Comparison of the functional outcome and pain relief of Intra articular Hylan GF-20 Vs. Methyl Prednisolone Acetate for Grade II Osteo Arthritis – Knee

INTRODUCTION: Osteoarthritis (OA) of the knee is characterized by chronic pain, cartilage matrix degradation, deterioration of the mechanical properties of the synovial fluid, bony osteophyte formation, and episodic inflammation. Compared to healthy joints, the synovial fluid in joints affected by OA can be characterized by both diminished molecular weight and concentration of its primary functional constituent, hyaluronan. Hyaluronan is a polysaccharide consisting of repeating linear dimers of N-acetylglucosamine and glucuronic acid. It is physiologically ubiquitous in the animal kingdom, in particular existing as a large molecular weight substance in bony joints where small quantities serve as both a lubricant and a transport medium for nutrients, proteins, and degradation products related to joint tissue metabolism. Lower molecular weight hyaluronan found in osteoarthritic joints fails to retain its viscoelasticity and ability to withstand shear forces, both small (normal joint movement) and large (high impact forces). As a result, joint surfaces can become progressively damaged when endogenous hyaluronan production is reduced by disease. Corticosteroids may work through influencing levels of collagenase and aggrecan, as well as matrix metalloproteinases and proinflammatory cytokines. No single cause of OA found no far. Multiple factors that might cause OA includes, genetic predisposition, age, injury prior to adulthood, microtrauma, body weight, stress on the joint, occupational task i.e., repetitive knee bending, heavy lifting and previous surgery of joint. AIMS AND OBJECTIVES: To compare the functional outcome and pain relief of Intra articular Hylan GF-20 Vs. Methyl Prednisolone Acetate for Grade II Osteo Arthritis – Knee. Study Centre: Government Institute of Rehabilitation Medicine, KK Nagar, Chennai-600 083. Duration of study: 18 months (March-2015 to August-2016). Study design: Prospective Single blinded Cohort study. - Subjects will be randomized by systematic random sampling, according to registration number of the study - Odd numbers (Group A) will be treated with Hylan GF-20. - Even numbers (Group B) will be treated with Methyl Prednisolone Acetate. METHODOLOGY: - Patients will be given test dose of 0.5ml of Lignocaine 2%. - They will be taken to Operation theatre and parts will be cleaned with Betadine and drapped with sterile towel. - Under aseptic precautions, Lignocaine 2% will be injected to anesthetise the injection site. - By following randomization procedure, either Hylan-GF20 (48mg)/methyl prednisolone acetate(40mg) will then be infiltrated into the knee joint space after confirmation by aspiration technique by infero lateral approach. - After infiltration the subjects will be observed for 15 minutes for adverse reactions. - Subjects will be asked to report immediately in case of adverse reactions like post injection flare (increased pain, swelling)/hypersensitivity reactions etc., - Also they will be given 3 days of analgesics and antibiotics. Inclusion criteria: 1. Age > 45 years, 2. Grade II osteoarthritis knee by Kellgren-Lawrence grading, 3. Knee pain with failed conservative treatment for 1 month, 4. Stiffness:< 30mts, 5. Crepitus, 6. Bony tenderness, 7. Bony enlargement, 8. No palpable warmth. Exclusion criteria: 1. Post Operative cases, 2. Cellulitis / Infections, 3. Any implants inside, 4. Associated with DVT calf muscles, 5. Non co-operative patient, 6. Low I.Q Patients /psychiatric patient, 7. Trauma, 8. Meniscal injury, 9. Anterior/Posterior cruciate ligament injury, 10. Medial/Lateral collateral ligament injury, 11. Bursitis, 12. Rheumatoid arthritis, 13. Pseudogout, 14. Other grades of osteo arthritis knee. Sample size: Approx 30+30. Product/Investigation details: Investigations: FBS, PPBS, X-ray knee-AP and Lateral. Product details: Methylprednisolone acetate – 80mg, Hylan-GF 20 – 48mg. Data collection and Methods: - Subjects will be randomized according to registration number of the study. - Odd numbers (Group A) will be treated with Hylan GF-20. - Even numbers (Group B) will be treated with Methyl Prednisolone Acetate. - Case History age, sex, duration of pain will be collected. Anthropometric measurements height and weight of the patient will be collected. - They will be assessed with pre procedural and post procedural. o pain score using Visual Analog Score (VAS). o WOMAC-C score. o Range of Movements of Knee. - The assessment will be analysed using SPSS software (version 21). RESULTS: There were 23 males and 37 females enrolled in the study, among which 14 males (60.9% of total males) and 16 females (43.2% of total females) were enrolled in Hylan group and 9 males (29.1% of total males) and 21 females (56.8% of total females) were enrolled in the steroid group. 49 patients had pain along anterior aspect of knee joint and 11 patients had pain along medial joint line. Among hylan group, 25 patients had pain along anterior aspect and 5 had pain along medial joint line. In steroid group, 24 had pain along anterior aspect and 6 had pain along medial joint line. Pain was assessed using Visual Analog Scoring (VAS) in this study. It showed significant pain relief with hylan group over due course of time. In steroid group, there was initial pain response till 8 weeks after the treatment, but later the pain score started to show upward trend in later weeks. In conclusion, pain relief was better in hylan group than steroid group with p value < 0.05 in all the follow up period except 8th week. Functional assessment after the treatment was done using WOMAC score (The Western Ontario and McMaster Universities Arthritis Index) and improvement in range of movements of the knee in this study. It showed significant functional improvement with hylan group over due course of time. In steroid group, there was initial better response till 8 weeks, but later the functional ability started to reduce in later weeks. In conclusion, functional improvement as per WOMAC score was better in hylan group than steroid group with p value <0.05. Functional assessment after the treatment was also done using range of movements (ROM). It showed significant improvement in ROM with hylan group over due course of time and remained stable in 12th and 26th weeks. In steroid group, there was initial better response around 4th and 8th weeks, but later ROM got reduced and did not show any further change in later weeks. In conclusion, functional improvement as per ROM was better in hylan group than steroid group with p value < 0.05. CONCLUSIONS: Intra articular Hylan GF-20 shows statistically significant improvement in Pain in analyzing the patients with Visual Analog Score (VAS). • Similarly, there is improvement in range of movements and WOMAC score (C domain) in hylan group. • For steroid group, there is initial statistical improvement upto 8 weeks in pain and other functional components, but after 8 weeks, there is no clinical improvement. • Hence Hylan GF-20 can be considered as an important therapeutic measure in the management of OA knee

