Blind Control Research Articles

EFEKTIVITAS PREEMTIF KETAMIN SUB DOSIS DALAM MENGURANGI KEBUTUHAN OPIOID INTRAOPERATIF DAN LAMA WAKTU EKSTUBASI

Surgical perioperative management undergoes updates to support postoperative patient outcomes. The concept of longer preoperative fasting times, cleansing ofthe gastrointestinal tract, and re-feeding after 3-5 days after surgery has begun to be abandoned which is then formulated into a new protocol called ERAS(Enhanced Recovery After Surgery) including preoperative counseling, optimization of nutrients, the use of standard anesthesia and analgesy drugs, as well asearly mobilization using the concept of preemptive analgesia. The use of low-dose ketamine for postoperative analgesia has evolved in part due to nmdaantagonistic properties that reduce central sensitization and opioid tolerance but are still controversial. This study aims to study the effects of low-dose ketamineas a preemptive and evaluate the total needs of opiods, as well as the length of time extubation with single blind experimental research. Patients with label A gotpreemptive therapy of subdose ketamine while label B got perioperative standard analgesia therapy. Analgesia in groups A and B is administered before surgery.Treatment control is done with single blind control that is the patient does not know the type of drug given. The comparison of the amount of fentanyl in the controlgroup and treatment in this study was significantly different (p=0.044). The old comparison of extubation in both groups obtained a significant p value (<0.0001).Preemptive administration of subdose ketamine effectively decreases the amount of fentanyl administration used during surgery and shortens the extucation time.
 Keywords: Preemptive; Ketamin subdose; Fentanil; Extucation Time.

Pain sensitivity in men who have never experienced a headache: an observer blinded case control study

BackgroundHeadache affects 90–99% of the population. Based on the question “Do you think that you never ever in your whole life have had a headache?” 4% of the population say that they have never experienced a headache. The rarity of never having had a headache suggests that distinct biological and environmental factors may be at play. We hypothesized that people who have never experienced a headache had a lower general pain sensitivity than controls.MethodsWe included 99 male participants, 47 headache free participants and 52 controls, in an observer blinded nested case-control study. We investigated cold pain threshold and heat pain threshold using a standardized quantitative sensory testing protocol, pericranial tenderness with total tenderness score and pain tolerance with the cold pressor test. Differences between the two groups were assessed with the unpaired Student’s t-test or Mann-Whitney U test as appropriate.ResultsThere was no difference in age, weight or mean arterial pressure between headache free participants and controls. We found no difference in pain detection threshold, pericranial tenderness or pain tolerance between headache free participants and controls.ConclusionOur study clearly shows that freedom from headache is not caused by a lower general pain sensitivity. The results support the hypothesis that headache is caused by specific mechanisms, which are present in the primary headache disorders, rather than by a decreased general sensitivity to painful stimuli.Trial registrationRegistered at ClinicalTrials.gov (NCT04217616), 3rd January 2020, retrospectively registered.

Comfort and efficiency-based improvements to the control of residential Venetian blinds

This study focuses on the control of movable Venetian blinds. Multiple improvements to an existing on/off open-loop control strategy in a case-study apartment have been simulated in TRNSYS 18, thanks to the detailed optical and thermal modelling allowed by the Bidirectional Scattering Distribution Function (BSDF) used as input to the Type56_CFS. The control strategy improvements include the combination of rule-based, closed-loop and discrete state control, in addition to four control strategy activation methods (three use a schedule, and one measures the external temperature). Simulated control inputs include internal temperature, external temperature and vertical irradiance. The results show reductions in overheating, achieved without completely blocking natural illumination or compromising heating demand. While on/off control in winter often leads to increased heating energy consumption, the space sees regular overheating when on/off control is inactive over winter. Conversely, discrete state control is able to more precisely control solar gains in winter to maintain an adequate temperature without utilising the heating system, all the while allowing some level of natural illumination. Ultimately, it is concluded that the choice of the control strategy depends on which objective (minimisation of heating energy consumption, maximisation of daylight harvesting, reduction of overheating risk, etc.) is prioritised.

