A COMPARATIVE RANDOMIZED STUDY TO EVALUATE THE ROLE OF DRAINS IN ELECTIVE AND EMERGENCY ABDOMINAL SURGERIES

Background: Abdominal drainage following gastrointestinal surgery has often been a matter of contention. Advances in surgical techniques and perioperative patient care have consistently decreased postoperative complication rates. Aim: To determine the evidence-based value of prophylactic drainage versus non drainage in gastrointestinal surgeries and relative complications and morbidity associated with it. Material and Methods: A total of 82 patients were included in our study. All patients were divided into two groups- Group A and Group B randomly. Post-operatively patients were monitored and evaluated based on pre-determined outcome measures. Results: In our study out of 82 patints no signicant difference was seen (p value>0.01) when drain was compared to non drainage in routine surgeries with respect to ileus duration, anastomotic leak, surgical site infection, mortality, etc. Conclusions: When abdominal drain is routinely put, with its associated consequences, no clinical benet is derived. Therefore drainage in abdominal surgeries should not be routinely used in all patients however it can be used selectively in specic patients with clear indications.

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The Role of Pathological Method and Clearance Definition for the Evaluation of Margin Status after Pancreatoduodenectomy for Periampullary Cancer. Results of a Multicenter Prospective Randomized Trial

Cancers ◽

10.3390/cancers13092097 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2097

Author(s):

Gennaro Nappo ◽

Domenico Borzomati ◽

Alessandro Zerbi ◽

Paola Spaggiari ◽

Ugo Boggi ◽

...

Keyword(s):

Prognostic Factor ◽

Randomized Study ◽

Periampullary Cancer ◽

Significant Prognostic Factor ◽

Prognostic Role ◽

R1 Resection ◽

Group A ◽

Group B

Background: There is extreme heterogeneity in the available literature on the determination of R1 resection rate after pancreatoduodenectomy (PD); consequently, its prognostic role is still debated. The aims of this multicenter randomized study were to evaluate the effect of sampling and clearance definition in determining R1 rate after PD for periampullary cancer and to assess the prognostic role of R1 resection. Methods: PD specimens were randomized to Leeds Pathology Protocol (LEEPP) (group A) or the conventional method adopted before the study (group B). R1 rate was determined by adopting 0- and 1-mm clearance; the association between R1, local recurrence (LR) and overall survival (OS) was also evaluated. Results. One-hundred-sixty-eight PD specimens were included. With 0 mm clearance, R1 rate was 26.2% and 20.2% for groups A and B, respectively; with 1 mm, R1 rate was 60.7% and 57.1%, respectively (p > 0.05). Only in group A was R1 found to be a significant prognostic factor: at 0 mm, median OS was 36 and 20 months for R0 and R1, respectively, while at 1 mm, median OS was not reached and 30 months. At multivariate analysis, R1 resection was found to be a significant prognostic factor independent of clearance definition only in the case of the adoption of LEEPP. Conclusions. The 1 mm clearance is the most effective factor in determining the R1 rate after PD. However, the pathological method is crucial to accurately evaluate its prognostic role: only R1 resections obtained with the adoption of LEEPP seem to significantly affect prognosis.

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Pull-Type Radiologically Inserted Gastrostomy: An Improvised Technique Using a Frugal Innovation

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-1681124 ◽

2019 ◽

Vol 03 (01) ◽

pp. 007-011

Author(s):

Anurag Chahal ◽

Sundeep Malla ◽

Chinmaya Dash ◽

Deepak Gupta ◽

Shivanand Gamanagatti

Keyword(s):

