Modified technique of end to side distal radio-cephalic shunt to overcome juxta-anastomotic stenosis

Background: Juxta-anastomotic stenosis (JAS) is one of the predominant causes of arteriovenous fistula (AVF) failure, with the reported incidence of 65%, so that technical modification to alter the outflow vein configuration using the modified technique has been applied to prevent JAS and improve AVF maturation. The aim of the study to evaluate the modified technique of end-to-side distal radiocephalic A-V fistula regarding maturation, patency rate and the resultant juxta-anastomotic stenosis.Methods: This prospective study was carried out on 80 patients with end stage renal disease (ESRD) at vascular surgery unit in general surgery department, Menoufia university hospital that prepared for dialysis. 40 patients "intervention group" underwent the modified technique to establish a functioning radiocephalic fistula; the other group (40 patients, control group) had the conventional technique of end to side radiocephalic fistula. Follow up of patients was over 6 months regarding function, patency rate and development of juxta-anastomotic stenosis.Results: There was statistically significant difference between 2 groups regarding primary failure, patency and JAS. Primary failure was detected in 2 patients in group A and in 5 patients in group B (p-value is 0.04). Considering patency rate, after 3 months the ratio between group A and group B was 37:34 with significant P value of 0.02, and after 6 months the ratio was 35:33 with P value of 0.03. Regarding JAS, by the end of follow up period, 4 patients diagnosed with JAS in group A, while group B had 8 patients, with p value of 0.01.Conclusions: Modified technique of end to side anastomosis for primary radio-cephalic fistula creation has better patency rate and low incidence of JAS than conventional method.

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Fistula first, graft on arterialized vein second

Vascular ◽

10.1177/1708538114542479 ◽

2014 ◽

Vol 23 (3) ◽

pp. 265-269

Author(s):

Giuseppe Galzerano ◽

Michele Giubbolini ◽

Francesco Setacci ◽

Gianmarco de Donato ◽

Pasqualino Sirignano ◽

...

Keyword(s):

Patency Rate ◽

Rank Test ◽

P Value ◽

Secondary Patency ◽

Kaplan Meier ◽

Significant Difference ◽

Group A ◽

Group B ◽

Vein Stenosis

Objectives Arterovenous grafts (AVGs) present a feasible solution for creating a vascular access in patients who are unsuitable for autogenous fistula (AVF). The aim of this study is to assess the prevention rate of vein stenosis, placing a graft on an arterialized vein (GAV) instead of an anastomized AVG in a native vein (GNV). Methods This was a cohort study conducted from January 2009 to November 2012. All consecutive patients who underwent AVG in our institution were included. All patients requiring a secondary intervention were also referred to our centre. Patients underwent ultrasound follow up at first and the every month. A Kaplan–Meier method was used; a Log-rank test was used to identify whether significant difference existed between GAV and GNV ( p < 0.05). Results Forty-six grafts were placed. Twenty patients had arterialized receiving veins (group A), while 26 patients received an AVG immediately because they lacked autogenous veins suitable for fistula (group B).The average follow-up period was 16.1 months (range 0–41). The group A 41 months-patency rate was 84.3%, while group B was 43.7% ( p = 0.06). Secondary patency was similar in the two groups. Conclusions Vein arterialization seems to prevent venous stenosis improving AVG-patency rate. More data are needed; however, the borderline p value encourages new studies.

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Efficacy and Safety of Fenofibrate in Uncomplicated Hyperbilirubinemia in Newborn: A Randomized Trial, with a 6-month Follow-up

Asian Journal of Pediatric Research ◽

10.9734/ajpr/2020/v4i230147 ◽

2020 ◽

pp. 37-42

Author(s):

Jayendra R. Gohil ◽

Vishal S. Rathod ◽

Bhoomika D. Rathod

Keyword(s):

