15-day Follow-up Period Research Articles

Auriculoterapia para redução da dor crônica na coluna vertebral em trabalhadores da saúde: ensaio clínico

Objective: to evaluate the effectiveness of auriculotherapy in reducing chronic musculoskeletal pain in the spine of health workers. Method: a randomized, triple-blind clinical trial conducted with health workers diagnosed with chronic spinal pain. Eight sessions of auriculotherapy with seeds were applied, two per week. The outcomes were measured with the Numerical Pain Scale, Brief Pain Inventory, Rolland-Morris Disability Questionnaire and SF-36 instruments, in the 1st, 4th and 8th session, and in the 15-day follow-up period. Descriptive and inferential analyses were performed. Results: 34 workers took part in the Intervention Group and 33 in the Control Group, and both presented reduced pain intensity (p>0.05). In the follow-up period, there was a greater reduction in the Intervention Group (3.32 ± 0.42), when compared to the Control Group (5.00 ± 0.43) (p=0.007). In quality of life, there was improved vitality (p=0.012) and limitation due to emotional aspects (p=0.025). The relationship between auriculotherapy, physical disability and pain interference did not differ between the groups (p>0.05). Medication use in the follow-up period remained unchanged in the Control Group (77.8%) when compared to the Intervention Group (22.2%) (p=0.013). Conclusion: auriculotherapy exerted the same effect between the groups on pain intensity, lasting longer in the follow-up period. There was an improvement in quality of life and a reduction in medication use. REBEC: RBR-3jvmdn.

Evaluation of Micronutrients and Pro-Inflammatory Cytokines Levels in Nutritionally Deprived Children—A Tertiary Care Hospital-Based Study

Background: Severe acute malnutrition (SAM) is a significant public health problem in developing countries, including India, where a significant proportion of children suffer from malnutrition. Objective: This research aims to investigate the factors contributing to severe acute malnutrition (SAM). Additionally, the study seeks to explore the relationship between micronutrient levels and pro-inflammatory cytokines in SAM children with and without clinical complications. Furthermore, the effectiveness of antibiotic treatment in SAM children without complications is evaluated. Methods: The study involved three groups comprising 66 subjects each: a healthy control group, SAM children with complications, and SAM children without complications. Blood samples were collected, and various analyses were conducted, including biochemical, hematological, micronutrient, and pro-inflammatory marker quantification. The data were analyzed using SPSS version 22.0. Results: The results indicate that the levels of IL-6, CRP, and TNF-α were significantly higher in the SAM group with complications compared to both the control group and the SAM group without complications. Zinc and copper levels were significantly lower in both SAM groups compared to the control group, and a negative correlation was observed between zinc levels and inflammatory markers. The study also assessed the efficacy of antibiotic treatment in SAM children without complications by comparing their weight, height, weight-for-height, and weight-for-age at baseline and after a 15-day follow-up period. Significant improvements in these parameters were observed in both the group receiving antibiotic treatment and the group not receiving antibiotic treatment. Conclusion: The findings suggest that a combination of antibiotic treatment and nutritional support can lead to significant clinical improvements in SAM children without complications. This study has important implications for the management and treatment of SAM in India and other developing countries.

