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Summary Objectives This study aimed to examine the effect of dextrose drink (D) on blood glucose, VO2max, and sprint speed compared with Sodium-Dextrose drink. Equipment and Methods: We conducted a double-blinded crossover study of 22 young male (19 ± 1.1 years) soccer players, consumed either Dextrose drink or Sodium-Dextrose drink. We compared pre- and post-data of Blood Glucose, VO2max, and sprint speed between the dextrose and sodium-dextrose drinks groups. The primary outcome was differences in ΔBlood Glucose between D and Sodium-D group. Secondary outcomes were differences in ΔVO2max and Δsprint speed between D and Sodium-D group. Results The mean BG level was higher in D compared with Sodium-D group [136 ± 22.9 mg/dl vs. 118 ± 21.5 mg/dl] (P = 0.009). Mean differences of ΔBG of D (mean before and mean after) compared with ΔBG Sodium-D (mean before and mean after) is 16.8 mg/dl (P = 0.001). The mean of sprint speed is faster in the D group [15.2 ± 1.25 sec vs. 15.9 ± 1.61 sec] (P = 0.019), but we found no significant differences in VO2max between both groups [42.1 ± 3.44 ml/min/kg vs. 42.3 ± 3.98 ml/min/kg] (P = 0.834). Conclusion The present study demonstrated that dextrose drink without added sodium has a large influence on increasing blood glucose level and sprint speed.

Background Surgery is regarded as the primary treatment for breast cancer. Chronic post-surgical pain (CPSP) is a recognised complication after breast cancer surgery, and it is estimated to affect 20–30% of women. Pain catastrophizing has emerged as one of the most influential psychological variables associated with CPSP. Methods This trial will be a single-centre, prospective, double-blinded, superiority, randomised controlled trial (RCT). Patients scheduled for elective breast cancer surgery (wide local excision or mastectomy with or without axillary lymph node dissection) will be screened preoperatively for high pain catastrophising. Patients with high pain catastrophising, defined as a score of ≥ 24 on the Pain Catastrophising Scale will be deemed eligible for inclusion in the study. Participants will be randomly assigned to receive either a cognitive behavioural therapy or an educational mindfulness based programme during their perioperative period. The primary outcome is the Brief Pain Inventory short form average pain severity score at 3 months postoperatively. Secondary outcomes include patient-reported quality of recovery at days 1–2 after surgery, levels of pain catastrophising, reported depressed mood and anxiety. Discussion To the best of our knowledge, this protocol describes the first RCT which directly examines the effect of perioperative cognitive behavioural therapy on CPSP among breast cancer patients with high pain catastrophising characteristics. The outcomes of this trial may have significant implications for these patients because perioperative cognitive behavioural therapy has the potential to become an important perioperative intervention to complement patient management. Trial registration ClinicalTrials.govNCT04924010. Registered on 11 June 2021. All item from the World Health Organisation Trial Registration Data set have been included.

Objective Using stringent inclusion criteria, a double-blinded study protocol, and fluoroscopically guided injections, we compare intra-articular sacroiliac joint platelet-rich plasma injections with intra-articular steroids. Design Double-blind, randomized controlled trial. Setting Two large university-based interdisciplinary spine centers. Subjects A total of 26 patients with a positive diagnostic block (>80% relief). Methods Subjects who had a positive diagnostic block were randomized to undergo either a fluoroscopically guided intra-articular injection of steroid or a platelet-rich plasma injection. Follow-up was at 1 month, 3 months, and 6 months. Outcomes included level of pain, as indicated on a 0- to 100-mm numeric pain rating scale, and functional disability score, obtained via the Oswestry Disability Index (ODI). Results At 1, 3, and 6 months, both groups improved; however, subjects who received steroid injections reported lower pain scores than did subjects who received platelet-rich plasma. Using categorical data, we observed significantly more responders (defined as pain scores that improved by 50% or more from baseline) at 1 and 3 months in the group who received steroids than in the group who received platelet-rich plasma. Conclusion Although both groups showed improvements in pain and function, the steroid group had significantly greater response and significantly more responders than did the platelet-rich plasma group.

Background and purpose — The sacroiliac joint is increasingly recognized as a cause of pain in 15–30% of patients with low back pain. Nonoperative management is not always successful and surgical treatment with fusion of the joint is increasingly recommended. According to the literature, minimally invasive fusion reduces pain and improves function compared with nonoperative treatment. It is, however, unclear to what extent the placebo effect influences these results. Patients and methods — The trial is designed as a prospective multi-center, double-blind, randomized shamsurgery controlled trial with 2 parallel groups. 60 patients with a suspected diagnosis of sacroiliac joint pain confirmed with sacroiliac joint injection are included according to the trial inclusion criteria. Patients are randomized with a 1:1 allocation into 2 groups of 30 patients each. The primary end-point is group difference in sacroiliac joint pain intensity on the operated side at 6 months postoperatively, measured by the Numeric Rating Scale. The main objective is to examine whether there is a difference in pain reduction between patients treated with a minimally invasive fusion of the sacroiliac joint compared with patients undergoing a sham operation. Results — Unblinding occurs after the completed 6-month follow-up. The primary analysis will be performed when all patients have completed 6 months’ follow-up. Follow-ups are continued to at least 2 years postoperatively. Data from the different groups will be compared based on the “intention to treat” principle.

Background: Hypophonia is a prevailing problem in people with multiple sclerosis (PwMS). However, evidence supporting the effectiveness of voice rehabilitation is lacking. Objective: The aim of this study was to identify the most effective method to reduce hypophonia. Methods: In this randomized controlled trial, 44 PwMS were randomized to intensive and high-effort voice treatment groups, the LSVT-LOUD®, and conventional treatment group. Subjects received 16 treatments (4 sessions/week) lasting 45 minutes. The primary outcome was voice intensity (dB) in monologue, vocalization, and sentences while voice handicap index (VHI) measured voice self-perception. Outcomes were assessed by a blinded observer at baseline, post-treatment, and 15-month follow-up (FU). Results: Linear models revealed a significant post-intervention between-group mean difference in favor of LSVT-LOUD for monologue: +6.3 dB (95% CI: 2.5 to 10.1); vocalization: +7.4 dB (95% CI: 2.3 to 12.5); and sentences: +9.5 dB (95% CI: 4.7 to 14.3). However, 43.7% PwMS in the LSVT-LOUD and 10% in the conventional treatment group obtained a full recovery of voice intensity (>60 dB) post-treatment, Fisher’s test = 13.3, p Conclusion: LSVT-LOUD can be a valid treatment to increase voice intensity in PwMS. However, results suggest the need for FU interventions targeting maintenance.

