controlled clinical study
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2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Luise Drewas ◽  
Hassan Ghadir ◽  
Rüdiger Neef ◽  
Karl-Stefan Delank ◽  
Ursula Wolf

Abstract Background Delirium is one of the most frequent complications in hospitalized elderly patients with additional costs such as prolongation of hospital stays and institutionalization, with risk of reduced functional recovery, long-term cognitive impairment, and increased morbidity and mortality. We analyzed the effect of individual pharmacotherapy management (IPM) in the University Hospital Halle in geriatric trauma patients on complicating delirium and aimed to identify associated factors. Methods In a retrospective controlled clinical study of 404 hospitalized trauma patients ≥70 years we compared the IPM intervention group (IG) with a control group (CG) before IPM implementation. Delirium was recorded from the hospital discharge letter. The medication review and data records included baseline data, all medications, diagnoses, electrocardiogram (ECG), laboratory and vital parameters during hospitalization. The IPM internist and the senior trauma physician guaranteed personnel and structural continuity in the implementation of the interdisciplinary patient rounds. Results There was a highly matched congruence between CG and IG in terms of age, gender, residency, BMI, most diagnoses, and injury patterns to compare the two groups. The total number of medications per patient was 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG). Our targeted IPM focus on 6 frontline aspects with reduction of antipsychotics, anticholinergic burden, benzodiazepines, serotonergic opioids, elimination of pharmacokinetic and pharmacodynamic drug interactions and overdosage reduced complicating delirium from 5% to almost zero at 0.5%. The association of IPM with a significant 10-fold reduction, OR = 0.09 [95% CI 0.01–0.7], in univariable regression, maintained of clinical relevance in multivariable regression OR = 0.1 [95% CI 0.01–1.1]. Factors most strongly associated with complicating delirium in univariable regression were cognitive dysfunction, nursing home residency, muscle relaxants, antiparkinsonian agents, xanthines, transient disorientation documented in the fall risk scale, antibiotic-requiring infections, antifungals, antipsychotics, and intensive care stay, the two latter maintaining significance in multivariable regression. Conclusions IPM is associated with a highly effective prevention of complicating delirium in the elderly trauma patients. For patient safety it should be integrated as an essential preventative contribution. The associated factors help identify patients at risk.


Perio J ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 28-37
Author(s):  
Dalia Shawky Gaber ◽  
Nevine Hassan Kheir El Din ◽  
Hamdy Ahmed Nassar ◽  
Mostafa Saad El-Din Ashmawy ◽  
Ola Mohamed Ezzatt

Background: This study aimed to evaluate the effects of lycopene gel, as a natural antioxidant, mixed with a nanohydroxyapatite graft (NHG) covered by an occlusive resorbable collagen membrane (CM) in the surgical treatment of grade II furcation defects and on the gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG), as a marker of oxidative injury. Methods: In this randomized controlled clinical study a total of 24 patients with grade II furcation defects were randomly assigned into three equal groups. Furcation defects in group I were managed with lycopene gel mixed with NHG and CM, group II with NHG and CM, and group III with open flap debridement only. Site-specific changes in clinical parameters including probing depth (PD), vertical clinical attachment level (VCAL), horizontal clinical attachment level (HCAL), radiographic maximum vertical depth (MAX V), and maximum horizontal depth (MAX H) were measured at baseline and six months postoperatively. Gingival crevicular fluid levels of 8-OHdG were analyzed using enzyme-linked immunosorbent assay (ELISA) at baseline, one week, and three months. Results: Surgical management of grade II furcation defects resulted in a significant reduction in PD and 8-OHdG levels and a gain in CAL, MAX V, and MAX H in all groups. The differences between lycopene treated sites compared to NHG and CM alone were not significant at six months but demonstrated significantly superior clinical parameters compared to open flap debridement alone. Conclusion: Lycopene does not confer a benefit when combined with NHG in the surgical treatment of grade II furcation defects.


