Outcomes of ketorolac versus depomedrol infiltrations for subacromial impingement syndrome: a randomized controlled trial

PURPOSE

Local subacromial infiltration with steroids is a common method of treatment of subacromial impingement syndrome. However, the use of steroids has concerns like tendon rupture, articular cartilage changes and infections. Local NSAIDs infiltration has recently been tried in literature. This study compares the effect of subacromial injections of ketorolac with steroids.

METHODS

A randomized controlled study was planned with 35 patients in each group. Patients in group-1 were infiltrated with subacromial ketorolac (60 mg with 2% lignocaine) and in group-2 with a steroid (methylprednisolone-40 mg with 2% lignocaine). A similar rehabilitation protocol was followed, and clinical outcomes were analyzed using visual analog scale (VAS) for pain and shoulder pain and disability score (SPADI) and range of motion at one-month and three-months follow-up.

RESULTS

Total data of 67 patients were analyzed, as three patients were lost to follow-up. In group 1, mean VAS improved from 7.9 [Formula: see text] 0.95 to 3.19 [Formula: see text] 0.81 (p < 0.001) and SPADI improved from 61.41 [Formula: see text] 11.86 to 28.91 [Formula: see text] 9.06 (p < 0.001) at three months, respectively. In group 2, mean VAS improved from 8.05 [Formula: see text] 0.94 to 2.9 [Formula: see text] 0.64 (p < 0.001) and SPADI improved from 63.45 [Formula: see text] 9.64 to 25.32 [Formula: see text] 6.87 (p < 0.001) at three months, respectively. However, there were no differences in functional outcomes between the groups (p = 0.21 for VAS, p = 0.16 for SPADI).

CONCLUSION

Subacromial ketorolac infiltration has an equivalent outcome as that of steroid infiltration. Ketorolac could be considered as a reasonable alternative to steroids in cases where it is contraindicated.

Measurement of R(D) and R(D^{*}) with a Semileptonic Tagging Method

The experimental results on the ratios of branching fractions R(D)=B(B[over ¯]→Dτ^{-}ν[over ¯]_{τ})/B(B[over ¯]→Dℓ^{-}ν[over ¯]_{ℓ}) and R(D^{*})=B(B[over ¯]→D^{*}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]→D^{*}ℓ^{-}ν[over ¯]_{ℓ}), where ℓ denotes an electron or a muon, show a long-standing discrepancy with the standard model predictions, and might hint at a violation of lepton flavor universality. We report a new simultaneous measurement of R(D) and R(D^{*}), based on a data sample containing 772×10^{6}  BB[over ¯] events recorded at the ϒ(4S) resonance with the Belle detector at the KEKB e^{+}e^{-} collider. In this analysis the tag-side B meson is reconstructed in a semileptonic decay mode and the signal-side τ is reconstructed in a purely leptonic decay. The measured values are R(D)=0.307±0.037±0.016 and R(D^{*})=0.283±0.018±0.014, where the first uncertainties are statistical and the second are systematic. These results are in agreement with the standard model predictions within 0.2, 1.1, and 0.8 standard deviations for R(D), R(D^{*}), and their combination, respectively. This work constitutes the most precise measurements of R(D) and R(D^{*}) performed to date as well as the first result for R(D) based on a semileptonic tagging method.

Search for an Invisibly Decaying Z^{'} Boson at Belle II in e^{+}e^{-}→μ^{+}μ^{-}(e^{±}μ^{∓}) Plus Missing Energy Final States

Theories beyond the standard model often predict the existence of an additional neutral boson, the Z^{'}. Using data collected by the Belle II experiment during 2018 at the SuperKEKB collider, we perform the first searches for the invisible decay of a Z^{'} in the process e^{+}e^{-}→μ^{+}μ^{-}Z^{'} and of a lepton-flavor-violating Z^{'} in e^{+}e^{-}→e^{±}μ^{∓}Z^{'}. We do not find any excess of events and set 90% credibility level upper limits on the cross sections of these processes. We translate the former, in the framework of an L_{μ}-L_{τ} theory, into upper limits on the Z^{'} coupling constant at the level of 5×10^{-2}-1 for M_{Z^{'}}≤6  GeV/c^{2}.

Observation of the Radiative Decays of ϒ(1S) to χ_{c1}

We report the first observation of the radiative decay of the ϒ(1S) into a charmonium state. The significance of the observed signal of ϒ(1S)→γχ_{c1} is 6.3 standard deviations including systematics. The branching fraction is calculated to be B[ϒ(1S)→γχ_{c1}]=[4.7_{-1.8}^{+2.4}(stat)_{-0.5}^{+0.4}(sys)×10^{-5}]. We also searched for ϒ(1S) radiative decays into χ_{c0,2} and η_{c}(1S,2S), and set upper limits on their branching fractions. These results are obtained from a 24.9  fb^{-1} data sample collected with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider at a center-of-mass energy equal to the ϒ(2S) mass using ϒ(1S) tagging by the ϒ(2S)→ϒ(1S)π^{+}π^{-} transitions.

