Objective: To compare the efficacy and safety of rabeprazole and esomeprazole in mild-to-moderate erosive gastroesophageal reflux disease (GERD). Materials and Methods: A randomized, single-blinded, outdoor-based clinical study was conducted on 60 patients of mild-to-moderate erosive GERD. After baseline clinical assessment and investigations, rabeprazole (40 mg) was prescribed to 30 patients and esomeprazole (40 mg) to another 30 patients for 4 weeks. The efficacy variables were change in GERD symptom scoring, endoscopic findings, and Quality of Life in Reflux and Dyspepsia (QOLRAD) scoring over 4 weeks. Result: Heartburn, acid regurgitation, and overall GERD symptom scoring (P = 0.01) were significantly decreased with rabeprazole in comparison to esomeprazole. The comparative study of all five domains of the QOLARD questionnaire including overall scoring revealed a statistically significant improvement in the rabeprazole group. Endoscopic findings in the rabeprazole group showed an absolute improvement of 30% and relative improvement of 55% over esomeprazole. Both the drugs were well tolerated having no significant difference in the incidence of adverse effects. Conclusion: Rabeprazole (40 mg) is a better choice for mild-to-moderate GERD compared with esomeprazole (40 mg) because of its better efficacy and safety profile.

Objective: To find out the most common bacterial pathogens responsible for post-operative wound infection and their antibiotic sensitivity profile. Materials and Methods: This prospective, observational study was carried out in patients of postoperative wound infection. Samples from wound discharge were collected using a sterile swab and studied for identification of isolates by Gram stains and culture growth followed by in vitro antibiotic susceptibility testing performed by disc diffusion method on Mueller Hinton agar. Results: Out of 183 organisms, 126 (68.85%) isolated organisms were gram negative. Staphylococcus aureus, 48 (26.23%), was the predominant organism. S. aureus was sensitive to rifampicin (89.58%), levofloxacin (60.42%), and vancomycin (54.17%). Pseudomonas aeruginosa was sensitive to ciprofloxacin (83.78%), gatifloxacin (51.35%), and meropenem (51.35%). Escherichia coli was sensitive to levofloxacin (72.41%) and ciprofloxacin (62.07%). Klebsiella pneumoniae was sensitive to ciprofloxacin (63.16%), levofloxacin (63.16%), gatifloxacin (63.16%), and linezolid (56.52%). Proteus mirabilis was sensitive to ciprofloxacin (75%) and linezolid (62.50). Proteus vulgaris was sensitive to ampicillin+sulbactam (57.14%) followed by levofloxacin (50%). Conclusions: There is an alarming increase of infections caused by antibiotic-resistant bacteria, particularly in the emergence of VRSA/VISA, meropenem, and third generation cephalosporin resistant Pseudomonas aeruginosa. Linezolid showing sensitivity against Gram negative bacteria.

Objective: To estimate the prevalence of insulin resistant syndrome (IRS) among newly diagnosed patients with type 2 diabetes and to test their validity against two indices of insulin resistance (IR). Materials and Methods: Prevalence of IRS was estimated according to the criteria used by ATP III in newly diagnosed type 2 diabetic patients. Sensitivity and specificity of the ACE criteria were calculated against two indices of IR namely fasting insulin (FI) level > 12 mU/l and McAuley index (McA) < 5.8. [McA= exp [2.63--0.28 ln(insulin in mU/l) -- 0.31 ln(triglycerides in mmol/l)]. Results: 35.7% of patients had IRS by ATP III criteria. 64.3% of patients were insulin resistant by FI and McA in each index. In patients who had IRS with ATP criteria, 80% and 86.6% were found to have McA and FI in the insulin resistant range. Out of the patients who were resistant by McA, only 40.6% had IR by ACE criteria and 93% had shown IR by FI. Out of all patients who did not fulfill the ATP III for IR, 74% and 59% were detected as having IR by fasting insulin and McA respectively. Sensitivity of the ACE criteria when tested against the FI and McA were 37.5% and 40.6%, specificity were 70% and 80%, respectively. Conclusions: IRS was common among the newly diagnosed patients with type 2 diabetes. ACE criteria showed an acceptable specificity but lack adequate sensitivity when compared with the two Indices of insulin resistance. More valid and clinically useful criteria should be available for the accurate diagnosis of IRS in clinical practice.