Single Dose ◽

Serum Bilirubin ◽

Total Serum Bilirubin ◽

Total Serum ◽

Control Group ◽

Term Neonates ◽

Significant Difference ◽

Group A ◽

Group B

Objective: To study the effect and safety of Fenofibrate in uncomplicated hyperbilirubinemia in newborn with 6-month follow-up. Materials and Methods: This is a randomized controlled clinical trial conducted in 60 normal term neonates admitted for uncomplicated hyperbilirubinemia in NICU at Sir T G Hospital, Bhavnagar from January 2012 to December 2012. The data included: age, sex, total serum bilirubin (TSB), weight and duration of phototherapy. All neonates enrolled in the study received phototherapy. They were divided in two groups of 30 each: control group A and group B receiving Fenofibrate (100 mg/kg single dose). There was statistically insignificant difference between the parameters of age, sex, weight and TSB between the two groups at hospitalization. Data was analyzed by using appropriate statistical methods. Results: Mean values for total serum bilirubin in Fenofibrate group B at 24 and 48 hours after admission were significantly lower than those for control group A (p<0.0001, p=0.0001). There was no significant difference in fall of TSB between 24 and 48 hours. The mean duration of phototherapy in Fenofibrate group (44.8h: 24-72h) was significantly shorter than that in control group (55.2 h: 24‐96 h) (P=0.02). There were no side effects of the drug observed during the study and during 6 months follow up period. Conclusion: Fenofibrate as a single 100 mg/kg dose in healthy full term neonates, is effective and a safe drug (till six-month follow-up) for neonatal hyperbilirubinemia, that can decrease the time needed for phototherapy and hence hospitalization. Effect of a single dose seems to wane after 24 hours.

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A study of effect of topical anaesthetics on injection pain during immunization in infants

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20202542 ◽

2020 ◽

Vol 7 (7) ◽

pp. 1463

Author(s):

Magesh Kumar ◽

V. Venkateshwar

Keyword(s):

Intervention Group ◽

Injection Pain ◽

Control Group ◽

P Value ◽

Open Label ◽

Topical Anesthetic ◽

Vaccine Injection ◽

Pain Scores ◽

Significant Difference ◽

Group B

Background: Immunization is a necessary aspect of health care of children and injections are there for unavoidable. Many factors affect injection pain during immunization in infants. This study aims to see the effect of use of local anesthetics delivered by various modes for attenuation of vaccine related injection pain in infants and to compare them.Methods: An Open Label Four-Arm Randomized Control Trial of 300 healthy infants of age group 6 weeks to 6 months reported to immunization clinic for immunization with DPT-HiB-Hepatitis B combination vaccine were taken for study. The enrolled subjects were allocated into control group and intervention group (who were applied some form of local anesthesia).Results: Among the four groups of the patients studied we observed a statistical difference in the mean pain scores of the patients recorded at 15 second, 60 second and 5 min after vaccine injection (p value 0.0024 - 0.000). Group A (Infants with topical occlusive LA cream) showed minimum pain scores values at 15 second, 60 second and 5 min after vaccine injection, followed by Group C (Infants with topical LA spray with vapocoolant) whereas Control group (Infants not received any local anaesthesia) and Group B (Infants with topical LA spray without vapocoolant) exhibited the maximum pain scores.Conclusions: Topical occlusive local anesthetic cream and topical LA spray with vapocoolent, were found to be better than topical LA spray without vapocoolant or no topical anesthetic. Use of topical occlusive LA cream led to a lowest pain score. There was no significant difference in the profile of side effects following injection in the four group.

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Prophylactic Effect of Memantine in Docetaxel Induced Neuropathy in Patients With Breast Cancer

10.21203/rs.3.rs-692391/v1 ◽

2021 ◽

Author(s):

Pegah Mohammadzadeh ◽

Elnaz Shaseb ◽

Zohreh Sanaat ◽

Parvin Sarbakhsh ◽

Nasrin Gholami ◽

...

