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

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

International Surgery Journal ◽

10.18203/2349-2902.isj20191060 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1029

Author(s):

Haitham Atif ◽

Nehad Abdou Zaid ◽

Abd El-Mieniem Fareed Mohamed ◽

Yehia Mohamed Alkhateep

Keyword(s):

Patency Rate ◽

Intervention Group ◽

Anastomotic Stenosis ◽

Control Group ◽

P Value ◽

Modified Technique ◽

Significant Difference ◽

Group A ◽

Group B

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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EFFECT OF POST-ISOMETRIC RELAXATION AND RECIPROCAL INHIBITION IN OSTEOARTHRITIS KNEE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i6.17720 ◽

2017 ◽

Vol 10 (6) ◽

pp. 135

Author(s):

Sushmita Singh ◽

Vaishali Krishnat Jagtap ◽

Poovishnu Devi T

Keyword(s):

Reciprocal Inhibition ◽

P Value ◽

Random Allocation ◽

Medical Sciences ◽

Anova Test ◽

Osteoarthritis Knee ◽

Significant Difference ◽

Group A ◽

Group B ◽

Ethical Clearance

Objectives : To evaluateeffect of post-isometric relaxation, reciprocal inhibition andcombined effect post-isometric relaxation and reciprocal inhibition in osteoarthritis knee.Method :Ethical clearance was obtained from Institutional Ethical Committee, KIMSDU karad. Comparative study conducted at Physiotherapy Dept. of Krishna Institute of medical sciences. A total of 30 subjectswere equally divided into three groups using Convenientsampling with random allocation(Group A,Group B and Group C).Baseline treatment was given to all three groups(IFT and HMP). Group A was given post-isometric relaxation, Group B was given reciprocal inhibition and Group C was given combination of post-isometric relaxation and reciprocal inhibition. Result: Statistical analysis was done using paired t test and ANOVA test. Inpre intervention there was no statistical significant difference seen with p values for VAS of 0.3408 and for WOMAC of 0.5424. While on comparing the post interventional values, the results between the three Groups using ANOVA test revealed that there was very significant difference seen with p value for VAS of 0.0023 and for WOMAC of 0.0019.Conclusion: From the study it can be concluded thatthere was significant effect of post-isometric relaxation and reciprocal inhibition in OA knee.

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Effect on serum potassium level in patients of diabetic nephropathy on spironolactone and ramipril over follow up period

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195540 ◽

2019 ◽

Vol 7 (12) ◽

pp. 4691

Author(s):

Ashish Naresh ◽

Mahendra Pal Singh ◽

Richa Giri

Keyword(s):

Diabetes Mellitus ◽

Diabetic Nephropathy ◽

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

P Value ◽

Base Line ◽

Group A ◽

Group B

Background: The study was conducted to evaluate the change in serum potassium level over follow up period in patients of diabetic nephropathy on spironolactone (25 mg) and ramipril (5 mg) and compare the results with diabetic nephropathy patients on Spironolactone (25 mg) alone.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70 yr.) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Inclusion criteria followed in study were Age 30-70 years, diagnosed type 2 diabetes mellitus, serum potassium level <5 meq/l, estimated GFR >30 ml/min/1.73m2 and HbA1c <10%. Exclusion criteria were type 1 diabetes mellitus, impaired glucose tolerance secondary to endocrine disease, exocrine pancreatic disease, SBP >180 mmHg DBP >110 mmHg, UTI, hematuria, acute febrile illness, vigorous exercise, short-term pronounced hyperglycemia, obstructive uropathy, confirmed or suspected renal artery disease by USG doppler study, Serum potassium level >5.5 meq/l. Patients were divided in two groups, group A (n= 28, spironolactone 25 mg and ramipril 5 mg) and group B (n=27, spironolactone 25 mg). Subjects were followed over 12 weeks and baseline and 12-week serum potassium being compared. Other baseline base line laboratory investigation such as serum lipid profile, HbA1c, eGFR, fundus examination, ultrasonography (KUB), serum urea, serum creatinine, hemoglobin, were taken at the starting point.Results: Both the group after receiving respective drug were followed for 3-month duration and serum potassium level measured at end of 3 months. Mean values of baseline and follow up serum potassium for group A and group B were 4.24±0.59, 4.07±0.61 and 4.35±0.55, 4.16±0.61 respectively, p value found to be >0.05 at 95% CI.Conclusions: In the study it was concluded that p value found to be >0.05 at 95% C.I denoting that there is no significant difference between mean value of base line and follow up serum potassium value in both group. None of patients in either group had experienced hyperkalaemia over follow up period though serum potassium level were slightly higher in group A, but this difference was statistically not significant. Follow up period of study should be long enough to comment on safety profile of combining spironolactone and ACE inhibitors in diabetic nephropathy patients.

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Dynamic Increase in JAK2V617F Allele Burden Is a Predictive Parameter for the Transformation into Myelofibrosis from Polycythemia Vera and Essential Thrombocytosis

Blood ◽

10.1182/blood.v124.21.1832.1832 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1832-1832

Author(s):

Shuichi Shirane ◽

Marito Araki ◽

Soji Morishita ◽

Yumi Hironaka ◽

Masaaki Noguchi ◽

...

Keyword(s):

Polycythemia Vera ◽

Disease Duration ◽

Base Line ◽

Allele Burden ◽

Significant Difference ◽

Group A ◽

Group B ◽

Jak2v617f Allele Burden ◽

First Diagnosis

Abstract Patients diagnosed with polycythemia vera (PV) or essential thrombocythemia (ET), a subtype of myeloproliferative neoplasms (MPN), sometimes suffer disease transformation into myelofibrosis (MF) associated with poorer prognosis. Thus, predicting which patients have a risk of MF transformation is an important task. Following the identification of a driver mutation JAK2V617F in a majority of MPN patients, several studies was performed to investigate the potential of JAK2V617F allele burden as a diagnostic marker for MF-transformation. However, the results differ between cohorts presumably due to a lack of accurate JAK2V617F allele burden measurement. Since we have previously developed alternative-binding probe competitive polymerase chain reaction (ABC-PCR) that accurately determines the JAK2V617F allele burden, we assessed the predictive value of JAK2V617F allele burden in MF-transformation in Japanese MPN cohort. In a retrospective study, we compared JAK2V617F allele burdens between formalin-fixed paraffin embedded-bone marrow (FFPE-BM) from initial diagnosis and peripheral blood (PB) from follow-up visits. We first examined whether the allele burdens in FFPE-BM and PB were comparable when they are collected at the same time. Determining the allele burdens in a set of FFPE-BM and PB taken from same patient within a 3-month period, we observed that allele burdens from these specimens are significantly correlated (n=26, R²=0.97), which is consistent with previous report with a larger cohort (Blood 122; 3784-6). Thus, in subsequent analyses, we set a base line of the mutant allele burden determined from FFPE-BM, which is then compared with allele burdens from PB during the disease duration. We examined 14 PV and 20 ET patients (mean disease duration 69.2 months) defined by WHO 2008 MPN criteria. From first diagnosis to the time when MF-transformation was first recognized, JAK2V617F allele burden was significantly increased (mean increase 19.5±17.3%, p=0.044) in patients with MF-transformation (n=11). While patients with no MF-transformation (n=23) presented limited changes (mean increase 3.9±16.1%) over a similar duration period. When subclassifying patients into three groups based on the change or the base line value of JAK2V617F allele burden, MF-transformation was more frequently (p=0.034) observed in patients whose JAK2V617F allele burden was either increased by more than 10% during the follow-up (group A) or higher at first diagnosis than the mean values for each disease (PV; 71.7%, ET; 35.5%) (group B). MF-transformation was 2 out of 4 (50%) in the group A, and 9 out of 22 (41%) in the group B. In contrast, MF transformation in the rest of the patients (group C) was 0 out of 8 (0%). Hydoxyurea-treated (n=16, 6 PV and 10 ET) and –untreated (n=18, 8 PV and 10 ET) patients do not show significant difference in frequencies of MF-transformation, confirming that Hydoxyurea has no preventative effect against MF-transformation. In conclusion, our study showed that higher JAK2V617F allele burden at first diagnosis or a dynamic increase in allele burden during the follow-up period is a predictive factor for MF-transformation. Thus, a routine measurement of the JAK2V617F allele burden by an accurate assay system is recommended to predict MF-transformation. Disclosures No relevant conflicts of interest to declare.

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465 No Role for Postoperative Antibiotics in Uncomplicated Appendicitis

British Journal of Surgery ◽

10.1093/bjs/znab134.283 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

N Ayoub ◽

Y Tryliskyy ◽

M K Baig

Keyword(s):

Wound Infection ◽

P Value ◽

Nice Guidelines ◽

Uncomplicated Appendicitis ◽

Perforated Appendix ◽

Group A ◽

Preoperative Antibiotics ◽

Group B ◽

Variable Practice

Abstract Introduction Several studies have shown benefit from use of preoperative antibiotics in reducing postoperative infection after appendectomy as well as efficacy of postoperative antibiotics in complicated appendicitis (defined as perforated appendix or presence of pus in peritoneum). While for uncomplicated appendicitis, several studies showed no benefit from antibiotics postoperatively but there are no clear NICE guidelines till now and so surgeons have different practice based on their preferences. Method This study included patients who had appendectomy for uncomplicated appendicitis in Worthing hospital from 1st July 2019 till 30th June 2020. The end point was 30-day follow up postoperatively for wound infection or collection. Results 90 patients were admitted with uncomplicated appendicitis with age 6-80 years (mean of 31.3). 46 patients (51%) did not receive postoperative antibiotics (group A) and 44 (49%) received postoperative antibiotics (group B) with a variable practice from one dose to 8-day course. postoperatively, only 1 patient (2.1%) in group A developed wound infection requiring drainage while none in group B developed complications (p-value=1). Conclusions Administration of postoperative antibiotics in uncomplicated appendicitis showed no superiority over non-administration. in addition, they add extra cost on NHS. So, their routine use postoperatively is not recommended, however, larger studies are required to confirm this.

