Terms Of Mean Change Research Articles

Impact of Dapagliflozin Adjunctive Therapy on the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes and Chronic Kidney Disease Stages 2-5: A systematic review and meta-analysis.

This meta-analysis investigated efficacy of dapagliflozin as adjunctive therapy for patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) stages 2-5. A systematic search was conducted of selected databases for randomised controlled trials that reported the mean change in estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) from baseline. Out of 1,682 identified studies, 9 trials comprising 13,057 patients were included. A pooled estimate of 5 studies indicated that dapagliflozin did not affect eGFR; however, in 2 studies, it significantly reduced chronic eGFR decline compared to placebo (mean difference [MD] ± 2.74; 95% confidence interval [CI]: 1.55, 3.92; P <0.00001). Additionally, a pooled estimate of 4 studies showed that dapagliflozin significantly reduced UACR (MD -23.99%; 95% CI: -34.82--13.15; P <0.0001; I2 = 0%). Therefore, long-term use of dapagliflozin significantly attenuates eGFR decline and reduces albuminuria in patients with T2DM and CKD.

A prospective randomized study examining the impact of intravenous versus inhalational anesthesia on postoperative cognitive decline and delirium

The present prospective randomized study was designed to investigate whether the development of Post Operative Cognitive Decline (POCD) is related to anesthesia type in older adults. All patients were screened for delirium and mental status, received baseline neuropsychological assessment, and evaluation of activities of daily living (ADLs). Follow-up assessments were performed at 3-6 months and 12-18 months. Patients were randomized to receive either inhalation anesthesia (ISO) with isoflurane or total intravenous anesthesia (TIVA) with propofol for maintenance anesthesia. ISO (n = 99) and TIVA (n = 100) groups were similar in demographics, preoperative cognition, and incidence of post-operative delirium. Groups did not differ in terms of mean change in memory or executive function from baseline to follow-up. Pre-surgical cognitive function is the only variable predictive of the development of POCD. Anesthetic type was not predictive of POCD. However, ADLs were predictive of post-operative delirium development. Overall, this pilot study represents a prospective, randomized study demonstrating that when examining ISO versus TIVA for maintenance of general anesthesia, there is no significant difference in cognition between anesthetic types. There is also no difference in the occurrence of postoperative delirium. Postoperative cognitive decline was best predicted by lower baseline cognition and functional status.

Head-To-Head Comparison of Vortioxetine Versus Desvenlafaxine in Patients With Major Depressive Disorder With Partial Response to SSRI Therapy: Results of the VIVRE Study.

Objective: To compare the efficacy of vortioxetine and the serotonin-norepinephrine reuptake inhibitor (SNRI) desvenlafaxine in patients with major depressive disorder (MDD) experiencing partial response to initial treatment with a selective serotonin reuptake inhibitor (SSRI).Methods: This randomized, double-blind, active-controlled, parallel-group, 8-week study of vortioxetine (10 or 20 mg/d; n = 309) versus desvenlafaxine (50 mg/d: n = 293) was conducted from June 2020 to February 2022 in adults with a DSM-5 diagnosis of MDD who experienced partial response to SSRI monotherapy. The primary endpoint was mean change from baseline to week 8 in Montgomery-Åsberg Depression Rating Scale (MADRS) total score. Differences between groups were analyzed using mixed models for repeated measures.Results: Non-inferiority of vortioxetine versus desvenlafaxine was established in terms of mean change from baseline to week 8 in MADRS total score; however, a numeric advantage was observed in favor of vortioxetine (difference, -0.47 MADRS points [95% CI, -1.61 to 0.67]; P = .420). At week 8, significantly more vortioxetine-treated than desvenlafaxine-treated patients had achieved symptomatic and functional remission (ie, Clinical Global Impressions-Severity of Illness scale [CGI-S] score ≤ 2) (32.5% vs 24.8%, respectively; odds ratio = 1.48 [95% CI, 1.03 to 2.15]; P = .034). Vortioxetine-treated patients also experienced significantly greater improvements in daily and social functioning assessed by the Functioning Assessment Short Test (P = .009 and .045 vs desvenlafaxine, respectively) and reported significantly greater satisfaction with their medication assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire (P = .044). Treatment-emergent adverse events (TEAEs) were reported in 46.1% and 39.6% of patients in the vortioxetine and desvenlafaxine groups, respectively; these were mostly mild or moderate in intensity (> 98% of all TEAEs in each group).Conclusions: Compared with the SNRI desvenlafaxine, vortioxetine was associated with significantly higher rates of CGI-S remission, better daily and social functioning, and greater treatment satisfaction in patients with MDD and partial response to SSRIs. These findings support the use of vortioxetine before SNRIs in the treatment algorithm in patients with MDD.Trial Registration: ClinicalTrials.gov Identifier: NCT04448431.

Comparison of the use of intravenous iron sucrose with intravenous ferric Carboxymaltose for treatment of iron deficiency anaemia in pregnant patients

BACKGROUND &amp; OBJECTIVE: Iron deficiency results in major disabilities and death all over the world, about two billion people are suffering from anaemia at the moment. To compare intravenous iron sucrose with intravenous ferric carboxymaltose in terms of mean change in hemoglobin level and mean corpuscular volume (MCV) for treatment of iron deficiency anaemia in pregnant patients.&#x0D; METHODOLOGY: Prospective comparative study was conducted at the department of Obstetrics/ Gynecology of POF Hospital Wah Cantt and HIT Hospital Taxila Cantt. The study duration was 2 years, from January 2017-December 2018. A total of 80 patients were included in the study. Patients were randomly divided into two groups; in Group-A; 40 patients were given intravenous iron sucrose, and in Group B, 40 patients were given intravenous ferric carboxymaltose. Patients were observed for hemoglobin level and mean corpuscular volume (MCV). Data analysis was done with SPSS version 24. An Independent t-test was applied, and results with p-value ≤0.05 were found significant.&#x0D; RESULTS: Post-treatment hemoglobin means level in the iron sucrose group was 9.90±0.4SD, and in the intravenous ferric carboxymaltose group, post-treatment hemoglobin was 10.71±0.9SD (p≤0.001). In the iron sucrose group, the post-treatment mean corpuscular volume mean level was 81.94±6.0SD and in the intravenous ferric carboxymaltose group mean post-treatment mean corpuscular volume was 88.08±7.1SD (p≤0.001)&#x0D; CONCLUSION: Treatment with intravenous iron caboxymaltose is superior to intravenous iron sucrose with respect to hematological response, which seems to be safe, as very few severe side effects were observed.

Efficacy and safety of brolucizumab versus aflibercept in patients with neovascular age-related macular degeneration: a randomized trial in Indian patients

BackgroundThe current standard treatment for neovascular age-related macular degeneration (nAMD) involves intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents. The aim of the present study was to compare the effectiveness and safety of two anti-VEGF drugs: brolucizumab and aflibercept, in treatment-naïve nAMD Indian patients over a period of 48 weeks.MethodsA prospective, randomized, single-centre, single-blinded, two-arm comparative study was conducted between March 2021 and February 2022. Of the 114 patients, 56 received intravitreal injections of brolucizumab (6 mg/50 µL) while 58 received aflibercept (2 mg/50 µL). The patients received 03 initial loading doses at 4-week intervals of both the agents and then respective therapies were given as individualized pro re nata (PRN) regimen based on the signs of active macular neovascularization. The functional and anatomical outcomes measured were mean change in best-corrected visual acuity (BCVA, logMAR), central macular thickness (CMT, µm), presence of intraretinal fluid, subretinal fluid or subretinal hyper-reflective material. Furthermore, the average number of additional injections required after the loading doses, the injection-free interval and safety of both the drugs were also assessed.ResultsBrolucizumab was found to be non-inferior to aflibercept in terms of mean change in BCVA (−0.13 ± 0.21 logMAR vs. −0.10 ± 0.15 logMAR) and reduction in CMT (−112.59 ± 81.23 µm vs. −86.38 ± 71.82 µm). The percentage of eyes with IRF and SHRM was comparable between both the groups while fewer eyes treated with brolucizumab indicated SRF presence than aflibercept after the loading doses. These beneficial effects of brolucizumab were observed with significant (p < 0.0001) lesser number of injections (1.8 ± 1.1 vs. 3.8 ± 1.5) from week 12 to week 48. Moreover, the probability of no injections after the loading doses was significantly higher with brolucizumab compared to aflibercept indicating prolonged injection-free intervals. The average ocular side effects were comparable in the two groups. One adverse event of severe vitritis requiring treatment with oral steroids occurred in Brolucizumab group, while no such event occurred in Aflibercept group.ConclusionThe results of the present study suggest non-inferiority of brolucizumab PRN regimen to aflibercept PRN regimen in treatment naïve nAMD Indian patients while achieving longer inter-injection intervals.Trial registration Clinical Trial Registration of India (CTRI/2021/06/034415). Registered 03 March, 2021, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=54328&EncHid=&userName =

Preprocedural features of patients under antihypertensive drugs may help identify responders to renal denervation: a hypothesis-generating study.

