आघात एवं उपचार जर्नल

This is an open label, descriptive, single-arm study of patients, 2 to <18 years of age conducted at the out-patient department, Research Institute for Tropical Medicine (RITM), the primary objective of which is to evaluate the effectiveness and safety of silver sulfadiazine in preventing infection in potentially contaminated traumatic wounds among children 2 to <18 years of age.

All of the 50 subjects enrolled had contaminated wound upon enrolment, without oral antibiotics and other topical medications previously used. After seven days of Flammazine application, 100% had clinical successand after 14 days of application, 100% of the subjects likewise had persistent clinical success. At baseline, the most common criteria present was pain (96%) followed by erythema (94%). 58% had mild itching, and 56% had mild tissue edema. Overall, the SIRS (Severity of Infection Rating Scale) scores improved after 7 days (100%) and 100% of the subjects had SIRS score of 0 after 14 days.

The study has shown that 1% Silver Sulfadiazine appears to be an effective and safe alternative to antibiotics in the management of wound infections which are potentially contaminated among children 2 to <18 years of age.

The psychotropic medications that we commonly use in our day-to-day life clinical practice are comparable to the players of a football team. If benzodiazepine, whether it is lorazepam, clonazepam, or clobazam is our goalkeeper, then in a 4-3-3 formation we have four strong defenders in the form of fluoxetine, sertraline, paroxetine, and escitalopram. If Lithium is our central defensive midfielder, then the two wingers of our team are valproate and carbamazepine. With quetiapine as our central attacking midfielder, the two lethal strikers at our disposal are risperidone and olanzapine. Thus, we have a good team of 11 players. And we are ready for our game against psychiatric disorders. But, like injury being commonplace for players in a football field, also we have to deal with adverse effects in our practice; sexual dysfunction is one of them. From a category-based classification of psychotropic medications, we are moving towards a mechanism-based one. Talking about mechanisms, prolactin raising ‘antipsychotic’ is responsible for sexual dysfunction associated with psychotropic use. ‘Antidepressant’ with higher serotonergic property can also cause sexual dysfunction. There are practical solutions to the problem. Prolactin sparing antipsychotic has less potential to cause sexual dysfunction. Among antidepressants, mirtazapine and bupropion are useful agents. At times, treatment with molecules like sildenafil is necessary. When we combine with this pharmacological approach that of psychosocial intervention, we arrive at a synergic reaction. The ultimate goal is to tailor make our treatment, or in other words ‘personalised medicine in psychiatry’.

It is human nature not to deviate from accepted norms as we become accustomed to them. Medical science is a fast-growing science which is being practiced at many places and in many different ways. No doubt various societies are formed and many conferences are organized top compare results and to bring a uniformity in coining and defining medical terms.

Pre-existing alcohol related complications are a common occurrence amongst individuals admitted for Traumatic Brain Injury (TBI) and is estimated to be about 44% to 66% in TBI patients. In fact, alcohol intoxication is a major cause of TBI. The contribution of alcohol abuse as a cause of TBI and its influence over the pathophysiology of TBI is well studied and well known. However, the influence of TBI on alcohol consumption is still in its preliminary stages. The underlying reasons for it may be the complex interaction between the pathological changes induced by TBI itself and changes in environmental factors following an episode of TBI. The resulting alteration in alcohol-related behaviors post-TBI can affect cognitive and neurological functions and thus can influence the overall recovery of the patient.

Hence, understanding changes in alcohol behavior after TBI, with respect to the timing and causes responsible for the change, is important from the perspective of long-term outcome in these patients. In this review article, we discuss a number of studies to determine changes in alcohol drinking behavior following TBI and summarize the findings with respect to the timing of significant change in behavior, as well as the factors influencing this change. Overall it can provide an important piece of information regarding the preventive measures in a major subset of the population at risk of alcohol-use disorders and utilizing them at a time when the prevention can have a maximal impact.

On July 24th 2017, the Association of the United States Army (AUSA) held a panel discussion to discuss the United States Army-Marine Corps White Paper entitled, “Multi-Domain Battle (MDB): Combined Arms for the 21st century.

Introduction: Cryotherapy has been widely used as an acute treatment for traumatic injuries. However, it is rarely continuously used for fracture treatment for several weeks, particularly for refractory fractures. Some judo therapists, who can treat traumatic injuries under the Japanese law, use cryotherapy as a continuous treatment for fractures. Herein, we report a case of Jones fracture (refractory) treated by a therapist using continuous cryotherapy.

Case presentation: A 49-year-old woman had a non-transposable Jones fracture located at the metaphysis of the right 5th metatarsal from an inversion injury in the ankle. At this time, the patient had severe pain and swelling, and her walking ability was impaired. Three days after the fracture, the therapist started conservative treatment mainly using cryotherapy for the lesion part for 15 min thrice every day; splint-fixation using a hard cardboard was then performed using the standard style of the Japanese Judo therapy.

Fifteen days after the fracture, the numerical rating scale (NRS) score of the patient notably decreased to 1.5 compared with the first NRS score of 10. Moreover, pain upon normal walking with full-weight bearing completely resolved, and the ankle had a full range of motion. Moreover, there was no muscle atrophy.

Twenty-four days after the fracture following daily cryotherapy, the NRS score was 0, and there were no problems in the performance of activities of daily living and work. Moreover, mild running and going up and down the stairs became possible.

Finally, the patient showed excellent clinical and functional results at the two-month and one-week follow-up, and the side effects of this therapy were not observed.

Conclusion: This case highlights the use of cryotherapy as a continuous treatment for Jones fracture.