Statistical Significant Reduction Research Articles

Mandatory Review of Prescription Drug Monitoring Program Before Issuance of a Controlled Substance Results in Overall Reduction of Prescriptions Including Opioids and Benzodiazepines

Background: To date, there is limited research on whether the various types of mandatory usage of prescription drug monitoring programs (PDMP) have any effects on prescribing patterns, drug usage, patient care, and drug diversion (8-10). Within the United States (US), there is wide variation in individual states’ requirements for the usage of PDMPs. Objective: The objective of this study was to determine whether mandatory prescriber review of a PDMP prior to each issuance of a controlled substance resulted in a reduction in the total number of controlled substance prescriptions dispensed. Study Design: A retrospective review of the State of Wisconsin’s PDMP controlled substance database from April 2015 to March 2019 was performed. The evaluation compared the number of prescriptions among individual drug classes (opioids, benzodiazepines, stimulants) dispensed throughout the state before and after April 1st, 2017, when implementation of a state law mandating the review of the PDMP during each patient encounter prior to issuing a prescription for a controlled substance took effect. Setting: Research was conducted using Wisconsin’s PDMP controlled substance database from April 2015 to March 2019. During this time, controlled substance policy has come to the forefront of the nation due to issues with an opioid epidemic. Methods: Descriptive analysis was used to express data as n and % for categorical data and average ± standard deviation for numerical data. Before- and after-prescription totals were analyzed using a paired t test and Levene’s test for equality of variances. The P value was considered significant at a level ≤ .05. Limitations: Limitations to this study included its retrospective design, focus on a single US state, and possible unforeseen contributors to cause and effect. Results: Prior to the enforcement of the state’s mandatory PDMP legislation, an average of 844,314 controlled substance prescriptions were written monthly. Following the implementation of the law, the average monthly total prescriptions written within the state decreased to 708,063. This was an average monthly reduction of 136,251 prescriptions written or 16.1%. Statistically significant reductions were also seen in opioid and benzodiazepine subgroups (23.0%, 16.3%). Conclusion: Our study suggests that state-enforced mandatory usage of a PDMP, which records all controlled substance prescriptions filled by a pharmacy such as opioids, benzodiazepines, amphetamines, etc. at every encounter prior to prescribing any controlled substance, can provide for a significant reduction in controlled substance prescriptions, specifically opioids and benzodiazepines. Key words: Prescription drug monitoring program, opioids, mandatory usage, benzodiazepines, Wisconsin

Video-assisted thoracoscopic sympathectomy versus modified Wittmoser method in surgical management of primary hyperhidrosis

PurposesWe compared two different surgical methods evaluating the effectiveness of procedures and the quality of life (QoL) of patients.MethodsFrom January 2010 to November 2017 we carried out 476 biportal video-assisted thoracoscopic surgery (VATS) approaches of sympathetic chain in 238 patients. One hundred and twenty-nine (54%) patients underwent conventional sympathectomy (CS) while 109 (46%) patients underwent sympathicotomy associated with the division of the rami communicantes (MWT). Quality of Life (QoL) was classified as follows: from 20 to 35 excellent; from 36 to 51 very good; from 52 to 68 good; from 69 to 84 poor; and > 84 very poor.ResultsWe noticed statistical significant reduction of complications comparing CS with MWT approaches (chest pain from 36.4 to 4.5%; paresthesias from 8.5 to 3.6%; bradycardia from 28.6 to 10%, respectively). The preoperative and postoperative QoL index evaluation revealed a statistically significant improvement after surgery (CS: 86 ± 2 versus 35 ± 1, p = 0.00001; MWT: 85 ± 1 versus 33 ± 2, p = 0.00001), with general satisfaction of the two techniques.ConclusionModified Wittmoser method seems to be a valid alternative to conventional sympathectomy, minimizing the percentage rate of complications and showing significant effectiveness in the quality of life improvement.

