A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model

2020 ◽  
pp. 000348942094677
Author(s):  
Paul Wistermayer ◽  
Derek Escalante ◽  
Wesley McIlwain ◽  
Derek J. Rogers
Keyword(s):  
Controlled Trial ◽  
Intraclass Correlation ◽  
Rabbit Model ◽  
Preventive Treatment ◽  
Subglottic Stenosis ◽  
Control Group ◽  
Rater Agreement ◽  
Post Injury ◽  
Cross Sectional

Objective: Iatrogenic injury is a common cause of subglottic stenosis (SGS). We investigated the role of pre-injury dexamethasone as a preventive treatment for iatrogenic subglottic stenosis. Methods: 16 New Zealand White rabbits were used in an IACUC approved study. Subjects were divided into two groups: intramuscular dexamethasone (DEX) at a dose of 2 mg/kg 15 minutes prior to an endoscopic injury to create SGS, and the same injury creation with a preoperative intramuscular saline (SAL) injection. Three independent, blinded raters evaluated endoscopic images to obtain cross sectional area (CSA) airway measurements. Rabbit airways were measured just prior to injury and at one week post-injury. All subjects were provided as-needed postoperative steroids and buprenorphine for symptoms of respiratory distress. Data analysis was performed using Student t-test. Intraclass correlation coefficients were used to assess inter-rater agreement. Results: All subjects survived to the one-week post-injury airway evaluation. There was no difference in airway size between groups prior to injury ( P = .28). Subjects in the DEX group demonstrated an average stenosis of 20.3% (95% CI 10.2-30.5) at one week compared to 60.6% (95% CI 40.3-80.9) in the SAL group ( P = .01). Subjects in the control group required significantly more doses of postoperative dexamethasone ( P = .02). Inter-rater agreement for between raters was excellent (ICC = .88). Conclusion: This is the first study to examine the role of pre-injury glucocorticoids in preventing iatrogenic subglottic stenosis. In our model, a single dose of intramuscular dexamethasone given prior to a subglottic injury resulted in a statistically significant reduction in airway stenosis. This research suggests that administering systemic dexamethasone should be considered prior to any procedure that may injure the subglottis, including traumatic intubation, to prevent iatrogenic subglottic stenosis.

scholarly journals Arousability, Personality, and Decision-Making Ability in Dissociative Disorder

2021 ◽  
pp. 025371762098155
Author(s):  
Doyel Ghosh ◽  
Pritha Mukhopadhyay ◽  
Ishani Chatterjee ◽  
Prasanta Kumar Roy
Keyword(s):  
Decision Making ◽  
Iowa Gambling Task ◽  
Psychiatric Patients ◽  
Economic Status ◽  
Reaction Time Task ◽  
Conversion Disorder ◽  
Control Group ◽  
Cross Sectional ◽  
Personality Disposition

Background: There is a gap in understanding the pathogenesis of dissociative conversion disorder (DCD), despite the disorder having a strong historical root. The role of personality and neurocognitive factors are now highlighted; however, inconsistencies are reported. This study explores the personality disposition, arousability, and decision-making ability of patients with DCD, in reference to a healthy control group (HCG). Methods: In this cross-sectional study, the sample comprised ten adult psychiatric patients with DCD. Ten participants of the HCG were matched according to age, gender, education, economic status, domicile, religious background, and handedness. The study assessed personality disposition with Temperament and Character Inventory, arousability with reaction time task, and decision-making ability with the Iowa Gambling Task (IGT PEBL version). Results: The DCD group differed significantly on personality disposition related to both temperament and character. There was also evidence of easy arousability and frustration along with deficit in executive function related to decision-making ability. Conclusion: This study highlights the presence of both temperamental and characterological factors associated with DCD. Moreover, this study identifies the role of cognitive arousability and decision-making or feedback utilization ability in the psychopathology of DCD.

Role of diffusion tensor imaging in the evaluation of ulnar nerve involvement in leprosy

2021 ◽  
pp. 20210290
Author(s):  
Ankita Aggarwal ◽  
Chandan Jyoti Das ◽  
Neena Khanna ◽  
Raju Sharma ◽  
Deep Narayan Srivastava ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Peripheral Neuropathy ◽  
Ulnar Nerve ◽  
Diffusion Tensor ◽  
Cross Sectional Area ◽  
Ulnar Neuropathy ◽  
Control Group ◽  
Sectional Area ◽  
Cross Sectional

