4th Week Of Treatment Research Articles

Comparative Effect of Augmented Reality and Routine Physical Therapy on Balance and Postural Control in Patients with Parkinson’s disease

Background: Parkinson's disease is a neurodegenerative condition that often manifests in old age with generalized slowness of movements (bradykinesia) and a minimum of one additional symptom of tremor at rest or stiffness. Objective: The purpose is to compare the effects of Augmented Reality and Routine Physical Therapy on balance and Postural Control in Patients with Parkinson's disease. Methodology: It was a randomized clinical trial done in the Neuro medicine and physiotherapy department of Allied Hospital, Faisalabad. A sample size of 62 patients was divided into two equal groups. Patients in Group A had conventional physiotherapy, while those in Group B received augmented reality and conventional physiotherapy. Non probability sampling technique was used. Data was collected on the baseline and then data was collected after 8th weeks, and final data was collected after 12th weeks. Tools for collection of data were the Berg balance scale, timed up and go, and one leg stance test. Results: An Independent sample t-test was used to check the difference between groups in pre and post intervention which shows the statistical difference in both groups after the 8th and 12th weeks of treatment. However, mean differences show that group B has more good results. Repeated measure analysis of variance also shows that there is a significant difference between treatment groups in the within-group analysis. Conclusion: Our study concludes that an augmented reality regimen along with physiotherapy is beneficial for Parkinson’s patients to improve balance and postural control.

Final conclusions of the own investigations of combined antihypertensive treatment on clinical state in patients with arterial hypertension without and with diabetes mellitus: use of own materials in education in nation. and Engl. languages at pre- and po

General practice – family medicine department. Object of investigation – patients with confirmed diagnosis of arterial hypertension without and with diabetes mellitus of second type, which were under observation at the primary medical care centers. 
 The aim of the investigation was the study of efficiency of the combined (calcium channel blocker – amlodipin besilat and angiotensin II receptor antagonist – valsartan) antihypertensive treatment in patients with arterial hypertension combined with diabetes mellitus from the start of the treatment in the practice of primary care physician.
 Methods of the investigation included physical examination, general clinical, instrumental and laboratory methods, monitoring of side effects.
 As a result it was found, that combined antihypertensive treatment (amlodipin and valsartan) is effective and safe in patients with arterial hypertension and diabetes mellitus of 2 type, which helps to reach the target level of arterial pressure in 72 % of patients and can be recommended from the beginning of the treatment in the practice of family physician. Maximal effect of the treatment in patients with arterial hypertension of II-III degree and diabetes mellitus of 2 type was observed only at 12th week of treatment. At combined antihypertensive treatment (amlodipin and valsartan) they observed tendency to the reduction of left ventricle hypertrophy. Despite the rate and percentage of the reaching of target arterial pressure were lower in the group of patients, which have diabetes mellitus of 2 type, it is necessary to recommend more active modification of the way of life in the named group of patients. It was found reduction of heart and vascular risks in the group of patients with arterial hypertension II–III degree with diabetes mellitus 2 type. This makes the basis for more active modification of life style and using from the start of the treatment combined antihypertensive therapy immediately. Consider all found results using from the start of the treatment combined antihypertensive therapy immediately by the primary care physician is proved for patients with arterial hypertension combined with diabetes mellitus.
 Accumulated materials (including theoretical reviews, demonstrative poster reports etc.) are used at training of interns in speciality «general practice – family medicine», during practical classes for higher courses education in national and English languages

Efficacy and Mechanism of Highly Active Umbilical Cord Mesenchymal Stem Cells in the Treatment of Osteoporosis in Rats.

A rat model of osteoporosis was induced with dexamethasone sodium phosphate. Highly active umbilical cord mesenchymal stem cells (HA-UCMSCs) and UCMSCs were isolated, cultured, identified, and infused intravenously once at a dose of 2.29 × 106 cells/kg. In the 4th week of treatment, bone mineral density (BMD) was evaluated via cross-micro-CT, tibial structure was observed via HE staining, osteogenic differentiation of bone marrow mesenchymal stem cells (BMMSCs) was examined via alizarin red staining, and carboxy-terminal cross-linked telopeptide (CTX), nuclear factor-κβ ligand (RANKL), procollagen type 1 N-terminal propeptide (PINP) and osteoprotegerin (OPG) levels were investigated via enzyme-linked immunosorbent assays (ELISAs). BMMSCs were treated with 10-6 mol/L dexamethasone and cocultured with HA-UCMSCs and UCMSCs in transwells. The osteogenic and adipogenic differentiation of BMMSCs was subsequently examined through directional induction culture. The protein expression levels of WNT, β-catenin, RUNX2, IFN-γ and IL-17 in the bone tissue were measured via Western blotting. The BMD in the healthy group was higher than that in the model group. Both UCMSCs and HA-UCMSCs exhibited a fusiform morphology; swirling growth; high expression of CD73, CD90 and CD105; and low expression of CD34 and CD45 and could differentiate into adipocytes, osteoblasts and chondrocytes, while HA-UCMSCs were smaller in size; had a higher nuclear percentage; and higher differentiation efficiency. Compared with those in the model group, the BMD increased, the bone structure improved, the trabecular area, number, and perimeter increased, the osteogenic differentiation of BMMSCs increased, RANKL expression decreased, and PINP expression increased after UCMSC and HA-UCMSC treatment for 4 weeks. Furthermore, the BMD, trabecular area, number and perimeter, calcareous nodule counts, and OPG/RANKL ratio were higher in the HA-UCMSC treatment group than in the UCMSC treatment group. The osteogenic and adipogenic differentiation of dexamethasone-treated BMMSCs was enhanced after the coculture of UCMSCs and HA-UCMSCs, and the HA-UCMSC group exhibited better effects than the UCMSC coculture group. The protein expression of WNT, β-catenin, and runx2 was upregulated, and IFN-γ and IL-17 expression was downregulated after UCMSC and HA-UCMSC treatment. HA-UCMSCs have a stronger therapeutic effect on osteoporosis compared with that of UCMSCs. These effects include an improved bone structure, increased BMD, an increased number and perimeter of trabeculae, and enhanced osteogenic differentiation of BMMSCs via activation of the WNT/β-catenin pathway and inhibition of inflammation.</p>.

P700 The efficacy of adalimumab combined with surgery for rectovaginal fistula in Crohn's disease：a single-center retrospective study

Abstract Background To assess the efficacy of adalimumab(ADA)combined with surgery in the treatment of Crohn's disease patients with rectovaginal fistulas. Methods A single-center retrospective study. The baseline data of patients with Crohn’s rectovaginal fistulas who visited the Anorectal Department of the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2020 to July 2022 and accepted ADA combined with surgery treatment were included. Crohn’s disease Activity Index(CDAI), perianal disease activity index(PDAI) and inflammatory parameters, including Erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP), were statistically analyzed at weeks0, 48. Follow-up was performed every 8 weeks. The outcomes included clinical response, clinical remission, fistula response, fistula remission, fistula remission under MRI, endoscopic response and endoscopic remission. Results A total of 43 RVF patients were included, 53.4% (23/43) patients were treated with Seton,44.1% (19/43) patients were treated with Advancement flap and 2.3%(1/43) patient was treated with Fecal diversion, with a median follow-up of 11.0 (2.5-15.0) months. After 48 weeks of treatment, CDAI[325(262,397)vs.197(134,396)], PDAI[8(6,9) vs. 5(3,6)], ESR[31(8,50) mm/h vs. 10(4,28)mm/h]and CRP[4.62(0.85, 14.45)mg/L vs.0.5(0.5,2.14)mg/L] were significantly lower than 0 week (Table 1) . CDAI, PDAI, ESR and CRP at the 48th week of treatment were significantly lower than those before treatment (p&amp;lt;0.05). At the last follow-up, 62.7%(27/43) patients achieved clinical response, 30.2%(13/43) achieved clinical remission. Meanwhile 69.7%(30/43) of patients achieved fistula response,32.5%(14/43) achieved fistula remission(Table 2),and 25.5%(11/43) achieved fistula remission under MRI; A total of 37 patients completed endoscopic re-examination, including 54.0% (20/37) of patients with endoscopic response and 24.3%(9/37) with endoscopic remission. Conclusion ADA combined with surgery is effective in the treatment of patients with Crohn’s rectovaginal fistulas.

Effect of Pelvic Radiation on Haematopoeitic and Gastrointestinal Syndromes: a Prospective &amp; Observational Study

Radiotherapy may induce irreversible damage on healthy tissues surrounding the tumor. It has been reported that the majority of patients receiving pelvic radiation therapy show early or late tissue reactions of graded severity as radiotherapy affects not only the targeted tumor cells but also the surrounding healthy tissues. This prospective, observational study was conducted to observe the effects of pelvic radiation on haematopoeitic and gastrointestinal syndromes. It was done in Radiation Oncology department of National Institute of Cancer Research and Hospital, Dhaka between July 2011 to June  2012. The study participants were all patients getting pelvic radiation in the concerned department. A blood profile was done before radiotherapy. Clinical evaluation as per RTOG Guideline was done to access the gastrointestinal syndromes. Then, pelvic radiation was started and CBC was done and recorded weekly as well as gastrointestinal toxicity grading. Main outcome measures were hemoglobin, TC of WBC, nausea, vomiting, diarrhea. Before treatment the mean hemoglobin % was 11.0±1.1 mg/dl, during 4th week of treatment it 10.37±0.7 mg/dl.The mean TC of WBC was found 11107.4±13481.4 mm3, during 4th week of treatment the mean TC of WBC was found 7550.6±2514.6 mm3.Nausea and vomiting increased upto 3rd week but decline in subsequent follow-up. 42% patients had diarrhea during 2ndand 3rd week of treatment, 20.0% in 4thweek and only 2.0% found in 5th week. It can be said that hematopoetic and gastrointestinal syndromes are significantly correlated in patients undergoing pelvic radiation following 4th week of follow up reports. J Bangladesh Coll Phys Surg 2024; 42: 31-37

Treatment of Willis-Ekbom Disease (Restless Leg Syndrome); The Efficacy of Mulligan's Traction Straight Leg Raise among Paramedical Professionals.

