Impact of COVID-19 on Clinical Practices during Lockdown: A pan India Survey of Orthopaedic Surgeons

@#Introduction: The social lockdown measures imposed to contain the COVID-19 pandemic, have had profound effects on the healthcare systems across the world and India has been no exception to it. The study was aimed to evaluate the impact of COVID-19 on orthopaedic practice in India during the lockdown period and assess the preparedness of orthopaedic surgeons for resuming clinical practice after the initial lockdown was lifted. Materials and Methods: An online survey of 35 questions was conducted to evaluate impact on (i) general orthopaedic practice (ii) hospital protocols (iii) out-patient practice (iv) surgical practice (v) personal protective equipment (PPE) use and (vi) post-lockdown preparedness. Results: A total number of 588 practising orthopaedic surgeons from India completed the survey. Majority (88.3%) found severe impact (>50%) on trauma surgery and nontrauma surgery with significant reduction in out -patient attendance compared to corresponding time in 2019. There were significant changes made in individual hospital protocols (91.7 %). Appropriate required PPE was available in majority of the hospitals (74.3%). No remodelling or upgrading of the existing operating theatre infrastructure was done by most surgeons (89.5%). Conclusion: This pan India survey of orthopaedic surgeons has indicated that COVID-19 has had a profound impact on their outpatient and surgical trauma and non-trauma practice, due to the lockdown and resulted in significant changes to hospital protocols. Preparedness to resume clinical and surgical practice was associated with anxiety in two-thirds of the respondents. Majority of the orthopaedic practitioners felt that they would continue to conduct pre-operative COVID-19 screening and use PPE even after the lockdown is over.

A Study of Efficacy and Tolerability of Rosehip Extract (Gopo) vs. Ibuprofen (a nsaid) in Treatment of Osteoarthritis in Weight Bearing Joints

Introduction: Osteoarthritis is the most common form of arthritis. Osteoarthritis is a joint failure, which occurs due to pathological change in all structure joint. Aim: The aim of the study was to compare the efficacy and tolerability of Rosehip Extract and ibuprofen along with individual effect of both drugs. Materials and Methods: This was an open, randomized, prospective study to compare ROSE HIP Extract and IBUPROFEN for treatment of Osteoarthritis in 100 patients. In this study two comparative groups (50 each) were taken. First group was prescribed 400 mg TDS Ibuprofen and the other group was given Rose hip extract in the form of 275 mg capsule BD. The pain assessment was done through Womac scale and visual analogue scale. The data was collected for efficacy and tolerability for both drugs at 14 days and 3 months. Result: In ibuprofen group, the mean score of pain intensity on womac scale on visit 1 was 39.2 ± 9.58 which was decreased to 11.62 ± 4.97 in the last visit. On VAS scale on visit 1 was 7.26 ± 1.426 and was decreased to 3.36 ± 1.467 at visit 3. In rosehip group. The mean score of pain intensity on WOMAC scale on visit 1 was 38.44 ± 8.45, 30.88 ± 8.068 which was decreased to 26.68 ± 8.474. The mean score of pain intensity at on VAS scale on visit 1 was 7.02 ± 1.06, 5.84 ± 1 and was decreased to 4.6 ± 1.16 at the end of study. Conclusion: Ibuprofen is a better choice than rosehip because it had shown better improvement. Both rosehip and ibuprofen were well tolerated.

A Study of Efficacy and Tolerability of Rosehip Extract (Gopo) vs. Ibuprofen (a nsaid) in Treatment of Osteoarthritis in Weight Bearing Joints