The Hearing-Aid Speech Perception Index (HASPI) Version 2

This paper presents a revised version of the Hearing-Aid Speech Perception Index (HASPI). The index is based on a model of the auditory periphery that incorporates changes due to hearing loss and is valid for both normal-hearing and hearing-impaired listeners. It is an intrusive metric that compares the time-frequency envelope and temporal fine structure (TFS) of a degraded signal to an unprocessed reference. The first modification to HASPI is an extension to the range of envelope modulation rates considered in the metric. HASPI applies a lowpass filter to the time-frequency envelope modulation, and in the new version this single filter is replaced by a modulation filterbank. The temporal fine structure (TFS) analysis in the original version of HASPI is replaced by the filterbank outputs at higher modulation rates that represent auditory roughness and periodicity. The second modification is replacing the parametric model combining envelope and TFS measurements used in the original version with an ensemble of neural networks. The improved version of HASPI is compared to the original version for datasets from five experiments that encompass noise and nonlinear distortion, frequency compression, ideal binary mask noise suppression, speech modified using a noise vocoder, and speech in reverberation. The new version of HASPI is shown to have a statistically-significant reduction in RMS error compared to the original version for most of the data considered, and to be significantly more accurate for speech in reverberation.

Pharmacological evaluation of analgesic, anti-inflammatory and antipyretic activities of ethanolic extract of Indigofera argentea Burm. f.

Ethnopharmacological relevanceIndigofera argentea Burm. f.; commonly known as neel, jantari, hathio; is traditionally used for the treatment of headache, fever, inflammation and body pain. Local communities also used this plant for the treatment of malaria, jaundice, vertigo and gastric disorders. Aim of the studyThis study is aimed to evaluate the toxicity and possible analgesic, anti-inflammatory and antipyretic activities of the ethanolic crude extract of Indigofera argentea (IaCr) to support its use in folk medicine and to screen the phytochemical constituents and antioxidant activity. Materials and methodsAqueous ethanolic (30:70) extract of whole plant of Indigofera argentea (IaCr) was prepared and phytochemical study was performed by preliminary methods followed by HPLC and DPPH method. In vivo experiments were performed in Wistar albino rats including hot plate, tail immersion, formalin and capsaicin-induced pain tests in rats and acetic acid-induced writhing test in mice. Anti-inflammatory activity was assessed by using in vitro human red blood cell (HRBC) membrane stabilization and carrageenan-induced rat paw edema test, while antipyretic activity was evaluated by Brewer’s yeast-induced pyrexia test. ResultsThe crude extract of Indigofera argentea confirmed the presence of flavonoids, glycosides, alkaloids, saponins and tannins as soluble ethanolic constituents in preliminary study. The maximum quantity of gallic acid equivalent (GAE) phenolics, and quercetin equivalent (QE) flavonoid content found was 81 ± 2 mg GAE/g and 56 ± 1.4 mg QE/g of extract respectively. Quantification based on HPLC exposed the presence of phenols and flavonoids, quercetin, gallic acid, caffeic acid, chlorogenic acid, benzoic acid, ferulic acid and coumaric acid. In vivo experiments revealed significant P < 0.05) dose-dependent inhibition in hot plate, tail immersion and capsaicin-induced pain test. IaCr showed significant inhibition of pain latency against both phases in formalin test and considerably decreased the number of writhes caused by acetic acid at the doses of 30, 100 and 300 mg/kg. In the in vitro anti-inflammatory (HRBC) assay, IaCr showed good membrane stability with maximum percentage hemolysis inhibition of 49.29% while in carrageenan-induced paw edema test in rats the IaCr showed significant anti-inflammatory action in a dose-dependent fashion. Statistical significant reduction in rectal temperature was observed at the doses of 100 and 300 mg/kg in yeast-induced pyrexia test in rats. ConclusionThe results of the experimental studies proved the analgesic, anti-inflammatory and antipyretic activities of Indigofera argentea and supported the traditional use of this plant.

Taurolidine lock solution for catheter-related bloodstream infections in pediatric patients: A meta-analysis.

