Violence against resident doctors, its psychological impact and associated factors in accident & emergency department in a tertiary care institute of Haryana

Background: Violence in the healthcare setting is very common with the emergency department (ED) having the highest rate of violence in the hospital. While on one hand, the physical violence at the workplace has always been well recognized, the existence of psychological violence has been long underestimated. Materials and Methods: The study was a descriptive type of cross-sectional study conducted in 6 months in a tertiary care center of Haryana among doctors in Emergency and casualty Department. Study subjects were junior residents and senior residents posted in the emergency department. The questionnaire is a predesigned survey questionnaire formulated by ILO/ ICN/ WHO/ PSI Joint. Results: Most of the physical violence was seen in Surgery & Orthopaedics department with respective frequency of 44% & 39% respectively; while most of the verbal abuse reported in Medicine department with frequency of 33%. Most of the physical violence and verbal abuse occurred in age group of 25-29; males were more predisposed to both physical and psychological violence. Only 63% of the subjects knew about the procedures of reporting existing in the health facility. Conclusion: The study concludes that physical violence and verbal abuse are high in our institute, but majority of doctors did not know about the procedures of reporting.

Oxidative stress and antioxidant vitamins in leprosy.

Background: Leprosy is a disease of great antiquity and it still continues to be a significant public health problem in few countries including India .Of the various mechanisms that influence the pathogenesis of leprosy, oxidative stress is important which occurs due to derangement in the balance between ROS and natural antioxidants. Hence this study attempted to assess the oxidative stress and antioxidant status in terms of MDA and vitamin E, vitamin C respectively in leprosy. Methods: Hundred untreated leprosy patients (50 PB and 50 MB) were studied and compared with 50 healthy controls. Serum Malondialdehyde (MDA) and vitamin E, vitamin C was measured by spectrophotometric method. Serum malondialdehyde (MDA) was measured as an indicator of lipid peroxidation and antioxidant status was assessed by estimating serum vitamin E and vitamin C levels. Results: Significant rise in serum MDA (P <0.001) in both PB and MB leprosy was seen when compared with controls. The vitamin E level was significantly decreased in both PB and MB leprosy patients as compared to controls. The vitamin C level was significantly decrease (P<0.001) in MB leprosy patients as compared to controls. Conclusions: Elevated MDA levels indicate oxidative stress in leprosy patients, denoting its crucial involvement in the pathogenesis and tissue damage in leprosy. Hence MDA levels can be used to monitor prognosis, treatment and control of leprosy. Decreased vitamin E, C levels in leprosy can be improved by oral vitamin E, C supplementation.

Pre - emptive epidural analgesia with bupivacaine, deltiazem and ketamine singly or in combination - A Randomised Trial.

Background: A randomized control study was designed to compare postoperative epidural analgesia by preemptive use of epidural administration of local anesthetic- bupivacaine alone and in combination with NMDA blocker- ketamine or calcium channel blocker- diltiazem singly or both in combination . Medhods: Sixty female patients in age group 35-50 yrs with ASA grade I and II, posted for open abdominal hysterectomy were randomly distributed in four groups after ethical committee approval and written consent. They were given epidurally 0.4 ml /kg of 0.5 % Bupivacaine in Control group, 0.4 ml /kg of 0.5 % Bupivacaine + Ketamine 5mg in BK group , 0.4 ml /kg of 0.5 % Bupivacaine + Diltiazem 10 mg in BD group and 0.4 ml /kg of 0.5 % Bupivacaine + Ketamine 5 mg + Diltiazem 10 mg in BKD group. Results: BK group had significant pain free period (8.8 ± 1.37) post operatively as compared to rest three groups (P < 0.01). BD group (5.8 ± 0.94) also had comparable pain relief.BKgroup needed three to four number of top-up's in first 24 hours (3.37 ± 0.46) where as BD group needed five to seven number of top-up's in next 24 hours (5.93 ± 0.70) (P < 0.01). BK group and BKD group patients were sedated resulting in reduced number of top-ups required in first 24 hours. Conclusion: Ketamine and diltiazem were found to be synergetic with bupivacaine for preemptive epidural analgesia. Diltiazem was better option over ketamine when sedation is not desirable.

The effects of sudarshan kriya yoga on some physiological and biochemical parameters in mild hypertensive patients.

An open label intervention study was undertaken on 26 mild hypertensives and 26 apparently healthy adults (30–60 y), for the effect of Sudarshan Kriya Yoga practice for two months as complementary therapy. In the hypertensives, there was a significant decrease in diastolic blood pressure (P<0.01), serum urea (P<0.01) and plasma MDA (malondialdehyde adducts) as oxidative stress marker (P<0.05). Other parameters; viz.; plasma levels of cholesterol, triglycerides, glucose, did not change significantly (P>0.1). The pattern of change in most of the study parameters was such that values above normal range were lowered but values within normal range were unaltered. The action of Yoga on diastolic blood pressure, malondialdehyde adducts and kidney function in hypertensives was of counteractive nature and felt to be distinctly different than the effect of drugs.