A comparative study of the effect of different topical agents on burn wound infections

Background:

Topical agents are used to treat burn wound infections.

Aims and Objective:

The present work was aimed to find out the in vitro efficacy of different topical agents against burn wound pathogens.

Settings and Design:

Randomly selected gram-positive (29) and gram-negative bacterial (119) isolates from burn wound cases admitted in burn unit of Choithram Hospital and Research Centre, Indore, were included in the in vitro activity testing for silver nitrate, silver sulphadiazine (SSD), chlorhexidine, cetrimide, nitrofuran, soframycin, betadine, benzalkonium chloride and honey by growth inhibition on agar medium.

Materials and Methods:

Multidrug-resistant isolates of gram-positive and gram-negative bacteria were checked for different topical agents. 1% topical agent was mixed with Mueller-Hinton agar. Two microlitres of bacterial suspension adjusted to 0.5 McFarland turbidity standard was spread over the topical agent containing plates. The plates without the topical agent were used as control plates. The plates were incubated for 48 h at 37°C.

Results:

SSD (148/148), silver nitrate (148/148) and chlorhexidine (148/148) showed excellent activity against all the pathogens. Neosporin had poor activity against Pseudomonas aeruginosa, (4/44) Proteus spp. (2/4) and group D streptococci (1/4). Betadine did not show activity against the bacterial isolates in the presence of organic matter. Honey did not exert any antimicrobial activity under the study conditions.

Conclusion:

SSD, silver nitrate and chlorhexidine have excellent activity against all the bacterial pathogens and could be used empirically, while identification of the infective agent is required for selecting the alternative topical agents such as nitrofuran, soframycin, and benzalkonium chloride.KEY WORDS: Benzalkonium chloride, burn wounds, cetrimide, chlorhexidine, nitrofuran, silver nitrate, silver sulphadiazine, topical gents     

Long-Term Clinical Outcomes of Peritoneal Dialysis Patients: 9-Year Experience of a Single Center from North India

♦ Objective: There is a paucity of published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of continuous ambulatory PD (CAPD) in India in 1991. The purpose of this study is to report long-term clinical outcomes of PD patients at a single center.♦ Design: Retrospective study.♦ Setting: A government-owned tertiary-care hospital in North India.♦ Patients: Patients who were initiated on CAPD between October 2002 and June 2011, and who survived and/or had more than 6 months’ follow-up on this treatment with last follow-up till December 31, 2011, were studied.♦ Results: A total of 60 patients were included in the analysis. The mean age of the patients was 60.2 ± 9.2 years. The majority (65%) of the patients lived in rural areas. A high proportion (47%) were diabetic and 62% had ≥ 2 comorbidities. Total duration on peritoneal dialysis treatment was 1,773 patient-months (148 patient-years) with a mean duration of 29.6 ± 23 patient-months and median duration of 25 patient-months (range 6 - 110 patient-months). Overall patient and technique survival at 1, 2, 3, 4 and 5 years was 77%, 53%, 25%, 15%, and 10% respectively. Patient survival of diabetics vs non-diabetics at 1, 2, 3, 4, and 5 years was 68% vs 84%, 54% vs 53%, 14% vs 34%, 11% vs 19%, and 11% vs 13%, respectively. The mortality in non-diabetics (16/32) was less than that in diabetic (18/28) patients (p = not significant). The main cause of mortality in these patients was cardiac followed by sepsis. There were 58 episodes of peritonitis. The rate of peritonitis was 1 episode per 30.6 patient-months or 0.39 episodes per patient-year. Furthermore, the total number of episodes of peritonitis and number of episodes of peritonitis per patient were higher in the non-survival group (p < 0.05). The incidence of tuberculosis (TB), herpes zoster (HZ) and hernias was 15%, 10% and 5% respectively.♦ Conclusion: The study reports long-term outcomes of the PD patients, the majority of whom were elderly with a high burden of comorbidities. There was a high proportion of diabetics. The survival of diabetic vs non-diabetic and elderly vs non-elderly PD patients was similar in our study. The mortality in non-diabetics was less than that in diabetic patients. TB and HZ were common causes of morbidity. Peritonitis was associated with mortality in these patients.     

Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial

Purpose

There is no consensus about the best option of internal fixation for unstable intertrochanteric fractures. The aim of the present study was to compare proximal femoral nail (PFN) with contralateral reverse distal femoral locking compression plate (reverse-DFLCP) in the management of unstable intertrochanteric fractures with compromised lateral wall.

Method

In a randomized controlled study, from November 2011 to October 2012, 40 patients with unstable intertrochanteric fractures with compromised lateral wall (AO 31A 2.2 to 3.3) had osteosynthesis by PFN (n = 20) or reverse-DFLCP (n = 20). Intra-operative variables compared were duration of surgery, blood loss during surgery, fluoroscopy time and surgeons perception of the surgery. Patients were followed up clinically for a minimum of one year. Functional outcome was assessed by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12. Failure was defined as any condition which would necessitate revision surgery with change of implant.

Results

Duration of surgery (p = 0.022), blood loss during surgery (p = 0.008) and fluoroscopy time (p = 0.0001) were significantly less in the PFN group than in the reverse-DFLCP group. No significant difference was found in type of reduction, difficulty in reduction and surgeon’s perception of surgery. The PFN group had better functional outcome than the reverse-DFLCP group. HHS for the PFN group was 81.53 ± 13.21 and for the reverse-DFLCP group it was 68.43 ± 14.36 (p = 0.018). SF-12 physical (p = 0.002) and mental component (p = 0.007) scores in the PFN group was significantly better than in the reverse-DFLCP group. There was one failure in the PFN group as compared to six in the reverse-DFLCP group (p = 0.036).

Conclusion

Due to favourable intra-operative variables, better functional outcome and lower failure rates, we conclude that PFN is a better implant than reverse-DFLCP for intertrochanteric fractures with compromised lateral wall.Keyword: Unstable intertrochanteric fractures, Lateral wall, Proximal femoral nail, Reverse distal femoral locking compression plate     

Role of cytokines in the clinical manifestation of exophthalmia in newborn calves with tropical theileriosis

The present study aimed to evaluate the pathology of the exophthalmia and the host-immune response in naturally Theileria annulata-infected calves. The newborn calves detected positive for theileriosis were grouped into calves with theileriosis and absence of exophthalmia (n = 30), and calves with theileriosis and the presence of exophthalmia (n = 13). Sixteen healthy calves, free from any haemoprotozoal infection, were kept as healthy controls. A significantly (P ≤ .001) higher circulating levels of tumour necrosis factor-α (TNF-α) and interleukin-10 (IL-10) were estimated in diseased calves with and without exophthalmia as compared to healthy controls. Contrarily, significantly (P ≤ .01) lower interferon-γ (IFN-γ) level was estimated in diseased calves. The diseased calves with exophthalmia revealed significantly higher levels of TNF-α (P ≤ .001) and IL-10 (P ≤ .006) as compared to the diseased calves without exophthalmia. The diseased calves were not found to have an elevated intraocular pressure; rather they had significantly (P ≤ .001) lower intraocular pressure compared to the healthy controls. An elevated systemic TNF-α level might be attributed to the exophthalmia in calves with tropical theileriosis. The elevated circulatory IL-10 and reduced IFN-γ levels could be one of the strategies of Theileria annulata to escape the host immunity.     

Peripheral Neurectomy: Minimally Invasive Surgical Modality for Trigeminal Neuralgia in Indian Population: A Retrospective Analysis of 20 Cases

Objective

To evaluate the efficacy of peripheral neurectomy in 20 cases of trigeminal neuralgia as minimally invasive surgical treatment modality.

Materials and methods

Twenty (12 males and 8 females) patients with trigeminal neuralgia aged between 35 and 68 years (mean 48 years), who had undergone peripheral neurectomy, were retrospectively analyzed for relief of pain, complications, recurrence of pain, and any additional procedure required to treat recurrence, in a follow-up period of 36 months postoperatively.

Results

There was no significant intra-operative and post-operative complications. There was recurrence of pain in two patients (10 %) in 24 and 28 months post-operative follow-up respectively, whereas, rest of the 18 patients were symptom free during 36 months follow-up.

Conclusion

Peripheral neurectomy is one of the minimally invasive and expeditious forms of surgical modality for the treatment of trigeminal neuralgia. This treatment option is cost effective and provides long term relief from neuralgic pain.     

BiOCl/WS2 hybrid nanosheet (2D/2D) heterojunctions for visible-light-driven photocatalytic degradation of organic/inorganic water pollutants

This report presents the superior visible-light-driven photocatalytic response of novel 2D/2D BiOCl/WS₂ (BW_X) hybrid nanosheet heterojunctions prepared by a simple solution based sonochemical technique. These BW_X hybrid nanosheets are composed of 2D transition metal dichalcogenide material WS₂ and BiOCl nanosheets. The comparative study of photocatalytic activity of BiOCl and BiOCl/WS₂ hybrid nanosheets is carried out via photodegradation of Malachite Green (MG) and photoreduction of heavy metal ion Cr(vi) under visible light irradiation. The quantum efficiency of the samples is estimated in terms of the incident photon to electron conversion efficiency (IPCE) measurements. Nearly 98.4% of the MG degradation was achieved over BiOCl/WS₂ (2%) photocatalyst in 45 min of irradiation. BiOCl/WS₂ (2%) hybrid nanosheet catalyst showed the highest external quantum efficiency (EQE) in both the UV and visible regimes. This accomplishment demonstrated the promise of commercial application of the 2D/2D BiOCl/WS₂ (2%) hybrid nanosheet photocatalyst.

Achieved highest photocatalytic performance of 2D/2D BiOCl/WS₂ (2%) hybrid nanosheets for MG degradation (∼98.4% in 45 min) and Cr(vi) reduction.     

Viral hepatitis: A brief introduction,review of management,advances and challenges

Viral hepatitis represents a major public health hazard and is associated with significant global mortality. Over the last decade, there have been significant developments in the prevention and treatment of viral hepatitis. These changes have led to a situation whereby global elimination has become a realistic goal, fully endorsed by the World Health Organization (WHO). By 2030, the WHO aims to reduce viral hepatitis mortality by 65% and reduce new infections by 90% by 2030. These are ambitious targets and will only be met through a sustained programme. This will require expertise from hepatologists and virologists and the fields of public health and primary care. In this article, we review the causes of viral hepatitis, its management through prevention and treatments, and the most pressing challenges and recent advances.