ABSTRACT
BACKGROUND: Hepatorenal Syndrome (HRS) is a reversible functional renal impairment that occurs in patients with advanced liver cirrhosis or those with fulminant hepatic failure. AIM: To evaluate the effect of terlipressin and albumin combination in various clinical outcomes in Hepatorenal Syndrome patientsMethods and Material: It was a prospective study involving 50 patients with HRS. The effectiveness parameters of the treatments were: confirmed HRS reversal, Recurrence of HRS within 90 days of treatment and mortality rate up to 90 days. The safety assessment includes adverse events collected up to 14 days of post-treatment. The quality of life of HRS patients was assessed using SF-12 questionnaire. RESULTS: In the present study the mean age of patients was found to be 55.10 ± 9.35 years. Mean serum creatinine values were found to be reduced (1.22 ± 0.96) by 10th day in type 1 HRS which indicated improved renal function. Study patients showed a marked improvement in liver function throughout the observation period. 74% of patients did not have HRS recurrence and 79.48% of patients had completely relieved from HRS. Loose stool (14.2%) and hyponatremia (14.2%) were the prominent side effects of the therapy. The quality of life of patients also showed a statistically significant betterment in both physical and mental functioning. CONCLUSIONS: Our study concluded that terlipressin and albumin combination was safe and effective in successfully stabilising cirrhosis patients with Hepatorenal Syndrome and bridging eligible patients to liver transplantation by restoring the liver and renal function with minimal adverse effects.
Subject(s)
Albumins/administration & dosage , Hepatorenal Syndrome/drug therapy , Liver Cirrhosis/complications , Terlipressin/administration & dosage , Vasoconstrictor Agents/administration & dosage , Aged , Drug Therapy, Combination , Female , Hepatorenal Syndrome/etiology , Humans , India , Kidney/drug effects , Kidney/physiopathology , Kidney Function Tests , Male , Middle Aged , Prospective Studies , Quality of Life , Recurrence , Tertiary Care Centers , Treatment OutcomeABSTRACT
Trichosporon asahii is a rare opportunistic fungal pathogen that causes fatal systemic infection in immunocompromised patients. Neutropenia developing due to malignancies is an important risk factor for fungal infection. Invasive infections due to T. asahii can be divided into disseminated and localized forms. The disseminated form is more common and usually occurs in neutropenic patients. The patient typically has an acute febrile illness that progresses rapidly to multiorgan failure. Here, we are presenting a case of fungal sepsis by invasive T. asahii in a 1-year-old child with Wilms Tumor. To the best of our knowledge, this is the first time that fungal sepsis due to T. asahii has been reported in a Wilms tumor patient. The incidence of rare invasive fungal infections is increasing in immunocompromised patients in whom management becomes difficult due to their heterogenous antifungal susceptibility pattern and intrinsic resistance to the standard antifungal agents that are routinely given. The patient was admitted with high spiking fever, and his laboratory investigations suggested neutropenia. T. asahii was isolated from the blood culture, for which he was started on inj. voriconozole. After 14 days of treatment, the fungus was cleared out from the patient's blood.
Subject(s)
Catheter-Related Infections/microbiology , Catheters, Indwelling/adverse effects , Fungemia/immunology , Immunocompromised Host , Trichosporonosis/immunology , Antifungal Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols , Dactinomycin , Humans , Infant , Kidney Neoplasms/drug therapy , Male , Trichosporonosis/drug therapy , Vincristine , Voriconazole/therapeutic useABSTRACT
OBJECTIVES: To evaluate the efficacy and safety of lorazepam in reducing psychological distress and chemotherapy-induced nausea and vomiting. METHODOLOGY: It was a prospective interventional study with seventy patients for a period of 1 year. In which, patients' anxiety, distress and status of nausea, and vomiting were assessed in the first four chemotherapy cycles before drug intervention. During the subsequent chemotherapy cycles, the outcomes of the intervention were reassessed along with patient's quality of life (QOL). RESULTS: Out of seventy patients, 62 showed improvement in their distress level after the drug intervention and patient counseling. Lorazepam along with other antiemetic drugs reduced chemotherapy-induced delayed nausea and vomiting. During the course of the study, 15 patients experienced drowsiness as an adverse reaction to lorazepam. The overall QOL of the population was also improved with lorazepam. CONCLUSION: Lorazepam along with patient counseling can improve patient's psychological distress and thus their QOL. The off-labeled use of lorazepam can be utilized for controlling chemotherapy-induced nausea vomiting.
