Clinical Side Effects Research Articles

A combined subcision approach with either fractional CO2 laser (10,600 nm) or cross-linked hyaluronic acid versus subcision alone in atrophic post-acne scar treatment

Different treatment options for post-acne scars exist, but with varying clinical efficacy, side effects, and prolonged downtime. This study aims to compare the efficacy and safety of combined subcision with either fractional CO2 laser or cross-linked hyaluronic acid filler (HA) versus subcision alone in the treatment of facial atrophic post-acne scars. Forty patients with atrophic post-acne scars were subjected to subcision on both sides of the face, then were randomly divided into three groups. Group I (20 patients): subcision combined with cross-linked HA filler injection at one side of the face; group II (20 patients): subcision followed by fractional CO2 at the other side of the face; and group III (20 patients): with subcision only as a control group. Treatment sessions were every month until clinical improvement or for maximum three sessions. The treatment’s efficacy was assessed by Goodman and Baron’s qualitative and quantitative grading systems. The two blinded investigator scores showed significant improvement in both the filler side versus subcision (p value = 0.015), and the fractional laser side versus subcision (p value < 0.001), with no statistically significant difference between both sides (p value = 0.171). Qualitative grading by Goodman and Baron scores showed that the percentage of patients with excellent improvement was higher in group 1 and group 2 than in group 3 with p value = 0.031; also the mean percentage of reduction in quantitative grading was higher in group 1 and group 2 than in group 3 with p value < 0.00. Either combined subcision with fractional CO2 laser or with cross-linked HA filler achieved superior improvement in facial atrophic post acne scars treatment with no serious side effects in this study. However, subcision only by blunt canula also had modest improvement.

Efficacy and Safety of Medical Marijuana in Migraine Headache: A Systematic Review.

Medical marijuana treatment for migraine is becoming more common, although the legality and societal acceptance of marijuana for medical purposes in the United States have been challenged by the stigma attached to it as a recreational drug. These substances function to reduce nociception and decrease the frequency of migraine by having an impact on the endocannabinoid system.Our study reviewed the clinical response, dosing, and side effects of marijuana in migraine management.Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a literature search in PubMed, Google Scholar, and Science Direct, and nine studies were included in the systematic review. The studies demonstrated that medical marijuana has a significant clinical response by reducing the length and frequency of migraines. No severe adverse effects were noted. Due to its effectiveness and convenience, medical marijuana therapy may be helpful for patients suffering from migraines. However, additional clinical trials and observational studies with longer follow-ups are required to study the efficacy and safety of the drug.

Structural Remodeling Mechanism of the Toxic Amyloid Fibrillary Mediated by Epigallocatechin-3-gallate.

Numerous therapeutic agents and strategies were designed targeting the therapies of Alzheimer's disease, but many have been suspended due to their severe clinical side effects (such as encephalopathy) on patients. The attractiveness for small molecules with good biocompatibility is therefore restarted. Epigallocatechin-3-gallate (EGCG), extracted from green tea, is expected to be a promising small-molecule drug candidate, which can remodel the structure of preformed β-sheet-rich oligomers/fibrils and then effectively interfere with neurodegenerative processes. However, as the structure of non-fibrillary aggregates cannot be directly characterized, the atomic details of the underlying inhibitory and destructive mechanisms still remain elusive to date. Here, all-atom molecular dynamics simulations and experiments were carried out to elucidate the EGCG-induced remodeling mechanism of amyloid β (Aβ) fibrils. We showed that EGCG was indeed an effective Aβ fibril inhibitor. EGCG was capable of mediating conformational rearrangement of Aβ1-42 fibrils (from a β-sheet to a random coil structure) and triggering the disintegration of fibrils in a dose-dependent manner. EGCG redirected the structure of Aβ by breaking the β-sheet structure and hydrogen bonds between peptide chains within the Aβ protofibrils, especially the parallel β-strand (L17VFFAEDVGS26). Moreover, reduced solvent exposure and multisite binding patterns all tended to induce the conformation conversion of Aβ17-42 pentameric protofibrils, destroying pre-formed fibrils and inhibiting continued fibril growth. Detailed data analysis revealed that structural features of EGCG with abundant benzene ring and phenolic hydroxyl moieties preferentially interact with the parallel β-strands to effectually hinder the interaction of the interpeptide chain and the growth of the ordered β-sheet structure. Furthermore, experimental studies confirmed that EGCG was able to disaggregate the preformed fibrils and alter the protein structure. This study will enable a deeper understanding of fundamental principles for design of structural-based inhibitors.

Systematic review and meta-analysis of the efficacy of acupuncture as an adjunct to IVF cycles in China and the world.

Acupuncture has been introduced as an adjuvant therapy to in vitro fertilization (IVF) cycles in many randomized controlled trials (RCTs). However, there has been a debate among trials regarding the effectiveness and safety of the procedure. To determine how effective and safe acupuncture is as an adjunct to IVF cycles for primary and secondary female infertility. We conducted a literature search for relevant RCTs and ultimately included nine studies. The main selected outcomes included the rates of clinical pregnancy, ongoing pregnancy, miscarriage, live birth, and side effects. Patients receiving acupuncture were grouped together regardless of the acupuncture points used or the protocol for the insertion of needles. We performed a subgroup analysis according to whether studies originated inside and outside China to investigate the results of the different RCTs. We pooled outcomes as a risk ratio (RR) with 95% confidence interval (CI). The analysis revealed that in China, acupuncture led to lower clinical [RR=0.80, 95% CI (0.66, 0.97), p=0.02] and ongoing [RR=0.78, 95% CI (0.63, 0.97), p=0.03] pregnancy rates than placebo. Outside China, acupuncture increased clinical pregnancy rates [RR=1.38, 95% CI (1.11, 1.71), p=0.003] and ongoing [RR=1.73, 95% CI (1.29, 2.31), p<0.001] pregnancy rates. Rates of live birth and miscarriage did not significantly differ between the arms. Regarding side effects, acupuncture groups had a significantly higher rate of puncture site itching compared to control groups [RR=1.51, 95% CI (1.12, 2.04), p=0.007]. Overall analysis does not show a statistically significant increase in clinical pregnancy rates worldwide when using acupuncture as an adjunct therapy to IVF. There were no issues regarding patient safety from any included study. Subgroup results indicated that better rates for clinical pregnancy seem to be occurring more often in RCTs performed outside China than within.

Mutation of the Drosophila melanogaster serotonin transporter dSERT impacts sleep, courtship, and feeding behaviors.

The Serotonin Transporter (SERT) regulates extracellular serotonin levels and is the target of most current drugs used to treat depression. The mechanisms by which inhibition of SERT activity influences behavior are poorly understood. To address this question in the model organism Drosophila melanogaster, we developed new loss of function mutations in Drosophila SERT (dSERT). Previous studies in both flies and mammals have implicated serotonin as an important neuromodulator of sleep, and our newly generated dSERT mutants show an increase in total sleep and altered sleep architecture that is mimicked by feeding the SSRI citalopram. Differences in daytime versus nighttime sleep architecture as well as genetic rescue experiments unexpectedly suggest that distinct serotonergic circuits may modulate daytime versus nighttime sleep. dSERT mutants also show defects in copulation and food intake, akin to the clinical side effects of SSRIs and consistent with the pleomorphic influence of serotonin on the behavior of D. melanogaster. Starvation did not overcome the sleep drive in the mutants and in male dSERT mutants, the drive to mate also failed to overcome sleep drive. dSERT may be used to further explore the mechanisms by which serotonin regulates sleep and its interplay with other complex behaviors.

Short-form development of the specific module of the QLICD-CRF(V2.0) for assessing the quality of life of patients with chronic renal failure

BackgroundA short instrument would enhance the viability of a study. Therefore, we aimed to shorten the specific module (SPD-10) of the Quality of Life Instrument for Chronic Diseases - Chronic Renal Failure (QLICD-CRF) for assessing the quality of life of patients with chronic renal failure.MethodsThe 10-item SPD-10 was self-administered to 164 patients with chronic renal failure. A shortened form was first obtained by a tandem use of the classical test theory (CTT), the generalizability theory (GT), and the item response theory (IRT). In addition, we also shortened the SPD-10 by the Optimal Test Assembly (OTA).ResultsBoth the tandem use of GT, CTT and IRT, and the OTA derived the same 7-item shortened version (SPD-7). It included items CRF1, CRF2, CRF3, CRF4, CRF6, CRF8, and CRF9 of the SPD-10. The SPD-7 had a Cronbach alpha of 0.78. The correlation coefficients of its total and factor scores with those of the SPD-10 were 0.96 and 0.98, respectively. Confirmatory factor analysis confirmed the unidimensional structure of the SPD-7, with the comparative fit index=0.96, the Tucker-Lewis index=0.94, and the root mean square error of approximation=0.09.ConclusionThe short-form SPD-7 is reliable and valid for assessing the impact of clinical symptoms and side effects on the quality of life of patients with chronic renal failure. It is an efficient option without compromising the measurement performance of the SPD-10.

