Sample Student's T-test Research Articles

A comparative study of sevoflurane induction using continuous tidal volume breaths versus three vital capacity breaths technique in adult patients undergoing elective surgical procedures under general anaesthesia

Introduction: Previous studies have shown stable cardiovascular parameters and minimal airway irritation with sevoflurane induction in adults. Also, time taken for induction is comparable to intravenous drugs. The authors planned to conduct a randomized, control study to compare the effect of continuous tidal volume breaths versus three vital capacity breaths for sevoflurane induction on time taken for induction, haemodynamic parameters and intubating conditions in adult patients undergoing elective surgery under general anaesthesia. Materials and Methods: Sixty patients planned to undergo elective surgical procedures under general anaesthesia were included in study. Patients were divided randomly using sealed opaque envelope method in group 1 and group 2 of thirty patients each. Group 1 patients received continuous tidal volume breath and group 2 patients received three vital capacity breaths. The statistical analysis was done using IBM SPSS Statistics Software Version 15.0. The independent samples Student t-test was used to determine the differences in basic clinical characteristics, mean Arterial Pressure, heart Rate, and intubation time between the two groups. Quantitative data were evaluated by chi square test. Any p value less than 0.05 was considered as significant. Result: Variation in heart rate between two groups was statistically significant at 1 min. (p=0.04), 2 min. (p=0.01) and 3 min. (p=0.004) after start of induction. The time taken for loss of consciousness was significantly less in vital capacity induction group. (p Conclusion: Heart rate and mean arterial pressure remain stable during sevoflurane induction in adult patients using three vital capacity breath or tidal volume breath technique. Intubating conditions are better and time taken to lose consciousness is less with vital capacity breaths. Keywords: Sevoflurane, Adult, Tidal volume, Vital capacity.

Plasma-Based Inflammatory Signatures in Patients with Sickle Cell Disease during Baseline Health and Acute Pain

INTRODUCTION: Pain, the most common complication of sickle cell disease (SCD), presents as both sudden acute pain and chronic daily pain. However, there is wide variability in frequency and presentation of pain despite inheritance of the same monogenic gene defect. SCD has long been recognized as a chronic inflammatory condition. The ongoing effect of repeated vaso-occlusion, ischemia-reperfusion injury and hemolysis contribute to further SCD inflammation and likely pain. Regulation of the immune response can potentially modulate the inflammatory impact on pain. The collective balance of these inflammatory mediators in union in SCD patients and how this balance may change during baseline health and acute pain is unknown. The objective of this work was to determine the balance between patients' inflammatory and immune regulatory response and examine whether this balance changes during acute pain in patients with SCD. METHODS: We conducted a cross sectional analysis involving 3 cohorts: patients with SCD who were in their baseline health state, patients with SCD who had an acute pain episode and healthy African American controls. We used a novel bioassay originally developed for use in type 1 diabetes and applied to cystic fibrosis, inflammatory bowel disease and influenza to determine the inflammatory/immune regulatory response. This response was calculated as a composite Inflammatory Index (I.I.com) from these 3 patient cohorts. Patient plasma was co-cultured with cryopreserved PBMCs from a healthy donor to induce transcription (Figure 1). We identified informative transcripts that differentiate SCD patients from healthy controls thereby defining the disease-specific plasma-induced signature and retained ones differentially expressed between patients with SCD and controls that exhibit a fold change >1.4, ANOVA p-value of <0.05 and an FDR <10%. The data were subjected to ontological analyses for quantitative interpretation with Database for Annotation, Visualization and Integrated Discovery (DAVID) and Ingenuity Pathway Analysis (IPA). Our scoring strategy used the degree of induction of genes in inflammatory and regulatory ontological classes. The composite I.I.com was calculated using the average ratio between the mean log intensity of the genes classified as being "inflammatory" versus "regulatory". Independent samples Student's t-test was used to compare the mean I.I.com between 1) SCD baseline health cohort and controls and 2) SCD baseline health cohort and SCD acute pain cohort. RESULTS: Plasma from 16 patients with SCD in baseline health, 27 patients with SCD with an acute pain episode, and 45 African American controls were collected and analyzed. The average age of the study population was 12.6 (SD=3.6) years old and 52.3% were female. Quantitative scoring of plasma-induced signatures showed SCD patients had significantly higher mean I.I.com during baseline health compared to controls (0.713 vs. -1.235-12, p=5.4625-11). In addition, patients with SCD during acute pain episodes had significantly higher I.I.com than patients in baseline health (1.282 vs. 0.713, p=5.2051-8) (Figure 2). Heat map in Figure 3 shows differential gene expression between the cohorts; green and red colors in heat maps represent lower or higher relative expression respectively. CONCLUSION: Our findings show distinct immune signatures in SCD patients compared to controls and distinct signatures in SCD patients during acute pain episodes as compared to baseline health. The novel assay used to assess the inflammatory and immune regulatory gene expression in the three cohorts studied allowed for the determination of the balance between the two immune states. The imbalance between inflammation and immune regulation shown in our results in SCD patients of SCD pain. Further investigation into the specific inflammatory pathways that contribute to altered immune response could lead to novel targets for pain treatment. Disclosures Mucalo: NIH/NINDS: Research Funding; NIH/NHLBI: Research Funding. Jia:NIH/NHBLI: Research Funding; NIH/NINDS: Research Funding. Panepinto:NINDS: Research Funding; HRSA: Research Funding; NINDS: Research Funding; NHLBI: Research Funding. Roethle:NIH/NHLBI: Research Funding; NIH/NINDS: Research Funding. Hessner:NIH/NHLBI: Research Funding; NIH/NINDS: Research Funding. Brandow:NIH / NHLBI: Research Funding; Greater Milwaukee Foundation: Research Funding.

