Difference In Percentage Reduction Research Articles

Pneumatic Compression-Assisted Lymphoscintigraphy for Quantitative Evaluation of Breast Cancer-Related Lymphedema.

Acquired lymphedema of upper extremity is a chronic pathologic status that frequently occurs after breast cancer treatment. Reliable and quantitative evaluation of lymphedema is crucial for successful management of patients. Although lymphoscintigraphy is the primary investigation for the confirmation and evaluation of lymphedema, the specific protocol of stress intervention is not well established. This study aims to introduce intermittent pneumatic compression (IPC) as a part of stress lymphoscintigraphy and compare the effectiveness of conventional stress lymphoscintigraphy (CSL) and pneumatic compression-assisted lymphoscintigraphy (PCAL). Our study was designed as a retrospective analysis of 85 breast cancer patients with lymphedema who underwent lymphoscintigraphy utilizing either IPC device or conventional stress maneuver and received complex decongestive therapy. The flow extent of the lymphatic fluid (FE) was evaluated using a 0- to 4-point scale based on lymphoscintigraphic images. The visualization of lymph nodes was also assessed. The clinical outcomes were evaluated by changes in side-to-side circumferential and volume differences of upper extremities and compared between groups. Of 85 patients, 47 underwent CSL, and 38 underwent PCAL. Participants with relatively preserved flow extent of the lymphatic fluid (FE 3) showed a significant difference in percentage reduction of volume (PRV) between CSL and PCAL groups ( P = 0.036). In the other groups, CSL and PCAL demonstrated comparable differences in PRV without statistical significance. Our study suggests that participants in the PCAL group with relatively preserved lymphatic flow extent (FE 3) had better PRV compared with those in the CSL group. The use of IPC devices in lymphoscintigraphy with the novel stress maneuver can help in the quantitative description of lymphedema status and the selection of an appropriate treatment method.

Determination and analysis of pesticide residues in fieldgrown and greenhouse-grown tomatoes using liquid chromatography-mass spectrometry

The present study aimed to extract pesticide residues in the field and greenhouse-grown tomatoes and homemade paste based on the (QuEChERS) method before being determined by liquid chromatography-mass spectrometry (LC-MS). The mean difference in percentage reduction of deltamethrin (DLM) and acetamiprid (ACT) in raw tomatoes of greenhouse-grown was obtained at 91.42 and 90.00%, respectively, which was insignificantly more than filed condition (84.91% and 86.34%). Maximum reduction percentages of the DLM in paste under greenhouse and field tomato conditions were achieved by more than 95.86% and 93.11%, respectively. The residual concentration of both DLM (91.42%) and ACT (90.00%) in the greenhouse decreased more than the field (84.91% and 86.34%), respectively. Abamectin(ABA) reached below the MRL in a shorter time after spraying (2 days). Considering the pre-harvest interval (PHI) period of deltamethrin and abamectin can reach their residual concentration to the MRL in both conditions, which were determined by LC-MS. According to the results of the current study, 7 and 5 days can be suggested as the PHI period of the acetamiprid for field and greenhouse-grown tomatoes, respectively. Therefore, using pesticides in the proper dosage, considering appropriate PHI, and harvesting can reduce their residues in agricultural products.

Stability analysis of high-rise building and optimization of bracing configuration

The present trend in construction industries is to build tall buildings due to available land scarcity and rise in population. As the height of the building increases, the sway of the building also increases and due to sway, the building stability will be affected. To reduce sway, one of the commonly used techniques is the provision of bracings. Triangulation is created by inserting diagonal structural members (bracing system) into the rectangular areas. Bending of columns and beams in the structure can be reduced by adopting these systems which in turn increases the stiffness of the system. Paper mainly explains the effect of different bracing configurations like X bracing, V bracing, diagonal bracing in multi storied RCC buildings. Various parameters like varying floor height and storey number are considered for detailed dynamic time history analysis. It was observed that there was a considerable variation in the displacement for the varying floor height. X bracing provides a better result in a range of 30% − 40% of reduction in structural deflection. Under similar conditions both V and diagonal bracings had slighter difference in percentage reduction and also diagonal bracing can be preferred in an economical point of view.

Does symptom severity predict response to low-dose onabotulinumtoxinA for the treatment of urgency urinary incontinence?