Objective: Early detection of peripheral neuropathy is extremely important as leprosy is one of the treatable causes of peripheral neuropathy. The study was undertaken to assess the role of diffusion tensor imaging (DTI) in ulnar neuropathy in leprosy patients. Methods: This was a case–control study including 38 patients (72 nerves) and 5 controls (10 nerves) done between January 2017 and June 2019. Skin biopsy proven cases of leprosy, having symptoms of ulnar neuropathy (proven on nerve conduction study) were included. MRI was performed on a 3 T MR system. Mean cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of ulnar nerve at cubital tunnel were calculated. Additional ancillary findings and appearance of base sequences were evaluated. Results: Ulnar nerve showed thickening with altered T2W signal in all the affected nerves, having an average cross-sectional area of 0.26 cm2. Low FA with mean of 0.397 ± 0.19 and high ADC with mean of 1.28 ± 0.427 x 10 −3 mm2/s of ulnar nerve in retrocondylar groove was obtained. In the control group, mean cross-sectional area was 0.71cm2 with mean FA and ADC of 0.53 ± 0.088 and 1.03 ± 0.24 x 10 −3 mm2/s respectively. Statistically no significant difference was seen in diseased and control group. Cut-off to detect neuropathy for FA and ADC is 0.4835 and 1.1020 × 10 −3 mm2/s respectively. Conclusion: DTI though is challenging in peripheral nerves, however, is proving to be a powerful complementary tool for assessment of peripheral neuropathy. Our study validates its utility in infective neuropathies. Advances in knowledge: 1. DTI is a potential complementary tool for detection of peripheral neuropathies and can be incorporated in standard MR neurography protocol. 2. In leprosy-related ulnar neuropathy, altered signal intensity with thickening or abscess of the nerve is appreciated along with locoregional nodes and secondary denervation changes along with reduction of FA and rise in ADC value. 3. Best cut-offs obtained in our study for FA and ADC are 0.4835 and 1.1020 × 10 −3 mm2/s respectively.

scholarly journals Does Intramedullary Nailing for Distal Fibular Fractures Restore Anatomic Parameters and Syndesmotic Relationship?

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0000
Author(s):  
Natalio R. Cuchacovich Mikenberg ◽  
Francisco J. Bravo Gallardo ◽  
Esteban Giannini ◽  
Claudia Astudillo ◽  
Manuel J. Pellegrini ◽  
...  
Keyword(s):  
Statistical Power ◽  
Intraclass Correlation ◽  
Total Sample ◽  
Cross Sectional Study ◽  
Wilcoxon Test ◽  
Medium Size ◽  
Control Group ◽  
Cross Sectional ◽  
Rotation Length ◽  
Paired Control

Category: Trauma; Ankle Introduction/Purpose: Fibular nailing (FN) is a method of fixation that has proven to be useful for the treatment of distal fibular fractures (DF). FN minimizes soft tissue complications, provides similar stability compared to plating with less hardware related symptoms. Nevertheless, FN has been associated with syndesmotic malreduction and incapacity of restoring length and rotation of the fibula. We aimed to evaluate the fibular and syndesmotic reduction after fixation with FN compared to the uninjured ankle. Methods: Prospective cohort, cross-sectional study with a paired control group. Patients with DF fractures treated with FN between January 2017 and July 2019 were included. Immediate postoperative bilateral Ankle CT was obtained in all cases. Two independent radiologists performed all the measurements on both ankles (fibular rotation, length, translation, and syndesmotic diastasis. Statistical analysis was made using the Wilcoxon Test and Intraclass correlation coefficient (ICC). Considering a medium size sample effect, 95% confidence with .05 alpha error, a total sample of 26 subjects were needed to achieve a .80 of statistical power (G-Power 3.1). All analyses were performed using SPSS V20. Results: Twenty-six patients were included (14 Women). The mean age was 47 years (18-91). No statistically significant differences were identified considering fibular rotation (p:0,694), fibular length (p:0,585) and syndesmotic diastasis (p:0,078) between the injured and uninjured ankle. Fibular translation has statistical differences (p:0,043). The ICC shows an excellent concordance between radiologists except for Fibular translation (ICC 0,47) Conclusion: In this cohort, fixation of DF fractures with FN allows restoration of anatomical parameters of the ankle in terms of fibular rotation, length, and syndesmotic diastasis. However, Fibular translation had significant differences compared with the uninjured ankle.

150 Falls in Malaysia: Magnitude, Risk, Disparities, and Solutions

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv34-iv39
Author(s):  
Maw Pin Tan ◽  
Sumaiyah Mat ◽  
Deepa Alex ◽  
Shahrul Bahyah Kamaruzzaman
Keyword(s):  
Ethnic Differences ◽  
Cultural Practices ◽  
Longitudinal Research ◽  
Controlled Trial ◽  
Intervention Group ◽  
Psychological Status ◽  
Control Group ◽  
Cross Sectional ◽  
One Year ◽  
Risk Factors For Falls

Abstract The Malaysian Elders Longitudinal Research (MELoR) study found 1 in 4 residents aged 65 years and over living in the Klang Valley of Malaysia fall at least once a year in their survey conducted between 2013 and 2015. Recent figures obtained from the First Older Persons’ National Health and Morbidity Survey conducted in 2018 revealed that 15% of Malaysians aged 60 years and over fall at least once a year. In a 10-year follow-up study involving 200 individuals who presented to the emergency department over a six-month period in 2002, 22% were no longer alive at one year, and 80% had died at 10 years. Older age, indoor falls, subsequent hospital admission and functional impairment predicted death at one year. Cross-sectional data from MELoR revealed ethnic differences in fall prevalence, with the ethnic Indians more likely to report falls in the past 12 months compared to the ethnic Malays. Independent risk factors for falls identified from MELoR were urinary incontinence, reduced grip strength, hearing impairment, comorbidities and reducing walking speed. The ethnic differences in falls in our population remain unexplained. Lifestyle and cultural practices may well be the underlying rationale, but genetic influences cannot currently be ruled out. The results of a randomized controlled trial on multifactorial interventions, the Malaysian Falls Assessment and Intervention Trial (MyFAIT), was published last year. Mo differences in falls outcomes with an individualized multifactorial intervention were observed, despite improvements in physical performance and psychological status in the intervention group compared to the control group. The research group has now secured two-year funding to evaluate post-fall behavior in our setting in the Life After Falls (LiAF) study. In addition, dissemination and upskilling efforts are underway through training workshops, formation of the Malaysian Falls Network (MyFalls) and collaborations with the private sector to increase awareness on falls and increase fall prevention efforts throughout the country.

Antibiotics and Steroids in the Treatment of Acquired Subglottic Stenosis

1983 ◽  
Vol 92 (4) ◽  
pp. 377-382 ◽  
Author(s):  
John S. Supance
Keyword(s):  
Animal Model ◽  
Subglottic Stenosis ◽  
Control Group ◽  
Cross Sectional ◽  
Procaine Penicillin ◽  
Therapy Animals ◽  
Significant Difference ◽  
Medical Regimens ◽  
And Control ◽  
Systemic Antibiotics

The efficacy of a combination of systemic antibiotics and a steroid in the prevention of acquired subglottic stenosis (ASGS) was evaluated employing a previously developed canine animal model. Thirty-five healthy, postweanling mongrel puppies aged 5 weeks were each intubated for 14 days with an uncuffed polyvinyl endotracheal tube. Twenty puppies received intramuscular dexamethasone (1 mg) daily, and procaine penicillin (100,000 IU) and dihydrostreptomycin (0.125 g) in two divided doses on the day of intubation and each day thereafter until the completion of the study. The remaining 15 puppies served as a control group and received no medical therapy. Animals from both groups were killed at 5, 7, 12, 15, 20, 30, and 56 days following intubation. Comparative examinations of the laryngotracheal complexes of treated and control dogs showed that there was no significant difference between the two groups in the ultimate degree of ASGS attained, as determined by intraluminal cross-sectional area analysis, or in the extent of the lesion as documented by gross and microscopic histology. This investigation showed that the specific systemic combination of two antibiotics and a steroid used in the study was not efficacious in the prevention of ASGS in a canine animal model; for this reason we question the benefit of analogous medical regimens employed to prevent ASGS in infants and children who require long-term endotracheal intubation.

scholarly journals Effect of HSV-2 Suppressive Therapy on Genital Tract HIV-1 RNA Shedding among Women on HAART: A Pilot Randomized Controlled Trial

2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
A. E. Nijhawan ◽  
A. K. DeLong ◽  
S. Chapman ◽  
A. Rana ◽  
J. Kurpewski ◽  
...  
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Genital Tract ◽  
Controlled Trial ◽  
Sexual Transmission ◽  
Suppressive Therapy ◽  
Control Group ◽  
Highly Active ◽  
One Year ◽  
Hiv 1