Keyword(s):

Breast Cancer ◽

Peripheral Neuropathy ◽

Intervention Group ◽

Metastatic Breast ◽

Control Group ◽

P Value ◽

Control Groups ◽

Significant Difference ◽

And Control

Abstract Purpose Peripheral neuropathy is a complication of taxane that in severe cases can limit the optimal treatment. The aim of this study was to evaluate the efficacy of memantine in prevention of docetaxel induced peripheral neuropathy in patients with breast cancer. Methods In this randomized clinical trial, 40 women between the ages of 18 and 64 years with non-metastatic breast cancer (stages I to III) were included (registry number: IRCT20160310026998N9 and registry date: 26 March 2019). All patients were treated with the AC-T regimen (with docetaxel). Patients in intervention group received memantine at a dose of 20 mg for 8 weeks at the beginning of the first cycle of docetaxel. Patients in control group did not take any medication for neuropathy prevention. To assess the neuropathy, DN4 and CTCAE questionnaires were used at baseline, one months, three months and six months after the intervention. Results The DN4 questionnaire score was remarkably less in memantine group in follow up one (p-value: 0.033) and three (p < 00.1). The CTCAE follow up score did not change during study. The Neuropathy duration and Neuropathy onset, were shown significant difference between the intervention and control groups, p = 0.050 and p = 0.001, respectively. From 40 patients, 8 (40%) in memantine group and 2 (10%) in control group, did not experience any kind of neuropathy. Conclusion Data showed that prophylactic administration of memantine 20 mg/day has been effective in prevention of severity and incidence of docetaxel induced neuropathy in patients with breast cancer.

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Effects of posterior capsule stretch on adhesive capsulitis.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.3868 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1272-1277

Author(s):

Madiha Maryam ◽

Muhammad Kashif ◽

Abdul Ghafoor Sajjad ◽

Razia Rizwan ◽

Sehrish Ali ◽

...

Keyword(s):

Internal Rotation ◽

Manual Therapy ◽

Functional Disability ◽

Adhesive Capsulitis ◽

Mean Value ◽

Control Group ◽

P Value ◽

Significant Difference ◽

Group A ◽

Group B

To compare the effect of posterior capsular stretch on pain, ROM and functional disability in Adhesive Capsulitis. Study Design: Experimental, Randomized Control Trail. Setting: Department of Physiotherapy, Capital Development Authority Hospital Islamabad. Period: October 2015 to March 2016. Materials and Methods: Forty female patients having aged between 40 to 70 years with freezing and frozen stage of adhesive capsulitis were screened out. Adhesive capsulitis secondary to cervical Spondylosis, osteoporosis, direct trauma and any inflammation were excluded from the study. Subjects were randomly placed into two groups lottery method, the experimental group having 19 subjects received posterior capsular stretch along with conventional manual therapy and electrotherapy whereas the control group had 21 subjects and they were given manual therapy and electrotherapy alone. The Numeric Pain Rating Scale, Shoulder Pain and Disability Index, and Range of Motion of shoulder joint were used as outcome measures. All the patients were assessed at baseline before intervention and at the completion of 6 weeks of treatment. Data was analyzed using SPSS version 20. Results: Abduction, Internal Rotation and disability show significant result. The abduction mean value of Group A was 115.00±22.023and of the Group B was 81.74±20.653 with p value was P<05. The internal rotation mean value of Group A was 70.71±12.776 and for the Group B was 60.32±8.699 and having p value P<05. The SPADI mean value of Group A was 51.76±22.043 and for the Group B was 24.24±7.287 having p value P<05. The NPRS and external rotation showed non-significant difference. Conclusion: It is concluded that posterior capsular stretch along with mobilization is more effective in treating ROM and functional disability.

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Reduction in Blood Loss with Tranexamic Acid use in Dynamic Hip Screw Surgery for Intertrochanteric Fractures

10.53350/pjmhs211571657 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1657-1760

Author(s):

Muhammad Akram ◽

Ali Muqadas ◽

Arif Mahmood ◽

Faheem Mubashir Farooqi ◽

Shumaila Jabbar

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Dynamic Hip Screw ◽

Control Group ◽

P Value ◽

Intertrochanteric Fractures ◽

Significant Difference ◽

Group A ◽

Hip Screw ◽

Group B

Aim: To compare the mean decrease in hemoglobin levels in fixation of intertrochanteric fractures with or without use of Tranexamic acid. Methods: This study was conducted at Orthopedics Unit II, Mayo Hospital Lahore, Pakistan. Total 78 patients were included in the study. Duration of study was from 15-07-2017 till 15-01-2018.Study was approved by hospital ethical committee. A written informed consent was taken. Diagnosis was made clinically and with help of radiology. Patients were randomly divided into two groups. Patients in intervention Tranexamic acid (TXA) group received 15 mg/kg of Tranexamic acid at the time of induction of anesthesia and repeated after three hours, while those in the control group received placebo which is normal saline, intravenously. Results: There were 16(41%) males and 23(59%) females in group-A. There were 15(38.5%) males and 24(61.5%) females in group-B. Mean age in group A (control) with standard deviation was 44.2051±9.64141. Mean age in group B (TXA) was 45.9744±9.03061. p value 0.0046. Mean BMI in group A was 25.65±5.136. Mean BMI in group B was 24.307±2.153. p value 0.233. In group A 13(33.3%) patients had hypertension and 26(66.67%) did not have hypertension in group-A. In group B 16 (46.2%) patients had hypertension and 21 (53.8%) did not have hypertension in group-B. Mean fall in Hb in Group A was 9.47±1.054. Mean fall in Hb in group B was 9.547±0.9402. p value 0.001. Statistically significant difference was present in Group B (TXA) in term of mean fall in Hb ( p value 0.001). Conclusion: We in our study concluded that the patients in TXA group who were given tranexamic acid 1g intravenously before start of surgery had a lesser fall in mean Hb for the operative treatment of per trochanteric fractures with dynamic hip screw. Hence injecting tranexamic acid intravenously can effectively reduce the blood loss during DHS surgery for the intertrochanteric fractures. Keywords: Interochanteric fracture, tanexamic acid, blood loss

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P3130Relation between serum levels of long acting penicillin and the inflammatory markers: High sensitivity C-reactive protein and interleukin-6 in patients with chronic rheumatic heart disease

European Heart Journal ◽

10.1093/eurheartj/ehz745.0205 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O A Rifaie ◽

M A Hamza ◽

S M Amin ◽

M A Yousef

Keyword(s):

Heart Disease ◽

High Sensitivity ◽

Serum Levels ◽

Control Group ◽

P Value ◽

Significant Difference ◽

Inflammatory State ◽

Group A ◽

Long Acting ◽

Group B

Abstract Background There is evidence of a chronic inflammatory state in patients with chronic rheumatic valvular heart disease (RhD) as shown by high serum levels of high sensitivity C-reactive protein (CRP) and interleukin-6 (IL6). Despite the efficacy of long acting penicillin (LAP) in secondary prevention of rheumatic fever, its effect on this inflammatory state is still unknown Objective We sought to study the effect of (LAP) on the inflammatory markers, (CRP) and (IL-6), in patients with chronic rheumatic heart disease. Methods Eighty patients having (RhD) patients coming to our university hospitals outpatient clinic for rheumatic fever secondary prophylaxis by regular administration of (LAP) were enrolled in. the study. Patients were divided into to 3 groups: Group A; 70 patients with (RhD) already on prophylactic (LAP), Group B; 10 patients with (RhD) who have not yet started prophylactic (LAP), Group C; control group of 10 healthy individuals not known to have (RhD). Serum levels of (LAP), (IL6) and (CRP) were measured for the three groups. Results . Group A had significantly lower (IL6) levels than group B (25.22±33.50 vs. 126.1±33.76ng/ml, respectively, p<0.0001). (IL6) levels were significantly lower in control subjects compared to patients in group B (3.600±2.319, 25.22±33.50 ng/ml respectively, p<0.0001). However, IL6 levels in the control group were lower but non-significantly different compared to Group A . (CRP) level was lower in group A than group B (8419±4935 vs. 14400±3375mg/dl respectively, p=0.0002). (CRP) levels were significantly lower in control subjects compared to patients in group A and group B. (IL6) values were positively correlated with (CRP) values (r=0.6387, p<0.0001). (CRP) level negatively correlated with Long acting penicillin level (r=−0.5277, p<0.0001). (IL-6) level negatively correlated with (LAP) level (r=−0.4401, p<0.0001). There was a highly significant difference between (LAP) level in compliant and non-compliant patients (1.045±1.270 vs. 0.0785±0.1057ng/ml, respectively, p value <0.0001). There was also a highly significant difference between (CRP) level in compliant and non-compliant patients (7640±4558 vs. 13090±4717 mg/dl, respectively, p value 0.005).Moreover, there was a significant difference between (IL-6) levels in compliant and non-compliant patients (21.53±32.70 vs. 47.40±30.91 ng/ml, respectively, p value 0.03). Conclusion Serum (LAP) has a strong negative correlation with (IL-6) and (CRP) levels. Regular administration of (LAP) strongly ameliorates the inflammatory state seen in patients with (RhD).

