Loss Of Appetite Research Articles

Caregiver-reported symptomburden and preferences for therapeutic goals in pediatric primary sclerosing cholangitis.

This study analyzed qualitative and quantitative survey responses from 51 pediatric primary sclerosing cholangitis (PSC) patients and caregivers using the PSC Partners Patient Registry-Our Voices survey. The most common symptoms reported by children/caregivers include: fatigue (71%), abdominal pain (69%), anxiety (59%), appetite loss (51%), insomnia (49%), and pruritus (45%). When experiencing symptoms at their worst, over half of patients/caregivers reported limitations in physically demanding activities (67%), work/school duties (63%), social life activities (55%), and activities for fun or exercise (53%). Over half of patients/caregivers expressed willingness to participate in clinical trials, however none reported ever participating in trials for new or investigational PSC drugs. This study revealed a substantial patient/caregiver-reported symptom burden for children with PSC that impacts quality of life and limits access to clinical trials. Future efforts should focus on developing patient-centered clinical endpoints for PSC trials, increasing trial availability for pediatric PSC patients, and reducing logistical barriers to trial involvement.

Quality of life assessment in diffuse large B-cell lymphoma (DLBCL) in REFLECT: a prospective, non-interventional, multicenter, German study, assessing Sandoz rituximab in combination with CHOP

Health-related quality of life (HRQoL) data are important indicators of health status in patients with lymphoma. The objective of this analysis was to assess the impact of treatment with Sandoz rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) on HRQoL in treatment-naïve adult patients with diffuse large B-cell lymphoma (DLBCL) included in the prospective, real-world REFLECT study. REFLECT is the first prospective study to assess HRQoL in patients with DLBCL treated with a rituximab biosimilar. HRQoL was assessed via the patient-reported European Organization for Research and Treatment of Cancer Core Quality of Life questionnaire at baseline, mid-treatment (month 3), end of treatment (month 6), and follow-up (months 9 and 12). Subgroup analyses were performed to evaluate the influence of baseline characteristics on HRQoL, and associations between baseline HRQoL and treatment response. HRQoL was assessed in 169 patients. Mean global health status score remained stable from baseline (54.8) to mid-treatment (month 3; 54.7), before steadily improving through to end of treatment (month 6; 61.4), and follow-up month 9 (64.9) and month 12 (68.8). Similar trends were observed across most functional and symptom subscales. Higher cognitive, physical, or role functioning, and less appetite loss, diarrhea, fatigue, or pain at baseline, were all associated with an improved likelihood of reaching a complete versus partial response at the end of treatment. Overall, these findings confirm the HRQoL benefits of R-CHOP therapy in treatment-naïve adult patients with DLBCL, and suggest that baseline HRQoL may be predictive of treatment response.

A case of acute kidney injury and Fanconi syndrome while taking multiple supplements, including Red Yeast Rice Cholesterol Help®.

A 62-year-old man visited his primary care physician with the complaints of loss of appetite and fatigue. He was admitted to our hospital based on a diagnosis of acute kidney injury, Fanconi syndrome as indicated by hypokalemia, hypouricemia, hypophosphatemia, elevated glucose levels in urine, and aminoaciduria. He had been taking multiple supplements, including Red Yeast Rice Cholesterol Help®, for one and a half years. After admission, all the supplements were stopped. Blood samples were collected; however, the samples were negative for diseases that could cause Fanconi syndrome. Renal biopsy revealed renal proximal tubular damage, mainly characterized by simplification of the proximal tubular epithelium. The mycotoxin, citrinin, which is reported to be produced by the mold used for producing red yeast rice, but not the mold Monascus pilosus used for Red Yeast Rice Cholesterol Help®, reportedly causes proximal tubular damage. However, although the causative agent has not been identified, it was thought that a substance similar to citrinin, produced by the mold used for Red Yeast Rice Cholesterol Help®, caused proximal tubular damage, leading to acute kidney injury and Fanconi syndrome. Hence, all supplements were stopped, and the patient was treated with oral potassium and phosphorus preparations, leading to gradual recovery of his kidney function. We herein report the first case of acute kidney injury and Fanconi syndrome in a patient taking multiple health supplements, including Red Yeast Rice Cholesterol Help®. Early discontinuation of the oral supplements was probably useful in improving the patient's kidney function.

