Two-year Prospective Observational Study Research Articles

Predictors of 2-Year Mortality in Patients Receiving Long-Term Oxygen Therapy: A Prospective Observational Study.

Background: Patients receiving long-term oxygen therapy are in a state of progressive respiratory dysfunction and have high mortality. However, the predictors of mortality in these patients have not yet been established. Objectives: This prospective observational study aimed to identify the predictors of two-year mortality in patients receiving long-term oxygen therapy. Design, Setting/Subjects: This two-year prospective observational study included 96 patients who received long-term oxygen therapy in the outpatient department of the National Hospital Organization Nishiniigata Chuo Hospital in Japan. Measurements: The updated Charlson Comorbidity Index, body mass index, handgrip strength, modified British Medical Research Council scale (mMRC), Barthel Index (BI), and Montreal Cognitive Assessment (MoCA) were collected in 2019 as a baseline. Outcome was defined as mortality due to chronic respiratory disease during the two-year follow-up period, and predictors were estimated using age- and sex-adjusted Cox proportional hazards model. Results: The 83 patients that were followed up, 30 (36%) died. The Cox proportional hazards model estimated handgrip strength (adjusted hazard ratio [HR]: 0.89; 95% confidence interval [CI]: 0.84-0.94; p < 0.01; Wald: 14.38.), mMRC (adjusted HR: 1.96; 95% CI: 1.36-2.83; p < 0.01; Wald: 13.16.), BI (adjusted HR: 0.95; 95% CI: 0.93-0.98; p < 0.01; Wald: 17.07.), and MoCA (adjusted HR: 2.17; 95% CI: 1.31-3.59; p < 0.01; Wald: 9.06) as predictors. Conclusions: This study indicated that handgrip strength, dyspnea, activities of daily living, and cognitive function were predictors of two-year mortality in patients receiving long-term oxygen therapy.

Predictive factors of catch-up growth in term, small for gestational age infants: a two-year prospective observational study in Algeria.

Most small for gestational age (SGA) infants show catch-up growth but the minority who do not may benefit from growth-promoting treatment. We determined the prevalence of, and risk factors for, failure to show catch-up growth in term SGA infants. Prospective observational study of infants born at 37-42 weeks gestation between December 2012 and March 2014 with birth weight <10th percentile. Length, weight and head circumference were measured from birth to 2 years. Of 457 (3.9 %) term infants with SGA, 446 (97.6 %) were followed up until 2 years. At 24 months, supine length, weight and head circumference were ≥-2 standard deviation score (SDS) in 87.9 , 96.4 and 97.1 % subjects, with persistent short stature in 12.1 %. In a multivariate analysis, the independent predictors of failure to show catch-up growth at 24 months were: maternal height <150 cm, difference between mid-parental height and birth length of ≥2.2 SDS, height at 24 months <-2 SDS below mid-parental height SDS, history of SGA, ponderal index <3rd centile and duration of breast feeding <3 months. This study provides data concerning the epidemiology of SGA in Algeria and the factors associated with post-natal growth. Establishing which children remain short at 2 years has identified a cohort of patients requiring continuing follow up, with a view to instituting growth hormone therapy in selected cases. These results favour the setting up of an integrated national program to register SGA infants at birth, with re-evaluation at 2 years. (250 words).

Study Protocol: Gut microbiota profiles implicated in the onset of autism spectrum disorders in preterm infants: A two-year follow-up study

IntroductionPreterm infants are at high-risk of developing autism spectrum disorders (ASD). The underlying mechanisms that explain the link between prematurity and ASD are unclear. Perinatal environmental factors may disrupt the gut-brain communication, when the gut microbiome composition is established and brain programming occurs. Therefore, the disruption of the gut-brain axis communication in response to perinatal environmental events may shed light on the association between prematurity and ASD.ObjectivesTo describe a new research project protocol which aim is to develop a dynamic model of gut microbiota variation in response to environmental factors that modulate the ASD risk in preterm infants.MethodsA two-year prospective observational study will be carried out, in which preterm infants will be assessed at birth, 40th postmenstrual week, at 6, 12, and 24 months of corrected age. Two-hundred preterm infants will be recruited. A comprehensive assessment will be conducted by collecting data on sociodemographic characteristics, medical history, family functioning, neurodevelopment, ASD screening, and diagnosis. Microbiome composition and microbial activity will be determined from feces.ResultsThe expected results are: i) to characterize ASD since its early manifestations in an at-risk population, allowing an early diagnosis and intervention to improve clinical outcomes; ii) to identify early microbiota biomarkers in order to find potential pathophysiological pathways; iii) to understand the protective and risk factors associated to ASD since perinatal period.ConclusionsA two-year predictive model will be generated based on environmental and gut microbiota variables. This predictive model of ASD would allow prevention, early diagnosis, improvement of prognosis, and personalized treatments in preterm infants.DisclosureNo significant relationships.

Neonatal Resuscitation Skill-Training Using a New Neonatal Simulator, Facilitated by Local Motivators: Two-Year Prospective Observational Study of 9000 Trainings.

Globally, intrapartum-related complications account for approximately 2 million perinatal deaths annually. Adequate skills in neonatal resuscitation are required to reduce perinatal mortality. NeoNatalie Live is a newborn simulator providing immediate feedback, originally designed to accomplish Helping Babies Breathe training in low-resource settings. The objectives of this study were to describe changes in staff participation, skill-training frequency, and simulated ventilation quality before and after the introduction of “local motivators” in a rural Tanzanian hospital with 4000–5000 deliveries annually. Midwives (n = 15–27) were encouraged to perform in situ low-dose high-frequency simulation skill-training using NeoNatalie Live from September 2016 through to August 2018. Frequency and quality of trainings were automatically recorded in the simulator. The number of skill-trainings increased from 688 (12 months) to 8451 (11 months) after the introduction of local motivators in October 2017. Staff participation increased from 43% to 74% of the midwives. The quality of training performance, measured as “well done” feedback, increased from 75% to 91%. We conclude that training frequency, participation, and performance increased after introduction of dedicated motivators. In addition, the immediate constructive feedback features of the simulator may have influenced motivation and training quality performance.

Outcome of Prophylactic Noninvasive Ventilation Following Planned Extubation in High-risk Patients: A Two-year Prospective Observational Study from a General Intensive Care Unit.

IntroductionProphylactic use of noninvasive ventilation (NIV) is recommended following extubation in patients at high risk of extubation failure. In a prospective cohort study, we examined the impact of prophylactic NIV in this subset of patients, potentially exploring the risk factors for extubation failure in them and the impact of extubation failure on organ function. We also explored the effect of fluid balance on extubation failure or success in this high-risk patient subgroup.Materials and methodsConsecutive adult patients (≥18 years) admitted in the mixed intensive care unit (ICU) of a tertiary care center, between January 1, 2018, and December 31, 2019, who passed a spontaneous breathing trial (SBT) following at least 12 hours of invasive mechanical ventilation and put on prophylactic NIV for being at a high risk of extubation failure, were prospectively followed throughout their hospital stay. Extubation failure was defined as developing respiratory failure within 72 hours postextubation requiring reintubation or still requiring NIV support at 72 hours postextubation.ResultsA total of 85 patients were included in the study. 11.8% of patients had extubation failure at 72 hours with an overall reintubation rate of 10.5%. Higher age (p < 0.05), longer duration of invasive ventilation (p < 0.05), and higher sequential organ failure assessment (SOFA) score at extubation (p < 0.05) were identified as risk factors for extubation failure in univariate analysis. However, in the multivariate analysis, only a higher SOFA score remained statistically significant in forward logistic regression analysis (p < 0.05). We found a clear trend toward worsening organ function score in the extubation failure group in the first 72 hours postextubation, suggesting extubation failure as a risk factor for organ dysfunction. Cumulative fluid balance was higher both at extubation and in subsequent 3 days postextubation in the failure group, but the differences were not statistically significant.ConclusionHigher age, longer duration of invasive ventilation, and higher baseline SOFA score at extubation remain risk factors for extubation failure even in this high-risk subset of patients on prophylactic NIV. Extubation failure is associated with the worsening of organ function. A trend toward higher cumulative fluid balance both at extubation and postextubation, suggests aggressive de-resuscitation as a potentially helpful strategy in preventing extubation failure.How to cite this articleGhosh S, Chawla A, Jhalani R, Salhotra R, Arora G, Nagar S, et al. Outcome of Prophylactic Noninvasive Ventilation Following Planned Extubation in High-risk Patients: A Two-year Prospective Observational Study from a General Intensive Care Unit. Indian J Crit Care Med 2020;24(12):1185–1192.