Long-term safety and efficacy of intramyocardial adenovirus-mediated VEGF-DΔNΔC gene therapy: eight-year follow-up of phase 1 KAT301 study

Abstract Backgound/Introduction In phase I KAT301 trial, adenovirus-mediated intramyocardial vascular endothelial growth factor-DΔNΔC (VEGF-D) gene therapy (GT) resulted in a significant improvement in myocardial perfusion reserve and relieved angina at 1-year follow-up without major safety concerns. Purpose Our objective was to investigate the long-term safety and efficacy of AdVEGF-D GT. A total of 30 patients (24 VEGF-D and 6 randomized and blinded controls) participated in KAT301 trial. Methods The mean follow-up time was 8.2 years (range 6.3–10.4 years). Patients were interviewed for the current severity of symptoms (Canadian Cardiovascular Society class, CCS) and perceived benefit from GT. Medical records were reviewed to assess the incidence of major cardiovascular adverse events (MACEs) and other predefined endpoints including cancer. Results MACE occurred in 15 patients in VEGF-D group and in five patients in control group (21.5 vs. 24.9 per 100 patient-years; hazard ratio 0.90; 95% confidence interval 0.09–9.32; P=0.95). Mortality and comorbidity were similar between the groups. Angina symptoms (CCS) were less severe compared to baseline in VEGF-D group (1.9 vs. 2.9; P=0.006) but not in control group (2.2 vs. 2.6; P=0.414). Conclusion(s) Our study indicates that intramyocardial AdVEGF-D GT is safe in the long-term. In addition, the relief of symptoms remained significant during the follow-up. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Kuopio University Hospital Heart Center Figure 1. The incidence of MACEFigure 2. CCS class

A Comparison Between Different Doses of intrathecal nalbuphine with Bubivacaine and Intrathecal Fentanyl with Bubivacine during elective Caesarean Section under Spinal Anesthesia; A Prospective Randomized Double Blind Control Trial

A Comparison Between Different Doses of intrathecal nalbuphine with Bubivacaine and Intrathecal Fentanyl with Bubivacine during elective Caesarean Section under Spinal Anesthesia; A Prospective Randomized Double Blind Control Trial

Chronic Urinary Infection in Overactive Bladder Syndrome: A Prospective, Blinded Case Control Study.

ObjectivesTo investigate whether women with overactive bladder (OAB) symptoms and no evidence of clinical infection by conventional clean-catch midstream urine cultures have alternative indicators of sub-clinical infection.Patients/Subjects, Materials & MethodsThe study was a prospective, blinded case-control study with 147 participants recruited, including 73 OAB patients and 74 controls. The OAB group comprised female patients of at least 18 years of age who presented with OAB symptoms for more than 3 months. Clean-catch midstream urine samples were examined for pyuria by microscopy; subjected to routine and enhanced microbiological cultures and examined for the presence of 10 different cytokines, chemokines, and prostaglandins by ELISA.ResultsThe mean age and BMI of participants in both groups were similar. No significant difference in the number of women with pyuria was observed between OAB and control groups (p = 0.651). Routine laboratory cultures were positive in three (4%) of women in the OAB group, whereas the enhanced cultures isolated bacteria in 17 (23.2%) of the OAB patients. In the control group, no positive cultures were observed using routine laboratory cultures, whereas enhanced culture isolated bacteria in 8 (10.8%) patients. No significant differences were observed in the concentrations of PGE2, PGF2α, MCP-1, sCD40L, MIP-1β, IL12p70/p40, IL12/IL-23p40, IL-5, EGF and GRO-α between the OAB and control groups.ConclusionsPatients with OAB symptoms have significant bacterial growth on enhanced culture of the urine, which is often not detectable through routine culture, suggesting a subclinical infection. Enhanced culture techniques should therefore be used routinely for the effective diagnosis and management of OAB.

Effects of Non-periodized and Linear Periodized Combined Exercise Training on Insulin Resistance Indicators in Adults with Obesity: A Randomized Controlled Trial

