Conventional Medical Treatment Research Articles

Holistic approaches to living well with endometriosis

Endometriosis is a common chronic non curable neuro-inflammatory condition, which can cause endometriosis-related pelvic pain (ERPP). Sufferers may struggle with side effects and/or risks from conventional medical and surgical treatments, or not get pain relief. Increasing numbers of endometriosis patients wish to explore holistic management with fewer side effects, however it is important that medical professionals maintain an evidence-based practice for recommended treatments. We present up-to-date evidence of holistic strategies used for managing ERPP including nutrition, body and mind therapies, acupuncture, traditional Chinese medicine (TCM) and the use of adjunct devices such as phallus length reducers and transcutaneous electrical nerve stimulation (TENS). Recent findings: Nutrition: Gluten-free, low-nickel and high intake of omega-3 polyunsaturated fatty acids diets improve ERPP. Low FODMAP (fermentable oligo-, di-, monosaccharides and polyols), plant-based diet and antioxidant vitamin supplementation is helpful including those with concurrent irritable bowel syndrome. Body and Mind: Cognitive behaviour therapy (CBT) is beneficial in postoperative pain reduction, whilst mindfulness has been shown to reduce pain scores and dyschezia. Progressive muscle relaxation therapy and regular yoga sessions improve ERPP and Quality of life. Acupuncture: Acupuncture and moxibustion show improved pain scores compared to conventional therapies alone. Adjunct devices: TENS improves deep dyspareunia and reduces the number of days pain is experienced. Summary: Holistic management strategies for ERPP should be incorporated into routine counselling when discussing conservative, medical and or surgical treatments for endometriosis. The growing evidence presented for the use of holistic management strategies gives hope to those patients who cannot have, or don’t respond to conventional approaches and as an adjunct alongside standard treatments. These findings should be incorporated into the routine counselling when seeing patients in the gynaecology outpatient setting presenting with chronic pelvic pain.

The Role of Echocardiography in monitoring patients supported with Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal membrane oxygenation (ECMO) is a form of critical care support for patients with severe respiratory or circulatory failure where conventional medical treatments have failed. Two main configurations of ECMO exist: Venovenous (VV) to support failing lungs, and venoarterial (VA) for circulatory shock. Echocardiography is an invaluable tool in the assessment of patients requiring ECMO. It can be utilised for decision-making regarding the most appropriate configuration, detection and management of complications, and to guide weaning. This concise review is intended to be a primer on the role of echocardiography for patients requiring ECMO for circulatory failure.

Understanding the influence of Manasika Bhavas on Stanya Kshaya: A Conceptual Study

Breast milk stands as the foremost source of nutrition in every individual's early life. According to Ayurveda, Stanya is considered an Upadhatu of Rasa and is pivotal for the nourishment and development of infants. Ayurveda defines decreased breast milk or lactation insufficiency as Stanya Kshaya, primarily attributed to emotions like anger, grief, and excessive affection, alongside dietary influences. Psychological factors such as emotional stress, anxiety, and maternal health also significantly impact milk production, necessitating both psychological and medical interventions. Any disruption in Agni affects Ahara Rasa, leading to disturbances in Rasa Dhatu, thereby affecting Stanya. Psychological aspects play a crucial role in the proper formation of Ahara Rasa. The significance of Manasika Bhavas lies in their advocacy of Soumanasya as a primary treatment for Ksheerajanana. This paper explores the correlation between psychological well-being and lactation outcomes, drawing on both contemporary psychological research and traditional Ayurvedic principles. Psychological stress, anxiety, depression, and maternal bonding are examined as key factors affecting hormonal balance and neuroendocrine pathways involved in lactation. Understanding these influences is crucial for holistic approaches to maternal health and breastfeeding support. The integration of psychological interventions alongside conventional medical treatments could enhance maternal lactation success rates and overall maternal-infant health outcomes. Thus, managing Stanya Kshaya requires thorough consideration of both psychological factors and dietary practices.

