scholarly journals Comparison of combined intraarticular (IA) and intravenous (IV) administration of tranexamic acid with IA and IV alone in patients undergoing total knee arthroplasty without drainage catheter: a clinical trial study

2021 ◽  
Author(s):  
Nima Bagheri ◽  
Mohammad Amin Amini ◽  
Arezu Pourahmad ◽  
Farzad Vosughi ◽  
Alireza Moharrami ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Blood Loss ◽  
The Other ◽  
P Value ◽  
Drainage Catheter ◽  
Total Knee ◽  
Matched Case ◽  
The Mean ◽  
Double Blinded ◽  
Hemoglobin Drop

Abstract Purpose we aim to determine the most effective route for TXA administration (among IA, IV, combined IA/IV) for TKA surgeries using tourniquet without drainage catheters Methods We performed a double-blinded clinical trial on a total of 147 TKA candidates. The amount of blood loss and hemoglobin drop were evaluated in three matched case groups administered TXA during the TKA either via IV, IA or IV plus IA route. Drainage catheter was used for none of the cases. Results The combined group showed an average blood loss of 630 ± 252 ml which was significantly lower than the IV group (878 ± 268 ml, P-value < 0.01) and the IA group (774 ± 288 ml, P-value = 0.03). Besides, the mean hemoglobin and hematocrit drop was significantly lower in the combined group compared to the other two groups, 48 and 72 hours postoperatively (P value < 0.05). Conclusions The TXA administration via IV plus IA route had 28% and 19% reduction of blood loss in comparison with using the TXA via IV alone and IA alone methods respectively. Therefore, given the surgery is performed with tourniquet application, TXA usage via IV plus IA route may be a more effective way for reducing the perioperative blood loss in TKA cases in patients undergoing TKA without drain placement.

scholarly journals Comparison of early results of total knee replacement performed with Zimmer iASSIST versus conventional technique

2020 ◽  
Vol 27 (2) ◽  
pp. 208-213
Author(s):  
Ho Yeung Cyrus Lai ◽  
Yan Ho Bruce Tang ◽  
Hok Leung Wong
Keyword(s):  
Blood Loss ◽  
Tibial Component ◽  
Mechanical Axis ◽  
Operation Time ◽  
Conventional Technique ◽  
Coronal Alignment ◽  
Posterior Slope ◽  
Total Knee ◽  
The Mean ◽  
Hemoglobin Drop

Background: Zimmer iASSIST knee is an accelerometer-based navigation system with the aim of achieving better alignment in total knee arthroplasty (TKA). We have started using this system since early 2016. This is a retrospective case–control study, which aims to compare the radiological alignment, operation time, and blood loss of TKAs performed using the iASSIST system and those using conventional techniques. Materials and Methods: 42 TKAs using Zimmer iASSIST and 44 TKAs using conventional instrumentation were recruited. The overall coronal alignment and the coronal and sagittal alignment of the femoral and tibial component were compared. For coronal alignment, additional analysis of the absolute deviation from neutral mechanical axis was performed to avoid canceling out of varus/valgus deviation. The number of outliers, operation time, and blood loss in terms of maximal hemoglobin drop were also compared. Results: When comparing the alignment of the iASSIST group with the conventional group, there were no significant differences ( p > 0.05) in the number of outliers, mean coronal alignments, mean deviation from neutral coronal mechanical axis (2.9° vs. 2.9°), and femoral component flexion angle (4.9° vs. 4.7°). The difference in the mean tibial component posterior slope was significant (5.7° vs. 7.1°, p < 0.05). The mean operation time was significantly longer by 13 min ( p < 0.05) in the iASSIST group. There were no significant differences in the mean hemoglobin drop between the two groups. Conclusion: The results demonstrated no significant differences in terms of coronal radiological alignment, femoral flexion angle, outliers, and blood loss between iASSIST and conventional technique. There was a small but statistically significant difference in tibial posterior slope. The iASSIST group needed a longer operation time.

scholarly journals Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bing-xin Kang ◽  
Hui Xu ◽  
Chen-xin Gao ◽  
Sheng Zhong ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Randomized Controlled ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
D Dimer

Abstract Background We aimed to determine the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who had undergone primary unilateral total knee arthroplasty (TKA). Methods For this single-center, single-blind randomized controlled clinical trial, 10 male and 87 female participants with RA, aged 50–75 years, who underwent unilateral primary TKA were recruited. The patients received one dose of 1 g IV-TXA 10 min before skin incision, followed by articular injection of 1.5 g tranexamic acid after cavity suture during the surgery. The patients were randomly assigned (1:1) into two groups and received an additional single dose of IV-TXA (1 g) for 3 h (group A) or three doses of IV-TXA (1 g) for 3, 6, and 12 h (group B) postoperatively. Primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum hemoglobin (Hb) level decrease. Secondary outcomes were transfusion rate and D-dimer levels. All parameters were measured postoperatively during inpatient hospital stay. Results The mean TBL, HBL, and maximum Hb level decrease in group B (506.1 ± 227.0 mL, 471.6 ± 224.0 mL, and 17.5 ± 7.7 g/L, respectively) were significantly lower than those in group A (608.8 ± 244.8 mL, P = 0.035; 574.0 ± 242.3 mL, P = 0.033; and 23.42 ± 9.2 g/L, P = 0.001, respectively). No episode of transfusion occurred. The D-dimer level was lower in group B than in group A on postoperative day 1 (P <  0.001), and the incidence of thromboembolic events was similar between the groups (P > 0.05). Conclusion In patients with RA, three doses of postoperative IV-TXA further facilitated HBL and Hb level decrease without increasing the incidence of adverse events in a short period after TKA. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR1900025013).

scholarly journals The Effect of Urtica Dioica Extract on Blood Lipids Profile in Patients with Type 2 Diabetes: A Randomized Double-blinded Clinical Trial

2021 ◽  
Author(s):  
Roya Khajeh Mehrizi ◽  
Hassan Mozaffari-Khosravi ◽  
Parisa Aboee
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Clinical Trial ◽  
Total Cholesterol ◽  
Density Lipoprotein ◽  
Urtica Dioica ◽  
Significant Difference ◽  
The Mean ◽  
Double Blinded

Background: Diabetes is an endocrine disorder that is strongly associated with cardiovascular disease. The use of alternative therapy has recently increased and medicinal plants are one of the alternative therapies for diabetic patients. This study aimed to evaluate the protective effect of Urtica dioica (Nettle) on lipid profile in patients with type 2 diabetes (T2D). Method: This parallel randomized double-blinded clinical trial was conducted on 60 men and women with T2D for an 8-week period. The participants were randomly assigned to received 100mg/kg/day extract of Urtica Dioica (UG) and the placebo group (PG). Blood triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDLc) and high density lipoprotein cholesterol (HDLc) were measured at baseline and end of the study. The data were analyzed using SPSS 16.0 and P < 0.05 was considered significant. Results: The mean difference of total cholesterol showed no significant difference in the UG compared to the PG which were -10.56±40.5 and -19.5± 35.9 (P = 0.14), respectively. The study also showed no significant difference between TG and LDLc in the UG compared to the PG (-39.8±171.5 vs. -23.37±72.3 (P = 0.68) and -3.16±33.4 vs. -11.2±35.6 (P = 0.15), respectively). The mean difference of HDLc in the UG and PG were -2.68±8.11 and 2.62±10.6 (P = 0.05), respectively, indicating a significant increase in the UG compared to the PG. Conclusion: The results demonstrated that consumption of 100mg/kg/day extract of UD for 8 weeks by increasing HDL concentration can decrease the risk of cardiovascular disease in patients with T2D.

A Randomized, Controlled Clinical Trial of Four Anti-Dandruff Shampoos

1981 ◽  
Vol 9 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Marvin Rapaport
Keyword(s):  
Clinical Trial ◽  
Test Preparation ◽  
The Other ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Randomized Controlled ◽  
The Mean ◽  
Rate Of Improvement

A total of 199 patients were selected for a comparison of the anti-dandruff efficacy of four shampoos. After a 2-week lead-in (all patients used only Johnson's Baby Shampoo twice weekly) the patients were randomly assigned to Selsun Blue®, Head & Shoulders®, Flex®, or Tegrin®. The test preparation, which was unknown to the observer, was used twice weekly for 4 weeks. Loose and adherent dandruff were each rated on a scale of 0 to 20 (absent to severe) at the end of the lead-in (when a total score of 15 was required), and each week of study. The mean total pre-study score for all subjects was 19.5. At the end of the study the mean improvement scores were: 162 (Selsun Blue), 14.6 (Head & Shoulders), 13.5 (Flex), and 13.1 (Tegrin). The improvement was significantly greater (p < 0.05) on Selsun Blue than on any of the other shampoos. At the end of the study significantly (p < 0.05) more patients had total scores of zero on Selsun Blue (15) than on Tegrin or Head & Shoulders. In addition, the rate of improvement was significantly (p < 0.05) faster with Selsun Blue than with any of the other test preparations.

