A comparative study of efficacy and safety of tamsulosin with    nifedipine versus tamsulosin alone as medical expulsive therapy for lower ureteric stones

Background: Lower ureteric stones (LUS) comprises of 70% of ureteric stones. Spontaneous passage depends on stone size and location in ureter. Impacted calculi initiate smooth muscles contractions causing ureteric spasms. α-1 blockers like tamsulosin and calcium channel blocker like nifedipine relaxes ureteric smooth muscle, facilitating spontaneous expulsion. Pain and discomfort associated with urolithiasis, hospitalization and surgical cost can be minimized by medical expulsive therapy. Many studies had compared efficacy of tamsulosin with nifedipine, only few have explored the combination. This study compared efficacy of nifedipine and tamsulosin versus tamsulosin alone.Methods: 64 patients with LUS (5-10 mm) were assigned into 2 groups. Group 1 received tamsulosin and nifedipine and group 2 only tamsulosin. Rate of expulsion, time to expulsion, analgesic frequency and pain VAS score were analyzed. Chi-square or Fisher’s exact test to analyze categorical data, Mann Whitney U test or unpaired t test for differences between groups and Wilcoxon matched-pairs signed rank test for within group. A p<0.05 was statistically significant.Results: Rate of expulsion was 87.5% in group 1 and 65.6% in group 2 (p<0.05). Mean expulsion time was 6.68±1.89 days for group 1 and 8.52±2.62 in group 2 (p<0.05). Analgesic requirement was similar. Adverse effects were headache, dizziness and postural hypotension.Conclusions: Combination therapy yielded better rate of expulsion and reduction in stone expulsion time than tamsulosin alone. Thus, combination therapy can be considered for effective treatment outcomes.

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Abstract P860: Is Now the Time to Wake Up?

Stroke ◽

10.1161/str.52.suppl_1.p860 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Dawn K Beland ◽

Gregory Panza

Keyword(s):

Ischemic Stroke ◽

Patient Characteristics ◽

Categorical Variables ◽

Time Of Arrival ◽

Chi Square ◽

Peak Period ◽

Hospital Arrival ◽

Exact Test ◽

Group 2 ◽

Group 1

Thrombolytic treatment for patients who wake with acute ischemic stroke based on MRI DWI-FLAIR mismatch was added to AHA’s 2019 stroke guidelines. While changes were implemented to facilitate care in 2019, it was determined that managing each patient on a case-by-case basis would best use system resources. The spring of 2020 brought new challenges in delay to hospital arrival due to COVID-19. Purpose: Evaluate the current process of managing potential wake up treatment eligible patients. Methods: All ischemic stroke discharges during CT’s rise and peak of the pandemic were reviewed, January 1 - May 31, 2020. Records were reviewed to determine time of arrival, onset or last seen well, time found, NIHSS, treatment or hyperacute MRI done, and any contraindication based on wake up criteria. A chi-square of proportions or Fisher’s Exact test was used to examine the association between month of discharge and patient characteristics for categorical variables. A Kruskal-Wallis H test was used for the continuous NIHSS variable. Results: Since the first COVID-19 patients were admitted in early March, results from January and February were combined (Group 1 n=122) and compared to March, April and May (Group 2 n=143). There was a non-significant (p=0.48) increase from group 1 (62.3%) to group 2 (66.4%) in the percentage arriving more than 4.5 hours from onset or LSW. In addition, group 1 had higher NIHSSs than group 2 (median, IQR=6, 9 vs 3, 10, respectively), but this was not significant (p=0.27, H=1.21). This did however translate into fewer meeting wake up criteria for treatment during the rise and peak period (Group 1=6.6%, Group 2=2.8%; p=0.15). Use of hyperacute MRI was significantly higher in group 1 than group 2 (5.7% vs 0%, p=0.004) since no patients received a hyperacute MRI during peak pandemic. Conclusions: While more patients were expected to be eligible for acute thrombolytics using the wake up criteria due to delay in hospital arrival, this was not observed. Instead, patients arriving during the peak of the pandemic were less severe. Although a hyperacute MRI was still possible without confirmation of COVID-19 negative status, none were done. Enhancements to facilitate obtaining a hyperacute MRI are still needed regardless of reason for patient delay to hospital arrival.

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Decrease in Driveline Infections with Change in Driveline Management Protocol

The VAD Journal ◽

10.14434/vad.v2i0.27938 ◽

2016 ◽

Cited By ~ 1

Author(s):

Saima Aslam ◽

Jennifer Dan ◽

Amanda Topik ◽

Michael Belyk ◽

Francesca Torriani ◽

...

