Significant Difference In Clinical Improvement Research Articles

Complete Versus Incomplete Antenatal Corticosteroid Therapy and Number of Doses of Surfactant Used Posnatally: A Single-Center Study

Introduction: Antenatal corticosteroid therapy reduces the risk of developing RDS in premature infants. A single complete course of two doses of betamethasone is recommended between 24 weeks and 34 weeks. There are few data on the neonatal effects of an incomplete course of antenatal corticosteroid therapy. The main objective of our study is to evaluate the effectiveness of a complete versus incomplete course of antenatal corticosteroid therapy on the number of doses of surfactant received postnatally. Methods: This is a single-center retrospective study, including 145 newborns with RDS, divided into 2 groups according to the number of doses of antenatal corticosteroid therapy (1 dose; n = 23 and 2 doses; n = 95). Results: The clinical characteristics of the newborns were similar in the 2 groups. The number of doses of surfactants received postnatally and the severity of RDS are not influenced by the number of doses of antenatal corticosteroid therapy. On the other hand, the number of doses of surfactants received is influenced by the term of birth, the presence of an neonatal sepsis and by resuscitation in the delivery room. The severity of RDS is not influenced either by the interval between the last dose of antenatal corticosteroid therapy and delivery, nor by the cause of prematurity. We did not note any statistically significant difference in clinical improvement (duration of intubation, duration of non-invasive ventilation), the need for postnatal corticosteroid therapy and the risk of occurrence of morbidity and mortality (mortality rate, occurrence of BPD, IVH, severe NEC) between the two groups. Conclusion: just like a complete course, an incomplete course of antenatal corticosteroid therapy can also act on the severity of RDS. Prospective randomized studies should be considered for a formal determination of the neonatal effects of a complete versus incomplete course of antenatal corticosteroid therapy, including the trial BETADOSE.

An Updated Systematic Review on Remdesivir's Safety and Efficacy in Patients Afflicted With COVID-19.

Globally, the coronavirus disease 2019 (COVID-19) had a significant impact on everyone's lives and put a tremendous strain on healthcare systems. Since the outbreak began, remdesivir has been investigated as a potential treatment for COVID-19 that may be both effective and safe. Remdesivir has had a huge impact on the disease's progression, complications, and mortality. This review provides an updated assessment of the literature regarding remdesivir's efficacy and safety for the treatment of patients with COVID-19. The search was performed through PubMed, Web of Science, Cochrane, and Scopus for articles published from2019 toSeptember 20, 2022. Studies that assessed remdesivir's efficacy and safety were included in this review, with clinical improvements as the primary outcome measure. Seventeen studies were identified following the implementation of the search strategy. Among them, 11 corroborated remdesivir's efficacy. Meanwhile, the remaining six studies did not observe a statistically significant difference in clinical improvement. Remdesivir is a potentially safe and effective antiviral that shows clinical improvement especially when used during the early course of the disease. However, current literature still questions its safety in patients who are afflicted with the complications of COVID-19, highlighting the need for studies on a large scale.

Artículo traducido] Sonidegib para el tratamiento del carcinoma basocelular avanzado en práctica clínica real: estudio nacional multicéntrico

BackgroundBasal cell carcinoma (BCC) is the most prevalent cancer. A minority of BCCs have an aggressive behaviour (laBCC) and may require hedgehog pathway inhibitors such as sonidegib as its treatment. ObjectiveTo describe the use of sonidegib in a large number of patients and provide more data on its real-life efficacy and safety profile. MethodsWe conducted a retrospective and multicentric study that included patients treated with sonidegib. Epidemiological, effectiveness and safety data were collected. ResultsA total of 82 patients with a mean age of 73.9 years were included. Ten patients had Gorlin syndrome. Median treatment duration was 6 months. Median follow-up duration was 34.2 months. Globally, 81.7% of the patients showed clinical improvement (52.4% partial response and 29.3% complete response), 12.2% clinical stability and 6.1% disease progression. There was no statistically significant difference in clinical improvement between the 24 h and 48 h sonidegib posology. After 6 months of treatment, 48.8% of the patients discontinued sonidegib. Prior vismodegib treatment and recurrent primary BCC were associated with a poorer response to sonidegib. At 6 months of treatment, 68.3% of the patients experienced at least one adverse effect. ConclusionSonidegib shows good effectiveness and acceptable safety profile in usual clinical practice.

Sonidegib as a Locally Advanced Basal Cell Carcinoma Therapy in Real-life Clinical Setting: A National Multicentre Study

BackgroundBasal cell carcinoma (BCC) is the most prevalent cancer. A minority of BCCs have an aggressive behaviour (laBCC) and may require hedgehog pathway inhibitors such as sonidegib as its treatment. ObjectiveTo describe the use of sonidegib in a large number of patients and provide more data on its real-life efficacy and safety profile. MethodsWe conducted a retrospective and multicentric study that included patients treated with sonidegib. Epidemiological, effectiveness and safety data were collected. ResultsA total of 82 patients with a mean age of 73.9 years were included. Ten patients had Gorlin syndrome. Median treatment duration was 6 months. Median follow-up duration was 34.2 months. Globally, 81.7% of the patients showed clinical improvement (52.4% partial response and 29.3% complete response), 12.2% clinical stability and 6.1% disease progression. There was no statistically significant difference in clinical improvement between the 24h and 48h sonidegib posology. After 6 months of treatment, 48.8% of the patients discontinued sonidegib. Prior vismodegib treatment and recurrent primary BCC were associated with a poorer response to sonidegib. At 6 months of treatment, 68.3% of the patients experienced at least one adverse effect. ConclusionSonidegib shows good effectiveness and acceptable safety profile in usual clinical practice.

Unilateral versus bilateral instrumentation with lumbar interbody fusion for degenerative lumbar diseases: A retrospective study

Abstract Purpose To assess the clinical and radiological outcomes of patients experiencing fusion technique by unilateral versus bilateral instrumentation with interbody lumbar fusion. Materials and methods Fifty-nine patients were included in this study. Thirty-six patients were managed with bilateral PSF and interbody fusion, and 23 had unilateral PSF and interbody fusion. Clinically, the patients were evaluated using the mJOA score. They were followed up for a minimum period of 3 years. Fusion at follow-up was established using radiographs. Results Procedure periods were quicker, and blood loss was fewer in the unilateral group. Fusion rates were comparable in both groups with insignificant differences. There was a statistically significant difference in clinical improvement of JOA scores in both groups. Conclusion Unilateral pedicle screw fixation together with interbody fusion is an efficient choice in chosen cases. Prospective, randomized research with a higher number of cases and longer follow-up times is required for more consistent outcomes.

Efficacy and harms of tocilizumab for the treatment of COVID-19 patients: A systematic review and meta-analysis.

IntroductionWe systematically assessed benefits and harms of tocilizumab (TCZ), which is an antibody blocking IL-6 receptors, in hospitalized COVID-19 patients.MethodsFive electronic databases and two preprint webpages were searched until March 4, 2021. Randomized controlled trials (RCTs) and inverse probability treatment weighting (IPTW) cohorts assessing TCZ effects in hospitalized, COVID-19 adult patients were included. Primary outcomes were all-cause mortality, clinical worsening, clinical improvement, need for mechanical ventilation, and adverse events (AE). Inverse variance random-effects meta-analyses were performed with quality of evidence (QoE) evaluated using GRADE methodology.ResultsNine RCTs (n = 7,021) and nine IPTW cohorts (n = 7,796) were included. TCZ significantly reduced all-cause mortality in RCTs (RR 0.89, 95%CI 0.81–0.98, p = 0.03; moderate QoE) and non-significantly in cohorts (RR 0.67, 95%CI 0.44–1.02, p = 0.08; very low QoE) vs. control (standard of care [SOC] or placebo). TCZ significantly reduced the need for mechanical ventilation (RR 0.80, 95%CI 0.71–0.90, p = 0.001; moderate QoE) and length of stay (MD -1.92 days, 95%CI -3.46 to -0.38, p = 0.01; low QoE) vs. control in RCTs. There was no significant difference in clinical improvement or worsening between treatments. AEs, severe AEs, bleeding and thrombotic events were similar between arms in RCTs, but there was higher neutropenia risk with TCZ (very low QoE). Subgroup analyses by disease severity or risk of bias (RoB) were consistent with main analyses. Quality of evidence was moderate to very low in both RCTs and cohorts.ConclusionsIn comparison to SOC or placebo, TCZ reduced all-cause mortality in all studies and reduced mechanical ventilation and length of stay in RCTs in hospitalized COVID-19 patients. Other clinical outcomes were not significantly impacted. TCZ did not have effect on AEs, except a significant increased neutropenia risk in RCTs. TCZ has a potential role in the treatment of hospitalized COVID-19 patients.

Efficacy and Safety of PD-1/PD-L1 Inhibitor Chemotherapy Combined with Lung Cancer Fang No. 1 in Relapsed and Refractory SCLC: A Retrospective Observational Study.

Background Relapsed and refractory small cell lung cancer (SCLC) accounts for about 15% of all lung cancers. The prognosis of patients is poor. The 5-year survival rate is almost 0. The average survival time of patients who refuse to receive treatment is only 2-4 months. For patients with extensive-stage SCLC, the current first-line treatment regimens are mainly platinum-containing double-drug chemotherapy. Poside combined with cisplatin/carboplatin and irinotecan combined with cisplatin/carboplatin are commonly used clinical regimens for the treatment of patients with extensive-stage SCLC. Although SCLC is very sensitive to radiotherapy and chemotherapy, most patients will develop recurrence and metastasis after initial treatment. Therefore, it is necessary to study clinically effective therapeutic drugs for relapsed and refractory SCLC. Objective To investigate the relationship between programmed death receptor-1 (programmed death receptor-1 (PD-1)) and programmed death receptor-ligand 1 (programmed death-ligand 1 (PD-L1)) inhibitors and Lung Cancer No. 1 efficacy and safety of Lung Cancer Fang No. 1 in the treatment of relapsed and refractory SCLC. Methods 80 patients with refractory SCLC were selected and randomly divided into control group and treatment group with 40 cases in each group. Among them, the control group received PD-1/PD-L1 inhibitor chemotherapy, and the treatment group received PD-1/PD-L1 inhibitor chemotherapy combined with Lung Cancer Fang No. 1 treatment. The differences in immune and tumor marker levels, clinical efficacy, and prognostic complications between the two groups before and after treatment were observed and compared. Results Before treatment, there was no significant difference in clinical improvement between the two groups. After treatment, the clinical symptom scores and body weight changes in the treatment group were significantly improved. The clinical symptom scores in the treatment group were lower than those in the control group, but the body weight changes were higher than those in the control group. The difference was statistically significant (P < 0.05). Before treatment, there was no significant difference in the levels of tumor markers between the two groups. After treatment, the levels of CYFRA21-1, CA125, and VGEF in the treatment group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in the immune level between the two groups before treatment (P > 0.05), while the differences in CD4+, CD3+, and CD4+/CD8+ after treatment were significant, and the treatment group was higher than the control group, with statistical significance (P < 0.05). After treatment, the clinical efficacy of the two groups was significantly improved. The DCR90.00% of the treatment group was significantly higher than that of the control group, 67.50%, and the difference was statistically significant (P < 0.05). The analysis of complications after treatment showed that fatigue, anorexia, hypertension, hand-foot syndrome, diarrhea, leukopenia, thrombocytopenia, and urinary protein in the treatment group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion PD-1/PD-L1 inhibitor chemotherapy combined with Lung Cancer Fang No. 1 has a good and safe effect on SCLC patients. It has a good curative effect in improving the clinical symptoms of patients. It can stabilize the tumor, inhibit the development of lung cancer, improve the body's cellular immune function, adjust the level and expression of tumor markers, improve the body's material metabolism, and restore the balance of yin and yang in the body.

