Gastroesophageal reflux disease: Treatment options are beyond the proton pump inhibitors.

Objectives: To observe the effects of different combinations of medicines in GERD patients by using FSSG score. Study Design: Observational Study. Setting: Al-Tibri Medical College Hospital, Isra University Karachi Campus Karachi. Period: June 2017 to December 2017. Material & Methods: The study was conducted on GERD patients at Tertiary Care Hospital of Karachi. Adult patients from male and female gender with clinical symptoms suggestive of GERD were included. During clinical history taking patients were interviewed to respond symptoms frequency of FSSG questionnaire score from 0 to 4 on each question. All 154 eligible patients enrolled in the study and divided into three groups Group I (PPI alone), Group II (PPI with prokinetic) and Group III (PPI, prokinetic and SSRI). After 2 weeks of treatment, FSSG score of every participant was calculated. Results: Results of 134 patients 72 (53.3%) males and 63 (46.7%) females were analyzed. The cumulative mean age was 37.12±8.221 (range 16 – 60) years. The patients were grouped by single blind randomization method, each group I and group II consisted of 45 subjects and 44 patients were enrolled in group III. The mean FSSG score prior to treatment and after treatment was 21.194±4.786 and 14.962±3.696 respectively, hence, the gradient of pre-treatment and post-treatment was 6.231±4.601. The three groups shown significant improvement in FSSG score after treatment but the group III had shown highest improvement in mean FSSG score of 7.522±3.592, followed by group II with 7.2889±3.805and group I had shown the lowest improvement of 3.911±5.346 but statistical analysis revealed these improvements within each group as insignificant while turned to be significant when groups were analyzed with each other. (p 0.003). Conclusion: The results of this study suggests that PPIs alone have good therapeutic role but as dysmotility aspect of GERD and psychological comorbidity is very common in those patients and is likely to play an important role in response, or failure of response, to proton pump inhibitor treatment. Hence, addition of prokinetic and anxiolytics can augment the response rate.

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Prevalence of anaemia among children under five years in tertiary care hospital of Nepal.

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v13i1.12998 ◽

2015 ◽

Vol 13 (1) ◽

pp. 33-36 ◽

Cited By ~ 1

Author(s):

Sundari Joshi ◽

Megha Pradhan Pradhan ◽

Ujjwal Joshi

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Severe Anaemia ◽

Care Hospital ◽

Cross Sectional ◽

Children Under Five ◽

Group Iii ◽

Under Five ◽

Group I ◽

Group Ii

Introduction: Anaemia is a pathologic deficiency in oxygen-carrying haemoglobin in red blood cells which may be the result of genetic diseases, infections and deficiency of several nutrients. Nepal is one of the developing countries where anaemia is one of the most serious public health problems. So, a study was planned to evaluate the prevalence of anaemia among children under five years in tertiary care hospital of Nepal. Methods: A cross-sectional study was carried out from August 2011 to January 2012 using a structured questionnaire interview and observation. The children were divided into three groups: group I (0-1 years), group II (>1-3 years), group III (>3-5 years). Anaemia was assessed using haemoglobin measurement in gram in decilitre on Sysmex KX -21 (automated haematology analyzer). The severity of anaemia were grouped as follows: severe anaemia, < 7.0 g/dL; moderate anaemia, 7.0 to 8.9 g/dL; and mild anaemia, 9.0 to 10.9 g/dL as per WHO classification. Stool test was also carried out to assess worm infestation. Data were analysed using SPSS 11.5. Results: There were 208 children among which 52.9 % were male while 47.10 % were female. The overall prevalence of anaemia was found to be 49.5% of which 43.3% had mild, 15.8% had moderate and 0.5% had severe anaemia. Out of 20 children in group I, 70 % were anaemic. Among the 94 each in group II and group III, children suffering from anaemia were 51% and 43% respectively. The stool investigations showed that 5.3 % children suffered from worm infestations. Conclusions: prevalence of anaemia was seen in 49.5% of children below five years age group and the diet and worm infestations didn’t affect it.doi: http://dx.doi.org/10.3126/mjsbh.v13i1.12998

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Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

