Efficacy and safety of ceftazidime-avibactam versus imipenem-cilastatin in the treatment of complicated urinary tract infections, including acute pyelonephritis, in hospitalized adults: Results of a prospective, investigator-blinded, randomized study
Vazquez J.A.,Ford Motor Company |
Gonzalez Patzan L.D.,Centro Medico Militar |
Stricklin D.,Four Rivers Clinical Research Inc. |
Duttaroy D.D.,Medical College Baroda |
And 3 more authors.
Current Medical Research and Opinion | Year: 2012
Objectives: The aim of this prospective phase II, randomized, investigator-blinded study (NCT00690378) was to compare the efficacy and safety of ceftazidime-avibactam and imipenem-cilastatin in hospitalized adults with serious complicated urinary tract infection (cUTI) due to Gram-negative pathogens. Patients and methods: Patients aged between 18 and 90 years with cUTI were enrolled and stratified by infection type (acute pyelonephritis or other cUTI) and randomized 1:1 to receive intravenous ceftazidime 500mg plus avibactam 125mg every 8 hours or imipenem-cilastatin 500mg every 6 hours. Patients meeting pre-specified improvement criteria after 4 days could be switched to oral ciprofloxacin. Patients were treated for a total of 7-14 days. The primary efficacy objective was a favorable microbiological response at the test-of-cure (TOC) visit 5-9 days post-therapy in microbiologically evaluable (ME) patients. Results: Overall, 135 patients received study therapy (safety population); 62 were included in the ME population (ceftazidime-avibactam, n=27; imipenem-cilastatin, n=35). The predominant uropathogen was Escherichia coli. Favorable microbiological response was achieved in 70.4% of ME patients receiving ceftazidime-avibactam and 71.4% receiving imipenem-cilastatin at the TOC visit (observed difference-1.1% [95% CI:-27.2%, 25.0%]). Among ME patients with ceftazidime-resistant uropathogens, response was observed in 6/7 (85.7%) receiving ceftazidime-avibactam. Adverse events were observed in 67.6% and 76.1% of patients receiving ceftazidime-avibactam and imipenem-cilastatin, respectively. Limitations of the study include the small number of patients in the ME population. Conclusion: The results suggest that the efficacy and safety of ceftazidime-avibactam may be similar to that of imipenem-cilastatin. © 2012 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.
Dosi R.V.,Medical College Baroda
BMJ case reports | Year: 2013
Secondary diabetes mellitus is known to occur in acromegaly due to insulin resistance caused by growth hormone excess. However, diabetes in acromegaly usually does not lead to ketosis. We describe an unusual case of a patient that presented with diabetic ketoacidosis in the emergency room with thirst, polyuria and dyspnoea. The patient was subsequently diagnosed with a growth hormone-secreting pitutary macroadenoma as the underlying pathology; after initial stabilisation with insulin and fluids, the patient was successfully treated with trans-sphenoidal surgery.
Deshpande S.,Gujarat Medical Education and Research Society |
Patel N.,New York University |
Godbole V.,Gujarat Medical Education and Research Society |
Champaneri V.,Gujarat Medical Education and Research Society |
And 2 more authors.
Journal of Clinical and Diagnostic Research | Year: 2014
Background: Hypertension (HTN) is a major risk factor contributing to premature mortality from cardiovascular and cerebrovascular disease.To decrease morbidity and mortality from HTN, timely diagnosis of the disease and its complications, urgent treatment and referrals are required. General Practioners (GPs) are the first tier of the health care system in India and have a wide scope of practice. It is important to know the awareness and approach of primary care physicians to hypertension in their daily practice as compared to standard practice recommendations and guidelines, to identify targets for improvements. With this objective we decided to interview them personally and analyse their approach. Materials and Methods: We conducted a cross-sectional survey in 80 general practitioners (GPs) of the western part of Vadodara city with the use of a questionnaire prepared from JNC-7 guidelines and standard medical books. Seventy seven [97.55%] GPs completed the questionnaire and their responses were statistically analysed. Results: Twenty percent of GPs were not applying BP cuff properly for BP measurement. Only 18% and 16.6% could diagnose isolated diastolic hypertension (IDH) and isolated systolic hypertension respectively (ISH) and 21% and 29% would have considered treatment of IDH and ISH respectively.48% consider treating pre-hypertension using non-pharmacological measures. Only 21% use thiazide diuretics for uncomplicated HTN and 50% use beta-blockers in coronary artery disease patients. Conclusion: In our study, most of the GPs in western Vadodara are well aware and updated about the initial lab investigations,non-pharmacological measures and complications of HTN but lack an effective approach towards history taking for HTN,technique for measurement of blood pressure, diagnosis and treatment of IDH and ISH. Pre-hypertension and systolic and diastolic hypertension is under-treated and thiazide diuretics are underutilized. This study can be used to identify targets and approaches to improve hypertension management at the primary care level.
Vaghela P.,Medical College Baroda |
Shah D.,Medical College Baroda |
Shah S.,Medical College BarodaGujarat |
Surgical Chronicles | Year: 2016
Spontaneous splenic hematoma without any history of trauma is a rarest of event.following trauma it is commoner. A 25 year old male presented to us with the complaint of lump in left upper abdomen since age of ten years and pain since last 4 days. On examination there was 18 × 10 cm smooth firm lump with notch was palpable in left hypochondrium and left lumbar region. He underwent blood investigations and radiological investigations, who suggested splenic hematoma with sickle cell β-thalassemia. Elective laparotomy was planned and total splenectomy was done. Specimen was sent for histopathology examination. The splenic hematoma in absence of trauma is one of the rarest condition. It always needs thorough hematological and radiological investigations and surgical intervention is planned according to the presentation and reports.
Parmar N.T.,Medical College Baroda |
Parmar A.G.,Medical College Baroda |
Mazumdar V.S.,Medical College Baroda
Journal of Obstetrics and Gynecology of India | Year: 2016
Background: Constant decline in maternal mortality ratio has given rise to the need of a new indicator. This search has motivated investigation of severe maternal morbidity—“maternal near-miss” (MNM) event. World Health Organization (WHO) defines MNM as “a woman who, being close to death, survives a complication that occurred during pregnancy, delivery or up to 42 days after the end of her pregnancy”. Methodology: A hospital-based cross-sectional study was carried out at Sir Sayajirao General Hospital (SSGH), a tertiary care referral hospital in Vadodara, Central Gujarat, from May to September 2012. MNM events were identified according to either WHO or Mantel et al. criteria or both. Results: During study period, 1929 live births, 18 maternal deaths and 46 “near-miss” cases were recorded. Among these 46 near-miss cases, 57 near-miss events were identified. Calculated MNM ratio was 23.85/1000 live births, MNM rate was 20.6/1000 obstetric admissions, the ratio of maternal death to MNM event was 1:2.6, and overall Mortality index was 28.1 %. Among near-miss cases, percentage of preterm delivery was 42 % and stillbirth rate was 35 % (16/46). Out of 46 MNM, pregnancies were continued in 3 while 43 pregnancies were terminated. (25 live births, 16 stillbirths, 2 abortions). Conclusion: Identification of preventable factors and special preventive actions should be taken for management of complications in such near-miss cases. © 2016 Federation of Obstetric & Gynecological Societies of India