A study to compare the efficacy of intermittent versus continuous regimen of pantaprazole in the management of upper gastrointestinal bleed (non variceal)

Background: UGI bleeding is defined as bleeding that occurs in the digestive tract proximal to the ligament of treitz. Intermittent dosage regimen IV bolus and high dose IV continuous infusion forms helps in achieving and maintaining this pH goal of more than 6 which forms optimal environment for peptic ulcer healing and clot stabilization to occur. Theoretically, high-dose IV continuous infusion should provide the most potent acid suppression. Aims and objective was to compare the efficacy of intermittent dose of pantoprazole given for 3 days i.e. 40mg intravenous twice a day versus continuous infusion dose of pantaprazole i.e. 80mg intravenous bolus followed by 8mg/hour for first 72hours in the treatment of UGI bleed.Methods: Patients of UGI bleed were randomly assigned to receive either continuous or intermittent regimen of pantaprazole as a part of management.Results: Among 118 patients of peptic ulcer disease, 7 patients had rebleed and 111 patients had no rebleed.3 patients among 59 patients who received continuous regimen and 4 patients among 59 patients who received intermittent regimen had rebleed with a total of 7 patients among 118 patients. Among 118 patients only 2 patients of the total had need for surgery for stabilization. Among 59 patients who received continuous regimen 2 patients needed surgery while none of the 59 patients who received intermittent regimen needed for surgery. Of the 118 patients 10 patients had mortality at the end of 30 day period. In both the regimes 5 patients died.Conclusions: The difference between Rockall score of the intermittent and continuous regimen group was statistically insignificant. The incidence of rebleed was 5.1 % for continuous and 6.7% for intermittent regimen which was statiscally insignificant. The incidence of mortality was similar 8.5%in both regimen.

Effect of continuous versus intermittent orthodontic forces on root resorption: A microcomputed tomography study

ABSTRACT Objectives: To compare the extent of root resorption and the amount of tooth movement between continuous orthodontic force and intermittent orthodontic force that was activated in a similar way to a 4-week orthodontic adjustment period. Materials and Methods: Twenty-five patients who required the extraction of upper first premolars were recruited in this study. A buccally directed continuous force of 150 g was applied to the upper first premolar on one side for 15 weeks. A buccally directed intermittent force (28 days on, 7 days off) of the same magnitude was applied to the contralateral first premolar. The teeth were extracted at the end of the experimental period and processed for volumetric evaluations of resorption craters. The degree of tooth movement and rotation were measured on the study models. Results: Continuous force application displayed significantly higher root resorption volume than the intermittent force application (P < .05), particularly on the buccal and lingual surfaces (P < .05) and the middle third of the root (P < .01). There was more tipping and rotational movement in the continuous force group. Conclusions: In a 4-week orthodontic adjustment period, intermittent force significantly reduced the amount of root resorption compared with continuous force. Although there was less degree of tooth movement with intermittent force, unwanted rotational movement was avoided. This is crucial in patients who are predisposed to orthodontically induced inflammatory root resorption, and the use of this intermittent regimen should be considered.

A PROSPECTIVE STUDY BASED ON THE EVALUATION OF DAILY AND INTERMITTENT DOSAGE REGIMEN OF ANTI-TUBERCULAR (ATT) DRUG THERAPY

Anti-TB drug induced hepatotoxicity causes treatment interruption, poor compliance, increased mortality and morbidity, and modification of treatment regimen. Hence, we need to assess the effect of dosing schedule of daily and intermittent regimens and identify patients with increased risk of developing drug induced hepatotoxicity. To determine the frequency and risk factors associated with anti-tuberculosis drug induced hepatotoxicity in daily and intermittent dosage regimen of anti- tubercular therapy, a prospective study was conducted with 130 patients diagnosed with tuberculosis, followed clinically and biochemically before and after the initiation of anti-tuberculosis drugs. Complete history including demographic details and physical examination were documented. Among 53 patients, 28.3% of the patients developed anti- tuberculosis drug induced hepatotoxicity with higher incidence in those receiving daily regimen than the intermittent regimen (P = 0.00). On comparing the site of tuberculosis, higher risk of drug induced hepatotoxicity was reported in cases with pulmonary tuberculosis (P = 0.01) than with extra-pulmonary tuberculosis. Among the 23 patients with anti– tuberculosis drug induced hepatotoxicity, 52% were noted to have moderate hepatotoxicity based on the severity grading of hepatotoxicity and 44% noted as probable based on the Roussel-Uclaf causality assessment method. Body mass index < 20kg/m2 (P = 0.042) and concomitant use of other hepatotoxic drug (P = 0.005) were risk factors for anti-TB DIH. Higher incidence of anti- tuberculosis drug induced hepatotoxicity was found in patients who received daily regimen rather than intermittent regimen. Extreme precaution should be taken in patients with body mass index < 20kg/m2 and also among those using concomitant hepatotoxic drugs.

Peak Plasma Concentration of Azithromycin and Treatment Responses in Mycobacterium avium Complex Lung Disease

ABSTRACTMacrolides, such as azithromycin (AZM) and clarithromycin, are the cornerstones of treatment forMycobacterium aviumcomplex lung disease (MAC-LD). Current guidelines recommend daily therapy with AZM for cavitary MAC-LD and intermittent therapy for noncavitary MAC-LD, but the effectiveness of these regimens has not been thoroughly investigated. This study evaluated associations between microbiological response and estimated peak plasma concentrations (Cmax) of AZM. The AZMCmaxwas measured in patients receiving daily therapy (250 mg of AZM daily,n= 77) or intermittent therapy (500 mg of AZM three times weekly,n= 89) for MAC-LD and daily therapy forMycobacterium abscessuscomplex LD (MABC-LD) (250 mg of AZM daily,n= 55). The AZMCmaxwas lower with the daily regimen for MAC-LD (median, 0.24 μg/ml) than with the intermittent regimen for MAC-LD (median, 0.65 μg/ml;P< 0.001) or daily therapy for MABC-LD (median, 0.53 μg/ml;P< 0.001). After adjusting for confounding factors, AZMCmaxwas independently associated with favorable microbiological responses in MAC-LD patients receiving a daily regimen (adjusted odds ratio [aOR], 1.58; 95% confidence interval [CI], 1.01 to 2.48;P= 0.044) but not an intermittent regimen (aOR, 0.85; 95% CI, 0.58 to 1.23,P= 0.379). With the daily AZM-based multidrug regimen for MAC-LD, a low AZMCmaxwas common, whereas a higher AZMCmaxwas associated with favorable microbiologic responses. The results also suggested that the addition of rifampin may lower AZMCmax. When a daily AZM-based multidrug regimen is used for treating severe MAC-LD, such as cavitary disease, the currently recommended AZM dose might be suboptimal. (This study has been registered at ClinicalTrials.gov under identifier NCT00970801.)