Comparative study of the efficacy of Ionic Silver Solution and Super Oxidized Solution in the management of chronic wounds.

Background: Chronic wounds are of many etiologies and difficult to treat. Many commercial products to manage such wounds are available, which claim to have good outcomes. Aim of this study was to compare the efficacy of Ionic Silver Solution and Super Oxidized Solution in the management of chronic wounds. Methods: Patients with chronic wounds were randomly placed in two groups-Group A (Ionic Silver Solution) and Group B (Super Oxidized Solution) with 30 patients each. The dressings were continued until the wound healed completely or the wound was ready for a definitive procedure. Wound parameters were recorded as per Bates Jensen Wound Assessment Tool (BJWAT) Score. Results: FIfty patients completed the study. The scores were compared at the initiation and endpoint of treatment. The pretreatment total for BJWAT was 916 and 924 in group A and group B respectively, which was not statistically significant. Post-treatment improvement was noticed in both the groups and the score decreased to 510 and 675 in group A and group B respectively (p = 0.001). Ionic Silver Solution and Super Oxidized Solution both were found to be effective in improving the overall wound condition. However, Ionic Silver Solution was found to be more effective than Super Oxidized Solution in the healing of chronic wounds. Complete healing was noticed in a small number (6%) of patients. These agents can therefore best prepare the wounds for early surgical intervention. Conclusion: Both the agents were found to be safe and useful in the management of chronic wounds. However, Ionic Silver Solution was found to be more effective than the super oxidized solution in this study.

Clinical Characteristics and Metabolic Profiles of Non-Alcoholic Fatty Liver Disease (NAFLD) in Lean Patients and Their Comparison with Obese and Overweight NAFLD.

Non -alcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease throughout the world. The spectrum of NAFLD includes a non-serious condition called fatty liver, a more serious condition named non-alcoholic steatohepatitis (NASH) which may lead to severe liver scarring and cirrhosis. Obesity and diabetes mellitus are established risk factors for NAFLD. However, it has been increasingly reported among lean or non-obese and non diabetic patients. The aim of this study was to evaluate the magnitude, clinical and metabolic profiles of NAFLD in normal body mass index (BMI) subjects, defined as lean NAFLD, as compared to overweight or obese NAFLD and lean healthy controls. MATERIAL: 92 consecutive NAFLD and 90 healthy controls were studied between 2021 March to 2021 August, for a period of 6 months. Patients of NAFLD were diagnosed on the basis of ultrasonography features, presence of metabolic syndrome or insulin resistance. Patients with a BMI of less than 23 kg/m2 were defined as lean NAFLD. Alcoholic patients, those with liver diseases of other known causes, patients on medications known to induce fatty liver were excluded. For comparing the characteristics of lean NAFLD patients, we also included 90 lean healthy subjects with normal liver on ultrasonography as control subjects. OBSERVATION: Among the 92 NAFLD patients, 18 (19.56%) were lean or non-obese, while 48 (52.17%) were obese, and 26 (28.26%) were overweight. The lean NAFLD cohort was younger (p<0.001), more commonly female, had a lower prevalence of diabetes (p=0.01) and metabolic syndrome (p<0.001). The serum lipid profile was similar in all the three BMI categories and 82% of the lean NAFLD were dyslipidemic. In comparison to obese subjects, patients with lean NAFLD had significantly less fibrosis. Despite being lean, the mean BMI of lean NAFLD patients was still higher than healthy control group. CONCLUSION: Dyslipidemia is frequently associated with lean NAFLD. Lean NAFLD when compared to obese or overweight NAFLD, have lower prevalence of type 2 diabetes mellitus, metabolic syndrome and less fibrosis on fibroscan of liver. They donot have abdominal obesity, but their BMI was higher than healthy controls.

Comparison of the Pentax Airway Scope and McGrath Videolaryngoscope with the Macintosh laryngoscope in tracheal intubation by anaesthetists unfamiliar with videolaryngoscopes: a manikin study.

Videolaryngoscopes are becoming widely available and have been suggested as a replacement for the Macintosh in cases of cervical instability or even for use in the first instance. There is limited existing data on the use of videoscopes by experienced anaesthetists who are inexperienced in the use of videoscopes. We used a manikin model to compare time to intubation between the Macintosh blade, Pentax Airway Scope and the McGrath videolaryngoscope in a simulated urgent intubation by 23 experienced anaesthetists with no prior experience in the use of these videoscopes. We also measured the number of attempts and success of intubation within three minutes. Ease of device use and laryngoscopic view obtained were also recorded. We found that all participants could intubate the manikin within three minutes, with a median of one attempt using the Pentax Airway Scope. Only 48% of participants (n=11) could intubate within three minutes using the McGrath videolaryngoscope and required a median of three attempts. This difference occurred despite the majority of anaesthetists obtaining a Grade 1 Cormack and Lehane view with both videoscopes. We demonstrated that anaesthetists who were naive to these videoscopes can successfully intubate the trachea using the Pentax Airway Scope but not the McGrath videolaryngoscope.

Long-term neurological complications associated with surgery and peripheral nerve blockade: outcomes after 1065 consecutive blocks.

Peripheral nerve blockade is gaining popularity as an analgesic option for both upper or lower limb surgery. Published evidence supports the improved efficacy of regional techniques when compared to conventional opioid analgesia. The incidence of neurological deficit after surgery associated with peripheral nerve block is unclear. This paper reports on neurological outcomes occurring after 1065 consecutive peripheral nerve blocks over a one-year period from a single institution. All patients receiving peripheral nerve blocks for surgery were prospectively followed for up to 12 months to determine the incidence and probable cause of any persistent neurological deficit. Formal independent neurological review and testing was undertaken as indicated. Thirteen patients reported symptoms that warranted further investigation. A variety of probable causes were identified, with peripheral nerve block being implicated in two cases (one resolved at nine months and one remaining persistent). Overall incidence of block-related neuropathy was 0.22%. Persistent postoperative neuropathy is a rare but serious complication of surgery associated with peripheral nerve block. Formal follow-up of all such blocks is recommended to assess causality and allow for early intervention.