Clinical presentation, management and outcomes of myocardial infarction in the Heart Center, Al-Thawra Hospital, Sana'a City, Yemen: Stemi cardiac arrest management outcomes

Background and aim: Acute ST-segment elevation myocardial infarction (STEMI) is a critical medical emergency requiring emergency evaluation, diagnosis, and intervention. The aim of the study was to evaluate the clinical presentation, type of treatment, and outcomes of patients with acute ST-segment elevation myocardial infarction at the Heart Center of Al-Thawra Hospital, Sana'a. Methods: prospective study. We enrolled all patients with a final diagnosis of STEMI who have been admitted to the cardiac CCU in the cardiac center in AL-Thawrah Hospital during one year, January to December 2023. Results: A total of 358 patients with STEMI were analyzed. The mean age was 55 ± 8 years old, with male patients representing 80% (286)). The traditional risk factors among these patients were: hypertension 28.23% (101), smoking represents 26.05% (93), diabetes mellitus represents 19% (68), BMI > 30 kg/m2 represents 16.34% (57), and khat chewing represents 78.2% (279). STEMI patients who managed by primary PCI were 14% (50). Patients who have been managed by thrombolytic therapy were 28% (101) and the conventional medical treatment was managed for those who arrived after 12 hours and represent 58%% (204). The most commonly used thrombolytic was streptokinase in 96% (97) of patients who received thrombolytics. Primary PCI within 24 hours has been done in 14% (50) of cases. Heart failure (EF < 50%) represented (26%) (93), cardiovascular shock was 13% (46 cases), and mortality rate was 11% (39 cases))

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

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

Homoeopathy vs. conventional primary care in children during the first 24 months of life—a pragmatic randomised controlled trial

To compare the difference between primary homoeopathic and conventional paediatric care in treating acute illnesses in children in their first 24 months of life. One hundred eight Indian singleton newborns delivered at 37 to 42 weeks gestation were randomised at birth (1:1) to receive either homoeopathic or conventional primary care for any acute illness over the study period. In the homoeopathic group, conventional medical treatment was added when medically indicated. Clinicians and parents were unblinded. Children in the homoeopathic group experienced significantly fewer sick days than those in the conventional group (RR: 0.37, 95% CI: 0.24–0.58; p < 0.001), with correspondingly fewer sickness episodes (RR: 0.53, 95% CI: 0.32–0.87; p = .013), as well as fewer respiratory illnesses over the 24-month period. They were taller (F (1, 97) = 8.92, p = .004, partial eta squared = 0.84) but not heavier than their conventionally treated counterparts. They required fewer antibiotics, and their treatment cost was lower.Conclusion: Homoeopathy, using conventional medicine as a safety backdrop, was more effective than conventional treatment in preventing sick days, sickness episodes, and respiratory illnesses in the first 24 months of life. It necessitated fewer antibiotics and its overall cost was lower. This study supports homoeopathy, using conventional medicine as a safety backdrop, as a safe and cost-effective primary care modality during the first 2 years of life.Trial registration: Clinical Trial Registry-India (2018/09/015641). https://ctri.nic.in/Clinicaltrials/login.phpWhat is Known:• Due to their holistic nature, many Complementary and Alternative Medical (CAM) modalities are not readily amenable to assessment by head-to-head RCT for a given Indication.• We propose a pragmatic, RCT comparing homoeopathic with conventional medicine as a system.What is New:• Homoeopathic was apparently superior to conventional primary care in preventing sick days, sickness episodes, and respiratory illness episodes and was significantly associated with growth in height but not weight and required fewer antibiotics in children from birth to 24 months of age.

Bloodletting for Acute Stroke Recovery: A Systematic Review and Meta-Analysis.

Bloodletting is a non-pharmacological treatment commonly used for acute stroke in traditional East Asian medicine. This study evaluated the efficacy and safety of bloodletting in acute stroke recovery. We conducted a comprehensive search of eight electronic databases up to 4 June 2024 to identify relevant randomized controlled trials (RCTs). Review Manager 5.4 was used for the meta-analysis, with methodological quality assessed using the Cochrane Risk of Bias 2 tool and the GRADE approach. Seventeen RCTs were included in this meta-analysis. The bloodletting group showed statistically significant improvements in neurological deficits compared to the non-bloodletting group, as measured using the National Institutes of Health Stroke Scale (mean difference [MD]: -2.08, 95% confidence interval [CI]: -3.13 to -1.02) and the treatment effective rate (risk ratio: 1.17, 95% CI: 1.11 to 1.22). Motor function also improved significantly in both upper (Fugl-Meyer Assessment, MD: 12.20, 95% CI: 9.67 to 14.73) and lower extremities (MD: 3.86, 95% CI: 2.16 to 5.56). The effect on daily living activities was not significant overall, but benefits were observed in patients treated within three days of stroke onset (Barthel Index, standardized MD: 0.85, 95% CI: 0.01 to 1.69). No significant differences in the frequency of adverse events were observed between the groups. Bloodletting may be an effective and safe adjunctive therapy for patients with acute stroke receiving conventional Western medical treatment. However, further research is necessary because of the small sample sizes and low quality of the included studies.

