14 research outputs found
Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial
Background
Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.
Methods
FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762.
Findings
Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months.
Interpretation
Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.
Funding
UK Stroke Association and NIHR Health Technology Assessment Programme
A novel methodology for stabilization of silver nanoparticles on cotton, nylon and cotton/nylon fabrics using chitosan and triethyl orthoformate for enhanced and elongated anti-bacterial performance
In the present study, the commercially available three different cotton, nylon and cotton/nylon fabrics were first modified by chitosan coating in the presence of a crosslinker triethyl orthoformate (TEOF) and then were loaded with silver nanoparticles. Resulted cotton‑silver (Ag-Cs-Cot), nylon‑silver (Ag-Cs-Nylon) and cotton-nylon silver (Ag-Cs-Cot-Nyl) fabrics showed extra-long anti-bacterial activity. In FTIR spectra the stretch of secondary amine near the 3375 cm indicated the silver attachment to the amine group of the chitosan and the peak at 1650 cm confirmed that TEOF bonded chitosan to fabrics. In SEM images smooth surfaces of fabrics without any damage by modification process were observed. The antibacterial activity showed 90 % bacterial inhibition against the E. coli and 89 % bacterial inhibition against S. aureus. The modified fabrics were washed with non-ionic detergent (10 g/l) and retained anti-bacterial activity till 50 washing cycles. Finally, the commercial potential of cotton‑silver fabric was evaluated by stitching it with the socks of football players and interestingly results showed that the modified fabric on the socks showed >90 % bacterial inhibition as compared to the plain fabric after 90 min playing activity. [Abstract copyright: Copyright © 2024. Published by Elsevier B.V.
Thigh-length compression stockings and DVT after stroke
Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease