Intra-operative drug level monitoring of pre-operative antibiotic for surgical prophylaxis in the patients of elective spinal surgery.

OBJECTIVES: Single dose prophylaxis is good enough for general surgery with low risk patients. However, the evidence for the effectiveness of single dose anti-microbial prophylaxis (AMP) is not conclusive in high risk patients and spinal surgeries requiring instrumentation or the use of implants in particular. No studies have explored the various concentration of ceftriaxone in plasma and tissue as well during an ongoing spinal surgery. Therefore, the objective of study was to correlate the serum and tissue concentrations of ceftriaxone with the SSI and identify patients with increased risk of SSI. METHODS: It was an open label prospective study in 50 consecutive patients who underwent elective spine surgery under prophylactic cover of ceftriaxone. Serum and tissue concentration were estimated by high pressure liquid chromatography during the ongoing surgery. RESULTS: Subjects were observed for any post-operative complications including SSI. Serum (p=0.002) and tissue (p=0.012) concentrations of ceftriaxone at the closure of spinal surgery were associated with SSI. Duration of the surgery (p=0.04) and use of implants (p=0.02) were also important surgery related risk factors. CONCLUSIONS: Serum and tissue concentrations of ceftriaxone at the closure and duration of surgery and instrumentation or use of implants in the spinal surgery are good predictors of SSI.

Variability in the serum and tissue concentrations of pre-incisional ceftriaxone for surgery in paediatric population and outcome of surgical-site infections; An open labelled, prospective, non-randomized, analytical study.

Studies have determined the serum concentration of ceftriaxone in the adult population, but there are only a few studies that measured the tissue concentrations. However, no studies have concurrently evaluated the serum and tissue concentrations of ceftrixaone in elective pediatric surgery patients. Therefore, our study was planned to evaluate the serum and tissue concentrations of single dose intravenous prophylactic ceftriaxone intra-operatively during an ongoing pediatric surgery and the outcome of surgical-site infections (SSIs). We did a correlation analysis to determine the relationship of various concentrations and surgery related risk factors with the outcome of SSIs. It was an open label prospective study in 50 patients who underwent elective pediatric surgery under prophylactic cover of ceftriaxone. Serum and tissue concentration were estimated by High Pressure Liquid Chromatography (HPLC). Subjects were observed for post operative complications including SSI. Serum and tissue concentrations of ceftriaxone were significant at test value of 4 â€‹mg/L. Tissue concentrations of ceftriaxone at incision (p â€‹= â€‹0.02) and closure (p â€‹= â€‹0.04) were significantly correlated with SSI but there was no significant association. The measured serum ceftriaxone concentrations were more than 20 times the susceptible minimum inhibitory concentration (MIC) at any given point of the surgery. On the other hand, this target level was achieved at the tissue levels in the majority of the patient. The factors associated with SSI were duration of surgery, wound category of contaminated clean type, the use of urinary catheter and implants in the surgery. An intra-operative re-dose, extension of dose or addition of another antibiotic may be considered for such patients.

Pharmacological evaluation of prophylactic anti-microbial use in laparoscopic cholecystectomy; an open labelled study evaluating the concentrations of single dose intravenous ceftriaxone at serum and tissue level.

OBJECTIVE: The goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its optimum level at the start and throughout the surgery. The rationale for the use of antibiotics is not well accepted; possible side effects and development of microbial resistance patterns are potential risks along with the financial burden. Therefore, the present study was conducted with the aim to clinically evaluate the serum and tissue concentration of single-dose prophylactic ceftriaxone during an ongoing laparoscopic cholecystectomy (LC) and to find out risk factors for post operative surgical site infections (SSI). METHOD: It was an open labelled prospective study in 50 consecutive patients who underwent elective laparoscopic cholecystectomy under prophylactic cover of ceftriaxone. Serum and tissue concentration were estimated by High Performance Liquid Chromatography during the ongoing surgery. Subjects were observed for any post-operative complications including SSI. RESULTS: Serum and tissue concentrations of ceftriaxone were significant at test value of 4 milligrams/Litre. Body mass index was significantly correlated with the tissue concentration of ceftriaxone at the time of incision. The rate of SSI was 2%. It significantly correlated with age more than 60 years, diabetes and infected bile. CONCLUSION: A single prophylactic intra-venous dose of 1 g ceftriaxone immediately prior to skin incision in LC is good enough for prevention of SSI in Indian patients.

Antibiotic prophylaxis and surgical site infections; a prospective open label study to clinically evaluate the serum and tissue concentration of single dose prophylactic ceftriaxone in laparoscopic cholecystectomy.

OBJECTIVE: The goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its optimum level at the start and throughout the surgery. The rationale for the use of antibiotics is not well accepted, possible side effects and development of microbial resistance patterns are potential risks along with the financial burden. Therefore, the present study was conducted with the aim to clinically evaluate the serum and tissue concentration of single dose prophylactic ceftriaxone during an ongoing laparoscopic cholecystectomy and to find out risk factors for postoperative surgical site infection. METHOD: It was an open label prospective study in 50 consecutive patients who underwent elective laparoscopic cholecystectomy under prophylactic cover of ceftriaxone. Serum and tissue concentrations were estimated by HPLC during the ongoing surgery. Subjects were observed for any postoperative complications including SSI. RESULTS: Serum and tissue concentrations of ceftriaxone were significant at test value of 4 mg/L. Body mass index was significantly correlated with the tissue concentration of ceftriaxone at the time of incision. The rate of SSI was 2%. It was significantly correlated with age more than 60 years, diabetes, and infected bile. CONCLUSION: A single prophylactic iv dose of 1 g ceftriaxone immediately prior to skin incision in LC is good enough for prevention of SSI in Indian patients.

Cheiloscopy and blood groups: Aid in forensic identification.

INTRODUCTION: Every person has certain features that make them radically distinct from others. One such feature is lip prints. Lip prints remain the same throughout life and are uninfluenced by injuries, diseases, or environmental changes. Different individuals have specific blood groups according to the various antigen-antibody reactions in their bloodstream. AIM: To determine the distribution of different patterns of lip prints among subjects having different ABO and Rh blood groups. OBJECTIVE: To determine the correlation between respective characteristics of subjects. METHODOLOGY: In this study, lip prints were obtained from 122 subjects (62 males and 60 females), and associated blood-group matching was performed to determine the predominant lip print type and to determine any correlation between lip print types and blood groups. Tsuchihashi's classification of type I (complete vertical grooves), type I' (incomplete vertical grooves), type II (forking grooves), type III (intersecting grooves), type IV (reticular grooves), and type V (indeterminate grooves) was used to compare with the ABO and Rh blood grouping systems. RESULT: No correlation was found between lip prints and blood groups. CONCLUSION: No significant correlation exists between blood group and lip prints. Lip prints play a vital role in identification because they are unique.

Tobacco abuse amongst the school going students of 15 to 18 years of Almora district, Uttarakhand: a cross sectional study.

PURPOSE: The present study was done to assess the prevalence of tobacco abuse among school going students of the age group 15 to 18 year old in the rural areas of Almora district, Uttrakhand state, India. MATERIALS AND METHODS: Schools were grouped into 4 zones north, south and east, west based on their location in district, respectively. Second stage one private and one government school was randomly selected from each zone of rural Almora. All students belonging to age 15 to 18 year were selected from the selected schools. Data was collected by a pretested, closed ended questionnaire. RESULTS: Overall, the prevalence of tobacco consumption among the adolescents was 45.42%. 63% male and 47.1% female adolescents were habituated to it. All female and majority of the male adolescents predominantly consumed a smokeless form of tobacco. CONCLUSION: The prevalence of tobacco consumption indicates a downward shift in the age for the uptake of tobacco habit by adolescents and a rising prevalence among girls. Our findings suggest that tobacco use prevention and control measures are warranted and should be started very early preferably at primary education level.

