“ROLE OF PARTOGRAM IN MANAGEMENT OF LABOUR IN PRIMIGRAVIDA PATIENT AT TERTIARY CARE CENTRE”

2021 ◽  
pp. 49-53
Author(s):  
Surabhi Gupta ◽  
Preeti Sharma
Keyword(s):  
Tertiary Care ◽  
World Health ◽  
Normal Vaginal Delivery ◽  
Tertiary Care Centre ◽  
Obstructed Labor ◽  
Group Iii ◽  
Group I ◽  
Management Protocol ◽  
Prolonged Labor ◽  
Group Ii

Introduction: Although labor is a natural physiological process characterized by progressive increase in frequency, intensity and duration of uterine contractions, resulting in effacement and dilatation of cervix, with descent of the fetus through the birth canal, this physiologic process many a time may lead to prolonged labor. The partograph developed by World Health Organization is the best-known partograph in the lowresource setting. Partograph when used with dened management protocol is an inexpensive tool which can effectively monitor labor and be helpful in reducing incidences of both maternal and fetal morbidity and mortality by reducing the number of operative interventions, prolonged labor, obstructed labor and caesarean section. Then WHO in 1994 endorsed the partogram and later modied in 2000 and removed latent phase and dened active phase at 4 centimetres instead of previously used 3 centimetres. WHO advocated its use as a necessary tool in management of labor and recommended its universal use during labor. Objective: To analyse the patterns of labor amongst spontaneous parturient using a WHO modied partogram and to compare outcome of labor and neonatal outcomes in relation to partogram ndings. Methods: This prospective study was carried over a period of 18 months on 100 parturients. Modied WHO Partogram was used to assess the progress of the labor. Parturients were divided on basis of partogram ndings. Group-I (n=64), where parturients partogram remained to the left of alert line, Group-II (n=20), where parturients partogram remained between the alert and action lines and Group-III (n=16), where parturients partogram crossed the action line. In these three groups, the maternal and fetal outcomes were assessed. Results: Normal vaginal delivery was done in 95.3% of Group-I, 80% of Group-II and 43.75% of Group-III parturients. Instrumental delivery was done in 1.56% of Group-I, 10% of Group-II and 18.75% of Group-III parturients. LSCS was done in 3.1% of Group-I, 10% of Group-II and 37.5% of Group-III parturients. Instrumental / LSCS deliveries were higher in Group-II and Group-III parturients. Alarge proportion of newborns of Group-II and Group-III parturients had Apgar Score <7. Conclusion: The Modied WHO partogram is very helpful in the prediction of maternal and fetal outcome. It is highly recommended for use in resource decient medical facilities, where early decision for delivery or referral can be taken on the basis of partogram ndings..

scholarly journals Prevalence of anaemia among children under five years in tertiary care hospital of Nepal.

2015 ◽  
Vol 13 (1) ◽  
pp. 33-36 ◽  
Author(s):  
Sundari Joshi ◽  
Megha Pradhan Pradhan ◽  
Ujjwal Joshi
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Severe Anaemia ◽  
Care Hospital ◽  
Cross Sectional ◽  
Children Under Five ◽  
Group Iii ◽  
Under Five ◽  
Group I ◽  
Group Ii

Introduction: Anaemia is a pathologic deficiency in oxygen-carrying haemoglobin in red blood cells which may be the result of genetic diseases, infections and deficiency of several nutrients. Nepal is one of the developing countries where anaemia is one of the most serious public health problems. So, a study was planned to evaluate the prevalence of anaemia among children under five years in tertiary care hospital of Nepal. Methods: A cross-sectional study was carried out from August 2011 to January 2012 using a structured questionnaire interview and observation. The children were divided into three groups: group I (0-1 years), group II (>1-3 years), group III (>3-5 years). Anaemia was assessed using  haemoglobin measurement in gram in decilitre on Sysmex KX -21 (automated haematology analyzer). The severity of anaemia were grouped as follows: severe anaemia, < 7.0 g/dL; moderate anaemia, 7.0 to 8.9 g/dL; and mild anaemia, 9.0 to 10.9 g/dL as per WHO classification. Stool test was also carried out to assess worm infestation. Data were analysed using SPSS 11.5. Results: There were 208 children among which 52.9 % were male while 47.10 % were female.  The overall prevalence of anaemia was found to be 49.5% of which 43.3% had mild, 15.8% had moderate and 0.5% had severe anaemia. Out of 20 children in group I, 70 % were anaemic. Among the 94 each in group II and group III, children suffering from anaemia were 51% and 43% respectively. The stool investigations showed that 5.3 % children suffered from worm infestations.   Conclusions: prevalence of anaemia was seen in 49.5% of children below five years age group and the diet and worm infestations didn’t affect it.doi:  http://dx.doi.org/10.3126/mjsbh.v13i1.12998

scholarly journals Assessment of Outcome of Intrathecal Analgesia in Multiparous Women Undergoing Vaginal Delivery

