Medicine as a Corporate Enterprise: A Welcome Step?

The medical profession is set for a change. It is being redesigned as a corporate enterprise. The health-care industry has proved to be lucrative and therefore has seen the entry of newer players from the corporate field into the market. The “Medical-Industrial complex” has led to the commercialization of health care well beyond what traditional practitioners would consider ideal. Medicine is being treated as a business, with cost curtailment measures and profit margins often dictating physicians' choices. A number of factors decide working environment in a corporate setup, all of which may affect the sacrosanct physician-doctor relationship and “physician” ethics. On the other side, the ability of the corporate sector to bring about a welcome change in the health-care sector in terms of availability of newer modalities of management, implementation of preventive and personalized health-care programme and, at the same time, adding to the comfort of the treating physician cannot be ignored

ASIAN JOURNAL OF MEDICAL SCIENCES DOI:10.3126/ajms.v1i1.2794 Analysis of Limb Injury Patterns in Victims of two Wheeler Accidents

Objectives: A retrospective study was carried out to analyse the two wheeler accidents that presented over a one year period to a single institution and to study the pattern of limb injuries according to zones assigned to the limb. The mode of injury in the two wheeler accidents and the differences in limb injuries between the driver and the pillion riding passenger were also studied. Methods: All the road traffic accidents that could be attributed to two wheelers were obtained with the help of trauma records and the nominal registers and ward records. Limb injuries were then assigned to various anatomical zones that were created for the purpose of the study. The upper limb and lower limb injuries were separately analysed for differences between the driver and the pillion rider. Results: There were 242 two wheeler accidents seen between 1st jan 2008 to 31st dec 2008, of these 110 had limb injuries. 96 cases were eventually included and of these 67 were drivers. The most common mode of injury was a skid and fall of the vehicle ( 42%). Pillion riders were injured more often in collisions between two and four wheelers. The commonest injury in drivers was in wrist and hand regions of the upper limb and the tibia and ankle regions of the lower limb. In the pillion rider, lower limb injuries were commonest in the tibia and ankle whereas in the upper limb shoulder and wrist injuries predominated. Conclusion: Two wheeler accidents cause significant morbidity in both the driver and pillion rider, the tibia and ankle are commonly injured in both the populations whereas minor differences in upper limb injury are seen between the two groups

Neuropathic pain among patients with primary knee osteoarthritis: Results of a cross-sectional study from a tertiary care center in Southern India

Background: Pain in knee osteoarthritis (OA) may have a neuropathic component. We used the Douleur Neuropathique in 4 questions (DN4) questionnaire to assess neuropathic pain in knee OA and to identify factors associated with neuropathic pain. Methods: A total of 161 patients with knee OA satisfying the American College of Rheumatology 1986 classification criteria for knee OA were prospectively studied. DN4 questionnaire was administered; a score of ≥4/10 was classified as diagnostic for neuropathic pain. The Indian version of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess pain, stiffness, and physical function. Factors associated with neuropathic pain were explored. Results: Mean age was 55.7 ± 8.8 years. The mean total Indian WOMAC was 75.07 ± 13.8 and WOMAC pain score was 16.1 ± 3.6. Seventy-nine patients of 161 (49%) had DN4 score ≥4 (neuropathic pain present). When diabetics were excluded (n = 58), the proportion of patients with DN4 score ≥4 reduced to 45.6%. The most frequently described pain characteristic was sensation of electric shock (58.4%). Mean total WOMAC and physical function subscale were significantly higher in neuropathic pain group when compared to the group without neuropathic pain (DN4 ≤3), 77.5 ± 11.5 versus 72.6 ± 15.5, P = 0.024 and 54.3 ± 8.8 and 49.8 ± 12.6, respectively, P = 0.008. Conclusions: Neuropathic pain (DN4 ≥4) was seen in up to 49% patients with knee OA. Centrally acting drugs such as tricyclic antidepressants or duloxetine can be used to improve the quality of life and physical function of knee OA patients with neuropathic pain

A study of incidence and risk factors of Surgical site infection following orthopedic surgical procedure in a tertiary care hospital in south India

Introduction: Surgical site infection following orthopaedic surgeries is a particularly catastrophic complication. So identification and stratification of risk factors of surgical site infection is utmost important in implementation of measures to prevent surgical site infection. Materials and Methods: This study was done in JIPMER Puducherry between January 2013 and August 2014. We aimed at identifying the incidence of surgical site infection and also tried to find out the factors associated with a higher risk for SSI. We studied a total of 249 patients, and collected their demographic data as per our proforma and at the end of the study data was compared among two groups of patients (patients with SSI vs Patients without SSI). Results: We found in our study that the incidence of patients developing surgical site infection as 11.6% (29 patients). BMI (>25), use of C arm, duration of surgery (>3 hours), duration of closed suction drain (>2 days) and amount of collection of drain (>170 ml) are risk factors of post-operative wound discharge and infection. Conclusion: The present study shows that incidence of surgical site infection in our patient population is11.6%, and out of various parameters studied we found that, BMI, use of C-arm, blood transfusion, duration of closed suction drain and amount of collection in suction drain to be important risk factors for the development of surgical site infectio