RESUMEN
Objective: To study the effects of cilostazol in patients with mild to moderate peripheral arterial disease [PAD] using the improvement in ankle brachial pressure index [ABI]
Methodology: This hospital based interventionist study was a prospective, open labeled clinical trial. After the baseline data collection cilostazol was given to the group A, while the group B didn't receive cilostazol. The effect of intervention was noted at the timed study points at 4, 6 and 12 weeks .The antiplatelets were used in the group B as a control
Results: The ABI improvement at the end of the study in the cilostazol treated group was marked compared with the control group. The group A had 65 males and 35 females, while the group B had 74 males and 26 females. The total ABI improved in the right and left lower limb with a P value of 0.001 each. The ABI results were better in the male, diabetic and hypertensive subsets of study as compared with female, obese and smoker
Conclusion: Cilostazol significantly improves ABI in PAD. Its use in the indicat-ed population group should be encouraged to improve the management and prevent the complications
RESUMEN
Background: Co-amoxiclav which is a combination of Amoxicillin and Calvulanic acid is one of the most commonly prescribed antibiotics so there was need to study the side effects of this drug
Objectives: This study was done to enlist the adverse reactions especially the gastroinstestinal and hepatotoxic adverse reactions in patients who were prescribed co-amoxiclav
Patients and Methods: This cross-sectional study was conducted on 200 patients, both indoors and out-doors in the Department of Medicine of Khyber Teaching Hospital [KTH], Lady Reading Hospital [LRH] and Hayatabad Medical Complex Peshawar, in months of August-October of 2013. The individuals included in the study were those treated as inpatient or outpatient with the diagnoses of uncomplicated UTIs, RTIs including Sinusitis and Pneumonia and the Skin infection. Those who were below the age of 18 years, requiring more than one antibiotic, having previously known chronic disease especially the liver disease or on any long-term medications, alcoholics and pregnant ladies were excluded from the study. A detailed questionnaire mentioning the age, sex and ethnicity of the patients, indications for the use of co-amoxiclav, duration of the treatment, base line LFTs including Bilirubin, SGPT and Alkaline Phosphatase and use of any concomitant drugs was devised. The patients were asked for follow up at weekly intervals for eight weeks after the course of treatment and assessed clinically and biochemically and LFTs recorded. This study which was approved by the Ethics Committee of our hospital was self-funded by the authors and informed consent was taken from every patient. The data was processed using SPSS version 16
Results: Amoxicillin- Calvulanate combination was seen to be well tolerated by most of the patients in our study subjects and adverse reaction were noted only in 36 [18%] of the patients. The commonest side effect was diarrhea seen in 24 [12%] of the patients which was more severe in patients getting higher doses and for more than a week. Side effects were commonly seen in old patients 16 [8%] and in chronic smokers. Hepatotoxic side effects were seen in 6 [3%] of the participants mainly cholestatic type of derangement on LFTs was seen and the toxicity was Mild i.e. Grade 1 in five of them as per National Institute of Cancer's, "Common Toxicity Criteria for Adverse Events, version 4.0 [CTCAEv4]" while one developed Grade 2 Hepatocellular type of Liver injury secondary to Co-Amoxiclav. Only 2% of the patients were discontinued with the drug when they developed signs and symptoms of allergy on the 1[st] day of treatment while Oral candidiasis was seen in only 1% of the study subjects
Conclusion: Gastrointestinal and hepatic side effects are uncommon with Co-Amoxiclav and the commonest adverse reaction is diarrhea. Clinically obvious jaundice along with biochemically deranged LFTs is pretty remote possibility and can be reverted on stopping the drug and commencing the supportive treatment
RESUMEN
To identify the clinical features and outcome of Guillain Barre syndrome [GBS] in patients presenting to general I. C. U. This descriptive study was carried out on patients with the clinical evidence of GBS admitted in the General Intensive Care Unit of Lady Reading Hospital Peshawar, from January to December 2005. All those patients having sensory loss or in whom only legs were affected were excluded from the study. Each patient had a detailed interview and underwent complete neurological and systemic examination. After the confirmation of diagnosis of GBS, the treatment was started accordingly. In this study 14 patients with GBS were treated. There were 13 [93%] male and 1 [07%] female. Ten [71.4%] were in the age range of 15-60 years. All [100%] patients presented with limb weakness. Numbness and paraesthesia was noted in 9 [64.28%] patients. Four [28.57%] patients presented with respiratory difficulty. Muscle weakness and absent reflexes were present in all patlents. Nine [64.1%] patients were offered conservative treatment and 4 [28.6%] patients were treated with assisted ventilation and 1 [07.1%] patient received lmmunoglobulins therapy. Four [28.6%] patients expired in ICU due to respiratory failure in spite of being on ventilator. One [07.1%] patient was taken to home by the attendant against medical advice. More males are affected than females. Limb weakness, respiratory muscles weakness and absent or diminished reflexes are the commonest clinlcal features. Hlgh mortality in this disease is associated with respiratory failure