In vivo study of interferon-γ, transforming growth factor-β, and interleukin-4 gene expression induced by radioadaptive response.

In the present study, the radioadaptive role of the immune system induced by low dose (LD) was investigated for its in vivo protective activity. Quantitative analysis of cytokine gene expression was assessed for their in vivo activity in BALB/c mice. To evaluate the adaptive response induced by LD on the mice spleen lymphocyte, the cytokine interleukin (IL)-4, interferon (IFN)-γ, and transforming growth factor (TGF)-β expression was measured by a real-time quantitative polymerase chain reaction. To verify the radioadaptive effect of LD, animals were preirradiated at 10 cGy from a 60 Co source and then challenge dose at 200 cGy was delivered. Independent sample student's t-test was employed to compare cytokine gene expression in radioadaptive (10 + 200 cGy), LD (10 cGy), high-dose (HD, 200 cGy), and control groups of animals. Following the HD, the cytokine gene expression of IFN-γ, IL-4, and TGF-β was significantly decreased compared to the control group (P = 0.0001). However, TGF-β expression was also decreased significantly in the LD and adaptive groups compared to the control group (P = 0.0001). IFN-γ/IL-4 ratio in the adaptive group was significantly decreased compared to the HD group (P = 0.0001). These results indicate that the immune system plays an important role for radioadaptive response induction by LD radiation to adjust the harmful effects of HD irradiation.

A Pilot Study of Serum Parathyroid Hormone in Acute Coronary Syndrome

Acute coronary syndrome (ACS) is the public health issue as it is the single most common cause of death in the world. Role of vitamin D in cardiovascular health is of much interest at present. Experimental, as well as, some observational studies suggest that vitamin D and its metabolites are integrally related to blood pressure and the rennin-angiotensin system. Vitamin D insufficiency affects almost 50% of the population worldwide. Few studies have been carried out to determine the prevalence of hypovitaminosis D in Bangladesh . 30 Patient with ACS were included in this study who had admitted in the department of Cardiology of Bangabandhu Sheikh Mujib Medical University (BSMMU) patient with in first 48 hours of the onset of chest pain. This study was conducted from 1st July’18 to 30th June’19 (One year) by Purposive sampling. Data analysis was carried out by using the statistical package for Social Science (SPSS) version 20.0 windows software. Baseline characteristics have been compared using the independent sample student t-test test where appropriate. The student t-test was used to assess the correlation between PTH levels. p-value <0.05 was taken as significant. We found an association between elevated PTH levels and ACS.
 University Heart Journal Vol. 16, No. 2, Jul 2020; 71-77

What is the appropriate aganglionic bowel length on contrast enema for attempting single stage transanal endorectal pull-through in Hirschsprung disease?

PurposeTo identify influence of different values of age and abnormal bowel length in HD patients selected for single stage TERPT which affects the technique of surgery. MethodsThis observational study was carried out for over 2.5 years. All children younger than 14 years old with clinical suspicion for HD, typical transitional zone (TZ) on contrast enema (CE) distal to splenic flexure, preoperative diagnosis approved by full thickness biopsy, no previous surgical history and no urgency were included. The distance between the anus and TZ was considered as aganglionic length on CE. Biopsy was taken from distal to proximal of resected bowel to reach circumferentially normal innervated bowel. Paired sample Student's t-test, Pearson correlation test, receiver operating characteristic (ROC) analysis were performed. ResultsForty-eight patients were enrolled in this study. Measured mean for aganglionic bowel length on CE and pathology were 33.5 ± 17.1 cm and 56.8 ± 33.5 cm, respectively (p < 0.01). Correlation coefficient (R) and coefficient of determination (R2) were 0.632 and 40%, respectively (p < 0.01). The difference between radiologic and pathologic measurements in females was higher than males (mean: 29.3 vs 21.9 cm) but was not statistically significant (p = 0.75). There was statistically significant difference between CE and pathologic results in the infants younger than 10 months (p = .004). Abnormal bowel length equal to 52 cm predicted requirement of laparoscopy assistance/laparotomy with 75% sensitivity and 85% specificity. ConclusionOur investigation showed it is safe to attempt for single stage TERPT when aganglionic length on CE is less than 52 cm and the child with HD is older than 10 months. Chance of requiring additional laparotomy or laparoscopy assistance is low in these patients. Type of studyStudy of diagnostic test. Level of evidenceLevel II.

Effectiveness of a short functional restoration program for patients with chronic low back pain: A cohort study of 193 patients.

Functional restoration programs (FRPs) are integrative programs to improve function in chronic low back pain (cLBP). They are costly and time-consuming. The aim was to assess the effectiveness of a condensed FRP (CFRP) for patients with cLBP in professional activity. Longitudinal 3 months study of patients with cLBP in one tertiary care hospital, participating in a CFRP over 4 separate days. The primary outcome was the Oswestry Disability Index (ODI). Secondary outcomes included pain, quality of life (EQ5D), patient acceptable symptom state, presenteeism, absenteeism and psychological distress. Outcomes were compared using paired sample Student's t-test or Chi2 between baseline and last follow-up. Logistic regression was used to identify factors associated with better response (improvement of ODI higher than 12.8). In all, 193 patients were analysed, mean age 44.6 (standard deviation (SD) 10.4) years, mean cLBP duration 9.0 (SD 8.8) years. A small improvement was observed for ODI (mean difference -5.9, 95% confidence interval: -7.6, -4.1), as well as most other outcomes. Multivariate analysis showed an association between ODI improvement and higher duration of low back pain (odds ratio for 5 years: 1.41 (1.06,1.88)) and lower baseline back strength (Sorensen, odds ratio for 1min: 0.54 [0.29,0.99]). This CFRP showed small effect to improve function, pain and other quality of life, in cLBP. Four-day programs may be an interesting option in cLBP patients still in professional activity for whom a long 1-month FRP is difficultly manageable. Further studies with randomized controlled designs are needed to confirm the benefits.

P1001Efficacy of ranolazine for the prevention of atrial fibrillation in high-risk patients with chronic coronary syndrome and hypertension

Abstract Background Ranolazine currently is used to relief angina symptoms in patients with chronic coronary syndrome (CCS). Additional its anti-angina effect it has been showing antiarrhythmic effect by predominantly inhibiting late sodium and rapid potassium rectifier current. We aimed to assess the efficacy of ranolazine for the prevention of atrial fibrillation (AF) in high-risk patients older than 60 years with CCS at least &amp;gt;5 years and hypertension. Methods 264 older high-risk patients (&amp;gt;60 years) with CCS and hypertension were prospectively enrolled (mean age was 66 ± 11.5 years, male 48%). Among them 132 patients have received additional ranolazine to the standard therapy while control group patients (n = 132) have received only standard therapy. Mean follow-up period was 5.0 ± 4.6 years. All statistical analyzes was performed using one sample student t-test. Results Initial baseline characteristics of patients were not statistically different. During the follow-up period in 8.3 % (n = 11) of patents have occurred MACE (AMI, PCI, CABG, death) in ranolazine group vs. in 9.8% (n = 13) of patients in the control group (P &amp;gt; 0.05). During the follow-up AF (paroxysmal and persistent) was developed significantly lower in ranolizine group than standard group (respectively: 13.6 % vs.18 percentage; P &amp;lt; 0.05). Sinus rhythm was recovered in the higher percent of patients in ranolazine group than standard group after cardioversion (89% vs. 79%, P &amp;lt; 0.05). Conclusion: Adding ranolazine to the standard treatment seems to have a beneficial role for the prevention of AF in high-risk patients with CCS and hypertension.

The Effect of Residual Food Stain on Candida Albicans Colonisation of Denture Acrylics

Objectives: In the UK, 19% of adults wear dentures. Failure to keep a denture clean can lead to staining from foods, along with subsequent colonisation of the denture and associated mucosa by microorganisms, particularly Candida albicans. This colonisation can potentially lead to chronic erythematous candidosis and other oral infections. This study investigated the association between staining of denture acrylics by different food types and subsequent C. albicans colonisation. Materials and Methods: Chemically polymerised acrylic specimens were produced and stained for 14 days with six different combinations of food stains. The level of acrylic staining was determined spectrophotometrically. Specimens were then incubated in Sabouraud-dextrose broth (SAB) or SAB inoculated with Candida albicans. Confocal laser scanning microscopy coupled with propidium iodide staining of C. albicans was used to determine the extent of C. albicans colonisation to these acrylics. Results analysed descriptively and by one-way analysis of variance (ANOVA), one sample student t-test, and Dunnett’s test. Results: Acrylics in Group 4 (stained with spices, tomato puree, acai berry juice and sunflower oil) exhibited highest staining but had low C. albicans colonisation. Highest C. albicans colonisation occurred with Group 5 (sunflower oil) stained acrylics. The unstained control acrylic group had lowest colonisation. Conclusion: This study demonstrated that staining acrylics with certain foods promoted C. albicans colonisation, but this was not associated with level of visual staining. Further research is required to determine the precise mechanism(s) by which residual food stains promote candidal colonisation on denture acrylics. This knowledge may then be used by dental professionals to advise patients on improving denture hygiene to improve not only denture aesthetics but also minimise Candida biofilms.

