Sealed Envelope Method Research Articles

Comparing the Sedative Effect of Dexmedetomidine and Propofol in Mechanically Ventilated Patients Using Salivary Alpha-Amylase as a Stress Marker: A Randomized Open-Label Trial

Background: Patients receiving mechanical ventilation (MV) in the intensive care unit (ICU) experience significant distress, which triggers a stress response. Objectives: This study aimed to assess the effectiveness of dexmedetomidine and propofol in reducing stress levels, using salivary alpha-amylase (SAA) as a specific indicator of stress. Methods: A randomized, open-label trial was conducted involving 40 patients newly placed on MV. In a parallel study design, participants were randomly assigned into two equal groups (n = 20) through the sealed envelope method using computer-generated randomization. Group D received dexmedetomidine at a dosage of 0.2 to 1.4 μg/kg/h, while group P received propofol at a dosage of 0.3 to 4 mg/kg/h for sedation. Salivary alpha-amylase levels were measured according to the kit manufacturer's protocol. Results: Salivary alpha-amylase levels were significantly lower in group D than in group P at 12, 24, 36, and 48 hours after the initiation of MV (P < 0.05). Heart rate and mean arterial pressure were also significantly lower in group D at 12, 18, and 24 hours (P < 0.05). The duration of MV was significantly shorter in group D compared to group P (4.4 ± 1.85 vs 6.1 ± 2.45 days, P = 0.018). There were no significant differences in ICU length of stay, mortality, or adverse events between the groups. Conclusions: Dexmedetomidine demonstrated superior stress-reducing effects compared to propofol in MV patients, as evidenced by lower SAA levels and improved hemodynamic stability. The shorter duration of MV in the dexmedetomidine group further suggests potential clinical benefits of its use in managing stress in MV patients.

Clinical Evaluation of a Novel Compression Device For Ultrasound-Guided Repair of Femoral Artery Pseudoaneurysms: A Double-Blind Clinical Trial

Background: Femoral artery pseudoaneurysm is a well-known complication after conventional angiography. Today, the treatment of choice for this condition is noninvasive repair using manual ultrasound-guided compression. Objectives: This study aimed to evaluate the efficacy of a novel compression device in improving angiography-induced pseudoaneurysm treatment compared to manual ultrasound-guided compression repair. Patients and Method: A double-blind, randomized clinical trial was performed on patients with femoral angiography-induced pseudoaneurysm in the Radiology Department of Ghaem Hospital, Mashhad, Iran. Based on color Doppler ultrasound exams, patients diagnosed with a pseudoaneurysm within 72 hours of angiography were included in the study. Patients were excluded if they had complete blockage, complete pseudoaneurysm thrombosis, abscess, surface tissue infection, or open wound in the area. The patients were allocated to a manual ultrasound-guided compression group or a device-assisted compression group using simple randomization with a sealed envelope method. After collecting demographic data, the patients underwent an ultrasound exam of the groin to determine and record the size of the pseudoaneurysm and the ratio of thrombosis to open lumen. The therapeutic success rate was defined as complete lumen thrombosis after conducting the compression procedure one to three times. Also, the pain score was measured during compression using the Visual Analog Scale based on a scale of 0 - 10. The duration of successful procedures was also documented. The patients were monitored for 6 hours for any side effects. The level of statistical significance was set at P < 0.05 for all tests. Results: The study was performed on 22 patients (13 males/9 females) with a mean age of 65.5 ± 3.5 years divided into two groups of device-assisted (n = 11) and manual ultrasound-guided (n = 11) compression repair. The two groups did not differ significantly in terms of demographic variables or initial ultrasound variables associated with the pseudoaneurysm. The device-assisted compression group was found to have lower pain intensity (5.0 ± 1.0 vs. 6.0 ± 0.8; P = 0.024) and a significantly higher success rate (100% vs. 45.5%; P = 0.004) compared to the manual compression group. None of the patients showed any side effects. Conclusion: This preliminary study showed that the proposed device is completely safe and may improve the success rate while decreasing pain scores during ultrasound-guided compression procedures. Using a large multicenter study design, evaluating the efficacy of the novel device for hemostasis during sheath removal and adding new equipment to the device, such as manometers to apply controlled pressure, are suggested for future studies.

Aerobic Exercise Versus Plyometrics in Reducing Anxiety Levels in College Students With Mild Generalized Anxiety Disorder.