Bangladesh Journal of Child Health ◽

10.3329/bjch.v41i3.36951 ◽

2018 ◽

Vol 41 (3) ◽

pp. 159-164 ◽

Cited By ~ 1

Author(s):

Madhabi Baidya ◽

Mahfuza Shirin ◽

Liton Chandra Saha

Keyword(s):

Perinatal Asphyxia ◽

Care Center ◽

Tertiary Care ◽

Preterm Neonates ◽

P Value ◽

Care Hospital ◽

Cross Sectional ◽

Neonatal Transport ◽

Group I ◽

Group Ii

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

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A randomised trial of 5% minoxidil versus combination of 5% minoxidil and oral spironolactone in treatment of female pattern hair loss

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20194565 ◽

2019 ◽

Vol 5 (4) ◽

pp. 668

Author(s):

Nachiket Madhukarrao Palaskar ◽

Nitin Dinkar Chaudhari ◽

Garima Laxminarayan Balpande ◽

Swapna Subhash Khatu

Keyword(s):

Combination Therapy ◽

Hair Loss ◽

Tertiary Care ◽

Randomised Trial ◽

Life Questionnaire ◽

Care Hospital ◽

Female Pattern Hair Loss ◽

Group I ◽

Topical Minoxidil ◽

Group Ii

Background: Female pattern hair loss (FPHL) is a common form of nonscarring hair loss. We compared the usefulness and safety of topical minoxidil alone with combination of oral spironolactone and topical minoxidil in the treatment of FPHL.Methods: This prospective, single-centre, randomised open label study over 100 patients attending tertiary care hospital in Mumbai during period December 2011 to June 2012. The data were entered into SPSS version 21 for analysis. Data collected were coded and described as frequency and percentage for qualitative data and means and standard deviation for quantitative data. Statistical analysis was done using chi-square and student t test. Statistical significance was considered if p value was less than 0.05.Results: There were 48 patients in Group I and 46 patients in Group II. At 6 months, significantly higher mean Sinclair grade was observed among Group I patients as compared to Group II patients (2.85±0.68 vs 2.56±0.50, p=0.02). We observed a significant improvement in women’s androgenetic alopecia quality of life questionnaire in Group I patients at 12 months after treatment (26.93±2.25 vs 23.47±2.95, p<0.001). Minoxidil and spironolactone were tolerated well by the patients.Conclusions: Combination therapy of topical minoxidil and oral spironolactone has an additive effect. However, plateau of effectiveness of the combination therapy in normoandrogenic patients at 6 months of therapy was observed. We recommend the combination for 6 months and continuation of therapy with minoxidil only.

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Serum Zinc Status in Post Menopausal Women Attending in a Tertiary Care Hospital of Bangladesh

BIRDEM Medical Journal ◽

10.3329/birdem.v9i2.41281 ◽

2019 ◽

Vol 9 (2) ◽

pp. 147-150

Author(s):

Nadia Ferdous ◽

Farzana Akonjee Mishu ◽

Shamsunnahar ◽

Fahmida Islam ◽

Shabnam Sarwar Sejooti

Keyword(s):

Clinical Symptoms ◽

Tertiary Care ◽

Serum Zinc ◽

Premenopausal Women ◽

Care Hospital ◽

College Hospital ◽

Medical College ◽

Significant Difference ◽

Zinc Levels ◽

Serum Zinc Levels

Background: Nutritional needs change throughout the various stages of life. While overall caloric needs tend to decrease with age, the requirements for individual micronutrients do not decrease. In fact, the needs for some micronutrients actually increase with age. The risk of nutritional disturbances mainly trace elements deficiencies is high during postmenopause causing or intensifying serious clinical symptoms. Methods: This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with the Department of Obstetrics and Gynecology , Mymensingh Medical College Hospital during the period from July 2013 to June 2014. A total of 100 subjects were included in this study. Among them 50 apperantly healthy postmenopausal womenaged between 45-70 years were considered as case and another 50 regular menstruating premenopausal women aged between 30-40 years were selected as control. Results: The mean age of case and control groups was 50.5± 2.3 years and 36.5± 4.4 years respectively. In this study serum zinc levels in cases and controls were 71.54 ± 5.69 ìg /dl and 74.68 ± 5.453 ìg/dl respectively, and there was significant difference(p<0.01). Conclusion: Serum zinc level was significantly decreased in postmenopausal group in comparison to premenopausal women (p< 0.01). Estimation of serum zinc levels might be incorporated in every postmenopausal for possible prevention of complications. Birdem Med J 2019; 9(2): 147-150

