A community dweller’s perspective of a day shoulder arthroplasty surgery.

The following study was a qualitative interpretive descriptive study aimed at investigating immediate barriers or difficulties in the lives of the community dwellers as well as modifications occurring in the daily routine activities shortly after the out-patient total shoulder arthroplasty procedure. The personal and surgical factors affecting at-home recovery were focussed alongside exploring the coping mechanisms and adaptations in everyday day life. The study mainly focused on the initial three weeks\u27 duration after the discharge. The study followed the constructivist paradigm, adopting the interpretive description methodology. A total of 19 subjects who underwent same/ single day discharge total shoulder arthroplasty were targeted for recruitment at the Hand & Upper Limb Centre, St. Joseph’s Hospital by purposeful sampling method. The participants were interviewed either in person or over the telephone. Data was analyzed by Braun and Clarke’s Thematic Analysis Approach. The identified themes shed light upon the physical, emotional, and environmental impacts caused by a day surgery. These are further influenced by demographic characteristics such as age, gender, marital status, and type of occupation as well as surgery-related factors like reason for surgery, availability of supports, surgical literacy, and patient and caregiver education. The adaptations for basic everyday tasks were dependent upon the living conditions post-operatively. The importance of social and community supports as well as patient and caregiver education especially after a day surgery were highlighted. Preparedness for surgical procedures yield higher satisfaction and better patient experience was a noble finding

Drug utilization pattern of antimicrobial drugs in intensive care unit of a tertiary care hospital attached with a medical college

Background: A number of antimicrobial drugs are prescribed to the patients in Intensive Care Unit (ICU). Drug utilization research was defined by WHO as the study of marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. There is lack of information about the use of antimicrobial agents in the ICU at GGGH till date. So we decided to conduct this type of study.Methods: A prospective observational study was carried out for 12 months. Patients of age >18 of both sexes who was admitted in ICU were included in the study while pregnant and lactating women excluded. The prescribing pattern was analyzed by using World Health Organization basic drug indicators. Results: Among 611 patients, 373 (61.04%) were male and 238 (38.95%) were female. The most common emergency was post-operative 204 (33.38%).The most common prescribed antimicrobial drug group and drug was antiamoebic drugs and metronidazole respectively in 437 (24.04%) out of total drugs prescribed. The numbers of antimicrobial drugs prescribed per patient were 2.97. 68% drugs were prescribed from WHO and national EML list. Total 57.26% drugs were prescribed by generic name. Average antimicrobial drug cost per patient was 1805.34 rs.Conclusions: Despite of limitations of present study it gives important conclusion about how antimicrobial drugs are used in GGGH ICU. This information can be used for improvement of current treatment strategies

Drug utilization study of psychotropic drugs in outdoor patients in a tertiary care hospital attached with a medical college

Background: Psychotropic drugs have a great importance in psychiatric practice. Today many newer drug like selective serotonin reuptake inhibitors and atypical antipsychotic drugs has changed treatment protocol. Hence, the study was carried out to find morbidity pattern of psychiatric illness and prescribing pattern of psychiatric illness.Methods: A prospective cross-sectional study was carried out for 12 months. Patients of all ages and both sexes were included in the study while inpatients and referred patients were excluded. The prescribing pattern was analyzed by using World Health Organization (WHO) basic drug indicators.Results: Among 600 patients, male patient were 291 (48.50%) and female patient were 309 (51.50%). The most common disorder was depression 208 (34.66%) followed by schizophrenia 192 (32.00%). The numbers of psychotropic drugs prescribed a patient were 2.51. 39.39% drugs were prescribed from the WHO essential medicines list. Total 89.18% drugs were prescribed by generic name. Benzodiazepines were the most common prescribed drugs. Atypical antipsychotic drugs were commonly used than typical antipsychotic drugs. Central anticholinergic drug was used in 43.15% patients receiving antipsychotic drugs.Conclusion: Overall, the drugs were prescribed rationally. Benzodiazepine should be prescribed only for short-term duration. Use of central acting anticholinergic drugs with all antipsychotic drugs was not justified

An Innovative New Treatment for Asherman Syndrome with an Intrauterine Amniograft: A Case Series

Objective: To determine if placing a cryopreserved amniotic membrane product (AmnioGraft) at the time of hysteroscopic treatment for Asherman syndrome will promote regeneration of the endometrium.Methods: This case-series evaluated the use of an allogenic AmnioGraft technology on women with the diagnosis of severe Asherman syndrome, a thin endometrial stripe, and a desire for future fertility. An AmnioGraft is a novel treatment modality to reduce infl ammation and adhesion formation after hysteroscopic adhesiolysis. The AmnioGraft is designed to prevent scaring, reduce infl ammation, and promote wound healing, which would be benefi cial in the treatment of Asherman syndrome. After obtaining consent, women underwent operative hysteroscopy, lysis of intrauterine synechiae under ultrasound guidance, and curettage. A 3.5x3.5cm AmnioGraft was wrapped around a Cook intrauterine balloon stent and inserted into the uterus for two weeks.Results: Ten women received the AmnioGraft between the years 2011-2015. Six of the ten women had amenorrhea prior to the surgery (ranging from 1.5-12 months of amenorrhea), and all of the women achieved menses post-operatively. The average change in the pre to post-operative endometrial thickness was an increase of 3.3mm. Four of the ten women achieved pregnancy.Conclusion: The AmnioGraft may provide an alternative treatment option for patients with Asherman syndrome who desire future menses and pregnancy. Larger randomized studies need to be performed to confirm this result.</p

Knowledge, attitude and practice of self medication among the staff-members of Charotar University of Science and Technology: Knowledge, Attitude and Practice of Self Medication among the Staff-members

