Earlier Clinical Improvement Research Articles

Effectiveness of Less Invasive Surfactant Administration in Preterm with Respiratory Distress Syndrome

Background: Neonatal respiratory distress syndrome due to surfactant deficiency is associated with high morbidity and mortality in preterm infants. While studies have should that early treatment with surfactant therapy has markedly reduced mortality. There are certain methods by which surfactant can be given, the most common initially used was intubation and mechanical ventilation which itself is also associated with many complications. LISA i.e. less invasive surfactant administration is an emerging technique in which surfactant is given via soft tube without intubation and oxygen support given with nasal CPAP, which has been internationally studied and preferred with significantly reduced need of mechanical ventilation. Objective: To determine the effectiveness of Less Invasive Surfactant Administration (LISA) in preterm neonates with respiratory distress syndrome. Study Design: Descriptive, case series. Settings: Department of neonatology of children hospital, PIMS Hospital, Islamabad Pakistan. Duration: Total 6 months duration from 31st August 2019 to 28th February 2020. Methods: A total of 85 preterm babies with respiratory distress 2 syndrome fulfilling the following criteria were selected. Extremely and very low birth weight i.e. <1.5kg and extremely sick were excluded. Patients were given surfactant through the soft nasotracheal tube and put on CPAP and the children's condition was assessed during 72 hours of procedure for improvement and related complications like pneumothorax, need of mechanical ventilation and mortality. Neonates having earlier clinical improvement with no prolonged need of mechanical ventilation and having fewer complications were considered effective. Results: Mean gestational age was 33.08 ± 1.35 weeks. Out of the 85 patients, 46 (54.12%) were male and 39 (45.88%) were females with male to female ratio of 1.2:1. Mean birth weight was 2.50 ± 0.73 kg. The effectiveness of LISA in preterm neonates with respiratory distress syndrome was found in 63 (74.12%) patients. Conclusion: This study concluded that the effectiveness of LISA in preterm neonates with respiratory distress syndrome is quite high.

Earlier clinical response predicts low rates of radiographic progression in biologic-naïve patients with active psoriatic arthritis receiving guselkumab treatment

ObjectiveAssess relationship between earlier clinical improvement and radiographic progression (RP) over 2 years in guselkumab-treated patients with active psoriatic arthritis (PsA).MethodPost hoc analyses combined data from DISCOVER-2 biologic-naïve adults with active PsA randomized to either guselkumab 100 mg every 4 weeks (Q4W) or guselkumab at W0, W4, then Q8W. Correlations (Spearman’s coefficient) between baseline disease parameters and total PsA-modified van der Heijde-Sharp (vdH-S) score were examined. Repeated-measures mixed models, adjusted for known RP risk factors, assessed the relationship between Disease Activity Index in PsA (DAPSA) improvement, DAPSA improvement exceeding the median or the minimal clinically important difference (MCID), or DAPSA low disease activity (LDA) at W8 and RP rate, assessed by change from baseline in vdH-S score through W100.ResultsBaseline age, PsA duration, CRP level, and swollen joint count, but not psoriasis duration/severity, weakly correlated with baseline vdH-S score. Elevated baseline CRP (parameter estimate [β] = 0.17–0.18, p < 0.03) and vdH-S score (β = 0.02, p < 0.0001) significantly associated with greater RP through W100. Greater improvement in DAPSA (β = -0.03, p = 0.0096), achievement of DAPSA improvement > median (least squares mean [LSM] difference: -0.66, p = 0.0405) or > MCID (-0.67, p = 0.0610), or DAPSA LDA (-1.44, p = 0.0151) by W8 with guselkumab significantly associated with less RP through W100. The effect of W8 DAPSA LDA on future RP was strengthened over time among achievers vs. non-achievers (LSM difference enhanced from -1.05 [p = 0.0267] at W52 to -1.84 [p = 0.0154] at W100).ConclusionsIn guselkumab-treated patients with active PsA, earlier improvement in joint symptoms significantly associated with lower RP rates through 2 years, indicating blockade of the IL-23 pathway may modify long-term disease course and prevent further joint damage.Key Points• Greater improvement in DAPSA at Week 8 of guselkumab treatment was significantly associated with less progression of structural joint damage at 2 years in patients with active psoriatic arthritis (PsA).• Early control of peripheral joint disease activity with blockade of the IL-23 pathway may modify long-term PsA trajectory and prevent further joint damage.

