Decrease In Total Duration Research Articles

Refractory tympanostomy tube otorrhea: Outcomes with otowick placement

ObjectiveTo evaluate rates of resolution of and antibiotic use in refractory otorrhea (otorrhea ≥2 weeks with no more than 2 days of otorrhea resolution during the episode) with otowick placement in comparison to medical therapy and tube removals with or without replacements. Study designRetrospective cohort study of pediatric patients with a history of tympanostomy tube placement and refractory otorrhea between 2017 and 2022. SettingCleveland Clinic Foundation (CCF) pediatric otolaryngology group. MethodsDemographic data (sex, race, and age at tympanostomy tube placement) were collected. Outcome measures included number of oral and topical antibiotic treatments, duration of otorrhea episode, and resolution of otorrhea at 1 and 3 months follow-up. Wilcoxon rank sum and Kruskal-Wallis tests were used to compare number of antibiotics treatments. An ANOVA test and linear regression model using log-transformed data were used to compare duration of otorrhea. Fisher's exact test was used to compare rates of otorrhea recurrence. Results70 patients met inclusion criteria: 37 male (52.9%), 33 female (47.1%), with an average age at tube placement of 29.66 months. There was a statistically significant decrease in total duration of otorrhea (in days) with otowicks (17.29 ± 13.13), compared to patients receiving medical therapy (27.09 ± 22.02) and tube removals and replacements (29.63 ± 19.95) (p = 0.025). There was no significant difference between the follow-up rates of resolution at 1 month (p = 1) and 3 months (p = 0.12). ConclusionOtowick use is associated with shorter duration of otorrhea and can be considered as a first-line treatment for refractory otorrhea. Otowicks and medical therapy alone can reduce need for tube removals and the associated risk of anesthesia.

Vortioxetine increases absence-like seizures in WAG/Rij rats but decreases penicillin- and pentylenetetrazole-induced seizures in Wistar rats

AimDepression is the major psychiatric disorder in patients with epilepsy. Vortioxetine is a novel antidepressant drug for the treatment of major depressive disorders. In the present study, effects of vortioxetine were evaluated in different experimental epilepsy models of rats. Materials and methodsFifty-six adult male Wistar rats and 28 WAG/Rij rats were divided into 12 groups of 7 rats each. Experiments were conducted with penicillin (500 IU, i.c.) and pentylenetetrazole models (50 mg/kg, intraperitoneally (i.p.)) in Wistar rats and genetic absence epileptic WAG/Rij rats. The vortioxetine (1, 5, or 10 mg/kg, i.p.) was evaluated in these three models. All groups were compared with their control groups. ResultsIn the penicillin-induced seizure model, 1, 5, or 10 mg/kg vortioxetine administration significantly decreased mean spike frequency. In the pentylenetetrazole-induced seizure model, 1, 5, or 10 mg/kg vortioxetine demonstrated a significant dose-dependent decrease in mean spike frequency, an increase in the latency to minor and major seizures, and a decrease in total duration of major seizure and convulsion stage. In genetic absence epileptic WAG/Rij rats, 1 mg/kg vortioxetine caused no significant alteration in the number and duration of SWDs compared to the controls, while 5 and 10 mg/kg doses of vortioxetine increased the number and duration of SWDs. Amplitude of the epileptiform activity did not change in any of the experimental epilepsy models. ConclusionThe results of this study suggested that vortioxetine has anticonvulsant activity in penicillin- and pentylenetetrazole-induced seizure models. However, it exhibited proconvulsant activity in the absence epileptic WAG/Rij rats.

Multi-Center Prospective Study of Restrictive Post-Operative Antibiotic Treatment of Children with Complicated Appendicitis.

Background: No consensus has been reached regarding the most advantageous duration of antibiotic prophylaxis to decrease post-operative infection complications of appendectomy for acute complex appendicitis. This study aimed to determine the efficacy of short-term antibiotic treatment on post-operative complications in children with complex appendicitis. Methods: A multi-center, parallel group, randomized study was conducted in patients younger than 14 years of age with complicated appendicitis at three hospitals in China. The qualified patients were randomized prospectively to either the restrictive 72-hour short-term antibiotic strategy or the standard antibiotic usage. A comparison of the complications within 24 months, including infectious complications and long-term results, were conducted between the two groups. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR), number ChiCTR1900023941 and is complete. Results: A shorter duration of antibiotic treatment had no effect on intestinal function recovery, antibiotic-associated diarrhea, and health-care-associated Clostridium difficile infection and infectious complication, including intra-abdominal abscess development (17.9% vs. 18.0%, p = 0.52). Furthermore, no substantial difference for re-admission requirement and re-operation were found between the two treatment strategies. A sizeable decrease in total duration of hospitalization (p < 0.001) and average total antibiotic duration (p < 0.001) were observed for the restrictive antibiotic strategy group. Conclusion: In complicated appendicitis, the restrictive antibiotic usage was equivalent to standard antibiotic usage in terms of short- and long-term outcomes, but with shorter hospital stays and fewer antibiotic agents.

Clinical Effectiveness of L-arginin Supplementation in Patients with Coronary Artery Disease and Metabolic Syndrome

The objective: to assess the clinical effectiveness of exogenous L-arginine («Sargin», Farmak) on the background of the basic therapy of CAD, combined with MS, based on its influence on vegetative, electrical, ischemic changes of myocardium and quality of life of patients with coronary artery disease, comorbid with MS.Materials and methods. Аn open, prospective, monocentric, randomized clinical study in parallel groups involved 50 patients with CAD: stable exertional angina of II–III functional class with concomitant MS (men – 18, women – 30, median age 68.0 (60.0, 78.0) years). All patients were given a complex clinical examination in accordance with modern standards, in which vegetative and ischemic disturbances were assessed using daily ECG monitoring by Holter, the quality of life of patients – using the modifiedSeattle questionnaire. Patients were divided into two groups by the method of block randomization: group 1 - 25 patients, who received only basic therapy; group 2 - 25 patients, who were prescribed exogenous L-arginine («Sargin», Farmak) by intravenous infusion in 100 ml 1 time per day for 10 days in addition to the basic therapy. The assessment of the efficacy and safety of the prescribed treatment was carried out on the 10–12th day after the initiation of therapy.Results. According to the results of the study, in the group of patients receiving exogenous L-arginine («Sargin», Farmak) in addition to the basic therapy, a significantly lower level of diastolic blood pressure (by 7,50%), TG (by 22,07%), and a significantly higher the level of HDL cholesterol (by 27,69%) was observed if compared to patients in group 1 (p&lt;0,05). According to the results of daily ECG monitoring in patients of the group2, a significantly smaller number of episodes of ventricular and supraventricular extrasystoles, the decrease in total duration of the ST segment depression per day (by 2,25 times), the duration of its maximum episode (by 4 times) and the maximum depth of the ST segment depression (by 19,57%) were detected, if compared to the patients receiving only basic therapy (p&lt;0,05). In patients, receiving therapy with the addition of exogenous L-arginine («Sargin», Farmak), an increase in the total activity of the autonomic nervous system (SDNNi) and the normalization of sympathetic/parasympathetic balance (LF/HF ratio) at the daytime and night period was observed (p&lt;0,05); according to the Seattle questionnaire data, a decrease in the incidence of angina attacks (by 35,95%, p&lt;0,05), higher treatment satisfaction rates (by 16,89%; p&lt;0,05) and the rate of its effectiveness (by 9,39%; p &lt;0,05) was observed.Conclusions. The addition of L-arginine («Sargin», Farmak) to the basic therapy of patients with coronary artery disease and the MS is associated with better clinical course of disease, contributes to the reduction of vegetative, arrhythmic, ischemic changes in the myocardium, is accompanied by an improvement in the quality of life of patients. The obtained data allow to confirm the expedience of inclusion of the exogenous L-arginine («Sargin», Farmak) to the basic treatment of CAD, combined with metabolic syndrome.

A gain-of-function study of amelioration of pentylenetetrazole-induced seizures by endogenous prostaglandin D2

We previously showed that knockout mice of hematopoietic prostaglandin (PG) D synthase (H-PGDS) produce less PGD2 to exacerbate pentylenetetrazole (PTZ)-induced seizures. Here, we adopted a gain-of-function strategy and used transgenic mice that over-express human H-PGDS enzyme, to elucidate the role of overproduction of endogenous PGD2 in PTZ-induced seizures. H-PGDS-transgenic mice showed the elevated level of a urinary metabolite of PGD2, tetranor-PGDM, 3.3- and 2.8-fold higher than the wild-type littermates under the basal condition and after the PTZ administration, respectively, without significantly changing the urinary concentration of a PGE2-metabolite, tetranor-PGE2. The intensity of PTZ-induced seizures was decreased in H-PGDS-transgenic mice as evident by the increased seizure onset latency, and a decrease in total duration of generalized tonic-clonic seizures and a total number of EEG seizure spikes during the postictal period (84 s, 17 s, and 5.3/min, respectively), as compared to wild-type mice (53 s, 24 s, and 12.6/min, respectively). These results indicate that overproduction of endogenous PGD2 decreased PTZ-induces seizures.

The effect of synthetic genistein on menopause symptom management in healthy postmenopausal women: A multi-center, randomized, placebo-controlled study

Objective To evaluate the efficacy of synthetic genistein for reducing the frequency and severity of hot flushes. Study design A 12 week randomized double-blind, placebo-controlled study in which 84 postmenopausal women received placebo or a single 30 mg dose of synthetic genistein. Outcome measures primary: percentage change in the number of daily hot flushes from pre-treatment to week 12. Secondary: duration and severity of daily hot flushes, Greene Climacteric Scale score, serum follicle stimulating hormone (FSH), 17β-estradiol and endometrial thickness. Results Genistein supplemented subjects completing at least 4 weeks on trial ( n = 40) demonstrated a 51% reduction (9.4–4.7/day) in the number of hot flushes by week 12 compared to a 27% reduction in the placebo group (9.9–7.1/day) ( p = 0.026). Subjects in the genistein group also reported significantly fewer hot flushes per day ( p = 0.010) and a decrease in total duration of hot flushes per day ( p = 0.009) at week 12 versus placebo. Subjects on genistein ( n = 32) completing 12 weeks on trial demonstrated a 51% reduction (9.7–4.7/day) in the number of hot flushes by week 12 ( p = 0.049) compared to 30% reduction in the placebo group (9.8–7.0/day) and had fewer hot flushes per day and a decrease in total duration of hot flushes per day at week 12 compared to placebo ( p = 0.020 and p = 0.017, respectively). There were no differences between groups in Greene Climacteric Scale, FSH, 17β-estradiol, endometrial thickness or adverse events. Conclusions The current study provides the first evidence that a single daily dose of 30 mg of synthetic genistein reduces hot flush frequency and duration.

EARLY LIGATION OF PDA, EFFECT ON BPD AND POSTOPERATIVE VENTILATOR TIME

A retrospective and prospective study was undertaken to determine whether early ligation of PDA (7 days of age or less) resulted in a decreased incidence of BPD and shorter period of ventilatory support in infants with RDS and cardiopulmonary failure. The diagnosis of a PDA was made on clinical grounds (murmur, hyperactive precordlum and pulses) with several infants having aortographic and/or echocardiographic confirmation of a PDA prior to surgery. The early group consisted of 16 infants (B.W. 1240 gms, G.A. 29.2 weeks), operated on at a mean of 4.8 days, while the late group consisted of 20 infants (B.W. 1175 gms, G.A. 28.5 weeks) operated on at 14.4 days. Infants developing clinical and X-ray evidence of BPD (15 of 36, 41%) received assisted ventilation for 8.2 days preoperatively and 16.6 days postoperatively. Infants not developing BPD received assisted ventilation for 5.9 days preoperatively and 3.0 days postoperatively. Infants operated on early (≤ 7 days) received 4.7 days of ventilatory support postoperatively of whom only 25% (4/16) developed BPD. Infants operated beyond 7 days required 16.6 days of ventilatory assistance postoperatively. Among this group 55% developed BPD (11/20). The combined mortality was 36% (13/36) with 35% (7/20) in the late group and 37% (6/16) in the early group. There was 1 perioperative death and 12 late deaths. These data indicate that while there was no statistical difference in mortality, there was a significant decrease in total duration of ventilatory time and BPD in the early treated group.