The negative cofactor 2 complex is a key regulator of drug resistance in Aspergillus fumigatus

The frequency of antifungal resistance, particularly to the azole class of ergosterol biosynthetic inhibitors, is a growing global health problem. Survival rates for those infected with resistant isolates are exceptionally low. Beyond modification of the drug target, our understanding of the molecular basis of azole resistance in the fungal pathogen Aspergillus fumigatus is limited. We reasoned that clinically relevant antifungal resistance could derive from transcriptional rewiring, promoting drug resistance without concomitant reductions in pathogenicity. Here we report a genome-wide annotation of transcriptional regulators in A. fumigatus and construction of a library of 484 transcription factor null mutants. We identify 12 regulators that have a demonstrable role in itraconazole susceptibility and show that loss of the negative cofactor 2 complex leads to resistance, not only to the azoles but also the salvage therapeutics amphotericin B and terbinafine without significantly affecting pathogenicity.

Resistance to primary treatments of invasive aspergillosis is growing. Here, the authors generate a knockout library for 484 transcription factors in Aspergillus fumigatus, and show that loss of the NCT complex leads to cross-resistance to all primary and some salvage therapeutics without affecting pathogenicity.

Intolerance to early oral feeding in enhanced recovery after colorectal surgery: an early red flag?

AIM

Enhanced recovery programmes (ERPs) involve early postoperative oral feeding. The aim of this study was to test the hypothesis that intolerance to early feeding was associated with a complicated postoperative course.

METHOD

A retrospective cohort analysis of the prospective multicentre database developed by the Francophone Group for Enhanced Recovery after Surgery (GRACE) was undertaken. Seventy-one centres in Belgium, France and Switzerland participated in the study. All patients were encouraged to eat within 24 h after surgery. Patients were separated into two groups according to whether early feeding was well tolerated (WT) or poorly tolerated (PT). The primary outcome measure was overall postoperative complications. Secondary outcome measures were unplanned reoperation, early mobilization rate and duration of postoperative hospital stay.

RESULTS

Among the cohort of 3034 patients, early feeding was WT in 2614 patients (WT group) and PT in 420 patients (PT group). There were significantly more postoperative complications in the PT group than in the WT group (52.1% vs 17.0%, respectively; P = 0.001), namely more unplanned reoperations, less early mobilization and longer postoperative hospital stay. Multivariate analyses confirmed that PT early feeding was the main and dominant independent factor for postoperative complications [OR 4.47 (95% CI3.49-5.72); P < 0.001], more unplanned reoperations and longer hospital stay.

CONCLUSIONS

This study demonstrates a close relationship between intolerance to early feeding and a complicated postoperative course. Whenever this simple very early red flag is observed, discharge should not be planned until postoperative complications have been ruled out.

Co-circulation of dengue virus type 3-genotype I and type 2-Cosmopolitan genotype in 2018 outbreak in Dhaka, Bangladesh

Dengue virus (DENV) that caused an outbreak in Dhaka, Bangladesh during 2018 was analysed phylogenetically. DENV samples were classified into type 2-Cosmopolitan genotype (54%) and type 3-genotype I (46%), indicating co-circulation of two DENV types and resurgence of type 3 associated with genotype replacement.

Constraints on Light Dark Matter Particles Interacting with Electrons from DAMIC at SNOLAB

We report direct-detection constraints on light dark matter particles interacting with electrons. The results are based on a method that exploits the extremely low levels of leakage current of the DAMIC detector at SNOLAB of 2-6×10^{-22}  A cm^{-2}. We evaluate the charge distribution of pixels that collect <10e^{-} for contributions beyond the leakage current that may be attributed to dark matter interactions. Constraints are placed on so-far unexplored parameter space for dark matter masses between 0.6 and 100  MeV c^{-2}. We also present new constraints on hidden-photon dark matter with masses in the range 1.2-30  eV c^{-2}.

Understanding the perspectives of older adults and elderly regarding vaccination; a snapshot in four European countries

Prevention of infectious diseases in elderly by immunization is a prerequisite to ensuring healthy ageing. However, in order for the vaccine programs to be effective, these need to be provided by health care professionals who have up-to-date knowledge and high motivation. Furthermore, the knowledge and attitudes towards vaccination in the targeted age groups needs to be fully understood. When focusing on the information provision, it is important to know from whom or which institution older adults and elderly would like to receive and in which form.

In January 2019, an international project called the VITAL (The Vaccines and InfecTious diseases in the Ageing population) project was started, within the framework of IMI (Innovative Medicines Initiatives). One of the goals of the VITAL project is to develop strategies to educate and train health care professionals (HCPs) and to promote awareness among stakeholders involved in elderly care management.