QUATTRO-II randomized trial: CAPOXIRI+bevacizumab vs. FOLFOXIRI+bevacizumab as first-line treatment in patients with mCRC

The QUATTRO-II trial examined the efficacy and safety of capecitabine+oxaliplatin+irinotecan (CAPOXIRI)+bevacizumab (BEV) vs. 5-fluorouracil+folinic acid+oxaliplatin+irinotecan (FOLFOXIRI)+BEV in metastatic colorectal cancer (mCRC). In this phase II study (ClinicalTrials.gov: NCT04097444; jRCTs041190072), patients were randomized (1:1) to FOLFOXIRI+BEV or CAPOXIRI+BEV. The induction treatment in the FOLFOXIRI+BEV/CAPOXIRI+BEV arms was continued for 8/6 cycles (maximum 12/8 cycles if feasible), and the maintenance treatment was 5-fluorouracil/leucovorin+BEV or capecitabine+BEV at the investigators' discretion. The primary endpoint was progression-free survival (PFS), with the two arms deemed equivalent if the hazard ratio (HR) of the point estimate was 0.80<HR<1.25. Secondary endpoints were overall response rate (ORR), overall survival (OS), incidence of adverse events (AEs), and patient-reported outcomes. Overall, 51 and 52 patients were randomized to FOLFOXIRI+BEV and CAPOXIRI+BEV, respectively. The study met itsprimary endpoint; PFS at median follow-up of 23.7 months was 10.6 months (95% confidence interval [CI], 7.7-13.3) in the FOLFOXIRI+BEV arm vs. 10.9months (95% CI, 9.3-14.3) in the CAPOXIRI+BEV arm (HR1.114 [0.80<HR<1.25], p= 0.654). In the FOLFOXIRI+BEV vs. CAPOXIRI+BEV arms, the 2-year OS rate (95% CI) was 65.5% (49.5%-77.6%) vs. 74.3% (59.8%-84.2%), and the ORR (95% CI) was 76.5% (62.5%-87.2%) vs. 84.6% (71.9%-93.1%). Major (grade ≥3) AEs in the FOLFOXIRI+BEV vs. CAPOXIRI+BEV arms were neutropenia (68.6% vs. 40.4%), febrile neutropenia (9.8% vs. 11.5%), diarrhea (7.8% vs. 17.3%), and appetite loss (7.8% vs. 17.3%). CAPOXIRI+BEV was well tolerated with reduced hematological toxicity and efficacy comparable to those of FOLFOXIRI+BEV, providing a potentially convenient first-line treatment alternative to FOLFOXIRI+BEV in patients with mCRC. Chugai Pharmaceutical Co., Ltd.

BMI, weight change, appetite reduction and cognitive impairment of elderly patients with diabetes

Body weight is related to both diabetes and cognitive impairment; however, the associations between body mass index (BMI) and cognitive impairment have been reported less frequently among diabetes patients. A total of 1355 patients with type 2 diabetes aged ≥ 60 years were included in this study. The Montreal Cognitive Assessment (MoCA) was administered to assess participants’ cognitive status. We collected self-reported body weight, weight loss and appetite loss data using questionnaires. Associations between body weight status (in childhood, midlife age, and late life), weight loss, appetite changes and cognitive impairment were explored using logistic regression. Among the participants, 41.7% exhibited cognitive impairment. Overweight in childhood and late life was associated with cognitive impairment among diabetes patients (OR 2.63, 95% CI 1.52–4.55; OR 1.32, 95% CI 1.03–1.69). Diabetes patients with cognitive impairment were more likely to report a body weight decline and appetite reduction in the past three months (OR 4.18, 95% CI 2.61–6.71; OR 4.41, 95% CI 2.67–7.29). Higher BMI, weight loss, and appetite reduction were positively correlated with cognitive impairment. Given the risk of cognitive impairment, we suggest that body weight and BMI decline should be monitored in patients with diabetes.

Patient-reported outcomes for the phase 3 FURLONG study of furmonertinib versus gefitinib as first-line therapy for Chinese patients with locally advanced or metastatic EGFR mutation-positive non-small cell lung cancer

Furmonertinib showed superior efficacy compared with gefitinib as first-line therapy in patients with epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) in the FURLONG study. Here we present prespecified secondary endpoints of patient-reported outcomes (PRO). In this multicentre, double-blind, double-dummy, randomised phase 3 study, patients were 1:1 randomly assigned to receive furmonertinib 80mg once daily or gefitinib 250mg once daily. PROs assessed by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and Quality-of-Life Questionnaire Lung Cancer 13 were analysed using a mixed model for repeated measures and time-to-event analyses. A difference in score of 10 points or more was deemed clinically relevant. Three hundred and fifty-seven patients (furmonertinib group, n=178; gefitinib group, n=179) received at least one dose of the study drug, all of whom completed at least one PRO assessment. Statistically significant difference of overall score changes from baseline favoured furmonertinib in physical functioning (between-group difference 2.14 [95% CI 0.25-4.04], p=0.027), nausea/vomiting (-1.56 [95% CI-2.62 to-0.49], p=0.004), appetite loss (-2.24 [95% CI-4.26 to-0.23], p=0.029), diarrhoea (-3.36 [95% CI-5.19 to-1.54], p < 0.001), alopecia (-2.62 [95% CI-4.54 to-0.71], p=0.007), and pain in other parts (-4.55 [95% CI-7.37 to-1.74], p=0.002), but not reached clinical relevance. Time to deterioration in physical functioning (hazard ratio 0.63 [95% CI 0.42-0.94], p=0.021), cognitive functioning (0.73 [95% CI 0.54-0.98], p=0.034), nausea/vomiting (0.64 [95% CI 0.41-0.99], p=0.042), appetite loss (0.63 [95% CI 0.43-0.92], p=0.016), diarrhoea (0.63 [95% CI 0.46-0.85], p=0.002), dyspnoea (0.72 [95% CI 0.53-0.98], p=0.034), cough (0.67 [95% CI 0.44-1.00], p=0.049), dysphagia (0.54 [95% CI 0.35-0.83], p=0.004), and alopecia (0.62 [95% CI 0.42-0.90], p=0.012) was longer with furmonertinib versus gefitinib. In patients with locally advanced or metastatic EGFR mutation-positive NSCLC, furmonertinib showed improved scores and delayed deterioration in several functioning and symptoms compared to gefitinib. Shanghai Allist Pharmaceutical Technology Co., Ltd and the National Science and Technology Major Project for Key New Drug Development (2017ZX09304015).