ObjectiveIntradetrusor onabotulinumtoxinA is a third-line treatment for urgency urinary incontinence (UUI) which is customarily reserved for severe disease. We sought to determine if symptom severity predicts the proportional response to onabotulinumtoxinA and whether low-dose injection may be an appropriate treatment for mild-moderate symptoms. Study DesignThis prospective cohort study compared patients with urgency urinary incontinence who were recruited from the Urogynecology Clinic with mild-moderate (2–9 episodes/3-day diary) and severe UUI (>9 episodes/3-day diary) symptoms. Twenty-eight subjects were treated (11 mild-moderate, 17 severe) with 50 units of intradetrusor onabotulinumtoxinA. Voiding diaries and validated questionnaires (UDI-6 and IIQ-7) were collected at baseline and one, six, and twelve months post-treatment. The primary outcome was the difference in percent reduction in UUI episodes per 3-day diary at one month. Secondary outcomes included differences in absolute reduction of UUI events, treatment success rate (defined as greater than 50% reduction in UUI episodes), changes in UDI-6 and IIQ-7 questionnaire scores, and rates of urinary retention, self-catheterization, and urinary tract infection. Normally distributed data are presented as means with standard deviations (SD) and groups were compared using the two sample t-test. Data that were not normally distributed are presented as medians with the interquartile range (IQR) and were compared using the Wilcoxon rank sum test. ResultsThe mild-moderate group showed median improvement; 100% (IQR: 100%, 100%) and severe group; 81% (IQR: 35%, 100%), p < 0.019. Both had significant improvement in UUI episodes; the mild-moderate group decreased by four and the severe group by 15. No differences were noted in percent reduction between groups. There was no association between baseline severity and percent reduction in UUI episodes (rs = 0.127, p = 0.544); however, absolute reduction was highly correlated (rs = −0.821, p < 0.001). Treatment success was 90% in mild-moderate and 73% in the severe group (p = 0.615). Complications included urinary tract infections (25%) and intermittent catheterization (3.6%). ConclusionsPatients with both mild-moderate and severe symptoms showed a statistically significant improvement in UUI events from baseline to one month, but no difference between the groups in proportional improvement or treatment success.

Reductions in Positive Clostridioides difficile Events Reportable to NHSN With Adoption of Reflex EIA Testing in 13 Atlanta Hospitals

Background: US hospitals are required to report C. difficile infections (CDIs) to the NHSN as a performance measure tied to payment penalties for poor scores. Currently, only the charted CDI test results performed last in reflex testing scenarios are reported to the NHSN (CDI events). We describe the reduction in NHSN CDI events from the addition of a reflex toxin enzyme immunoassay (EIA) after a positive nucleic acid amplification test (NAAT) in teaching and nonteaching hospitals, and we estimate the impact on standardized infection ratios (SIR). Methods: Reporting of all CDI test results, by test method, occurred during April 2018–July 2019 to the Georgia Emerging Infections program (funded by the Centers for Disease Control and Prevention), which conducts active population-based surveillance in an 8-county Atlanta area (population, 4 million). Among facilities starting reflex EIA testing, results were aggregated by test method during months of reflex testing to calculate facility-specific reduction in NHSN CDI events (% reduction; 1-[no. EIA+/no. NAAT+]). Differences in percent reduction between facilities by characteristic were compared using the Kruskal-Wallis test. We simulated expected changes in the SIR for a range of reductions, assuming equal effect on both community-onset (CO) and hospital-onset (HO) tests. Each facility’s historical NHSN CDI events prior to reflex testing were used to estimate changes to facility-specific SIRs by reducing values by the corresponding facility’s percent reduction. Results: Overall, 13 acute-care hospitals (bed size, 52–633; ICU bed size, 6–105) started reflex testing during the study period (mean, 7 months, 15,800 admissions, 66,400 patient days), resulting in 550 +NAAT tests reflexing to 180 +EIA tests (pooled mean 58% reduction). Percent reduction varied (mean, 67%; range, 42%–81%) but did not differ between larger (≥217 beds) and smaller hospitals (61 vs 50% reduction; P &gt; .05) or by outsourced versus inhouse testing (65% vs 54% reduction; P &gt; .05). Simulations identified a threshold reduction at which point effect on HO counteract the effects on CO events enough to reduce the SIR; thresholds for nonteaching and teaching were 26% and 32% reduction, respectively (Fig. 1). The estimated reductions in facility-specific SIRs using measured percent reductions on historic NHSN CDI events closely paralleled the simulation, and the mean estimated change in SIR was −46% (range, −12% to −71%) (Fig. 1). Conclusions: Although the magnitude of the effect varied, all 13 facilities experienced dramatic reductions in CDI events reportable to NHSN due to reflex testing; applying these reductions to historical NHSN data illustrates anticipated reductions in their facility-specific SIRs due to this testing change.Funding: NoneDisclosures: Scott Fridkin, consulting fee, vaccine industry (various) (spouse)