Atomoxetine Decreases Mitochondrial Biogenesis, Fission and Fusion In Human Neuron-like Cells But Does Not Alter Antioxidant Defences.

Atomoxetine (ATX) is a presynaptic norepinephrine transporter (NET) inhibitor widely prescribed for attention-deficit/hyperactivity disorder (ADHD) due to its low abuse potential and absence of psychostimulant effects. While NET inhibition is implicated in the clinical response, several additional pharmacoactivities may contribute to clinical efficacy or unwanted side effects. We recently reported that ATX can dose-dependently alter mitochondrial function and cellular redox status. Here, we assessed potential alterations in mitochondrial biogenesis, mitochondrial dynamics and cellular antioxidant capacity following high- and low-dose ATX treatment of differentiated human neuroblastoma cells. Human SH-SY5Y neuroblastoma cells were treated with ATX (1, 5, 10, 20 and 50 μM) for 7 days under differentiation culture conditions. Changes in the expression levels of protein markers for mitochondrial biogenesis, fusion and fission as well as of antioxidant proteins were analysed by Western blot. High-dose ATX (50 μM) reduced while low-dose ATX (10 μM) increased mitochondrial biogenesis as evidenced by parallel changes in SDHA, COX-I, PGC1α and TFAM expression. High-dose ATX also reduced mitochondrial fusion as evidenced by OPA1 and MFN2 downregulation, and mitochondrial fission as indicated by DRP1 and Fis1 downregulation. In contrast, ATX did not alter expression of the antioxidant enzymes SOD1 and catalase, the phase II transcription factor Nfr2, or the Nfr2-regulated antioxidant enzyme NQO1. Clinical responses and side effects of ATX may be mediated by dose-dependent modulation of mitochondrial biogenesis and dynamics as well as NET inhibition.

Clinical Study on the Efficacy of Bevacizumab in Combination with Pembrolizumab on Cellular Immune Function in the Treatment of Driver Gene-Negative Stage IV Lung Adenocarcinoma.

To explore the efficacy of bevacizumab in combination with PD-1 immune drug pembrolizumab on cellular immune function in the treatment of driver gene-negative stage IV lung adenocarcinoma and its short-term survival effect. From February 2020 to December 2021, 85 patients with driver gene-negative stage IV lung adenocarcinoma were admitted to our hospital and treated with first-line therapy, and their clinical records were reviewed retrospectively. According to the treatments, the patients were separated into two groups the combination group (n = 45) and the control group (n = 40). The treatment regimen of the control group was an AP chemotherapy regimen (pemetrexed combined with cisplatin) + PD-1 immune drug pembrolizumab. The treatment regimen of the combination group was AP chemotherapy regimen + PD-1 immune drug pembrolizumab combined with bevacizumab. We evaluated the pre- and post-treatment cellular immunological function of the two patient groups and discussed the difference between them. There was a substantial difference in the overall effective rate and the disease control rate between the two groups, with the former being 27.50% compared to 48.89% and the latter being 72.50% compared to 93.33% among these 85 patients studied. The KPS for the combination group improved and stayed at 91.11% after treatment, which is considerably better than the KPS for the control group, which was 42.50% (χ 2 = 23.09, P < 0.05). There was no significant difference (P > 0.05) in the numbers of CD3+, CD4+, CD19+, CD8+, or CD4+/CD8+ cells pretreatment between the two groups, but after treatment, the combination group had significantly higher numbers of all these cells. Neither the CD8+ nor the CD19+ level was significantly different between the control and combination groups (P > 0.05). Furthermore, the incidence of common clinical side effects was similar between the two groups (P > 0.05). Proteinuria, tiredness, increased alanine aminotransferase, hypertension, immunological pneumonia, muscle pain, arthralgia, hypothyroidism, etc. were the most common side effects reported among both groups throughout therapy. A grade IV side effect is rare. After follow-up until March 2022, the median PFS for the control group was 9.00 ± 1.65 months (95% CI, 5.76-12.24) and the mean PFS was 11.48 ± 0.91 months (95% CI, 9.69-13.26). Comparison of the median PFS of the combination group (13.00 ± 1.10) months (95% CI: 10.84-15.16) with the average PFS of the group (15.52 ± 0.88) months (95% CI = 13.79-17.25) reveals a statistically significant difference (P < 0.05). Combining bevacizumab with the PD-1 immune medication pembrolizumab to treat patients with stage IV lung adenocarcinoma improves the quality of life, short-term therapeutic effectiveness, immune function, and PFS.

