Indian system of medicine used concurrently with standard conventional medicine improves quality of life in patients of cardio vascular diseases (C.V.D)

Worldwide there is increased shift towards usage of traditional medicine in patients of chronic diseases like Cardio Vascular Disorders. In India, these medicines are used concurrently. Objective of the study was to ascertain prevalence and effect of concurrent traditional drug therapy with standard pharmacotherapy in patients with CVD. The present study used a cross sectional study design to assess the prevalence and a prospective cohort design to assess the effect of concurrent Ayurvedic medicines with standard pharmacotherapy in terms of quality of life. After screening 600 patients, 128 were found taking such medicines. Out of these, 100 were recruited as cases (Group-I), while 100 who were matched in terms of age, body mass index, ejection fraction, and receiving standard therapy only were recruited as controls (Group-II). Assessment parameters included demographic, biochemical, ejection fraction through echocardiography, distance covered in six Minute walk Test (6MWT), Quality of Life (QOL) through Kansas City Cardio-myopathy Questionnaire (KCCQ) and Seattle Angina Questionnaire (SAQ) with follow up at 6 months. Prakriti as mentioned in Ayurveda was also assessed using a questionnaire. Both groups were comparable at base line. Total 87 in Group-I and 91 in Group-II completed the study. Further, 76% patients were diagnosed with heart failure (HF) and 24% with coronary artery disease (CAD). There was no change in distance covered in 6MWT in both HF or CAD groups. But there was improvement in all cases in domains of KCCQ and SAQ as compared to controls. To conclude, concurrent use of traditional medicine with standard conventional care in CVD may improve quality of life in cardiovascular disorders.

Influence of Blood Transfusion on the Clinical Course and Immediate Outcome of Trauma Patients: Retrospective Study in a Tertiary Trauma Care Centre in Northern India

Background: Red blood cell transfusion is a prominent faction of the standard protocol for management of trauma patients. Clinical research over the past two decades has linked RBC transfusion with increased odds of morbidity and mortality. We conducted a study to assess influence of transfusion on survival and the clinical course of trauma patients in a level I trauma care center. Methodology: Retrospective review of the blood bank registry was conducted (Jan-June 2012). 100 acutely injured trauma patients who received blood transfusion were selected and categorized based on the number of units transfused; group I (1-5 units) n= 40; group II (6-9 units) n=40 & group III (>10 units) n= 20. Study control were trauma patients who did not receive transfusion group IV (n= 40). The clinical course of the patients was followed via computerized patient record system maintained by our institution. Analysis was done to compare outcome (in hospital mortality, organ failure, infections, length of stay) between the study and control groups, also between groups based on units transfused. Results: Severity of injury was significantly higher in patients who received transfusion than those who did not (p< 0.001). Transfusion was associated with high rate of infection (62%), organ failures (43%) and mortality (39%). Number of units transfused also correlated with injury severity (p< 0.001). Incidence of renal failure (20%), liver failure (35%) was high in group II. Also 50% developed sepsis in group II compared to 13.6 % in group I, and 31.8 % in group III. (p< 0.001). Highest mortality rate was observed in group II (67.5%), followed by 60% in group III and lowest in group IV 2.5% (p< 0.001). Conclusion: We observed a surrogate relationship between severity of injury and transfusion requirements. Transfusion-related adversities may be more reflective of the confounding effect of severity of injury than RBC transfusion. Therefore evaluating the risks and benefits of blood transfusion in trauma management is recommended

CIFKAS A Measurer of Functional Disability Status in Knee Osteoarthritis

Knee osteoarthritis (OA) results in structural and functional abnormalities and reduced functional performance abilities. In developing countries majority of population lives in rural areas having limited resources and socio-cultural biodiversity. Their personal, socio-cultural and occupational habits vary and need to be addressed. So a culturally relevant and contextually appropriate, Composite Indian Functional Knee Assessment Scale (CIFKAS) for measuring the functional status in knee osteoarthritis was formulated. 128 participants from various geographical regions of India of age range 40 to 60 years using convenient sampling were included and informed consent signed by the participants. Each participant was assigned to one of the two groups. 39 participants in group A reported no episode of knee pain while 89 participants in group B reported at least one episode of knee pain in the last two months. Each participant was assessed on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and CIFKAS and statistical analysis was done. The Pearson correlation coefficient calculated for all 128 subjects for pain, physical functional abilities and total functional disability score were 0.878, 0.925 and 0.945 respectively. Between group analysis was done using Independent t test and p value was found to be not significant for pain (≤178), highly significant for physical functional abilities (p≤0001) and very significant for total functional disability status score (p≤004). The results indicate that both WOMAC and CIFKAS are highly correlated and there is no difference between the two for measuring pain, but for functional ability and overall functional disability status within their functional context, CIFKAS is a better tool than WOMAC.KEYWORDS: Knee osteoarthritis; Functional disability; Socio-cultural biodiversities; Functional contextInternet Journal of Medical Update 2012 January;7(1):47-5