Ketorolac Is Not More Effective Than Flunixin Meglumine or Phenylbutazone in Reducing Foot Pain in Horses

The objective was to compare the analgesic efficacy of ketorolac tromethamine (KT) and two other nonsteroidal anti-inflammatory drugs (NSAIDs), including flunixin meglumine (FM) and phenylbutazone (PB), using a heart bar shoe (HBS) model of reversible foot lameness in horses. Nine adult horses were used in a blinded, randomized, placebo-controlled crossover study. After induction of left front limb lameness using a modified HBS model, one of three NSAIDs (KT, 2.0 mg/kg IV; FM, 1.1 mg/kg IV; PB, 4.4 mg/kg IV) or saline (placebo) was administered IV as a single dose. Lameness was assessed every 30 minutes for 2 hours, then every hour up to 12 hours using both a lameness grading scale (lameness score; LS) and a body-mounted inertial sensor system (lameness locator; LL). High-performance liquid chromatography and mass spectrometry were used to measure plasma drug concentration at various time points. There was no difference in percent reduction of LS or LL value between KT and any other group, or between FM and placebo. The PB group showed a significantly higher percentage in LS reduction than the placebo and FM groups. The mean percent reduction in LL value was greater for the PB group than that for the placebo and FM groups. Plasma drug concentration was similar among horses for each drug at each time point, with drug concentrations decreasing over time. Thus, variation in plasma drug concentration did not influence lameness reduction for any drug. Ketorolac tromethamine was not superior to FM or PB in reducing lameness using a HBS model.

Curve severity and apical vertebral rotation and their association with curve flexibility in adolescent idiopathic scoliosis

PurposeTo determine the association between coronal Cobb’s angle and Nash–Moe index in patients with adolescent idiopathic scoliosis. We also attempted to determine whether apical vertebral derotation depended upon the curve flexibility.Overview of literatureThe three-dimensional nature of adolescent idiopathic scoliosis (AIS) is well established. Knowledge of all components of this complex deformity is essential to formulate effective treatment strategies. Though the importance of quantifying all the components of the deformity, in AIS, has been analysed in detail, very few studies have been done to ascertain the relationship between the coronal plane deformity and apical vertebral rotation.MethodsDigitalised standing and supine stretch anteroposterior (AP) radiographs of 158 patients with AIS were analysed. The standing and supine stretch AP radiographs were compared to calculate the percentage reduction of Cobb’s angle to determine curve flexibility. The derotation of the apical vertebra on application of traction was also noted. The one-way repeated ANOVA was used to determine the association between Cobb’s angle and Nash–Moe index. The independent sample t test was used to determine whether a statistically significant difference was present, in the age of the patient, severity of the curve and percentage reduction of Cobb’s angle between those curves that derotated and those that did not, when stretched.ResultsThe one-way repeated ANOVA revealed an association between Cobb’s angle and Nash–Moe index on the standing and supine AP stretch radiographs (P < 0.01). The Independent sample t-test showed a statistically significant difference in percentage reduction of Cobb’s angle between those curves that derotated compared to those that did not, on stretch (P < 0.01).ConclusionsThis study demonstrates that there is an association between apical vertebral rotation and the coronal plane deformity. It also demonstrates that flexible curves derotate to a greater extent compared to rigid curves, when stretched.

Methods to Modulate the Inflammatory Response through Molecular Targeting‐CRISPR versus Adenovirus.