Glia from the central and peripheral nervous system are differentially affected by paclitaxel chemotherapy via modulating their neuroinflammatory and neuroregenerative properties.

Glia are critical players in defining synaptic contacts and maintaining neuronal homeostasis. Both astrocytes as glia of the central nervous system (CNS), as well as satellite glial cells (SGC) as glia of the peripheral nervous system (PNS), intimately interact with microglia, especially under pathological conditions when glia regulate degenerative as well as regenerative processes. The chemotherapeutic agent paclitaxel evokes peripheral neuropathy and cognitive deficits; however, the mechanisms underlying these diverse clinical side effects are unclear. We aimed to elucidate the direct effects of paclitaxel on the function of astrocytes, microglia, and SGCs, and their glia-glia and neuronal-glia interactions. After intravenous application, paclitaxel was present in the dorsal root ganglia of the PNS and the CNS of rodents. In vitro, SGC enhanced the expression of pro-inflammatory factors and reduced the expression of neurotrophic factor NT-3 upon exposure to paclitaxel, resulting in predominantly neurotoxic effects. Likewise, paclitaxel induced a switch towards a pro-inflammatory phenotype in microglia, exerting neurotoxicity. In contrast, astrocytes expressed neuroprotective markers and increasingly expressed S100A10 after paclitaxel exposure. Astrocytes, and to a lesser extent SGCs, had regulatory effects on microglia independent of paclitaxel exposure. Data suggest that paclitaxel differentially modulates glia cells regarding their (neuro-) inflammatory and (neuro-) regenerative properties and also affects their interaction. By elucidating those processes, our data contribute to the understanding of the mechanistic pathways of paclitaxel-induced side effects in CNS and PNS.

Effects of Buprenorphine and Carprofen on Appetite in New Zealand White Rabbits (Oryctolagus cuniculus).

Rabbits are especially susceptible to adverse effects related to surgery, which can lead to inappetence and gastrointestinal (GI) stasis. However, these adverse effects may be related to discomfort from the procedure, anesthesia, the analgesics used, and the stress of restraint for analgesic administration. Opioid and NSAID analgesics which are frequently used in rabbits, can contribute to these adverse effects. This study compared the clinical GI side effects of buprenorphine and carprofen to saline controls in New Zealand White rabbits after a nonsurgical anesthetic event. Nine rabbits (3 females and 6 males, aged 8 to 20 mo) were randomly rotated through 5 treatment groups with a 7-d washout period between treatments: anesthesia control (no treatment), buprenorphine (0.05 mg/kg SC every 12 h for 72 h), carprofen (5 mg/kg SC every 24 h for 72 h), twice daily saline control (equivalent volume to buprenorphine SC every 12 h for 72 h), and once daily saline control (equivalent volume to carprofen SC every 24 h for 72 h). All rabbits were anesthetized 5 times and received initial treatments on the day of anesthesia. Generalized linear mixed models were used to assess food intake, water intake, and fecal output score for 7 days after anesthesia. Analysis showed that buprenorphine-treated rabbits had a significant 4-d decrease in food intake and a 3-d decrease in fecal output score compared with baseline. None of the other treatment groups showed any changes in food intake or fecal output score compared with baseline. These findings demonstrate that in the absence of pain, buprenorphine significantly depresses food intake in rabbits and that restraint and injections have minimal effect on food intake despite the possibility of increased stress.

Production of anti-tetanus toxin IgY and study of its protective effects in a mouse model

ABSTRACT Tetanus is an acute and often fatal infectious disease caused by Clostridium tetani. Tetanus toxin (TT) is responsible for spastic paralysis observed in tetanus. Anti-tetanus antibodies obtained from horses and humans are the most antitoxins used for tetanus treatment, although some clinical side effects and disadvantages have been reported in their application. The aim of this study is the production of anti-TT IgY and evaluation of its protective effects in a mouse model. Anti-TT IgY was purified from the egg yolk using PEG6000 precipitation and water dilution methods, and its purity was verified by SDS-PAGE. Finally, the potency of purified anti-TT IgY in neutralizing the lethal effects of TT was studied in vivo using a mouse model. PEG6000 precipitation method had better results. Animal studies showed that the purified IgY neutralized the toxic effects of 100 MLD of TT and multiple intravenous-dose injections of anti-TT IgY also had a continuous effect of TT neutralization. The purified anti-TT IgY was effective in neutralizing the lethal activity of TT in a mouse model. Our results suggested that IgY could be an alternative therapeutic source for the management of tetanus in the future. Abbreviations Anti-TT, Anti-tetanus toxin; ELISA, Enzyme-linked immunosorbent assay; IgY, Immunoglobulin Y; MLD, Minimum lethal dose; PBS, Phosphate buffer solution; PEG, Polyethylene glycol; SDS-PAGE, Sodium dodecyl sulfate polyacrylamide gel electrophoresis; TIG, Tetanus immune globulin; TT, Tetanus toxin; WD, Water dilution; RT, Room temperature.

Brucellar Spondylitis causes Alteration in Serum protein and Electrophoretic pattern

Background and Objectives: The frequency of Brucellosis is expanding in the Middle East particularly in Iraq. Spondylitis is the most incessant difficulty, yet it is hard to analyze in light of the fact that its clinical side effects are vague. The cross-sectional study was conducted to evaluate abnormal serum protein electrophoresis patience living with brucellar spondylitis and it is related to the disease. This study shares out the distribution of protein pattern in Brucellar spondylitis patients. Methods: The current study included a total number of 40 voluntary subjects covers of 25 cases and 15 controls. Total serum protein was determined using the biuret method, serum albumin was determined using bromocresol green method, Serum protein electrophoresis was determined using SAS-MX serum protein gel. Results: Total proteins, Alpha 1 Globulin, and Gamma Globulin were significantly increased in Brucellar spondylitis when compared to controls. Ratio Albumin/Gamma was significantly decreased in Brucellar spondylitis compared to control. Albumin, Alpha 2 Globulin, and Beta Globulin did not appear significant difference. According to the multivariable regression analysis the level of Alpha 1 Globulin was highly related to total protein in Brucellar spondylitis. The cluster analysis showed that the investigated parameters organized into four clusters in the serum of patients with Brucellar spondylitis. Conclusion: we conclude that Total proteins, Alpha 1 Globulin, and Gamma Globulin have altered in patients Brucellar spondylitis when compared to control, Also Alpha 1 Globulin was associated with total protein in the studied cases.

Financial toxicity in lung cancer.

In the United States, lung cancer is the third most common cancer and the overall leading cause of cancer death. Due to advances in immunotherapy and targeted therapy, 5-year survival is increasing. The growing population of patients with lung cancer and cancer survivors highlights the importance of comprehensive cancer care, including recognizing and addressing financial toxicity. Financial toxicity is a term used to contextualize the negative effects of the costs of cancer treatment in terms of patient quality of life. The American Society of Clinical Oncology (ASCO) Value Framework places emphasis on high-value care as it evaluates cancer treatments "based on clinical benefit, side effects, and improvements in patient symptoms or quality of life in the context of cost". Prior studies have shown that risk factors for financial toxicity in patients with lung cancer include lower household income or savings, inability to afford basic necessities, higher than anticipated out of pocket expenses, and taking sick leave. Among lung cancer survivors, patients experience increased unemployment and lower wages compared to the general population underscoring the lasting effects of financial toxicity. Financial toxicity is associated with increased psychosocial distress and decreased quality of life, and bankruptcy is an independent predictor of mortality in patients with cancer. Despite the negative implications of financial toxicity on patients, standardized screening practices and evidence-based interventions are lacking. The "COmphrensive Score for financial Toxicity (COST)" tool has been validated for assessing financial toxicity with correlation with health-related quality of life. Further research is needed to understand the utility of incorporating routine screening for financial toxicity into clinical practice and the efficacy of interventions. Understanding the relationship between financial toxicity and quality of life and survival is critical to providing high-value cancer care and survivorship care.