Infection is one of the most commonly described complications, and a major cause of morbidity and mortality in pediatric patients treated using central venous catheters (CVCs). Taurolidine lock solutions have been used to decrease catheter-related bloodstream infections (CRBSIs) in both adult and pediatric patients. The purpose of this study was to systematically search the literature and conduct a meta-analysis to determine the efficacy of taurolidine in reducing CRBSI in children. We conducted an electronic search of the PubMed, EMBASE, Cochrane Library, TRIP Database, CINAHL, and Google Scholar databases for articles published up to 1st November 2019. Eligible studies included randomized controlled trials (RCTs) comparing the effects of taurolidine with control for preventing CRBSI in pediatric patients. Four studies were included. Our results indicated a statistical significant reduction in the total number of CRBSI with taurolidine as compared to control (RR: 0.23; 95% CI:0.13, 0.40; I2 = 0%; P<0.00001). The pooled analysis also indicated a statistical significant reduction in the incidence of CRBSI (defined as the number of CRBSI events/1000 catheter days) in the taurolidine group (MD: -1.12; 95% CI:-1.54, -0.71; I2 = 1%; P<0.00001). The number of catheters removed due to infection or suspected infection was not significantly different between the two groups (RR: 0.68; 95% CI:0.22, 2.10; I2 = 56%; P = 0.50) (Fig 5). The quality of the included studies was not high. The use of taurolidine as a catheter locking solution may significantly reduce CRBSI in pediatric patients. However, the quality of current evidence is not high and further high-quality large scale RCTs are needed to corroborate our results.

Effect of Aloe Vera Gel on Severity of Radiation Induced Dermatitis among Patients after Mastectomy

Radiation induced dermatitis is a significant adverse effect of radiation therapy occurring in the majority of patients treated with this modality such as mastectomy. No standard treatment has been recommended for the prevention of this side effect. This article is a report of a study evaluating the effect of Aloe Vera gel on severity of radiation induced dermatitis among patients after mastectomy. A time-series nonequivalent quasi-experimental research design was utilized, hence, a convenient sample of 132 adult female patients receiving radiation therapy after mastectomy were equally assigned randomly to either a study or a control group. Data were collected using two tools: 1) Demographic and Medical Data Sheet, and 2) Radiation Induced Skin Reaction Assessment Scale (RISRAS). The study results revealed statistical significant reduction in radiation induced dermatitis severity scores among the study group compared to the control group. It was concluded that the use of Aloe Vera gel is effective in reducing the severity of radiation induced dermatitis among patients after mastectomy.

Hypothermia during Surgical Treatment of Type A Aortic Dissection: A 16 Years' Experience.

Acute aortic dissection (AAD) is among the most challenging cases for surgical treatment and requires procedural expertise for its safe conduct. Aortic surgery has undergone several changes over the last years, especially concerning cerebral protection. The brilliant results obtained with the aid of selective anterograde cerebral perfusion led to a progressive increase of circulatory arrest temperature, with the rise of safe time along with a reduction of the extracorporeal circulation time and hypothermia-related side effects. However, there is still no definitive consensus concerning the optimal range of temperature to be used during circulatory arrest. Objectives. This is a retrospective observational study, and we examined 16-year trends in the presentation, diagnosis, hospital outcome and treatment of A AAD type. In our Cardiac Surgery Unit in Policlinico Umberto I of Rome, our analysis focused on patients, who received ACP during aortic surgery and we analyzed the differences between two distinct groups based on the lowest temperature reached during CPB conduction: Lower Temperature Group (LT) (T < 24°C) versus Higher Temperature Group (HT) (T ≥ 24°C) arrest circulation temperature. Methods. Data from 241 patients enrolled between August 2002 and March 2018 were analyzed. Patients were divided according to the lowest temperature reached into 2 groups: Lower Temperature group (LT) (94 patients) and Higher Temperature Group (HT) (147 patients). Results. Our results showed a significant reduction of in-hospital mortality and in-hospital results in patients with higher CPB temperature. The global incidence of complications was statistically reduced in HT group: we found a statistical significant reduction of intestinal ischemia, and a similar trend also for other complications analyzed, such as infections. Since the two groups were similar for type of surgical procedures, we considered these differences depending on the lower temperature value reached, according to the current literature. Conclusions. We found a significantly higher mortality in patients with lower temperature during CPB and a global reduction of complications and in particular a significant reduction of intestinal ischemia in patients with higher temperature during CPB. We found a similar trend in other fields of investigations, so we can conclude that circulatory arrest performed at temperature ≥24°C nasopharyngeal temperature associated with ACP is a safe strategy for aortic surgery for AAD.