Transfection and transduction are the primary methods of molecular manipulation both in vitro and in vivo. Two commonly used methods are clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated protein 9 (Cas9) transfection and adenoviral transduction. While both methods are used to knockdown or knock‐in a genes of interest, each method differs in the method of cellular incorporation and genomic manipulation. CRISPR/CAS9 transfection utilizes the Cas9 protein to aid and enhance transfection efficiency. Alternatively, adenoviral transduction utilizes a modified adenovirus vector (and other viral infection properties) to incorporate or knockdown the gene of interest. The effectiveness of each method in genomic manipulation is not clearly defined. In our studies, we selectively knocked down myeloid differentiation primary response 88 (MyD88) in Raw 264.7 macrophages using either CRISPR/Cas9 transfection or adenoviral transduction. These cells were then treated with an acute dose (10 ng/mL) of lipopolysaccharide (LPS), a bacterial outer membrane vesicle, for 6 and 24 hours to induce an inflammatory response to which MyD88 serves as an intermediary cytokine. We verified the knockdown of MyD88 using Western Blotting and Image J quantification. Macrophages transfected with a CRISPR MyD88 (CrMKO) produced a 52% knockdown when compared to cells transfected with CRISPR RosA (CrRosA), a control vector, at 30 hours post transfection. Comparatively, macrophages transduced with ad‐GFP‐m‐MyD88 (ad‐MKO), an adenoviral MyD88 knockout vector, produced only a 20% knockdown when compared with control cells transduced with ad‐GFP. At 48 hours post transfection/transduction, both CrMKO cells and ad‐MKO cells demonstrated a 78% reduction in MyD88 relative to control. To determine the downstream effects of MyD88 knockdown by these methods, we measured the secretion of Tumor Necrosis Factor alpha (TNFα) and Interleukin 10 (IL‐10), in cells treated with LPS for 24 hours. The following values are presented as percent reduction when compared to non‐transfected macrophages treated with LPS. In CrRosA cells, there was a 24% reduction in TNFα secretion compared to the 62% reduction in CrMKO cells. In a similar fashion, IL‐10 demonstrated a 24% and 77% reduction in secretion in CrRosA and CrMKO cells, respectively. However, in ad‐MKO cells there was no significant difference in percent reduction in either TNFα or IL‐10 secretion relative to control cells. These data suggest that unlike adenoviral transduction, MyD88 knockdown in macrophages mediated by CRISPR/Cas9 produced a significant decrease in the downstream secretion of both TNFα and IL‐10 (p&lt;0.03 and p&lt;0.05, respectively). Overall, these data suggest CRISPR/Cas9 transfection serves as a better tool for modulating the inflammatory response through molecular targeting.Support or Funding InformationThe views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government. This abstract has been approved for public release with unlimited distribution.

Impact of Phacoemulsification Combined with XEN Gel Stent Implantation on Corneal Endothelial Cell Density: 2-Year Results

Corneal integrity has long been a preoccupation of glaucoma surgeons considering glaucoma drainage device surgery or antimetabolite-enhanced trabeculectomy. Despite having demonstrated a good safety profile and significant intraocular pressure-lowering capacities, the impact of XEN gel stents on endothelial density was never specifically investigated. The purpose of this study is to assess the effect of XEN gel stents on central endothelial cell density (ECD) over 24 months. To achieve this, we compared the effect on ECD of combined XEN surgery with that of a standard phacoemulsification procedure. This was an investigator-initiated, retrospective study, conducted at a single tertiary glaucoma center. Patients with primary or secondary open-angle glaucoma who underwent XEN implantation combined with phacoemulsification between January 2015 and June 2016 were retrospectively enrolled. Patients who had undergone standalone phacoemulsification over the same period of time were enrolled to form the control group of this comparative study. The primary outcome measure was the ECD. Patients who had undergone standalone XEN implantation and patients for whom both a baseline and 24-month ECD could not be obtained were excluded from the analysis. Percentages of ECD reductions were calculated for each studied eye, and the mean of ECD reductions was calculated for each group as well as for subgroups. Thirty-two eyes of 23 patients (mean age=76.0±7.9 y, 60% female) underwent standalone phacoemulsification (n=15) or combined XEN surgery (n=17) and had an ECD both at baseline and 24-month postoperatively. Mean baseline ECDs were 2568±491 versus 2379±335 cells/mm, respectively (P=0.21). In the combined XEN surgery group, 58.8% of eyes (n=10) required at least 1 mitomycin C (MMC)-enhanced needling revision to maintain their target intraocular pressure. In the standalone phacoemulsification group, ECD decreased by a mean 14.5%, from 2567.7±491.2 to 2196.1±591.9 cell/mm (P=0.072). In the combined XEN surgery group, ECD decreased by a mean 14.3%, from 2378.8±334.7 to 2039.6±451.1 cell/mm (P=0.018). The difference in percentage reduction of ECD between the 2 groups was not statistically significant (P=0.226). Within the combined XEN surgery group, the ECD decreased by a mean of 15.4% in patients who did not undergo needling revisions and by 13.1% in patients who underwent the MMC-augmented procedure (P=0.485). In the 3 patients who underwent >1 needling revision, a 21.3% reduction in ECD was observed, but the difference was not statistically significant (P=0.653). Neither the time of the first needling (P=0.452), the patients' age (P=0.285), or sex (P=0.308) was statistically associated with ECD loss. The present study demonstrated that the XEN gel implant combined with phacoemulsification produces 24-month ECD loss of a similar magnitude to that observed following standalone phacoemulsification. MMC-augmented needling revisions do not appear to have an impact on ECD.