Advancing Cardiovascular Health: Unveiling the Role of Traditional and Natural Medicine

In the quest for optimizing cardiovascular health, contemporary research increasingly explores the potential benefits of traditional and natural medicinal modalities. This paper provides insights into the therapeutic avenues offered by traditional medicine systems and natural remedies in cardiovascular care. Incorporating knowledge from ancient healing traditions like Ayurveda and Traditional Chinese Medicine (TCM) alongside contemporary research on the efficacy of natural compounds, the paper aims to elucidate their cardiovascular effects. Specifically, it examines the impact of lifestyle modifications, dietary supplements, and botanical extracts on cardiovascular health. Synthesizing evidence from clinical trials, preclinical studies, and traditional knowledge systems, the paper underscores the importance of integrating traditional and natural medicine practices with conventional medical interventions. This integration is vital for enhancing our understanding and management of cardiovascular diseases, contributing to more effective preventive strategies and optimized therapeutic outcomes in cardiovascular medicine.

Biological Treatment of Knee Osteoarthritis. The Role of Mesenchymal Stem Cells and Platelet‐Rich Plasma

Summary. Osteoarthritis (OA) is the most common joint disease, which is associated with growing population ageing. Beyond conventional medical and surgical interventions, there is an increasing number of “biological” therapies. These therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. The aim of this review was to analyze current evidence regarding mesenchymal stem cells (MSCs) therapy and platelet-rich plasma (PRP). There is some evidence to suggest symptomatic improvement with MSCs injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI, and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. Although controlled studies have been conducted to evaluate effectiveness in OA, they have been often of small size, limited statistical power, uncertain blindness, and using various methodologies. These deficiencies leave open the question of whether they have been validated as effective therapies in OA. The conclusions of this review are that all biological interventions definitely require clinical trials with robust methodology to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects.

Rapid Lifestyle Recommendations to Improve Urologic, Heart and Overall Health.

This literature review is intended to highlight recent correlations between urologic, heart and overall health by emphasizing healthy eating patterns, physical activity, alcohol minimization and tobacco elimination, healthy sleep, weight, cholesterol, blood sugar, blood pressure management, and mental health awareness. Meta-analyses, systematic reviews, and clinical studies espouse a unified message for prevention, reducing the risk of disease recurrence, progression, complementing conventional medical intervention efficacy, and mitigating treatment side effects. Limiting or eliminating alcohol consumption could be considered an independent recommendation and adding a mental health and miscellaneous (genetic risk and lifestyle, planetary health, HPV or other vaccination awareness, spirituality, etc.) category could allow for individualized educational opportunities, synergism appreciation, and self-improvement. Urologic healthcare professionals have the potential to strengthen the collective public health goal of improving the quality and quantity of the lives of patients able to adhere to these heart healthy recommendations.

7661 Therapeutic Plasma Exchange as a Bridge Therapy to Total Thyroidectomy in Treatment-Resistant Amiodarone-Induced Thyrotoxicosis