BackgroundThe aim was to verify the effect of non-periodized and linear periodized combined (aerobic plus resistance) exercise training on insulin resistance markers in adults with obesity.MethodsA blinded randomized control trial was conducted with three groups of individuals with obesity (BMI, 30–39.9 kg/m2): control group (CG, n = 23), non-periodized group (NG, n = 23), and linear periodized group (PG, n = 23). The NG and PG performed aerobic and resistance exercises in the same session in aerobic-resistance order for 16 weeks. Both intervention groups trained three sessions weekly, with a total duration of 60 min each. The aerobic training of the NG had a duration of 30 min always between 50% and 59% of the reserve heart rate (HRres), while resistance exercise was comprised of 6 exercises, performed always in 2 × 10–12 maximum repetitions (MRs). The PG progressed the aerobic and resistance training from 40%–49% to 60%–69% (HRres) and from 2 × 12–14 to 2 × 8–10 RM, respectively, along the intervention period. The evaluated indicators of insulin resistance included fasting glucose, fasting insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) collected pre- and post-intervention. The analyses to verify the exercise training effect were performed using generalized estimating equations.ResultsAfter 16 weeks of training, per protocol analysis (n = 39) showed significant reductions in HOMA-IR only in the training groups (NG: Δ = − 1.6, PG: Δ = − 0.6; p = 0.094). Intention-to-treat analysis demonstrated significant reductions in fasting insulin levels (NG: Δ = − 1.4, PG: Δ = − 1.0; p = 0.004) and HOMA-IR (NG: Δ = − 5.5, PG: Δ = − 3.8; p = 0.002).ConclusionPeriodized and non-periodized combined exercise training similarly reduces insulin resistance markers in adults with obesity.Trial registration: Brazilian Registry of Clinical Trials, RBR-3c7rt3. Registered 07 February 2019—https://ensaiosclinicos.gov.br/trial/5970/1.

The Effect of Extract Bitter Melon and Snakehead Fish on Advanced Glycation End Products

Diabetes mellitus type-2 is a transformation of insulin function in peripheral tissues or disorders of pancreatic β cells. The combination of glycation and glucose oxidation in type 2 DM patients results in the formation of AGEs which can result in oxidative stress. One of the efforts to reduce oxidative stress is the use of natural ingredients as a source of antioxidants. For example, bitter melon (Momordica Charantia) and snakehead fish (Channa Striata) extracts. The combination of bitter melon and snakehead fish extracts against AGEs levels is still limited and has only been tested on Wistar rats and mice. This study aims to determine how much effect the combination of bitter melon and snakehead fish extracts has on AGEs levels in type-2 DM patients. This study was clinical experimental randomized double blind control trial. The experiment conducted at Purwosari Public Health Center, Surakarta and the examination of AGEs levels was in the Clinical Pathology Laboratory of Dr Moewardi Surakarta from July to August 2020. Comparative analysis if the results were normally distributed, in pairs, numerical data and consists of 2 groups then use the paired sample t-test. The results were significant if p

Comparison of Dexmedetomidine, midazolam and propofol for sedation of post operative patients on mechanical ventilation- An open label randomised control trial

Mechanical ventilation is a life-sustaining therapy for the treatment of patients with acute respiratory failure. One of the key factors for good clinical practice in the ICU is to provide adequate sedation. An ideal sedative should provide a rapid onset, a rapid recovery. On this background the present study is designed to evaluate the efficacy and safety of dexmedetomidine, propofol and midazolam for sedating property, hemodynamic effects and analgesic. It is an open label, single blinded randomized control trial. Census sampling is planned for recruitment which will have maximum power and type I error <0.05.This study is carried out in 39 adult patients with Glasgow coma scale score of 9-15, Patients were divided randomly into three groups of 13 each. Group M patients received IV inj. Midazolam loading dose 0.15mg/kg followed by maintenance dose of 0.02-0.1mg/kg/hour. Group P patients received intravenous inj. Propofol loading dose of 1.5mg/kg followed by continuous infusion of 1-6 mg/kg/hr. Group D patients received intravenous inj. Dexmedetomidine loading dose of 1μg/kg followed by maintenance dose of 0.2-0.5 μg/kg/hr of continuous infusion by infusion pump. Desired depth of sedation was assessed by Ramsay Sedation Score. The difference in mean age and ASA status among the three groups are not statistically significant. There is no statistical significance of sex & GCS status of the patients of these three groups. In our study, difference of mean HR at different time interval was not statistically significant. But the fall in Heart Rate is more in Group D and Group M than in Group P. The mean heart rate is less in Group D compared to Group M and Group P after 45 minutes of infusion. We found that difference of mean SBP & DBP at different time interval was not statistically significant. In overall Dexmedetomidine Group showed stable RSS score throughout the time interval (between RSS 2 to 3). One patient in Dexmedetomidine group developed bradycardia. Mean opioid at 24th hour was significantly higher in group M than other group and difference was statistically significant and post sedation delirium was not statistically significant. In this study we found that difference of mean hemodynamic parameters at different time interval in three drugs was not statistically significant. The Heart Rate remain lower in Dexmedetomidine Group compared to Midazolam and Propofol Group after 45 minutes of infusion.

