Challenges In Care Research Articles

Abstract A023: Arachidonic acid metabolism promoting cross resistance in melanoma cells

Abstract Melanoma patients initially respond well to first line immunotherapy. However, cross resistance to immunotherapy and BRAF/MEK inhibitor is a clinical challenge for melanoma care. To investigate drug tolerant and resistant mechanisms promoting cross resistance, we analyzed RNA-sequencing and gene set enrichment targeted therapy resistant melanoma cells revealing an enriched arachidonic acid gene signature. Intracellular arachidonic acid levels were increased in drug resistant and drug tolerant melanoma models. Arachidonic acid is enzymatically converted by COX1 and COX2 to prostaglandins, which is subsequently secreted into the microenvironment. Drug tolerant and resistant cells had increased protein expression of COX1 and COX2 concurrently with increased secretion of prostaglandin E2. COX1/2 inhibition and COX2 knockdown in vitro had no effect on cell growth in drug tolerant or resistant cells compared to parental cells. However, secreted prostaglandins are known immunomodulators, thus we explored how COX1/2 inhibition in combination with BRAF inhibitor plus MEK inhibitor affected immune cell infiltration. COX1/2 inhibition increased CD4+ and CD8+ T cell infiltration as compared to BRAF inhibitor plus MEK inhibitor alone. Under constant BRAF inhibitor plus MEK inhibitor treatment, we found that COX1/2 inhibition upon reaching MRD status prevented tumor relapse in vivo and increased survival dependent on an immune system. Future studies will evaluate the importance of arachidonic acid metabolism in promoting cross resistance to immune checkpoint blockade and whether T cell depletion prevents the delayed tumor relapse. Overall, COX1/2 inhibition delayed tumor relapse and survival in an immune-dependent manner and demonstrated a potential cross resistant mechanism. Citation Format: Casey D. Stefanski, Daniel A. Erkes, Timothy J. Purwin, Glenn L. Mersky, Erica L. Kitterman, Manal Mustafa, Jelan Haj, Diana Melissaratos, Andrew E. Aplin. Arachidonic acid metabolism promoting cross resistance in melanoma cells [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A023.

Declining pain medicine fellowship applications from 2019 to 2024: A concerning trend among anesthesia residents and a growing gender disparity.

The fields of anesthesiology and pain medicine are experiencing significant changes driven by market forces and professional preferences. While demand for anesthesiologists is rising, pain medicine is facing a decline in fellowship applications. This study analyzed data from the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP) from 2019 to 2023, focusing on trends in fellowship applications to pain medicine programs. Additionally, preliminary data from the 2024 match cycle were examined. There has been a notable decrease in anesthesiology residents applying to pain medicine fellowships, with applications dropping from 351 in 2019 to 193 in 2023. The overall decline in anesthesia-based applicants to pain medicine fellowships was 45%, signaling the highest detriment among anesthesiology applicants compared to other specialties. Gender disparities have been prevalent, with the absolute number of female applicants decreasing every year since 2019. Additionally, the 2023 match saw a significant number of unfilled programs, with 35 out of 115 programs failing to fill all positions. Preliminary data from the 2024 match cycle suggest this downward trend is continuing. The decline in pain medicine fellowship applications, particularly among anesthesiology residents, signals potential future workforce shortages and challenges in patient care. Recruitment strategies should include early exposure to pain medicine during residency, enhanced mentorship programs, and robust recruitment efforts (including virtual options). Addressing these issues is essential to ensure enough trained specialists to meet the growing need for pain specialists nationally.

Establishment of a Brain Tumor Consortium of Africa: Advancing Collaborative Research and Advocacy for Brain Tumors in Africa