Abstract Disclosure: M. Maher: None. R. McEvoy: None. V. Farnan: None. D.J. Tansey: None. S. McKenna: None. J. O'Connell: None. R. McQuillan: None. M. Griffin: None. J. Lyne: None. C. Magee: None. C. Traynor: None. A. Hudson: None. M.W. O'Reilly: None. A. Agha: None. M. Sherlock: None. C.M. Moran: None. Background: Amiodarone-induced thyrotoxicosis (AIT) is challenging to manage where conventional medical treatment fails. We report our experience using therapeutic plasma exchange (TPE) to prepare for salvage thyroidectomy. Clinical Cases: A 53-year-old man was diagnosed with AIT type 2 (FT4 45.3pmol/L, RR 12-22; TSH 0.02mU/L, RR 0.27-4.20) whilst on amiodarone, on a background of lamin A/C cardiomyopathy. He remained thyrotoxic despite carbimazole, prednisolone, iodine solution and cholestyramine. TFTs following 4 TPE sessions showed an improvement in TSH (0.03mU/L) and total T4 (129nmol/L, RR 63-151), despite rising FT4 (91.5pmol/L) and FT3 (12.56pmol/L, RR 2.43-6.01).A 47-year-old man was diagnosed with TRAb-negative AIT type 1 (FT4 51.2pmol/L, TSH 0.03mU/L) on a background of atrial fibrillation treated with amiodarone. He became progressively more thyrotoxic despite carbimazole, prednisolone, lithium and cholestyramine. Following 4 TPE sessions, TFTs demonstrated a reduction in FT4 (42.9pmol/L) and FT3 (10pmol/L, RR 3.1-6.8), along with normalisation of total T4 (155nmol/L, RR 66-181).A 56-year-old female was diagnosed with AIT type 2 (FT4 33.9pmol/L, TSH 0.02mU/L), whilst on amiodarone for ventricular fibrillation. She became rapidly and progressively more thyrotoxic despite carbimazole, prednisolone, iodine solution and cholestyramine (FT4 &amp;gt;100pmol/L). After 5 TPE sessions, TFTs showed a persistently elevated FT4 (&amp;gt;100pmol/L), FT3 (13.1pmol/L), and total T4 (318nmol/L). Lastly, a 65-year-old gentleman was diagnosed with AIT type 2 (FT4 &amp;gt;100pmol/L, FT3 18.4pmol/L, Total T4 &amp;gt;320nmol/L, TSH &amp;lt;0.01mU/L) on a background of atrial fibrillation that had been treated with amiodarone. FT3 showed a modest reduction (8.2pmol/L) following treatment with carbimazole and prednisolone; however, FT4 remained &amp;gt;100pmol/L. The patient developed acute decompensated heart failure and underwent TPE as a bridge to emergency thyroidectomy. Following 3 TPE sessions, TFTs demonstrated a reduction in FT4 (67.3pmol/L) and Total T4 (223nmol/L). All 4 patients underwent uneventful thyroidectomy and were subsequently rendered euthyroid with thyroxine. Heparin was administered during TPE in all cases. Conclusion: TPE is beneficial as a bridge to thyroidectomy in treatment-resistant AIT. Our cases demonstrate that the biochemical response is variable. Given the possibility for heparin to cause displacement of bound thyroid hormones, Total T4 may be a better biochemical indicator of response than free thyroid hormone(s) for patients on TPE. Presentation: 6/2/2024

A Comprehensive Review of Herbal Medicines for the Treatment of Alzheimer's Disease

Abstract: The choices of treatment for Alzheimer's are based on NMDA-receptor antagonists and cholinesterase inhibitors, although their efficacy as a therapy is still up for debate. BPSD (Behavioural and Psychological Symptoms of Dementia) have been treated using herbal medicine products, with varying degrees of success. This manuscript sets out to answer the question, "Can herbs be effective in the treatment of cognitive impairments in patients?" by examining evidences from controlled research. The process by which Alzheimer's disease develops remains a mystery, and the present Alzheimer's treatment strategy, which consists of administering a single medicine to treat a single target, appears to be clinically ineffective. AD treatment will require a combination of approaches that target many signs and causes of the disease. The results of currently available licensed therapies for AD are often disappointing, and alternative medicine, especially herbal therapy, may play a role. Over 80% of the world's population, particularly in developing nation, gets their main health care from herbal medicines. They have persisted through the years due to their low risk, high reward, widespread acceptance across cultures, and absence of detrimental side effects. In some cases, herbal remedies have proven to be more effective than conventional medical treatments. They are assumed to be natural unless proven otherwise by the presence of unnatural additives. The absence of adverse reactions is a major advantage of herbal treatment. In addition, they provide ongoing advantages to health. Salvia officinalis, Ginkgo biloba, Melissa officinalis, Panax ginseng, Coriandrum sativum, Curcuma longa, Ashwagandha, Uncaria Tomentosa, Crocus Sativus and Allium Sativum are all studied for their potential effects on Alzheimer's disease.

Patients' Expectations of Yoga and Associated Therapies Influence Treatment Outcome: A Convenience Sampling Pre-Post Study from India.