Renal denervation (RDN) is effective to lower systolic blood pressure (SBP) in essential hypertension. However, patient selection under medications remains an important unmet clinical need. This multicenter study aimed at observing whether preprocedural features associated with increased renin-angiotensin-aldosterone activity influence RDN response. This study enrolled the patients who underwent RDN for uncontrolled hypertension. Medical records were reviewd and patients were divided into 2 groups depending by meeting any of the following conditions prior to RDN: (1) >10 mmHg of office SBP reduction after aldosterone inhibition, (2) aldosterone-renin ratio >30 or (3) slow flow on the renal angiogram. RDN responders were defined by a reduction in 24-hour mean ≥6 mmHg or by ≥1 class of antihypertensive drug withdraw. A total of 46 patients were enrolled, of which 27 (59%) were in control group A and 19 (41%) in group B. The baseline age, gender, office and 24-hour SBP (mean 140.0 ± 12.8 mmHg vs. 144.0 ± 16.5 mmHg, p = 0.577) were comparable, while the number of prescribed drug classes was fewer in group A (4.0 ± 1.3 vs. 4.9 ± 0.9, p = 0.014). The proportion patients with prescribed aldosterone antagonist or high aldosterone-renin ratios were higher in group B. At 12 months post RDN, the results were significantly better in group B in terms of mean change in office SBP (12.4 ± 23.5 mmHg vs. 29.9 ± 25.5 mmHg, p = 0.046) and the proportion of RDN responders (51.9% vs. 89.5%, p < 0.001). RDN was more effective in patients with any of 3 clinical indices.

Comparative Study for the Effectiveness of Dry Needling and Deep Friction Massage in Lateral Epicondylitis

Objective: To compare the effectiveness of dry needling and deep friction massage in the management of patients with lateral epicondylitis. Methodology: Thirty two patients with lateral epicondylitis were divided into two groups using lottery method who were meeting the inclusion &amp; exclusion criteria. Both groups (Group A deep friction massage and Group B dry needling) received six treatment sessions at frequency of two sessions per week. Assessments were conducted before intervention and after the end of 2nd, 4th and 6th intervention session using numeric Pain Rating Scale (NPRS), patient related tennis elbow evaluation questionnaire (PRTEEQ) and pain free grip strength using a hand dynamometer. Results: The mean pain reduction in dry needling and deep friction massage group was 3.52 ± 0.59 and 2.86 ± 0.64 respectively making dry needling a better intervention in reducing pain. The mean change in the total score of PRTEEQ across dry needing and deep friction group was 22.35 ± 7.07 and 20.26 ± 7.18 respectively making both intervention equally effective in reducing pain. In terms of mean change in the strength across dry needing and deep friction group was 7.412 ± 0.563 and 7.533 ± 0.624 respectively making both intervention equally effective in improvement of strength in patients with lateral epicondylitis. Conclusion: This study suggests that both dry needling and deep friction massage are effective in the improvement of strength and in reducing pain but comparing mean difference of pre and post outcome measure score dry needling is a better intervention in reducing pain in patients with lateral epicondylitis. Key words: Tennis Elbow, Deep Friction Massage, Dry Needling

Comparison of Epinephrine and Salbutamol Nebulization in Acute Bronchiolitis in terms of mean change in RDAI Score