Background: Restless Leg Syndrome (RLS) is a generalized neurological sensory-motor disorder characterized by intense restlessness and discomfort in the lower extremities, leading to an urge to move the legs at sleep time. Treatment protocols for RLS may include thermotherapy, stretching exercises, and Mulligan’s traction straight leg raise (SLR). Mulligan’s traction SLR is an effective method that influences peripheral and central neural pathways through mobilization, thereby alleviating RLS symptoms. Objective: The study aimed to compare the efficacy of stretching exercises and Mulligan traction straight leg raise in reducing RLS severity among paramedical staff. Methods: This randomized clinical trial included a sample size of 38 paramedical staff members diagnosed with RLS using standard criteria. Participants were allocated using the Convenient Sampling Technique and randomly assigned into Group 1 (Stretching Exercises) and Group 2 (Mulligan Traction SLR) through coin tossing. Each group consisted of 19 participants. The interventions were conducted three times per week for one month. Assessments were made using the RLS Severity Scale, Numeric Pain Rating Scale, Groningen Sleep Quality Scale, and Goniometer at baseline, and after the 2nd and 4th weeks of treatment. Results: The study indicated that both treatments were effective in treating RLS, showing a significant difference with p&lt;0.05. However, Mulligan's TSLR exhibited remarkable results in improving sleep quality, increasing SLR range of both legs, reducing pain intensity, and improving RLS symptoms, with p-values of 0.001, 0.000, 0.012, and 0.001, respectively. Data analysis was conducted using the Statistical Package for Social Sciences (SPSS) version 26. Conclusion: The study concluded that both Stretching Exercises and Mulligan's TSLR are effective treatments for RLS. However, Mulligan's TSLR showed superior effectiveness in reducing pain levels, RLS symptoms, and in improving sleep quality and SLR range among paramedical staff members.

Effects of Low-Level Laser Therapy on Shoulder Pain, Functional Disability and Range of Motion in Patients with Type II Slap Tear

BACKGROUND: Low-level lasers may occasionally replace surgery or medications without adverse effects, so studying them stands to reason. It heals, regenerates tissue, reduces inflammation, discomfort, and boosts immunity. Research is continuing. It may help physical therapy, healthcare, and the community by being cost-efficient, simple, and successful. OBJECTIVE: To compare the effects of low-level laser therapy and routine physical therapy on shoulder pain, functional disability, and range of motion in patients with Type II SLAP tear. METHODS: It was a Randomized Controlled Trial conducted at Physical therapy department, Sialkot Medical and Physiotherapy Center Branches Pasroor and Sambrail. The estimated sample size is 52, and adjusting for an expected 20% dropouts, the sample size was 62, allocated 31 in each group. Both male and female patients with Age between 50-70 years having Type II SLAP tear, Visual analogue scale (VAS) score above 3 and the patients diagnosed by physician, orthopedic physician or surgeon or rheumatologist were included. The included patients were allocated in group A, routine physical therapy, and Group B low level laser. All the patients were assessed at baseline, at 4th week of Treatment and at 8th week of Treatment for pain, shoulder pain and disability index and shoulder ranges. RESULTS: The results regarding age showed mean and standard deviation to be 1.8387±.77875 in routine physical therapy group while 1.8065±.79244 in low level laser therapy group. The comparison of mean SPADI total score at 8th week of assessment it was found to be respectively 58.3226±4.57083 and 50.3871±4.85577 with a significant mean difference of 7.935 in favor of low-level laser therapy as shown by p value 0.000. Other outcome measures including pain and shoulder ranges were also significantly improved in low level laser therapy group, p value &lt; 0.05. CONCUSSION: The findings of the study concluded that low level plays the therapy is significantly more effective improving pain disability and shoulder range of motions in patients with slap tear, except for abduction range of motion which was improved equally in both groups. Moreover, within routine physical therapy and low-level laser therapy group showed significant improvement at pre and post level of assessment except that of total shoulder and pain disability index score which was not improved significantly in routine physical therapy group without combination of low-level laser therapy.

A3 receptor as a target for the treatment of Alzheimer’s disease

AbstractBackgroundAlzheimer’s disease (AD) is a progressive neurodegenerative disease with clinical features including memory loss, cognitive impairment and dementia that affects over six million Americans. Current treatments for AD have limited efficacy due, in part, to the poorly understood multifactorial nature of the mechanisms driving AD. Our data suggests that alteration of adenosine kinase‐dependent adenosine metabolism and inadequate A3 adenosine receptor (A3AR) signaling in the central nervous system (CNS) are key to these processes. The SAMP8 mouse are a mouse model of sporadic AD exhibiting many key characteristics of AD including age‐associated impairment in learning and memory, which corresponds to age‐related increase in beta amyloid, phosphorylated tau, oxidative stress, neuroinflammation, impaired efflux across the blood‐brain barrier and increased regulatory T‐cells in the brain.MethodWe first measured expressions of ADK and A3AR in the hippocampus of 12 month old. SAMP8 mice. We then treated 11 month old SAMP8 mice with MRS5980 an A3AR receptor agonist MLN5980 every other day for 6 weeks. At the end of the 4th week of treatment, behavior tests were conducted for two weeks. Mice were tested in T‐maze, Novel Object Recognition (NORPT), elevated plus maze and open field.Result12 month old SAMP8 mice treated with the A3AR agonist MRS5980 had improved learning and memory in the T‐maze and NORPT compared to the vehicle treated control mice. There was no difference between the young vehicle treated SAMP8 mice and the MRS5980 treated mice. MRS5980 did not affect activity or anxiety in the open field or elevated plus mazes indicating these factors did nor contribute to improvement in learning and memory.ConclusionHere we identify A3AR in key cognitive centers of the brain and its expression increases with cognitive impairment in the SAMP8 AD mouse model. Moreover, adenosine kinase, an enzyme that reduces extracellular adenosine, also increased. We discovered that supplemental A3AR signaling with highly selective, orally bioavailable, CNS‐penetrant A3AR agonists reversed cognitive impairment without any confounding influence on locomotor activity or anxiety. Our results indicate that A3AR is a useful pathway to give additional insight into changes in the brain with AD potential novel therapies.

5-aminolevulinic acid photodynamic therapy using 560-1200 nm followed by 420-1200 nm broadband light in the treatment of moderate-to-severe acne

BackgroundModerate-to-severe acne vulgaris, which is a chronic inflammatory skin disease, seriously impacts millions of people. However, traditional therapies may cause severe adverse reactions that are unacceptable to many patients, thus limiting the further application of these therapies. Novel therapeutic approaches to effectively treat moderate-to-severe acne vulgaris with minimal adverse reactions are urgently needed. In this retrospective study, we investigated the efficacy and adverse reactions of photodynamic therapy (PDT) using 560–1200 nm followed by 420–1200 nm broadband light (BBL). MethodsTwenty-four patients with moderate-to-severe acne vulgaris were included in the study and all patients expressed a strong desire for beauty. After aminolevulinic acid (ALA) gel applied, the entire face was sequentially irradiated by using BBL with a 560 nm cut-off filter (560–1200 nm), followed by BBL with a 420 nm cut-off filter (420–1200 nm). The clinical efficacy was evaluated by the proportion of patients achieving cured response and excellent response (effective rate), based on the percentage of lesions reduction (treatment rate). The fluorescent images and photographs of acne vulgaris were recorded. Pain and other common local adverse reactions during the treatment were also recorded and evaluated. ResultsIn patients with moderate acne, the mean treatment rates were 57.74 ± 16.40 (%) and 87.40 ± 8.521 (%) at the 6th week and 12th week of treatment, respectively. In patients with severe acne, the mean treatment rates were 60.95 ± 12.06 (%) and 85.04 ± 9.115 (%) at the 6th week and 12th week of treatment, respectively. At the 6th and 12th weeks of treatment, the effective rates of patients were 20.00 % and 93.33 % in patients with moderate acne, and 0.000 % and 88.89 % in patients with severe acne, respectively. Pain scores were significantly higher in patients with severe acne compared to patients with moderate acne when receiving 560–1200 nm BBL-PDT. Additionally, patients when receiving 420–1200 nm BBL-PDT exhibited significantly higher pain scores than those when receiving 560–1200 nm BBL-PDT. The degree of erythema was more severe in patients with severe acne than in those with moderate acne. The pigmentation was observed in one patient with moderate acne and one patient with severe acne. ConclusionThe 560–1200 nm and 420–1200 nm BBL-PDT therapy can effectively treat moderate-to-severe acne vulgaris with tolerable adverse reactions, providing a new option for patients with higher esthetic requirements.

Effects of Natural Extract Rosmarinic Acid on Sleep Quality and Daily Care in Patients with Depression