Prospective study on health-related quality of life, oral mucositis and oral health on during treatment of head and neck cancer

BackgroundFew studies have examined health related Quality of Life (HR-QoL) during the treatment of head and neck cancer (HNC) with even fewer focusing on the impact of oral mucositis (OM) on HR-QoL. Studies performed during treatment of HNC makes it possible to follow fluctuations in HR-QoL, OM and other treatment related side effects. The aim was to prospectively analyze HR-QoL, changes in clinical variables and the impact of OM on HR-QoL during HNC treatment.Materials and methodsPatients were recruited before commencing curative cancer treatment and were given professional oral care weekly during oncologic treatment. HR-QoL was reported before, during (week 2, 4 and 6) and three months after treatment using the EORTC Quality of Life questionnaires C30 and H&N35 and the stimulated whole salivary secretion rate was determined at the same time-points. OM (erythema and ulceration) was registered using the Oral Mucositis Assessment Scale (OMAS), at baseline, weekly during treatment and post treatment. Differences in HR-QoL between different timepoints were analyzed. To analyze the impact of OM on HR-QoL the patients were categorized into two groups: no/mild OM (OMAS ulceration score 0–1) or severe OM (OMAS ulceration score ≥ 2) and HR-QoL was compared between the two OM groups at three timepoints during treatment.ResultsFifty-seven patients (43 men, 14 women), with a mean age of 58 years were included. Patients reported progressively impaired HR-QoL, with peak issues noted at weeks 4 and 6, particularly in social eating, senses, appetite loss, sticky saliva, and decreasing salivary secretion rates were determined. Patients with severe OM reported worse HR-QoL compared to those with no/mild OM. Persistent problems 3 months post treatment were appetite loss, dry mouth, senses (smell and taste) and problems with social eating.ConclusionPatients experienced exacerbated symptoms and problems weeks 4 and 6 of oncological treatment, especially among those with severe OM, stressing the importance of clinically monitoring the patients to reduce and alleviate their symptoms. Persistent problems three months post treatment are likely associated with the reduced salivary secretion rate indicating that patients should be monitored also after completed oncological treatment.

Sonographic Evaluation of Cholelithiasis in Diabetic Patients at District Swabi

Background: Cholelithiasis, the formation of gallstones in the gallbladder, is prevalent among individuals experiencing abdominal discomfort such as epigastric pain, nausea, and loss of appetite. The relationship between diabetes and the increased risk of developing gallstones has been noted, highlighting the importance of understanding this association for better disease management. Objective: The aim of this study was to evaluate the prevalence and characteristics of gallstones in diabetic patients in the district of Swabi using ultrasonography to enhance early diagnosis and treatment approaches. Methods: This cross-sectional study was conducted at the Department of Radiology, District Head Quarters Hospital, Swabi, Pakistan. Participants included individuals presenting with upper right quadrant pain or with a history of diabetes. Ultrasonographic examinations were performed using a Toshiba Xeiro convex probe with a frequency range of 3-5 MHz. Data was collected through clinical histories and radiographic examinations, and analyzed using SPSS version 25. Ethics approval was obtained in accordance with the Declaration of Helsinki, and all participants provided informed consent. Results: A total of 112 patients were enrolled with ages ranging from 8 to 80 years (mean ± SD = 39.37 ± 16.72 years). Females constituted 56.4% (n=62) and males 43.6% (n=48) of the study population. The majority, 88.2% (n=97), reported right hypochondriac pain. Among the patients, 60% (n=66) had multiple gallstones; of these, 36.4% (n=24) were diabetic. Conversely, 40% (n=44) had a single stone, with 38.6% (n=17) being diabetic. Conclusion: The study indicates a significant association between diabetes and the presence of multiple gallstones, underscoring the need for routine ultrasonographic screening in diabetic patients experiencing right hypochondriac pain. Early detection could lead to better management and potentially reduce complications associated with cholelithiasis.