2020 ◽  
Vol 5 (1) ◽  
pp. 153-155
Author(s):  
Sanjay Melville Masih ◽  
Rakesh Kumar Gupta
Keyword(s):  
Vaginal Delivery ◽  
Group Iv ◽  
Normal Vaginal Delivery ◽  
Secondary Outcome ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Multiparous Women ◽  
Group Ii ◽  
Intrathecal Analgesia

Background: The present study was conducted to assess the outcome of intrathecal analgesia in multiparous women undergoing vaginal delivery. Subjects and Methods: The present study was conducted among 80 multiparous women ages ranged 18- 40 years. All patients received 0.5 ml of intrathecal injection of 2.5 mg bupivacaine 0.5% and 1 ml dexamethasone 4 mg plus a 0.5 ml adjuvant. The adjuvants in group I patients were 100 μg morphine, 25 μg fentanyl in group II, 5 μg dexmedetomidine in group III and normal saline in group IV (control group). The primary and secondary outcome was the duration of pain relief, the analgesia onset time, the maximum level of sensory block, the visual analogue scale (VAS) was recorded. Results: The mean duration of analgesia in group I was 182.4 minutes, in group II was 170.5 minutes, in group III was 200.4 minutes and in group, IV was 140.2 minutes. The onset of analgesia was 3.9 minutes, 2.8 minutes, 2.7 minutes and 4.5 minutes in group I, II, III and IV respectively. S1 sensory regression time (minutes) was 181.4, 157.4, 185.3 and 130.6 in group I, II, III and IV respectively. Modified Bromage scale 5 minutes, 15 minutes and 30 minutes after IT in all groups was 0.0. VAS was 1.3, 1.6, 1.6 and 3.1 with significant differences in all groups (P< 0.05). There was non- significant difference in mean age, weight, height and gestational age between all groups (P> 0.05). There was a non- significant difference in APGAR 1, 5, umbilical pH immediately after delivery, neonatal HR after 5minute, 15 minutes and 30 minutes in all groups (P> 0.05). Conclusion: The authors found that dexmedetomidine is a safe and effective adjuvant to intrathecal bupivacaine-dexamethasone in multiparous women undergoing normal vaginal delivery.

scholarly journals Effect of Povidone Iodine Versus Chlorhexidine Mouthwash on Oral Mucositis among Cancer Patients

2021 ◽  
Author(s):  
. Jyothi ◽  
S Latha ◽  
K Pavithra ◽  
M Nalini ◽  
Sowmya J Rao ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cancer Patients ◽  
Oral Mucositis ◽  
Povidone Iodine ◽  
Tertiary Care ◽  
World Health ◽  
Care Hospital ◽  
Group I ◽  
Grading Scale ◽  
Group Ii