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Estimation of Serum Copper in Post-menopausal Women Attending in a Tertiary Care Hospital, Bangladesh

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v10i2.44118 ◽

2019 ◽

Vol 10 (2) ◽

pp. 110-113

Author(s):

N Ferdous ◽

Farzana Akonjee Mishu ◽

Shamsunnahar ◽

Syed Md Tanjilul Haque ◽

ANM Ashikur Rahman Khan ◽

...

Keyword(s):

Clinical Symptoms ◽

Tertiary Care ◽

Premenopausal Women ◽

Serum Copper ◽

Copper Level ◽

Care Hospital ◽

College Hospital ◽

Cross Sectional ◽

Medical College ◽

Significant Difference

Background: Nutritional needs change throughout the various stages of life. While overall caloric needs tend to decrease with age, the requirements for individual micronutrients do not decrease. In fact, the needs for some micronutrients actually increase with age. The risk of nutritional disturbances mainly trace elements deficiencies is high during postmenopause causing or intensifying serious clinical symptoms. Methods: This cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital during the period from July 2013 to June 2014. A total of 100 subjects were included in this study. Among them 50 apperantly healthy postmenopausal women (Case) aged between 45-60 years were considered as case and another 50 regular menstruating premenopausal women(Control) aged between 30-40 years were selected as control. Results: The mean age of cases and control groups was 50.5±2.3 years and 36.5±4.4 years respectively. In this study we found Serum Copper levels in cases and controls were 115.36±8.836 µg /dl and 90.58 ±6.315 µg/dl respectively had (p< 0.01) significant difference. Conclusion: Serum Copper level was significantly increased in postmenopausal group in comparison to premenopausal women (p< 0.01). Estimation of serum Cu level might be incorporated in every postmenopausal woman for prevention of complications. Anwer Khan Modern Medical College Journal Vol. 10, No. 2: July 2019, P 110-113

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A comparative study of tapentadol versus tramadol in the treatment of low back pain

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20202942 ◽

2020 ◽

Vol 9 (7) ◽

pp. 1064

Author(s):

Laxman Verma ◽

Pankaj Kumar Chaudhary ◽

Chandresh Gupta ◽

Umesh Saroj

Keyword(s):

Pain Intensity ◽

Tertiary Care ◽

Care Hospital ◽

Medical Assessment ◽

Group I ◽

Parallel Group ◽

Reduction Of Pain ◽

The Mean ◽

Group Ii ◽

The Difference

Background: Nontraumatic musculoskeletal disorders are the main reason for presentation to the emergency department with Rachialgia being the most common reason to request medical assessment among them. Methods: This was a prospective, randomized, parallel group open labelled study conducted in a district level tertiary care hospital attached to a medical teaching institute. Patients were randomized into two groups. Group I (63 patients) received tablet tramadol 50 mg twice daily orally and group II (63 patients) received tablet tapentadol 50 mg twice daily orally.Results: The mean age of the patients of group I was 40.6±9.6 years and in the group II was 42.7±10.6 years. A total of 61 males participated in the study of which 31 males were enrolled in group I and 30 in group II while 65 females participated in the study of which 32 females were enrolled in group I and 33 in group II. The mean reduction of pain intensity VAS score at the end of 4 weeks from baseline in group I and group II were 34.57 and 37.55 respectively. The difference in the mean reduction of pain intensity VAS between the two groups was not statistically significant.Conclusions: We conclude that both the drugs show significant reduction in the pain intensity in moderate to severe CLBP patients. Tapentadol is as efficacious as tramadol in moderate to severe CLBP. However, tapentadol is better tolerated than tramadol.

