scholarly journals Comparison of 21 Days Versus 10 Days Bladder Catheterization after Hypospadias Repair

Esculapio ◽  
2021 ◽  
Vol 17 (2) ◽  
pp. 187-190
Author(s):  
Muhammad Abdullah ◽  
Muhammad Saleem ◽  
Ghulam Mujtaba Zafar ◽  
Farrukh Mehmood Sattar ◽  
Imran Hashim ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Wound Dehiscence ◽  
Catheter Removal ◽  
Fistula Formation ◽  
P Value ◽  
Hypospadias Repair ◽  
Bladder Catheterization ◽  
Group 2 ◽  
Group 1

Objectives: To compare 21 days versus 10 days bladder catheterization after hypospadias repair. Methods: After approval from ethical committee, Randomised controlled trial performed, in which 196 male patients were enrolled in the study that was conducted at department of pediatric surgery, Children hospital, Lahore. All patients underwent Snodgrass procedure. Group-1 patients were considered for 10 days bladder catheterization for hypospadias repair and group-2 patients were catheterized for 21 days. Complications were documented on follow-up visits in group 1 at 1 week (17 days), 3 weeks (34 days), and 6 weeks (51 days) after catheter removal. In group 2 at 1 week (day 28th), 3 weeks (day 42nd), 6 weeks (day 63rd) after catheter removal. Results: The mean age in group-1 and group-2 was 7.25 ± 3.22 years and 6.29±3.02 years. There were significantly less cases of urethrocutaneous fistula in group 2 when compared to group 1. Urethro-cutaneous fistulas (UCF) developed in 13(13.26%) ,11(11.22%) and 10 (10.2%) cases at 1, 3, and 6 weeks post catheter removal follow up in group 1. While in group 2 UCF developed in 4 (4.08%), 3(3.1%) and 2(2.04%) at 1, 3, and 6 weeks follow up. There were 5(5.2%) and 4(4.1%) cases of post-operative wound infection in groups 1 and 2 respectively (p-value = 0.500). Wound dehiscence was seen in 1 (1.02%) case in group 1 and was not seen in group 2(p value =0.500). glans dehiscence was not seen in group 1 while 1 (1.02%) case seen in group 2 (p value 0.500). Conclusion: We conclude that 21 days catheterization after hypospadias repair gives better outcome and fewer complications when compared to 10 days catheterization. Keywords: Bladder catheterization; Hypospadias repair; Fistula formation. How to cite: Abdullah M., Saleem M., Zafar M.G., Sattar M.F., Hasnain I, Wasti R.A. Comparison of 21 Days Versus 10 Days Bladder Catheterization for Hypospadias Repair. Esculapio 2021;17(02):187-190.

scholarly journals THE ROLE OF MYOCARDIAL REVASCULARIZATION IN THE SURVIVAL OF PATIENTS WITH ALTERED CORONARY BLOOD FLOW DETECTED BY TRANSTHORACIC ULTRASOUND

2019 ◽  
Vol 34 (1) ◽  
pp. 54-60
Author(s):  
M. S. Kamenskikh ◽  
A. V. Zagatina ◽  
N. T. Zhuravskaya ◽  
Yu. N. Fedotov ◽  
D. V. Shmatov
Keyword(s):  
Blood Flow ◽  
Coronary Blood Flow ◽  
Myocardial Revascularization ◽  
Control Group ◽  
P Value ◽  
Coronary Events ◽  
Group 2 ◽  
Group 1 ◽  
Flow Velocities

Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of <0.009; and a p-value for the differences compared with the Control group (р2) of <0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1<0.05; p2<0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.Conclusions: 1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

Predictive Value of Minimal Residual Disease: Analysis By Flow-Cytometry in Children with Relapsed Acute Lymphoblastic Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2494-2494
Author(s):  
Myriam Ruth Guitter ◽  
Jorge Gabriel Rossi ◽  
Elisa Sajaroff ◽  
Carolina Carrara ◽  
Pizzi Silvia ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
P Value ◽  
Time Points ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Group 1

Abstract Introduction: Despite the advances observed in the outcome of pediatric acute lymphoblastic leukemia (ALL) treatment during the last 20 years, relapse remains the most common cause of treatment failure in childhood ALL. Several factors have been associated to the prognosis of these patients; however, minimal residual disease (MRD) emerges as a relevant predictor of outcome. Objectives: The aims of this study were to assess MRD by flow-cytometry in relapsed ALL and to evaluate its prognostic impact as a predictor factor of outcome at the end of the induction therapy and prior to hematopoietic stem cell transplantation (HSCT). Patients and Methods: From Aug'10 to Jun'15, 123 ALL patients were treated at our center. MRD determination at least at two time-points during relapse treatment was a requirement for considering a patient eligible for the present study. Sixty-six cases were excluded due to the following causes: 10 patients died during induction, 2 died early in complete remission (CR), 29 did not respond to chemotherapy, in 13 patients MRD determination was not performed: 4 did not have clinical data available, 4 patients were Down Syndrome and 4 children received treatment for relapse in other centers. Thus, fifty-seven patients achieved CR and were evaluated for MRD at two time points. Of them, 56 patients belonged to S4 and S3 and 1 patient to S1 group as defined by the Berlin-Frankfurt-Münster stratification for relapsed ALL. MRD was analyzed by multiparametric flow-cytometry following ALL-IC 2009 guidelines. Negative MRD was defined as disclosing less than 0.1% of blasts. For this analysis, patients were stratified based on MRD levels at two different time points: after end of induction, before HSCT or at any other time point during the follow-up for patients who did not undergo HSCT. Three groups were defined: Group-1: negative at both time points (n= 23), Group-2: positive at 1 time point (n= 13) and Group-3: positive at both time points (n= 21). Patients who relapsed before receiving HSCT were considered Group-3. Twenty-five patients underwent HSCT: 13 of them from Group-1, 9 from Group-2 (2 had positive MRD previous to receive HSCT) and 3 patients from Group-3. HSCT was performed with matched familiar donor in 16 cases and matched unrelated donor in 9 cases. Results: The distribution of events according to receiving or not HSCT was: 5 died due to transplant related mortality (TRM), 9 relapsed after receiving HSCT and 16 during treatment with chemotherapy. With a median follow-up of 16 (range: 6-67) months, overall 3-year EFS probability (EFSp) (SE) was 32 (8)%. The 3-year EFSp was 75 (11)% for Group-1, 24 (14)% for Group-2 and 0% for Group-3 (p-value <0.00001). Comparing patients who did not receive HSCT vs. patients who did, EFSp (SE) was 32 (12)% and 29 (11)% respectively (p-value: non-significant). The EFSp (SE) according to MRD groups in patients who underwent HSCT was: Group-1: 53 (19)%, Group-2: 14 (13)% and 0% for Group-3 (p-value: 0.06). Conclusions: MRD quantification by flow-cytometry demonstrated to be a significant prognostic factor for relapsed ALL. Both, TRM and death in CR rates, were high and should be decreased by improving supportive measures. MRD determination by flow-cytometry in patients who underwent HSCT showed a trend to achieve a better EFSp, thus representing a relevant tool for stratifying relapsed ALL patients in order to achieve a better selection of patients to receive HSCT. Disclosures No relevant conflicts of interest to declare.

Effect of Lisinopril and Verapamil on Angiopoietin 2 and Endostatin in Hypertensive Diabetic Patients with Nephropathy: A Randomized Trial

2021 ◽  
Vol 53 (07) ◽  
pp. 470-477
Author(s):  
Al-Aliaa M. Sallam ◽  
Mohamed Salem ◽  
Eman Abdel-Aleem ◽  
Hala O. El-Mesallamy
Keyword(s):  
Early Stage ◽  
Controlled Trial ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Converting Enzyme Inhibitors ◽  
Angiogenic Proteins ◽  
Group 2 ◽  
Angiopoietin 2 ◽  
Group 1

