Contemporary Management Strategies Research Articles

What to do about recurrent urinary tract infections: A review of evidence behind emerging therapies.

Recurrent urinary tract infections (rUTIs) can be debilitating for patients and pose an increasing challenge in the primary care setting. An efficient approach enables timely access and effective carefor patients. Recent research and pharmaceutical developments have provided new avenues for treating this common condition. A narrative review was conducted to provide a targeted overview of contemporary management strategies in rUTIs to assist primary care physicians in managing patients with rUTIs efficiently and effectively. Recurrent urinary tract infections require investigation and risk factor identification. Appropriate patient education in the primary care setting, behavioural modifications and commencement of non-antibiotic treatment might reduce rUTI. Certain patients might require referral to a urologist for consideration of other treatment strategies and further investigation.

Taking a BiTE out of Lymphoma: Bispecific Antibodies in B-Cell Non-Hodgkin Lymphoma.

B-cell non-Hodgkin's lymphoma (NHL) refers to a heterogenous group of diseases, all of which have a wide range of treatment strategies and patient outcomes. There have been multiple novel, immune-based therapies approved in NHL in the last decade, including bispecific antibodies (BsAbs) and chimeric antigen receptor therapy (CAR-T). With a host of new therapies, an important next step will be determining how these therapies should be sequenced in contemporary management strategies. This review seeks to offer a framework for the ways in which BsABs can be incorporated into the current management paradigm for NHL, with special attention paid to diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and mantle cell lymphoma (MCL).

Management of excessive soil H+ ion induced toxicities by application of organic seaweed amendment enhances photosynthesis and resource use efficiencies in rice (Oryza sativa)

Globally, soil acidification is a serious environmental issue that reduces commercial agricultural production. Rice is subjected to nutritional stress due to acidic soil, which is a major impediment to rice production. Since acid soil threatens rice plants with soil compaction, nutrient loss, and plant stress-induced oxidative cell damage that results in affecting the photosynthetic system, restricting the availability of water, and reducing overall plant growth and productivity. Since contemporary soil acidification management strategies provide mediocre results, the use of Sargassum wightii seaweed-based biostimulants (BS) and soil amendments is sought as an environmentally friendly alternative strategy, and therefore its potential isevaluated in this study. BS was able to mediate soil quality by improving soil pH and structure along with facilitating nitrogen phytoavailability. BS also increased the activity of the antioxidant enzyme system, superoxide dismutase ((48%), peroxidase (76.6%), and ascorbate peroxidase (63.5%), aggregating the monaldehyde-mediating accumulation of osmoprotective proline in roots, that was evident from rapid initiation of root hair growth in treated seedlings. BS was also able to physiologically modulate photosynthetic activities and chlorophyll production (24.31%) in leaves, maintaining the efficiency of plant water use by regulating the stomatal conductance (0.91 mol/m/s) and the transpiration rate (13.2 mM/m/s). The BS compounds were also successful in facilitating nitrogen uptake resulting in improved plant growth (59%), tiller-panicle number, and yield (52.57%), demonstrating a resourceful nitrogen use efficiency (71.96%) previously affected by stress induced by acid soil. Therefore, the study affirms the competent potential of S. wightii-based soil amendment to be applied not only to improve soil quality, but also to increase plant production and yield.

A comprehensive analysis of linear and non-linear deterioration rates in dual-warehouse inventory systems

This study presents an inventory system where items have an initial linear deterioration rate that transitions to a non-linear pattern, addressing a critical aspect of contemporary supply chain management. Our research introduces a dual warehouse inventory model comprising a rented facility and utilizing an owned warehouse. This unique approach is geared towards products experiencing a shift in deterioration rates, starting linearly and progressing non-linearly. The model operates under a constant demand rate, allowing for partial backlogging during shortages. Key to our analysis are distinct holding costs assigned to each warehouse, reflecting real-world scenarios. We derive conditions that minimize the total cost, supporting these with numerical examples spanning various parameter settings. A comprehensive sensitivity analysis evaluates the influence of each parameter’s alteration, keeping others constant. This analysis illuminates the model’s robustness and adaptability to different operational contexts. The findings offer significant managerial implications, providing valuable insights for effectively managing inventory in scenarios where product deterioration rates change over time. Our approach distinguishes itself by integrating linear and non-linear deterioration patterns within a dual warehouse system, a novel contribution to inventory management literature. The practical relevance of our model is underlined by its applicability in diverse supply chain environments, making it an essential tool for contemporary inventory management strategies.

Paediatric femoral shaft fractures: an instructional review for the FRCS examination.

This review presents the principal features of paediatric femoral shaft fractures including the contemporary management strategies and relevant supporting evidence. The article is an overview of information relevant to clinical practice, in addition to preparation for the FRCS (Orth) examination.

Comprehensive Insights into Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a prevalent vascular disorder characterized by the narrowing or obstruction of arteries, predominantly affecting the lower extremities. This bibliographic review explores the multifaceted aspects of PAD, emphasizing epidemiology, significance, and the theoretical framework encompassing its definition, risk factors, pathophysiology, and contemporary management strategies. In this comprehensive analysis, we delve into the intricate interplay of factors contributing to PAD, from the demographic landscape to the molecular intricacies. Despite advancements in therapeutic modalities, the intricate nature of PAD warrants a nuanced understanding for effective clinical intervention. The ensuing discussion navigates through contemporary perspectives on PAD, synthesizing current evidence to inform clinical practice. In conclusion, this review underscores the imperative of a holistic approach in managing PAD, integrating evolving scientific insights with pragmatic clinical considerations.

Degenerative Disorder of Temporomandibular Joint- Current Practices and Treatment Modality

Degenerative Joint Disorders (DJD) of the Temporomandibular Joint (TMJ) represent a challenging and multifaceted group of conditions that severely impact the joint's function and quality of life. This comprehensive review delves into the etiology, pathogenesis, clinical manifestations, and contemporary management strategies of TMJ-OA. While systemic illnesses, aging processes, hormonal factors, and behavioral factors have been implicated in its development, recent evidence highlights the pivotal role of mechanical overloading in initiating a series of degenerative changes within the TMJ.Painful joints, a hallmark of TMJ-OA, result from the soft tissues around the affected joint and reflexive muscle spasm, following Hilton's law, which innervates the joint's muscles and overlying skin. This self-preservation reflex protects against further joint damage. Moreover, painful symptoms may arise from subchondral bone destruction.Recognizing the importance of understanding the biomechanical environment within the TMJ, this review underscores its relevance in identifying the mechanisms behind TMJ pain and disability. Furthermore, it discusses the potential application of tissue engineering in TMJ reconstruction, emphasizing the need to learn from past TMJ implant experiences.In the context of treatment, the review highlights the significance of managing TMJ-OA, focusing on restoring function and reducing pain. Treatment modalities span from non-invasive therapies to surgical options, with the latter reserved for cases unresponsive to conservative approaches and severely affecting an individual's quality of life.This review serves as a vital resource for both clinicians and researchers, offering insights into the multifaceted nature of TMJ-OA and the evolving landscape of its diagnosis and management, incorporating biomechanical considerations and potential advances in tissue engineering. Understanding the complexities of TMJ-OA is instrumental in enhancing the care and well-being of individuals affected by this condition.

Technological innovations in agriculture: Impact on production efficiency

The necessity to meet the food needs of Azerbaijan requires modernisation of the agricultural industry navigating the challenges associated with an innovative mode of progress. This process is accompanied by technical and technological optimisation of most of the production processes in agriculture. The aim of this research was to examine and assess the integration of technological innovations in Azerbaijan’s agricultural sector. The investigation employed fundamental scientific methods, including system analysis, synthetic method, method of abstraction, deductive method, and methods of summarisation, and concretisation. During the investigation, the main objectives of technological modernisation of the agrarian sector were analysed, the dynamics of their impact on the efficiency of production depending on different factors was investigated, measures for optimisation of the situation with regard to the priority of innovative solutions were developed. Additionally, the research explored the potential application of contemporary management and technological strategies to mitigate the adverse environmental effects of agricultural production. This involved integrating environmental safety and economic efficiency through the adoption of cutting-edge innovative technological approaches. Their effectiveness as a viable tool for the transformation of the agrarian sector following the current social and economic requirements for the intensification of its development was determined. Implementing the ecosystem approach and adopting integrated agro-landscape management can pave the way for a renewed development of the agronomy industry in Azerbaijan. The results of this study carry significant practical implications for advancing and modernising the country’s agricultural economy system, contributing to the formulation of targeted programs for technological innovations

Cash Management: A Key Driver of Performance for Conventional Banks in Pakistan

This research examines the critical influence of cash management on the financial efficacy of the conventional banking sector in Pakistan. This study represents the initial attempt to assess the influence of liquidity, debt ratio, and bank size on return on assets among five conventional banks in Pakistan. Information was obtained from audited annual reports from publicly traded banks that span from 2017 to 2021. The results indicate a significant positive correlation between liquidity and return on assets (ROA). Additionally, a significant negative association between debt ratio and ROA is examined. Furthermore, the study reveals that the size of banks exhibits a significant negative relationship with ROA. The study will provide valuable insights for financial managers, portfolio analysts, treasurers, and controllers on the practical implementation of contemporary cash management strategies.

Towards a ‘systems’ approach for viral challenge experiments in shrimp: Reporting guidelines for publication

AbstractThe success of contemporary disease management strategies in shrimp aquaculture, such as the ‘systems’ approach, is predicated on robust knowledge of the conditions and interactions between the host, pathogen and environment that promote disease. Pathogen challenge experiments (PCEs) are a power tool for investigating these conditions and interactions. However, absence of accurately reported experimental detail in published PCEs limits scientific transparency, reproducibility, and the potential for the research to make progressive advancements contributing to contemporary shrimp disease management strategies. This review identifies and discusses key factors relating to the host (shrimp), pathogen (virus), and environment that should be carefully considered during the design and publication of PCEs. We offer substantial evidence of their impact on viral disease outcomes, drawn from the existing body of literature, to supporting their consideration. The prevalence of reported experimental details for these factors across 186 viral PCEs in shrimp were evaluated. The review highlights a concerning paucity of experimental detail reported in published shrimp PCEs. We propose a checklist for the minimum reportable information in the publication of shrimp viral PCEs, hereafter referred to as the Shrimp PCE Reporting Guidelines (SPERG). The guidelines aim to enhance the transparency and standardisation of reporting in published PCEs, ensuring that key factors pertaining to the shrimp, pathogen, and environment are adequately considered and documented. Adoption of SPERG is envisaged to empower researchers, reviewers, and readers to assess the internal and external validity of PCEs, facilitating critical evaluation and improved utility of PCE findings for contemporary disease management.

Consequences of rewetting and ditch cleaning on hydrology, water quality and greenhouse gas balance in a drained northern landscape

Drainage for forestry has created ~ 1 million km of artificial waterways in Sweden, making it one of the largest human-induced environmental disturbances in the country. These extensive modifications of both peatland and mineral soil dominated landscapes still carry largely unknown, but potentially enormous environmental legacy effects. However, the consequences of contemporary ditch management strategies, such as hydrological restoration via ditch blocking or enhancing forest drainage to promote biomass production via ditch cleaning, on water resources and greenhouse gas (GHG) fluxes are unclear. To close the gap between science and management, we have developed a unique field research platform to experimentally evaluate key environmental strategies for drained northern landscapes with the aim to avoid further environmental degeneration. The Trollberget Experimental Area (TEA) includes replicated and controlled treatments applied at the catchment scale based on a BACI approach (before-after and control-impact). The treatments represent the dominant ecosystem types impacted by ditching in Sweden and the boreal zone: (1) rewetting of a drained peatland, (2) ditch cleaning in productive upland forests and (3) leaving these ditches unmanaged. Here we describe the TEA platform, report initial results, suggest ways forward for how to best manage this historical large-scale alteration of the boreal landscape, as well as warn against applying these treatments broadly before more long-term results are reported.

Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies.

Central venous stenosis is a significant and frequently encountered problem in managing hemodialysis (HD) patients. Venous hypertension, often accompanied by severe symptoms, undermines the integrity of the hemodialysis access circuit. In central venous stenosis, dialysis through an arteriovenous fistula is usually inefficient, with high recirculation rates and prolonged bleeding after dialysis. Central vein stenosis is a known complication of indwelling intravascular and cardiac devices, such as peripherally inserted central catheters, long-term cuffed hemodialysis catheters, and pacemaker wires. Hence, preventing this challenging condition requires minimization of central venous catheter use. Endovascular interventions are the primary approach for treating central vein stenosis. Percutaneous angioplasty and stent placement may reestablish vascular function in cases of elastic and recurrent lesions. Currently, there is no consensus on the optimal treatment, as existing management approaches have a wide range of patency rates.

Swyer Syndrome: An in-Depth Exploration of Phenotypic and Genotypic Features in 46, XY Disorders of Sex Development

Swyer Syndrome, also known as 46, XY Complete Gonadal Dysgenesis, is a rare and intriguing disorder of sexual development characterized by a phenotypic female appearance in individuals possessing a 46,XY karyotype. This enigmatic condition results from a cascade of genetic and hormonal events, which ultimately lead to the absence of functional gonads, presenting a challenging diagnostic and therapeutic conundrum. In this comprehensive review, we delve into the intricate landscape of Swyer syndrome, elucidating its genetic underpinnings, clinical manifestations, diagnostic approaches, and contemporary management strategies. By consolidating current knowledge, this article aims to provide a valuable resource for healthcare professionals, geneticists, and researchers interested in unraveling the complexities of disorders of sex development and the genetic determinants of sexual differentiation.