5-ALA fluorescence in randomly selected pediatric brain tumors assessed by spectroscopy and surgical microscope

PurposeFluorescence-guided surgery applying 5-aminolevulinic acid (5-ALA) in high-grade gliomas is an established method in adults. In children, results have so far been ambiguous. The aim of this study was to investigate 5-ALA-induced fluorescence in pediatric brain tumors by using the surgical microscope and a spectroscopic hand-held probe.MethodsFourteen randomly selected children (age 4–17) with newly MRI-verified brain tumors were included. No selection was based on the suspected diagnosis prior to surgery. All patients received 5-ALA (20 mg /kg) either orally or via a gastric tube prior to surgery. Intratumoral fluorescence was detected with the microscope and the probe. Moreover, fluorescence in the skin of the forearm was measured. Histopathology samples revealed seven low-grade gliomas, four medulloblastomas, one diffuse intrinsic pontine glioma, one glioblastoma and one atypical meningioma. Blood samples were analyzed, and potential clinical side effects were monitored.ResultsMicroscopically, vague fluorescence was visible in two patients. Intratumoral fluorescence could be detected in five patients with the probe, including the two patients with vague microscopic fluorescence. Three of the oldest children had PpIX fluorescence in the skin. Nine children did not show any fluorescence in the tumor or in the skin. No clinical side effects or laboratory adverse events were observed.ConclusionFluorescence could not be used to guide surgery in this study, neither with the surgical microscope nor with the hand-held probe. In nine children, no fluorescence was discerned and children with noticeable fluorescence were all older than nine years. 5-ALA was considered safe to apply in children.

Is Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study

ObjectivesTo investigate the effects of prolotherapy (PrT) on pain, functionality, clinical improvement and to compare the 5% low and 15% high dose dextrose PrT in chronic lateral epicondylitis. DesignA double-blind, parallel groups, randomized controlled study. SettingsOutpatient Clinic. ParticipantsSixty patients (N=60), aged 44.30±10.31 years old, with chronic lateral epicondylitis were allocated randomly into 3 groups. InterventionsTo Group 1 5% dextrose PrT, to Group 2 15% dextrose PrT, to Group 3 0.9% saline injections were done at 3 times (weeks 0, 3, 6), to the entheses of forearm extensors and annular ligament. Main Outcome MeasuresThe primary outcomes were handgrip strength, visual analog scale-rest (VAS-R), visual analog scale-activity (VAS-A), pressure-pain threshold, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH). The secondary outcomes were clinical improvement (Disease Global Assessment Questionnaire), side effects, and complications. Primary outcomes were collected at baseline week 0, week 3, and 12. Secondary outcomes were collected at weeks 3 and 12. ResultsIn Group 2, VAS-A and VAS-R (at week 3), handgrip strength and pressure-pain threshold (at week 12) were significantly different than other groups (P<.05). In Groups 1 and 2, there was a difference in primary outcomes at week 12 than baseline (P<.05). In Group 3, there was no difference in VAS-R, VAS-A, and handgrip strength at weeks 3 and 12 than baseline (P>.05). ConclusionIn chronic lateral epicondylitis, 5% and 15% dextrose PrT is more effective in pain, handgrip strength, functionality, and clinical improvement than %0.9 saline. There was no difference in functionality, clinical improvement, side effects, and complications between the PrT groups. 15% dextrose PrT was more effective in handgrip strength and pressure-pain threshold at week 12 and pain at week 3. We recommend 15% dextrose PrT based on this study.

Prevention of Adverse Outcomes and Treatment Side Effects in Patients with Neuromuscular Disorders.

In this article, we review prevention of serious adverse clinical outcomes and treatment side effects in patients with neuromuscular disorders including myopathies and myasthenia gravis. While neither of these entities is preventable, their course can often be modified, and severe sequelae may be prevented, with the identification of risk factors and proactive attention toward treatment planning.

S1637 Outcomes in Patient With Refractory Gastroparesis on Domperidone-A 12-Year Experience

Introduction: Domperidone (Domp), a prokinetic with less side effects than metoclopramide, the only FDA-approved medication for gastroparesis (GP), is only available via the FDA IND program. Our aim was to examine clinical response and side effects profiles of patients (pts) enrolled in our program to identify those most likely to benefit. Methods: Records of pts enrolled from 2010 through 2021 were examined. Pts who completed an initial (PAGI sym) were contacted for a repeat PAGI-sym. Pts self-reported quality of life. Records of disenrolled (DE) pts were reviewed for cause for disenrollment, adverse effects if any and improvement of symptoms on Domp. Data is reported at percentages and mean ± SD. Variables were compared using Chi-squared test (categorical) and t-test. P< 0.05 was considered significant. Results: 301 pts (85.7% F), were consented. 189 pts were disenrolled (DE), of which 31 never started drug, and 67 charts were reviewed in detail. 41 pts still enrolled (E) had initial and followup PAGI-sym. Of these, 32 (78%) were female, mean age on entry was 50 yrs, with 70.1% older than 40 yrs. Mean treatment duration was 39±39.3 mo. Top GP causes were idiopathic (43.9%), diabetes (24.4%) and post-surgical (12.2%). There was no significant difference in causes or initial symptom severity between genders. There was significant improvement in the severity of all symptoms on PAGI-sym scale after Domp treatment (Table). Gender and age groups did not affect this improvement. Overall self-reported quality of life (QoL) improved regardless of gender, age group and use of psychotropic medication. Reasons for disenrollment for all 189 DE pts are shown in Figure. Six had QTc prolongation (3.2%). In the 67 pts with detailed review, the GP cause was similar in those with symptom remission as in all the DE and E pts. Treatment duration of DE pts was 22.2±22.8 months, shorter than the 41 E pts (P< 0.005). Pts with symptom remission were on Domp treatment for 45.7 ± 26.74 mo, longer than pts withdrawn for other reasons (mean 14.83±15.54 mo, P< 0.001). Most (72%) DE pts reported improvement in symptoms. Conclusion: In summary, Domp improves symptoms related to GP regardless of etiology. Nearly 2 thirds disenrolled over time, but very few have prolonged QTc. Detailed review in a subset of pts suggest no specific etiologies result in better symptom response to domperidone, or predict likelihood of adverse events. Symptom remission can take several years to be sufficient to discontinue treatment.Figure 1.: Reasons for Disenrollemnt in 189 DE Patients. Table 1. - Comparison of Symptom Improvement in All Enrolled Patients PAGISYM-1 (mean +/- SD) PAGISYM-2 (mean +/-SD) P value Regurgitation 2.23 +/- 1.55 1.27 +/- 1.1 < 0.001 Nausea 3 +/- 1.7 1.66 +/- 1.15 < 0.001 Upper Abdominal Pain 2.66 +/- 1.59 1.37 +/- 1.18 < 0.001 Stomach Fullness 3.45 +/- 1.48 2.41 +/- 1.32 0.003 Loss of Appetite 2.9 +/- 1.74 1.46 +/- 1.4 < 0.001 Upper Abdominal discomfort 2.7 +/- 1.54 1.46 +/- 1.29 < 0.001 Bloating 3.48 +/- 1.55 2.2 +/- 1.5 < 0.001 Retching 1.4 +/- 1.53 0.61 +/- 0.92 < 0.001 Stomach or Belly Visibly Larger 2.69 +/- 1.89 1.55 +/- 1.45 0.001 Vomiting 1.89 +/- 1.84 0.78 +/- 1.17 0.001 Not Able to Finish a Normal Sized Meal 3.5 +/- 1.52 2.05 +/- 1.45 < 0.001 Feeling Excessively Full After Meals 3.75 +/- 1.28 1.93 +/- 1.44 < 0.001

Yeşil iguanalarda Hirstiellosis'e karşı ivermektin solüsyonunun etkinliği

Interest in green iguanas (Iguana iguana) as pet animals is increasing day by day. Compared to other pet animals, the diagnosis and treatment methods of reptilian diseases are limited. Considering that these diseases will also concern public health, new research is required. Hirstiellosis is a zoonotic ectoparasitic disease seen in green iguanas (Iguana iguana). Recommended therapies are mostly empirical, some of which can be low-impact or toxic. The objective of this study is to determine the effectiveness of ivermectin solution (5 mg/l) in the treatment of hirstiellosis and to provide preliminary data for further studies. Ivermectin solution was found to be effective in the treatment of three iguanas with the aforementioned disease, and no clinical side effects were found in the control examinations made at regular intervals.

A meta-analysis of clinical effects of microscopic unilateral laminectomy bilateral decompression (ULBD) versus biportal endoscopic ULBD for lumbar canal stenosis.

