Role of STIMULAN in chronic osteomyelitis-A randomised blinded study on 95 patients comparing 3 antibiotic compositions, bead quality, forming & absorption time.

Introduction: Chronic Osteomyelitis is a well-known clinical entity affecting patients holistically and presents with multiple treatment challenges. Local antibiotic delivery with biodegradable drug carriers has shown promising results. Materials and methods: Prospective multicenter study performed at 2 centers from November 2021 to January 2023 on 95 osteomyelitis patients treated with surgical debridement & STIMULAN™ for local antibiotic delivery. Patients were randomized into 3 groups. Authors compared antibiotic combinations, bead quality, bead setting, and resorption time for calcium sulfate beads- STIMULAN™. Additionally, organisms isolated, WBC Turnover time, Hypersensitivity Reactions, Recurrence, and Revision Rates were documented. Results: 95 patients underwent surgical debridement and STIMULAN™ bead application for chronic osteomyelitis. The proximal 1/3rd tibia was commonly affected. The most common symptoms were sinus and pus discharge in 96.84 % & 86.31 % of patients respectively (p < 0.001). Staphylococcus aureus & MRSA were isolated in 37.8 % & 29.4 % of the patient's wound culture respectively. Bead setting time in Descending order was Group 3 > Group 2 > Group 1 (p < 0.001). Bead setting first in Group 1 followed by Group 3 & 2. On compression, Group-1 beads withstood maximum compression forces & had smooth even bead surfaces. On radiographs, 1/3rd bead volume in ascending order was Group 3 > Group 2 > Group 1 (p < 0.001). 2/3rd reduction in ascending order was Group 3 > Group 2 > Group 1. Complete bead absorption was earliest seen in Group 3 followed by Group 2 & Group 1 (p < 0.001). Recurrence in 2 patients (Group 2) at 6 weeks. Revision rate: 2.10 %. There were no incidences of hypersensitivity. Suture removal was done at 16 ± 2 days. Conclusion: STIMULAN™ combination with tobramycin, vancomycin, and gentamycin is stable, and forms uniform beads with predictable drug elution & bead resorption with negligible side effects. A mixture with higher liquid content sets later, forms softer beads, and resorbs earlier.

Funding Pattern Comparison Pre- and Post-Ayushman Bharat National Health Scheme (AB-PMJAY) in Active Females Undergoing TKA for Advanced Knee Arthritis with Clinical, QoL Analysis and AB-PMJAY Technical Data.

Introduction: Patients visiting for Knee Arthroplasty have often been treated at neighborhood clinics and bonesetters. India floated world's largest publicly funded national health insurance program -AB-PMJAY covering Knee Arthroplasty. AB-PMJAY's data for Arthroplasty has not been published. Methods: A Prospective study from Jan 2016- Jan 2023 on females undergoing TKA. Age, DEXA Score, Walking Ability, KSS, 10MWT, SF36 Scores, Funding Pattern before and after AB-PMJAY, Time to Approval, Time to discharge, Time to Query reply and Rejection Rates were documented. Results: 790 patients (91.86%) received treatment previously. 650 (78.54%) patients lived with family & 32 patients lost to follow-up. 37.67% & 62.32% patients had Grade. 3 & 4 osteoarthritis respectively. Commonest comorbidity was Vitamin D deficiency followed by Menopause and Hypertension. Post-treatment Vitamin D deficiency reduced from 68.59% to 2.17% at 3 months. Post-surgery, Functional Scores improved significantly at 1st and 6th month. VAS dropped significantly from 7.8 to 3.6 at 1st month follow up. At 6 months, 81.52% patients were independent outdoor walkers compared to 9.42% (baseline). Average hospital stay-54 hours and Return to work- 42 days. Central health scheme beneficiaries rose significantly from 12% (pre-PMJAY) to 42% (post-PMJAY). With AB-PMJAY, no rejection for surgical procedures, Time to surgery approval was 16 hours (mean) and Time to Discharge was 8 hours (mean). Time to reply was 6 hours (mean). Conclusion: Evident rise in patients getting TKA done through AB-PMJAY. TKA has become an affordable and achievable target for financially deprived patients, post regulation of knee implant prices & AB-PMJAY.

Scattered Musculoskeletal Venous Malformations in Children: A Rare Report on Clinical Evaluation and Sclerotherapy with Adjunctive Stasis of Efflux.

Introduction: Venous malformations are rare lesions of unknown etiology, with a reported incidence of 0.8-1%. Patients with inexorable growth and expansion of vascular malformations, or" have an unpredictable clinical course and a wide range of presenting symptoms. Often, they are erroneously diagnosed and inadequately treated due to their rarity and lack of expertise among clinicians. To author's information this is the first report of diffuse venous malformations with multiple phleboliths involving various compartments of the upper extremity in children. Case Report: The uthors discuss the clinical presentation, evaluation, and treatment over 8 months of slow-flow venous malformations with phleboliths in an11-year-old girl presenting with multiple painful swellings throughout her right upper extremity. The right upper extremity had multiple swellings over the right hand, forearm, arm, and shoulder region involving multiple compartments. The digital swellings had bluish discoloration, indicating a vascular nature. Blood tests revealed a raised D-dimer level (2.42 mg/L). Radiographs, Ultrasound, Magnetic resonance imaging, and CT angiography suggested a slow-flow venous malformation. The excisional biopsy confirmed the diagnosis. Ultrasound-guided Sclerotherapy with the Sclerotherapy with Adjunctive Stasis of Efflux Technique was performed for other lesions. Sodium Tetradecyl Sulfate (60 mg/2 mL; 0.5mL) was used in each lesion. Post-intervention, at 6 months follow-up, cosmetic appearance improved drastically, with the hands benefitted most. Parents were satisfied with overall outcome. Sclerotherapy was stopped after 4 cycles. Conclusion: Ultrasound-guided sclerotherapy is effective in treating venous malformations. The ideal result is seen after 4-5 sittings. Sclerotherapy must be performed in the operating theatre under sedation or appropriate anesthesia with resuscitation equipment at the ready disposal. Excision is reserved for bigger superficial lesions.