Keyword(s):

Rank Test ◽

Ventricular Assist ◽

Exact Test ◽

Management Protocol ◽

Group 2 ◽

Student’S T ◽

Optimal Approach ◽

Dressing Change ◽

Group 1

Background Driveline infections (DLI) are a significant cause of morbidity and mortality in ventricular assist device (VAD) recipients. We compared driveline infection (DLI) rate after an institutional change in driveline management protocol. Methods We retrospectively reviewed records of left VAD recipients at our institution, based on driveline management. Group 1: daily driveline dressing change consisting of chlorhexidine cleansing, sterile 4x4 gauze, and use of an abdominal binder. Group 2: Dressing change every 3 days consisting of chlorhexidine cleansing, non-sterile silver-impregnated foam with overlying clear dressing, and use of a driveline anchor. Follow-up was censored at first DLI, device removal, transplant or death. Additionally, Group 1 patients’ follow-up was censored when the change in protocol occurred. Statistical analysis: Student’s t-test, Fisher’s exact test, Kaplan-Meier curve and log-rank test. Results DLI occurred in 16% of 88 VAD recipients (Group 1 n=24, Group 2 n=64). The new driveline management protocol resulted in significantly fewer DLI in Group 2 (6.3% vs. 41.7%, p<0.0001). Conclusions An updated driveline management protocol demonstrated significant reduction in DLI at our institution. Studies evaluating the optimal approach for driveline management are needed in order to develop a standardized regimen aimed at lowering the risk of DLI.

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The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

Blood Purification ◽

10.1159/000515639 ◽

2021 ◽

pp. 1-7

Author(s):

Emre Erdem ◽

Ahmet Karatas ◽

Tevfik Ecder

Keyword(s):

Serum Ferritin ◽

Hemodialysis Patients ◽

Rank Test ◽

Significant Difference ◽

All Cause Mortality ◽

Group 3 ◽

Group 2 ◽

The Relationship ◽

Group 1

Introduction: The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. Methods: A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin <800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin >1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. Results: Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, p = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; p = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; p = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; p = 0.063). Conclusion: Time-averaged serum ferritin levels >1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

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Short-Term Effect of Orthodontic Treatment with Clear Aligners on Pain and sEMG Activity of Masticatory Muscles

Medicina ◽

10.3390/medicina57020178 ◽

2021 ◽

Vol 57 (2) ◽

pp. 178

Author(s):

Alessandro Nota ◽

Silvia Caruso ◽

Shideh Ehsani ◽

Gianmaria Fabrizio Ferrazzano ◽

Roberto Gatto ◽

...

Keyword(s):

Surface Electromyography ◽

Orthodontic Treatment ◽

Masticatory Muscles ◽

Rank Test ◽

Nominal Data ◽

Chi Square ◽

Initial Reduction ◽

Signed Rank Test ◽

Chi Square Test ◽

Semg Activity

Background and objectives: The aim of this study is to evaluate mandibular elevator muscles activity and pain on palpation in the early stages of orthodontic treatment with clear aligners using surface electromyography (sEMG). Materials and methods: Surface electromyography (sEMG) activity and pain level on muscle palpation of masseter and anterior temporalis muscles were recorded in a sample of 16 adult subjects (aged 18–32 years; mean 22.5 +/− 3.5 SD) undergoing orthodontic treatment with clear aligners before the treatment (T0), after 1 month of treatment (two clear aligners) (T1), and after 3 months of treatment (T2) (six clear aligners). A chi-square test for nominal data, a Friedman test, and a Wilcoxon-signed rank test as post hoc analysis were applied. Results: No statistically significant differences in muscular pain were observed. At T1, the sEMG activity of masseter muscles at mandibular rest position showed a statistically significant reduction, but after 3 months (T2), the data appeared similar to T0 (p = 0.03 and p = 0.02). Conclusions: During the treatment with clear aligners, subjects could experience an initial reduction in the masseter basal activity after 1 month of treatment. This effect tends to decrease to baseline levels after 3 months of therapy.

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Do Camels (Camelus dromedarius) Need Shaded Areas? A Case Study of the Camel Market in Doha

Animals ◽

10.3390/ani11020480 ◽

2021 ◽

Vol 11 (2) ◽

pp. 480

Author(s):

Martina Zappaterra ◽

Laura Menchetti ◽

Leonardo Nanni Costa ◽

Barbara Padalino

Keyword(s):

Ad Hoc ◽

The Sun ◽

Chi Square ◽

Chi Square Test ◽

Variable Space ◽

Group 2 ◽

Sun And Shade ◽

Poor Welfare ◽

Group 1

This study aimed at documenting whether dromedary camels have a preference for shade and how their behavior would change depending on the presence of shade and variable space allowance. A total of 421 animals kept in 76 pens (66 with shelter (Group 1), and 10 without shelter (Group 2)) at the camel market in Doha (Qatar) were recorded for 1 min around 11:00 a.m. when the temperature was above 40 °C. The number of animals in the sun and shade and their behaviors were analyzed using an ad libitum sampling method and an ad hoc ethogram. The results of a chi-square test indicated that camels in Group 1 had a clear preference for shade (p < 0.001). The majority of Group 1 camels were indeed observed in the shade (312/421; 74.11%). These camels spent more time in recumbency and ruminating, while standing, walking, and self-grooming were more commonly expressed by the camels in the sun (p < 0.001). Moreover, locomotory stereotypic behaviors (i.e., pacing) increased as space allowance decreased (p = 0.002). Based on the findings of this pilot study, camels demonstrated a preference for shade; shade seemed to promote positive welfare, while overcrowding seemed to trigger stereotypy and poor welfare. Overall, our preliminary results are novel and provide evidence that shaded areas are of paramount importance for camel welfare. Further research, involving designed studies at multiple locations is needed to confirm these results.

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Phenotypic Characterization of Juvenile Idiopathic Arthritis in African American Children

The Journal of Rheumatology ◽

10.3899/jrheum.150891 ◽

2016 ◽

Vol 43 (4) ◽

pp. 799-803 ◽

Cited By ~ 6

Author(s):

Lauren Fitzpatrick ◽

K. Alaine Broadaway ◽

Lori Ponder ◽

Sheila T. Angeles-Han ◽

Kirsten Jenkins ◽

...

Keyword(s):

African American ◽

Juvenile Idiopathic Arthritis ◽

Early Onset ◽

Disease Onset ◽

Phenotypic Characterization ◽

Rank Test ◽

Chi Square ◽

Phenotypic Data ◽

Exact Test ◽

American Children

Objective.Juvenile idiopathic arthritis (JIA) affects children of all races. Prior studies suggest that phenotypic features of JIA in African American (AA) children differ from those of non-Hispanic white (NHW) children. We evaluated the phenotypic differences at presentation between AA and NHW children enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, and replicated the findings in a JIA cohort from a large center in the southeastern United States.Methods.Children with JIA enrolled in the multicenter CARRA Registry and from Emory University formed the study and replication cohorts. Phenotypic data on non-Hispanic AA children were compared with NHW children with JIA using the chi-square test, Fisher’s exact test, and the Wilcoxon signed-rank test.Results.In all, 4177 NHW and 292 AA JIA cases from the CARRA Registry and 212 NHW and 71 AA cases from Emory were analyzed. AA subjects more often had rheumatoid factor (RF)-positive polyarthritis in both the CARRA (13.4% vs 4.7%, p = 5.3 × 10−7) and the Emory (26.8% vs 6.1%, p = 1.1 × 10−5) cohorts. AA children had positive tests for RF and cyclic citrullinated peptide antibodies (CCP) more frequently, but oligoarticular or early onset antinuclear antibody (ANA)-positive JIA less frequently in both cohorts. AA children were older at onset in both cohorts and this difference persisted after excluding RF-positive polyarthritis in the CARRA Registry (median age 8.5 vs 5.0 yrs, p = 1.4 × 10−8).Conclusion.Compared with NHW children, AA children with JIA are more likely to have RF/CCP-positive polyarthritis, are older at disease onset, and less likely to have oligoarticular or ANA-positive, early-onset JIA, suggesting that the JIA phenotype is different in AA children.

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Effect of vitamin A on severity of acute diarrhea in children

Paediatrica Indonesiana ◽

10.14238/pi53.3.2013.125-31 ◽

2013 ◽

Vol 53 (3) ◽

pp. 125

Author(s):

Marlisye Marpaung ◽

Supriatmo Supriatmo ◽

Atan Baas Sinuhaji

Keyword(s):

