Comparison of the efficacy of propranolol versus amitriptyline as monotherapy for prophylaxis of migraine

Background

Approximately 15% of migraine sufferers need preventative medicine because they have more than two episodes each month. Migraine is a regular, persistent condition that frequently makes victims helpless. Numerous drugs from various classes have so far been used in migraine prophylaxis. Their effectiveness is recurrently overshadowed by their side effects because they must be used for a long time, which occasionally necessitates stopping the drug.

Materials and Methods

In the tertiary care teaching hospital's department of medicine, a prospective, comparative, open-label study was initiated. Two groups of 80 patients were randomly chosen. For 3 months, the 40 patients in Group A were given a tablet of amitriptyline 10 mg once daily, whereas the 40 patients in Group B were given a tablet of propranolol 20 mg once a day. At the conclusion of the fourth, eighth, and twelfth weeks, the patients' own self-assessment migraine diary and a 4-point pain scale were used to grade the intensity of the headaches.

Results

As a result, in Group A, the mean migraine attack severity in periods 1 and 2 was 5.88 2.69 and 5.41 2.48, respectively. In Group B, the mean was 5.15 2.75 in period 1 and 5.66 2.78 in period 2, respectively. The average length of a migraine attack in Group A was 20.30 5.61 h in period 1 and 16.75 5.23 h in period 2. In Group B, the mean was 16.59 3.21 in period 1 and 18.78 5.14 in period 2. Between groups A and B, there was a statistically significant difference.

Conclusion

The average number of migraine attacks reduced in the amitriptyline and propranolol groups as the treatment duration increased. Amitriptyline is a popular medication with established effectiveness and manageable levels of negative side effects. It is the tricyclic antidepressant that is most frequently used to prevent headaches. When administered for migraine prevention, it generates a quick response within 3 months. Propranolol is less effective than amitriptyline at reducing the frequency, length, and severity of episodes.

Idiopathic pulmonary fibrosis: Addressing the current and future therapeutic advances along with the role of Sotatercept in the management of pulmonary hypertension

BACKGROUND

Idiopathic pulmonary fibrosis (IPF) is a progressive and debilitating lung disease characterized by irreversible scarring of the lungs. The cause of IPF is unknown, but it is thought to involve a combination of genetic and environmental factors. There is no cure for IPF, and treatment is focused on slowing disease progression and relieving symptoms.

AIMS

We aimed in this review to investigate and provide the latest insights into IPF management modalities, including the potential of Saracatinibas a substitute for current IPF drugs. We also investigated the therapeutic potential of Sotatercept in addressing pulmonary hypertension associated with IPF.

MATERIALS AND METHODS

We conducted a comprehensive literature review of relevant studies on IPF management. We searched electronic databases, including PubMed, Scopus, Embase, and Web of science.

RESULTS

The two Food and Drug Administration-approved drugs for IPF, Pirfenidone, and Nintedanib, have been pivotal in slowing disease progression, yet experimental evidence suggests that Saracatinib surpasses their efficacy. Preclinical trials investigating the potential of Saracatinib, a tyrosine kinase inhibitor, have shown to be more effective than current IPF drugs in slowing disease progression in preclinical studies. Also, Sotatercept,a fusion protein, has been shown to reduce pulmonary vascular resistance and improve exercise tolerance in patients with PH associated with IPF in clinical trials.

CONCLUSIONS

The advancements discussed in this review hold the promise of improving the quality of life for IPF patients and enhancing our understanding of this condition. There remains a need for further research to confirm the efficacy and safety of new IPF treatments and to develop more effective strategies for managing exacerbations.

Evaluating the knowledge, attitudes, and practices of healthcare workers regarding high-risk nosocomial infections: A global cross-sectional study

Background

Healthcare workers (HCWs) play a vital role in delivering care and are frequently exposed to the risk of acquiring infections within the hospital setting. Around 15% of hospitalized patients suffer from these infections globally. However, the role and awareness of HCWs in the transmission of hospital-acquired infections (HAIs) or nosocomial infections is still unclear. This study aimed to evaluate the knowledge, attitude, and practices (KAP) toward high-risk microbial infections among HCWs on a global scale to identify measures to address this problem.

Method

A cross-sectional descriptive study was conducted between 2022 and 2023, with HCWs selected as the study population. Data concerning KAP were collected through a self-administered online survey questionnaire, using a nonprobability convenience sampling method. Descriptive statistics and regression analysis were used to analyze the data.

Results

A total of 743 HCWs from various countries participated in the study, with the majority of respondents being doctors (64.9%). Data were mainly obtained from Saudi Arabia (26.78%), Iraq (25.84%), India (15.7%), the United States of America (15.2%), and Africa (Sudan, Nigeria) (13.98%). The frequency of good KAP scores among physicians (KAP: 82.5, 80.66, and 70.5), nurses (KAP: 74.1, 73.07, and 88.7), medical practitioners (KAP: 87.2, 77.58, and 75.1), and technicians (KAP: 76.1, 74.38, and 89.6) were obtained as mentioned. With respect to experience, HCWs showed good KAP scores in 1-5 years (KAP: 82.4, 83.3, and 74.1), 5-10 years (KAP: 80.6, 74.54, 83), 10-20 years (KAP: 74.7, 79.1, and 82.7), and >20 years (KAP: 84.6, 78.8, and 82.8) categories.

Conclusion

This study suggests that HCWs have good KAP regarding infection prevention, but there is still room for improvement. Educational seminars and awareness programs can provide better adherence to barrier protection measures such as hand washing, use of gloves, and hand disinfection.

Neurological, Psychiatric, and Multisystemic Involvement of Fragile X Syndrome Along With Its Pathophysiology, Methods of Screening, and Current Treatment Modalities

Fragile X syndrome (FXS) is a hereditary disease that predominantly leads to intellectual disability (ID) in boys. It is the second prominent cause of ID, which manifests as a result of the atypical development of the cytosine-guanine-guanine (CGG) region. This irregular extension of the CGG region gives rise to methylation and silencing of the fragile X mental retardation 1 (FMR1) gene, causing a loss of the fragile X mental retardation 1 protein (FMRP). This reduction or loss of FMRP is the main cause of ID. It has a multisystemic involvement showing neuropsychiatric features such as ID, speech and language delay, autism spectrum disorder, sensory hyperarousal, social anxiety, abnormal eye contact, shyness, and aggressive behaviour. It is also known to cause musculoskeletal symptoms, ocular symptoms, cardiac abnormalities, and gastrointestinal symptoms. The management is challenging, and there is no known cure for the disease; hence an early diagnosis of the condition is needed through prenatal screening offered to couples with familial history of ID before conception. The management rests on non-pharmacological modalities, including applied behaviour analysis, physical therapy, occupational therapy, speech-language therapy, and pharmacologic management through symptomatic treatment of comorbid behaviours and psychiatric problems and some forms of targeted therapy.

Chronic Kidney Disease of Unknown Etiology in a Tertiary Care Teaching Hospital

Background Several primary studies have looked at the burden of chronic kidney disease among diabetic patients, but their results have shown significant variance in India. In order to determine the combined prevalence of chronic kidney disease and associated risk factors among patients with diabetes, this study used a combination of methods. Methods Over the course of two years, a cross-sectional observational study was undertaken in the Tertiary Care Teaching Hospital's Department of General Medicine including all chronic kidney disease patients of 18 years of age and above of either gender. People not suffering from the disease were chosen as controls. Kidney Injury Molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin-ELISA (NGAL-ELISA) sample analysis by the kit method was done. The study was carried out in accordance with Schedule Y, ICH GCP principles, and the Helsinki Declaration after receiving approval from the institutional ethics committee. Results In our study, the urinary mean KIM-1 was 49.75±4.35 μg/g Cr in the Chronic Kidney Disease of Unknown etiology (CKDu) group and 1.43±0.15 μg/g Cr in the controls group. The mean NGAL levels of the CKDu Group and the controls group were 8.94±1.31 μg/g and 0.41±0.05 μg/g, respectively. In CKDu and the controls group, the mean eGFR (ml/min/1.73m²) was 69.83±7.91 and 108±3.7, respectively. The mean serum creatinine (mg/dL) was reported 3.79 in the CKDu group and 1.0 in the controls group. Conclusion Despite the urban centers previously being thought of as a non-endemic location, for the first time in the city, 60 CKDu patients are reported in this study. This is the first study to use the urinary biomarkers KIM-1 and NGAL to find suspected cases of CKDu and early kidney damage in local communities in the urban centers.

Modified technique of high-resolution ultrasonography of the normal cervical esophagus

BACKGROUND AND AIM

To study a modified technique of neck ultrasound for the visualization of cervical esophagus using a high-resolution and high frequency linear transducer in normal subjects.