Objective: This study was conducted to compare epinephrine and salbutamol nebulization in emergency management of moderately ill children less than one and a half years old with bronchiolitis in terms of mean change in respiratory distress assessment instrument (RDAI) score.&#x0D; Materials and Methods: Randomized controlled design was selected in this trial at the Department of Pediatrics, KRL Hospital Islamabad, Pakistan from 24th April 2016 to 24th October 2016. Sixty children with acute bronchiolitis, having a moderate degree of illness (RDAI 8-15) were included in this study. Patient were randomly allocated into Group A (epinephrine = 0.1 mL/kg in concentration of 1:10000) and Group B (salbutamol = 0.15 mg/kg combined with 3 mL 0.9% normal saline). It was delivered by a nebulizer and a face mask with a continuous flow of 6 L/min at100% oxygen. Data was collected on a predesigned performa and assessed with reference to mean change in RDAI score.&#x0D; Results: The patients ' mean age in Group A and Group B were 10.57±4.22 and 11.63±3.14 months, respectively. The majority of the patients were males (56%). The mean RDAI score was insignificant between the two groups, both at baseline (11.57±2.21 in epinephrine group vs 11.3±2.14 in salbutamol group, p = 0.63) and 125 minutes (4.77±2.19 in Epinephrine group vs 5.43±1.69 in Salbutamol group, p = 0.19). However, when stratified according to age and gender, the mean RDAI score was found statistically significant among the 2-12 months age group (p = 0.0045) and female gender (p = 0.0052).&#x0D; Conclusion: Epinephrine and salbutamol have similar effects in acute bronchiolitis when compared with regards to mean change in RDAI score.

Comparison between methyldopa and combination of methyldopa and nifedipine in terms of mean change in blood pressure in pregnancy induced hypertension

Objective: Comparison between Methyldopa and combination of Methyldopa and Nifedipine in terms of mean change in blood pressure in pregnancy induced hypertension. Material and methods: This randomized controlled trial was conducted at Department of Obstetrics and Gynecology, Combined Military Hospital Bahawalpur from February 2020 to August 2020 over the period of 6 months. Total 80 patients with pregnancy induced hypertension as per operational definition having age 20-40 years and having gestational age ≥ 20 weeks assessed on LMP were selected. Results: Mean age of the patients was 30.81 ± 5.670 years, mean age of patients of group A was 31.50 ± 5.809 years and mean age of group B was 30.13 ± 5.515 years. Mean gestational age was 30.17 ± 5.981 weeks, mean gestational age of patients of group A was 29.70 ± 6.329 weeks and mean gestational age of patients of group B was 30.65 ± 5.65 weeks. In group A, mean diastolic blood pressure was decrease from 101.2250 ± 4.97938 to 84.5000 ± 3.26599 and in group B from 107.7750 ± 7.18434 to 82.5000 ± 2.25320. Comparison of mean decrease in diastolic blood pressure between group A (High dose Methyldopa) and group B (Low dose Low dose Methyldopa with Nifedipine) was done. Mean decrease in diastolic blood pressure in group A was 16.72 ± 3.935 and in group B was 25.28 ± 6.876. Statistically significant difference of mean decrease in diastolic blood pressure between the both groups was noted with p value 0.000. Conclusion: Results of this study showed that Low dose Methyldopa with Nifedipine combination is more effective as compared to High dose Methyldopa to reduce diastolic blood pressure in pregnant women suffering from pregnancy induced hypertension. Keywords: Diastolic blood pressure, Methyldopa, Nifedipine, Pregnancy induced hypertension, Systolic blood pressure

COMPARISON OF THE PARENTERAL AND ORAL VITAMIN D SUPPLEMENTATION IN THE TREATMENT OF NUTRITIONAL RICKETS IN TERMS OF MEAN CHANGE IN SERUM CALCIUM, PHOSPHORUS, AND ALKALINE PHOSPHATASE

ABSTRACT: &#x0D; BACKGROUND &amp; OBJECTIVE: Rickets is a common presentation on the pediatric floor, with nutritional rickets being the cause of leading significant morbidity, disability, especially in the developing countries of the world. The objective is to compare the efficacy of parenteral and oral vitamin D supplementation in the treatment of nutritional rickets&#x0D; METHODOLOGY: This comparative interventional, prospective analysis was conducted at Aziz Fatimah Hospital Faisalabad (1-1-2017 to 30-6-2017) outdoor patients divided into parenteral and oral groups. All of the outcome variables were measured at baseline and one month after treatment.&#x0D; RESULTS: In this study, mean age was calculated as 2.12 + 0.76 years and 2.15+0.77 in parental and oral groups respectively. 49.29% (n=69) and 45%(n=63) were male and 50.71%(n=71) and 55% (n=77) were female respectively in both groups. At baseline, serum calcium was 8.68 + 0.35 and 8.71 + 0.37 (p=0.62) serum phosphorus was 3.92 + 9.22 and 3.84 + 0.20 (p=0.03), and serum alkaline phosphatase was 230.01 + 13.09 and 228.89 + 13.80 (p=0.48) in parenteral and oral groups respectively. After treatment the mean change seen in serum calcium was 1.14 + 0.26 and 0.72 + 0.19 (p=0.001), serum phosphorus was 1.42 + 0.33 and 0.71 + 0.26 (p=0.001), serum Alkaline phosphatase was 79.48 + 14.84 and 23.65 + 12.21 (p=0.001) in parenteral and oral groups respectively.&#x0D; CONCLUSION: We concluded that the parenteral route for vitamin. D supplementation is significantly better than the oral route in treating nutritional rickets in terms of mean change in serum calcium, serum phosphorus, and serum alkaline phosphatase.