Palpable udder defects are associated with decreased lamb production in commercial ewes

In pasture-based sheep production systems total weight of lamb weaned impacts flock profitability. Udder defects have been associated with poor lamb survival and lower lamb growth rates to weaning in non-dairy breed sheep. However, it is the combination of these two factors that influences ewe flock productivity and value to the farmer. The objective of this study was to describe associations between ewe udder palpation (normal vs. abnormal; where abnormal is diffuse udder hardness, or palpable lumps(s), on one or both udder halves), and total kilograms of lamb weaned. Mixed-age Romney ewes were enrolled from a commercial sheep flock located near Masterton, Wairarapa, New Zealand, in a two-year prospective observational study; 981 ewes in 2017 and 790 ewes in 2018. In each year, ewes had their udders palpated at four key management times (pre-mating, pre-lambing, tailing and weaning). During the lambing period, twice daily lambing observations were undertaken to match lambs with their dams, while at weaning in each year total weight of lamb weaned per ewe was calculated (where kilograms of lamb weaned equalled the sum of the weight(s) of live offspring at weaning). Analyses used matched methods for each time udder palpation occurred. Each ewe with an abnormal udder was matched to four ewes with normal udders, based on: parturition date, number of lambs born in the litter, and ewe weight and body condition score prior to lambing. The prevalence of ewes with abnormal udder palpations ranged from 2.7% - 7.7% at each of the measurement times. At all management times, ewes that had abnormal udder palpation weaned significantly less total kilograms of lamb compared to ewes that had normal udder palpation. Importantly, pre-mating udder palpations were predictive of total weight of lamb weaned. Ewes with normal udders pre-mating weaned an estimated mean of 42.2 kg and 45.4 kg in 2017 and 2018 respectively, while ewes with abnormal udders weaned 25.8% less lamb (p<0.0001) in 2017 and 33.2% less lamb (p<0.0001) in 2018. These results suggest commercial farmers could use udder palpation prior to mating as a tool to identify and prioritise culling of ewes with palpable udder defects, as these ewes are predicted to have lower lamb production.

Evaluation of upper blepharoplasty outcome-objective measurements and patients` satisfaction

Background/Aim. Upper blepharoplasty is one of the most often performed aesthetic operations and is indicated for periorbital rejuvenation or correction of some functional problems. The aim of the study was to evaluate the outcome of this procedure and to assess patients? satisfaction and possibilities of objective measurement of operative results. Methods. A two-year prospective observational study was conducted among female patients who had upper blepharoplasty done by the same surgeon. Data were collected from medical documentation, questionnaire, and objective measurements conducted via standardized digital photographs taken before and two months after surgery. Tarsal platform show (TPS) and brow fat span (BFS) were measured at three points (P1, P2, P3) before and two months after the surgery. A questionnaire conducted before surgery and two months after it included general complaints considering upper eyelids (visual field narrowing, fallen eyelids, the sensation of heavy eyelids, raising head backward in order to enhance vision, headache), patients? assessment of eyelid asymmetry and an additional questionnaire after surgery included questions for the surgeon and patients concerning satisfaction with treatment outcome. Results. This study involved 50 female patients aged be-tween 33 and 67 years (49.98 ? 8.6 years). There was a statistically significant difference in all points for TPS and BFS measurements before and after the operation. No significant asymmetries were noticed between eyes neither before nor after surgery. There was a statistically significant difference in operation success among 3 age categories in TPS-P1 (?2 = 13.089, df = 2, p = 0.001) and TPS-P2 (?2 = 8.386, df = 2, p = 0.015) with best results achieved in older patients (&gt; 55 years). There was strong positive, statistically significant correlation between patient?s and surgeon?s satisfaction (r= 0.704, p = 0.002), as well as between patients? satisfaction and their age (r = 0.704, p = 0.002). Conclusion. Realistic expectations, adequate information about the surgery and possible complications, are essential to satisfied patients. Objective measurements correlate with patients? satisfaction and together with photographs can be a useful tool in communication with them.

COMPARISON OF VARIOUS TECHNIQUES FOR MANAGEMENT OF FISTULA-IN-ANO

INTRODUCTION: Cirrhosis is a condition that is defined histopathologically and has a variety of clinical manifestations and complications, some of which can be life-threatening. Patients with cirrhosis and portal hypertension exhibit characteristic cardiovascular & pulmonary hemodynamic changes. The cardiovascular complications include systolic dysfunction, diastolic dysfunction & electrochemical abnormalities like prolonged QT interval in Electrocardiogram (ECG), and Respiratory complications include Consolidation, Pleural Effusion & Pulmonary Arterial Hypertension, which may be due to Hepatopulmonary or Portopulmonary syndrome STUDY DESIGN: A two-year prospective observational study was conducted from July,2014 to June 2016 AIM: To study the different cardiac and pulmonary complications in the patients of Liver Cirrhosis. MATERIALS & METHODS: A two-year prospective observational study was conducted from July,2014 to June 2016 at a tertiary care hospital in Ahmedabad, Gujarat, India, including 30 patients (>12 years old), who were known cases of cirrhosis of liver as well as those newly diagnosed with it, with cardiopulmonary complications, developed after liver cirrhosis, in the absence of other etiological factors. Clinical profile with laboratory studies and diagnostic tests were studied. RESULTS: This study showed that cardiopulmonary complications in cirrhotic patients are more frequently seen in males than females, which commonly manifest during third & fourth decade. Dyspnoea is the most common symptom seen in the study. Among the pulmonary complications, Pneumonia & Hydrothorax are more common compared to hepatopulmonary & portopulmonary syndromes, and among cardiac complications, Diastolic dysfunction is a major complication in such patients, which increases with increasing severity of cirrhosis, as indicated by CP score. CONCLUSION: Among these patients, Cardiac and pulmonary complications have nearly the same incidences.

Cardiac & Pulmonary Complications Seen in Liver Cirrhosis-An Observational Study at a Tertiary Care Hospital

INTRODUCTION: Cirrhosis is a condition that is defined histopathologically and has a variety of clinical manifestations and complications, some of which can be life-threatening. Patients with cirrhosis and portal hypertension exhibit characteristic cardiovascular & pulmonary hemodynamic changes. The cardiovascular complications include systolic dysfunction, diastolic dysfunction & electrochemical abnormalities like prolonged QT interval in Electrocardiogram (ECG), and Respiratory complications include Consolidation, Pleural Effusion & Pulmonary Arterial Hypertension, which may be due to Hepatopulmonary or Portopulmonary syndrome STUDY DESIGN: A two-year prospective observational study was conducted from July,2014 to June 2016 AIM: To study the different cardiac and pulmonary complications in the patients of Liver Cirrhosis. MATERIALS & METHODS: A two-year prospective observational study was conducted from July,2014 to June 2016 at a tertiary care hospital in Ahmedabad, Gujarat, India, including 30 patients (>12 years old), who were known cases of cirrhosis of liver as well as those newly diagnosed with it, with cardiopulmonary complications, developed after liver cirrhosis, in the absence of other etiological factors. Clinical profile with laboratory studies and diagnostic tests were studied. RESULTS: This study showed that cardiopulmonary complications in cirrhotic patients are more frequently seen in males than females, which commonly manifest during third & fourth decade. Dyspnoea is the most common symptom seen in the study. Among the pulmonary complications, Pneumonia & Hydrothorax are more common compared to hepatopulmonary & portopulmonary syndromes, and among cardiac complications, Diastolic dysfunction is a major complication in such patients, which increases with increasing severity of cirrhosis, as indicated by CP score. CONCLUSION: Among these patients, Cardiac and pulmonary complications have nearly the same incidences.

