Spontaneous Bacterial Peritonitis (SBP), a known complication of cirrhosis Liver is an acute bacterial infection of the peritoneum. Usually no source of infection is easily identifiable. Objective: To compare the efficacy of Ciprofloxacin and Cefotaxime in Cirrhosis Liver patients with SBP. Material and Methods: This prospective, comparative, single center study was conducted in the Department of Medicine, Khyber Teaching Hospital Peshawar from 1st October 2017 to 31st December 2018. A total of 300 admitted patients having Cirrhosis Liver with SBP were included in this study. The patients were randomized into Group A and Group B. Group A was treated with Intravenous Ciprofloxacin and Group B was treated with Intravenous Cefotaxime given twice daily for a period of 5 days. Diagnostic peritoneal paracentesis was done before the start of the treatment and repeated after 5 days therapy. Patients who were either non cirrhotic or had secondary bacterial peritonitis were excluded from the study. Results: A total of 300 Cirrhosis Liver patients with SBP were studied in two equal randomized groups. Out of these 168 were male and 132 were female. The mean age of patients in study was 51.14±11.9 years. The age ranged between 15-75 years. In Group A, 82 percent responded to ciprofloxacin and in group B, 86 percent responded to cefotaxime. Conclusion: Both intravenous ciprofloxacin and cefotaxime are effective in treating spontaneous bacterial peritonitis in patients with Cirrhosis Liver. Key Words: Ciprofloxacin, Cefotaxime, Spontaneous bacterial peritonitis, Efficacy.
Mr R was a 45-year-old man who had been diagnosed with hepatitis C, genotype 3a. He was commenced on a 16-week course of pegylated interferon-α2a 180 μg per week and ribavirin 400 mg twice daily. He was otherwise healthy and had recently completed the Boston marathon. During treatment the only complaints Mr R made were of sleep disturbance and weight loss as a result of reduced appetite which are recognized side effects of the treatment. Six days after completion of his treatment Mr R was picked up in the street by the police following several complaints from members of public. He was seen trying to damage parked cars and shouting repeatedly that he was God. He was agitated and had to be handcuffed by the police who escorted him to hospital. A physical examination was unremarkable except for a raised pulse rate of 120 beats per minute. There was no significant abnormality in his blood test results. He was placed on Section 2 of the Mental Health Act for assessment of a suspected mental illness. Mr R had neither a past psychiatric history nor any past family psychiatric history. On admission to the psychiatric ward he believed that he was being followed on CCTV and made sexually inappropriate comments to staff. As he continued to be highly agitated olanzapine 10 mg intramuscularly was administered. Over the next day Mr R remained elated in mood and irritable with paranoid thoughts. Mr R did not require further emergency intramuscular medications as he gradually became calmer and more cooperative. Three days after admission his mental state and behaviour began to show significant improvement. He had wished not to take oral olanzapine that was prescribed and hence no psychotropic medications were used following the initial olanzapine dose on admission. Mr R said that he had no recollection of being brought in by the police or his psychotic behaviour. He and his family denied that alcohol or illicit drugs had been used. He did recall that his sleep had been very poor, a common feature in mania, in the days before his admission. A computed tomography scan of his head was normal. Seven days after admission he was visited by his family and allowed leave off the ward as there were no remaining psychotic or manic symptoms. He was later discharged from the ward after uneventful leave at home and remained well 6 months on.
Objectives:To determine the level of knowledge& practice regarding extended program of immunization (EPI) in Pakistan among medical students.Design:A questionnaire based survey done amongst the students of a medical college of Peshawar.Methodology:A questionnaire was developed in the line with study objectives and circulated among students of third, fourth and final year of a medical college of Peshawar .Fifty students were selected from each class randomly. They were provided the assurance regarding the confidentiality of their response.Results:Total of 150 students was interviewed .All students were in age group 20-25 yrs. Males were 42.6% and female were 57.4%. Good knowledge was observed in 27.3% of students, average knowledge was observed in 56.6% while 16% had poor level of knowledge. Regarding practice 78% used to recommend immunization to other while 22% did not give any advice regarding immunization to anyone .Most of the students having good knowledge were from final year class (16%).Conclusion:Efforts towards ensuring adequate exposure to immunization education during training years are need to eliminate one of the barriers to adequate immunization in children.
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