Supine versus prone PCNL in lower calyceal stone: Comparative study in a tertiary care center

2020 ◽  
pp. 039156032096240
Author(s):  
Sunirmal Choudhury ◽  
Paragmani Talukdar ◽  
Tapan Kumar Mandal ◽  
Tapas Kumar Majhi
Keyword(s):  
Prone Position ◽  
Care Center ◽  
Tertiary Care ◽  
Renal Calculus ◽  
P Value ◽  
Tertiary Care Center ◽  
Stone Free Rate ◽  
The Mean ◽  
Hemoglobin Drop ◽  
Free Rate

Introduction: Renal calculus disease is an age old disease of human being. PCNL (Percutaneous nephrolithotomy) stands as a gold standard treatment for large renal calculus which is traditionally being done in prone position. Objective: To evaluate the safety and efficacy of supine PCNL versus prone PCNL comparing intraoperative time, requirement of relook PCNL, post op hemoglobin drop, post operative hospital stay, post operative complication, SFR ( stone free rate). Methods and materials: It is a prospective study done in Urology department in a tertiary care center in Eastern India between October 2017 and October 2018. A total of 84 patients with lower calyceal renal stones underwent PCNL, 42 of them in supine and 42 in prone position. Lower calyceal stone, size measuring 1 to 2 cm were included in the study. Results: The mean intra operative time was 91.76 min in supine group and 85.43 min in prone group with a p value of 0.115. The mean hemoglobin drop was 1.11 g/dl and 1.18 g/dl in supine and prone position, respectively ( p value 0.75). The mean post operative hospital stay was 4.1 and 3.86 days in supine and prone group ( p value 0.58), respectively. Two patients in each group require relook PCNL. Stone free rate at 1 month was 95.23% and 90.47% ( p value 0.9), respectively in case of supine and prone group. Conclusion: Supine PCNL is feasible, comparable to prone PCNL in respect to operative parameters with relatively higher stone free rate though statistically insignificant.

scholarly journals Considering the hypothesis of the pathophysiology of cellulite in its treatment

2017 ◽  
Vol 9 (2) ◽  
Author(s):  
José Maria Pereira de Godoy ◽  
Ana Carolina Pereira de Godoy ◽  
Maria de Fatima Guerreiro Godoy
Keyword(s):  
Clinical Trial ◽  
Medical Records ◽  
Ethics Committee ◽  
Clinical Treatment ◽  
P Value ◽  
Lymph Drainage ◽  
The Mean ◽  
Cervical Stimulation ◽  
Alpha Error ◽  
Paired T Test

The aim of this study was to evaluate perimetric reductions in the clinical treatment of cellulite (aesthetics) using the Godoy method in a randomized retrospective clinical trial. The medical records of 150 patients treated for cellulite in the period from 2006 to 2011 in the Clinica Godoy were revisited. Treatment comprised manual and mechanical lymph drainage and cervical stimulation for one hour per day over 10 days. The paired t-test was used for statistical analysis, with an alpha error of 5% (P-value <0.05) being considered acceptable. This study was started after being approved by the Research Ethics Committee of the Medicine School in São José do Rio Preto (FAMERP - no. 395- 2010), Brazil and after being registered as a clinical trial. The mean reduction of the 150 patients was 3.81±2.76 g (P-value <0.0001; 95% confidence interval: 3.408-4.223). A significant reduction in size was seen with the clinical treatment of cellulite giving an improvement in the physical appearance. Pathophysiological mechanisms such as regional skin lymphostasis seem to be involved in the formation of cellulite.

scholarly journals Local infiltration of analgesia and tranexamic acid is safe and efficacious in reducing blood loss and comparable to intra-articular tranexamic acid in total knee replacements

2021 ◽  
Author(s):  
H Sivasubramanian ◽  
CMP Tan ◽  
L Wang
Keyword(s):  
Pain Relief ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Functional Outcomes ◽  
Primary Total Knee Replacement ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

Introduction: The use of peri-articular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) tranexamic acid has not been well explored in literature. This retrospective cohort study aims to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate post-operative pain relief and functional outcomes in unilateral primary total knee replacement (TKA) patients. Methods: 63 patients who underwent a unilateral primary total knee replacement procedure were divided into 2 groups: 42 patients in the IA TXA delivery group, 21 patients in the PA TXA group. 1g of TXA was utilized for all patients. All patients had pericapsular infiltration consisting of 0.5ml of Adrenaline, 0.4ml of Morphine, 1g of Vancomycin, 1ml of Ketorolac and 15ml of Ropivacaine. Outcomes for blood loss, and surrogate markers for immediate functional recovery were measured. Results: 54.0% of the patients were female, 46.0% male. The mean drop in post-operative Hb levels in the PA and IA group was 2.0g/dL and 1.6 g/dL respectively, and statistically insignificant (p=0.10). The mean HCT drop in the PA and IA group was 6.1% and 5.3% respectively and statistically insignificant (p=0.58). The POD 1 and discharge day flexion angles, POD 1 and POD 2 VAS scores, gait distance on discharge, and length of hospitalization stay were largely similar in both groups. Conclusion: Our study shows that both IA and PA TXA with analgesic components are equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.

scholarly journals A Comparative Study of Active Management of the Third Stage of Labor IV Methergine and IM Oxytocin

2021 ◽  
pp. 267-272
Author(s):  
K. Sharmila
Keyword(s):  
Blood Loss ◽  
The United States ◽  
Active Management ◽  
P Value ◽  
Negative Effects ◽  
The Third ◽  
Third Stage Of Labor ◽  
Group I ◽  
Third Stage ◽  
The Mean

Postpartum haemorrhage (PPH) has been more common over the last three decades, accounting for 11% of all pregnancy-related deaths in the United States. In the third stage of labour, risk classification and active management are crucial preventative techniques. To avoid negative effects, a multidisciplinary approach to PPH patient care is required. To treat uterine atony, uterotonic medicines like oxytocin are used in combination with manipulative procedures like uterine massage and balloon tamponade. The amount of blood loss, duration of the third stage, need for MRP, incidence of PPH, need for repeated oxytocics, and its side effects were measured in Group I 100 women who were administered injection oxytocin 10 IU injection methergin 0.2 mg IV within one minute of the baby's delivery. The mean blood loss at vaginal delivery in Group I was 100-150 ml and in group I P value 0.027, which was statistically significant .In  Group II was 160-200 ml with P value 0.036, which was statistically significant. The mean duration of third stag labour in Group 1 was 124.6 min and Group 2 was 144.8 min intravenous methergin is a better uterotonic when compared to intramuscular oxytocin to reduce the amount of blood loss at delivery and prevent complications like atonic PPH.

scholarly journals Comparison of Intra-Articular versus Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Study

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Kornah BA ◽  
◽  
Mansour GM ◽  
Mohamed MTI ◽  
◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
University Hospital ◽  
Postoperative Blood Loss ◽  
Soft Tissue Release ◽  
P Value ◽  
Intravenous Application ◽  
Total Knee

Background: Total Knee Arthroplasty (TKA) is widely used in clinical applications. Considerable postoperative blood loss, however, is an unavoidable occurrence due to the extensive soft-tissue release, and the large area of cancellous bone osteotomy associated with the procedure. Besides, knee flexion and extension activities those begin the day after the operation adds to the problem. Aim of the Work: To compare between the intra-articular and the intravenous application of Tranexamic Acid (TXA) in total knee arthroplasty. Patients and Methods: It is a prospective Double-blinded Randomized controlled trial. This prospective study was conducted at El-Hussein University Hospital & El Agouza Hospital on 30 patients who undergo total knee arthroplasty and fulfill all inclusion and exclusion criteria. Results: The results were the average total blood loss in the drain after 48hrs. In the 1st group was 365±74.722 while average blood loss in the 2nd group was 575±88.976. This indicates a significant decrease in blood loss in the 1st group (intraarticular TXA group) than the 2nd group (intravenous TXA group) the P value <0.001 which is highly significant. It was found that The decrease in Hb level is less in the 1st group than in the 2nd group which indicates less postoperative anemia in the blood count, the P-value <0.05 considered significant.

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