Efficacy of rural camps in achieving vision 2020: Our contribution

: To assess the effectiveness of rural camps held under DBCS (District Blindness Control Programme) & compare the results of cataract surgery at base hospital cases. It is a retrospective observational study, medical records of patients operated for cataract in camp & patients operated in base hospital are analyzed.In our hospital outpatient department, we saw 2,08,716 patients from 2010-2019 and 7796 underwent cataract surgery. Under DBCS we conducted 262 camps from 2010-2019 & 4611 underwent cataract surgery.A total of 27,524 patients got screened in 262 rural camps and 4671 underwent small incision cataract surgery at the base hospital after detailed clinical examination and IOL (intraocular lens) power calculation for each patient. Among 2,08,716 outpatients at the base hospital, 7796 underwent cataract surgery. The rate of intraoperative complications in the base hospital was 0.885% whereas in camp cases 1.94%.IOL implantation is done in 100%cases in base hospital surgeries and 0.064%patients left aphakic among rural camps.Screening at outreach camps and surgeries at the base hospital can have excellent results. Mass surgeries in camps following standard protocol can have the least number of complications.

A RANDOMIZED CONTROL TRIAL ON EFFICACY OF ANALGESIC EFFECT OF 5% DEXTROSE CAUDAL EPIDURAL INJECTION FOR NON-SPECIFIC CHRONIC LOW BACK PAIN

Background: Low back pain (LBP) is a major health issue that causes more disability and global burden than any other conditions. It is one of the most common musculoskeletal disorders. Chronic low back pain (CLBP) is dened as a pain that persists for more than 3 months, or longer than the expected healing period. It is associated with increased medical expenditure, work absence, and loss of quality of life. This study aims to ascertain efcacy of 5% dextrose (D5W) in chronic non-specic low back pain. Material and Methods: This study is conducted on patient suffering from chronic low back pain presenting in Department of PM&R, SMS Hospital, Jaipur. It is a Single blind randomized control trial study. We include 34 patients of non-specic chronic LBPin each group as sample size which is further enhanced and rounded off to 40 patients in each group as nal sample size expecting 10% attrition/drop out. Results: We found that mean age of our study group is 49 years. This is female dominant study with 56.25% patients. Dextrose participants reported greater Numerical Rating scale pain score change at baseline (6.4 vs 6.25 points, p=0.59), but there is signicant reduction of mean NRS st nd rd st pain score at 1 week (4.9 vs 5.4 points, p=01), 2 week (4 vs 5.45 points, p=0.0001), 3 week (3.15 vs 5.32 points, p=0.<0.0001), 1 month (2.95 vs nd rd 5.32 points, p=<0.0001), 2 month (2.9 vs 5.32 points, p=<0.0001) and 3 month (2.82 vs 5.32 points, p=<0.0001). CONCLUSION: Serial caudal epidural injection of D5W resulted in consistent post injection analgesia and clinically signicant improvement in pain through 3 months among participants with non-specic CLBP. Patients with CLBPcan be treated effectively by using 5% dextrose.

Effectiveness of prophylactic ondansetron in preventing spinal anesthesia induced hypotension and bradycardia in pregnant mother undergoing elective cesarean delivery: A double blinded randomized control trial, 2021

BackgroundSpinal anesthesia is the most common techniques of regional anesthesia for cesarean section. However, hypotension is the most common complication associated with nausea and vomiting, altered mental status and risk of aspiration. Bradycardia is also a common feature of profound circulatory collapse under neuraxial anesthesia. After verification that, serotonin can induce BJR reflex and can causes bradycardia or hypotension, researchers started to evaluate the effect of ondansetron to decrease BJR reflex in human being. ObjectivesTo assess the effect of prophylactic ondansetron for prevention of spinal induced hypotension and bradycardia in parturients undergoing cesarean delivery from June 1, 2020 to January 30, 2021. Methodology: A double blinded randomized control trial conducted in Dilla university referral hospital by recruiting 70 patients with systematic random sampling technique. Patients were randomized into ondansetron group (n = 35) and control group (n = 35). Mann Whitney U test was used for continuous non-normally distributed data and independent sample t-test for normally distributed data. Mixed ANOVA was used to analysis the interaction of the within and between factors. Categorical variable between the groups were analyzed using fisher exact and chi square test. p -value<0.05 is considered statically significant. ResultThere were no significant differences in the incidence of hypotension between ondansetron (20(57) and saline group (21(60%)). There were no significant difference in incidence of bradycardia among the two groups p > 0.05. Perioperative Phenylephrine consumption was 36.43 ± 45.91 mcg and 32.14 ± 46.79 mcg in ondansetron and saline group respectively with P = 0.700. The incidence of shivering was lower in ondansetron group (11%) than saline group (45%) with (p = 0.04) and the perioperative rescue shivering requirement was higher in saline group (p = 0.00). Conclusionand Recommendations: Prophylaxis administration of intravenous Ondansetron at a dose of 10 mg before spinal anesthesia was not effective in reducing the incidence of hypotension and bradycardia in pregnant women undergoing cesarean section.

