Trends in antimicrobial susceptibility of blood culture-positive typhoid fever over half a decade in adults attending a tertiary care teaching hospital in South India

Background: Typhoid fever is a public health concern in developing countries. Developed countries have also been influenced due to tourism. The drugs used for treating typhoid fever can and have been rendered unusable due to resistance. Monitoring and updating the Salmonella antibiogram is needed to prevent therapeutic failures. This study confirms to the same goal.Methods: This study was conducted retrospectively in a tertiary care hospital in North Kerala with data collected from 2013 to 2017. Years were categorized into four quarters to analyze seasonality. Positive blood culture samples of adults, identified to be Salmonella typhi or paratyphi were subjected to antimicrobial sensitivity.Results: 37 Salmonella isolates were included. July-September quarter was found to have maximum incidence of typhoid fever followed by April-June quarter. All isolates were 100% sensitive to ceftriaxone, chloramphenicol, and amoxicillin-clavulanic acid. Sensitivity lacked for nalidixic acid (48.65%), ciprofloxacin (48.65%) and levofloxacin (70.27%). Sensitivity to ampicillin and cotrimoxazole was 86.49% and 91.89%. Azithromycin efficacy was good overall (94.59%) with resistant isolates emerging in final year of this study.Conclusions: Monsoon is most conducive for typhoid fever occurrence followed by summer. This study confirms utility of ceftriaxone and futility of quinolones and fluoroquinolones in typhoid fever treatment. Azithromycin has started showing emergence of resistance. Ampicillin and cotrimoxazole cannot be relied upon due to variability in sensitivity patterns. Chloramphenicol showed full efficacy throughout the study period which is encouraging. Amoxicillin-clavulinic acid, surprisingly was 100% effective throughout study period. However, no contemporary data is available for comparison.

A Technique to Increase Retention of all Metal and Porcelain Fused to Metal Crowns to Cast Post and Core Restorations

Retention prevents dental restoration from being dislodged along its path of insertion. However, classic retentive factors are not always possible to implement in fixed prosthodontics. Therefore, it may be helpful to utilize non-conventional methods to enhance retention in situations where retention can’t be obtained from primary and secondary retentive factors. This article describes a technique to increase crown retention to cast post and core by using a horizontal retentive post to lock the crown to the cast post and core.

A study on prescribing errors in in-patients of a corporate tertiary care hospital in North India

Background: Prescribing errors are a subset of medication errors which have a potential for grave harm to the patient. Identification and acknowledgement of such errors can ameliorate much of this danger. Studies of prescribing errors are sparse in India. Such studies, whatever have been conducted, mainly focus on the out-patients or the patients on discharge. Hence, this study was undertaken to study the prescribing errors in prescriptions generated for patients admitted in wards of a corporate hospital in North India.Methods: The prescriptions for in-patients admitted in wards were analyzed for different types of prescribing errors in individual drug orders and prescription as a whole.Results: The prescribing error rate was found to be 3.3% in this study. Of all errors, errors leading to delays in patient care (i.e. Errors of prescription writing) (54.54%) and erroneous copying of the prescription to the drug chart by junior/ resident doctors (Transcription errors) (31.31%) were found to be the major causes of prescribing errors in this study. Of the former category, prescribing a wrong strength (24.24%) and illegible drug orders (12.12%) were the most numerous error subtypes. Errors leading to sub-optimal patient care (i.e. Errors of decision making) were least identified of which Therapeutic duplication (12.12%) was the most common subtype.Conclusions: The error rate found in this study is comparable to the data available from developed countries. However, there are significant differences in the occurrences of error subtypes found in this study as compared to the studies of the west.

Trans-oral endoscopic partial adenoidectomy does not worsen the speech after cleft palate repair / Adenoidectomia parcial endoscópica transoral não piora a fala de pacientes com correção cirúrgica de fenda palatina