Human health as a motivator for climate change mitigation: results from four European high-income countries

Invoking health benefits to promote climate-friendly household behavior has three unique advantages: (i) health co-benefits accrue directly to the acting individual, they are "private goods" rather than public ones; (ii) the evidence base for, and magnitude of health co-benefits is well-established; and (iii) the idea of a healthy life-style is well-engrained in public discourse, much more so than that of a climate-friendly life-style. In previous research, assessing the influence of information on health effects on people’s motivation to adopt mitigation actions, health co-benefits for the individual were typically confounded with collective health co-benefits, for example from pollution reduction. The present research aims to overcome this limitation by providing information on individual health co-benefits that are unconditional on the actions of others (direct health co-benefits). We report effects of this kind of health information on stated willingness to adopt mitigation actions as well as on simulation-based carbon emission reductions in a pre-registered experimental setting among 308 households in 4 mid-size case-study cities in 4 European high-income countries: France, Germany, Norway and Sweden. For each mitigation action from the sectors food, housing, and mobility, half of the sample received the amount of CO2equivalents (CO2-eq) saved and the financial costs or savings the respective action generated. The other half additionally received information on direct health co-benefits, where applicable. For households receiving information on direct health co-benefits, we find a higher mean willingness to adopt food and housing actions, and a greater proportion very willing to adopt one or more mitigation actions (OR 1.86, 95% CI 1.1, 3.12); and a greater simulated reduction in overall carbon footprint: difference in percent reduction -2.70%, (95% CI -5.34, -0.04) overall and -4.45%, (95% CI -8.26, -0.64) for food. Our study is the first to show that providing information on strictly unconditional, individual health co-benefits can motivate households in high-income countries to adopt mitigation actions.

Efficacy of application of an alcohol-based antiseptic hand rub or a 2% chlorhexidine gluconate scrub for immediate reduction of the bacterial population on the skin of dogs.

OBJECTIVE To compare the efficacy of application of an alcohol-based antiseptic (80% ethyl alcohol) hand rub (ABAHR) with that of a 2% chlorhexidine gluconate scrub (CGS2) for immediate reduction of the bacterial population on the skin of dogs. ANIMALS 50 client-owned dogs with no evidence of skin disease. PROCEDURES On each dog, 2 areas of hair on the ventral aspect of the abdomen were clipped with a No. 40 blade and cleared of debris. A direct contact plate holding tryptic soy agar with polysorbate 80 and lecithin was gently pressed (for 2 seconds) on each skin site (preapplication sample). The CGS2 and ABAHR were each aseptically applied to 1 skin site on each dog. A direct contact plate was subsequently applied to each site in a similar manner (postapplication sample). All plates were cultured, and bacterial isolates were identified and quantified by the number of CFUs per plate. RESULTS Application of the CGS2 and ABAHR significantly decreased skin bacterial colony counts, compared with findings for preapplication samples. The number of CFUs per plate or postapplication percentage reduction in CFUs per plate did not differ between treatments. There were no adverse skin reactions associated with either application. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that applications of ABAHR and CGS2 were equally effective at immediately reducing the bacterial population on the skin of dogs, and there was no significant difference in percentage reduction in colony counts between the 2 applications.

Effect of SLCO1B1 T521C on statin-induced reduction in low-density lipoprotein cholesterol: a systematic review and meta-analysis

Increasing number of studies have examined the effect of SLCO1B1 T521C polymorphism on lipid-lowering efficacy of statin. This study was conducted to clarify the effect of SLCO1B1 T521C on the rate of statin-induced reduction in low-density lipoprotein cholesterol (LDL-C). The databases of PubMed, Embase, Ovid, and Cochrane Library were searched for all published studies from inception to April 2018. Using the Review Manager 5, the pooled estimates of the weighted mean difference (WMD) of the percent changes of LDL-C and corresponding 95% confidence intervals (CIs) were calculated. A total of 17 cohort studies were included in this meta-analysis. The percent reduction in LDL-C was slightly higher in the statin users carrying 521TT than in the users carrying 521CC (WMD: 2.41; 95% CI: 0.15, 4.67; p=0.04). Sim-ilarly, the carriers of 521TC achieved slightly higher reduction in LDL-C than the carriers of 521CC (WMD: 2.07; 95% CI: 0.79, 3.35; p=0.002). However, no significant difference in percent reduction was found between the carriers and non-carriers of the 521C allele (TC+CC vs TT, WMD: 0.87; 95% CI: -0.67, 2.41; p=0.27). These results imply that the SLCO1B1 T521C polymorphism has little or no effect on the rate of reduction in LDL-C following statin therapy.

In Vitro and In Vivo Quality Evaluation of Glibenclamide Tablets Marketed in Addis Ababa, Ethiopia.

