Lactulose versus lactitol in acute hepatic encephalopathy (HE).

Hepatic encephalopathy (HE), a syndrome observed in some patients with cirrhosis, with depressed level of consciousness. Lactulose as well as lactitol has been used in the treatment of HE. Lactitol is comparable to lactulose in the treatment of HE with fewer side effects and better tolerated. However, literature showed equal efficacy of both drugs. So we conducted this trial to find better drug to implement its use in future. Objective: To compare the effectiveness of lactulose and lactitol in patients with acute hepatic encephalopathy. Study Design: Randomized Controlled Trial. Setting: Department of Medicine OPD and Emergency (East, West, North, South), Mayo Hospital, Lahore. Period: 6 Months June 2017 to Dec 2017. Material & Methods: 570 patients were included through non-probability, consecutive sampling after informed consent. Initial grade of HE was assessed and patients were randomly divided in two groups by using lottery method i.e. lactulose or lactitol. Patients were admitted to ward for management and kept under observation for 5 days. After 5 days, HE grades was measured again, then improvement in grade of HE (effectiveness) was measured. All data was entered and analyzed by using SPSS version 21.0. Chi-square was applied to compare both groups for effectiveness taking p-value≤0.05 as significant. Results: In this study the mean age of the patients was 44.22 ±11.81 years, the male to female ratio of the patients was 2.4:1. The mean duration of the cirrhosis of the patients was 3.73±1.61 months. In our study the effectiveness was achieved in 538 (94.39%) patients, out of which 263 cases were from lactulose group and 275 were from lactitol group and the difference was significant (p<0.0.5). Conclusion: Our study results concluded that Lactitol is better choice for the treatment of patients with acute hepatic encephalopathy as compared to lactulose. More efficacy was achieved in lactitol group patients than in lactulose group patients.

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Ideal sedation for stroke thrombectomy: a prospective pilot single-center observational study

Neurosurgical FOCUS ◽

10.3171/2018.11.focus18522 ◽

2019 ◽

Vol 46 (2) ◽

pp. E16 ◽

Cited By ~ 3

Author(s):

M. Asif Taqi ◽

Sajid S. Suriya ◽

Ajeet Sodhi ◽

Syed A. Quadri ◽

Mudassir Farooqui ◽

...

Keyword(s):

Interventional Radiology ◽

Ischemic Stroke ◽

Controlled Trial ◽

Time Interval ◽

Open Label ◽

Anterior Circulation ◽

Clinical Trial Registration ◽

Female Ratio ◽

The Mean ◽

The Difference

OBJECTIVESeveral retrospective studies have supported the use of conscious sedation (CS) over general anesthesia (GA) as the preferred methods of sedation for stroke thrombectomy, but a recent randomized controlled trial showed no difference in outcomes after CS or GA. The purpose of the Ideal Sedation for Stroke Thrombectomy (ISST) study was to evaluate the difference in time and outcomes in the reperfusion of anterior circulation in ischemic stroke using GA and monitored anesthesia care (MAC).METHODSThe ISST study was a prospective, open-label registry. A total of 40 patients who underwent mechanical thrombectomy for anterior circulation ischemic stroke were enrolled. Informed consent was obtained from each patient before enrollment. The primary endpoint included the interval between the patient’s arrival to the interventional radiology room and reperfusion time. Secondary endpoints were evaluated to estimate the effects on the outcome of patients between the 2 sedation methods.RESULTSOf the 40 patients, 32 received thrombectomy under MAC and 8 patients under GA. The male-to-female ratio was 18:14 in the MAC group and 4:4 in the GA group. The mean time from interventional radiology room arrival to reperfusion in the GA group was 2 times higher than that in the MAC group. Complete reperfusion (TICI grade 3) was achieved in more than 50% of patients in both groups. The mean modified Rankin Scale score at 3 months was < 2 in the MAC group and > 3 in the GA group (p = 0.021).CONCLUSIONSThe findings from the pilot study showed a significantly shorter time interval between IR arrival and reperfusion and better outcomes in patients undergoing reperfusion for ischemic stroke in the anterior circulation using MAC compared with GA.Clinical trial registration no.: NCT03036631 (clinicaltrials.gov)

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LOWER URETERIC STONES EXPULSION;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.09.899 ◽

2017 ◽

Vol 24 (09) ◽

pp. 1331-1335

Author(s):

Khalid Hussain ◽

Maria Tarique ◽

Attiq ur Rehman Khan ◽

Asim Bukhari ◽

Bilal Akhter ◽

...

