Systematic review of non-surgical therapies for osteoarthritis of the hand: an update.

OBJECTIVE: To update our earlier systematic reviews which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not evaluated. DESIGN: RCTs published between March 2008 and December 2015 were added to the previous systematic reviews. RESULTS: A total of 95 RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this update. Generally, the methodological quality of these RCTs has improved since the last update, with more studies describing their methods for randomization, blinding, and allocation concealment. However, RCTs continue to be weakened by a lack of consistent case definition and a lack of standardized outcome assessments specific to hand OA. The number and location of evaluated hand joints continues to be underreported, and only 25% of RCTs adequately described the method used to ensure allocation concealment. These remain major weaknesses of published RCTs. A meta-analysis could not be performed because of marked study heterogeneity, insufficient statistical data available in the published RCTs, and a small number of identical comparators. CONCLUSION: Hand OA is a complex area in which to study the efficacy of therapies. There has been an improvement in the overall design and conduct of RCTs, however, additional large RCTs with a more robust methodological approach specific to hand OA are needed in order to make clinically relevant conclusions about the efficacy of the diverse treatment options available.

Facial Assessment and Cosmetic Enhancement Quality of Life Questionnaire (FACE-Q) Arabic Validation.

Background  Rhinoplasty, a common cosmetic surgery, improves aesthetic appearance and nasal function. Outcomes are typically measured by patient satisfaction and quality of life impact. However, a gap exists in validated non-English assessment tools, especially in Arabic, which hinders accurately capturing patient experiences in Arabic-speaking populations. To fill this gap, this study aims to translate and validate the "Rhinoplasty" module of the Facial Assessment and Cosmetic Enhancement Quality of Life Questionnaire (FACE-Q) self-questionnaire into Arabic. Methods A cross-sectional study was conducted at the Otorhinolaryngology Department of the National Guard Health Affairs in Riyadh, Saudi Arabia. Adults who underwent rhinoplasty from 2017 to 2021 were included if they had at least one year of follow-up and were contactable. A sample size of 109 was determined, and the participants were selected using probability cluster sampling. A 33-item FACE-Q scale was administered via telephone, with scores converted to a 0-100 scale for analysis. Translation involved a two-way process with independent translations and back-translations, followed by review and pilot testing. Results The study included 137 participants (mean age, 32.5 years; 53 men, 84 women), predominantly electing cosmetic surgery, with an average of four years post-surgery. The internal consistency of the scales varied, with the self-acceptance/love scale showing acceptable reliability (Cronbach's alpha = 0.73) and other scales suggesting item redundancy (Cronbach's alpha for aesthetic scales > 0.94). The self-rated complications scale did not meet the acceptability threshold, indicating a need for scale revision. Conclusions The Arabic translation of the FACE-Q Rhinoplasty module shows potential as a reliable tool for evaluating patient satisfaction and quality of life after rhinoplasty in Arabic-speaking patients. Further refinement is necessary to address item redundancy and enhance cultural specificity. This work underscores the importance of culturally sensitive tools for global applicability in cosmetic surgery outcomes research.

Role of reactive oxygen species in pathogenesis of nephrotic syndrome.

Nephrotic syndrome is the common chronic disorder characterized by alteration of permeability of the glomerular capillary wall, resulting in its inability to restrict the urinary loss of proteins. Nephrotic syndrome is characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia associated with peripheral edema. The molecular basis of glomerular permselectivity remains largely unknown. In recent years it has been proposed that Nephrotic syndrome is a consequence of an imbalance between oxidant and antioxidant activity. The present study was aimed to test that the reactive oxygen species are the mediators of excessive protein permeability and other complications of Nephrotic syndrome. For this 30 adults with Nephrotic syndrome were studied. The control group comprised 30 healthy adults matched for age. Serum levels of lipid peroxides, nitric oxide (NO⊙), α- tocopherol, ascorbic acid, erythrocyte superoxide dismutase activity, serum albumin, uric acid, cholesterol and plasma total antioxidant capacity were measured. Student's 't' test was applied for statistical analysis. There was a significant increase in lipid peroxide (1.58 ± 0.42 in controls, 3.64 ±1.3 in patients) (P<0.001) levels in study group as compared with controls. α-tocopherol (12.95 ± 1.04 in controls, 9.93 ± 1.43 in patients) (P<0.001), erythrocyte SOD activity(1.88 ± 0.9 in controls 1.07 ± 0.5 in patients) (P=0.01), serum albumin(4.06 ± 0.50 in controls, 3.04 ± 0.11 in patients) (P<0.001), and plasma total antioxidant capacity (847.33 ± 126.83 in controls, 684.00±102.94 in patients) (P<0.001) were significantly decreased. There was non-significant increase in uric acid (P>0.05), a non-significant decrease in NO⊙ (38.48 ± 15.47 in controls 37.47 ± 14.27 in patients) (P>0.05) and ascorbic acid levels ascorbic acid,( 0.95 ± 0.31in controls 0.79 ± 0.30 in patients) (P>0.05) in study group as compared with controls. Imbalance between oxidants and antioxidants may contribute to pathogenesis of proteinuria and related complications in nephrotic syndrome.

Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel.

Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.

Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel.

AIM: The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND: The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS: The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION: Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.

Development and validation of a reversed-phase HPLC method for simultaneous estimation of ambroxol hydrochloride and azithromycin in tablet dosage form.

A simple, precise and accurate reversed-phase liquid chromatographic method has been developed for the simultaneous estimation of ambroxol hydrochloride and azithromycin in tablet formulations. The chromatographic separation was achieved on a Xterra RP18 (250 mm x 4.6 mm, 5 microm) analytical column. A Mixture of acetonitrile-dipotassium phosphate (30 mM) (50:50, v/v) (pH 9.0) was used as the mobile phase, at a flow rate of 1.7 ml/min and detector wavelength at 215 nm. The retention time of ambroxol and azithromycin was found to be 5.0 and 11.5 min, respectively. The validation of the proposed method was carried out for specificity, linearity, accuracy, precision, limit of detection, limit of quantitation and robustness. The linear dynamic ranges were from 30-180 to 250-1500 microg/ml for ambroxol hydrochloride and azithromycin, respectively. The percentage recovery obtained for ambroxol hydrochloride and azithromycin were 99.40 and 99.90%, respectively. Limit of detection and quantification for azithromycin were 0.8 and 2.3 microg/ml, for ambroxol hydrochloride 0.004 and 0.01 microg/ml, respectively. The developed method can be used for routine quality control analysis of titled drugs in combination in tablet formulation.

Simultaneous determination of aceclofenac, paracetamol, and chlorzoxazone by RP-HPLC in pharmaceutical dosage form.

A simple, rapid, and precise reversed-phase liquid chromatographic method is developed for simultaneous determination of paracetamol, aceclofenac, and chlorzoxazone in their ternary mixtures of commercial pharmaceutical preparation. This method uses a Zorbax SB C18, 250 x 4.6 mm, 5 microm analytical column. Mobile phase is acetonitrile and buffer (40:60, v/v), buffer containing 50 mM orthophosporic acid; pH of the buffer is adjusted to 6 with 10% w/v sodium hydroxide solution. The instrumental settings are at a flow rate of 1 mL/min; the column temperature is 25 degrees C, and detector wavelength is 270 nm. The sample concentrations are measured on weight basis to avoid the internal standard. The method is validated and shown to be linear. The correlation coefficients for paracetamol, aceclofenac, and chlorzoxazone are 0.9981, 0.9990, and 0.9986, respectively. The recovery values for paracetamol, aceclofenac, and chlorzoxazone ranged from 100.7-101.4%, 100.4-101.0%, and 100.5-101.3%, respectively. The relative standard deviation for six replicates is always less than 2%. This HPLC method is successfully applied to the simultaneous quantitative analysis of the title drugs in tablets and can be applied for assay and dissolution test of tablets for the estimation of paracetamol, aceclofenac, and chlorozoxazone in their commercial samples.

Epilepsy: public knowledge and attitude in a slum area of Karachi, Pakistan.

BACKGROUND: Epilepsy is a common but widely misunderstood illness. Consequently, epileptics suffer from considerable stigmatization in society. Since no studies have detailed the misperceptions about epilepsy in our community, it is not possible to provide focused intervention aimed at eliminating this prejudice. PURPOSE: To assess the knowledge and attitude regarding epilepsy in an adult population of a Karachi slum area. METHODS: A face-to-face interview was conducted on 487 consenting adult non-epileptics (305 males; 182 females) who were conveniently sampled. Chi-square test was employed to calculate the variability in knowledge and attitude with demographic and other variables. RESULTS: In all, 12.5% had never heard about epilepsy. Among the rest, 66.7% identified epilepsy as being non-infectious, while 28.2% were unaware of any treatment available for it. Among the other 71.8%, 62.7% were aware of the existence of anti-epileptic drugs. Religious/spiritual treatment was chosen as the most effective treatment by 33.1%. Males were more likely to identify epilepsy as being non-infectious (p=0.02). Nearly 18% of the respondents would not object to their child marrying an epileptic, 69.5% did not want to socially isolate the epileptics, 83.1% said epileptics could receive academic education, 85.6% said they could perform activities of daily life and 62.4% said they could become useful members of the society. Those who considered epilepsy to be infectious were more likely to carry negative attitudes towards epilepsy (p<0.01 with four attitudes). CONCLUSIONS: Considerable gaps exist in the community's knowledge about epilepsy. Some of these may explain the prevalence of negative attitudes towards this ailment.

Novel Use of an Orbital Atherectomy Device for In-Stent Restenosis: Lessons Learned.

We present a case of a 67-year-old man with stage III chronic kidney disease, uncontrolled diabetes mellitus, coronary artery disease, and high surgical risk who presented with two episodes of acute coronary syndrome attributed to in-stent restenosis (ISR) associated with heavily calcified lesions. In this case, we were able to improve luminal patency with orbital atherectomy system (OAS); however, withdrawal of the device resulted in a device/stent interaction, causing failure of the device. Given limitations in current evidence and therapies, managing ISR can be a technical and cognitive challenge. Balloon expansion of the affected region often provides unsatisfactory results, possibly related to significant calcium burden. OAS could be an efficacious way of reestablishing luminal patency in ISR lesions, as these lesions are often heavily calcified.

Regulation of penicillin acylase in Escherichia coli by cyclic AMP.

1. Cyclic AMP was found to stimulate penicillin acylase activity. 2. It also overcame the repression of glucose and restored enzyme synthesis to the non-repressed levels. 3. The conversion of inactive enzyme precursor into active enzyme was not stimulated by cyclic AMP in cells in which protein synthesis was inhibited by chloramphenicol. 4. Cyclic AMP failed to stimulate enzyme production in cells in which messenger RNA synthesis was arrested by rifampicin or inducer removal. 5. Cyclic AMP appears to participate in the regulation of this enzyme at the transcriptional level.

Measles case fatality among the under-fives: a multivariate analysis of risk factors in a rural area of Bangladesh.

This study investigated the relationship of measles case fatality among the under-fives with age, case type, complications, sex, mother's education, and household economic condition in a rural area of Bangladesh. A total of 3465 measles cases were detected during 1980 and 61 of them died of measles associated complications within 45 days of rash onset. Case type, sex, mother's education and household economic condition were found to have statistically significant impact on case fatality. Risk of death among the secondary cases was 1.87 times higher than in the primary cases, girls had 2.73 times higher risk of death than boys. Children of mothers without any formal schooling and those from the poorest households experienced 1.83 and 2.18 times higher risk of death than their counterparts whose mothers had at least one year of schooling and from economically better off households respectively.

Rapid sequence induction with oral endotracheal intubation in the multiply injured patient.

The charts of 1798 consecutive admissions at this level one trauma center to evaluate the practice of emergency airway control were reviewed. A total of 335 patients required endotracheal intubation, 320 oral endotracheal, 12 nasotracheal, and three surgical. A technique of rapid sequence induction (RSI) with oral endotracheal intubation was the method of airway control in 260 spontaneously breathing patients. Prior cervical spine evaluation was not obtained. In all instances airway control was prompt and accurate. There were no hemodynamic nor neurologic complications secondary to RSI or oral endotracheal intubation. It is believed that RSI with oral endotracheal intubation is a reasonable alternative to nasotracheal intubation in the spontaneously breathing patient.