Bochdalek Hernia: A Comprehensive Review of Pathophysiology, Clinical Presentation, Diagnostic Modalities, and Contemporary Management Strategies

Bochdalek hernia, a rare congenital diaphragmatic anomaly, has garnered substantial attention due to its intricate pathophysiological underpinnings and multifaceted clinical implications. This article endeavors to provide an exhaustive analysis of Bochdalek hernia, encompassing its embryological origins, intricate pathophysiology involving the posterolateral diaphragmatic defect, and the subsequent herniation of abdominal contents into the thoracic cavity. A meticulous exploration of the clinical presentation underscores the considerable variation in symptomatology, ranging from asymptomatic cases incidentally detected on imaging, to severe respiratory distress and life-threatening consequences in neonates. The diagnostic armamentarium, including radiographic, ultrasonographic, and tomographic modalities, is scrutinized with a focus on their respective sensitivities and specificities in discerning this anatomical aberration. In light of contemporary advancements, the article elucidates the expanding role of three-dimensional reconstructions and minimally invasive techniques in achieving accurate diagnosis and surgical planning. Furthermore, the management landscape is delineated, encompassing conservative approaches for asymptomatic cases, urgent surgical interventions for acute presentations, and the nuanced perioperative considerations for neonates and pediatric patients. A comprehensive overview of surgical techniques, ranging from traditional open procedures to the evolving realm of robotic-assisted and laparoscopic repairs, is provided, with emphasis on individualized strategies tailored to patient-specific factors. In summation, this article offers a comprehensive and sophisticated exploration of Bochdalek hernia, amalgamating embryology, pathophysiology, clinical presentation, diagnostic modalities, and contemporary management paradigms. It is envisaged that this review will serve as a valuable resource for medical practitioners, surgeons, and researchers, fostering an enriched understanding of this intricate condition and facilitating informed decision-making in its management.

Intuitive evaluation of contemporary management strategies in thymoma - the largest Indian experience.

The aim was perusal of the treatment strategies, clinical outcomes and factors impacting these outcomes in thymoma. A total of 119 patients diagnosed and treated cases of thymoma, at our hospital, were taken for analysis. Thirty-one patients were excluded due to inadequate medical records. Descriptive statistics were used to report demographic and clinical characteristics. Time period between diagnosis and death was defined as overall survival (OS). Multivariate analysis (MVA), using cox regression modelling, was done by including clinicopathological factors in a bid to identify prognostic factors influencing OS. SPSS version 26 was used for statistical analysis. The mean age of the patients was 52.17 years and 39 (44.3%), 19 (21.6%), 17 (1.3%) and 13 (4.8%) patients presented with Masaoka stage II, IV, III and I, respectively. Surgery was done in 64 (72.7%) of the patients as a part of the treatment strategy. Radiotherapy was administered to a total of 57 patients with a median dose of 50.4 Gy. Early Masaoka stage at presentation and use of surgery in the treatment plan were statistically significant prognostic factors for a better overall survival on multivariate analysis. Judicious use of radiotherapy and chemotherapy in locally advanced cases may render them resectable. In a bid to gain good survival rates, aggressive multimodality treatment should be offered to the patients.

Mango anthracnose disease: the current situation and direction for future research.

Mango anthracnose disease (MAD) is a destructive disease of mangoes, with estimated yield losses of up to 100% in unmanaged plantations. Several strains that constitute Colletotrichum complexes are implicated in MAD worldwide. All mangoes grown for commercial purposes are susceptible, and a resistant cultivar for all strains is not presently available on the market. The infection can widely spread before being detected since the disease is invincible until after a protracted latent period. The detection of multiple strains of the pathogen in Mexico, Brazil, and China has prompted a significant increase in research on the disease. Synthetic pesticide application is the primary management technique used to manage the disease. However, newly observed declines in anthracnose susceptibility to many fungicides highlight the need for more environmentally friendly approaches. Recent progress in understanding the host range, molecular and phenotypic characterization, and susceptibility of the disease in several mango cultivars is discussed in this review. It provides updates on the mode of transmission, infection biology and contemporary management strategies. We suggest an integrated and ecologically sound approach to managing MAD.