Keyword(s):

Controlled Trial ◽

Oral Treatment ◽

P Value ◽

X Rays ◽

Female Ratio ◽

Group A ◽

Insignificant Difference ◽

The Mean ◽

Group B ◽

Trial Setting

Objectives: To compare Tamsulosin versus ESWL for lower ureteric stonesexpulsion. Study Design: Randomized controlled trial. Setting: Outpatient Department ofUrology at Services Hospital, Lahore. Period: January 2015 to December 2015. Material& Methods: Total 50 patients were enrolled in study. Patients were divided into 2 groups.In group A, 25 patients received daily oral treatment of 0.4mg Tamsulosin for 28 days, andin group B, 25 patients were treated with ESWL. A stone-free condition, was defined as thecomplete absence of any stone based on plain abdominal X-rays observed and during followupvisits at the time of treatment of stone was noted. Results: The mean age of the patientswere recorded as 33.20±9.23 years. There were 40(80%) males and 10(20%) females with maleto female ratio of 4:1. Out of 50 patients, 16(32%) presented with hematuria, 3(6%) had feverwhile 31(62%) appeared with no complication status. Out of 50 patients, 21(42%) presentedwith expulsion time 08-14 days in which 14(28%) were from tamsulosin group and 07(14%)were from ESWL group, similarly 19(38%) patients appeared with expulsion time of 15-28 daysin which 10(20%) were from tamsulosin group and 09(18%) were from ESWL group. Statisticallythere is insignificant difference between the groups i.e. p-value=0.28 Ns. Conclusion: Thisstudy suggests that the tamsulosin helps in the earlier clearance of stone fragments andreduces the complications as compared to ESWL.

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Anatomical Variations of the Paranasal Sinuses and the Nasal Cavity

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24837 ◽

2019 ◽

Vol 21 (1) ◽

pp. 7-11

Author(s):

Kundan Kumar Shrestha ◽

K Acharya ◽

RR Joshi ◽

S Maharjan ◽

D Adhikari

Keyword(s):

Anatomical Variation ◽

Anatomical Variations ◽

P Value ◽

Deviated Nasal Septum ◽

Chi Square ◽

Female Ratio ◽

Chi Square Test ◽

The Difference ◽

The Right ◽

Sinonasal Symptoms

Computed tomography (CT) of the para-nasal sinuses (PNS) has nowadays become the investigation of choice for the diagnosis of sinonasal diseases. Numerous sinonasal anatomic variants exist and are frequently seen on CT scans. A sound knowledge of these variations is important not only for diagnosis but also for planning surgery in order to avoid complications. The aim of this study is to investigate the frequency of these variations in patients with sinonasal symptoms and also to determine their relation to sinonasal disease if any. A total of 76 patients were included in the study from August 2017 to July 2018 of which 43 (56.6%) were males and while 33 (43.4%) were females with male to female ratio of 1.3:1. The ages of patients ranged from 14 to 72 years with a mean age of 33.2±14.2 years. Out of 76 patients, 68 (89.5%) had at least one type of anatomical variation while 8 (10.5%) had no variation. Only one variation was seen in 39 (51.3%) patients while 29 (38.2%) had two or more variations. The most common variant was deviated nasal septum (DNS), occurring in 49 (64.5%) patients followed by concha bullosa (CB) and agger nasi cell (AN) seen in 15 (19.7%) and 14 (18.4%) patients respectively. Genderwise, anatomical variations were seen more in males but the difference was not statistically significant. Some variations were seen more on the right side while others on the left. Some variations were present bilaterally. The difference was not statistically significant. The presence of DNS was statistically significant in the study population (p value 0.012 in nonparametric chi square test). The age group 14 to 30 years showed maximum variations though not significant statistically. Therefore, during management of patients with sinonasal symptoms, these variations need to be addressed, if required, surgically. Proper knowledge of both common and uncommon sinonasal variations in our community could help in better surgical planning and overall management of sinonasal disorders.

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Relationship of Physiotherapy Intervention and the Level of Community Reintegration of Stroke Survivors In Accra, Ghana

Journal of Preventive and Rehabilitative Medicine ◽

10.21617/jprm2021.318 ◽

2021 ◽

Vol 3 (1) ◽

pp. 31-39

Author(s):

Dorcas Kyela Yusuf ◽

◽

Samuel Koranteng Kwakye ◽

Jonathan Quartey ◽

◽

...