Background Generalized anxiety disorder is one of the most prevalentmental disorders, characterized byexcessive anxiety and worry that affectboth mental and physical health. These pervasive illnesses have a crippling effect on people's everyday lives, quality of life, and wellness and are also highly linked with cardiovascular risk factors. Physical activity-based therapies have shown promising effects in treating a range of mental disorders, from psychosis to dementia. Out of many conventional therapies, aerobic exercise and plyometrics have been found to be effective in reducing anxiety levels. Aim This study aims to compare the effectiveness of aerobic exercise and plyometrics in reducing anxiety levels in college students with mild generalized anxiety disorder. Materials and methods A total of 96 subjects were selected for the studyusing a stratified sampling technique;48 subjects were assigned to the aerobic exercise group (Group A) and 48 to the plyometric group (Group P). Randomization was done using the sealed envelope method. This study includes students aged 18-25 years, both genders, with a body mass index of <30, a Beck Anxiety Inventory (BAI) score of 8-15, and at least six months without practicing any kind of physical activity. The exclusion criteria are subjects with other psychotic disorders, a history of cardiovascular disease, chronic kidney disease, inflammatory disease, malignant conditions, neurological disorders, anemia, with comorbid conditions, who were involved in supportive therapy for anxiety such as cognitive behavioral therapy, use of anxiolytic drugs, females with menstrual disorders, and subjects with recent trauma or injuries (fracture, ligament sprain, or muscle strain). The treatment duration for both groups was three days per week for a total of four weeks. Group A consists of five minutes of warm-up, 30 minutes of walking, and five minutes of cool-down, for a total of 40 minutes. Group P consists of warm-up of five minutes, high knees, single leg hop and jump squats of two sets and 10 repetitions for 30 minutes, and a cool-down of five minutes, for a total of 40 minutes. Conclusion The anxiety levels were analyzed using the BAI, revealing that bothgroups have shown improvements in Beck anxiety scores; however,Group A has shown a comparatively more significant improvement than Group P.

Enhancing Guidewire Efficacy for Trans-radial Access: The EAGER Randomized Controlled Trial.

Background: The 1.5mm 'Baby J' hydrophilic narrow J tipped wire is a development of the standard 0.035" 3mm J tipped peripheral guidewire, designed to improve efficiency of transradial coronary procedures by safely navigating small caliber radial arteries to the aorta. There is currently a lack of evidence comparing the procedural success and safety of different peripheral guidewires used in transradial cardiac procedures. We compared the efficacy and safety of a narrow J tipped hydrophilic 0.035" wire (intervention - Radifocus™ 'Baby J' guidewire, TERUMO Co., Tokyo, Japan). versus standard fixed core (FC) 0.035" J wire (control). Methods: Investigator initiated, blinded, Australian, multicenter randomized trial in patients undergoing clinically indicated coronary angiography and/or PCI. Randomized 1:1 via sealed envelope method to use either the control or the intervention guidewire. The primary endpoint (technical success) was defined as gaining aortic root access with the randomized guidewire. Results: 330 patients were randomized between October 2022 - June 2023 (median age 69 years, 36% female, BMI 29 kg/m²). The primary endpoint was achieved more frequently in the intervention group [96% v 84%; mean difference 12% (95% CI 5.7-18.3); p<0.001]. Women assigned to the control wire experienced a higher failure rate compared to men (31% v 8% in men; p<0.001). Fluoroscopy time was significantly shorter in the baby J group (median 344 versus 491 seconds; p=0.024). The main mechanisms of failure using the control wire were radial artery spasm (15/26; 57%) and subclavian tortuosity (5/26; 19.2%). There were no differences in overall procedure times, MACE, or vascular complications between guidewires. Conclusions: A narrow 1.5mm J tipped hydrophilic guidewire resulted in greater technical success and reduced fluoroscopy time compared to the standard 3mm J tip non-hydrophilic guidewire. The guidewire is safe and demonstrated key incremental benefits for the trans-radial approach particularly in women.