The mechanism of action of rosmarinic acid (RA), a natural extract from rosemary, on sleep quality (SQ) and daily care (DC) in depressed patients was investigated. Firstly, RA was extracted from rosemary and prepared into RA essential oil (RAEO). High-performance liquid chromatography with diode array detector (HPLC-DAD) was utilized to analyze the chromatography of RA. Subsequently, a retrospective analysis was conducted on 60 depressed patients admitted to the hospital, who were randomly rolled into an observation (Obs) group (treated with escitalopram (SE) and RA) (n = 30) and a control (Ctrl) group (treated with SE) (n = 30). The efficacy of patients was analyzed before and after they were treated differently at 2, 4, 6, and 8 weeks. The levels of nitric oxide (NO) and NO synthase (NOS) of patients in different groups were compared, and the depression status, sleep quality (evaluated using the Pittsburgh Sleep Quality Index, PSQI), and overall quality of life (QOL, evaluated using the General Quality of Life Inventory-74, GQOLI-74) were assessed. The HPLC-DAD-MS analysis indicated that the aqueous solution of RA had multiple biological activities. The PSQI score in the Obs group was lower and the GQOLI-74 score was higher, showing great differences with P &lt;0.05 to those in the Ctrl group. Furthermore, the Obs group had much higher Hamilton Depression Scale (HAMD) scores after 2, 4, 6, and 8 weeks of treatment (P &lt;0.05). The Hamilton Anxiety Scale (HAMA) scores of both groups gradually decreased with the increase of treatment duration, showing great differences before treatment, at the 2nd week, and the 4th week of treatment (P &gt;0.05). However, marked differences were observed at the 6th and 8th weeks in contrast to those before treatment (P &lt;0.05). In the 8th week, patients in the Obs and Ctrl groups exhibited obvious differences to the anxiety levels before treatment (P &lt;0.05). It suggested that the anxiety levels of all patients improved, but that in the Obs group was improved more. In conclusion, the RAEO had a positive impact on sleep quality and daily care in depressed patients, and can serve as a feasible adjunctive treatment method worthy of clinical promotion.

Medical management/Non-surgical of ectopic pregnancy: Case report and review of literature

Ectopic pregnancy is a cause of maternal morbidity and mortality. Management options are surgical, medical and expectant management. Medical management also known as the non-surgical approach is not widely practiced in our environment despite its several advantages over the traditional open salpingectomy including its less invasiveness, reduced cost and absence of anaesthetic risk, surgical risk and need for hospital admission. It however requires early presentation and diagnosis before tubal rupture, a well motivated patient and fulfilment of strict criteria in well selected patients. Aim. To present this rare case report of the medical/non-surgical management of unruptured ectopic pregnancy and a review of the literature. Case report: Mrs AW, Para 3+0 (2 alive) who presented with lower abdominal pains and abnormal scanty vaginal bleeding following 6 weeks of amenorrhoea. Her physical examination revealed a stable cardiovascular state. There were no significant abdominal findings. Vaginal examination revealed positive cervical motion tenderness. A diagnosis unruptured ectopic pregnancy was made. Pelvic ultrasound scan revealed a cystic left adnexial mass measuring 1.94 cm by 1.7 cm with thickened, well circumscribed margins and it contained an echogenic mass (fetal pole) with cardiac pulsation (145/min). The crown-rump length was 0.76cm which corresponded to 6 weeks plus 5 days of gestation. Her serum β hCG was 3625.8miu/ml. She expressed her aversion for a surgical intervention having had 3 previous surgeries. She gave an informed consent for medical/non-surgical management with intramuscular Methotrexate. She subsequently received 3 doses of weekly 100mg intramuscular methotrexate. Each dose of Methotrexate was preceded by re-evaluation of liver/renal function test, full blood count and serum β hCG. By the 4th week of treatment the success of her treatment was confirmed by the insignificant level of β hCG and findings at TVS. She was counselled on the need for prompt localization of any subsequent pregnancy. Conclusion: We presented Mrs AW who was successfully managed for unruptured ectopic pregnancy using the medical/non-surgical approach on out-patient basis. Proper patient selection and follow-up is required for a favourable outcome,

Comparison of Dexamethasone Versus Methylprednisolone With Bupivacaine in Transversus Abdominis Plane Block for Attenuation of Chronic Postoperative Abdominal Pain.

Background Opioids, which have well-known adverse effects such as drowsiness paralytic ileus and respiratory depression, were mostly utilised to treat postoperative pain in the past. The increased incidence of side effectshas led to a rise in interest in pain management techniques that spare opioids. Persistent abdominal pain following surgery has a major detrimental effect on patients' quality of life. While epidural analgesia is widely regarded as the gold standard to combat the pain that is present post abdominal surgeries, it is not devoid ofdrawbacks. The transversus abdominis plane (TAP) block has developed as a potentially effective treatment for severe abdominal pain. The TAP block acts on the neuro-fascial plane between the internal oblique and transversus abdominis muscles, which is innervated by spinal nerves from T6 to L1. Studies reveal that the addition of corticosteroids to bupivacaine in TAP blocks provides pain relief and improves the quality of life of the patient. Aims and objectives In this study, the effects ofbupivacaine and corticosteroids, particularly dexamethasone and methylprednisolone, on chronic abdominal pain following surgery are examined. Assessing the quality of pain relief is the primary objective. Methodology Thirty patients who had undergone abdominal surgery and had been having persistent abdominal pain for six to eight months thereafter and had attempted unsuccessfully to treat the pain with alternative pain relief methods participated in the study. They were divided into two groups at random. Dexamethasone and bupivacaine were given to patients in Group D while methylprednisolone and bupivacaine were given to patients in Group M for ultrasonography (USG)-guided bilateral TAP blocks. At various intervals up to 12 weeks after injection, the patient's pain levels were measured using the visual analogue score (VAS), and their quality of life was assessed using the quality-of-life score. Results Patients in Group M experienced significantly less pain than those in Group D at the fourth, sixth, and 12th weeks of treatment. Furthermore, in the fourth, sixth, and 12th weeks, patients in Group M reported a superior quality of life in comparison to those in Group D. Conclusion Patients with persistent postoperative abdominal pain receiving bupivacaine and methylprednisolone in an ultrasonography-guided TAP block experience more effective and long-lasting pain relief than those who receive bupivacaine and dexamethasone. The quality of life for patients may be enhanced by using corticosteroids to optimise postoperative pain management strategies and lessen the need for opioids, as this study highlights.

