Background: Adherence to a medical treatment regimen is an essential determinant of clinical success and professional success of doctor as well. Compared with the thousands of trials for individual drugs and treatments, there are few relatively rigorous trials of adherence interventions. Our study is a small effort towards understanding reasons for poor compliance among paediatric patients.Methods: The 256 cases that were selected for study had various clinical conditions. Compliance definition was applied only for those who received antibiotics. For other cases who received drugs other than antibiotics, we asked number of skipped doses. Data collected by paediatrician during follow-up or next visit because of some other illness and by telephone call to parents by assistant. Parents and kids were asked about the reasons for skipping the doses and also about their personal preferences towards medicines.Results: Out of 256 children 93 were prescribed antibiotics, 37.63% had good compliance and 62.36% had poor compliance.7% never skipped any medicine, 62% skipped less often (≤5 times) and 31% skipped. Very often (≥6 times), taste (67%), quantity (52%), apparent recovery (62%), school (65%), sleeping (56%), timing with food (47%) and bottle getting finished (49%) were the most common reasons for missing the dose of any medicine. Adherence was better when less number of doses were given less often. Chocolate flavor was liked by most kids.Conclusions: Prescribing medications should involve parents, children and practitioners in an open discussion around the most suitable, palatable formulations for successful treatment outcomes.
Background: Dengue is most common arboviral disease caused by 4 types of dengue viruses. In most of the hospitals laboratory diagnosis is made by dengue serology using Rapid Immunochromatographic Test for NS1Ag, IgM and IgG antibodies. We found more morbidity and mortality in suspected dengue cases whose serology was negative for dengue.Methods: Children with clinical features suggestive for case definition for dengue, who belonged to group C of World Health organisation (WHO) guidelines for dengue fever (severe dengue), were included. They were categorised into dengue positive and dengue negative groups. The clinical features and complications of the disease between the two groups were compared.Results: 98 cases (77.8%) were serologically positive for dengue and 28 (22.2%) were negative. 39% of the patients with dengue negative serology developed hypotensive shock in comparison to 18% of dengue positive cases, mortality in serology negative cases (21%) was significantly higher than positive cases (8%).Conclusions: We could not find the reasons for more morbidity and mortality in seronegative dengue group, we stress up on improving the sensitivity and specificity of rapid diagnostic tests. More caution need to be taken for serology negative dengue cases. Epidemiological studies directed to find circulation of other viruses which causes dengue like symptoms should be made.
Background: Dengue is the commonest mosquito born viral infection. The numbers of dengue cases are increasing in recent days. Though the manifestations of dengue are complex, management is made simple by WHO-2009 guidelines. Many of clinicians are unaware or not sensitized about WHO-2009 guidelines in classification and management of dengue cases.Methods: 143 suspected dengue cases were selected based on presumptive diagnostic criteria and were classified as group A, B and C, and all the patients were treated according to WHO guidelines. 108 cases with positive dengue IgM/IgG were chosen for analysis and rest of the cases were excluded from the study. The ELISA for IgM & IgG was sent on 5th-6th day of fever.Results: 108 dengue IgM/IgG positive cases were selected for the study. They were grouped as Group A (20), Gr B (60), Gr C (28) according to guidelines. Most common associated symptoms were vomiting (60%), pain abdomen (61%), and puffiness of face (58%). Rashes were present in small number of patients (7.4%) and bleeding in 2.7% children. 5% in group A, 6.6% in group B and 17.8% in group C had platelet counts of <20000/mm3. 70% children of Group -A, 75% of Group -B and 85.7% of Group -C had PCV of >35, with maximum of 53.2 belonging to Group C. None of the patient received platelet transfusion. All children recovered well.Conclusions: In the present study we managed all the dengue cases as per guidelines of WHO-2009. The treatment is cost effective and has very good outcome with less complications. The mortality, morbidity and duration of hospital stay were reduced. The need for iv fluids, blood and blood products were brought down significantly.
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