Vitamin A ◽

Acute Diarrhea ◽

Vitamin A Deficiency ◽

Stool Consistency ◽

Chi Square ◽

Vitamin A Supplementation ◽

Body Weights ◽

Group 2 ◽

Stool Volume ◽

Group 1

Background Vitamin A deficiency may increase the risk or bea cause of diarrhea. Many studies have been conducted on theefficacy of vitamin A in the management of acute diarrhea, butthe outcomes remain inconclusive.Objective To determine the effectiveness of vitamin A in reducingthe severity of acute diarrhea in children.Methods We performed a single􀁈blind􀁈randomized controlledtrial in the Secanggang District, Langkat Regency, North ofSumatera, from August 2009 to January 2010 in children aged6 months to 5 years, who had diarrheas. Subjects were dividedinto two groups. Group 1 received a single dose of vitamin A(100,000 IU for subjects aged 6 to 11 month old or with bodyweights :s 10 kg, or 200,000 IU for subjects aged 2: 12 month oldor with body weights> 10 kg). Group 2 received a single doseof placebo. The establishment of severity was based on changesin diarrheal frequency, stool consistency, volume and durationof diarrhea after treatment. We performed independent T􀁈testand Chi square tests for statistical analyses. The study was anintention􀁈to􀁈treat analysis.Results We enrolled 120 children who were randomized intotwo groups of 60 subjects each. Group 1, received vitamin Aand group 2 received a placebo. The results showed significantdifferences between the two groups in stool volume starting onthe first day (95%CI 192.30 to 3237.51; P􀁉O.OOI), as well asdiarrheal frequency (P=O.OOl) and stool consistency (P=O.OOl)on the second day observation and duration of diarrhea followingtreatment (95%CI - 40.60 to - 25.79; P􀁉O.OOI;).Conclusions Vitamin A supplementation is effective in reducingthe severity of acute diarrhea in children under five years of age.[Paediatr lndones. 2013;53:125-31.]

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173TRANSFER OF VITRIFIED BLASTOCYSTS FROM ONE OR TWO SUPEROVULATED LARGE WHITE HYPERPROLIFIC DONORS TO MEISHAN RECIPIENTS: REPRODUCTIVE PARAMETERS AT DAY 30 OF PREGNANCY

Reproduction Fertility and Development ◽

10.1071/rdv16n1ab173 ◽

2004 ◽

Vol 16 (2) ◽

pp. 208

Author(s):

C. Cuello ◽

F. Berthelot ◽

F. Martinat-Botté ◽

P. Guillouet ◽

V. Furstoss ◽

...

Keyword(s):

Pregnancy Rate ◽

Fisher Exact Test ◽

Corpora Lutea ◽

Large White ◽

Embryo Survival ◽

Exact Test ◽

Group 2 ◽

Fresh Semen ◽

Group 1

The present study was designed to determine the effect of pooling embryos from two donors on the reproductive success of transfer of vitrified/warmed porcine blastocysts. Superovulated Large White hyperprolific gilts (n=24) were used as embryo donors. Gilts were artificially inseminated 12 and 24h after initial detection of estrus using fresh semen, and slaughtered on Days 5.5 to 6 of the estrous cycle (Day 0=Onset of estrus). Embryos were recovered by flushing the uterine horns, and unhatched blastocysts were selected. Vitrification and warming were performed as reported previously (Berthelot et al., 2000 Cryobiology 41, 116–124). Embryo transfers were conducted in asynchronous (−24h) Meishan gilts (n=20). Twenty vitrified/warmed blastocysts were surgically transferred into one uterine horn. Ten recipients received embryos from one donor (group 1) and the other ten transfers were performed with mixed embryos from two donors (group 2). Pregnancy was assessed ultrasonographically at Day 25 after estrus and recipients were slaughtered five days later. The pregnancy rate from the different groups was compared using Fisher exact test. The GLM procedure of SAS was used to determine the effect of the origin of embryos (one or two donors) on the number of developed fetuses and viable fetuses at Day 30 of pregnancy. The ovulation rate was 32.5±11.8 (mean±SD). The total number of embryos collected was 634, of which 57 (9.0%), 36 (5.7%), 513 (80.9%) and 28 (4.4%), were unfertilized oocytes and degenerated embryos, morulae, unhatched blastocysts and hatched blastocysts, respectively. The ratio of collected embryos to the number of corpora lutea was 81.3%. The pregnancy rate for group 1 (70%) was not different (P>0.05) than that for group 2 (90%). No significant differences were detected between group 1 and group 2 for in vivo embryo development (number fetuses/transferred embryos in pregnant recipients; 33.3% v. 40%) or in vivo embryo survival (number viable fetuses/transferred embryos in pregnant recipients; 27.9% v. 33.9%). However, the in vivo efficiency (number viable fetuses/total transferred embryos) was higher (P<0.05) when transfers were performed with embryos from two donors (19.5% v. 30.5%). These results indicate that pooling embryos from two donors increases the in vivo efficiency after transfer of vitrified/warmed porcine blastocysts. This study was supported by grant from SENECA (FPI/99, Spain).

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Efficacy of azoximer bromide in the treatment of hospitalized patients with moderate to severe community-acquired pneumonia

Medical Council ◽

10.21518/2079-701x-2021-18-106-117 ◽

2021 ◽

pp. 106-117

Author(s):

S. K. Zyryanov ◽

O. I. Butranova ◽

A. V. Ershov ◽

Z. Sh. Manasova

Keyword(s):

Combination Therapy ◽

Community Acquired Pneumonia ◽

Hospitalized Patients ◽

Study Group ◽

Therapy Regimen ◽

Duration Of Hospital Stay ◽

Comparator Group ◽

Group 2 ◽

Severe Community Acquired Pneumonia ◽

Group 1

Introduction. The high incidence of community-acquired pneumonia and the high complication rates in the cases of severe pneumonia actualize the search for new pharmacotherapy tools to improve the effectiveness of standard patient management regimens. A high level of severe inflammatory response underlies the high risk for developing septic complications of pneumonia, along with impaired immune responses.The aim is to evaluate the efficacy of azoximer bromide introduction in the combination therapy regimen for hospitalized patients with moderate to severe community-acquired pneumonia.Materials and methods. A prospective, open label, parallel group, randomized study comparing the efficacy of azoximer bromide introduction in the combination therapy of hospitalized patients with moderate to severe community-acquired pneumonia was conducted at the premises of Federal Scientific and Clinical Center for Reanimatology and Rehabilitation. 30 patients were included in the study group and 37 patients in the comparator group. The baseline characteristics were comparable in both groups. Results. The azoximer bromide introduction in the combination therapy of patients with community-acquired pneumonia led to a statistically significant reduction in the duration of hospital stay (Me (LQ; HQ): 9 (8; 10) days for the study group and 13 (10; 14) days for the comparator group, (p = 0.000078), duration of ICU stay (Me (LQ; HQ) 2 days (1.5; 2.5) and 5 days (5.0; 6.0), respectively, (p = 0.00001), the duration of febrile fever 5 (± 0.6) days versus 10 (± 1.2) days (p = 0.0000), the incidence of acute respiratory failure (13.33% in group 1 versus 37.84% in group 2, p = 0.024) and septic shock (10% in group 1 versus 32.43% in group 2, p = 0.0285).Conclusions. The azoximer bromide introduction in the standard therapy regimen for patients with community-acquired pneumonia allowed to reduce the duration of hospital stay, the duration of ICU stay, the length of febrile fever, the incidence of septic shock and respiratory failure. The possible mechanisms of action may include a reduction of the severe inflammatory reactions and an optimization of the patient's immune response to the infectious process.

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Abstract 111: Exclusive Involvement of Interventional Cardiologist in the Decision Making Process Improves Door-to-balloon Time by Significant Shortening of Decision-to-balloon Time Instead of EKG-to-decision Time In ST Elevation Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a111 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Daming Zhu ◽

Yuanyuan Zhang ◽

Nowwar Mustafa ◽

Angela Hoban ◽

Dan Murphy ◽

...

Keyword(s):

Decision Making ◽

Decision Time ◽

Decision Making Process ◽

Primary Pci ◽

Chi Square ◽

Comprehensive Strategy ◽

Interventional Cardiologist ◽

Group 2 ◽

Door To Balloon ◽

Group 1

Background: We have had a “one call activation system” for primary PCI at our regional academic center since 1999. The ED physician initiated the system with the decision for primary PCI made by cardiologist (interventional or non-interventional) on call. But since July 1, 2009, only interventional cardiologists are involved in the decision making process. Otherwise, the comprehensive strategy remained the same. As we have reported previously, this new strategy resulted in a shortened door-to-balloon (D2B) time. In the present study, we analyzed the D2B timeline intervals to determine where the major gains were achieved. Methods: We conducted a retrospective analysis of 665 consecutive patients presenting to our institution with suspicion of acute STEMI during a 30-month period. Group 1 consisted of patients in the 12 months (July 1 2008-June 30 2009) before and Group 2 consisted of patients in the 18 months (July 1 2009-Dec. 31 2010) after the system change was instituted. Mann-Whitney U test and chi-square test were used for statistical analysis. Results: 218 patients in group 1 were taken to the cath lab of which 180 received primary PCI. 349 patients in group 2 were taken to the cath lab of which 275 received primary PCI. The results were presented in the table. Conclusions: Comprehensive strategy with exclusive involvement of interventional cardiologist resulted in a significant decrement in decision-to-balloon time. The EKG-to-decision time did not decrease, contrary to our expectation.

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