Background: It is a well-known fact that drug-induced bleeding causes considerable morbidity and mortality. Drugs that induce bleeding do so by affecting either anti-platelet Function and /or coagulation. By the frequency of their use, anti-platelet, a coagulant, thrombolytic and NSAIDs are the most commonly implicated drugs. Upper gastrointestinal bleeding is commonest adverse drug reaction associated with hospital admission. Significant number of these could be prevented if simple guidelines are followed. Spontaneous cessation of bleeding occurs in as many as 85% of cases. Early intervention is required in those if bleeding does not stop spontaneously. Objective of the study was to determine the pattern of drug induced bleeding in tertiary care hospital setting. Methods: It was a hospital based observational study conducted during one year study dura on ((June 1, 2014 to May 31, 2015) amongst all adult patients admitted to the hospital with drug induced bleeding. Statistical analysis was done by frequency measurement for categorical variables. Chi-square test was used to determine associations. A p-value of<0.05 was taken as statistically significant. Results: A total number of 110 cases with history of bleeding were enrolled. Commonest drug that caused bleeding was a platelet with 29 (26%) cases followed by combination of 2 or more drugs in 25 (23%) cases, then NSAIDs and anticoagulants in 24 (21%) and 23 (20%) cases respectively. Upper gastrointestinal bleeding was the commonest site of bleeding seen in 64 (58%) cases. The commonest drugs causing upper GI bleeding were NSAIDs seen in 24 (37.5%) cases followed by a platelet 22 (34.3%), combined drugs in 09 (14%) cases. (P<0.001) In overall severity most cases of drug induced bleeding had mild bleeding with 61 cases as compared to 38 cases of moderate and 11 cases of severe bleeding. There were significantly higher proportion of mild and moderate bleeding in upper gastrointestinal bleed cases in comparison to other sites of drug induced bleeding in this study (p<0.01). 7 (6.4%) out of 110 patients died and 103 (93.6%) patients recovered and were discharged. Conclusions: Clinical management of bleeds requires careful assessment of the patient, haemodynamic stabilisation, discontinuation of the offending medication and, where appropriate, reversal of the haemorrhagic effects and specific therapies such as endoscopic haemostatic therapy.
INTRODUCTIONThe global burden and threat of non-communicable diseases (NCD) constitutes a major public health challenge that undermines social and economic development throughout the world. A total of 56 million deaths occurred worldwide during 2012. Of these, 38 million were due to NCDs, principally cardiovascular diseases, cancer and chronic respiratory diseases. Nearly three quarters of these NCD deaths (28 million) occurred in low-and middle-income countries. The leading causes of NCD deaths in 2012 were: cardiovascular diseases (17.5 million deaths or 46.2% of NCD deaths), cancers (8.2 million, or 21.7% of NCD deaths), respiratory diseases, including asthma and chronic obstructive pulmonary disease (4.0 million, or 10.7% of NCD deaths) and diabetes (1.5 million, or 4% of NCD deaths). 1 Thus, these four major NCDs were responsible for 82% of NCD deaths. Although morbidity and mortality from non-communicable diseases mainly occur in adulthood, exposure to risk factors begins in early childhood. According to World Health Organization (WHO) projection, the total annual number of deaths from non communicable diseases will increase to 55 million by 2030. 2 ABSTRACTBackground: Non communicable diseases (NCDs) are the leading causes of death globally, killing more people each year than all other causes combined. NCDs are caused, to a large extent, by four behavioural risk factors that are pervasive aspects of economic transition, rapid urbanization, and 21 st century lifestyles: Tobacco use, unhealthy diet, insufficient physical activity, and the harmful use of alcohol. Methods: This was a cross sectional study conducted in public institutions of urban field practice area of department of Community Medicine. World Health Organization (WHO) STEPS approach was used to find the prevalence of risk factors. The study was conducted in public institutions among working population aged 18 years and above. Results: A total of 350 participants were included in the study. The overall prevalence of tobacco use was 23.4%. The prevalence of alcohol consumption was 36%. None of the participant was consuming more than five servings of fruits and vegetables per day. Physical inactivity was seen in 51%. Total of 32.6% were found to be hypertensive. Conclusions: This study shows the high burden of risk factors for NCDs in the working population. Action should be oriented toward curbing the NCD risk factors and promoting healthier lifestyles to reduce NCD incidence rates and push back the age of NCD onset.
RATIONALE: Panic disorder (PD) has been shown to be associated with worse asthma outcomes in individuals with asthma, but the psychophysiological mechanisms underlying this association remain unclear. Some theories suggest that asthmatics with PD have worse underlying asthma severity and some argue that they simply report more symptoms based on their tendency to catastrophize bodily sensations. METHODS: A total of 39 patients (19 with and 20 without PD) with physician-diagnosed asthma underwent standard metacholine challenge testing (MCT). Demographic and medical/asthma history information was collected at baseline. Pre and post MCT patients completed the Panic symptom scale (PSS), the Modified Borg Scale (MBS), and the Subjective distress visual analogue scale (SD-VAS). Heart rate (HR), systolic, and diastolic blood pressure (SBP/DBP) were recorded pre, during, and post MCT. RESULTS: There were no differences in PC20 values between asthmatics with and without PD (F=0.21, p=0.652). PD patients had a higher number of panic symptoms (from the PSS) at post-test compared to those without PD ([M (SD)] PD pre = 2.21 (2.42), PD post = 5.00 (3.32); non-PD pre = 0.75 (1.07), non-PD post = 2.25 (1.89): F=5.05, p=0.031). There were no differences in MBS (F=0.70, p=0.407), SD-VAS anxiety (F=0.36, p=0.554), SD-VAS worry (F=0.84, p=0.366), HR (F=0.06, p=0.805), SBP (F=0.49, p=0.487), or DBP (F=0.01, p=0.942) between PD and non-PD patients. CONCLUSIONS: Results suggest that having PD is associated with increased subjective responses during MCT, with no impact on objective measures of asthma. Future research should focus on the potential impact of these increased panic attack-like symptoms on long-term asthma care and if intervening on them influences outcomes such as emergency room visits. Financial Support: SLB and KLL were supported by CIHR and FRQS salary awards.
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