Prospective Randomized Control Study Research Articles

Clinical evaluation of 0.8% hyaluronic acid gel adjunctive to scaling and root planning in the treatment of chronic periodontitis in Hyderabad Sindh.

Objective: To determine the effect of hyaluronic acid as an adjuvant to root planning and scaling for the management of chronic periodontitis patients. Study Design: Prospective Randomized-controlled Clinical study. Setting: Department of Periodontology, Faculty of Dentistry Isra Dental College Hyderabad. Period: 1st July 2022 to 31st June 2023. Methods: A total of 50 diagnosed patients of chronic periodontitis and assigned into two groups according to the treatment given. Group A received Hyaluronic acid+Scaling and Root Planning whereas group B patients received Scaling and Root Planning alone. Patients were clinically evaluated before receiving treatment. Periodontal Depth (PD), Clinical Attachment level (CAL), Blood on Probe (BOP), and Plague Index (PI) were recorded at Baseline appointments, 3rd-month appointments, and 6th-month appointments after receiving treatment. The results were analyzed by SPSS version 21. Results: in both groups, significant improvement was observed in the mean value of PD, and CAL after receiving treatment, while comparing both groups, Group A patients found more significant results (<0.05) as compared to Group B. The study also found a significant reduction in BOP and PI of both groups of patients after receiving treatment but there was not any significant difference found in the mean value of BOP and PI in both groups. Conclusion: The study was conducted to determine the effectiveness of Hyaluronic acid as an adjuvant therapy that may affect chronic periodontitis along with SRP. The current study concluded hyaluronic acid gel is an effective adjuvant therapy with SRP.

Safety and Efficacy of Enhanced Recovery after Surgery Protocol in Pediatric Patients Undergoing Hepato-Pancreatico-Biliary Surgery: A Prospective Randomized Control Study

ABSTRACT Introduction: Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body’s reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients. Materials and Methods: This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software. Results: The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups. Conclusion: Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.

Late video-assisted thoracoscopic surgery versus thoracostomy tube reinsertion for retained hemothorax after penetrating trauma, a prospective randomized control study.

Early video-assisted thoracoscopic surgery (VATS) is the recommended treatment of choice for retained hemothorax (RH). A prospective single-center randomized control study was conducted to compare outcomes between VATS and thoracostomy tube (TT) reinsertion for patients with RH after penetrating trauma in a resource constrained unit. Our hypothesis was that patients with a RH receiving VATS instead of TT reinsertion would have a shorter hospital stay and lesser complications. From January 2014 to November 2019, stable patients with thoracic penetrating trauma complicated with retained hemothoraces were randomized to either VATS or TT reinsertion. The outcomes were length of hospital stay (LOS) and complications. Out of the 77 patients assessed for eligibility, 65 patients were randomized and 62 analyzed: 30 in the VATS arm and 32 in the TT reinsertion arm. Demographics and mechanisms of injury were comparable between the two arms. Length of hospital stay was: preprocedure: VATS 6.8 (+/-2.8) days and TT 6.6 (+/- 2.4) days (p=0.932) and postprocedure: VATS 5.1 (+/-2.3) days, TT 7.1 (+/-6.3) days (p=0.459), total LOS VATS 12 (+/- 3.9) days, and TT 14.4 (+/-7) days (p=0.224). The TT arm had 15 complications compared to the VATS arm of four (p=0.004). There were two additional procedures in the VATS arm and 10 in the TT arm (p=0.014). VATS proved to be the better treatment modality for RH with fewer complications and less need of additional procedures, while the LOS between the two groups was not statistically different.