2021 ◽  
Vol p6 (1) ◽  
pp. 3157-3162
Author(s):  
Sindhu Umesh ◽  
Jayasudha G. C ◽  
Ramesh M

Cervical Erosion may present with symptoms like vaginal discharge or serious problems of female infertility and thus gains importance in the gynaecological practice1. This entity is correlated with GarbhashayaMukhaGata Vrana (GGV), of Vatakaphaja variety. In the present study, Kushtadi YoniVarti (KYV) 2 is proposed as a local treatment for Cervical Erosion. The present study has two groups: Group A:30 patients, were treated with Kush- tadi Yoni Varti, followed by Sukhoshna Jala Prakshalana for 7 consecutive days. Group B:30 patients were ad- vised with Pathya and apathy for 7 days. The Follow up for both groups were on 14th Day and 21st Day. The re- sults were analysed statistically with paired and unpaired t-test. On comparing the two groups, it was found that the efficacy of treatment in Group A was better than the efficacy of treatment in Group B with reference to amount and odour of discharge, appearance and degree of erosion. Keywords: Cervical Erosion, Kushtadi Yoni Varti, GarbhashayaMukhaVrana, PAP Smear.


2021 ◽  
Author(s):  
Punam Khobarkar ◽  
Jayant Gulhane ◽  
Amit Nakanekar

Abstract Type 2 Diabetes mellitus in obese persons is becoming threatening disease due to increasing prevalence of its microvascular and macro vascular complications. A multi targeted treatment can be considered better over single targeted treatment; in view of multiple pathways involved in pathogenesis of diabetes and its complications. This open labelled randomized controlled clinical Study was aimed to evaluate clinical efficacy of ‘Vidangadi Lauha’(An Ayurveda formulation) in comparison with metformin for obese type II diabetes mellitus. Participants were divided into two groups. Trial group received Vidangadi Lauha 5gm BID and control group received tablet metformin 500mg BID for duration of 3 months. Among 550 screened participants 120 participants were eligible, out of them 100 participants were enrolled and randomized by computer generated method, out of them 80 patients (40 in each group) completed the trial. Both the treatments were equally effective in reducing blood sugar fasting(F), post meal(PM) glycated Haemoglobin (HbA1C) and Body Mass Index (BMI). Vidangadi Lauha is more effective in reducing Ayurvedic Symptoms, waist hip ratio and cholesterol as compared to Metformin. High Density Lipoproteins (HDL) were improved by minor clinical difference in both the groups. Both the treatment does not have statistically significant effect in reducing Low Density Lipoproteins (LDL).


Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhaoyan Feng ◽  
Xiao Shi ◽  
Xue Yan ◽  
Yamin Zhu ◽  
Juan Gu ◽  
...  

Abstract Background Emergence agitation (EA) after general anesthesia is a common complication in the post-anesthesia care unit (PACU). Once EA occurs, there are still no guidelines established for the treatment in adults. Propofol is excessively used in managing agitated patients in the PACU, but it lacks analgesia and can result in apnea. Intraoperative infusion of dexmedetomidine has been proven to have a preventive effect on EA, but the treatment effect of dexmedetomidine on EA remains unknown. This study aims to compare the effects between dexmedetomidine and propofol on relieving EA in adult patients after general anesthesia in the PACU. Methods In this randomized, superiority, controlled clinical study, a total of 120 adult patients aged 18–65 years of both genders, with American Society of Anesthesiologists (ASA) classification I or II developing EA in the PACU after general anesthesia, will be enrolled. Patients will be randomized at a 1:1 ratio into two groups, receiving either a single dose of dexmedetomidine (0.7μg/kg) or propofol (0.5 mg/kg). The primary outcome is the proportion of patients having a recurrent EA within 15 min after intervention in the PACU. Discussion Previous studies have focused on premedication for preventing EA, while therapeutics for reliving EA have rarely been reported. To our knowledge, this study is the first randomized, superiority, controlled trial to compare a bolus of dexmedetomidine with the current routine care for this indication. Trial registration ClinicalTrials.govNCT04142840. Registered on October 26, 2019


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