Diagnostic accuracy of the postoperative C - reactive protein to albumin ratio in prediction of complications after major abdominal surgery.

Introduction:postoperative complications are common after surgery for both benign and malignant disease, and results in infections, extended hospital stay, delayed return to normal status, increased financial burden and long-term morbidity hence early recognition of surgical complications and management is of utmost importance.Aim:To assess the predictive value of C-reactive protein to albumin ratio (CAR) and C-reactive protein (CRP) in determining the post-operative complications following major abdominal surgeries.Methods:this two-year prospective observational study was carried out at acharya vinoba bhave hospital and risk factors for post-operative complications in 100 eligible patients who were undergone major abdominal surgeries were identified using uni and multivariate analysis. Cut Coff values, PPV, sensitivity and specificity of CAR and CRP was analysed by ROC curve.Results:in our study 62% patient developed post-operative complications and CAR on post-op. day three found to be independent risk factor for prediction of post-op. complication and has higher PPV than CRP. CAR cut-off value of 2.16 is associated with more post op complications.Conclusion:From our study it can be hypothesized that patients having CAR value of more than 2.16 on post op day 3 should be monitored carefully for development of complications. So that early intervention could reduce the unwanted sequelae associated with it.

National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study

BackgroundThe national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital’s rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT.MethodsWe conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS’s accuracy to predict two distinct outcomes: RRT patient’s I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT.ResultsThe final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort’s median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22–1.35) and in-hospital (1.15; 1.10–1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69–0.77) and in-hospital (0.68; 0.64–0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69–0.76 and 0.68; 0.64–0.71) for these outcomes, respectively.ConclusionsWe found that in patients attended by a RRT, the NEWS predicts patient’s hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.

The one-leg portion of the Stand–Up Test predicts fall risk in aged individuals: A prospective cohort study

BackgroundFalls are a primary cause of physical disability in older adults, making them a major public health problem. Locomotive syndrome risk assessments have proven to be simple to administer, practical, and useful as screening tools in detecting decreased mobility in middle-aged and elderly adults. The current prospective study investigated whether these tests were associated with future falls among elderly Japanese. MethodsThis study was a two-year prospective observational study. A total of 1800 individuals (aged 65–79 years) who were without certification of long-term care or physical disability were initially invited through letters to participate in the study. Of these, 499 individuals (225 men, 274 women) agreed to participate and underwent baseline assessments. Demographic information, body function physical performance measurements, and locomotive syndrome risk tests [Stand–Up Test (SUT), Two-Step Test (TST), and the 25-question Geriatric Locomotive Function Scale (GLFS-25)] were assessed. Following baseline evaluation, we sent a follow-up questionnaire to assess fall history in the past two years. Participants were classified as either “non-fallers” or “fallers” (denoted by one or more falls). Multiple logistic regression was used to evaluate the association between falls and each factor by providing adjusted odds ratio estimates. ResultsThe follow-up questionnaire was returned by 399 participants, 54 of whom (13.5%) fell at least once during the two-year observation period. The multiple logistic regression analysis revealed that difficulty with standing on one leg from a 40-cm-high seat (a portion of the SUT) was a significant predictor of future falls (odds ratio = 2.20, 95%CI = 1.04–4.69, p = 0.04). A history of falling was also a risk factor of falls. ConclusionOur results suggest that standing on one leg from a 40-cm-high seat is predictive of falling in older adults, even after adjustment for previous falls and other confounding variables.

