End Of 24th Week Research Articles

Comparative study of internal fixation of diaphyseal fractures of both bones of the forearm in adults between intramedullary nailing and plate osteosynthesis

Background: Diaphyseal forearm fracture is one of the most commonly encountered fractures of the upper extremity. The literatures comparing the outcome of plate fixation and intramedullary nailing in adults are scarce and therefore the consensus on superiority of one over the other is lacking. This study was undertaken to compare the outcome of these operative techniques in adults with diaphyseal fracture of both bone forearm. Aims and Objectives: This study was undertaken to compare the outcome of plate fixation and intramedullary nailing in adults with diaphyseal fracture of both bone forearm. Materials and Methods: Patients of 18–70 years of age, with diaphyseal fractures of both bones of the forearm of <21 days old, were recruited. Patients were randomly allocated to two treatment groups: intramedullary nailing and plate osteosynthesis. Patients were followed up at 4th week, 12th week, and 24th week post-operative period. Functional outcome was measured at the end of 24th week based on the Clinical and Radiological parameters by Anderson et al., Score, Grace-Eversman Score, and Disabilities of the Arm, Shoulder and Hand (DASH) Score. Results: This study comprised of 40 cases (n=40) who completed the follow-up period of 24 weeks. Most of the patients treated with plate (80%) demonstrated excellent outcome as per Anderson et al., score while the outcome was unsatisfactory in 50% of those treated with nails. About 90% of the patients of plate group had excellent result in contrast to 50% in case of nail group following Grace Eversman criteria. Considering DASH score, the former group showed mostly excellent (40%) and good (45%) outcome while the latter exhibited mostly fair (55%) and good (30%) result. Conclusion: It may be stated that plate osteosynthesis is a better option in the treatment of diaphyseal fracture of both bones forearm in adults.

The constitution of functional model rabbit bladder with acellular matrix

Aim: In this study, for the useable of bladder acelluar matrix in urinary tissue engineering, we compared the urodynamic and histopathological results between normal, partial cystectomy and bladder acellular matrix allograft (BAMA) augmented cystoplasty groups in rabbit model. Methods: There were five groups each consisting three rabbits. Urodynamic investigation was applied to all animals at the beging of the study. Then, in the first control group, the rabbits were sacrified and the bladders were removed for histopathological examination. In the second control group the same procedures were realized at the end of 24th week. In the third group, partial cystectomy was performed to the animals and followed for 24 weeks. Partial cystectomy and BAMA augmented cystoplasty were performed to the animals in the 4th and 5th groups. The animals were sacrified at the end of 12th and 24th weeks, respectively. In the 3th, 4th and 5th groups urodynamic investigations were performed before sacrification. Then bladders were underwent for histopathological examination. Results: There was no significant difference in term of bladder capacity between both control and BAMA augmented groups. Detrusor presures were no statistical different in all groups. However bladder capacity has significantly reduced in partial cystectomy group. In histopathological evaluations there were no differences between control and partial cystectomy groups. In BAMA augmented groups urothelium and vascularization were nearly the same as control groups however muscle layer was less organized and was thinner than control groups. Collagen depositon and innervation in BAMA augmented bladder were more prominent than that of the control group. Conclusion: In our animal study; although the detrusor muscle had less organized with more collagen deposition, the BAMA augmented bladders had near normal capacity and compliance with normal detrusor presures.

A Comparative Study of Local Ultrasound Therapy and Local Steroid Injection in Patients of Carpal Tunnel Syndrome

Abstract Introduction Carpal tunnel syndrome is the most common compressive neuropathy of upper extremity affecting predominantly females of middle age group. Symptoms include pain, paracsthesia, numbness in median nerve distribution of hand. Study design Comparative type of interventional study. Study area Department of Physical Medicine and Rehabilitation, SMS Medical College and attached group of hospitals, Jaipur. Duration of study One and a half years April 2014-October 2015. Aims and objective To compare the efficacy of local ultrasound therapy and local corticosteroid injection for carpal tunnel syndrome management. Study population A total of sixty patients with CTS (agep>18 years) were randomly assigned to the steroid treatment plus splinting(group A) or ultrasound treatment plus splinting(group B). Results The mean age of study population was 45.47±12.24 years with males comprising 13.3% and females 86.6% of whole study. At baseline all outcome variables were comparable statistically in both the groups (p>0.05). In follow-up assessment at 8th week, statistically significant improvement was obtained in all clinical and electrophysiological parameters in group A: Grip strength, symptom severity score, functional status score, median DML, sensory nerve conduction velocity (p<0.001 for each). Also the group B showed improvement in all parameters except grip strength. At the end of 24th week all outcome variables showed decline in improvement as comparative to 8th week, but still they were better than baseline in both groups. There was no significant difference between the groups in outcome variables except for the grip strength. Conclusion Ultrasound treatment provided improvement comparable to steroid injection in all clinical and electrophysiological parameters in patients with CTS except grip strength. Overall steroid therapy is more effective than ultrasound therapy. Effectiveness of treatment persist for at least 6 months then it lessens, so long follow-up is required.