Evolution of total hip arthroplasty in patients younger than 30 years of age: A systematic review and meta-analysis.

While surgical technique and implant technology for total hip arthroplasty (THA) has improved over the years, it is unclear whether recent progress has translated to improved clinical outcomes for young patients. The goal of this study is to determine trends in (1) indications, (2) surgical technique (3) clinical and radiographic outcomes, and (4) survivorship for THA in patients younger than 30years of age. MedLine, Cochrane, EMBASE, and Google Scholar were searched using several key phrases for articles focusing on THA performed on patients younger than 30years of age between 1971 and 2020. A total of 34 qualifying articles were identified and stratified into three groups according to operative years and compared to one another on the basis of (1) indications; (2) fixation technique; (3) implant design; (4) clinical and radiographic outcomes; and (7) survivorship. The mean patient age at index THA were 20.5 (9-30), 22.1 (11-30) and 21.5 (10-30) years, respectively, for each study group. Over time, patients underwent fewer THAs for JRA (Juvenile Rheumatoid Arthritis) (p < 0.001) but more for post-treatment and iatrogenic avascular necrosis (p < 0.001; p < 0.001). Early THAs primarily used metal on UHMWPE (Ultra high molecular weight polyethylene) (71.7%, p < 0.001), modern THA predominantly use ceramic on HXLPE (Highly cross-linked polyethylene) (42.5%, p < 0.001). Early fixation methods used cement (60.4%, p < 0.001), and modern fixation primarily use press fit technology (95.9%, p < 0.001). Prevalence of radiographic loosening decreased significantly (p < 0.001) over time. There was no significant difference in clinical improvement on HHS. Lastly, fewer patients required THA revision in recent decades (p < 0.001). Advances in surgical technique and technology have served to improve implant longevity. Surprisingly, subjective clinical scores showed no significant improvement over time, suggesting that early iterations of THA were extremely successful.

Mechanical Thrombectomy in Patients Presenting with NIHSS Score

Background and ObjectivesGroundbreaking trials have shown the tremendous efficacy of mechanical thrombectomy for large vessel occlusions. Currently, mechanical thrombectomy is limited to patients with NIHSS scores ≥6. We investigated the feasibility and safety of MT in patients presenting with NIHSS scores <6. Materials and MethodsA retrospective review of patient who presented with acute ischemic stroke due to large vessel occlusion with an NIHSS score <6 between 2015 – 2021. The patients were then divided into two groups: those who received mechanical thrombectomy and those who did not. ResultsAmong 83 patients, 41 received a mechanical thrombectomy while 42 received medical treatment only. The mean age in the mechanical thrombectomy group was 66 years versus 60 years in the medical group (p = 0.06). Risk factors for stroke did not differ significantly between both groups. 14 patients (34.1%) in the mechanical thrombectomy group and 20 (47.6%) in the medical group received tissue plasminogen activator. No significant difference in clinical improvement (NIHSS) at discharge (p=0.85) or the mRS score at 90 days (p = 0.15) was noted. Mechanical thrombectomy was associated with smaller infarct size (p=0.04) and decreased mortality (p=0.03). ConclusionsMechanical thrombectomy is safe and effective for patients who present with large vessel occlusions and low initial NIHSS scores. Therefore, the decision to offer the patient mechanical thrombectomy or not should not be decided by NIHSS score alone. Rather, the decision should be multifactorial with the aim of maximizing the patients’ outcomes.

Patterns and Distribution of Deep Vein Thrombosis and Its Effects on Clinical Outcomes After Opening-Wedge High Tibial Osteotomy.