Good quality drugs fulfilling the regulatory parameters and produced per the current good manufacturing (CGMP) standards are very critical for best therapeutic outcome in patient therapy. Hence, this study assesses quality as well as physicochemical bioequivalence of five brands of glibenclamide tablets marketed in Addis Ababa using in vitro and in vivo methods. Friability, disintegration, dissolution, and assay for the content of active ingredients were evaluated using the methods described in the British Pharmacopeia (2009) and United States Pharmacopeia (2007). All the brands of glibenclamide tablets complied with the official specification for hardness, friability, disintegration, and assay. Difference factor (f1) values were less than 15 and similarity factor (f2) values were greater than 50 for all products of glibenclamide. The hypoglycemic effect of different products of glibenclamide tablets was evaluated on normoglycemic mice. The in vivo studies indicated that there is no significant difference in percent reduction of blood glucose level between the brands of glibenclamide and the innovator product (p > 0.05). Hence, based on the in vivo results and in vitro dissolution studies, the brands might be substituted with the innovator product in clinical practice.

Evaluation of lipid lowering ability of atorvastatin and ezetimibe combination as compared with atorvastatin monotherapy

Background: Many patients on statin therapy do not achieve recommended LDL cholesterol goals. They require either high dose statin regimen or combination of statins with other lipid modifying agents. Ezetimibe is a novel drug when added to statins, will provide additional reduction in LDL-C level.Methods: Total 100 patients with CHD or hypertension and having serum LDL-C levels of ≥100 mg/dl were enrolled for the study and were randomly allocated to two groups. Baseline investigations done. Patients from Group I received Atorvastatin (10mg) per day orally and patients from group II received combination of Atorvastatin (10mg) and Ezetimibe (10mg) per day orally. Study treatment was started on the day of randomization and continued for 12 weeks and follow up visits were scheduled at 4, 8, and 12 weeks. During each follow up investigations repeated and patients were interviewed and examined for occurrence of any adverse effect.Results: There was greater reduction in levels of LDL-C, Total cholesterol and serum triglycerides in patients treated with Atorvastatin plus Ezetimibe combination as compared to those patients treated with Atorvastatin alone. This difference in percentage reduction in LDL-C, Total cholesterol and serum triglycerides levels in two groups was highly significant at 4, 8 and 12 weeks (p&lt;0.01).Conclusions: Addition of Ezetimibe to Atorvastatin offers a very effective and well tolerated option for patients with CHD and hypertension having LDL-C levels of &gt;100mg/dl as it significantly lowers the LDL-C along with total cholesterol and triglycerides.

Comparative study of papaya dressing versus normal saline dressing in healing of ulcers

Background: Chronic non-healing wounds pose a remarkable challenge to health professionals and drain our resources. In recent years, prevalence of diabetic foot ulcers is growing at epidemic proportion in India and worldwide. There are various modalities available for wound debridement. In present study, authors have compared two debridement methods, one which we use regularly in their hospital, wet to dry normal saline dressing and enzymatic debridement with papaya.Methods: This was a randomized, comparative interventional study of 100 patients carried out in Kilpauk Medical College Hospital from August 2013 to August 2014 to compare to efficacy of papaya dressing over normal saline dressing in chronic non-healing wounds.Results: The mean reduction in slough/necrotic tissue in at time of inclusion in study and four week after the study was assessed. In saline dressing, mean reduction was 13.156, standard deviation 3.4558. The mean reduction in slough/necrotic tissue in papaya dressing 10.5, standard deviation 0.7071. There was significant difference in percentage reduction in slough/necrotic tissue within the two groups. Similarly, for the cases with active ulcer, the size assessment at the time of inclusion in the study and three week after was again analysed using student t-test and the mean ulcer size in papaya dressing 2.5062 and standard deviation 1.504. Mean ulcer size in normal saline dressing 2.1564 and standard deviation 1.2961.Conclusions: Present study concluded that favourable and significant ulcer healing rate with improvement and reduction in clinical severity suggests that enzymatic debridement with papaya dressing plays an important role in management of chronic non-healing ulcers.