A Randomized clinical trial comparing the efficacy of ultrasound-guided erector spinae block and paravertebral block in preventing postherpetic neuralgia in patients with zoster-associated pain

Abstract Background and Aims: The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. Paravertebral block (PVB) and erector-spinae block (ESPB) are two novel techniques for treating this distressing condition. We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ). Material and Methods: Sixty patients in pain due to AHZ were selected for a prospective randomized control study after approval from Institutional Ethical Committee. Written informed consent was taken. Patients were randomized and allotted into Control-group: standard treatment (oral antivirals, analgesics, neuropathic medicines); PVB-Group: standard treatment with PVB and ESPB- Group: standard treatment with ESPB. Under ultrasound guidance, both blocks were administered with 20 ml of 0.25% bupivacaine + dexamethasone 8 mg. Efficacy was evaluated on the 15th, 30th, and 60th day post treatment. The primary endpoint was the proportion of patients with adequate relief from pain and allodynia post study. Results: The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). The proportion of patients with pain relief was higher among the PVB group compared to the ESPB group but not statistically significant (p 0.749). On day 60, the mean pain score was 2.45 (±3.05) and 2.15 (±2.7) in ESPB and PVB groups, respectively, and 4.3 (±2.27) in the control group (p 0.003). Conclusion: PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN.

Impact of bariatric surgery on cytochrome P 450 enzyme activity.

Bariatric surgeries are becoming more prevalent as obesity rates continue to rise. Being that it is an effective weight-loss procedure, it can induce significant anatomical, physiological, and metabolic alterations, which affect the pharmacokinetics of various medications. Cytochrome (CYP) P450 is a group of enzymes that are primarily responsible for metabolizing most medications. Bariatric surgery may affect CYP activity and consequently alter metabolism of various medications, and the resulting weight loss may influence the metabolism of various drugs. This study investigates the impact of bariatric surgery on which CYP enzymes are affected and their effects medications. Authors of this study did an extensive literature review and research in databases including PubMed and EMBASE. The evidence was gathered for medication efficacy influenced by enzyme fluctuations to advocate for further studies for patients that undergo bariatric surgery. The search was limited to English-language results and is deemed up to date as of September 2023. There are numerous studies that indicated alterations of the CYP enzyme activity, which affects the pharmacokinetics of medications used to treat acute and chronic conditions after bariatric surgery. There are various mechanisms involved in CYP enzyme activity leading to fluctuations and the clearance of medications and subsequently compromising the efficacy and safety of these agents. It is imperative to conduct more prospective randomized control studies with longer duration to guide clinicians on how to manage medications with various CYP activity for patients' post-bariatric surgery.

The Clinical Efficacy of Adding Ceftazidime/Avibactam to Standard Therapy in Treating Infections Caused by Carbapenem-Resistant Klebsiella pneumonia with blaOXA-48-like Genes.

Ceftazidime/avibactam (CAZ-AVI) is FDA-approved for managing infections caused by resistant gram-negative bacilli, particularly infections via carbapenem-resistant Enterobacterales pathogens. The clinical data are still limited, particularly those in Saudi Arabia. The present study is a retrospective cohort study that was carried out at the Armed Forces Hospital in the southern region of Saudi Arabia to compare the clinical and microbiological outcomes for CAZ-AVI-treated patients as monotherapy and as an add-on to standard therapy for carbapenem-resistant Klebsiella pneumonia (CRKP) OXA-48 infections to those treated with standard drugs. The study included CRKP OXA-48-like infected patients who were administered antibiotics for more than seven days from 1 August 2018 to May 2023. Patients' baseline characteristics and demography were extracted from the clinical records, and their clinical/microbiology efficiencies were assessed as per the corresponding definitions. Univariate and multivariate logistic regressions were conducted to identify the potential independent variable for CAZ-AVI efficiency. A total of 114 patient files were included for the evaluation. Among these patients, 64 used CAZ-AVI combined with standard therapy and were included in the intervention group, and 50 of them used standard therapy and were included in the comparative group. Following analysis, CAZ-AVI's clinical success was 42.2% (p = 0.028), while the intervention versus comparative groups showed decreased 30-day all-cause mortality (50.0% versus 70.0%; p = 0.036) and infection recurrence (7.8% versus 24.0%; p = 0.019), as well as substantially increased rates of microbial eradication (68.8% versus 42.0%; p = 0.007). CAZ-AVI add-on therapy rather than monotherapy showed statistically significant favored clinical and microbial outcomes over the standard therapy. Furthermore, sex (female %), ICU admission, and fever were negatively associated with patients' 30-day all-cause mortality, serving as independent negative factors. Only fever, CRP bio levels, inotropes, and ICU admissions were significant predictors influencing the CAZ-AVI's clinical efficiency. The duration of CAZ-AVI therapy positively influenced CAZ-AVI's microbial eradication, while both WBC counts and fever experiences were negative predictors. This study shows the effective usage of CAZ-AVI against CRKP OXA-48-like infections. The influencing independent variables depicted here should recommend that clinicians individualize the CAZ-AVI dose based on co-existing risk factors to achieve optimal survival and efficacy. Prospective multicenter and randomized control studies are recommended, with individualized CAZ-AVI precision administration implemented based on patients' characteristics.

