Short- and Long-term Effects of Neuromodulators for Unexplained Chronic Cough

2018 ◽  
Vol 159 (3) ◽  
pp. 508-515 ◽  
Author(s):  
Andrew Jay Bowen ◽  
Amy S. Nowacki ◽  
Kevin Contrera ◽  
Douglas Trask ◽  
James Kaltenbach ◽  
...  
Keyword(s):  
Chronic Cough ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Treatment Time ◽  
Tertiary Care ◽  
Care Hospital ◽  
Long Term Effects ◽  
Leicester Cough Questionnaire ◽  
Short And Long Term

Objective To evaluate the short- and long-term effects of tricyclic antidepressants (TCAs) and gabapentin in the treatment of unexplained chronic cough (UCC). Study Design Prospective cohort. Setting Tertiary care hospital. Subjects and Methods Patients seen between July 2016 and March 2017 were included following a formal workup and clinical evaluation indicative of UCC. Patients were placed on either a TCA (amitriptyline or nortriptyline) or gabapentin. Leicester Cough Questionnaire (LCQ) and percentage improvement scores were obtained prior to treatment initiation and at 2 and 6 months of neuromodulator treatment. A linear mixed model assessed the change in LCQ score between the 2 treatment time points and baseline scores. Results Twenty-eight patients completed a total of 37 neuromodulator trials. Gabapentin demonstrated statistically significant improvement in LCQ scores at 2 months (2.48 points, P≤ .01) and 6 months (5.40 points, P = .01) of treatment as compared with baseline. Patients taking TCAs demonstrated statistically significant improvement of LCQ scores at 2 months of treatment (3.46 points, P≤ .01). However, the majority of patients discontinued treatment, most commonly secondary to the development of tachyphylaxis after 2 months, precluding analysis at 6 months. Conclusion While both neuromodulator classes demonstrated short-term benefit, the majority of patients discontinue treatment prior to 6 months, with patients taking TCAs discontinuing more frequently than patients on gabapentin. Future investigations are warranted evaluating tachyphylaxis and the utility of dual treatment therapies designed to address peripheral and central sensory pathways involved in UCC.

Central Incisor Width as a Predictor of Appropriate Curette Size in Adenoidectomy

2001 ◽  
Vol 110 (9) ◽  
pp. 841-843
Author(s):  
Darren J. Hohn ◽  
Daniel G. Deschler ◽  
John A. Tucker
Keyword(s):  
Regression Analysis ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Eustachian Tube ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Central Incisor ◽  
Short And Long Term

As inadvertent eustachian tube injury during adenoidectomy can have serious short- and long-term implications, a simple anatomic correlate that could predict the optimal curette choice for adenoidectomy, especially in severely hypertrophic cases, is beneficial. This study evaluates the correlation of the distance between the lateral borders of the upper central incisors and the distance between the tori tubarius in the nasopharynx. One hundred one consecutive patients undergoing adenoidectomy at a pediatric tertiary care hospital were enrolled in this study. The patients ranged in age from 7 months to 15 years. No complications were noted in any of the procedures. During the operation, the distance between the central upper incisors was measured in millimeters, as was the inter-tubarius width (ITW). A multiple regression analysis was completed to assess the correlation between central incisor width and ITW. Age and inter-incisor width were positively correlated with ITW in a statistically significant manner (p = .007 and p = .006, respectively). The distance between the lateral borders of the upper central incisors predicts the distance between the tori tubarius in the nasopharynx. Therefore, an adenoid curette the window of which does not overlap the lateral aspects of the central upper incisors can be used relatively safely, even in fields with poor visualization.

scholarly journals ASSESSMENT OF THE POSSIBLE CAUSES OF DIABETES MELLITUS DEVELOPED IN PATIENTS POST COVID-19 TREATMENT IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 11-15
Author(s):  
KHUJITH RAJUENI ◽  
RUTUJA AMBEKAR ◽  
HITENDRAPAL SOLANKI ◽  
ABDULRAHAMAN ABUBAKAR MOMIN ◽  
SUNITA PAWAR
Keyword(s):  
Diabetes Mellitus ◽  
Incidence Rate ◽  
Tertiary Care Hospital ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Medical Attention ◽  
Care Hospital ◽  
Long Term Effects ◽  
Clinical Investigations