Introduction: Radiation therapy and chemotherapy are the standard treatment given for cancer, which leads to the variety of adverse effects of which Oral Mucositis (OM) is one of the common side-effects. It is responsible for patient discomfort and decreases their level of functioning. Both Chlorhexidine and Povidone Iodine have got antimicrobial and antifungal activity which decreases the severity of mucositis. Aim: To compare the effectiveness of Povidone Iodine and Chlorhexidine mouthwash on OM among cancer patients undergoing radiation therapy or chemotherapy. Materials and Methods: A prospective observational study was conducted in the tertiary care hospital of Mangaluru, Karnataka, India for the duration of one year and three months from December 2015-March 2017. Fifty cancer subjects aged between 25 to 65 years and who developed OM after radiation therapy or chemotherapy were selected by purposive sampling technique. Data were collected using the demographic profile, clinical proforma and World Health Organisation (WHO) OM grading scale (2004) from 19.09.2016 to 17.12.2016. Experimental group I received 10 mL of diluted Povidone Iodine mouthwash and group II received 10 mL of diluted chlorhexidine mouthwash. Level of OM in the group I and group II were assessed on the 1st, 3rd, 5th and 7th day using WHO OM grading scale (2004). The data were analysed by descriptive and inferential statistics (Wilcoxon signed- rank test, Mann-Whitney U test, Repeated measures ANOVA) using SPSS version 16.0. Results: Among the 50 cancer subjects, majority 30 (60%) were in the age group between 55-64 years and majority 35 (70%) were receiving radiation therapy. On day seven, in the group I (Povidone Iodine) majority 14 (56%) subjects had mild level of mucositis whereas in the group II (Chlorhexidine) majority 14 (56%) subjects had moderate mucositis. Comparison of the effect of Povidone Iodine and Chlorhexidine mouthwash using Friedman’s ANOVA showed that there was a difference in the level of mucositis (p<0.05) at 5% level of significance among two groups. The study findings also revealed a difference in the level of mucositis between day 1 to day 3, 5 and 7 (Mann-Whitney U test) (p<0.05) in both the groups. Conclusion: Povidone Iodine mouth wash was more effective than Chlorhexidine mouthwashes in reducing OM, and the patients were more comfortable after the use of the mouthwash.

Moderate to severe hyperphosphataemia as an independent prognostic factor for 28-day mortality in adult patients with sepsis

2020 ◽  
Vol 37 (6) ◽  
pp. 355-361
Author(s):  
Dong-Hyun Jang ◽  
You Hwan Jo ◽  
Jae Hyuk Lee ◽  
Joonghee Kim ◽  
Seung Min Park ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Tertiary Care ◽  
Prognostic Indicator ◽  
Group Iv ◽  
Phosphate Concentration ◽  
Group Iii ◽  
Risk Of Death ◽  
Group I ◽  
Group Ii ◽  
Cox Proportional Hazard Regression

BackgroundIschaemic tissue injury caused by tissue hypoperfusion is one of the major consequences of sepsis. Phosphate concentrations are elevated in ischaemic tissue injury. This study was performed to investigate the association of phosphate concentrations with mortality in patients with sepsis.MethodsThis was a retrospective cohort study of patients with sepsis conducted at an urban, tertiary care emergency department (ED) in Korea. Patients with sepsis arriving between March 2010 and April 2017 were stratified into four groups according to the initial phosphate concentration at presentation to the ED: group I (hypophosphataemia, phosphate <2 mg/dL), group II (normophosphataemia, phosphate 2–4 mg/dL), group III (mild hyperphosphataemia, phosphate 4–6 mg/dL), group IV (moderate to severe hyperphosphataemia, phosphate ≥6 mg/dL). Multivariable Cox proportional hazard regression analyses were performed to evaluate the independent association of initial phosphate concentration with 28-day mortality.ResultsOf the 3034 participants in the study, the overall mortality rate was 21.9%. The 28-day mortality rates were group I (hypophosphataemia) 14.6%, group II 17.4% (normophosphataemia), group III (mild hyperphosphataemia) 29.2% and group IV (moderate to severe hyperphosphataemia) 51.4%, respectively (p<0.001). In the multivariable analyses, patients with severe hyperphosphataemia had a significantly higher risk of death than those with normal phosphate levels (HR 1.59; 95% CI 1.23 to 2.05). Mortality in the other groups was not significantly different from mortality in patients with normophosphataemia.ConclusionsModerate to severe hyperphosphataemia was associated with 28-day mortality in patients with sepsis. Phosphate level could be used as a prognostic indicator in sepsis.

scholarly journals IUFD incidence, causes and complications: a retrospective study done at a tertiary care centre in greater Noida, India

2017 ◽  
Vol 6 (12) ◽  
pp. 5483
Author(s):  
Shehla Jamal ◽  
Shelly Agarwal
Keyword(s):  
Retrospective Study ◽  
Fetal Heart ◽  
Tertiary Care ◽  
Care Centre ◽  
Hypertensive Disorders Of Pregnancy ◽  
Early Assessment ◽  
Tertiary Care Centre ◽  
Still Births ◽  
Management Protocol ◽  
Prolonged Labor

