Determinants of delay in initiation of post exposure prophylaxis for rabies prevention among animal bite cases attending a rural tertiary care hospital of Haryana

Introduction : Rabies is a fatal but vaccine-preventable viral disease. Animal bite victims who report in primary and secondary level health care lack some measures which can help in protecting and preventing deaths due to rabies. The most important factor for prevention of death due to rabies is the timely administration of post-exposure prophylaxis (PEP) among animal bite victims. Therefore, in addition to an understanding of the epidemiological distribution of animal bites, it is necessary to explore the factors leading to delay in PEP initiation. Objective: To determine the determinants of delay in initiation of post exposure prophylaxis for rabies prevention among animal bite cases attending anti-rabies clinic of a ruraltertiary care hospital in Sonepat, Haryana. Method: This cross-sectional study was conducted at an Immunization-cum-antirabies clinic of Bhagat Phool Singh Government Medical Collegefor Women, Khanpur Kalan, Sonepat, Haryana. A pre tested, structured questionnaire was used to collect information among 410 participants after taking consent. The Institutional Ethics Committee of institute approved the study. The groups were compared with Chi-square test for categorical data. Results: Delay was present among 27.3% of participants. Significant factors of delay were no local wound treatment, any treatment taken prior to anti-rabies vaccine administration, rabies clinic closed on holidays, unawareness about PEP, non-availability of accompaniment, transportation issues and money problem for transportation. Knowledge also played significant role as delay was significantly more among the participants not having knowledge regarding source of infection, mode of transmission and incubation period of rabies. Conclusions: Delay ininitiation of PEP was common and were significantly associated with lack of knowledge and unawareness, closure of rabies clinic on Sundays/holidays, non-availability of accompaniment and money problem during transportation

Assesment of Insulin Resistence in Different Stages of Chronic Kidney Disease

Introduction: Epidural anaesthesia and analgesia hasjustified use in the perioperative care of high-risk surgicalpatients, as they give better analgesia, and also improvedoutcome. Thoracic Epidural analgesia is an excellent methodof postoperative and post injury pain control in proceduresinvolving significant thoracic and abdominal injury weathertraumatically or surgically induced. Though Bupivacaine isconsidered to be the drug of choice, many other agents arebeing used for epidural anesthesia.Material and Methods: This study was carried out on 105ASA grade I and II nulliparous patients, between 20 to 70 yearsof age undergoing laparotomy, voluntary donor nephrectomyand renal surgeries. They were randomly divided in theBuprenorphine, Bupivacaine and Fentanyl Groups. Quality ofanalgesia and post-operative complications were monitored.Results: Analgesic failure was observed in all the threeGroups. But complete pain relief was better in theBuprenorphine Group. Also, complications (hypotension,bradycardia, sedation) were less in the Buprenorphine Groupthan in the Bupivacaine and Fentanyl Groups.Conclusion: Buprenorphine is safer and provides betterquality analgesia than Bupivacaine and Fentanyl.