Changes in Segmental and Lumbar Lordosis After Lateral Lumbar Interbody Fusion With Different Lordotic Cage Angulations

Lateral lumbar interbody fusion (LLIF) affords a wide operative corridor to allow for a large interbody cage implantation for segmental reconstruction. There is a paucity of data describing segmental lordosis (SL) achieved with lordotic implants of varying angles. Here we compare changes in SL and lumbar lordosis (LL) after implantation of 6°, 10°, and 12° cages. We retrospectively reviewed LLIF cases over a 5.5-year period. We derived SL and LL using the standard cobb angle measurement from a standing lateral radiograph. We analyzed mean changes in SL and LL over time using the linear mixed effect model to estimate these longitudinal changes. The most frequently treated level was L3-4, followed by L4-5. Significant increases in mean SL were found at each follow-up time point for all the cohorts. In an intercohort comparison, the mean changes in SL at immediate postoperative and last follow-up were significantly greater in the 10° cohort than 6° ([7.4° versus 3.1°, P = .004], [6.1° versus 2.3°, P = .025] respectively). The 12° cohort had higher mean change in SL at last follow-up than the 6° cohort (5.9° versus 2.3°, P = .022). There was no difference in mean change in SL between the 10° and 12° cohorts. No difference in overall mean LL over time was found. In terms of mean change in LL, no difference was observed except at immediate and 6-month postoperative in the 10° cohort ([9.6°, P = .001], [8.5, P = .003] respectively). By comparing mean change in LL, no difference existed except between the 10° and 6° immediately after surgery (9.6° versus 0.2°, P = .006). LLIF cages significantly improve SL at the index level. However, this increase in SL is greater for 10° and 12° cages than the standard 6° cage. Use of 10° cages also resulted in overall improved LL than 6° cages. 3. Lateral lumbar interbody fusion.

COMPARISON OF MONTHLY PULSE OF ORAL AZITHROMYCIN WITH DAILY DOXYCYCLINE IN THE TREATMENT OF MODERATE ACNE VULGARIS

Objective: To compare oral Azithromycin with oral Doxycycline in treatment of moderate Acne Vulgaris.&#x0D; Study design: Randomized control trial&#x0D; Place and duration of the study: Dermatology Department , Pak Emirates Military Hospital, Rawalpindi from 1st August 2017 till 31st January 2018.&#x0D; Materials and methods: A total of 92 patients with moderate Acne were selected from Dermatology outpatient department (OPD) Pak Emirates Military Hospital Rawalpindi, after written informed consent. Patients were randomly allocated to one of the two treatment groups: Group A and Group B by lottery method. Patients in group A were given oral Azithromycin 500 mg daily for four consecutive days each month for 03 months and patients in group B were given oral Doxycycline 100 mg daily for 03 months. Patients were reviewed monthly for 03 months and Acne Severity Index (ASI) was recorded at baseline, at one month and three months. The primary outcome measured was more than 50% decrease from baseline in ASI within 3 months of treatment, using Global Acne Grading System (GAGS).&#x0D; Results: Mean age of patients in group A was 21.80 + 4.64 years whereas mean age of patients in group B was 21.61 + 4.48 years. In group A mean pre-treatment ASI was 24.83 + 3.15 and mean post-treatment ASI was 10.15 + 1.7. In group B mean pre-treatment ASI was 25.30 ± 2.96 and mean post-treatment ASI was 9.86 + 1.58.&#x0D; Conclusion: Azithromycin is comparable to Doxycycline in terms of mean change in ASI, in the treatment of moderate Acne Vulgaris.

COMPARISON OF INTRAVENOUS LIGNOCAINE VS NALBUPHINE IN ATTENUATION OF HEMODYNAMIC RESPONSE TO AWAKE TRACHEAL EXTUBATION IN ENT SURGERIES

Objective: To compare intravenous lignocaine vs. intravenous nalbuphine in terms of mean change in heart rate and mean arterial pressures (MAP) during awake tracheal extubation.&#x0D; Study Design: Randomized control trial.&#x0D; Place and Duration of Study: Main Operation Theatre, Combined Military Hospital Rawalpindi, from May 2016to Dec 2016.&#x0D; Methodology: After approval of the study by the institution’s research ethics committee, the patients meetinginclusion criteria were assigned randomly to one of the two groups by lottery method. On return of spontaneous ventilation, patients in group L received intravenous lignocaine 1.5 mg/kg while group N patients received intravenous Nalbuphine 0.2mg/kg. Data recorded immediately (T1) and 5min after (T2) extubation.&#x0D; Results: After stratification of data in terms of age, gender, duration of surgery and ASA classification, evaluation of hemodynamic parameters (HR and MAP) between the two groups was done. The mean change in HR in group L was 6.66 ± 1.53 bpm and in group N was 4.43 ± 1.35. The mean change in MAP in group L was 4.90 ± 1.49 mm of Hg and in group N was 3.23 ± 1.33. p-value in both parameters was found to be less than 0.05 and thus declared significant.Conclusion: We concluded that intravenous nalbuphine, in the dose of 0.2mg/kg, is a better attenuator ofhemodynamic response to extubation as compared to intravenous lignocaine and provides better stability ofHeart rate and Mean arterial Pressure.

Efficacy of Intravitreal Bevacizumab in Chronic Central Serous Chorioretinopathy in Terms of Mean Reduction of Central Macular Thickness in Pakistani Patients

Background: Central serous chorioretinopathy (CSCR) is an idiopathic condition described by serous neurosensory retinal detachment at the posterior pole, usually associated with serous retinal pigment epithelial detachment (PED). CSCR patients as a rule have good visual prognosis. In most of the patients, CSCR is self-limiting and patients regain the last visual acuity. However, some patients may have visual disability due to permanent RPE and photoreceptor damage. Objective: The objective of the study is to determine the effect of intravitreal Bevacizumab in cases of chronic central serous chorioretinopathy in terms of mean change in central macular thickness. Study Design: Interventional experimental study. Settings: The study was conducted in Department of Ophthalmology, Allied Hospital, Faisalabad Pakistan. Duration: 2 years from January 2017 to December 2018. Methodology: An aggregate of 95 cases were recruited for the study. Study included both male and female patients with diagnosis of chronic CSCR (at least 6month duration). Best corrected visual acuity, Intra Ocular Pressure on Goldman applanation Tonometer and Optical coherence tomography on Optovue were recorded of both eye of all patients. Before starting the treatment, informed consent was signed by every patient and they were called on the day of injection. Intravitreal off label Bevacizumab (1.25/0.05ml) was given through pars plana in operation theater under aseptic conditions. After injection topical antibiotic drops were given to patients for one week and patients called for follow up after one week, one month, 2 month and 3 months. Same parameters BCVA, IOP, Dilated fundus examine and OCT was recorded on every visit. The final outcome i.e., change in central macular thickness was recorded. Results: In this study, out of 95 cases, 53.68%(n=51) were between 30-45 years of age while 46.32%(n=44) were between 46-60 years of age, mean ± SD was calculated as 46.83+7.82 years, 74.74%(n=71) were male and 25.26%(n=24) were females. Pre-treatment mean central macular thickness was recorded as 344.77+14.61µ which reduced to 154.57+16.57 µ, mean difference was recorded as 190.2+21.46 µ, p value was 0.0001 showing a significant difference. Conclusion: We concluded that intravitreal Bevacizumab significantly reduced central macular thickness in cases of chronic central serous chorioretinopathy.

Calcifediol is superior to cholecalciferol in improving vitamin D status in postmenopausal women: a randomized trial.