Background. The role of suppressive HSV therapy in women coinfected with HSV-2 and HIV-1 taking highly active antiretroviral therapy (HAART) is unclear.Methods. 60 women with HIV-1/HSV-2 coinfection on HAART with plasma HIV-1 viral load (PVL) ≤75 copies/mL were randomized to receive acyclovir (N=30) or no acyclovir (N=30). PVL, genital tract (GT) HIV-1, and GT HSV were measured every 4 weeks for one year.Results. Detection of GT HIV-1 was not significantly different in the two arms (OR 1.23,P=0.67), although this pilot study was underpowered to detect this difference. When PVL was undetectable, the odds of detecting GT HIV were 0.4 times smaller in the acyclovir arm than in the control arm, though this was not statistically significant (P=0.07). The odds of detecting GT HSV DNA in women receiving acyclovir were significantly lower than in women in the control group, OR 0.38,P<0.05.Conclusions. Chronic suppressive therapy with acyclovir in HIV-1/HSV-2-positive women on HAART significantly reduces asymptomatic GT HSV shedding, though not GT HIV shedding or PVL. PVL was strongly associated with GT HIV shedding, reinforcing the importance of HAART in decreasing HIV sexual transmission.

scholarly journals Evaluation of spontaneous retinal venous pulsation in primary open-angle and primary angle-closure glaucoma patients

2020 ◽  
Vol 2 (1) ◽  
pp. 27-41
Author(s):  
Sylves Patrick ◽  
Chan Hui Tze ◽  
Rasdi Abdul Rashid ◽  
Liza Sharmini Ahmad Tajudin
Keyword(s):  
Cross Sectional Study ◽  
Angle Closure ◽  
Control Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Venous Pulsation ◽  
Primary Glaucoma

Introduction: Spontaneous retinal venous pulsation (SRVP) is a rhythmic variation in the calibre of one or more retinal veins. The incidence of SRVP was reduced in glaucoma patients. It was also reduced in people with raised intracranial pressure compared to a healthy population. Purpose: The main objective was to report the frequency and rate of SRVP in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) patients and to associate these with the severity of glaucoma in Malay patients. Design of study: A comparative cross-sectional study. Materials and methods: A comparative cross-sectional study involving primary glaucoma patients attending the eye clinic at Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia, was performed between December 2015 and June 2017. The main outcomes measured were the presence and rate of SRVP using a confocalscanning laser ophthalmoscope (Spectralis High-Resolution Optical Coherence Tomography Angiography, Heidelberg Engineering GmbH, Heidelberg, Germany). In the presence of SRVP, the rate of SRVP in one minute was counted manually based on the real-time fundus movie recorded using the confocal scanning laser ophthalmoscope. Results: Thirty-eight POAG, 14 PACG, and 51 control group subjects were included. There was a significantly lower incidence of SRVP in primary glaucoma patients than in the control group (p = 0.003). The presence of SRVP was significantly lower in POAG than PACG (p = 0.04). There was no significant difference in the rate ofSRVP between primary glaucoma patients and the control group (p = 0.873) or between the POAG group and PACG group (p = 0.511). There was no association of incidence (p = 0.574) and rate (p = 0.167) of SRVP according to the severity of glaucoma. Systolic blood pressure (95% CI: 0.95–1.00, p = 0.038) and retinal nervefibre layer thickness (95% CI: 1.01–1.09, p = 0.008) showed a significant association with the presence of SRVP. Conclusions: SRVP is a potential predictive factor for detection of primary glaucoma. The role of SRVP in the severity of glaucoma is still unclear. The role of SRVP in PACG patients warrants further studies in the future.

scholarly journals Physical activity and markers of glycation in older individuals: data from a combined cross-sectional and randomized controlled trial (EXAMIN AGE)

2020 ◽  
Vol 134 (9) ◽  
pp. 1095-1105
Author(s):  
Mathias D.G. Van den Eynde ◽  
Lukas Streese ◽  
Alfons J.H.M. Houben ◽  
Coen D.A. Stehouwer ◽  
Jean L.J.M. Scheijen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Risk ◽  
Controlled Trial ◽  
Interval Training ◽  
Ultra Performance Liquid Chromatography ◽  
Control Group ◽  
Older Individuals ◽  
Cross Sectional ◽  
Pharmacological Agents ◽  
Glucose And Lipid Metabolism