BACKGROUND Local anaesthetics helps in preventing pain during surgical and dental procedures by blocking the peripheral nerves. The primary objective of this investigation was to compare and evaluate 4 % articaine hydrochloride (with 1 : 100000 adrenaline) and 2 % lignocaine hydrochloride (with 1 : 80000 adrenaline) in terms of pulpal anaesthesia, volume of anaesthetic solution administered, need of re-anaesthesia and difficulty of extraction during orthodontic extraction of maxillary first premolars. METHODS This prospective randomized, double-blinded study was conducted on 43 patients of less than 40 years of age requiring bilateral maxillary first premolar extractions for orthodontic purposes. Each patient was randomly assigned to receive either 2 % lignocaine hydrochloride or 4 % articaine hydrochloride for premolar extraction of one side and other solution was administered for premolar extraction of contralateral side spaced 1 to 3 weeks apart. In each patient, the difference in pulpal anaesthesia, volume of anaesthetic solution administered, need of re-anaesthesia, difficulty of extraction and duration of anaesthesia was assessed on administration of lignocaine hydrochloride and articaine hydrochloride. RESULTS Statistically significant difference in pulpal anaesthesia levels was found when the articaine and lignocaine groups (P > 0.05) were compared, with a higher mean pulpal anaesthesia among the articaine group. There was no difference in volume of anaesthetic solution administered on buccal and palatal side among the articaine and lignocaine groups. Only 2.3 % of patients in both the groups required re-anaesthesia on the buccal side. There was no significant difference in difficulty of extraction in both the groups. The articaine group had a longer mean duration of anaesthesia as compared to the lignocaine group which was highly significant. CONCLUSIONS Articaine may be used to replace lignocaine in orthodontic extraction of maxillary premolars with clinical advantages like higher pulpal anaesthesia and longer duration of anaesthesia. KEY WORDS Local Anaesthetic, Lignocaine Hydrochloride, Articaine Hydrochloride, Orthodontic Extraction, Prospective Study, Double-Blinded Study.

BACKGROUND Bleeding during functional endoscopy sinus surgery (FESS) remains a main consideration. Even a small amount of blood may disturb the endoscopic view, increasing the likelihood of complications. So, we decided to compare the effects of clonidine and atenolol as oral premedication for hypotensive anaesthesia in patients undergoing FESS under general anaesthesia. The purpose of this study was to analyse and compare the efficacy of oral atenolol versus oral clonidine as premedication under general anaesthesia for induced hypotension in patients undergoing a functional endoscopic sinus surgery. METHODS The study included total 100 patients of age (18 – 60 years) [American Society of Anaesthesiologists (ASA grade I and II)] who were randomly divided into two groups of 50 each. Group - A (n = 50), a non-labelled clonidine tablet PO was given to the patients in the clonidine group in the dose of 2 mcg/kg at 7 pm the day before surgery and 4 mcg/kg two hours before surgery. Group - B (n = 50), a non-labelled atenolol 25 mg tablet was given PO to the patients in the atenolol group at 7 pm the day before surgery and also 2 hours before surgery. Induction and maintenance of general anaesthesia was performed by the same standard protocol for both groups. Hemodynamic effects [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), quality of surgical field, intraoperative complications, and post anaesthetic discharge score system (PADSS)] were recorded and statistically analysed. RESULTS The hemodynamic stability and good quality surgical field was obtained in both the groups. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. CONCLUSIONS We conclude that both oral clonidine and atenolol premedication provides superior and predictable perioperative hemodynamic control, reduces the requirement of hypotensive agents, and produces acceptable recovery characteristics. The lesser incidence of intraoperative complications recorded with atenolol gives it a more favourable profile when compared to clonidine. KEYWORDS Atenolol, Clonidine, Functional Endoscopic Sinus Surgery (FESS)

Brachial plexus anaesthesia has been an indispensable tool in the anaesthesiologist's armamentarium. Clinical studies have shown that levobupivacaine and ropivacaine have fewer adverse effects on the cardiovascular and central nervous system making them more advantageous in regional anaesthesia techniques. Less information is available regarding their comparable clinical data. Only a few studies have compared levobupivacaine and ropivacaine for brachial plexus blocks; hence, this study was aimed to compare the analgesic effectiveness and nerve block characteristics of ropivacaine and levobupivacaine in supraclavicular brachial plexus blocks in upper limb surgeries.Patients with American Society of Anaesthesiologists physical status I or II coming for elective upper limb surgeries were included in the study. Total numbers of 62 patients were randomly allocated into two groups, group A and group B. Group A received 25mL of 0.75% ropivacaine, and group B received 25mL of 0.5% levobupivacaine. The duration of analgesia, onset of block, duration of sensory, and motor blockade were studied and compared.The mean duration of analgesia in group ropivacaine was 8.33 hours and in group levobupivacaine was 10.23 hours which was statistically significant. Ropivacaine had a faster sensory onset compared to levobupivacaine (5.22 vs. 6.88 minutes). The duration of sensory and motor blockade was longer with levobupivacaine than ropivacaine (sensory-8.64 vs. 10.29 hours, motor-8.32 vs. 9.8 hours).Levobupivacaine had longer duration of analgesia. The sensory and motor blockade was also longer with levobupivacaine.

