3rd Visit Research Articles

Investigating the Additive Effects of Loxacon® Food Supplement Capsules in Patients with Knee Osteoarthritis. A Multicenter, Randomized, Double-Blind, Controlled, Crossover, Follow-Up, Three-Arm Study.

Osteoarthritis is one of the most common locomotor diseases, with a steadily increasing prevalence and incidence. Loxacon® is a food supplement capsule containing vitamins, minerals, and herbal extracts with Boswellia serrata extract and Harpagophytum procumbens extract as its two main active components. The study involved 88 patients at 4 sites. The 88 patients were divided into 3 groups. The first group received physical therapy and Loxacon® capsules for 5 weeks, while the second group (30 patients) received physical therapy only for 5 weeks, and the third group (30 patients) received physical therapy and placebo capsules for 5 weeks. After 5 weeks, physical therapy was discontinued in all three groups and all groups continued Loxacon® capsules exclusively for an additional 60 days. Physical therapy had been carried out by a standard protocol over 5 weeks. Investigated parameters included Western Ontario and McMaster Universities Arthritis Index (WOMAC) testing, European Quality of Life (EQ-5D-5L) quality of life test and the Range of Motion (ROM). Among the 4 visual analogue scale (VAS) values investigated from WOMAC, significant change was seen for functionality in all three groups; however, the extent of change was twice as large in the physical therapy + Loxacon® group at Visit 2 in comparison with the other two groups. In the physical therapy + placebo group, improvement was seen only at the 3rd visit when they were also receiving Loxacon® capsules. The most pronounced difference was seen in the minimum clinically important difference index, calculated from the quality of life-VAS, where those taking Loxacon® capsules had a chance 3 times as high to obtain clinical improvement versus the other two groups. Our study confirmed that a combination of boswellic acid and harpagosides is beneficial as an additional therapy in knee OA.

ASSESSMENT OF EYE DROP INSTALLATION TECHNIQUE AMONG PATIENTS ATTENDING OUTPATIENT CLINIC AT PT. JLNGMC, CHAMBA

Objective: A good eye drops installation technique and its knowledge is vital for curing eye ailments and preventing eye from harmful effects of over-dose and under-dose of drugs. The current study assessed the eye drop installation technique and corrected it by imparting them education regarding the same. Methods: A total of 120 patients were enrolled in the cross-sectional study using consecutive sampling technique till the sample size was achieved in a tertiary care hospital. The participants were observed by the trained observers for their steps of technique for installing eye drops and the errors were noted which were corrected by the observers and followed up till 3 visits to observe a change in the steps of technique. Results: The mean age of study participants was 41.44±15.4 y. Majority of them were in the age group 18-30 y (35%), females (55.8%), and belonging to upper middle socio-economic status (31.7%). Majority of study participants had 6/6 VA in right eye (65%) and left eye (61.7%). “Drop land on first attempt” and “direct bottle towards eyes” showed maximum improvement of 45.8% each followed by “tilt head while putting” showed 45 % improvement between 1st visit and 3rd visit. “Trouble putting drops” showed least improvement by 20% between 1st and 3rd visit. All the favorable ophthalmic practices showed a statically significant (<0.05) increase in their proportion in each visit. Conclusion: A high prevalence of errors while installing eye drops among participants were observed which were improved by educating them about right steps, as observe in follow up visits.

Prediction of Cerebral Palsy and Other Motor Developmental Trajectories in High-Risk Neonate Using the Rapid Neurodevelopmental Assessment (RNDA)

Background: Cerebral Palsy (CP) is a prevalent motor disability affecting children globally, emphasizing the need for early identification and intervention. The Rapid Neurodevelopmental Assessment (RNDA) offers a comprehensive approach to predict CP and other motor developmental trajectories in high-risk neonates. Objective: This longitudinal cohort study aims to evaluate the effectiveness of RNDA in predicting CP and motor developmental trajectories. Method: Seventy term neonates from Dhaka Shishu (Children) Hospital were included, with neurodevelopmental assessments conducted using RNDA. Assessments were performed at 3 months and 6-9 months, with CP evaluation at 12 months using clinical examinations. Results: Prolonged labor (44.3%) and delayed cry after birth (31.4%) were common among the study patients (n=70), with varying modes of delivery including normal vaginal delivery (50.0%), vaginal delivery with complications (12.9%), and lower uterine cesarean section (37.1%). Muscle tone, primitive reflexes, gross and fine motor skills, epilepsy, and microcephaly were evaluated across visits to identify impending CP. Significant associations were found between hypertonicity, primitive reflex impairment, gross motor impairment, and fine motor impairment with impending CP across visits, particularly in the 3rd visit (p<0.05). Sensitivity, specificity, accuracy, and predictive values varied across parameters and visits, with fine motor skills and gross motor skills showing the highest sensitivity in the 3rd visit (86.4% and 100.0%, respectively). Additionally, abnormal EEG, USG of the brain, and MRI findings were significantly associated with impending CP, with USG of the brain demonstrating the highest sensitivity (93.3%) and MRI showing the highest specificity (70.0%). Conclusion: RNDA emerges as a valuable tool for early prediction of CP and motor developmental trajectories in high-risk neonates. Early identification through RNDA facilitates timely interventions, optimizing long-term neurodevelopmental outcomes.

The evolution of cardiac function in patients with non-Hodgkin’s lymphoma under chemotherapy

In clinical practice, the treatment of non-Hodgkin’s lymphoma (NHL) often involves the combination of several chemotherapy agents, radiotherapy and immunotherapy. While these multimodal approaches improve the efficacy of pathology-specific treatment, they also increase the risk of cardiovascular complications, the most common of which is ventricular dysfunction induced by anti-tumor therapy. Aim of the study: Evaluation of the impact of anti-tumor treatment of NHL on the trajectory of left and right ventricular echocardiographic function. Materials and methods: 127 randomly selected patients from the hematology departments of the PSMI Institute of Oncology were included in the study. Patients were investigated during 3 visits by comprehensive echocardiography, the first visit was up to the onset of anti-tumoral treatment, the 2nd visit was 1 month after initiation and the 3rd visit at 6 months after the debut of chemotherapy. Results: During the anti-tumor treatment, a statistically significant decrease in left ventricular systolic indicators was attested by following parameters: left ventricular ejection fraction (LV EF), mean left ventricular S’, the ratio between the maximum velocity of the E wave and the flow propagation velocity (E/Vp), with an ANOVA p-value <0.001. Regarding the right ventricular systolic function, the indices reflected by TAPSE and S’ right ventricular free wall were reduced statistically significantly also (p ANOVA <0.001). The given analysis confirmed the impairment of ventricular relaxation throughout the treatment, the increase in left ventricular filling pressures, the ratio E/A and E/e’ showed a statisticallysignificant increase, parameters such as the deceleration time of the E wave, the relaxation isovolumetric time, the ratio e’/a’ did not register a statistically significant dynamic (p ANOVA = 0,897; 0,705 and 0,145 respectively). 6 months after the start of treatment, cardiac dysfunction associated with cancer therapy (CTRCD) was found in 18 patients (14,2%), 8 (6,3%) presented a moderate asymptomatic form, 7 (5,7%) had a mild asymptomatic form and 3 (2,4%) a symptomatic one.Conclusion: The left ventricular systolic function was statistically significantly reduced under the impact of the applied treatment, which was confirmed by the LV EF, the mean S’ value at the LV and the E/Vp ratio, the diastolic function having an impact through the E/A and E/e’ ratio. Regarding the function of the right ventricle, we attested statistically significant changes only in the longitudinal contraction parameters. CTRCD was confirmed in 18 patients.

Dynamics of clinical and echocardiographic parameters of patients with cardiovascular diseases 3, 12 and 26 months after COVID-19 pneumonia

Aim: to study the dynamics of clinical and echocardiographic parameters in patients with cardiovascular diseases (CVD) at 3, 12, and 26 months after COVID-19 pneumonia. Material and methods. The dynamics of clinical and echocardiographic parameters were studied in 130 patients with CVD at 3, 12, and 26 months after COVID-19 pneumonia (57 ± 8 years old, 46.9 % males). Results. Between the 1st and 2nd visits, body mass index (BMI) increased (30.6 ± 5.1 kg/m2 vs. 31.4 ± 5.4 kg/m2, p < 0.001), the number of patients with obesity of grades 2 –3 increased (14.6 % vs. 23.1 %, p < 0.001). Early diastolic septal mitral annular velocity decreased from the 2nd to the 3rd visit (7.0 [6.0; 8.0] cm/s vs. 6.0 [5.0; 8.0] cm/s, p = 0.023), as did the maximum diastolic lateral tricuspid annular velocity (12.0 [11.0; 14.0] cm/s vs. 8.0 [6.0; 9.0] cm/s, p < 0.001). Between the 2nd and 3rd visits, the average global longitudinal strain of the left ventricle increased ( –19.3 ± 2.6 % vs. –19.8 ± 2.2 %, p = 0.034), the frequency of detecting its reduced values decreased (34.9 % vs. 17.4 %, p = 0.003). Conclusion. In the long term after COVID-19 pneumonia, patients with CVD show an increase in BMI accompanied by worsening of diastolic ventricular function parameters without signifi cant progression in the frequency and severity of CVD.

Alterations in muscle strength among patients with GI cancers receiving oral nutritional support as soon as malnutrition was detected: ONMUS study.