Keyword(s):

P Value ◽

Stroke Survivors ◽

Community Reintegration ◽

Chi Square ◽

Disability Score ◽

End Point ◽

Physiotherapy Intervention ◽

The Mean ◽

The Difference ◽

Relationship Of

Background: Stroke is one of the major causes of death and disability in the world. During rehabilitation, there appears to be little or no emphasis placed on reintegrating the stroke survivors into their communities.The study sought out to determine the relationship between physiotherapy and the level of community reintegration among stroke survivors.Method: This observational study involved51 stroke survivors referred to physiotherapy departments of selected hospitals in Accra. Participants completed the Reintegration to Normal Living Index and the Modified Rankin Scale at baseline and after 8 weeks of physiotherapy sessions. Wilcoxon’s test was used to assess the difference between the baseline and end point scores for reintegration and disability while Chi square and Spearman correlation were used to test for associations between physiotherapy intervention and community reintegration. A p-value of 0.05 was set.Results: The mean reintegration score at baseline was 55.5±17.00 and 76±14.00 at end point (p = 0.001) while the mean disability score at baseline was 3.43±0.67 and 2.31±0.68 at end point (p = 0.001) showing a significant level of improvement from baseline to endpoint of the reintegration and disability scores. There was a low association between duration of stroke (p=0.008) and duration of physiotherapy (p=0.038) with regards to reintegration 8 weeks post physiotherapy.Conclusion: Physiotherapy plays a role in the reintegrating of stroke survivors into their communities. Incorporation of community reintegration into rehabilitation programmes for stroke survivors could be useful. Efforts to include physiotherapy to reintegrate stroke survivors could therefore be strengthened

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Role of Early Tracheostomy in the Management of Severe Head Injury

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v23i3.358 ◽

2019 ◽

Vol 23 (3) ◽

pp. 188-192

Author(s):

ABDUL MAJID ◽

MUHAMMAD FAROOQ ◽

MUHAMMAD SHAKIR ◽

ZUBAIR MUSTAFA KHAN ◽

SAJID IQBAL

Keyword(s):

Controlled Trial ◽

Head Injuries ◽

P Value ◽

Chi Square ◽

Early Tracheostomy ◽

Qualitative Variables ◽

Chi Square Test ◽

The Mean ◽

Complications And Mortality

Objective: The objective of this study was to compare the role of early and late tracheostomy in patients presenting with severe head injuries.Material and Methods: This randomized controlled trial study was conducted in the department of neurosurgery, Lahore General Hospital Lahore from March 2018 to August 2018, after taking approval from the ethical committee. A total of one hundred and thirty patients was divided randomly into early (within three days) and late(after three days) tracheostomy groups. After tracheostomy, data regarding acute physiology, age and chronic health evaluation II (APACHE II), the total number of days since ventilation, tracheostomy, weaning, discharge from ICU and hospital, complications and mortality were noted. All the data was entered and analyzed with SPSS23.0. Quantitative variables were presented as mean and standard deviation, qualitative variables were presented as numbers and percentage. The Chi-square test was applied. A p-value of ≤0.05 was considered significant.Results: The mean age of the patients was 33.13 ± 2.53 years. There were 84 males (64.61%) and 46 females (35.38%) in the study. The duration of mechanical ventilation, ICU stay and stay in hospital for early and late tracheostomy groups were 25.68 ± 2.94 vs. 33.37 ± 3.32 days, 29.42 ± 2.97 vs. 38.54 ± 3.80 days and 37.20 ± 2.98 vs. 47.15 ± 3.84 days respectively. Four patients (3.08%) and seven patients (5.38%) suffered from mortality.Conclusion: Early tracheostomy among the patients presenting with severe head injuries was associated with a better outcome than late tracheostomy.

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Differences of young adult smokers and non-smokers saliva reviewed by salivary pH, viscosity, and volume

Padjadjaran Journal of Dentistry ◽

10.24198/pjd.vol31no2.22863 ◽

2019 ◽

Vol 31 (2) ◽

pp. 142

Author(s):

Dias Mareta Kusumaningrum ◽

Sri Tjahajawati ◽

Ervin Rizali

Keyword(s):

