Alternative Treatments Research Articles

PROTOCOLOS TERAPÊUTICOS PARA O TRATAMENTO DA ESPOROTRICOSE FELINA REFRATÁRIA E INOVAÇÕES DECORRENTES DAS PESQUISAS

Sporotrichosis in felines is much more pathogenic than in other animals or in humans, even if immunocompetent, which makes treatment a challenge in clinical medicine, as many of them are refractory to the preferred therapy such as Itraconazole or Ketoconazole. This situation also arises from the prolonged oral administration of the medication, the animal's reluctance to take the drug and the guardian's abandonment of the prescription when he notices an improvement in the lesions caused by the disease, which generates relapses and resistance to the antifungals available on the market. Itraconazole, as well as Ketoconazole, act by causing permeability of the plasma membrane and cell necrosis, however, they have adverse effects such as nausea and vomiting in the first and liver disease as relevance in the second. Terbinafine works by interrupting the synthesis of ergosterol and as a consequence the cell membrane ruptures and death, however, it also has side effects such as gastrointestinal and skin problems. Potassium iodide can be used in combination with azoles or Terbinafine, although the literature does not agree with the issue, as not all felines respond to treatment, adverse effects are due to iodism such as depression, anorexia, vomiting and diarrhea. There are also alternative treatments that can enhance oral medication, such as laser therapy, ozone therapy, cryotherapy and cryosurgery. Due to the issue of non-responsive felines, there is research being developed aiming to provide new therapeutic horizons for these animals, such as the use of intranasal infusion of 1% Clotrimazole spray associated with Itraconazole added with Potassium iodide or not, with good results, no relapses and no side effects. NikZ, the result of a substance produced by the bacterium Streptomyces tendae, called Nikkomycin Z, also appears as a new therapeutic potential for the treatment of Sporotrix spp., with a blocking effect on chitin synthase present in the cell wall of fungi, were maide research with dogs, rats and is in Phase 1 of experiments on humans. NikZ represents a new form of prescription, as it can be placed in the animals' drinking water, avoiding the desertion of those responsible for the felines, it has no observable adverse effects in the analyzes carried out and represents an alternative for cats refractory to existing medical protocols in veterinary.

Study the Antifungal Effects of Green Synthesized Silver Nanoparticles on the Aspergillus niger, Microsporum canis, and Candida albicans

: The increasing prevalence of drug-resistant fungal pathogens and the limitations of current antifungal therapies underscore the need for novel alternative treatments. This study aimed to evaluate the antifungal effects of green-synthesized silver nanoparticles (Ag NPs) on three clinically significant fungi: Aspergillus niger, Microsporum canis, and Candida albicans. Silver nanoparticles were synthesized using plant-based extracts to ensure eco-friendly production methods. The synthesized Ag NPs were characterized using UV spectrophotometry, Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), dynamic light scattering (DLS), zeta potential measurements, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Characterization assays revealed spherical particles with colloidal stability, an average size of approximately 80 nm, a Polydispersity Index of 0.4, and a surface charge of 62.3 mV. Minimum inhibitory concentration (MIC) values demonstrated effective suppression of fungal growth at low nanoparticle concentrations. In conclusion, our study highlights the potential of green-synthesized Ag NPs as a promising alternative to conventional antifungal agents, emphasizing their significant advantages in biocompatibility and eco-friendliness. These findings could pave the way for a new era in treating fungal infections, particularly those caused by drug-resistant strains.

Making Sense of Topical Pain Relief Options: Comparing Topical Analgesics in Efficacy and Safety.

In patients with musculoskeletal (MSK) conditions, pain is the leading contributor to disability and significantly limits mobility and dexterity. This narrative review describes the efficacy and safety of topical analgesics in common use today. Secondary literature gained via a literature search using PubMed.gov and the Cochrane library were used. Recent literature (2000-2023) on several major classes of topical analgesics and topical delivery systems were reviewed to provide strength of recommendation taxonomy (SORT) levels. A total of 86 articles were reviewed. Level 2. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and cabbage leaf wraps (CLW) appear to be best suited for multiple types of acute MSK pain, and topical nitroglycerin is helpful when used specifically for rotator cuff pain in patients seeking relief while performing activities of daily living and willing to treat for long periods of time. For compounded topical formulations, it may be better to offer single agent creams based on patient preferences. Little data support the use of cryotherapy. Traumeel could be a promising natural analgesic that compares with diclofenac. Topical lidocaine appears best suited for postherpetic neuropathic pain. O24 is a reasonable alternative with a low risk profile to treat pain in patients with fibromyalgia syndrome. Choice of topical agents should be guided by current evidence accounting for type of pain, medication side effects, patient comorbidities, as well as patient preference, convenience, and cost. Of the topical analgesics and modalities reviewed, SORT level A evidence was found for topical NSAID use in decreasing MSK pain, topical lidocaine for postherpetic neuralgia, and nitroglycerin patches for treating rotator cuff pain if used for prolonged periods of time. Alternative treatments such as CLW and Traumeel show promising results (SORT level B).