MANAGEMENT OF DERMATOPHYTOSIS WITH AYURVEDIC INTERVENTION: A CASE REPORT

Dermatophytosis (tinea) infections are superficial fungal diseases caused by dermatophytes, a genus of fungus that penetrates and develops in dead keratin. Fungal infections are more likely to recur and, if left untreated, can result in the emergence of more serious illnesses. Even though there are many antifungal medications available to treat tinea infection, relapses and recurrences show that the pathogenic organism is not easily destroyed, necessitating more study to develop new therapeutic choices. In Ayurveda, many drugs are claimed to have the krimighna effect, which can lead to a more efficient course of treatment. Dermatophytosis can be simulated with dadru kushtha since the clinical characteristics of the disease are more closely related to dermatophytosis. Material and Method: In this case report, a 30-year-old female patient was successfully treated with the Ayurvedic interventions of chakramarda beeja churna, vidanga beeja, kampillaka, rala, tankana bhasma, and aaroyavardhini vati after being diagnosed with dadru kushtha (tinea corporis) based on symptoms. Result: After 45 days of consistent treatment, there was total relief from the symptoms of kandu (itching), daha (burning sensation), raga (erythema), pidika (eruptions), and utsanna mandala (elevated circular skin lesion), and there was no recurrence in the 15-day follow-up period. Conclusion: Dermatophytosis can be effectively treated with Ayurvedic bahiparimarjana (external application) and shamana chikitsa, along with dietary restrictions and personal hygiene.

B-PO03-186 MONITORING ATRIAL FIBRILLATION PATIENTS USING ACTIVE CONTACTLESS VIDEOPLESTHYMOGRAPHY IMPLEMENTED ON A PERSONAL TABLET

Early detection of subclinical AF can help prevent significant complications such as embolic stroke, heart failure, and AF-related hospitalizations. We evaluated the performance of a facial pulsation detection video technology called videoplethysmography (VPG) to detect the presence of AF using a monitoring method that does not require a dedicated sensor and/or cumbersome recording procedures. We enrolled patients with AF undergoing either cardioversion or ablation therapy. Patients were asked to collect two 25-sec video recordings daily using a smart tablet loaded with the VPG technology. Early recurrence of AF during the 15-day follow-up period was based on continuous ECG recording (14-day patch monitor). ECGs were manually annotated for the presence of AF episodes lasting >15-sec in duration. The VPG algorithm measured pulse irregularity and was designed to minimize false positive detections. Development and validation were performed on independent datasets (½ split without a subject in common). We report the specificity, sensitivity, and accuracy of the video-based method to detect early recurrence of AF during the follow-up period. The motion of the patient's face was tracked, but no feedback was provided to the subjects during the measurement. We enrolled 112 patients (age: 65∓9 years, 81 men) over an 18 month period. Five subjects did not collect any quality data while 107 patients collected 7∓5 minutes of data on average at home (min:30sec, max: 25min) over 12∓3 days (min:1.5, max:14.7 days). Thirty subjects (28%) experienced at least one 15-sec AF episode post-procedure. The sensitivity and specificity of the AF detection algorithm based on a total duration of 7 min. of video recordings, over 12 days were 33% and 95% in the validation dataset (accuracy: 74%). Less than one-minute daily monitoring using a contactless VPG method can detect AF in one-third of patients experiencing an early recurrence of AF with a 5% false-positive rate. The sensitivity of the VPG method is expected to increase with a larger number of daily VPG recordings.

Minimally invasive urologic surgery is safe during COVID-19: experience from two high-volume centers in Italy.

Potential risks of COVID-19 spread during minimally invasive procedures caused several concerns among surgeons, despite the lack of high-level evidence. Urological robotic and laparoscopic surgery is performed in elective setting in almost all occasions, thus allowing adequate planning and stratification. Two high-volume urological centers in Italy performed 77 robotic and laparoscopic surgeries during the “lockdown” period and adopted various strategies to prevent contamination. First of all, all patients were tested negative with nasopharyngeal swab before the surgical intervention. Patients and personnel were provided adequate personal protective equipment and intraoperative strategies to prevent smoke formation and pneumoperitoneum spread were adopted. No patients nor staff members tested positive for COVID-19 during a 15-day follow-up period. In conclusion, minimally invasive urologic surgery can be safely performed during the pandemic period with adequate planning. We believe that renouncing the benefits of it would be counterproductive, especially in a scenario of long-lasting cohabitation with the virus.

Evaluation of the effectiveness and tolerance of tetracosactide in the treatment of post-dural puncture headaches (ESYBRECHE): a study protocol for a randomised controlled trial

BackgroundPost-dural puncture headache (PDPH) is one of the most common complications of neuraxial anaesthesia. It limits patients’ general activity and increases the length of hospital stays and the use of care. It is particularly disabling during the postpartum period, when mothers have to take care of their child. Epidural blood patch is the standard treatment for PDPH. However, it is an invasive procedure that may result in rare but serious complications. Recent evidence has suggested that adrenocorticotropic hormone (ACTH) is effective in the management of PDPH. The aim of this study is to assess the efficacy and safety of tetracosactide (Synacthen®), a synthetic analogue of ACTH, for PDPH treatment in patients who receive neuraxial anaesthesia during labour.MethodsThis randomised, double-blind, placebo-controlled, parallel-arm trial, is performed in two French university hospitals. Eligible patients are those suffering from postpartum PDPH, who are randomised to receive either 1 mg of tetracosactide intravenously over 20 min or to 0.9% saline (placebo). The primary endpoint is the rate of epidural blood patch within a 15-day follow-up period. Headache duration, pain intensity, reduction of general activity, increase in length of hospital stay, adverse events, analgesic use (type and duration) and number of blood patches per patient in each group are recorded.DiscussionWe expect a decrease in the use of epidural blood patch in those receiving tetracosactide, thus indicating a decrease in PDPH symptoms in these patients. This will define the therapeutic success of tetracosactide and the possibility to use this treatment as a non-invasive alternative to blood patch for PDPH treatment.Trial registrationPrimary RegistryClinicalTrials.gov Protocol Registration and Results SystemDate of Registration 24 June 2016Unique Protocol ID 69HCL15_0429Secondary IDsEudraCT Number 2015–003357-17ClinicalTrials.gov ID NCT02813655ANSM 160214A-31Protocol versionV4 28/09/2018

The Effects of Hyaluronic Acid on Traumatic Urethral Inflammation

Purpose: This study investigated the possible beneficial effect of hyaluronic acid (HA) on traumatic urethral healing. Methods: A total of 40 adult male Wistar rats were randomized into four groups: control, sham (serum physiologic; SF group), HA 1.8%, and HA 3%. A tiny hook was introduced and drawn at the 12 o’clock position into the urethra for the SF and HA groups to create a urethral inflammation model. Either SF or HA was applied intraurethrally for 5 consecutive days. After a 15-day follow-up period (21st day of the study), penile tissue was harvested and evaluated histopathologically. Results: None of the groups showed inflammation at the end of study. Pathological findings such as calcification, hemorrhage, and stenosis were observed in the wound healing and these findings were present in all trauma groups. A significant increase in tissue thickness was observed in the group treated with saline (p = 0.004). No statistically significant difference was found in the two groups receiving HA treatment compared to the SF group. Conclusion: These data suggest that HA does not provide a beneficial effect on the connective tissue repairment when it is applied locally during the acute period of urethral injury for 5 consecutive days. There is a need for further studies in which the duration of drug use is extended or the dosage is increased.

Effects of auricular acupuncture on chronic pain in people with back musculoskeletal disorders: a randomized clinical trial.

To evaluate the effects of auricular acupuncture on pain intensity, its impact on daily activities, the relief provided by the intervention, and the pain threshold in people with back musculoskeletal disorders. Randomized clinical trial carried out with people randomly allocated into three groups: treatment, placebo, and control. Evaluations were performed using the Brief Pain Inventory and a digital algometer before (initial) and after (final) the treatment and after a 15-day follow-up period. The sample was 110 people. There was a decrease in pain intensity in the treatment and placebo groups as revealed by the comparison between the initial and final evaluations (p<0.05), and in the treatment group in the comparison between the initial and follow-up evaluations (p<0.05). A decreased impact of pain on daily activities in the treatment and placebo groups over time was found (p<0.05). At the final evaluation, the impact of pain was lower in the treatment group (p<0.05). Auricular acupuncture did not increase the pain threshold. Auricular acupuncture presented positive effects by reducing the chronic pain intensity and its impact on daily activities in people with back musculoskeletal disorders. Brazilian Clinical Trials Registry: RBR-5X69X2.

Lebanese Registry in the Management of Antibiotic Associated Diarrhea in Children: Observational Study in Daily Practice

Background: Antibiotic-associated diarrhea (AAD) is a common complication in patients prescribed antibiotics, and represents an economic and health burden. Evidence that probiotics may be beneficial for the prevention of AAD is increasing. The aims of this registry were to assess the prevalence of probiotic prescriptions in pediatric patients for whom an antibiotic treatment regimen was prescribed, and to explore the potential health benefits that such an administration may provide. Methods: This longitudinal, multicenter, observational study enrolled 249 pediatric patients prescribed an antibiotic treatment for 5 - 14 days, with or without a concomitant probiotic. The number of probiotic-administered patients, and AAD incidence rates throughout the 15-day follow-up period, were assessed. Results: Of the 246 patients who met inclusion/exclusion criteria in Lebanon, the investigators had prescribed an additional probiotic treatment to 118 (48%) of them, while, the other 128 (52%) did not receive such additional treatment. A significantly higher number of patients in the probiotic group were at high risk of developing diarrhea (probiotic: 27.1% vs. no probiotic: 6.3%; P < 0.001). Among high risk patients, the frequency of diarrhea was doubled in the group with no probiotics (probiotic: 21.9% (n = 7) vs. no probiotic: 50.0% (n = 4); P = 0.182). Despite the significantly larger number of probiotic-administered patients that were at high risk of developing diarrhea, the proportion of patients who reported developing diarrhea was not statistically different between the two groups (probiotic: n = 22 (18.6%) vs. no probiotic: n = 24 (18.8%); P = 0.983). Conclusions: In conclusion, this Lebanese disease registry demonstrated that almost half of pediatric patients with mild to moderate infections were prescribed probiotics in combination with antibiotics to decrease the risk of AAD. This observation was particularly significant in the high risk population as per the treating physicia n’ s judgment. Int J Clin Pediatr. 2017;6(1-2):8-19 doi: https://doi.org/10.14740/ijcp269w

Homeopathic Ear Drops as an Adjunct in Reducing Antibiotic Usage in Children With Acute Otitis Media

Objective. To determine if use of a homeopathic ear drop preparation reduces antibiotic use in children diagnosed with acute otitis media (AOM). Methods. Children 6 months to 11 years old, diagnosed with AOM and managed with a delayed antibiotic approach, were randomized to standard therapy alone or standard therapy plus a homeopathic ear drop preparation. The primary outcome was whether or not the antibiotic prescription given at the index visit was filled during a 12- to 15-day follow-up period. Results. Among 210 enrolled children, follow-up antibiotic data were collected on 206. During the 12- to 15-day follow-up period, fewer parents of children randomized to the homeopathic ear drops group filled the antibiotic prescription compared with those of children receiving standard therapy alone (26.9% and 41.2%, respectively, P = .032). Conclusion. Homeopathic ear drops may be effective in reducing the use of antibiotics in children with AOM managed with a delayed antibiotic approach.

Human Embryonic and Induced Pluripotent Stem Cell–Derived Cardiomyocytes Exhibit Beat Rate Variability and Power-Law Behavior

The sinoatrial node is the main impulse-generating tissue in the heart. Atrioventricular conduction block and arrhythmias caused by sinoatrial node dysfunction are clinically important and generally treated with electronic pacemakers. Although an excellent solution, electronic pacemakers incorporate limitations that have stimulated research on biological pacing. To assess the suitability of potential biological pacemakers, we tested the hypothesis that the spontaneous electric activity of human embryonic stem cell-derived cardiomyocytes (hESC-CMs) and induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) exhibit beat rate variability and power-law behavior comparable to those of human sinoatrial node. We recorded extracellular electrograms from hESC-CMs and iPSC-CMs under stable conditions for up to 15 days. The beat rate time series of the spontaneous activity were examined in terms of their power spectral density and additional methods derived from nonlinear dynamics. The major findings were that the mean beat rate of hESC-CMs and iPSC-CMs was stable throughout the 15-day follow-up period and was similar in both cell types, that hESC-CMs and iPSC-CMs exhibited intrinsic beat rate variability and fractal behavior, and that isoproterenol increased and carbamylcholine decreased the beating rate in both hESC-CMs and iPSC-CMs. This is the first study demonstrating that hESC-CMs and iPSC-CMs exhibit beat rate variability and power-law behavior as in humans, thus supporting the potential capability of these cell sources to serve as biological pacemakers. Our ability to generate sinoatrial-compatible spontaneous cardiomyocytes from the patient's own hair (via keratinocyte-derived iPSCs), thus eliminating the critical need for immunosuppression, renders these myocytes an attractive cell source as biological pacemakers.

Inhibition of Experimental Proliferative Vitreoretinopathy with Protein Kinase C Inhibitor (Chelerythrine Chloride) and Melatonin

Purpose: To investigate whether a protein kinase C (PKC) inhibitor and melatonin prevent proliferative vitreoretinopathy (PVR). Methods: Twentypigmented rabbits were used in this study. All rabbits except controls received an intravitreal injection of 0.15 ml (75,000 units) of platelet-rich plasma into their left eye. The animals were divided into four groups: group I was treated with intravitreal injection of 0.1 ml (100 µmol/ml) of PKC inhibitor (chelerythrine chloride), group II received 1 ml (4 mg/kg) of intraperitoneal melatonin for 3 days, group III received nothing (blank group), and group IV (control group) received only 0.5 ml of 1% ethanol intraperitoneally for 3 days. Proliferative changes were graded in a masked fashion by indirect ophthalmoscopy for a 15-day follow-up period. The malondialdehyde (MDA), reduced glutathione (GSH) and total nitrite levels were measured in the vitreous humor. Results: The grades of PVR were A and B in group I and II, treated with PKC inhibitor and melatonin, respectively. The PVR grade in the blank group was C-D. The mean MDA level in group I (4.2 ± 0.9 µmol/l) was significantly lower than in the blank group (6.0 ± 1.0 µmol/l; p < 0.05). The mean GSH level in group I (66.3 ± 8.8 µmol/l) was not significantly different from that in the blank group (p > 0.05). The MDA and GSH levels in group II were 3.2 ± 0.7 and 70.1 ± 13.3 µmol/l, respectively. Both these levels were significantly different from those of the blank group (p < 0.05). The NO levels in both treatment groups were significantly lower than in the blank group (p < 0.001). Conclusion: These findings suggest an inhibitory effect of PKC inhibitor and melatonin on PVR. The inhibition of PVR development was associated with lower MDA and NO levels with higher GSH levels in the treatment groups.

Use of caffeic acid phenethyl ester and cortisone may prevent proliferative vitreoretinopathy.