Efficacy of omega 3 fatty acid as an adjunct in the management of chronic periodontitis: A randomized controlled trial

: Periodontitis is conventionally treated with both surgical and nonsurgical methods. Various adjuncts have been used previously with compromised efficacy. Recently omega-3(ώ-3) polyunsaturated fatty acids (PUFA) including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were shown to have therapeutic anti-inflammatory and protective actions in inflammatory diseases including periodontitis. The purpose of the present study was to evaluate and compare the clinical efficacy of ώ-3 fatty acids as an adjunct to scaling and root planing in the treatment of periodontitis. 110 Patients were selected for the study out of which 20 were excluded (12 not meeting the inclusion criteria and 8 refused to participate). 90 patients (48 in test and 42 in the control group) after randomisation through a coin toss method were enrolled in a single-blind randomised controlled trial conducted in the Periodontics department of a dental college. Full mouth subgingival scaling and root planing and ώ-3 fatty acid 500 mg (EPA/DHA 180/120 mg), BD daily for 1 month was given to the test group and subgingival scaling and root planing only was given to the control group. Clinical parameters like probing pocket depth, clinical attachment level, plaque index and gingival index were recorded at baseline, 1 and 3 months and were compared. Statistical analyses demonstrated a significant reduction in probing pocket depth (t = 65.56, P = 0.000) and (t = 51.69, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. There was a significant gain in clinical attachment level (t = 63.29, P = 0.000) and (t = 31.03, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. The gingival index shows an appreciable reduction in both groups, and in test group, it is statistically significant at 3 months (t = 2.15, P = 0.03). There was no statistical significant reduction in plaque index at 3 months (t = 0, P = 0.997). The present study showed that adjunctive use of ώ-3 fatty acids proved to be beneficial over scaling and root planing alone in the treatment of chronic moderate periodontitis. The beneficial effects were in terms of significant improvements in clinical parameters, probing pocket depth, and clinical attachment level and gingival index. Dietary modulation is now emerging as an adjunct to periodontal therapy. Hence, omega-3 fatty acid may be used routinely in the management of chronic periodontitis.

Social distancing merely stabilized COVID-19 in the United States.

Social distancing measures have been imposed across the United States in order to stem the spread of COVID‐19. We quantify the reduction in the doubling rate, by state, that is associated with this intervention. Using the earlier of K‐12 school closures and restaurant closures, by state, to define the start of the intervention, and considering daily confirmed cases through April 23, 2020, we find that social distancing is associated with a statistically‐significant () reduction in the doubling rate for all states except for Nebraska, North Dakota, and South Dakota, when controlling for false discovery, with the doubling rate averaged across the states falling from 0.302 (0.285, 0.320) days to 0.010 (0.007, 0.028) days. However, we do not find that social distancing has made the spread subcritical. Instead, social distancing has merely stabilized the spread of the disease. We provide an illustration of our findings for each state, including estimates of the effective reproduction number, R, both with and without social distancing. We also discuss the policy implications of our findings.

Photo-activated disinfection with light-emitting diode reduces some key periodontal pathogens in chronic periodontitis

The aim of the present study was to evaluate the potential of minimally invasive periodontal treatment using repeated photo-activated oral disinfection (PAD) with red light emitting diodes as an adjunct to ultrasonic scaling (US) in the treatment of chronic periodontitis. In a single-centred, randomized clinical trial involved 40 patients with untreated chronic periodontitis received US with repeated 3 episodes of PAD (test group) or US alone (control group). Clinical parameters (plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL)) were recorded for 12 months and subgingival biofilm analyses for five periodontal pathogens (A. actinomycetemcomitans (Aa), P. gingivalis (Pg), P. intermedia (Pi), T. forsythia (Tf), T. denticola (Td)) were performed for 6 months. Supportive periodontal treatment (SPT) was repeated every 3 months during the clinical trial, additional one episode of PAD was also applied in the test group. Both treatment modalities improved clinical parameters after 3 months and SPT maintained favourable clinical outcomes during 12 months. There were no statistical significant differences between the treatment groups. Statistical significant reduction of Aa, Pg, Tf, Td (p<0.05) was observed in the test group. In moderate pockets significant reduction of Pg, Tf, Td (p<0.05) and in deep periodontal pockets reduction of Pg, Pi, Td (p<0.05) was observed. Within the limits of the present study it may be concluded that the addition of PAD to US significantly reduced some key periodontal pathogens, however, patients with a history of periodontitis should be on SPT every 3-4 months.

The effect of chronic stress on the testis of adult albino Rats and the possible protective effect of astaxanthin supplementation (Histological, immunohistochemical and biochemical studies)

Background and Objectives: Stress can disrupt homeostasic balance within the organisms. Chronic stress can have damaging effects on the whole organism. The present study aimed to throw more light on themolecular,immunological and histological alterations in adult albino rat’s testis subjected to chronic stress and to demonstrate whether the potential chronic stress‑induced testicular alterations could be ameliorated by astaxanthin or not.Materials and Methods: Forty healthy adult male albino rats were used in this study, they were assigned as 3 main groups: Group I (Control group) which are subdivided into two equal groups, Group II (stress group) rats were restrained for 1 h and after 4 hs they are forced to swim for 15 minutes every day for 6 months, and Group III (protective group) rats were subjected to stressors as previous group in concomitant with daily administration of astaxanthin (25mg/kg b.w.) dissolved in 1ml normal saline in a single daily doseorally in a single daily dose. Blood samples and testicular tissues were collected and assayed for histological, immunohistochemical and biochemical changes.Results: The results of the present study demon‌strated thatthere were degenerative changes in spermatogenic and Sertoli cells of stress group and were associated with statistical significant reduction in height of germinal epithelium, Ki-67 and vimentinimmunoexpression.These changes were observed to be reduced in astaxanthin protected group.Also,there was a decrease in serum testosterone levels in stress group, which were normalized after astaxanthin administration. Also, stress significantly increased the serum levels of malondialdehyde, and decreased levels of total antioxidant capacity TAC.Conclusions: This study concluded that astaxanthin has beneficial protective effects against the deleterious effects of chronic stress on the testis. Therefore, it may be a suitable nutrional supplement in alleviating some negative aspects of chronic stress effects on testis.

The effect of wet-dry cycles on tensile properties of unidirectional flax fiber reinforced polymers

The impact of moisture is a critical research focus for natural fibres. There is a significant decrease in mechanical performance when fully saturated; however, this may not be representative of real-life applications. In this study, the tensile performance of flax fibre reinforced polymers (FFRP) is investigated when exposed to wet-dry cycles. Manufacturing method, fibre type and resin type were varied throughout this research program. Vacuum bag moulded specimens exhibited an increased strength of 19%, increased rupture strain of 105% and reduced tensile modulus of 29% when saturated; however, it reverted to its original state once dried. When exposed to wet-dry cycles, a statistically-significant reduction in mechanical properties began after 3 cycles, with a maximum reduction of 12% strength and 19% stiffness. Conversely, degradation for wet lay-up moulded specimens was delayed until 12 cycles. When epoxy was replaced with an epoxidized pine oil (EPO) blended resin, there was no mechanical difference throughout wet-dry cycles; however, FTIR showed signs of hydrolysis for both resins. Furthermore, the glass transition temperature of epoxy reduced from 87.2° to 77.8 °C, whereas that of EPO increased from 65.6 °C to 70.2 °C. Glass-FRP was tested in parallel, and exhibited no change to performance across the entire conditioning protocol.