FP050Trajectory of dialysate IL-6 and gelsolin and their associations with infectious history in incident peritoneal dialysis patients: a two-year prospective observational study

FP050Trajectory of dialysate IL-6 and gelsolin and their associations with infectious history in incident peritoneal dialysis patients: a two-year prospective observational study

Orofacial symptoms and oral health-related quality of life in juvenile idiopathic arthritis: a two-year prospective observational study

BackgroundLittle is known about the chronicity of orofacial symptoms and how this influences the oral health-related quality of life in juvenile idiopathic arthritis (JIA). Therefore, our objectives were to study the long-term changes in self-reported orofacial symptoms, and to define the impact of orofacial symptoms on oral health-related quality of life in JIA.MethodsAt baseline (T0), 157 consecutive JIA patients ≤20 years completed a patient pain questionnaire that incorporates domains related to the orofacial area. At the 2 year follow-up (T1), 113 patients completed the same questionnaire (response rate 72%) in addition to the Child Perception’s Questionnaire; a validated 31-item questionnaire addressing oral health-related quality of life.ResultsAt T0, 53% (60/113) of patients reported the presence of orofacial pain, and 36% (41/113) of patients reported compromised orofacial function. At T1, 77% (46/60) of patients with pain at T0 reported persistent pain, and 66% (27/41) of patients with functional disability at T0 reported persistent disability. Patients with orofacial symptoms reported a significantly greater prevalence of negative impact of orofacial conditions on general quality of life and within the domains of emotional and social well-being compared to asymptomatic patients.ConclusionSelf-reported orofacial pain and functional disability were common findings in a cohort of JIA patients followed over 2 years. These symptoms seem to persist over time in most patients, and have a significant negative impact on oral health-related quality of life.

Oral teicoplanin versus oral vancomycin for the treatment of severe Clostridium difficile infection: a prospective observational study.

The aim of this study was to compare clinical cure rate, recurrence rate and time to resolution of diarrhea in patients with severe and severe-complicated Clostridium difficile infection (CDI) treated with teicoplanin or vancomycin. This two-year prospective observational study included patients with first episode or first recurrence of CDI who had severe or severe-complicated CDI and were treated with teicoplanin or vancomycin. Primary outcomes of interest were clinical cure rate at discharge and recurrence rate after eight weeks follow up, and secondary outcomes were all-cause mortality and time to resolution of diarrhea. Among 287 study patients, 107 were treated with teicoplanin and 180 with vancomycin. The mean age of patients was 73.5 ± 10.6years. One hundred eighty six patients (64.8%) had prior CDI episode. Severe complicated disease was detected in 23/107 (21.5%) and 42/180 (23.3%) patients treated with teicoplanin and vancomycin, respectively. There was no statistically significant difference in time to resolution of diarrhea between two treatment arms (6.0 ± 3.4 vs 6.2 ± 3.1days, p = 0.672). Treatment with teicoplanin resulted in significantly higher clinical cure rate compared to vancomycin [90.7% vs 79.4%, p = 0.013, odds ratio (OR) (95% confidence interval (CI)) 2.51 (1.19-5.28)]. Recurrence rates were significantly lower in patients treated with teicoplanin [9/97 (9.3%) vs 49/143 (34.3%), p < 0.001, OR (95%CI) 0.20 (0.09-0.42)]. There was no statistically significant difference in overall mortality rate. Teicoplanin might be a good treatment option for patients with severe CDI. Patients treated with teicoplanin experienced remarkably lower recurrence rates compared to vancomycin-treated patients.