Background:Although a few studies have reported the incidence of deep vein thrombosis (DVT) after opening-wedge high tibial osteotomy (OWHTO), previous studies focused only on symptomatic DVT. Information is lacking regarding the overall incidence of DVT after OWHTO, thrombus location, and the relationship between DVT and clinical outcome.Purpose:To determine the overall incidence of DVT and classify the location of DVT after OWHTO. We also determined whether significant differences in clinical improvement exist in patients with and without DVT at 6 months and at 2 years after OWHTO.Study Design:Case-control study; Level of evidence, 3.Methods:This study included 46 patients (47 knees) who underwent OWHTO. All patients were instructed to perform knee range of motion exercises and partial weightbearing after drain removal. None of the patients received a chemoprophylaxis for DVT except intermittent pneumatic compression. DVT was diagnosed using 128-row multidetector computed tomography performed before discharge on the fourth postoperative day. The location was classified into 6 segments in the distal portion (muscular and axial veins) and proximal portion (popliteal, femoral, and common femoral veins and veins located above the iliac vein). International Knee Documentation Committee (IKDC) score was assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years using a linear mixed model.Results:Although the incidence of symptomatic DVT was 8.5% (n = 4), the overall incidence of early DVT was 44.7% (n = 21). All DVTs were located in the distal portion of the lower extremity vein, and 76.2% of the DVTs were located in an axial vein. The IKDC scores were 33.6 ± 7.2 and 35.3 ± 9.1 (P = .910) preoperatively, 38.1 ± 5.6 and 40.6 ± 8.4 (P = .531) at 6 months after surgery, and 44.8 ± 6.9 and 45.9 ± 11.4 (P = .786) at 2 years after surgery in patients without and those with DVT, respectively.Conclusion:The overall incidence of early DVT after OWHTO was 44.7%. DVT after OWHTO was found particularly around the osteotomy site (76.2%). Patients with DVT did not have inferior short-term clinical outcomes after surgery.

A comparative study to determine the short-term mortality and clinical improvement in hepatic encephalopathy using either rifaximin and or lactulose

Background: Hepatic encephalopathy can be reversed by correcting precipitating factors and efficiently managed by lactulose and or rifaximin.&#x0D; Aims and Objective: The aim of this study to compare the effectiveness of three different modes of treatment in our study populations.&#x0D; Materials and Methods: Ninety patients of decompensated chronic liver diseases were selected and randomised to treat with either lactulose or rifaximin or both lactulose and rifaximin (30 patients in each group) for 7 days. Clinical outcome and short term mortality were noted in each group of treatment. This study was to review the comparison of the effectiveness of Rifaximin (1200mg/day , in 3 divided doses ) alone or in combination with Lactulose (60gram/day ,in divided doses) or Lactulose (60gram/day) alone to reduce the short term mortality and clinical improvement in hepatic encephalopathy of any grade of any cause in adult (&gt;18 years) admitted patients of decompensated chronic liver diseases.&#x0D; Result: Clinical improvement was noted in all three modes of treatment but there is no statistically significant difference in clinical improvement of hepatic encephalopathy when compared amongst each of three modes of treatment. There was obvious reduction of short term mortality or clinical down gradation of hepatic encephalopathy grade after 7 days treatment using lactulose or rifaximin or combined lactulose and rifaximin but there was no statistically significant difference in this regard among these three modes of treatment.&#x0D; Conclusion: All three modes of treatment are equally effective though combination therapy is little better.

The Effect of Nigella Sativa on Clinical Improvement of Laryngopharyngeal Reflux Patients

Background : Laryngopharyngeal Reflux (LPR) decribes as retrograde reflux from gaster into the laryngopharynx because of the premature relaxation upper esophageal sphincter. The management of LPR patients includes lifestyle and dietary arrangements, medical therapy and surgical management. Nigella sativa (NS) / black cumin has anti-inflammatory, anti-oxidant and gastroprotective effects that are expected to provide clinical improvement in LPR patients.Objective : The purpose of this study was to determine the effectiveness of NS on the clinical improvement of LPR patients.Methods : This research is an intervention study using pre and post test design methods of 34 LPR patients in Dr. Kariadi, hospital and 2 affiliated hospital from November 2019 - March 2020.Result : 24 patients with complete data while 10 patients were unable to evaluate RFS because of a pandemic. The treatment group (15 patients) were given omeprazole 20 mg / 12 hours plus NS 1000 mg / 12 hours orally and control group (9 patients) were given omeprazole 20 mg / 12 hours orally and placebo. Data were tested by Shapiro Wilk test, followed by the appropriate parametric test, and Fisher's exact test. There were no differences in clinical improvement in LPR based on RSI and RFS values between groups given additional NS and groups without NS, p 0.105.Conclusion : there were no significant differences in clinical improvement between groups given additional NS and groups without NS.