Harnessing Nature's Potential: Innovating Antibacterial Cream through Garlic and Clove Extracts

The onset of the antibiotics period was characterised by the clinical implementation of penicillin, the inaugural antibiotic, unearthed in 1928 by Alexander Fleming in the green mould Penicillium notatum. Garlic and clove have long been used as traditional treatments for different diseases, including infections. Their antibacterial qualities have been attributed to their sulfur-containing components, such as allicin and ajoene in garlic, and eugenol and isoeugenol in clove. In this study, we wanted to produce a novel antibacterial cream leveraging the synergistic properties of garlic and clove extracts. The cream was manufactured utilizing a simple and scalable technique, and its antimicrobial activity was assessed against a panel of microbes present in our surrounding. The results indicated that the cream had considerable antibacterial action against all tested microorganisms, with minimum inhibitory concentrations (MICs) comparable to conventional antibiotics. This study establishes a groundbreaking, ecologically-oriented method for safeguarding and healing the skin. The tropical antimicrobial cream provides a secure and efficient substitute for traditional antimicrobials that may have harsh effects, while also including the nourishing and rejuvenating qualities of tropical botanicals. This groundbreaking research marks a significant advancement in the realm of natural, holistic skin health solutions. The tropical antimicrobial cream stands as a potent alternative to conventional, potentially harsh antimicrobials, offering a safe and effective way to combat skin infections and irritations. Furthermore, its incorporation of nourishing and restorative tropical botanicals transcends mere protection, promoting overall skin health and well-being. Beyond the individual benefits, this innovation holds immense potential for promoting sustainable practices within tropical ecosystems by leveraging resources responsibly and ethically. This paves the way for a future where nature's wisdom empowers us to safeguard our skin with gentle effectiveness, while simultaneously cherishing and preserving the biodiversity that holds the key to our well-being.

Anti-inflammatory effectiveness of Peperomia pellucida (L.) Kunth in rats induced with periodontitis

BackgroundPeriodontitis, marked by deep periodontal pocket depth (PPD), facilitates bacterial colonization and inflammation, necessitating adjunctive therapies. Although 0.2 % chlorhexidine (CHX) mouthwash is effective, its side effects have led to the search for alternative treatments. Peperomia pellucida (L.) Kunth, known as Pepper Elder, is a traditional medicinal plant with potential as an adjunctive herbal therapy for periodontitis. ObjectiveThis study aimed to investigate the anti-inflammatory efficacy of Peperomia pellucida extract in rats with induced periodontitis. MethodsA post-test control group design was used in this laboratory experimental study. Four groups of Wistar strain Rattus norvegicus rats were utilized: a Pristine group (without periodontitis), a negative control group (induced periodontitis only), a positive control group (induced periodontitis and administered 0.2 % CHX), and an experimental group (induced periodontitis and administered 2.5 μL of Pepper Elder extract). Each treatment group received daily administration for one week. PPD measurements were taken on days 0, 3, 5, and 7. Blood serum was collected on day 7 for ELISA to measure IL-1β, TNF-α, IL-10, and IL-13 levels. Statistical analysis was performed using the Kruskal-Wallis test with a post hoc LSD and Mann-Whitney test. ResultsThe extract-treated rats showed a decrease in PPD, with significant differences between the extract group and the negative control group (p < 0.05). TNF-α levels in the extract group differed significantly from the negative control group (p < 0.05) but not from the Pristine and positive control groups. IL-1β levels differed significantly only from the negative control group. IL-10 levels were significantly different from both the Pristine and negative control groups, while IL-13 levels differed significantly only from the negative control group. ConclusionPeperomia pellucida (L.) Kunth extract exhibits anti-inflammatory effects in rats with induced periodontitis.

