The pattern of Bacterial Growth in Infected Wounds Following Emergency Laparotomy with The Variation of Sensitivity to Antibiotics-A Study of 58 Cases

Background: An emergency laparotomy is a commonly performed operation by general surgeons where the abdomen is opened and the abdominal organs examined for any injury or disease. A few major indications for an emergency laparotomy are perforation peritonitis, acute intestinal obstruction, burst appendix and blunt or penetrating abdominal injuries either due to roadside accidents, fall from height or gun shot or stab injuries. The study aims to see the causative organism of wound infection and prevent misuse of antibiotics in infected wounds following emergency laparotomy.Material & Methods:This observational study was carried out in the Department of Surgery, Khulna Medical College, Khulna from July 2008 to June 2009. A total of 58 specimens consisting of wound swabs, pus, purulent exudates or wound discharge were collected from patients who had emergency laparotomy at Khulna Medical College.Results:Out of 58 patients with abdominal operation developed wound infection following emergency laparotomy, 14 cases were ileal perforation, 19 cases were duodenal ulcer perforation, and 9 cases were sigmoid volvulus, and F13 cases were small intestinal obstruction and 3 were blunt abdominal trauma. Among 58 postoperative abdominal wound infected cases all require antibiotics and regular dressing 60.34% require a secondary stitch 25.86% require no secondary stitch and 13.79% required wound excision with a secondary stitch.Conclusions:Postoperative complications are more common after emergency laparotomies compared to elective laparotomies. Maximum complications were found in patients with delayed presentation or in patients having any associated co-morbidities. Therefore, early detection and immediate intervention with better postoperative care can minimize postoperative complications. The present study suggests that proper awareness among rural populations, adequate health education to seek prompt medical aid, a good referral and efficient transportation can reduce the delayed presentation which in turn will prevent postoperative complications following emergency laparotomy.

Role of Peptic Ulcer Perforation (PULP) score to Predict the Outcome in Patients with Perforated Peptic Ulcer

Background: Peptic ulcer disease is a global burden of disease associated with potentially life-threatening complications, including bleeding, perforation and obstruction. Perforated peptic ulcer (PPU) is a frequent emergency condition worldwide with associated morbidity and mortality. Variations in the clinical presentation, as well as delay in diagnosis and work-up at admission to the hospital, may potentially cause a worsening of symptoms and a deterioration of the clinical condition, with a detrimental outcome. Therefore, accurate and early identification of high-risk surgical patients with perforated peptic ulcers (PPUs) is important for triage and risk stratification. Currently, the ASA score and the Boey score are the most frequently used prognostic scoring systems in patients with PPU. Yet, the ASA score is a general surgical risk score not intended for PPU patients in particular. Moreover, the external validation of the Boey score is uncertain. PULP score appears to have the greatest predictability of the outcome of perforated PUD. Aim of the study: The objective of the study was to evaluate the role of the PULP score in the prediction of outcomes in patients with a perforated ulcer.Material & Methods:It is an observational cross-sectional study, carried out in the Department of Surgery, Dhaka Medical College Hospital, Dhaka. Ethical approval was obtained from the Dhaka Medical College ethical review board. Patients aged 18 to 60 years admitted to the emergency department with a clinical diagnosis of perforated peptic ulcer disease, confirmed by different investigation modalities, e.g, imaging, sonography, laboratory test, etc were enrolled in the study. The data regarding sociodemographic, clinical, biochemical, radiological and surgical profiles were recorded. The operation was done by upper midline incision under general anesthesia. A modified Graham’s patch technique was used to repair the duodenal ulcer. Postoperative follow up was conducted meticulously. Patient outcome was assessed during their hospital stay and then OPD follow-up or by telephone interviews up to 30 days after the intervention. All the information is recorded in the data collection sheet. All collected questionnaires were checked very carefully to identify the error in the data. Data processing work consisted of registration schedules, editing computerization, preparation of dummy tables, and analyzing and matching data. Data was processed and analysed with the help of the computer program SPSS and Microsoft excel. Quantitative data are expressed as mean and standard deviation and qualitative data as frequency and percentage. The comparison was done by tabulation and graphical presentation in the form of tables, pie charts, graphs, bar diagrams, histograms &charts etc.Results:Present study demonstrates that the maximum number of patients (43.0%) was between 51-60 years of age group, mean age of the patient was 49.35 ± 11.7 years. The male and female ratio was 3.54:1. Maximum (57%) patients came from urban, (36%) rural and (7%) urban non-slum areas. In this study, the most common signs were tachycardia (100%), abdominal tenderness (100%), abdominal rigidity (100%), absence of vowel sound (86.2%), and obliteration of liver dullness (78.7%), dehydration (67.5%). The time lapse between the onset of symptoms and admission to the hospital varied from 4 hours to 4 days. Most of the patients (76.0%) were admitted after 24 hours. In this study, PULP score was assessed according to the operational definition of optimal cut-off point 7, below this considered as low-risk patients. in this study 85% were 0-7 PULP scores and 15% were PULP scores 8-18. Patients’ condition after proper treatment, symptoms, degree of abnormalities or dependence on the daily physiological activity and the clinical outcome had evaluated and measured by follow up and close monitoring. The study shows that 69.0% of the patients recovered completely, but 24.0% of patients had developed complications. The mortality rate in this study was 7.0%. Finally, a correlation of the PULP score with mortality of perforated PUD was carried out. Among the 7 expired cases the, PULP score was correlated with 6 cases like high risk. In 93 cases of recovered, the PULP score was predicted in 84 cases as low risk. So the effectiveness of PULP has proven significant in the prediction of mortality in perforated PUD patients. The Sensitivity and Specificity of the Peptic Ulcer Perforation (PULP) score was 85.7% and 90.3% respectively. Similarly, the positive predictive value and accuracy rate for the same was 40.0% and 90.0% respectively.Conclusion: Patients with perforated peptic ulcer (PPU) often present with acute, severe illness that carries a high risk for morbidity and mortality. Several prognostic scoring systems have been suggested to identify high-risk surgical patients with perforated peptic ulcers accurately and early. The present study demonstrates that the PULP score can be used to predict 30-day mortality accurately in patients operated for PPU. The prognostic predictors included in the PULP score can be readily identified prior to surgery. The PULP score can assist in the accurate and early identification of high-risk patients with PPU.

Shelf life evaluation of Laghu Sutashekhara Rasa – A preliminary assessment

Background: Laghu Sutashekhara Rasa (LSR) is a herbo mineral formulation containing Shuddha Gairika(Fe2O3) and Shunthi (Zingiber officinale Roxb.) with the levigation of Nagawalli Swarasa (fresh juice ofPiper betel Linn.) prepared as per the reference of Rasatarangini Parishistha. This is an importantformulation in Ayurveda therapeutics, but its shelf life is not evaluated till date. The Govt. of India Gazettespecifies the shelf life of various Ayurvedic medicines. However, there is a need to revalidate the shelf lifeof individual formulations by following parameters prevalent in respective scenario.Objectives: To evaluate shelf life of Laghu Sutashekhara Rasa.Materials and methods: Laghu Sutashekhara Rasa was prepared in the Pharmacy, Gujarat Ayurved University, Jamnagar following classical guidelines. The samples were subjected to accelerated stabilitystudy maintaining temperature and humidity 40 ± 2 _x005F_x005F_x0001_C and 75 ± 5% respectively. Relevant analyticalparameters were analyzed at an interval of 0, 1, 3 and 6 months to check the degradation levels in theformulation.Result: Product was free from microbial contamination and heavy metals were within the prescribedlimits. There were insignificant changes in physico-chemical profiles at different intervals of analysis.On extrapolation of the observations, the shelf life of Rasayoga was found to be 2 years and 8 months.Conclusion: The shelf life of Laghu Sutashekhara Rasa was found to be less than the given standards inofficial gazettes of Govt. of India. This decreased shelf life may be because of the predominantly(approximately 70%) herbal component present in the formulation.

