ETIOLOGY AND OUTCOME OF ESOPHAGEAL STRICTURE AMONG CHILDREN: LOCAL DATA FROM TERTIARY CARE CHILDREN HOSPITAL OF MULTAN, PAKISTAN

Objective: The objective of the study is to study drug utilization in patients with breast carcinoma receiving systemic chemotherapy in government as well as private set-up. Methods: This was a record-based, retrospective-prospective study, analyzing the prescription pattern of drugs used for systemic chemotherapy in patients diagnosed with carcinoma breast at government teaching hospital (GTH) and private trust hospital (PTH) for 1 year in 600 patients. Patient’s demographic, clinical, and therapeutic data were collected from the files and personal interviews and analyzed in Microsoft Excel. Results: Diagnosis of breast carcinoma was highest in age bracket of 40–49 years (32.33% GTH and 32.67% PTH), and the most common presenting symptom was painless lump (76.33% GTH and 83% PTH). In GTH, most frequently prescribed regimen was 4AC → 4T → RT (17.33%). In PTH, most commonly prescribed regimen was 6FEC → RT (19.33%). Highest prescribed drugs were A (32.8%), C (29.12%), and F (20.24%) in GTH and A (32.26%), F (31.68%), and E (16.45%) in PTH. Average number of drugs prescribed per prescription was 12.55 and 11.37; percentage of chemotherapeutic agents prescribed by generic name was 100 and 95.02, and from the WHO essential drug list (2015) was 96.43 and 82.77 in GTH and PTH, respectively (A= Cyclophosphamide, C= Doxorubicin, T=Taxanes [Paclitaxel/Docetaxel], F=5-fluorouracil, E=Epirubicin, RT=Radiotherapy, → followed by, the number indicates chemotherapy cycle). Conclusion: The study results can help in generating local data regarding drug use pattern of the systemic chemotherapeutic agents in breast cancer patients and promote rational drug use.

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ADVERSE DRUG REACTIONS IN PEDIATRIC PATIENTS IN A TERTIARY CARE HOSPITAL IN KOLLAM

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i4.40453 ◽

2021 ◽

pp. 113-115

Author(s):

REEJA R ◽

BEENA JS ◽

AJITHKRISHNAN AS ◽

BINDULATHA NAIR R

Keyword(s):

Adverse Drug Reactions ◽

Pediatric Patients ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Drug Reactions ◽

Local Data ◽

Cross Sectional ◽

Dosing Regimens

Objective: Adverse drug reactions have not been as thoroughly studied in children as they have in adults. Extrapolation of efficacy, dosing regimens, and ADRs from adult data are inappropriate owing to developmental changes in physiology and drug handling. There is a lack of local data regarding the potential risk of ADRs in pediatric patients. Objective of this study is to identify the adverse drug reaction (ADR) profile in pediatric patients. Methods: In this cross-sectional study, 450 children attending the pediatric inpatient and outpatient department were selected, and the CDSCO reporting form for suspected ADR reporting forms was collected from those who had any adverse events by the consulting pediatrician. Later, this form was analyzed for the details for ADRs and assessed for causality, severity, and preventability using Naranjo’s algorithm, Hartwig and Siegel scale, and modified Schumock and Thornton scale of adverse drug reactions. Results: The cross-sectional study revealed a prevalence of 12.89%. Antibiotics caused more ADRs than any other group of drugs. Dermatological ADRs were the most common. Most ADRs were not preventable and were of moderate severity. The causality assessment showed that most ADRs were possible category. Conclusion: The ADRs are often unrecognized. We need more strict monitoring for early detection, treatment, and more importantly prevention of these events in the future. For that, more awareness programs, CMEs and teamwork are extremely important among the caregivers.

