Acetazolamide in prevention of acute mountain sickness: a double-blind controlled cross-over study.

Twenty-four amateur climbers took part in a double-blind controlled cross-over trial of acetazolamide versus placebo for the prevention of acute mountain sickness. They climbed Kilimanjaro (5895 m) and Mt Kenya (5186 m) in three weeks with five rest days between ascents. The severity of acute mountain sickness was gauged by a score derived from symptoms recorded daily by each subject. On kilimanjaro those taking acetazolamide reached a higher altitude (11 v 4 reached the summit) and had a lower symptom score than those taking placebo (mean 4.8 v 14.3). Those who had taken acetazolamide on Kilimanjaro maintained their low symptom scores while taking placebo on Mt Kenya (mean score 1.9), whereas those who had taken placebo on Kilimanjaro experienced a pronounced improvement when they took acetazolamide on Mt Kenya (mean score 2.5). Acute mountain sickness prevented one subject for completing either ascent. Acetazolamide was acceptable to 23 of the 24 subjects. Acetazolamide is recommended as an acceptable and effective prophylactic for acute mountain sickness.     

Electric convulsion therapy in depression: a double-blind controlled trial.

The therapeutic effect of simulated and real bilateral electric convulsion therapy was examined in a double-blind, randomised trial on 22 patients with a primary depressive illness. Each treatment was given twice weekly for three weeks and the results assessed by the psychiatrist using a visual analogue rating scale, nurses using a nine-point rating scale, and the patients themselves using the Beck Depression Inventory. With all three methods of assessment patients given the real treatment substantially improved (p less than 0.001), whereas those given simulated treatment showed little change. Three weeks after substituting real treatment for simulated, however, these patients were also significantly improved (psychiatrist''s rating p less than 0.001; nurses'' rating p less than 0.005; Beck inventory p less than 0.005). These findings confirm the value of electric convulsion therapy in severe depressive illness and strongly suggest that the convulsion is important for the therapeutic effect.     

Efficacy of potassium and magnesium in essential hypertension: a double-blind,placebo controlled,crossover study.

OBJECTIVE--To evaluate the antihypertensive activity of potassium given alone or in combination with magnesium in patients with mild hypertension. DESIGN--A double blind, randomised, placebo controlled, crossover trial of 32 weeks'' duration. SETTINGS--Cardiology outpatient department, Sassoon General Hospitals, Pune, India. PATIENTS--37 Adults with mild hypertension (diastolic blood pressure less than 110 mm Hg). INTERVENTION--Patients received either placebo or potassium 60 mmol/day alone or in combination with magnesium 20 mmol/day in a crossover design. No other drug treatment was allowed. MEASUREMENTS--Blood pressure and heart rate assessed at weekly intervals and biochemical parameters at monthly intervals. RESULTS--Potassium alone or in combination with magnesium produced a significant reduction in systolic and diastolic blood pressures (p less than 0.001) and a significant reduction in serum cholesterol concentration (p less than 0.05); other biochemical variables did not change. Magnesium did not have an additional effect. Urinary potassium excretion increased significantly in the groups who received potassium alone or in combination with magnesium. The drug was well tolerated and compliance was satisfactory. CONCLUSION--Potassium 60 mmol/day lowers arterial blood pressure in patients with mild hypertension. Giving magnesium as well has no added advantage.     

Residual effects of eszopiclone and placebo in healthy elderly subjects: a randomized double-blind study

Sleep and Biological Rhythms - Next-day residual effects are a common problem with current hypnotics. The purpose of the present study was to evaluate the residual effects of eszopiclone on the...     