Vaccination in latent papillomavirus infections: An experimental randomized, prospective, open-label, controlled trial

Background. Human papillomavirus refers to one of the most common sexually transmitted infections with the majority of viruses in the host being transient carriers, the so-called latent forms of papillomavirus infection. Persistence of cancer-associated human papillomavirus is fraught with cervical intraepithelial neoplasia, and subsequent cervical cancer. Measures for secondary prevention of cervical cancer in latent forms of papillomavirus infection are yet to be developed, which predetermined the present study.Objectives. To increase the effectiveness of secondary prevention of cervical cancer by improving the algorithm for managing latent forms of papillomavirus infection in women. Methods. A randomized controlled trial enrolled 152 patients diagnosed with a latent papillomavirus infection. Patient examination and data analysis were carried out at clinical trial centers of the Department of Obstetrics, Gynecology and Perinatology of Kuban State Medical University (Russia) in 2020–2024. The trial involved patients aged 18 to 35 years. Patients were divided into 2 groups using the sealed code envelope method: Group I (comparison group) (n = 74) — microbiological sanitation of the cervicovaginal zone (as indicated) and observation for 36 months with annual control of viral load, colposcopy and oncocytology; Group II (study group) (n = 78) — microbiological sanitation of the cervicovaginal zone (as indicated) and administration of quadrivalent recombinant human papillomavirus vaccine (types 6, 11, 16, 18) (3 doses intramuscularly: second and third doses were administered 1 and 3 months after the first one). Each patient was analyzed for the effectiveness of preventive therapy according to the dynamics of indicators: colposcopy, cytology (Papanicolau staining), and molecular biological analysis (polymerase chain reaction). The indicators were evaluated after 12, 24, and 36 months. Statistical analysis of the results was carried out using IBM SPSS Statistics 26 (IBM, USA) variation statistics programs.Results. Vaccination with a quadrivalent recombinant vaccine against human papillomavirus of types 6, 11, 16, 18 against the background of correction of dysbiotic vaginal and cervical disorders in latent forms of papillomavirus infection in women was revealed to cause a 9.3-fold decrease (compared to the study group) in realization of latent persistence of viruses into subclinical (25.7 % in group I vs. 9.0 % in group II) and clinical forms of papillomavirus infection (cervical intraepithelial neoplasia) — 12.1 % in group I vs. 1.3 % in group II, to reduce the persistence of human papillomavirus and the appearance of their new genotypes, the viral load of highly oncogenic types of human papillomavirus (1.9 times —3.2 ± 2.4 geq/ml in group I versus 1.7 ± 2.1 geq/ml in group II).Conclusion. The trial has shown that human papillomavirus vaccination is associated with a reduced risk of realization of latent forms of papillomavirus infection into clinical forms as cervical intraepithelial neoplasia and, consequently, cervical cancer, thereby being considered promising for secondary prevention of this pathology.

Effects of concurrent training on glycemic and vascular parameters among patients with T2DM-associated Peripheral Artery Disease.

To evaluate the effects of CT to improve HbA1C and ABI among the T2DM-associated PAD population. A randomized, single-blinded, two-arm trial was conducted at the Department of Rehabilitation Sciences of Dr. Ziauddin Hospital in Karachi between July to September 2023. A total of 80 T2DM-associated PAD patients were included and randomly divided into Experimental Group (n=40) and Control Group (n=40), using the sealed envelope method. Experimental group patients received Concurrent Training (CT), whereas Control Group patients underwent Aerobic Training (AT) for 12 weeks. Both groups received thirty-minute sessions three times a week that was progressed to 60 minutes over 12 weeks. HbA1C and ABI were measured at baseline and after 12 weeks. Analysis revealed an average age of 46.75±3.59 and the duration of T2DM for developing PAD is 14.82±2.23 on average. Findings revealed that both training groups were significantly effective (p<0.000) at 95% CI in improving glycemic and vascular parameters after 12 weeks. Subsequently, findings showed that the CT group showed more significant improvement than AT group in improving HbA1C for glycemic control (p=0.002, CT: pre: 9.53±1.406, post: 7.81±0.81, AT: pre: 8.74±0.908, post: 8.15±0.83) and ABI for systemic blood flow (p=0.0001, CT: pre: 0.84±0.03, post: 0.94±0.03, AT: pre: 0.82±0.02, post: 0.86±0.02). CT showed a two-fold improvement in glycemic control and arterial blood flow than AT group, which represents that CT is an effective therapeutic approach for T2DM-associated Fontain's stage IIa PAD rehabilitation.

Effects of Exercise and Kinesiotaping with and without Wedge Insole on Pain and Function in Patients with Grade 3 Knee Osteoarthritis

Abstract Background: Knee osteoarthritis (OA) is a common degenerative joint disease, often resulting from wear-and-tear and articular cartilage loss. This condition frequently leads to significant pain and physical limitations, affecting the quality of life, particularly in older adults. Objective: To determine the effectiveness of exercise combined with Kinesio tape (KT) and wedge insoles on pain and physical limitations in patients with grade 3 knee osteoarthritis. Methods: A randomized clinical trial was conducted on a sample of 60 participants diagnosed with grade 3 knee OA. Participants were randomly divided into two groups of 30 each using a sealed envelope method. Group A received exercise, KT, and wedge insoles, while Group B received exercise and KT only. Both groups underwent 24 sessions over eight weeks, with three sessions per week. The interventions included electrotherapeutic modalities, strengthening exercises for the quadriceps and hamstrings, and KT application. Pain and physical function were measured using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, the fourth week, and the eighth week. Data were analyzed using SPSS version 25, with the Friedman test assessing within-group effects and the Mann-Whitney U test evaluating between-group differences. Statistical significance was set at p &lt; 0.05. Results: Group A consisted of 12 males (40%) and 18 females (60%), with a mean age of 52.33 ± 6.34 years. Group B had 10 males (33.3%) and 20 females (66.7%), with a mean age of 52.94 ± 5.75 years. Significant improvements were observed within both groups in VAS and WOMAC scores (p &lt; 0.05). Post-treatment, Group A demonstrated greater improvements in VAS (mean difference = 2.5, p = 0.000) and WOMAC (mean difference = 15.3, p = 0.000) compared to Group B. Conclusion: Both exercise combined with KT and exercise combined with KT and wedge insoles were effective in reducing pain and improving physical function in patients with grade 3 knee osteoarthritis. However, the combination of exercise and KT without wedge insoles produced superior effects. These findings suggest that KT, as an adjunct to exercise therapy, may provide additional benefits for managing knee OA. Keywords: Knee Osteoarthritis, Kinesio Tape, Wedge Insole, Pain Management, Physical Function, Randomized Clinical Trial, Non-Surgical Treatment, Electrotherapeutic Modalities, Strengthening Exercises, Visual Analogue Scale, WOMAC

Comparative study between efficacy of Excimer light with topical Tacrolimus 0.1% versus excimer light with topical Bimatoprost 0.01% in treatment of facial Vitiligo

Loss and absence of melanocytes due to a number of factors is responsible for vitiligo; known to be the commonest disorder of pigmentation. The aim of the current work was to compare the efficacy and safety of excimer light with topical tacrolimus ointment 0.1% versus excimer light with topical bimatoprost gel 0.01% in treatment of facial vitiligo. The study was carried out on 48 patients presented with facial vitiligo. The patients were divided randomly using sealed envelope method into two groups (24 patients each). Group 1 were treated with excimer light plus topical tacrolimus ointment 0.1% and group 2 treated with excimer light plus topical bimatoprost gel 0.01%. Clinical improvement based on the quartile grading scale at the end of treatment did not show any statistically significant difference between groups. The majority of subjects in both groups experienced good to excellent improvement. Only 20.9% of patients in group 1 and 33.3% of subjects in group 2 achieved less than 50% repigmentation (p = 0.889). Our study demonstrated that 0.01% topical bimatoprost gel in combination with excimer light is considered safe and effective as treatment of nonsegmental facial vitiligo with comparable results to 0.1% tacrolimus.

Comparative Evaluation of New Needleless Local Anesthetic System (INJEX) and Conventional Syringe Needle Technique during Pulpotomy Treatment: A Randomized Clinical Trial.

The dreaded sensation of pain in the dental chair has a significant impact on children's behavior. This study aimed to compare and contrast the perception of pain and patient behavior between the use of INJEX and the conventional syringe needle technique during pulpotomy among children. A randomized clinical trial was designed and conducted among pediatric dentistry patients aged 6-12 years old. Fifty-eight children were divided into two groups, conventional syringe needle and INJEX, using simple randomization method applying the sequentially numbered, opaque, sealed envelope method of allocation concealment. Anesthesia was administered to the groups as local infiltration by a single operator following routine behavior guidance techniques. After 3 min, pulpotomy was performed using the standard protocol. The Face, Legs, Activity, Cry, Consolability (FLACC) scale and Wong-Baker FACES Pain Rating Scale (WBS) were used to assess the intensity of pain, while the Frankl behavior rating scale (FBRS) was used to assess the children's behavior. During anesthesia, most of the participants in the INJEX group (median = 3) had higher FBRS scores compared with the conventional syringe needle group (median = 2), and the difference was very highly significant (p-value < 0.001). Analyzing the FLACC scores during local anesthesia administration revealed a high statistical significance (p-value < 0.01) across the two groups. A very high statistically significant difference (p-values < 0.001) with higher WBS scores for pain intensity was seen in the group using conventional syringe needles. INJEX administration significantly reduced the intensity of pain experienced by the children and helped maintain a positive attitude among them during pulpotomy. It provided a positive and comfortable experience for both the child and the practitioner. Therefore, it can serve as an excellent alternative to conventional needle anesthesia.

An eight-week single-blind randomised controlled trial on dual task balance training and motor imagery practice in ischaemic stroke survivors.

The purpose of this study was to find the effects of motor imagery on balance and mobility of stroke patients.This was a single-blind randomised controlled trial which included a total of 30 patients. These patients were assigned into two group: experimental (n=15) and control (n=15) by sealed envelope method. Functional Reach Test (FRT), Time Up and Go Test (TUGT), Berg Balance Scale (BBS), and Movement Imagery Questionnaire (MIQ) were used as assessment tools. The overall mean age of the participants was 52.63 ±8.78 years. Between groups analysis showed non-statistically significant difference (p>0.05) in FRT but significant difference in TUGT, BBS, and MIQ-3 (p<0.009) after eight weeks of training. Within group analysis showed statistically significant difference (p<0.05) for all outcome measures. This study concluded that motor imagery is an effective treatment strategy for improving balance and mobility in stroke patients and brings better results as compared to conventional treatments.

Comparison of dexmedetomidine and propofol infusion on intraoperative haemodynamics during functional endoscopic sinus surgery under general anaesthesia- A randomized controlled trial

Functional endoscopic sinus surgery (FESS) is a surgical technique to treat sinonasal diseases. Intraoperative bleeding is one of the major challenges, which hinder the confined area of visibility and prolongs the procedure. Intraoperative induced hypotension can reduce intraoperative bleeding, to provide clear surgical field for dissection and hence decreasing operative time. So, we compared effect of dexmedetomidine and propofol infusion on the intraoperative haemodynamics during functional endoscopic sinus surgery (FESS). To study the effect of intravenous (IV) dexmedetomidine and propofol infusion on intraoperative haemodynamics under general anaesthesia in functional endoscopic sinus surgery(FESS). Secondary aim was to study estimated blood loss if any. To study the effect of I.V. dexmedetomidine and propofol infusion on intraoperative haemodynamics under general anaesthesia in functional endoscopic sinus surgery (FESS). Patients were divided randomly by sealed envelope method into two groups with 30 patients in each group. Group D patients received dexmedetomidine 1ug/kg as a loading dose over 20 minutes followed by 0.3 ug/kg/hr infusion for maintainence. Group P patients received propofol 2mg/kg as a loading dose followed by 100-200 ug/kg/min infusion for maintenance. The findings in our study highlights that dexmedetomidine infusion decreases haemodynamic parameters like arterial blood pressure and heart rate more as compared to propofol infusion during FESS. The effect on hemodynamics sustained and consistent without requirement of additional hypotensive agents. So altogether, this lead to better surgical field. Use of dexmedetomidine is a safe and effective method to control bleeding and improve the quality of surgical field and intraoperative haemodynamics.

Comparison of Plantar Pressure Distribution and Ultrasonographic and Clinical Features After Application of Different Energy Levels of Extracorporeal Shockwave Therapy in Patients with Plantar Fasciitis: A Randomized, Prospective, Double-Blind Clinical Trial.

The effectiveness of different energy levels used in extracorporeal shockwave therapy (ESWT) has been investigated in previous studies, but controversy remains regarding which energy levels should be used in the treatment of plantar fasciitis. We compared the efficacy of different energy levels used in ESWT in the treatment of plantar fasciitis using plantar fascia thickness and pressure distribution. Between July 2021 and September 2021, a total of 51 patients (71 feet) with plantar fasciitis were randomized into three treatment groups using the sealed envelope method. Group 1 (n = 25) received low energy density (0.09 mJ/mm2), group 2 (n = 25) received medium energy density (0.18 mJ/mm2), and group 3 (n = 21) received high energy density (0.38 mJ/mm2). Each group received three sessions of ESWT at a frequency of 2,000 shocks per minute at 1-week intervals. Patients were evaluated before and after treatment using a visual analog scale (VAS) for pain, the Foot Function Index (FFI), plantar fascia thickness measured by ultrasonography, and plantar pressure distribution. Posttreatment VAS and FFI scores were determined to be significantly lower than the values before treatment in the three groups (P < .001). There were no significant differences among groups in pretreatment and posttreatment values of VAS, FFI, plantar fascia thickness, and pressure distribution (P > .05). No significant differences were found among groups in percentage changes in all of the outcome parameters (P > .05). There was no superiority among low, medium, or high levels of ESWT in terms of pain, foot functions, fascia thickness, and pressure distribution in the treatment of plantar fasciitis.