Prospective Randomized Pilot Trial on the Effects of Mild Hypercapnia on Cerebral Oxygen Saturation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

A single-center prospective randomized controlled study was conducted to assess the effect of targeted mild hypercapnia (TMH) on cerebral oxygen saturation (rSO2) in patients undergoing off-pump coronary artery bypass grafting (CABG). A prospective randomized controlled study involving 100 patients undergoing off-pump CABG at U. N. Mehta Hospital, Ahmedabad, Gujarat, India. Patients were randomized to either the TMH (PaCO2 45-55 mmHg) or the targeted normocapnia (TN; PaCO2 35-45 mmHg) group, containing 50 patients in each group. Monitoring of rSO2, heart rate, mean arterial pressure (MAP), PaCO2, and peripheral oxygen saturation was done at baseline, after induction, after left internal mammary artery harvesting, at each grafting (distal and proximal), after protamine, and after shifting to the intensive care unit. The standardized minimental-state examination (SMMSE) was performed preoperatively and at 8, 12, and 24 hours postextubation. Data were analyzed using an independent sample t test. The TMH group had higher MAP during grafting (p < 0.001) and higher rSO2 on both sides during distal and proximal grafting (p < 0.001) and after protamine (p < 0.05), as compared to the TN group. Compared to preoperative values, SMMSE scores in the TN group were significantly lower at 12 and 24 hours postextubation (p < 0.001). TMH during grafting increased the cerebral blood flow and rSO2 when hemodynamic instability was very common. It has a protective role on the brain and helps maintain cognition postoperatively.

Rosacea of the scalp: Results from a retrospective and prospective randomized controlled study

Rosacea of the scalp: Results from a retrospective and prospective randomized controlled study

All-arthroscopic versus mini-open double row rotator cuff repair – A prospective randomised control study based on functional and radiological outcomes

PurposeIn an era where arthroscopic rotator cuff repair is dominant in the United States (77.9 % preference) compared to open surgery (53.33 %), a shift towards minimally invasive All-Arthroscopic (AA) techniques over classical Mini-Open (MO) repair is emerging. This study explores current trends in shoulder procedures in India and compares functional outcomes and radiological repair integrity between AA and MO techniques, which are understudied in the Indian context. MethodologyIn this prospective study, 60 patients (30 in the AA group and 30 in the MO group) with rotator cuff tears underwent assessment. Pre/post-operative clinical evaluations and 12-month follow-ups using UCLA and Oxford Shoulder Score, along with preoperative MRI and postoperative USG, were conducted. ResultsAt one-year follow-up, the AA group showed better functional outcomes (53.3 % excellent/good vs. 30.0 % in MO). No significant radiological differences (Sugaya grading) were found. Tear size was comparable with no association with functional/radiological outcomes. ConclusionThe AA group demonstrated favourable functional outcomes, matched to MO group findings, which is in accordance with global studies. Despite higher costs, the increasing popularity of AA in India is justified by enhanced results and reduced postoperative discomfort.