Advances in Prostate Cancer Immunotherapy: Current Options and Emerging Novel Approaches

Prostate cancer (PCa) is a significant malignancy in men, contributing considerably to the rise in male mortality rates worldwide. Men diagnosed with PCa may have either localized or advanced stages of the disease. Globally, it ranks as the second most common and fifth most aggressive cancer type in males. The likelihood of developing prostate cancer in a man’s lifetime is approximately one in seven. Epidemiological research has linked various environmental and genetic factors to the abnormal growth of prostate cells, which leads to the formation of cancerous cells. Men experiencing a recurrence of prostate cancer or presenting with metastasis typically undergo androgen deprivation therapy (ADT), along with salvage radiotherapy and chemotherapy. While current treatment methods are more effective when used in combination, prostate cancer remains incurable. Research efforts are focused on exploring alternative treatments, including traditional medicine, nanotechnology applications, and gene therapy, to address drug resistance and mitigate the side effects associated with existing treatments. This article provides an overview the current treatment methods, and ongoing research into new treatment alternatives.

Trends in Korean intervention studies on complementary and alternative therapies in rehabilitation nursing.

In nursing, complementary and alternative therapies (CATs) can be provided alongside, or as alternatives, to conventional medical treatments to maximize therapeutic effects, accelerate rehabilitation, and enhance patient satisfaction. Fostering the correct knowledge and attitudes toward CATs is crucial not only for theoretical development but also for practical application. To gain a comprehensive understanding of recent domestic research trends, this study conducted an integrative review to analyze different types of CAT-related intervention studies in rehabilitation nursing in South Korea. A literature search of relevant databases suggested 14 papers. The review revealed that most studies focused on older adult patients, with manipulative and body-based therapies being the most common CAT interventions, followed by energy therapies, mind-body therapies, and others. The efficacy analysis of the CATs used in the selected studies indicated that their effects varied depending on participant characteristics and outcome measures, even when the same CAT was employed. To advance the field of rehabilitation nursing, effective CATs that are proven to be safe for older adult patients need to be developed and actively utilized. Additionally, specialized nurse training programs and clinical and community-based applications for rehabilitation patients requiring interventions need to be developed.

Alternative Treatments for Zirconium Oxide to Compare Commonly Used Surface Treatments to Determine Which Has the Least Effect on the Phase Transformation.

Traditional mechanical processing of zirconium leads to an unfavorable transformation, from a metastable tetragonal phase to a monoclinic phase (t→m), which weakens the structure of the material and subsequently leads to damage to the prosthetic restoration. The aim of this research is to compare commonly used surface treatments to determine which has the least effect on t→m. Thirty cylindrical samples made of sintered zirconium were divided into six groups based on the following treatments: polishing, grinding, sandblasting, chemical etching, laser structuring or dry plasma etching. After surface treatment, the samples were subjected to the following tests: X-Ray Diffraction, microscopic examination, surface wettability and surface roughness measurements. Chemical etching, laser structuring and plasma etching significantly reduce the content of the monoclinic phase. All surface treatments significantly reduced the final amount of the monoclinic phase. However, chemical etching did not provide sufficient surface roughness. Both laser and plasma processing offer the advantage of creating structural patterns on the surface of elements. However, as plasma etching requires a mask to obtain the appropriate pattern on the surface, it seems that laser processing offers more and varied structuring possibilities. Laser structuring is easier to control and more economical than the other methods.

Integrating planetary health education into tertiary curricula: a practical toolbox for implementation.

To present a series of case studies from our respective countries and disciplines on approaches to implementing the Planetary Health Education Framework in university health professional education programs, and to propose a curriculum implementation and evaluation toolbox for educators to facilitate the adoption of similar initiatives in their programs. We emphasize the importance of applying an Indigenous lens to curriculum needs assessment, development, implementation, and evaluation. Case studies from Australia and United States were collated using a six-stage design-based educational research framework (Focus, Formulation, Contextualization, Definition, Implementation, Evaluation) for teaching planetary health and methods of curriculum evaluation. These components were then mapped to derive the curriculum implementation toolbox reflecting the six-stage design-based educational research framework. The case studies demonstrated different approaches to successful integration of the Planetary Health Education Framework in medicine, nursing, public health, and allied health disciplines. This integration often involved Indigenous perspectives on environmental stewardship, holistic health, and community well-being into the curriculum. The case studies also highlighted the importance of community engagement, cultural competency, and interdisciplinary collaboration in curriculum development. Findings from case studies were used to propose a curriculum implementation toolbox to assist educators in adapting and integrating planetary health education into their own programs. While valuable frameworks for teaching planetary health in health science programs exist, challenges remain in implementing these frameworks in real-world educational environments. The proposed curriculum implementation toolbox offers practical strategies and resources for educators to incorporate these principles into their teaching. Additionally, the case studies reported here contribute to the growing body of literature on planetary health education pertinent to addressing the triple planetary crisis.

Factors Associated With Acceptance of an Optional Diagnosis.

A sensation becomes a symptom (a concern) when a person associates it with potential illness. In the absence of objective evidence of a pathophysiological process that has important health consequences without treatment, assigning a diagnosis to the sensation is optional. This is important because labeling of benign bodily sensations as pathophysiology has potential advantages and disadvantages. We asked what patient and clinician factors are associated with willingness to accept an optional diagnosis. In a survey administered using Amazon M-Turk, 536 people anonymously completed validated measures for symptoms of anxiety and depression, intolerance of uncertainty, and skepticism regarding the healthcare system. They then viewed fictional personal medical scenarios in which they were asked to imagine they experienced certain symptoms, and were offered an optional diagnosis of a nerve problem, muscle pain syndrome, or fatigue syndrome, and were asked to rate their willingness to accept the diagnosis on an 12-point ordinal scale from 0 indicating "I do not accept it at all" to 11 indicating "I accept it with enthusiasm." The language of the scenarios was varied to attempt to reflect critical thinking, denigration of other doctors, an alternative mental health focus, or a hopeful outlook. Multilevel linear regression was used to identify factors associated with likelihood of accepting an optional diagnosis. Threshold likelihood of accepting an optional diagnosis greater than 5.5 on a 0 to 11 ordinal scale was independently associated with greater symptoms of anxiety (regression coefficient [RC]=0.38, 95% confidence interval [95% CI]=0.30-0.47, P <.001), greater skepticism regarding the healthcare system (RC=0.11, 95% CI=0.076-0.13, P <.001), and delivery tones characterized by either denigration of other doctors (RC=0.39, 95% CI=0.19-0.60, P <.001) or a hopeful outlook (RC=0.50, 95% CI=0.26-0.73, P <.001). Likelihood of accepting an optional diagnosis may be a sign of relative vulnerability from feelings of distress or distrust of medical evidence. Given this potential vulnerability, clinicians can take care to limit persuasive communication styles that can influence acceptance of optional diagnoses. III prognostic.

Medical and health benefits of noise reduction at Intensive Care Units

Introduction: The presence of excessive noise poses a significant risk to the overall well-being and health of individuals. The presence of elevated noise levels within Intensive Care Units (ICUs) has the potential to exert detrimental effects on both the well-being of patients and the healthcare personnel. The aim of this study: This study aims to gather knowledge about the effects of noise pollution on patient’s wellbeing within Intensive Care Units, analyze various investigations around the world and discuss the possible preventive methods of reducing noise and thus sleep disturbances. Materials and methods: This review was based on available data collected in the PubMed database and Google Scholar web search engine using the key words Intensive Care Unit, sleep deprivation, noise pollution Conclusions: Intensive Care Unit noise disrupts patient’s sleep, communication, and increases stress, potentially leading to medical errors and longer recovery times. Addressing this issue is vital, aligning with patient-centered care and holistic therapy trends. Solutions include architectural changes, quieter equipment, staff education, clinical guidelines, and providing earplugs and eye masks for patient comfort. Noise negatively impacts sleep, causing circadian disruptions, cognitive impairments, and health issues. Identifying and mitigating noise sources can significantly enhance patient well-being and treatment outcomes.

Integralidade na formação de Terapeutas Ocupacionais: análise das percepções e estrutura curricular da Graduação

Introduction: Integrative and Complementary Health Practices (PICS) in the area of ​​Occupational Therapy (OT) require training and discussion in the graduation process to guarantee access and care within the integral reasoning of the body, mind, emotions and connections. Objectives: To verify the training, perceptions and experiences with PICS of OT undergraduates at the Faculty of Medicine of Ribeirão Preto at the University of São Paulo. Methods: Cross-sectional, exploratory, descriptive and quantitative study using an online questionnaire developed in research with undergraduates in the last semester and analysis of the curricular structure and teaching plans. Results and discussion: Of the total of 17 undergraduates, 12 reported knowledge about PICS (100%), 92% used them for personal purposes, and 17% stated doubts about their effectiveness and uncertainty about their credibility in the Brazilian Unified Health System (SUS) as a therapeutic resource in the profession. There was minimal training offered on PICS, of the 69 subjects in the undergraduate course, 3 dealt with the topic in a theoretical and experimental way, with a low workload and insufficient content for logic and professional use. Final considerations: There is a need for curricular changes to incorporate these practices as a therapeutic resource within the profession in order to guarantee access and quality care to the population.

A Study on Health-Promoting Effects of Assistive Technology.

This study evaluated the health-promoting effects of assistive technology(AT) from a holistic health perspective with the data from the rapid Assistive Technology Assessment (rATA) survey conducted by the World Health Organization (WHO) in China in 2021. Through a generalized ordered logit regression, we found that AT mainly aids in the reduction of "severe impairment" in basic activities of daily living (BADL) and facilitates the attainment of "minimal impairment" in instrumental activities of daily living (IADL), indicating that AT at the current stage not only serves as a tool to maintain basic survival, but also plays a crucial role in promoting overall health. Further research ascertained that the effects of assistive technology on BADL and IADL bear resemblances between two age groups but differ between urban and rural residents. Consequently, efforts must be made to enhance the supply system of AT, thereby improving social well-being for all.

Moral challenges and understanding of clinical ethics in Tanzanian hospitals: Perspectives of healthcare professionals.

Healthcare professionals encounter many moral challenges in their daily clinical practice. However, there have been few studies on the subject matter in Tanzania. This study aims to provide an account of moral challenges faced by healthcare professionals in Tanzanian hospitals, their understanding of clinical ethics, and the ethics education they have received. Many participants reported receiving some kind of ethics training through formal education and on-the-job training. Some participants understood ethics in healthcare settings as adherence to established laws, regulations, guidelines, procedures, norms, and rules essential in clinical practice. Analysis of the data identified four themes of moral challenges. These challenges are related to 1) decision-making and communication in clinical practice, 2) scarcity of medical resources and prioritization in clinical practice, 3) withdrawal of curative treatment, and 4) conflicts between professional judgment, religious convictions and adherence to alternative treatments. Based on the findings, we suggest a context-sensitive form of clinical ethics training to prepare healthcare professionals to recognize and address these moral challenges.

Health-seeking dynamics and uptake of ethnomedical therapies for chronic pain among people who use drugs in Nigeria

This study explored health-seeking practices and utilization of ethnomedical therapies for chronic pain management among people who use drugs (PWUD) in Nigeria. Data were generated through in-depth interviews with PWUD who lived with chronic pain (n = 26). Participants were recruited through snowball sampling in Uyo, Nigeria. Interviews were recorded, transcribed verbatim, coded and analysed thematically. Participants reported challenges with biomedical pain management, including a lack of cure for pain and low adherence to medications due to financial constraints and restrictions on dispensing of pharmaceutical opioids. These challenges contributed to inadequate biomedical management of chronic pain and encouraged utilization of herbal remedies, including those originating from other ethno-linguistic settings. While some preferred herbal remedies to biomedical care, others used these remedies due to inability to access biomedical pain management. Further, while some found herbal remedies to be helpful in relieving pain, others experienced adverse reactions and sought emergency medical services for this reason. As a result, they disavowed ethnomedical therapies and reaffirmed trust in biomedicine. Participants choose between biomedicine and ethnomedical therapies in managing chronic pain, and these choices were often shaped by structural inequality and the wider context of medical pluralism. Findings indicate a need to promote diversity and choice in healthcare and ensure access to safe, equitable and culturally-appropriate care through health insurance coverage and formal regulation of ethnomedical providers.

To Evaluate Structured Competency-Based Curriculum for Health Programs among Community Medicine Postgraduates: Mixed Method Approach

Background: The postgraduate curriculum needs to be given a definite shape so as to make health programs more intensive and integrative. In the present scenario, most of the information is unclear and infrequent. A structured public health competency-based education is an important aspect to consider for integrative health care. Evaluate the structured competency-based curriculum (SCBC) prepared on health program matters. Methods: Mixed method model involving postgraduate students, faculties in community medicine departments of selected medical colleges and stakeholders from district administration. The SCBC was piloted and validated for use. The evaluation was then done based on pre- and posttest performance analysis, satisfaction survey, and questionnaires for reaction and learning components. Results: For a complete understanding of the program, students had to invest 52 hours of stipulated time. CBC assessment mean scores for a) problems in PHC and programmatic evaluation (78.9%) and b) identification of success and failure of programs (78.2%) were more than 75% mean score; whereas, assessment scores for topics on a) resource allocation and b) evaluation of program as write-up was 65% and 52%, respectively. As compared to the conventional method, the SCBC showed a critical evaluation score of 70% with a 0.001 significance level. Discussion and Conclusion: Students’ narratives were that they could understand as well as integrate them better on the field. There was enhanced satisfaction and encouragement. Structured curriculum will also help in making learning more student-centric and go a long way in boosting their creativity.

The Potential Role of Herbal Plants in the Management of Depression: Pre-Clinical and Clinical Evidence

Depression, a debilitating mental health disorder affecting millions worldwide, con-tinues to challenge the medical community. While several pharmacological interventions ex-ist, their efficacy and side effects often warrant the exploration of alternative treatments. Natu-ral products derived from plants have gained attention for their potential antidepressant prop-erties in preclinical studies. This comprehensive review examines the antidepressant activity of various plant-based extracts through preclinical investigations and explores the underlying mechanisms of action. Our review systematically analyzes the literature, encompassing a wide range of plants. We present evidence from pre-clinical and clinical studies, highlighting the behavioural and neurochemical changes induced by these plant-derived compounds. Further-more, we delve into the potential mechanisms of action, encompassing modulation of neuro-transmitters, anti-inflammatory effects, neurogenesis promotion, and antioxidant properties. The reviewed studies suggest that numerous plants possess promising antidepressant proper-ties, potentially offering novel therapeutic avenues. However, the variability in methodologies and the need for further clinical validation underscore the complexity of translating preclinical findings into effective treatments. This review serves as a valuable resource for researchers and clinicians alike, shedding light on the current state of knowledge regarding plants with an-tidepressant potential and their underlying mechanisms of action, paving the way for future investigations and therapeutic developments in the field of depression management.

Flavonoids against depression: a comprehensive review of literature.

Depression is a state of low mood and aversion to activity, which affects a person's thoughts, behavior, motivation, feelings, and sense of wellbeing. Pharmacologic therapies are still the best effective treatment of depression. Still, most antidepressant drugs have low efficacy and delayed onset of therapeutic action, have different side effects, and even exacerbate depression. Such conditions make it possible to look for alternatives. Consequently, we decided to summarize the impact of flavonoids on depression in this review. We searched scientific databases such as SCOPUS, PubMed, and Google Scholar to find relevant studies until July 2022. A wide variety of natural components have been shown to alleviate depression, one of which is flavonoids. Due to the growing tendency to use natural antidepressant drugs, scientific studies are increasingly being conducted on flavonoids. This study aims to review the latest scientific researches that indicate the antidepressant potential of flavonoids. Various mechanisms include neurotransmitter system modulation and dopaminergic, noradrenergic, and serotonergic pathways regulation in the central nervous system. Different compounds of flavonoids have antidepressant properties in vivo or in vitro experiments or clinical trials and can be used as alternative and complementary treatments for depression. In general, it was observed that there were no severe side effects. Our study proves the antidepressant potential of flavonoids, and considering the limited side effects, they can be used as complementary medicine for depressed patients.

Can ChatGPT-4 Diagnose and Treat Like an Orthopaedic Surgeon? Testing Clinical Decision Making and Diagnostic Ability in Soft-Tissue Pathologies of the Foot and Ankle.

