iosr-JDMS   Volume-11 ~ Issue-5

Abstract: Oral care is a vital component of holistic nursing in hospitalized patients and its provision influences the overall wellbeing of patients. Aim: To compare the effectiveness of 0.2% chlorhexidine and oral routine care in terms of oral health status and oral microbiological colony count of self care deficit clients. Setting and Design: Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMS&R) Hospital Mullana Ambala. A true experimental, pre test- post test control group design was used. Method and material: Sixty self care deficit clients were selected using purposive sampling technique and were randomly assigned to experimental (0.2% chlorhexidine) and control group (oral routine care) by using lottery method. The data was collected by "modified Beck oral assessment scale" and "oral microbiological colony count recording sheet". Statistical Analysis Used: The data were analyzed using chi-square, paired t-test and unpaired t-test. Results: The finding of the study indicated that both the groups (experimental and control group) were homogenous before administering oral care. After administering oral care, the mean oral health status score was significantly lower in experimental group than control group (6.10 versus 11.57; "t‟= 8.90; df=58; p = 0.001). The mean oral microbiological colony count of Candida (50.93 versus 217.37 ), Moraxella Catarrhalis (44.70 versus 185.83 ), Alpha Hemolytic Streptococci (52.77 versus 183.80), Klebsilla (55.63 versus 178.10) and CoNS (64.5 versus 186.60 ) was significantly lower in experimental group than control group ( p <0.05). No significant association was found among levels of oral health status and levels of oral microbiological colony count with selected demographic and clinical variables. Conclusion: 0.2% chlorhexidine was more effective than oral routine care in improving oral health status and decreasing oral microbiological colony count among self care deficit clients.

Keywords: 0.2% Chlorhexidine oral care, Mircobiological colony count, Oral health status, Oral routine care, Self care deficit clients.

[1]. Ulman Almanda, "0.2% chlorhexidine oral care in icu clients in terms of oral health status" http://eprints.qut.edu.au/31765/1/Amanda_Ullman_Thesis.pdf (Book style with paper title and editor)
[2]. Developing and implementing an oral care policy and assessment tool [internet] http://nursingstandard.rcnpublishing.co.uk/archive/ article
[3]. Morris Braham R, "Oral health and care in the intensive care unit: state of the science." Am J Crit Care 13(1), 2001: 25-33; discussion 34. (book style)
[4]. Tablan OC, "Guidelines for preventing health-care-associated pneumonia: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee" MMWR RecommRep. 2004;53(RR-3):1-36. http://www.guideline.gov. Accessed July 25, 2007. (Conference proceedings)
[5]. Feider LL, " Oral care practices for orally intubated critically ill adults" Am J Crit Care.2010; 19(2):175-183.
[6]. Albandar JM, "Global epidemiology of periodontal diseases: an overview" Periodontology 2002; 29:7-10.
[7]. Spence K, " Nursing management a systems approach, Philadelphia" W. B. Saunders Company, 2000;56-74
[8]. Ullman Amanda, "Oral health of critically ill clients" http://eprints.qut.edu.au/31765/1/Amanda_Ullman_Thesis.pdf
[9]. Becks, H, "dental caries: Prevention and prognosis" J. Am. Dent. Assoc. 2000;31:1189-1200. (book style)
[10]. Nancy J. Ames, " Effects of Systematic Oral Care in Critically Ill Patients: A Multicenter Study" Am J Crit Care 2011;20:e103-e114 (book style)

Abstract: Thygeson's superficial punctate keratitis is a subtle, chronic and bilateral condition of the corneal epithelium, typically manifests with acute exacerbations and remissions. The etiology remains uncertain, despite the possibility of viral etiology was suspected. Topical steroid administration is useful in aborting an acute phase; but steroid induced cataract and glaucoma developed on long term usage. Topical cyclosporine A was used successfully for prolonged periods with minimal ocular surface irritation. The purpose of this case study was to highlight the importance of diagnosing the problem clinically and also to report efficacy and ocular side effects of topical cyclosporine A. Twenty six year old boy presented with persistent foreign body sensation in July 2011, since one month in both the eyes. Slit lamp microscopic examination revealed bilateral, multiple and punctate corneal epithelial lesions. The lesions resolved on topical steroids but recurred after cessation of the therapy. With the daily instillation of topical cyclosporine A, recurrence was not observed in two year follow up. Although topical steroid was useful in aborting an acute phase, the disease remitted on cessation of the therapy. Topical cyclosporine A, used for two years was effective in controlling the exacerbations without discernible ocular side effects.

Keywords: Cyclosporine A (CSA), Polymerase chain reaction (PCR), Thygeson's superficial punctate keratitis (TSPK)

[1]. THYGESON P (1950). Superficial keratitis. J Am Med Assoc; 144(18):1544-9.
[2]. Duszak RS (2007). Diagnosis and management of Thygeson's superficial punctate keratitis. Optometry; 78(7):333-8.
[3]. Connell PP et al (2007). The role of common viral ocular pathogens in Thygeson's superficial punctate keratitis. Br J Ophthalmol; 91(8):1038-41.
[4]. Reinhard T et al (2004). PCR for varicella zoster virus genome negative in corneal epithelial cells of patients with Thygeson's superficial punctate keratitis. Eye (Lond); 18(3):304-5.
[5]. Darrell RW (1981). Thygeson's superficial punctate keratitis: natural history and association with HLA DR3. Trans Am Ophthalmol Soc;79:486-516.
[6]. Nagra PK et al (2004). Thygeson's superficial punctate keratitis: ten years' experience. Ophthalmology; 111(1):34-7.
[7]. Kawamoto K et al (2009). In vivo observation of Langerhans cells by laser confocal microscopy in Thygeson's superficial punctate keratitis. Mol Vis; 15:1456-62.