Early Monoclonal Para Protein Reduction and Response in Multiple Myeloma (EMPEROR study)

Introduction. An early and rapid reduction of monoclonal para protein with bortezomib or bortezomib/doxorubicin therapy in relapsed/refractory myeloma has been associated with a longer time to progression1. However there are no studies to look at early monoclonal paraprotein reduction and response to treatment in newly diagnosed myeloma.Our unit looked at retrospective data in a cohort of newly diagnosed myeloma patients from 2010 till 2016 that were treated with regimens containing a novel agent backbone. The study looked at the paraprotein values pre-induction chemotherapy and the response to first cycle of induction chemotherapy. Further data was collected as regards the nadir paraprotein as well as death and follow-up.Methods. Data was collected on the patients with newly diagnosed myeloma including demographics, paraprotein isotype, and baseline paraprotein values. The patient's induction regimen including number of cycles for induction was collected. Paraprotein levels were measured post first cycle of induction as well as the lowest values post-induction were documented. Patients were grouped according to the best response based on International Myeloma Working Group classification2. Survival was calculated using the Kaplan-Meier product limit method with start time (ie landmark) designated as the date of the first measurement of paraprotein after cycle 1. Univariate analysis was performed using Fisher exact test for categorical variables, Wilcoxon rank-sum test for continuous variables, and logrank test for overall survival.Results: 44 patients were included in the study. There were 24 males and 20 females. Median age of patients was 67 years (range 41-85 years). The distribution of paraprotein isotypes were as follows: IgG kappa 13, IgG lambda 12, IgA kappa 5, IgA lambda 5, kappa light chain 7 and lambda light chain 2 patients. The median value of baseline paraprotein pre induction was 35 g/l (range 7-86 g/l) and light chain difference was 2892 mg/l (range 98-14388 mg/l). The distribution of the type of induction chemotherapy received was as follows: VCD 25, CTD 12, MPT 4 and VMP 3. The median percentage reduction in disease marker (paraprotein level or difference between involved and uninvolved light chain) post first cycle was 59% (range 0-100%) (Table 1). No significant difference in percentage reduction of disease marker post first cycle according to novel agent backbone was seen (P = .140, Table 2). Percentage reduction in disease marker was significantly greater for patients with light chain myeloma compared with those with intact paraprotein (P = .001, Table 3). The best response to induction was 2 patients with stable disease, 16 with partial response, 23 with very good partial response (VGPR) and 3 in complete remission (CR)2. Of 21 patients who had 50% or greater reduction of disease marker after first cycle of induction, 15 patients achieved VGPR/CR (71%) and 6 patients had a less than VGPR. Of 15 patients who had less than 50% reduction of paraprotein levels after first cycle, 6 patients had VGPR/CR and 9 patients had less than VGPR. Overall survival at 3 years after date of first cycle of induction was 63%. No difference in survival was noted in patients groups with more than 50% reduction or less than 50% reduction of disease marker after first cycle of induction .Conclusion : For patients with myeloma treated with novel agent containing regimens, an early rapid reduction in disease marker was more common with light chain myeloma compared with myeloma with intact paraprotein. However, no difference in depth of response or survival was observed according to early rapid reduction. These results suggest a difference in disease kinetics based on the type of disease marker in myeloma which may have implications for treatment scheduling. Patients with > 50% reduction in disease marker appeared to be more likely to achieve at least VGPR compared with those with < 50% reduction (odds ratio 3.6, P = .089)

Serotonin transporter gene (SLC6A4) polymorphisms are associated with response to fluoxetine in south Indian major depressive disorder patients

Up to 30-40% of the major depressive disorder patients do not respond sufficiently to antidepressant treatment. Genetic variations in the serotonin transporter gene have been implicated in modulating treatment response to selective serotonin reuptake inhibitors, and this association is influenced by ethnicity. We investigated the influence of serotonin transporter gene variants 5-HTTLPR and rs25531 in Indian population on fluoxetine response. One hundred and two major depressive disorder patients were started on fluoxetine treatment and after 6weeks, classified as responders (n=56) and non-responders (n=46) using Hamilton depression rating scale and genotyped. Fisher's exact test was used to compare genotype frequencies between responders and non-responders. One-way analysis of variance and student t test were used to compare the percentage reduction (week 0-6) in Hamilton depression rating scores between genotype and haplotype groups. We observed a significant association between LL genotype of 5-HTTLPR and fluoxetine treatment response (p=0.0066, OR (95%)=4.0 (1.45-11.03)) but not with the functional groups of 5-HTTLPR -rs25531. However, there was a significant difference in percentage reduction in HAM-D scores (week 0-6) between 5-HTTLPR genotypes (LL vs. LS+SS, p=0.0036; LL vs. LS, p=0.0109) as well as the functionally grouped haplotypes of 5-HTTLPR -rs25531 (LALA carriers vs. non-carriers of LALA, p=0.0118; LALA vs. LAS+ LALG, p=0.0419). The LL genotype and LALA haplotype of SLC6A4 are associated with favorable treatment response to fluoxetine in south Indian major depression patients.

Microbiological analysis after complete or partial removal of carious dentin using two different techniques in primary teeth: A randomized clinical trial.