Correlation of rearfoot angle to Q-angle in patellofemoral pain syndrome: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Objective of the study was to evaluate the correlation between rearfoot posture to Q-angle in patients with patellofemoral pain syndrome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a two-year prospective observational study in which all patients with patellofemoral pain syndrome in the age group of 20-30 years were included in the study. The static Q-angle and the rearfoot angles of these subjects were measured and analyzed statistically for their correlation.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were sixty patients who fulfilled the inclusion criteria of the study. Pearson product moment correlation showed 27% subjects having rearfoot valgus and 73% having rearfoot varus angle. T test showed statistically significant Q-angle for rearfoot varus compared to rearfoot valgus.&lt;/p&gt;&lt;p class="western"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Rearfoot varus is more commonly associated with patellofemoral pain syndrome. The Q-angle increases in both rearfoot varus and valgus but is significantly more in patients with rearfoot varus. &lt;/p&gt;

Retrograde intramedullary nailing for fractures of distal femur: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objective of the present study was &lt;span lang="EN-IN"&gt;to evaluate the clinical and functional outcome of retrograde intramedullary interlocking nailing for fractures of distal femur.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This two-year prospective observational study includes all patients with fractures of distal femur who underwent retrograde intramedullary interlocking nailing. The patient was placed supine on fracture table with the affected limb flexed to 60&lt;sup&gt;o&lt;/sup&gt;. Through a transpatellar approach, the nail was introduced in a retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight-bearing was progressed after signs of fracture union were noted on x-rays. The outcome was evaluated for time taken for fracture union, complications and secondary procedures, knee range of motion and function at 1 year follow up using modified knee-rating scale of the hospital for special surgery.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;There were 21 patients who underwent retrograde intramedullary nailing for fractures of distal femur during the study period. According to AO/ASIF system, fractures were classified as A1 (n=15), A2 (n=3), and A3 (n=3). In 17 patients, fracture united without complications or secondary procedures. Fractures united at a mean time of 19.4 weeks. There were no varus or valgus malalignments but one patient had significant limb shortening. At the end of 1 year, excellent to good functional outcome was noted in 81% of patients. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Retrograde intramedullary nail fixation is a reliable method for treatment of fractures of distal femur. It promotes high rates of fracture union with minimal complications. This method does not interfere significantly with the knee function postoperatively.&lt;/span&gt;&lt;/p&gt;

Refractory Status Epilepticus in Children: Intention to Treat With Continuous Infusions of Midazolam and Pentobarbital.

To describe pediatric patients with convulsive refractory status epilepticus in whom there is intention to use an IV anesthetic for seizure control. Two-year prospective observational study evaluating patients (age range, 1 mo to 21 yr) with refractory status epilepticus not responding to two antiepileptic drug classes and treated with continuous infusion of anesthetic agent. Nine pediatric hospitals in the United States. In a cohort of 111 patients with refractory status epilepticus (median age, 3.7 yr; 50% male), 54 (49%) underwent continuous infusion of anesthetic treatment. The median (interquartile range) ICU length of stay was 10 (3-20) days. Up to four "cycles" of serial anesthetic therapy were used, and seizure termination was achieved in 94% by the second cycle. Seizure duration in controlled patients was 5.9 (1.9-34) hours for the first cycle and longer when a second cycle was required (30 [4-120] hr; p = 0.048). Midazolam was the most frequent first-line anesthetic agent (78%); pentobarbital was the most frequently used second-line agent after midazolam failure (82%). An electroencephalographic endpoint was used in over half of the patients; higher midazolam dosing was used with a burst suppression endpoint. In midazolam nonresponders, transition to a second agent occurred after a median of 1 day. Most patients (94%) experienced seizure termination with these two therapies. Midazolam and pentobarbital remain the mainstay of continuous infusion therapy for refractory status epilepticus in the pediatric patient. The majority of patients experience seizure termination within a median of 30 hours. These data have implications for the design and feasibility of future intervention trials. That is, testing a new anesthetic anticonvulsant after failure of both midazolam and pentobarbital is unlikely to be feasible in a pediatric study, whereas a decision to test an alternative to pentobarbital, after midazolam failure, may be possible in a multicenter multinational study.

