Current Medical Management Research Articles

The Current Update of Conventional and Innovative Treatment Strategies for Central Nervous System Injury.

This review explores the complex challenges and advancements in the treatment of traumatic brain injury (TBI) and spinal cord injury (SCI). Traumatic injuries to the central nervous system (CNS) trigger intricate pathophysiological responses, frequently leading to profound and enduring disabilities. This article delves into the dual phases of injury-primary impacts and the subsequent secondary biochemical cascades-that worsen initial damage. Conventional treatments have traditionally prioritized immediate stabilization, surgical interventions, and supportive medical care to manage both the primary and secondary damage associated with central nervous system injuries. We explore current surgical and medical management strategies, emphasizing the crucial role of rehabilitation and the promising potential of stem cell therapies and immune modulation. Advances in stem cell therapy, gene editing, and neuroprosthetics are revolutionizing treatment approaches, providing opportunities not just for recovery but also for the regeneration of impaired neural tissues. This review aims to emphasize emerging therapeutic strategies that hold promise for enhancing outcomes and improving the quality of life for affected individuals worldwide.

Interventional radiology for prevention and management of postpartum haemorrhage: a single centre retrospective cohort study.

Postpartum haemorrhage (PPH) remains a leading cause of maternal death despite current medical management. Surgical interventions are still needed for refractory bleeding. Interventional radiology (IR) can be a successful intermediary that avoids the need for hysterectomy. Nevertheless, IR outcome data in a peripartum setting are limited. The objective of this study is to document the efficacy and safety of IR. Retrospective study reviewed the records of consecutive patients who underwent peripartum IR from 01/01/2010 until 31/12/2020 in a tertiary academic centre. Patients were divided in a prophylactic and a therapeutic group. Information about interventions before and after IR, and IR specific complications was retrieved. Efficacy was defined by the number of transfusions and additional surgical interventions needed after IR, and safety was assessed by the incidence of IR related complications. Fifty-four patients, prophylactic group (n = 24) and therapeutic group (n = 30), were identified. In both groups, IR was successful with 1.5 ± 2.9 packed cells transfused post-IR (1.0 ± 2.1 prophylactic vs 1.9 ± 3.3 therapeutic; p = 0.261). Additional surgical interventions were required in n = 5 patients (9.2%), n = 1 (4.2%) in the prophylactic vs. n = 4 (13.3%) in the therapeutic group. Complications were reported in n = 12 patients (22.2%), n = 2 (8.3%) prophylactic vs. n = 10 (33.3%) in therapeutic group. Mostly minor complications, as puncture site hematoma or bleeding, were reported in n = 4 (7.4%). Severe complications as necrosis and metabolic complications were reported in n = 2 patients (3.9%). IR for prevention and treatment of PPH was highly successful and associated with minor complications.

A case of Gloriosa superba poisoning

ABSTRACT Gloriosa superba (GSb), or Glory Lily, is not an uncommon plant found in Sri Lanka. Every part of the plant is poisonous, especially the rhizome. It contains mainly colchicine and gloriocine which are toxic alkaloids. Fatalities following ingestion are rarely reported with current medical management. A 37-year-old male, with history of cannabis dependence and heroin abuse, ingested one and half of GSb rhizomes following a family dispute, witnessed by his family. He was hospitalized nearly eighteen hours later and he developed severe gastro-enteritis associated with nausea and vomiting. The patient’s presenting condition necessitated intensive care management for severe liver and renal failure. On the second day following admission he underwent haemodialysis and one cycle of plasma paresis but he ultimately succumbed due to unresponsive cardiac failure with arrhythmia. Subsequent autopsy examination revealed inflamed stomach and small intestinal mucosa with erosions, severe diffuse pulmonary haemorrhages with oedema, necrosis of liver and myocardium, and acute tubular necrosis. Multi-organ failure due to ingestion of GSb attributed to his death and manner of death was concluded as suicide following an inquest. This case report highlights the severity of effects of GSb poisoning including the effects on myocardium which is rarely encountered in clinical practice.