The Efficacy of Transverse Abdominal Plane Block with Bupivacaine Combined with Dexamethasone for the Management of Post-Caesarean Pain

Introduction: Caesarean section (CS) is a commonly performed major surgical procedure that causes significant postoperative pain. The objective of this study was to evaluate the efficacy of the transverse abdominal plane block (TAPB) in the management of post-caesarean pain at the Souro Sanou Teaching Hospital (CHUSS) of Bobo Dioulasso. Methodology: This was a single blind randomised clinical trial. One hundred patients admitted for CS under spinal anaesthesia were randomised into two groups using the sealed envelope method. The intrathecal morphine (ITM) group received 100 µg morphine intrathecally at induction and the TAPB group a bilateral TAPB at the end of the caesarean section with 20 ml of 0.25% bupivacaine and 4 mg dexamethasone in the same syringe on each side. The proportion of mild pain, numeric rating scale (NRS) &lt; 3 on mobilisation at 24 hours post-caesarean was the primary outcome. Results: The 2 groups were comparable for socio-demographic and clinical characteristics. The mean age of the patients was 28.14 ± 6.34 years and 29.08 ± 5.58 years (p=0.43). At rest at 24 hours post-op, the proportion of NRS &lt; 3 was 100% for the TAPB group and 88% for the ITM group (p=0.49). On mobilisation at 24 hours post-op, 96% of patients in the TAPB group and 74% in the ITM group (p=0.002) had a NRS &lt; 3. At rest at 48 hours post-op, it was 100% for the TAPB group and 88% for the ITM group (p=0.027). On mobilisation at 48 hours post-op, it was 94% for the TAPB group and 70% for the ITM group (p=0.002). Postoperative nausea and vomiting (PONV) were present in 50% of patients in the ITM group and 6% in the TAPB group (p&lt;0.001). Conclusion: TAPB significantly reduced pain scores on mobilisation in the post-caesarean period with a significant reduction in PONV.

Effectiveness of dynamic neuromuscular stabilization, neurodevelopmental techniques and proprioceptive neuromuscular facilitation on trunk and gait parameters in patients with subacute stroke: A three-arm parallel randomised clinical trial

Background Today, stroke is the principal cause of demise in both developed and developing countries. There are different techniques used to treat patients with sub-acute stroke. Trunk muscles play a key role, i.e. in keeping the spine and trunk in place. This stabilization requires moving the head and extremities freely and selectively. The aim of this study is to compare the effectiveness of dynamic neuromuscular stabilization (DNS), neurodevelopmental techniques (NDT) and proprioceptive neuromuscular facilitation (PNF) on trunk and gait parameters in the subacute phase of stroke. This study is intended to ascertain the efficacy of all three approaches individually and to compare the effectiveness of DNS, NDT and PNF on trunk and gait parameters. Furthermore, the findings of this study could be used to assist post-stroke survivors in their early recovery and improve their level of independence. Methods In this interventional study, participants will be divided into three groups, and in each group, 20 patients will be assigned randomly to each group using the sequentially numbered opaque sealed envelope method. Group A patients will be given DNS, Group B will be given NDT, and Group C will be given PNF. The patients will be given treatment for five days for four consecutive weeks. Outcome measures that will be used are trunk impairment scale (TIS), dynamic gait index (DGI) and gait parameters. Data will be collected before and after the 4-week treatment period. Conclusions After the study, a conclusion will be drawn regarding which treatment technique is most suitable among all the three strategies for treating stroke patients if the hypothesis of the study is found valid. Clinical Trials Registry – India (CTRI) reference no. CTRI/2022/06/043037; date of registration 22/05/2022.