Young Adult ◽

Mean Value ◽

P Value ◽

Chi Square ◽

Tissue Integrity ◽

Significant Difference ◽

Salivary Ph ◽

Oral Tissue ◽

The Mean ◽

The Difference

Introduction: Salivary pH, viscosity and volume play an important role in maintaining tooth and oral tissue integrity. The purpose of this research was to evaluate the difference of young adult smokers and non-smokers saliva reviewed by its pH, viscosity and volume. Methods: The research sample of 28 smokers and 24 non-smokers. Saliva was collected by spitting method then the pH, viscosity and volume was measured. The data was analyze using independent sample t-test and chi-square. Results: The result indicated that there was a significant difference in the mean value of salivary pH on smokers and non-smokers with p-value 0.000 (p < 0.05). There was a significant difference in the mean value of salivary viscosity on smokers and non-smokers with p-value 0.000 (p < 0.05.) There was a significant difference in the mean value of salivary volume on smokers and non-smokers with p-value 0.000 (p < 0.05). Conclusion: The conclusion of the research showed that salivary pH of smokers was lower than non-smokers, salivary viscosity of smokers was higher than non-smokers and salivary volume of smokers was fewer than non-smokers.Keywords: Young adult, smokers, non-smokers, saliva, salivary pH, salivary viscosity, salivary volume

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One Point Fixation Versus Two Point Fixation in Zygomaticomaxillary Complex Fractures

Journal of The Pakistan Dental Association ◽

10.25301/jpda.302.74 ◽

2021 ◽

Vol 30 (02) ◽

pp. 74-80

Author(s):

Muhammad Husnain Akram ◽

◽

Muhammad Mustafa Ch ◽

Armaghan Israr Mirza ◽

Muhammad Usman Akhtar ◽

...

Keyword(s):

Controlled Trial ◽

Point Group ◽

Fixation Method ◽

P Value ◽

Female Ratio ◽

Complex Fractures ◽

Dental Hospital ◽

The Mean ◽

Male To Female ◽

Zygomaticomaxillary Complex

OBJECTIVE: To compare the mean satisfaction of patients undergoing one point fixation versus two point fixation for zygomaticomaxillary complex fractures. METHODOLOGY: This randomized controlled trial was performed at Oral and Maxillofacial surgey department Punjab Dental Hospital. The duration of this study was 6 months (28-8-18 to 28-2-19). After meeting the inclusion criteria 74 patients were enrolled. Informed consent and demographic information was taken. Patients were randomly divided into two groups. One group is treated with one point fixation method and other with two point fixation. Patient were evaluated in terms of satisfaction of score on 3rd day, 14th day and 28th day and were recorded as per operational definitions. All the collected data was entered and analyzed on SPSS version 20. RESULTS: In this study the mean age of patients in one point group was 42.46±15.325 years while in two points group was 49.32±13.145 years, male to female ratio of the patients was 1.2:1. The mean PSS in one point group was 5.98±0.89 while in two points group was 3.775±0.609 (p-value=<0.001). CONCLUSION: One point fixation is smarter method and provide significantly better satisfaction than to two point fixation method for ZMC fractures KEYWORDS: Zygomaticomaxillary Complex Fractures, One Point, Two Point, Satisfaction

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Comparison of Early Versus Delayed Showering on Post-Operative Wound Infections

Journal of Bahria University Medical and Dental College ◽

10.51985/rscp2625 ◽

2021 ◽

Vol 11 (03) ◽

pp. 125-128

Author(s):

Salman Habib Abbasi ◽

Abdul Basit ◽

Muhammad Farooq ◽

Fazal Hussain Shah

Keyword(s):

Controlled Trial ◽

P Value ◽

Continuous Variables ◽

Chi Square ◽

Surgical Wounds ◽

Qualitative Variables ◽

Chi Square Test ◽

Surgery First ◽

The Mean ◽

Clean Contaminated

Objectives: To compare frequency of SSIs with and without early showering after clean and clean contaminated surgical wounds. Study Design and Setting: Randomized controlled trial was conducted at Department of Surgery. HIT Hospital, Taxila from June 2020 to December 2020. Methodology: A total of 130 participants were recruited after taking informed consent. After clean and clean-contaminated surgery, first group was subjected to early showering (48 hours after surgery) while second group was not allowed showering until removal of stiches. Both groups were compared in terms of SSIs. Data was entered into SPSS version 25. The mean and standard deviation were used for the expression of continuous variables while frequency and proportion were used for qualitative variables. Both groups were compared by independent sample t test and chi square test. A p value of <0.05 was considered statistically significant. Results: The mean age of the patients was 39.92 ± 11.42 years and there was male gender dominancy i.e. 74 (56.9%) were males while 56 (43.1%) were females. Clean surgeries were 81 (62.3%) and clean-contaminated proportion was 49 (37.7%). Collectively, 12 (9.2%) patients developed SSIs during clinical followup. There was no difference between groups in terms of age, gender, and wound types (p values 0.680, 0.157 and 0.587 respectively). In shower group, 3 (4.6%) and in nonshower group, 9 (13.8%) patients developed SSIs (p value 0.069). Conclusion: Early postoperative showering can be implemented safely in clean and clean contaminated surgical wounds to minimize SSIs. The results should be evaluated in large RCTs