METHODS

Consecutive control subjects were patients who underwent abdominal sonography for other diseases and had no past or current history of dysphagia or esophageal disorders. The thyroid gland was used as a transducer window to obtain images. We used a slightly flexed neck position with the head turned 45 degrees to the opposite side while scanning the neck on either side.

RESULTS

One-hundred subjects were scanned and their age range was 10-74 years (male:female ratio 1:1). In 36% of cases it was difficult to visualize the right lateral 2/3rd in the traditional scanning position of the neck. This improved to 2% with the modified neck position. All patients had the left window visualized with both neck positions. The transverse diameter, anterior-posterior diameter and wall thickness measures were all significantly greater with the modified technique. All patients tolerated the procedure with no reported discomfort.

CONCLUSIONS

This modified technique provides superior views of the cervical esophagus, particularly from the right window, in almost all patients. Normal parameters using ultrasound have now been established.

Transient small bowel intussusceptions: ultrasound findings and clinical significance

PURPOSE

To study the ultrasound (US) findings and clinical significance of transient small bowel intussusceptions (TSBI) in adults and children.

METHODS

Clinical records and US findings of 108 consecutive patients of intestinal intussusception diagnosed on US between August 1995 and August 2004 were reviewed. In all cases, the length, diameter, wall thickness and color Doppler study of the bowel segment involved in intussusception were evaluated. Subsequent follow-up scans were performed at 30 min, 3 days and 2 weeks. Patients were clinically followed up for 6 months.

RESULTS

Forty-one patients were diagnosed as TSBI. Thirty-six intussusceptions were incidentally detected during US performed for some unrelated disease or vague abdominal symptom. Five patients presented with signs of obstruction at the time of the initial US diagnosis; however, the intussusceptions resolved without any treatment and were not detected on follow-up scans. Sixty-seven symptomatic patients required surgical intervention.

CONCLUSION

Incidentally detected, small bowel intussusceptions without an identifiable pathological lead point, with a normal wall thickness, a length of less than 3.5 cm, normal nondilated proximal bowel and normal vascularity on color Doppler reduce spontaneously and are of no clinical significance.

Ultrasound in the diagnosis of typhoid fever

OBJECTIVES

To establish the efficacy of ultrasound (US) of the abdomen as a diagnostic test in Typhoid. To determine the ultrasound diagnostic criteria in cases of Typhoid.

METHODS

The Widal test is the most commonly used method of detecting Typhoid fever, but does not provide results until a week after onset of fever due to the need for enough antibodies to develop to render a positive result. Abdominal Ultrasound was performed within three days of the onset of fever in 80 cases suspected to be having Typhoid fever. Subsequent follow-up scans were performed at five days, ten days and fifteen days. Subsequently, all 80 cases were found to be Widal positive and Salmonella culture was positive in 32 cases. We present our findings in 26 patients in the age group between 4 to 20 years in whom both Widal test and Salmonella culture was subsequently positive.

RESULTS

The US findings were as follows: splenomegaly (n-26, 100%); Bowel wall thickening (n-22, 85%); mesenteric lymphadenopathy(n-20,77%); hepatomegaly with normal parenchymal echotexture (n-8, 31%); thickened gall bladder (n-16, 62%); biliary sludge (n-6, 23%); positive US Murphy's sign (n-7, 27%); pericholecystic edema with increased vascularity (n-6, 23%); mucosal ulceration in the wall of the gall bladder (n-1, 3.8%).

CONCLUSION

In endemic areas like India, ultrasound findings of hepatomegaly, splenomegaly, ileal and cecal thickening, mesenteric lymphadenopathy and thick-walled gallbladder are diagnostic features of typhoid. Ultrasound can be a non-invasive, economical and a reasonably sensitive tool for diagnosing typhoid when serology is equivocal and cultures are negative.

Multilayer-enzyme linked immunosorbent assay (ML-ELISA) for detection of Entamoeba histolytica trophozoite coproantigen

Multilayer ELISA (ML-ELISA) method for Entamoeba histolytica trophozoite coproantigen was developed for diagnosis of amoebiasis and its usefulness vis-a-vis microscopic examination analysed for paired specimens from 87 patients from Lucknow and Hyderabad, India. All the stool specimens positive for trophozoites were also found to be positive in ML-ELISA. Out of a total 32 samples positive for cysts in microscopy 21 (65.62%) gave positive reactions for coproantigen. Results on 26 samples drawn from otherwise healthy subjects with negative microscopical picture, 4 were positive for coproantigen. The results of the present study indicate that ML-ELISA test is suitable for early diagnosis of acute amoebic patients for timely treatment.