Introduction. Patients with chronic liver disease (CLD) are more likely to have severe morbidity and fatality rate due to superimposed acute or chronic hepatitis B (HBV) infection. The literature has shown that hepatitis B vaccines are safe and effective in patients with CLD, but the data in cirrhosis liver is lacking. We assessed the safety and immunogenicity of HBV vaccine in patients with cirrhosis liver. Methods. CTP classes A and B CLD patients negative for hepatitis B surface antigen and antibody to hepatitis B core antigen were included. All patients received three doses of hepatitis B vaccine 20 mcg intramuscularly at 0, 30, and 60 days. Anti-HBs antibody was measured after 120 days. Results. 52 patients with mean age 47.48 ± 9.37 years were studied. Response rates in CTP classes A and B were 88% and 33.3%. We observed that the alcoholic chronic liver disease had less antibody response (44%) than other causes of chronic liver disease such as cryptogenic 69% and HCV 75%. Conclusions. Patients with cirrhosis liver will have low antibody hepatitis B titers compared to general population. As the age and liver disease progress, the response rate for hepatitis B vaccination will still remain to be weaker.

Demographic profiles, volume consumed, time to hospitalization, clinical presentation, laboratory findings, treatment details, and outcomes of patients with hair dye poisoning were analyzed to assess the effect of Super Vasmol 33. The efficacy of methylprednisolone as compared to hydrocortisone in patients was also investigated. Findings show that there are significant differences in the clinical profiles laboratory markers such as markers of leukocytosis, rhabdomyolysis, and hepatitis among patients who consumed fewer volumes than larger volumes. Toxicity is dose dependent with increased morbidity and mortality. Consumption of even lower volumes resulted in hepatitis. For an apparently similar clinical and laboratory profile of patients, treatment with hydrocortisone is as effective as methylprednisolone in the clinical outcomes. These findings suggest that Super Vasmol 33 is emerging as a major source of poisoning.

Background and Aims:Dexmedetomidine (Dex), a highly selective α2-adrenoreceptor agonist, is used for sedation management in various clinical settings and shows anaesthetic-sparing effect. Our aim was to study the effects of Dex on requirements of propofol, ketamine, and intraoperative haemodynamic variations during burns debridement and dressing changes, and compare its effectiveness and safety with combination of ketamine and propofol.Methods:Sixty adult patients posted for elective debridement and dressing were included in the study. Thirty patients received Dex (intramuscular)(IM) 1 μg/kg, 1 h before shifting to the operation theatre while the other thirty did not. Anaesthesia was induced with propofol and ketamine followed by adjusted infusion to achieve a Ramsay Sedation Scale score (RSS) of six in all patients. Intraoperatively haemodynamic parameters were recorded at regular intervals of 5, 15, 30, 45, and 60 min. The mean data between the groups were compared by unpaired t test and medians by Mann-Whitney U test. Within group analysis was performed by using repeated measures ANOVA. P < 0.05 was considered significant.Results:The dose requirement of ketamine and propofol in Dex group was significantly lower when compared to control group (100.5 ± 17.58 mg vs. 231.5 ± 60.39 mg (P < 0.0001) and 127.7 ± 15.47 mg vs. 254 ± 59.22 mg (P < 0.0001) respectively). Additionally, recovery time was lower in the Dex group as compared to the control group, 9.57 ± 1.50 min vs. 11.53 ± 2.56 min (P = 0.0006). Haemodynamic variations were also significantly lower in the Dex group as compared to the control group.Conclusion:Dexmedetomidine (1 μg/kg IM) reduced the requirement of propofol and ketamine, with more stable intraoperative haemodynamics.

Background. We assessed the prescribing trends, average number of drugs per prescription, and cost per prescription during the initial contact of the patient with the physician in emergency room. Methods. This retro-prospective study was conducted over a period of six months. Medical records of two hundred patients were reviewed for prescribing patterns. Results. 52 different types of drugs (996 drugs) were prescribed in total 200 prescriptions during the mean time spent in emergency room of 2.8 ± 1.4 hours. The average number of drugs per prescription was 4.2 ± 1.2. 95% of drugs were prescribed by trade name. Average drugs cost per prescription was 784 ± 134 rupees (17USD). Conclusion. Polypharmacy remains the main form of irrational prescribing. Prescribing patterns of drugs were knowledge based rather than WHO criteria for rational use of drugs.

Aim. To evaluate the antibacterial activity of four endodontic sealers on Enterococcus faecalis by a direct contact test. Material and Methods. Enterococcus faecalis was used as a test organism. Direct contact test which is based on measuring the effect of close contact between test bacteria and tested material on the kinetics of bacterial growth was performed to overcome the disadvantages of agar diffusion test. The sealers tested were zinc oxide eugenol-based sealer, glass-ionomer-based sealer, polydimethyl-siloxane-based sealer, and urethane dimethacrylate resin-based sealer. Data was collected by recording the optical density with the help of a spectrophotometer. Results. The sealers exhibited different inhibitory effects. The results obtained were subjected to statistical analysis by Kruskal Wallis analysis of variance and Dunn's multiple comparison test. Group comparison showed very highly significant difference between the groups. Conclusion. Zinc oxide eugenol-based sealer was the most effective and urethane dimethacrylate resin-based sealer was the least effective against Enterococcus faecalis, whereas glass-ionomer-based and polydimethyl-siloxane-based sealers were effective only for a short period. Inhibition of the bacterial growth is related to the direct contact of the microorganism with the sealer.