Radiation Dose ◽

Safety Profile ◽

Conventional Technique ◽

New Technique ◽

Fluoroscopy Time ◽

P Value ◽

Complication Rates ◽

Nasogastric Feeding ◽

Group A ◽

Group B

Abstract Purpose To describe a new technique for “pull type” radiologically inserted gastrostomy (RIG) and prospectively compare it with conventional (described) technique in terms of technical ease (fluoroscopy time, radiation dose) and safety profile. Materials and Methods Adult patients with head injury with Glasgow coma scale (GCS) (M score) < 5, one week after decompression or those requiring nutritional support for > 4 weeks, or patients with recurrent aspiration pneumonitis on nasogastric feeding were included. Hemodynamically unstable patients or those with uncorrectable coagulopathy were excluded. Patients underwent pull-type RIG with alternate patient getting allocated to groups A (conventional technique) and B (new technique). The authors compared the technical success, complication rate, fluoroscopy time, radiation dose, and cost of hardware in these two groups. Results The average fluoroscopy time for group A (9 patients) was 498.7 ± 145.3 seconds, whereas for group B (16 patients), it was 302.8 ± 54.1 seconds with p-value = 0.06. The mean radiation dose of group A was 74.7 ± 15.7 mGy, whereas for group B, it was 56.7 ± 14.1 mGy (p-value = 0.004). The minor complication rates were 11.1% in both the groups. Conclusion The authors’ innovative technique using a customized snare has the potential to increase the technical ease of pull-type RIG with reduced fluoroscopy time, radiation dose, and cost with a similar safety profile.

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Clinical benefits of sequential administration of docetaxel and intermittent erlotinib as a second-line therapy for advanced non-small cell lung cancer (NSCLC): A phase II randomized study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e18049 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e18049-e18049

Author(s):

Francisco Aparisi ◽

Alfredo Sanchez-Hernandez ◽

Vicente Giner ◽

José Muñoz-Langa ◽

Gaspar Esquerdo ◽

...

Keyword(s):

Overall Survival ◽

Phase Ii ◽

Advanced Nsclc ◽

Randomized Study ◽

Stage Iv ◽

Primary Objective ◽

P Value ◽

Sequential Administration ◽

Group A ◽

Group B

e18049 Background: Patients (p) with advanced NSCLC have few treatment options after progressing to 1st-line platinum doublet chemotherapy. Several preclinical and phase I studies have suggested that sequential administration of erlotinib (E) and docetaxel could avoid possible negative interactions and optimize the benefit obtained against NSCLC. This randomized phase II was designed to address the clinical benefit obtained with the use of sequential administration of docetaxel and intermittent E. Methods: 70 p with advanced NSCLC progressing to previous PDC for advanced disease were randomized (1:1): Group A (n = 34): Docetaxel 75 mg/m2 day 1 and intermittent E (day 2-16), up to 4 cycles, followed by E in monotherapy; and Group B (n = 36): E in monotherapy. Treatment was administered until unacceptable toxicity or disease progression. Primary endpoint: rate of p free of progression at 6 months; secondary endpoints: progression-free survival (PFS), overall survival (OS), disease control rate (DCR) and safety. The study has completed enrolment. At the date of cut-off for this communication, data of 60 patients were available: 30 in Group A/30 in Group B. Results: Baseline characteristics: non-adenocarcinoma (60.3%), current/former smokers (95%), male (90%) and stage IV (87.9%). 6 months PFS: 13.5% in the sequential arm. PFS: 2.7 months (m) in Group A (95% CI 2.1 – 3.8) and 2 m in Group B (95% CI 1.7 – 2.4) p value 0.08. Median OS: 11.0 m (95% CI 4.5 – 13.4) in group A and 4.7m (95% CI 2.5 – 6.6) in Group B with a p value 0.02. DCR: 44.4% in the experimental group whereas in the E one was 30.8%. Adverse events (AEs), including skin rash and diarrhea, were all generally tolerable. Of interest, the low number of p developing neutropenia in the D + E arm. Conclusions: Although the primary objective has not been met, an encouraging benefit on survival has been shown in the exploratory analysis, with a median overall survival of 11 months for patients treated with the sequential regimen (p value 0.02). Final data will be presented during the meeting.