Randomized Controlled Trial to Compare Baska® Mask versus ProSeal Laryngeal Mask Airway for General Anesthesia with Intermittent Positive Pressure Ventilation.

Introduction:A myriad of supraglottic airway devices (SADs) are developed over time to search the device that conforms to the anatomy of the human respiratory tract noninvasively, but these devices are associated with the risk of aspiration. Baska® mask (BM) is the latest addition to the family of SADs to circumvent the incidence of aspiration.Aims of Study:The aim of the study was to compare the sealing pressure and rapidity of the insertion of BM with ProSeal laryngeal mask (PLM) airway and the incidence of laryngopharyngeal morbidity between two devices.Materials and Methods:A randomized prospective open-label study was done on sixty adult patients of the age group of 18–60 years after approval from the institutional ethical committee and registration of trial in the Clinical Trials Registry. The patients were randomly divided into two groups: Group I (BM) where BM was inserted after the induction of general anesthesia and Group II (PLM) where PLM was inserted after induction. The airway sealing pressure in BM was calculated. The mean time of insertion of respective SAD and the number of successful attempts were also recorded in both groups. For analysis of continuous variables, independent sample Student's t-test was applied, and for categorical variables, Chi-square test was used. P < 0.05 was considered statistically significant.Results:The rate of successful attempts of insertion was comparable in both the groups. The mean insertion time was 14.25 ± 3.82 s in BM group and 22.01 ± 2.64 s in PLM group, which was statistically significant. The airway sealing pressure was 30.25 ± 3.34 cmH2O in BM group and 23.50 ± 4.05 cmH2O in PLM group, which was also statistically significant.Conclusion:BM has better ease of insertion with adequate sealing pressure as compared to PLM airway, thus reducing the chances of aspiration and offering its potential application in securing airway in emergency situations.

Association of eruption timing of first permanent molars and incisors with body mass index of children in Bengaluru City

Background: Tooth eruption is influenced by various factors which include physiological and genetic factors. The first permanent teeth to erupt are the permanent first molars at the age of 6 years. The timing of eruption of permanent teeth can be affected by the body mass index (BMI) which is a predictor of the overall growth of the child. Aim: The aim of the study was to determine the association of eruption timing of the mandibular and maxillary first permanent molars and incisors with BMI of children in Bengaluru city. Materials and Methods: In this cross-sectional study, 3166 schoolchildren (1636 boys and 1530 girls) between the ages of 5 and 10 years were selected. Oral examination was carried out to record the presence of the permanent first molars and incisors. The height in meters and weight in kilograms of each child were recorded and the BMI was calculated. Statistical Package for Social Sciences for Windows, Version 22.0, Released 2013, IBM Corp., Armonk, NY, USA, was used to analyze the data. The median age of eruption was calculated by using Probit analysis. Independent sample Student's t-test was used to compare the distribution of erupted teeth between girls and boys at different age groups. The association between BMI and eruption timing was derived using Pearson's correlation coefficient. Results: The first permanent tooth to erupt was the mandibular first molar at the age of 5.76 ± 1.3 years. Girls showed an earlier age of eruption of all the teeth except the mandibular central incisors. A statistically significant inverse association was seen between BMI and eruption timing of the teeth examined (P

Ni-Ti alloy remnants after root canal preparation with Ni-Ti engine-driven files: a preliminary report

Aim: Aim of the present study was to assess any signs of Ni-Ti alloy remnants in the root canal after preparation and investigate if this aspect may be influenced by the steam sterilization of the files. Materials and Methods: 20 extracted upper first premolars with complete root formation and apical foramina and three kits of BioRace instruments (FKG, Le Chaux-of-Fonds, Switzerland) were used in the present study. The first BioRace kit was used to prepare 10 teeth (20 canals), without sterilization between the root canal preparations, while the second sample group was subjected to steam sterilization after each tooth (two canals) prepared. The third kit of instruments was used as a control group. Files were then analyzed by means of scanning electron microscope (SEM) using magnifications between 500 and 4.000x. Images were taken on sections D1-D8 of each file. Files weight was measured using a precision weight scale with readability of 0,001g to quantify the possible alloy loss and file degradation occurred during their use. Teeth were then sectioned on their length and submitted to EDX analysis in search of possible alloy particles within the root canals, using magnifications between 30 and 300x. In the same manner, the irrigant used during the root shaping was collected and analyzed. Differences in weight were statistically analysed using the independent sample Student t-test (p<0.05). Results: No file separation was registered in both groups analyzed. Weight measurements and SEM micrographs showed signs of higher degradation for samples from group 2. EDX analysis showed some Ni-Ti particles in roots prepared in group 2. Conclusions: Metal strips, weight loss and micro-fractures appeared on the files subjected to steam sterilization between the uses. Ni-Ti particles detached from files, during their intra-canal use were found on the root canal walls.

Modulation of the inflammatory response benefits treatment-resistant bipolar depression: A randomized clinical trial

ObjectiveThe goal of this study was to reduce treatment resistance and enhance antidepressant response in patients with treatment-resistant bipolar depression (TRBDD) by modulating inflammatory activation. MethodsForty-seven TRBDD patients completed a randomized, double-blind, placebo (PBO)-controlled two-arm study using celecoxib (CBX), a cyclooxygenase 2 (COX-2) inhibitor, in combination with escitalopram (ESC). The Hamilton Depression (17-Item) and the Hamilton Anxiety Rating Scales were used to quantify symptom severity. Self-rating instruments included BDI, BAI and QLES-Q questioner. An adverse events inventory was used, and the possibility of bleeding diathesis was monitored. Complete blood count (CBC), prothrombin time (PT), and activated partial thromboplastin time (APTT) were determined. Comparison of mood scores between the CBX and PBO groups were conducted using a mixed ANOVA and an Independent Sample Student t-test. ResultsThe CBX adjunctive treatment produced significantly more responders and remitters than the PBO arm. Compared to the PBO group (n = 20), the CBX group (n = 27) experienced lower depression severity through the entire course of the study, showing significant decrease in depression and anxiety scores as early as week 1. Except for initial mild nausea, no adverse events were reported and study medications were well tolerated. ConclusionsModulation of the inflammatory response through targeted inhibition of the enzyme COX-2 by means of CBX reduces TRBDD and augments and accelerates treatment response in an efficacious and safe manner. Future studies should replicate these findings and additionally investigate whether prolonged administration of CBX is required to maintain remission by adding a discontinuation phase to the study design. Trial RegistrationClinicaltrials.gov ID: NCT01479829.

4944The contribution of familial hypercholesterolemia (FH) to premature coronary artery disease decreased by 2-fold between 1998 and 2018 in a founder population with high prevalence of FH

Abstract Background Familial hypercholesterolemia (FH) is an autosomal dominant trait associated with high risk of premature coronary artery disease (CAD). The worldwide prevalence of FH is estimated at 1:250 to 1:500. In certain populations, including French Canadians (FC), the prevalence is significantly higher however. From 1995 to 1998, FH contributed to 9.6% of angiographically proven CAD in a FC founder population, the burden being the highest in men aged &lt;50 years (20.6%). In the past 2 decades, powerful statins, ezetimibe and other low-density lipoprotein-Cholesterol (LDL-C) modulators, such as PCSK9 inhibitors, have been progressively introduced and several FH diagnosis scoring systems or guidelines have been developed and disseminated in order to facilitate FH recognition and management. The impact of these measures on the FH burden is however not documented. Purpose To compare the burden of FH twenty years apart in FC patients hospitalized for CAD. Methods Lipid profiles, cardiovascular risk factors and FH status of 1,132 FC patients who were hospitalized for a CAD event and who consecutively attended the cardiovascular disease clinic in 2017 and 2018 were compared to those of 2,506 who consecutively presented angiographically proven CAD two decades ago. FH status was based on Simon Broome and FH Canada definitions. In 1998, all consenting CAD patients were also molecularly screened for the most prevalent FH causing mutations in FC. Comparisons between groups were performed using Chi-square and independent samples Student's t-test. Results Most patients in both cohorts were males (74.5% vs 73.9% in 1998 vs. 2018, respectively). At admission, mean LDL-C (± SD) was 3.99±1.67 in 1998 vs. 2.22±1.06 in 2018 (p&lt;0.001). The proportion of patients who were treated with a statin or another lipid lowering agent was 32.9% in 1998 compared to 67.6% in 2018 (p&lt;0.001) and the drug regimen was also significantly different. In 1998, 24.6% of patients had LDL-C &gt;5.0 mmol/L at admission compared to 4.2% in 2018. Definite FH was diagnosed in 9.6% of patients in the 1998 cohort compared to 4.7% in the 2018 cohort (p&lt;0.001). FH patients hospitalized for CAD were significantly older in 2018 than in 1998 (56.3±11.3 vs. 49.2±10.9 in men, p=0.001; 61.1±11.8 vs. 53.2±12.3 in women, p=0.02). In the same period, the relative burden of diabetes and other lipid disorders, including high-density lipoprotein dysmetabolism significantly increased (p&lt;0.001). Conclusions Over a period of 20 years, in a founder population with a high prevalence of FH, the contribution of FH to hospitalizations for CAD decreased by 2-fold and affected patients now tend to be hospitalized at an older age than 2 decades ago. This suggests that early diagnosis and more effective management of FH in the last 2 decades have contributed to significantly decrease its burden. Acknowledgement/Funding ECOGENE-21, Amgen, Sanofi

