for the use only of a registered medical practitioner or a hospital or a laboratory.

 

A potent source of G.U.T. Infection

CATHETERISATION'

in Orthopaedic & General Surgery Departments

BANGSHIL (Alarsin) Prevents it

 

BANGSHIL IN THE TREATMENT OF URINARY TRACT INFECTION IN CASES OF TRAUMATIC PARAPLEGIA AND CASES OF MULTIPLE FRACTURES

By

Dr. S.K. Lohokare, M.S., Orthopaedic Surgeon Sassoon Gen. Hospital & Shreeyas Hospital, Poona

 

This study shows: BANGSHIL is useful in preventing and controlling urinary tract infection where indwelling catherter and repeated catheterisation were necessary, due to paralysis of bladder and consequent loss of micturition control, in cases of fractures or due to other factors.

 

INTRODUCTION

Traumatic fractures of spinal column with paraplegia or quadriplegia are associated with paralysis of bladder and consequent loss of micturition control. Cases of traumatic multiple fractures and fracture of the neck of femur in old patients may be associated with loss of micturi­tion control due to shock, prolonged immobili­sation and old age. Loss of micturition control may also occur in cases like T.B. Spine with paraplegia, prolapsed intenrertebral disc with paraplegia, bilateral hemiplegia, transverse myelitis with paraplegia etc. All such cases re­quire indwelling catheter till paralysis is reco­vered and micturition control is restored loss of micturition control is invariably associated with urinary stasis which forms a good ground for in­fection. Infection of the urinary tract occurs due to trauma of repeated catheterisations. Once the infection occurs, it spreads to the bladder from where it may progress to kidneys and may result in serious complications. The infection of the urinary tract produces symptoms like burn­ing micturition, fever with rigors, dysuria, incon­tinence, and may later lead to uraemia and sep­ticemia.

All such cases associated with paralysis of bladder and consequent loss of micturition con­trol need rigid bladder drainage by an indwel­ling catheter, repeated catheterisation and the use of urinary antiseptics, antibiotics and diure­tics:

The problems of management in such cases are :­

1. Toxic side effects due to prolonged use of urinary antiseptics and antibiotics.

2. Development of resistant strains of the or­ganisms and consequent ineffectiveness of the drugs used.

 

MATERIALS AND METHODS

50 cases from the orthopaedic wards of the Sassoon Hospital and Shreeyas Hospital, Poona, were selected for the study of Bangshil (Alarsin), an Ayurvedic preparation. The period of trial extended from June 1973 to June 1975.

Indwelling catheter was used in all these cases before, when they had paralysis of bladder and consequent loss of micturition control. Be(ore the use of Bangshil, general and urinary com­plaints were recorded and urine examination, urine culture and blood urea estimation were done and these investigations were repeated after the trials.

Symptomatology: Burning micturition (60%) and pain (20%) were the most common presenting symptoms. The details are given in Table No. I.

TABLE-1

Symptoms

Symptom	No.	%
Burning micturition:	30	60%
Pain:	10	20%
Fever:	5	10%
Haematuria:	5	10%
Total:	50	100%

 

Diagnosis:

Fracture of thoracolumbar spine with paraplegia was the largest group with 14 cases (28%). It is interesting to note that among the 8 cases with fracture of neck of femur in old age, 5 cases had enlarged prostate also. Be­sides fracture cases, the study includes these 11 cases: T.B. Spine with Paraplegia (5), Bilatoral hemiplegia (1), Transverse myelitis with paraplegia (1), prolapsed intervertebrat disc (3), and lumber spondylolisthesis (1). The details are given in Table No II.

 

TABLE-II

1	Fracture Apine-Thoraco-lumbar with paraplegia:	14	28%
2	Facture - Cervical Spine, with quadriplegia:	6	12%
3	Prolapsed Intervertebral Disc, with paraplegia:	2	4%
4	Tuberculosis of the Spine, with paraplegia:	5	10%
5	Bilateral Hemiplegia:	1	2%
6	Transverse Myelitis, with paraplegia:	1	2%
7	Fracture spine, without paraplegia:	6		12%
8	Multiple Fractures:	1		2%
9	Old age with fracture of the neck of femur:	3		6%
10	Old age with fracture of the neck
	with enlarged prostate:	5		10%
11	Fracture skull with monoplegia:	1		2%
12	Fracture pelvis:	3		6%
13	Prolapsed intervertebral disc:	1		2%
14	Lumbar Spondylolisthesis:	1		2%
	TOTAL:	50		100%

 

Urine Culture:

E. Coli was the most com­mon organism affecting 20 cases (46%) Pro­teus was next, affecting 10 cases (23%) 5 pa­tients had pseudomonas, 3 had Kelebsiella and 5 patients had Mixed Infection. In 7 patients urine culture was negative.