Aortic rupture in blunt trauma.

Traumatic rupture of the thoracic aorta should be suspected in all patients who have a history of severe deceleration injury or blunt chest trauma. A good upright (except in fractured spine) and supine x-rays of the chest using the correct technique are important. Mediastinum widening (subjective impression or mediastinum to chest ratio of 1:4) and/or loss of aortic knob contour or disfigurement should lend more support to a thoracic aortogram. The other findings discussed are rarely found alone and are almost always associated with multiple findings. The only way to diagnose a ruptured thoracic aorta is to do a comprehensive aortogram with biplanar films and always to have a high index of suspicion.

Colon operations without wound infection. Principles and techniques in 101 cases.

A total of 101 consecutive elective colon operations were performed with no postoperative wound infection. Patients with a wide variety of diagnoses and procedures were included in the series. Many factors contribute to the formation of postoperative wound infections. A comprehensive approach with attention to preoperative nutritional assessment, bowel preparation, wound protection, sterile technique, closure of the incision, and systemic prophylactic antibiotics contributed to the overall good results.

Intra-operative echocardiography: a useful tool in the localization of small intracardiac foreign bodies.

Small intracardiac foreign bodies may be difficult to palpate and localize at surgery using conventional diagnostic procedures. The use of intra-operative echocardiography greatly facilitates the localization of intramyocardial foreign bodies, and minimizes operative time and iatrogenic myocardial damage. A case is presented in which this diagnostic modality was used.

Iliac vein to pulmonary artery missile embolus: case report and review of the literature.

Intravascular foreign body emboli, although first reported in 1834, are rare sequelae of penetrating injuries. We report a case of missile embolus to the pulmonary artery after penetrating injury to the left iliac vein and artery. A review of the literature and discussion of appropriate management are presented.

Synthesis and properties of halogenated 7-deaza-2'-deoxyxanthosine and protected derivatives for oligonucleotide synthesis.

The 7-bromo- (4a) and 7-iodo- (4b) derivatives of 7-deaza-2'-deoxyxanthosine (5) are prepared. Furthermore, the building blocks 6-8 of 7-deaza-2'-deoxyxanthosine (5) are synthesized and tested for their usage in oligonucleotide synthesis.

Comparative study of diclofenac sodium and flurbiprofen in osteoarthritis.

A comparative study was conducted to evaluate the therapeutic efficacy of diclofenac sodium and flurbiprofen both non-steroidal anti-inflammatory drugs (NSAIDS) in osteoarthritis. Forty patients of either sex between the ages of 35-60 years suffering from osteoarthritis of at least one knee joint minimum of eight weeks duration were included in the study. Diclofenac sodium exhibited better results by improving the signs and symptoms of osteoarthritis in both high and low doses compared to flurbiprofen. The adverse effects observed were similar in both groups.

Effect of hypothermia on the twitch and tetanic contractions of denervated rat diaphragm muscle under isotonic conditions.

Effect of hypothermia was studied on the twitch and tetanic contractions of the chronically denervated rat diaphragm muscles under isotonic conditions. The muscles were denervated for 15-20 days and the temperature was lowered from 35 degrees C to 15 degrees C. The results showed that hypothermia and chronic denervation had very little effect on the isotonic contraction parameters since these were found to be unaltered at all temperatures except at 15 degrees C. It is suggested that denervation has no significant effect on the contractile component of our experimental muscles.

Effect of temperature on the maximum rate of rise of tension in denervated rat diaphragm muscle.

Effects of chronic denervation and temperature were studied on the maximum rate of rise of tension in isometric twitch and tetanus of rat diaphragm muscles. The muscles were denervated for 15-20 days and the maximum rate of rise of tension was measured according to Hill (1951). The results showed that the maximum rate of rise of tension in twitch and tetanus was temperature dependent, exponentially increasing with increasing temperatures in both the normal and denervated muscles. A further observation was that the maximum rate of rise of tension in denervated muscle was always smaller than normal controls. It is suggested that probable changes in the series elasticity and duration of active state in the denervated muscle are responsible for the observed changes.