A comparative evaluation of 0.75% ropivacaine with fentanyl versus 0.75% ropivacaine with dexmedetomidine in intrathecal anesthesia for lower limb surgeries

Background: Anesthesia for lower limb surgeries can be administered locally, regionally (spinal or epidural), or generally. The primary option is still spinal anesthesia because of its quick onset, excellent blockage, low infection risk, low failure rate, and affordability. The most widely utilized method is bupivacaine spinal anesthesia. By extending and strengthening the sensory blockade, an adjuvant not only boosts the effectiveness of a local anesthetic but also lowers the dosage of local anesthetic drugs. Aims and Objectives: The aims and objectives of the study are to assess the synergistic effect and safety of adding dexmedetomidine to ropivacaine 0.75% in the subarachnoid block for lower limb surgeries compared to fentanyl to ropivacaine 0.75%. Materials and Methods: The present study was a prospective randomized control study, carried out at the Department of Anesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, for a period of 2 years. Two groups of 30 subjects each were selected for the study by simple random sampling. Patients with physical status ASA 1 or 2 who underwent elective lower limb surgeries were included. Patients in Group F (n = 30) received 3 mL of isobaric 0.75% ropivacaine and 25 μg fentanyl (0.5 mL) and in Group D (n = 30) received 3 mL of isobaric 0.75% ropivacaine with 10 μg dexmedetomidine (0.5 mL). Sensory testing was assessed by loss of pinprick sensation. The motor block in the lower limb was graded according to the modified Bromage scale. Duration of analgesia was noted. Hemodynamic parameters were recorded every 5 min for 1st 30 min and thereafter every 30 min till the patient complained of pain. Results were analyzed using the SPSS 20.0 version and the association was tested using Student t-test and Chi-square test. Results: The average time for sensory block onset was 2.93 ± 0.25 min in Group D and 2.43 ± 1.14 min in Group F. In both Group D and Group F, the length of the sensory block was 281.33 ± 25.15 and 144.67 ± 19.43, respectively, and was extremely significant both statistically and clinically. When compared to Group F, which had analgesia for 144.67 ± 19.43 min, Group D experienced analgesia for a significantly longer duration, 360.67 ± 16.17 min. There was a statistically significant difference (&lt;0.001). In Group D, the average motor block duration was 339.67 ± 19.21 min, whereas in Group F, it was 92.33 ± 16.95 min. Conclusion: When compared to fentanyl as an adjuvant to ropivacaine, intrathecal dexmedetomidine causes a faster onset of sensory and motor blockade and a longer duration of motor and sensory block, as well as hemodynamic stability, higher sedation, and a longer duration of post-operative analgesia.

A Study to Assess the Efficacy of Ultrasound-guided Bilateral Erector Spinae Plane Block for Total Abdominal Hysterectomy under Spinal Anesthesia: A Prospective Randomized Control Study

Abstract Background: Postoperative discomfort after a total abdominal hysterectomy (TAH) is severe. The Erector spinae plane block (ESPB) is the latest addition to the multimodal pain management regimen, providing both visceral and somatic analgesia. Aim: The aim of this study was assessed the postoperative analgesic efficacy of ultrasound-guided bilateral ESPB for TAH. Materials and Methods: 70 female patients aged 40 to 60 years, American society of anaesthesiology (ASA) physical status class I and II posted for TAH were enrolled. Group ESPB+SA(n=35) received bilateral ESPB using 0.25% ropivacaine hydrochloride 15ml with 0.5µ/kg dexmedetomidine on each side before spinal anaesthesia, while group SA (n=35) received only spinal anaesthesia. Postoperative follow-up for 24 hours.Statistical analysis used: Independent-samples student t-test. Results: The total dose of tramadol injection consumed in the first 24 hours postoperatively in group ESPB+SA was significantly low (110.34mg) as compared to group SA (334.29mg) (P &lt; 0.001). Time for first rescue analgesia was prolonged significantly in group ESPB+SA while it was very short in Group SA(P &lt; 0.001). Postoperatively the mean modified defense and veterans pain rating scale (DVPRS) for pain was lower in group ESPB+SA than in group SA, and the difference was statistically significant (P &lt; 0.001). Similarly, scores for other modified DVPRS components, such as sleep, activity, mood and stress were lower in the ESPB+SA group. Conclusions: Bilateral ultrasound-guided ESPB prior to spinal anaesthesia offers effective and prolonged postoperative analgesia, with significantly lower postoperative tramadol use and a higher satisfaction score in patients undergoing TAH under spinal anaesthesia.

