaison psychiatrists are expected to form an integral part of the multidisciplinary team, which manages patients with DT in acute-care settings. Only skilled and knowledgeable liaison psychiatrists relying on standardized treatment protocols can make certain that patients with DT receive adequate care. The liaison psychiatrist also needs to ensure a safe and humane withdrawal that protects the patient's dignity and prepares the patient for on-going treatment of dependence.
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Psychiatry , Benzodiazepines , Alcohol Withdrawal Delirium , Alcohol AbstinenceABSTRACT
Background & objectives: CAGE-AID questionnaire is a short, useful screening tool for substance dependence. Assessment of one family member for the screening of substance dependence in the family could be useful in clinical practice and research. In this study, we aimed to assess the validity of the Family CAGE-AID questionnaire for the diagnosis of substance dependence. Methods: Cross-sectional assessments using CAGE-AID and Family CAGE-AID questionnaires were conducted both for the study participants (n = 210) and their family members. The participants were recruited from two different treatment settings: a treatment seeking population from a de-addiction centre, and non-treatment seekers for substance use disorders from the psychiatry outpatient department. ICD-10 criteria and subsequent detailed clinical interview by a trained psychiatrist were used for the final diagnosis of substance dependence. Results: In the psychiatry outpatient group, the scores on CAGE-AID and Family CAGE-AID questionnaires were significantly correlated with the ICD-10 symptom score (r=0.81 and 0.70, respectively). In the same group, inter-rater agreement of the Family CAGE-AID was good with CAGE-AID and moderate with ICD-10 diagnosis of substance dependence (Cohen’s kappa 0.78 and 0.61, respectively). A cut-off score of three on Family CAGE-AID was found to be 95·8 per cent sensitive and 100 per cent specific. Interpretation & conclusions: Family CAGE-AID questionnaire is a valid screening instrument for the diagnosis of substance dependence, with acceptable sensitivity and specificity of a cut-off score of three. The simplicity and the brevity of such an instrument can be valuable in the clinical settings of developing countries and also for epidemiological studies.
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Background & objectives: The research on the association of metabolic syndrome (MS) and substance abuse is scanty. The present research aimed to study the prevalence and correlates of MS among the inpatients at a Drug De-addiction Centre in north India. Methods: Consecutive male subjects (N=110) admitted to a drug de-addiction centre during July to December 2009 with a primary diagnosis of alcohol or opioid dependence were evaluated for the presence of MS as per the International Diabetes Federation (IDF) criteria. Results: The prevalence of MS was 24.6 and 29.3 per cent in alcohol and opioid dependent groups, respectively. MS showed a significant association with the age and body mass index (BMI) in the opioid dependent group. Co-morbid tobacco use was not associated with MS in either group. Interpretation & conclusions: The prevalence of MS in our sample of alcohol and opioid dependent male inpatients was greater than the prevalence of MS in general population, however it was comparable to that reported in physical and other psychiatric disorder populations. Even though the absence of any comparative study limits the generalizability of our findings, results indicate towards a need for screening of the patients with substance dependence especially for those aged above 30 years and/or having a high BMI for MS.