The Effect of Intraoperative Music on Sedation, Anxiety, and Hemodynamic Responses among Patients Undergoing Lower Segment Cesarean Section under Spinal Anesthesia

Background and Aim: Anxiety levels are high in spinal anesthesia as patients are awake. Sedation has an advantage that patients feel comfortable but if sedative drugs are not used judiciously, they can suppress the cardiovascular and respiratory system, lower core body temperature, or severely lower blood pressure. Music reduces awareness under anesthesia and has antianxiety effects. The effect of music on sedation using bispectral index (BIS) along with anxiety and hemodynamic parameters at different time intervals has been studied. Material and Methods: A hospital-based prospective randomized interventional study was done on 60 patients aged between 18 and 35 years undergoing lower segment cesarean sections. Two groups (music headphones with music and nonmusic headphones without music), each containing 30 subjects, were formed using a simple random technique by the sealed envelope method. The levels of sedation using BIS were measured preoperatively, after giving spinal anesthesia, then every 10 min till the end of surgery. Moreover, hemodynamic parameters were also monitored and recorded preoperatively and every 10 min till the end of surgery. Anxiety was measured using a visual analog score for anxiety preoperatively and postoperatively. Results: The BIS index was significantly lower in the music group compared to the nonmusic group from 20 min after start of surgery to the end of surgery (86.17 ± 4.48 vs. 75.73 ± 3.97, P &lt; 0.001). Anxiety was also significantly lower in the music group than in the nonmusic group (4.03 ± 1.47 vs. 0.50 ± 1.57, P &lt; 0.005). Heart rate (HR) was lower in the music group after 20 min of music therapy compared to the nonmusic group (87.87 ± 11.21 vs. 79.67 ± 6.67, P = 0.004) but there was no statistically significant difference in systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and saturation of oxygen between two groups. Conclusion: Our data showed that intraoperative music listening under regional anesthesia has effect on sedation, anxiety, and physiological variables. Therefore, music therapy can be used as nonpharmacological intervention for reducing anxiety and sedation during surgery.

Ab. No. 69 Comparative Study on Effect of Square Stepping Exercises With Conventional Balance Exercises on Balance in Community Dwelling Elderly Population: A Randomized Control Trial

Introduction: Determining &amp; comparing the effects of Square Stepping Exercises (SSE) versus Conventional balance exercises after 4 weeks training in the older adults. To tackle age-related decline in balance performance in elderly, physical interventions are essential. SSE is a novel intervention that can enhance balance and reduce the risk of falls. Methods: 40 healthy community dwelling older individuals of age 60 years &amp; more with ability to walk backwards for 3 meters were included in the study. Participants were randomly allocated into two groups of 20 each using sealed envelope method. Limits of Stability (LOS) and Mini-BES Test were assessed as outcome measures prior to and after the 4 weeks of training. Non-Parametric test were used to analyze the data of Mini BESTest as the data was not normally distributed. Whereas the rest of the data (LOS) were normally distributed, hence parametric tests were used to analyze. Results: Both the groups showed statistically significant results when compared to their pre-intervention scores (p&lt;0.0001) The between group comparison did not show any statistically significant difference on balance components (p&gt;0.05). Conclusions: Both Conventional balance training exercises and Square stepping exercises were found to be equally effective in improving balance in elderly. Implications: SSE does not have an advantage over the conventional balance exercises, however it can be used as an adjunct to the conventional balance training to introduce variety in training of community dwelling elderly with adequate safety measures in place.

Is basal cisternostomy in traumatic brain injury a need of hour or white elephant - A randomized trial to answer.

Basal cisternostomy (BC) recently emerged as an adjuvant/alternative procedure to decompressive craniectomy (DC) in traumatic brain injuries (TBIs) with its potential to effectively reduce both intracranial pressure (ICP) and brain edema. However, its role in TBI is not yet established in the true sense and with clarity. The objective of the present study was to evaluate the effect of adjuvant BC on ICP, mortality, and clinicoradiological outcome. A single-center randomized control trial was conducted. Fifty patients were assigned to each DC-group and DC+BC-group. Randomization was done using the sealed envelope method. Both groups were followed in the postoperative period to compare the impact of surgery on ICP, radiological changes, and clinical outcome (mortality, days on ventilator/in intensive care unit (ICU), and Glasgow outcome scale-extended (GOS-E) at 12 weeks). Both groups were comparable in terms of preoperative clinicoradiological characteristics. On postoperative days 1, 2, and 3, mean ICP was significantly low in the DC+BC-group (P < 0.0001). The decline in ICP in the DC+BC-group was significant in both moderate and severe TBI patients. In comparison, DC+BC-group has a shorter duration of mechanical ventilation/ICU stay and significantly better GOS-E score at 12 weeks (P < 0.0001*). The mortality rate was less in the DC+BC-group (48%) as compared to the DC-group (64%). Among radiological features, mean midline shift and mean outward brain herniation were significantly less in the DC+BC group. Bone-flap replacement was possible in ten patients of DC+BC-group at the time of primary surgery. Results of our study indicated that BC is beneficial in reducing both ICP and brain edema, which translates into favorable clinicoradiological outcomes.

