chapter4.5
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
This study shows: BANGSHIL is useful in preventing and controlling urinary tract infection where indwelling catheter 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 intervertebral 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 septicaemia.
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
- Toxic side effects due to prolonged use of urinary antiseptics and antibiotics.
- 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. Before 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.
TABLE-I
| 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), Bilateral hemiplegia (1), Transverse myelitis with paraplegia (1), prolapsed intervertebral disc (3), and lumbar spondylolisthesis (1).
TABLE-II
| No. | Diagnosis | Cases | % |
|---|---|---|---|
| 1 | Fracture Spine – Thoraco-lumbar with paraplegia | 14 | 28% |
| 2 | Fracture – 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 neck of femur | 3 | 6% |
| 10 | Old age with fracture of 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 Klebsiella and 5 patients had Mixed Infection. In 7 patients urine culture was negative.
TABLE-III
| Organism | No. of Cases | % |
|---|---|---|
| E. Coli | 20 | 46% |
| Proteus | 10 | 23% |
| Pseudomonas | 5 | 12% |
| Klebsiella | 5 | 7% |
| 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:
- Clinical relief of urinary complaints.
- Response of the drug to urine culture.
- 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).
TABLE-IV
Showing the results of Urine Culture before and after Bangshil Treatment
| Organism | Before Treatment | Positive After Treatment | % | Negative Culture | % |
|---|---|---|---|---|---|
| E. Coli | 20 | 5 | 25% | 15 | 75% |
| Proteus | 10 | 2 | 20% | 8 | 80% |
| Pseudomonas | 5 | 1 | 20% | 4 | 80% |
| Klebsiella | 3 | 0 | - | 3 | 100% |
| 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.
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 observation extending up to 6 months.
SUMMARY
- 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.
- Bangshil was given 2 tabs. three times a day for two weeks, and then 1 tab. three times a day for one more week.
- Within the trial period symptomatic relief was obtained in all the cases (100%), and bacteriological cure in 81%.
- 39 cases continued to stay in the Hospital even after a month, up to a maximum of 6 months. They continued to receive Bangshil, 1 tab. three times a day, as long as they were in the Hospital.
- 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.
- 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.
ACKNOWLEDGEMENT
I 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 G.U.T. diseases
Bladder Control • Enlarged Prostate
From SURGERY - UROLOGY - ORTHOPAEDIC DEPARTMENTS
- Bapat S.S., MS, FRCS, FRCS (E), Poona – paper at 21st annual conference of International College of Surgeons, Indian Section, Gulbarga, 1975.
- Agarwal, R.S., MS, Dept. Surgery, S.P. Medical College, Bikaner (Raj.) – The Rajasthan Medical Journal, Vol. 15:1, 1975.
- Singh T.B., MS, Chauhan N.S., MBBS, Dept. Surgery, G.R. Medical College, Gwalior – National Medical Gazette, Gwalior, Vol. 13:9, 1974.
- 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
- 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 Conference, Hubli, 1973.
From V.D. DEPARTMENTS
- Mrs. Tijoriwala, MBBS, DVD; Tambe S.G., MBBS, DVD, Municipal V.D. Clinic, Bombay-8 – Indian Journal of Dermatology & Venereology, June 1967.
- Motala, G.I., MBBS, DDV, DVD, Consulting Skin & V.D. Specialist – Indian Practitioner, Vol. 19:12, 1966.
From MEDICINE DEPARTMENTS
- 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, 119-121, 1972.
- Bajpai, C.M., B.Sc., MD, Physician & Cardiologist, Varanasi – paper at 32nd U.P. State Medical Conference, Bareilly, 1957.
- Patel, B.D., MB, MRCP, DTMH (Lond.), FCCP (USA), Consulting Physician, Baroda – paper at 23rd Gujarat State Annual Medical Conference, Broach, 1970.
ENLARGED PROSTATE
- Bapat, S.S., MS, FRCS, FRCS (E), Consulting Urologist, Poona. Double blind cross over recheck study of Bangshil in chronic urethritis and prostatitis – paper at 21st annual conference of International College of Surgeon, Indian Section, Gulbarga, 1975.
- Singh, T.B., MS, Prof. of Surgery; Chauhan, N.S., MBBS., Dept. of Surg., G.R. Medical College, Gwalior. Clinical Study with Fortege & Bangshil in cases of Benign Enlargement of prostate and urinary tract infection – National Medical Gazette, Gwalior, Vol. 13:9, 1974.
- 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.