The objective of this study was to report a case of a person with psychiatric illness treated with clozapine presented with diabetic ketoacidosis (DKA). A clinical monitoring was done on a 38-year-old Indian man affected by schizoaffective disorder, bipolar type presented with DKA after 3 months of clozapine therapy (250 mg/day). After treatment of DKA and discontinuation of clozapine, the patient improved symptomatically, his blood sugar levels normalized and insulin requirements also decreased. This report thus highlights that clinicians should be vigilant about the potential risk of new-onset diabetes and DKA in patients taking clozapine and utilize appropriate clinical and laboratory monitoring early in the course of treatment to prevent serious adverse effects.
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The study aims to characterize community-acquired sepsis patients admitted to our 1300-bedded tertiary care hospital in South India from the Surviving Sepsis Campaign (SSC) guideline-compliant e-sepsis registry stratified by focus of infection. The prospective observational study recruited 1009 adult sepsis patients presenting to the emergency department at the center based on Sepsis-2 criteria for a period of three years. Of the patients, 41% were between 61 and 80 years with a mean age of 57.37 ± 13.5%. A total of 13.5% (136) was under septic shock and in-hospital mortality for the study cohort was 25%. The 3 h and 6 h bundle compliance rates observed were 37% and 49%, respectively, without significant survival benefits. Predictors of mortality among patients with bloodstream infections were septic shock (p = 0.01, OR 2.4, 95% CI 1.23–4.79) and neutrophil-to-lymphocyte ratio (p = 0.008, OR 1.01, 95% CI 1.009–1.066). The presence of Acinetobacter (p = 0.005, OR 4.07, 95% CI 1.37–12.09), Candida non-albicans (p = 0.001, OR16.02, 95% CI 3.0–84.2) and septic shock (p = 0.071, OR 2.5, 95% CI 0.97–6.6) were significant predictors of mortality in patients with community-acquired pneumonia. The registry has proven to be a key data source detailing regional microbial etiology and clinical outcomes of adult sepsis patients, enabling comprehensive evaluation of regional community-acquired sepsis to tailor institutional sepsis treatment protocols.
Background: Adult sepsis in India poses a major challenge for clinicians and hospitals given the complete lack of local and national data of its public health magnitude. Severe sepsis is often associated with high mortality and morbidity leading to increased cost of care for patients and institutions. To better respond to the clinical and financial cost of sepsis care in our tertiary care hospital we developed a sepsis registry based on the Surviving Sepsis Campaign. Methods & Materials: A computer based real time sepsis registry was developed to collect data of all sepsis patients presenting to the ED. This registry included demographic information, prehospital care, clinical information and patient care details as per the Surviving Sepsis Campaign guidelines. This database was aligned with our hospital laboratory information system. Frequent reviews of the data collection process, quality and completeness were done to optimize the registry. Results: Out of a total 301 patients, 66% (199/301) were males. 44% (131/301) were between 61-80 yrs while 34% (102/301) were between 41-60yrs of age. 40% (120/301) of the cases were transfers from nearby hospitals to our tertiary care. Further categorization revealed 46% cases were 'sepsis', 14% 'septic shock' and 40% were 'severe sepsis'. The SOFA score on admission of the 65% of the cases were < 9 while 19% had a SOFA score of 9-10 and 16% had a score more than 11. 51% (153/301) had an average length of stay < 7 days. The primary focus of infection were pneumonia (39%), UTI (38%) and skin and soft tissue infections (16%). 22% of the cases had concomitant bacteremia. Compliance with the 3hr bundle was present in 83% of the cases. Overall mortality was 28% (86/301) with male gender and a SOFA score of > 9 significantly associated with fatality (p<0.05). Lack of compliance with 3 hr bundle and lactate levels > 2.5 mmol/L were also associated with mortality (p<0.05). 71% of the registry cases were culture positive, of which 33% had a polymicrobial infection. Conclusion: This sepsis registry is proving to be a key data source for defining the burden of the disease in our community.
BACKGROUND Government Medical College, Thiruvananthapuram, was converted to a Covid hospital but there was no shutdown or restriction of functioning of routine nonCovid treatment services. Objectives were to study the clinical profile of patients visiting ENT outpatient department during national lockdown period, evaluate the usage of safety practices by patients to protect from Covid-19 infection and determine the proportion of patients using teleconsultation services. METHODS This is a descriptive study. All patients, who attended and / or given dates to visit the ENT outpatient department during study period were included in the study. Data collected was analysed using SPSS software version 25. RESULTS Among patients who visited the outpatient department, 54.3 % were males. Majority belonged to age group of above 40 years. 82 % of old patients on followup could not attend outpatient because of lack of transportation. Majority of new cases were road traffic accidents and acute infections of ear and nose. Although majority had access to treatment from hospitals in their locality, they did not utilise the option. 98 % were aware of COVID-19 infection and were practicing safety precautions. Only 13 patients out of 219 were using the facility of teleconsultation. CONCLUSIONS This study reveals a wide gap in the present method of implementation of referrals to tertiary care. E medicine and teleconsultation services should be encouraged and used effectively. High rate of adoption of the safety measures among the public was another highlight obtained from this study. KEYWORDS Clinical Profile, COVID-19, Government Medical College, National Lockdown, Safety Practices
Introduction Clinical pharmacist can enthusiastically involve in oncology department through utilizing the skills and knowledge to support wide variety of functions in patient care. The impact of pharmaceutical care services in oncology department were analysed through various approaches including the analysis of knowledge level of patients towards the disease and its management through patient counselling, monitoring of performance status, observing of ADR and drug safety. Incidence of cancer was scrutinized during the study. Methodology: A Prospective interventional study was conducted from November 2019 to March 2020 with the support of institutional ethical approval at oncology department of Lourdes hospital, Ernakulam. 133 patients were included with all type of cancer. Data collected through Performa with KAP questionnaire and direct interview was conducted. Statistical significance was evaluated through p value of <0.001 Result: 123 patients were completed both questionnaire. Among this 69.91% were females and most of the patients belonged to 50 – 65yeras age group and carcinoma was frequently reported type. End of the study showed significant change in the knowledge level of patients after interaction with the clinical pharmacist. 26 ADRs were reported including solitary and multiple ADRs. Recommendations associated with drug reconstitution, administration were frequently given to the nurses. Most of the interventions to improve therapeutic outcome of the patients were accepted by the oncologist. Conclusion Clinical pharmacist can actively participate in all aspects of the oncology department in association with physician and other health care providers to improve the therapeutic outcome and quality of life of patients.
Background: The cytotoxic chemotherapy is the mainstay treatment of cancer and it is usually complicated with infections. Appropriate antibiotics and other supportive medications must be started immediately as bacterial infections may progress with the absence of granulocytes. Improved outcomes can be seen with empirical administration of broad-spectrum antibiotics and they remain as the standard of care. Patients with intermediate-risk for Febrile Nuetropenia (FN) (10%-20%) need to be evaluated for additional patient risk factors, after assessment, patients who present with at least one of the risk factors for FN is recommended for treatment with a G-CSF. Methodology: Our study was a retrospective cohort single centered observational study carried out randomly in 104 patients in the oncology department of Lourdes hospital, Cochin Data of the patients were collected from Mediware system, medical records and Statistical software SPSS were used for analysis of the data. Results: In our study febrile neutropenia was managed using antimicrobials, of which antibiotics and antifungals prescribed were 12.09% and 1.97% respectively and with granulocyte-colony stimulating factors (G-CSFs) (6.15%). Principally used empirical monotherapy was meropenem sulbactum / meropenem (n = 48) which was followed by piperacillin tazobactum (n=18) and cefoperazone sulbactum (n=15) This study had a leading prescription of Cyclophosphamide containing chemotherapy regimens which led to neutropenia. Breast cancer patients accounts the majority of febrile neutropenic episodes despite of receiving GCSF prophylaxis. The most common type of cancer patients who are suffering from neutropenia were breast cancer. The compliance with National Comprehensive Cancer Network (NCCN) guidelines were analyzed in that we can see 84.6% patients had partial compliance and 14.4% patients had full compliance. Conclusion: A total of 66 patients received both antibiotics and G-CSF treatment however 13 patients and 25 patients were managed only with G-CSF and antibiotic therapy respectively. This study had a leading prescription of Cyclophosphamide containing chemotherapy regimens which led to neutropenia. These regimens were used mainly in breast cancer patients. Breast cancer patients accounts the majority of febrile neutropenic episodes despite of receiving GCSF prophylaxis. The most common type of cancer patients who are suffering from neutropenia were breast cancer. The NCCN guidelines, majority of patients showed partial compliance(86.6%) and about (14.4%) showed full compliance.
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