P5346The effect of seizure type on ictal and early post-ictal Heart Rate Variability in patients with focal resistant epilepsy

Abstract Background Seizures commonly affect the heart rate and its variability. The increased interest in this area of research is related to the possible connection with sudden unexpected death in epilepsy (SUDEP). Generalized tonic-clonic seizures (GTCS) are reported as the most consistent risk factor for SUDEP. However, the general risk of seizures (and their type) on cardiac function still remains uncertain. Purpose To evaluate the influence of seizure type (GTCS vs non-GTCS) on ictal and early post-ictal Heart Rate Variability (HRV) in patients with refractory epilepsy. Methods From January 2015 to July 2018, we prospectively evaluated 121 patients admitted to our institution's Epilepsy Monitoring Unit with focal resistant epilepsy. All patients underwent a 48-hour Holter recording. We included only patients who had both GTCS and non-GTCS during the recording and selected the first seizure of each type to analyze. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing 5-min-ECG epochs, starting with the seizure onset (ictal and early post-ictal period). The study was approved by our Institution Ethics Committee and all patients gave informed consent. Results Fourteen patients were included (7 Females, 4 patients with Temporal Lobe Epilepsy). The median age was 39 years (min-max, 18–57). Thirty-six percent presented cardiovascular risk factors without known cardiac disease. A significant statistical reduction was found for AVNN (p=0.013), RMSSD (p=0.008), pNN50 (p=0.005) and HF (p=0.003), during GTCS when compared with non-GTCS (Wilcoxon test, p&lt;0.05; two tailed). Conclusion Our study shows a significant reduced vagal tone during GTCS when compared with non-GTCS. Hence, GTCS had a more pronounced impact on HRV changes than other seizure types, which can be associated with higher SUDEP risk after GTCS.

P2624Association between renal dysfunction and cardiac sympathetic innervation in patients with heart failure

Abstract Introduction In heart failure (HF) a strict interaction exists between heart and kidney. Previous studies reported a significant impact of sympathetic overdrive, that causes beta-adrenoceptor desensitization, in both renal and heart failure progression. It can be hypothesized that renal failure might be associated with impaired sympathetic activity assessed directly at the myocardial level in patients affected by HF. Purpose Aim of the present observational study was to assess the relationship between renal dysfunction and cardiac sympathetic innervation in HF patients with mildly and severely reduced ejection fraction (HFrEF and HFmEF). Methods Two-hundred and sixty-three patients (84% males; 66±10.8 years) with mild-to-severe HF (EF 31±6.8%) underwent iodine-123 meta-iodobenzylguanidine (123I-MIBG) myocardial scintigraphy to assess sympathetic innervation, evaluating early and late heart to mediastinum (H/M) ratios and washout rate. All patients also underwent clinical evaluation and venous blood sample collection for the assessment of serum creatinine and consequently the estimation of glomerular filtration rate (eGFR) by EPI formula. Results A direct correlation was found between EPI-eGFR and late H/M (r=0,215; p&lt;0.001) (figure 1), with an inverse correlation between NYHA class and late H/M (r=0,152; p=0.013), and a direct correlation between left ventricular EF and late H/M (r=0,348; p&lt;0.001). These results were not confirmed for early H/M, nor washout rate. Dividing the population in reduced eGFR and normal eGFR (cut-off ≤60 ml/min/1,73m2), a statistical significant reduction of late H/M value was found in patients with reduced eGFR (late H/M = 1,49±0,21) compared with patients with preserved eGFR (late H/M = 1,56±0,26) (p=0.020). In a multivariate model, adjusting eGFR for NYHA class and left ventricular EF, reduced eGFR and left ventricular EF remained significant predictors of reduced late H/M (p=0.006 and p&lt;0.001, respectively). Figure 1. linear regression curve Conclusions Patients with impaired renal function and HF show impaired cardiac sympathetic activity compared to HF patients with preserved renal function, and reduced eGFR estimated by EPI formula is a significant predictor of reduced late H/M evaluated by 123I-MIBG. Thus, in future studies, the combination of these two parameters might provide addictive prognostic information in HF patients.

