Informatics Publishing Limited

Abstract

Methodology: The study protocol was approved by the hospital human ethical committee. The patients of either sex who were aged between 18 and 60 years and admitted within 72 hours of their onset of emergency conditions were enrolled prospectively as per our study criteria for six months. The patients clinical and medication data were collected from the case records. Further, the data was analyzed and compared against national essential medication list.

Results and Discussion: Totally 100 emergency patients (Males 51%, Females 49%) were enrolled. Mean age of the patients was 36.3±1.1years. Of these cases, most commonly found emergencies were Fever (33%) followed by Acute Gastroenteritis (22%), and Upper respiratory tract infection (11%) among others. On average, 3.9±1.5 drugs were prescribed per patient.

Anti-pyretics (80.66%), antibiotics (11.33%) and analgesics and antiinflammatory drugs (8%) were found prescribed for patients suffering from fever. Acetaminophen (81%) was prescribed to treat high fever (over 100°F), Diclofenac(75%) was found prescribed for treating patients suffering from fever with body pain and Amoxicillin(60%) was found prescribed for treating the patients suffering from fever who are susceptible for infections. The results obtained in our study was similar to the results shown by Dhamija P et al.

Proton pump inhibitors (56%), Anti emetics (18.33%), Anti-diarrhoeals (7%) and Antimicrobials (%) were found prescribed for patients with Acute gastroenteritis. Pantoprazole (97.1%) was most extensively used Proton pump inhibitor. Ondansetron(71.4%) was used as Anti emetic. Loperamide (55.55%) was used for treating diarrhoea. Ofloxacin + Ornidazole infusion combination was used to treat gastroenteritis patients susceptible to infections. This study results were comparable to the study done by Pantanwala et al. All the prescribed drugs were utilized under nurse direct observation. The total number of drugs evaluated during the study was compared to the national list of essential medicines and was found to show 52.30% compliance to the NLEM 2011 which was better as shown in the study of Barot et al.

Conclusion: The medications such as Acetaminophen, Diclofenac, and Amoxicillin are frequently utilized to treat emergency patients with fever while Pantoprazole, Ondansetron, Loperamide and Ofloxacin and Ornidazole combination was utilized to treat emergency patients with gastritis and these drugs were prescribed according to national essential drug list.

Keywords

Full Text

Abstract

The most common co-occurring disorders with TS are Attention Deficit Hyperkinetic Disorder (ADHD) 50-60% and Obsessive Compulsive Disorder (OCD) 30-70%.

This Case report describes the history of a 38-year-old man who showed symptoms of tic disorder, was initially misdiagnosed as having psychosis that later proved to be Tourette Syndrome. The patient was presented to the Psychiatry department in the October 2013 with chief complaints of repetitive turning of face to the left, anger outbursts, involuntary raising of the upper limbs, foul words usage and occasionally counting fingers over the past year that intensified in the 15 days prior to admission.

The patient was prescribed a typical anti-psychotic such as Risperidone 2mg twice a day. Consequent admissions over the next one year showed new symptoms such as irritability, sudden movements of both upper and lower limbs, which progressed to jerking, hitting of his forehead multiple times, generalized body weakness, tremors of limbs that invariably led to disturbed sleep patterns. He was given combinations of neuroleptics such as Haloperidol and Olanzapine at doses of 5mg respectively with anti-depressants such as Lorazepam 1mg once daily and Fluoxetine 2omg thrice daily along with an anti-muscaranic agent Trihexyphenidyl 2mg twice daily.

The patient was non-compliant with the prescribed medications. The patient reported in June 2015 and was admitted for a period of one month with extra pyramidal symptoms (EPS) as a side effect of the anti Haloperidol. The doctors decreased the dose of Haloperidol to 2.5 mg once daily to minimize his symptoms. Although the tic symptoms decreased effectively during his hospital stay, there were clear abnormalities in his social interaction which the doctors diagnosed later as schizoid personality traits.

Keywords

Full Text

Abstract

EM is known to be caused by medications such as Barbiturates, Hydantoins, Nonsteroidal anti-inflammatory drugs, Penicillins, Phenothiazine and Sulfonamides.

Literature has revealed several cases of Fluoroquinolone (Ciprofloxacin) induced EM in India. Ciprofloxacin is mainly used in conditions such as Gonorrhea, Lower respiratory tract infection, Nosocomial pneumonia and mainly for Urinary tract infections.

This is a case report of a 43 year old female patient who reported to the Dermatology outpatient department of the hospital. She came in with symptoms such as multiple targeted dark coloured patches on legs, abdomen, hands and trunk. She also presented with a single whitish lesions on the mouth over the mucosal region of the hard palate.

The patient had a history of taking Tablet Ciprofloxacin 500mg for complaints of fever and burning micturition that developed 20 days before admission. In order to diagnose effectively, a biopsy was done which suggested Erythema Multiforme secondary to drugs.

The doctors prescribed oral prednisolone ( 30mg OD initially for 7 days which was tapered to 20mg OD for 7 days and later 10mg OD for 3 days) for the lesion over the mouth and Anti Histamines like Levocitrizine at 10mg BD for 15days for the itching.

A cream containing Aloevera and Vit E ( VenusiaMax) was prescribed for local application BD for 15days and a prophylactic course of anti-biotic ( Tab Amoxiclav 625mg BD for 6days) was initiated. After a period of 15days ,the patient showed no signs of recurrence and her symptoms subsided satisfactorily. The doctors then discharged her with a tapered dose of corticosteroid along with Tablet Ultracet for pain whenever needed.

Keywords

Full Text