AbstractAngiogenesis is a multistep process implicated in the pathophysiology and progression of diabetic nephropathy (DN). Angiotensin-converting enzyme inhibitors (ACEI) and calcium channel blockers (CCB) have an important role in DN. We performed a randomized-controlled trial of lisinopril alone (an ACEI) or in combination with verapamil (a CCB) as a therapy for DN in type 2 diabetes mellitus (T2DM) patients with hypertension (HTN) and urinary albumin creatinine ratio (UACR) (30–300 mg/g) also to evaluate their effect on UACR, the angiogenic proteins: Angiopoietin 2 (Ang-2) and Endostatin (EST). Forty T2DM patients with microalbuminuria, aged 45–65 years were included. Patients were randomly assigned into group 1 receiving oral lisinopril and group 2 receiving oral lisinopril and verapamil once daily. After 3 months follow-up fasting blood glucose (FPG), HbA1c, lipid profile, UACR, serum urea and creatinine levels were assessed. EST and Ang-2 were measured using ELISA technique. Baseline Ang-2 and EST levels were elevated in both groups compared with controls (p<0.001). After follow-up, group 2 had significantly decreased FPG, HbA1c, UACR, EST and Ang-2 compared with their baseline levels (p<0.001 for all comparisons) and with group 1 (p<0.001). No adverse reactions were reported. Baseline EST and Ang-2 were positively correlated to UACR (r=0.753, p<0.001) (r=0.685, p<0.001). Lisinopril/verapamil combination enhanced glycemic control and kidney function via diminishing EST and Ang-2. This combination can be considered as a safe and effective approach for early stage nephropathy therapy in T2DM.

scholarly journals Compare frequency of wound infection with ceftriaxone versus amoxicillin in females undergoing C section

2021 ◽  
Vol 15 (7) ◽  
pp. 1607-1609
Author(s):  
Aneeqa Ilyas ◽  
Bilal Rafique Malik ◽  
Rehan Anwar
Keyword(s):  
Cesarean Section ◽  
Wound Infection ◽  
Gestational Age ◽  
Bacterial Infections ◽  
Controlled Trial ◽  
P Value ◽  
The Mean ◽  
Group 2 ◽  
Trial Setting ◽  
Group 1

Background:Post-caesarean wound infection is a frightful complication of cesarean delivery and increase burden on health care system. Prevention of post-cesarean wound infection must be the priority in any healthcare center in developing countries. Amoxicillin is an antibiotic often used for the treatment of a number of bacterial infections. Aim: To compare the frequency of wound infection with ceftriaxone versus amoxicillin in females undergoing cesarean section at term Study design: Randomized Controlled Trial Setting & duration: Department of Medicine and Gynecology, SIMS, Lahore from 01-07-2020 to 31-12- 2020. Methods: After fulfilling the selection criteria, 250 females were enrolled and were divided randomly into two equal groups. Group 1 was given intravenous amoxicillin and group 2 was given intravenous ceftriaxone. Then cesarean was done under spinal anesthesia. Post-op wound infection was noted in all the females. The data was analyzed in SPSS. Results: The mean age of the females of amoxicillin group was 28.09±6.01 years whereas the mean age of the ceftriaxone group females was 29.38 ± 6.41 years. The mean gestational age of the females in amoxicillin group was 38.98 ± 0.85 weeks whereas the mean gestational age in ceftriaxone group was 38.94±0.79 weeks. The mean BMI of the females in amoxicillin group was 26.58 ± 6.27 kg/m2 whereas the mean BMI in ceftriaxone group was 29.32±6.36kg/m2. The post-cesarean wound infection was found in 2(1.6%) females in amoxicillin group while in 8(6.4%) females in ceftriaxone group. This difference was statistically insignificant i.e. p-value=0.0.053. Conclusion: The amoxicillin is more effective from prevention of post-op wound infection than to ceftriaxone in females underwent cesarean section. Keywords: Amoxicillin, Ceftriaxone, cesarean section, post-cesarean wound infection

scholarly journals FSH stimulated inhibin B (FSH-iB): A novel marker for the accurate prediction of pubertal outcome in delayed puberty

2021 ◽  
Author(s):  
Shakun Chaudhary ◽  
Rama Walia ◽  
Anil Bhansali ◽  
Devi Dayal ◽  
Naresh Sachdeva ◽  
...  
Keyword(s):  
Validation Cohort ◽  
Hypogonadotropic Hypogonadism ◽  
Inhibin B ◽  
Stimulation Test ◽  
Delayed Puberty ◽  
P Value ◽  
Healthy Children ◽  
Group 2 ◽  
Group 1