TABLE-III

Organism (In 7 patients urine culture was negative)

Organism	No. of cases	%
1. E. Coli	20	46%
2. Proteus	10	23%
3. Pseudomonas	5	12%
4. Klebsiella	5	7%
5. Mixed Infection	5	12%
Total	43	100%

 

Blood Urea: Blood urea was estimated in all the cases. The value was found raised in 20 cases (40%).

 

Dosage of Bangshil:

All the 50 cases were given Bangshil 2 tabs. three times a day, for two weeks, and then 1 tab. three times a day for another week. Those cases which remained in the ward for more than a month, continued to receive 1 tab. three times a day as long as they stayed in the hospital, which ranged from 3 to 6 months.

 

RESULTS

Results were observed for:

1. Clinical relief of urinary complaints.

2. Response of the drug to urine culture.

3. Response of the drug to Blood urea estimation.

 

Fever, pain, burning micturition and haematuria were relieved completely in 47 cases (94%), the intensity was minimised in the rest of cases after a week's treatment. Those 3 cases (6%) who did not completely respond within a week, responded within a maximum of one month.

In 35 cases (81 %), urine culture became negative with three weeks of treatment (Trial period). Only 5 cases of E. Coli, 2 cases of pro­teus and 1 case of pseudomonas did not re­spond to therapy. In Klebsiella and Mixed Infec­tions, the response was 100%. The results are given in detail in Table No IV.

 

TABLE-1V

Showing the results of Urine Culture before and after Bangshil Treatment

Before Treatment   Organism                Positive Culture		After  Treatment   Positive             %      Negative Culture     % Culture                    (Excellent Response)
1. E. Coli	20	5	25%	15	75%
2. Proteus	10	2	20%	8	80%
3. Pseudomonas	5	1	20%	4	80%
4. Klebsiella	3	0	-	3	100%
5. Mixed Infection	5	0	-	5	100%
Total	43	8	19%	35	81%

 

Before the trial 20 patients had raised blood urea. After 3 weeks of treatment (trial period), in 17 cases the Blood urea was reduced to nor­mal, giving a relief rate of 85%. No significant change was noted in the remaining 3 cases (15%).

 

CONCLUSION

Urinary tract infection associated with paralysis of bladder and consequent loss of micturition control must be prevented by in­dwelling catheter and catheterisations under rigid aseptic control. However strict these mea­sures are, usually infection sets in due to trauma to the urinary tract due to repeated catheterisations. Once the infection sets in pro­longed use of urinary antiseptics and antibiotics are necessary to control the same. Prolonged use of these drugs is not devoid of toxic or side effects. Besides, the emergence of resistant st­rains of the organisms makes the therapy inef­fective.

In this study, Bangshil has been quite effec­tive against E. Coli, Proteus, pseudomonas, Klebsiella and Mixed Infection, which are the commonly found organisms in urinary tract in­fection. Bacteriological cure was obtained in 81 % of the cases and symptomatic relief in

100% of the cases under trial. No toxic or side effects of tab. Bangshil were noticed in any of the cases during the trial period or during the period of observatiuon extending up to 6 months.

 

SUMMARY

1. Bangshil was tried in 50 cases of urinary tract infection. 39 cases were of fractures and 11 cases belonged to other factors like T.B. Spine with paraplegia etc. All the cases had indwelling catheter and repeated catheteri­sations before the commencement of the trial with Bangshil.

2. Bang'shil was given 2 tabs. three times a day for two weeks, and then 1 tab. three times a day for one more week. Thus period of trial with Bangshil treatment lasted for three weeks.