Objective: Novel COVID-19 virus is extensively being studied for its long-term effects. A predominant trend of development of Diabetes Mellitus (DM) in Covid-19 patients is being observed, and hence further relation is explored in this study. Methods: This is an observational inductive retrospective study conducted for four months in a tertiary care hospital. The study included subjects who recovered from COVID-19 and were treated post-COVID-19 in the hospital. The subjects who had stable glucose counts were excluded. The data obtained from the medical record department encompassed demographic details and clinical data of the patient. The data were tabulated, and observations were reported using descriptive analysis. Results: Among 5632 admitted patients for COVID-19, 694 came for follow-up. 105 patients were re-admitted, but 11 had newly developed DM, and 14 observed uncontrolled DM managed by medical attention. The reported incidence rate in Newly-Diagnosed DM was 0.195%, and the person above 41 y was at greater risk. Similarly, the incidence rate in Uncontrolled-DM was 13.33%, and persons above 47 y were at greater risk. It was found that both these categories of patients had comorbidities, and the development of this was seen between the 25th-40th day. In both cases, males were more prone than females. Conclusion: The study reports a bi-directional relationship between Covid-19 and DM. The use of steroids may have stepped-up this relationship. Cautious use of steroids, changes in the hospital formulary, and further quantitative clinical investigations are primary recommendations that may prevent such episodes.

scholarly journals Persistent Symptoms in Post-COVID-19 Patients Attending Follow-Up OPD at Sukraraj Tropical and Infectious Disease Hospital (STIDH), Kathmandu, Nepal

2021 ◽  
Vol 6 (3) ◽  
pp. 113
Author(s):  
Anup Bastola ◽  
Richa Nepal ◽  
Bikesh Shrestha ◽  
Kijan Maharjan ◽  
Sanjay Shrestha ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Long Term Effects ◽  
Persistent Symptoms ◽  
History Of ◽  
Polymerase Chain ◽  
Disease Hospital ◽  
Time Of Presentation

The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33.1%), 33 (28%), and 32 (27.1%) patients, respectively. The findings in our study highlight the need for extended monitoring of post-COVID-19 patients following discharge, in order to understand and mitigate long-term implications of the disease.

scholarly journals The chemo-gut study: investigating the long-term effects of chemotherapy on gut microbiota, metabolic, immune, psychological and cognitive parameters in young adult Cancer survivors; study protocol

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Julie M. Deleemans ◽  
Faye Chleilat ◽  
Raylene A. Reimer ◽  
Jan-Willem Henning ◽  
Mohamad Baydoun ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Cancer Survivors ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Bacterial Species ◽  
Long Term Effects ◽  
Young Adult Cancer Survivors ◽  
Adult Cancer Survivors ◽  
Patient Reported

Abstract Background The gut microbiota is an important modulator of immune, metabolic, psychological and cognitive mechanisms. Chemotherapy adversely affects the gut microbiota, inducing acute dysbiosis, and alters physiological and psychological function. Cancer among young adults has risen 38% in recent decades. Understanding chemotherapy’s long-term effects on gut microbiota and psycho-physiological function is critical to improve survivors’ physical and mental health, but remains unexamined. Restoration of the gut microbiota via targeted therapies (e.g. probiotics) could potentially prevent or reverse the psycho-physiological deficits often found in young survivors following chemotherapy, ultimately leading to reduced symptom burden and improved health. Methods This longitudinal study investigates chemotherapy induced long-term gut dysbiosis, and associations between gut microbiota, and immune, metabolic, cognitive and psychological parameters using data collected at < 2 month (T1), 3–4 months (T2), and 5–6 months (T3) post-chemotherapy. Participants will be 18–39 year old blood or solid tumor cancer survivors (n = 50), and a healthy sibling, partner or friend as a control (n = 50). Gut microbiota composition will be measured from fecal samples using 16 s RNA sequencing. Psychological and cognitive patient reported outcome measures will include depression, anxiety, post-traumatic stress disorder symptoms, pain, fatigue, and social and cognitive function. Dual-energy X-ray Absorptiometry (DXA) will be used to measure fat and lean mass, and bone mineral concentration. Pro-inflammatory cytokines, C-reactive protein (CRP), lipopolysaccharide (LPS), serotonin, and brain derived neurotrophic factor (BDNF) will be measured in serum, and long-term cortisol will be assayed from hair. Regression and linear mixed model (LMM) analyses will examine associations across time points (T1 – T3), between groups, and covariates with gut microbiota, cognitive, psychological, and physiological parameters. Conclusion Knowing what bacterial species are depleted after chemotherapy, how long these effects last, and the physiological mechanisms that may drive psychological and cognitive issues among survivors will allow for targeted, integrative interventions to be developed, helping to prevent or reverse some of the late-effects of treatment that many young cancer survivors face. This protocol has been approved by the Health Research Ethics Board of Alberta Cancer Committee (ID: HREBA.CC-19-0018).