Abstract Background Brain tumors represent a significant global health challenge, with rising incidence and mortality impacting individuals worldwide and contributing to cancer-related morbidity and mortality. In Africa, this burden is exacerbated by limited access to advanced diagnostics, treatment options, and multi-disciplinary care, compounded by the absence of standardized cancer registration and tumor biobanking. The introduction of molecular diagnostics, as outlined in the 2021 WHO CNS tumor classification, adds complexity to brain tumor management, particularly in regions with scarce resources. Methods To address these issues, the Brain Tumor Consortium for Africa (BTCA) was established in 2023, bringing together experts to improve CNS tumor diagnosis, patient care, and research. The initial project, conducted via an electronic questionnaire, aimed to assess neuro-oncology capacity across SSA. Results The study revealed significant gaps, with a limited number of institutions incorporating molecular subtyping into their diagnostic algorithms. The consortium’s efforts focus on enhancing local data use, informing public policy, and promoting collaboration to advance neuro-oncology practices in Africa. By fostering a network enlisting the expertise of collaborators in the field of neurosurgery, neurology, neuropathology, anatomic pathology, and medical and radiation oncology, the BTCA seeks to improve brain tumor management through better diagnostics, infrastructure and policy advocacy. Future directions include expanding molecular diagnostic capabilities, standardizing brain tumor biobanking, enhancing data collection, and advocating for improved brain tumor care in national health agendas. Conclusion The BTCA represents a pioneering model of collaboration and innovation in addressing the unique challenges of brain tumor care in Africa.

Fear of movement interacts with trunk mobility, and pain intensity to predict disability in patients with chronic low back pain: a classification and regression tree (CART) analysis.

Low back pain significantly impacts global health, particularly in low-income areas where primary care challenges are prevalent. Assessing both biophysical and psychological factors associated with low back pain-related disability is crucial for developing effective screening and management strategies. This study aimed to examine the association between fear of movement, trunk mobility, pain intensity, physical activity, and low back pain-related disability, and to identify key factors contributing to higher disability levels in patients with chronic low back pain. This cross-sectional study analyzed data from 381 chronic low back pain patients aged over 18, collected at a primary care ambulatory between 2015 and 2019. Variables measured included pain intensity, fear of movement, physical activity, trunk mobility, and disability. A Classification and Regression Tree approach was used to model disability predictors. Fear of movement was the main driver of high disability (OR = 17.3, 95%CI 8.9-33.7). Two profiles were particularly prone to higher disability: patients with high fear of movement (>47.5) and pain intensity > 1.5; and those with lower fear of movement but poor trunk mobility (>36.5 cm). Patients with better trunk mobility and low pain intensity (≤3.5) showed significantly less disability (OR = 0.06, 95%CI 0.02-0.17). The findings highlight the need for integrating better psychological and biophysical assessments in managing chronic low back pain. Understanding how fear of movement, trunk mobility, and pain interaction can improve screening accuracy and optimize care in resource-limited settings, using valid and feasible tools for these scenarios.

A model for integrating palliative care into Eastern Mediterranean health systems with a primary care approach.

Palliative care in the Eastern Mediterranean Region (EMR) faces challenges despite the high number of patients in need. To provide accessible, affordable, and timely services, it is crucial to adopt a suitable care model. World health organization (WHO) recommends integrating palliative care with primary health care (PHC). Given the unique conditions of EMR countries, there is a need to design a model tailored to these contexts. This study is a multi-method research project conducted through several sub-studies, including a literature review, policy analysis, expert opinion (Delphi Method), dimension-specific analysis, model development, and its validation and refinement (Delphi Method). Drawing from the WHO model, six dimensions: policy, drug availability, education, community integration, service delivery, and research were considered to developing the model and implementation requirements. Within each dimension, evidence-based solutions tailored to the region's context were explored. A successful palliative care model requires, in the policy dimension, oversight by the Ministry of Health (MOH). Having a focal-person or working group within the MOH is crucial for policy-making, formulation, and approval of clinical guidelines, as well as addressing care challenges. It is essential to provide access to morphine and other essential medications, along with facilitating the administration and consumption of morphine at home. Conducting empowerment courses for care providers, can address various challenges. Community involvement through volunteers, charities, and non-governmental organizations (NGOs) is also important. To ensure service provision, monitoring and evaluating systems are crucial, along with striving for service continuity through an appropriate payment system. Lastly, research is necessary for needs assessment, evidence-based practice, and designing evaluation indicators. The proposed model relies on community health workers, especially nurses, as multitasking professionals available for community palliative care. In the presented model, special attention has been given to networking, collaboration, and the use of digital health technologies to support nurses. The model proposed for integrating palliative care into PHC should serve as a framework that enhances access to available and affordable services for countries in the region. While this model was developed based on the overall conditions of the region, each country can tailor it to its unique strengths and opportunities.

The Role of Primary Care in Achieving Life's Essential 8: A Scientific Statement From the American Heart Association.

