Comparison Of Superficial Surgical Site Infections Following Use Of Diathermy And Scalpel For Making Skin Incisions In Open Inguinal Hernia Repair

The use of electrocautery for making skin incisions remains controversial. Its effect on the rate of Superficial Surgical Site Infection (SSSI) vis-à-vis scalpel use was compared in this study. Atotal of 100 patients undergoing open inguinal hernia repair were divided into two: 50 in Electrocautery group, 50 in Scalpel group. Patients were assessed for up to 30 days post-operatively by an assessor blinded to the method used for making skin incision. CDC/NHSN criterion for SSSI was adopted for wound assessment while grading was done using Southampton Wound Grading System. Both groups had comparable mean age (p-value=0.29) and BMI (p-value=0.39). The difference in the incidence of SSSI (5 in Electrocautery, 7 in Scalpel group) on statistical analysis was found to not be significant (p-value=0.53). We conclude that skin incision made with electrocautery is a safe alternative and a convenient method for performing surgeries.

Safe transportation of biomedical waste in a health care institution.

Introduction: The chances of health care waste (Biomedical waste) coming in contact with the health care workers, patients, visitors, sanitary workers, waste handlers, public, rag pickers and animals during transportation are high. Materials and Methods: The study was conducted over a period of seven months (April 2013–October 2013) in a 500‑bedded hospital where the average quantum of biomedical waste is 0.8 kg/bed/day. The issues related to transportation of health care waste from 39 generation sites to the health care waste storage site inside the hospital (intramural transfer) were addressed and analysed in a predesigned proforma. Results: The biomedical waste management team inspected the generation sites in the hospital on a daily basis and conformance to the procedures was checked. It was found that waste was collected at scheduled timings in 99.6% occasions; however, compliance to wearing personal protective equipment (PPE) was poor and ranged from 1.22−1.84%. Conclusion: Transportation of health care waste is a crucial step in its management. Regular training program for all the sections of health care workers with special emphasis on waste handlers is needed.

Microteaching for MBBS students.

It is education which makes the man, a good or bad man according to its education content and its nature and its methods.

Persistent vegetative state after traumatic brain injury - a case report and review of the.

Persistent vegetative state (PVS) is a chronic neurological disorder of consciousness, in which patients appear to be awake, but show no behavioural evidence of awareness. It cannot be diagnosed with certainty and misdiagnosis is very frequent. Its management has become one of the most controversial and emotive issues in medical ethics and medical law over the past few decades. The results of recent neuroimaging studies along with well-documented reports of significant late recovery of some PVS patients have challenged the long-held view that restoration of function in the severely traumatic brain injury (TBI) patients is not possible. Some clinicians believe that PVS is a misused term with the potential consequences of withdrawal and withholding of care, and tendency towards less aggressive management. Further naming these patients as “vegetative” has been misinterpreted by many groups that the patient is no more a human but “vegetable” like. Recently there has been an attempt to replace PVS by new, more appropriate name "Unresponsive Wakefulness Syndrome" (UWS). As opposed to brain death, PVS is not recognized by statute as death in any legal system. The context within which end of life decisions are being made for these patients has led to outrage especially if decisions were made to terminate hydration and nutrition. We present a case of young boy who is in a PVS following TBI with the aim to review some of the contemporary issues regarding their management.

Determination of the relative parallelism of occlusal plane to three ala-tragal lines in various skeletal malocclusions: A cephalometric study.

Background: Establishment of a proper occlusal plane is needed for developing an occlusion that is compatible with the biomechanics of a stomatognathic system. There has been a great deal of controversy regarding the anatomic reference point/s taken for identifying the Camper's plane (Ala-Tragus) to which the occlusal plane is oriented parallel in regular complete denture Prosthodontic practice. There has been no study in literature to correlate the occlusal plane to the Camper's plane in various skeletal malocclusions using landmarks on a lateral Cephalogram. Aim : The aim of the study isto determine the relative parallelism of the occlusal plane to ala- tragal lines in various malocclusions. Methodology: A total of sixty subjects belonging to Class I, Class II and class III malocclusions were selected for the study. Markings with radiopaque marker of 1 mm diameter were adhered against the superior, middle and inferior border of the tragus and against the lower borer of ala of the nose. Lateral cephalograms were obtained for all of the pateints. Tracing was performed for all of these radiographs. Statistical Analysis Used: Analysis of Variance (ANOVA) test and Post-Hoc test of Bonferroni were used to compare the angles formed at the superior, middle and inferior borders with the occlusal plane. Results: The result from the present study showed that in Class I and Class III malocclusion, the line drawn from the lower border of ala of the nose to the inferior position of the tragus (Camper' plane C) was relatively parallel to occlusal plane; and, in Class II malocclusion, the line drawn from the lower border of ala of nose to middle border of tragus (Camper's plane B) was relatively parallel to occlusal plane.

Determination of the comfort zone for intergingival height and its practical application to treatment planning: A survey.

Background: The concept of the 'comfort zone' for intergingival height is a simple guideline to help establish the correct vertical dimension necessary for occlusal harmony in any individual. It can be used as a guide for identifying individuals at relatively greater risk of developing temporomandibular dysfunction and also when rebuilding the occlusion in the treatment of patients with temporomandibular dysfunction. The intergingival height varies according to the patient's age and stage of development, as well as with the height of the incisor crowns. In orthodontics this parameter can be used to track the progress of a patient being treated with functional appliances. This parameter has not been studied in detail and hence this survey was designed and conducted to gain information regarding its significance. Objectives: The objectives of this survey were to estimate the value of 'comfort zone' for intergingival height in the region of the central incisor and to establish the norm for the comfort zone in males and females. Materials and Methods: The intergingival height was measured in the region of the right central incisor using a vernier caliper. The intergingival height was measured as the vertical distance from the midpoint of the free gingival margin of the right maxillary central incisor to a similar point on the right mandibular central incisor, with the teeth in occlusion. Results: According to the results of this, the range for the comfort zone for intergingival height in all subjects was 15.96-16.55 mm. The range for female subjects was 14.86-15.32 mm and the range for male subjects was 17.12-17.67 mm. Conclusion: The comfort zone of intergingival height should become a part of our vocabulary and should be routinely utilized as a guideline for consistently achieving the correct vertical dimension at the end of treatment. The areas of utilization of this measurement are many and it should be used to assist in achieving better and more stable clinical results.

Classification of Cleft Lip And Cleft Palate - A Review.

Classification for cleft lip and palate is imp ortant fo r both clinical research and epidemiological investigation. Classification of the cleft lip and cleft palate plays an important role in diagnosis and planning the treatment. It involves the embryological processes, the frontonasal and the right and left processes of the maxilla. The incisive foramen is a basic anatomic landmark for classification of cleft l ip and palate. Davis and Ritchie’s classification was a fundamental classification, which is followed by symbolic representation of Kernahan and their modifications. Newer approaches have also used mathematical expressions to provide a complete description of the deformity including those which can be used for computerized data analysis. This article is a review of the past and the most recent classifications, a bird's eye view on how improvements/advancements in the field have led to a better understanding and representation of the various types of cleft deformities.

Surgical And Orthodontic Management of Dental Cyclops : A Case Report.

Impacted Central Incisor tooth is a common finding in the Orthodontic practice. But managing of Impacted Incisor which is unfavorable with Dilaceration is a tough task. We are presenting a case of Maxillary impacted incisor with Dilaceration.

Comparative assessment in enzyme activities and microbial populations during normal and vermicomposting.

Changes in extracellular enzyme activities and microbial populations were studied during the normal composting and vermicomposting of fruitpulp, vegetable waste, groundnut husk and cowdung. The microbial numbers and their extracellular enzyme profiles showed relative variation and were found increasingly more abundant in vermicompost than in normal compost leading to the conversion of agricultural waste into value added product. In vermicompost, the maximum enzyme activities (cellulase, amylase, invertase, protease and urease) were observed during 21-35 days. The cellulase, amylase and protease activities of vermicompost reached the maximum values by 28th day of 1175, 825 µg reducing sugar g-1 hr-1 and 28 µ mol of aminoacid g-1 hr-1 of vermicompost samples respectively. Similarly the invertase and urease activities reached to peak values of 876 µg reducing sugar g-1 hr-1 and 197 µg -N g-1 ha-1 sample on 35th day respectively. Most of the enzymes showed correlation with change in number and types of different microbial groups like bacteria, fungi and actinomycetes during vermicomposting with maximum number of 126 x 106, 28 x 104 and 93 x 105 CFU g-1 sample respectively. In contrast delayed greatest enzyme activities were observed on 42-49th day i.e., last days of normal composting. Earthworms stimulated biochemical activity and nutrient cycling by 40-45% contributing to the reduction of period of degradation of agricultural wastes resulting in maturation of vermicompost by 28th day.

Liver oxidative stress of the grey mullet Mugil cephalus presents seasonal variations in Ennore estuary

The objective of this study was to determine the liver oxidative stress status of grey mullets living in heavy-metal-rich polluted Ennore estuary compared with unpolluted Kovalam estuary. Fish were collected from both estuaries during the monsoon and summer seasons from October 2004 to September 2006. Fish liver homogenate (N = 20 per group) was prepared for evaluating oxidative stress parameters. Fish living in the polluted estuary had significantly higher lipid oxidation products, conjugated dienes (0.346 ± 0.017 vs 0.141 ± 0.012 DA233/mg protein), lipid hydroperoxides (0.752 ± 0.032 vs 0.443 ± 0.03 nmol/mg protein), and lipid peroxides (3.447 ± 0.14vs 1.456 ± 0.096 nmol MDA/mg protein) than those of the unpolluted estuary during the summer. In contrast, significantly lower levels of superoxide dismutase (20.39 ± 1.14 vs 53.63 ± 1.48 units/mg protein) and catalase (116 ± 6.87vs 153 ± 8.92 units/mg protein) were detected in the liver of fish from the polluted estuary (Ennore) compared to fish from the unpolluted estuary (Kovalam) during the summer. Variations in most of the oxidative stress parameters were observed between the summer and monsoon seasons, indicating the importance of seasonal variation for estuaries and their inhabitants.

Knowledge, attitudes and practices (KAP) regarding the management of diarrhea by pharmacists and licensed drug sellers in eastern Nepal.

Diarrhea constitutes a major cause of morbidity and mortality in developing countries. Inappropriate drug prescribing is common in diarrhea, resulting in an increase in cost and adverse drug reactions. In Nepal, drug sellers often act as the first contact persons for the underprivileged. No information has been available regarding their knowledge, attitudes and practices (KAP) regarding diarrhea management. Using a structured questionnaire, between the 1st of January and the 31st of December 2003, 109 drug sellers in eastern Nepal were interviewed about their educational status, patient/attendant presentation at the outlet and their advice to patients/attendants. Only 2.7% of drug sellers were qualified in health education. Eighty percent of the patients/attendants sought advice from the drug sellers, only 20% presented to the outlet with prescriptions. The data reveals that about half of them were taking note of the nature of the diarrhea. Although 62 (56.8%) of them were aware of dehydration, only 2 (1.8%) of them knew all three signs of dehydration (dry tongue, non-elastic skin and sunken eyes). Sixty-six (60.5%) of them knew about oral rehydration solution (ORS), its principle and the required period of administration. About 50 to 60% of them were aware of the implications resulting from dehydration from uncontrolled diarrhea and of the importance of ORS in its management. Only 20% of the drug sellers advised ORS alone, otherwise it was dispensed along with drugs, such as antimotility agents (AMA) or metronidazole. As a result of the above findings, it is important to educate the drug sellers by conferring knowledge about the ethical aspects of drugs in the management of diarrhea.

Clinical and aetiological profile of hepatoma at a tertiary care centre.

Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. Infection with the hepatitis B virus (HBV) is one of the high-risk factors for the development of HCC, particularly in Asia and Africa. Other risk factors include hepatitis C virus (HCV) infection and, to a certain extent, exposure to a liver-specific carcinogen such as aflatoxin B, and alcohol consumption. In the present retrospective study, we analysed the clinical profile and aetiological role of HBV and HCV in HCC. A total of 40 cases of HCC (33 males and 7 females, age range 22-80 years) were seen from January 1999 to June 2001 at our institute. A detailed history of age, sex, past history of liver disease, clinical symptoms and presenting complaints was recorded. The most common presenting complaints were abdominal distention, pedal oedema and pain abdomen. Underlying cirrhosis of the liver was seen in 30 cases (75%), Child's A in 6, Child's B in 11 and Child's C in 13 cases. A history of alcoholism was present in 6 patients. All the patients were tested for HBsAg and anti-HCV by ELISA. HBsAg and anti-HCV was positive in 19 (47.5%) and 8 patients (20%), respectively. The diagnosis in the majority of cases was derived by FNAC and in a few by imaging techniques plus alfa-fetoprotein (AFP) evaluation. The diagnosis was confirmed by FNAC in 34, CT scan and AFP in 2, and ultrasound abdomen and AFP in 4 cases. We conclude that viral infection (HBV > HCV) is still a major aetiological factor and the incidence of HCV infection appears to be increasing. The majority of the cases of HCC studied had a cirrhotic background.

An anticlastogenic in vivo micronucleus assay for tea.

Common use of antimutagens and anticarcinogens in everyday life is an effective measure for preventing human cancer and genetic diseases. Antioxidant properties of tea have vast potential as protective agents against diverse toxic effects. The present study was aimed to evaluate the role of aqueous clonal tea extracts (green tea, oolong tea and black tea) in modulating the genotoxic damage induced by cyclophosphamide (CP), a commonly used chemotherapeutic drug and a well-known mutagen and clastogen. All the three tea extracts at 1 and 2% concentration did not increase the frequency of micronucleated polychromatic erythrocytes (MPE) in bone marrow cells of mice when administered individually. The tea extracts decreased the micronuclei (MN) induced by CP. Therefore, regular intake of tea may improve the antioxidant status in in vivo and thereby reduce the risk of cancer and coronary heart disease.

Felodipine potentiates morphine analgesia in control and streptozotocin diabetic female rats.

Tolerance to morphine analgesia was seen in diabetes. Calcium channel blockers potentiate opioid analgesia while calcium agonists antagonize. Therefore, the present study using thermal pain threshold was taken up to find out, whether felodipine, altered morphine analgesia in experimental diabetes. From the end of 6th week of streptozotocin-diabetes, felodipine was administered po for 2 week to half of the control and diabetic female rats. Morphine analgesia was recorded 1 hr after the first (acute effect) and last dose (chronic effect) of felodipine. Significant elevation of pain threshold was seen in the first 6 weeks in diabetic rats compared to controls. No tolerance was seen to morphine (2 mg/kg, sc) analgesia in diabetic rats. In both control and diabetic rats acute administration of felodipine produced significant analgesia while both acute and chronic administration of felodipine produced significant potentiation of morphine analgesia in control diabetic rats. The results suggest that prior felodipine may enhance morphine analgesia, and that this needs to be explored further in various types of pain.

A comparative study of prescribing pattern at different levels of health care delivery system in Bangalore district.

A study of prescribing pattern in tertiary, primary and urban general practice levels of the Indian health care delivery system was undertaken by analyzing 1810 prescriptions for 3932 drugs. The study evaluated feasibility of data acquisition methods and compared the prescribing frequency of various drug groups and of individual drugs in three commonly used categories. The mean number of drugs per prescription was highest in urban general practice (2.41). The four most frequently prescribed drug groups were antibacterials, vitamins, nonsteroidal antiinflammatory drugs (NSAIDs) and respiratory drugs. The study delineates the differences in prescribing frequency of drug groups and individual drugs across the three levels of health care and the results suggest intervention strategies to promote rational drug therapy.

Effect of felodipine on cholinergic responses of the colonic smooth muscle of streptozotocin induced diabetic rats.

In streptozotocin induced diabetic rats, irrespective of felodipine treatment (5 mg/kg/day po for 4 weeks), a reduction in contractile response of colonic smooth muscle in vitro was observed. Similarly, in both control and diabetic rats treated with felodipine, contractile response was reduced. However, in felodipine treated diabetic rats there was a significant increase in response to exogenous acetylcholine. It may be of interest to study the effect of felodipine, on gastro-intestinal motility in vivo in diabetic rats, to enable extrapolation of the present results to the effect of felodipine on gastrointestinal complications of diabetes mellitus.