Prospective Observational Comparative Study Research Articles

A prospective observational study of outcome of conservative management in blunt abdominal trauma

Introduction: Blunt abdominal trauma (BAT) presently is the third most common form of trauma worldwide. The management of blunt abdominal trauma (BAT) is challenging. Management may involve non-operative measures or surgical treatment, as appropriate. Recently there has been increasing trend towards non operative management (NOM) of blunt trauma amounting to 80% of the cases with failure rates of 2-3%. NOM is a standard protocol for hemodynamically stable solid organ injuries. Present research was conducted to study the spectrum, mode of injuries and role of conservative management and its subsequent outcome in cases of BAT. Material & Methods: A hospital based prospective observational comparative study was conducted at Department of Surgery of a tertiary care hospital. A total of 50 cases of blunt abdominal trauma coming to our hospital and fulfilling eligibility criteria were included in the study after taking informed consent. After initial assessment and stabilization of the patient in the emergency ward, the patient was followed in the inpatient ward to assess for clinical improvement. Management decisions i.e. conservative or operative was taken by treating surgeons. All cases managed conservatively were monitored closely for any complications and requirement for conversion to operative treatment was noted. Data was analyzed using statistical software SPSS ver. 21.Results: Mean age of the study subjects was 32.62 years with 94% males. Most common mode of Injury was road traffic accident (80%) followed by fall from height (20%). Most common site of injury in blunt abdominal trauma cases was spleen (34%) followed by liver (26%). Conservative management was tried initially in 47 (94%) cases. A total of 7 patients out of 47 (14.9%) were converted from conservative to operative management after initial investigations. During the course of hospital stay, 4 out of 40 (10%) cases were converted to operative management. Mortality rate observed in the cases of abdominal blunt trauma in present study was 16%. A solitary patient expired on conservative management, giving failure rate in conservatively managed cases as 2.8%.Conclusion:Our study proves that non operative management is a safe and effective method in the treatment of blunt injury abdomen. Close monitoring of vital signs and repeated clinical examinations is important as management by conservative management depends on clinical and hemodynamic stability of the patient.

A Prospective Observational Comparative Study of Novel Autologous Negative Pressure Epidermal Harvesting System (ANPEHS or EHS) and Suction Blister Grafting (SBG) in Treatment of Stable Vitiligo.

Background:Vitiligo surgery has evolved a long way from punch skin grafts to the epidermal cell suspension and latest to the extracted hair follicle outer root sheath cell suspension transplantation (EHFORSCS). In the latest development, the novel technique autologous negative pressure epidermal harvesting system (ANPEHS) seems to be a good addition to the prevailing therapy in vitiligo.Aims and Objectives:The aim of this work was to study and compare novel ANPEHS and suction blister grafting (SBG) in the treatment of stable vitiligo.Materials and Methods:This was a prospective, single-centered, observational, open-labeled comparative study of the rate and final extent of repigmentation in ANPEHS or EHS and SBG in the management of stable vitiligo. The patients in this study were drawn from the outpatient Department of Dermatology of a Tertiary Care Hospital of the Armed Forces from July 1 2015 to December 31, 2016. A total of 40 patients with at least two comparable depigmented patches of 6 months’ stability were recruited. Both procedures were performed in the same patient on the same day. Informed consents were taken from all the patients. Each patient in the study had undergone a detailed clinical, general physical, systemic, and a dermatological examination. Clinical photographs had been taken before and after grafting, monthly for the first 6 months then bimonthly for the next 6 months. Donor site was preferably inner aspect of thigh.Statistical Analysis Used:“Chi-square test” and “statistical significance” (P value) methods.Results:Of total 80 patches, excellent results were seen in 82.9% patches by using the EHS method and 80% excellent results by using the SBG method. Similarly, very good results were seen in 2.9% patches and good results in 5.7% patches by using both methods. 11.4% patches showed poor results by using the SBG method and 8.6% patches showed poor results by using the EHS method.Conclusions:The EHS method is a simple, painless, less time-consuming, expensive but effective technique to produce homogeneous repigmentation without any donor site anesthesia and complication.

