scholarly journals A prospective randomized single blind study to compare the safety and efficacy of propronolol and topiramate in migraine prophylaxis

Author(s):  
Keelu Rajkumar ◽  
Pothuru Anil Kumar

Background: The aim of the study was to compare the Safety and efficacy of propranolol and topiramate in migraine prophylaxis.Methods: This was a prospective, randomized, single blind study which was conducted for six months in 100 patients of outpatient department of Neurology Government General Hospital, Guntur.Results: Among the hundred patients fifty were allotted to group A – propranolol 40 mg bd and fifty were allotted to group B- topiramate 25 mg bd. statistically there is no significant differences were found between the treatment groups of Propranolol and topiramate for the reduction in mean duration and severity of migraine headaches. Both Propranolol and topiramate have p value<0.001. This shows that both propranolol and topiramate have significantly decreased in the mean duration and severity of migraine attacks. However, in the present study topiramate is slightly more efficacious in reducing the symptoms of migraine frequency per month (days), duration and severity (visual analogue scale- VAS score) from baseline at the end of six months. The decrease in frequency of migraine attacks from 10.44±4.38 to 3.18±4.48 i.e., 70.2% from baseline is seen with topiramate.Conclusions: This study demonstrated that both propranolol and topiramate could significantly reduce migraine headache frequency, duration and intensity. However, compared with propranolol topiramate showed better results. topiramate 25 mg reduced the symptoms like frequency, duration and severity of migraine attacks from base line at the end of six months but more number of adverse effects were seen in topiramate group.

2018 ◽  
Vol 25 (12) ◽  
pp. 1892-1898
Author(s):  
Brig (Retd) Muhammad Boota ◽  
Sohail Nasir ◽  
Imran Hyder

Introduction: There have been several methods used to prevent or attenuate the adverse hemodynamic changes following endotracheal intubation, but not many studies have been done for the same purpose in patients undergoing nasotracheal intubation. Deepening of anaesthesia, omitting cholinergic premedication, pre-treatment with vasodilators such as nitroglycerine, beta blockers, calcium channel blockers and opioids are few of the different techniques used when trachea is intubated orally or nasally, to blunt significant swings in hemodynamic parameters. We assessed the effectiveness of oral gabapentin to determine changes in hemodynamic response in normotensive patients following nasotracheal intubationwith or without laryngoscopy for elective maxillofacial surgeries. Study Design: Randomized double blind, placebo-controlled clinical trial. Setting: Department of Anesthesia & Intensive Care, Fauji Foundation Hospital Rawalpindi. Period: 18 months after approval from the ethical committee. Material & Methods: Total 130 patients were included in the study. These patients were randomly divided into 2 groups. In Group-A patients were given 800 mg gabapentin and in Group-B patients were given placebo. Heart rate and mean arterial pressures were recorded just before intubation as base line values, and then average readings were taken at 1 minute, 3 minutes, 5 minutes and 10 minutes after intubation. Bradycardia and hypotension were adequately treated with intravenous atropine and vasopressors. Data entry and analysis was done by using SPSS 17. Results: Total 130 patients who underwent elective surgeries were included in the study and divided into 2 groups each group containing 65 patients each. At 1st minute MAP in Group-A (oral gabapentin) and in Group-B (Placebo) was 86.89±4.36 and 98.70±4.39. At 3rd minute MAP in Group-A, in Group-B was 83.40±4.05 and 92.93±4.79. At 5th minute MAP was 82.50±5.00 and 88.03±4.22 and lastly at 10th minute MAP was 79.81±5.37 in Group-A and 83.18±4.77 in Group-B respectively. P-value at 1st, 3rd, 5th and at 10th minutes showed that statistically MAP was different in both treatment groups at the above mentioned time intervals. 1st minute: p-value=0.042, 3rd minute: p-value=0.000, 5th minute: p-value=0.000 and at 10th minute: p-value=0.000. At 1st minute heart rate in Group-A and Group-B was 87.89±1.39 and 93.47±6.88 respectively. At 3rd minute heart rate in Group-A and Group-B was 83.47±5.47 and 89.70±6.76. At 5th minute heart rate was 82.10±5.01 and 84.60±5.91 and lastly at 10th minute heart rate was 78.09±6.79 in Group-A and 77.27±5.34 in Group-B respectively. P -value at 1st, 3rd and 5th minutes showed that statistically heart rate was different in both treatment groups at the above mentioned time intervals. But at 10th minute heart rate was statistically same in both treatment groups. 1st minute: p-value=0.144, 3rd minute: p-value=0.000, 5th minute: p-value=0.011 and at 10th minute: p-value=0.448. Conclusion: According to the results of this study it was observed that oral gabapentin is effective in modifying hemodynamic response to nasotracheal intubation in normotensive patients undergoing elective maxillofacial surgeries. MAP (10th Minute: Group-A vs. Group-B: 0.000) & Heart Rate (10th Minute: Group-A vs. Group-B:0.448)


Author(s):  
Nagaraju Kancherla ◽  
G. Chitti Babu ◽  
Hukum Singh ◽  
Mayank Khandelwal ◽  
Nitika Sharma ◽  
...  