Shilajit is being widely used to cure a number of diseases across the world. It has wide medicinal values in various traditional systems of medicine worldwide. Shilajit has an important place in the Ayurvedic classic texts and being used as like a panacea, as Acharya Charaka cited in their popular verse that there is no curable decease on the earth, which could not be treated with the proper administration of Shilajit Rasayana. In modern days a number of research have been conducted across the world on parameters as defined and established on modern paradigms, and it has been concluded that Shilajit may play an important Roles in curing various life style deceases or infectious deceases. The aim and objective of current study to summarize the modern findings available online or offline on resources like Pub-Med, Google Scholar, and Science direct and another database, and cross relate the same with the establishment and verses of classical Ayurvedic Texts. The physical and chemical properties of Shilajit has also been discussed and summarized with special reference to modern findings. After going through a number of literature it may be concluded that Shilajit obviously have miraculous property as described in classical text and folk lore, but there is a limitation when reviewed on modern parameters, and that limitations is definitely lack of appropriate numbers of double blinded clinical trials and efficacy evaluation. Maximum studies available now a days are either in-vivo or in-vitro study, only a few human clinical trials are present.

Purpose To investigate the effects of lactoferrin (LF) on infectious diseases in Japanese summer. Methods An intake of placebo, 200 mg, or 600 mg of LF were administered to healthy adults in Kyushu University of Health and Welfare for 12 weeks in a randomized, double-blinded, placebo-controlled parallel-group comparative trial. The primary endpoints were the prevalence and duration of infectious diseases and changes in immune parameters. Results Three hundred and ten subjects were randomized (placebo, n = 104; 200 mg, n = 103; 600 mg, n = 103). Twenty subjects were lost to the follow-up, leaving 290 for a full analysis set (n = 99; n = 95; n = 96). The duration (day) of total infectious diseases was shorter in the 200 mg group (2.0, p = 0.045) and 600 mg group (2.0, p = 0.010) than in the placebo group (3.0). The duration of summer colds was shorter in the 600 mg group (2.0, p = 0.036) than in the placebo group (3.0). No significant differences were observed in the prevalence of infectious diseases or changes in immune parameters. In exploratory investigations, changes in the neutrophil phagocytic capacity, cortisol concentrations, and T score of “Vigor/Activity” in the Profile of Mood States 2 were greater in the 600 mg group than in the placebo group, when analysis was done on the lower half groups at the baseline. Adverse events were similar in each group and none had a causal relationship with the intake of the test foods. Conclusions In summer, the intake of LF attenuates infectious diseases, including summer colds.

Background One of the cardinal points to be considered during endodontic procedures in children is the measure of postoperative pain. Aim and objective To evaluate the quality of obturation and its effect on postoperative pain with three file systems in primary mandibular molars during 1 week follow-up. Materials and methods The study was conducted as a double-blinded randomized controlled trial. The participants between 6 years and 9 years old requiring a pulpectomy were recruited for the trial. Forty-five primary mandibular molars were randomly allocated into 15 teeth each in Hand K-files; Kedo-SH and Kedo-SG Blue groups. Wong Baker's FACES Pain Rating Scale was used for assessing the postoperative pain in the children for 1 week. Pearson's Chi-square test, Kruskal–Wallis test, and Mann–Whitney U test were used for analyzing the data statistically. Results Optimal fillings were observed more in the Kedo-SG Blue group (80.0%) compared to the other two groups (p < 0.017). On intergroup analysis, the Kedo-SG Blue group reported less postoperative pain compared to Kedo-SH group on day 1 while on day 7 no postoperative pain was experienced in either of the groups. Less postoperative pain was reported by the children in whom the canals were optimally filled compared to overfilling and underfilling. Conclusion Kedo-SG Blue resulted in less postoperative pain when compared to Kedo-SH and hand K-files, whereas optimally filled children experienced less postoperative pain compared to overfilling and underfilling. Clinical significance A felicitous pediatric dental practice includes appropriate assessment and management of postoperative pain in children. Hence, the present study is important in highlighting the affiliation of postoperative pain with quality of obturation following an endodontic intervention in children. How to cite this article Jeevanandan G, Govindaraju L, Subramanian EMG, et al. Comparative Evaluation of Quality of Obturation and Its Effect on Postoperative Pain between Pediatric Hand and Rotary Files: A Double-blinded Randomized Controlled Trial. Int J Clin Pediatr Dent 2021;14(1):88–96.

Background. The precise mechanism of 2-channel neuromuscular electrical stimulation (NMES) treatment is unknown, and controversy remains over its efficacy. The sequential 4-channel NMES was newly developed based on normal contractile sequences of swallowing-related muscles. Objective. To assess the clinical efficacy of sequential 4-channel NMES during swallowing. Methods. In this prospective RCT, 52 inpatients with dysphagia (acute, subacute, and chronic state) after stroke, brain tumor, or encephalitis were enrolled. Participants who underwent a videofluoroscopic swallowing study (VFSS) and clinical evaluation were enrolled and were randomly assigned to the 4-channel NMES or sham group. The 4-channel NMES and sham groups swallowed thin and honey-like fluids under NMES (sequential stimulation on suprahyoid and infrahyoid) and sham stimulation, respectively. The procedures were evaluated with the VFSS. Pre- and post-treatment evaluations were performed with the videofluoroscopic dysphagia scale (VDS), penetration–aspiration scale (PAS), Likert scale, and kinematic analysis. Results. The 4-channel NMES group showed significantly greater improvements than the sham group with respect to oral VDS, pharyngeal VDS, total VDS, and PAS ( P < .05). Furthermore, the Likert scale for satisfaction, easiness, and discomfort for swallowing showed favorable results for the 4-channel NMES group ( P < .05). In the kinematic analysis, the peak speed point, distance, and velocity of hyoid movement were significantly greater in the 4-channel NMES group ( P < .05). Conclusions. Sequential 4-channel NMES activating the suprahyoid, thyrohyoid, and other infrahyoid muscles during swallowing showed significant clinical improvement with respect to VDS, PAS, and kinematic analysis. Therefore, sequential 4-channel NMES is a potential new functional electrical stimulation system for the treatment of dysphagia.

