A comparative study to determine the role of pre and post-operative antibiotic therapy versus only pre-operative antibiotic therapy in patients of non-perforated acute appendicitis

Background: If properly used in appendicitis, antibiotics can reduce the rate of infection by 50%. The use of post-operative antibiotics for preventing infective complications in non-perforated cases is still controversial.Methods: A randomised prospective study was conducted in the Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi with patients who presented acute appendicitis. A minimum number of 30 patients each in group A (pre-operative and post-operative antibiotics) and group B (only pre-operative antibiotics) were evaluated for 18 months, from January 2018 to June 2019.Results: The mean age of group A is 29.9±15.16 years and in group B is 25.97±9.470 years (p value=0.122, insignificant). There was male preponderance. The seroma formation in both the groups was 10.00% and no patients developed intra-abdominal abscess. The incidence of local site oedema was 10% in both the groups A and B and their p value is insignificant. In both the groups A and B, 10% of the people developed pus discharge from the stitch line and the p value is insignificant. In group A, 6.67% of the patients and in group B 10.00% of the patients developed stitch line inflammatory changes and the p value insignificant. In group A, 13.3% and in group B, 10.00% of the patients developed fever and their p value is 1. The mean length of hospital in case 1.23±0.5 days (group A) and is 1.17±0.45 days (group B) (p value=0.508).Conclusions: Hence we can conclude that a well-chosen and adequately-timed pre-operative antibiotics are adequate in preventing post-operative complications and post-operative antibiotics do not affect the same.

E-Learning Versus Traditional Teaching in Medical Education: A Comparative Study

Background: Traditional method of learning via face to face lecture has been in curriculum since timesimmemorial. E-learning via multimedia has been a recent introduction in education system. Purpose: Tocompare e-learning with the traditional method of teaching in medical education. Material and Methods: Thetwo different methods of teaching were applied on the same group of students. A total of six lectures wereconducted. Three of them were taught by traditional method of teaching and three by e-leaning. Formativeassessment in the form of written examination was carried out, followed by qualitative assessment at the endof session. Results: The mean marks obtained after Exam-1 (i.e. following traditional teaching method) was6.46 ± 1.48 and mean marks obtained after Exam-2 (i.e. following e-learning) was 8.37 ± 1.27. The meandifference score was 1.91 ± 1.55. The paired t-test was applied, and the value of t was 11.96 with p-value<0.001. The results between two teaching methods were statistically significant. For qualitative analysisLikert scale was used. 66% of students strongly agreed that e-learning is a superior method than traditionalmethod of learning. Conclusion: The e-learning proved to be more efficient and uniform method of studentlearning with revision facilities.

Netarsudil: a novel intra-ocular pressure lowering agent

Optic disc health is an important indicator of visual functions. The first line of management to prevent/halt the damage to optic disc is to control responsible pathological condition, if identified. In absence of identifiable cause, the most validated approach is lowering of intra-ocular pressure (IOP). Individually, as well as combinations of currently available drugs are not fully effective in all patients of glaucoma in achieving desired IOP control. Hence, there is a need of newer alternatives which address this unmet need. Recently, a newer IOP lowering agent with a novel mechanism of action, netarsudil, has been approved by United States Food and Drug Administration (US-FDA) in December 2017. Netarsudil acts by inhibiting Rho-associated protein kinase resulting in lowering of overall tone of the contractible cells in trabecular meshwork thereby improving drainage of aqueous humor outflow and lowering of IOP. Though in its early days, this drug gives an armamentarium to ophthalmologists and physicians to control IOP in patients of open-angle glaucoma and ocular hypertension.

Effects of calcium channel blocker, nifedipine, on antidepressant activity of fl uvoxamine, venlafaxine and tianeptine in mice.

Background: Cardiovascular diseases are commonly associated with depression. Calcium channel blockers (CCBs) form commonly used group of drugs for the treatment of a number of cardiovascular diseases. Nifedipine, a CCB, has been shown to possess antidepressant activity and potentiate antidepressant activity of imipramine and sertraline, however, literature on its interaction with newer antidepressant drugs such as fl uvoxamine, venlafaxine and tianeptine is limited. Hence, the present study was undertaken. Methods: The study was carried out in albino mice in two phases. In Phase I, antidepressant activity of nifedipine, fl uvoxamine, venlafaxine and tianeptine were confi rmed after their single dose administration using forced swim test (FST) and tail suspension test (TST) and their minimum antidepressant doses were determined. In Phase II, the effect of nifedipine on antidepressant activity of fl uvoxamine, venlafaxine and tianeptine was studied by orally administering sub-antidepressant doses of these drugs for 28 days. FST and TST were carried out on 1st, 14th and 28th day of the study and change in immobility period was observed. Results: In Phase I, all the studied drugs exhibited dose dependent antidepressant activity in both FST and TST. Minimal antidepressant dose of nifedipine, fl uvoxamine, venlafaxine and tianeptine was observed as 10, 25, 25 and 10 mg/kg respectively. In Phase II, combinations of sub-antidepressant dose of nifedipine (5 mg/kg) with sub-antidepressant doses of fl uvoxamine (12.5 mg/kg), venlafaxine (12.5 mg/kg) and tianeptine (5 mg/kg) exhibited enhanced antidepressant activity when compared to the control group and individual drug groups after same duration of treatment. Conclusions: Nifedipine, fluvoxamine, venlafaxine and tianeptine possess antidepressant activity and nifedipine exhibits synergistic antidepressant activity with fl uvoxamine, venlafaxine and tianeptine.

Prescription patterns of antihypertensive drugs in a tertiary care hospital in India.

Background: The present study was conducted to analyze the prescribing patterns and utilization of antihypertensive drugs at a tertiary care center in India. Methods: A cross-sectional analysis of prescriptions of patients of essential hypertension attending outpatient department of a tertiary care hospital during the period of December 2011 to March 2012 was done. Hypertensive patients with comorbidities were excluded from study. The data were analyzed to fi nd out demographic characteristics of patients, number of drugs prescribed per prescription, drugs, which are commonly prescribed, antihypertensive drugs used concurrently, percentage of drugs prescribed by generic name and over all drug utilization frequency. Results: During the study period, 465 prescriptions for hypertension were analyzed. This study revealed that most of the patients were on combination of antihypertensive drugs (67.97%) while 31.18% patients received mono therapy. Among mono therapy drugs, calcium channel blockers (CCB) (31.03%) were prescribed most. Utilization of other major drug classes as mono therapy in decreasing order is angiotensinconverting enzyme inhibitors (28.28%), diuretics (17.93%), beta-blockers (11.72%) and angiotensin receptor blockers (10.34%). Among those who were treated with drug combinations, 64.24% received 2-drug, 25.95% received 3-drug regimen and 8.54% received 4-drug regimen. In combination therapy, 2-drug combination consisting of a CCB and a diuretic was most commonly (24.14%) prescribed. Conclusions: This study represents the current prescribing patterns for antihypertensive drugs and provides the baseline data for similar studies in future, as patterns in prescribing antihypertensive drugs keep changing.

Effect of Inula racemosa root extract on cardiac function and oxidative stress against isoproterenol-induced myocardial infarction.

The cardioprotective potential of Inula racemosa root hydroalcoholic extract against isoproterenol-induced myocardial infarction was investigated in rats. The rats treated with isoproterenol (85 mg/kg, s.c.) exhibited myocardial infarction, as evidenced by significant (P<0.05) decrease in mean arterial pressure, heart rate, contractility, relaxation along with increased left ventricular end diastolic pressure, as well as decreased endogenous myocardial enzymatic and non-enzymatic antioxidants. Isoproterenol also significantly (P<0.05) induced lipid peroxidation and increased leakage of myocyte injury marker enzymes. Pretreatment with I. racemosa extract (50, 100 or 200 mg/kg per day, p.o.) for 21 consecutive days, followed by isoproterenol injections on days 19th and 20th significantly (P<0.05) improved cardiac function by increasing the heart rate, mean arterial pressure, contractility and relaxation along with decreasing left ventricular end diastolic pressure. Pretreatment with I. racemosa also significantly (P<0.05) restored the reduced form of glutathione and endogenous antioxidant enzymes superoxide dismutase, catalase, glutathione peroxidase from the heart, which were depleted after isoproterenol administration. In addition to restoration of antioxidants, I. racemosa significantly (P<0.05) inhibited lipid peroxidation and prevented the leakage of myocytes specific marker enzymes creatine phosphokinase-MB and lactate dehydrogenase from the heart. Thus, it is concluded that I. racemosa protects heart from isoproterenol-induced myocardial injury by reducing oxidative stress and modulating hemodynamic and ventricular functions of the heart. Present study findings demonstrate the cardioprotective effect of I. racemosa and support the pharmacological relevance of its use and cardioprotection mechanism in ischemic heart disease as well as substantiate its traditional claim