Social media analysis of pain outcomes following targeted muscle reinnervation

AimTMR was developed to improve myoelectric prosthesis control for amputees; however, it has become an area of interest in pain modulation. Studies show evidence that this procedure alleviates chronic pain in amputees. The primary objective of this study is to utilize social media analysis to understand patients’ post-operative pain, satisfaction, and recovery time after TMR. MethodsData was collected from one Facebook group via posts and comments referencing TMR. Posts published between January 1st, 2020, and March 24th, 2023, were analyzed. Data collected included pain prior to surgery, pain in immediate post-op period, and how pain changed after surgery. Results43 individuals commented on their TMR experience. 31 had favorable surgical outcomes, 7 felt surgery worsened their pain or there was not significant change in their pain levels, and the remaining 5 commented during the initial post-operative period. 24 patients described their pain in the immediate post-operative period and 100% said that post-operative pain was worse than chronic pain. Of 28 authors who commented on overall reduction in chronic pain, 24 reported TMR reduced their pain, while 4 had no change or worsened pain. ConclusionsThe 24 patients who reported improvement in chronic pain aligns with current literature suggesting that TMR is a viable treatment option for pain. Current medical management of similar conditions leaves up to 80% of patients unsatisfied with pain control. This analysis supports the evidence that TMR is an effective treatment for patients who are experiencing post-amputation pain.

Analyzing Ghana's Pharmacy Act, 1994 (Act 489) Regarding Quality Control and Negligence Liability Measures for Artificial Intelligence Pharmacy Systems

The objective of this systematic review was to assess the adequacy of current medication management in Ghana considering the risks posed by increased artificial intelligence (AI) automation in pharmacies worldwide A qualitative comparative approach was used despite reviewed the Ghana 1994 Pharmacy Act against recognition of AI challenges and international governance guidelines . The results revealed flaws in terms of quality prerequisites, transparency checklists and liability mechanisms developed for AI systems compared to existing regulations of the manual process. Outdated approaches to patient care that fail to ensure patient safety or address threats to the accuracy of recommendations from data collection biases and technical errors. Proposed changes include a requirement for usability testing before approving AI pharmacy deployments and the creation of a review board to review post-implementation systems for validity. Updating regulations to deal with modern equipment puts innovation and responsible regulation in the fast-paced healthcare industry. This study contributes significantly to preliminary research on AI policy readiness in the Ghanaian legal context, and suggests a feasible methodology for exploring qualitative differences for use in companies and countries competing for technology a disturbing, increasingly beyond the date code. Early government reform helps keep pace with the realities of adoption.

Understanding to Concept of Jarajanya Vyadhi (ageing related diseases) w.s.r. to Sandhigatavata (osteo arthritis)

As age advances Vata Dosha increases in an individual. This increasing Vata trigger and accelerates Dhatu Kshaya (depletion of tissues) and Bala Kshaya (diminished the body strength). Hence advancing age makes man prone to many diseases especially degenerative disorders. Asthis (bones) are the main seat of Vata Dosha and Sandhis (joints) is the main seat of Kapha Dosha. Vata Dosha is responsible for different body movements like Prasaarana and Akunchana of Sandhi (flexion and extension of joints), whereas Shleshaka Kapha located in Sandhi (joints) is provides nutrition, protection and to minimize the friction during the movement. Sandhigatavata is Vata pradhana vyadhi. It is quite similar to osteoarthritis, a degenerative joint disease stand in modern medical science. Sandhigatavata is Vata dominating disorder which result in inflammatory and degenerative changes in joints. Osteoarthritis is a disease of musculoskeletal system, affecting the joints mostly in elderly population and in weight bearing joints (particularly knee joint). The current standard modern medical pharmacological management of osteoarthritis includes the administration of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). However, their use neither provides adequate and significant relief in symptoms nor deceleration in disease process. Therefore, Vata shamaka aushadhis along with local application e.g. Abhyanga, different form of Swedana are beneficial. As Sandhigatavata is ageing related heath condition, Rasayana chikitsa can also be helpful in the management of Sandhigatavata (Osteoarthritis). This article enlighten the knowledge about Jarajanya vyadhi especially Sandhigatavata.