BACKGROUND The incidence of pain on propofol injection varies between 28 – 90 % during induction and may be severe. Ramosetron has been proved efficacious in reducing propofol pain in adults but not in children, therefore we conducted this double blinded randomized controlled study to determine the effectiveness of ramosetron in attenuating propofol induced pain in children. The purpose of this study was to compare the effectiveness of injection ramosetron, a 5HT3 antagonist and lidocaine, the commonest drug for attenuation of pain caused by injection propofol. METHODS This is a randomised double-blinded study. Eighty children of American Society of Anaesthesiologist (ASA) grade I - II, aged 4 - 14 years, undergoing elective surgical procedures under general anaesthesia were randomly assigned to two groups of 40 each. Group PR received 6 µg/kg of ramosetron and Group PL received 0.2 mg/kg of 2 % lidocaine. After injection of study drug, occlusion of venous drainage was done manually by a trained assistant at mid-arm for 60 seconds. After releasing manual occlusion Injection propofol (1 %) 2 mg/kg was administered slowly over a period of 5 seconds. A four point scale was used to assess the severity of pain. The results were analysed by using unpaired student’s t - test and chi-square test/Fisher’s exact test. P value of < 0.05 was considered statistically significant. RESULTS The demographic characteristics were comparable in both groups. The incidence of no pain in Group PR and Group PL was 60 % (N = 24) and 65 % (N = 26) respectively which was comparable. The incidence of mild, moderate and severe pain was comparable in both groups. The overall incidence of propofol injection pain in group PL and group PR was 35 % and 40 % respectively (P = 0.862). CONCLUSIONS Intravenous ramosetron at a dose of 6 µg/kg can effectively attenuate the propofol induced pain comparable to 0.2 mg/kg of lidocaine in children. KEYWORDS Children, Lidocaine, Propofol Induced Pain, Ramosetron

Background Atopic dermatitis (AD) is a common and chronic inflammatory skin disease that erupts periodically. Although the negative impact of the disorder on overall quality of life has been well established, new treatments for AD are still needed. Various studies have reported on cannabidiol's effectiveness in relieving pain and easing inflammation while not presenting major health risks. Aims In this communication, we aim to demonstrate the effectiveness of a novel cannabidiol (CBD) and aspartame formulation, JW-100, in relieving signs and symptoms of AD. Patients/methods We conducted a double-blinded placebo-controlled interventional study randomizing patients to one of three treatment groups: JW-100 (CBD plus aspartame), CBD only, or placebo topical formulations. The Investigator's Static Global Assessment (ISGA) score was used to document any changes in AD resulting from the applied interventions at 14 days. Results Fifty-seven patients completed the trial and were included in the final analysis. The ISGA score of the patients at baseline was 2.56, 2.24, and 2.24, for the JW-100, CBD, and placebo groups, respectively. After two weeks of treatment, the ISGA score reduced by 1.28, 0.81, and 0.71, for the JW-100, CBD, and placebo groups, respectively. The JW-100 cohorts demonstrated statistically significant ISGA score reduction (p = 0.042). 50% of patients in the JW-100 group achieved ISGA score of clear or almost clear (0 or 1) with at least a 2-grade improvement from baseline after treatment (p = 0.028). Only 20% and 15% of patients in the CBD only and placebo groups reported ISGA score of clear or almost clear (0 or 1). Conclusions JW-100, a novel topical formulation containing CBD and aspartame, was demonstrated to produce statistically significant improvements in AD following 14 days of topical application.

To assess the speed and accuracy of a checklist user interface for the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).A diagnostic tool formatted as a checklist was developed and compared to an existing diagnostic tool, the DC/TMD diagnsostic decision trees. Both types of tools use the DC/TMD and were tested by dental students, interns, and residents in the USA and Japan for diagnosis of hypothetical patients. The comparisons were done in a randomized, crossover, controlled, double-blinded trial.Overall, subjects using the experimental tool answered 25% more correct diagnoses (P.001) and missed 27% fewer diagnoses (P.01). They were also able to finalize their diagnoses faster than those using the control tool, in 16% less time (P.05). The difference in accuracy was more pronounced in complex cases, while the difference in speed was more pronounced in simple cases.This checklist is an alternative user interface for the DC/TMD.

The aim of this study is to determine the effects of local anesthetics administered intraperitoneally in laparoscopic appendectomy.Patients who underwent laparoscopic appendectomy due to acute appendicitis were enrolled in the study. The children were divided into two groups. Intraperitoneal bupivacaine injection to appendectomy site and subdiaphragmatic area was performed after resection of appendix and aspirastion of intraperitoneal reactive fluid in Group 1 while Group 2 did not receive this therapy. The children were questioned by a nurse at postoperative 1st, 6th, 12th, and 24th h. Pain scores (PS) (abdominal), abdominal wall incisional pain (IP), shoulder pain (SP), and first need for analgesics were recorded.One hundred and twenty children were enrolled to the study. There was no significant difference in PS values and IP values between the two groups (p0.05). SP values at 12th and 24th h were significantly lower in Group 1 (p0.05). There was a statistically significant reduce in analgesic need in Group 1 (p=0.007).Intraperitoneal bupivacaine instillation to surgery site and subdiaphragmatic area seems to reduce the SP post-opera-tive and also reduce post-operative analgesic need. More meaningful results can be obtained with an increase in the number of patients.