VISCUM ALBUM PINI EFFECT ON RABBIT SPERMATOZOA MOTILITY, VIABILITY, MEMBRANE AND ACROSOME INTEGRITY IN VITRO

Mistletoe (Viscum album L.) was previously described as an effective additive in the therapy of patients with cancer after medical therapy of the primary neoplasia. The defence activity and also direct cytotoxic stimulation was found to be upstanding for the anti-carcinogenic action. The main target of this study was to detect the effect of Viscum album pini L. at various concentration 1.0 (PA); 0.66 (PB); 0.33 (PC); 0.1 (PD); 0.066 (PE) and 0.033 (PF) mg/mL on the fine rabbit spermatozoa motility parameters at various time periods (0; 1; 2 and 3 h) during the cultivation in vitro. The CASA methodology was applied to estimate the spermatozoa motility parameters. The spermatozoa motility at the beginning of the experiment (Time 0) found decreased rate for examined doses of Viscum album pini compared to the control, but the statistical significant reduction was observed (p

Prevalence of Montelukast Use as an Add-On Therapy among Iraqi Asthmatics on Treatment Attending Al-Kindy Teaching Hospital and Al-Zahraa Center of Asthma and Allergy.

BACKGROUND:Montelukast (Singulair) is a cysteinyl leukotriene receptor antagonist, used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergic rhinitis and asthma, also used for exercise-induced bronchospasm.AIM:This study was performed to determine the prevalence of Montelukast use as an add-on therapy among Iraqi asthmatic patients on treatment. Comparing the effectiveness of regimens with and without montelukast.METHODS:This descriptive cross-sectional study was carried out on 73 Iraqi asthmatic patients on treatment of both sexes with age range (18-60) years old, attending Al-Kindy Teaching Hospital and Al-Zahraa Centre of Asthma and Allergy, Baghdad, for the period between February and March 2017. A questionnaire was specifically prepared to meet the objectives and was used to collect the data of the study.RESULTS:There was a significant statistical reduction of frequency in asthmatic attacks after Montelukast treatment (p-value < 0.05). Out of 73 patients, 39 were males, and 34 were females, 46 were jobless, 37 were married, 63 were urban residents, 63 were educated. Prevalence of exacerbation factors was as following: infection was found in 60.3% of the patients, exercise in 57.5%, dust in 72.6%, smoking in 60.6%, food in 24.7%, others (stress, perfumes) in 20.5%. The prevalence of Montelukast use in this study was 46% (34 patients). Out of 34 patients using Montelukast, 28 were using inhaled salbutamol, 5 were using oral salbutamol, 15 were using inhaled corticosteroids, 9 were using systematic corticosteroids, 2 were using xanthines, and 6 were using ketotifen.CONCLUSION:Montelukast was used as add-on therapy with the inhaled corticosteroids to reduce the required dose of inhaled corticosteroids also the use of Montelukast lead to reduced number of exacerbations which will be reflected on the use of inhaled salbutamol and systematic corticosteroids. Also, Montelukast was superior to xanthines and ketotifen as an add-on therapy.

Effect of Field Massage on Bilirubin Level and Stool Passage Frequency among Neonates with Hyperbilirubinemia under Phototherapy

Background: Neonatal jaundice is one of the most common problems in neonatal period and the main causes for admissions at neonatal intensive care units and effects on neonates during the first two weeks of life. Aim of this study was to determine the effect of field massage on bilirubin level and stool passage frequency among neonates with hyperbilirubinemia under phototherapy. Research design: quasi-experimental research design was utilized in this study. Setting: Neonatal Intensive Care Unit in Assiut University Children Hospital. Subjects: purposive sampling included 60 neonates with hyperbilirubinemia divided randomly into study and control groups. Tool: Neonatal Assessment sheet included age, gender, birth weight, onset of hyperbilirubinemia, daily total serum bilirubin level, hospital stay and stool frequency. Results indicated that five days of field massage has exceeded number of defecation in the study group and high statistical significant reduction in the level of serum bilirubin in the study group than control group (p<0.001). Conclusion: Field massage with phototherapy in neonates with hyperbilirubinemia was effective in increasing number of stool frequency and reducing total serum bilirubin level. Recommendations: Educational training program should be provided for nurses about field massage as non-pharmacological intervention to reduce serum bilirubin level and increase stool passage frequency.