Abstract TP51: Improving Prescriptions of Cardiovascular-Effective Anti-Diabetic Medications in Patients With Stroke and Type 2 Diabetes

Background and Issue: Type 2 diabetes (DM2) and cardiovascular (CV) disease pose significant risks for ischemic stroke, with a heightened impact on marginalized and under-resourced communities. Despite known CV benefits of newer anti-diabetic medications like glucagonlike peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 (SGLT2) inhibitors, these medications are under prescribed. To improve utilization, we conducted a quality improvement (QI) project to enhance prescription rates for these medications. The QI initiative focused on improving diabetes education and ensuring appropriate hypoglycemic medications were provided at discharge, with an aim of reducing the incidence of recurrent strokes. Purpose: The goal of this QI initiative was to improve prescription rates of GLP-1 R or SGLT2 inhibitors in eligible patients with stroke. Method: An assessment of current diabetic referral practices and medical therapy management were conducted, and an algorithm aimed at streamlining referrals for diabetic consults for patients with stroke developed. A diabetic educator or advanced practice nurse was consulted for patients with stroke and elevated A1c. Patients were then evaluated for qualification and use of GLP-1 RA or SGLT2 inhibitors, and discharge recommendations provided. A stroke registry was used to conduct a retrospective analysis of cases with stroke and DM2 for discharged prescriptions of GLP-1 R or SGLT2 inhibitors. Pre-implementation data from October 2021 to March 2022 were compared to post-implementation data from October 2022 to March 2023. Results: A review of 273 cases was completed. Prior to the QI implementation, 14.2% (19 of 134) of cases admitted for stroke with a secondary diagnosis of DM2 and elevated A1c were discharged home on a GLP-1 RA or SGLT2 inhibitor compared with 28.8% (40 of 139) of cases post implementation. Conclusion: Implementation of a QI process aimed at increasing the number of written discharge prescriptions for DM2 medications with proven CV benefits demonstrated a substantial increase in the number of written prescriptions for these medications at discharge.

Proactive Risk Management using Healthcare Failure Mode Effect Analysis Tool to Improve Medication Management Process

Proactive risk management program is essential to maintain the quality and safety of patient care, treatment, and services within a healthcare system. According to the Joint Commission, hospitals need to adopt a proactive approach for risk management and develop risk mitigation strategies to reduce or eliminate the potentially harmful impact of possible risk. There are multiple tools that can be used for proactive analysis. Leaders of Evercare hospital Dhaka selected Healthcare FMEA tool to identify the potential failure modes in the current medication management process as it is one of the complex and high processes in healthcare settings. A multidisciplinary Healthcare FMEA team was formed comprising physician, nurse, pharmacist, quality, IT personnel and senior managements of EHD to conduct Healthcare FMEA. After completing Healthcare FMEA, twenty failure modes(n-20) and fifty-nine potential causes(n-59) of failure modes were detected in existing medication management process of EHD. The hazardous score was Two hundred & seventeen (n-217). There were Twelve major failures modes with higher hazardous score. Healthcare FMEA team members decided to eliminate major failures and actions were taken to control these failures. The main objective of this study is to maintain the medication error of EHD within the target (2/1000 patient days) by implementing required strategies and redesigning existing medication management process. The limitation of this study was it is a time-consuming process, it only helps to identify the possibilities of fail; it does not eliminate them, additional efforts are required to develop corrective action. Pulse Vol.15, 2023 P: 28-33

The use of pentoxifylline within the medical regime for the management and prevention of osteoradionecrosis in patients with cardiac‐, cerebrovascular and thromboembolic conditions

AbstractObjectiveOsteoradionecrosis (ORN) is a serious and late complication following radiotherapy for head and neck cancer (HNC). Current medical management involves the use of pentoxifylline, which is advised to be used with caution in certain patients with cardiac‐ or cerebrovascular conditions. This retrospective review aims to assess the clinical outcomes of patients medically managed on the background of pre‐existing cardiac‐ and cerebrovascular conditions or treatment with anticoagulant/antiplatelet therapy for thromboembolic disease.Materials and MethodsClinical records of 36 patients were identified and reviewed retrospectively. Patients were split into two subgroups—patients having treatment for established ORN (n = 21) and patients ‘at risk’ of ORN following dentoalveolar surgery (n = 15).ResultsIn the established ORN group, 38% healed, and 57% were considered stable. In the prophylaxis group, 100% of cases healed with no ORN. Overall, across both groups, most patients reported no major side effects from pentoxifylline, with the most common being gastric irritation (n = 3, 8%).ConclusionThis retrospective review provides early valuable insight on pentoxifylline for patients with existing cardiac‐, cerebrovascular and thrombo‐embolic conditions who have been treated with radiotherapy for HNC, both prophylactically to help prevent ORN and as treatment for established ORN.

Peripheral Neuropathy in Older Adults

Peripheral neuropathies are commonly encountered in older adults, exhibit a wide spectrum of symptoms, and have diverse etiologies. In older adults, peripheral neuropathy is associated with increased falls, as well as functional and cognitive decline. The current medical management of peripheral neuropathy mostly involves symptomatic management. It is important to identify the underlying etiology of peripheral neuropathy and to address the risk of falls in older adult patients. Once the risk of falls is identified, fall prevention strategies need to be implemented.

Interventional procedures for refractory neuropathic pain

Neuropathic pain is an increasingly common disease affecting millions of individuals worldwide. Refractory pain poses a significant impact on patients’ quality of life, financial and economic stability, and social interaction. Numerous effective modalities for treatment of refractory neuropathic pain are presently available. Currently, many options provide symptomatic treatment but are associated with an unfavorable side effect profile and increased risk of addiction. The present investigation reviews current medical management for refractory neuropathic pain including the use of antidepressants, anticonvulsants, gabapentinoids and opioid therapy, as well as interventional pain procedures such as spinal cord stimulation (SCS) and intrathecal targeted drug delivery. While multidisciplinary management with lifestyle modification and pharmacologic regimens remains at the forefront of treating many of these patients, interventional modalities are growing in popularity and have been demonstrated to be highly efficacious. In this regard, continued understanding of the pathophysiology surrounding refractory neuropathic pain has led to the development of interventional procedures and better outcomes for patients suffering from refractory neuropathic pain. When and if patients fail conservative therapy, interventional techniques are desirable alternatives for pain management. SCS and intrathecal targeted drug delivery are important tools for the treatment of refractory neuropathic pain. In summary, treatment modalities for refractory neuropathic pain are evolving with demonstrated efficacy. This review aims to outline the efficacy of various interventional procedures for refractory neuropathic pain in comparison to traditional drug therapies.

Therapeutic targeting of hypoxia inducible factor in acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is characterized by bilateral chest infiltration and acute hypoxic respiratory failure. ARDS carries significant morbidity and mortality despite advancements in medical management, calling for the development of novel therapeutic targets. Hypoxia-inducible factor (HIF) is a heterodimeric protein involved in various essential pathways, including metabolic reprogramming, immune modulation, angiogenesis and cell cycle regulation. HIF is routinely degraded in homeostasis conditions via the prolyl hydroxylase domain/von Hippel-Lindau protein pathway. However, HIF is stabilized in ARDS via various mechanisms (oxygen-dependent and independent) as an endogenous protective pathway and plays multifaceted roles in different cell populations. This review focuses on the functional role of HIF and its target genes during ARDS, as well as how HIF has evolved as a therapeutic target in current medical management.

Penanganan Limbah Medis Padat di Puskesmas X

Public Health Centre facilities are integral to the healthcare system, playing a vital role in safeguarding public health at the primary level. These facilities, beyond delivering medical services, generate substantial quantities of medical waste due to various healthcare procedures. The management of medical waste in these centers presents challenges, notably the need for interim storage before third-party collection. Additionally, monthly solid medical waste transportation from all District health centers poses concerns about potential waste accumulation. This study falls into the category of descriptive research, aiming to provide an illustrative snapshot of current solid medical waste management. A survey at Public Health Centre X found that each polyclinic produces an average of 0.49 kg of solid medical waste daily, totaling 76.4 kg per month. Notably, all samples during packaging, transportation, and storage phases failed to meet specified criteria. Similarly, during sorting, the majority (83%) did not meet standards, with only one sample (16.3%) complying. This underscores the pressing need for staff training in medical waste procedures. To elevate medical waste management standards, health centers must integrate policies and regulations into their daily operations. Additionally, improving current facilities, infrastructure, and procedures is paramount to address this issue effectively. In conclusion, Public Health Centre facilities, vital for primary healthcare, grapple with medical waste management challenges. This study underscores the importance of immediate action in staff training and policy integration while investing in facility enhancements to achieve optimal medical waste management.

Pediatric chronic rhinosinusitis.