Platelet Rich Plasma Therapy and Understanding the Risk Factors of Heel Pain Syndrome

Category:Basic Sciences/Biologics, Hindfoot, SportsIntroduction/Purpose:Heel pain syndrome is a complex condition causing morbidity and decreases the quality of life in our adult population. It is known that individuals with a body mass index (BMI) of more than >30 kg/m2 have increased risk of plantar fasciitis. However, heel pain consists of larger entities not merely to plantar fasciitis alone. Limited study mentioned the association between hypertension and musculoskeletal pain. Platelet rich plasma (PRP) therapy is an emerging treatment option for its regenerative properties in the treatment of degenerative enthesopathic conditions as in plantar fasciitis and lateral elbow epicondylitis. We hypothesize that obesity (BMI>30 kg/m2) and hypertension do influence the poorer outcome after PRP injection in individuals with heel pain.Methods:We analysed 154 heel pain cases from orthopaedic outpatient clinic that were treated with PRP injection. BMI and BP were taken as preadmission measurements with at least three readings for blood pressure. PRP was harvested from the antecubital vein, and spun in a centrifuge machine. Follow-up was conducted with AOFAS Ankle Hindfoot system before injection, 6 weeks and up to 2 years after injection.Results:Mean age was 49.96 (range 20-81 years old) with 52.60% female and 47.4% male. Plantar fasciitis was the majority source of heel pain (71.43%) followed by achilles tendinopathy (26.62%), posterior tibial tendon disorder (1.3%), and peroneal tendinopathy (0.65%). One hundred and twenty-eight (83.1%) patients achieved resolution of heel pain and related symptoms after injection. Statistical analysis was performed using one sample student t-test. No statistical significant result was found in both overweight (p =0.29) and obesity grade 1 (p = 0.40). Statistical significant result found in the prehypertension group (p<0.04).Conclusion:Based on this preliminary data, we recommend weight loss with trials of lifestyle modification in individuals with obesity, and better control of our patients’ blood pressure in order to achieve comparable outcome with normal BMI population.

Ligandless dispersive solid phase extraction of cobalt ion using magnetic graphene oxide as an adsorbent followed by its determination with electrothermal atomic absorption spectrometry

ABSTRACT Ligandless dispersive solid phase extraction technique was used for preconcentration of cobalt ion (Co2+) followed by its determination using electrothermal atomic absorption spectrometry (ETAAS). Graphene oxide (GO) was synthesised from graphite by the Hummer method and chemically magnetised to synthesise of the magnetic graphene oxide (MGO). The synthesised MGO was characterised by the Fourier transform-infrared spectrophotometry (FT-IR), vibrating sample magnetometer (VSM), scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) and then used as an adsorbent for solid phase extraction of Co2+. The main parameters affecting the extraction recovery of Co2+ including pH of sample solution, amounts of adsorbent, extraction time and type and concentration of desorption solvent were investigated and optimised. The calibration curve was plotted in the range of 0.08–1.2 µg L−1 Co2+ with a correlation coefficient of 0.9987. The intra-day precision based on six replicate analysis of 0.2 µg L−1 Co2+ was 3.8% and the limit of detection (LOD) was 0.023 µg L−1 Co2+ (n = 5). Also, the adsorption isotherms and adsorption kinetics were investigated and based on the obtained results, the adsorption of Co2+ onto the MGO nanocomposite followed by both Langmuir and Freundlich isotherms with a maximum adsorption capacity of 114.9 mg g−1 Co2+. The results of kinetic models also show that the adsorption of Co2+ followed by the pseudo second order kinetic model. The accuracy of the proposed method was successfully checked by the analysis of two certified reference materials including certified reference material-trace metals in drinking water (CRM-TMDW) and spinach leaves 1570a samples (Student t-test with 95% confidence limit, n = 5). Finally, the proposed rapid and efficient solid phase extraction technique was used for the determination of trace levels of Co2+ in the human saliva, urine and different real samples.