741 Background: The main goal of our multicenter study, focusing on patients with gastrointestinal (GI) cancers receiving nutritional support, was to monitor the alterations in muscle strength among individuals who began oral nutritional support (ONS) as soon as malnutrition was detected. Additionally, our study had secondary objectives, which included assessing the adherence to ONS, examining the impact of ONS on anthropometric measurements, analyzing chemotherapy compliance, and evaluating the overall quality of life. Methods: The ONMUS study was conducted at 8 centers in Turkey. The study aimed to involve patients with GI cancer who had used ONS for a minimum of 1 week and had an ECOG performance score of 0-1. Patients underwent evaluations by both a dietitian and an oncologist during the baseline visit, as well as at the 2nd and 3rd month visits. Various parameters, including age, gender, performance status, disease stage, treatment adherence, food consumption records, anthropometric measurements, muscle function measured with a handgrip device, and quality of life scales, were assessed. Results: The study comprised 426 patients. The median age was 62 years, with a range spanning from 19 to 90 years. Colorectal cancer was the primary diagnosis in 51% of the patients, while hepatobiliary, gastric, esophageal, and small bowel cancers accounted for 20.9%, 20.7%, 6.5%, and 1% of cases, respectively. A significant majority, 78.2% (n=319), of the patients were diagnosed at stage 4, and nearly all, 99.3% (n=411), were undergoing chemotherapy. Patients who adhered to ONS at or above 75% of the recommended usage were categorized as compliant. Among this group, there was a significant increase in body mass index ( P=0.005). Handgrip measurements for assessing muscle strength demonstrated a statistically significant increase, with handgrip weight rising from 24.9 ± 8.9 kg at the first visit to 26.1 ± 8.9 kg at the third visit ( P=0.009). ONS-compliant patients also showed statistically significant improvements in weight, total body water, basal metabolic rate, and calf circumference measurements. The proportion of ONS-compliant patients decreased from 80.5% (n=343) at the first visit to 62.4% (n=93) at the third visit. Additionally, a statistically significant improvement was observed in food consumption records ( P=0.004). In assessments using the EORTC QLQ-C30, there were significant improvements noted in general health status, fatigue, pain, and insomnia scales, as well as in physical, emotional, and social functioning. Furthermore, a significant difference was identified between visits 1 and 2 in PG-SGA scoring ( P<0.001). Conclusions: ONS compliance is evident in the significant improvement observed in muscle strength, anthropometric measurements, and quality of life data. The importance of addressing malnutrition in patients with GI cancer cannot be overstated. Therefore, it is imperative to maintain regular monitoring of their nutritional status and adherence to ONS.

To study the role of tofacitinib and betamethasone pulse in the treatment of vitiligo at a tertiary care centre: an observational comparative study

Background: According to recent updates, both genetic and non-genetic factors play a role in the pathogenesis of vitiligo, and CD8T lymphocytes and interferon γ are also known to result in vitiligo. The new oral biologic tofacitinib, which is a Janus kinase inhibitor, is a new addition to the armamentarium of immunosuppressive therapy to halt disease progression in vitiligo. Tofacitinib is also known to inhibit IFN-γ mediated inflammation, which is an important step in the development of vitiligo lesions. Aims and objectives: The aim of this study was to compare tofacitinib with betamethasone pulse in reducing the disease activity with respect to reduction in VASI (vitiligo area severity index) and BSA (body surface area) in patients with vitiligo. The primary objective was to see the efficacy of tofacitinib over betamethasone in the treatment of vitiligo, and the secondary objective was to assess its safety in treating vitiligo patients. Methodology: All the patients with vitiligo of age >12 years attending the dermatology clinic of our institute and willing to give written informed consent were included in the study. Group A patients were prescribed betamethasone 4 mg twice weekly, and group B patients were given tofacitinib 5 mg twice daily, followed by sun exposure in both groups, and photography was done at each monthly visit. Results: The mean change in VASI and BSA in the tofacitinib group was better at each visit than in the betamethasone group. The mean VASI scores at baseline, 1st, 2nd, and 3rd visits were 13.64, 12.79, 11.57, and 10.57, respectively, and the mean BSA at baseline, 1st, 2nd, and 3rd visits were 10.80, 9.75, 8.30, and 7.75 respectively, in the betamethasone group. Similarly, in the tofacitinib group, mean BSA values from baseline to the 3rd visit were consecutively 11.47, 9.50, 7.50, and 5.25, and mean VASIs were 14.92, 12.46, 9.46, and 7.08, respectively. Further, mean changes in BSA and VASI from baseline at each visit. as depicted in graphs 1 and 2, were more in tofacitinib group. There was no side effect in either group at any of the visits. Conclusion: Tofacitinib, along with sun exposure, can cause faster repigmentation and faster control of disease activity, as evident from mean changes at each visit, than oral betamethasone pulse in vitiligo patients.

Динамика клинических и иммунологических показателей при патогенетической терапии острого или обострения хронического фарингита