An association between expectations of treatment and treatment outcome has been reported for conventional medical and surgical treatments. However, this association has not been described for yoga therapy. The present study recruited patients (154 males and 145 females, n = 299; age 48.8 ± 14.7 years) who had been admitted to a residential wellness center, most commonly with diseases of the musculoskeletal system or connective tissue; endocrine, nutritional, or metabolic diseases; and digestive system disorders (all based on ICD-11). Assessments included: (1) expectations of yoga and associated therapies at baseline using two questionnaires (Treatment Expectation Questionnaire and Expectation for Treatment Scale); and (2) treatment outcome at baseline and after 7 days of yoga and associated therapies using the Physical Health Questionnaire and Global Perceived Effect scale. The intervention included yoga and additional therapies (e.g., hydrotherapy and ayurveda for approximately 40% of the time). Multivariable regression analyses (controlled for variation due to age, gender, education, and baseline Physical Health Questionnaire scores) demonstrated that expectations of (1) positive outcomes of all aspects of treatment significantly predicted better overall perceived effect of treatment; (2) symptom resolution (positive expectations) significantly predicted higher total Physical Health Questionnaire scores, with better digestion; and (3) low adverse outcomes significantly predicted better sleep. The findings support the premise that higher positive expectations and lower negative expectations of yoga therapy predict better treatment outcomes. These findings suggest that people should be well-informed about the reported benefits and the less-frequent negative outcomes of yoga therapy so that their expectations may be positive yet realistic, optimally influencing treatment outcomes.

Long-term Outcomes of Botulinum Toxin Injection Into the External Anal Sphincters: An Effective New Treatment of Chronic Functional Constipation in Children

BackgroundBotulinum toxin (BT) is a well-recognised treatment of chronic functional constipation (FC) and soiling refractory to medical treatment. The aims of this study were to assess the short and long-term outcomes of BT injection into the external anal sphincter muscles (EAS) for chronic FC treatment. MethodsWe studied 196 children unresponsive to medical management of chronic FC, soiling, painful defecation and withholding behaviour (Rome III criteria) from April 2011 to January 2023. All patients underwent anorectal manometry (ARM) and endosonography-guided BT injection (Dysport® or Botox®) 10 units/kg body weight (maximum 200 units) into the EAS muscles at 3 and 9 o’clock positions and colonic transit study. Outcomes were measured using a validated symptom severity (SS) score questionnaire pre-operatively, at 3–6 months and 12–24 months follow up including: defecation frequency and pain, soiling, laxative(s), general health, behaviour, symptom improvement and faecaloma. Sum of scores ranged from 0 (best) to 65 (worst). We used Wilcoxon signed-rank test for matched-pairs related analysis and data presented as median (range) and p value < 0.05 was considered significant. Results196 patients (104 male) with a median age of 7 (1–16) years underwent anorectal investigations and BT injection into the external anal sphincters during 12 year study period. The median short and long term follow-up was 4 (1–27) months and 16 (5–60) months, respectively. 26 (13 %) patients had autism and 14 (7.1 %) had attention deficit hyperactivity disorder (ADHD). Median anal sphincter resting pressure was of 55 (20.5–113) mmHg. The pre-operative total SS score improved from median 31/65 (4–57) before BT treatment to median 15/65 (0–49) at 4-month after BT injection and median 16/65 (0–56) at 16-month follow-up, p < 0.001. 80 % (104/130) of patients showed significant short-term and 79 % (71/90) showed long-term improvement of their chronic FC symptoms following BT injections. 9 % (18/196) children required second BT injection for symptom recurrence and 18.3 % (36/196) required formation of an antegrade colonic enema (ACE) stoma. ConclusionBT injection is an effective and safe new treatment of chronic FC unresponsive to conventional medical treatments. In our experience, 80 % of children have significant improvement of their symptoms and 9 % require repeat BT injection during a long term follow-up.

Targeting carbon-neutral waste reduction: Novel process design, modelling and optimization for converting medical waste into hydrogen

This study proposes a novel system designed to turn waste masks (WM) into hydrogen while aiming at carbon neutrality. The system utilizes plasma gasification to primarily convert WM into syngas, which is subsequently upgraded through water gas shift to enhance hydrogen fraction. To mitigate carbon emissions, carbon capture techniques including monoethanolamine-based carbon absorption and oxy-fuel combustion are incorporated into the system. A high-fidelity model of the designed process is developed in Aspen Plus. Machine learning-driven optimization is applied to identify the optimal operating conditions. Utilizing Gaussian process regression-based surrogate optimization, the system achieves around 0.5 kg CO2 eq/kg H2 of levelized emissions per unit hydrogen (LEH) in the reaction stage and the execution time required for optimization is only 4 s, outperforming detailed process models-based optimization. Energy assessment highlights plasma gasification and CO2 absorption as the primary sources of energy loss. Furthermore, life cycle analysis indicates that CO2 absorption is the primary contributor to carbon emissions, accounting for approximately 60% of the total emissions. With levelized emissions of 1.27 kg CO2 eq/kg WM and 5.18 CO2 eq/kg H2, the designed system demonstrates superiority over conventional medical waste treatment and hydrogen production methods.