Direct and fast determination of polychlorinated biphenyls in contaminated soils and sediments by thermal desorption-gas chromatography-tandem mass spectrometry

A direct procedure based on thermal desorption-gas chromatography-tandem mass spectrometry (TD–GC–MS–MS) was developed for the fast extraction of seven polychlorinated biphenyls (PCBs) from sediments and soils. PCBs were directly extracted, from 20 to 75 mg of sample, without any chemical pre-treatment or use of organic solvents, after the addition of 10 µL internal standard (PCB 195) in acetone. Sample treatment was totally automated. PCBs were extracted at 250 °C for 20 min, using a helium flow and the PCBs were trapped in a cryogenic Tenax trap at −10 °C. After that, analytes were directly desorbed at 270 °C and introduced to the GC–MS–MS system. Recoveries were established using spiked soil and sediment from 2.5 to 50 ng g−1, obtaining values from 74 to 127%. The limits of quantification were from 1.0 to 1.7 ng g−1 for soil and from 0.3 to 0.4 ng g−1 for sediments, respectively. Precision, assessed as the relative standard deviation (RSD), was lower than 8 and 11% for sediment and soil analysis, respectively, except for PCB-28 in soil samples which provided a RSD of 18%. Certified reference material and field samples were analysed by the proposed TD–GC–MS–MS method. Results were compared by a paired samples Student's t-test with those obtained by a reference extraction procedure based on pressurized solvent extraction, followed by stir bar sorptive extraction, being statistically comparable (α = 0.05). A comprehensive greenmetric evaluation of the proposed method was carried out, having the TD extraction a negligible environmental impact as compared to conventional extraction procedures.

Cost Effective Analysis Between Glimipiride and Gliptin Used in Diabetic Patients in Tertiary Care Hospital

Diabetes mellitus is a spectrum of common metabolic disorders arising from various mechanisms all resulting in hyperglycemia. It is a disorder which can lead to coronary artery disease, cerebro- vascular disease, Nephropathy, Diabetic retinopathy, Neuropathy. So, early treatment is necessary to prevent these complications. In this regard, Oral Hypoglycemic drugs are most common type of treatment given for patient. A better cost effective drug can minimize the economic burden on the patients as it is a chronic diseases. The present study was aimed to asses cost effectiveness between glimepride and gliptin that may improve the clinical and economical aspect of patient and increase quality of health in patient. The present study was made to conduct cost effective analysis between glimepride and gliptin. It is a prospective observational study conducted in Basaveshwara Medical College, Hospital and Research Centre and Chitradurga Diabetic Centre for a period of six months. Patients admitted in General medicine above the age of 30 yrs are included. The data was collected from medical records of the patients and documented in suitable designed form.A total of 104 patients were enrolled during the study period, 70 are inpatients and 34 are outpatients. 5 were dropped out from the study. The results reveal that Glimepride has got more efficacy than gliptin. It provided long term Glycemic control than gliptin and also remain less costly compare to gliptin. The one sample student T-test results showed the P value was 0.000*. After follow up glimepride proved to be cost effective drug. Increased health expenditures have led to the need to find out the optimal therapy at the lowest price. This study concluded that Glimepride is more efficacious and cost effective drug than Gliptin. Since diabetes is a chronic disease with long duration, Glimepride might be preferred to Gliptin. It also reveal that glimepride leads to improvements in quality adjusted-life expectancy and is a cost-effective option for the treatment of Type 2 diabetes.

Do cosmetic treatments increase the incorporation of amphetamines into hair?

According to several studies, the concentration of drugs in hair may decrease by bleaching or dyeing; however, at the same time, treated hair could incorporate greater quantity of drugs from sweat or sebum than intact hair. The aim of this study is to assess the incorporation of amphetamine (AP), methamphetamine (MA) and 3,4-methylenedioxy-methamphetamine (MDMA) from sweat or sebum to virgin, dyed, and bleached hair. Drug-free head hair samples (from 20 volunteers) were divided into four locks, one of them was left untreated, another was subjected to dyeing treatment, and the last two were subjected to different degree of bleaching. Virgin, dyed, mildly as well as severely bleached locks of hair were exposed to artificial sweat or sebum containing AP, MA, and MDMA (500 ng/g), at 37 °C for a time period of 8 and 24 h, respectively. After the exposure, all the hair samples were tested by GC/MS in SIM mode, applying an already published method. Drug concentrations in hair ranged 0.41 to 2.20 ng/mg from artificial sweat, while only reached 0.27 ng/mg from artificial sebum. The differences of each drug concentration (AP, MA, MDMA) between different kind of hair were statistically compared: virgin hair vs. dyed hair, virgin hair vs mildly bleached hair, virgin hair vs. severely bleached hair. The differences between different drugs concentration within each kind of hair (virgin, dyed, mildly and severely bleached) were, as well, statistically compared: AP vs. MA, AP vs. MDMA, MA vs. MDMA. In all cases, differences were calculated between locks of hair from the same volunteer. The paired samples Student's t-test was applied in cases where the concentration differences followed the normal law. In these cases the extent of the difference was calculated with a confidence interval of 95%. The paired samples Wilcoxon's t -test was applied in cases where the concentration differences did not follow the normal law. Regarding the incorporation of AP, MA and MDMA from artificial sweat in vitro, the analysis provides evidence that the mean concentration for each drug in dyed or bleached hair is higher than the mean concentration in virgin hair, and that the differences between means are likely to be between 0.15 and 0.57 ng/mg, depending on the drug and the compared pairs. The incorporation of different drugs in the same kind of hair shows little differences in virgin and dyed hair, but the mean concentration of MDMA in bleached hair is higher than the mean concentration of AP; the differences between means are likely to be between 0.08 and 0.16 ng/mg. Regarding the incorporation of AP, MA and MDMA from artificial sebum in vitro, the differences between mean concentrations are lower for every compared pair, in relation to the incorporation from sweat. AP is not incorporated into hair from sweat or sebum to a greater extent than MDMA. Higher positivity rates for AP have been found in dyed or bleached hair in relation to virgin hair, detecting both significant [1] and non-significant [2] differences in the target populations. Based on these facts and the quantitative results of in vitro incorporation of amphetamine derivatives in hair, when interpreting the results from cosmetically treated hair, consideration should be given not only to the possibility that the treatment will lead to a decrease in drug concentration, but also to an increase. This consideration is particularly relevant if the detected levels are close to the cut-off.