Introduction: Osteoarthritis is the most common form of arthritis. Osteoarthritis is a joint failure, which occurs due to pathological change in all structure joint. Aim: The aim of the study was to compare the efficacy and tolerability of Rosehip Extract and ibuprofen along with individual effect of both drugs. Materials and Methods: This was an open, randomized, prospective study to compare ROSE HIP Extract and IBUPROFEN for treatment of Osteoarthritis in 100 patients. In this study two comparative groups (50 each) were taken. First group was prescribed 400 mg TDS Ibuprofen and the other group was given Rose hip extract in the form of 275 mg capsule BD. The pain assessment was done through Womac scale and visual analogue scale. The data was collected for efficacy and tolerability for both drugs at 14 days and 3 months. Result: In ibuprofen group, the mean score of pain intensity on womac scale on visit 1 was 39.2 ± 9.58 which was decreased to 11.62 ± 4.97 in the last visit. On VAS scale on visit 1 was 7.26 ± 1.426 and was decreased to 3.36 ± 1.467 at visit 3. In rosehip group. The mean score of pain intensity on WOMAC scale on visit 1 was 38.44 ± 8.45, 30.88 ± 8.068 which was decreased to 26.68 ± 8.474. The mean score of pain intensity at on VAS scale on visit 1 was 7.02 ± 1.06, 5.84 ± 1 and was decreased to 4.6 ± 1.16 at the end of study. Conclusion: Ibuprofen is a better choice than rosehip because it had shown better improvement. Both rosehip and ibuprofen were well tolerated.

DOTS centre at a tertiary care teaching hospital: lessons learned and future directions.

BACKGROUND: In 1993, Government of India started the Revised National Tuberculosis Control Programme (RNTCP). A model Directly Observed Therapy, Short-Course (DOTS) centre was established at the All India Institute of Medical Sciences (AIIMS) to (i) identify the challenges and opportunities in establishing DOTS centres at tertiary care facilities, (ii) to teach the strategies of RNTCP to medical and paramedical staff, and (iii) to undertake relevant operational research connected with tuberculosis (TB) treatment and control. In this communication, we describe the experience of establishing a DOTS centre at India's premier medical institute and discuss the lessons learned. METHODS: Since September 2001 through November 2002 AIIMS employees and their dependants diagnosed with tuberculosis were enrolled for treatment at AIIMS DOTS centre. One hundred sixty-eight patients were diagnosed as suffering from tuberculosis. Of these 49 patients were referred out and remaining 119 patients were treated at AIIMS DOTS centre. RESULTS: Treatment success was achieved in 80% (20/25) of new smear positive cases and the DOTS centre achieved other targets set up by the RNTCP. As the results of the pilot study at AIIMS DOTS centre were favourable, the facilities of AIIMS DOTS centre were extended to the general public from September 2002 onwards. CONCLUSION: Despite tremendous patient load at tertiary care facilities, it is possible to achieve targets established by the RNTCP. However, additional research needs to be conducted especially relating to drug resistance and surrogate markers of failure under RNTCP.

Asparagus racemosus--an update.

Asparagus racemosus (Shatavari) is recommended in Ayurvedic texts for prevention and treatment of gastric ulcers, dyspepsia and as a galactogogue. A. racemosus has also been used successfully by some Ayurvedic practitioners for nervous disorders, inflammation, liver diseases and certain infectious diseases. However, no scientific proof justifying aforementioned uses of root extract of A. racemosus is available so far. Recently few reports are available demonstrating beneficial effects of alcoholic and water extracts of the root of A. racemosus in some clinical conditions and experimentally induced diseases, e.g. galactogogue effect, antihepatotoxic and immunomodulatory activities. The present article includes the detailed exploration of pharmacological properties of the root extract of A. racemosus reported so far.

Cefuroxime axetil in the treatment of Salmonella typhi infection (enteric fever) in adults.

A study to evaluate the efficacy and safety of Cefuroxime Axetil in enteric fever was carried out in 30 adult hospitalised patients of either sex. A positive blood culture for S. typhi and sensitivity to cefuroxime axetil were confirmed prior to treatment. On admission, the baseline signs and symptoms were recorded and treatment initiated with cefuroxime axetil in a dose of 500 mg bd; which was continued for 7 days after normalization of temperature. The various clinical parameters were followed up daily during the treatment period and discharge permitted on normalization of temperature. Blood culture for S. typhi was repeated 3 days after stopping treatment. Follow-up Widal, stool and urine cultures were done wherever possible to check for relapse or carrier state. All the patients responded clinically to treatment and had bacteriologically negative blood cultures by the end of 14 days treatment. 87% of the patients responded within 7 days of treatment of which 60% were graded as Excellent responders as they responded within 4 days itself; while 13% took a longer time to respond. There were no relapses or carrier state as indicated by negative follow-up stool cultures. Only one patient reported a side-effect of mild headache confirming the safety of the drug. We conclude that Cefuroxime axetil in a dose of 500 mg bd is an effective and safe drug in the treatment of multi drug resistant enteric fever.