An up-to-date overview of diagnosis, differential diagnosis, comorbidities, and current medical and surgical management of pediatric chronic rhinosinusitis (PCRS). Review of current evidence-based literature on PCRS. Diagnosis of PCRS seems to be improving based on recent evidence using nasal endoscopy as well as computed tomography scanning. Recent literature supports the fact that chronic adenoiditis can be an independent etiology of symptoms of chronic sinusitis, that are very similar to chronic adenoiditis. Allergic rhinitis and immune deficiency play important roles in the management of PCRS. Surgery for PCRS has evolved significantly in the last 15-20 years to include adenoidectomy as well as endoscopic sinus surgery. PCRS is very common in children causing poor QOL for these children. Medical management remains the main stay of treatment with attention to management of co-morbidities that may contribute to the disease severity. Making the correct diagnosis will help with the choice of surgical intervention if medical management fails.

Widespread Bilateral Pulmonary Embolism: A Case Report

We present a 45-year-old man with a personal pathological history of deep vein thrombosis of the lower limbs without current medical management. It begins suddenly with respiratory difficulty, decreased oxygen saturation, and dyspnea. Upon arrival at the emergency department, chest angio tomography was performed, highlighting bilateral filling defects, from main branches to segmental branches, so admission to the hemodynamics room for right heart catheterization was decided. Thrombectomy, bilateral ultrasound rheolysis and targeted fibrinolysis were performed, with improvement in mean pulmonary artery pressure (mPAP) to 19 mmHg compared to the previous one.

Heart Failure in Patients with Chronic Kidney Disease.

The function of the kidney is tightly linked to the function of the heart. Dysfunction/disease of the kidney may initiate, accentuate, or precipitate of the cardiac dysfunction/disease and vice versa, contributing to a negative spiral. Further, the reciprocal association between the heart and the kidney may occur on top of other entities, usually diabetes, hypertension, and atherosclerosis, simultaneously affecting the two organs. Chronic kidney disease (CKD) can influence cardiac function through altered hemodynamics and salt and water retention, leading to venous congestion and therefore, not surprisingly, to heart failure (HF). Management of HF in CKD is challenging due to several factors, including complex interplays between these two conditions, the effect of kidney dysfunction on the metabolism of HF medications, the effect of HF medications on kidney function, and the high risk for anemia and hyperkalemia. As a result, in most HF trials, patients with severe renal impairment (i.e., eGFR 30 mL/min/1.73 m2 or less) are excluded. The present review discusses the epidemiology, pathophysiology, and current medical management in patients with HF developing in the context of CKD.

Effectiveness of Shuxuening injection in coronary heart disease: a systematic review and meta-analysis.

Background: Coronary heart disease (CHD) poses a serious threat to public health, and the current medical management still faces significant challenges. Reliable evidence on the efficacy of Shuxuening injection (SXNI) in CHD is still lacking, even though it is widely used in China. Purpose: To evaluate the efficacy of SXNI combination therapy in treating CHD. Methods: A systematic search of eight databases was conducted to identify relevant randomized controlled trials (RCTs) from the inception of each database until June 2023. ROB 2.0, RevMan 5.4, and Stata 15.1 were used for quality evaluation and data analysis. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Results: A total of 3,779 participants from 39 studies were included. The results showed SXNI combination therapy increased the clinical efficacy and decreased the frequency and duration of angina. Furthermore, SXNI combination therapy improved cardiac function of patients by decreasing LVEDD, and increased CI, CO, and LVEF. It also improved blood lipid profiles by increasing HDL, decreasing TC, TG, and LDL. The thrombosis factors of patients were also improved by decreasing FIB, PV, HCT, and HS. Moreover, SXNI combination therapy was superior to the conventional treatment in improving CRP levels, increasing ECG efficacy and BNP. However, due to the limited safety information, reliable safety conclusions could not be drawn. Furthermore, the levels of evidence ranged from very low to moderate due to publication bias and heterogeneity. Conclusion: SXNI can effectively improve angina symptoms, clinical efficacy, cardiac function, blood lipid indicators, and thrombosis factors of patients with CHD. However, more multi-center and large-sample studies are needed to confirm the conclusions due to the limitations of this study. Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399606; Identifier: CRD42023433292.

Neuromodulation of spinal reflex pathway for the treatment of detrusor overactivity by medial plantar nerve stimulation at surface of sole of foot in patients with spinal cord injury.