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Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

Journal of Neurosurgery Spine ◽

10.3171/2021.9.spine21822 ◽

2021 ◽

pp. 1-11

Keyword(s):

Scale Score ◽

Neck Disability Index ◽

Implant Removal ◽

Odontoid Fractures ◽

Significant Difference ◽

Flexion Extension ◽

Group A ◽

Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

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Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000231 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Hwa Jun Kang ◽

Hong-Geun Jung ◽

Jong-Soo Lee ◽

Sungwook Kim ◽

Mao Yuan Sun

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Fixation Method ◽

Kirschner Wires ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

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Comparable Efficacy of Terbinafine and Itraconazole in the Treatment of Tinea Pedis

Bangladesh Journal of Medicine ◽

10.3329/bjmed.v21i2.13615 ◽

2013 ◽

Vol 21 (2) ◽

pp. 74-79

Author(s):

Md Abdul Wahab ◽

Mohammad Jamal Uddin ◽

Biswas Shahen Hassan ◽

Md Zafrul Islam ◽

Ishrat Bhuiyan ◽

...

Keyword(s):

Fungal Infection ◽

Tinea Pedis ◽

Comparable Efficacy ◽

P Value ◽

Mycological Cure ◽

Efficacy Analysis ◽

Group A ◽

Group B

Background: Tinea pedis (athlets foot) is the most common fungal infection. Relapse is common in tinea pedis and may be result of recurrence following inadequate treatment or reinfection. Objective: To evaluate the comparable efficacy of terbinafine and itraconazole in the treatment of tinea pedis. Methods: 120 patients of tinea pedis confirmed by KOH microscopy were included in the study. The study was carried out in three different Hospitals and Private Chambers for a period of 3 years from July 2006 to June 2009. Mean age of the patients was 40.28±10.23. The patients were devided into 2 equal group:A & B. Group- A was given terbinafine 250 mg/day and group-B was given intraconazole 200 mg/day for 2 weeks. Results: Follow up 2 weeks after cessation of therapy revealed clinical and mycological cure of 93.3% in terbinafine group and 86.6% in itraconazole group. Conclusion: Efficacy analysis revealed that terbinafine is superior than itraconazole in the treatment of tinea pedis (P value 0.224). DOI: http://dx.doi.org/10.3329/bjmed.v21i2.13615 Bangladesh J Medicine 2010; 21: 74-79

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Effects of Dexmedetomidine on Intraoperative Hemodynamic Responses in Patients Undergoing Laparoscopic Cholecystectomy: A Randomised Double Blind Trial

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v7i4.7629 ◽

2021 ◽

Author(s):

Dhanashree Dongare ◽

Smita Gharde

Keyword(s):

Laparoscopic Cholecystectomy ◽

Base Line ◽

Loading Dose ◽

Double Blind Trial ◽

Hemodynamic Responses ◽

Double Blind ◽

Significant Difference ◽

Group A ◽

American Society ◽

Group B

Background: Dexmedetomidine is selective alpha 2 agonist with sedative sympatholytic, analgesic properties and is used as an anaesthetic adjuvant. We have evaluated the effect of dexmedetomidine on various hemodynamic responses to incidences such as laryngoscopy, endotracheal intubation, exubation and pneumoperitoneum in patients who were undergoing surgeries like laparoscopic cholecystectomy. We have used loading dose of 0.5mcg/kg of inj. Dexmedetomidine given over 10 minutes followed by infusion of a dose of 0.3mcg/kg/hour for the control of hemodynamic response to laparoscopy. Methods: Patient of either sex aged between 18-50 yrs, belongs to ASA I and II (AMERICAN SOCIETY OF ANAESTHESIOLOGY) posted for laparoscopic cholecystectomy were included. Institutional ethical committee clearance was obtained prior to study. After enrolment and valid written consent was taken. 60 patients were enrolled written valid informed consent was taken. Patients were divided into two groups 30 each with computerized randomization. Base line parameters were noted. Observer and patient was blinded for the content of syringe. Group A received injection dexmedetomidine and group B received bolus and infusion of normal saline at same rate. Routine general anaesthesia was instituted. Parameters were noted after induction, after intubation, after co2 insufflation, after 20 min, after 40 min, after co2 deflation, after extubation, after 1 and 2 hrs post-extubation. Results: Group A showed significantly less rise in HR and MAP than Group B. Requirement of intraoperative propofol was more in Group B. There was no significant difference for time taken to awakening in both groups. Conclusion: We found Injection Dexmedetomidine in given doses gave good hemodynamic control with minimal undesired effects during laparoscopy.

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