Radial to Axillary Nerve Transfer Outcomes in Shoulder Abduction: A Systematic Review.

Background:Brachial plexus and axillary nerve injuries often result in paralysis of the deltoid muscle. This can be functionally debilitating for patients and have a negative impact on their activities of daily living. In these settings, transferring the branch of the radial nerve innervating the triceps to the axillary nerve is a viable treatment option. Additional nerve transfers may be warranted. This study sought to determine the efficacy of nerve transfer procedures in the setting of brachial plexus and axillary nerve injuries and factors affecting clinical outcomes.Methods:The U.S. National Library of Medicine’s website “PubMed” was queried for “radial to axillary nerve transfer” and “brachial plexus nerve transfer.” An initial review by two authors was performed to identify relevant articles followed by a third author validation utilizing inclusion and exclusion criteria. Individual patient outcomes were recorded and pooled for final analysis.Results:Of the 80 patients, 66 (82.5%) had clinical improvement after surgical nerve transfer procedures. Significant difference in clinical improvement following nerve transfer procedures was correlated with patient age, mechanism of injury, brachial plexus vs isolated axillary nerve injuries, multiple nerve transfers vs single nerve transfers, and surgery within the first 7 months of injury. The branch of the radial nerve supplying the triceps long head showed improved clinical results compared with the branch of the radial nerve supplying the triceps medial head and anconeus.Conclusion:Nerve transfers have been shown to be effective in restoring shoulder abduction in both isolated axillary nerve injuries and brachial plexus injuries.

Efficacy and safety of fluoroquinolone-containing regimens in treating pulmonary Mycobacterium avium complex disease: A propensity score analysis.

BackgroundAlthough combination therapy using clarithromycin, rifampicin, and ethambutol is recommended for patients with pulmonary Mycobacterium avium complex (MAC) disease, some patients do not tolerate it because of adverse effects or underlying diseases. The efficacy and safety of fluoroquinolone-containing combination regimens as an alternative remain uncertain. This study aimed to compare the efficacy and safety of fluoroquinolone-containing regimens with those of the standard regimens for treating pulmonary MAC disease.MethodsWe retrospectively included consecutive MAC patients who were treated in our hospital between January 2011 and May 2019. Patients treated with fluoroquinolone-containing regimens who had relapsed after treatment with standard regimens were excluded. A propensity score analysis was conducted to reduce selection bias, and the proportions of clinical improvement, defined by chest imaging findings and sputum conversion, were compared between the fluoroquinolone-containing regimen and standard regimen groups.ResultsWe analyzed 28 patients who received fluoroquinolone-containing regimens and 46 who received the standard regimen. Fluoroquinolone-containing regimens were more likely selected for patients with cavitary lesions, diabetes mellitus, culture negativity, a low daily physical activity level, a decreased lymphocyte count and an increased CRP level. The propensity score was calculated using these variables (C-statistic of the area under the receiver operating characteristic curve of the propensity score: 0.807, p < 0.0001). The fluoroquinolone-containing regimens were significantly inferior to the standard regimen in clinical improvements (p = 0.002, Log-rank test) in the univariate analysis, but the significance was lost after adjusting for the propensity score (HR 0.553, 95% CI 0.285–1.074, p = 0.080). Six (21%) patients in the fluoroquinolone-containing regimen group and ten (22%) patients in the standard regimen group experienced low-grade adverse effects.ConclusionsThere was no significant difference in clinical improvement between these regimens after propensity score adjustment. A large-scale prospective study is required to validate these results.

Outcomes of Partial Meniscectomy in Obese Patients: A Systematic Review and Meta-Analysis.