Abstract Background Clinicians have long been struggling to find an effective tool to predict onset of puberty. Objective To explore stimulability of inhibin B after exogenous FSH and it’s potential role for prediction of onset of puberty. Design and participants Study subjects were enrolled into “exploratory cohort”(n=42) and “validation cohort”(n=19). “Exploratory cohort” was further divided into Group-1(Healthy children with spontaneous puberty: SP, n=26) and Group-2 (Patients of hypogonadotropic hypogonadism: HH, n=16). “Validation cohort” included children who presented with complaints of delayed puberty. Intervention and outcome Participants were subjected to FSH stimulation test and GnRHa stimulation test. Cut-offs derived from “exploratory cohort” for basal and FSH stimulated inhibin B(FSH-iB) were applied on “validation cohort” .Basal LH, GnRHa stimulated LH, basal inhibin B and FSH-iB were compared with clinical outcome on prospective follow-up for prediction of onset of puberty. Results There was statistically significant increment in inhibin B after exogenous FSH in Group 1(SP) in both male(188.8 pg/ml;p-value-0.002) and female (1065 pg/ml;p-value-0.023) subjects. The increment was not statistically significant in Group 2(HH) in both genders. FSH-iB at a cut-off of 116.14 pg/ml in male and 116.50 pg/ml in female had 100% sensitivity and specificity for labelling entry into puberty. On application of these cut-offs on “validation cohort”, FSH-iB had 100% PPV, NPV and diagnostic accuracy for prediction of onset of puberty. Conclusion Inhibin B was stimulable in both male and female subjects. FSH-iB can be considered as novel and promising investigation for prediction of onset of puberty. Future studies are required for further validation.

scholarly journals MANAGEMENT OF COTTON BUD INDUCED OTITIS EXTERNA BY UNIQUE METHOD

2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. S448-51
Author(s):  
Syed Muhammad Asad Shabbir Bukhari ◽  
Sohail Aslam ◽  
Naeem Riaz ◽  
Muhammad Waqas Ayub ◽  
Irfan Saeed ◽  
...  
Keyword(s):  
Otitis Externa ◽  
Sampling Technique ◽  
P Value ◽  
Chi Square ◽  
Management Protocol ◽  
Unique Method ◽  
Group 2 ◽  
Better Than ◽  
Group 1

Objective: To compare the recovery of patients in both groups having acute otitis externa induced by cotton buds/various objects. One group by old method and second group by unique method. Study Design: Quasi-experimental study. Place and Duration of Study: Pakistan Naval Ship Shifa Karachi, from Jan to Dec 2020. Methodology: Non-probability convenience sampling technique was applied. Out of 50 cases were selected for group 1 management. Fifty cases were selected for group 2 management. A chi-square test was applied to compare the recovery of two groups of patients on the 14th day and 42nd day of follow-up. p-value was kept 0.05 as significant. Results: A total of 100 cases were treated in 2 groups. The gender distribution of the study was 54 females and 46 males. The mean age of the study population was 33.09 ± 12.93 years. p-value was calculated on the 14th day and 42nd days. A 2x2 table of 14th follow up day showed recovery by both groups with a p-value of 0.041 which is <0.05. This showed that group 2 management was statistically better than group 1 management. Conclusion: The second group was managed with eardrops containing Betamethasone and Neomycin. This management protocol is unique and better than conventional management as done in the first group.

scholarly journals On Whether Therapeutic Plasma Exchange is Effective Against Severe/Critical COVID-19 Pneumonia

2021 ◽  
Author(s):  
Luca Cegolon ◽  
Behzad Einollahi ◽  
Sina Imanizadeh ◽  
Mohammad Rezapour ◽  
Mohammad Javanbakht ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Structural Equation ◽  
Cox Regression ◽  
Controlled Trial ◽  
Therapeutic Plasma Exchange ◽  
Equation Modeling ◽  
Control Group ◽  
P Value ◽  
Group 2 ◽  
Group 1

