Indian Guidelines on Nebulization Therapy.

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.

Prosthetic Rehabilitation of Lower Limb with RTV Siliconee Using Prosthodontic Clinical and Laboratory Techniques - A Case Report.

Amputation of all or part of a limb may be due to systemic disease, vascular disease, infection, local injury or trauma. Partially amputated lower limbs present a variety of unique clinical and prosthetic challenges, because of distinctly different amputation levels of the lower limb. A female patient with history of Partial Foot Amputation (PFA) surgery at metatarsophalangeal joint level, due to crush injury reported for prosthetic rehabilitation. This case was successfully rehabilitated using room temperature vulcanizing (RTV) medical grade silicone for fabrication of foot prosthesis. Though limited in its function, it amply proves that the clinical and laboratory techniques used in fabrication of maxillofacial prosthesis can be effectively adapted for the fabrication of body prosthesis like toes and feet to enhance the quality of life of the patients. The patient was reviewed every year for three years.

A Sectional Splint for Maintaining Surgically Enhanced Vertical Height in an Oral Submucous Fibrosis Patient: A Case Report.

Oral submucous fibrosis (OSMF) is a chronic inflammatory disease that results in a progressive juxtaepithelial fibrosis of the oral soft tissues, causing an increasing difficulty in mouth opening, chewing, swallowing and speaking. It is regarded as a precancerous and potentially malignant condition. The fibrosis of oral mucosa leads to limited mouth opening and difficulty in mastication. Prosthetic rehabilitation of patients with OSMF offers a formidable challenge due to the restricted mouth opening. Management of the limited mouth opening is usually by surgery. Herein, we describe a procedure to maintain the increased mouth opening that is achieved through surgery. Maintaining this opening would make it easier for any further prosthetic rehabilitation at a later stage.