Depression in elderly medical inpatients: a meta-analysis of outcomes

OBJECTIVE: To determine the prognosis of elderly medical inpatients with depression. DATA SOURCES: A MEDLINE search for relevant articles published from January 1980 to September 1996 and a search of the PSYCH INFO database for articles published from January 1984 to September 1996. The bibliographies of identified articles were searched for additional references. STUDY SELECTION: Eight reports (involving 265 patients with depression) met the following 5 inclusion criteria: original research, published in English or French, population of general medical inpatients, mean age of depressed patients 60 years and over, and affective state reported as an outcome. The validity of the studies was assessed according to the criteria for prognostic studies described by the Evidence-Based Medicine Working Group. DATA EXTRACTION: Information about the patient population, the proportion of cases detected and treated by attending physicians, the length of follow-up, the affective outcome and the prognostic factors was abstracted from each report. DATA SYNTHESIS: All of the studies had some methodologic limitations. A meta-analysis of outcomes at 3 months or less indicated that 18% of patients were well, 43% were depressed and 22% were dead. At 12 months or more, 19% were well, 29% were depressed and 53% were dead. Factors associated with worse outcomes included more severe depression, more serious physical illness and symptoms of depression before admission. CONCLUSIONS: Elderly medical inpatients who are depressed appear to have a very poor prognosis: the recovery rate among these patients is low and the mortality rate high.     

Screening for hypothyroidism in elderly inpatients.

Routine biochemical screening for hypothyroidism in 2000 geriatric inpatients proved valuable and practicable and yielded 46 cases (2.3%). A non-specific clinical picture was particularly common, with less than a third of the cases showing "typical" signs and symptoms. Psychiatric manifestations, especially depression, were important and frequent and responded well to thyroxine. There was a preponderance of female cases of hypothyroidism and a strong association with other autoimmune diseases, notably pernicious anaemia and rheumatoid arthritis.     

Value of bromocriptine in unexplained primary infertility: a double-blind controlled trial.

In a double-blind controlled study, 47 women with unexplained primary infertility were allocated at random to treatment with either bromocriptine 2.5 mg twice daily (24 patients) or placebo (23). Both groups showed a fall in serum prolactin concentrations but the reduction was much greater in the bromocriptine-treated group. Neither group showed a change in serum oestrogen or progesterone concentrations. Bromocriptine significantly reduced the duration of the follicular phase of the menstrual cycle but had no effect on the luteal phase. Five women conceived during treatment with placebo and seven during treatment with bromocriptine, but analysis of the cumulative conception rates showed no significant difference between the groups. The women who conceived were significantly younger and had a significantly shorter history of infertility than the women who did not conceive, but subtracting the number of years of infertility from age eliminated this difference. The results show that bromocriptine in the dose and duration of administration used in the trial is of no value in unexplained primary infertility.     

Blood pressure reduction in elderly: a randomised controlled trial of methyldopa.

A total of 123 out of 549 elderly residents of local authority welfare homes in Nottinghamshire were found at screening to have a standing or lying diastolic blood pressure of 100 mm Hg or more. These 123 subjects were randomly allocated to simple observation or to treatment with methyldopa. The cumulative mortality was similar in the observed and treated groups and in the normotensive group from which the subjects had been separated. Thus moderate hypertension, whether treated or not, was not a major risk predictor in the elderly population studied.     

Day hospital rehabilitation--effectiveness and cost in the elderly: a randomised controlled trial.

The effectiveness and cost of day hospital care in rehabilitation were studied in a randomised controlled trial in 120 elderly patients who were assessed at referral and six weeks and five months later in activities of daily living skills and mood. Day hospital patients were compared with a control group, who were managed as they would have been before the availability of day hospital care. Day hospital patients showed a significant improvement in performance of activities of daily living at six weeks but not at five months; however, they had a sustained improvement in mood. The cost of day hospital rehabilitation was one third greater than that of rehabilitation by alternative means. In its current form the geriatric day hospital is not a cheap alternative to other means of rehabilitation. Expensive components of the day hospital should be critically re-examined and renewed emphasis placed on sufficient inpatient beds, domiciliary services, and day care centres.     

Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study.