Background: Demise of a fetus is not only a cause of distress to the parents but also leaves the obstetrician with little choice. Managing such a pregnancy and counselling of the patient becomes a difficult task for us. Early assessment and timely intervention are the key approaches for reducing the incidence of still births globally. By such a strategy, peripartum complications can also be reduced. The current study was undertaken with an aim to assess the incidence of IUFD, causes and peripartum complications associated, in order to formulate a management protocol at our centre.Methods: This is a retrospective study done over a period extending from September 2014 to October 2015. IUFD was taken as absent fetal heart sounds beyond 20 weeks gestation which was confirmed by sonography. Maternal and fetal records were analysed for studying demographic profile, obstetric details including present and past complications, along with evaluation of fetal parameters.Results: Total number of deliveries over this period was 995 and cases of IUFD reported were 56. Hence calculated proportion was 5.62%. Majority of the cases were unbooked (66%) and presented to obstetric casualty. Maximum cases were found in primi gravida patients, i.e., 35.7% and most of the cases were identified at a gestational age of 20-24 weeks, 32.1%. Hypertensive disorders of pregnancy, 41% and Anaemia, 25% were found to be the leading maternal causes at our centre. Whereas congenital anomalies 23.2% and Antepartum haemorrhage 30.3% were the commonest causes in fetal and placental factors studied. Prolonged labor was observed in 33.9% and Atonic PPH was present in 21.4% patients. ARF was present in 3.5% and DIC was also found in 3.5% of the cases. However, no explainable cause could be found in 12.5% of the patients.Conclusions: Barring the unexplained fetal losses, most of the causes that were ascertained in present study were avoidable. This highlights the importance of our need to understand the avoidable causes of IUFD and to enforce the need of adequate antenatal care so as to timely identify the risk factors. In addition, the necessity of pre-conceptional counselling in order to avoid complications and recurrence must also be emphasized.

scholarly journals BREAST FEEDING

2011 ◽  
Vol 18 (01) ◽  
pp. 18-23
Author(s):  
ALIYA ISLAM ◽  
NUSRAT AJAB KHAN ◽  
USMA NAILA
Keyword(s):  
Breast Feeding ◽  
Post Partum ◽  
Demographic Data ◽  
Tertiary Care ◽  
Military Hospital ◽  
P Value ◽  
Tertiary Care Centre ◽  
Group I ◽  
Causative Factors ◽  
Group Ii

Objective: To study the causative factors responsible for avoidance of Breast Feeding in post-partum women attending the post-natal OPD in MH Rawalpindi. Design: Comparative cross sectional study. Setting: Dept of Gynae and Obstetrics, Military Hospital, Rawalpindi. Tertiary care centre from all the Pakistan dealing with other ranks of Pak Army. Duration: Nine months (From 01.01.2007 to 1.10.2007). Materials and Methods: Study was done on 1000 patients at post-natal Gynae OPD. Patients were divided into two groups of 500 each. Those patients who were exclusively breast feeding their babies were included in group-II while group-I included those patients who were not breast feeding their babies at all. Patients demographic data was entered on questionnaire and factors involved were interpreted. The most important causative factor responsible for avoidance of breast feeding in group-I were noted down. The mothers in group-II were enquired about that problem. Data was analyzed by using computer software programme SPSS version 11. Chi square test was used to see the significance of difference between group-I and group-II and results were considered significant if P value is less than 0.05. Results: The study showed that as compared to group-II causative factors involved in avoidance of breast feeding in group-I were pain at operated site 148, working women 38, Sick baby 26,Cracked nipples and mastitis 59, Breast abscess 4, Social Myths 58, Multiple Births 2, Inverted Nipples 5 and failure of proper counseling 160. Conclusions: Most of the factors responsible for avoidance of breast feeding are preventable and treatable. General population should be educated regarding the benefits of breast feeding in the mother and baby. Thus reducing mortality rate in woman and infants.

scholarly journals Clinical profile and pattern of bacterial isolates from bile aspirates of cholecystectomy patients

2019 ◽  
Vol 7 (11) ◽  
pp. 4010
Author(s):  
Shewtank Goel ◽  
Pooja Tripathi Pandey ◽  
Abhay Kumar ◽  
Deval Kumar Arora ◽  
Nidhish Kumar ◽  
...  
Keyword(s):  
Gall Bladder ◽  
Bacterial Growth ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Bacterial Isolates ◽  
Group Iii ◽  
Group I ◽  
Number Of Patients ◽  
Group Ii ◽  
Study Participants