Objective: To compare the effectiveness of the ciprofloxacin-metronidazole (CIP-MET) regimen with the ceftriaxone-metronidazole (CEF-MET) regimen for operative site infection control in women undergoing obstetrical and gynecological surgeries. Materials and Methods: One thousand and eighty-four case records of women who had undergone various obstetrical and gynecological surgeries who were given CIP-MET regimen and CEF-MET regimen were analyzed in predesigned and pretested proforma. Patients who were given CIP-MET regimen and CEF-MET regimen were classified as Group 1 and Group 2 respectively. The mode of administration of both the regimens was noted. Numbers of wound infections were recorded in the respective groups. Socioeconomic status and hemoglobin level of the patients were noted. Other data such as hospital stay, duration of operation were also noted. Results: Out of a total of 1084 case records, 31 (5.8%) and eight (0.7%) patients contracted wound infections in Group 1 and Group 2 respectively (P = 0.0001). Conclusion: The CEF-MET regimen was found superior to the CIP-MET regimen to control operative site infection in obstetrical and gynecological surgeries.

Objective: To compare the use and reliability of self-reported tobacco use (both smoked and smokeless) among patients with bipolar disorder and somatoform disorders. Materials and Methods: The study was conducted at psychiatry out-patient department of a tertiary care hospital. A total of 50 consecutive patients were recruited. The subjects were asked about the use of tobacco products (smoked as well as smokeless) over the past one week. Those reporting affirmatively in response to the question were assessed using Fagerstrom Test for Nicotine Dependence (FTND) scales. Quantitative urinary cotinine levels were assessed using Enzyme-linked immunosorbent assay (ELISA). Results: Calculation of Cohen's kappa using cross tabulation revealed discordance between the self-reported use of smoked as well as smokeless tobacco products in both the groups. Analysis using the lower cut off of 50 ng/ ml also revealed discordance between the self-reported tobacco use (smoked as well as smokeless) for both the groups. Conclusions: The reliability of self-report is questionable among both these groups for smoking as well as smokeless tobacco products.

Objective: To compare the anti-ulcer activity of buffered pantoprazole tablet against plain pantoprazole in pyloric ligated rats. Materials and Methods: In vivo pyloric ligated ulcerogenesis model was used to assess the effect of buffered pantoprazole on the volume of the gastric content, pH, total and free acidity, and ulcerogenic lesion. Pantoprazole level in gastric content and concurrently in stomach tissue was assessed by High Performance Liquid Chromatography (HPLC) analysis. Results: Buffered tablet effectively increases the pH of the gastric content above 4 up to 6 h (P<0.001) protecting pantoprazole from acid degradation resulting in high concentration in the gastric content and stomach tissue. Conclusions: This study substantiates better, faster and prolonged bioavailability of pantoprazole-buffered tablet compared to plain pantoprazole.

Oral combined contraceptive pill (OCCP) is popular as birth control pills. Like all other drugs, they are not free from risks. Women taking certain types of OCCP have higher risk of developing deep vein thrombosis (DVT). A 29 year old married woman had taken OCCP for 3.5 months, developed deep vein thrombosis of left leg. Hereditary and acquired causes of DVT were excluded. She was treated with parenteral and oral anticoagulants simultaneously and was advised to discontinue OCCP. Initially the risk of blood clot was believed to be due to dose of estrogen but recent study relates it to the type of progesterone involved in OCCP. Thus, it is still a matter of debate, whether to associate risk of DVT to the amount of estrogen alone or also to the type of progestin. Apart from careful selection of patients, one should also look for the risk of venous thromboembolism irrespective of type of OCCP prescribed.

Seven years old male child (24 kg weight) diagnosed as a case of sub acute appendicitis treated with ciprofloxacin, immediately developed multiple erythmatous papules. Reaction subsided after withholding ciprofloxacin and treatment with dexamethasone and chlorpheneramine maleate. It was developed again when treated with levofloxacin and subsided after withdrawal. IgE binding at 7 ^th position of core structure of fluoroquinolones likely to be the mechanism. As all the fluoroquinolones have similar core structure, hypersensitivity to one may have cross sensitivity to other fluoroquinolones. It is advisable to avoid other fluoroquinolones and switch over to other group of antibiotics when hypersensitivity to one occurs.

Paracetamol is one of the most commonly used drugs both over the counter and on prescription. Liquid paracetamol is available over the counter all over the world. Most commonly available concentrations are 120 mg/5 ml and 250 mg/5 ml. Many parents and healthcare professionals assume that doses available in different countries are similar. However, 500 mg/5 ml bottle is available in some countries including the United Kingdom. This leaves a potential for accidental overdose with therapeutic intent. We have reviewed the experience of diagnosing and managing an interesting case of paracetamol over dosage caused by several ingestions over 24 hours period (staggered paracetamol over dosage). It highlights the importance of communication between health professionals and parents while managing common medical problems.