Objective. To study the anti-inflammatory properties of Tonsilgon N preparation and its effect on the indices of local immunity of oropharyngeal mucosa in patients with acute or exacerbation of chronic pharyngitis without a pronounced systemic inflammatory syndrome. Patients and methods. 60 people diagnosed with acute catarrhal pharyngitis with intoxication syndrome were examined. Group 1 – 30 people took the drug Tonsilgon N in the form of alcohol solution, group 2 – 30 people – sage in the form of tablets for resorption in the oral cavity according to the scheme of 25 drops or 1 tablet every 2 hours for the first 3 days of treatment, then 3 times a day until day 7 inclusive. Pharyngoscopy was performed by an otorhinolaryngologist at each visit on day 1, day 3–4 and day 7–8 of the disease. Using a 10-point visual analogue scale (VAS) with scores from 0 (no sign) to 10, we evaluated the severity of symptoms (pain when swallowing, a feeling of parching in the oropharynx, a feeling of a foreign body in the oropharynx, dry cough, weakness, headache) and the condition of the oropharyngeal mucosa. Additionally, at 3 visits, scrapings from the oropharyngeal mucosa were made with a cytobrush probe and the content of IL-6 and sIgA proteins was determined by enzyme immunoassay. For the control group, 30 conventionally healthy people were taken, not differing in sex and age from the main group of patients and having no inclusion criteria. Results. All patients by day 7 of observation had no expressed complaints, none of them had progression of inflammatory process or development of any complications, patients did not need further continuation of treatment. Pain at swallowing, feelings of foreign body in the oropharynx, feelings of feathering and intensity of hyperemia of the mucous membrane of the posterior pharyngeal wall when treated with Tonsilgon N on the 3–4 day of observation compared to the group of patients taking Sage. On the 7th day of observation at Tonsilgon N treatment all analyzed clinical manifestations of pharyngitis were absent, and in Sage group in some cases weakly expressed symptoms of pain at swallowing, feeling of foreign body in the oropharynx, feeling of fever, intensity of hyperemia of the mucous membrane of the back wall of the pharynx (Me = 0 [0;1] points) and dry cough (Me = 0 [0;0.5] points) remained. On day 1 of observation, an increase in IL-6 protein content compared with normal was noted in pharyngitis, and sIgA levels were low. Further, both groups showed a decrease in IL-6 level, in group 1 in the group receiving Tonsilgon N, its level on the 2nd and 3rd visit was lower compared to group 2. The amount of sIgA on the first day with pharyngitis was minimal, then in group 1 its values increased on day 3 but remained below control, and in group 2 further decreased, on day 7 of observation in group 1 sIgA slightly increased but was below control. In group 2 the sIgA level was determined in minimal values. Conclusion. Tonsilgon N or sage therapy showed a clear relief of clinical symptoms of tonsillopharyngitis during the treatment period without taking non-steroidal anti-inflammatory drugs, and their reduction was significantly faster with Tonsilgon N. Decrease of proinflammatory cytokine IL-6 on the background of treatment was faster on the background of treatment with Tonsilgon N. Increased synthesis of sIgA against the background of Tonsilgon N treatment allows to explain the rapid onset of clinical recovery in patients and to identify an additional mechanism of action of this drug on the local immune response of the oropharyngeal mucosa. It can be assumed that Tonsilgon N is not only pathogenetic, but also immunoregulatory, creating the most effective response of the body to inflammation. Key words: pharyngitis, oropharyngeal mucosa, interleukin-6 (IL-6), secretory immunoglobulin A (sIgA), enzyme-linked immunosorbent assay (ELISA), treatment, Tonsilgon N, sage

Aspirin pharmacokinetics and pharmacodynamics through gestation

ObjectiveWe sought to describe the pharmacokinetics and pharmacodynamics of aspirin through pregnancy (first and third trimester), to identify covariates that significantly impact aspirin pharmacokinetics (PK) and to identify the relationship between aspirin pharmacokinetics and pharmacodynamics (PD). Study DesignThis is a prospective study of patients at high risk for preeclampsia recommended to take 81mg aspirin daily. This study involved three visits: baseline: 1st trimester (10-16’ weeks) 6-hour PK visit, done prior to initiation of aspirin; follow up-1: 2-4 weeks after aspirin initiation; Follow up-2: 3rd trimester 6-hour PK visit (28-32 weeks’). The following were assessed at each visit: weight/BMI, PFA-100 (Siemens), urinary thromboxane B2 (TX-B2), serum thromboxane B2 (TX-B2) and plasma salicylic acid. The PK visits consisted of blood work done at baseline (pre-dose), administration of 81mg non-enteric coated aspirin, and then plasma blood level of salicylic acid assessed at 30minutes and then hourly 1-6 hours after dose. Pearson correlation and multivariable regression were used to identify associations between parameters and identify relevant covariates. Log-adjusted values used for regression analysis. P<0.05 considered significant. ResultsNineteen participants were included with first trimester data, and 16 with third trimester data. There was no statistically significant change in mean PK parameters between the first and third trimester, although there was a trend to lower Cmax in the 3rd vs 1st trimester (p=0.08). In multivariable regression, baseline obesity and current BMI as a continuous measure were negatively associated with log-adjusted peak salicylic acid concentration (-0.28 (-0.46 - -0.11), p=0.003 and -0.02 (-0.03 - -0.009), p=0.001 respectively) and log-adjusted plasma salicylic acid area under the curve 0-6hr post-dose (AUC0-6) (-0.25 (-0.45 – 0.05), p=0.02, -0.04 (-0.07 - -0.01), p=0.008 respectively). There was a significant decrease in urinary thromboxane 2-4 weeks after aspirin initiation compared to baseline, which correlated with a concomitant increase in PFA-100 closure time. In multivariable regression model, there was a strong association between plasma salicylic acid concentration (area under the curve 0-6hrs post-dose) and urinary thromboxane (B=-3.12 (-5.38 - -1.04), p=0.006), and with urinary thromboxane suppression and platelet inhibition, PFA-100 (-0.23 (-0.31 - -0.14), p<0.001). With progressive thromboxane suppression, platelet inhibition (PFA-100 closure time) increased. Individual comorbidities including weight, hypertension, and diabetes, also impacted aspirin response. ConclusionWe have demonstrated the relationship between individual factors, plasma concentrations of salicylic acid, thromboxane suppression, and platelet inhibition at a single dose (81mg) of aspirin taken through pregnancy. Our findings suggest dose modification of aspirin in pregnancy may help to achieve the optimal response. Our results may be used to facilitate computational modeling to identify optimal dosing taking into consideration individual factors

Priority choice of topical antibacterial drugs in the commonly accepted paradigm of acute rhinosinusitis treatment