Impact of nicotine replacement therapy as an adjunct to anti-tuberculosis treatment and behaviour change counselling in newly diagnosed pulmonary tuberculosis patients: an open-label, randomised controlled trial.

We evaluated the impact of intensive smoking cessation activities as an adjunct to anti-tuberculosis treatment on patient-related treatment outcomes. In this open-label, randomised controlled trial, self-reporting smokers with pulmonary tuberculosis who initiated standard anti-tuberculosis treatment were randomised to either nicotine replacement therapy and behaviour change counselling (n = 400) or counselling alone (n = 400) provided at baseline and two follow-up visits. The primary outcomes were change in TBscore at 24-weeks and culture conversion at 8-weeks. Biochemical smoking quit rates defined as serum cotinine levels <10 ng/mL and/or exhaled carbon monoxide levels <6 ppm (47·8% vs 32·4%, p-value =< 0·001) and self-reported quit rates (69.3% vs 38·7%, p-value =< 0·001) were significantly higher in the intervention arm at 24-weeks. Though the TBscores at 24 weeks (95% CI) were lower in the intervention arm [2·07 (1·98, 2·17) versus 2.12 (2·02, 2·21)], the difference was not clinically meaningful. Patients in the control arm required treatment extension more often than intervention arm (6·4% vs 2·6%, p-value = 0·02). Combining nicotine replacement therapy with behaviour change counselling resulted in significantly higher quit rates and lower cotinine levels, however, impact on patient-related (TBscore) or microbiological outcomes (culture conversion) were not seen

Study protocol for economic evaluation of probiotic intervention for prevention of neonatal sepsis in 0-2-month old low-birth weight infants in India: the ProSPoNS trial

Introduction: The ProSPoNS trial is a multicentre, double-blind, placebo-controlled trial to evaluate the role of probiotics in prevention of neonatal sepsis. The present protocol describes the data and methodology for the cost utility of the probiotic intervention alongside the controlled trial. Methods and analysis: A societal perspective will be adopted in the economic evaluation. Direct medical and non-medical costs associated with neonatal sepsis and its treatment would be ascertained in both the intervention and the control arm. Intervention costs will be facilitated through primary data collection and programme budgetary records. Treatment cost for neonatal sepsis and associated conditions will be accessed from Indian national costing database estimating healthcare system costs. A cost–utility design will be employed with outcome as incremental cost per disability-adjusted life year averted. Considering a time-horizon of 6 months, trial estimates will be extrapolated to model the cost and consequences among high-risk neonatal population in India. A discount rate of 3% will be used. Impact of uncertainties present in analysis will be addressed through both deterministic and probabilistic sensitivity analysis. Ethics and dissemination: Has been obtained from EC of the six participating sites (MGIMS Wardha, KEM Pune, JIPMER Puducherry, AIPH, Bhubaneswar, LHMC New Delhi, SMC Meerut) as well as from the ERC of LSTM, UK. A peer-reviewed article will be published after completion of the study. Findings will be disseminated to the community of the study sites, with academic bodies and policymakers. Registration: The protocol has been approved by the regulatory authority (Central Drugs Standards Control Organisation; CDSCO) in India (CT-NOC No. CT/NOC/17/2019 dated 1 March 2019). The ProSPoNS trial is registered at the Clinical Trial Registry of India (CTRI). Registered on 16 May 2019. Trial registration number: CTRI/2019/05/019197; Clinical Trial Registry

Measurement of t(t)over-bar normalised multi-differential cross sections in pp collisions at root s=13 TeV, and simultaneous determination of the strong coupling strength, top quark pole mass, and parton distribution functions

Peer reviewe