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Neonatal sepsis following prolonged rupture of membranes in a tertiary care hospital in Karachi, Pakistan

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3136 ◽

2014 ◽

Vol 8 (01) ◽

pp. 067-073 ◽

Cited By ~ 15

Author(s):

Muhammad Matloob Alam ◽

Ali Faisal Saleem ◽

Abdul Sattar Shaikh ◽

Owais Munir ◽

Maqbool Qadir

Keyword(s):

Risk Factors ◽

Neonatal Sepsis ◽

Tertiary Care ◽

Group B Streptococcus ◽

Neonatal Morbidity ◽

Cost Effective ◽

Klebsiella Pneumonia ◽

Care Hospital ◽

Local Data ◽

Group B

Introduction: Prolonged rupture of membrane (PROM) is an important risk factor for early onset neonatal sepsis (EONS), which is associated with increased neonatal morbidity and mortality. We reported the incidence and associated risk factors of PROM for culture-proven EONS. Methodology:The medical records of all neonates born at Aga Khan University, Karachi over a period of five years (2007-2011) with PROM (> 18 hours) were reviewed. Data about maternal and neonatal risk factors for EONS was collected and adjusted logistic regression (AOR) analysis was applied. Results:Incidence of PROM in this neonatal birth cohort was 27/1,000 live births. A total of 17 (4%) cases with blood-culture proven bacterial sepsis were identified within 72 hours of birth. Klebsiella pneumonia (n = 5; 29%) and Pseudomonas aeruginosa (n = 4; 24%) were the commonest isolates followed by group B Streptococcus (n = 3; 18%) and Escherichia coli (n = 2; 12%). Maternal fever (p = <0.001; AOR, 36.6), chorioamnionitis (p < 0.001; AOR, 4.1), PROM > 48 hr. (p < 0.001; AOR, 8.2), neonatal prematurity < 34 weeks (p < 0.001; AOR, 4.1) and low birth weight < 1,500 grams (p 0.001; AOR, 9.8) along with neonatal thrombocytopenia and raised CRP were found to be independent risk factors associated with culture-proven EONS in PROM. Conclusions: Preventive measures should focus on recognition of these high-risk infants with prompt laboratory screening for sepsis and early institution of empirical antibiotic based on local data. Such approaches would be a safe and cost-effective strategy, especially in developing countries.

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Effectiveness of Implementing a Locally Developed Antibiotic Use Guideline for Community-Acquired Cellulitis at a Large Tertiary Care University Hospital in Thailand

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa411 ◽

2020 ◽

Vol 7 (10) ◽

Author(s):

Rujipas Sirijatuphat ◽

Pornboonya Nookeu ◽

Visanu Thamlikitkul

Keyword(s):

Antibiotic Treatment ◽

Broad Spectrum ◽

Group Treatment ◽

Tertiary Care ◽

Antibiotic Use ◽

University Hospital ◽

Local Data ◽

Interactive Education ◽

Large Tertiary Care ◽

Antibiotic Combination

Abstract Background To determine the effectiveness of implementing a locally developed clinical practice guideline (CPG) for antibiotic treatment in adults with community-acquired cellulitis at Siriraj Hospital in Bangkok, Thailand. Methods The CPG for antibiotic treatment of community-acquired cellulitis was developed based on local data during June to December 2016. The CPG was introduced by multifaceted interventions, including posters, brochures, circular letters, social media, conference, classroom training, and interactive education during January to September 2018. Results Among 360 patients with community-acquired cellulitis, 84.4% were ambulatory and 15.6% were hospitalized. The median age of patients was 62 years, and 59.4% were female. Antibiotic prescription according to CPG (CPG-compliant group) was observed in 251 patients (69.7%), and CPG noncompliance was found in 109 patients (30.3%) (CPG-noncompliant group). The demographics and characteristics of patients were comparable between groups. Patients in the CPG-compliant group had a significantly lower rate of intravenous antibiotics (18.7% vs 33.9%, P = .007), lower prescription rate of broad-spectrum antibiotics (14.7% vs 78.9%, P < .001) and antibiotic combination (6.4% vs 13.8%, P = .022), shorter median duration of antibiotic treatment (7 vs 10 days, P < .001), lower median cost of antibiotic treatment (US $3 vs $7, P < .001), and lower median hospitalization cost (US $601 vs $1587, P = .008) than those in the CPG-noncompliant group. Treatment outcomes were not significantly different between groups. Conclusions Adherence to CPG seems to reduce inappropriate prescription of broad-spectrum antibiotic or antibiotic combination and treatment costs in adults with community-acquired cellulitis without differences in favorable outcomes or adverse events.