Effect of Adding Kinesiotaping to Median Nerve Gliding Exercise Toward Hand Performance of Patients with Carpal Tunnel Syndrome by Using Michigan Hand Outcomes Questionnaire

Background: CTS occurs due to local compression of the median nerve with manifestations of neuropathy, mostly in the productive population. Many conservative treatments have been observed to reduce the degree of pain and quality of life in CTS patients. Kinesiotaping is a new therapy that has been widely used for various musculoskeletal conditions and is known for reducing median nerve compression. Aim: To determine the effect of adding kinesiotaping to median nerve gliding exercise on hand function in CTS patients by using the Michigan Hand Outcomes Questionnaire. Methods: This research was an experimental randomized pre-and post-test group design. A sample of 24 patients from the Medical Rehabilitation Outpatient in RSUP Dr. Kariadi were divided into two groups randomly. The intervention group (n=12, dropout 1) got kinesiotaping application and median nerve gliding exercise. The control group (n=12, dropout 1) did the median nerve gliding exercise only. Hand performance has been evaluated before and at the end of the 4th week of treatment by using the Michigan Hand Outcomes Questionnaire. Result: There were significant improvements in the intervention group’s right-hand function (p&lt;0,001), activities of daily living (ADLs) or the ability of the right hand to do certain tasks (p&lt;0,001), work performance (p&lt;0,001), pain (p=0,024), and satisfaction (p&lt;0,001), as compared to the control group. Meanwhile, the intervention and the control group did not show significant differences in left-hand function score (p=0.884), left-hand ability score (p=0.884), and aesthetics score (p=1,000). Conclusion: There was a positive effect on improving hand performance in CTS patients by adding kinesiotaping to median nerve gliding exercises.

Different Biomarkers of Response to Treatment with Selective Jak-1 Inhibitors in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a systemic autoimmune disease that causes progressive joint damage. The Janus kinase (JAK) inhibitors (JAK-I) represent a new therapeutic option for RA patients, blocking the intracellular JAK-STAT pathway. Today, no studies have been conducted to determine whether new biomarkers could better reflect disease activity in patients treated with JAK-I than traditional disease activity indicators. Thus, the aim of our study was to determine additional disease activity biomarkers in RA patients receiving selective JAK-1 inhibitors. we enrolled 57 patients with RA: 34 patients were treated with Upadacitinib (UPA) and 23 patients with Filgotinib (FIL). All patients were evaluated for clinimetry with DAS28 and Crohn's Disease Activity Index (CDAI), number of tender and swollen joints, Visual Analogic Scale (VAS), Physician Global Assessment (PhGA), and Health Assessment Questionnaire (HAQ), at baseline and at the 12th week of treatment. Lymphocyte subpopulations, complete blood count, erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), anti-cyclic citrullinated peptide antibodies (APCA), rheumatoid factor (RF) IgM, interleukin 6 (IL-6), circulating calprotectin (cCLP), tumor necrosis factor α (TNFα), soluble urokinase Plasminogen Activator Receptor (suPAR), complement functional activity were measured at baseline and after the 12th week of treatment. in both groups of patients, we documented a significant reduction in the clinimetric parameters DAS28, CDAI, number of tender joints, number of swollen joints, VAS, PhGA, and HAQ. Moreover, significant differences were reported for laboratory parameters of ESR, CRP, IL-6, suPAR, cCLP, and PLT/L ratio in both groups. However, no difference was demonstrated between the two groups for changes in renal, hepatic, and lipid parameters. the suPAR and cCLP levels may lead towards a different therapeutic choice between UPA and FIL, with the expression of two different RA pathophenotypes directing FIL towards a lymphocyte-poor form and UPA towards a myeloid form of RA.

Eye Movement Desensitization and Reprocessing Therapy in Adolescents With Panic Disorder: A Twelve-Week Follow-Up Study.

The aim of this study is to investigate the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) treatment in adolescents with panic disorder (PD). This follow-up study consists of 30 adolescents with PD without agoraphobia, aged 14-17 (15.53 ± .97). They were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present, also the Panic and Agoraphobia Scale (PAS) and Beck Anxiety Inventory (BAI) were administered at baseline, at the end of the 4th and 12th weeks of treatment. EMDR therapy which is an eight-phase treatment approach composed of standardized protocols and procedures was applied for 12weeks, one session per week. The baseline mean of the total PAS score decreased from 40.06 to 13.13 at fourth week and 1.2 at the end of 12th week of treatment. In addition, BAI score decreased significantly from 33.67 to 13.83 at 4weeks and 5.31 at the end of 12th week of treatment. Overall, our results underscore the effectiveness of EMDR in adolescents with PD. Moreover, the current study suggests that EMDR may represent an effective intervention technique for PD in adolescents to protect against relapses and to overcome a fear of future attacks.

Dual A1 and A2A adenosine receptor antagonists, methoxy substituted 2-benzylidene-1-indanone, suppresses intestinal postprandial glucose and attenuates hyperglycaemia in fructose-streptozotocin diabetic rats

Background/AimRecent research suggests that adenosine receptors (ARs) influence many of the metabolic abnormalities associated with diabetes. A non-xanthine benzylidene indanone derivative 2-(3,4-dihydroxybenzylidene)-4-methoxy-2,3-dihydro-1 H-inden-1-one (2-BI), has shown to exhibit higher affinity at A1/A2A ARs compared to caffeine. Due to its structural similarity to caffeine, and the established antidiabetic effects of caffeine, the current study was initiated to explore the possible antidiabetic effect of 2-BI.MethodsThe study was designed to assess the antidiabetic effects of several A1 and/or A2A AR antagonists, via intestinal glucose absorption and glucose-lowering effects in fructose-streptozotocin (STZ) induced diabetic rats. Six-week-old male Sprague-Dawley rats were induced with diabetes via fructose and streptozotocin. Rats were treated for 4 weeks with AR antagonists, metformin and pioglitazone, respectively. Non-fasting blood glucose (NFBG) was determined weekly and the oral glucose tolerance test (OGTT) was conducted at the end of the intervention period.ResultsDual A1/A2A AR antagonists (caffeine and 2-BI) decreased glucose absorption in the intestinal membrane significantly (p < 0.01), while the selective A2A AR antagonist (Istradefylline), showed the highest significant (p < 0.001) reduction in intestinal glucose absorption. The selective A1 antagonist (DPCPX) had the least significant (p < 0.05) reduction in glucose absorption. Similarly, dual A1/A2A AR antagonists and selective A2A AR antagonists significantly reduced non-fast blood glucose and improved glucose tolerance in diabetic rats from the first week of the treatment. Conversely, the selective A1 AR antagonist did not reduce non-fast blood glucose significantly until the 4th week of treatment. 2-BI, caffeine and istradefylline compared well with standard antidiabetic treatments, metformin and pioglitazone, and in some cases performed even better.Conclusion2-BI exhibited good antidiabetic activity by reducing intestinal postprandial glucose absorption and improving glucose tolerance in a diabetic animal model. The dual antagonism of A1/A2A ARs presents a positive synergism that could provide a new possibility for the treatment of diabetes.

Real-life Data of Glecaprevir/Pibrentasvir in Chronic Hepatitis C Patients: A Single-center Study

Background: Glecaprevir/pibrentasvir (G/P) is a pangenotypic direct-acting antiviral (DAA) drug with a high resistance barrier. It has been used in patients with chronic hepatitis C in Turkey since March 2019. This drug's efficacy and safety data in Turkey are very limited, and there are not enough studies on real-life data. Objectives: In this study, we aim to present real-life data, efficacy, and safety for our patients. Methods: In this retrospective, observational, single-center study, 116 patients who were started on G/P (100mg/40mg) oral therapy at the infectious diseases clinic between March 2019 and December 2021 due to HCV were included. Of the 116 patients included in the study, 92 were analyzed. Demographic data of the patients, previous treatment experience, drug use, viral load (HCV RNA levels at the 4th week of treatment and 12th week after treatment), and viral genotype data were obtained retrospectively from the automation system. Statistical analysis IBM SPSS version 21.0 statistical package program was used. Results: Seventy-one (77.2%) of the patients were male, and 21 (22.8%) were female, with a mean age of 47.4 (18 - 89). Genotype distribution of patients 8.7% (n = 8) type 1a, 31.5% (n = 29) type 1b, 26.1% (n = 24) type 2, 22.9% (n = 21) type 3, 10.9% (n = 10) were type 4, 8.7% (n = 8) of the patients were treatment-experienced. In our study, there were no patients with cirrhosis. SVR-12 could not be obtained from a patient infected with only genotype 1a. In addition, this patient was co-infected with Hepatitis B. No side effects were observed in any of the patients that required treatment discontinuation. The SVR-12 rate was 98.6% with patients per protocol analysis (PP), but the SVR-12 rate was 77.2% with intention to treat analysis (ITT). Conclusions: In conclusion, this study suggested that G/P therapy in Turkey is used in real life with very high efficacy and tolerability. In addition, a significant change was observed in the genotype distribution previously reported in Turkey in the patient group we treated.

A randomized controlled trial of thrice-weekly versus thrice-daily oral ferrous fumarate treatment in adult patients with iron-deficiency anemia.