Comparative evaluation of the clinical efficacy and safety of ondansetron and metoclopramide in the prophylaxis of emesis induced by cancer chemotherapy regimens including cisplatin.

The efficacy and safety of ondansetron was evaluated and compared with metoclopramide in 93 patients receiving cisplatin containing cancer chemotherapy in a randomized, parallel group study. 8 mg Ondansetron i.v. was administered prior to chemotherapy followed by two further doses of 8 mg i.v. over the first 24 hours. Ondansetron 8 mg b.d. was then administered orally for the next 5 days. The metoclopramide dosage was 20 mg i.v. prior to chemotherapy followed by 2 i.v. doses of 10 mg each, 4 hours apart. For the next 5 days, an oral dose of 20 mg metoclopramide was administered. The anti-emetic efficacy of ondansetron as a prophylactic treatment was found to be significantly more effective than metoclopramide both during the acute and delayed phase of nausea and vomiting. Both treatments were well tolerated with no reported side-effects.

Effect of nitrendipine, nimodipine and nisoldipine on water and electrolytes excretion in rats.

In water loaded (5 ml/100 g) unanesthetized rats. nitrendipine (NT), nimodipine (NM) and nisoldipine (NS) (5 mg/ kg, i.p.) caused significant (P < 0.01) increase in water and Na+ excretion. However, there was no significant increase in K+ excretion after NT, NM and NS administration. NS was more potent in increasing excretion of water load as compared to NT and NM. The glomerular filtration rate as assessed by creatinine clearance, was significantly (P < 0.01) increased in NT, NM and NS (5 mg/kg, i.p.) treated groups as compared to control. The mean creatinine clearance values after NT, NM and NS were 26.95 +/- 0.35, 22.11 +/- 0.72 and 28.13 +/- 0.95 respectively as compared to 22.19 +/- 0.51, 18.77 +/- 0.42 and 22.97 +/- 0.60 in corresponding control groups. The results of the study suggest that in addition to other effects, NT, NM and NS have a selective inhibitory effect on Na+ handling mechanisms in the nephron.

Detection of antibodies to phenolic glycolipid by ELISA in leprosy patients.

Antibody (IgM) response to PGL-1, a surface glycolipid unique to Mycobacterium leprae has been studied in 25 cases each of lepromatous and tuberculoid leprosy and in 25 healthy controls. The absorbance value at 488 nm was expressed as antibody titre. Serum antibody titre was found to be significantly higher in patients than controls. Results confirm that antibody response in leprosy patients depend upon bacterial load.

Detection of Chlamydia trachomatis antigen by enzyme immunoassay in patients with pelvic inflammatory disease.

In 27 out of the 60 women clinically suspected to have pelvic inflammatory disease (PID) studied, the C. trachomatis antigen titre was found to be higher than the cut-off value. Since the presence of C. trachomatis antigen was detected in 45 per cent of women, it is suggested that all the PID patients may be investigated by ELISA to confirm the role of C. trachomatis as the etiological agent.

Effect of adenosine and inosine on carbon tetrachloride-induced liver damage in rats.

Liver damage induced in rats by carbon tetrachloride (CCL4) was obvious macroscopically as well as microscopically in stained sections. Levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transpeptidase (gamma-GT) were also significantly raised. Adenosine and inosine effectively countered the damage when these were given before and during the period during which CCl4 produces the typical damage. The beneficial effect was seen in biochemical as well as pathological studies.

Double blind, placebo controlled trial on the cytoprotective effect of misoprostol in subjects with rheumatoid arthritis, osteoarthritis and seronegative spondarthropathy on NSAIDs.

Ninety arthritic patients were randomly allotted to receive misoprostol 200 micrograms thrice daily or placebo, for 4 weeks, while they were started on various NSAIDs. While upper gastrointestinal symptoms occurred equally in both groups, patients on placebo had significantly more post-therapy abnormal endoscopy findings. Misoprostol was well tolerated without any adverse side effects; it did not interfere with the therapeutic efficacy of the NSAIDs. Arthritic patients requiring long term NSAID therapy appear to benefit from misoprostol because of its cytoprotective effect on the gastrointestinal mucosa.