OBJECTIVE: To compare the findings in dizzy elderly people with those in controls of a similar age to identify which investigations differentiate dizzy from non-dizzy patients and to design an investigational algorithm. DESIGN: Community based study of clinical and laboratory findings in dizzy and control elderly people. SETTING: Research outpatient clinic at a teaching hospital. SUBJECTS: 149 dizzy and 97 control subjects aged over 65 years recruited from a community survey and articles in the local press. MAIN OUTCOME MEASURES: Findings on physical examination, blood testing, electrocardiography (at rest and over 24 hours), electronystagmography, posturography, and magnetic resonance imaging of head and neck (125 (84%) dizzy subjects and 86 (89%) controls); hospital anxiety and depression score; responses to hyperventilation, carotid sinus massage, and the Hallpike manoeuvre. RESULTS: Blood profile, electrocardiography, electronystagmography, and magnetic resonance imaging failed to distinguish dizzy from control subjects because of the frequency of asymptomatic abnormalities in controls. Posturography and clinical assessment (physical examination, dizziness provocation, and psychological assessment) showed significant differences between the groups. A cause of the dizziness was identified from clinical diagnostic criteria based on accepted definitions in 143 subjects, with 126 having more than one cause. The most common diagnoses were central vascular disease (105) and cervical spondylosis (98), often accompanied by poor vision and anxiety. CONCLUSION: Expensive investigations are rarely helpful in dizzy elderly people. The cause of the dizziness can be diagnosed in most cases on the basis of a thorough clinical examination without recourse to hospital referral.     

Management of acute stroke in the elderly: follow-up of a controlled trial.

Follow-up of a controlled trial of the management of acute stroke in the elderly showed that the improvement in functional outcome at the time of discharge from hospital that had been achieved through establishing a stroke unit had disappeared by one year. Factors that might have contributed to this included overprotection by the families of patients who had been treated in the stroke unit, who were not permitted to carry out activities of daily living in which they were independent, and the early discharge from medical units of patients whose full rehabilitation potential had not been realised. Prolonging the benefits of short-term gains in functional outcome through the intervention of a stroke unit requires that all the links in the chain of stroke rehabilitation are maintained, including the proper orientation of patients'' families before discharge from hospital.     

Perioperative Duloxetine and Etoricoxibto improve postoperative pain after lumbar Laminectomy: a randomized,double-blind,controlled study

Background

Duloxetine, Etoricoxib and opioid are of the commonly administered drugs in Lumbar laminectomy. The aim of this study is to assess the effect of perioperative use of Duloxetine in combination with Etoricoxib on postoperative pain and opioid requirements.

Methods

One hundred twenty patients with ASA physical status were enrolled with age between 18 and 70 years. Patients were divided randomly into four groups of 30 patients: group P received placebo, group E received etoricoxib 120 mg, group D received duloxetine 60 mg and group D/E received duloxetine 60 mg capsules and etoricoxib 120 mg; 1 h before surgery and 24 h after.

Results

Neither Duloxetine nor etoricoxib individually had effect on pain with movement, while their combination revealed a significant reduction in pain scores over the entire postoperative period at rest and on movement. Etoricoxib showed a significant decrease in pain at all times at rest when compared with group P, while it showed significant pain decrease only at 0, 2 and 4 h when compared with group D. On the other hand duloxetine alone showed significant decrease in pain at rest at 24 h and 48 h when compared with group P. ConcerningMorphine requirement after 24 h.; it wassignificantly lower in the D/E group in comparison with groups P, E and D. It should be noted also that there was a significant decrease morphine requirement in both groups E and D.

Conclusion

The perioperative administration of the combination of etoricoxib and duloxetine improved analgesia and reduced opioid consumption without significant side effects.

Trial registration

ISRCTN48329522. 17 June 2017

     

Dose-response studies of Ropivacaine in blood flow of upper extremity after supraclavicular block: a double-blind randomized controlled study

Background

The sympathetic block of upper limb leading to increased blood flow has important clinical implication in microvascular surgery. However, little is known regarding the relationship between concentration of local anesthetic and blood flow of upper limb. The aim of this dose–response study was to determine the ED₅₀ and ED₉₅ of ropivacaine in blood flow after supraclavicular block (SB).

Methods

Patients undergoing upper limb surgery and supraclavicular block were randomly assigned to receive 30ml ropivacaine in concentrations of 0.125%(A Group), 0.2%(B Group), 0.25%(C Group), 0.375%(D Group), 0.5%(E Group), or 0.75%(F Group) (n=13 per group). All patients received supraclavicular block (SB). Time average maximum velocity (TAMAX), cross-sectional area (CSA) of brachial artery and skin temperatures (T_s) were measured repeatedly at the same marked points, they were taken at baseline (before block, t₀) and at 30min after SB (t₁). Blood flow(BF) = TAMAX× CSA×60 sec.. Relative blood flow (ΔBF) = BF_t1/ BF_t0. Success of SB was assessed simultaneously. Supplementary anesthesia and other adverse events (AE) were recorded.