Kidney disease knowledge among patients visiting the nephrology clinic in the Kingdom of Saudi Arabia.

This study aimed to explore chronic kidney disease (CKD)-related knowledge and its predictors among non-dialysis patients with CKD in the Kingdom of Saudi Arabia (KSA). It was a cross-sectional survey conducted at 2 nephrology centers in KSA. Data were gathered using a survey questionnaire that included sociodemographic information and enquiries about CKD. The questionnaire used to explore CKD knowledge consisted of 24 questions with 3 multiple-choice answers for each question: "True," "False," and "I don't know." Data were obtained from 185 patients who visited a nephrology clinic. The major study population was drawn from the western region of the Kingdom of Saudi Arabia. The participants' mean (SD) total renal disease knowledge scores was 12.56 (3.55) out of a maximum of 24 points on the renal disease knowledge assessment. This suggests that the participants, on average, exhibited a moderate level of knowledge regarding renal disease. Most respondents correctly answered questions related to blood and urine tests (90.3% and 89.7%, respectively), living with a single kidney (88.1%), kidney function in blood cleansing (83.8%), risk factors like diabetes (82.7%), and hypertension (80%). Additionally, they recognized symptoms such as water retention (85.9%) and fatigue (61.6%) and the potential of certain medications to slow chronic kidney disease progression (72.4%). However, fewer respondents correctly identified nausea/vomiting (31.4%) and loss of appetite (31.4%) as signs of kidney disease, the role of kidneys in maintaining blood pressure (58.9%) and bone health (16.2%), and obesity as a risk factor (54.1%). Furthermore, there were notable differences in knowledge scores between genders, with men scoring significantly higher than women (2.05, P = .041). In general, the understanding of CKD within the CKD patient community in the KSA was at a moderate level. However, male respondents had a greater understanding of CKD than did female respondents. The findings of this study indicate an urgent need to conduct educational activities to improve CKD knowledge among patients with CKD in the KSA.

Appendiceal neoplasms derived from appendiceal tip remnants following appendectomy: a report of two cases

BackgroundNeoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal “stump”. Here, we present two surgical cases of appendiceal neoplasms derived from appendiceal “tip” remnants.Case presentationThe first patient was a 71-year-old man who had undergone laparoscopic appendectomy for acute appendicitis 12 years prior. During appendectomy, the appendiceal root was ligated, but the appendix was not completely removed due to severe inflammation. At the most recent presentation, computed tomography (CT) was performed to examine choledocholithiasis, which incidentally revealed a cystic lesion of approximately 90 mm adjacent to the cecum. A retrospective review revealed that the cystic lesion had increased in size over time, and laparoscopic ileocecal resection was performed. Pathology revealed no continuity from the appendiceal orifice to the cyst, and a diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) was made from the appendiceal tip remnant. The patient was discharged without complications. The second patient was a 65-year-old man who had undergone surgery for peritonitis due to severe appendicitis 21 years prior. During this operation, the appendix could not be clearly identified due to severe inflammation; consequently, cecal resection was performed. He was referred to our department with a chief complaint of general fatigue and loss of appetite and a cystic lesion of approximately 85 mm close to the cecum that had increased over time. CT showed irregular wall thickening, and malignancy could not be ruled out; therefore, laparoscopic ileocecal resection with D3 lymph node dissection was performed. The pathological diagnosis revealed mucinous adenocarcinoma (TXN0M0) arising from the remnant appendiceal tip. The patient is undergoing follow-up without postoperative adjuvant chemotherapy, with no evidence of pseudomyxoma peritonei or cancer recurrence for 32 months postoperatively.ConclusionsIf appendicitis-associated inflammation is sufficiently severe that accurate identification of the appendix is difficult, it may remain on the apical side of the appendix, even if the root of the appendix is ligated and removed. If the appendectomy is terminated incompletely, it is necessary to check for the presence of a residual appendix postoperatively and provide appropriate follow-up.

