A comparative single dose study of oral acetaminophen 650 mg to its standard 500 mg dose in adult pyrexia patients in a tertiary care hospital

Background: Acetaminophen commonly called as paracetamol is the most used ‘over-the-counter’ analgesic for headache, musculoskeletal pain, dysmenorrhoea etc. It is the best drug to be used as antipyretic for fever due to any cause and safest to be prescribed in all age groups. Antipyretic dose of acetaminophen is 325 to 650 mg; 3 to 4 times a day and is available in the strength of 650 mg and 500 mg tablets. This study was conducted to analyse the antipyretic efficacy and safety profile of two different doses of acetaminophen in patients with low grade fever.Methods: 300 hospitalised patients aged more than 18 years, in department of General Medicine, having low grade fever (38º to 39º C) were randomly allocated into two groups of 150 each, group A received 500 mg and group B received 650 mg of single oral dose of acetaminophen tablets. Oral temperature was measured before dosing, 30 minutes after dosing, one hour, two hourlies thereafter for 6 hours after the dose. Safety was assessed by monitoring for adverse effects during the study and 24 hours after administration of the assigned drug.Results: There was a statistically significant decrease in temperature in group B patients from baseline 39.06±0.87º C to 37.02±0.89º C at the end of 6th hour as compared with 39.18±0.80º C to 38.03±0.77º C in Group A patients (p=0.031).Conclusions: Our study concluded that acetaminophen in a dose of 650 mg is highly efficacious antipyretic drug compared to acetaminophen 500 mg with no adverse effects.

Comparison of clinical parameters with APACHE-II, Sequential Organ Failure Assessment and Clinical Pulmonary Infection Score scores in predicting treatment outcome of patients with ventilator associated pneumonia

Background: The objective of this study was to study the multiple clinical parameters in patients with VAP and to compare the 3 scores namely, APACHE II, SOFA and CPIS in predicting the treatment outcome of patients with ventilator associated pneumonia.Methods: It was a cross sectional observational study conducted on forty patients admitted in ICU between June 2018 and July 2019, who developed VAP after admission to ICU. Logistic regression analysis was applied to estimate the predictive ability of the APACHE II, SOFA and CPIS scoring systems in assessing VAP-related mortality. A p value of <0.05 was considered significant. All analyses were performed using SPSS software version 10.Results: The sample size in our study was 40 patients. The mean age of patients was 43.4±15.9. The mean duration of mechanical ventilation before VAP onset was 8±2 days. Klebsiella species was the most common organism isolated from ET aspirate. Of the three scores only APACHE II was independent predictor of the mortality in the logistic regression analysis.Conclusions: APACHE II score is better at predicting mortality in patients with VAP as compared to SOFA and CPIS scores. Age, co-morbidities, duration of ICU stay, time of acquiring VAP, multi organ dysfunction, need for ionotropes and multi drug resistant organisms play an important role in predicting the outcome of patients.

A prospective study to assess glycemic status as a possible prognostic marker in non diabetic acute organophosphate poisoning patients

Background: Organophosphates (OP) are a diverse group of insecticides used for pest control. Due to easy availability of these compounds over the counter, organophosphate poisoning continues to be a major cause of deliberate self-harm. Although choline esterase inhibition plays a key role in OP poisoning, other metabolic factors like dysglycemia contribute to the severity of poisoning. The present study attempts to assess glycaemic variability as a probable prognostic factor in acute OP poisoning. Aim of the study was to correlate the blood glucose levels with the severity and treatment outcome of acute organophosphate poisoning.Methods: 100 patients of acute organophosphate poisoning admitted in the hospitals affiliated to Bangalore Medical College and Research Institute during the study period from August 2018 to July 2019, were enrolled into the study as per the inclusion criteria and graded into mild, moderate & severe, based on Peradeniya organophosphorus poisoning (POP) scale. Random blood sugar (RBS) was estimated at the time of admission and patients were followed up till recovery/death.Results: The patients in this study were categorized into hypoglycemics (10%), euglycemics (75%) and hyperglycemic (15%). 16% of euglycemics, 30% of hypoglycemics and 60% of hyperglycemics had severe grade of poisoning. The ventilator requirements in hypoglycaemics, euglycemics and hyperglycemics were 40%,48% and 80% respectively. The outcome in terms of mortality was 8% in euglycemics group and 20% in hyperglycemics group. Hence hyperglycemia was found to be a poor prognostic marker in acute organophosphate poisoning.Conclusions: RBS at admission in acute organophosphate poisoning patients is a simple, inexpensive tool that may help to predict the clinical outcome. Early identification of the poor prognostic indicators may help in timely intervention, to reduce morbidity and mortality, especially in a resource limited country like India.

Study of microbial pattern and antibiotic sensitivity pattern in hospitalised acute exacerbation of COPD patients

Background: Most of the acute exacerbations of COPD are preventable and curable. More than 50% of them are infectious in nature and strain of the pathogen causing them is quite variable from place to place and often determines the severity of exacerbation. Antibiotic resistance has created a bigger challenge for the treating physicians to have a better treatment outcome. Our objective was to study the bacterial profile and antibiotic sensitivity pattern in all acute exacerbation of hospitalized COPD patients.Methods: All patients admitted for COPD exacerbation were evaluated for their sputum culture and sensitivity and followed up.Results: Totally 148 patients were included in the study and organisms were isolated 72 patients. Important organisms isolated were Klebsiella (20), Pseudomonas (16), Streptococci (8), Staphylococcus aureus (8), MTB (4) etc. Many MDR strains were noted. Resistance to newer antibiotics were also noted.64 patients out of 148 required a change in antibiotic (40 in culture positive group, 24 in culture negative group) and there were 12 deaths noted in study. Mortality and morbidity were more in culture negative group and in those who had MDR strains.Conclusions: Gradual shift to gram negative bacilli was observed in infective exacerbation of COPD. Multiple resistant strains were noted and often responsible for poor recovery. Early diagnosis and proper antibiotic selection is the key for a good treatment outcome.