Standardized Opioid Counseling Is Underperformed Before and After Anterior Cruciate Ligament Reconstruction

To characterize contemporary pain management strategies after anterior cruciate ligament reconstruction (ACLR) within the US and international orthopaedic community. This was a cross-sectional survey-based study disseminated to a consortium of expert orthopaedic surgeons in the management of anterior cruciate ligament injuries. The survey was a 27-question, multiple choice-style questionnaire with question topics ranging from demographic characteristics and practice characteristics to surgeon-specific pain management strategies in the postoperative period after ACLR. Specific topics of interest included the use of preoperative opioid education and/or counseling sessions, implementation of standardized pain management regimens, use of pain tracking systems, and use of any adjunct non-narcotic analgesic modalities. A total of 34 completed surveys were collected, representing a 73.9% response rate. Over 85% of respondents reported prescribing opioids as a standardized postoperative regimen after ACLR. Surgeons reported prescribing 5- to 10-mg doses, with the tablet count ranging anywhere from fewer than 10 tablets to more than 20 tablets, often instructing their patients to stop opioid use 2 to 4 days postoperatively. Prescribed dosages remained stable or decreased over the past 6 months with increased use of non-narcotic adjuncts. Only one-third of respondents reported using standardized preoperative opioid counseling, with even fewer discussing postoperative discontinuation protocols. Over 85% of respondents prescribe opioids as a standardized postoperative regimen after ACLR, with only 15% providing non-narcotic pain regimens. However, prescribed dosages have remained stable or decreased over the past 6 months with increased use of non-narcotic adjuncts. Only one-third of respondents use standardized preoperative opioid counseling, with even fewer discussing postoperative discontinuation protocols. The ongoing opioid epidemic has created an urgent need to identify the most effective pain management strategies after orthopaedic procedures, especially ACLR. This study provides important information about current pain management practices for patients who have undergone ACLR.

Pancreatic cancer associated ascites: Risk factors, outcomes, and management.

e16305 Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with significant morbidity and mortality as most patients present with advanced disease. The development of ascites has been associated with poor outcomes and further characterization and contemporary management strategies are needed. Therefore, we performed a comprehensive analysis of PDAC patients with ascites, including clinical and biological data, to describe its incidence, associated clinical factors, and outcomes. Methods: Patients were prospectively consented and enrolled the Gastrointestinal Biobank (“GI-Bank”) at Cedars-Sinai Medical Center, which collected patient specimens, associated clinical data, and self-reported questionnaires. Data was consolidated using a standard software tool (Redcap). Statistical analysis was conducted using Excel and using Datatab.net software tools. Results: Of the 437 patients with PDAC, 182 (41.6%) developed ascites. Overall survival (OS) between ascites and non-ascites groups were significantly different by log-rank test (p = 0.001), and estimated median OS was 473 days (95% CI [407, 537]) in ascites patients versus 554 days [467, 678] in non-ascites patients. In Cox proportional hazards model analysis, ascites status, but not sex or race, was associated with decreased survival (HR 1.49, [1.18, 1.87]). Ascitic fluid data was obtained in 77 patients; 62 (80.5%) had SAAG > 1.1; 14(22.6%) of SAAG > 1.1 patients also had positive cytology. The estimated median OS from the diagnosis of ascites was 100 days [76, 128] and median time to puncture was 4 days. Estimated median time from first tap to death was 56 days [42, 95]. 90 (49.5%) were treated with diuretics and 41 (22.5%) were treated with PleurX catheter. Patients with ascites had a worse survival and were more likely to receive greater than one chemotherapy regimen. There was no relationship between ascites and receipt of surgery or radiation. Conclusions: The development of ascites in patients with pancreatic cancer is common and contributes to significant morbidity and mortality. The use of diuretics is lower than would be expected for patients with elevated SAAG. Prospective evaluation of management strategies is needed to improve this important clinical conundrum.

Contemporary management of extracranial vascular malformations.

Vascular malformations are congenital vascular anomalies that originate because of disorganized angiogenesis, most commonly from spontaneous somatic genetic mutations. The modern management of vascular malformations requires a multidisciplinary team that offers patients the gamut of medical, surgical, and percutaneous treatment options with supportive care. This manuscript discusses the standard and contemporary management strategies surrounding extracranial vascular malformations and overgrowth syndromes.

AB154. SOH23ABS_234. A systematic review and meta-analysis of contemporary management of perianal abscess: to pack or not to pack

Background: Traditional management of perianal abscesses involves incising the skin over the abscess to drain the abscess and allow wound irrigation. Following drainage an internal dressing is applied (packing) and is changed regularly until the abscess has healed by secondary intention. More contemporary perianal management strategies such as refraining from regular post-operative packing have shown promising results. The aim of this study was to synthesize the evidence for packing perianal abscesses compared to non-packing.