Platelet-Rich Plasma in the Prevention and Treatment of Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Meta-Analysis.

Medication-related osteonecrosis of the jaw (MRONJ) is a significant complication associated with bisphosphonates, impacting jaw osteoclasts, and causing altered bone remodelling. Prevention involves stabilizing systemic pathology, considering antiresorptive therapies, and exploring platelet-rich fibrin (PRF) for wound healing and tissue regeneration. The study aims to assess the efficacy of PRF in MRONJ treatment and highlight research gaps for more robust investigations. Following PRISMA and MOOSE guidelines, this systematic review and meta-analysis included English publications from 2013 to 2023, employing a systematic search in databases such as MEDLINE, Scopus, and Web of Science. Quality assessment used the Cochrane Collaboration's tool and the NOS, with the main meta-analysis concentrating on PRF-treated MRONJ cases, assessing resolution rates, and prioritizing healing outcomes and infection absence as primary endpoints. The study, encompassing 11 articles and 480 participants with MRONJ, demonstrated that in stage 1 procedures, PRF significantly outperformed conventional medical treatments (OR: 2.93, 95% CI: 1.54-5.59, P=0.001), particularly at the mandible site (OR: 1.65, 95% CI: 0.86-3.17, P=0.13). PRF also exhibited significantly superior healing outcomes compared with conventional medical treatments (OR: 4.45, 95% CI: 1.58-12.53, P=0.005), supporting its consideration as a valuable alternative in specific MRONJ management scenarios. This study highlights PRF's effectiveness in early MRONJ interventions and specific anatomic sites, despite acknowledged limitations, emphasizing the need for further research, and supporting its consideration in MRONJ surgical management.

Mediterranean diet and exercise are associated with better disease control in psoriatic arthritis.

Psoriatic arthritis (PsA) is associated with obesity and other related comorbidities, which impose an additional burden on disease activity and response to treatment. We investigated the impact of Mediterranean diet, and exercise on the presentation and severity of PsA. Three hundred fifty-five patients with PsA (n = 279) and psoriasis (PsO) (n = 76) were included in a cross-sectional study. Demographic and clinical characteristics and dietary and exercise patterns were recorded. Patients were grouped into (i) high, moderate, and low Mediterranean diet adherence and (ii) high, medium, and low activity level. Levels of diet and exercise were correlated with disease activity indices. PsA patients had more comorbidities than their PsO counterparts (42.7% vs. 26.3%, p = .038). The majority showed a low exercise pattern (total = 71.3%, PsA = 72.4%, PsO = 67.1%). Approximately half (total = 44.2%, PsA = 43.4%, PsO = 47.4%) did not follow a Mediterranean diet. Disease Activity in Psoriatic Arthritis Score (DAPSA) (p = .004), tender (p = .003) and swollen (p = .015) joint counts, erythrocyte sedimentation rate (ESR) (p = .001), and Psoriasis Area and Severity Index (PASI) (p = .015) had an inverse correlation with exercise. Higher Mediterranean diet adherence was associated with reduced ESR (p = .056), PASI (p = .011), and body surface area (BSA) (p = .009) indices. After adjusting for body mass index (BMI), exercise retained its positive correlation with PsA disease activity, but diet showed significant correlation only with enthesitis (p = 0.015). Uptake of a Mediterranean diet and exercise have positive effects on PsA activity, independently of BMI. These findings support lifestyle recommendations to supplement conventional treatment for improvement in disease outcomes. Key points • Diet and lifestyle are important influencers of health-related outcomes in PsA. • In this cross-sectional study of 355 patients with psoriatic disease, we found that Med Diet and exercise improve outcomes in PsA independently of weight loss. • Our results suggest that diet and lifestyle modifications should supplement conventional medical treatments.

