A prospective observational study on prevention of contractures of upper limb following burn

Background: Over 1 lakh people are affected by burn every year in India and 20 thousands of them die per year. Post burn contracture is a common sequele occurring after burn. Upper limb contractures are also occurring more commonly because it is most mobile part of body and likely to be involved in burn. There are many studies on management of post burn contractures but literature about prevention of contracture is little, hence this study was conducted. The aim of this study was to recognise various preventive measures to prevent post burn contractures of upper extremity.Methods: This study was conducted in NSCBM Subharti Medical College and Hospital located in Meerut (North India) from October 2012 to October 2014 in Department of Surgery. It was a prospective observational study consisted of 80 cases who presented as acute burn of upper limb admitted in the hospital.Results: In our study early excision with skin grafting was done in 20 patients (25%) while delayed skin grafting was done in 25 patients (31%) while 35 patients (44%) were managed conservatively. In our study 20 patients reported back with a post burn contracture. The reason found was non-compliance to antideformity splint and physiotherapy.Conclusions: Early surgical management of deep burns, physiotherapy, anti-deformity position and proper splintage can significantly reduce the development of post burn contracture.

Pattern of adverse drug reactions reported at a tertiary care teaching hospital in northern India

Background: Adverse drug reactions (ADRs) are among the leading cause of morbidity and mortality in hospital setup. This study was conducted with the aim of understanding the pattern and occurrence of ADRs to minimize their risk and safeguard public health.Methods: This study is a retrospective analysis of pattern of ADRs reported at ADR monitoring centre (AMC) in a tertiary care hospital. A total of 207 spontaneous ADR reports collected over a period of 18 months were analysed for pattern and type of reactions, demographic profile of patients, organ system affected by ADRs, causative drugs, route of drug administration, severity of reaction, their outcome, management and causality assessment.Results: Most common age group affected by ADRs was 41-50 years with almost equal involvement of male and female gender. Cutaneous reactions involving skin like rashes and itching were most common ADRs. The most common causative drug for ADRs were antimicrobials agents like Penicillin and Cephalosporin group of antibiotics. Orally administered drugs were most commonly involved in causing ADRs. Most of the ADRs belonged to Type A category, were non-serious and moderate in severity. Most of the patients recovered from the ADRs on stopping the suspected drug. On assessing the causality, most of the ADRs were probable with the suspected drugs.Conclusions: Most of the patients recover from ADRs with appropriate and timely intervention, but it is important to understand the pattern and occurrence of ADRs for patient safety and this is possible only with an effective and robust pharmacovigilance system.

A Prospective Study Of Fixation Of Fracture Lateral End Clavicle By A Novel Technique & Its Early Results

Background: Fracture Lateral end clavicle can be managed by various treatment modalities, with different pros & cons. Our study is a prospective study, showing a novel technique & its early results. We found initial results to be very encouraging. Material & Methods: We had utilized this novel fixation technique on 16 patients & operative indication in all patients was Neer type 2 lateral end clavicle fractures. In this study, 14 patients were male while 2 were female in age group 25 to 58 years (mean 41 years). All the patients were operated within 2 weeks of sustaining trauma to clavicle .Early results were encouraging in these patients with minimum follow up of 4 months & maximum of 12 months. Constant murley scores measured & compared were found to be approaching at the opposite shoulder levels at the end of 6 months after surgery. Results: All 16 patients were available for evolution after minimum follow up of 4 months and maximum of 12 months. All the patients regained pain less shoulder with bony union & returned to pre–injury activity level after a mean of 4 months. During post operative follow up after 2 weeks, 2 months & 4 month post–operative radiographs demonstrated good hold of initial bony reduction Conclusion: The concept of this technique is novel and provides for a strong fixation across the fracture site in addition to other benefits outlined above. Further studies with longer follow up and more number of patients need to be done to elucidate out correct surgical utility of technique over others.

Relationship Of Perioperative Hyperglycemia And Postoperative Infection In Elective Abdominal Surgery In Non Diabetic Patient

BACKGROUND: Postoperative infections are common in surgical patients leading to increased morbidity and mortality. Patients are susceptible to stress-induced hyperglycemia following operation, independent of the diabetic status. Perioperative hyperglycemia in critically ill surgical patients increases the risk of postoperative infections and its consequences. Despite 30 million operations performed in United States and much more in India each year, the clear association between perioperative blood glucose (BG) level and postoperative infection (POI) remain ill-defined for the majority of surgery patients. AIM: To identify the relationship of perioperative hyperglycemia and post-operative infection in elective abdominal surgery in non diabetic patients. MATERIAL AND METHODS: This is a prospective, observational study of 150 patients who were non diabetic and underwent an elective abdominal surgery. The primary outcome of interest was POI, defined as the occurrence of 1 or more reports of pneumonia, wound infections, urinary tract infections, and sepsis in the first 30 days after surgery and one year after surgery in case of use of prosthesis. The primary predictor of interest was peri-operative hyperglycemia, defined as the RBS of >150mg/dl in the perioperative period (just prior to surgery and within 12 hr and within 24 hr after the skin closure). In the study 500 patient were screened for perioperative hyperglycemia out of which only 150(30%) patient had RBS>150mg/dl in perioperative period. RESULTS AND CONCLUSIONS:There was significant change in RBS in the perioperative period. The overall incidence of POI in 150 cases of Elective Abdominal Surgeries was 7.33%. Wound infection was observed in 7 cases (4.66%) and 4 cases (2.66%) had respiratory complication. Risk factors like old age, contaminated wound, higher ASA grade and increased duration of surgery are associated with increased POI.The most common complication was wound infection

Assessment of awareness towards pharmacovigilance programme of india and reporting of adverse drug reactions among nurses in a tertiary care hospital

Background: The success of PvPI depends upon spontaneous reporting of ADRs by health care professionals especially nurses as they are usually first contact persons for patients in case of ADRs after use of medicines. Underreporting of ADRs due to inadequate reporting culture among health care professionals is the main hindrance in the path of this programme. So, to assess the awareness, attitude and practices of nurses regarding PvPI and ADR reporting this study was undertaken.Methods: It was a cross-sectional, questionnaire-based study in which 130 nurses responded. The 12-items questionnaire feedback form provided by Indian Pharmacopoeia Commission (IPC) was used to assess the awareness of nurses towards pharmacovigilance programme and Adverse Drug Reaction (ADR) reporting practices.Results: After analysing the questionnaire, it was observed that, despite satisfactory level of awareness and interest of the nurses to participate in this programme, still there is meagre ADR reporting practices among the nurses.Conclusions: Lack of reporting culture and improper communication is the root of problem which should be overcome in future by proper training for patient safety.

Comparison of anti-inflammatory efficacy of lercanidipine and Tanacetum parthenium with indomethacin in rats

Background: Inflammation can be classified as either acute or chronic. NSAIDs are the most commonly prescribed drugs worldwide, and mostly have adverse effects. Lercanidipine a CCB of (DHPs) blocks the mediators of inflammation and has additional anti-inflammatory potential. Tanacetum parthenium (Feverfew) extracts have also shown its anti-inflammatory effects in experimental studies. It was decided to study anti-inflammatory effects of Lercanidipine and Tanacetum parthenium which was compared with Indomethacin. The present study was aimed to evaluate and compare the anti-inflammatory effect of lercanidipine and Tanacetum parthenium with Indomethacin in rats.Methods: The study was conducted in the department of Pharmacology UPUMS, Saifai after getting approval from IAEC.A total of 24 animals divided into 4 groups of six (n=6) animals each group were used, and the anti-inflammatory effects of both drugs were evaluated by Carrageenan-induced Paw Edema Model by digital Plethysmometer in rats, drug administration was with the same frequency.Results: The result of the present study had shown that lercanidipine produced anti-inflammatory effect compared to Indomethacin, while its efficacy in reducing paw edema was better at 1st hour, 48 and 72 hours while at 2nd hour and 3rd hour Indomethacin had better efficacy. Tanacetum parthenium also decreased paw edema at 2nd, 3rd, 48 and 72 hour while at 1st hour no effect was seen. However, at 72 hours, shown good efficacy compared to lercanidipine and Indomethacin.Conclusions: Lercanidipine could be a promising anti-inflammatory drug in reducing the inflammation and edema. However, herbal drug (Tanacetum parthenium) has shown anti- inflammatory efficacy when compared with Indomethacin. Both drugs were found safe during our study.

Spectrophotometric evaluation of calcium ion release from different calcium hydroxide preparations: an in-vitro study

Abstract: Pulp tissue conditions such as infections have long been treated with calcium hydroxide (CaOH). In the last decade, use of mineral trioxide aggregate (MTA) has gained ground. This study was carried out to comparatively evaluate the Ca release from CaOH powder with different vehicles and different types of MTA. Materials and Methods: 40 single rooted mandibular premolars were selected, decoronated and biomechanically prepared. They were randomly divided into four groups, consisting of 10 samples each. Root canals were packed with different preparations of CaOH and MTA. Calcium ion release was evaluated with an UV-spectrophotometer. Result: Amongst the CaOH preparations, using propylene glycol as a vehicle produced extended release of calcium ions (7.34 +/- 0.01) for a period of 14 days. Whereas, amongst MTA based products, MTA angelus produced the maximum release of calcium ions (2.42 +/- 0.010). A statistically significant difference was present between the four groups (p<0.05). Conclusion: Propylene glycol mixed with CaOH powder, produces a higher and extended release of calcium ions compared to distilled water. MTA angelus produces consistent calcium ion release.

A clinical rating scale for the assessment of facial aging in Indian population.