Evaluation of the efficacy and safety of azathioprine (Azoran), in fresh cases of renal homotransplantation.

In a randomised, controlled study, the efficacy and safety of an indigenously developed azathioprine formulation, Azoran/1000 (Searle), was compared with an imported formulation Imuran, as an immunosuppressive agent in fresh cases of renal transplantation. All 14 patients enrolled into the trial completed the study period were analysed. There were 8 episodes of rejection, 4 in each group. All these cases responded to pulse steroids. There was no instance of severe bone marrow suppression or hepatitis in either group and none of the patients had any drug related adverse effects. The results of this study show that Azoran is equiefficacious and safe as an immunosuppressive drug in renal transplants and compares satisfactorily in all respects with the imported formulation Imuran and has the added advantage of being easily available and less costly.

Effect of vitamin D supplementation in lactating rats on the neonatal growth.

In lactating rats consuming a commercial diet adequate in calcium, phosphorus and vitamin D, the effect of supplementation of 3000 IU and 7,500 IU of vitamin D3 on the lactational performance of the dams and soft tissue and skeletal growth in the pups has been investigated. On 28th day of age, the pups in the supplemented groups were significantly heavier than in the control group. Study of the indices of cellular growth in the liver and gastrocnemius muscle revealed that the increase in the soft tissue weight was due to a significant increase in protein, RNA and DNA contents (cellular hyperplasia) without any change in protein/DNA ratio (cell size). In the tibia, compared to controls, the dry bone weight and ash weight were more in the supplemented groups, but ash weight/dry bone weight ratio was not altered. The improvement in the neonatal growth was most probably due to the greater milk yield observed in the dams in supplemented groups and not due to any anabolic effect in the pups since direct administration of 500 IU or 1,000 IU of vitamin D3 in 10 day old pups did not increase their body weight.

Immunoglobulins IgG, IgM and IgA levels in preterm and small for date newborns.

Forty preterm [14 small for gestational age (SGA), 26 average for gestational age (AGA)] and 40 term (10 SGA and 30 AGA) babies were tested for immunoglobulins (Ig), G, M and A levels. IgG levels increased with gestational age from 922.00 +/- 14.00 mg/dl at 34 weeks to 1827.33 +/- 184.09 mg/dl at 40 weeks. Mean immunoglobulins were lower in SGA babies. IgG was 1029.59 +/- 122.80 mg/dl in SGA preterm babies and increased to 1262.00 +/- 200.0 mg/dl in 2 kg babies. IgM and IgA although increased with higher birth weight but rise was not statistically significant. More care to avoid infections in preterm and SGA babies, with lower immunoglobulin levels and less resistance, is recommended.

Effects of feeding low protein diet with and without leucine supplementation on protein status of lactating females and their pups.

Female rats were fed low protein diet (10% casein) either as such or supplemented with 3% leucine during pregnancy and lactation. Changes in litter size and the survival rate, growth and protein status of the pups were noted. The milk yield and hepatic and mammary gland protein status of the mothers were also studied. Feeding low protein diet reduced litter size, increased their mortality and resulted in poor growth of the pups. It also resulted in poor hepatic and mammary gland protein status of the mothers, as well as reduced their milk yield. On adding 3% leucine to 10% casein in the diet, the changes observed in the low protein group, did not alter in any manner.

Gamma-glutamyl transpeptidase in leprosy.

Activity of the enzyme-gamma-glutamyl transpeptidase (GGTP) was measured in sera of 20 patients each of paucibacillary and multibacillary leprosy and 20 healthy controls. None of the subjects had any systemic or hepatic disease and none had taken any hepatotoxic or antileprotic drugs in the past 3 months. Mean values in the paucibacillary group (38.62 +/- 1.99 U/L) and in the multibacillary group (59.04 +/- 3.13 U/L) were significantly higher compared to that in controls (32.04 +/- 0.66 U/L). Mean value in the multibacillary group was also significantly higher compared to that in the paucibacillary group.