To reduce morbidity and mortality rates of cardiovascular disease, an urgent need exists to improve cardiovascular health among US adults. In 2022, the American Heart Association issued Life's Essential 8, which identifies and defines 8 health behaviors and factors that, when optimized through a combination of primary prevention, risk factor management, and effective treatments, can promote ideal cardiovascular health. Because of its central role in patient care across the life span, primary care is in a strategic position to promote Life's Essential 8 and improve cardiovascular health in the United States. High-quality primary care is person-centered, team-based, community-aligned, and designed to provide affordable optimized health care. The purpose of this scientific statement from the American Heart Association is to provide evidence-based guidance on how primary care, as a field and practice, can support patients in implementing Life's Essential 8. The scientific statement aims to describe the role and functions of primary care, provide evidence for how primary care can be leveraged to promote Life's Essential 8, examine the role of primary care in providing access to care and mitigating disparities in cardiovascular health, review challenges in primary care, and propose solutions to address challenges in achieving Life's Essential 8.

The Promise of Remote Patient Monitoring.

The promise of remote patient monitoring (RPM) lies in its ability to revolutionize health care delivery by enabling continuous, real-time tracking of patient health outside traditional clinical settings. The COVID-19 pandemic accelerated the adoption of RPM, particularly in underserved and rural populations, highlighting both its potential and the persistent barriers that limit its widespread use. This paper explores the critical role of technological advancements-such as wearables, artificial intelligence (AI), and broadband expansion-in sustaining and optimizing RPM in the postpandemic era. We examine Michigan as a microcosm of national health care challenges, focusing on its diverse population and geographic barriers, and propose condition-specific RPM protocols to address these inequities. Key facilitators and barriers to RPM implementation are discussed, with a focus on AI integration, community engagement, and digital infrastructure. We also explore the role of policy reform and public-private partnerships in supporting RPM's scalability and long-term sustainability. Our findings suggest that while RPM offers a powerful tool for improving health care access and outcomes, especially for chronic conditions and rural maternal health, sustained investment in technology and infrastructure is critical. By addressing these challenges, RPM can become a cornerstone of modern health care, reducing disparities and improving care delivery for underserved populations.

Internet Use Maintains Cognitive Function among middle- and old-aged Chinese: A Five-year Longitudinal Study.

Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the elderly population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet usage among middle-aged and elderly individuals. This study aims to explore the association between internet usage and age-related cognitive decline among middle- and old-aged Chinese. To gain a more comprehensive understanding of the effects of internet usage, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet usage on cognitive function for characteristics significantly linked to cognition in stratified analysis. We analyzed data based on 12,770 dementia-free participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study. We employed a fixed-effects model to assess the relationship between internet usage and cognitive decline, and further validated it using multiple linear regression, generalized estimating equations (GEE), propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW). We further examined the varying effects of internet device type and frequency on cognitive function using fixed-effects models and Spearman's rank correlation. The Karlson-Holm-Breen (KHB) method was used to estimate the mediating role of internet usage in the urban-rural cognitive gap. Participants using the internet (n=1,005) were younger, more likely to be male, more educated, married, retired, living in an urban area, and had higher cognitive assessment scores compared with non-users (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391 to 0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases at 2.2% (15/671) compared with non-users at 5.3% (379/7,099; P<.001). The negative impact of aging (> 50) on cognitive function was consistently less pronounced among internet users compared to non-users. Furthermore, increased frequency of internet usage was associated with greater cognitive benefits for middle-aged and elderly individuals (rs = 0.378, P<.001). Among digital devices used for internet access, cellphones (β=0.398, 95% CI 0.283 to 0.495) seem to have a higher level of cognitive protection compared to computers (β=0.147, 95% CI 0.091 to 0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effects, P<0.001). This study reveals that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet usagehas the potential to be a viable, cost-effective, non-pharmacological intervention forcognitive decline among middle-aged and elderly individuals.

Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study.

In Pakistan's remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS's cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue.