Background: Antibiotic policy and appropriate antibiotic prophylaxis cannot be designed unless data is available about bacteria colonizing the bile associated with gall bladder disease.  Authors aim was to assess the clinical profile and pattern of bacterial isolates from bile aspirates of cholecystectomy patients seeking care at a tertiary care teaching hospital.Methods: Patients who underwent cholecystectomy for various hepatobiliary ailments during year 2017-18 formed the study population. Bile aspirates were collected during cholecystectomy and sent to the microbiology laboratory. Ultrasonography, computed tomography and MRCP were done to confirm the gall bladder pathology before surgery.Results: Out of total eighty-six patients, bacterial growth was observed in 28 (32.56%) subjects. As per division of bile samples, maximum number of study participants (39.29%) having bactibilia were seen in Group II. Group with second highest number of patients showing bactibilia was Group III with 9 subjects (32.14%). Eight subjects (28.57%) exhibited bacterial growth in bile aspirates in Group I subjects. Three patients (10.71%) showed bile infected with multiple bacteria i.e. polymicrobial infection. The gram-negative preponderance was seen in all the three groups with Escherichia coli being most common in group I and II. Pseudomonas aeruginosa was isolated in majority of the patients in group II and III.Conclusions: It is advised that all patients undergoing cholecystectomy must have their bile aspirated during cholecystectomy and sent for microbiological examination and culture. It will help in choosing appropriate antibiotic to prevent infection.

scholarly journals Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy

2017 ◽  
Vol 9 (3) ◽  
pp. 88-93
Author(s):  
Alexandra Gorelik ◽  
Jake Osborne ◽  
Alexander Papachristos ◽  
Anita Skandarajah ◽  
Daniel Hng ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Total Thyroidectomy ◽  
Calcium Supplementation ◽  
Hospital Length Of Stay ◽  
Protocol Implementation ◽  
Group Iii ◽  
Group I ◽  
Management Protocol ◽  
Group Ii ◽  
Clinically Significant

ABSTRACT Introduction Hypocalcemia is a common complication of thyroidectomy. We aimed to assess compliance with a targeted calcium and calcitriol supplementation protocol and hypothesized that it would allow safe early discharge without an increase in readmissions. Materials and methods In 2009, we instituted a targeted early postoperative calcium and calcitriol supplementation protocol based on postoperative parathyroid hormone (PTH). We retrospectively reviewed all patients who had a total or completion thyroidectomy over a 4-year period prior to protocol implementation (group I: 2005—2008) and over a 5-year period after protocol implementation (group II: 2010—2014), as well as all patients operated on in the private setting with the senior author over a 1-year period (group III: 2013). Endpoints for analysis were clinically significant hypocalcemia, protocol compliance, hospital length of stay (LOS), and readmission for hypocalcemia. Results Compliance with the protocol was high; however, the accuracy of supplementation prescription was significantly lower in group II than in group III (p < 0.0001). Mean corrected calcium on postoperative day 1 was significantly higher in groups II (2.29 mmol/L) and III (2.27 mmol/L) compared with group I (2.15 mmol/L; p < 0.0001). Forty (30.5%) patients had clinically significant hypocalcemia in group I, compared with 21 (10.8%) in group II, and 2 (3.3%) in group III (p < 0.0001). The LOS was significantly decreased after protocol introduction (p < 0.0001). Conclusion Selective prophylactic calcium supplementation reduces LOS after total thyroidectomy. Clinical significance Introducing a new management protocol in the public hospital system poses challenges with compliance; however, it was successful in lowering rates of symptomatic hypocalcemia and LOS without an increase in the readmission rate. How to cite this article Osborne J, Papachristos A, Skandarajah A, Gorelik A, Hng D, Miller J. Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy. World J Endoc Surg 2017;9(3):88-93.