3. Within the trial period symptomatic relief was obtained in all the cases (100%), and bac­teriological cure in 81 %.

4. 39 cases continued to stay in the Hospital even after a month, upto a maximum of 6 months. They continued to receive Bangshil, 1 tab. three times a day, as long as they were in the Hospital. They remained free of urinary complaints.

5. No toxic or side effects were noticed during the trial period or during their continued stay in the Hospital to a maximum period of 6 months.

6. This study has shown that Bangshil is useful in preventing and controlling urinary tract in­fection where indwelling catheter and re­peated catheterisations were necessary due to paralysis of bladder and consequent loss of micturition control, in cases of fractures or due to other factors.

 

ACKNOWLEDGEMENT

1 am thankful to the Dean, B.J. Medical Col­lege, Pune, for allowing me to conduct this study. I also thank M/s. Alarsin Pharmaceuti­cals, Bombay-400 023 for the liberal supply of Bangshil tablets required for conducting this trial.

Published research studies on BANGSHIL

in specific & Non-specific

o G.U.T. diseases 9 Bladder Control e Enlarged Prostate

From SURGERY - UROLOGY - OR­THOPAEDIC DEPARTMENTS

1. Bapat S.S., MS, FRCS, FRCS (E) Poona. - paper at 21 st annual conference of interna­tional college of surgeons, Indian Section, Gulburga, 1975.

2. Agarwal, R.S., MS, Dept. Surgery, S.P. Medical College, Bikaner (Raj).-The Rajastfian Medical Journal, Vol. 15: 1, 1975.

3. Singh T. B., MS, Chauhan N. S., MBBS, Dept. Surgery, G.R. Medical College, Gwalior. - National Medical Gazette, Gwalior, Vol. 13:9,1974.

4. Mohanty B., MS, Phd., Surgery Dept., S. C.B. Medical College, Cuttack. - The In­dian Practitioner:. 24 (2): 139-143, Feb. 1971.

from OBST. & GYNAEC. DEPARTMENTS

5. Anjeneyulu, R., MD, DGO. Vartak, M. M., MBBS, DGO, Chitale, S.V., MBBS, DCP

B.J. Medical College, Poona. - paper at 49th All India Medical Conf. Hubli, 1973.

from V.D. DEPARTMENTS

6. Mrs. Tijoriwala, MBBS, DVD, Tambe. S.G., MBBS, DVD, Municipal V.D. Clinic, Bom­bay-8.-Indian Jr. of Dermatology & Ven­ereology, June 1967.

7. Motala, G. I., MBBS, DDV, DVD, Consult­ing Skin & V.D. Specialist.-Indian Prac­titioner, Vol. 19; 12, 1966.

from MEDICINE DEPARTMENTS

8. Wahab, M.A., MD, Tejwani, B. M., MD., Pathak, L., MD; Surinder Singh, MD, FCCP, Medical College, Jabalpur (M.P.) - The Indian Practitioner, Vol. 25: 3:15,119-21 1972.

9. Bajpai, C.M., B.Sc., MD, Physician & Car­diologist, Varanasi,-paper at 32nd U.P. State Medical Conference, Bareilly 1957.

10. Patel, B.D., MB, MRCP, DTMH (Lond.), FCCP (USA), Consulting Physician, Baroda.-paper at 23rd Gujarat State An­nual Medical Conference, Broach, 1970.

ENLARGED PROSTATE

1. Bapat, S.S., MS, FRCS, FRCS (E), Con­sulting Urologist, Poona. Double blind cross over recheck study of `Bangshil' in chronic urthritis and prostatitis.-paper at 21 st annual conference of international col­lege of surgeon, Indian Section, Gulbarga, 1975.

2. Singh, T.B., MS, Prof. of Surgery; Chauhan, N.S., MBBS., Dept. of Surg., G.R. Medical College, Gwalior. Clinical Study with f=ortege & Bangshil in cases of Benign Enlargement of prostate and uri­nary tract infection.-National Medical Gazette, Gwalior, Vol. 13:9,1974.

3. Wahab, M.A., BSc., MD., Tejwani, B.N., MD.: Pathak, L., MD: Surinder Singh, MD, FCCP, Medical College, Jabalpur, Bangshil & Fortege in Benign Prostatic Hypertrophy.-Current Medical Practice, Dec. 1971.

 

 

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