EOLP-02. END-OF-LIFE CHALLENGES IN NEURO-ONCOLOGICAL PATIENT CARE: A YOUNGNOA SURVEY

Abstract BACKGROUND Malignant brain tumors inevitably relapse, almost always causing significant functional and neurological impairments. Thus, palliative care is crucial in managing individuals with malignant brain tumors. It is essential for neuro-oncologists to be well-prepared to openly communicate about and meet the palliative needs of these patients. With this survey, we sought to evaluate palliative care practices in Germany and their impact on the treatment of neuro-oncological patients. METHODS We conducted an anonymous, interdisciplinary survey targeting palliative care practices among neuro-oncologists in Germany, all members of the Neuro-oncology Working Group of the German Cancer Society. The questionnaire, designed in close coordination with board-certified palliative care specialists, was distributed to 450 physicians. It collected personal information and assessed respondents’ knowledge of and access to palliative care structures. The survey was conducted online from March 31 to April 30, 2023. RESULTS Ninety-two physicians completed the survey. Of these, 81 (88%) reported feeling comfortable with end-of-life conversations, while 11 (12%) did not. No significant differences were observed between the two subgroups regarding their level of medical education (p=0.7140), workplace (p=0.4966), sex (p=0.9999), medical specialty (p=0.5478), or region of practice (p=0.9999). However, those comfortable with end-of-life discussions had significantly more palliative care training either during specialty training (p=0.0475) or through active participation in palliative care courses (p=0.0254). Further detailed analysis is in progress. CONCLUSIONS The survey indicates that while the majority of participants are comfortable with end-of-life discussions, a clear correlation exists between their comfort level and the extent of palliative care training received. This highlights the critical need for enhanced and targeted palliative care education within neuro-oncology training programs to prepare physicians for the complex communication and care challenges in neuro-oncological palliation. Further analysis will continue to explore additional educational and systemic factors that could increase the quality of palliative care in neuro-oncology.

Recent Updates and Emerging Challenges in Anaesthesia, Critical Care and Pain Medicine

Recent Updates and Emerging Challenges in Anaesthesia, Critical Care and Pain Medicine

WOUND DRESSINGS FOR SORPTION THERAPY IN THE TREATMENT OF PURULENT WOUNDS: a review article

Surgical infections remain one of the most challenging and urgent issues in modern medicine, reaching a socio-ecological scale of significance nationwide. Despite advances in treating purulent wounds, the prevalence of patients with purulent surgical infections remains high. According to both domestic and international sources, surgical patients with purulent-inflammatory conditions comprise 35–45% of the total patient population in general surgery wards. In some cases, purulent infections become acute and can lead to the generalization of the purulent process, resulting in sepsis and even death. Mortality rates from acute surgical infections range from 19% to 70% within surgical hospitals. Additionally, there has been an increase in the transition of acute purulent processes to chronic stages, which prolongs the treatment duration for these patients. The prevention and treatment of surgical infections are therefore of paramount importance, representing one of the core challenges in surgical care. Optimal local treatment of purulent wounds requires adherence to essential principles, including active surgical intervention, antibiotic therapy throughout the wound healing stages, and local wound management under bandages. An analysis of the literature reveals that sorption-application therapy is gaining prominence in modern surgical practice for local wound management. This approach, which utilizes advanced interactive wound dressings with combined adsorption, osmotic, and necrolytic effects, has shown significant improvements in the effectiveness of purulent wound treatment.

Safety and Tolerability of a Shorter Agalsidase Beta Infusion Time in Patients with Classic or Later-Onset Fabry Disease

Background: The multisystem manifestations of Fabry disease can create major challenges in patient care. Although enzyme replacement therapy with recombinant agalsidase beta has demonstrated clinical benefits, the standard fortnightly, multi-hour infusion regimen imposes a substantial burden on patients. Methods: We assessed the safety and feasibility of shortening the agalsidase beta infusion time to 90 min in adult patients with classic or later-onset Fabry disease in the absence of premedication. A total of 39 consecutive adult patients (agalsidase-naïve: n = 7; with significant comorbidities: n = 15) with no recent infusion-associated reactions underwent a total of 85 agalsidase beta infusions in our tertiary reference centre for lysosomal diseases. Each infusion was administered at a constant rate (between 0.78 and 1.17 mg/min, depending on the total dose administered). Results: No adverse events of any type (including discomfort and infusion-associated reactions) were reported during or after infusions. The patients’ vital signs and physical examination remained stable, and patients’ satisfaction was high. Conclusions: Our results suggest that shortening the agalsidase beta infusion time to 90 min is safe and feasible in stably treated adult patients with Fabry disease and no recent infusion-associated reactions.

Navigating Voluntarily Stopping Eating and Drinking in Hospice Settings: A Multidisciplinary Approach.