Abstract Background: Advanced glycation end products (AGEs) are protein modifications that are predominantly formed from dicarbonyl compounds that arise from glucose and lipid metabolism. AGEs and sedentary behavior have been identified as a driver of accelerated (vascular) aging. The effect of physical activity on AGE accumulation is unknown. Therefore, we investigated whether plasma AGEs and dicarbonyl levels are different across older individuals that were active or sedentary and whether plasma AGEs are affected by high-intensity interval training (HIIT). Methods: We included healthy older active (HA, n=38, 44.7% female, 60.1 ± 7.7 years old) and healthy older sedentary (HS, n=36, 72.2% female, 60.0 ± 7.3 years old) individuals as well as older sedentary individuals with increased cardiovascular risk (SR, n=84, 50% female, 58.7 ± 6.6 years old). The SR group was randomized into a 12-week walking-based HIIT program or control group. We measured protein-bound and free plasma AGEs and dicarbonyls by ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) at baseline and after the HIIT intervention. Results: Protein-bound AGE Nε-(carboxymethyl)lysine (CML) was lower in SR (2.6 ± 0.5 μmol/l) and HS (3.1 ± 0.5 μmol/l) than in HA (3.6 ± 0.6 μmol/l; P&lt;0.05) and remained significantly lower after adjustment for several potential confounders. None of the other glycation markers were different between HS and HA. HIIT did not change plasma AGEs and dicarbonyls in SR. Discussion: Although lifestyle interventions may act as important modulators of cardiovascular risk, HIIT is not a potent short-term intervention to reduce glycation in older individuals, underlining the need for other approaches, such as pharmacological agents, to reduce AGEs and lower cardiovascular risk in this population.

scholarly journals Does demineralized bone matrix enhance tendon-to-bone healing after rotator cuff repair in a rabbit model?

2019 ◽  
Author(s):  
Woo-Yong Lee ◽  
Young-Mo Kim ◽  
Hyun-Dae Shin ◽  
Deuk-Soo Hwang ◽  
Yong-Bum Joo ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Demineralized Bone Matrix ◽  
Bone Matrix ◽  
Rabbit Model ◽  
Longitudinal Direction ◽  
Collagen Fibers ◽  
Control Group ◽  
The Right ◽  
Demineralized Bone

Abstract Background The purpose of this study was to compare the histologic outcomes after rotator cuff (RC) repair between with demineralized bone matrix (DBM) augmentation and without DBM and to evaluate the role of DBM for tendon-to-bone (TB) healing in a rabbit model. Methods Twenty-six adult male New Zealand white rabbits were randomly allocated to the control group (n = 13) or the DBM group (n = 13). A chronic RC tear was generated on the right shoulder of all rabbits. In the control group, RC repair was achieved by a standard transosseous technique. In the DBM group, RC repair was achieved using the same technique, and DBM was interposed between the cuff and bone. After 8 weeks, the RC tendon entheses from all rabbits were processed for gross and histologic examination. Results In the control group, the tendon midsubstance was disorganized with randomly and loosely arranged collagen fibers and rounded fibroblastic nuclei. The TB interface was predominantly fibrous with small regions of fibrocartilage, especially mineralized fibrocartilage. In the DBM group, the tendon midsubstance appeared normal and comprised densely arranged collagen fibers, with orientated crimped collagen fibers running in the longitudinal direction of the tendon. These fibers were interspersed with elongated fibroblast nuclei. The TB interface consisted of organized collagen fibers with large quantities of fibrocartilage and mineralized fibrocartilage. Conclusion DBM augmentation at the RC-to-bone interface enhances TB healing after RC repair.

scholarly journals Role of probiotics in preterm infants: a randomized controlled trial

2017 ◽  
Vol 4 (2) ◽  
pp. 447 ◽  
Author(s):  
Sukanyaa S. ◽  
Vinoth S. ◽  
Ramesh S.
Keyword(s):  
Weight Gain ◽  
Preterm Infants ◽  
Controlled Trial ◽  
Health Benefit ◽  
Control Group ◽  
P Value ◽  
Average Weight ◽  
Preterm Babies ◽  
Average Weight Gain

Background: Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Probiotics are proposed to aid in the quicker colonisation of the preterm gut by various mechanisms thereby providing innumerable health benefits to the preterm infants. Hence we conducted a study to analyse the role of probiotics in preterm babies. Our primary aim was to compare the weight gain pattern among preterm infants: those receiving probiotic and those who did not receive the probiotic.Methods: Preterm/VLBW babies were selected, randomized and placed into two groups. One group was given the chosen probiotic and the other was kept as control. The weight gain pattern and the duration of hospital stay among the two groups was compared at the end of one month of age.Results: The average weight gain in the probiotic group was higher than the control group which was statistically significant. (mean difference: 0.230 + 0.11 95% CI: -0.796 to -0.251 p value <0.000).Conclusions: Our study was yet another evidence proving the utility of probiotics in the field of neonatalogy.

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