Abstract: This article describes a male patient who presented with trismus due to submucous fibrosis and how in course of time it turned malignant into oral squammous cell carcinoma. Oral submucous fibrosis (OSF) is a chronic, complex, irreversible, highly potent pre-cancerous condition characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the submucosal tissues (lamina propria and deeper connective tissues). As the disease progresses, the jaws become rigid to the point that the sufferer is unable to open his mouth. The condition is linked to oral cancers and is associated with areca nut chewing, the main component of betel quid. Areca nut or betel quid chewing, a habit similar to tobacco chewing, is practiced predominately in Southeast Asia and India, dating back thousands of years.

[1]. Schwartz, J.: Atrophia Idiopathica (Tropica) Mucosae Oris, Demonstrated at the Eleventh International Dental Congress, London, 1952. (Cited by Sirsat and Khanolkar.:<o)
[2]. Sirsat, S. M., and Khanolkar, V. R.: Submucous Fibrosis of the Palate and Pillars of the Fauces, Indian J. M. SC. 16: 189-197, 1962.
[3]. Joshi, 8. 0.: Submucous Fibrosis of the Palate and Pillars, Indian J. Otolaryng. 4: 1-4, 1953.
[4]. Su, I. P : Idiopathic Scleroderma of the Mouth ; Report of Three cases, Arch. Otolaryng.59: 330-332, 1954
[5]. Baa, R. V., and Raju, P. R.: A Preliminary Report on the Treatment of Sul~mucous Fibrosis of the Oral Cavity With Cortisone, Indian J. Otolnryng. 6: 81-83, 1954.
[6]. Behl, P. N.: Practice of Dermatology, Bombay, 1962, Allied Publishers Private, Ltd. [7]. JensJ. Pindborg,SatyavatiM.Sirsat.Oralsubmucousfibrosis Oral Surgery, Oral Medicine, Oral Pathology, Volume 22, Issue 6, December 1966, Pages 764-779
[8]. Aziz SR. Oral submucous fibrosis: an unusual disease. J N J Dent Assoc1997;68:17–9.
[9]. Pindborg JJ, Mehta FS, Gupta PC, Daftary DK. Prevalence of oralsubmucous fibrosis among 50,915 Indian villagers. Br J Cancer1968;22:646–54.
[10]. Gupta PC, Hebert JR, Bhonsle RB, Sinor PN, Mehta H, Mehta FS. Dietaryfactors in oral leukoplakia and submucous fibrosis in a population-basedcase control study in Gujarat, India. Oral Dis 1998;4:200–6.

Abstract:Necrotizing Fasciitis (NF) is a rapidly spreading flesh eating disease of skin & subcutaneous tissue. It can involve any part of the body mostly involving perineal region & anterior abdomen wall but breast involvement is rare. Thus early diagnosis and proper surgical treatment can prevent significant morbidity.

Keywords: Breast, Necrotizing Fasciitis, Postpartum period, Debridement

[1] Saira Nizami,Kamran Mohiuddin,Mohsin-e-Azam,Hasnain Zafar, ,Muhammed Ashraf Memon, Necrotizing Fasciitis of the Breast-case report. The Breast Journal, Volume 12 Number 2, 2006 168–169

[2] Shah J, Sharma AK, O'Donoghue JM, Mearns B, Johri A, Thomas V. Necrotising fasciitis of the breast.Br J Plast Surg2001;54:67–68

[3] Hasham S, Matteucci P, Stanley PR, Hart NB. Necrotizing fasciitis.BMJ 2005; 330:830–33.

[4] Sarani B, Strong M, Pascual J, Schwab CW: Necrotizing fasciitis: Current concept and review of the literature. J Am Coll Surg 009, 208(2):279-288.

[5] Korhan Taviloglu and Hakan Yanar .Necrotizing fasciitis: strategies for diagnosis and management. World Journal of Emergency Surgery2007, 2:19. doi:10.1186/1749-7922-2-19.

[6] Elliot DC, Kufera JA, Myer RA. Necrotizing soft tissue infection: risk factors for mortality and strategies for management. Annals of Surgery 1996; 224: 672-83.

[7] Elliott D, Kufera JA, Myers RA: The microbiology of necrotizing soft tissue infectionAm J Surg 2000, 179(5):361-6.

[8] McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. 1995. Determinants of mortality for necrotizing soft-tissue infections. Ann. Surg. 221:558-563;discussion563-565

[9] Gurpreet Singh, Sunil K Sinha, Shailesh Adhikary, K Srinivas Babu,Pallab Ray, Satish K Khanna et al. Necrotising infections of soft tissues –a clinical profile, European Journal of Surgery 2002;168(60):366-71.