Enlightening Network Lifetime based on Dynamic Time Orient Energy Optimization in Wireless Sensor Network

Mobile Ad-hoc Networks (MANET) are a set of Large-scale infrastructure and mobile device networks that build themselves without centralized control to provide various services through mobile. However, the quality of service of MANET is highly dependent on multiple parameters. Many routing schemes in literature use hop count, mobility speed, direction, etc. Similarly, the flow-based approach chooses long routes, which increases latency and reduces throughput efficiency. However, not all methods work well with all Quality of Service (QoS) parameters. To introduce a Dynamic Time Orient Energy Optimization (DTOEO) algorithm to construct the energy-based tree formation to achieve the minimum energy consumption network. Energy-based Dynamic Tree Routing to provide higher energy node and shortest route estimation that help to better transmission quality. In this proposed DTOEO method, perform three stages, there are i). Source node discovery process, ii). Time-orient density estimation, and iii). Energy-based Dynamic Tree Routing. In this stage, orient density estimation evaluates the data transmission size for each window period. To assess the consuming energy in the overall network. The proposed method of performance evaluation using various QoS matrices and its comparison to the existing process provides better performance

Fair Fuzzy Matching in Middle Fuzzy Graph

A fuzzy matching is a set of edges in which an edge does not incident on a vertex with same membership value. If every vertex of fuzzy graph is M-Plunged then the fuzzy matching is called as fair fuzzy matching. In this paper, we introduce the new concept of fair fuzzy matching in Middle fuzzy graph. We discussed some properties based on these concepts in an Absolute Fuzzy Labeling Graph.