Choroidal thickness after anti‐vascular endothelial growth factor in treatment‐naïve typical neovascular age‐related macular degeneration patients: A systematic review and meta‐analysis

Aims/Purpose: To evaluate the effect of anti‐vascular endothelial growth factor (anti‐VEGF) on choroidal thickness (CT) in treatment‐naïve typical neovascular age‐related macular degeneration (AMD) patients during the loading phase.Methods: A systematic literature search was conducted in CENTRAL, MEDLINE, EMBASE, Scopus, Web of Science, Clinical Trials, ICTRP and ISRCTN from inception to October 19, 2022. The protocol was registered with PROSPERO (CRD42022371192). We included both retrospective and prospective randomized controlled trials, cohort studies, case control and case series of typical neovascular AMD patients. Studies with polypoidal choroidal vasculopathy or unclear diagnoses and reports in other languages than English were excluded. Risk of bias was assessed using critical appraisal tools provided by Joanna Briggs Institute.Results: 43 studies were included in the review. Meta‐analysis of all studies reporting sufficient data and simultaneously disregarding measurement technique, macular neovascularization (MNV) type and anti‐VEGF type, yielded a significant decrease of CT with anti‐VEGF treatment. To decrease bias, sub‐analyses for Type 1 and 2 MNV sorted by anti‐VEGF type found a significant effect for both aflibercept and ranibizumab, and the effect appears greater in the aflibercept group. For Type 3 MNV, the baseline CT was generally thinner and the decrease more modest.Conclusions: Anti‐VEGF drugs decrease CT in typical neovascular AMD. There is a greater effect of aflibercept compared to ranibizumab. For bevacizumab and brolucizumab there are few studies, but available data show a tendency of greater effect in the latter. There are low numbers of randomized trials on the topic and publication bias might affect the results. More studies randomized to treatment of patients with a thin baseline choroid should be conducted.

Comparison between Lidocaine Spray and Oral Paracetamol for Pain Reduction during Amniocentesis in Second Trimester Pregnancy; A Randomize Controlled Trial

Objective: The aim of this study was to compare the efficacy of lidocaine spray and oral paracetamol on pain reduction in pregnant women in the second trimester during amniocentesis. Materials and Methods: This was a prospective randomized-controlled trial study conducted at Maternal and Fetal Medicine unit, Thammasat University Hospital, Pathum Thani, Thailand between June 2022 and April 2023. Participants were pregnant women who underwent amniocentesis during gestational age between 15 and 20 weeks. They were allocated into three groups namely lidocaine, paracetamol and control groups. Subjects in lidocaine group received 8 puffs of 10% lidocaine (80 mg) spray onto the marked puncture site for five minutes before amniocentesis and ingested 1 placebo tablet 1 hour before procedure. Paracetamol group ingested 650 mg paracetamol orally 1 hour before amniocentesis and received 8 puffs of normal saline spray on the marked puncture site. Control group received 8 puffs of normal saline spray onto the marked puncture site for five minutes before amniocentesis and ingested 1 placebo tablet 1 hour before amniocentesis. Expected pain (Te), during procedure (T0), 15 and 30 minutes after procedure (T15 and T30) were evaluated based on 10-cm visual analog scale (VAS). Results: A total of 510 pregnant women were recruited and divided equally (170 cases per group). Mean maternal age was 36.1 years old. Demographic characters of three groups were comparable. Lidocaine had more pain reduction than paracetamol and control group at T0, T15 and T30 (at T0: 3.06±2.16 vs 3.96±2.42 vs 3.92±2.35, P value &lt; 0.001, T15: 1.12±1.38 vs 1.92±1.47 vs 1.98±1.87, P value &lt; 0.001, T30: 0.64±0.95 vs 1.33±0.97 vs 1.09±1.44, P value &lt; 0.001). However, paracetamol had no significant difference in pain reduction compared to control group. Conclusion: Lidocaine spray before amniocentesis had more efficacy on pain reduction during amniocentesis, 15 and 30 minutes after procedure.