OsbjectiveSeveral studies have shown that both microscopic unilateral laminotomy bilateral decompression (ULBD) and unilateral biportal endoscopic (UBE) ULBD are effective for treating lumbar canal stenosis (LCS). However, there are different viewpoints as to which surgical technique is superior. Therefore, this meta-analysis investigated the clinical efficacy and side effects of microscopic ULBD and UBE ULBD for treating LCS.MethodsTo identify relevant studies describing the clinical outcomes and complication rates of microscopic ULBD and UBE ULBD for LCS, several databases were systematically searched in the Internet. The visual analog scale score for back and leg pain and the Oswestry Disability Index were used to assess clinical outcomes. Furthermore, data about perioperative outcomes and complications were documented.ResultsIn total, six studies with 450 participants were included in this meta-analysis. The UBE ULBD was found to be superior to microscopic ULBD in terms of efficacy against early postoperative back and leg pain. However, there was no significant difference between the two procedures in terms of final clinical outcomes and complications. In addition, compared with microscopic ULBD, UBE ULBD was associated with a significant reduction in the length of hospital stay and C-reactive protein levels 2 days after surgery.ConclusionUBE ULBD and microscopic ULBD for the treatment of LCS were similar in terms of final clinical outcomes and complications. However, UBE ULBD has several advantages over microscopic ULBE, including a shorter hospital stay and faster alleviation of postoperative back and leg pain.

Paraphenylenediamine (Hair Dye) Poisoning: A Prospective Study on the Clinical Outcome and Side Effects Profile.

Background: Systemic poisoning with paraphenylenediamine (PPD) also known as Kalapathar, is an emerging suicidal trend in developing south Asian and African countries. The clinical distinction of hair dye toxicity comprises severe angioedema of the face and neck, tongue swelling resulting in upper airway obstruction, acute liver injury, myocarditis, and rhabdomyolysis complicating to acute kidney injury.Aim: To raise awareness, document the characteristic clinical spectra, and prevent and predict the outcome of poisoning (suicidal or accidental) with PPD (hair-dye) based on clinical complications, early baseline laboratory results and creatine phosphokinase (CPK) levels monitoring.Place and duration: Department of Medicine and Emergency, Sheikh Zayed Hospital, Rahim Yar Khan. One year of study from August 19, 2021 to August 17, 2022.Methods: A total of 103 patients, with no comorbidities, who presented with acute PPD poisoning were included in this study. The demographic profile, clinical features, laboratory results, route and mode of intoxication were noted in a special proforma. Furthermore, clinical outcomes in the form of need for tracheostomy or mechanical ventilation, mortality and mean hospital stay were also documented. The percentages were calculated for categorical data like demographic profile, clinical features and clinical outcomes. Mean and standard deviation was calculated for continuous variables, i.e., laboratory parameters.Results: Out of 103 patients, 88 (85.4%) were females who belonged to a low socioeconomic class (89%). The mean age of the patients was 26.39 ± 3.41 years. The majority of cases were suicidal self-poisoning (98%), and the route was oral (98%). In 82 (79.6%) of the patients, the characteristic cervicofacial angioedema, dysphagia, dysphonia, tongue swelling and stridor were noted. Clinical complications such as rhabdomyolysis (67.9%), chocolate-colored urine (82.5%), hepatitis (58.2%), and acute kidney injury (22.3%) were noted in the later clinical stages of PPD poisoning. Emergency tracheostomy was performed in 77.6% of patients. The mortality rate in this study stands at 12.6% and the mean hospital stay at 6.25 ±3.99 days. The mean and standard deviation of serum creatinine, CPK, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total leukocyte count (TLC), and serum potassium were, respectively, noted at 2.431 ± 2.275 mg/dL, 1090.8 ± 218.6 IU/L, 476.8 ± 1038.8 IU/L, 639.1 ± 1006, 11100 ± 4124.1 cells/mm3, and 4.8 ± 1.061 mmol/L.Conclusion: PPD is emerging as the poison of choice in suicidal young female patients due to its easy, low-cost availability and higher mortality. The cervicofacial angioedema, tongue swelling and rhabdomyolysis impending acute kidney injury are hallmarks of PPD poisoning. The treatment is largely supportive with no specific antidote available. Early clinical diagnosis and supportive therapeutic management in the form of maintenance of airway patency, timely tracheostomy with post-operative tube care, intravenous medications (fluids, steroids, antihistamine), and renal dialysis can save lives and may lead to full recovery. In addition, strict legal measures should be endorsed to ban the sale and use of lethal PPD in hair dyes.