Impact of hyperglycemia on tuberculosis treatment outcomes: a cohort study

Hyperglycemia is prevalent and closely associated with pulmonary tuberculosis (PTB). This study aimed to investigate the effects of hyperglycemia on the outcomes of PTB treatment. This study comprised 791 patients with PTB in total. Patients with fasting plasma glucose levels of ≥ 6.1 mmol/L were diagnosed with hyperglycemia. Anthropometric and baseline demographic data were also collected. The treatment response was assessed based on clinical symptoms (sputum production, cough, chest pain, fever, hemoptysis, night sweats, loss of appetite, and fatigue), sputum smear, chest computed tomography (CT), and adverse gastrointestinal responses (vomiting, nausea, abdominal distension, diarrhea, and constipation). A generalized estimating equation (GEE) was used to evaluate these relationships. Hyperglycemia affected 266 (33.6%) of the 791 patients with PTB. In GEE analyses, patients with hyperglycemia exhibited a greater incidence of elevated tuberculosis (TB) scores (odds ratio (OR) 1.569; 95% CI 1.040–2.369), cough (OR 1.332; 95% CI 1.050–1.690), and night sweats (OR 1.694; 95% CI 1.288–2.335). Hyperglycemia was linked with a higher risk of positive sputum smears (OR 1.941; 95% CI 1.382–2.727). During therapy, hyperglycemia was also associated with an increased incidence of vomiting (OR 2.738; 95% CI 1.041–7.198), abdominal distension (OR 2.230; 95% CI 1.193–4.171), and constipation (OR 2.372; 95% CI 1.442–3.902). However, the CT results indicated that hyperglycemia did not affect pulmonary lesions in patients with TB. Patients with TB and hyperglycemia are at a higher risk of severe clinical manifestations, positive sputum smears, and adverse gastrointestinal effects and, therefore, the special situation of hyperglycemic patients should be considered in the prevention and treatment of TB.

Analysis of gastric electrical rhythm in patients with type 2 diabetes mellitus

AimTo analysis the change of electrogastrogram (EGG) in patients with type 2 diabetes mellitus (T2DM), and evaluate the prevalence of abnormal gastric electrical rhythm (AGER) and its relative influencing factors.MethodsA total of 65 patients with T2DM hospitalized at the Second Affiliated Hospital of Soochow University from Dec. 2020 to Dec. 2021 were included in the cross-sectional study. General information, clinical data, and medical history data of all study subjects, including name, gender, body mass index (BMI), duration of diabetes, anti-diabetic therapies, high blood pressure (HBP) history, smoking history, and medication history, were completely collected. The results of laboratory tests, including biochemical parameters, glycosylated hemoglobin (HbA1c), fasting C-peptide, 2 h postprandial C-peptide, 24 h urine total protein (24 hUTP), urine microalbumin creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were recorded. EGG, Gastroparesis Cardinal Symptom Index (GCSI), gastric emptying ultrasound, fundus examination, carotid artery ultrasonography, cardiac autonomic function test, heart rate variability (HRV) were all examined and recorded as well. According to the results of EGG, the subjects were divided into normal gastric electrical rhythm (NGER) group and abnormal gastric electrical rhythm (AGER) group.Results(1) Fasting blood glucose (FBG), HbA1c, the presence of diabetic peripheral neuropathy (DPN) and diabetic cardiac autonomic neuropathy (DCAN) were significantly higher in the AGER group (p < 0.05). Low frequency (LF) and high frequency (HF), the indicators of HRV, were significantly lower in the AGER group (p < 0.05). In addition, the prevalence of feeling excessively full after meals, loss of appetite, and stomach or belly visibly larger after meals of gastrointestinal symptoms of gastroparesis were significantly higher in the AGER group (p < 0.05). Multiple logistic regression analysis showed that FBG and the prevalence of DCAN were the independent risk factors.ConclusionAGER was associated with high FBG and the presence of DCAN. EGG examination is recommended for patients with gastrointestinal symptoms and clues of DCAN.

Results from a randomised, open-label trial of a multimodal intervention (exercise, nutrition and anti-inflammatory medication) plus standard care versus standard care alone to attenuate cachexia in patients with advanced cancer undergoing chemotherapy.

LBA12007 Background: Cancer cachexia arises from the interaction between the host and the tumour, triggering an inflammatory response that leads to weight and appetite loss, diminished physical activity, reduced treatment efficacy and survival. Combining interventions to address inflammation, weight loss, and physical activity is proposed as an effective strategy. Building on a promising pilot study, we conducted the MENAC (Multimodal Exercise Nutrition Anti-inflammatory Cachexia) trial to comprehensively evaluate this approach in patients with lung and pancreatic cancer undergoing systemic anti-cancer treatment (SACT). Methods: MENAC was an investigator-initiated, multicentre, open label, randomised phase 3 trial conducted at 17 sites in 4 countries. Patients with stage III or IV lung or pancreatic cancer receiving SACT with non-curative intent were randomly assigned (1:1) to a multimodal intervention consisting of nutritional counselling plus fish oil containing oral nutritional supplements, physical exercise [endurance and strength] and non-steroidal anti-inflammatory drugs [NSAIDs]) versus standard care. Randomisation was stratified by country, cancer type and stage. Primary Objective: To assess differences between arms in change in body weight. Secondary Objectives: To assess differences in muscle mass (measured by CT L3 technique) and physical activity (assessed through step counts using ActivPAL activity meter) between arms. Assessments were conducted at basline (pre-randomisation) and at endpoint (after 6 weeks). Results: From May 2015 to February 2022, 212 patients were enrolled (105 to multimodal treatment, 107 standard care). Over 6 weeks, weight stabilised in patients assigned to multimodal treatment compared with those assigned to standard care (mean weight change [SD] 0.05 kg [3.8] vs – 0.99 kg [3.2], respectively) with a mean difference in weight change of -1.04, 95 % CI -2.02 to -0.06, p=0.04. There was no conclusive difference in muscle mass (mean change [SD] -6.5cm2 [ 10.1] vs -6.3cm2 [11.9], p=0.93) or in mean step counts [SD] (-377.7 [2075] vs -458 [1858], p=0.89). There were 28 and 24 reported SAEs in the intervention and control arm respectively, no SUSARs were reported. Conclusions: A multimodal cachexia intervention stabilised weight compared to standard care at six weeks. There was no difference in physical activity or muscle mass between trial arms. Clinical trial information: NCT02330926 .