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Multiple craniotomies in the management of multifocal and multicentric glioblastoma

Journal of Neurosurgery ◽

10.3171/2010.6.jns091326 ◽

2011 ◽

Vol 114 (3) ◽

pp. 576-584 ◽

Cited By ~ 43

Author(s):

Wael Hassaneen ◽

Nicholas B. Levine ◽

Dima Suki ◽

Abhijit L. Salaskar ◽

Alessandra de Moura Lima ◽

...

Keyword(s):

Postoperative Morbidity ◽

Extent Of Resection ◽

Survival Duration ◽

Karnofsky Performance Scale ◽

Complication Rates ◽

Group A ◽

Group B ◽

Performance Scale ◽

Single Lesion

Object Multiple craniotomies have been performed for resection of multiple brain metastases in the same surgical session with satisfactory outcomes, but the role of this procedure in the management of multifocal and multicentric glioblastomas is undetermined, although it is not the standard approach at most centers. Methods The authors performed a retrospective analysis of data prospectively collected between 1993 and 2008 in 20 patients with multifocal or multicentric glioblastomas (Group A) who underwent resection of all lesions via multiple craniotomies during a single surgical session. Twenty patients who underwent resection of solitary glioblastoma (Group B) were selected to match Group A with respect to the preoperative Karnofsky Performance Scale (KPS) score, tumor functional grade, extent of resection, age at time of surgery, and year of surgery. Clinical and neurosurgical outcomes were evaluated. Results In Group A, the median age was 52 years (range 32–78 years); 70% of patients were male; the median preoperative KPS score was 80 (range 50–100); and 9 patients had multicentric glioblastomas and 11 had multifocal glioblastomas. Aggressive resection of all lesions in Group A was achieved via multiple craniotomies in the same session, with a median extent of resection of 100%. Groups A and B were comparable with respect to all the matching variables as well as the amount of tumor necrosis, number of cysts, and the use of intraoperative navigation. The overall median survival duration was 9.7 months in Group A and 10.5 months in Group B (p = 0.34). Group A and Group B (single craniotomy) had complication rates of 30% and 35% and 30-day mortality rates of 5% (1 patient) and 0%, respectively. Conclusions Aggressive resection of all lesions in selected patients with multifocal or multicentric glioblastomas resulted in a survival duration comparable with that of patients undergoing surgery for a single lesion, without an associated increase in postoperative morbidity. This finding may indicate that conventional wisdom of a minimal role for surgical treatment in glioblastoma should at least be questioned.

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EFFECT OF ADJUVANT MELATONIN WITH CLOMIPHENE CITRATE ON OVULATORY AND FERTILITY RATES IN PCOS INFERTILE PATIENTS.

10.36106/paripex/4802194 ◽

2020 ◽

pp. 58-60

Author(s):

Meenal Jain ◽

Richa Singh ◽

Rachna Agarwal

Keyword(s):

Clomiphene Citrate ◽

Pregnancy Rates ◽

Control Group ◽

P Value ◽

Fertility Rates ◽

Group A ◽

Anti Oxidant ◽

Group B ◽

Oxidant Effect

AIM: To study the effect of adjuvant melatonin with clomiphene citrate on ovulution and fertility rates in infertile PCO patients. MATERIAL AND METHODS: A total of 107 cases participated in the study out of which 7 women were excluded from the study. So the results of 100 women were analyzed. Out of 100 women 50 were of group A i.e. clomiphene supplemented with melatonin group and 50 were in group B which was clomiphene only group with no supplementation. Cases were followed for three cycles and pregnancy rates in both groups were evaluated. RESULTS: Study demonstrated the potential benefit of melatonin supplementation in naturally conceived cycles where ovulation induction was given by en-clomiphene citrate. The ovulation rates were comparable in both study Vs control group (68% Vs 66%) while there was increase in pregnancy rate in melatonin group (36% Vs 24%). However difference between pregnancy rates in both the groups failed to reach statistically significant levels (p value 0.4065). CONCLUSION: The adjuvant role of melatonin with en-clomiphene citrate in cases of Infertile PCO patients is in improving pregnancy rates; which is due to strong anti-oxidant effect of melatonin which in turn reduces oxidative stress thus resulting in good quality oocyte production.