STUDY ON THE ROLE OF VENTILATION-PERFUSION SCAN IN DETECTION OF SILENT PULMONARY EMBOLISM IN NEPHROTIC SYNDROME CHILDREN

2021 ◽  
pp. 81-83
Author(s):  
Srabani Sen ◽  
Suprit Basu ◽  
Malay Kumar Sinha
Keyword(s):  
Pulmonary Embolism ◽  
Nephrotic Syndrome ◽  
Pulmonary Thromboembolism ◽  
Tertiary Care ◽  
Pediatric Nephrology ◽  
Tertiary Care Centre ◽  
Group Iii ◽  
Group I ◽  
Duration Of Illness ◽  
Perfusion Scan

INTRODUCTION: Clinically silent pulmonary thromboembolism is commoner than symptomatic one in children with nephrotic syndrome. The present study was done to look for the occurrence of asymptomatic pulmonary thromboembolism in children with nephrotic syndrome using V IQ scan, which is noninvasive, cost effective. MATERIALS AND METHODS: This prospective study conducted at a tertiary care centre over a period of one year on one hundred children with nephrotic syndrome between the ages of 5 and 15 years with a median age of 8 years attending the Pediatric Nephrology Clinic were taken up for the study. Patients showing defect in Tc99m-MAA perfusion scintigraphy underwent ventilation scan within 24-48 hours. Scan ndings were interpreted by two nuclear medicine physicians independently who were unaware of illness of the patients. The results were interpreted according to Modied Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) criteria. The overall incidence of abnormal V/Q RESULTS: scan in our study was 14%. Individually the incidence was 13.9% in group I, 22.22% in group II and 3.6% in group III, which indicates that patients with steroid resistant and steroid sensitive nephrotic syndrome in relapse were prone to develop thromboembolic complications more than those who were in remission. Combined scintigraphic evidence of pulmonary thromboembolism was 18.05% in Groups I and II compared to 3.6% in controls (Group III). Patients with abnormal ventilation-perfusion scan showed s CONCLUSION: ignicantly larger (p<0.05) duration of illness (mean 69.7±55.3 months) and signicantly greater degree (p<0.001) of proteinuria as compared to patients with normal ventilation-perfusion scan who had mean duration of illness of 45.5±38.0 months.

scholarly journals Gastroesophageal reflux disease: Treatment options are beyond the proton pump inhibitors.

2020 ◽  
Vol 27 (07) ◽  
pp. 1401-1407
Author(s):  
Abdul Rabb Bhutto ◽  
Amanullah Abbasi ◽  
Sultan Ahmed Chandio ◽  
Aftab Ahmed Lolai ◽  
Muhammad Arsalan
Keyword(s):  
Proton Pump ◽  
Clinical Symptoms ◽  
Treatment Options ◽  
Tertiary Care ◽  
Female Gender ◽  
Care Hospital ◽  
College Hospital ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Objectives: To observe the effects of different combinations of medicines in GERD patients by using FSSG score. Study Design: Observational Study. Setting: Al-Tibri Medical College Hospital, Isra University Karachi Campus Karachi. Period: June 2017 to December 2017. Material & Methods: The study was conducted on GERD patients at Tertiary Care Hospital of Karachi. Adult patients from male and female gender with clinical symptoms suggestive of GERD were included. During clinical history taking patients were interviewed to respond symptoms frequency of FSSG questionnaire score from 0 to 4 on each question. All 154 eligible patients enrolled in the study and divided into three groups Group I (PPI alone), Group II (PPI with prokinetic) and Group III (PPI, prokinetic and SSRI). After 2 weeks of treatment, FSSG score of every participant was calculated. Results: Results of 134 patients 72 (53.3%) males and 63 (46.7%) females were analyzed. The cumulative mean age was 37.12±8.221 (range 16 – 60) years. The patients were grouped by single blind randomization method, each group I and group II consisted of 45 subjects and 44 patients were enrolled in group III. The mean FSSG score prior to treatment and after treatment was 21.194±4.786 and 14.962±3.696 respectively, hence, the gradient of pre-treatment and post-treatment was 6.231±4.601. The three groups shown significant improvement in FSSG score after treatment but the group III had shown highest improvement in mean FSSG score of 7.522±3.592, followed by group II with 7.2889±3.805and group I had shown the lowest improvement of 3.911±5.346 but statistical analysis revealed these improvements within each group as insignificant while turned to be significant when groups were analyzed with each other. (p 0.003). Conclusion: The results of this study suggests that PPIs alone have good therapeutic role but as dysmotility aspect of GERD and psychological comorbidity is very common in those patients and is likely to play an important role in response, or failure of response, to proton pump inhibitor treatment. Hence, addition of prokinetic and anxiolytics can augment the response rate.

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