Deep Featured Adaptive Dense Net Convolutional Neural Network Based Cardiac Risk Prediction in Big Data Healthcare Environment

In recent days, cardiac vascular disease has been one of the deadliest health-affecting factors causing sudden death. So, the importance of early risk prediction through feature analysis has become a big problem in data analysis because more nonlinear time series data increase the feature dimension. Irrelevant feature dimension scaling affects the prediction accuracy and leads to classification inaccuracy. To resolve this problem, we propose an Enhanced Healthcare data analysis model for cardiac data prediction using an adaptive Deep Featured Adaptive Convolution Neural Network for early risk identification. Initially, the preprocessing was augmented to formalize the time series data collected from the CVD-DS dataset. Then the feature evaluation was carried out with the Relative Subset Clustering (RSC) approach. The Cardiac Deficiency Prediction rate (CDPr) was estimated to identify the relational feature to subset margins. Based on the CDPr weight the feature is extracted using Cross-Over Mutual Scaling Feature Selection Model (CMSFS). The selected features get with a deep neural classifier based on logical neurons. They are then constructed into a Dense Net Convolution Neural Network (DN-CNN) classifier to feed forward the feature values and predict the Disease Affection Rate (DAR) by class category. The proposed system produces high prediction accuracy in classification, precision, and recall rate to support premature treatment for early cardiac disease risk prediction.

A Study on Kabasuram (கபசுரம்)

Patients attending the OPD, IPD of NIS having the compliance of kabasuram diagnosed clinically and the patients were observed for clinical diagnosis, laboratory diagnosis. Classical symptoms of kabasuram with emphasis to symptoms of acute bronchitis like Fever, Cough with or without expectorant, headache, constipation, poor appetite,myalgia Clinical diagnosis of kabasuram was done on the basis of clinical features described in Balavagadam text. Laboratory diagnosis was done by modern methods of examinations. Diagnosis had been based on the specially prepared proforma, including all clinical signs and symptoms of the disease, in which detailed history had been taken The signs, symptoms, and etiopathogenesis of lower respiratory illlness explained in modern diagnosis have lot of similarities with the disease entity kabasuram. The medicine chosen for clinical treatment and management of kabasuram is Silaethuma sura Kudineer internally two times in a day for 3days. All the patients were kept under strict dietary control during the treatment. The observation on effect of therapy was encouraging. The clinical efficacy of the drug was analyzed statistically on all the symptoms mentioned in the assessment criteria. The observation made during the clinical study showed that the trail drug Silaethuma sura Kudineer was clinically effective. In Bio chemical analysis, the trial medicine Silaethuma sura kudineer had ferrous iron, phosphate, Fluoride, starch, tannins, alkaloids, aminoacids, proteins, flavonids. CONCLUSION: All the forty patients of kabasuram were treated with Silaethuma sura Kudineer internally two (or) three times in a day. The ingredients of Silaethuma sura Kudineer are feasible and useful; these compounds may serve as potentially useful drug candidates for development at a lower cost. The medicine has many properties to control the signs and symptoms of kabasuram. During the course of treatment, no adverse interactions were observed. Clinical results were found to be significant good improvement was found in 77.5% of cases, moderate in 22.5% of cases. Because of the efficient results clinically, the study may be carried over to further researches and it may motivate the upcoming generation to manage the disease kabasuram through the siddha medicine and also this study throw new glitters for the Siddha Medicine. The present clinical study has established that Silaethuma sura Kudineer is having good result in reducing the majority of symptoms of kabasuram. Because of the encouraging clinical outcome the study may be further carried out with the same drug in a large Number of cases of Kabasuram

Effectiveness of laughter therapy in reduction of depression among senior citizens residing at selected old age home in Virudhunagar, Tamilnadu.