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Comparative Epidemiology and Resistance Trends of Common Urinary Pathogens in a Tertiary-Care Hospital: A 10-Year Surveillance Study

Medicina ◽

10.3390/medicina55070356 ◽

2019 ◽

Vol 55 (7) ◽

pp. 356 ◽

Cited By ~ 23

Author(s):

Gajdács ◽

Ábrók ◽

Lázár ◽

Burián

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Local Data ◽

Klebsiella Species ◽

E Coli ◽

Large Patient ◽

Utilization Data ◽

Tract Infections ◽

Outpatient Settings

Background and Objective: Urinary tract infections (UTIs) are common in human medicine, affecting large patient populations worldwide. The principal cause of UTIs is uropathogenic Escherichia coli (UPEC) and Klebsiella, both in community and nosocomial settings. The assessment of local data on prevalence and resistance is essential to evaluate trends over time and to reflect on the national situation, compared to international data, using the methods of analytical epidemiology. Materials and Methods: The aim of this study was to assess resistance trends and epidemiology of UTIs caused by E. coli and Klebsiella species in inpatients and outpatients at a tertiary-care hospital in Hungary, using microbiological data. To evaluate resistance trends, several antibiotics were chosen as indicator drugs, based on local utilization data. Results: E. coli was the most prevalent isolate, representing 56.75 ± 4.86% for outpatients and 42.29 ± 2.94% for inpatients. For E. coli, the ratio of resistant strains for several antibiotics was significantly higher in the inpatient group, while in Klebsiella, similar trends were only observed for gentamicin. Extended-spectrum β-lactamase (ESBL)-producing isolates were detected in 4.33–9.15% and 23.22–34.22% from outpatient, 8.85–38.97% and 10.89–36.06% from inpatient samples for E. coli and Klebsiella, respectively. Conclusions: Resistance developments in common UTI pathogens (especially to fosfomycin, sulfamethoxazole-trimethoprim, fluoroquinolones, and 3rd generation cephalosporins), seriously curb therapeutic options, especially in outpatient settings.

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Outcomes of the management of corrosive injuries of the upper digestive tract in a tertiary care center

Diseases of the Esophagus ◽

10.1093/dote/doab096 ◽

2022 ◽

Author(s):

Ravi Shankar Biswas ◽

Dipankar Ray

Keyword(s):

Esophageal Stricture ◽

Care Center ◽

Tertiary Care ◽

Aerodigestive Tract ◽

Esophageal Injury ◽

Gastric Injury ◽

Endoscopic Dilatation ◽

Injury Management ◽

Corrosive Esophageal Stricture ◽

Stricture Recurrence

Summary Esophageal stricture is the most common delayed sequelae of aerodigestive tract corrosive injuries. Early endoscopic dilatation is an integral part of corrosive injury management. Self-dilatation of the esophagus is effective in preventing stricture recurrence. In this prospective study, we included patients with corrosive aerodigestive tract injury from January 2009 to December 2020. We analyzed the outcome of the endoscopic dilatation and self-dilatation treatments administered to patients with a corrosive esophageal stricture. Among 295 patients, 164 had an esophageal injury, 73 had esophago-gastric injury, 55 had a gastric injury, and 3 had the pharyngeal injury. Of the 295 patients, 194 (81.85%) underwent dilatation, and 13 patients with diffuse esophageal injury underwent upfront surgery. Successful dilatation was performed in 169 (87.11%) patients. Of the 68 patients undergoing self-dilatation, 63 patients achieved nutritional autonomy by 28 days. Early endoscopic dilatation effectively prevents surgery, and self-dilatation appears promising to prevent recurrent esophageal stricture.

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