Sub-Chronic Toxicity Test of Purple Leaf Extract on the Kidney Histopathology of Male White Rats

Traditional herbal medicine has become increasingly popular as an alternative to conventional medical treatments. Although the plant offers numerous health benefits, caution should be exercised regarding its long-term use. Long-term use of traditional herbal remedies can have detrimental effects on the kidneys. This study was designed to assess the histological changes in the kidneys of male rats following 28 days of purple sage leaf extract administration and to identify potential harmful effects. The study utilized 20 male Wistar rats and utilized a randomized group design for the experimental methodology. Rats were categorized into four distinct groups, consisting of one control group and three treatment groups. The control group received solely sodium chloride, whereas the treatment group 1 (P1) received 500 mg/kg BB of purple sage ethanol extract. Treatment group 2 received up to 2000 mg/kg BB of purple sage ethanol extract, while treatment group 3 received up to 5000 mg/kg BB. The oral examination was conducted for a duration of 28 days. The treatment groups showed an increase in weight and organ index of the right kidney. The findings suggest a potential for toxicity resulting from the administration of purple sage leaf extract over a duration of 28 days.

Relationship Between Treatment Hours of Selected Disciplines And Change in Pain Impact During the Year Following Referral to an Interdisciplinary Pain Management Center: A Latent Class Analysis.

Introduction: Pain management clinics differ in treatments offered, and little evidence exists regarding which combinations of therapies result in best outcomes. This study analyzed clinical encounters and pain outcomes data for associations between treatment composition and outcomes. Methods: Retrospective observational study of 2,142 predominantly active-duty US service members referred to an interdisciplinary pain management center between 2014 and 2021. Latent class analysis was used to identify treatment groups with distinct outcome patterns during the year following initial assessment. The primary outcome measure was the National Institutes of Health Task Force on Research Standards for Chronic Low-Back Pain impact score. Results: Four distinct treatment groups were identified: 1 group engaged in conventional medical therapies alone (n = 726, median 3.5 treatment hours), and 3 groups used a combination of conventional, psychological, rehabilitative, and complementary therapies, with different levels of treatment hours: low (n = 814, median 15.7 h), medium (n = 177, median 40.1 h), and high (n = 425, median 72.5 h). All groups showed significant improvement in pain impact score from baseline up to 9 months but not at 12 months following initial assessment. At the 6-month time point, the group with high multimodal treatment hours had the most improvement in pain impact (-3.1 [95% CI -3.8, -2.4]) compared with the group using only conventional therapies (-1.0 points [95% CI -1.8, -0.1]) or with low multimodal treatment hours (-1.3 points [95% CI -1.9, -0.7]). There were no between-group differences at the 9- or 12-month time points. Conclusion: These results suggest that a combination of pain therapy approaches results in greater reduction in pain impact than the use of conventional medical treatment alone for up to 6 months after initiating therapy and that there may be a threshold of treatment hours that must be exceeded to achieve this benefit. Clinical trial registration: As this study is not a clinical trial, no registration was required.

Medication-related burden among Iraqi patients with ulcerative colitis: a cross-sectional study.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by recurring periods of inflammation and remission, primarily affecting the colon. The concept of medication-related burden, which refers to the adverse effects experienced by patients due to conventional medical treatments, is relatively new in the field. This study aimed to measure medication-related burden among patients with ulcerative colitis in Iraq. The study was conducted at the Gastroenterology and Hepatology Teaching Hospital, Medical City, Baghdad, Iraq, from December 2022 to May 2023. We used the Arabic version of the Living with Medicines Questionnaire version 3 (LMQ-3) to explore medication-related burdens experienced by patients with UC. Eighty-six patients with ulcerative colitis were included. The mean of the total medication-related burden score was 107.5 ± 20.7. The findings showed that 45.3% of patients with UC had a moderate degree of medication-related burden, followed by minimum burden (44.2%), high burden (5.8%), and no burden (4.7%). The lowest median burden scores emerged in five domains: interactions with healthcare professionals, practical difficulties with medication use, medication side effects, medication effectiveness, and the impact on daily life. Conversely, the highest-burden scores were noted in the cost, concerns about medication use, and autonomy to vary the regimen domains. In multivariate analysis, none of the patient-related variables was independently correlated with the total medication-related burden score. A large proportion of the patients with UC who participated in the current study reported varying degrees of medication-related burden, with the majority having a minimum to moderate medication-related burden.