Results

Significant increase in TAMAX, CSA, BF and T_s were seen in all concentration groups at t₁ comparing with t₀ (P<0.001). There was an upward trend of TAMAX, CSA, BF with the increasing concentration of ropivacaine except T_s. There was no significant different of T_s at t₁ among different concentration group. The dose-response formula of ropivacaine on ΔBF was Y=1+3.188/(1+10^((?2.451-X) × 1.730)) and ED₅₀/ED₉₅ (95%CI) were 0.35/1.94%(0.25–0.45/0.83–4.52), and R² (coefficient of determination) =0.85. ED₅₀/ED₉₅ (95%CI) values of sensory block were 0.18/0.33% (0.15–0.21/0.27–0.51), R²=0.904.

Conclusions

The dose-response curve between SB ropivacaine and the changes of BF was determined. The ED₅₀/ED₉₅ of ropivacaine of ΔBF are 0.35/1.94% (0.25–0.45/0.83–4.52). TAMAX, CSA and BF consistently increased with ropivacaine concentration. The maximal sympathetic block needs higher concentration than that complete sensation block needs which may benefit for microvascular surgery.

Trial registration

Clinicaltrials.gov NCT02139982. Retrospectively registered (Date of registration: May, 2014).

     

Management of acute stroke in the elderly: preliminary results of a controlled trial.

A randomised controlled trial compared the management of elderly patients with acute stroke in a stroke unit and medical units. A significantly higher proportion of patients discharged from the stroke unit (78 of the 155 admitted) were assessed as independent compared with patients discharged from medical units (49 of the 152 admitted). The intensive use of treatment that might have been implied by creating a stroke unit did not occur, although almost all the patients admitted to the unit received occupational therapy while only 47% of the patients admitted to medical units received occupational therapy. The delay before starting treatment was significantly shorter in the stroke unit. Results of this trial show that the stroke unit improved the natural history of stroke by increasing the proportion of patients who were returned to functional independence.     

Lipid accumulation in the rat liver: a histological and biochemical study.

The sequential pattern of lipid accumulation and associated biochemical changes were studied in two commonly used experimental models of nutritional fatty liver in rats. Female rats were maintained for 8 weeks on high fat, low protein diets containing adequate methionine and choline, and drinking water ad libitum (Diet 1), or deficient in methionine and choline and containing 20% ethanol as a substitute for drinking water (Diet 2). Histologically, there was a progressive increase in liver lipids, mainly in the periportal areas. Occasional foci of liver cell necrosis with lipogranuloma formation occurred in areas of severe fatty change. These changes appeared earlier and were more marked in rats maintained on Diet 2. Electron micrographs revealed large lipid droplets in the liver cells, which sometimes contained myelin figures. The mitochondria were enlarged, distorted and appeared as amorphous structures with disorientated cristae in rats on Diet 1, whereas they had a condensed conformation in rats maintained on Diet 2. Rough endoplasmic reticulum was fragmented and degranulated particularly in rats on Diet 1, and smooth endoplasmic reticulum showed hyperplasia and vesiculation in rats on Diet 2. There was a progressive increase in the total liver lipids and triglycerides in both the groups of rats. This fatty change was accompanied by a significant increase in hepatic 3-hydroxybutyrate, acetoacetate, malate, 2-oxoglutarate, citrate, lactate, ammonia, glutamate, alanine and aspartate, and a significant decrease in oxaloacetate, urea and glucose concentrations. The mass action ratios for alanine aminotransferase, aspartate amino transferase, and glutamate dehydrogenase, generally moved in a parallel direction. Hepatic ATP content was considerably reduced accompanied by a decrease in [ATP]/[ADP] ratios and a significant increased in [lactate]/[pyruvate] and [3-hydroxybutyrate]/[acetoacetate] ratios. There was a corresponding decrease in the [NAD+]/[NADH] ratios both in the cytoplasmic and mitochondrial compartments. These biochemical changes were particularly severe in rats maintained on Diet 1 and Diet 2 for 8 weeks. There was a very good relationship between impaired mitochondrial and endoplasmic reticulum functions, redox and phosphorylation states, and the relevance of their changes to the fate of fatty liver cells.