Assess the effectiveness of oral versus parenteral antibiotics in children under five years of age, diagnosed with severe pneumonia in a private teaching hospital, Telangana state

Introduction: The most significant and striking feature of pneumonia is consolidation. Pneumonia continues to be the biggest killer disease globally, of less than five years children. Pneumonia accounts for 15% of all deaths of children under 5 years old, killing 8, 08694 children in 2017.Methodology: Hospital based prospective observational comparative study. This study was conducted in the department of paediatrics, RVM institute of medical sciences and research canter. This study was approved by the RVM institutional ethical committee prior to the study. The study was conducted between the months of September 2019 to January 2020.100 children who are diagnosed with severe pneumonia were included in this the study.Results: A total of 100 children have been enrolled in the present study. Among them 56 (56%) are Males and 44 (44%) are Females. Male: female ratio was 1.3: 0.8. Treatment Failure rate in oral amoxicillin group is 24% and in Inj.ampicillin plus Amikacin (parenteral) group is 16%.The difference in treatment outcome in the two groups is not statistically significant. (p = 1.0000, p = 0.3173). Conclusion: Proper training of care givers and treating clinicians to promptly recognize the danger signs of very severe pneumonia, one can safely treat the patients with severe pneumonia with oral Amoxicillin.

A prospective study to determine social demographic pattern in severe acute malnutrition in 6 months to 5 years aged children

Background: Burden of malnutrition is much higher in South Asia as compared to that in Africa and rest of the World. South Asia contributes to about 60% of the cases. Education of women has been seen to be the most effective in improving child’s health. Present study is done to evaluate social demographic pattern in cases of severe acute malnutrition.Methods: Present study is prospective observational comparative study conducted at Department of Pediatrics included 175 cases after taking a informed written consent from the parent. Out of which 22 were lost to follow up and remaining 153 cases were analysed and further evaluated in the studyResults: Cases who were from 6 month to 24 months of age were 73.2% (n=112) and rest of them were above 24 months of age. Girls were 53.6 % and 46.4% were boys. Percentage of illiterate mother was 41.2%, till primary were 28.8% and Only 10.4% of mothers were graduate. Nearly 50% of the households had per capita income less than or equal to 1000.Conclusions: SAM was more common in children < 24 months of age, boys and girls were almost equally affected. Maternal literacy and low per capita income was an important factor associated with SAM patients.

Clinical efficacy and safety of trimetazidine as an add-on with standard therapy in patients with coronary artery disease of South India

PurposeThere have been few reports on the efficacy and safety of trimetazidine in the Indian population. The study aim is to assess the efficacy and safety of trimetazidine as on add-on with standard therapy in patients with coronary artery disease (CAD) of South India. MethodsA 6-month prospective observational comparative study was conducted in 100 patients with CAD. Group A received standard therapy, and group B received standard therapy along with 35 mg of trimetazidine per os (p.o.) twice daily. Quality of life was analyzed using SF-36 questionnaire, and echocardiographic parameters were recorded at the baseline and follow-up in both groups. Laboratory parameters and the safety profile were assessed in both the study groups. The data were analyzed using SPSS, version 17, software. ResultsAt the follow-up, group B patients showed significant improvement in left ventricular ejection fraction (p-value < 0.001); left ventricular end-diastolic diameter (p-value < 0.01), left ventricular end-systolic diameter (p-value < 0.01), left ventricular end-diastolic volume (p-value < 0.01), left ventricular end-systolic volume (p-value < 0.01), wall motion index score (p-value < 0.05), E/A ratio (p-value < 0.05) compared with group A patients. All eight domains of quality of life were significantly improved in group B with P-value < 0.05, whereas group A showed no difference. No deaths occurred in the study, but few side effects were recorded in both groups. ConclusionTrimetazidine along with standard therapy improved left ventricular functioning with fewer side effects.

Lung Cancer Surveillance After Definitive Curative-Intent Therapy: ASCO Guideline.