We briefly focus on the results of studies undertaken in four European countries (Italy, France, The Netherlands and Hungary), which reveal the perspective of older adults and elderly regarding influenza, pneumococcal, herpes zoster vaccination and respiratory syncytial virus (RSV) as well as generic characteristics of the vaccines and diseases.

We will show how attitudes towards vaccination are represented in our study population and which determinants influence the decision-making process of accepting vaccination. Furthermore, we shall elaborate on how the decision-making process towards vaccination takes place and which additional information is needed.

In the second part of the session, we shall invite the audience to reflect on the findings and identify the factors they consider most important for setting up a training and education programme on vaccination.

Physiological responses of a juvenile marine estuarine-dependent fish (Family Sparidae) to changing salinity

Estuaries are subject to high environmental variability coupled to tidal salinity shifts. Under restricted freshwater flow and prolonged drought conditions, salinity may exceed natural ranges and thus organisms may experience stressful hypersaline conditions. This study assessed the physiology of a juvenile marine estuarine-dependent species Rhabdosargus holubi (Family: Sparidae) under changing salinity to determine the impact on respiration and survival under shock and acclimatisation exposures. Oxygen consumption was not significantly different in the 2.5 to 45 salinity range and the interaction between temperature and salinity was not significant at the moderate levels tested. This confirmed the strong osmoregulatory capabilities of marine estuarine-dependent R. holubi. However, respiration was impacted at salinities of 55-62.5. The salinity tolerance ranges of R. holubi were expanded beyond those previously observed in the laboratory, to a maximum of 77 when fish were gradually exposed to daily 20% incremental changes. This indicated the ability to adapt to hypersaline conditions that occur gradually in anthropogenically altered estuaries which is an important aspect for management decisions regarding freshwater inputs. The adaptability of Rhabdosargus holubi to hypersaline conditions in estuaries may thereby ensure the maintenance of populations in the short term under certain environmental conditions, such as those currently occurring in a freshwater-scarce South Africa. However, in the long term and at more extreme salinities (> 55), the physiology of R. holubi and similar species may be compromised, thus placing the species at risk.

EXABCal: A program for calculating photon exposure and energy absorption buildup factors

This research presents a new Windows compatible program (EXABCal) for photon exposure and energy absorption buildup factors for standard energy grid from 0.015- 15 MeV for elements, mixtures and compound. This program was written using Python programming language and the calculation of buildup factors was based on the well-known Geometric Progression (GP) fitting procedure. The equivalent atomic numbers and GP fitting parameters of mixtures and compounds can also be evaluated using this program. The program has been used to evaluate the photon exposure and energy absorption buildup factors for standard energy grid from 0.015- 15 MeV for water, air and concrete, compared with values from the American Nuclear Society (ANS) standard reference data (ANSI-6.4.3) and found to be of high accurate with minimal errors. The program is fast and easy to use and will be of valuable interest to medical Physicist, radiation Physicists, Radiation shielding design engineers, students, teachers and researchers and other experts working in areas where nuclear radiation is applied.

A review of the evidence and cost of therapies for cutaneous lupus erythematosus

Cutaneous lupus erythematosus (CLE)-a common presentation of lupus erythematosus-may exist independently or as a part of the systemic manifestations of systemic lupus erythematosus. The effects of living with and treating a chronic condition such as CLE can be debilitating to a patient's health and finances. The management of patients with CLE is made particularly challenging by poor compliance, limited therapeutic options, scarcity of evidence supporting their use, and significant differences in costs of medications. Effective management of CLE should center on prevention, individualized treatment regimens, and a mutual understanding of the challenges that patients with CLE face. This article seeks to provide an overview of the efficacy, safety, and cost of therapeutic options for CLE.

Organophosphorus Compounds Poisoning in a Neonate: A Case Report

Organophosphorus compounds (OPC) are widely used insecticides. Such poisoning is very rare in neonate. A 23 days old infant was admitted with severe respiratory distress, excessive secretion from nose and mouth, bluish discoloration of extremities and poor feeding for 4 hours. He was pale, cyanosed and lethargic with gasping respiration. Frothing was coming through mouth and nose. There was watering of eyes, pupils were pin pointed and light reflex was sluggish. The baby was hypothermic, hypotonic with altered sensorium. Capillary refill time was <3 sec. The neonate was gasping; there was crepitation over lung fields. Precordium and abdomen was normal. An odor of OPC was smelt on clothing and secretions of the infant. The baby was wrapped with a cloth that was ware during pesticide spraying in the field. In addition to general measures, decontamination of skin and clothing and gastric lavage was done. Empirical antibiotic, injection atropine and pralidoxime were given. Patient showed clinical improvement with disappearance of cholinergic signs. The baby was discharged on 7th day of admission after full recovery.