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Primary prophylaxis of hepatic encephalopathy in decompensated cirrhosis: Low dose vs. full dose rifaximin

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.5.549 ◽

2019 ◽

Vol 35 (5) ◽

Author(s):

Shahid Sarwar ◽

Bushra Muhyuddin ◽

Abdul Aleem ◽

Muhammad Arif Nadeem

Keyword(s):

Hepatic Encephalopathy ◽

Low Dose ◽

Randomized Study ◽

Primary Prophylaxis ◽

Decompensated Cirrhosis ◽

P Value ◽

Female Ratio ◽

Full Dose ◽

Group A ◽

Group B

Objective: To compare efficacy of high vs low dose rifaximin for primary prophylaxis of portosystemic encephalopathy (PSE) in decompensated liver cirrhosis. Methods: In a quasi-experimental double blind randomized study at Services Institute of Medical Sciences (SIMS), Lahore from August 2017 to August 2018, patients of decompensated cirrhosis with no previous PSE were randomized to receive twice daily rifaximin 200mg in Group-A and 550mg in Group-B. Patients were followed for 6 months for development of PSE. Results: In 75 included patients, mean age was 53.8(±10.7) years and male/female ratio was 0.97/1(37/38). After randomization, 34 (45.3%) patients were included in Group-A and 41 (54.7%) patients in Group-B. During 6 month follow up 24 (32%) patients developed PSE, 12 (35.2%) in Group-A and 12 (29.2%) in Group-B, difference was not significant (p value 0.57). In 6 months, 13 (17.3%) patient died, 6 (17.6%) in Group-A and 7 (17.07%) patients in Group-B, difference not significant (p value 0.94). Patients who died had higher bilirubin (p < 0.00), higher serum creatinine (p 0.05), high CTP score (p 0.04) and worse MELD score (p 0.004). Conclusion: Rifaximin is not effective for primary prophylaxis of overt hepatic encephalopathy in decompensated cirrhosis patients. doi: https://doi.org/10.12669/pjms.35.5.549 How to cite this:Sarwar S, Muhyuddin B, Aleem A, Nadeem MA. Primary prophylaxis of hepatic encephalopathy in decompensated cirrhosis: Low dose vs. full dose rifaximin. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.549 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A comparison among PCNL, Miniperc and Ultraminiperc for lower calyceal stones between 1 and 2 cm: A multicenter experience

10.21203/rs.3.rs-17249/v1 ◽

2020 ◽

Author(s):

Giorgio Bozzini ◽

Tahsin B Aydogan ◽

Maria Chiara Sighinolfi ◽

Umberto Besana ◽

Alberto Calori ◽

...

Keyword(s):

