Australasian Medical Journal
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Antibiotic Usage in Primary Health in Bangladesh
No full textBackgroundAntibiotics are one of the most expensive and frequently used medications in clinical settings. To achieve a better of antibiotic usage in Bangladesh, a pilot study was carried out at a primary health care unit in Bangladesh.Method The study involved the analysis of treatment records for 150 in-patients at a primary health complex in Bangladesh from January 2009 to June 2009. ResultsAntibiotic prescription was the highest for those aged 5 to 11, and above 65 years. Males had 20% more antibiotics than females. The highest prescribed antibiotic was Ceftriaxone (30.19%) followed by Cefixime (18.87%), and Amoxycillin (16.98%). Antibiotics were most frequently prescribed for physical assault, general weakness, acute watery diarrhea, acute trauma, gastrointestinal symptoms and respiratory diseases. Two or more antibiotics were used in 8-19% of cases and were prescribed mostly for physical assault, gastrointestinal symptoms and acute watery diarrhea. The average cost of each prescription was Bangladeshi Taka (BDT) 238.50 and the antibiotics accounted for BDT 136.30. The group who received antibiotics paid on average BDT 105.90 more than the group not receiving an antibiotic.ConclusionThese results suggest possible antibiotic misuse in some diagnoses and age groups
Who Knows They Have A Treatment Plan?
Get PDFBackground:Guidelines for the effective care of chronic and complex conditions increasingly recommend developing treatment plans in collaboration with patients as one strategy in a coordinated approach to management. We examined the socio-demographic characteristics associated with the development of treatment plans for patients with asthma, diabetes or a cardiovascular condition to establish what proportion of patients with these conditions recalled being consulted in the plan’s preparation. Method:Serial, cross-sectional population based surveys using computer assisted telephone interviews (CATI) with 2,296 randomly selected adult participants with asthma, diabetes or a cardiovascular condition living in Queensland in 2006 and 2,203 adults with these conditions in 2008.Results:The proportion of patients with asthma, diabetes or a cardiovascular condition aware of having a treatment plan for their chronic condition increased almost two-fold between 2006 and 2008. Approximately half the respondents did not recall being asked for their input into the plan. Patients with a cardiovascular condition, older patients, and early school leavers were less likely to recall having a treatment plan. There were some variations when each condition was examined separately.Conclusion:Overall, the use of treatment plans and engagement of patients in their development remains low, particularly in those subgroups of the community who are most likely to benefit.
HIV Testing and Counselling in Rural India
No full textBackgroundThe human immunodeficiency virus (HIV) infection is a global pandemic and has grown into a public health problem of unprecedented magnitude. Integrated counselling and testing centre’s (ICTCs) have established as a cost-effective intervention to reverse this epidemic. The objective of this study was to find out the profile of clients attending the ICTC.Method Data was collected over six months at an ICTC in a rural-private tertiary care hospital in Wardha district. 650 study participants attended the ICTC either by self referral or following referral by a health care provider. Data was collected by the counsellor and it was retrospective data.ResultsSeropositivity rate among ICTC clients was 12.5% (n=81), out of these, 70.5% were male. The majority (41.1%) of ICTC attendee belonged to the 16-30 years age group. Many attendees (31.5%) were skilled workers and 29.7% had completed their education up to high school level. Sero prevalence decreased with higher educational status and improved job type. 79.5% individuals were heterosexual and had a history of multiple sexual partners. All HIV positive clients were referred to a care and support programme but only 32% visited within on week and around 60.2% within one month. ConclusionICTC centres at private rural hospitals should be encouraged so that people from such areas can access services to establish their HIV status. Seropositive clients can then be referred in a timely fashion to appropriate care and support programmes
Valsartan, Nebivolol and Blood Pressure
No full textBackgroundThe exploration of Blood Pressure (BP) variability and of the influence of different antihypertensive drugs on BP variability may improve understanding of the mechanism involved in BP changes induced by drugs. We therefore evaluated the long-term effects of the angiotensin-receptor blocker Valsartan and of the ultraselective beta blocker Nebivolol.MethodsA prospective study was conducted at the regional outpatient Diagnosis and Treatment Center from Cluj-Napoca, Romania. The study included newly diagnosed adult hypertensives of either sex. All patients underwent 24 hour ambulatory blood pressure monitoring (ABPM) and systolic and diastolic 24 hour blood pressure variability was measured. A total of 80 hypertensive patients were randomely assigned to receive 80 mg of Valsartan or 5 mg of Nebivolol.Patients were divided into two groups according to antihypertensive medication: group A included 42 hypertensive patients treated with Valsartan and group B included 38 hypertensive patients treated with Nebivolol.ResultsBoth Valsartan and Nebivolol decreased 24h BP variability but long-term treatment with Valsartan proved to be more efficient in reducing SBP variability during the night time period. Valsartan significantly reduces systolic BP variability during the night time period when compared to Nebivolol Conclusions: Treatment with ARBs (Valsartan) and BBs (Nebivolol) efficiently reduced the BP variability during the day and night period of time as first line antihypertensive agents. Valsartan significantly reduces systolic BP variability during the night time period when compared to Nebivolol. Antihypertensive treatment using long acting agents like an angiotensin receptor blocker or an ultraselective beta blocker could offer a better cardiovascular protection by reducing the BP variability
Blood Stream Infections in Western Nepal
No full textBackground Blood stream infections (BSIs) are important determinants for prolonged hospital stay and if uncontrolled, progress to become life-threatening. The aim of this study is to determine the common bacterial agents associated with BSI and their antimicrobial susceptibility patterns in a tertiary care teaching hospital in the Western region of Nepal. Method A cross-sectional study was conducted for a 20 month period from January 2006 to August 2007. All adult patients with fever (temperature ≥ 38°C) when assessed in the outpatient department or various inpatient wards were enrolled in the study. Results Of the 933 patients with febrile illness, only 96 were diagnosed to have BSIs. Salmonella spp., Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus were the common etiological agents of BSIs. S. Paratyphi A and S. Paratyphi B were responsible for 46.7% of the enteric fever cases. The clinical diagnosis of enteric fever was not sensitive and specific. The members of Enterobacteriaceae were frequently resistant to ampicillin, amoxicillin/ clavulanic acid and gentamicin. About one-third of the K.pneumoniae, E.coli and Enterobacter spp. produced extended-spectrum β-lactamases. The non-fermenters were unusually sensitive to most antibiotics. Conclusion Gram-negative bacteria were the predominant causes of BSIs. The occurrence of drug resistant S. Paratyphi A is of great concern for travellers, as they are not protected with an effective vaccine. Imipenem showed good activity against Pseudomonas aeruginosa indicating lack or low level of MBL activity