ChatGPT-4, a chatbot with an ability to carry human-like conversation, has attracted attention after demonstrating aptitude to pass professional licensure examinations. The purpose of this study was to explore the diagnostic and decision-making capacities of ChatGPT-4 in clinical management specifically assessing for accuracy in the identification and treatment of soft-tissue foot and ankle pathologies. This study presented eight soft-tissue-related foot and ankle cases to ChatGPT-4, with each case assessed by three fellowship-trained foot and ankle orthopaedic surgeons. The evaluation system included five criteria within a Likert scale, scoring from 5 (lowest) to 25 (highest possible). The average sum score of all cases was 22.0. The Morton neuroma case received the highest score (24.7), and the peroneal tendon tear case received the lowest score (16.3). Subgroup analyses of each of the 5 criterion using showed no notable differences in surgeon grading. Criteria 3 (provide alternative treatments) and 4 (provide comprehensive information) were graded markedly lower than criteria 1 (diagnose), 2 (treat), and 5 (provide accurate information) (for both criteria 3 and 4: P = 0.007; P = 0.032; P < 0.0001). Criteria 5 was graded markedly higher than criteria 2, 3, and 4 (P = 0.02; P < 0.0001; P < 0.0001). This study demonstrates that ChatGPT-4 effectively diagnosed and provided reliable treatment options for most soft-tissue foot and ankle cases presented, noting consistency among surgeon evaluators. Individual criterion assessment revealed that ChatGPT-4 was most effective in diagnosing and suggesting appropriate treatment, but limitations were seen in the chatbot's ability to provide comprehensive information and alternative treatment options. In addition, the chatbot successfully did not suggest fabricated treatment options, a common concern in prior literature. This resource could be useful for clinicians seeking reliable patient education materials without the fear of inconsistencies, although comprehensive information beyond treatment may be limited.

THE ROLE OF PHYSICAL ACTIVITY IN IMPROVING THE QUALITY OF SLEEP OF PATIENTS WITH VARIOUS SLEEP DISORDERS

Sleep is an important human behavior and difficulties with sleep are closely related to health, potentially leading to the development of diseases and a reduced quality of life. Sleep disorders cover a wide range of problems associated with mental health disorders, such as anxiety and depression, and contribute to an increased tendency to become overweight or obese. In addition, sleep difficulties can lead to more serious sleep disorders, such as problems with sleep maintenance, poor sleep efficiency, and reduced daytime attention. The purpose of the study is to highlight the role of physical activity in improving the quality of sleep in patients with various sleep disorders. Materials and methods. To better understand the impact of physical activity on sleep quality and its positive effect on sleep onset and duration, a search of scientific literature was conducted between 2019 and 2024 in the PubMed, Scopus, Web of Science, and Google Scholar databases using the terms “exercise,” “sleep,” “quality of life,” “insomnia,” and “activity.” The search resulted in the selection of publications that examined the relationship between daily sleep and physical activity and will be discussed in this review. Results. The study identified potential biological pathways that explain the possible interactions between sleep and physical activity in the short and long term. Acute or repetitive physical activity increases total sleep time by reducing insulin resistance and the concentration of inflammatory markers, better regulation of circadian rhythm, and the release of brain-derived neurotrophic factor. In turn, sleep deprivation can alter physical performance or contribute to fatigue during physical activity by increasing cortisol concentrations, decreasing growth hormone and prolactin concentrations, and stimulating inflammatory markers. Scientific studies have established the beneficial effects of physical activity in alleviating sleep problems. Numerous studies show that moderate to vigorous physical activity has a positive effect on sleep quality. Physical activity has pluripotential beneficial effects on bodily functions. These benefits include a reduction in the incidence of cardiovascular disease, coronary heart disease, hypertension, type 2 diabetes, and death. In addition to these effects, physical activity has a significant beneficial effect on the onset, duration, and quality of sleep, which complements its beneficial effects. In contrast, lack of sleep is associated with an increased incidence of cardiovascular complications and death. In this regard, physical activity serves as a non-pharmacological means of improving sleep, especially in older people who often have difficulty falling asleep. Regarding the time of exercise and its effect on sleep, there was no difference between morning and evening exercise in terms of sleep onset and quality. In addition, the multifaceted benefits of physical activity go beyond improving sleep to contribute to overall well-being and longevity, offering a comprehensive health solution that is comparatively better than alternative treatments. Conclusions. Based on the research presented here, it can be concluded that the scientific literature has identified an improvement in sleep quality after physical activity, and empirical evidence confirms its positive impact, regardless of type or intensity. Increased physical activity was found to be associated with improved total sleep duration, reduced sleep latency, and improved sleep efficiency. Exercise can improve sleep by reducing sleep latency and increasing slow wave sleep.