Background: In India, antimicrobial resistance (AMR) remains a major challenge for treatment of infectious diseases mainly due to inappropriate and high consumption of antibiotics. Judicious choice of antibiotics and its optimistic utilization can be one of the potent ways to control the epidemic rise in AMR. The objective of this case series was to determine the clinical utility of antibiotic adjuvant entity (CSE-1034) (Ceftriaxone+Sulbactam+EDTA) in complicated urinary tract infection (cUTI) cases.
Methods: Patients suffering from multi-drug resistant (MDR) cUTIs and treated with CSE-1034 as monotherapy or combination therapy were screened and further analyzed. CSE-1034 therapy was started empirically in all these subjects and continued or discontinued based on culture sensitivity profile and clinical outcome. All the statistical analysis was performed using Chi-square test.
Results: 20 culture-positive patients with mean age of 51±7.3 years were included in this case series. The most common pathogen isolated was E. coli (60%) followed by K. pneumonia (25%) and A. baumannii (15%). Culture sensitivity profile has shown that pathogens isolated from all subjects showed no sensitivity to Cefazolin, Ceftriaxone, Cefipime, 25% to Pipericillin-Tazobactam (pip-taz), 20% to Cefaperozone-Sulbactam, 5% to fluoroquinolones and 90% to Meropenem. Susceptibility pattern to CSE-1034 and Colistin was 100%. 90% (18/20) patients treated empirically with CSE-1034 were cured with CSE-1034 monotherapy and 10% (2/20) with CSE-1034+Levofloxacin combination therapy.
Conclusion: From this case series, it can be suggested that CSE-134 alone or in combination with Levofloxacin appears to be an effective drug for treatment of MDR cUTI and can serve as effective replacement to Pip-Taz and β-lactam/β-lactam inhibitor combinations.
Background: Hypoglycemia refers to a clinical condition resulting from an abnormally low plasma glucose level <40 mg/dl without symptoms and <50 mg/dl with symptoms. Clinically, it is characterized by varying degree of neurological dysfunction and is responsive to the administration of glucose. Hypoglycemia is commonly caused by drugs used to treat diabetes mellitus.
Objective: To study the clinical profile, precipitating factors and outcome in the patients of hypoglycemia.
Materials and Methods: This hospital based 2 years prospective study was conducted in the Department of Medicine, Kasturba Medical College and hospital, Manipal, Karnataka. Clinical profile of 100 diabetic patients on OHA’s or Insulin treatment with the diagnosis of hypoglycemia were analyzed. The criteria for hypoglycemia was blood glucose level of <40mg/dl without symptoms and <50 mg/dl with symptoms.
Results: Out of 100 patients, 30 (30%) patients were of type 1 diabetes mellitus and 70 (70%) patients of type 2 diabetes mellitus. The male:female ratio was 1:1.7. The most common precipitating factor was found to be delaying or skipping meals (80%), followed by decreased carbohydrate intake (70%), increase in insulin or OHAs dosage (54%), decrease in insulin requirement (10%). The most common autonomic symptom was sweating (90%) followed by palpitation (80%). Neuroglycopenic symptoms were observed at much lower blood glucose level. Majority of hypoglycemic patients (68%) had blood glucose in the range 31-40 mg/dl. 64 patients (64%) were on only insulin therapy and 16 (16%) patients were on OHAs. 20 (20%) patients were on combination (insulin+OHAs) therapy. Maximum incidence of hypoglycemia was reported among patients who were on combination of short acting plus intermediate-acting (i.e Premix – 30/70) Insulin. However, within the set of patients developing hypoglycaemia due to OHA’s, the frequency was much higher (62.5%) with a combination therapy of OHA’s as compared to monotherapy (37.5%). All hypoglycaemic patients received IV dextrose (25%) and responded well to treatment. Present study did not show any mortality due to hypoglycemia.
Conclusion: Hypoglycemia is the most common acute metabolic complication of diabetes mellitus on treatment. Elderly diabetics, patients with chronic kidney disease and patients on long acting insulin/sulfonylureas (used either alone or in combination) are more prone to develop hypoglycemia. Diabetic patients should be familiar with hypoglycemia symptom profile so that they can perceive the early onset of hypoglycemia and an appropriate action can be taken immediately.