Introduction: Multimodal analgesia (MMA) is the current standard practice to provide post-cesarean analgesia. The aim of this study was to compare the analgesic efficacy of quadratus lumborum (QL) block and transversus abdominis plane (TAP) block as an adjunct to MMA. Method: Eighty mothers undergoing cesarean delivery under spinal anesthesia were randomized to receive either TA P or transmuscular QL block (QLB) with 20 mL 0.375% ropivacaine on each side. Postoperatively, all the subjects were assessed at 2, 4, 6, 8, 12, 18, and 24 hours. The primary outcome was the time to first analgesic request. The secondary outcomes were the pain scores during rest and movement, number of doses of tramadol, postoperative nausea-vomiting, sedation, and mother’s satisfaction with the pain management. Results: The median (IQR) time to first analgesic request was 12 (9.25, 13) hours in the QL group and 9 (8.25, 11.37) hours in the TA P group (p = 0.0008). Patients in QL group consumed less doses of tramadol than those in TA P group (p < 0.0001). Pain scores were significantly lower in the QL group at all time points (p < 0.0001) except at 8th hour when at rest, p = 0.0024, and on movement, p = 0.0028. The maternal satisfaction was significantly higher in the QL group (p = 0.0017). Conclusion: Our study showed the significant delay in time to first analgesic request in QL group patients. Patients in the QL group had lower pain scores, required fewer analgesic supplements, and had more satisfaction. Nausea-vomiting and sedation were comparable.

To test the hypothesis that β -glucan enhances protective qi (PQi), an important Chinese medicine (CM) concept which stipulates that a protective force circulates throughout the body surface and works as the first line of defense against “external pernicious influences”. A total of 138 participants with PQi deficiency (PQD) were randomized to receive β -glucan (200 mg daily) or placebo for 12 weeks. Participants’ PQi status was assessed every 2 weeks via conventional diagnosis and a standardized protocol from which a PQD severity and risk score was derived. Indices of participants’ immune and general health status were also monitored, including upper respiratory tract infection (URTI), saliva secretory IgA (sIgA), and self-reported measures of physical and mental health (PROMIS). PQi status was not significantly different between the β -glucan and placebo treatment groups at baseline but improved significantly in the β -glucan (vs. placebo) group in a time-dependent manner. The intergroup differences [95% confidence interval (CI)] in severity score (scale: 1–5), risk score (scale: 0–1), and proportion of PQD participants (%) at finish line was 0.49 (0.35–0.62), 0.48 (0.35–0.61), and 0.36 (0.25–0.47), respectively. Additionally, β -glucan improved URTI symptom (scale: 1–9) and PROMIS physical (scale: 16.2–67.7) and mental (scale: 21.2–67.6) scores by a magnitude (95% CI) of 1.0 (0.21–1.86), 5.7 (2.33–9.07), and 3.0 (20.37–6.37), respectively, over placebo. β -glucan ameliorates PQi in PQD individuals. By using stringent evidence-based methodologies, our study demonstrated that Western medicine-derived remedies, such as β -glucan, can be employed to advance CM therapeutics. (ClinicalTrial.Gov registry: NCT03782974)

In a polarized society, it is a university’s responsibility to offer courses that explore highly controversial issues. Traditional forms of debate may create barriers to knowledge and entrenchment ...

Background Laryngeal paralysis commonly affects older Labrador retrievers. Currently, dogs with severe disease require surgical intervention, most commonly arytenoid lateralization. Anecdotally, doxepin has been proposed to help dogs with laryngeal paralysis. Hypothesis Doxepin will improve quality of life measures assessed by owners of Labrador retrievers with laryngeal paralysis not requiring emergency surgery. Animals Twenty-two Labrador retrievers with laryngeal paralysis. Methods Dogs were randomized to receive doxepin (3-5 mg/kg q12h PO) or placebo for 28 days. Owners completed quality-of-life assessments before and after completing the study. Data were compared between groups using Rank-Sum tests or Fisher's exact tests. Results The 2 groups of dogs did not differ at baseline except for owner-perceived degree of ataxia (owners of dogs receiving doxepin considered them more ataxic than owners of dogs receiving placebo). After 28 days, owner-assessed quality of life measures did not differ between dogs receiving doxepin or placebo (dogs worsening: doxepin = 2, placebo = 1; dogs unchanged: doxepin = 6, placebo = 7; dogs improved: doxepin = 4, placebo = 2; P = .84). Dogs receiving placebo had a greater improvement in client-assessed overall health than dogs receiving doxepin (mean ranks: doxepin = 4.36, placebo = 6.64; P = .04). The study was terminated at this interim analysis. Conclusions and clinical importance Doxepin did not appear to improve any measures of owner-assessed quality of life in Labrador retrievers with laryngeal paralysis.

BACKGROUND Dexamethasone (DES) is a very potent anti-inflammatory and analgesic glucocorticoid with very strong activity. The current study is randomised to determine the onset time, duration, and analgesic potency of bupivacaine (BUC) 0.5 percent, relative to BUC 0.5 percent and DES 8 mg by supraclavicular approach for brachial plexus block. METHODS In patients posted for upper limb surgery under a supraclavicular block, a prospective, randomised, double-blinded study was conducted. 60 Class I and II American Society of Anesthesiologists (ASA) patients were randomly divided into two classes. Group A received 0.5 percent of 30 ml BUS and group B received 0.5 percent of 28 ml BUS and 8 mg of 2 ml DES combined. For a single shot blockade of the supraclavicular brachial plexus, 30 ml of a solution was required. RESULTS The mean age of patients who received BUS was 36.9 ± 10.4 years and those who received BUS + DES was 34.7 ± 7.1 years (P = 0.328), there was no statistically significant difference between the mean ages of two groups (P > 0.05). The mean time of onset of sensory block in the BUS group was 8.6 ± 1.2 minutes and 5.6 ± 0.7 minutes in the BUS + DES group. There was a statistically significant difference between the onset of motor block in minutes among BUS and BUS + DES groups, there was a statistically significant difference between the mean ages of the two groups (P < 0.001). There was no statistically meaningful difference between the BUS and BUS + DES classes at various time intervals in the mean heart rate, difference in systolic blood pressure and diastolic blood pressure, and oxygen saturation. CONCLUSIONS The start of sensory and motor blockade also prolongs the length of DES 8 mg to BUS 0.5 percent speeds, thereby supplying improved analgesia and reducing the rescue analgesic requirements. KEYWORDS Bupivacaine, Dexamethasone, Brachial Plexus, Supraclavicular, Sensory Block