Treatment of Osteoarthritis of the Knee with a Combination of Autologous Conditioned Serum and Physiotherapy: A Two-Year Observational Study.

BackgroundAutologous conditioned serum (ACS) is an autologous blood product that has shown efficacy against knee osteoarthritis (OA) in randomized controlled trials. However, there are few reports of its effectiveness in everyday practice. Here, we report clinical efficacy results from a two-year prospective observational study of patients with highly symptomatic knee OA who received ACS in conjunction with physiotherapy.Methods118 patients with unilateral knee OA (Kellgren-Lawrence grades I–IV), who were candidates for surgery but instead chose conservative treatment, were treated with a combination of four intra-articular injections of ACS (2 mL each) once weekly over four weeks and subsequent physiotherapy applied 4 weeks after ACS injection. Main endpoints of the study were pain (Numeric Rating Scale [NRS]) assessed at 0, 3, 6, 12 and 24 months, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score, assessed at 0 and 24 months. The effect size (Cohen’s d) was calculated for pain and WOMAC outcomes, with effect sizes >0.8 considered large.ResultsBy 3 months, there were significant improvements in pain (NRS) from baseline (-63.0%, p<0.001), which were maintained over 24 months. Mean WOMAC global score was reduced at 24 months compared to baseline (-56.9%, p<0.001), as were WOMAC subscores of pain (-86.0%, p<0.001) and function (-51.3%, p<0.001). Effect sizes for pain (>5) and WOMAC improvement (8.0–13.6) were very large. Only one patient received total knee joint replacement during the study. Clinical improvement did not correlate with gender, age, Kellgren-Lawrence grade, or body mass index.ConclusionsTreatment with ACS and physiotherapy produced a rapid decline in pain, which was sustained for the entire two years of the study. This was accompanied by a large improvement in WOMAC scores at two years. These results confirm that ACS combined with physiotherapy is an effective treatment for OA of the knee.

Atherosclerosis progression in psoriatic arthritis patients despite the treatment with tumor necrosis factor-alpha blockers: A two-year prospective observational study

ObjectiveTo evaluate the progression of subclinical atherosclerosis in Psoriatic Arthritis (PsA) patients treated with anti-tumor necrosis factor (TNF)-α agents. MethodsThirty-two PsA patients classified according to the CASPAR criteria and attending the Rheumatology Unit of the University of Padua Medical Center were enrolled in a two-year prospective, observational study. In accordance with the ASAS/EULAR recommendations on the management of these patients, those studied were prescribed biological agents [etanercept (n=21), adalimumab (n=6), infliximab (n=5)]. Plasma lipids, inflammatory biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), vessel endothelium growth factor (VEGF), osteoprotegerin (OPG), and TNF-α, as well as Disease Activity Score 28 calculated with CRP (DAS 28-CRP) were evaluated at baseline and after two years of treatment. Bilateral carotid B-mode ultrasound measurements [the mean-intima media thickness (mean-IMT), the mean maximum-IMT (M-Max)] of each carotid artery segment (common, bulb, and internal carotid artery) and the post-occlusion flow-mediated dilation (FMD) of the brachial artery were also assessed at baseline and after two years. ResultsDespite an improvement in the DAS 28-CRP score (P<0.0005) and lower low-density lipoprotein cholesterol (P<0.013) and triglyceride (P<0.036) values, there was a significant progression in both the mean-IMT (P<0.0005) and M-Max (P<0.0005). Moreover, no recovery in FMD (P=ns) was observed after two years of anti TNF-α treatment. Serum TNF-α levels were increased (P=0.003) and OPG values were decreased (P=0.011) at the end of follow- up with respect to baseline values. ConclusionsDespite improvement in clinical status, arterial remodelling was observed in the PsA patients who were treated with anti TNF-α agents for two years.