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The Effect of Purgative Manna and Clofibrate on Neonatal Unconjugated Hyperbilirubinemia

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i6.1882 ◽

2019 ◽

Author(s):

Abolfazl Mahyar ◽

Shahrokh Mehrpisheh ◽

Bahman Khajeh ◽

Parviz Ayazi ◽

Sonia Oveisi ◽

...

Keyword(s):

Serum Bilirubin ◽

Intervention Group ◽

Serum Bilirubin Level ◽

Control Group ◽

Term Neonates ◽

Unconjugated Hyperbilirubinemia ◽

Significant Difference ◽

Group A ◽

Hospital Stays ◽

Group B

Abstract- This study was conducted to determine the effect of purgative Manna and clofibrate on unconjugated hyperbilirubinemia of term neonates. In this randomized clinical trial study, sixty neonates suffering from unconjugated hyperbilirubinemia were evaluated. The neonates were divided into three groups using balanced block randomization. Group A (control group-received only phototherapy), group B (intervention group-received purgative Manna and phototherapy) and group C (intervention group-received clofibrate and phototherapy). After the intervention, the amount of serum bilirubin reduction was compared between groups. There was no significant difference among group A, B, and C in terms of serum bilirubin reduction in 24, 48 and 72 hours after starting the intervention (P>0.05). The hospital stays in the control group was significantly longer than the intervention groups (P<0.05). No side effects were observed related to using purgative Mienna and clofibrate. The present study showed that prescribing of purgative Manna and clofibrate has no effect on reduction of serum bilirubin level in term neonates with unconjugated hyperbilirubinemia. Thus, it seems that the administration of these drugs is not necessary. Further studies in this regard are recommended.

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Comparison of Analgesic Effects of UST with NSAIDs and without NSAIDs in Patients with De Quervain’s Disease

TAJ Journal of Teachers Association ◽

10.3329/taj.v32i1.42685 ◽

2019 ◽

Vol 32 (1) ◽

pp. 25-32

Author(s):

ABM Zafar Sadeque ◽

AKM Salek ◽

Md Tariqul Islam Khan ◽

Badrunnesa Ahmed ◽

Hasan Habibur Rahman ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Pain Treatment ◽