This article explores current global research on voluntarily stopping eating and drinking (VSED) and presents a detailed, deidentified case study of a patient who elected VSED in a hospice setting in the Southeastern United States. It highlights the collaborative efforts of health care professionals in effectively supporting the patient and family, sharing multiple perspectives from various health care team members who cared for the patient and family. It offers evidence-based recommendations to guide health care teams through the ethical, medical, and emotional challenges of VSED, ensuring compassionate and competent care. The article emphasizes the importance of structured protocols and empathetic care in hospice settings, advocating for the education and preparation of health care teams and families to address the complex challenges associated with VSED. By promoting open communication, interdisciplinary collaboration, and comprehensive support, hospices can respect the autonomy of patients and families choosing VSED, ensuring a compassionate and dignified end-of-life experience.

Challenges of Polish families related to caring for a disabled child at home: a cross-sectional study.

A family with a disabled child has major changes and challenges. The difficulties experienced by the whole family are of various natures and relate to emotional, psychological, caring, and financial problems. The aim of the study is to learn about the challenges and involvement of Polish families in caring for a disabled child in the home environment. A cross-sectional pilot study was conducted in a group of 103 parents of disabled children. The proprietary questionnaire and a standardized scale for the Generalized Self-Efficacy Survey (GSES) were used as a research tool. The material for the study was collected online, using Google Forms software, and statistically processed. Emotional contact with a disabled child turned out to be the most difficult aspect of care for almost half of the respondents (42.7%). The vast majority of respondents (75.7%) described the level of difficulty in caring for a disabled child as much higher than the level of difficulty in caring for a healthy child. Most parents (87%) spend between 10 and 20% of their family income on the treatment and rehabilitation of disabled children. A significant relationship was noted between the assessment of the family's economic situation and place of residence (χ2P = 27.32; p < 0.0001; Vc 0.51). Parents of children with disabilities who live in rural areas and have less education are less well off financially. The average GSES score was 24.54 and was in 4 sten. The biggest care challenge for parents of disabled children turned out to be emotional contact with the child. The GSES index for parents of children with disabilities is lower than the average values obtained in Polish studies, which translates into worse coping with problems.

The Effect of Hypnobirthing Method to Prevent Imminent Prematural Delivery Through Reducing Stress Levels in Factory Working Mothers

Every day, a total of 800 women die from complications that occur during pregnancy and childbirth. Preterm birth is a major challenge in perinatal health care. In the United States, one in eight babies (12%) is born prematurely; of these, 80% are born at 32-36 weeks of gestation and 20% are born at 22-32 weeks. Premature babies (&lt;32 weeks) are at increased risk of neonatal mortality and morbidity. One of the factors causing premature birth is antenatal depression. A systematic review of studies conducted in developed and low-income countries reported the prevalence of antenatal depression in the range of 5% to 30% and 15.6% to 31.1%). Increased risk of premature birth 1.2 times premature birth and 1.3 times risk of low birth weight. Sociodemographic factors play a major role in the incidence of imminent premature labor. The results of a study in 2014 showed that 54.8% of mothers giving birth at Sidoarjo Regional Hospital had a heavy workload. The results of the study showed that there was a relationship between the workload of pregnant women and the incidence of preterm labor with a p value = 0.008 (P &lt;0.05). Pregnant women with heavy workloads are caused by mothers having jobs with a shift work system, long working hours &gt;7 hours/day or &gt;49 hours/week, working in factories with an average break time of 1 hour and activities such as lifting or pushing goods. In addition, after working outside the home, mothers still do household chores such as cooking, sweeping, washing without the help of others. The reason mothers work on average is to help the family economy. Other factors are anxiety in pregnancy, health risks, domestic violence, length of work per day, nutritional factors during work, length of rest at work, partner support, household income, mother's education level, mother's age, parity Hypnobirthing relaxation provides positive suggestions to the mother. This suggestion changes beta brain waves (conscious mind) into alpha waves (unconscious mind) in the cerebral cortex, then a sensory association process occurs which causes stimuli to be analyzed, understood and arranged into an object and the meaning of the stimulus. The provision of one hypnosis session referring to The Creative Psychosocial Genomic Healing Experience protocol can significantly increase immediate-early gene expression (Zif-268), increase stem cell activity, reduce stress and inflammation at the cellular level. This study aims to explain the effectiveness of the influence of hypnobirthing on reducing the scale of depression in Partus Prematurus Imminens. The expected benefits in this study are to develop the potential for preventing premature labor with the hypnobirthing method.

Assessing the therapeutic efficacy of Cefoperazone Sodium and Sulbactam Sodium in managing surgical site infections: a retrospective analysis

Surgical site infections (SSIs) pose significant challenges in surgical care, impacting patient recovery and healthcare costs. The increasing prevalence of antibiotic-resistant bacteria necessitates effective antimicrobial strategies. This study assesses the therapeutic efficacy and safety of Cefoperazone Sodium and Sulbactam Sodium in managing SSIs and compares its effectiveness against a standard treatment. A retrospective analysis was conducted on 110 patients with clinically and microbiologically confirmed SSIs from December 2020 to December 2023. Patients were divided into two groups: 55 received Cefoperazone Sodium and Sulbactam Sodium, while 55 were treated with Cefuroxime. The efficacy was evaluated based on microbiological eradication and clinical improvement, assessed after 3 days of treatment. Statistical analyses were performed using SPSS version 27.0, with significance set at p < 0.05. Demographic and clinical characteristics showed no significant differences between groups, ensuring comparability. The observation group demonstrated a cure rate of 58.18% and an overall efficacy rate of 94.55%. In contrast, the control group showed a cure rate of 32.73% and an overall efficacy rate of 70.91%. Statistical analysis revealed a significant difference in therapeutic success between the groups (Chi-square value of 9.16, p-value < 0.05). The combination of Cefoperazone Sodium and Sulbactam Sodium could provide a more effective option for managing SSIs, potentially improving cure rates and overall treatment outcomes compared to Cefuroxime.

Retrospective analysis of medication-related osteonecrosis of the jaw at a maxillofacial prosthetics clinic

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) poses significant challenges in patient care because of its complex etiology, clinical manifestations, and management. This study aims to provide an overview of patients with MRONJ treated at our clinic over the past 12 years, highlighting incidence, clinical characteristics, and prosthetic treatment outcomes. Materials and Methods: The study included patients with MRONJ who visited our clinic between January 2012 and April 2024. Data on demographic characteristics, lesion location, clinical presentation, primary diseases, prosthetic management and medications were collected from health records. Results: This retrospective analysis of cases of MRONJ over 12 years at a maxillofacial prosthetics clinic reveals a rising prevalence of the condition, particularly in the elderly, with treatments for breast and prostate cancer emerging as prominent risk factors. Distinct medication-specific effects on distribution of lesions suggest variation in pathogenic mechanisms, which require tailored treatment strategies. Management strategies encompass a spectrum of interventions from conservative measures to prosthetic rehabilitation, highlighting the importance of interdisciplinary collaboration and personalized care. Conclusion: The rising incidence of MRONJ, especially among elderly patients, indicates the need for enhanced preventive measures and interdisciplinary care. Breast and prostate cancer treatments are significant risk factors, necessitating tailored monitoring. Effective prosthetic management is crucial for improving oral function and quality of life in MRONJ patients.

Prostate cancer in transgender women - challenges in research and clinical care.

Prostate cancer in transgender women - challenges in research and clinical care.

Review on understanding of Astha Sthoulya Doshas and Sthoulya Lakshanas

Sthoulya is one among Santarpanotta Vikara and it is caused by Kapha Pradhana and Medodhushti. All the Santarponotta Nidanas and Medodhushti which will lead for Sthoulya. Sthoulya mainly features Chala Sphik Sthanah Udara Lambanam and Atisweda, Dhourgandy, Dourbalya as associated symptoms and these are considered as Sthoulya Doshas. Sthoulya leads to Kshudra Swasa and Alpaprana. Which implies the effect of Sthoulya on Pranavaha Srotas i.e., impairment in respiratory function which indicates Sthoulya does changes in normal breathing pattern. Life style disease and non-communicable diseases are major concern of health in present era. Obesity and Overweight are the major health care challenge that occupies the first place among non-communicable diseases creating an enormous socioeconomic and public health burden in most countries and is a worldwide epidemic. The worldwide prevalence of obesity nearly tripled between 1975 and 2020. Involvement of Meda, Agni, Kapha and Vata make the vicious curve of Samprapthi leading to chronic symptoms and complications like Ashta Sthoulya Doshas. Involved Agni and Ama in different stages which will make complicity to manage the Stholya and holistic approach is needed to treat the comorbidities like Ashta Sthoulya Doshas.