ABSTRACT INTRODUCTION: Adenoid hypertrophy may play a role in velopharyngeal closure especially in patients with palatal abnormality; adenoidectomy may lead to velopharyngeal insufficiency and hyper nasal speech. Patients with cleft palate even after repair should not undergo adenoidectomy unless absolutely needed, and in such situations, conservative or partial adenoidectomy is performed to avoid the occurrence of velopharyngeal insufficiency. Trans-oral endoscopic adenoidectomy enables the surgeon to inspect the velopharyngeal valve during the procedure. OBJECTIVE: The aim of this study was to assess the effect of transoral endoscopic partial adenoidectomy on the speech of children with repaired cleft palate. METHODS: Twenty children with repaired cleft palate underwent transoral endoscopic partial adenoidectomy to relieve their airway obstruction. The procedure was completely visualized with the use of a 70° 4 mm nasal endoscope; the upper part of the adenoid was removed using adenoid curette and St. Claire Thompson forceps, while the lower part was retained to maintain the velopharyngeal competence. Preoperative and postoperative evaluation of speech was performed, subjectively by auditory perceptual assessment, and objectively by nasometric assessment. RESULTS: Speech was not adversely affected after surgery. The difference between preoperative and postoperative auditory perceptual assessment and nasalance scores for nasal and oral sentences was insignificant (p = 0.231, 0.442, 0.118 respectively). CONCLUSIONS: Transoral endoscopic partial adenoidectomy is a safe method; it does not worsen the speech of repaired cleft palate patients. It enables the surgeon to strictly inspect the velopharyngeal valve during the procedure with better determination of the adenoidal part that may contribute in velopharyngeal closure.

Resumo Introdução: A hipertrofia da adenoide pode desempenhar um papel no fechamento velofaríngeo, especialmente em pacientes com anormalidade palatal; a adenoidectomia pode levar à insuficiência velofaríngea e fala hipernasal. Os pacientes com fenda palatina, mesmo após a correção, não devem ser submetidos a adenoidectomia, exceto quando absolutamente necessário e, em tais situações, a forma conservadora ou parcial é realizada para evitar a ocorrência de insuficiência velofaríngea. A adenoidectomia endoscópica transoral permite ao cirurgião inspecionar a válvula velofaríngea durante o procedimento. Objetivo: O objetivo deste estudo foi avaliar o efeito da adenoidectomia parcial endoscópica transoral na fala de crianças submetidas à correção de fenda palatina. Método: Um total de 20 crianças com fenda palatina previamente corrigida, foi submetida a adenoidectomia parcial endoscópica transoral, para desobstrução das vias aéreas,. O procedimento foi completamente visualizado com o uso de um endoscópio de 4 mm e ângulo de 70º; a parte superior da adenoide foi removida com uma cureta para adenoide e fórceps St. ClaireThompson, enquanto a parte inferior foi conservada para manter a competência velofaríngea. Avaliações da fala foram realizadas nos períodos pré e pós-operatório, de forma subjetiva pelaavaliação perceptivo-auditiva, e objetiva pela avaliação nasométrica. Resultados: A fala não foi prejudicada após a cirurgia. A diferença entre os escores da avaliação perceptivo-auditiva e nasalância para as sentenças nasais e orais nos períodos pré e pós-operatório foi insignificante (p = 0,231, 0,442, 0,118, respectivamente). Conclusões: A adenoidectomia parcial endoscópica transoral é um método seguro, e não piora a fala dos pacientes com fenda palatina operada. Ela permite que o cirurgião inspecione rigorosamente a válvula velofaríngea durante o procedimento, com melhor determinação da parte adenoide que pode contribuir para o fechamento velofaríngeo.

Pattern of drug use in psoriasis inpatients in the department of dermatology at a tertiary care teaching hospital.

Background: The pattern of drug use in people hospitalized with a primary diagnosis of psoriasis has never been studied previously in India. The aim of the study was to characterize the prescription pattern of people admitted to hospital with psoriasis so that rational prescribing could be promoted among dermatologists. Methods: Case files belonging to 32 patients, admitted in the Department of Dermatology with psoriasis, of a tertiary care teaching hospital in Kerala, over a period of 1-year were retrieved with the assistance of the medical records department. The data thus obtained was analyzed using descriptive statistics. Results: The average age of patients who were admitted with psoriasis was 49.9 years, and their average duration of hospital stay was 7.96 days. A total of 296 formulations were prescribed to 32 patients. Out of 296 formulations, only 10 (3.37%) were generic and rest 286 (96.62%) branded. Fixed dose combinations consisted of 32.43% (96/296) of the prescribed formulations. Psoriasis vulgaris (56.25%) was the most common cause for admission. Of all the prescribed medications, 4 (1.35%) did not contain clear instructions for the route of administration. Strength was clearly mentioned in only 89 (30%) of the preparations. In 98% of the prescriptions, the exact dose was missing. Conclusions: The study reveals various deficiencies which exist in the prescribing pattern of drugs for management of psoriasis. Educational interventions among the doctors as well as students should be carried out to promote rational drug use.