A Comparison of the Postoperative Analgesic Efficacy of Two Different Doses of Caudal Clonidine as Adjunct to Caudal Bupivacaine in Infraumbilical Surgeries in Younger Children.

Managing peri operative pain in smaller children is challenging but beneficial. Caudal epidural block with local anaesthetic and adjuvant in proper dose can significantly prolong the duration of analgesia while avoiding dose related side effects of both the drugs. We selected clonidine as adjuvant to bupivacaine in caudal blocks for perioperative pain management in 80 children during infra umbilical surgeries performed under general anaesthesia. MethodsThe children were randomly allocated into two groups, Group A (n=40) and Group B (n=40). Group A received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 1 μg/Kg in 1 mL normal saline and Group B received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 0.5 μg/Kg in 1 mL normal saline, after inhalational anaesthesia. Heart rate, blood pressure, respiratory rate, oxygen saturation, sedation score, Bromage score and pain score were monitored and recorded peri-operatively. Time to first rescue analgesic at pain score of 12, total number of rescue analgesic doses required, and side effects were also recorded. Data was analysed using appropriate statistical tests. ResultsGroup B patients had significantly higher heart rates, systolic and diastolic blood pressures, respiratory rates and pain scores compared to Group A patients at 50 mins post operatively. The requirement of rescue analgesics in Group B was earlier and higher than Group A. Group A patients remained haemodynamically stable and pain free for longer period. There was no significant difference in side effects between the groups. ConclusionsAddition of 1 μg/Kg clonidine to caudal epidural bupivacaine improves the quality and prolongs the duration of postoperative analgesia compared to addition of 0.5 μg/Kg clonidine without causing significant side effects.

Antimicrobial Resistance Pattern of Bacterial Isolates among Nosocomial Infections (Urinary Tract Infection and Blood Stream Infection) from the Intensive Care Unit of a Tertiary Care Government Hospital in India.

Development of antimicrobial resistance (AMR) to different generations of common antibiotics by various organisms is rising alarmingly. A nationwide standard antibiotic policy is needed. We wanted to study the resistant organisms, the drug class to which organisms are becoming resistant and identify factors favoring the development of AMR for formulating an effective antibiotic policy. MethodsWe conducted this observational study from January 2018 to May 2019 in a tertiary care hospital in India. Sample (urine, blood from ICU patients) processing, organism identification and antibiotic susceptibility tests were carried out as per the institutional guidelines in the Microbiology Department from where data collection was done. ResultsOut of 500 samples, 145 (29%) showed significant growth of organisms exhibiting resistance to either single or multiple drugs. Acinetobacter spp. was the most common organism isolated with a total of 40 (27.58%), followed by Klebsiella spp. 23 (15.83%), MRSA 20 (13.79%), E. coli 15 (10.34%), Pseudomonas 12 (8.27%), Enterococci 12 (8.27%), and CoNS 7 (4.82%). Among GNB, Klebsiella and E. coli showed minimal resistance to polymyxins, fosfomycin, minocycline and tigecycline. Among Staphylococcus spp. maximum sensitivity was seen to teicoplanin, tobramycin, tigecycline and minocycline. Acinetobacter spp. showed high sensitivity to polymyxins, tobramycin, tetracycline, tigecycline and minocycline. ConclusionsAMR was highly prevalent with hospital acquired organisms, and against commonly used antibiotics. Variation of resistance and sensitivity pattern with time and local microflora necessitates periodic AMR monitoring and rotation of antibiotics is suggested to restrict further emergence of resistance. Focusing on the organisms causing UTI and BSI and their resistance pattern, helps in selecting proper antibiotic therapy and in strengthening general sepsis measures.

Neonatal Sepsis is Still a Major Problem in Tertiary Care Hospitals.

In a developing country like India, one of the most important health hazards is neonatal sepsis. The ever full SNCUs of the hospitals are living proof of this. The neonates both early and late are extremely vulnerable to all organisms, both in the community and much more so in the hospital. Neonatal sepsis contributes to infant mortality rate in a very significant way. Nosocomial neonatal sepsis is much more dangerous and contributes to morbidity and mortality in a very big way.METHODSIn this study, neonatal sepsis was assessed by culture of blood, pus from infected umbilical stump, and CSF sample received from SNCU. The isolated organisms were identified phenotypically following our laboratory protocol. Antibiotic sensitivity testing was done by Kirby-Bauer method, following CLSI guidelines.RESULTSIt was found that 48% of the total samples received from SNCU were growth positive. Klebsiella pneumoniae was isolated in maximum number of cases, 42.85% followed by Staphylococcus aureus 18.53%. Antibiotic sensitivity test by Kirby- Bauer method showed that all Gram-positive cocci were sensitive to vancomycin. There was only one linezolid resistant Staphylococcus aureus. Among the Gram-negative bacilli 100% isolates were sensitive to carbapenems. Acinetobacter baumannii and Pseudomonas aeruginosa isolates were multidrug resistant.CONCLUSIONSSNCU admitted babies are extremely vulnerable to septicaemia. The ever-changing drug resistant patterns of the infecting organisms is a perineal problem. Thus, infection control measures are to be strictly enforced in this setting.

Comparative Study Of Conventional Local Steroid Injections Only With Multi-Drugs Therapy And Steroid Injections In Oral Submucosal Fibrosis (OSMF)

Oral submucous fiosis (OSMF) is defined as the chronic inflammatory disease and progressive fiosis with localized collagen disorder involving oral mucosa. There are multiple pathophysiological changes that occur in this disease. The aim of this study is to establish that multidrugs needed for effective conservative treatment in oral submucous fiosis. A total number of 35 cases of OSMF managed in our ENT out patient department (OPD) over one year period ( March 2010 to Feuary 2011) were followed up until July 2011 and the results were analyzed retrospectively to find out any incidence of recurrence of this disease. All the cases received injection steroid and hyaluronidase with multivitamins (A,C and E in higher doses) for 10 weeks. At the end of treatment all the patients were relieved of burning sensation of mouth and got nearnormal mouth opening. The oral mucosa also changed from pale to pink. During follow-up no recurrence was detected. The study suggested that Vitamins A, C and E in higher doses are required to ensure best possible result apart from intralesional steroid and hyaluronidase as a standard conservative treatment protocol in oral submucous fiosis.

Intralesional Sclerotherapy Cures Unusual Presentation of Hemangioma in a Child.

Hemangiomas are benign tumors made up of blood vessels. They usually regress spontaneously within 9 years of age. Hemangioma of retropharyngeal space is a rare entity. History, digital palpation, computed tomography (CT) and fine-needle aspiration cytology (FNAC) clinches the diagnosis. We want to report a case of retropharyngeal hemangioma in a 33-month-old female child who presented with respiratory distress. She was diagnosed and treated successfully in our department.

An overview on microwave mediated synthesis.

Microwave-assisted organic synthesis is an enabling technology for accelerating drug discovery and development processes. Microwave organic synthesis opens up new opportunities to the synthetic chemist in the form of new reaction that are not possible by conventional heating and serve a flexible platform for chemical reaction. This review focuses on the advances in the developing of innovative application of microwave mediated synthesis. The efficiency of microwave flash-heating chemistry in dramatically reducing reaction times (reduced from days and hours to minutes and seconds) has recently been proven in several different fields of organic chemistry. The time saved by using focused microwaves is potentially important in traditional organic synthesis but could be of even greater importance in high-speed combinatorial and medicinal chemistry. The study presents examples that demonstrate the significance of these advantages to industrial application.