Is complementary and alternative medicine effective in job satisfaction among dentists with musculoskeletal disorders? A cross sectional study.

BACKGROUND: Musculoskeletal disorders have serious impact on the profession of dentistry. There is common occurrence of pain due to incorrect posture in dental professionals. Complementary and alternative medicine (CAM) therapies may cast a new light on preventing and intercepting musculoskeletal disorders (MSD). An epidemiological study was conducted in an effort to contribute to the prevention of musculoskeletal disorders in dentistry. The purpose of this study was to determine the prevalence of MSD at dentists using CAM as a treatment and preventive modality for MSD and to compare job/career satisfaction between dentists who use CAM and conventional therapy (CT). MATERIAL AND METHODS: Dentists registered in Uttrakhand state, India, under the Dental Council of India and registered members of the Indian Dental Association, Uttrakhand branch (N = 1496) were surveyed. Statistical analysis was conducted using SPSS 17. RESULTS: A response rate of 84% (N = 1257) was obtained, revealing that 90% (N = 1131) had the problem of MSD. Seventy three percentage (N = 826) of dentists with MSD reported the use of CAM and CT. Complementary and alternative medicine users reported greater overall health (72.7% vs. 51%, p < 0.001), job satisfaction (61.2% vs. 35%, p < 0.001) and work efficiency compared to CT users. CONCLUSION: Complementary and alternative medicine therapies may improve quality of life, reduce work interruption and enhance job satisfaction for dentists who suffers from MSD. Through the course of their studies, dentists should be equipped with knowledge on ergonomics and CAM therapies, such as yoga and others, to help them prevent musculoskeletal disorders more effectively.

A randomized controlled clinical trial of Ocimum sanctum and chlorhexidine mouthwash on dental plaque and gingival inflammation.

BACKGROUND: Periodontal diseases are ubiquitous, affecting all dentate animals. Regular methods for controlling it have been found to be ineffective, which have paved the way for the use of herbal products as an adjunctive to mechanical therapy as they are free to untoward effects and hence can be used for a long period of time. Ocimum sanctum is a plant which has the greater medicinal value and enormous properties for curing and preventing disease. OBJECTIVE: In the present study we assessed the effectiveness of Ocimum sanctum on dental plaque, gingival inflammation and comparison with gold standard chlorhexidine and normal saline (placebo). MATERIALS AND METHODS: A triple blind randomized control trial was conducted among volunteered medical students. They were randomly allocated into three study groups: (1) Ocimum sanctum mouthwash (n = 36); (2) Chlorhexidine (active control) (n = 36); (3) normal saline (negative control) (n = 36). Assessment was carried out according to plaque score and gingival score. Statistical analysis was carried out later to compare the effect of both mouthwash. ANOVA (Analysis of variance) and post-hoc LSD tests were performed using software package used for statistical analysis (SPSS) version 17. P ≤0.05 was considered as statistically significant. RESULTS: Our result showed that Ocimum sanctum mouthrinse is equally effective in reducing plaque and gingivitis as Chlorhexidine. The results demonstrated a significant reduction in gingival bleeding and plaque indices in both groups over a period of 15 and 30 days as compared to control group. CONCLUSION: The results of the present study indicate that Ocimum sanctum mouthrinse may prove to be an effective mouthwash owing to its ability in decreasing periodontal indices by reducing plaque accumulation, gingival inflammation and bleeding. It has no side effect as compared to chlorhexidine.

Use of complementary and alternative medicine for work related musculoskeletal disorders associated with job contentment in dental professionals: Indian outlook.

BACKGROUND: High prevalence rates of work-related musculoskeletal disorders (WRMSD) among dentists have been reported. Complementary and alternative medicine (CAM) therapies can be helpful in managing and preventing work-related musculoskeletal disorders. The purpose of this study was to determine if dental professionals are using CAM for work-related musculoskeletal disorders. Who have greater job satisfaction: dentist who uses Complementary and alternative medicine (CAM) or conventional therapy (CT) as a treatment modality for WRMSD. METHOD: Dentists who registered in Uttar Pradesh state, India under Indian Dental Council, Uttar Pradesh branch (n=1134) were surveyed. Data were analyzed using univariate and bivariate analyses and logistic regression. RESULT: A response rate of 53% (n=601) was obtained, revealing that 82% (n=487) of the respondents suffered from work-related musculoskeletal disorders. The use of complementary and alternative medicine or conventional therapy was reported among 80% (n=390) of the dentists with work-related musculoskeletal disorders. Complementary and alternative medicine users reported greater overall health compared to conventional therapy users (P<0.001). Of those with work-related musculoskeletal disorders, 35.5% (n=172) considered a career change for once, and 4.0% (n=19) reported having left dentistry. CONCLUSION: Complementary and alternative medicine therapies may improve quality of life, reduce work disruptions and enhance job satisfaction for dentists who suffer from work-related musculoskeletal disorders. It is important that dentists incorporate complementary and alternative medicine strategies into practice to facilitate musculoskeletal health that will enable longer and healthier careers, increase productivity, provide safer workplace and prevent musculoskeletal disorders.

Effect of Aloe vera mouthwash on periodontal health: triple blind randomized control trial.

BACKGROUND: With the increasing incidence of periodontal diseases and development of antibiotic resistance, the global need for alternative treatment modalities, safe, effective, and economical products is the need of time. Aloe vera is a medicinal plant which has the greater medicinal value and enormous properties for curing and preventing oral diseases disease. AIM: The aim of the study was to access the effect of Aloe vera mouthwash on the dental plaque and gingivitis and comparing it with the bench mark control chlorhexidine and placebo. MATERIAL AND METHODS: 345 healthy subjects were randomly allocated in 3 groups to the test group (n=115) - mouthwash containing Aloe vera, Control group (n=115) -chlorhexidene group, Distilled water - Placebo (n=115) . Plaque Index (PI) and Gingival Index (GI) were assessed at days 0, 15 and 30. Subjects were asked to rinse their mouth with the stated mouthwash, twice a day, during a 30-day period. RESULTS: Our result showed that Aloe vera mouthrinse is equally effective in reducing periodontal indices as Chlorhexidine. The results demonstrated a significant reduction of gingival bleeding and plaque indices in both groups over a period of 15 and 30 days as compared to placebo group. There was a significant reduction on plaque and gingivitis in Aloe vera and chlorhexidine groups and no statistically significant difference was observed among them (p>0.05). Aloe vera mouthwash showed no side effects as seen with chlorhexidine. CONCLUSION: The results of the present study indicate that Aloe vera may prove to be an effective mouthwash owing to its ability in reducing periodontal indices.

Effect of Terminalia chebula extract and chlorhexidine on salivary pH and periodontal health: 2 weeks randomized control trial.

A double blind, randomized, controlled study with three parallel treatment groups was done to evaluate the efficacy of a Terminalia chebula 10% mouth rinse compared with chlorhexidine 0.12% mouth rinse, applied two times daily for 2 weeks, in the treatment of dental plaque and gingivitis. Seventy-eight patients were included in the study. The efficacy variables were periodontal indices on days 0, 7 and 14 after commencement of therapy. Twenty six patients received chlorhexidine mouth rinse, twenty six Terminalia chebula mouth rinse and twenty six received saline solution. The clinical parameters were significantly reduced by both chlorhexidine and Terminalia chebula mouth rinse although no significant difference was seen between the two groups (P > 0.05). This study demonstrated that Terminalia chebula mouth rinse is effective in reducing microbial plaque, gingival inflammation and neutralizing salivary pH.