Clinical evaluation of post-operative analgesia comparing suprascapular nerve block and interscalene brachial plexus block in patients undergoing shoulder arthroscopic surgery.

BACKGROUND: Shoulder arthroscopic surgeries have a high incidence of severe post-operative pain significant enough to interfere with recovery and rehabilitation. A regional anaesthetic technique combined with general anaesthesia reduces intra-operative requirements of anaesthesia and provides a better post-operative pain relief. As the commonly employed technique of interscalene brachial plexus block (ISB) is associated with potential serious complications, suprascapular nerve block (SSB) can be used as a safer alternative. METHODS AND MATERIAL: In this prospective study, 60 ASA 1 or 2 adult patients undergoing shoulder arthroscopic surgery were randomised into two groups - ISB and SSB. In group ISB, ISB with 20 ml of 0.5% bupivacaine mixed with 75 µg clonidine was given. In the SSB group SSB was given with 15 ml of 0.5% bupivacaine with 75 µg clonidine. Pain was assessed using visual analogue scale and verbal pain scale scores and time to first rescue analgesia was noted. We used Student's t test and Chi-square/Fisher Exact test and used a statistical software to compare data. RESULTS: In the present study, the mean duration of analgesia was 2.53 ± 2.26 h in SSB group compared to 7.23 ± 6.83 h in group ISB (p value < 0.05). Overall rescue analgesic requirements were higher in SSB group compared to ISB group (63.3% versus 40.0%) but this was statistically not significant (p value > 0.05). CONCLUSION: Both interscalene and SSB can be used to provide intra-operative and post-operative analgesia in patients undergoing shoulder arthroscopy.

Fatal rabies despite post-exposure prophylaxis.

Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.

Epidemiology of cholera--a five year study.

A total of 286 strains of Vibro Cholerae were isolated and tested over a period of five years. The strains were identified by standard methods and confirmed by slide agglutination tests with polyvalent, Ogawa and Inaba antisera. The non-agglutinating strains were tested with O-139 antisera. The maximum number of cases were found in the age group of 0-10 years. The number of females affected was more than the males. V. cholerae O-139 was isolated in the year 1998 and then again in 2000. V. cholerae serotype Inaba was found only in the year 1999. All of the other isolates belonged to the serotype Ogawa. The periodic shift between O1 and O-139 serogoups is reminiscent of the shifts from the Ogawa to the Inaba serotypes periodically witnessed among V. cholerae, possibly mediated by the immune pressure in the population.

Prevalence of resistant Staphylococcus aureus at Aurangabad.

Seven hundred and eighty three isolates of Staphylococcus aureus isolated from pus (586), blood (78), sputum (25), urine (23), cerebrospinal fluid (23) and various other body fluids (48) were subjected to in-vitro antimicrobial susceptibility testing by modified Kirby-Bauer method. Almost all the isolates were resistant to penicillin (99.62 per cent) and ampicillin (99.62 per cent). Resistance to erythromycin, tetracycline and cotrimoxazole was observed in 88.5, 87.62, and 80.85 per cent isolates respectively. Resistance to gentamicin was 68.32 per cent. Resistance to most of the commonly used antimicrobial agents indicates a need to replace these drugs with other agents and maintenance of surveillance to detect changing patterns of resistance.

Changing aetiology of urinary tract infections and emergence of drug resistance as a major problem.

A study was undertaken to ascertain the spectrum of causative agents responsible for UTI and to detect the magnitude of anti microbial resistance in aetiological agents. Klebsiella species caused urinary tract infection in maximum number of cases (124, 37.35%) followed by Escherichia coli (114, 34.4%), Pseudomonas aeruginosa 32 (9.64%) and Staphylococcus aureus 23 (6.93%). Other organisms caused urinary tract infection in 39 (11.75%) cases. Resistance to gentamicin was observed in 83% S. aureus, 84.7% Klebsiella species, 78.1% Escherichia coli, 71.9% Pseudomonas aeruginosa and 94.8% of remaining isolates. A large number of isolates (> 90%) were resistant to ampicillin, Cotrimoxazole erythromycin, and chloramphenicol. All the isolates of S.aureus were resistant to penicillin. This observations indicate extremely high degree of resistance in urinary pathogen and warrant change in antibiotic usage as well as formulation of policy for rational use of antibiotics.