Evaluation of lidocaine ointment in treatment of chronic anal fissure

زمینه و هدف: تا چند سال اخیر درمان اصلی فیشر مزمن آنال، روشهای جراحی جهت اسفنکتروتومی لترال به روش باز یا بسته بود. در طی سال های اخیر استفاده از درمان طبی در درمان این بیماری مطرح شده است که هر یک دارای محدودیت هایی می باشد. این مطالعه با هدف مقایسه دو روش جراحی و درمان طبی لیدوکائین در درمان فیشر مزمن آنال انجام شده است. روش بررسی: در این مطالعه نیمه تجربی 180 بیمار مبتلا به فیشر مزمن آنال که با علایم بیش از 6 هفته به درمانگاه جراحی بیمارستان الزهرا(س) اصفهان مراجعه کرده بودند به روش در دسترس انتخاب شدند. پس از اخذ شرح حال از بیماران و معاینه و تایید فیشر مزمن دو روش درمان جهت بیماران توضیح داده می شد و بر اساس انتخاب ایشان بیمار در گروه یک (جراحی) و یا دو (درمان طبی با لیدوکائین) قرار می گرفت. روش درمان جراحی شامل اسفنکتروتومی لترال اسفنکتر داخلی به روش بسته بود. روش درمان طبی شامل رژیم پر فیبر، طشت آب گرم، قرص سی لاکس هر شب، قرص ناپروکسن 250 میلی گرم هر 12 ساعت و استعمال پماد لیدوکائین 5 درصد قبل از اجابت مزاج و شستشوی مداوم ناحیه مقعد در حین اجابت مزاج بود. در هر دو گروه بیماران به مدت 8 هفته پی گیری شدند. داده ها به کمک آزمون های آماری کای دو، فیشر و من ویتنی تجزیه و تحلیل گردید. یافته ها: تعداد بیمارانی که مورد عمل جراحی قرار گرفتند 100 نفر و تعداد بیمارن گروه درمان طبی 80 نفر بود. میانگین سنی بیماران گروه اول 3/4±2/36 سال و گروه دوم 1/3±3/38 سال بود (05/0P>). از نظر جنسی بین دو گروه اختلاف معنی داری وجود نداشت. .مدت علایم بیماری در گروه جراحی 5/2±1/8 هفـته و در گروه درمان طبی 1/3±9/7 هفته بود (05/0P>). در گروه جراحی عوارض پس از عمل شامل 10 مورد اکیموز پوستی (10) 2 مورد هماتوم بزرگ (2) و 10 مورد (10) بی اختیاری خفیف نسبت به باد بود. در گروه دوم هیچ عارضه ای دیده نشد. میزان بروز ترمیم زخم در گروه اول 93 و در گروه دوم 75 بود (05/0

Awareness of islamic banking products among muslims: The case of Australia

© The Editor(s) (if applicable) and the Author(s) 2016. The concept of interest-free financing was practiced by Arabs prior to the advent of Islam, and was later adopted by Muslims as an acceptable form of trade financing. While the system had been used on a small scale for centuries, its commercial application began in the 1970s.1 Since then Islamic financing has experienced worldwide acceptance, and by early 2003 there were at least 176 Islamic banks around the world, with deposits in excess of $147bn

Outcomes with plug‐based versus suture‐based vascular closure device after transfemoral transcatheter aortic valve replacement: A systematic review and meta‐analysis

Background Studies comparing plug-based (i.e., MANTA) with suture-based (i.e., ProStar XL and ProGlide) vascular closure devices (VCDs) for large-bore access closure after transcatheter aortic valve replacement (TAVR) have yielded mixed results. Aims To examine the comparative safety and efficacy of both types of VCDs among TAVR recipients. Methods An electronic database search was performed through March 2022 for studies comparing access-site related vascular complications with plug-based versus suture-based VCDs for large-bore access site closure after transfemoral (TF) TAVR. Results Ten studies (2 randomized controlled trials [RCTs] and 8 observational studies) with 3113 patients (MANTA = 1358, ProGlide/ProStar XL = 1755) were included. There was no difference between plug-based and suture-based VCD in the incidence of access-site major vascular complications (3.1% vs. 3.3%, odds ratio [OR]: 0.89; 95% confidence interval [CI]: 0.52−1.53). The incidence of VCD failure was lower in plug-based VCD (5.2% vs. 7.1%, OR: 0.64; 95% CI: 0.44−0.91). There was a trend toward a higher incidence of unplanned vascular intervention in plug-based VCD (8.2% vs. 5.9%, OR: 1.35; 95% CI: 0.97−1.89). Length of stay was shorter with MANTA. Subgroup analyses suggested significant interaction based on study designs such that there was higher incidence of access-site vascular complications and bleeding events with plug-based versus suture-based VCD among RCTs. Conclusion In patients undergoing TF-TAVR, large-bore access site closure with plug-based VCD was associated with a similar safety profile as suture-based VCD. However, subgroup analysis showed that plug-based VCD was associated with higher incidence of vascular and bleeding complications in RCTs

Peripartum Pulmonary Embolism

Pregnancy and peripartum increase the risk of venous thromboembolism (VTE) by many folds. Interestingly, the VTE is more common during the pregnancy, whereas the pulmonary embolism is more frequent in postpartum period. There are various risk factors for the VTE and pulmonary embolism in these patients. The important risks are improper thromboprophylaxis, obesity, and multigravida. The clinical parameters and the d-dimer are not used for diagnosis of thromboembolism during pregnancy and in the postpartum period. The compression ultrasonography (CUSG) is commonly used for VTE diagnosis; for the pulmonary embolism diagnosis, one has to consider the radiation hazard to the fetus as well as to the mothers. Ventilation/perfusion scan is the imaging of choice for patient who has respiratory signs with normal chest radiograph. If chest X-ray is abnormal with suspicion of peripartum pulmonary embolism (PPE), the choice should be computed tomographic angiography. Heparin and its derivatives remained the anticoagulation of choice for the treatment of VTE as well as the PPE, as it is a shorter acting, easy to reverse with protamine sulfate. Proper thromboprophylaxis is the key for prevention of VTE and peripartum pulmonary embolism

In silico development of simple sequence repeat markers within the aeschynomenoid/dalbergoid and genistoid clades of the Leguminosae family and their transferability to Arachis hypogaea, groundnut

Cultivated groundnut (Arachis hypogaea L.) is an agronomically and economically important oilseed crop grown extensively throughout the semi-arid tropics of Asia, Africa and Latin America. The genetic base of the cultivated groundnut is very narrow as a result of the genetic bottleneck associated with recent polyploidization which makes it critical to determine the levels of genetic diversity within available germplasm collections prior to breeding. In groundnut, the use of SSRs for diversity assessment may offer the potential to reveal genetic variation within the genome of the cultivated species. An alternative bioinformatics, or in silico approach, to identifying SSRs suitable for application in cultivated groundnut is presented, as a low-cost alternative to wet lab SSR identification. All available nucleotide sequences from species within the aeschynomenoid/dalbergoid and genistoid clades of the Leguminosae family were searched for SSR motifs and primers designed from 109 unique SSRs. Representative accessions from six genera within the aeschynomenoid/dalbergoid and genistoid clades were selected for assessing SSR-transferability rates. In total, 60% of the total cross-genera transfer testing reactions gave prominent and reproducible amplicons, with 51 of the 109 SSRs amplifying in A. hypogaea. These 51 SSRs were further tested against 27 diverse Arachis accessions and 18 revealed polymorphism, demonstrating that the in silico approach to SSR identification and development is a valid strategy in lesser-studied crops

Dex-CSDH randomised, placebo-controlled trial of dexamethasone for chronic subdural haematoma: report of the internal pilot phase.

The Dex-CSDH trial is a randomised, double-blind, placebo-controlled trial of dexamethasone for patients with a symptomatic chronic subdural haematoma. The trial commenced with an internal pilot, whose primary objective was to assess the feasibility of multi-centre recruitment. Primary outcome data collection and safety were also assessed, whilst maintaining blinding. We aimed to recruit 100 patients from United Kingdom Neurosurgical Units within 12 months. Trial participants were randomised to a 2-week course of dexamethasone or placebo in addition to receiving standard care (which could include surgery). The primary outcome measure of the trial is the modified Rankin Scale at 6 months. This pilot recruited ahead of target; 100 patients were recruited within nine months of commencement. 47% of screened patients consented to recruitment. The primary outcome measure was collected in 98% of patients. No safety concerns were raised by the independent data monitoring and ethics committee and only five patients were withdrawn from drug treatment. Pilot trial data can inform on the design and resource provision for substantive trials. This internal pilot was successful in determining recruitment feasibility. Excellent follow-up rates were achieved and exploratory outcome measures were added to increase the scientific value of the trial.NIHR HT

Comprehensive early intervention for patients with first-episode psychosis in Japan (J-CAP): study protocol for a randomised controlled trial

<p>Abstract</p> <p>Introduction</p> <p>Comprehensive approaches for patients with psychotic symptoms play essential roles in the symptomatic and functional outcomes of patients, especially during disease onset. In Japan, the shortage of mental health services, particularly for outpatients, and community-based supports has been a major problem. The purpose of this trial is to investigate the effectiveness and affordability of 18-month comprehensive early intervention services for patients with first-episode psychosis compared with typical treatment.</p> <p>Methods</p> <p>This interventional, parallel, single-blinded (open but blinded raters trial) was effectively designed. The participants are patients with a diagnosis of F2 or F3 (International Classification of Disease, 10 th revision), with psychotic symptoms. The inclusion criteria were an age of 15-35 years, onset of psychotic symptoms within 5 years, first-episode psychosis, and residence in the catchment area of each site. Allocation will be conducted equally between case management and standard care groups. After enrollment, standard care will be provided for both groups, and community-based care to promote recovery for 18 months will be provided for the comprehensive approach group. The primary outcome will be the function domain of the global assessment of functioning scores at 18 months after enrollment. Data assessment will be performed at enrollment and 18, 36, and 60 months after enrollment. The target sample size will be 150, and registration will occur from March 1, 2011, to September 30, 2012.</p> <p>Discussion</p> <p>This trial will provide promising results about the effectiveness and cost-effectiveness of early intervention services in Japan to improve the quality and quantity of community mental health services.</p> <p>Trial registration</p> <p>This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry (No. UMIN000005092).</p

Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study

Background Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews. Methods We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD. Findings The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21–70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23–62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7–53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4–19·2), population prevalence of depression was 13·7% (10·1–18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9–26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3–26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0–15·1). Interpretation The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention