Study on the functional outcome of fluoroscopically guided transforaminal epidural steroid injections in patients suffering from lumbar disc herniation

Background: Intervertebral disc herniation of the lumbar region is one of the common causes of acute low back ache and lower extremity pain. While multiple treatment modalities exist, the efficacy of the usage of a transforaminal steroid injection as a tool to either alleviate pain or delay surgery needs to be further evaluated. The aim of this study is to determine the functional outcome of patients suffering from lumbar disc herniation treated with fluroscopically-guided transforaminal epidural steroid injections.Methods: This is a prospective case study in which total of 43 patients were included in the study dating between August 2014 and July 2015. These patients were evaluated and identified with lumbar disc herniation, confirmed with a magnetic resonance imaging prior to the procedure. A pre-injection VAS score was taken. These patients were administered TFESI under fluoroscopic guidance using 2ml of 40mg of Methylprednisolone with 1 ml of 2% xylocaine. They were then evaluated during follow up at 2 weeks, 6 weeks, 12 weeks, and 6 months. Their pain outcome was evaluated using the VAS (visual analog scale) scores and functional outcome was evaluated using Oswestry disability index (ODI).Results: All patients showed significant improvement in the VAS score during their regular follow up when compared to their pre injection levels. Patient satisfaction was the high at 2 weeks post operatively slightly declining over time. 3 patients underwent surgery during the follow up period. The ODI scores also showed significant improvements when compared to the pre injection scores at all follow up periodsConclusions: TFESI provides significant short-term pain relief in patients suffering from a single level lumbar herniated disc and is a viable, effective short-term analgesic tool to address pain and may retard an early surgical intervention

Cost-effectiveness of janus kinase inhibitors for rheumatoid arthritis: A systematic review and meta-analysis of cost-utility studies

Introduction: Janus kinase inhibitors (JAK-i), a class of targeted synthetic disease-modifying antirheumatic drugs (tDMARDs), are suggested as second or third-line therapies in rheumatoid arthritis (RA). Synthesized cost-effective evidence would aid in informed decision-making given the similar clinical effectiveness of JAKi, but incongruent cost-effectiveness reports.Methods: Literature search was conducted in PubMed, Embase, Scopus, and Tufts Medical Centers’ cost-effective analysis registry. We pooled the incremental net benefit (INB) with 95% confidence interval (CI) using random-effects model and the heterogeneity was assessed using Cochrane-Q test and I2 statistic. Modified economic evaluation bias checklist was used to assess the quality of selected studies. Publication bias was assessed using a funnel plot and Egger’s test. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) assessment was performed to assess the certainty of outcomes presented.Results: We included seventeen relevant studies for systematic review, of which fifteen were eligible for meta-analysis. The meta-analysis results showed that JAK-i is cost-effective compared to csDMARDS/bDMARDs with a pooled INB (INBp) of $19,886 (95$23,144 (74.1–46,214) and high heterogeneity (I2 = 99.67). But on a separate analysis JAK-i as second-line treatment is not cost-effective than TNF-a-i (INBp = $25,813, -5,714 to 57,340). However, leave-one-out analysis found that omitting a single outlier makes JAK-i cost-effective. Further, JAK-i is not cost-effective as a third-line treatment for csDMARD-TNF-a-I failed RA, compared to csDMARDs/bDMARDs with INBp$26,157 (-7,284 to 59,598).Conclusion: Meta-analysis suggests that JAK-i is cost-effective when used after csDMARD failure but not cost-effective when used after csDMARD-TNF-a-i failure with low certainty of evidence.Clinical Trial Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222541, identifier CRD4202122254

A note on the occurrence of large scale fish mortality along the Chaliyar River near Beypore

An unusual phenomenon of large scale fish mortality was noticed at Chaliyar river in Beypore on the morning of 3rd May 1966. The fishermen noticed hundreds of fish struggling and coming up on the surface of water in a dazed and dead condition and showing signs of suffocation. They caught the dead and dying fish and sold them immediately in the market. No adverse effect as a result of eating these fish was noticed

Hepatoprotective effect of obeticholic acid on acetaminophen induced hepatotoxicity in mice

Acetaminophen (APAP) is commonly used as analgesic and antipyretic drug for relieving mild and moderate pain, but at high doses produces hepatic necrosis. Though, Obeticholic acid (OCA) has been tested in range of diseases, its therapeutic potential against APAP-induced hepatic injury remains to be elucidated. Thus, in this study, we investigated the preventive effect of OCA along with N-acetylcysteine (NAC) and Silymarin (SIL) against acetaminophen-induced hepatotoxicity in mice. SIL (100 mg/kg, po) and OCA (30 mg/kg, po) were administered continuously for six days prior to APAP administration. After sixth dose, animas were fasted for 12 h and treated with 300 mg/kg APAP and then received SIL (100 mg/kg, po), NAC (500 mg/kg, ip) and OCA (30 mg/kg, po) at 1 h after APAP. Mice were sacrificed 6 h after APAP injection. Analysis of serum Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), liver glutathione (GSH) and histopathology were employed for assessment of hepatotoxicity. APAP group showed a significant increase in ALT, AST, ALP and centriolobular hepatic necrosis with a significant decrease in glutathione in comparison to control group. All these parameters were significantly improved in all the three treated groups when compared to APAP group. In conclusion, Obeticholic acid (OCA), Silymarin (SIL) and N-acetylcysteine (NAC) are suggested to protect against APAP-induced hepatotoxicity in mice by ameliorating liver enzymes, antioxidant effect and decreasing liver necrosis

On Distinguishing Between Valuation and Arbitrage Motivated Short Selling

The short interest data reported in the United States aggregate valuation shorts (motivated by a pessimistic opinion on firm value) and arbitrage shorts (motivated by various arbitrage or hedging strategies). However, the information content of these two sources of short interest is different and hence their association with future returns is expected to be different. In recent years, the association between short interest and future returns has weakened considerably, reflecting the increasing importance of institutions that execute arbitrage strategies. The primary contribution of this study is an empirical model that ex-ante helps differentiate valuation shorts from arbitrage shorts. In out-of-sample tests, we document that, consistent with theoretical predictions, the firms identified by the model as valuation shorts exhibit high short interest and poor future returns. Furthermore, firms identified as arbitrage shorts do not exhibit significant negative returns but instead exhibit characteristics associated with arbitrage strategies. The paper also identifies variables that are correlated with the information set of short sellers. We present an application that exploits the model\u27s ability to ex-ante identify poor performers and discuss broader applications in other finance settings

Do Short Sellers Target Firms with Poor Earnings Quality? Evidence from Earnings Restatements

We study the behavior of short sellers around earnings restatements. We find that short sellers accumulate positions in restating firms several months in advance of the restatement and subsequently unwind these positions after the drop in share price induced by the restatement. The increase in short interest is larger for firms with high levels of accruals prior to restatement, and the association between short interest and accruals is robust to controlling for other factors that affect the shorting decision. We document that heavily shorted firms experience poor subsequent performance and a higher rate of delisting. Overall, these results suggest that the motive for short selling is, at least in part, related to suspect financial reporting and that short sellers pay attention to the same type of information that is being conveyed by accruals

On Distinguishing Between Valuation and Arbitrage Motivated Short Selling

The short interest data reported in the United States aggregate valuation shorts (motivated by a pessimistic opinion on firm value) and arbitrage shorts (motivated by various arbitrage or hedging strategies). However, the information content of these two sources of short interest is different and hence their association with future returns is expected to be different. In recent years, the association between short interest and future returns has weakened considerably, reflecting the increasing importance of institutions that execute arbitrage strategies. The primary contribution of this study is an empirical model that ex-ante helps differentiate valuation shorts from arbitrage shorts. In out-of-sample tests, we document that, consistent with theoretical predictions, the firms identified by the model as valuation shorts exhibit high short interest and poor future returns. Furthermore, firms identified as arbitrage shorts do not exhibit significant negative returns but instead exhibit characteristics associated with arbitrage strategies. The paper also identifies variables that are correlated with the information set of short sellers. We present an application that exploits the model\u27s ability to ex-ante identify poor performers and discuss broader applications in other finance settings

Concentrations of pyrazinamide attained in serum with different doses of the drug*

Serial concentrations of pyrazinamide in 3 volunteers showed that increasing the dose from 22 mg/kg of body-weight to 66 mg/kg resulted in substantially higher serum concentrations of the drug and a longer period of coverage (at a concentration of 25 μg/ml). Similarly, in a study based on 6 tuberculous patients, increasing the dose of pyrazinamide from 66 mg/kg to 88 mg/kg led to appreciably higher concentrations in the serum. In neither series of tests was any acute hepatic toxicity observed. The findings suggest that it would be interesting to study the effect of doses of about 90 mg/kg of pyrazinamide in once-weekly regimens of chemotherapy for the treatment of tuberculosis