A Double-Blinded Prospective Randomized Control Study of Preoperative Administration of Intravenous Mephentermine Vs Intramuscular Mephentermine in Preventing Post-Spinal Hypotension in Caesarean Section

Context: Mephentermine by intramuscular route prevents post-spinal anesthesia hypotension. However, the intravenous route had not been tried earlier for this prophylactic purpose. Aims: Comparing the safety and efficacy of intravenous and intramuscular routes of mephentermine in preventing maternal hypotension during cesarean section (CS). The primary objective was to compare the incidences of hypotension. Methods and Material: ASA II term parturients posted for CS were randomized into three groups. Group I received intravenous mephentermine 10 mg just before spinal and 1 ml normal saline (NS) by intramuscular route 10 minutes before spinal. Group M received intramuscular mephentermine 15 mg 10 minutes before spinal and 1 ml NS by the intravenous route just before spinal. Group C received 1 ml NS intramuscularly 10 minutes before spinal and 1 ml NS by the intravenous route just before spinal. The vital parameters, episodes of hypotension, adverse events, and neonatal parameters were assessed. Results: During midterm analysis, it was found that Group I had significantly higher adverse effects, so data collection was stopped, with a total intake of 25 patients in Group M, 22 patients in Group I, and 20 patients in Group C, respectively. The incidence of hypotension was less with the use of IM (8%) and IV (22.7%) mephentermine compared to the control group (P value: &lt;0.05). Group I had significantly more adverse events like headache (59%), chest pain (36.36%), and ST changes compared to other groups (P value: &lt;0.001). Conclusions: We conclude that the intramuscular route is better for preventing post-spinal hypotension in cesarean section with lesser maternal side effects and a better Apgar score.

Improving Glaucoma Patients' Quality of Life and Adherence With a Digital Health Application: [RETRACTED

Empowering glaucoma patients to access their individual glaucoma related health data by using a digital health application leads to a significant improvement in quality of life and adherence. Evaluate the effectiveness of improvement of glaucoma associated quality of life and adherence in patients using a digital health application. A prospective randomized monocentric controlled study of 77 patients with primary open angle glaucoma. Patients were recruited at the University Hospital Erlangen. Patients in the intervention group tracked their intraocular pressure, symptoms and therapy using a digital application. Based on the collected data the SmartTonoTracker® gave patients simple statistics and basic recommendations for further treatment. An increasing score on the GlauQol-36 item questionnaire and the MMAS-8 score, conducted at baseline and follow-up by the intervention group, was considered successful. Statistical analysis was conducted using the unpaired t-test, paired t-test, Man-Whitney-U test, frequency analysis, frequency distribution and Pearson-correlation. Significant difference in the patients´ glaucoma-associated quality of life between the intervention group (rate of improvement: 7.6%, P =0.047), and the control group (rate of improvement: 0.17%, P =0.047) was shown. Also, a significant difference in adherence between the intervention group, showing a 9.8% rate of improvement ( P =0.002), and the control group, showing a 3.8% rate of improvement ( P =0.002), was shown. Enabling patients to access individual health related glaucoma data by using a digital health application and supporting them with information on their disease led to an improvement in glaucoma-associated quality of life and adherence.

Temporal effects of an original myopia song on school children’s myopia and awareness: a 3-year prospective study

ABSTRACT Clinical Relevance Raising children’s myopia prevention awareness and behaviour tends to exhibits a protective effect against myopia among schoolchildren. Background To investigate the effect of an original myopia song in raising school children’s awareness of healthier eye use behaviour and on myopia prevention. Methods In this prospective randomised control study, two groups of students from one primary schools in Jiangxi, China, were enrolled and monitored from grade 3 to grade 6 (2016–2019). The primary outcome was the change in axial length (AL) after the intervention. Secondary outcomes included changes in spherical equivalent refraction (SER), near work and outdoor time, corrected near and distant visual acuity, visual discomfort score (VDS) and accommodative lag. Results Four hundred students (193 females, 48.25%) aged 9.3 (range 8–10) years with emmetropia to moderate myopia were enrolled. Children in the myopia song group had a significantly shorter AL and less myopic refractive change than those in the control group (p = 0.04 and 0.02, respectively). Compared with the control group, children in the myopia song group spent less time on near work and more time outdoors (p = 0.04 and 0.04, respectively). At the final follow-up, the proportion of children with myopia was significantly lower in the myopia song group (30.5%) than in the control group (41%) (p = 0.03). No significant differences were found for the secondary outcomes, including corrected near and distant visual acuity, VDS and accommodative lag. Conclusions An original myopia song performed twice daily in primary schools appeared to have a modest effect on myopia control among school-aged children by changing their lifestyles in the long term.

