Folic acid supplementation in postmenopausal women with hot flushes: phase III randomised double-blind placebo-controlled trial

Objective To assess whether folic acid supplementation ameliorates hot flushes. Design Double-blind, placebo-controlled randomised trial. Setting Nine hospitals in England. Population Postmenopausal women experiencing ≥50 hot flushes weekly. Methods Women (n = 164) were randomly assigned in a 1:1 ratio to receive folic acid 5 mg tablet or placebo daily for 12 weeks. Participants recorded frequency and severity of hot flushes in a Sloan Diary daily and completed Greene Climacteric and Utian Quality of Life (UQoL) Scales at 4-week intervals. Main outcome measures The change in daily Hot Flush Score at week 12 from randomisation based on Sloan Diary Composite Score B calculation. Results Data of 143 (87%) women were available for the primary outcome. The mean change (SD) in Hot Flush Score at week 12 was −6.98 (10.30) and −4.57 (9.46) for folic acid and placebo group, respectively. The difference between groups in the mean change was −2.41 (95% CI −5.68 to 0.87) (P = 0.149) and in the adjusted mean change −2.61 (95% CI −5.72 to 0.49) (P = 0.098). Analysis of secondary outcomes indicated an increased benefit in the folic acid group regarding changes in total and emotional UQoL scores at week 8 when compared with placebo. The difference in the mean change from baseline was 5.22 (95% CI 1.16–9.28) and 1.88 (95% CI 0.23–3.52) for total and emotional score, respectively. Conclusions The study was not able to demonstrate that folic acid had a statistically significant greater benefit in reducing Hot Flush Score over 12 weeks in postmenopausal women when compared with placebo. Tweetable abstract Folic acid may ameliorate hot flushes in postmenopausal women but confirmation is required from a larger study

The new era of vascular interventions: The venous side

In spite of the huge advances in endovascular management of arterial diseases, surgery remained for a long time the only available option for treating veins. The situation has changed dramatically since the introduction of minimally invasive interventions for treating superficial as well as deep venous diseases. Objectives: To review the recent advances in venous imaging and interventions for treatment of varicose veins, venous outflow obstruction and deep vein thrombosis. Methods: Reviewing available literature providing evidence for the new technologies available for treating: 1- Chronic Venous Disease (including superficial varicose veins and deep venous obstructions). 2- Deep Vein thrombosis (DVT). Results: RCTs showed that ultrasound-guided endovenous thermal or chemical ablation of superficial varicose veins are as effective as surgical ligation and stripping with the additional advantages of being minimally invasive, with less complications and more patient satisfaction, potential treatment in out-patient setup and early return to work. Stenting of chronic deep venous obstruction is safe, effective in improving symptoms and treating venous leg ulcers. Catheter-directed thrombolysis and pharmaco-mechanical thrombolysis are both effective in treating acute DVT and reducing post-thrombotic manifestations. Conclusion: Current evidence shows that management of venous diseases is now shifting towards minimally invasive interventions with very promising results. Given the lots of research work done in the field nowadays and evolving technologies provided by manufacturers, it will soon be the standard of practice offered for patients with chronic venous disease

Drug eluting balloons in femoro-popliteal artery disease

Treatment of femoropopliteal artery disease by percutaneous transluminal angioplasty (PTA) is limited by high rates of restenosis (40% to 60%) 6 to 12 months after procedure. The high mechanical stress (bending, compression, torsion) that occurs in the femoropopliteal arteries with normal patient movement is associated with an increased risk for stent fractures and in-stent restenosis. Furthermore, the reduction of restenosis seen with drug-eluting stent treatment of coronary artery disease was not observed in several studies of drug-eluting stent use in femoropopliteal artery disease. Hence, an alternative stent-free therapy that may similarly reduce restenosis and improve clinical outcome has been sought. Objectives: To review the recent clinical trials using drug-eluting balloons (DEB) in treatment of femoropopliteal artery disease. Methods: There are four already finished randomized studies in patients with superficial femoral artery lesions investigating the efficacy of paclitaxel release by DEB. Currently there is a rapidly increasing clinical study program using DEB in different locations and indications. Results: All 4 trials demonstrated significantly improved patency rates at 12 and 24 months angiographic follow-up compared to standard PTA. DEB offer several advantages compared to drug eluting stents, since any stentless technology for improving long-term patency is preferable to overcome the drawbacks of stenting in this mobile segment. Conclusions: DEB technology has demonstrated the capacity to have a significant impact on the practice of percutaneous cardiovascular interventions in the future. Several clinical trials have demonstrated promising early and mid-term results in treating femoropopliteal lesions. Long-term results, exact indications, and optimal applications are yet to be determined

Characteristics and mitigation strategies for cell phone use while driving among young drivers in Qatar

There is no doubt that cell phone use while driving can lead to a higher probability of driver error, which increases the likelihood of more crashes. In Qatar, the high rate of cell phone use while driving among young drivers is a major traffic safety concern. The objectives of this study are to identify the factors affecting this hazardous behavior and to suggest practical solutions to deter this specific category of drivers from driving while distracted. The study combined stated and revealed preference questions to design a detailed survey questionnaire. Data were collected from a sample of 403 young drivers. The structural equation modeling results showed that, for the revealed preference, conducting public campaigns may provide a suitable solution to reduce cell phone usage while driving. On the other hand, increasing enforcement did not seem to have a significant effect on reducing this type of behavior. For the stated preference, young drivers who had a crash history resulting from cell phone usage tend to use their cell phones less than those who did not have a cell phone related crash. Furthermore, the driving experience and safe duration of distraction had a significant effect on the cell phone usage. Based on the results, it is recommended to provide road safety campaigns to educate young drivers on the risk associated with such behavior. This information is valuable to legislators and traffic safety experts dealing with this problem in Qatar and other countries in the region. - 2018 Elsevier LtdThis report was made possible by a UREP award [ UREP 15-065-3-016 ] from the Qatar National Research Fund (a member of The Qatar Foundation) . The statements made herein are solely the responsibility of the authors.Scopu

Perineal Reconstruction after Abdomino-Perineal Resection Using Gracilis Muscle Flap

Abstract Objective : To assess the efficacy of gracilis muscle flap in achieving healing of perineal defects after abdominoperineal resection (APR) for lower rectal or anal cancer. Methods : Eleven patients were subjected to gracilis muscle flap to reconstruct perineal wounds after APR. Both procedures were done simultaneously in eight patients, while delayed reconstruction was done in three patients. Postoperative complications were reported as well as healing time for all patients. Results : All patients received radiotherapy as a part of their management before the operation. Indications for operation ranged between recurrent rectal cancer, resistant anal cancer, low rectal cancer in obese patients with expected perineal wound complications, and patients with already nonhealing of perineal wounds after APR. The average duration of simultaneous APR and gracilis flap reconstruction was 235.75 ±32.2 minutes compared to 133.3 ± 12.6 minutes for gracilis flap reconstruction alone. Two patients had superficial donor site infection, one patient had mid-thigh numbness, all patients had minor perineal wound infection as we did not close perineal wounds and they were left to heal with secondary intention, and one patient had minor necrosis of the distal end of gracilis. All complications were treated successfully with conservative measures. The mean healing time of perineal wound was 68.18± 19.78 days. Conclusions : Gracilis muscle flap is an excellent option to assist perineal wound healing after APR for both rectal cancer and anal cancer with minimal complications at both the donor site and the perineal wound