Abstract Background. There is a risk of novel mutations of SARS-CoV-2 that may render COVID-19 resistant to most of the therapies, including antiviral drugs. The evidence around the application of therapeutic plasma exchange (TPE) for the management of critically ill COVID-19 patients is still provisional and further investigations are needed to confirm its eventual beneficial effects. Methods. We therefore carried out a single-centered retrospective observational non-placebo-controlled trial enrolling 73 inpatients from Baqiyatallah Hospital in Tehran (Iran) with diagnosis of COVID-19 pneumonia confirmed by real-time polymerase chain reaction (RT-PCR) on nasopharyngeal swabs and high-resolution computerized tomography chest scan. These patients were broken down into two groups: Group 1 (30 patients) receiving standard of care (corticosteroids, ceftriaxone, azithromycin, pantoprazole, hydroxychloroquine, lopinavir/ritonavir); and Group 2 (43 patients) receiving the above regimen plus TPE (replacing 2 liter of patients’ plasma by a solution, 50% of normal plasma and 50% of albumin at 5%) administered according to various time schedules. The follow-up time was 30 days and all-cause mortality was the endpoint. Results. Deaths were 6 (14%) in Group 2 and 14 (47%) in Group 1. However, different harmful risk factors prevailed among patients not receiving TPE rather than being equally split between the intervention and control group. We used an algorithm of Structural Equation Modeling (of STATA) to summarize a large pool of potential confounders into a single score (called with the descriptive name “severity”). Disease severity was significantly (Wilkinson rank sum test p-value=0.0000) lower among COVID-19 patients undergoing TPE (median: -2.82; range: -5.18; 7.96) as compared to those non receiving TPE (median: -1.35; range: -3.89; 8.84), confirming that treatment assignment involved a selection bias of patients according to the severity of COVID-19 at hospital admission. The adjustment for confounding was carried out using severity as covariate in Cox regression models. The univariate Hazard Ratio (HR) of 0.68 (95%CI: 0.26; 1.80; p=0.441) for TPE turned to 1.19 (95%CI: 0.43; 3.29; p=0.741) after adjusting for severity. Conclusions. The lower mortality observed among patients receiving TPE was due to a lower severity of COVID-19 rather than TPE effects. TRIAL REGISTRATIONIRCT registration number: IRCT20080901001165N58 (Iranian Registry of Clinical Trials)Registration date: 2020-05-27, 1399/03/07 (retrospectively registered)

COMPARISON OF FUNCTIONAL OUTCOME OF MODIFIED TBW VERSUS MODIFIED TBW AUGMENTED WITH CIRCUMFERENTIAL CERCLAGE WIRING IN TRANSVERSE FRACTURE OF PATELLA

2021 ◽  
pp. 47-48
Author(s):  
Satendra Kumar Sinha ◽  
Angwsa Hazowary
Keyword(s):  
Deep Infection ◽  
Tension Band ◽  
Tension Band Wiring ◽  
P Value ◽  
Complication Rates ◽  
Transverse Fracture ◽  
Group 2 ◽  
Displaced Fracture ◽  
Group 1

Background: The most common fracture of patella is transverse fracture of body. The gold standard treatment for displaced fracture is by tension band wiring (TBW) technique, augmentation with circumferential cerclage ss wiring has been suggested to improve the strength of the xation. Methods: The study was conducted at Nalanda Medical College, Patna during the period 2018-2020, by treating 28 patients. Group 1 (n=15) treated with modied tension band wiring (TBW) alone while as Group 2 (n=13) treated by modied TBW along with augmented circumferential cerclage ss wiring. Outcome was studied, graded and compared using the Modied Bostman Scale, union rates, and complication rates. Results: The results at nal follow up in group 1 were excellent in 10( 66.67%), good in 4(27.67%) and unsatisfactory in 1(6.67%). In group 2 the results were excellent in 8(61.54%), good in 5(38.46%) and no unsatisfactory results. Both groups have similar outcomes based on the scoring system used. The results were tested using t test and found to be different but not statistically signicant( p value- 0.469). In group one, 1(6.67%) developed deep infection and 1(6.67%) developed supercial infection. In group 2 2(15.38%) developed supercial infection, however these results are not statistically signicant (p value-0.432). Hardware irritation was seen in 3(20%) of group 1 and 3(23.07%) of group 2(p value>.05). 2(13.33%) of group 1 had implant removal during the course of follow up where as 2(15.38) in group 2 had hardware removal done. Conclusions: Modied tensioned band wiring for displaced transverse fracture of patella is an inexpensive and excellent method of treatment and the use of circumferential cerclage ss wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over xation with tension band wiring alone.

scholarly journals Can the risk of anal fistula development after perianal abscess drainage be reduced?