To provide evidence-based recommendations to practicing clinicians on radiographic imaging and biomarker surveillance strategies after definitive curative-intent therapy in patients with stage I-III non-small-cell lung cancer (NSCLC) and SCLC. ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, radiology, primary care, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2019. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. The literature search identified 14 relevant studies to inform the evidence base for this guideline. Patients should undergo surveillance imaging for recurrence every 6 months for 2 years and then annually for detection of new primary lung cancers. Chest computed tomography imaging is the optimal imaging modality for surveillance. Fluorodeoxyglucose positron emission tomography/computed tomography imaging should not be used as a surveillance tool. Surveillance imaging may not be offered to patients who are clinically unsuitable for or unwilling to accept further treatment. Age should not preclude surveillance imaging. Circulating biomarkers should not be used as a surveillance strategy for detection of recurrence. Brain magnetic resonance imaging should not be used for routine surveillance in stage I-III NSCLC but may be used every 3 months for the first year and every 6 months for the second year in patients with stage I-III small-cell lung cancer who have undergone curative-intent treatment.

Association of Deficiency of Maternal Vitamin D Levels with Severity of Preeclampsia

Introduction: Preeclampsia remains to be an important cause of maternal morbidity and mortality in both the developing and developed world. It is imperative to devise preventive strategies to reduce the burden of this disease. Vitamin D deficiency has emerged as an important inflammatory mediator in its pathogenesis. Objective: To find an association between the severity of preeclampsia and vitamin D deficiency amongst women attending a tertiary hospital in northern India. Material & Methods: this was a prospective comparative observational study. 125 women of preeclampsia and 125 controls were enrolled in the study after due written consent. The women of preelampsia were further divided into preeclampsia with or without severe features. After history, examination and relevant routine investigations, both groups underwent testing for vitamin D. Statistical analysis was conducted with the statistical package for the social science software version SPSS 20.0. The comparison of normally distributed continuous variables between the two groups was performed using Student’s t test and for more than two groups comparison done through ANOVA test. For all statistical tests, a p value less than 0.05 was taken to indicate a significant difference/ association. Result: 80% subjects of study group were significantly more vitamin D deficient as compared to 68% of controls (p-value=0.03). Patients with preeclampsia with severe features had significantly lower levels of Vitamin D as compared to controls indicating that increased vitamin D deficiency was associated with increased severity of preeclampsia. None of the cases with severe preeclampsia had normal levels of Vitamin D. This was statistically significant (p-value=0.046). Conclusion: Severe pre-eclampsia was significantly associated with Vit D deficiency. Prevention of Vitamin D deficiency could be beneficial to prevent pre-eclampsia but community intervention studies are required.

Prospective comparative analysis of arthroscopic debridement for primary and post-traumatic elbow osteoarthritis

IntroductionThe main aim of the present study was to compare the preoperative profiles and the efficacy of arthroscopic debridement for elbow osteoarthritis between patients with primary versus post-traumatic osteoarthritis. The study hypothesis was that the two groups would show no difference on either criterion. MethodIn the framework of a symposium of the French Arthroscopy Society (SFA), a prospective comparative multicenter study included 87 patients with 6 months’ follow-up of arthroscopic debridement for elbow osteoarthritis: 53 primary (G1) and 34 secondary (G2). Pre- and post-operative clinical assessment in both groups compared Andrews-Carson specific functional score for elbow osteoarthritis (main endpoint), and the QuickDash (QD), Patient-Related Elbow Evaluation (PREE) and Mayo Elbow Performance Score (MEPS) functional scores, pain on VAS, range of motion (RoM) and strength. ResultsArthroscopic debridement significantly improved all functional scores at 6 months, notably including the specific Andrews-Carson score, which showed gain in both groups: 68.5±28.7 (range, −5 to 110) in G1 and 62.6±25.4 (18 to 110) in G2 (P=0.35). Pain decreased significantly in both groups, by 5.1±2.6 points (range, 10 to 1) in G1 and 4.4±2.7 points (range, 8.5 to 1) in G2 (P=0.28). RoM in flexion-extension improved comparably in both groups, by 42.9±22.1 (−15 to 105) in G1 and 49.3±24.5 (10 to 90) in G2 (P=0.22). Strength in flexion improved comparably, by 7.6±4.7kg (−2 to 17.5) in G1 and 6.1±4.8kg (−1 to 13) in G2 (P=0.23). Discussion/conclusionThe study hypothesis was confirmed: there were no differences according to primary versus secondary osteoarthritis in preoperative profile or results. Elbow osteoarthritis entails mechanical impingement. Arthroscopic debridement gave good results independently of primary or post-traumatic etiology. Level of evidenceIII, prospective comparative observational multicenter cohort study.

A comparative study between open and laparoscopic repair of inguinal hernia

Background: Hernias of the abdominal wall constitute an important public health problem. Laparoscopic inguinal hernia repair (TEP) is a minimal access surgical procedure as compared to open hernia repair. The objective of the study was to compare open and laparoscopic hernia repair in terms of safety, complications, morbidity, recurrence, post-op pain and hospital stay.Methods: This was a prospective observational comparative study. Total 50 patients were taken in this study; out of them 25 patients subjected to group A (open repair of inguinal hernia) and 25 patients subjected to group B (laparoscopic repair of inguinal hernia). Postoperatively patients were observed for any complications and followed up one year.Results: Present study shows high incidence of inguinal hernia in males. Mean operative time for open hernia repair group was less than laparoscopic hernia repair group. Time to return to normal work, duration of hospital stay and postoperative pain were less in laparoscopic hernia repair group than open hernia repair group. Out of 25 patients in laparoscopic hernia repair (TEP) 1 patient had recurrence but in open hernia repair group there was no recurrence.Conclusions: Laparoscopic hernia repair is quite safe; it has definite advantages in bilateral and recurrent cases, postoperative pain, early return to normal activities, less postoperative hospital stay and better cosmetic results although it has its own disadvantages in terms of recurrence rate, operative time and cost effectiveness.

Prospective Observational Comparative Study of Response and Toxicities in Early Glottic Cancer Using Telecobalt Versus 3D-CRT.

The study was performed with 50 patients, 24 patients in Arm A and 26 patients in Arm B. Arm A-Conventional Telecobalt RT 66Gy/33 fraction in stage T1N0M0 and stage T2N0M0 and Arm B-3D-CRT 66Gy/33 fraction in T1N0M0 and T2N0M0 used. At the end of RT, 6weeks, 3months acute and late toxicities were noted by RTOG/EORTC morbidity scoring criteria for skin reaction, dysphagia and laryngeal toxicity. Fiber optic Laryngoscopy clinical assessment criteria were used to assess response after 6weeks, 3months of treatment completion. At 6weeks of follow-up-Both Arm A and B complete response rate were 83.3% and 88.5% respectively and at 3months rate were 85.0% and 95.7% respectively. There was no superiority of results with 3D-CRT over 2DRT. At the end of RT dysphagia grade 3 toxicity seen 1 patient (4.2%) but in Arm B (total 26 patients) no grade 3 toxicity found. At the end of 6week and 3month, one patient (4.3%) had grade 3 toxicity on Arm B only at 3month. All these results are comparable. At the end of RT, one patient (3.8%) had incidentally dermatitis grade 3 toxicity in Arm B only. But all the results are comparable. On follow up, 6week and 3months, no grade 3 toxicity noted. At the end of RT, grade 3 laryngeal toxicity noted in 3 (12.5%) in Arm A and 2 (7.7%) in Arm B, not statistically significant. At 6week, grade 3 toxicity found in 3/24 (12.5%) in Arm A and 2/26 (7.7%) in Arm B, at 3months, 1/26 (4.3%) patient had incidental grade 3 toxicity only in Arm B. As conformal radiotherapy is more time consuming, less available in India and more costly than 2DRT, we can consider Conventional 2D planning for patients in India where most of people belong to low economic profile. Due to limitation in sample size and long-term follow-up further randomized studies are needed to validate the results.

Choroidal Vascular Pattern in Cases of Sturge-Weber Syndrome

To study the choroidal vascular pattern in patients with Sturge-Weber syndrome (SWS) using swept-source OCT (SS-OCT). Prospective comparative observational study. All patients with SWS with no history of prior treatment for posterior segment pathology were included. Both eyes of all patients were studied using fundus imaging, SS-OCT, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICG) by 2 independent observers. The FFA and ICG were screened for any vascular abnormalities. The SS-OCT was evaluated for choroidal changes. A total of 34 eyes of 17 patients with diagnosed SWS in the age group 9 to 26 years were studied. The FFA and ICG in 7 and 11 patients, respectively, showed some vascular abnormalities. SS-OCT was performed in all patients. The diffuse choroidal hemangioma (DCH) was characterized by loss of the choroidal vascular pattern, increase in the choroidal thickness and loss of visualization of the sclerochoroidal interface. Based on the FFA, ICG, and SS-OCT imaging, there were 3 patients with no DCH, 5 with bilateral DCH, and the remaining 9 patients had unilateral DCH. The detection rate was 50% clinically: 52.94% with FFA, 82.35% with ICG, and 86.36% with SS-OCT. There was substantial agreement between the 2 observers for all 3 investigations. SS-OCT is a reliable noninvasive imaging modality for early diagnosis and follow-up of DCH over time.

Optical behavior of the eye implanted with extreme intraocular lens powers

To evaluate the induced ocular aberrations after cataract surgery with extreme low- powered and high-powered spherical monofocal intraocular lenses (IOLs) using a new pyramidal wavefront sensor aberrometer. Vissum Instituto Oftalmológico, Alicante, Spain. Prospective observational comparative study. This study included patients who had cataract surgery with implantation of a spherical monofocal IOL. The patients were divided into three groups according to the IOL power. Group 1: +20 diopters (D) to +23 D; Group 2: less than +10 D; and Group 3: +29 D or more. Assessment after 3months included: uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, contrast sensitivity function test (Ginsburg), corneal aberrometry, and total ocular aberrometry with a pyramidal wavefront sensor aberrometer (Osiris) for 4.0mm, 4.5mm, and 5.0mm pupil diameters. The study comprised 88 eyes of 56 patients. There were no differences between all groups in terms of refractive error, corneal aberrometry, or total ocular higher-order aberrations at any analyzed pupil diameter. The ocular spherical aberration (SA) was not significantly different between groups with a 4.0mm pupil. The SA was significantly lower in Group 2 when compared with Group 1 and Group 3 for both 4.5mm(P=.01 and P=.001, respectively) and 5.0mm(P=.002 and P=.002, respectively). There was no significant difference in SA between Group 1 (+20 D to 23 D) and Group 3 (≥+29 D) at any analyzed pupil diameter. Higher SA did not correlate to lower contrast sensitivity. Despite the theoretical evidence, only a negligible amount of clinically insignificant aberrations were induced by high-powered positive IOLs. Low-powered IOLs did not induce significant levels of SAs.

CT scan vs nasal endoscopy findings in the diagnosis of chronic rhinosinusitis: our experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Diagnostic nasal endoscopy and CT imaging are both widely used essential diagnostic tools for chronic rhinosinusitis (CRS). This study analyses their individual roles in the management of CRS as well as the degree of correlation between the two.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective observational comparative study was conducted in the Department of Otorhinolaryngology, Mahatma Gandhi Hospital, Jaipur from January, 2017 to June, 2018 on a sample size of 201 patients diagnosed with chronic rhinosinusitis, as per AAOHNS guidelines. DNE and CT PNS were done for all patients enrolled in the study, the findings of each were correlated and their individual sensitivity and specificity for each variable was calculated. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; On Comparing CT findings with diagnostic nasal endoscopic findings, Polyps were seen in 91 patients’ CT scans as opposed to 124 on DNE. B/L Polyps on CT imaging vs bilateral ethmoidal polyps visualized during DNE revealed a highly significant “P” value; whereas for antrochoanal polyps or unilateral polyps there was no significant difference. Maxillary sinus involvement is the most commonly observed finding in CT scan of PNS in CRS while deviated nasal septum is the most common finding on a diagnostic nasal endoscopy, seen in 60.7%. For anatomical variants like concha bullosa and paradoxical middle turbinate, no significant difference was seen.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; CT scans and DNE are both key pre-operative diagnostic tools for patients of CRS and both are complementary to each other in detecting type and extent of pathology.&lt;/p&gt;

15 - Safety and efficacy of superior calyceal access versus inferior calyceal access for pelvic and lower calyceal stones – prospective observational comparative study

15 - Safety and efficacy of superior calyceal access versus inferior calyceal access for pelvic and lower calyceal stones – prospective observational comparative study

Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: ASCO Clinical Practice Guideline.

The aim of the current work is to provide evidence-based recommendations to practicing physicians and others on the management of the neck in patients with squamous cell carcinoma of the oral cavity and oropharynx. ASCO convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2018. Outcomes of interest included survival, regional disease control, neck recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. The literature search identified 124 relevant studies to inform the evidence base for this guideline. Six clinical scenarios were devised; three for oral cavity cancer and three for oropharynx cancer, and recommendations were generated for each one. For oral cavity cancers, clinical scenarios focused on the indications for and the hallmarks of a high-quality neck dissection, indications for postoperative radiotherapy or chemoradiotherapy, and whether radiotherapy alone is sufficient elective treatment of an undissected neck compared with high-quality neck dissection. For oropharynx cancers, clinical scenarios focused on hallmarks of a high-quality neck dissection, factors that would favor operative versus nonoperative primary management, and clarifying criteria for an incomplete response to definitive chemoradiation for which salvage neck dissection would be recommended. Consensus was reached and recommendations were made for all six clinical scenarios. Additional information is available at www.asco.org/head-neck-cancer-guidelines .

Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1year.

Reducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU survivors. This study is a prospective observational comparative effectiveness cohort study involving 30 ICUs. It was an extension of the IPREA3 study, a cluster-randomized controlled trial designed to assess the efficacy of a tailored multicomponent program to reduce discomfort in critically ill patients. The program included assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to the healthcare team, and site-specific tailored interventions. The exposure was the implementation of this program. The eligible patients were exposed versus unexposed general adult ICU survivors. The prevalence of substantial PTSD symptoms at 1year was assessed based on the Impact of Event Scale-Revised (IES-R). Of the 1537 ICU survivors included in the study, 475 unexposed patients and 344 exposed patients had follow-up data at 1 year: 57 (12.0%) and 21 (6.1%) presented with PTSD at 1 year, respectively (p = 0.004). Considering the clustering and after adjusting for age, gender, McCabe classification, and ICU-related self-perceived overall discomfort score, exposed patients were significantly less likely than unexposed patients to have substantial PTSD symptoms at 1year (p = 0.015). Implementation of a tailored multicomponent program in the ICU that has proved to be effective for reducing self-perceived discomfort in general adult ICU survivors also reduced the prevalence of substantial PTSD symptoms at 1year. ClinicalTrials.gov identifier NCT02762409.

Pregnancy outcomes following maternal venlafaxine use: A prospective observational comparative cohort study

BackgroundVenlafaxine is a serotonin noradrenaline reuptake inhibitor used to treat major depressive episodes and anxiety disorders. The primary aim of this study was to investigate spontaneous abortion risks following gestational exposure. MethodsThis prospective observational comparative cohort study utilised data collected by the UK Teratology Information Service (UKTIS) between 1995 and 2018. The study sample included 281 venlafaxine exposed pregnancies matched to antidepressant unexposed (n = 1405) and SSRI exposed (n = 843) comparator groups. ResultsAfter correction for variation in competing outcome rates and the stage of pregnancy at reporting, no statistically significant differences in the hazard of spontaneous abortion was observed following gestational venlafaxine use compared with either antidepressant unexposed (HR 1.28, 95% CI; 0.850–1.94) or SSRI exposed (HR 1.03, 95% CI; 0.681–1.57) pregnancies. ConclusionsNo conclusive evidence is provided from this study that venlafaxine increases the risk of adverse pregnancy or fetal outcomes.