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Survival among patients admitted in PICU (Pediatric Intensive Care Unit) of tertiary childcare hospital.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.12.5991 ◽

2021 ◽

Vol 28 (12) ◽

pp. 1773-1777

Author(s):

Fatima Jabeen ◽

Asim Khurshid ◽

Maria Saleem

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Tertiary Care ◽

Pediatric Intensive Care ◽

Care Hospital ◽

Group Iii ◽

Group I ◽

Male Patients ◽

Study Participants

Objective: To determine the frequency of survival among patients admitted in Paediatric Intensive Care Unit (PICU) of tertiary care hospital according to disease severity score PRISM III. Study Design: Descriptive study. Setting: PICU of The Children’s Hospital and Institute of Child Health, Multan. Period: October 2019 to April 2020. Material & Methods: A total of 205 admitted children in PICU were recruited. PRISM III forms were filled and PRISM III score was calculated for all study participants. Results: Of these 205 study cases, 124 (60.5 %) were male patients while 81 (39.5 %) were female patients. Mean age of our study cases was 3.64 ± 1.96 years. Mean duration of PICU stay was 4.52 ± 3.59 days and 139 (67.8%) patients had PICU stay for upto 5 days. Mean PRISM III score was 11.25 ± 4.69 and 69 (33.7%) had group I score, 118 (57.6%) had group II score, 14 (6.8%) had group III score and 4 (2%) had group IV score. Of these 205 study cases, mortality was noted in 31 (15.1%). Conclusion: High Frequency of mortality among children admitted to pediatric intensive care unit (PICU) was observed and mortality was found to be increasing with increasing PRISM III score.

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A retrospective study on management of bell\'s palsy in a tertiary care hospital

Panacea Journal of Medical Sciences ◽

10.18231/j.pjms.2021.038 ◽

2021 ◽

Vol 11 (2) ◽

pp. 173-176

Author(s):

P.K Purushothaman ◽

Dhanyan Harshidan ◽

Priyangha Elangovan

Keyword(s):

Clinical Symptoms ◽

Tertiary Care ◽

Bell’S Palsy ◽

Care Hospital ◽

Bell's Palsy ◽

College Hospital ◽

Medical College ◽

Therapeutic Measures

Bell's palsy is the most common facial nerve disorder. The clinical symptoms of Bell's palsy include facial muscle paralysis, difficulty in eating, drinking and talking. Bell's palsy management is still controversial. Many patients recover spontaneously; some require medicines like corticosteroids, antiviral drugs and other managements.To study the effectiveness of Bell's palsy management that has been followed in our institution.This analysis had carried out from June 2016 to June 2019at SRM Medical College Hospital and Research Institute, Chennai. Total of 30 patients with Bell's palsy who had admitted in the Department of Otorhinolaryngology had enrolled in this study. All the patients underwent thorough clinical examination and laboratory investigation, and the results were statistically analyzed and discussed.Out of 30 patients, 16(53%) patients were males, and 14(47%) patients were females. 53.3% of patients had onset of symptoms after 48 hours. There was a statistical significant improvement in House-Brackman scale on 6 months follow-up.The therapeutic measures for Bell's palsy if initiated within 72 hours of onset aids in bringing better outcome and improves the quality of life in patients.

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Effect of Povidone Iodine Versus Chlorhexidine Mouthwash on Oral Mucositis among Cancer Patients

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46216.15429 ◽

2021 ◽

Author(s):

. Jyothi ◽

S Latha ◽

K Pavithra ◽

M Nalini ◽

Sowmya J Rao ◽

...

Keyword(s):