Control Group ◽

De Quervain’S Disease ◽

Significant Difference ◽

Group A ◽

Anti Inflammatory ◽

Group B

Background: De Quervain's disease has been described as an entrapment of the extensor pollicis brevis and abductor pollicis longus tendons in the first dorsal compartment of the wrist is a common cause of wrist and hand pain Treatment of the disease consists of pharmacological & non-pharmacological. The non-pharmacological includes immobilization, therapeutic heat and cold, electrical nerve stimulator, thumb stabilizer splint, postural correction at work and the adjustment of tools and equipment. This randomized clinical trial was performed to find out the effects of UST with NSAIDs and without NSAIDs in the patients of De Quervain’s disease. Methods: This randomized clinical trial was performed in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, over a period of six months. Group A-experimental or interventional group and group B-control group by randomization with the help of lottery. Experimental group was managed by activities of daily living (ADLs) instructions, ultrasound therapy (UST) with non-steroidal anti-inflammatory agents (NSAIDs gel), along with thumb spica splint. Control group B received previous management except non-steroidal anti-inflammatory agents (NSAIDs gel). All patients received therapeutic ultrasound in a same dosage (1 watt/ cm 2/min) for 8 minutes. An evaluation was made at initial visit and two weeks interval for 6 weeks. So, there were three follow up visits and these evaluations were performed by the same investigator. In each visit, measurement of pain intensity and disability level were performed by using visual analogue scale (VAS), Tenderness Index and Patient rated wrist evaluation (PRWE) respectively. All results was recorded systematically. A post intervention result was compared with baseline result by SPSS-20 Results: Out of 60 total patients 60(100%) had Finkelstein test positive. Significant difference between Group A and Group B was found at week 4 and Week 6 follow up (P<0.05) whereas other early follow up was non-significant in VAS analysis (p>0.05). Significant difference between Group A and Group B was found at week 4 and week 6 follow up (P<0.05) regarding change of tenderness and PRWE. Conclusion: Regarding treatment of De Quervain's disease, present study shown that UST with NSAIDs gel reduces the morbidity and relief of pain of patients when in comparison to other conventional treatment. TAJ 2019; 32(1): 25-32

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Comparative Efficacy of the Combination of Topical Betamethasone Dipropionate and Calcipotriene with Betamethasone Dipropionate and Calcipotriene Alone in the Treatment of Localized Vitiligo

Medicine Today ◽

10.3329/medtoday.v26i1.21310 ◽

2014 ◽

Vol 26 (1) ◽

pp. 31-35

Author(s):

Mohd Nurul Alam ◽

Md Abdul Wahab ◽

Md Anwar Husain ◽

Lubna Khondker ◽

Gulam Kazem Ali Ahmad ◽

...

Keyword(s):

Betamethasone Dipropionate ◽

Ordinal Scale ◽

P Value ◽

Base Line ◽

Anova Test ◽

Global Estimate ◽

Significant Difference ◽

Group A ◽

Group B

Vitiligo is an acquired skin disorder characterized by welldefined white patches that are often symmetrically distributed. The study was conducted to compare the efficacy of the combination of topical betamethasone dipropionate and calcipotriene with betamethasone dipropionate and calcipotriene alone in the treatment of localized vitiligo. A clinical trial was carried out with the patients of vitiligo from January 2012 to August 2012. In group A, 20 patients were applied betamethasone dipropionate cream 0.05% and topical calcipotriene ointment (0.005%), in group B, 20 patients were applied betamethasone dipropionate cream 0.05% only; In group C, 20 patients were applied calcipotriene ointment 0.005% alone. From base line percentage reduction of total lesion in 1st follow up in group A, group B and group C were 20%, 15% and 10% respectively. At 3rd follow up in group A, group B and group C it was 50%, 37% and 30% and at 5th follow up, it was 80%, 75% and 65% respectively. ANOVA test was done and found significant difference of reduction of total lesion of vitiligo among the groups (p< 0.05). At the completion of the study, each patient was separately graded the treated sides on a 6-point ordinal scale based on a global estimate of the change in vitiligo and found that, the very much improvement were 70%, 55% and 45%, much improvement were 20%, 30% and 35% and improvement were 10%, 15% and 20% in group A, group B and group C respectively. ANOVA test was found significant difference of success rate of patients of localized vitiligo among the groups (p value 0.005). Both the drugs, calcipotriene and betamethasone dipropionate when used individually, were found to be equally effective in the treatment of vitiligo, but the combination of the two was found to be superior in efficacy. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21310 Medicine Today 2014 Vol.26(1): 31-35

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