Brief Answer:
Gut flora depletion.

Detailed Answer:
Hello and thanks for query my dear,
Our gut consist of colonies of bacterias which are responsible for proper digestion of food.If this microbiota is disturbed food is improperly fermented causing production of large amount of gases in gut leading to bloating or belching.These gases may compress diaphragm causing hiccups.In old patient mobility of intestines is severly compromised leading to accumulation of large amount of gases in intestines.As persitaltic moments are week gas accumulates in intestines.
Another condition is-
Small Intestinal Bacterial Overgrowth can be a reason of severe flatulence .
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine, and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestines causing improper and disturbed food digestion.

I would suggest her to go for few tests
Ultra sound abdomen
Stool test under microscope
Complete blood count
Total and differential leucocyte count.

If stool test is positive for bacterial or protozoal infection.Start taking Zithromax(Azithromycin 500 mg once daily) and secnidazole 1 gram daily for 5 days.
Along with it take Fybrogel husk,It will increase the bulk of your stools.

Start giving her probiotic daily for 10 days.Probiotics are live bacteria and yeasts that are good for your health, especially yourdigestive system. We usually think of bacteria as something that causes diseases. But your body is full of bacteria, both good and bad. Probiotics are often called "good" or "helpful" bacteria because they help keep your gut healthy.
For hiccups Baclofen 10 mg can be given as and when required.
General precautions-
Eat light and easily digestible food.
Avoid meat.
Try boiled food(Vegetables) with spices and herbs for a week.
Drink plenty of orange juice and coconut water.

Hope i answered your query well.
Follow up with reports.
Regards.

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Brief Answer:
Follow up answer.

Detailed Answer:
Hello and thanks for follow up sir,
She has got pus cells in her urine and her fasting blood sugar is also high.Sugar always acts as a culture media for various bacterias and fungus.
So initially i would like to add
Tab Trazanta 5mg once daily 9a.m to contol her blood sugar
plus an antibiotic like Cefixime 400mg twice daily should be given for 5 days to control ongoing infection.
USG shows mild fatty liver changes(age related).

Give her 2 scoobs of veg protein(sugar free) with one cup of fat free milk.This would take care of her daily protein requirement and would keep her satiety suppressed.
Some other foods are
Bhuna chana
Peanuts
10gram almonds
All green vegetables
Apple,guava,Strawberry,pear.
Rice flakes,churma etc
give her VSL#3named probiotic twice daily(a good one).

Thanks

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Brief Answer:
All drugs are effective and safe.

Detailed Answer:
Hello dear and thanks for follow up,
Linagliptin belongs to the group of diabetes medications called DPP-4 inhibitors. It works by increasing the amount of incretin released by the intestine. Incretin is a hormone that raises insulin levels when blood sugar is high (especially after a meal) and decreases the amount of sugar made by the body.Its a very good drug and often used in patient in which metformin or glimipiride can't control sugar well.
Very safe in old patients and excellent results.

See she has infection in urine and has to take a good antibiotic for 5 days.Cefixime is among the safest cephalosporins very widely used and highly effective.No interaction with drugs she is on. don't consider nausea headache allergy etc as a side effect(even pollen can give you these symptoms).Don't unnecesarily google too much.
VSL#3 is one of the best imported probiotics and is very effective and well tolerated.Its sugar free,

Hope it cleared your query sir,
Please feel free to follow up any time.
Regards.

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Brief Answer:
Follow up answer.

Detailed Answer:
Wanted to confirm if test results would depend at the time when we give Urine?-No it does not. However it depends on quality of technician and machines a particular lab is having.

Do we need to still Continue Antibiotic since yesterday results does not show Pus cells in Urine-To be on safe side 4 tablets of cefixime are not going to cause any harm to her.So in case of deliema i would consider her as pus cell positive but give her cefixime for 3 days only.

Also attached the Stool Test results Request you to review and provide your inputs on the same-Pus cells are there in her stools.Whenever we are infected our body try to defend us but when immunity of body fails to kill external bacterias pus is formed.So again Cefixime has to be given for 3 days with metronidazole(anti protozoan)400mg thrice daily for 3 to 5 days.

HTTG -DGP-To rule out inflammatory bowel disease.I won't recomend it right now because she has a very short history plus her stool test shows infection.

B12-Vitamin B12 level-Not of much significance again.
Serum Sodium-Don't know whats the significance of just checking sodium levels in her case.

ALT is a part of liver function test.
Its a probitic named VSL#3 Can even get it online in USA.
Veloz 20 is an antacid and would help her with gas issues there is no harm in taking it.
Liofen 10 MG Tablet is an Antispastic agent which is used to relieve pain and improves the muscle movement.Can give both of them no problem,Would help her symptomatically.
Thank you.

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Brief Answer:
follow up.

Detailed Answer:
Hello again,
No mahacef is not a good one(MANKIND) company please use Taxim o or Zofix.
In case you can't get VSL#3 ask pharamcist to give any good quality probiotic.
Is Mahacef is available in USA?

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Brief Answer:
Please take the antibiotic in doses and frequency suggested.

Detailed Answer:
Hello again my dear,

Giving antibiotic only at night would just cause antibiotic resistance. Period of action of cefixime is 12 hours. So antibiotics would kill bacterias for 12 hours but if you don't give the second dose for the next 12 hours those bacterias would again form their colonies.

Taxim 200 twice daily will be ok however 400 mg twice daily could be given initially for 3 days followed by 200 mg twice daily for 2 days.
Yes, you may stop Sompraz and start the other one.

Metronidazole (Metrogyl/Flagyl) tablet 400 mg thrice daily for 3 days followed by twice daily for 2 days.

Please don't alter doses of antibiotics on your own as this may lead to antibiotic resistance.
Hope I cleared your doubts.
Feel free to follow up.

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