Introduction. In the complex therapy of acute rhinosinusitis, topical drugs with different mechanisms of action and influence on the main links in the pathogenesis of acute infectious lesions of the mucous membrane of the paranasal sinuses are widely used. Local drugs with antibacterial, as well as mucolytic and vasoconstrictor effects do not inhibit mucociliary clearance, have a convenient release form and ensure dosing accuracy with each use.Aim. Evaluation of the clinical effectiveness of the use in complex therapy of a topical antibiotic of the aminoglycoside group in combination with a drug having vasoconstrictive and mucolytic effects of domestic production in the treatment of acute bacterial rhinosinusitis.Materials and methods. The study involved 30 patients with a verified diagnosis of acute bacterial rhinosinusitis of moderate severity aged 18 to 68 years, who were divided into two groups. Patients of the first group (n = 15), in addition to complex treatment (antibacterial, antihistamine and unloading therapy, anti-inflammatory and puncture treatment), used a drug with a bactericidal effect from the group of aminoglycosides (Tramicent). Patients of the second group (n = 15) supplemented the same treatment with a drug with mucolytic and vasoconstrictive action (Rhinostein®). The effectiveness of therapy was evaluated based on the results of three visits to the doctor within two weeks.Results. The positive dynamics of the subjective and objective status of patients in both study groups was noted. By the 3rd visit (10–14 days), the severity of clinical manifestations in patients who used two drugs Tramicent and Rhinostein® as additional therapy was 2 times lower than at the first visit compared with the group of patients who used only Tramicent as additional therapy. The absence of complaints after treatment in the 2nd group was noted by 15% of the examined, in the 1st – 10%.Conclusions. Topical drug from the group of aminoglycosides containing the active substance framycetin sulfate (Tramicent) in the form of a spray is a safe and effective remedy in the complex therapy of bacterial rhinosinusitis, and its use in combination with the drug mucolytic and vasoconstrictive action (Rhinostein®) significantly reduces the duration of treatment and improves the quality of life of patients.

Evaluation of the efficacy and tolerability of the combination of lidocaine + phenazone in the local therapy of acute otitis media at the doperforative stage in adults

Introduction. Acute otitis media is a widespread multifactorial disease characterized by inflammatory changes in the mucosa of all parts of the middle ear. One of the most important tasks in the early stages of the disease is adequate anesthesia of patients. The article provides a retrospective assessment of the efficacy (speed of analgesia) and tolerability of topical use of Otipax® (lidocaine + phenazone) in adult patients with acute otitis media before perforation, the timing of its use is justified.Aim. To assess the efficacy and tolerability of topical Otipax® in adult patients with pre-perforated acute otitis media prescribed by a physician in routine practice.Materials and methods. Outpatient maps of 50 adult patients with acute otitis media were analyzed.Results. In almost all 50 patients after the use of Otipax®, the analgesic effect occurred after 3 minutes. The analgesic effect remained on average for 35–40 minutes, then the pain gradually resumed, but in dynamics there was a decrease in its intensity. Hearing loss and ear congestion were initially noted in all patients, by the 3rd visit these complaints persisted, but their intensity was significantly lower, on the 10th day of observation there were no subjectively impaired hearing in any of the patients, which corresponded to acumetric and tuning fork data. The anti-inflammatory effect of Otipax® after a day provided a significant decrease in the intensity and area of hyperemia and infiltration of the eardrum. After 10 days, almost all patients had no otoscopic signs of otitis media. No adverse events were reported during the follow-up period.Conclusions. The use of Otipax® (lidocaine + phenazone) ear drops complies with the clinical guidelines of the Ministry of Health of the Russian Federation in 2021 for the treatment of patients with acute otitis media before perforation, effectively and safely, is the method of choice for reducing ear pain in patients already at the primary appointment.

Impact of Treviamet® & Treviamet XR® on quality of life besides glycemic control in type 2 DM patients

BackgroundMaintaining the quality of life is the main objective of managing type 2 diabetes (T2DM) (QoL). Since it is a key factor in patient motivation and adherence, treatment-related QoL has always been considered when choosing glucose-lowering medicines. The objective of the study was to evaluate the quality of life besides glycemic control among type 2 diabetes mellitus patients receiving Treviamet® & Treviamet XR® (Sitagliptin with Metformin) in routine care.MethodsIt was a prospective, open-label, non-randomized clinical trial including T2DM patients uncontrolled on Metformin therapy. All patients received Treviamet® & Treviamet XR® for six months. Sequential changes in QoL, fasting plasma glucose, HbA1c, body weight, and blood pressure were monitored from baseline to 3 consecutive follow-up visits. The frequency of adverse events (AEs) was also noted throughout the study.ResultsA total of 504 patients were screened; 188 completed all three follow-ups. The mean QoL score significantly declined from 57.09% at baseline to 33.64% at the 3rd follow-up visit (p < 0.01). Moreover, a significant decline in mean HbA1c and FPG levels was observed from baseline to 3rd follow-up visit (p < 0.01). Minor adverse events were observed, including abdominal discomfort, nausea, flatulence, and indigestion. Gender, HbA1c, diarrhea, and abdominal discomfort were significant predictors of a patient’s QoL, as revealed by the Linear Regression Model (R2 = 0.265, F(16, 99) = 2.231).ConclusionTreviamet® & Treviamet XR® significantly improved glycemic control (HbA1c levels) and QoL in T2DM patients without serious adverse events.Trial registrationClinicalTrials.gov identifier (NCT05167513), Date of registration: December 22, 2021.