Suprasacral spinal cord lesions are prone to have neurogenic detrusor overactivity leading to urinary incontinence. Current medical management has known side-effects and often surgical managements are irreversible. Electrical stimulation to modulate spinal reflex pathway having same nerve root as urinary bladder is reported in the literature. This study aimed to reduce detrusor overactivity in patients with spinal cord injury (SCI) using surface electrical stimulation of medial plantar nerve at the sole of foot. Twenty adults with SCI having episode of at least 1 leak/day due to detrusor overactivity as diagnosed by cystometrogram (CMG), were on clean intermittent catheterization and ankle jerk was present consented for the study. Participants were asked to maintain bladder diary a week before and during 2 weeks of treatment. CMG was done on day-0 and day-14. cmcUroModul@tor®, an inhouse developed electrical stimulator was used for ½ h daily for period of 2 weeks. Patient satisfaction feedback questionnaire was taken on completion of treatment. CMG data were analyzed using Wilcoxon signed-ranked test while bladder diary was analyzed using binomial distribution. P < 0.05 was considered as statistically significant. Institutional Review Board (IRB) and ethics committee of Christian Medical College, Vellore, approved the study (CMC/IRB/11061). Statistical significant improvement in maximum detrusor pressure (P = 0.03) and cystometric capacity (P = 0.04) was observed. Of 20 subjects, 18 showed improvement in bladder diary. Neuromodulation of medial plantar nerve at sole of foot by surface electrical stimulation is non-invasive, cost-effective, and alternative simple treatment modality for urinary incontinence due to detrusor overactivity.

Systemic gene therapy using an AAV44.9 vector rescues a neonatal lethal mouse model of propionic acidemia

Propionic acidemia (PA) is rare autosomal recessive metabolic disorder caused by defects in the mitochondrially localized enzyme propionyl-coenzyme A (CoA) carboxylase. Patientswith PA can suffer from lethal metabolic decompensation and cardiomyopathy despite current medical management, which has led to the pursuit of gene therapy as a new treatment option for patients. Here we assess the therapeutic efficacy of a recently described adeno-associated virus (AAV) capsid, AAV44.9, to deliver a therapeutic PCCA transgene in a new mouse model of propionyl-CoA carboxylase α (PCCA) deficiency generated by genome editing. Pcca-/- mice recapitulate the severe neonatal presentation of PA and manifest uniform neonatal lethality, absent PCCA expression, and increased 2-methylcitrate. A single injection of the AAV44.9 PCCA vector in the immediate newborn period, systemically delivered at a dose of 1e11 vector genome (vg)/pup but not 1e10 vg/pup, increased survival, reduced plasma methylcitrate, and resulted in high levels of transgene expression in the liver and heart in treated Pcca-/- mice. Our studies not only establish a versatile and accurate new mouse model of PA but further demonstrate that the AAV44.9 vectors may be suitable for treatment of many metabolic disorders where hepato-cardiac transduction following systemic delivery is desired, such as PA, and, by extension, fatty acid oxidation defects and glycogen storage disorders.

A narrative review of the socioeconomic burden associated with generalised pustular psoriasis.

Generalised pustular psoriasis (GPP) is a rare, chronic and life-threatening inflammatory skin disease characterised by widespread eruption of sterile pustules. With the approval of a GPP flare treatment in several countries occurring only recently, the socioeconomic burden associated with GPP is not well established. To highlight current evidence for patient burden, healthcare resource utilization (HCRU) and costs associated with GPP. Patient burden results from serious complications including sepsis and cardiorespiratory failure causing hospitalization and death. HCRU is driven by high hospitalization rates and treatment costs. The mean duration of a GPP hospital stay ranges from 10 to 16 days. A quarter of patients require intensive care, and the mean intensive care stay is 18 days. In comparison to patients with plaque psoriasis (PsO), patients with GPP have: a 64% higher score on the Charlson Comorbidity Index; higher hospitalization rates (≤36.3% vs. ≤23.3%); lower overall quality of life, and higher symptom scores for pain, itch, fatigue, anxiety and depression; direct costs associated with treatment 1.3- to 4.5-fold higher; higher rates of disabled work status (20.0% vs. 7.6%); and increased presenteeism (i.e. worse impairment at work), impaired daily activities, and medically related absenteeism. Current medical management and drug treatment utilising non-GPP-specific therapies impose a significant patient and direct economic burden. GPP also imposes an indirect economic burden by increasing work productivity impairment and medically related absenteeism. This high level of socioeconomic burden reinforces the need for new therapies with proven efficacy in the treatment of GPP.