PROGNOSTIC VALUE OF SERUM HIGH SENSITIVITY C-REACTIVE PROTEIN IN PATIENTS WITH PERIODONTITIS AND DIABETES MELLITUS TYPE 2 AFTER NON-SURGICAL PERIODONTAL TREATMENT

Objectives: Our aim in the current study is to evaluate the level of high sensitivity C-reactive protein in serum of patients with periodontitis and type 2 diabetes before and after non-surgical periodontal treatment.Subjects and methods: 60 individuals in total with stage II grade A generalized periodontitis (n=20) and stage II grade B generalized periodontitis with type 2 diabetes (n=20) along with healthy control subjects (n=20) were enrolled in this study. Serum samples from all participants were obtained. Two serum samples, before & after non-surgical periodontal treatment, were gathered from patients with periodontitis and periodontitis with type 2 diabetes. Only one serum sample was collected from healthy controls. Enzyme linked immunosorbent assay technique (ELISA) was used to measure serum levels of high sensitivity C-reactive protein (hs-CRP).Results: The highest concentration of serum hs-CRP was detected in patients with periodontitis & type 2 diabetes. This is followed by periodontitis group and then controls subjects. A statistical significant reduction in the hs-CRP serum levels after non-surgical periodontal treatment was detected in periodontitis with diabetes group while the periodontitis group showed similar reduction but without statistical significance. High diagnostic accuracy of serum hs-CRP was revealed by the Receiver Operating Characteristic (ROC) curve analysis, especially when comparing periodontitis patients, with or without diabetes, with the control.Conclusions: Serum hs-CRP could be utilized as a prognostic marker in patients with periodontitis and type 2 diabetes.

The gagging patient in ORL examinations: predictors, evaluation and treatment.

Gagging may be a challenge in daily otorhinolaryngology (ORL) routine. This cross-sectional study aimed to examine conditions of gagging as limitation to ORL examination and the efficacy of acupressure as tool to reduce exaggerated gagging. The study was conducted on a total of 360 study subjects. There was a survey part and a routine ORL examination with observation of gagging behaviour. Through binomial univariate logistic regression, predictors of clinically relevant exaggerated gagging were identified. Wilcoxon signed rank test was used to evaluate efficacy of acupressure point CV-24 to reduce gagging while examination. First gagging's relevance was indicated by over 40% of study subjects showing clinically relevant exaggerated gagging. Furthermore, we found that more psychogenic than somatogenic features proved to be predictors of exaggerated gagging. Third acupressure point CV-24 showed statistical significant reduction of gagging intensity and improved examination feasibility. Awareness of exaggerated gagging's predictors are the first step to deal with gagging in daily practice. Acupressure might be an effective tool to overcome gagging in the affected patients. We suggest at least Level IV according to Oxford (UK) CEBM Levels of Evidence.

The efficacy of the ganglion impar block in perineal and pelvic cancer pain.

Visceral pain conducted by sympathetic fibers with pelvic and perineal origin can be treated using ganglion impar (GIB) or Walters' block in a simple and effective manner. This article aims to evaluate the effectiveness, security, and performance difficulty of GIB in patients with pelvic and perineal oncological pain. A retrospective study between January 2016 and August 2017. Patients with poorly controlled pelvic oncological pain and patients experimenting opioid side effects in which GIB was performed ambulatory were included. Prognostic GIB was performed, under echographic and fluoroscopic control, with local anesthetic and corticoid. The neurolytic block was performed under fluoroscopic guidance. The technique was performed by the same anesthetist with pain management competence. For statistical analysis, Microsoft Excel 2013® and IBM SPSS Statistics version 22.0 were used. Fifteen patients were included. One patient was excluded. A statistical significant basal pain score reduction was observed ((median of the verbal numerical scale (VNS) 7 (p25 = 7; p75 = 8)) compared with 72h median VNS 4 ((p25 = 3; p75 = 5.3) p= 0.001, and 3months (median VNS 4 (p25 = 3, p75 = 7)) p= 0.003 after the procedure. Regarding morphine consumption, a statistically significant reduction was observed 3months after GIB performance (p = 0.012). GIB is a safe and easy-to-perform technique achieving satisfactory and statistically significant results, regarding pain control improvement and opioid consumption reduction in patients which meet selection criteria. Prospective, randomized studies with more patients are needed for further conclusions.