Efficacy of ultrasound versus short wave diathermy in the treatment of chronic low back pain in patients with lumbar disk herniation: a prospective randomized control study

BackgroundLumbar disk herniation (LDH) is a cause of chronic low back pain (CLBP) treated using physical therapy (PT), including exercise and physical modalities such as ultrasound (US) and short wave diathermy (SWD). Despite the use of US and SWD, there is inconclusive evidence on their efficacy. The aim of this study was to investigate the efficacy of US and SWD in the treatment of CLBP in patients with LDH.MethodsA prospective randomized control clinical study. Individuals with radicular CLBP and LDH on magnetic resonance imaging, presenting to the Physical and Rehabilitation Medicine Department were randomized into 3 treatment groups. All participants received 10 sessions of hotpack, transcutaneous nerve stimulation (TENS) and therapeutic exercises. In addition, Group 1 received 10 sessions of therapeutic US (1 MHz, 1.5W/cm2, 10 min), Group 2 SWD (27.12 MHz, wavelength 11.06 m, induction technique, 20 min) to the lower back. Group 3 (control group) received hotpack, TENS and therapeutic exercises alone. Visual analogue scale (VAS) for LBP, Modified Oswestry Disability Index (MODI) and Short Form 36 (SF-36) were evaluated pre and post treatment and at one and three months follow up.ResultsIn all groups, VAS for LBP and MODI improved with treatment and at the one and three month follow up (p < 0.001). In Groups 1 and 2, MODI scores continued to reduce at 1 and 3 months (p < 0.001 and p = 0.012 respectively). SF-36 physical, social function and pain parameters reduced in all groups (p < 0.05). Role limitation due to physical and emotional problems, emotional well-being, vitality and mental health improved in Groups 1 and 2 (p < 0.05).ConclusionsDeep heating agents can be used as part of the physical therapy for CLBP in those with LDH with positive mid-term effects.Trial registrationNCT03835182, 02/04/2019.

Use of Low-Cost Task Trainer for Emergency Department Thoracotomy Training in General Surgery Residency Program

Emergency department thoracotomy (EDT) is an uncommon but potentially lifesaving procedure that warrants familiarity with anatomy, instruments, and indications necessary for completion. To address this need, we developed a low-cost EDT trainer. The primary objective of this study was to compare the effectiveness of a low-cost EDT trainer to teach emergency department thoracotomy with a discussion-based teaching session. Secondary objective was to study the face validity of the low-cost EDT trainer. A prospective 2-phase randomized control study was conducted. Participants were randomly divided into two groups. In phase one, baseline medical knowledge for both groups was assessed using a multiple-choice question pretest. In Group 1, each participant was taught EDT using a one-on-one discussion with a trauma surgeon, whereas Group 2 used the EDT trainer and debriefing for training. In phase 2 (1 month later), all participants completed a knowledge retention test and performed a videoed EDT using our EDT trainer, the video recordings were later reviewed by content experts blinded to the study participants using a checklist with a maximum score of 22. The participants also completed a reaction survey at the end of phase 2 of the study. OhioHealth Riverside Methodist Hospital, an urban tertiary care academic hospital in Columbus, Ohio. Nine senior surgery residents from training years 3 to 5. The mean score for the performance of the procedure for the simulation-based (Group 2) was significantly higher than that of the discussion-based (Group 1) (Rater 1: 21.2 ± 0.8 vs. 19.0 ± 2.0, p = 0.05, Rater 2: 20.4 ± 1.5 vs. 18.3±1.0, p = 0.04). Group 2 also was quicker than Group 1 in deciding to start the procedure by approximately 56 seconds. When comparing the mean pretest knowledge score to the mean knowledge retention score 30 days after training, the discussion-based group improved from 58.33% to 81.25% (p = 0.01); the simulation-trained group's scores remained at 68.33%. All the participants agreed or strongly agreed that the simulator provided a realistic opportunity to perform EDT and improved their confidence. The results of this pilot studysupport our hypothesis that using alow-cost EDT trainer effectively improves general surgery residents' confidence and procedural skills scores in a simulated environment. Further training with low-cost simulators may provide surgical residents with deliberate practice opportunities and improve performance when learning low-frequency procedures.