Aim: To perform phytochemical screening, isolate and characterize components from the n-hexane extract of Pseudocedrela kotschyi stem bark.
Methodology: The stem bark of P. kotschyi was collected, prepared and exhaustively extracted using analytical graded n-hexane and phytochemical constituents were determined according to the standard method. The Column chromatography technique was used to isolate and purify compound from n-hexane extract using gradient elution techniques. The isolated compound (PKV) obtained was subjected to physical, chemical and spectral analysis by UV, IR, 1D and 2D NMR.
Results: The Phytochemical screening revealed the presence of steroid/triterpenes and cardiac glycosides. The phytochemical investigation of the hexane extract of Pseudocedrela kotschyi led to the isolation of stigmasterol from the stem bark. The structure was ascertained by extensive comparison of the 1D & 2D NMR data and with their physical appearance with that reported in literature earlier.
Conclusion: To the best of our knowledge, this is the first report on the isolation of this compound from this plant.
Aims: To describe features of self-medication of children and determine factors associated with it.
Study Design: This was a cross-sectional study.
Place and Duration of Study: This study was conducted in five hospitals of Kisangani, in the Democratic Republic of Congo.
Methodology: We included all parents who brought their children for a new consultation. The dependent variables were the fact of giving medicines to children and the reasons related to this practice. Collected data were managed by Epi info™ 188.8.131.52. Chi-square test and Odds ratio evaluated the association between the level of instruction and other variables at 95% confidence interval.
Results: During the study period, 403 parents answered to our questionnaire. Most of them were mothers (94.8%). Parents’ education level was low (62.53%). Most of sick children were between 2 to 24 months-old (54.6%). They received at home 2.1 ± 1.3 drugs (1 to 8 drugs; median: 2 drugs): 81% were modern, 14% combined modern and traditional and 5% were traditional alone. Tablets and syrups were the two most used forms. Antipyretics like paracetamol were the most used. Parents gave drugs with dosage errors in 58% of cases. Only 37.8% of them asked advice from a physician, nurse or pharmacist to determine the dose. The main reasons for giving medicines without prescription were avoidance of too many formalities in hospitals or lack of enough money to bring children to the hospital.
Factors associated with self-medication were the female sex of parents (P = .004), the longer duration of the disease before bringing the child to the hospital (OR 1.5: 0.9 – 2.5; P = .04) and storage at home of drugs used formerly (OR 1.8: 1.1 – 3.1; P = .01). Parents of 30 years-old and less gave fewer medicines than more above 30 years-old (P = .0005).
Conclusion: The rate of children self-medication is high at Kisangani. Communication of health professionals, doctors, nurses and pharmacists is needed to reduce it.
Although an accurate diagnosis of malaria is key to effective rational malaria therapy, it has been the most neglected area of Malaria research. Thick blood film microscopy, Blood rapid diagnostic test (bRDT) and Urine Malaria Test (UMT) was comparatively used to study malaria prevalence as well as their sensitivity, specificity and predictive values in diagnosing malaria. A total of 100 samples were collected from patients attending University of Agriculture Makurdi health centre from September 2016 - January 2017 and analysed appropriately using standard procedures. The highest malaria prevalence 86(86%) was recorded in microscopic diagnosis followed by UMT 57(57%) while Blood Rapid diagnostic Test b(RDT) recorded the least malaria prevalence 50(50%). There was no significant difference (P > 0.05) in the prevalence of malaria in the different diagnostic methods used. Microscopic diagnosis recorded sensitivity and specificity of 100%, UMT recorded sensitivity of 79% and specificity of 100% while bRDT recorded sensitivity of 76% and specificity of 100%. There was a significant difference (P< 0.05) in the sensitivity and specificity among the different diagnostic methods used. The positive predictive value (PPV) and negative predictive value (NPV) microscopic diagnosis was 100% while bRDT also recorded a positive predictive value (PPV) of100% and a negative predictive value (NPV) of 75%. UMT equally had a positive predictive value (PPV) of 100% and a negative predictive value (NPV) 55.5%. The assessment of attributable fraction of fever associated with malaria among the participants showed that out of 86 malaria positive participants, 19 of had fever while 67 of them had malaria without any sign of fever.