Gamma Linolenic Acid in Dry Eye

In this prospective study to evaluate the role of gamma linolenic acid in the management of dry eye, 100 patients of dry eyes were studied by dividing randomly into two groups of 50 each. In the test group, all the 50 patients were put on medication which consisted of cap gamma linolenic acid - 120 mg once daily dose, artificial tears solution/ointments 4-6 times daily with a topical mild steroid (loteprednol etabonate 0.5%) thrice daily. In the control group all the 50 patients were put on artificial tear solution/ointments and topical mild steroid (loteprednol etabonate 0.5%) thrice daily. All the patients were subjected to slit lamp examination, schirmer test, and fluorescien stain for tear film break up time (TBUT). In the test group symptomatic relief was shown by all 50 (100%) patients after one week of treatment. There was not much improvement in the schirmer test and TBUT results at 1 week. At 1 month follow up the result showed improvement and at 6 months there was definite increase in the schirmer test & TBUT values. The results were not influenced by the age & gender of the patients. In the control group though there was definite symptomatic relief in all the patients, but there was no change in the major study parameters i.e. tear film meniscus height; schirmer test and TBUT. At six month of the study there was marginal improvement of the major parameters but there was a lot of difference between the test and control groups. Thus gamma linolenic acid has a definite role in the management of dry eye.

Corneo- Conjunctival Auto Grafting in Pterygium Surgery

To evaluate the efficacy of conjunctival auto grafting in surgical management of primary and recurrent pterygium, the record of 150 patients comprising 47 females and 103 males who underwent corneocunjunctival auto graft transplant surgery for primary and recurrent pterygia from 1997 to 2003 was reviewed retrospectively. Follow up was done for six months after the surgery. Recurrence of pterygium was considered as failure. All grafts were transplanted promptly. Recurrence was noted in four patients (2.6%). Mild discomfort in the immediate post-operative period was noted in all the patients. Donor site healed without any complication in all the patients.The results indicate that corneo-conjunctival autograft transplantation is an effective treatment for management of both primary & recurrent pterygia.

Reversible Blindness in Severe Preeclampsia and Eclampsia

Visual disturbances are common with severe preeclampsia, however, blindness either alone or accompanying convulsions is uncommon. Most women with varying degree of amaurosis are found to have radiographic evidence of extensive occipital lobe hypodensities.In this case report, we present the clinical course of two women in whom preeclampsia was further complicated by blindness. These were managed by standard pre eclampsia- eclampsia regimen used at our hospital which includes Diazepam /Phenytoin therapy to control seizures, nifedipine to lower elevated blood pressure, intravenous fluid restriction and termination of pregnancy. Abnormal findings in these women were seen by computed tomography and magnetic resonance imaging technique. CT demonstrated low density areas localized predominantly in occipital area. Blindness persisted from 24 hrs to 72 hrs, it subsequently resolved completely in both.

Squamous Cell Carcinoma of the Conjunctiva

A rare case of squamous cell carcinoma of the conjunctiva is presented here. This highlights the significance of aggressive management of such cases surgically and the use of adjuants per operatively to prevent recurrence.

Sympathetic Ophthalmia: Mangement and Role of Immunosuppressants.

Presented here is a case of sympathetic ophthalmia that provided us an opportunity to evaluate the eficacay of immunosuppressive drugs with steroids in reduced doses and their outcome in improving thevisual loss in a young patient who had fast deterioration in his visual acuity.