Randomized Study ◽

Patient Characteristics ◽

Complication Rates ◽

Treatment Rate ◽

X Ray ◽

Overall Evaluation ◽

Group A ◽

Nephron Loss ◽

Group B ◽

Free Status

Abstract Background Conventional Percutaneous Lithotripsy (PCNL) has been an effective, successful and easy approach for lower calyceal stones however risks of complications and nephron loss are inevitable. Our aim is to compare the efficacy and safety of PCNL, MiniPerc(MP) and UltraMiniPerc(UMP) for lower calyceal stones between 1 and 2 cm with a multicenter prospective randomized study. Methods Patients with single lower calyceal stone were enrolled. Exclusion criteria were the presence of coagulation impairments, age of <18 or >75, presence of infection or serious comorbidities. Patients were randomized in three groups; A: PCNL; B: MP; C: UMP. Patients were controlled with abdomen X-ray and computerized tomography scan after 3 months. A negative X-ray or an asymptomatic patient with stone fragments < 3 mm size were the criteria to assess the stone-free status. Patient characteristics, stone free rates (SFR)s, complications and re-treatment rates were analyzed. Results Between January 2015 and June 2018, 132 consecutive patients were enrolled. 44 patients for the Group A, 47 for Group B and 41 for Group C. The mean stone size were 16.38, 17.82 and 15.23mm respectively in Group A, B and C(p=0.34). The overall SFR was significantly higher in Group A(86.3%) and B(82.9%) as compared to Group C(78%)(p<0.05).The re-treatment rate was significantly higher in Group C(12.1%) and complication rates was higher in Group A (13.6%) as compared to others(p<0.05). Conclusions PCNL and MP were more effective than UMP to obtain a better SFR. Auxiliary and re-treatment rates were higher in UMP. On the other hand for such this kind of stones PCNL had more complications. Overall evaluation favors MP as a better indication in stones 1-2 cm size.

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THE PASSIVE CASE DETECTION OF MALARIA AT TEHSIL LIAQUETPUR

The Professional Medical Journal ◽

10.29309/tpmj/2006.13.01.5053 ◽

2006 ◽

Vol 13 (01) ◽

pp. 32-34

Author(s):

ABDUL REHMAN

Keyword(s):

Clinical Trial ◽

Control Programme ◽

P Value ◽

Malaria Control Programme ◽

Case Detection ◽

Passive Case Detection ◽

Group A ◽

Group B ◽

Better Than

Introduction: The purpose of this study is to compare the role of thedoctors and the medical technicians/ dispensers in passive case detection (PCD) of malaria.Design: This is a nonrandomized clinical trial. Material and Methods: The PCD slides data of Malaria Control Programme Laboratory atTehsil Headquarter Hospital Liaquetpur from 2001 to 2004 was divided into group A and Group B depending onwhether the slides were advised by the doctors or the medical technicians/dispensers. P value less than 0.05 was takenas significant. Results: The slide positivity rate (%) of Group A vs. Group B was 17.11 vs. 5.64 (p<0.0001) in 2001,9.35 vs. 3.17 (p<0.0001) in 2002, 5.76 vs. 1.61 (p<0.0001) in 2003 and 5.74 vs. 1.33 (p<0.0001) in 2004. Thefalciparum rate (%) of group A vs. group B was 2.59 vs. 0.46 (p<0.0001) in 2001, 2.06 vs. 1.15 (p=0.0342) in 2002,0.3 vs. 00 (p= 0.0767) in 2003 and 0.31 vs. 00 (p=0.1276) in 2004. Conclusion: The performance of doctors groupwas better than those of medical technicians/dispensers group

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Role of antihypertensives drugs on proteinuria in patients with chronic kidney disease and hypertension

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20174388 ◽

2017 ◽

Vol 6 (10) ◽

pp. 2522

Author(s):