Chemical characterization of an Ayurvedic herbo-mineral preparation- Mahalaxmivilas Rasa

Background: To protect the massive trust of patient in Ayurveda, a need aroused for the researches toascertain the quality, safety & efficacy of herbo-mineral preparations on scientific lines. The rasa-aushadhis are having qualities such as instant effectiveness, requirement in very small dosage and ampletherapeutic utility. Mahalaxmi Vilas Rasa [AFI, 20:27] has been used for treatment of a variety of ailmentssince time immemorial.Objective: To prepare Mahalaxmi Vilas Rasa as per standard operating procedures (SoPs) mentioned inclassical text and to characterize it chemically using modern analytical techniques.Materials and Methods: The drug (Mahalaxmi Vilas Rasa) in three batches was prepared in GMP certifiedpharmacy. Physico-chemical analysis, HPTLC, Assay of elements by AAS & ICP-AES were carried out as perAyurvedic Pharmacopoeia of India. Powder X-ray diffraction (XRD) was conducted using Rigaku UltimaIV X-ray diffractometer.Results: The elemental analysis shown the presence of Mercury, Sulphur, Calcium, Copper, Gold, Iron &Tin etc. and HPTLC revealed presence of organic constituents from plant material. The XRD had indicatedthat prepared drug contained free sulphur, cinnabar (mercury sulphide added as Kajjali), cassiterite (tinoxide, Vanga Bhasma), orpiment (Hartal, arsenic III sulphide) and mica (Leucite/ Zeolite, Abhrak Bhasma).The drug was also tested for residual pesticide and microbiological contamination which were foundwithin permissible limits.Conclusion: Classical pharmaceutical procedures of Mahalaxmi Vilas Rasa showed converting the macroelements into therapeutically effective medicines of micro form. Standards laid down in this study certainlyutilized as an important tool for standardization and quality assurance of this herbo-mineral formulation.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Alarming Signals Of Drug Addiction Among The Southern Youths In Bangladesh: A Survey Based Research

Background:Drug addictionisaseriouspublichealthcrisiswhichaffects almosteverysphereinacommunity inawayoranotherandthisinturncanpossibly leadto socialdisharmony,severecrimes,degradedsocialstatusandmostpossibly physicalandmental healthdeterioration.Thesolepurposeofourstudy wasaimedtoanalyzethecurrentawful situationofdrug addictionatfourdifferentsoutherncitiesofBangladesh.Methods:Thiscross sec-tionalhealthbasedsurvey wascarriedoutwithaself-designedstandardquestionnaireby manualdatacollectionover anine monthsperiod (12.09.2015to10.04.2016) atfour adjacent cities oopalganj, Khulna, Bagerhat andNarailrespectively. Total 300substanceabuserswere investigatedby majorlyvisitingattheirhomeandsometimesvisiting theplaceswherethey usually takedrugs.Descriptivestatisticswereappliedtothecollecteddataandanalyzedus-ing MicrosoftExcelsoftware.Results:Inthiscrosssectionalstudyweobservedthat,82%addicts arepredomi-nantlyyoungmalesmostly betweentheagesof10-30.About48%areaddictedby cannabis,19%and17%byyabaandphensedylrespectively.Incaseoffirststarting ofdruguse curiosity,surroundingenvironmentwerethepri-maryreasonandcannabisastheirfirstdrug (61%)followedbyphensedyl(16%).Atleast53%addict’srelayedonlocalitylikefriendsand 30%usedlocaldealersasamainsourcetocollecttheseabuseddrugs.Healthyfinancialsupport isveryimportantforcollectingabuseddrugsand30%addictsspendpocketmoney,23%job, 20%busi-nesssourcetobuythesecostlysubstances.Althoughitisimportanttomentionthat 61%addictsarecompro-mising eitherphysicalorpsychologicalcomplicationsbutitisoneof goodsymptomstoobservethatmorethan60%ofdrugaddictsaretrying togiveupaddiction formingagentsin thesedays. Conclusion: In recent yearsdrugaddictionhassignificantly increasedinthewholeworldespecially inSouthAsiancountries.Itmustbeemphasizedasan alarmingsignby thegovernmentaswellasawarenessamongthepeoplesarevery essentialto stop this criti-cal condition from affectingour futureyoungleaders

Pharmaceutical standardization of Apamarga kshara.

Standardization of herbal drugs is essential to certify their quality and purity. Kshara (alkaline substance) of Apamarga (Achyranthes aspera Linn.) is an important constituent in many Ayurvedic formulations, but its standard manufacturing process (SMP) is not attempted till date. This study is aimed to establish SMP for Apamarga kshara. In pharmaceutical process; generally the sediments of ash obtained at the end of washes will be discarded. However, in the study, we attempted to wash the sediments repeatedly by adding water to extract more Kshara. Apamarga was collected from the local area and authenticated. Kshara was prepared by following standard methods and the preliminary physicochemical profile was developed. It is observed that the ash yields Kshara even in the consecutive washes. First wash yielded 21.23% w/w Kshara, while the second and third washes yielded 9.38% w/w and 4.76% w/w, respectively. Repeated washes yield more Kshara. Hence, it is advocated to wash the ashes repeatedly. As the findings are encouraging, similar experiments can be extended to all other Kshara preparations.

Antidiabetic claims of Tinospora cordifolia (Willd.) Miers: Critical appraisal and role in therapy

Currently, available conventional options for diabetes mellitus have certain limitations of their own, and options from medicinal plants with antihyperglycemic activities are being searched to meet the need. Antidiabetic properties of Tinospora cordifolia are highly appreciated in Ayurveda and even in recent modern researches. Several studies on its extracts (viz. immunemodulatory, anti-hyperglycemic, antioxidant, adaptogenic, hepatoprotective, hormone regulator etc.) and isolated phytoconstituents (like tinosporin, berberine, jatrorrhizine etc.) have reported that it is a preventive and curative antidiabetic herb, which are substantiated by clinical trials. Scattered information pertaining to antidiabetic potential of Tinospora is reported. Present review encompasses (i) in-depth information of reported antidiabetic activities of the plant in light of available experimental and clinical studies, and (ii) understanding on the possible mechanism of its action in combating the complex pathology of diabetes.

GC-MS analysis and biological evaluation of essential oil of zanthoxylum rhesta [roxb.] DC pericarp

The present study reports the chemical composition, antioxidant, antibacterial, antidiarrheal as well as the spasmolytic activity of Zanthoxylum rhetsa [DC] essential oil, fractionated oil and its principal constituent [Terpinen-4-ol]. The constituents of essential oil were characterized by GC-FID and GC-MS. The pharmacological and biological activities of oil, its fraction and principal constituent were carried out in-vivo and in-vitro. The oil was rich in a group of monoterpene family, constituted mainly of terpinen-4-ol [25.43%], sabinene [16.50%], beta-pinene [10.4%], alpha-Terpineol [7.63%], gamma-Terpinene [5.64%], alpha-pinene [4.33%], and linalool [3.25%]. The antioxidant capacities of the oil, fractions and terpinen-4-ol were assessed by using spectrophotometry to measure free radical scavenger 2,2-diphenyl-1-picrylhydrazyl [DPPH]. Furthermore, the oil, its fractions and terpinen-4-ol exhibited appreciable antioxidant, antibacterial, antidiarrheal and non-selective spasmolytic activity. The study suggests that the oil and its main active constituent [terpinen-4-ol] of the studied plant would have high potential in the treatment of stress and gastrointestinal diseases

Seasonal variations in physicochemical profi les of Guduchi Satva (starchy substance from Tinospora cordifolia [Willd.] Miers).

Guduchi Satva (GS), the starchy material extracted from the Guduchi stem is well-known Ayurvedic single drug formulation having a wide range of therapeutic utility. Species of the plant, stem size, collection time, season and maturity of the plant may affect the yield and physico-chemical profi le of GS. However, published data on such variations is lacking. Considering this, present study is planned to screen seasonal variations in physico-chemical profi le of GS. 18 batches of GS were prepared in six different seasons (3 batches in each season) and fi ndings were systematically recorded. The obtained Satva was further subjected to relevant physico-chemical parameters. Principal component analysis method was adopted to analyze variations. Maximum yield of Satva was obtained in Shishira Ritu (January-February) while the minimum in Grishma (May-June). Variation in taste and color was found in Satva prepared in Varsha Ritu. All functional groups were found to be same in each season. Total alkaloidal contents found bit higher in Varsha and Vasanta. More residual x-variance in alcohol soluble extract and more leverage were observed in water soluble extract due to impact of seasonal spells.

Critical review on the pharmaceutical vistas of Lauha Kalpas (Iron formulations).

Iron is one among the major metals present in the earth’s crust and is essential for sound sustenance of human body. Its defi ciency leads to various health ailments. Contemporary medicine advises iron supplements in iron defi ciency anemia. Ayurvedic classics also quote signifi cant information about administration of iron. Lauha Kalpas are the unique compound herbo-mineral formulations where iron (Lauha) is used as a major ingredient. Relevant literature (Bhaishajya Ratnavali, Charaka Samhita, Rasendra Sara Samgraha etc.) reviewed to gather information about Lauha Kalpas. Critical analysis of these Lauha Kalpas reveals that ancient seers administered iron in a better acceptable form. Unlike popular understanding these are not only Khalviya preparations; but Churna (powders), Avaleha (confectionaries), Rasakriya (solidifi ed decoctions), and Putapaka (incinerated) form of preparations are also found. Apart from solid dosage forms, semisolid dosage forms mentioned in classics are very much useful. Unfortunately most of the formulations are not found in the market. Hence Pharmaceutical fi rms may bring these unique dosage forms in to the market to supply the healthcare needs of the community. It is interesting that iron preparations are used in Ayurveda in different medical conditions apart from anemia (Pandu). This leaves a scope for further researches on different dosage forms of iron and their indications.

Evaluation of immunomodulatory activity of “Shirishavaleha”–An Ayurvedic compound formulation in albino rats.

The immunomodulatory activity of Shirishavaleha prepared from two different parts of Shirisha (Albizia lebbeck Benth), i.e., Twak (Bark) and Sara (Heartwood) as main ingredients was evaluated for humoral antibody formation and cell-mediated immunity in established experimental models. The study used Wistar rats of either sex weighing 200 ± 40 g, while the test drug was administered orally at a dose of 1.8 g/kg. Hemagglutination titer and body weight were recorded to assess effects on humoral immunity; immunological paw edema was assessed for cell-mediated immunity. Shirishavaleha prepared from heartwood shows significant enhancement in antibody formation, attenuation of body weight changes, and suppression of immunological paw edema, while Shirishavaleha prepared from bark shows weak immunomodulatory activity. The study therefore concludes that Shirishavaleha prepared from heartwood has significant immunomodulatory activity.

Therapeutic potentials of metals in ancient India: A review through Charaka Samhita.

The Ayurvedic system of medicine has stood the test of time for four millennia or more. The ancient seers found that drugs of different origin (herbal, metal or animal) in addition to codes of conduct and dietary regulations are suitable tools to maintain health in healthy and eradicating diseases in diseased. Use of metallic preparations in healthcare is a unique feature in this system. Processed metals including Mercury, Gold, Silver, Lead, Zinc, Copper etc. were used very frequently by seers of the Indian tradition in different disease conditions with great authority. It is generally claimed, that these metals are detoxified during the highly complex manufacturing processes described in Ayurvedic, especially Rasashastra texts. Charaka Samhita, one of the scheduled books of Ayurveda also holds ample of references regarding the use of metals for different purposes, which are summarized in the current paper.

Effect of standard treatment guidelines with or without prescription audit on prescribing for acute respiratory tract infection (ARI) and diarrhoea in some thana health complexes (THCs) of Bangladesh.

Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as 'unsatisfactory performers'. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in > or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in > or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p<0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p<0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs.

Acute myocardial infarction in diabetics and non-diabetics

Four hundred and ninety one patients with acute myocardial infarction [AMI] were included in this study. The frequency of diabetes mellitus [DM] among them was 17%, being 25% in females and 14% in males [p < 0.004]. The immediate mortality rate [IMR] in diabetics was 35% compared to 20% in non-diabetics [p < 0.002]. The impact of DM occurred on both sexes but the main impact was on females above the age of 50. The mean age of diabetics was 59.7 [SD 8.6] years and of non-diabetics was 59.3 [SD 10.1] years. Smoking and hypercholesterolaemia were common among diabetics and non-diabetics. The frequency of hypertension was significantly higher in diabetics [p < 0.05] and was associated with significant increase of IMR in both groups [p < 0.01]. Cardiogenic shock, severe heart failure, hypotension and arrhythmias were the most serious complications of AMI in both groups. Heart failure was significantly more frequent in diabetics [p < 0.03] while cardiogenic shock, hypotension and arrhythmias occurred equally in both groups. We compared our findings with those of previous reports and the results were discussed