Efficacy and safety of povidone iodine with dimethyl sulfoxide vs 0.05% tretinoin in treatment of molluscum contagiosum: A randomized case control study

Efficacy and safety of povidone iodine with dimethyl sulfoxide vs 0.05% tretinoin in treatment of molluscum contagiosum: A randomized case control study

Effect of a dietary and exercise intervention in women with overweight and obesity undergoing fertility treatments: protocol for a randomized controlled trial

BackgroundDistinct molecular, inflammatory, and metabolic signatures are present in oocytes and follicular fluid derived from women with obesity when compared to those derived from normal weight women, which suggest existing signals that may program future offspring for metabolic diseases. This study aims to assess the feasibility and efficacy of a peri-conception nutrition and exercise intervention on mitigating obesity-associated changes in oocyte gene expression profiles and follicular fluid metabolites.MethodsThis single blinded randomized control trial will include 120 women with a BMI of 25–45 kg/m2, ≥21 years of age, and undergoing in vitro fertilization (IVF) treatments. Participants will be randomized to standard of care (N = 60) or an intervention group (N = 60) in a block design by polycystic ovary syndrome status. The intervention will combine a dietary component (Mediterranean meal plan) with exercise prescription following the Physical Activity Guidelines for Americans. Participants will be assessed pre- and post-intervention. The standard of care group will be offered to join the intervention group if the IVF treatments are unsuccessful as a cross over design. Recruitment is anticipated to start in July of 2021. Primary outcomes will include single oocyte gene expression profiles and follicular fluid metabolites. Mann-Whitney U nonparametric tests will be used to assess potential differences for each stratum. Follicular fluid and serum metabolites will be analyzed using a one-factor Analysis of Covariance (ANCOVA) at four levels, pair-wise comparisons using Tukey-Kramer post-hoc tests will be used to identify groups whose means differ significantly while retaining the family-wise error rate at 5%. When the design is balanced, two-way Analysis of Variance (ANOVA), or non-parametric Friedman test will be used in data analysis. Additionally, general linear models and ANCOVA may be used to control for covariates. Significance will be set at p < 0.05. Findings will be disseminated via peer-reviewed manuscripts and presentations at scientific conferences.DiscussionThis study will provide novel data and key information on the impact of a dietary and exercise intervention on oocyte gene expression and follicular fluid content. Results will demonstrate the potential of such intervention in mitigating obesity-induced changes in oocyte gene expression and follicular fluid metabolites.Trial registrationClinicalTrials.gov (NCT04273048): submitted November 13, 2019; posted February 17, 2020.

A prospective randomised control trial comparing functional with mechanical axis alignment in total knee arthroplasty: study protocol for an investigator initiated trial

BackgroundA drive to improve functional outcomes for patients undergoing total knee arthroplasty (TKA) has led to alternative alignment being used. Functional alignment (FA) uses intraoperative soft tissue tension to determine the optimal position of the prosthesis within the patient’s soft tissue envelope. Angular limits for bone resections are followed to prevent long-term prosthesis failure. This study will use the aid of robotic assistance to plan and implement the final prosthesis position. This method has yet to be compared to the traditional mechanically aligned (MA) knee in a randomised trial.MethodsA blinded randomised control trial with 100 patients will be undertaken via Perth Hip and Knee Clinic. Fifty patients will undergo a MA TKA and fifty will undergo a FA TKA. Both alignment techniques will be balanced via computer-assisted navigation to assess prosthetic gaps, being achieved via the initial bony resection and further soft tissue releases as required to achieve satisfactory balance. The primary outcome will be the Forgotten Joint Score (FJS) 2 years after surgery, with secondary outcomes being other patient-reported outcome measures, clinical functional assessment, radiographic position and complications. Other data that will be collected will be patient demography (sex, age, level of activity) and medical information (grade of knee injury, any other relevant medical information). The linear statistical model will be fitted to the response (FJS), including all the other variables as covariates.DiscussionMany surgeons are utilising alternative alignment techniques with a goal of achieving better functional outcomes for their patients. Currently, MA TKA remains the gold standard with good outcomes and excellent longevity. There is no published RCTs comparing FA to MA yet and only two registered studies are planned or currently in progress. This study utilises a FA technique which differs from the two studies. This study will help determine if FA TKA has superior functional results for patients.Trial registrationThis trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) http://www.anzctr.org.au: U1111-1257-2291, registered 25th Jan 2021. It is also listed on www.clinicaltrials.gov: NCT04748510.

Rational emotive occupational health coaching for quality of work-life among primary school administrators.

Background:This study aimed at investigating the effect of rational emotive occupational health coaching on quality of work-life among primary school administrators.Method:This is a double blinded and randomized control design study. A total of 158 administrators were sampled, half of them were exposed to rational emotive occupational health treatment package that lasted for 12 sessions. Two self-report measures were utilized in assessing the participants using quality of work life scale. Data collected were analyzed using MANOVA statistical tool.Result:The results showed that rational emotive occupational health coaching is effective in improving perception of quality of work-life among public administrators. A follow-up result showed that rational emotive occupational health coaching had a significant effect on primary school administrators’ quality of work life.Conclusion:This study concluded rational emotive occupation health coaching is useful therapeutic strategy in improving quality of work of primary school administrators, hence, future researchers and clinical practitioners should adopt cognitive-behavioral techniques and principles in helping employers as well as employees. Based on the primary findings and limitations of this study, future studies, occupational psychotherapists should qualitatively explore the clinical relevance of rational emotive occupational health practice across cultures using different populations

A three-arm single blind randomised control trial of na\xefve medical students performing a shoulder joint clinical examination

BackgroundTechnological advances have previously been hailed as a new dawn in Higher Education, with the advent of ‘massive open online courses’ (MOOCs) and online learning. Virtual platforms have potential advantages such as accessibility and availability but simply transferring educational material to the online environment may not ensure high quality learning. Clinical examination is a fundamental principle of medical assessment, and this study aimed to assess the role of technology in teaching these skills.Aims/objectivesTo determine whether three teaching modalities were of equal efficacy in teaching examination of the shoulder joint to naïve medical students.MethodsSixty-seven pre-clinical medical students naïve to large joint examination were recruited. Participants completed a learning style questionnaire and were then block randomised to three study: textbook study, face-to-face seminar, or video tutorial via online platform. The same examination technique was taught in all groups, with the intervention being the method of delivery All second year students were eligible for inclusion. The single exclusion criteria was previous exposure to clinical examination teaching. Students were assessed using a standardised scoring system at baseline (pre-intervention), and days 5 and 19 post-intervention (maximum score 30). Assessors were blinded to group allocation. The primary outcome was assessment score at day 5 post intervention.ResultsThere was no difference between the three groups at baseline assessment (mean scores 2.4 for textbook, 2.8 for face-to-face, and 3.1 for video; p = 0.267). Mean post-intervention scores were 16.5 textbook, 25.5 face-to-face, and 22.4 video (p < 0.001, η2 = .449). There was no change between day 5 and day 19 post-intervention assessment scores in any group (p = 0.373), Preferred learning style did not affect scores (p = 0.543).ConclusionFace-to-face teaching was the most effective method for teaching clinical examination of the shoulder. Technology can potentially increase accessibility and remove geographic barriers, but is not as effective if teaching techniques are simply mirrored in an online format.Online platforms allow in depth data analysis of how learners interact with educational material and this may have value in improving the design of online educational materials, and is a potential area for further research.

Angiotensin-converting enzyme inhibitor for post-transcatheter aortic valve implantation patients: study protocol for a multicenter randomized, open-label blinded endpoint control trial

BackgroundWith the expanded utilization of transcatheter aortic valve implantation (TAVI) to younger and lower surgical risk patients with severe aortic stenosis (AS), optimal medical therapy after TAVI procedure has become the main concern. Renin-angiotensin system inhibitors (RASi) are widely utilized in the area of cardiovascular disease including heart failure and myocardial infarction and revealed the ability to reverse left ventricular (LV) remodeling. Interests have, thus, been drawn in investigating whether the prescription of RASi after the TAVI procedure can prevent or reverse cardiac remodeling and improve long-term clinical outcomes. No recommendation regarding the prescription of RASi after TAVI is proposed yet due to the lack of evidence from randomized controlled trials, especially in the Chinese population. We, therefore, designed this randomized controlled trial to explore the effect of adding fosinopril to standard care in patients who underwent a successful TAVI procedure on the LV remodeling.MethodsA total of 200 post-TAVI patients from seven academic hospitals across China will be recruited and randomized with a ratio of 1:1 to receive standard care or standard care plus fosinopril. Follow-up visits will take place at 30 days, 3 months, 6 months, 12 months, and 24 months from randomization to assess the clinical symptoms, any adverse events, cardiac function, and quality of life. Cardiac magnetic resonance will be performed at baseline and repeated at the 24-month follow-up visit to assess LV remodeling.DiscussionThis study will provide evidence regarding medical therapy for AS patients who underwent TAVI and filling the gap in the Chinese population.Trial registrationChinese Clinical Trial Registry ChiCTR2100042266. Registered on 17 January 2021

Safety and Efficacy of Low-dose Selective Spinal Anesthesia with Bupivacaine and Fentanyl as Compared to Intravenous Sedation and Port-Site Infiltration for Outpatient Laparoscopic Tubal Ligation: A Randomized Controlled Trial.

Background:Selective spinal anesthesia has been safely applied for short-duration outpatient gynecological laparoscopic procedure. However, this anesthesia technique is often inadequate and not tolerated by awake patients due to pneumoperitoneum and visceral manipulation.Aims:We aimed to conduct a study to compare spinal anesthesia with bupivacaine, fentanyl, and i.v. sedation with i.v. sedation and laparoscopic port-site infiltration with local anaesthetic in outpatient laparoscopic tubal ligation procedures.Settings and Design:100 female patients posted for elective surgeries were recruited for a prospective single blind randomised control trial in a tertiary care center in two groups.Materials and Methods:In Group S, patients receive intrathecal 3 mg hyperbaric bupivacaine 0.5% plus 20 microgram fentanyl along with intravenous (i.v.) fentanyl at 1μg.kg-1.h-1 and in Group C i.v. fentanyl at 1μg.kg-1.h-1 along with laparoscopic port site infiltration with 0.5% bupivacaine. Postoperatively, overall patient satisfaction, visual analog score (VAS) score, duration of motor blockade, sensory blockade, and time to attain discharge criteria and any adverse.Statistical Analysis:Continuous variables between the groups were compared by the independent t-test and Wilcoxon rank sum. Chi-square and Fisher exact test used for the categorical value.Results:Overall VAS was significantly lower and patient satisfaction was higher in Group S than Group C. Time to oral intake was significantly prolonged in Group C 126.33 (±29.54) compared to group S 110.81 (±29.54). The requirement of total rescue analgesia (fentanyl) was significantly higher in Group C 2.0 (±0.6) μg.kg-1 compared to group S 0.79 (±0.53) μg.kg-1. Incidence of postoperative nausea vomiting (PONV) was significantly greater in Group C while incidence of pruritus was significantly greater in Group S.Conclusion:Low-dose intrathecal anesthesia with 3 mg bupivacaine and 20 μg fentanyl provided better analgesia, patient satisfaction and with less opioids consumption.

Comparative study on efficacy of ropivacaine and bupivacaine for supraclavicular brachial plexus

Supraclavicular brachial plexus block is a very popular mode of anaesthesia for various upper limb surgeries, due to its effectiveness in terms of cost, performance, margin of safety and good post-operative analgesia. The study was a prospective randomized, double blind control study conducted on 60 patients aged 20 to 60 years, undergoing elective upper limb surgeries under supraclavicular brachial plexus block. Onset of sensory block between the two groups shows that onset of block is earlier in group B (Ropivacaine) with mean value of 11.93 min compared to group A(Bupivacaine) with a mean value of 14.33 min and is statistically significant. Onset of motor block is higher in Group A with mean value of 19.7 min compared to group B which has a mean value of 14.9 min and is statistically significant. Comparison of duration of block between the two groups shows that duration of sensory block is longer in group A with a mean value of 446.43 min compared to group B with a mean value of 420.37 min and is statistically significant. Duration of motor block is longer in group A with a mean value 406.97 min and is statistically significant.