Use and Outcome of Remdesivir in patients with COVID 19 presenting to Mayo Hospital Lahore

Aim: To assess the usage of Remdesivir in COVID 19 patients admitted to Mayo hospital Lahore Methods: This Quasi experimental study was carried out in COVID-19 ward from July 2020 to September 2020 on patients presenting to Mayo Hospital with COVID-19.The sample size (n=150) was calculated through non-probability convenient sampling technique. We gave intravenous Remdesivir to hospitalized COVID-19 patients with proven SARS-CoV-2 infection with an oxygen saturation of ≤94% who were breathing ambient air or needed oxygen support and had an oxygen saturation of less than 94%. Remdesivir was administered to patients over the course of a 10-day course, starting with 200 mg intravenously (I/V) on day 1 and continuing with 100 mg per day for the following nine days. Results: Among 150 participants in our study, 103 (69%) were male and 47(31.3%) were females. Mean age was 57.37±13.42years. Selected parameters were evaluated at day 1, 5 and 10. Significant improvement in fever, dyspnea score, serum C- Reactive proteins (CRP) and lactate dehydrogenase (LDH) was found on day 1 and 10 with a p value of 0.01 to 0.000 for CRP and 0.48 to 0.000 for LDH respectively. Serum ferritin also showed a statistical difference with a significant p value of 0.038 at day 10 as compared to day 1 and 5. Conclusion: Among patients presenting with severe Covid-19, clinical improvement was noticed earlier in those who received Remdesivir than those who didn’t receive this drug. Measurement of effectiveness will require ongoing randomized controlled trials of Remdesivir drug therapy. Keywords: COVID-19, intravenous Remdesivir, earlier clinical improvement, outcome, oxygen support, breathlessness

Comparison of enrofloxacin and tulatromycin treatments in sheep with Pasteuralla multicida pneumonia

In this study, it was aimed to compare the treatments of enrofloxacin and tulatromycin in sheep with pneumonia caused by Pasteuralla multicida. A total of 45 female Tuj sheep between the ages of 2-6 were used in the study. Group 1 enrofloxacin administered 15 sheep, group 2 tulatromycin administered 15 sheep, and 15 healthy sheep of the same age group and characteristics formed the control group. Bronchoalveolar lavage fluid samples were obtained from sheep with clinical signs (cough, purulent, serous, mucopurulent nasal discharge) of respiratory system disease. After the microbiological examination of the samples taken, those positive for Pasteuralla multicida were included in the study. Blood samples (10 mL) from the Vena jugularis were collected in serum tubes with K2EDTA and gel from the sick animals before and after the treatment as well as once from the control group. In our study, rectal temperature, respirations per minute and pulse rates before treatment were found to be statistically significantly higher in patient groups compared to the control group (P&amp;lt;0.001). Total leukocyte count was found to be higher in the patient groups before treatment compared to the control group (P=0.010). Among the biochemical parameters, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, urea and creatine kinase levels were found to be statistically significantly higher in the patient groups compared to the control group before treatment (P&amp;lt;0.05). Clinical improvement was observed from the 3th day in group 2 and from the 5th day in group 1. As a result, administration of a single dose of tulatromycin resulted in earlier clinical improvement than administration of enrofloxacin for one week. At the same time, it was concluded that tulatromycin is more beneficial and practical in terms of a single application.

COMPARATIVE STUDY OF OUTCOMES OF PERCUTANEOUS NEEDLE ASPIRATION VERSUS PIGTAIL CATHETER DRAINAGE FOR SOLITARY LIVER ABSCESS.