Background: Neuropathic pain has a significant negative impact on the patients’ quality of life. Now a day’s anticonvulsants and antidepressants drugs are often used as first-line drugs for the treatment of neuropathic pain. The present study aims to evaluate the safety and efficacy of gabapentin, amitriptyline, and pregabalin in patients of severe neuropathic pain not controlled by simple analgesics.Methods: A total of 360 patients diagnosed with cases of chronic lumbar radiculopathy based on symptoms, clinical examination, X-ray, and magnetic resonance imagining (MRI) scan of the lumbosacral spine, were randomized into three groups. Group A patients received pregabalin 75 mg, Group B patients received gabapentin 300 mg, and Group C patients received amitriptyline 10 mg, respectively. Pain intensity was measured at the baseline, after 1 month and after 2 months with the Numeric pain rating scale (NPRS). Adverse drug reaction reported by the patient or observed by the clinician during the study was reported using the adverse drug reaction (ADR) reporting form.Results: At baseline, the mean±SD of NPRS score in Group A was 8.42±1.48, in Group B and Group C were 8.53±1.94 and 8.33±1.26 respectively with an F-value of 0.843 and p value of 0.584, which was not statistically significant. At 1 month, the mean±SD of NPRS score in Group A was 7.23±1.58, in Group B and Group C were 7.43±2.03 and 7.99±2.10 respectively with F-value of 1.58 and p value of 0.085 which was not statistically significant. At 2 months, the mean±SD of NPRS score in Group A was 4.38±2.72, in Group B and Group C were 4.74±2.86 and 6.32±2.31 respectively with F-value of 5.53 and p value of 0.002 which was statistically significant.Conclusions: Pregabalin has the advantages in terms of the NPRS score over gabapentin and amitriptyline. Gabapentin has fewer reported adverse effects and hence better patient compliance on long term use. Amitriptyline is more cost effective than pregabalin which is an important factor to keep in mind while treating patients.


2015 ◽  
Vol 10 (1) ◽  
pp. 74-79
Author(s):  
Md Shirajul Islam Khan ◽  
Md Nasir Uddin ◽  
Md Abdul Latif Khan ◽  
Rowshan Ara ◽  
Lubna Khondker

Introduction: The effectiveness of various topical agents for the treatment of plaque psoriasis is limited and the results are somewhat not satisfactory to some extent. Topical Calcipotriol can be used either monotherapy or combination therapy with betamethasone. This topical agent has “corticosteroid-sparing” benefit and reduction of side effects, duration of treatment and also relapse rates when used as combination therapy for the treatment of psoriasis. Objectives: The present study was conducted to compare the clinical efficacy between the topical Calcipotriol and combined formulation of topical Calcipotriol plus Betamethasone in the treatment of plaque type psoriasis. Materials and Methods: A clinical trial was carried out from January 2011 to Jan 2014 in outpatient department of Dermatology and Venereology, combined military hospital- Dhaka and Jessore Cantonment and Bangabandhu sheikh Mujib Medical University, Dhaka. Patients of plaque type psoriasis were the study population. Consequitive type of non-probability sampling method was followed in this study. Patients were divided into two groups.Group A was treated with topical Calcipotriol (0.005%) ointment and group B with combination of topical Calcipotriol plus Betamethasone ointment. Results: The mean percentage of Psoriasis Area and Severity Index (PASI) reduction after 4th week of treatment was 39.4 and 35.4 in group A and group B (p value >0.05) and after 8th week of 74 JAFMC Bangladesh. Vol 10, No 1 (June) 2014 therapy was 59.6 in-group A and 60.7 in-group B respectively. The mean baseline PASI score was 6.7±4.5 and after 8th week it was 2.0 ±1.4 for group A and mean baseline PASI score was 5.5 ±4.2 and after 8th week it was 2.5±1.4 for group B. There was statistically significant reduction in PASI score from base line after 8th week of treatment in both treatment groups (p < 0.001). After 8th week of treatment moderate response was 22(73.3%) in group A and 18(60%) in group B. Very good response was 4 (13.3%) in group A and 8 (26.7%) in group B and minimal response of treatment occurs equally 4 (13.3%) in group A and group B. Conclusion: In the light of the findings of this study, topical Calcipotriol(0.005%) alone or combination with Betamethasone is individually effective for the treatment of plaque psoriasis but combination therapy is more effective than monotherapy. Therefore it may be recommended that monotherapy can be replaced by combination therapy in treating plaque psoriasis. DOI: http://dx.doi.org/10.3329/jafmc.v10i1.22929 Journal of Armed Forces Medical College Bangladesh Vol.10(1) 2014


