A phase 4, randomized, head-to-head trial comparing the efficacy of subcutaneous injections of brodalumab to oral administrations of fumaric acid esters in adults with moderate-to-severe plaque psoriasis (CHANGE).

BACKGROUND: Brodalumab is a fully human monoclonal immunoglobulin IgG2 antibody that binds to the human IL-17 receptor subunit A and by that inhibits the biologic action of IL-17A, IL-17F, IL-17C and IL-17E. Therapy with fumaric acid esters (FAE) is a well established and widely used first-line systemic treatment for subjects with moderate-to-severe plaque psoriasis. OBJECTIVES: To compare brodalumab to FAE in terms of clinical efficacy, patient-reported outcomes and safety in subjects with moderate-to-severe plaque psoriasis who were naïve to systemic treatment. METHODS: Eligible subjects were randomized 1 : 1 to 210 mg brodalumab injections or oral FAE according to product label in this 24-week, open-label, assessor-blinded, multi-centre, head-to-head phase 4 trial. The primary endpoints were having PASI75 and having sPGA score of 0 or 1 (sPGA 0/1). Subjects with missing values for the primary endpoints were considered non-responders. RESULTS: A total of 210 subjects were randomized. 91/105 subjects completed brodalumab treatment and 58/105 subjects completed FAE treatment. At Week 24, significantly more subjects in the brodalumab group compared to the FAE group had PASI75 (81.0% vs. 38.1%, P < 0.001) and sPGA 0/1 (64.8% vs. 20.0%, P < 0.001). In the brodalumab group, the median time to both PASI75 and to PASI90 was significantly shorter than in the FAE group (4.1 weeks vs. 16.4 weeks, and 7.4 weeks vs. 24.4 weeks, respectively, P < 0.0001 for both). The rate of adverse events was lower in subjects treated with brodalumab compared to subjects treated with FAE (616.4 vs. 1195.8 events per 100 exposure years). No new safety signals were detected for brodalumab. CONCLUSIONS: Brodalumab was associated with rapid and significant improvements in signs and symptoms of moderate-to-severe plaque psoriasis, with a superior efficacy profile to what was observed with FAE in systemic-naïve subjects over 24 weeks.

The application of TachoSil® for sealing colorectal anastomosis: a feasibility study.

AIM: Anastomotic leakage is a frequent postoperative complication of colorectal resection. This nonrandomized study assessed the feasibility and safety of applying a haemostatic tissue sealant (TachoSil®) to colorectal anastomoses following resection. METHOD: TachoSil was applied as reinforcement of the anastomotic line after laparoscopic or open colorectal resection. The primary endpoint was the proportion of patients for whom TachoSil application was considered feasible by both the investigator and an independent external assessor. Application was considered feasible if TachoSil fully adhered, covered ≥1cm beyond the margin of the anastomotic line and patches overlapped by ≥1cm. Individual investigator assessment of feasibility and adverse events 30 days after surgery were also recorded. RESULTS: Twenty-five patients underwent anterior resection (seven open lower, nine open middle-upper, four laparoscopic lower and five laparoscopic middle-upper). In six cases a video-recording was not available because of technical problems. The primary endpoint was met in 12 of the remaining 19 patients (63%; 95% CI 38-84%), while in the other seven the application was recorded as not feasible because the assessor was unable to see the entire anastomosis. No application was assessed as unfeasible on the basis of visual evidence. When assessed by the investigator alone, TachoSil was considered feasible in all but one instance (96%; 95% CI 80-100%). There were 45 adverse events, of which 10 were serious. None was considered related to TachoSil. No deaths were reported. CONCLUSION: Application of TachoSil to reinforce the anastomotic line in colorectal resections appears to be feasible and well tolerated.

Effective management of Colles fracture using Murivenna and Abha Guggulu - A case report.

Colles fracture is the commonest fracture encountered in orthopedic practice that demands prompt therapeutic intervention, and adequate follow-up to ensure complete healing. Various types of fractures, methods of reduction, and healing have been explained in the classical Ayurveda texts. These techniques are scientific and time-tested. This paper aims to report the successful management of Colles fracture case using Ayurveda and modern techniques with the use of Murivenna (an oil-based herbal formulation mentioned in the contemporary texts of Ayurveda), half-cast POP, and aluminum splinted bandage along with the internal medicine AbhaGuggulu. A 75-year-old moderately built woman diagnosed with Colles fracture was treated with a closed manipulative reduction technique followed by a below-elbow half-cast POP and an aluminum splint. Murivenna was poured anteriorly to the fractured site and Abha Guggulu was administered internally. Re-bandaging was done on the 7th day and 21st day. The bandage was removed on the 35th day. The patient's condition improved considerably with a good range of wrist movements and then she was advised to commence rehabilitation. This integrative method, adhering to Ayurvedic principles and modern techniques is unique, patient-friendly, and without adverse events.

A review on the therapeutic effects of NetiKriya with special reference to JalaNeti.

Neti kriya is an integral part of shatkarmas/the six cleansing techniques that form the most important aspect of hatha yoga. Neti helps in preventing and managing upper respiratory tract diseases. An attempt is being made to collate and review articles that highlight the therapeutic effects of neti kriya. Databases like PubMed (January 1980-April 2016), Scopus and Ayush Portal were searched. We used keywords like jala neti, neti kriya, neti combined with terms such as yoga, sinusitis, rhinitis, common cold, vision, snoring, nasopharyngeal carcinoma and mental health for the search. As only a few results were obtained, we reviewed relevant studies with saline nasal irrigation. Evidence emerging from this review suggests that neti offers manifold benefits and relief from the antibiotic grip. Most studies support the role of neti in treating sinusitis, rhinosinusitis, allergic conditions and in improving vision. Jala neti has a significant role in improving the presence of mind and intelligence. We identified that it can be applied in mitigating post irradiation rhinosinusitis in nasopharyngeal carcinoma. However, randomized control trials must be conducted to substantiate the therapeutic efficacy of this simple cost-effective, non-pharmacological mode of treatment.

Biomedical waste management in Ayurveda hospitals - current practices and future prospectives.

Biomedical waste management is an integral part of traditional and contemporary system of health care. The paper focuses on the identification and classification of biomedical wastes in Ayurvedic hospitals, current practices of its management in Ayurveda hospitals and its future prospective. Databases like PubMed (1975-2017 Feb), Scopus (1960-2017), AYUSH Portal, DOAJ, DHARA and Google scholar were searched. We used the medical subject headings 'biomedical waste' and 'health care waste' for identification and classification. The terms 'biomedical waste management', 'health care waste management' alone and combined with 'Ayurveda' or 'Ayurvedic' for current practices and recent advances in the treatment of these wastes were used. We made a humble attempt to categorize the biomedical wastes from Ayurvedic hospitals as the available data about its grouping is very scarce. Proper biomedical waste management is the mainstay of hospital cleanliness, hospital hygiene and maintenance activities. Current disposal techniques adopted for Ayurveda biomedical wastes are - sewage/drains, incineration and land fill. But these methods are having some merits as well as demerits. Our review has identified a number of interesting areas for future research such as the logical application of bioremediation techniques in biomedical waste management and the usage of effective micro-organisms and solar energy in waste disposal.