Ayurvedic Management of Palmo-Plantar Psoriasis(~Ek kushta) : A Case Report

Psoriasis is a chronic variant of Psoriasis that characterstically affects the skin of the palms and soles and produces significant functional disability. It features hyperkeratotic, pustular skin lesions. Palmoplantar Pustulosis is a possibly related to dermatosis characterized by small sterile pustules that may be a type of Palmoplantar Psoriasis. As such they are associated with substantial impairment in quality of life. The exact cause of Palmoplantar Psoriasis is unkown. However, it is caused by a combination of genetic and enviornmental factors. In the present case study, female of age 40yrs visit in Ayurveda OPD had complaint of severe itching, redness and pain in skin lesions, transient white, brown, or red macule, localized at bilateral sole region and palm region since 2yrs. She had associated complaint of loss of appetite, headache, dizziness, disturbed sleep and irregular bowel evacuation since 2yrs. She took allopathic treatment but does’nt get any improvement so she decided to switch on Ayurveda management for better cure and preventive care. On the basis of clinical presentation patient was diagnosed with Vicharchika, type of Kushtha Roga so the line of management is based on Kushtha Chikitsa. After 2months of drug intervention Panchtikt Ghrita 10ml, OD in morning, in combination with Mahakalyanak Ghrita in dose of 5ml HS(at bed time) and Cap.Stresscom 2tab at night, patient get significant relief in symptoms ie. dryness and peeling of skin, pain and bleeding with severe itching. Size of lesions is reduced. This is effective in reducing the progression of disease and improve quality of life of patient.

Efficacy of powder of ginsengporia and atractylodis macrocephalae combined with aerobic exercise in the treatment of obese T2DM: A randomized controlled clinical trial

BackgroundTo explore the efficacy of powder of ginsengporia and atractylodis macrocephalae combined with aerobic exercise in the treatment of obese T2DM and its influence on glucose and lipid metabolism indices. ResultsBoth groups of patients were given metformin drug treatment. The control group was given aerobic exercise intervention, and the observation group was given ginsengporia and atractylodis macrocephalae on the basis of the control group. The total effective rate of the observation group (95.74%) was higher than that of the control group (82.98%) (P < 0.05). After treatment, the main symptoms of the observation group were less (P < 0.05), such as thirst and lack of desire to drink, fatigue, loss of appetite, limb numbness and tingling, sticky stool, scanty dark urine, and lower total score. FPG, 2hPG, and HbA1c were lower (P < 0.05), FINS, HOMA-IR, and HOMA-β were higher (P < 0.05), TG, TC, and LDL-C were lower, and HDL-C levels were higher in the observation group (P < 0.05). After treatment, Nesfatin-1 and adiponectin were lower, visfatin and leptin were higher (P < 0.05), and GIP and GLP-1 levels were higher in the observation group (P < 0.05). No significant difference was found in the incidence of adverse reactions between the two groups (P > 0.05). ConclusionsPowder of ginsengporia and atractylodis macrocephalae combined with aerobic exercise is effective in treating obese T2DM, which can alleviate clinical symptoms and the disorder of glucose and lipid metabolism, and improve the islet function and gastrointestinal function.How to cite: Liu G, Kanti Das S. Efficacy of powder of ginsengporia and atractylodis macrocephalae combined with aerobic exercise in the treatment of obese T2DM: A randomized controlled clinical trial. Electron J Biotechnol 2024;71. https://doi.org/10.1016/j.ejbt.2024.04.006.