Self-medication raises its occurrence in many situations in our everyday lives, which is an inappropriate and harmful practice. A research framework was conducted to evaluate the awareness, attitude and practice of self-medication among the CHARUSAT University staff members. Among the staff members, a pre-validated questionnaire was circulated. Using Microsoft Excel, information was gathered and evaluated and the results were represented as numbers and percentages. A total of 136 staff-members voluntarily took part in the study. We found that source of information of the drugs used for self-medication were “previous prescription (77.7%)” and the source of drugs was “medical store (78.8%)”. Only (34.3%) staff-members accepted the fact that they always visited a qualified practitioner whenever they got sick. Most of the staff-members took self-medication for headache (73.5%) followed by cough, cold, sore throat (73.5%) and fever (56.6%). Out of total 136 staff-members, most of them took Analgesics (61.8%) as self-medication followed by lozenges (66.2%). For almost 66.9 % of university staff members, self-medication was common. They provided a reason that “no need to visit a doctor for minor illnesses”. 73.5 % of the population has taken cough and cold preparations as self-medication

A Non-Invasive Determination of LOXL1 and Fibulin-5 Levels in the Vaginal Secretions of Women with and Without Pelvic Organ Prolapse.

The aim of this study was to determine if lysyl oxidase-like 1 (LOXL1) and Fibulin-5 (Fib-5), two crucial proteins in the elastin metabolism pathway, are detectable in the vaginal secretions of women with and without pelvic organ prolapse (POP). We then sought to quantify levels of these proteins in relation to prolapse. Vaginal secretions were obtained from 48 subjects (13 (27.1%) without and 35 (72.9%) with POP-Q Stage 2-4 prolapse). Eleven (22.9%) subjects were premenopausal and 37 (77.1%) were postmenopausal. Presence of LOXL-1 and Fibulin-5 within specimens were first identified via western blotting. Enzyme-Linked Immunosorbent Assays specific for LOXL1 and Fibulin-5 were conducted to quantify total protein secretion. LOXL1 was detected in 45/48 (93.8%) and Fibulin-5 was seen in 24/48 (50%) of subjects. LOXL1 values were lower in women without prolapse (13.3 ng/100 mg median, 24.4 IQR) vs. those with prolapse (26.4 ng/100 mg, 102.2 IQR). On multivariate analysis controlling for age, women with prolapse had a 544% (p=0.0042 higher LOXL1 protein level compared to those without. There was no significant differences in LOXL1 or Fibulin-5 protein detection with relation to menopausal status in bivariate analysis. This is the first published report of non-invasively measuring urogenital LOXL1 and Fibulin-5. In vaginal secretions, LOXL1 protein is higher in subjects with POP than those without

Drug utilization pattern of antimicrobial drugs in intensive care unit of a tertiary care hospital attached with a medical college

Background: A number of antimicrobial drugs are prescribed to the patients in Intensive Care Unit (ICU). Drug utilization research was defined by WHO as the study of marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. There is lack of information about the use of antimicrobial agents in the ICU at GGGH till date. So we decided to conduct this type of study.Methods: A prospective observational study was carried out for 12 months. Patients of age &gt;18 of both sexes who was admitted in ICU were included in the study while pregnant and lactating women excluded. The prescribing pattern was analyzed by using World Health Organization basic drug indicators. Results: Among 611 patients, 373 (61.04%) were male and 238 (38.95%) were female. The most common emergency was post-operative 204 (33.38%).The most common prescribed antimicrobial drug group and drug was antiamoebic drugs and metronidazole respectively in 437 (24.04%) out of total drugs prescribed. The numbers of antimicrobial drugs prescribed per patient were 2.97. 68% drugs were prescribed from WHO and national EML list. Total 57.26% drugs were prescribed by generic name. Average antimicrobial drug cost per patient was 1805.34 rs.Conclusions: Despite of limitations of present study it gives important conclusion about how antimicrobial drugs are used in GGGH ICU. This information can be used for improvement of current treatment strategies

Utility of point-of-care ultrasound in differentiating causes of shock in resource-limited setup

Background: Delivering early diagnosis of shock in resource-limited setting is challenging, especially with limited availability of point-of-care laboratory and radiological diagnostic facilities. There is growing urgency to provide point-of-care diagnosis and treatment for time-sensitive condition like shock. Aims: We tried to evaluate the application of point-of-care ultrasound (Rapid Ultrasound for Shock and Hypertension [RUSH] protocol) considering different disease cohort and practice realities in our setup. Settings and Design: This study was a single-center prospective diagnostic study to check the diagnostic accuracy of point-of-care ultrasound (RUSH protocol). This study was approved by the ethics committee. Materials and Methods: The study was conducted at the emergency medicine department of a tertiary care government hospital in Central Gujarat from November 16 to October 17. All adult patients with clinical features of shock with systolic blood pressure 1 presenting to emergency department were included as participants. The results of point-of-care ultrasound (RUSH protocol) were compared with the diagnosis given by consultants of respective department as per standard departmental practices. Statistical Analysis and Results: A total of 130 patients were enrolled in this study. Mean time taken to examine by the point-of-care Ultrasound (RUSH protocol) was 12 min (range 11–14 min). Kappa index was 0.860. This protocol was able to correctly diagnose 100% of obstructive shock, 96.3% of cardiogenic shock, 94.4% of hypovolemic shock, 80.9% of mixed type of shock, and 75% of distributive type of shock. Conclusion: This study highlights the role of point-of-care ultrasound (RUSH protocol) for early diagnosis of the shock etiology in emergency medicine department. Diagnosis using point-of-care ultrasound (RUSH protocol) significantly agreed with medical diagnosis. It showed good efficacy of point-of-care ultrasound (RUSH protocol) to differentiate causes of shock with good accuracy except distributive shock