A study to assess the effectiveness of laughter therapy in the reduction of depression among senior citizens residing at selected old age home in Virudhunagar. METHODOLOGY The quantitative research approach was used in this study. The research design adopted for this study was quasi experimental design. The study was conducted in Dhanaswamy Parimaladevi Social welfare Trust (Old age Home). Purposive sampling technique was used for sample selection . The sample size was 60 senior citizens with mild depression who fulfilled the inclusion criteria. OBJECTIVES 1. To assess the pretest level of depression in experimental and control group among senior citizens residing at selected old age home in Virudhunagar. 2. To assess the post test level of depression in experimental and control group among senior citizens residing at selected old age home in Virudhunagar. 3. To compare the pre and post test level of depression in the experimental group among senior citizens residing at selected old age home in Virudhunagar. 4. To find out the effectiveness of laughter therapy in experimental and control group in the reduction of depression among senior citizens residing at selected old age home in Virudhunagar. 5. To find out the association between post test level of depression in experimental and control groups with selected demographic variables such as age, gender, religion, education, previous occupation, marital status, family support, source of income, period of stay and mode of entering into an old age home. HYPOTHESIS: The mean post test depression score of the elderly will be significantly lesser than the mean pre- test depression score of the senior citizens residing at selected old age home among experimental group. There will be a significant association between the post test depression level of the senior citizens and their selected demographic variables such as age, gender, religion, education, previous occupation, marital status, family support, source of income, period of stay and mode of entering in to an old age home among experimental and control group. MAJOR FINDINGS: In the experimental group, 6.66% of the sample belonged to the age group of 70-79 years whereas only 36.66% of the sample belonged to the age group of 60-69 years. Female 66.66%, dominated the Male 33.33% and all of them 100% belongs to the Hindu community. The Number of illiterate higher 50%, than the literate. The majority of them (63.33%) was House wife or unemployed. 80% were married and 90% of the sample are having adequate family support. 93.33% of the sample were getting income from family members. The majority of them 60%, were staying in an old age home for 6-10 years and 70% as their self interested entered into an old age home

Comparative study of tympanoplasty in dry and wet ears

BACKGROUND: Chronic otitis media [COM] is a long standing infection of part or whole of middle ear cleft. Goals in treating COM is to achieve a safe ear, eradicate disease, stabilize or improve hearing by reconstructing the tympanic membrane and ossicular chain and to prevent further development of disease is considered while performing surgery for a TM perforation. The objective of the study include, determining the graft uptake rate in the patients with chronic perforation of the TM with/ without active discharge. PROCEDURE: The selected patients are subjected to clinical, audiological and laboratory investigation. • Detailed history of the patient, general and systemic examination of the patient. • Examination of the nose, throat and PNS for source of infection by nasal endoscopy. • Otological examination and hearing evaluation by tuning fork test. • PTA and relevant lab investigation including HAEMOGLOBIN, RBS, serum urea, serum creatinine, chest x ray and ECG. • Aural swab for pus culture and sensitivity. AIMS AND OBJECTIVES: 1. To compare the graft uptake rate in dry and wet ears. 2. To compare the post operative hearing improvement in dry and wet ears. METHODOLOGY: Study Design: Prospective randomized comparative clinical study. Setting: Study will be conducted at the department of ENT, Coimbatore medical college hospital, Coimbatore. Duration of the Study: ONE YEAR (OCTOBER 2016- SEPTEMBER 2017). Study Population: Patients attending the ENT OPD in Coimbatore Medical College Hospital, Coimbatore will be included in the study based on the selection criteria. Total of 100 patients will be included in the study. RESULTS: There was no significant difference between both groups in terms of hearing improvement and graft uptake

Detection of chitinase activity and its characterization from Pseudomonas fluorescens of tea rhizosphere

Please see the pdf file here: http://indsocplantationcrops.in/journal.ph

Assessment of Adherence with Ticagrelor in Acute Coronary Syndrome Patients in Tertiary Care Hospital

In our study adherence to Ticagrelor was poor in the 1 year follow up of Acute Coronary Syndrome patients. Premature discontinuation of Ticagrelor in routine clinical practice occurred in patients and was primarily related to adverse effects. The reasons for discontinuation of Ticagrelor were found to be ADRs issues in 43 patients (bleeding) 42 patients (dyspnoea) and 13 patients (bleeding and dyspnoea). Other issues like financial problem leaded to discontinuation in 30 patients. 44 patients strictly adhered to therapy. Because of discontinuation within 1 year 52 patients had clinical untoward events. Medication therapy discontinuation after MI is common and occurs early after discharge. Patients who discontinue taking Ticagrelor are at increased mortality risk. So this study suggested that adherence of medication strictly to be followed to avoid untoward complication of therapy in Acute coronary syndrome