OBJECTIVE To determine the dose of coenzyme Q10 (CoQ10) needed to achieve at least a 3-fold increase in plasma CoQ10 concentration in dogs with myxomatous mitral valve disease (MMVD) and congestive heart failure (CHF). ANIMALS 18 dogs with CHF due to MMVD and 12 healthy dogs. PROCEDURES In a randomized, double-blinded, controlled trial, dogs with MMVD were given 50 or 100 mg of water-soluble CoQ10 (ubiquinone; total daily dose, 100 mg [n = 5] or 200 mg [6]) or a placebo (7), PO, twice a day for 2 weeks in addition to regular cardiac treatment. Plasma CoQ10 concentration was measured in dogs with MMVD before (baseline) and at various time points after supplementation began and in healthy dogs once. Concentrations were compared among and within groups. RESULTS No significant difference in median baseline plasma CoQ10 concentration was detected between healthy dogs and dogs with MMVD. Fold increases in plasma CoQ10 concentrations ranged from 1.7 to 4.7 and 3.2 to 6.8 for individual dogs in the 100-mg and 200-mg groups, respectively. The change in plasma CoQ10 concentration after supplementation began was significantly higher than in the placebo group at 4 hours and 1 and 2 weeks for dogs in the 200-mg group and at 1 and 2 weeks for dogs in the 100-mg group. CONCLUSIONS AND CLINICAL RELEVANCE A daily CoQ10 dose of 200 mg was sufficient to achieve at least a 3-fold increase in plasma CoQ10 concentration and may be used in CoQ10 supplementation studies involving dogs with CHF due to MMVD.

Background: Flexible rectosigmoidoscopy is an easy and accessible exam to diagnose distal colon diseases, although many patients refuse to undergo it due to pain and discomfort during the procedure. Studies show that the application of local lidocaine, as an analgesic has no effect on pain relief in patients undergoing rectosigmoidoscopy. The current study aims at comparing the effects of diltiazem gel, an antispasmoic drug with local pain-reducing effects, with lidocaine gel in patients undergoing flexible rectosigmoidoscopy. Materials and Methods: The current double-blinded, randomized, clinical trial was performed to compare the effect of two topical drugs, lidocaine and diltiazem, on pain relief in patients undergoing rectosigmoidoscopy. A total of 80 patients who were potential candidates for rectosigmoidoscopy were enrolled in the study after obtaining the informed consent and then randomly assigned to one of the lidocaine gel (2 mL) or diltiazem gel (2 mL) group, 10 minutes prior to rectosigmoidoscopy. The level of pain in the patients during the procedure was measured using the visual analogue scale (VAS) and the results were recorded. The data were analyzed using paired samples ttest and independent t-test as well as analysis of covariance (ANOVA) with SPSS version 18. P-value Results: Of 80 patients, 35 (43.75%) were male and 45 (56.25%) female. The mean age and body mass index (BMI) of the patients were 51.45 ± 15.21 years and 25.95 ± 7.47 kg/m2, respectively, and there was no significant difference between the groups. The most frequent indications for rectosigmoidoscopy were abdominal pain (46.3%) and rectorrhagia (31.3%). The mean VAS score for pain reported by the patients in the lidocaine and diltiazem groups was 3.97 ± 2.89 and 2.60 ± 2.36, respectively. The VAS score for pain in the diltiazem group was significantly lower than lidocaine group (P = 0.023). Conclusion: The application of local diltiazem gel around the anus, in spite of no side effects, can effectively reduce the pain and discomfort in patients during rectosigmoidoscopy. Iranian Registry of Clinical Trials (Reg. No 31055).

Ranula is a rare benign cystic lesion in the floor of the mouth, which can herniate through the mylohyoid muscle and become a plunging ranula. Treatment for ranulas is currently surgical excision of the sublingual gland. Sclerotherapy with OK-432 is a well-established treatment of lymphatic malformations, but not yet thoroughly evaluated on ranulas. Objectives: To evaluate sclerotherapy of ranulas with OK-432 in a randomized double-blinded trial.20 patients with plunging or intraoral ranula were randomized to two double-blinded injections with OK-432 or saline. Effect on the ranula and evaluation of symptoms and QOL were investigated.Treatment response differed significantly between OK-432 and placebo,This study suggests that sclerotherapy with OK-432 in ranula is a very effective treatment for intraoral ranulas, but possibly less useful in plunging ranulas.This is a limited study, but we believe that sclerotherapy with OK-432 should be recommended as primary treatment at least for intraoral ranulas.

Background: Periprosthetic bone loss after Total Hip Arthroplasty (THA), detected as an early migration of the prosthesis may predict later loosening of the implant. Objective: We hypothesized that intra-operative bisphosphonate rinsing would reduce bone resorption after THA. It might therefore be possible to achieve better early fixation of the implant. Methods: Nineteen patients suffering from arthrosis were recruited in a prospective, double-blinded, randomized, placebo-controlled clinical pilot trial. Patients were operated with an uncemented Bimetric stem using tantalum markers. The femoral proximal intramedullary canal was rinsed with 1mM clodronate in nine patients and with saline in 10 patients. These patients were followed for two years using radiostereometric analysis (RSA), dual energy x-ray absorptiometry (DXA) and the Harris Hip Score (HHS). Results: We did not found any significant differences between the study groups with regards to the primary output measures (maximum total point motion, MTPM). However, there was evidence that clodronate could affect periprosthetic bone quality; a beneficial effect in BMD in Gruen zone 3 during the two-year follow-up was observed, BMD decreased less in the clodronate group (p = 0.02). The maximal x-translation of the stem at 3-24 months was significantly two-fold, being higher in the placebo group (p = 0.02). The baseline BMD and the maximal total point motion (MTPM) at 3-24 months showed a positive correlation in the clodronate group and a negative correlation in the placebo group. Conclusion: In conclusion, further studies with larger patient groups and longer follow-up periods are needed to estimate the clinical importance of these findings and further to prove if an intraoperative clodronate rinsing prior to application of femoral stem during THA can prevent periprosthetic bone loss. Clinical Trial Registration No.: NCT03803839

The objective of this randomised, double blinded clinical trial was to evaluate the efficacy of prophylactic administration of 4 mg ondansetron as monotherapy versus combination therapy of 4 mg ondansetron plus 8 mg dexamethasone for the prevention of intrathecal morphine-associated pruritus in caesarean section within 24 h. A total of 194 patients were included, 96 patients in the monotherapy group and 98 in the combination group. One hour after the operation, 11.5% of patients in ondansetron group had failure of prophylaxis for pruritus compared to 13.5% of patients in the combination group (

Objective: Mothers of many preterm babies are unable to produce sufficient milk for their babies during the prolonged hospitalization. Domperidone stimulates the release of prolactin, thereby incre...

Introduction: Postoperative sore throat (POST) is a common occurrence following general anesthesia with endotracheal intubation. The incidence of POST is estimated to be 21%-65% in various studies. Irritation and inammation of the air way are considered to be the cause of POST. Although considered a minor and self limiting complication, it may cause a signicant patient morbidity, dissatisfaction and increased the length of duration of hospital stay. Various pharmacological and non pharmacological methods have been tried to decrease POST with varying success rates. Among the interventions, the use of ketamine gargle or lozenges has highest success rates, but the problem with this is the bitter taste of the drug and the risk of aspiration, so aerosol route of drug administration gained popularity among the anesthesiologists with good acceptance from the patients. It is known that N-methyl-D-aspartate (NMDA) receptors have a role in nociception and inammation. Hence, this study is aimed at using the aerosol route of magnesium sulphate and ketamine and to nd it effectiveness in preventing POST. Aim Of The Study: To evaluate the effect of nebulized ketamine and nebulized magnesium sulphate for attenuation of postoperative sore throat in patients undergoing surgeries under general anesthesia with tracheal intubation. Materials And Methods: This study was done in the Department of Anesthesiology in collaboration with the Department of Surgery in Kanyakumari Government Medical College from January 2019 to December 2019. Patient planned for surgery under general anesthesia except head, neck & ENT surgeries were selected and randomized into two groups (35 each). Each group received nebulisation for 15 min before induction of general anaesthesia. Group M: Nebulization with 500mg magnesium sulphate in 5ml NS. Group K: Nebulization with 50mg ketamine in 5ml NS. The Parameters related to the study such as duration of laryngoscopy, time taken to intubate, duration of surgery, number of attempts to intubate were recorded. Incidence and severity of sore throat were assessed by four point scale. Incidence of sore throat is assessed for 24 hours. Complication were recorded. Results: We found that the demographic parameters were comparable and statistically insignicant. The mean duration of laryngoscopy difference between the two groups Group M - 24.54± 1.12 seconds and Group K - 24.49 ±1.15 seconds was not statistically signicant P= 0.834 (P>0.05). The mean time taken to intubate in Group M - 27.54± 1.12 seconds and Group K - 27.54± 1.12 seconds was not statistically signicant with P=1.000 respectively (P>0.05). The mean duration of surgery in Group M - 90.71±15.67 minutes and the Group K - 88.20 ±16.53 minutes between the two groups was not statistically signicant P= 0.516 (P>0.05). The mean difference of number of attempts taken to intubate between the two groups was statistically insignicant P=0.771 (P>0.05). The overall incidence of sore throat in Group M was 91% and in Group B was 34%. The severity of sore throat between Group M and Group K is statistically signicant at 2, 4, 6 hrs at grade 1 and grade 2. Conclusion: On the basis of our result, we can suggest that the use of perioperative ketamine nebulization when compared magnesium sulphate nebulization reduces the incidence and severity of post-operative sore throat at 4th and 6th hour during postoperative period in patients who had received general anesthesia with tracheal intubation.

Patients with arteriolosclerosis have impaired microvascular perfusion leading to impaired wound healing. Aged garlic extract has shown to have a positive impact on vascular elasticity. The present study aimed to assess the effect of long‐term treatment with AGE on peripheral tissue perfusion in patients with confirmed atherosclerosis. Ninety three patients with a CT‐scan confirmed coronary artery arteriolosclerosis were randomised in a double‐blind manner to placebo or 2400 mg AGE daily for 1 year. Peripheral tissue perfusion was evaluated at 0‐ and 12‐months using Laser Speckle Contrast Imaging. Measurement of post occlusive reactive hyperemia (PORH) and cutaneous vascular conductance (CVC) using acetylcholine iontophoresis (Ach) was conducted. After 12 months a significant increase of 21.6% (95% CI 3.2%‐40.0%, P

This study investigated the pharmacokinetics, pharmacodynamics, and safety of fotagliptin benzoate (fotagliptin), a dipeptidyl peptidase-4 (DPP-4) inhibitor, in Chinese patients with type 2 diabetes mellitus (T2DM). In a randomized, double-blinded, placebo-controlled study, 10 and 4 patients with T2DM were randomized and received, respectively, once-daily oral fotagliptin (24 mg) or placebo, for 14 days. The pharmacokinetics and pharmacodynamics were assessed throughout the study, including monitoring DPP-4, glucagon-like peptide-1 (GLP-1), glycosylated hemoglobin, and fasting blood glucose. Fotagliptin was rapidly absorbed, and the median time to maximum concentration value was ∼1.5 hours. Plasma fotagliptin levels were stable after 14 days of once-daily dosage. The accumulation ratios for the area under the plasma concentration-time curve of fotagliptin, M1, and M2-1, were 1.19 ± 0.10, 1.59 ± 0.27, and 1.39 ± 0.26, respectively. The durations for DPP-4 inhibition >80% in the fotagliptin group on days 1 and 14 were 23.5 and 24.0 hours, respectively. The concentrations of GLP-1 were higher on days 1 and 14 than at the baseline. No serious complications occurred. Fotagliptin showed favorable pharmacokinetics and pharmacodynamics and was well tolerated. Treatment with fotagliptin can achieve high DPP-4 inhibition and increase plasma GLP-1. A once-per-day dosing regimen may be recommended as clinically efficacious.

Background Different packing materials are applied to the nose at the end of surgery to maintain drainage and sinus ventilation of the paranasal sinuses and avoid some complications such as bleeding, infection, crustations, adhesions in the middle meatus and lateralization of the middle turbinate. Objective The study aims to compare the clinical outcomes of two absorbable packing materials, the synthetic polyurethane, and the naturally occurring Chitosan-based polymers (CBP) nasal packs, after functional endoscopic sinus surgery. Methods Fifty patients with bilateral chronic rhinosinusitis with nasal polypi were operated with 100 surgical cavities. At the end of the surgery, one side was randomly packed with synthetic polyurethane and the opposite side with CBP nasal pack. Measure their outcomes at week 1, 2, 4, 8 and 12 as the presence of remnants materials in the middle meatus, crustations, adhesions, bleeding, granulations, infection, and general satisfaction of patients. Results CBP nasal pack shows a statistically significant advantage only in the first two weeks as regard remnants material, crusting and bleeding. All over the 12 weeks, there was no statistically significant difference between the two types of packs as regard granulations, adhesions and infection. In the first month, eight patients of the CBP group experienced bad smell and two patients had watery rhinorrhea as adverse reaction without a statistically significant difference. Patients were generally satisfied without a statistically significant difference between the two types of packs. Conclusion Synthetic polyurethane and Chitosan-based polymers nasal packs are safe and efficient regarding; the mucosal healing, bleeding control, and the overall satisfaction of patients. The CBP showed a higher statistically significant advantage in the first two weeks only regarding the amount of the retained material, crusting as well as bleeding. Patients packed with CBP experienced fish-like smelly odor and watery rhinorrhea but there is no statistically significant difference.

Background Exercise training (ET) is current treatment method for venous insufficiency (VI). The comprehensive effect of ET in addition to compression therapy (CT) in VI is not clear. Method Twenty-four patients with VI were randomly divided into exercise group (EG) and control group (CG). While CG received only CT, EG was applied ET consisting of aerobic, strengthening and stretching exercises in addition to CT for 2 days/week, 6 weeks at hospital under the supervision of physiotherapist. All the patients were assessed with Chronic Venous Disease Quality Of Life Questionnaire-20, Short Form-36, Duplex Doppler Ultrasonography, Venous Clinical Severity Score, hand-held dynamometer, Visual Analogue Scale, circumference measurements, 6 minute-walking test, and 10-meter-walking test before and after the treatment. Result Except of hemodynamic status and edema (p > 0.05), all parameters were significantly different in favor of EG (p Conclusion ET in addition to CT was more effective and safe treatment in VI.

Background:Caudal analgesia is a safe technique that can be performed under fluoroscopy in lumbosacral spine surgeries. Studies have raised evidence supporting the use of epidural dexamethasone in ...

Background: Diaper dermatitis (DD) is a prevalent skin disease in children, which causes child discomfort and parental concern. This study aimed to compare the effects of aloe vera ointment with routine treatment on the severity of DD in hospitalized children. Materials and Methods: This double-blinded randomized clinical trial was carried out on 60 children aged less than two years admitted to Tabriz pediatric hospital in Iran from February to June 2017. Using convenience sampling method, the patients were assigned into two equal groups (n=30 in each) of intervention and control. The intervention group received routine combination treatment, whereas the control group received aloe vera ointment. The patients were examined on the first, third, and sixth days of the study. Data analysis was performed using SPSS software (version 22) and descriptive and analytical statistics. Results: The severity of DD in both groups improved on the sixth day compared to the first day. In comparison, no significant difference was observed between the two groups regarding the severity of dermatitis (P>0.05). Conclusion: Herbal products cause fewer side effects than chemical products and seem to have significant pharmacological effects on the skin. Thus, aloe vera ointment appears to help treat DD and, with further studies, may emerge as a possible therapeutic option.

Purpose Fast-track surgery is a developing trend in medical care. It is a core challenge for clinical anesthesia to reasonably reduce the dosage of opioids and relieve postoperative pain. Serratus anterior plane block (SAPB) is a novel analgesic technique with such advantages as easy operation, good safety, and few side effects. Patients and methods In total, 60 patients aged 18 to 65 years who were diagnosed with lung cancer and scheduled for thoracoscopic resection were randomly assigned to receive SABP or local infiltration anesthesia. We analyzed the time within 48 hrs after operation to visual analogue scale (VAS) pain score of 4 or higher and the number of patients requiring additional analgesics at 6 hrs and 12 hrs after operation. Results The estimated median time to VAS ≥4 was 4 hrs (1.32 to 6.68) in the control group and 11 hrs (6.71 to 15.29) in the SAPB group (log-rank test: P=0.008). The number of patients requiring additional analgesics at 6- and 12 hrs after operation was significantly lower in the SAPB group than that in the control group (P Conclusion Compared with local infiltration, SAPB provided extended postoperative analgesia after thoracoscopic surgery with reduced consumption of additional analgesics in the early postoperative stage.

ObjectiveTo investigate hearing and the take rate of crushed cartilage grafts in tympanoplasty.MethodsIn this double-blinded, randomised, controlled trial, 46 patients with tympanic membrane perforation were enrolled. A conchal cartilage graft was used for reconstruction in both intervention and control groups. In the intervention group, crushed cartilage was used. The success rate and hearing results were ascertained every four months over a one-year follow-up period.ResultsA total of 36 patients – 20 in the intervention group and 16 in the control group – completed one year of follow up. There were no statistically significant differences between the two groups in mean air–bone gap, bone conduction threshold, speech discrimination score or speech reception threshold.ConclusionThe reduction in living cells after crushed cartilage tympanoplasty may decrease the rigidity and the volume of the graft, but may not necessarily improve the hearing results.

Sedation with propofol is a part of the anesthetic induction procedure because it provides anxiolysis, amnesia and hypnosis; however, up to 5% of patients have pain at propofol injection and of these, 1% of them have severe or excruciating pain.