Objective: The aim of this study was to compare the outcomes of ultrasound guided percutaneous needle aspiration and percutaneous pigtail catheter drainage in the treatment of solitary liver abscess with respect to successful drainage, clinical improvement, reduction in size of abscess cavity, duration of hospital stay and procedure related complications. Methods: Prospective randomized study on 108 patients treated over a period of 30 months. Using standard randomization they were divided equally into two groups A and B. Group A patients underwent usg guided percutaneous needle aspiration for a maximum of three attempts, and Group B patients were treated by pigtail catheter drainage. All the patients received a uniform protocol based supportive care and antimicrobial treatment. Outcomes were compared with respect to successful drainage, resolution of symptom, fty percent reduction in size of abscess cavity, hospital stay duration and procedure related complications. Results: A successful drainage was noted in 52(96%) patients in group B treated with PCD and 46 (84%) patients in group A treated with PNA. 8(11%) patients in group A did not respond to three attempts due to very thick pus and they were offered pigtail catheter drainage. The duration required for initial clinical improvement and fty percent reduction of size of abscess cavity was signicantly lesser in group B. Though the duration of hospital stay was lesser in group B the difference was not statistically signicant. Complication was noted only in group B where one patient developed perihepatic and subdiaphragmatic collection and the other had peritonitis. Both were cured after surgical intervention. Conclusion: Both percutaneous needle aspiration and pigtail catheter drainage are almost equally effective in the treatment of solitary liver abscess. Though pigtail catheter drainage helped in earlier clinical improvement and reduction in cavity size but the difference in duration required for full recovery and complete resolution of abscess cavity was not statistically signicant. Hence the selection of the procedure needs to be individualized and should take into account various factors like patient's general condition, laboratory parameters, and nature of abscess cavity.

Treatment of Liver Abscess: A Comparison of Catheter Drainage and Needle Aspiration

Background The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Method This is a comparative study of 50 patients, presented in outpatient and emergency department at the hospital,equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Results The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Treatment of liver abscesses: A prospective randomized trial

Background: The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Methods: This is a prospective randomized comparative study of 60 patients, presented in outpatient and emergency department at the hospital, randomized equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Independent t-test was used to analyze these parameters. Results: The success rate was significantly better in catheter drainage group (P=0.006). The patients in pigtail catheter drainage group showed earlier clinical improvement (P=0.039) and 50% decrease in abscess cavity volume (P=0.000) as compared to those who underwent percutaneous needle aspiration. Conclusion: Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

The impact of four dynamic, goal-steered treatment strategies on the 5-year outcomes of rheumatoid arthritis patients in the BeSt study

ObjectiveTo compare clinical and radiological outcomes of four dynamic treatment strategies in recent-onset rheumatoid arthritis (RA) after 5 years follow-up.Methods508 patients with recent-onset RA were randomly assigned into four treatment...

Timing of clinical improvement and symptom resolution in the treatment of major depressive disorder

The goal of the present work is to assess for the relationship between the timing of clinical improvement and the resolution of depressive symptoms in Major Depressive Disorder (MDD). 182 MDD outpatients (40.5 ± 9.7 years; 53.8% female) who responded following an 8-week, 20 mg, open trial of fluoxetine were included in the analysis. The symptoms questionnaire (SQ) and Beck hopelessness scale (BHS) were also administered to 83 and 153 of these patients, respectively. Onset of clinical improvement was defined as a 30% decrease in 17-item Hamilton depression scale (HDRS-17) scores. Controlling for baseline symptom severity, we then assessed for the relationship between the timing of clinical improvement and depressive symptom at endpoint. Earlier clinical improvement in responders predicted lower HDRS-17, BHS, SQ-depression, SQ-anxiety, but not SQ-somatic symptom or SQ-anger/hostility scores at week 8. This was true regardless of whether improvement was defined as a continuous measure (30% decrease in symptom severity), as a dichotomous measure (clinical response occurring in the first two weeks of treatment). In conclusion, earlier clinical improvement with fluoxetine treatment is predictive of greater symptom resolution at endpoint. Further studies exploring the impact of various treatment modalities and placebo on the timing of clinical improvement and symptom resolution in MDD are warranted.