Ensuring Surgical Safety: Initial Footstep in a Thousand Mile Journey An Initial outcome Study from a Developing Country

Background: Surgical adverse events due to negligence are increasingly recognized as an important aspect for preventing morbidity and mortality in healthcare system. WHO Safe Surgical Checklist provides an opportunity for surgical teams to minimize surgical adverse events by following just a simple checklist. The aim of this study is to assess the compliance of different members of the surgical team to this checklist and post operative outcomes before and after an orientation programme regarding the checklist. Methods: We observed 100 elective surgeries in the Department of Surgery of our institution and collected the baseline data regarding the use of WHO Safe Surgical Checklist in these surgeries. Following the collection of baseline data we organised an orientation program for the surgical team at our institution and collected the same data after orientation. Data obtained both before and after the data collection were compared. Results: This study has shown significant improvement in certain sections of the WHO Safe Surgical Checklist such as conformation, by the patient himself, of his identity (10%) , site of surgery (23%) and procedure to be performed (35%) . A significant increase has also been shown in estimation of the duration of surgery by the surgeons (11%) and specimen labelling (44%). The members of the surgical team introduced themselves more number of times (17%) after the orientation. Number of deaths (50%) and surgical site infections (80% class1 SSI, 25 % class 2 SSI, 13% class 3 SSI, 52% class 4 SSI) has also been shown to decrease following the checklist implementation. Conclusion: Implementation of this WHO Safe Surgical Checklist is beneficial both to the patient and to the surgical team and is not very difficult to comply with, considering the excellent post operative outcomes shown in this study. Compliance with all items on the checklist with active co-operation, co-ordination and participation by all team members are key factors that led to the successful implementation of the checklist

Clinical challenges with excipients in insulin formulations and role of concentrated insulin

Most of the insulin formulations in clinical use contain phenol, meta-cresol or both as excipients. These excipients in insulin preparations provide stability and have antimicrobial properties. However, they are reported to be associated with undesirable side-effects especially localised allergic reactions. Amount of excipients injected per unit dose of insulin is a major determining factor in causation of these reactions. This review discusses the excipients in different insulin formulations available in India with potential of precipitating undesirable effects and the use of concentrated insulins to reduce these complications. To avoid the detrimental effects associated with excipients, removal of preservatives or use of insulin preparations devoid of excipients can be an option. Besides these approaches, one approach that can be considered is the use of concentrated insulin to reduce the volume of insulin dose and thereby the excipients. Concentrated insulins address the high insulin requirements of the growing population of patients with type 2 diabetes who require higher insulin doses. Concentrated insulins help in reduction of dose volume as well as amount of excipients injected per unit dose of insulin. U200 (concentrated r-DNA Human Insulin Premix 30/70-200 IU/ml) can be advantageous with better absorption from smaller quantity injected, lesser variability in absorption, lesser pain and discomfort due to smaller quantity, lesser chances of hypoglycaemia all of which can lead to better patient compliance. Thus, concentrated insulin U200 can be one of the alternatives to prevent/reduce clinical complications with excipients in insulins.

Preventive endodontics by direct pulp capping with restorative dentin substitute-biodentine: A series of fifteen cases

Treatment of mechanical exposure of the pulp during caries excavation presents a clinical challenge. In this case series of 15 patients, with a follow-up period of over a year, the outcome of direct pulp capping with Biodentine (septodont) after mechanical pulp exposure was assessed. Aim of Study: The aim of this study is to evaluate the outcome of direct pulp capping with Biodentine in deeply carious teeth when pulp was mechanically exposed during caries excavation and cavity preparation. Vital pulps exposed during caries excavation in molar teeth were treated with 3% sodium hypochlorite for 2 min. If adequate hemostasis was achieved, the pulp tissue was capped with Biodentine, which covered the entire pulpal floor. This was followed by the placement of a layer of resin-modified glass ionomer cement and a final layer of composite resin (Filtek Z350-3M) to complete the restoration. The patients were recalled periodically and evaluated for any evidence of pulpal/periapical pathology. Results: In the follow-up period that ranged from 12 to 24 months, all teeth were asymptomatic. Conclusion: Biodentine appears to be a suitable material for direct pulp capping under clinical conditions. However, long-term follow-up studies and controlled trials involving a large sample size are warranted.

Use of second-generation platelet concentrate (platelet-rich fibrin) and hydroxyapatite in the management of large periapical inflammatory lesion: A computed tomography scan analysis.

Periapical surgery is required when periradicular pathosis associated with endodontically treated teeth cannot be resolved by nonsurgical root canal therapy (retreatment), or when retreatment was unsuccessful, not feasible or contraindicated. Endodontic failures can occur when irritants remain within the confines of the root canal, or when an extraradicular infection cannot be eradicated by orthograde root canal treatment. Foreign‑body responses toward filling materials, toward cholesterol crystals or radicular cysts, might prevent complete periapical healing. We present here a case report wherein, combination of platelet‑rich fibrin (PRF) and the hydroxyapatite graft was used to achieve faster healing of the large periapical lesion. Healing was observed within 8 months, which were confirmed by computed tomography, following improved bone density. PRF has many advantages over platelet‑rich plasma. It provides a physiologic architecture that is very favorable to the healing process, which is obtained due to the slow polymerization process.