Iron deficiency anemia (IDA) is a common health problem in developing countries. Many studies have shown that low-dose oral iron could have similar efficacy and less gastrointestinal effects in iron deficiency without anemia. This prospective open-labeled randomized controlled study was designed to compare the response of 200 mg ferrous fumarate thrice-weekly (TIW) as not inferior to the thrice-daily (TID) regimen and to assess the incidence of adverse events (AEs) between two regimens in treating adult patients with IDA. The primary endpoint was either an increase in Hb ≥ 3 g/dL, having Hb of 12 g/dL in females or 13 g/dL in males at the 12th week of treatment. Secondary outcomes included adverse events (AEs), red blood cell indices, iron profiles, and patient compliance. Sixty-four patients were randomized: 32 in the TIW arm and the other 32 in the TID arm. The response rates were not different between two arms either with intention to treat analysis (72.0%, 95%CI 56.6-88.5 vs. 71.9%, 95%CI 53.3-86.3, p = 0.777); or per-protocol analysis (88.9%, 95%CI 70.8-97.6 vs. 88.5%, 95%CI 69.8-97.6, p = 1.0), respectively. The trial demonstrated non-inferiority at a margin of 23%. Although the iron profile response of the TID arm was earlier than the TIW arm, almost all patients recovered from anemic symptoms at week 4, and hematologic responses were not different at week 12. There were more gastrointestinal AEs in the TID arm. In conclusion, this study showed that the TIW was non-inferior to the TID iron treatment of IDA patients but less AEs and costs.

Comparison of the efficacy and safety of methotrexate alone or in combination with leflunomide in the treatment of juvenile idiopathic arthritis: a double-blind, placebo-controlled, randomized trial.

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disorder in children. Although methotrexate (MTX) is the first line disease-modifying antirheumatic drug for JIA, many patients do not respond well or cannot tolerate MTX. The aim of this study was to compare the effect of combination therapy of MTX and leflunomide (LFN) with MTX in patients who do not respond to MTX. Eighteen patients (2-20 years old) with polyarticular, oligoarticular or extended oligoarticular subtypes of JIA who did not respond to conventional JIA therapy participated in this double-blind, placebo-controlled, randomized trial. The intervention group received LFN and MTX for 3 months while the control group received oral placebo and MTX at a similar dose to the intervention group. Response to treatment was assessed every 4 weeks using the American College of Rheumatology Pediatric criteria (ACRPed) scale. Clinical criteria, including number of active joints and restricted joints, physician and patient global assessment, Childhood Health Assessment Questionnaire (CHAQ38) score, and serum erythrocyte sedimentation ratelevel, did not differ significantly between groups at baseline and at the end of the 4th and 8th weeks of treatment. Only the CHAQ38 score was significantly higher in the intervention group at the end of the 12th week of treatment. Analysis of the effect of treatment on study parameters revealed that only the global patient assessment score differed significantly between groups (p = 0.003). The results of this study showed that combining LFN with MTX does not improve clinical outcomes of JIA and may increase side effects in patients who do not respond to MTX.

Mid-treatment adaptive planning during thoracic radiation using 68 Ventilation-Perfusion Positron emission tomography

Four-Dimensional Gallium 68 Ventilation-Perfusion Positron Emission Tomography (68Ga-4D-V/Q PET/CT) allows for dynamic imaging of lung function. To date there has been no assessment of the feasibility of adapting radiation therapy plans to changes in lung function imaged at mid-treatment function using 68Ga-4D-V/Q PET/CT. This study assessed the potential reductions of dose to the functional lung when radiation therapy plans were adapted to avoid functional lung at the mid-treatment timepoint using volumetric arc radiotherapy (VMAT). MethodsA prospective clinical trial (U1111-1138–4421) was performed in patients undergoing conventionally fractionated radiation therapy for non-small cell lung cancer (NSCLC). A 68Ga-4D-V/Q PET/CT was acquired at baseline and in the 4th week of treatment. Functional lung target volumes using the ventilated and perfused lung were created. Baseline functional volumes were compared to the week 4 V/Q functional volumes to describe the change in function over time. For each patient, 3 VMAT plans were created and optimised to spare ventilated, perfused or anatomical lung. All key dosimetry metrics were then compared including dose to target volumes, dose to organs at risk and dose to the anatomical and functional sub-units of lung. Results25 patients had both baseline and 4 week mid treatment 68Ga-4D-V/Q PET/CT imaging. This resulted in a total of 75 adapted VMAT plans. The HPLung volume decreased in 16/25 patients with a mean of the change in volume (cc) −28 ± 515 cc [±SD, range −996 cc to 1496 cc]. The HVLung volume increased in 13/25 patients with mean of the change in volume (cc) + 112 ± 590 cc. [±SD, range −1424 cc to 950 cc]. The functional lung sparing technique was found to be feasible with no significant differences in dose to anatomically defined organs at risk. Most patients did derive a benefit with a reduction in functional volume receiving 20 Gy (fV20) and/or functional mean lung dose (fMLD) in either perfusion and/or ventilation. Patients with the most reduction in fV20 and fMLD were those with stage III NSCLC. ConclusionFunctional lung volumes change during treatment. Some patients benefit from using 68Ga-4D-V/Q PET/CT in the 4th week of radiation therapy to adapt radiation plans. In these patients, the role of mid-treatment adaptation requires further prospective investigation.