Clinical profile of dengue fever and dengue haemorrhagic fever in Indonesian children: A six year retrospective study

Background: Dengue infection is still a significant public health problem in Indonesia. An appropriate clinical profile is helpful in early identification of patients with a high risk for severe dengue infection. Objectives: To report the prevalence, characteristics, and clinical outcomes of patients with dengue fever (DF) and dengue haemorrhagic fever (DHF). Method: This was a retrospective study of childhood hospitalisation in Siloam Hospitals Lippo Village, Indonesia from January 2015 to December 2020. Demographic data, clinical signs, and laboratory findings were collected and processed using SPSS version 26. Results: Of 528 patients, 85.6% were DF, 10.4% were DHF grades I and II, and 4% were DHF grades III and IV. Median ages of patients with DF, DHF grades I and II, and DHF grades III and IV were 10.9, 12.4 and 8.5 years respectively. Common clinical symptoms of DF patients were headache (67.5%), loss of appetite (41.8%), and vomiting (40.9%). While 52.7% patients with DHF grades I and II had respiratory symptoms, 42.9% patients with DHF grades III and IV had hepatomegaly. Conclusions: Common clinical symptoms of DF and DHF patients were headache, loss of appetite and vomiting. Whilst 52.7% patients with DHF grades I and II had respiratory symptoms, 42.9% patients with DHF grades III and IV had hepatomegaly.

Efficacy and safety analysis of first-line tirelizumab combined with paclitaxel-containing chemotherapy regimen in 30 cases of real-world advanced gastric cancer in China.

e14643 Background: According to the latest global cancer statistics, gastric cancer is the 6th most common tumor with the highest incidence rate and the 5th highest mortality rate in the world. The primary treatment for advanced gastric cancer is still based on chemotherapy, and the median overall survival (OS) of patients treated with conventional chemotherapy is only 12 months. Recently, the rapid rise of immunotherapy has also brought new hope to gastric cancer patients. Many trials related to chemotherapy combined with immunotherapy for advanced gastric cancer are currently underway, which has been a hot research topic in recent years and has had auspicious positive results, such as the KEYNOTE-059 and CHECKMATE649 study. To reduce the burden of disease, the accessibility of innovative drugs has been significantly improved, providing more new clinical treatment ideas and options for Chinese patients with advanced gastric cancer. Methods: The study enrolled advanced gastric cancer (HER-2 negative) was treated with immune combination paclitaxel for first-line treatment, as follows: receiving intravenous albumin-conjugated paclitaxel (260 mg/m2) every 3 weeks; in combination with Tirelizumab (200 mg every three weeks), and after 4-6 cycles of treatment, Tirelizumab was maintained until disease progression or intolerance. The primary study endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoints were objective remission rate (ORR) and safety. Results: From July 2020 to August 2023, 30 patients received first-line immunization and paclitaxel-containing chemotherapy regimens at our center. The objective remission rate (ORR) was 40.9%, and the disease control rate (DCR) was 77.3%. The incidence of treatment-related grade 1-2 adverse reactions was: vomiting in 5 cases (16.7%), loss of appetite in 22 cases (73.3%), diarrhea in 10 cases (33.3%), transaminase elevation in 5 cases (16.7%), numbness of the hands and feet in 25 cases (83.3%), leukopenia in 7 cases (23.3%), and hemoglobin reduction in 16 cases (53.3%). hyperbilirubinemia in 2 cases (6.7%). Grade 3-4 adverse events and their incidence were: vomiting in 4 cases (13.3%), loss of appetite in 4 cases (13.3%), diarrhea in 1 case (3.3%), transaminase elevation in 2 cases (6.7%), leukopenia in 3 cases (10.0%), and hemoglobin reduction in 2 cases (6.7%). There were 3 cases of immunosuppressant-related adverse reactions (1 case of immunosuppressant-associated thyroiditis, 1 case of immunosuppressant-associated acute myocardial infarction, Conclusions: The first-line treatment of advanced gastric cancer with immune checkpoint inhibitors combined with paclitaxel-containing chemotherapy has a high rate of disease control, prolongs overall survival, has more clinical adverse reactions, is favored by grade 1-2 adverse reactions, and has a high degree of safety, and provides a new clinical idea for the first-line treatment of patients with advanced gastric cancer. Clinical trial information: KY2022-189-02.

A practical approach to nutritional intervention for people with chronic kidney disease in Vietnam.

A comprehensive nutritional management is necessary for favourable outcomes in patients with chronic kidney disease (CKD). We aimed to assess the changes in nutritional status and disease progression with nutritional management where renal replacement therapy (RRT) was not in place. A quasi-experiment intervention was conducted on 70 CKD patients at stages 3-5 from July to December 2022. Participants were excluded if they underwent RRT, including dialy-sis (hemodialysis or peritoneal dialysis), or kidney transplantation. The nutritional regimen covered nutrition-al counseling, samples of the dietary menu, and supplement products. We evaluated nutritional status using Subjective Global Assessment (SGA) scale and sub-clinical blood test at T0 (hospital admission) and T1 (two weeks after the admission or 24 hours before the discharge). After the intervention, the number of patients classified as malnutrition or at risk of malnourished reduced significantly (65.7% to 54.3% and 25.7% and 5.7%, respectively). The serum concentration of urea, creatinine and parathyroid hormone decreased remarkably, especially in patients receiving nutritional management. In the intervention group, the dietary pattern provided increased intakes of calcium and iron at T1, while phosphorus, sodium and potassium decreased after follow-up. Nausea/vomiting, loss of appetite, tiredness and sleep disorders were improved in the intervention compared to the control group. Nutritional therapy enhanced the nutritional sta-tus, and quality of dietary and renal function in CKD patients without RRT. Applying nutrition education and treatment at an early stage can slow CKD progression, which should be applicable elsewhere in Vietnam.