The prevalence of anxiety, stress, and depression with respect to coping strategies in caregivers of patients with head injuries

Context: Psychological problems are very common in traumatic patients' caregivers necessitating usage of appropriate coping strategies to promote their mental health. Aim: The aim of this study was to assess anxiety, stress, and depression as well as coping strategies in caregivers of patients with head injuries. Settings and Design: In this cross-sectional study, 127 caregivers of traumatic patients referred to educational hospitals of Zabol city were selected by convenience sampling method. Subjects and Methods: The data were collected using a demographic questionnaire, as well as Depression, Anxiety and Stress Scale-21 and the Jalowiec coping strategies tools. The data were analyzed using descriptive statistics, one-way ANOVA, independent samples Student's t-test, and multivariate regression model. Results: Our findings showed that more than 70% of the caregivers of patients with head injuries suffered from severe and very severe stress and anxiety. The multivariate regression model demonstrated a negative and significant relationship between either stress (B = −0.81 P = 0.001) or depression (B = −1.23 P = 0.000) and problem-based coping strategies. Furthermore, stress (B = 0.64 P = 0.006) and anxiety (B = 0.74 P = 0.002) were negatively associated with emotional-based coping strategies. Conclusion: Considering the high rates of anxiety, stress, and depression in caregivers of patients with head injuries and significant associations observed between these variables and problem-based strategies, it is necessary to identify and obviate factors leading to anxiety and to educate coping strategies to these individuals.

251: Accuracy of colorimetric quantitative blood loss estimation for identification of postpartum hemorrhage

Accurate estimated blood loss (EBL) is a core tenet of postpartum hemorrhage (PPH) protocols. Quantitative blood loss (QBL) aims to overcome inaccuracies associated with visual EBL. We compared the accuracy of obstetric EBL for prediction of postpartum hemoglobin (Hgb) changes before and after adoption of a colorimetric QBL system (Triton, Gauss Surgical). Retrospective cohort of deliveries before (“pre-QBL,” 8/2015-2/2017) and after (“post-QBL,” 8/2018- 3/2018) QBL adoption. Deliveries (3/2017-7/2017) were excluded during transition to QBL. Women met inclusion if they delivered at ≥20wks. All pre-QBL deliveries had physician EBL values. In the post-QBL phase, QBL was recorded as a separate value from physician EBL, but physicians were not blinded to the QBL value. The primary outcome was the difference between actual change in Hgb (predelivery Hgb - Hgb 24hrs after delivery) and predicted change in Hgb (predelivery Hgb - predicted Hgb 24hrs after delivery). Differences closer to 0 were more accurate with - and + values reflecting over- and underestimation, respectively. Predicted Hgb values were calculated using EBL, maternal blood volume and predelivery Hgb. Analyses were stratified by mode of delivery and PPH (EBL>1000mL). A secondary analysis compared predicted change in Hgb using pre-intervention EBL values and post -intervention QBL values. Secondary outcomes included composite maternal morbidity (blood transfusion >2 units, embolization, hysterectomy, ICU, exploratory laparotomy, DIC, intubation, kidney injury, and death) and time from PPH to transfusion of blood products. Mean differences between pre-QBL and post-QBL were evaluated with two- sample Student t-tests. There were 9,101 deliveries; 2,753 were post-QBL. Physician EBL was less accurate for prediction of change in Hgb after implementation of QBL in deliveries without PPH (Table 1). QBL values were more accurate than pre- intervention EBL values for prediction of Hgb change among cases of PPH (Table 2). Although less accurate, EBL in cases of PPH was an overestimate of change in Hgb. There was no difference in maternal composite morbidity (9.8 vs 12.3%; p=0.28) or median time to transfusion (17.0 vs 6.3 hours, p=0.51) between pre- and post-QBL. QBL estimates were more accurate in the setting of PPH; however, QBL adoption did not improve morbidity or time to transfusion in our tertiary care center. Analysis of the utility of QBL in other settings is warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)