Arthroscopic partial meniscectomy (APM) is one of the most commonly performed surgical procedures. However, the indications for APM are controversial and obese patients may have worse outcomes. This study's primary purpose was to investigate differences in outcome after APM associated with elevated body mass index (BMI). Secondary objectives included differences in pathophysiology, surgical complications/failures, or osteoarthritis development. MEDLINE, EMBASE, and OVID databases were systematically searched for eligible studies reporting on APM outcomes at a minimum of 1 year postoperatively. Studies that did not include BMI categorization were excluded. Meta-analysis was conducted with random-effects modeling where data from at least 2 studies was available. A total of 16 articles were included. Overweight/obese BMI was associated with worse preoperative Lysholm (mean difference, -6.06 [95% CI, -11.70 to -0.42]) and visual analogue scale pain scores (0.43 [0.07 to 0.79]). Worse postoperative normalized knee-specific patient-reported outcome scores were also associated with obese BMI (-4.57 [-5.33 to -3.81]). There were no significant differences in clinical improvement or osteoarthritis progression among BMI groups. Two studies found higher complication/failure rates, 3 articles associated medial meniscus posterior root tears, and 1 article found differences in gene transcript expression with increased BMI. Obesity is associated with worse knee function after APM, and patients with elevated BMI have worse preoperative knee pain and function. However, there is no difference in amount of improvement between elevated and normal BMI patients. Further prospective research is necessary to determine the comparative effectiveness of APM in patients with elevated BMI.

COMPARISON OF CLINICAL IMPROVEMENT OF BENIGN PAROXYSMAL POSITIONAL VERTIGO WITH AND WITHOUT HYPERTENSION

Background: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. Several studies have shown that comorbid hypertension can affect the prognosis of BPPV. This study aims to assess the comparison of clinical improvement in BPPV patients with and without hypertension. Method: This research is an analytical study with a cohort design. The research was conducted at the Neurology Polyclinic of RSUP Haji Adam Malik Medan for the period of October 1, 2019 to December 1, 2019. A total of 40 BPPV patients with and without hypertension were taken into the study sample, using consecutive sampling technique. For 7 days recurrence was recorded and on the 7th day, BPPV symptoms were reassessed with the Dix-Hallpike maneuver. Furthermore, statistical analysis was performed using the Mann Whitney U test and Kruskall Wallis test. Result: Of the 40 research subjects, there were 29 more women (72.5%) and the highest age was in the range&gt; 40 - 60 years as many as 23 subjects (57.5%). It was found that 6 people (30.0%) BPPV patients with hypertension and 17 people (85.0%) BPPV patients without hypertension experienced positive clinical improvement, while 14 people (70.0%) BPPV patients with hypertension and 3 people (15 , 0%) BPPV patients without hypertension experienced negative clinical improvement (p = 0.001). Conclusion: There is a significant difference in clinical improvement between BPPV patients with and without hypertension.

Efficacy of stem cell-conditioned medium vs. platelet-rich plasma as an adjuvant to ablative fractional CO2 laser resurfacing for atrophic post-acne scars: a split-face clinical trial

Objectives To explore the impact of using topical stem cell-conditioned medium (SC-CM) after fractional carbon dioxide laser (FCL) vs. combined FCL and platelet-rich plasma (PRP) or FCL alone in treatment of atrophic acne scars. Methods Thirty-three patients were randomly divided into two split-face groups. Group I (n = 17) received FCL plus topical SC-CM on one side or FCL plus saline on the other. Group II (n = 16) received FCL plus topical PRP or SC-CM. All patients had three monthly sessions. Clinical assessment was done at each visit, with a final assessment after 3 months. Skin biopsies were obtained for histological and quantitative molecular analysis after treatment. Results No significant difference in clinical improvement of acne scars was observed between the FCL/SC-CM and FCL only sides (p = .63), while better and faster improvement was detected on FCL/PRP side compared to FCL/SC-CM side (p = .006). There was no significant difference in downtime or adverse effects between the treated sides in either group. Dermal collagen was increased and procollagen type I gene was upregulated in both FCL/PRP and FCL/SC-CM sides compared to FCL only sides (p = .001 and p = .041, respectively). Conclusions Topical SC-CM could potentially enhance the efficacy of FCL. However, PRP seems to be a better alternative.

