RESUMO
Objective: To determine 3rd generation cephalosporin resistance in patients with community-acquired spontaneous bacterial peritonitis [SBP] using early response assessment
Methods: This prospective quasi-experimental study was carried out at Doctors Hospital and Medical Center from January 2016 to September 2018. Patients with cirrhosis and SBP were included. Third generation cephalosporins i.e. cefotaxime/ceftriaxone were used for treatment of SBP. Response after 48 hours was assessed and decline in ascitic fluid neutrophil count of < 25% of baseline was labelled as cephalosporin resistant. Carbapenem were used as second line treatment. Recovery and discharge or death of patients were primary end points
Results: Male to female ratio in 31 patients of SBP was 1.2/1 [17/14]. Hepato-renal syndrome was diagnosed in 11[37.9%] patients. Cefotaxime was used for 16[51.6%] patients whereas ceftriaxone for 15[48.3%] patients. Early response of SBP was noted in 26[83.8%] patients while 5 [16.2%] were non-responders to cephalosporins. SBP resolved in all non-responding patients with i/v carbapenem. In-hospital mortality was 12.9% and had no association with cephalosporin resistance. High bilirubin [p 0.04], deranged INR [p 0.008], low albumin [p 0.04], high Child Pugh [CTP] score [p 0.03] and MELD scores [p 0.009] were associated with in-hospital mortality
Conclusion: Cephalosporin resistance was present in 16.2% of study patients with community-acquired SBP. Mortality in SBP patients is associated with advanced stage of liver disease
RESUMO
Background: depression is an important health problem due to its prevalence and associated consequences. The life time prevalence of depression ranges between 10 to 21 % in population. According to the precipitation of the WHO, depression is estimated to become the second leading cause of dysfunction by the year 2020. Among medical students, academic stressors include the volume of material to be learned, academic performance and evaluation [examinations and continuous assessments]
Method: a cross-sectional study was conducted and the total of 300 Medical students from 18 to 25 years to age participated in this study. Students in this study were undergraduate students. Duke health profile were given to the students. Data analysis was done by using Chi square test
Results: 300 students from fourth year and final year were recruited for the study. Mean anxiety score was 35.4 SD + 19.9 with minimum score of 0 and maximum score of 99.6. Mean depression score was 35.9 SD + 21.8 with minimum score of 0 and maximum score of 100. Mean anxiety depression score was 28.8 SD + 33.8 with minimum score of 0 and maximum score of 100. Mental score was compared among medical students, 47.4% of fourth years and 34.2% of had severe mental stress [Score 75 - 100], Anxiety score was compared among medical students, 2.6% of fourth years and 3.4% of had severe anxiety [Score 75 - 100], Depression score was compared among medical students, 3.9% of fourth years and 5.5% of had severe depression [Score 75 - 100], 14.9% of fourth years and 18.5% of had moderate depression [Score 50 - 75]
Conclusion: anxiety score showed a little female predominance. Depression among medical students of fourth year was little more as compared to the final year students. Depression was more among male students than female students