2018 ◽  
Vol 23 (4) ◽  
pp. 514-518
Author(s):  
Sadaf Ghulam Rasul ◽  
Uzma Yaqub ◽  
Maida Manzoor ◽  
Hafsa Mubasshar

Endometriosis is an estrogen-regulated disease, and is signified by the existence of a particular endometrial tissue exterior to the uterus. It is a principal cause of long lasting morbidity, mostly from serious pelvic pain(1). Endometriotic tissue has the potential for aromatase gene expression that leads to aromataseand estrogen production. Danazol is a synthetic androgen whereas Letrozole is aromatase inhibitor. This study was conducted to compare the mean decrease in visual analogue scale (VAS) pain score with Danazol versus Letrozole for the pain management of endometriosis in females. A total of 140 females fulfillinginclusion criteria were registered and an non-probability purposive technique of sampling was used. Diagnostic laparoscopy was conducted to make a diagnosis of endometriosis. Females were divided into two groups. Females in group A received treatment with Letrozole tablets (2.5 mg/day) and in group B receivedDanazol tablets (600 mg/day) for 3 months. Pelvic pain was assessed using VAS score and the mean decrease in pain score was assessed between two groups using independent sample student t-test. Results of this study demonstrate that the mean age of the patients was 29.99±5.80 and the mean pain score before treatment in Letrozole group was 3.04±1.01 while in Danazol group was 5.05±1.02. Post-three months of treatments, mean pain score was 2.01±0.95 and 2.78±0.99 in Letrozole and Danazol groups, respectively. The mean decrease in pain score in Letrozole group was 1.02±1.09 (p-value=0.00) while in Danazol group; it was 3.06±1.23 (p-value=0.00). This difference in pain score was considerably different in both treatment groups. A higher decrease in pain score was observed in Danazol compared to Letrozole treated groups.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1496.2-1496
Author(s):  
M. Watanabe ◽  
Y. Haji ◽  
M. Kato ◽  
T. Ito ◽  
Y. Banno ◽  
...  

Background:Hydroxychloroquine (HCQ) is an essential drug for systemic lupus erythematosus. But in Japan, chloroquine and HCQ remain unavailable until mid 2015 because of a series of lawsuits about its retinal toxicity in the 1970s. There is insufficient knowledge regarding renal protective effect of HCQ.Objectives:We aimed to investigate its efficacy of adding HCQ for Lupus nephritis (LN) as a maintenance-phase therapy.Methods:We conducted an observational retrospective cohort study included patients with LN (n=42) in maintenance-phase in Japan. We reviewed medical records of LN patients aged > 18 years who were initiated HCQ from May 2015 to May 2018. Maintenance phase was defined as stabilization in serum creatinine and urinary segment after induction therapy and who achieved complete or partial remission. The annual change of proteinuria was compared between patients on HCQ who have proteinuria (>0.5g/gCr) or not. Other outcome measures were disease flare, dose of steroids, renal and immunologic features.Results:A total of 42 patients were analyzed and allocated to two groups based on their amount of daily urine protein level: HCQ with proteinuria as group A (>0.5g/gCr, n=14) and HCQ without proteinuria as group B(≦0.5g/gCr, n=28). Both groups were comparable, with mean (SD) age of 36.1 (12.9) years and 37.5 (13.8), female 78.6% and 92.9% in each group, mean (SD) disease duration until HCQ of 3.5 (3.25) and 3.3 (2.9) years in group A and group B, with prednisolone dose at base line of 10.3 (7.1) mg and 7.9 (4.4) mg, respectively. The mean (SD) proteinuria at base line was 1.38 (1.11) g/gCr in group A and 0.20 (0.09) g/gCr in group B and after 12 months, proteinuria decreased in group A (-1.34 g/gCr in group A vs +0.03 g/gCr in group B; p<.001;95% CI,0.305-0.736). No relapse was experienced in group A during the study period.Conclusion:In patients with clinically stable LN but with proteinuria, hydroxychloroquine is a good therapeutic option for achievement of complete remission.Disclosure of Interests:None declared