Ritu Bala ◽

Harminder Singh ◽

. Rupali ◽

Kuhu Verma

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Heart Rate ◽

P Value ◽

Biochemical Tests ◽

Mortality And Morbidity ◽

Significant Difference ◽

Group A ◽

Group B

Background: Hypertension is the most prevalent cardiovascular disease and the relevant data suggest that the burden, risk factors and co-morbidities associated with the essential hypertension is increasing with every passing day. It is one of the major chronic diseases resulting in high mortality and morbidity in today’s world. Aim: The aim of the study was to compare effects of cilnidipine and amlodipine on the blood pressure (BP), heart rate and proteinuria among patients of hypertension with chronic kidney disease.Methods: 100 patients were included in this study. Patients were randomly assigned into two groups Group A and Group B (50 each). Group A: Patients received Cilnidipine (5-10mg/day). Group B: Patients received amlodipine (5-10mg/day).Results: No significant difference in SBP, DBP, MBP and proteinuria while comparing both the groups of patients taking cilnidipine and amlodipine at baseline i.e. 0 to 12 week, 12 to 24 weeks and 0 to 24 weeks. Cilnidipine caused decrease in HR 0 to 12 week (p value 0.001), 12 to 24 weeks (p value 0.001) and 0 to 24 weeks (p value 0.0001). Amlodipine had increased heart rate from baseline to 12 weeks (p value 0.0001), 12 to 24 weeks (p value 0.051) and 0 to 24 weeks (p value 0.001). No significant difference was seen in any biochemical readings.Conclusions: There was a significant change in all the parameters including BP, heart rate, proteinuria and other biochemical tests when they compared within the group but no significant difference while comparing both the groups.

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Effect of Verapamil Adjuvant with Local Anaesthetic Mixtures in Supraclavicular Brachial Plexus Block

Bangladesh Medical Journal ◽

10.3329/bmj.v46i2.40218 ◽

2019 ◽

Vol 46 (2) ◽

pp. 43-47

Author(s):

Md Arman Ali ◽

Md Latifur Rahman ◽

Mehdi Hassan ◽

Rezwanur Rahman ◽

Kai Nur Asfia ◽

...

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Randomized Study ◽

Onset Time ◽

Sensory Block ◽

Local Anaesthetics ◽

P Value ◽

Group A ◽

Group B ◽

Plexus Block

Among the various approaches to block brachial plexus , supraclavicular approach offers a high success rate for elbow, forearm and hand surgery . Various adjuvant drugs have been used with local anesthetics in order to decrease the time of onset and prolong the duration and quality of regional blocks. So efforts were made to combine the adjuvant with local anesthetics to improve patient and surgeon satisfaction. In this randomized study we tried to see the effect of verapamil in brachial plexus block as an adjuvant with local anaesthetic .This randomized study wasconducted in Anaesthesiology department of ShaheedZiaurRahman Medical College Hospital after approved by the ethical review board of this hospital.The study subject were divided into two groups (Group A=only local anaesthetics&Group B=local anaesthetics with Verapamil) , 30 IN numbers in each group. Group-A patients was administered 15ml of 1% lignocaine with 15 ml of bupivacaine 0.25% while in Group-B patients was administered injection verapamil 3.5 ml (3.5 mg) in addition to the above mixture. In this study mean onset time of sensory block was 11.53 ± 1.4 minutes in group - A and 7.12 ± 1.68 minutes in group – B which is not statistically significant (p value = 0.057). The mean onset time of motor block in group A was 15.26 ± 1.96 min, and in group B was 11.58 ± 2.68 min and this difierence isstatistically significant (p value=0.000152). Duration of motor block was 96.30 min and 115.08 min in group A and Group B respectively. Sensory block was 157.26 min and 188.0 min in group A and Group B respectively. Regarding the heart rate, no significant difference was detected between the groups at the time of preanesthesia and at the 5 min after anaesthesia. Compared with group B patients, group A patients shows slight but statistically significant increased heart rate at the 10 min (80, 92 beat/min respectively) after brachial plexus block. At 30 minute after, mean systolic BP was 97.9±4.7 mmHg in group A and 84.3±5.0 mmHg in group B. At 45 minute after, mean systolic blood pressure was 94.6±15.6 mmHg and 84.3±5.0 mmHg in group A and group B respectively. At 60 minutes after, mean systolic blood pressure was 59.6±6.0 mmHg in group A and 61.2±9.4 mmHg in group B. At 15, 30 and 45 minute difference was statistically significant (p<0.05) between two groups. In conclusion, the study revealed that verapamil can be used as an adjuvant to decrease the onset time of sensory and motor blocks of bupivacaine in supraclavicular block. Moreover, verapamil doses in regional blocks did not show any hemodynamic side effects. Bangladesh Med J. 2017 May; 46 (2): 43-47

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