Psoriatik artritte sertolizumab pegol kullanımı

Summary Certolizumab pegol is first pegylated anti-TNF drugs. In this review, safety and efficacy of certolizumab pegol evaluated in patients with psoriatic arthritis. RAPID-PSA is 24 week, double blind, placebo controlled study which assess certolizumab 200 mg/every two weeks and 400 mg/month in patients with psoriatic arthritis. At the end of 24th week, 58.0% and 51.9% of patients achieve ACR 20% response (primary clinical endpoint) for 200 mg/every two weeks and 400 mg/month dosage, respectively. Efficacy of certolizumab start 1 to 2 weeks later. These efficacy continue at least 96 weeks. Additionaly, certolizumab pegol improve functional capacity, fatigue, quality of life, dermatology quality of life index and work productivity. Radiological progression is lower with certolizumab pegol than placebo. Advers events are comperable with other anti-TNF drugs. According to this results, certolizumab pegol is a therapeutic option for DMARD resistant psoriatic arthritis patients.

Thrombotic Thrombocytopenic Purpura Associated with Interferon alpha for the Treatment of Chronic Hepatitis C

Purpose: Thrombotic thrombocytopenic purpura (TTP) is a rare entity characterized by microangiopathic hemolytic anemia, thrombocytopenia and symptoms consisting of fever, neurologic, or renal dysfunction. Development of TTP has been reported in relationship with many drugs. We report a rare case of TTP associated with use of interferon alpha (INF-alpha) for the treatment of chronic hepatitis C. Methods: A 48-year-old female was diagnosed with hepatitis C eleven months ago. Liver biopsy revealed chronic hepatitis (grade 1 stage 0), and genotype of 1B. Treatment with INF and ribavarin was initiated six months ago. At the end of 24th week of treatment, she presented to the clinic with extensive bruising over both extremities. Laboratory data revealed hemoglobin of 8.9 g/dL, platelet count of 15 K/UL, blood urea nitrogen of 19 mg/dL, serum creatinine of 1.1 mg/dL, total bilirubin of 1.8 mg/dL, unconjugated bilirubin of 1.6 mg/dL, presence of > 1 schistocytes/hpf, negative Coombs, Lactate dehydrogenase (LDH) of 1050 U/dL, haptoglobulin of < 8 U/dL, and negative anti nuclear antibody and cryoglobulins. A clinical diagnosis of TTP was made based on presence of microangiopathic hemolytic anemia and non-immune mediated thrombocytopenia. Interferon treatment was stopped and patient was started on plasmapheresis. At the end of 8th treatment with plasmapheresis, platelets increased to 184 K/UL and LDH decreased to 200 U/dL. ADAMTS13 assay revealed decreased activity to 5% in presence of an inhibitor. Thrombocytopenia was resolved without any clinical sequelae. Results: Chronic acquired thrombocytopenia is seen in about 5–35% of patients with hepatitis C virus infection. The proposed mechanisms include direct infection by HCV of megakaryocyte lineage and/or dysregulation of the host immune system. However, thrombocytopenia may also be induced by INF-alpha therapy of chronic hepatitis C. In most cases, INF-alpha induced thrombocytopenia results from bone marrow suppression. A second rare cause of INF-induced thrombocytopenia is the development of autoimmune thrombocytopenia. Few case reports have associated TTP with INF- alpha use. Although the mechanism of this occurrence is unknown, it may involve a secondary release of cytokines, with perturbation of the immune system, or direct endothelial immunomodulating activities of INF. Conclusions: TTP should be considered in differential diagnosis of thrombocytopenia in patients with hepatitis C treated with interferon.