Reduction in the Rate of Mortality of Moderate to Severe COVID 19 Infected Patients with the use of Remdesivir - A Tertiary Care Hospital-Based Retrospective Observational Study.

Background: As the waves of coronavirus disease 2019 (COVID-19) pandemic continues, the current treatment modalities emphasize the use of antiviral agents to save the human lives. Even though remdesivir is one of the current recommended modalities, data on the efficacy of remdesivir in reducing the rate of 28-day mortality are still not concurrent in all the reports. Aim: The present study aimed to determine the effectiveness of remdesivir in reducing the rate of mortality in a tertiary care hospital as retrospective comparative analysis. Setting and Design: The present study is a retrospective, comparative analysis of accurate and well-documented case files. Methods: Data (n = 262) of COVID-19-infected patients admitted and treated with remdesivir (Gp R; n = 160) and without remdesivir (Gp NR: n = 102) between June 1, 2021, and November 30, 2021, were collected and analyzed to obtain the results. Statistical Analysis: The data from individual case files were transferred to excel files (Microsoft office, Redmond, WA, USA) and then analyzed using Statistical Package for the Social Studies (SPSS, IBM, Armonk, NY, USA). The descriptive statistical values were expressed as mean ± standard deviation and number, frequencies/percentages. Student's t-test, Chi-square test, and ANOVA were employed for comparative statistics. P < 0.05 was considered statistically significant. Results: On analysis of the extracted data, the age, Acute Physiology and Chronic Health Evaluation-IV score, and predicted mortality rate between two groups have not shown significant difference (P > 0.05, ANOVA) and were comparable (P > 0.05, ANOVA). Furthermore, the 28-day mortality rate was significantly reduced (P < 0/001) in the Gp R where the rate of mortality was found to be 6.87%, whereas in Gp NR, it was 29.41%. Conclusion: Treatment with remdesivir was able to significantly increase the rate of survival of the patients and reduction in day-28 mortality when compared with the patients who had undergone treatment without remdesivir. Therefore, the results of the current retrospective, observational analysis from a tertiary care hospital could also be a piece of remarkable information to a significant number of existing data globally.

Premedication with clonidine versus fentanyl for intraoperative hemodynamic stability and recovery outcome during laparoscopic cholecystectomy under general anesthesia.

BACKGROUND: Laparoscopic cholecystectomy under general anesthesia induced intraoperative hemodynamic responses which should be attenuated by appropriate premedication. The present study was aimed to compare the clinical efficacy of clonidine and fentanyl premedication during laparoscopic cholecystectomy for attenuation of hemodynamic responses with postoperative recovery outcome. SUBJECTS AND METHODS: In this prospective randomized double blind study 64 adult consented patients of either sex with ASA I and II, scheduled for elective laparoscopic cholecystectomy under general anesthesia and met the inclusion criteria, were allocated into two groups of 32 patients. Group C patients have received intravenous clonidine 1µg kg(-1) and Group F patients have received intravenous fentanyl 2µg kg(-1) 5 min before induction. Anesthetic and surgical techniques were standardized. All patients were assessed for intraoperative hemodynamic changes at specific time and postoperative recovery outcome. RESULTS: Premedication with clonidine or fentanyl has attenuated the hemodynamic responses of laryngoscopy and laparoscopy. Clonidine was superior to fentanyl for intraoperative hemodynamic stability. No significant differences in the postoperative recovery outcome were observed between the groups. Nausea, vomiting, shivering and respiratory depression were comparable between groups. CONCLUSION: Premedication with clonidine or fentanyl has effectively attenuated the intraoperative hemodynamic responses of laparoscopic cholecystectomy.

Dexmedetomidine premedication in relevance to ketamine anesthesia: A prospective study.

BACKGROUND: Ketamine-induced hemodynamic pressor response and psychomimetic effects should be attenuated by appropriate premedication. The present study was designed to evaluate the clinical efficacy and safety of dexmedetomidine premedication for balancing the ketamine-induced hemodynamic pressor response and psychomimetic effects. MATERIALS AND METHODS: A total of 80 normotensive adult consented patients of ASA grade I and II of both genders, aged 21 to 55 years, who met the inclusion criteria for elective surgery under ketamine anesthesia were randomized for this prospective blind study and divided into two treatment groups of 40 patients each. Group I patients received premedication of midazolam and Group II patients received premedication of dexmedetomidine. Anesthetic and surgical techniques were standardized. Both groups were assessed for changes in heart rate and systolic blood pressure intraoperatively and psychomimetic effects with behavioral changes postoperatively. RESULTS: Preoperatively, all patients were awake. Intraoperatively, the heart rate was 116.6±4.2 in group I versus 76.8±5.8 in group II (P value 0.0004) and systolic blood pressure was 153.07±16.05 in group I versus 139.17±19.9 in group II (P value 0.001). Post-anesthetic psychomimetic responses were not statistically significant between groups. CONCLUSION: The dexmedetomidine premedication effectively attenuated the ketamine induced hemodynamic pressor response and post-anesthetic delirium effects.