Saskatchewan Highways and Transportation Reduced Tire Pressure Initiative

1997 ◽  
Vol 1589 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Thomas L. Davies ◽  
Tami F. Wall ◽  
Allan Carpentier
Keyword(s):  
High Speed ◽  
Membrane Surface ◽  
Vehicle Stability ◽  
Road Maintenance ◽  
Long Term Effects ◽  
Tire Pressure ◽  
Reduced Pressure ◽  
Maintenance Costs ◽  
Short And Long Term

After examination of the research carried out by other agencies, Saskatchewan Highways and Transportation (SHT) embarked on an initiative to adapt low tire pressure technologies to the province's needs and environment. The focus of the initiative was to explore several technical questions from SHT's perspective: (a) Can low tire pressures be used to increase truck weights from secondary to primary without increasing road maintenance costs on thin membrane surface roads? (b) What are the short- and long-term effects of tire heating under high-speed/high-deflection constant reduced pressure (CRP) operations in a Saskatchewan environment? (c) What effects do lower tire pressures have on vehicle stability at highway speeds? To date, significant opportunities have been noted on local hauls (less than 30 min loaded at highway speeds) for CRP operation and long primary highway hauls that begin or end in relatively short secondary highway sections that limit vehicle weight allowed for the whole trip for central tire inflation technology. The background and environment for the initiative and the investigations and demonstrations envisioned and undertaken are briefly outlined.

Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter?

2019 ◽  
Vol 24 (2) ◽  
pp. 200-208
Author(s):  
Ravindra Arya ◽  
Francesco T. Mangano ◽  
Paul S. Horn ◽  
Sabrina K. Kaul ◽  
Serena K. Kaul ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Hippocampal Sclerosis ◽  
Brain Mri ◽  
Temporal Lobectomy ◽  
Seizure Freedom ◽  
Seizure Onset

OBJECTIVEThere is emerging data that adults with temporal lobe epilepsy (TLE) without a discrete lesion on brain MRI have surgical outcomes comparable to those with hippocampal sclerosis (HS). However, pediatric TLE is different from its adult counterpart. In this study, the authors investigated if the presence of a potentially epileptogenic lesion on presurgical brain MRI influences the long-term seizure outcomes after pediatric temporal lobectomy.METHODSChildren who underwent temporal lobectomy between 2007 and 2015 and had at least 1 year of seizure outcomes data were identified. These were classified into lesional and MRI-negative groups based on whether an epilepsy-protocol brain MRI showed a lesion sufficiently specific to guide surgical decisions. These patients were also categorized into pure TLE and temporal plus epilepsies based on the neurophysiological localization of the seizure-onset zone. Seizure outcomes at each follow-up visit were incorporated into a repeated-measures generalized linear mixed model (GLMM) with MRI status as a grouping variable. Clinical variables were incorporated into GLMM as covariates.RESULTSOne hundred nine patients (44 females) were included, aged 5 to 21 years, and were classified as lesional (73%), MRI negative (27%), pure TLE (56%), and temporal plus (44%). After a mean follow-up of 3.2 years (range 1.2–8.8 years), 66% of the patients were seizure free for ≥ 1 year at last follow-up. GLMM analysis revealed that lesional patients were more likely to be seizure free over the long term compared to MRI-negative patients for the overall cohort (OR 2.58, p < 0.0001) and for temporal plus epilepsies (OR 1.85, p = 0.0052). The effect of MRI lesion was not significant for pure TLE (OR 2.64, p = 0.0635). Concordance of ictal electroencephalography (OR 3.46, p < 0.0001), magnetoencephalography (OR 4.26, p < 0.0001), and later age of seizure onset (OR 1.05, p = 0.0091) were associated with a higher likelihood of seizure freedom. The most common histological findings included cortical dysplasia types 1B and 2A, HS (40% with dual pathology), and tuberous sclerosis.CONCLUSIONSA lesion on presurgical brain MRI is an important determinant of long-term seizure freedom after pediatric temporal lobectomy. Pediatric TLE is heterogeneous regarding etiologies and organization of seizure-onset zones with many patients qualifying for temporal plus nosology. The presence of an MRI lesion determined seizure outcomes in patients with temporal plus epilepsies. However, pure TLE had comparable surgical seizure outcomes for lesional and MRI-negative groups.

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