Effect of Perineural and Intravenous Dexamethasone on Duration of Analgesia in Supraclavicular Brachial Plexus Block with Bupivacaine: A Comparative Study.

Background:Perineural dexamethasone has been shown to improve analgesia in single injection supraclavicular block. Systemic mechanism of action of dexamethasone along with safety concerns of perineural route of administration has prompted the investigation of intravenous route as an alternative.Aims:We aim to compare the effects of dexamethasone as an additive to local anesthetic when used via perineural and intravenous route in terms of duration of analgesia and onset of motor and sensory block.Settings and Design:The study was done as a prospective comparative observational study conducted in a tertiary care hospital in India among 50 patients during a period of 1 year.Materials and Methods:Twenty-five patients aged 18–60 years, belonging to the American Society of Anesthesiologists physical status Classes I and II, receiving supraclavicular block with 0.5% bupivacaine and perineural dexamethasone were compared with similar number of patients receiving the block along with intravenous dexamethasone. Duration of analgesia, onset of sensory block, and onset of motor block were studied.Statistical Analysis:The results were analyzed using Chi-square test for qualitative variables and unpaired t-test for quantitative variables.Results:The duration of analgesia in the group receiving perineural dexamethasone (Group DP) 817.2 ± 88.011 min was comparable to the group receiving intravenous dexamethasone (Group DI) 858.00 ± 86.168, with a P = 0.104. Time to onset of sensory block in Group DP (10.20 ± 1.443 min) was significantly faster than that of Group DI (11.60 ± 1.443) with a P = 0.001. Time to onset of motor block in Group DP (13.92 ± 1.754 min) was significantly earlier than that of Group DI (14.96 ± 1.274 min) with a P = 0.02.Conclusion:It is concluded from this study that intravenous and perineural dexamethasone equally prolongs the duration of analgesia in supraclavicular block. However, perineural dexamethasone resulted in a faster onset of motor and sensory blockade.

Comparative study of different topical therapies for chronic rhinosinusitis

Objective To evaluate efficacy of different topical therapies in patients with CRS based on SNOT questionnare Design amp duration Prospective observational comparative study from February to May Setting District Hospital Pulwama A secondary care referral hospital in South Kashmir Results and conclusion A total of patients were enrolled in this study and placed in four groups of patients each in Groups A B C D SNOT questionnaire was basis of symptomatology before and after the intended topical therapy for weeks and objective outcome by diagnostic nasal endoscopy before start and again at culmination of therapy It was observed that maximum SNOT change was in Group A and B which involved topical therapy of normal saline and nasal steroid

A comparative Study of parenteral versus oral antibiotics in the treatment of severe pneumonia in children under five years of age

Introduction: Pneumonia is a disease known to mankind from antiquity. Pneumonia is an acute inflammation of the pulmonary parenchyma that can be caused by various infective and non-infective origins, presenting with physical and radiological features compatible with pulmonary consolidation of a part or parts of one or both lungs. Objective: This study is aimed to compare parenteral versus oral antibiotics in the treatment of severe pneumonia in children under five years of age. Materials and Methods: This is a prospective observational comparative study. This study was conducted in the department of pediatrics, MGM hospital, Kakatiya Medical College, Warangal. A total of 268 patients were recruited for the study as per the inclusion and exclusion criteria of the WHO guidelines for community acquired pneumonia. Results: A total of 268 children have been enrolled in the present study. Treatment Failure rate in oral amoxicillin group is 12.6% and in Inj. ampicillin plus amikacin group is 11.1%. The difference in treatment outcome in the two treatment groups is NOT statistically significant. A total of 17 out of 134 children in oral amoxicillin group have progressed to treatment failure which amounts to a failure rate of 12.68%. More than half (7/15) of the children who progressed cumulatively to treatment failure in the inj ampicillin plus amikacin group have developed at least one of the signs of WHO defined very severe pneumonia. Conclusion: In the present study it has been observed that there is no statistically significant difference in the failure rate in oral amoxicillin group and Inj. Ampicillin plus Inj. Amikacin group, suggesting similar outcome for severe pneumonia treated with oral amoxicillin and Inj. Ampicillin plus Amikacin.