ABSTRACTVitamin D has shown to play a role in multiple diseases due to its skeletal and extraskeletal actions. Furthermore, vitamin D deficiency has become a worldwide health issue. Few supplementation guidelines mention calcifediol treatment, despite being the direct precursor of calcitriol and the biomarker of vitamin D status. This 1‐year, phase III–IV, double‐blind, randomized, controlled, multicenter clinical trial assessed the efficacy and safety of calcifediol 0.266 mg soft capsules in vitamin D–deficient postmenopausal women, compared to cholecalciferol. Results reported here are from a prespecified interim analysis, for the evaluation of the study's primary endpoint: the percentage of patients with serum 25‐hydroxyvitamin D (25(OH)D) levels above 30 ng/ml after 4 months. A total of 303 patients were enrolled, of whom 298 were included in the intention‐to‐treat (ITT) population. Patients with baseline levels of serum 25(OH)D <20 ng/ml were randomized 1:1:1 to calcifediol 0.266 mg/month for 12 months, calcifediol 0.266 mg/month for 4 months followed by placebo for 8 months, and cholecalciferol 25,000 IU/month for 12 months. At month 4, 35.0% of postmenopausal women treated with calcifediol and 8.2% of those treated with cholecalciferol reached serum 25(OH)D levels above 30 ng/ml (p < 0.0001). The most remarkable difference between both drugs in terms of mean change in serum 25(OH)D levels was observed after the first month of treatment (mean ± standard deviation change = 9.7 ± 6.7 and 5.1 ± 3.5 ng/ml in patients treated with calcifediol and cholecalciferol, respectively). No relevant treatment‐related safety issues were reported in any of the groups studied. These results thus confirm that calcifediol is effective, faster, and more potent than cholecalciferol in raising serum 25(OH)D levels and is a valuable option for the treatment of vitamin D deficiency. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Efficacy and safety of tanezumab administered as a fixed dosing regimen in patients with knee or hip osteoarthritis: a meta-analysis of randomized controlled phase III trials.

This study aims to evaluate the efficacy and safety of tanezumab administered as a fixed dosing regimen in patients with knee or hip osteoarthritis. Randomized controlled phase III trials (RCTs) that evaluated the efficacy and safety associated with tanezumab for knee or hip OA were systematically identified by searching electronic databases, including Cochrane Library, PubMed, and Embase, for 30 years from December 1990 up to July 2020. Ten relevant studies were included in our meta-analysis. The research was reported based on the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure the reliability and verity of results. Our study showed that the tanezumab groups were more effective than the placebo groups in terms of mean change from the baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain (P < .00001), WOMAC physical functional (P < .00001), and patient's global assessment (PGA) (P < .00001). Discontinued due to adverse events (AEs) (P < .00001), serious AEs (P = .02), abnormal peripheral sensations (both P < .00001), and peripheral neuropathy (P < .002) in tanezumab groups were significantly higher than that in control groups. Compared with placebo, tanezumab can effectively relieve pain and improve WOMAC physical function and patient's global assessment (PGA) in knee and hip osteoarthritis. Meanwhile, adverse events are transient in nature and generally well-tolerated. However, we still need large-sample, high-quality studies to investigate the long-term safety of tanezumab to give the conclusion.

To compare rosuvastatin with atorvastatin in terms of mean change in LDL-C in patient of diabetes mellitus.

Diabetes Mellitus is a very common metabolic disorder characterized by hyperglycemia and altered metabolism of lipids, proteins and carbohydrates due to absolute or relative insulin deficiency or insulin resistance. There is a close association between complications of Diabetes and Diabetic Dyslipidemias. The lowering of LDL levels with statins varies from 20 to 60% and greatest effects are seen with the most potent statins such as Atorvastatin, and Rosuvastatin in higher doses. Objectives: The objective of the study was; to compare Rosuvastatin with Atorvastatin in terms of mean change in LDL-C in patients of Diabetes Mellitus. Study Design: Randomized Control Trail. Setting: Department of Medicine DHQ Hospital, Faisalabad. Period: Six months from 01/10/2018 to 31/03/2019. Material &amp; Methods: Results: A total of 160 cases (80 in each group) fulfilling the inclusive/exclusive criteria were enrolled to compare Rosuvastatin with Atorvastatin in terms of mean change in LDL-C in patients of Diabetes Mellitus. Mean LDL-C levels at baseline was recorded as159.61+1.22 in Group-A and 159.51+1.21 in Group-B, p value was calculated as 0.603 showing insignificant difference. Mean LDL-C after 6 weeks of treatment was recorded as129.11p+1.50 in Group-A and 129.89+2.23 in Group-B, p value was calculated as 0.01 showing significant difference. Mean change in LDL-C level after 6 weeks of treatment was recorded as 30.5+1.88 in Group-A and 29.63+2.57 in Group-B, p value was calculated as 0.01 showing a significant difference. The data was stratified for Age, Gender, Duration of Diabetes Mellitus and control of Diabetes Mellitus. Conclusion: This study proves superiority of Rosuvastain over Atorvastatin in reducing LDL-C level in type 2 DM Patients.

