ABSTRACT
Objectives: To know the incidence of post-operative wound infections in compound fractures & to evaluate the bacterial isolate and to identify the antibiotic sensitivity patterns in compound fractures to facilitate the use of effective prophylactic antibiotics to prevent infections. Methodology: This was a prospective study conducted at Jawahar Lal Nehru Medical College and Hospital between 1st may 2014 to 31st July 2014.This study included all the patients with Compound fractures of extremities, presenting to Orthopaedic emergency. All the open fractures were classified according to the Gustilo and Anderson’s classification. Two pus culture swabs were taken in all patients under all aseptic precautions. First sample was taken at time of arrival of patient at emergency department, and immediately sent for culture and sensitivity. Prophylactic antibiotic (i.v. cefoperazone) was started immediately after taking the first culture. Second pus culture swab was taken after three days, at the time of wound inspection. All the fractures were managed with thorough wound debridement and fracture stabilization. Data was collected according to set proforma, regarding the results of initial and post-operative swab cultures and were analysed. Observation & Results: This study involved fourty patients with compound fractures of extremities presenting to the emergency department. The incidence of wound infection before any operative procedure i.e, first pus culture in the study was fifty five percentage.. Out of twenty two infected cases thirteen patients had staphylococcus aureus as the growing organism. All Staph.aureus were found to be sensitive to amikacin, vancomycin. The incidence of wound infection in second pus culture report was found to be thirty percentages. In the second swab culture sample which was taken on third day, eight (twenty percentage) cultures showed Staph. aureus. Six were sensitive to amikacin, six were sensitive to cefazoline. Conclusion: Compound fractures are associated with high incidence of infection. Antibiotics should be such that it covers all the commonly infecting organisms. In this study the commonest infecting organism was found to be Staph. aureus followed by E. fecalis, Citrobacter, E. coli and Klebsiella. It indicates that antibotics should be given initially empirically to cover the Gram positive and negative bacteria followed by giving specific antibiotics following pus culture report to combat and eradicate wound infection. Most of these organisms were found to be sensitive to Cephalosporins, Vancomycin and Aminoglycosides. Thus it is highly recommended that Prophylactic antibiotics in the management of compound fractures should always include one Cephalosporin or Vancomycin and one Aminoglycoside to cover the commonly infecting organisms. The results of this study may hold true for elective Orthopaedic procedures also.
ABSTRACT
Background: The most common tool used for assessment of knowledge is the essay questions. Their evaluations depend upon test and item analysis which is consisting of analysis of individual questions and analysis of the whole test. The objective of our study was to calculate the Item analysis (Facility value, FV and discrimination index, DI) of questions given in terminal examination of MBBS students and observes the adequacy of questions framing in examination. Methods: Study contains 150 medical students undergone terminal examination consist of questions of essay type, structured essay type and short answer questions were given to the students. We divide them into high ability group and low ability group. Mark range was decided for essay type, structured essay type and short answer type questions and FV & DI was calculated. Results: Studies described that facility values of 62.5 percentage questions were come under recommended & acceptable range and 50 percentage questions were come under acceptable range. Discrimination value of 100 percentage questions were come under recommended & acceptable range where 75 percentage questions were come under acceptable range. Conclusion: The importance of item analysis is highlighted from our results. For improvement of examination items with average difficulty and high discrimination should be implemented into future examinations to improve test scores and properly discriminate among the students.