Effectiveness of Antimicrobial Therapy after Extraction of Impacted Mandibular Third Molar: A Randomized Clinical Trial.

AIM: The present study was conducted with the aim of evaluating the effectiveness of antimicrobial therapy following extraction of an impacted mandibular third molar. MATERIALS AND METHODS: This randomized controlled trial was conducted on a total of 60 patients who were randomly assigned into three groups: Group I individuals were given 625 mg of combined amoxicillin and clavulanic acid tablet; 625 mg of combined amoxicillin and clavulanic acid tablet + 400 mg metronidazole tablet was given to group II individuals; whereas group III individuals were assigned no treatment. All the individuals underwent surgical extraction of impacted mandibular third molars under strict aseptic techniques, with minimal trauma to the surrounding tissues. Mouth opening in millimeters was recorded postoperatively using Vernier calipers on the 1st, 3rd, 5th, and 7th days. A 4-point visual analog scale (VAS) was used for assessing postoperative pain. Patient satisfaction was further assessed in a subjective manner using a graded scale from "very satisfied" to "very unsatisfied". RESULTS: The present study included individuals between the ages of 20 and 35 years. Group II individuals showed slightly better satisfaction than the other group individuals. There was no statistically significant difference between the mean age of groups. It was observed that on day 3, the number of individuals with severe pain was slightly reduced in the group I compared with group III individuals. On day 5, participants with no pain were significantly more in group II followed by group I. Furthermore, there was a statistically significant difference between the study groups with respect to mouth opening on days 3 and 5. CONCLUSION: It was concluded from this trial that the administration of postoperative antimicrobials showed no significant differences in the degree of postoperative complications that occur following the surgical extraction of impacted mandibular third molars. CLINICAL SIGNIFICANCE: Antimicrobial drugs are routinely used to reduce the chances of surgical site infection, either preopera-tively or postoperatively. Therefore, the clinicians should have sound knowledge about choosing the better antimicrobial drug after the extraction of impacted third molars.

Simultaneous spectrophotometric estimation of Hydrochlorothiazide, Atenolol and Losartan potassium in tablet dosage form.

Two simple, accurate and reproducible spectrophotometric methods have been developed for the simultaneous estimation of Hydrochlorothiazide (Hctz), Atenolol (Atn) and Losartan potassium (Los) in combined tablet dosage forms. The first method involves determination using the simultaneous equation method, the sampling wavelengths selected are, 272.5 nm, 224 nm and 250 nm over the concentration ranges of 0.5-30 microg/ml, 1-50 microg/ ml and 1-60 microg/ml for Hctz, Atn and Los respectively. The second method is the First order derivative method, the sampling wavelengths selected for estimation of Hctz, Atn and Los are 280.5 nm, 233 nm and 244 nm with linearity in the concentration ranges of 0.5-30 microg/ ml, 1-50 microg/ml and 1-60 microg/ml respectively. The results of the analysis were validated statistically and recovery studies were carried out as per ICH guidelines.

Management of translocated and incarcerated intrauterine contraceptive devices.

Thirty-seven consecutive patients who reported with absent or snapped strings and failed attempts at removal of intrauterine contraceptive devices (IUCD) by hooks or curette were posted for hysteroscopy/laparotomy following a plain X-ray of the pelvis to exclude unrecognized spontaneous expulsion. Direct visualization of the endometrial cavity was invaluable in locating and removing IUCDs, particularly the embedded and fragmented ones. Translocated medicated devices were associated with dense adhesions, suggesting the need for their prompt removal. There appears to be an increased risk of translocation in lactating women.

PIP: 37 consecutive patients who presented with absent or snapped strings and failed attempts at IUD removal by hooks or curette were referred for hysteroscopy/laparotomy following a pelvic x-ray to exclude unrecognized spontaneous expulsion of the device. The IUD was extrauterine in 19 patients and incarcerated in the uterine cavity in the remaining 18 patients. 17 of the 19 extrauterine devices were copper containing and 2 were inert Lippes Loop IUDs. In all cases, copper devices were associated with dense adhesions. Only 2 patients complained of any abdominal pain. The IUD type among the 18 patients with intrauterine translocated devices was the Lippes Loop in 15 cases and the Copper T in the remaining 3 cases. 6 of these patients had complained of excessive bleeding with pain. Hysteroscopy is invaluable to remove embedded and fragmented IUDs. It is suggested that all devices translocated into the abdomen be removed to avoid potential complications. Laparotomy is the method of choice to remove medicated devices given the dense adhesions often associated with bowel loops. Risk factors considered to be associated with translocation include postpartum insertion, inserter skill, insertion technique, and the status and configuration of the cervix and uterus.