PURPOSE: To investigate whether caffeic acid phenethyl ester (CAPE) and cortisone prevent proliferative vitreoretinopathy (PVR). METHODS: Twenty pigmented rabbits were used in this study. All rabbits except controls received an intravitreal injection of 0.15 ml (75,000 U) of platelet-rich plasma into their left eye. The animals were divided into four groups: group I was treated with intraperitoneal injection of 0.5 ml (15 micromol/kg) of CAPE for 3 days, group II received 0.15 ml (4 mg/kg) of intravitreal cortisone, group III received nothing (blank group), and group IV (control group) received only 1 ml of 1% ethanol intraperitoneally daily for 3 days. Proliferative changes were graded in a masked fashion by indirect ophthalmoscopy for a 15-day follow-up period. The malondialdehyde (MDA), reduced glutathione (GSH) and total nitrite (NO) levels were measured in the vitreous humor. RESULTS: The grades of PVR were B-C in group I, and C-D in group II. The PVR grade in the control group was C-D. The mean MDA level in group I (4.0+/-0.8 micromol/l) was significantly lower than in the blank group (6.0 micromol/l) (p < 0.05). The mean GSH level in group I (71.0+/-11.2 micromol/l) was significantly different than in the blank group (p < 0.05). The MDA and GSH levels in group II were 4.7+/-0.6 micromol/l and 53.8+/-7.8 micromol/l, respectively. Both these levels were not significantly different from the blank group (p > 0.05). The NO levels in both treatment groups were significantly lower than in the blank group (p < 0.001). CONCLUSION: These findings suggest an inhibitory effect of CAPE on PVR. The inhibitory effect was supported by lower MDA and NO with higher GSH levels in treatment groups than in the blank group. There was no detected significant effect of cortisone for preventing PVR experimentally.

Determination of the inhibitory effect on Toxoplasma growth in the serum of AIDS patients during acute therapy for toxoplasmic encephalitis.

In 26 AIDS patients treated for toxoplasmic encephalitis, the inhibitory effect on Toxoxplasma growth of sequential sera taken before and after initiation of therapy was determined using a culture-based immunoassay and compared with pyrimethamine blood levels. A marked inhibition of Toxoplasma growth was observed 1 day after initiation of therapy with pyrimethamine plus sulfadiazine and was maintained between 67% and 93% throughout the 15-day follow-up period. The degree of inhibition was not correlated to pyrimethamine blood levels and seemed highly potentiated when sulfadiazine rather than macrolides was given in combination with pyrimethamine.

Intravenous amiodarone in treatment of recent-onset atrial fibrillation: Results of a randomized, controlled study

This study was designed to determine the efficacy of intravenous amiodarone in the management of recent-onset atrial fibrillation. The optimal approach for acute atrial fibrillation has not been established. Amiodarone is a unique antiarrhythmic agent with activity in both supraventricular and ventricular tachyarrhythmias, but its value for the restoration of sinus rhythm in patients with recent-onset atrial fibrillation has not been demonstrated. Sample size was calculated to detect a 25% increase in reversion rate with amiodarone with a statistical power of 80%. One hundred consecutive patients with recent-onset (<1 week) atrial fibrillation and not taking antiarrhythmic agents were randomized to receive either intravenous amiodarone, 5 mg/kg body weight in 30 min followed by 1,200 mg over 24 h, or an identical amount of saline. Both groups received intravenous digoxin, 0.5 mg initially, followed by 0.25 mg at 2 h and 0.25 mg every 6 h thereafter, to complete 24 h while the ventricular rate was >100 beats/min. Amiodarone and digoxin blood levels were determined. Both groups were homogeneous regarding underlying heart disease, time from onset to treatment, initial ventricular rate and left atrial size. By the end of the 24-h treatment period, 34 patients (68%, 95% confidence interval [CI] 53% to 80%) in the amiodarone group and 30 (60%, 95% CI 45% to 74%) in the control group had returned to sinus rhythm (p = 0.532). Mean times (+/-SD) of conversion were 328 +/- 335 and 332 +/- 359 min, respectively (p =0.957). Among patients who did not convert to sinus rhythm, treatment with amiodarone was associated with a slower ventricular rate (82 +/- 15 beats/min in the amiodarone group vs. 91 +/- 23 beats/min in the control group, p = 0.022). After restoration of sinus rhythm, atrial fibrillation recurred during a 15-day follow-up period in 4 (12%) of 34 patients (95% CI 3% to 27%) in the amiodarone group and in 3 (10%) of 30 (95% CI 2% to 26%) in the control group (p = 0.861). Intravenous amiodarone, at the doses used in this study, produces a modest but not significant benefit in converting acute atrial fibrillation to sinus rhythm.