The Impact of Psychological Nursing Intervention on Negative Emotions and Quality of Life in Elderly Patients with Chronic Hemodialysis for Uremia

Objective: This study aimed to investigate the impact of psychological nursing intervention on negative emotions and quality of life in elderly patients undergoing chronic hemodialysis for uremia. Methods: From January 2022 to June 2023, a total of 80 elderly patients receiving chronic hemodialysis for uremia were selected for the study. They were divided into two groups using a sealed envelope method, with 40 patients in each group. The control group received routine nursing interventions, while the observation group received psychological nursing intervention. Results: After 2 weeks of intervention, the observation group had significantly lower scores for negative emotions (P&lt;0.05), higher scores for quality of life (P&lt;0.05), and greater nursing satisfaction (P&lt;0.05) compared to the control group. Conclusion: Implementing psychological nursing intervention for elderly patients undergoing chronic hemodialysis for uremia can reduce negative emotions, improve quality of life, and increase nursing satisfaction. This intervention holds clinical significance.

Comparative Analysis of Speed Endurance Production and Maintenance Drills: A Study on Enhancing Performance in Hockey Players

Hockey features a variety of high-intensity motions that cause tiredness during the most intense moments of play. During these gaming phases, anaerobic energy turnover and muscular activation are significant, which may exhaust the physiological mechanisms that fight tiredness. Objective: To determine the effects of speed endurance production and speed endurance maintenance drills on hockey players. Methods: A quasi-experimental study was conducted at Gojra hockey club, Gojra. Total sample size was 60 male healthy field hockey players. Participants were selected by sealed envelope method and divided into Group A (speed endurance production) and Group B (speed endurance maintenance). Speed endurance production group received very high intensity training around 30 seconds exercise interval time followed by 2-3 minutes rest period to guarantee sufficient recovery time. Speed endurance maintenance training group involve small side games in 30-60 sec similar recovery time. The data were analysed using SPSS 23.0. Results: The age of participants with mean± SD was 21.60 ± 4.6. SEP and SEM techniques were applied in both groups. The result shows significant effect with (p˂0.05) in all respective tests: 50-meter, 400-meter, yo-yo distance and yo-yo Intermittent Recovery 2 and non-significant with (p˃0.05) in 100-meter, 200-meter and fatigue index test in between group analysis. It shows statistically significant effect within groups. Conclusions: Study concluded that speed endurance production and speed endurance maintenance is effective in improving intermittent exercise capacity and fatigue index in both groups.

OC-027 RANDOMISED CONTROLLED TRIAL OF THE DESARDA TECHNIQUE AND SUTURE REPAIR FOR OBSTRUCTED INGUINAL HERNIA

Abstract Aim Open inguinal hernia repair remains one of the most commonly performed operations worldwide. For elective surgery, mesh implantation is an established global ‘gold standard’. However, for emergency repair of obstructed hernia, non-mesh techniques may be utilised. We designed a randomised controlled trial to compare the open, non-mesh ‘Desarda’ against non-mesh suture darn repair in the treatment of obstructed inguinal hernias. Materials &amp; Methods A prospective randomized controlled trial was undertaken between Feb and Aug 2020 at the Emergency Unit, of a busy hospital in a resource-constrained setting. To identify a true difference in operating time, a sample size of 100 patients was calculated using WHO calculator. Exclusion criteria were patients ASA 3+ or with recurrent or strangulated intestine; ethical approval was obtained from the hospital Ethics’ Committee and informed consent obtained from all participants. Randomisation was by the sealed opaque envelope method. Data analysis by SPSS version 25 using Student t-test; p-value ≤0.05 was considered significant. Results Total 100 patients were included (71 male and 29 female). Mean age of patients: 39.1 years±6.1SD. Mean operative time was significantly lower in Desarda group (50.5±1.7) compared to sutured repair (58.8±2.1SD) p=0.000. Intra-operative and immediately postoperative complications were not identified in any of the patients. Patient reported outcomes will be reviewed at the 2-year point. Conclusion In this RCT of emergency repair of obstructed inguinal hernia, Desarda's repair was safe and effective and took significantly less surgical time compared to a standard sutured darn repair. Longer term, patient reported outcomes are awaited.