We report a case of coeliac axis thrombosis and splenic infarction presenting in a girl of 14 years who had been on the oral contraceptive pill (OCP), Marvelon (ethinyloestradiol 30 microg plus desogestrel 150 microg, Organon, Cambridge, UK), for 3 weeks. She had no other risk factors for thrombo-embolism. Diagnosis was made with duplex Doppler ultrasound and confirmed with dynamically-enhanced comput-ed tomography and magnetic resonance angiography, thus avoiding the need for percutaneous arteriography. Though mesenteric thrombo-embolic disease is recognised in association with use of the combined OCP, it has not previously been reported to affect the coeliac axis. Paediatricians and surgeons should be aware of the risks to young girls on the OCP, and consider it in their differential diagnosis of the acute abdomen.
INTRODUCTION Transitional care is an NHS priority with newly published NICE guidance. Many paediatric surgical patients need quality care to continue into adulthood. We undertook an evaluation of our departmental activity to assess the magnitude of this issue. METHODS We identified all outpatients ≥ 15 years (potentially requiring imminent transition) seen over a 12 month period for all five general paediatric surgery consultants in our tertiary centre. Those patients requiring transition were highlighted and the appropriate adult team for referral recorded. RESULTS There were 2989 general paediatric surgery clinic appointments within the year; 289 (9.7%) were for young people aged 15 years or older; 62 patients (28% of those ≥ 15years) were deemed to require transition into adult care. Significantly more patients having colorectal surgery required follow-up (P = 0.0009 Chi-square test) compared with patients in other subspecialties. CONCLUSIONS More patients than expected required transition. This may be the case in other units. Current best practice includes time intensive preclinic planning, careful preparation of patient and family, followed by joint clinics. A joint clinic appointment takes 30 minutes, allowing for comprehensive handover and forging new relationships. In our department, we need at least ten transition clinics across 2 years. Coalition with adult colleagues is vital. These data enable us to plan services to provide quality care for our adolescent patients and highlights colorectal surgery as a priority.
Abstract-Introduction:Premenstrual syndrome is a psychoneuroendocrine disorder of unknown etiology. Even after > 80 years of its 1st description, its definition, presenting patterns , diagnostic plan and treatment modalities are surrounded by many questions and controversies. This results in a large number of studies with different criteria's and methodologies so that their results are not comparable. Objective : To descries variability in opinions about PMS and highlight problems encountered in designing and conduct of clinical trials of various drugs in premenstrual syndrome. Method : The literature available in journals since inception of the term Premenstrual syndrome was reviewed. Variability in opinions of different workers regarding definition of PMS, days of premenstruum, diagnostic parameters was recorded and analysed. The methodological constraints in clinical trials of PMS due to lack of consensus among workers are mentioned and some corrective measures are suggested. Results : There is no consensus among workers regarding different aspects of premenstrual syndrome resulting in difficulties in designing and conduct of clinical trials in PMS. Conclusion :The authorities and organizations involved in research on PMS must frame standard guidelines for acceptable criteria and trial designs. So that comparative study of different trials becomes possible. Large multicentric trials in identical groups of population at same period of time by uniformly trained investigators are another alternative. Further research to elucidate exact etiopathogenesis and treatment guidelines is essential.
IntroductionHypertension is a chronic illness associated with high morbidity & mortality. A large number of antihypertensive drugs alone or in various combinations are available and physicians need to choose the most appropriate drug for a particular patient. The standard treatment guidelines and drug utilization studies at regular intervals help physicians to prescribe drugs rationally. The present study was conducted to analyze the prescription patterns of antihypertensive drugs and adherence to JNC VII guidelines in a North Indian tertiary care hospital. Methods Drug utilization data of 500 hypertensive patients, attending medicine Out Patient Department of Punjab Institute of Medical Sciences Hospital from October 2010 to March 2011 was collected from 24 hour hospital pharmacy. Following groups of anti hypertensive drugs were analyzed; Angiotensin converting enzyme inhibitors (ACE inhibitors), Angiotensin Receptor Blockers (ARBs), Beta Blockers, Calcium Channel Blockers (CCBs), Diuretics, Alpha Adrenergic Blockers and Central Sympatholytics. Patients suffering from essential hypertension with or without other co-morbid conditions were included in the study. Frequency and proportion of prescribing different groups of anti hypertensive drugs as monotherapy or combination therapy and prescription of fixed drug combinations (FDCs) was analyzed. ResultsThe most frequently prescribed antihypertensive drugs were diuretics followed by ARBs, Beta Blockers, CCB's and ACE inhibitors. 42.6% received monotherapy and 57.4% received combination therapy. 41.6% patients received fixed drug combinations. The prescription pattern was found to be in accordance with JNC VII guidelines.
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