Background: Estimation of facial aging has assumed growing importance due to the advent of several antiaging therapies. Evidence-based estimation of global facial aging is often necessary, especially for validation of these treatment modalities. Most available methods are expensive and have been used in fair skinned individuals. Aim: We attempted to develop a clinical rating scale for the estimation of global facial aging applied on an Indian population which has brown to black skin. We have also measured the association of this rating scale score with the chronological age. Methods: Initially, a 14- item summated rating scale was developed with inputs from fi ve dermatologists and a clinical pharmacologist. The rating scale was applied to 105 consenting subjects with healthy facial skin between 30 to 90 years of age. Intra- and inter-rater reliability was assessed. Results: The summated rating score showed a signifi cant positive correlation with the chronological age (Pearson’s correlation coeffi cient 0.834, P < 0.001). We omitted one item from the scale due to a low inter-rater agreement. The resulting 13-item rating scale was internally consistent (Cronbach’s alpha: 0.905), with substantial inter- and intra-rater reliability (intraclass correlation coeffi cient: 0.973 and 0.788, respectively). Principal components and predictive equation for perceptible age were identifi ed on further computation. Limitations: Participants of this study were limited to a particular ethnic group from West Bengal and other neighboring states of Eastern India. Conclusions: We have developed and validated a 13-item rating scale for the quantifi cation of global facial aging suitable for Indian (brown to black) skin type. This scale can be utilized effectively for clinical estimation of global facial aging.

Evaluation of antidepressant and analgesic activity of tapentadol with mirtazapine: an experimental study.

Background: Data comparing tapentadol with an antidepressant is limited. A comparison of tapentadol with mirtazapine at different dose has not been performed, the other antidepressant in the same therapeutic class with a significant market share, has been undertaken. In the absence of relevant data to assess the place that tapentadol should occupy in the therapeutic arsenal, indirect comparisons are the most rigorous way to go. We conducted a study evaluate antidepressant and analgesic activity of tapentadol with mirtazapine at different doses in Swiss albino mice. Methods: Tapentadol was administered at 10, 20 and 40 mg/kg (i.p) once daily for 14 days to swiss albino mice of either sex. The immobility period for antidepressant activity of mice were recorded in forced swim test and reaction time for analgesic activity of mice were recorded in tail flick test of the control and drug treated group. The antidepressant and analgesic activity of tapentadol (10, 20, 40 mg/kg i.p) was compared with that of mirtazapine (3, 5, 7 mg/kg i.p), administered for 14 days. Results: Tapentadol produced better antidepressant at (20, 40 mg/kg), but less at 10 mg/kg and significant analgesic activity at all the three doses, as indicated by reduction in immobility times and increase in reaction time as compared to control. Mirtazapine produced no antinociceptive activity at 3 mg/kg, but significant at 5, 7 mg/kg and showed better antidepressant activity at all the three doses in mice. The result of this study indicates the better analgesic activity of tapentadol at all the doses and least antidepressant activity at 10 mg/kg, as compared to mirtazapine which has shown better antidepressant activity at all the three doses but no analgesic activity at 3 mg/kg. Conclusion: It can be concluded that tapentadol is a better drug in case of depression associated with pain compared to mirtazapine in mice.

A review of transcranial magnetic stimulation.

Transcranial magnetic induction is a promising and powerful tool in the field of neuropsychiatry and has widespread application in basic neurophysiological & neuropsychiatric research, treatment of depression and other psychiatric disorders. Since it is a relatively new technique approved by the FDA, more prospective studies and clinical trials are needed to provide more accurate data and help optimize the treatment.

Prescription pattern of antimicrobial agents by dental practitioners: a questionnaire based study.

Background: The aim of this study was to know the pattern & rationality of antimicrobial prescription by dental practitioners. Methods: It was questionnaire based cross sectional study. A total of 175 questionnaires were distributed to dental practitioners working in a tertiary care Dental College & Hospital and private practitioners in Jaipur (Rajasthan). The questionnaire contained questions about years of practice, diagnosis for which antimicrobial were prescribed, dosage and duration of antimicrobial drugs for prophylaxis, acute and chronic conditions, patient compliance & adverse effects. Data was expressed as counts and percentages. Results: Out of 175 questionnaires distributed, 150 were included in the study. 78% dentists had practices less than 5 years duration. Most common indications for which antimicrobials were prescribed were abscess, cellulitis, irreversible pulpitis, and acute gingivitis. Most common antimicrobials used for prophylaxis were Amoxycillin and Metronidazole. For the treatment of acute and chronic conditions, Amoxycillin, Metronidazole, Ofloxacin and Ornidazole alone or in combination were used. Only 20% dentist advised culture & sensitivity tests. 74% patients completed the recommended course of antimicrobials. 56% patients reported adverse drug reactions (ADRs) with the most common being nausea and vomiting, but only 13% dentists reported them to proper authorities. Conclusions: In this study, Amoxycillin and Metronidazole were the most common drugs used for the management of oral diseases, but were prescribed without culture & sensitivity in most cases. 56% patients reported ADRs, but only 13% dentists reported them to proper authorities. Appropriate measures need to be taken to promote rational prescribing and ADR reporting.