Randomized control trial on impact of clinical pharmacist led interventions on antibiotic stewardship program in children 0 to 18 years age in a tertiary care hospital in southern India

A prospective randomized controlled interventional study was conducted at a quaternary care multispecialty hospital in South India with the primary objective of identifying opportunities to improve antibiotic prescribing patterns in neonates, children, and adolescents. The hospital has a robust clinical pharmacist program wherein antibiotic prescriptions were checked for appropriateness of antibiotic dose, route, formulation, duration of therapy, and IV to oral switch. These characteristics of antibiotic use were therefore similar in the 75 children in the control and 75 in the intervention group. The additional clinical pharmacist interventions analyzed in this study included checking if a provisional diagnosis had been made before initiating antibiotics, ensuring that appropriate cultures were sent before starting antibiotics, time taken to optimize antibiotic therapy in accordance to the culture sensitivity report and whether the indication for antibiotics use was as per Indian Acdemy of Pediatrics (IAP) Drug Formulary recommendations. The main outcomes were that all these parameters except the first (all children had a clinical diagnosis before initiating antibiotic/s) were better in the intervention group and there was a significant reduction in the total antibiotic days, an increase in antibiotic-free days, and an improvement in the appropriateness of duration of antibiotic therapy and frequency of the antibiotic dosing. However, since the incidence of severe sepsis was higher in the intervention group, broad-spectrum and restricted antibiotics were used, and thus treatment costs were higher in this group. The results indicate that despite already existing clinical pharmacist interventions, additional ones could further improve antibiotic prescription accuracy significantly; and re-emphasized the need to employ trained pediatric general and subspecialty clinical pharmacists in sufficient numbers to implement a successful pediatric antibiotic stewardship program in a hospital.

Effect of Preoperative Oral Carbohydrate Loading on Perioperative Hemodynamic in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Study

Background: Conventional preoperative fasting is associated with intravascular volume contraction, increased stress, hyperglycaemia in the perioperative period. Recently, the concept of preoperative carbohydrate loading is introduced. This study was conducted to reveal the relation between use of carbohydrate-rich fluid and perioperative hemodynamic, perfusion index, and glucose control of the patients, who were undergoing elective laparoscopic cholecystectomy under general anesthesia. Methods: This study is a double-blinded prospective randomized control study. The patients, who met the inclusion criteria were randomly divided into 2 groups of 43 each with the help of computer-generated randomization method. Patients who received preoperative carbohydrate loading and patients who follow conventional preoperative fasting for surgery were labelled as Group E and Group S respectively. Incidence of hypotension was the primary outcome; variation in blood pressure, heart rate, perfusion index, and blood glucose level were the secondary outcomes. Results: Intraoperative hypotensive episodes were significantly lower in the carbohydrate loading group in comparison to the conventional fasting group, p=0.023. The systolic, diastolic blood pressure and perfusion index were significantly lower in the conventional fasting group. Also, the heart rate was significantly higher in the conventional fasting group. Numeric rating scale, the score for pain taken at 1 hour postoperatively was significantly lower in the carbohydrate loading group. Blood glucose level postoperatively after 24 hours was significantly more in the conventional fasting group. Conclusion: The carbohydrate loading group has better hemodynamic stability and optimal intravascular volume after induction and intraoperatively. Also, the carbohydrate loading group had better glycaemic control and better pain relief postoperatively.