Effects of rehabilitation on the patients with chronic low back pain

This study was done to observe the effects of rehabilitation on chronic low back pain on 139 patient. They were divided into two groups: a) One group (n=71) received naproxen (non-steroidal anti-inflammatory drug, NSAID) with selective rehabilitation and b) another group (n= 68) treated with NSAID only. The patients were followed up weekly for eight weeks. The improvement was found in both groups after treatment. In patients with rehabilitation, the pre-treatment and post-treatment mean scores (Oswastry Disability Index, Visual Analogue Scale and Modified Zung Index) were 34.3 ± 9.8 and 9.9 ± 8.0 respectively (p&lt;0.001). Treatment with NSAID only reduced the mean scores from 34.9 ± 13.5 to 16.0 ± 14.4 (p&lt;0.001) after treatment. There was no significant difference in clinical improvement between the groups in pre-treatment compare with week one, rehabilitation group (29.7 ± 8.7) vs NSAID group (31.5 ± 13.8). While significant improvement was found in rehabilitation group in comparison to NSAID group after 8th week, rehabilitation group vs NSAID group scores were 10.0 ± 7.9 vs 15.9 ± 14.5 respectively (p= 0.004). In conclusion, rehabilitation can be used as an adjunct to NSAID for better improvement.

Prospective Randomized Trial Comparing Mobile-bearing and Fixed-bearing Total Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported longterm for MB-TAR and at intermediate-to-longterm follow-up for newer generation FB-TAR. Although comparisons between the two total ankle designs have been reported, to our knowledge, no investigation has compared the two designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: This investigation was approved by our institution’s IRB committee. Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65, range 35 to 85) were enrolled; demographic comparison between the two cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees or extensive talar dome wear pattern (“flat top talus”). Prospective patient-reported outcomes, physical exam and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score (VAS), short form 36 (SF-36), foot and ankle disability index (FADI), short musculoskeletal functional assessment (SMFA) and AOFAS ankle-hindfoot score. Surgeries were performed by non-design team orthopaedic foot and ankle specialists with total ankle replacement expertise. Statistically analysis was performed by a qualified statistician. Results: At average follow-up of 4.5 years (range 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, one had died, 4 were withdrawn after enrolling but prior to surgery and 4 were lost to follow-up. In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up. There was no statistically significant difference in improvement in clinical outcomes between the two groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FB-TAR, respectively. Re-operations were performed in 8 MB-TAR and 3 FB-TAR, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: For the first time, with a high level of evidence, our study confirms that patient reported and clinical outcomes are favorable for both designs and that there is no significant difference in clinical improvement between the two implants. The incidence of lucency/cyst formation was similar for MB-TAR and FB-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not correlate with radiographic findings. Re-operations were more common for MB-TAR and in the majority of cases were to relieve impingement or treat cysts rather than revise or remove metal implants.

Endovascular Treatment with Drug-Coated Balloons in Femoropopliteal Artery Disease

Objectives: In this study, we aimed to evaluate the one-year follow-up findings of endovascular treatment with drug-covered balloon in patients with femoropopliteal artery disease (FAD). Patients and Methods: From June 2012 to March 2015, 43 patients were enrolled in the study. Fifteen patients, 16 limbs and 19 lesions were treated with percutaneous transluminal angioplasty (PTA). Twenty-eight patients, 31 limbs and 36 lesions were treated with drug-coated balloon (DCB). At 12 months, all patients were examined with magnetic resonance angiography. Results: Primary patency was seen in 47.4% of the treated lesions in the PTA group and 80.5% in the DCB group. There was statistically significant difference in primary patency between the groups (P = 0.011). Clinical improvement was seen in 56.3% of the treated limbs in the PTA group and 83.9% in the DCB group. There was no statistically significant difference in clinical improvement between the two groups (P = 0.075). Conclusion: DCB with low restenosis rate can be used safely for endovascular treatment in patients with FAD as an alternative of standard balloon and stent.