Evaluation of granisetron as an antiemetic in patients undergoing abdominal hysterectomy under spinal anaesthesia

Background: PONV most common complications related to surgery and anaesthesia despite major advances in spinal, epidural and combined spinal-epidural anesthesia techniques IONV are still present in a significant number of patients. Ondansetron, used for controlling PONV induced by chemotherapy or radiation. Recently 5HT3 receptor antagonist granisetron has more potent, selective and longer acting activity than ondansetron. Granisetron is more active for control of PONV in cisplatin induced vomiting than ondansetron. It also reduces PONV in strabismus repair, tonsillectomy, and general surgeries, it has less side effects as compared to ondansetron. Objective of the study was to study efficacy and safety of granisetron and compare it with ondansetron for prevention of IONV and PONV.Methods: 80 ASA grade I and II women undergoing abdominal hysterectomy under spinal anaesthesia were studied. Patients in group A received injection granisetron 2 mg and group B injection ondansetron 4 mg,10 minutes prior to induction of spinal anaesthesia. Main outcome measures were occurrence of nausea, retching or vomiting in intraoperative and postoperative period at 6, 12, 18 and 24 hours’ post-surgery. The response of patient to therapy and side effects were evaluated in both groups. The results were analyzed by ‘z’ test (p<0.5) considered significant.Results: Demographic characteristics of both groups were comparable patients in granisetron (80%) had more complete response as compared to ondansetron (47.5%). Adverse effects were lower in granisetron group.Conclusions: Granisetron 2 Mg has better efficacy and safety profile than ondansetron 4 Mg

Evaluation of efficacy and tolerability of eperisone and thiocolchicoside in treatment of low back pain associated with muscle spasm: An open label, prospective, randomized controlled trial

Background: Low back pain has a high prevalence in adult population. Because of reflex muscle spasm, muscle relaxants are frequently used either alone or in combination with analgesics. Eperisone inhibits voltage gated sodium channels in brain stem and Thiocolchicoside acts via GABA-mediated mechanism to relax muscle spasm and relieves pain.Methods: This was a prospective; open labeled, randomized, two-arm, parallel group, controlled, clinical trial. 113 patients were randomised to two groups. Patients in group A received Tablet Eperisone 100 mg whereas patients in group B received Tablet Thiocolchicoside 8 mg for seven days along with Tablet Paracetamol 500 mg. The outcome measures of trial were the improvement in finger to floor distance (FFD) and pain in lumbar region, relief of spasm and tenderness of paravertebral muscles on day 4 and 7.Results: At the end of the study FFD reduced by 18 cm in group A (p < 0.0001*) and 17.36 cm in group B (p<0.0001*) from baseline. Mean score of pain on day 7 reduced by 5.64 scale in group A as compared to 5.42 scale in group B (p<0.0001* in both groups). Paravertebral tenderness reduced by 92.6% in group A and 94.6% in group B at the end of the trial. On day 7, the spasm relief was 87% in group A and 88% in group B.Conclusions: Eperisone is an effective muscle relaxant with equivalent efficacy compared to Thiocolchicoside, and has a better tolerability in treatment of low back pain with muscle spasm

The United States COVID-19 Forecast Hub dataset

Academic researchers, government agencies, industry groups, and individuals have produced forecasts at an unprecedented scale during the COVID-19 pandemic. To leverage these forecasts, the United States Centers for Disease Control and Prevention (CDC) partnered with an academic research lab at the University of Massachusetts Amherst to create the US COVID-19 Forecast Hub. Launched in April 2020, the Forecast Hub is a dataset with point and probabilistic forecasts of incident cases, incident hospitalizations, incident deaths, and cumulative deaths due to COVID-19 at county, state, and national, levels in the United States. Included forecasts represent a variety of modeling approaches, data sources, and assumptions regarding the spread of COVID-19. The goal of this dataset is to establish a standardized and comparable set of short-term forecasts from modeling teams. These data can be used to develop ensemble models, communicate forecasts to the public, create visualizations, compare models, and inform policies regarding COVID-19 mitigation. These open-source data are available via download from GitHub, through an online API, and through R packages

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline