Background: The aim of the study was to evaluate effect of collagenase ointment and povidone-iodine on non-healing ulcer in the form of duration of ulcer covered with red granulation tissue and total hospital stay.Methods: The Study was conducted on 80 patients admitted in Surgery Department, SSG Hospital and Medical College Baroda, Gujarat, India during November 2006 to October 2008. All ulcers due to trauma, chronic ulcer or infected ulcer following debridement and incision and drainage were included in this study. In group A were wounds dressed in collagenase ointment and in group B were wounds dressed in povidone-iodine ointment till second surgery or complete healing. All data from both groups were collected and analyzed by chi-square test.Results: In this study, there was no difference in age distribution (p=0.62, p>0.05) with similar male to female ratio in both groups and also no significant difference in distribution of wounds size in both groups (p=0.92, p>0.05). Average size of wound in group A was 43 sq. cm and group B was 44 sq. cm. The significant difference was seen on floor of ulcer by healthy granulation which came on an average of within 11days in group A and within 18 days in group B (p=0.005, p<0.05). There was also a significant difference in average hospital stay, which was 25 days in group A and 35 days in group B (p=0.01, p<0.05).Conclusions:Collagenase ointment is clinically more efficient as a topical dressing and lowers the morbidity by reducing the hospital stay and the duration of dressing by promoting healing in non-healing wounds than povidine-iodine ointment.

Background: This study describes the experience of arteriovenous fistula (AVF) creation as vascular access for haemodialysis.Methods: This study has been carried out in our hospital from January 2004 to December 2016. A total of 154 AVFs were created in 100 patients. Maximum follow-up was 2 years, and minimum was 6 months.Results: In this study of 100 cases of AVFs, primary patency rates by Kaplan Meier analysis showed 78.81% patency of fistulas at the end of 1 year and patency dropped to 14.81% at the end of 5 years. The primary failure rate was 21.2%. Basilic vein was used in 26.35% cases, cephalic vein in 63.5%, and antecubital vein in 9.75% cases. On table, bruit was present in 134 (90.9%) and thrill in 126 (89.3%) cases. During dialysis, flow rate >250ml/min was obtained in 40(29.9%) cases. In complications, 2 (0.4%) patients developed distal oedema.Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2mm, chances of AVF failure are high. Flow rates in patients with vein diam. More than 2mm was significantly higher as compared with patients with vein diam. Less than 2mm (P< 0.001). Flow rates are higher in non-diabetic patients as compared to diabetic patients (P <0.001). Average blood urea and serum creatinine values are significantly lesser in patients undergoing dialysis through successful fistulas as compared to patients with failed fistulas. Correspondingly, incidence of deaths is significantly lesser in patients with successful fistulas. During proximal side-to-side fistula between antecubital/basilic vein and brachial artery, dilating of the first valve toward wrist helps to develop distal veins in the forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in the arm.

IQVIA. Numbers of prescriptions and purchases (in $Can) were collected for 12month periods ending November for the past five years (2015)(2016)(2017)(2018)(2019). Results: The Canadian market for psychostimulants for ADHD has grown steadily since 2015, with prescriptions increasing by 53% (from 4.4 million in 2015 to 6.7 million in 2019) and total drugstore and hospital purchases increasing by 56% (from $330 million in 2015 to $515 million in 2019). Methylphenidates led the market in terms of prescriptions over the past five years (60%), while capturing 50% of purchases. Generic forms of psychostimulants accounted for 18.5% of prescriptions and 4.8% of purchases in the 12 months ending November 2019, up from 14.5% and 4.3%, respectively, in the 12 months ending November 2015. The contribution of lisdexamfetamine dimesylate has grown markedly over the past five years, with prescriptions increasing 90% and sales doubling from 2015 to 2019. In contrast, purchases of mixed salts amphetamine declined by 20% despite a 17% increase in prescriptions. Conclusions: Psychostimulants accounted for 90% of ADHD drug purchases in 2019, representing a market of $515 million dollars in Canada that has grown steadily since 2015.