2020 ◽  
Vol 66 (8) ◽  
pp. 1082-1086
Author(s):  
Feridun Suat Gokce ◽  
Aylin Hande Gokce
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Perianal Fistula ◽  
Perianal Abscess ◽  
Fistula Formation ◽  
Abscess Drainage ◽  
Group 2 ◽  
Lost Work Time ◽  
Group 1

SUMMARY OBJECTIVE Perianal abscesses are frequently seen in clinical practice, and perianal fistulas develop in 30%–50% of cases after treatment. This study investigated whether the type of dressing applied after abscess drainage is correlated with fistula development. Prevention of fistula formation would reduce both the loss of work and healthcare costs. METHODS The records of patients who underwent drainage of perianal abscesses between January 2015 and January 2018 were retrospectively reviewed. Patients with postoperative dressings changed with washing of the area in the hospital were included as Group 1. Patients with dressings changed at home and the area bathed in 10% povidone-iodine sitz bath were included as Group 2. The frequency and time of fistula formation, age, sex, cost, and workdays lost in the two groups were compared. RESULTS Between-group differences in age, sex, body mass index, and type of fistula that developed after months and 1 year of the abscess drainage were not statistically significant (p > 0.05). During follow-up, fistula development was significantly lower in Group 1 than in Group 2 (p < 0.001). The risk of perianal fistula development was significantly increased in those with a body mass index (BMI) > 30 (p = 0.004). CONCLUSIONS After perianal abscess drainage, in-hospital washing and dressing of the abscess area until abscess closure reduced the risk of perianal fistula, lost work time, and cost. The risk of perianal fistula development appeared to increase with BMI. A large, prospective study is needed for confirmation.

scholarly journals Comparison of High Intensity Accelerated Corneal Cross Linking Protocols in Treatment of Progressive Keratoconus;

2020 ◽  
Vol 36 (2) ◽  
Author(s):  
Bushra Akbar ◽  
Imran Basit ◽  
Amjad Akram ◽  
Maham Zahid
Keyword(s):  
Armed Forces ◽  
Comparable Efficacy ◽  
Cross Linking ◽  
P Value ◽  
Quasi Experimental ◽  
Final Time Point ◽  
Spss Software ◽  
Group 2 ◽  
Group 1

Purpose:  To compare the safety and efficacy of Accelerated Corneal Cross Linking (AXL) protocols ,9mW/cm2 for 10 min with 18mW/cm2 for 5 min in terms of refractive and topographic keratometric indices in patients with progressive keratoconus over 3, 6, 12 and 18 months follow-up. Study Design:  Quasi experimental study. Place and Duration of Study:  Armed Forces Institute of Ophthalmology Rawalpindi Pakistan, from Nov 2016 to Jun 2018. Material and Methods:  Sixty eyes, 30 in each group, of 55 consecutive patients diagnosed with progressive keratoconus were enrolled through convenience sampling and were subjected to AXL with irradiance protocols of 18 watt/cm2 for 5 minutes in group 1 and 9mwatt/cm2 for 10 minutes in group 2. All patients underwent a comprehensive ophthalmic examination at baseline and postoperative follow up visits at 3, 6, 12 and 18 months. Primary outcome parameter was disease stability defined as increase in maximum keratometry over baseline K max of no more than 1 diopter at 1 year after AXL. Statistical analysis of data was performed with IBM SPSS software (version 20.0 SPSS). P value of < 0.05 was considered as statistically significant. Results:  Disease stability was 96 % in each group. At the final time point of 18 months, group 2 (AXL 9mmwatt/cm2 for 10 min) was superior as compared to group 1 (AXL 18mmwatt/cm2 for 5 min) in terms of flattening of steep and sim K (p = 0.007, 0.023 respectively). Conclusion:  The two AXL protocols are safe and appear to show comparable efficacy in disease stability. They can be used alternatively in the treatment of progressive keratoconus.

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