EFFECT OF ZANJABĪL (ZINGIBER OFFICINALE) IN NON-ALCOHOLIC FATTY LIVER DISEASE- A RANDOMIZED CONTROLLED TRIAL

Non Alcoholic Fatty Liver Disease (NAFLD) is a reversible condition of the liver, wherein large vacuoles of triglyceride fat accumulates in liver cells via the process of steatosis, despite any evidence of excessive alcohol consumption. In view of present scenario of high prevalence and limited treatment options, this study was conducted to assess the effect of Murabba-i- Zanjabīl in NAFLD. Present study was designed as a randomized placebo controlled trial with 30 patients in test group and 10 patients in control group. Participants in test group were administered with Murabba-i- Zanjabīl, 5 gm twice daily, 30 minutes before food for 45 days and those in control group were given 1 capsule of 500 mg each containing wheat flour twice daily, 30 minutes before food for 45 days. All the participants were asked to follow up at every 15 days for assessment of subjective parameters. Objective parameter was assessed before and after the trial period. On statistical analysis the test formulation showed significant reduction in scores (p<0.05) for most of the parameters on both inter and intra group analysis, while the reduction in control group was not found to be statistically significant (p.0.05). This study lays out that Murabbā-i Zanjabīl in a dose of 5gm twice daily given for 45 days is more effective than placebo in treating NAFLD. There was no adverse effect reported during the trial. It was thus concluded that Murabbā-i Zanjabīl is effective and safe in therapeutic management of NAFLD

Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Background: Respiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity. Methods: PRISM was an open-label, randomised, phase 3 trial done at 70 hospitals across six countries. Patients aged 50 years or older who were undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive CPAP within 4 h of the end of surgery or usual postoperative care. Patients were randomly assigned using a computer-generated minimisation algorithm with inbuilt concealment. The primary outcome was a composite of pneumonia, endotracheal re-intubation, or death within 30 days after randomisation, assessed in the intention-to-treat population. Safety was assessed in all patients who received CPAP. The trial is registered with the ISRCTN registry, ISRCTN56012545. Findings: Between Feb 8, 2016, and Nov 11, 2019, 4806 patients were randomly assigned (2405 to the CPAP group and 2401 to the usual care group), of whom 4793 were included in the primary analysis (2396 in the CPAP group and 2397 in the usual care group). 195 (8\ub71%) of 2396 patients in the CPAP group and 197 (8\ub72%) of 2397 patients in the usual care group met the composite primary outcome (adjusted odds ratio 1\ub701 [95% CI 0\ub781-1\ub724]; p=0\ub795). 200 (8\ub79%) of 2241 patients in the CPAP group had adverse events. The most common adverse events were claustrophobia (78 [3\ub75%] of 2241 patients), oronasal dryness (43 [1\ub79%]), excessive air leak (36 [1\ub76%]), vomiting (26 [1\ub72%]), and pain (24 [1\ub71%]). There were two serious adverse events: one patient had significant hearing loss and one patient had obstruction of their venous catheter caused by a CPAP hood, which resulted in transient haemodynamic instability. Interpretation: In this large clinical effectiveness trial, CPAP did not reduce the incidence of pneumonia, endotracheal re-intubation, or death after major abdominal surgery. Although CPAP has an important role in the treatment of respiratory failure after surgery, routine use of prophylactic post-operative CPAP is not recommended