Background:The management of deep carious lesions can be done by various techniques but residual caries dilemma still persists and bacterial reduction in cavities treated by either partial or complete caries removal techniques is debatable. So the objective of the present randomized clinical trial was to compare microbial counts in cavities submitted to complete caries removal and partial caries removal using either hand instruments or burs before and after 3 weeks of restoration.Materials and Methods:Primary molars with acute carious lesions in inner half of dentine and vital pulp were randomly divided into three groups of 14 each: Group A: Partial caries removal using hand instruments atraumatic restorative treatment (ART) only; Group B: Partial caries removal using bur; Group C: Complete caries removal using bur and caries detector dye. Dentine sample obtained after caries removal and 3 weeks after restoration, were subjected to microbial culture and counting (colony-forming units [CFU]/mg of dentine) for total viable bacterial count, Streptococcus spp., mutans streptococci, Lactobacillus spp.Results:Three techniques of caries removal showed significant (P < 0.05) reduction in all microorganisms studied after 3 weeks of evaluation, but there was no statistically significant difference in percentage reduction of microbial count among three groups.Conclusion:Results suggest the use of partial caries removal in a single session as compared to complete caries removal as a part of treatment of deep lesions in deciduous teeth in order to reduce the risk of pulp exposure. Partial caries removal using ART can be preferred for community settings as public health procedure for caries management.

A new UV-LED device for automatic disinfection of stethoscope membranes

Stethoscopes are widely used by doctors and nurses. Poor stethoscope hygiene is a potential source of nosocomial infection. This study aimed to propose an innovative solution, based on the latest advances in ultraviolet (UV) light-emitting diodes (LEDs), for disinfecting stethoscope membranes automatically and efficiently. Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis were sown on 28 stethoscope membranes and then transferred to Petri dishes. Treatment involved illuminating exposed Petri dishes with a UVC LED for 1 minute. For each microbe, the number of colony-forming units (cfu) at 36°C was compared in control and treated dishes using the Wilcoxon signed-rank test. TheKruskal-Wallis test was used to assess percent reductions in bacteria. Statistical significance was setat99%. A significant reduction in cfu counts after UV treatment (P<.01) was found for all bacteria: 85.5% for E faecalis, 87.5% for S aureus, 94.3% for E coli, and 94.9% for P aeruginosa . No significant differences in percent reduction in cfu were found between bacteria (P>.01). The stethoscope, symbol of medicine and health care professionals, has been demonstrated to be a carrier of microorganisms. The treatment technique was effective and efficient in disinfecting the membranes. These promising results represent a step forward toward eliminating stethoscope membrane contamination with an innovative approach.

Abstract 226: Integration of Traditional and Alternate Chronic Care Models within a Primary Care Setting for Diabetes Management and Cardiovascular Disease Prevention

Background: Several chronic care models (CCMs) for diabetes management and cardiovascular disease prevention have been implemented, but outcomes have been marginal. Traditionally, CCMs have been offered within the trusted primary care practice environment, but self-management support is episodic, cost ineffective and difficult to scale. Alternate CCMs that offer self-management support mostly through telephone coaching or virtual (web/mobile platforms) interventions, enable easy access, scalability and cost effectiveness, yet are impaired by the limits of isolated self-management support when provided outside the context of the trusted, therapeutic relationship of a primary care practice. We hypothesize that an integrated model taking advantage of positive aspects of traditional and alternate CCMs will lead to positive behavioral change (empowerment), sustained patient participation and better outcomes. Methods: To test this hypothesis, we implemented the Empowerment and Participatory Care Model (EPCM) in a study center in Chennai, India by integrating face-to-face support with customized telephone, Internet and mobile phone enabled interventions within a primary care setting. Patients who participated in the traditional CCM formed the control group. Results: In the participents in traditional CCM (n=422), there was an average reduction of 0.57% in HbA1c, 16 mg/dl in fasting blood sugar, 30 mg/dl in post prandial blood sugar and 16 mg/dl of LDL at the end of year-one. In comparison, among the patients (66% men; mean age 52 yrs) who participated in the EPCM and had completed one-year in the program (n=112) there was average reduction of 1.6% in HbA1c, 57 mg/dl in fasting blood sugar, 80 mg/dl in post prandial blood sugar and 18 mg/dl of LDL (p&lt;0.01). Figure 1 shows the difference in percent reduction of the various biochemical parameters between the EPCM and the control group. The total cost of care (other than medication) per patient per year in the EPCM, after taking into consideration purchasing power parity between USA and India, was 900 USD. Conclusion: The persons with diabetes who participated in the EPCM had better quality of metabolic control, but long-term follow up is required to assess overall reduction in the risk of cardiovascular complications and cost effectiveness.