Comparison of effects of oral maternal hydration and intravenous infusions on Amniotic Fluid Index in third trimester isolated Oligohydramnios.

Objectives: To compare oral maternal hydration and intravenous infusion in women with third trimester isolated oligohydramnios in terms of mean change in amniotic fluid. Study Design: This is a Comparative Study. Setting: The study was conducted in Department of Gynecology, Pakistan Institute of Medical Sciences, Islamabad. Period: Between 1st May, 2015 to 31st July, 2016. Material &amp; Methods: One hundred and fourteen pregnant females with singleton pregnancy, beyond 28 weeks gestation and AFI &lt; 5cm were included. Placental insufficiency was ruled out on Doppler ultrasound of umbilical artery. Basal AFI and routine intake of fluid of all patients was noted. Patients were randomized either to receive oral maternal hydration or intravenous infusion. AFI measurement was repeated at 6th day after hydration therapy. Data was stratified for mean difference in improvement in amniotic fluid index. Results: One hundred and fourteen patients with mean age of 27.33 ± 3.87 years were included. 52 patients (45.6%) were primigravida and remaining 62 patients (54.4%) were multipara. Mean AFI value before treatment in sampled population was 3.35 ± 0.744 in oral hydration and 3.33 ± 0.787 in intravenous hydration (p=0.903). Mean AFI value after treatment was 5.53 ± 0.966 in oral hydration and 5.68 ± 1.490 in intravenous hydration, independent sample test showed non-significant (p=0.903) difference. Mean increase in AFI before and after treatment was cross tabulated and resultant difference was significant (p value=0.001). There is no effect of age, gestational age, history of oligohydramnios on improvement in amniotic fluid index. Conclusion: Both treatment modalities i.e. oral maternal hydration and intravenous infusion are effective in terms of improvement of amniotic fluid index but there is no difference in both treatments in pregnant females with isolated oligohydramnios in 3rd trimester at current sample size.

Topiramate for acute affective episodes in bipolar disorder in adults.

Topiramate for acute affective episodes in bipolar disorder in adults.

Effect of Vitamin K and Alendronate Combination Treatment on Bone Mineral Density of Postmenopausal Osteoporosis Patients: A Pilot Study

Introduction: Osteoporosis is a common problem in postmenopausal women. Numerous studies investigated the effects of vitamin K on bone health, which yielded conflicting results. In this study, we aimed to compare the effect of vitamin K and alendronate combination with alendronate alone on Bone Mineral Density (BMD) of women with postmenopausal osteoporosis. Materials and Methods: This study was performed in Imam Reza Hospital of Mashhad, Iran, during 14 months (January 1, 2014-February 29, 2015). Our patients (n=28) were randomly divided into two groups of receiving calcium, vitamin D, and alendronate (n=13) and receiving the same combination + vitamin K1 supplement (10 mg daily) (n=15). BMD was measured pre- and post-intervention by the same bone scanner. Results: The baseline characteristics of the two groups did not differ significantly. The mean variation in femoral neck BMD of the alendronate and alendronate + vitamin K groups were -4.20±11.91% and 0.39±11.80%, respectively. There was no significant difference between the two groups in terms of mean change in femoral neck BMD (P=0.32). The mean variations in lumbar spine BMD of the alendronate and alendronate + vitamin K groups were 0.71±0.06% and 0.76±0.11%, respectively. There was no significant difference between the two groups in terms of mean change in lumbar spine BMD (P=0.24). Conclusion: It was found that combined treatment with vitamin K and alendronate was not more effective than alendronate alone in increasing BMD of postmenopausal osteoporosis patients.