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PRECIPITATING FACTORS AND EFFICACY OF COMBINING LACTULOSE PLUS RIFAXIMIN IN THE TREATMENT OF HEPATIC ENCEPHALOPATHY DUE TO CIRRHOSIS AT CHO RAY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2020.4.8 ◽

2020 ◽

pp. 63-68

Author(s):

Phat Ho Tan ◽

Tam Vu Thi Minh ◽

Trong Huynh Nguyen Dang ◽

Phuong Tran Nhat Thi Anh ◽

Ngan Tran Thi Kim ◽

...

Keyword(s):

Hepatic Encephalopathy ◽

Gastrointestinal Bleeding ◽

Clinical Symptoms ◽

Controlled Trial ◽

P Value ◽

Precipitating Factors ◽

Overt Hepatic Encephalopathy ◽

Group A ◽

Group B ◽

Male To Female

Background: Hepatic encephalopathy is an important evidence that confirms impairment of liver function, may occur in about 40% of cirrhotics. Data about efficacy of rifaximin plus lactulose in the treatment of Vietnamese patients was still limited. This study aimed to determine the precipitating factors and to access the efficacy of lactulose plus rifaximin in overt hepatic encephalopathy. Patients and Methods: The prospective single-blind randomized controlled trial, 43 cirrhotics with overt hepatic encephalopathy without portal systemic shunting addmitted to gastroenterology department of Cho Ray Hospital from March 2019 to August 2019, were randomized into two groups (group A lactulose plus rifaximin 1.100 mg/day, n = 21; and group B only lactulose; n = 22). All patients were recorded for onset factors, clinical characteristics and assessing the recovery of hepatic encephalopathy. Results: The mean age of patients in this study was 54.8 ± 12.1 years (the ratio of male to female patients is 4.38 : 1). The leading cause of cirrhosis was alcohol (39.5%). The most common clinical symptoms were jaundice (83.7%), spider naevi (41.9%) and ascites (37.2%). The most common triggers were infection (51.2%), gastrointestinal bleeding (37.2%) and constipation (25.6%). The percentage of patients with complete improvement after treatment with lactulose plus rifaximin was 81% compared to 63.6% in the lactulose-treated patients only (95% CI: 0.539 - 1.147, p value = 0.206). Conclusion: Our data revealed that common triggers of hepatic encephalopathy were infections, gastrointestinal bleeding and constipation. The combination of lactulose plus rifaximin was more effective than rifaximin alone in the treatment of overt hepatic encephalopathy. Key words: hepatic encephalopathy, precipitating factor, lactulose, rifaximin

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Review of Academic Dishonesty among College Students

Review of European Studies ◽

10.5539/res.v8n4p158 ◽

2016 ◽

Vol 8 (4) ◽

pp. 158

Author(s):

Abolfazl Zolfaghari

Keyword(s):

Academic Dishonesty ◽

English Language ◽

Academic Environment ◽

Language Test ◽

Chi Square ◽

Quasi Experimental ◽

The Mean ◽

The Difference ◽

Basic English ◽

The Relationship

Cheating and academic dishonesty is a moral anomaly in the field of scientific research and reflecting, i.e., academic environment and studies show that this phenomenon in many of the worlds is important problem.This study measured the dishonesty of students in a quasi-experimental design. For this purpose, features lack of integrity by manipulating the facts were examined and meanwhile first, basic English language test coordination between the strict terms of the 280 students come to practice and after correction of examination papers by teachers, without leaving any traces on them instead, the plates are returned to students and provide them with answers to their paper to correct their score Master announced. The difference between the actual score (score of master) and score of the students to have their own, amount of honesty or lack of integrity appointed them and its relationship with some demographic and socio-ethical characteristics have been studied.The results showed that more than 62 percent of the students in your grade to master completely honest with 26.6 percent have low honesty and the rest did not have the necessary integrity and the mean difference of scores announced by the professors and students have been about two score. Also results of chi-square tests and gamma, about the relationship between students’ evaluation of amount of sincerity with sincerity in the declared objective amount of the master score was not significant, this finding means that between demonstrators and people of integrity and honesty in practice, there are gaps.

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