Subject: Participation in survey “POST -OPERATIVE INFLAMMATION EPIDEMIOLOGY AND MANAGEMENT”
Inflammation is a natural and essential response to cellular injury and mostly every injury or illness will have an inflammatory component. Inflammation is essential to limit exposure to harmful cellular debris and pathogens, and to promote healing. However, when it becomes uncontrolled or excessive then we can see delayed healing or chronic inflammatory conditions. Imbalances in inflammatory response results in hyperinflammation and altered immune competence increasing the risk of secondary injury i.e., postoperative complications and organ dysfunction resulting in increased risks of mortality or persistent disability. The importance of post-traumatic hyperinflammation and systemic inflammatory response syndrome (SIRS) has long been recognized.
Over 300 million major surgical procedures are performed every year; which are associated with an estimated 8 million peri-operative deaths. Despite relatively high mortality rate, value of surgery in managing symptoms of disease and prolonging life is unquestionable. Potential harm caused by the stress response to surgery needs to be considered. This stress response is comprised of neurohumoral, inflammatory-immune elements and is largely determined by magnitude of surgical injury, age, comorbidities (immune modulation) and anesthesia.
The proteolytic enzymes, also called proteases, are naturally occurring substances derived from animal or plant sources. Combined with the bioflavonoid rutin (rutoside), the proteases, trypsin and bromelain, have been extensively investigated as alternatives to conventional pharmaceutical treatments for pain and swelling associated with several common conditions. The oral proteases may inhibit the synthesis of pro-inflammatory prostaglandins, the immunomodulatory mechanisms include interaction with protease- activated receptors on certain immune cells, e.g., macrophages. Rutin, a glycoside of the flavonoid quercetin, is found in many plants and fruits, and pharmacological studies have actions including reduction of proinflammatory cytokines and improved antioxidant enzyme activities.
Systemic enzyme therapy (proteolytic enzymes, with or without flavonoids) has been recommended for many years for the treatment of pain and inflammation; it is delivered orally. Trypsin-Bromelain-Rutoside combination has become increasingly popular as an option to treat pain and inflammation. This combination is provided as enteric coated tablets, which protects it from stomach acid degradation. Few orally administered dispersible tablets are available
There is limited data available on the epidemiology and management of post operative/ post-procedure inflammation in Indian scenario. This multicentric survey is designed to understand more about the post-op inflammation in India.
If you agree to participate, you will be required to respond to questions of the enclosed questionnaire. We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this survey. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.
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