Anatomic and Surgical Aspects of Total Pancreatectomy in Swine

IntroductionThe swine is valuable model for preclinical research and surgical technique training. From the induction of Diabetes through total pancreatectomy, these animals can be used in many research studies, such as islet transplantation. In view of the lack of elucidation in literature, the purpose of this work is to describe anatomical aspects, surgical technique of total pancreatectomy, intra- and postoperative complications and autopsy results Material and MethodFive male pigs, hybrids (Large White/Landrace), 20-35 kg, submitted to total pancreatectomy with duodenum, bile duct and spleen preservation. Postoperatively, daily clinical assessment and capillary blood glucose collection were performed. At the end of the 30-day limit or in the occurrence of serious clinical complications, euthanasia and autopsy were performed ResultsThe average duration of surgery was 128 minutes, without intraoperative deaths or anesthesia induction failures. Median survival was 6.6 days. Postoperative complications were weight loss (3), emesis (2), constipation (2), abdominal distension (2), diarrhea (1) and loss of appetite (1). All animals were euthanized due to serious complications. Two animals presented surgical complications (duodenal necrosis with gastroparesis and internal hernia with intestinal necrosis). The other three animals presented serious clinical complications related to exocrine pancreatic insufficiency due to deficiency of pancreatic enzymes. Glycemic values above 200 mg/dL were found on the first postoperative day and above 300 mg/dL on the seventh day in all animals Discussion and ConclusionsIn this experiment, a model of total pancreatectomy with duodenum, spleen and bile duct preservation in pigs was established. All animals had diabetes, however animals without postoperative complications were euthanized due to serious complications related to pancreas exocrine insufficiency.

Effect of probiotics on quality of life for patients with cancer undergoing immunotherapy.

e24148 Background: Probiotics are crucial in oncology for enhancing gut health, boosting immune response, potentially improving immunotherapy efficacy, and reducing side effects of cancer treatments. Research links a healthy gut microbiome with better immunotherapy outcomes, however, more studies in this area are required to validate this hypothesis. Methods: Oncological patients at Hospital Ángeles Puebla's Comprehensive Cancer Center undergoing immunotherapy were invited to participate and provided their consent to receive a daily probiotic and prebiotic mix (including Lactobacillus rhamnosus, Bifidobacterium longum, Pediococcus pentosaceus, and others) for three months. Their health was closely monitored, and quality of life assessed using the EORTC-QLQ-C30 questionnaire at the start, day 45, and day 90. A Kruskal-Wallis H-test was conducted to correlate the EORTC-QLQ-C30 scores with their diagnosis, clinical stage, presence of comorbidities, and use of ancillary treatments, as well as a Spearman's test to associate these scores with their age. Results: 22 patients were included. Average age was 64.5 years, with 77% being male and 23% female. 68.18% were in stage IV, 4.55% in stage III, 18.18% in stage II, and 9.09% in stage I. Comorbidities included: diabetes in 31.82%, hypertension in 40.91%, and other diseases in 22.73%. Treatment regimens involved 81.81% receiving Anti-PD-L1 and 18.18% receiving Anti-PD-1. Additionally, 40.91% were on corticosteroids and another 40.91% on proton pump inhibitors as ancillary treatments. Median follow-up was 3.13 months, during which 23% of the patients experienced adverse events. Of these, 9.09% were grade 4 according to the CTCAE v.5, and 13.63% were grade 1. Significant differences were found between patients with hepatocellular carcinoma versus renal carcinoma in the overall score on day 1 (KW: 4.47, p-value: 0.0344), with no differences in the rest of the scores. Significant differences were also identified between patients with advanced-stage versus early or locally advanced-stage cancer in terms of pain (KWS: 4.091, p-value: 0.043), dyspnea (KWS: 4.355, p-value: 0.037), loss of appetite (KWS: 4.091, p-value: 0.043), constipation (KWS: 3.971, p-value: 0.046), and diarrhea (KWS: 4.355, p-value: 0.037). A negative correlation was found between age and social functioning (Spearman: -0.73, p-value: 0.03), as well as with the presence of pain (Spearman: -0.73, p-value: 0.04). Conclusions: In this study, we observed a decrease in symptoms and an increase in functionality and overall quality of life scores among the patients. This suggests that patients undergoing active immunotherapy treatment may benefit from the use of probiotics and prebiotics as an ancillary treatment. However, further extended studies with larger populations are necessary to corroborate our findings.