Radiation Therapy ◽

Cancer Patients ◽

Oral Mucositis ◽

Povidone Iodine ◽

Tertiary Care ◽

World Health ◽

Care Hospital ◽

Group I ◽

Grading Scale ◽

Group Ii

Introduction: Radiation therapy and chemotherapy are the standard treatment given for cancer, which leads to the variety of adverse effects of which Oral Mucositis (OM) is one of the common side-effects. It is responsible for patient discomfort and decreases their level of functioning. Both Chlorhexidine and Povidone Iodine have got antimicrobial and antifungal activity which decreases the severity of mucositis. Aim: To compare the effectiveness of Povidone Iodine and Chlorhexidine mouthwash on OM among cancer patients undergoing radiation therapy or chemotherapy. Materials and Methods: A prospective observational study was conducted in the tertiary care hospital of Mangaluru, Karnataka, India for the duration of one year and three months from December 2015-March 2017. Fifty cancer subjects aged between 25 to 65 years and who developed OM after radiation therapy or chemotherapy were selected by purposive sampling technique. Data were collected using the demographic profile, clinical proforma and World Health Organisation (WHO) OM grading scale (2004) from 19.09.2016 to 17.12.2016. Experimental group I received 10 mL of diluted Povidone Iodine mouthwash and group II received 10 mL of diluted chlorhexidine mouthwash. Level of OM in the group I and group II were assessed on the 1st, 3rd, 5th and 7th day using WHO OM grading scale (2004). The data were analysed by descriptive and inferential statistics (Wilcoxon signed- rank test, Mann-Whitney U test, Repeated measures ANOVA) using SPSS version 16.0. Results: Among the 50 cancer subjects, majority 30 (60%) were in the age group between 55-64 years and majority 35 (70%) were receiving radiation therapy. On day seven, in the group I (Povidone Iodine) majority 14 (56%) subjects had mild level of mucositis whereas in the group II (Chlorhexidine) majority 14 (56%) subjects had moderate mucositis. Comparison of the effect of Povidone Iodine and Chlorhexidine mouthwash using Friedman’s ANOVA showed that there was a difference in the level of mucositis (p<0.05) at 5% level of significance among two groups. The study findings also revealed a difference in the level of mucositis between day 1 to day 3, 5 and 7 (Mann-Whitney U test) (p<0.05) in both the groups. Conclusion: Povidone Iodine mouth wash was more effective than Chlorhexidine mouthwashes in reducing OM, and the patients were more comfortable after the use of the mouthwash.

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“ROLE OF PARTOGRAM IN MANAGEMENT OF LABOUR IN PRIMIGRAVIDA PATIENT AT TERTIARY CARE CENTRE”

10.36106/3125017 ◽

2021 ◽

pp. 49-53

Author(s):

Surabhi Gupta ◽

Preeti Sharma

Keyword(s):

Tertiary Care ◽

World Health ◽

Normal Vaginal Delivery ◽

Tertiary Care Centre ◽

Obstructed Labor ◽

Group Iii ◽

Group I ◽

Management Protocol ◽

Prolonged Labor ◽

Group Ii

Introduction: Although labor is a natural physiological process characterized by progressive increase in frequency, intensity and duration of uterine contractions, resulting in effacement and dilatation of cervix, with descent of the fetus through the birth canal, this physiologic process many a time may lead to prolonged labor. The partograph developed by World Health Organization is the best-known partograph in the lowresource setting. Partograph when used with dened management protocol is an inexpensive tool which can effectively monitor labor and be helpful in reducing incidences of both maternal and fetal morbidity and mortality by reducing the number of operative interventions, prolonged labor, obstructed labor and caesarean section. Then WHO in 1994 endorsed the partogram and later modied in 2000 and removed latent phase and dened active phase at 4 centimetres instead of previously used 3 centimetres. WHO advocated its use as a necessary tool in management of labor and recommended its universal use during labor. Objective: To analyse the patterns of labor amongst spontaneous parturient using a WHO modied partogram and to compare outcome of labor and neonatal outcomes in relation to partogram ndings. Methods: This prospective study was carried over a period of 18 months on 100 parturients. Modied WHO Partogram was used to assess the progress of the labor. Parturients were divided on basis of partogram ndings. Group-I (n=64), where parturients partogram remained to the left of alert line, Group-II (n=20), where parturients partogram remained between the alert and action lines and Group-III (n=16), where parturients partogram crossed the action line. In these three groups, the maternal and fetal outcomes were assessed. Results: Normal vaginal delivery was done in 95.3% of Group-I, 80% of Group-II and 43.75% of Group-III parturients. Instrumental delivery was done in 1.56% of Group-I, 10% of Group-II and 18.75% of Group-III parturients. LSCS was done in 3.1% of Group-I, 10% of Group-II and 37.5% of Group-III parturients. Instrumental / LSCS deliveries were higher in Group-II and Group-III parturients. Alarge proportion of newborns of Group-II and Group-III parturients had Apgar Score <7. Conclusion: The Modied WHO partogram is very helpful in the prediction of maternal and fetal outcome. It is highly recommended for use in resource decient medical facilities, where early decision for delivery or referral can be taken on the basis of partogram ndings..

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