2012 ◽  
Vol 19 (05) ◽  
pp. 710-714
Author(s):  
Muhammad ASGHER ◽  
ASIM GHAURI ◽  
MUHAMMAD ABDULLAH ◽  
Tariq Abassi

Objective: To compare the analgesic effects of combination of 0.5% Lidocaine plus Ketorolac in intravenous regionalanaesthesia technique with those of Lidocaine (0.5%) alone to prevent post operative pain after intravenous regional anaesthesia (Biersblock). Study design: Randomized Control Trial. Place and duration of study: The study was carried out at Department of Anaesthesiology,Intensive Care and pain management, Combined Military hospital, Rawalpindi from July 2008 to February 2009. Patients and Methods: Thestudy was conducted after complete evaluation of risk / benefit ratio to the patients. On the basis of random number method the patients weredivided into two equal groups (group A and group B). The number of patients in each group was 75. Group A was assigned Lidocaine in a dose of200mg 40ml of 0.5% solution and group B was assigned injection Ketorolac 30mg added to Lidocaine in a dose of 200mg 40ml of 0.5% solution.The patients were kept in post anaesthesia care unit for two hours and pain intensity was measured by visual analogue scale(VAS) on 15,30minutes,1hour, 1.5 and at 2 hours after the cuff deflation. The analgesic efficacy recorded on the basis of visual analog scale of two groups, wascompared using student’s t - test. p value of less than 0.05 was considered statistically significant. Results: In group A 33 males and 42 femaleswere enrolled for the study while in group B there were 38 males and 37 females. The mean age of the patients in group A was 34.31 ± 6.03years while in group B was 32.99 ± 6.08 years. Patients were also classified according to ASA classification in which 87 patients were classifiedas ASA – I and 63 patients as ASA – II. Group B which received Ketorolac in addition to Lidocaine for Bier’s block had low visual analogue scoresas compared to group A which received only Lidocaine for Bier’s block. P values obtained after the comparison of the mean VAS of two groupsat 15 minutes, 30 minutes, 1 hour, 1.5 hours and 2 hours were all less than 0.05 (0.002 for 15 minutes, 0.004 for 30 minutes, 0.001 for 1 hour,0.004 for 1.5 hours and 0.001 for 2 hours). Conclusions: Ketorolac improves the postoperative analgesia markedly when used with Lidocainein intravenous regional anaesthesia.


2021 ◽  
Vol 28 (05) ◽  
pp. 749-754
Author(s):  
Nadia Sharif ◽  
Uzma Manzoor ◽  
Saadia Bano ◽  
Uzma Shahzaad

Objective: To compare the efficacy of Letrozole and clomiphene citrate in Patients of Anovulation polycystic ovarian syndrome with Infertility. Study Design: Randomized Controlled Trial Setting: Department of Obstetrics and Gynecology Independent Medical College Faisalabad. Period: 30-09-2019 to 29-6-2020. Material & Methods: This study included 100 patients with 50 patients in each group. Group A received 2.5 to 5mg letrozole in each cycle from day 3 to 7. Group B received clomiphene citrate 50 to 100 mg incremental dose depending on ovarian response. Both Drugs were given for consecutive 3 to 6 cycles to see response. Main outcome Measure included optimal follicle size (> 18mm), endometrial thickness, and pregnancy rate. Epidemiological data and efficacy outcome measures were recorded on a Performa. Statistical analysis was done using SPSS version 13. Chi-square test applied and p-value <o.o5 was considered significant. Both group included primary infertility patients. Results: The mean age of patients was 28.03+ 3.02 years. Mean age of group A patients was 29.04+3.44 and 28.47+3.90 group B patients. Mono ovulation in group A patients (88.9%) and 27 in group b patients (60.0%). The mean endometrial thickness was 9.6mm + 1.6 in letrozole group and 6.9mm + 1.2 in clomiphene citrate group A. In group A 18% got pregnant from Letrozole group and 1.1% from the group B. Conclusion: Efficacy was significantly higher in group A Patients received letrozole as compared to patients echo received clomiphene citrate. The effects of Letrozole showed better outcome in terms of Ovulation Induction Endometrial Thickness and Pregnancy rate.


2021 ◽  
Vol 8 (2) ◽  
pp. 321-325
Author(s):  
Dinesh Kumar Singh ◽  
B B Baj ◽  
Vipin Goyal

The aim of our study to determine the role of tolvaptan in prevention of hyponatremia in transurethral resection of prostate surgery. This is randomized double-blind study conducted in 60 ASA grade status 1 and 2 patients age group between 45-80 yrs undergoing TURP under spinal anaesthesia in urology operation theatre in Mahatma Gandhi hospital Jaipur after receiving permission from hospital ethical committee. A detailed history, complete physical examination and routine investigation were done for all patients followed by informed written consent was obtained. Patients are randomly divided into 2 groups. In group A -30 patients who received orally tab tolvaptan 15 mg and group B-30 patients who received orally tab multivitamin 2 hrs before surgery after doing electrolytes of the patients in the morning. In both groups age (in yrs), wt (in kg), ASA grade, volume of irrigating fluid (in litres), volume of prostate resected (in gm) and duration of surgery (in minutes) all demographic and surgical details data were compared. Electrolytes were compared in both groups pre and post-operatively and statistical analysis was done.There was significant difference in post-operative sodium level between the two groups (A and B). The mean level of sodium significantly reduced post-operatively in group –B (control grp). The mean level of sodium significantly increased post-operatively in group –A (tolvaptan grp). We conclude single dose of tolvaptan -15 mg found to effective in prevention of hyponatremia in patients undergoing TURP.


Author(s):  
Muhammad Ahmad ◽  
Syed Tatheer Abbas ◽  
Amna Javaid ◽  
Naveed Arshad ◽  
Falak Shair

Objectives: To assess the comparison of harmonic scalpel versus Milligan Morgan technique in patients undergoing haemorrhoidectomy. Methodology: This randomized controlled trial study was conducted at General Hospital, Lahore, from March 2019 to September 2019. Informed consent was obtained from eligible 60 patients. Patients were randomly divided into two equal groups. In group-A, haemorrhoidectomy was conducted according to the harmonic scalpel method. In group-B, open haemorrhoidectomy was performed by the Milligan Morgan procedure. Data was assembled through a designed questionnaire and investigated via SPSS version 25. Data were stratified for descriptive statistics, level of haemorrhoids and period of haemorrhoids. Post-stratification, independent sample t-test was used. Results: Mean age of both groups patients were 44.6±7.6 and 43.8±8.2 years, respectively. In group-A, mean operative time was 20.8±2.8 minutes, while 26.5±2.8 minutes in group-B, which was statistically significant with p-value of 0.001. In group-A, mean convalescence period was 9.7±2.9 days, while 13.4±3.7 days in group-B, which was statistically significant with p-value of 0.001. The mean convalescence period with harmonic scalpel method was 7.4 days (range 5–14, SD 3.6) versus 18.6 days (range 7–30, SD 5.4) with Milligan Morgan technique (P?0.001). This research observed that harmonic scalpel method required almost six weeks for complete wound healing, whereas in  Milligan Morgan technique, complete wound healing was achieved after three months (P<0.05). Conclusion: Harmonic scalpel haemorrhoidectomy found an advantageous method when assessing the operative time and convalescence period. Hence, Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternative method for treating symptomatic haemorrhoids. Continuous...


2016 ◽  
Vol 5 (2) ◽  
pp. 32-36
Author(s):  
Azam Mahmood ◽  
Saad Saleem ◽  
Muhammad Usman Khan

OBJECTIVE To compare the effects of trigger point (TrP) pressure release with ultrasound therapy to reduce rhomboid pain due to TrP. STUDY DESIGN Experimental study STUDY SETTINGS Outpatient department of Ziauddin Hospital, Clifton campus, Karachi, Pakistan. SAMPLE SIZE 50 patients SAMPLING TECHNIQUE Simple random sampling. The patients were divided into two groups of 25. Group A were given TrP pressure release treatment with exercise and group B were given ultrasound (u/s) treatment with exercise. OUTCOME MEASURES The outcome measures were visual analog scale (VAS) for pain and functional rating index (FRI) for functional performance RESULTS In group A, mean pain score on VAS before the treatment were 5.88±1.130 and after treatment were 1.80±1.041 with a p-value of <0.006. Group B, mean pain score on VAS before treatment were 6.56±1.446, after treatment were 2.72±1.208, with a p-value of <0.006. The mean FRI in group A before treatment was 39.92 ± 2.691 and after treatment was 29.60 ± 5.454, with a p-value of 0.002. The mean FRI in Group B before treatment was 41.12 ± 2.505 and after treatment was 35.92 ± 4.183, with a p-value of 0.002.


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