Decrease of over-elevation in adduction after surgery of medial rectus muscles in partially refractive accommodative esotropia.

The course of over-elevation in adduction after strabismus surgery has been evaluated in a small number of research in the literature, we believe our study is the first to report the results in a specific group of esotropia (ET) patients. To report the course of postoperative over-elevation in adduction in patients who underwent surgery for horizontal deviation on the medial recti in partially accommodative ET. The medical charts of patients who had partially accommodative ET with over-elevation in adduction were reviewed retrospectively. A scale from -4 to +4 was used to grade the oblique muscle function. Among these, 17 patients who were operated solely on the horizontal rectus muscles were identified. The primary outcome measure was the degree of improvement in over-elevation in adduction after medial rectus surgery. Nine (52.9%) of the 17 patients (mean age: 5.18 ± 2.24 months) were males and 8 (47.1%) were females. The mean follow-up period was 17.06 ± 15.32 months. Overall, 15 patients (88.2%) achieved surgical success. The mean inferior oblique overaction was found 1.44 ± 0.56 preoperatively and the final postoperative mean inferior oblique overaction was 0.53 ± 0.51 (P = 0.001). Postoperative over-elevation in adduction after 3 months was significantly decreased compared to the preoperative value (P = 0.003, P = 0.001, P = 0.001 at 3rd and 6th months and final visits respectively). Over-elevation in adduction accompanying partially refractive accommodative ET seems to regress after medial rectus weakening surgery. This finding should be considered in the presurgical evaluation of these patients.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) and Serum Urate Concentrations: A Longitudinal Analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundIncreased serum urate (SU) and hyperuricemia (HU) are associated with chronic noncommunicable diseases and mortality. SU concentrations are affected by several factors, including diet, and are expected to rise with age. We investigated whether the Dietary Approaches to Stop Hypertension (DASH) diet alter this trend. ObjectiveThe objective was to assess whether adherence to the DASH diet predicts a longitudinal change in SU concentrations and risk of HU in 8 y of follow-up. MethodsLongitudinal analyses using baseline (2008–2010, aged 35–74 y), second (2012–2014), and third (2016–2018) visits data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The inclusion criteria were having complete food frequency questionnaire (FFQ) and urinary sodium measurement, in addition to having SU measurement at the 1st visit and at least 1 of the 2 follow-up visits. For the HU incidence analyses, participants had also to be free from HU at baseline. The final samples included 12575 individuals for the SU change analyses and 10549 for the HU incidence analyses. Adherence to DASH diet was assessed as continuous value. HU was defined as SU>6.8 mg/dL and/or urate-lowering therapy use. Mixed-effect linear and Poisson regressions (incidence rate ratio [IRR] and 95% confidence interval [CI]) were used in the analyses, adjusted for confounders. ResultsThe mean age was 51.4 (8.7) y, and 55.4% were females. SU means (standard deviation) were 5.4 (1.4) at 1st visit, 5.2 (1.4) at 2nd visit, and 5.1(1.3) mg/dL at 3rd visit. The HU incidence rate was 8.87 per 1000 person-y. Each additional point in adherence to the DASH diet accelerated SU decline (P< 0.01) and lowered the incidence of HU by 4.3% (IRR: 0.957; 95% CI: 0.938,0.977) in adjusted model. ConclusionThe present study findings reinforce the importance of encouraging the DASH diet as a healthy dietary pattern to control and reduce the SU concentrations and risk of HU.

Post-COVID-19 pulmonary complications among recovered COVID-19 patients: a cross-sectional study from Addis Ababa, Ethiopia

BackgroundThe COVID-19 pandemic has been linked to chronic pulmonary complications all over the world. Respiratory complications such as chronic cough, dyspnea, increased respiratory rate, and oxygen support demand are prevalent in recovered COVID-19 patients. These problems are long-term and have a negative impact on one’s quality of life. Patients must be evaluated for potential complications, and risk factors must be found. Some reports around the world explain the factors that contribute to the development of these complications. However, to the best of our understanding, no reports of post-COVID-19 complications have been reported from Ethiopia.MethodsFacility based cross-sectional study was done among 405 participants selected by simple random sampling technique. Structured questionnaire which includes participants’ demographic, clinical and 3rd month visit characteristics was collected by Open Data Kit and exported to SPSS version 25.0 for analysis. Percentage with frequency and median with Interquartile range was used in descriptive statistics. The association between variables was analyzed with bivariate and multi variable logistic regression. A statistical significance was declared at p-value < 0.05, with 95% confidence interval.ResultsThe median (Interquartile range) age of participants was 57.0 (43.0, 65.0) years, 63.2% were males. The prevalence of post-COVID-19 pulmonary complication in recovered COVID-19 patients was 14.1% (95% CI: 10.8%, 17.8%). After adjusting for possible confounders on multivariate analysis, older age [AOR = 0.227, 95% CI (0.08–0.66)] and consolidation [AOR = 0.497, 95% CI (0.258–0.957)] were shown to have significant association with post COVID-19 pulmonary complications.ConclusionThe prevalence of post COVID-19 pulmonary complication was observed to be lower than other reports globally. Older age and the presence of consolidation on lung imaging were associated with those complications. Clinicians are recommended to consider assessing the lasting effects of the pandemic, beyond immediate care, and should also investigate the COVID-19 history in patients presenting with respiratory issues.

Physical and psychological recovery after vaginal childbirth with and without epidural analgesia: A prospective cohort study.

Enhanced recovery is the gold standard in modern perioperative management, including that for cesarean deliveries. However, qualitative and quantitative data on the physical and psychological recovery of women after vaginal childbirth are limited. Whether neuraxial labor analgesia influences postpartum recovery is unknown. Primiparous women anticipating a vaginal childbirth between January 2020 and May 2021 were enrolled. Women with major comorbidities or postpartum complications and those who underwent a cesarean delivery were excluded. Daily step count was measured using a wrist-worn activity tracker (FitbitTM Inspire HR) for 120 hours after vaginal childbirth. Subjective fatigue levels and health-related quality of life were assessed using the Multidimensional Fatigue Inventory (MFI) and EuroQol 5 Dimension 5 Level (EQ-5D-5L), respectively, at the 3rd trimester antenatal visit, on postpartum day 1 and 3, and at the one-month postpartum visit. Rest and dynamic pain scores and the location of pain were documented by participants during postpartum hospitalization. Among 300 women who were enrolled antenatally, 95 and 116 had a vaginal delivery without (NCB group) and with (EPL group) epidural analgesia, respectively. The median number of steps per 24 hours increased daily in both groups, and no significant difference was detected between the groups. Postpartum pain was mild overall, with median rest and dynamic pain scores being less than 4 and similar between the groups. MFI and EQ-5D-5L scores were the worst on postpartum day 1 in both groups and gradually improved to antepartum level by the one-month postpartum visit. Higher MFI score on postpartum day 1, but not the use of epidural analgesia, was associated with lower odds of achieving adequate postpartum ambulation (defined as >3500 steps between 48 and 72 hours postpartum). The use of epidural analgesia was not associated with worse recovery outcomes during postpartum hospitalization. UMIN-CTR, #UMIN000039343, registered on January 31, 2020.

FRI268 Late Onset Polyglandular Autoimmune Syndrome Type 2

Abstract Disclosure: M.S. Nicholson: None. A. Barnett: None. A 66-year old white female was admitted for weakness, acute kidney injury, and hypotension. This is her 3rd hospital or ER visit in the last 12 months for similar complaints. She has a 25 year history of type 2 diabetes on insulin and oral therapy and 30 year history of hypothyroidism on levothyroxine 75 mcg daily. She was on oral estrogen replacement therapy for post-menopausal symptoms with a hysterectomy in her early 50s. She has a sister with type 2 diabetes on oral meds and hypothyroidism. She has a brother with type 1 diabetes. Her serum sodium was 135 mmol/L (135-145), potassium was 5.4 mEq/L (3.5 -5.1), and calcium was 9.2 (8.5-10.1). Her Creatinine was 1.2 with a GFR of 48. A random cortisol in the ED was 9.2 (no ref range). Blood pressure was low and she was tachycardic and her weight was 68 kg. She was a well developed female with a a tanned complexion. Areas of vitiligo were noted on her arms. A cosyntropin stimulation test was done midday with a baseline, 30, and 60 minute cortisol levels of 9.2, 8.8, and 9.3 respectively. Baseline ACTH was 877.6 pg/mL (7.2-63.6). Her TSH was 4.09 mIU/mL (0.358-3.74) and free T4 was 1.29 ng/dL (0.76-1.46). DHEA-S was 14 mcg/dL (13-130). She was started on stress dose steroids with rapid improvement in BP, hyponatremia, and symptoms. GAD-65 antibodies were above 250 IU/mL and 21-hydroxylase antibodies were positive. Her TPO antibodies were negative. Non-insulin diabetes medications were stopped and she was discharged home after stabilization on prednisone 5 mg daily and fludrocortisone 0.1 mg daily. This patient has an atypical presentation of polyglandular autoimmune syndrome type 2 (PAS2). She presented with an Addisons crisis at the age of 66. She was already diagnosed with hypothyroidism and insulin requiring diabetes and evidence of vitiligo. A majority of patients with PAS2 are female and present in their 20s to 40s with primary adrenal insufficiency and primary hypothyroidism. Her initial manifestation was hypothyroidism and then diabetes and vitiligo with adrenal insufficiency many years later. Her random cortisol was not suppressed and this lead to a delay in her diagnosis. This was likely due to oral estrogen therapy raising cortisol-binding globulin. Her elevated baseline ACTH and lack of response to ACTH stimulation confirmed her diagnosis of primary adrenal insufficiency. An ACTH stimulation test was repeated as an outpatient with similar response. This case highlights the importance of provocative testing for adrenal disorders and testing for autoimmune causes of endocrine disorders when patients are not responding as expected. Presentation: Friday, June 16, 2023

Breast feeding Status of Infants Born in a Baby Friendly Hospital Up to 180 days of life

Background : Initiation of breast-feeding (BF) within 1 hour after birth has been associated with reduced neonatal mortality. Baby Friendly Hospital Initiative has profound effects on appropriate practice of BF and thus helps to reduce infant mortality and morbidity.&#x0D; Objective : This study was conducted in the Department of Gynae and Obstetrics and Department of Paediatrics of Shaheed Suhrawardy Medical College Hospital (ShMCH), Dhaka, to observe the rate of exclusive breast feeding and home-based compliance.&#x0D; Methodology : Hundred (100) term babies of normal birth weight irrespective of sex, born in ShSMCH by normal vaginal delivery (NVD) or caesarian section were included. Data was collected from the mother with a pretested questionnaire at the postnatal period, at 6th week, 14th week and 6th month (180 days) of age.&#x0D; Result : The mean age of studied newborn (100) was 20±19.5 hours. All the infants started breast feeding after birth and among them 56% initiated with in 1 hour. Difficulty in breast feeding was found in 36(36.0%) infants, which was resolved mostly (94%) by nurse. Exclusive breastfeeding (EBF) was found in 100% of infants during discharge from hospital. During 1st and 2nd follow up we found 95 (95.0%) and 89 (89.0%) infants respectively were exclusively breastfed. In 3rd follow up at completed 6th month (180 days) 78 (78.0%) infants were exclusively breast fed. In our study 5 (5%) and 6 (6%) infants received supplementary food in 1st follow up and in 2nd follow up respectively. In the last follow up the number were 11 (11%) and the total number was 22 (22%).&#x0D; Conclusion : Exclusive breast feeding up to completion of 6 months (180 days) was found in 78.0% of infants. Maternal and relative’s misperception of baby’s crying due to insufficient breast milk and joining to job outside home were the causes of introduction of formula milk in the 1st, 2nd and 3rd visit respectively.&#x0D; Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 530-534

Evaluation of Corneal Endothelial Cell Density Changes in Eyes with Silicone Oil Tamponade after Pars Plana Vitrectomy

Aim To assess the changes in corneal endothelium by non-contact specular microscopy in eyes treated by pars plana vitrectomy (PPV) with temporary silicone oil (SO) tamponade with or without phacoemulsification. Patients and Methods We enrolled 24 patients, assigned into two groups: 12 patients underwent pars plana vitrectomy with SO injection (group 1) and 12 patients underwent combined phaco-vitrectomy with SO injection (group 2). All of them underwent an ophthalmological examination, which included: best corrected visual acuity (BCVA), intraocular pressure measurement, fundus examination and specular microscopy follow ups at the 1st week,1st month and 3rd month visits. Results The initial count of endothelial cell density (ECD) in group 1 was 2543.58 ± 759.62 cell/mm2 which decreased at 3rd month visit to 2299.33 ± 729.87 cell/mm2, while in group 2 was 2621.08 ± 514.50 &amp; 2307.50 ± 575.55 cell/mm2 respectively. We found statistically significant decrease in the mean cell density (MCD) in group 1 and group 2, at the 3rd month than at the 1st week. Three months after operation, coefficient of variation (CV) was 34.58 ± 4.29 % and 35.75 ± 4.16%, hexagonality (HEX) was 46.83 ± 8.67 % and 47.83 ± 10.50%, while mean central corneal thickness (CCT) was 553.08 ± 22.13 μm and 548.17 ± 33.12 for group 1 and 2 respectively, and no corneal edema reported at the study end. Conclusion The pars plana vitrectomy (PPV) with silicone oil (SO) injection procedure caused changes in corneal endothelial cells in varying between pleomorphism (decreased HEX), polymegathism (increased CV) and endothelial cell loss. A higher incidence of CV increase (polymegathism) reported after combined phaco-vitrectomy than pars plana vitrectomy alone with silicone tamponade. We recommend SO removal after achieving the proposed tamponading action of SO to avoid SO keratopathy.

Association between psoriasis and thyroid function: results from the Brazilian Longitudinal Study of Adults Health (ELSA-Brasil).

To determine the relationship between psoriasis, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triodothyronine (FT3), thyroid peroxidase antibodies (TPOAb), and subclinical thyroid dysfunctions in middle-aged and older adults. Cross-sectional analyses included a self-reported medical diagnosis of psoriasis and thyroid function from the 3rd visit (2017-2019) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TSH, FT4, and FT3 levels were analyzed as continuous variables and quintiles, and TPOAb positivity and subclinical hypothyroidism as a yes/no variable. Logistic regression models were built as crude and adjusted by main confounders (age, sex, education level, race/ethnicity, and smoking). From 9,649 participants (52.3% women; 59.2 ± 8.7 years old), the prevalence of psoriasis was 2.8% (n = 270). TSH, FT4, TPOAb positivity, and subclinical hypothyroidism were not associated with psoriasis in the main analyses. In the stratified analysis, our findings showed positive associations of the lowest (OR = 2.01; 95% CI 1.05-3.84; p = 0.036) and the highest (OR = 2.13; 95% CI 1.12-4.05; p = 0.022) quintiles of FT4 and a protective association of TPOAb positivity (OR = 0.43; 95% CI 0.19-0.98; p = 0.046) with prevalent psoriasis in women. In the logistic regression for FT3, participants in the 1st quintile showed a statistically significant association with psoriasis for the whole sample (OR = 1.66; 95% CI 1.11-2.46; p = 0.013) and for men (OR = 2.25; 95% CI 1.25-4.04; p = 0.007) in the sex-stratified analysis. The present study showed that the association of FT4 levels with psoriasis are different according to sex, with a possible U-shaped curve in women but not in men. Although there were some associations of FT3 with psoriasis, they may be a consequence of non-thyroidal illness syndrome. Further prospective data may clarify the association of thyroid function and psoriasis.