Equipment Design ; Gastrostomy ; instrumentation ; methods ; Humans

The case presented multifactorial facets of depression and diabetes leading to noncompliance to both medical and psychiatric treatment resulting in suicide. A biopsychosocial approach was done to elucidate the complexity of the case, factoring in the adolescent storm, vicious cycle of diabetes and depression and effect of enmeshed attachments. Management involved short-term and long-term goals, focusing on psychoeducation about the nature and course of depression, psychiatric impact of depression leading to noncompliance, suicide precaution and treatment plans through psychopharmacology and psychoterapy, family therapy, liaison with the Pediatric Endocrinology and Nutrition service and support group involvement.

Human ; Female ; Depression ; Insulin--administration & Dosage ; Family Therapy ; Psychopharmacology ; Suicide ; Depressive Disorder ; Psychotherapy ; Patient Compliance ; Diabetes Mellitus ; Self-help Groups

INTRODUCTION: Renal colic pain is a very severe pain usually being consulted at the emergency room.New pain relievers together with combination of other drugs is used for symptomatic relief. Thisstudy compared the efficacy and tolerability of Diclofenac versus Dexketoprofen with Hyoscine N-butyl bromide (HNBB) in the management of acute renal colic at the emergency room. METHODOLOGY: This was a single blind, randomized prospective study done from June 1, 2017 toAugust 31, 2017 at the emergency department of the Jose Reyes Memorial Medical Center. Allocationand randomization were done into two treatment groups: the Diclofenac and Dexketoprofen + HNBB.Subjectivity of pain relief was based using visual analogue score (VAS), this was taken before thetreatment and 15, 30 and 60 minutes after administration of treatment. RESULTS: Twenty nine (29) patients were grouped into two: Dicloenac group (n=15) and Dexketoprophen+ HNBB group (n= 14). Pain reduction in the combination group had a faster pain relief compared toDiclofenac alone with a 41% and 17% decline, respectively. The study showed that a faster pain reliefwas achieved with the Dexkoprophen + HNBB combination compared to Diclofenac alone. CONCLUSION Timing and onset of pain control in patients presenting with renal colic pain is essentialin the emergency room setting to provide adequate relief. The use of the combination therapy ofDexkotoprofen + HNNB may have a significant advantage in terms of rapid onset of relief.