Effective Supportive Therapy Research Articles

Mediastinal transposition of the greater omentum for treatment of infected prostheses of the ascending aorta and aortic arch.

To evaluate the outcomes of transposition of the omentum into the mediastinum to support the replacement of infected aortic grafts or to cover infected aortic grafts that are not amenable for surgical replacement. All patients with thoracic aortic graft infections who underwent mediastinal transposition of the omentum at our institution between 2005 and 2023 were included in this study. Mediastinal transposition of the omentum was performed either after replacement of the infected graft ("curative concept") or solely as bailout procedure by wrapping the infected graft ("palliative concept"). The diagnosis, including computed tomography scans during follow-up, was made according to the criteria of the Management of Aortic Graft Infection Collaboration. The patient cohort consisted of 31 patients. Both in-hospital and one-year mortality were 0% (n = 0) for the curative concept (n = 9) compared to 23% (n = 5) and 41% (n = 9) for the palliative concept (n = 22), respectively. There was no graft infection-associated death or recurrence of infection after 3 years in the curative group. Survival was 52% at 3 years in the palliative group, with freedom of infection in 59% of the patients (n = 13). Transposition of the omentum and wrapping of the infected aortic prosthetic graft is a useful bailout strategy for patients who are ineligible for replacement of an infected aortic graft. However, mortality stays high. For radical treatment of aortic graft infections, it may prove an effective supportive therapy and represents an important tool in the armamentarium of cardiac surgeons.

Inflammatory markers changes following acceptance-based behavioral psychotherapy in generalized anxiety disorder patients: Evidence from a randomized controlled trial

IntroductionGeneralized anxiety disorder (GAD) has been associated with elevated levels of C-reactive protein (CRP) and proinflammatory cytokines. Despite robust evidence as an effective treatment for GAD, research on the effects of cognitive-behavioral therapies (CBT) in the inflammatory profile of patients with clinical anxiety has presented mixed results. ObjectiveThe present study aimed to investigate the effect of an acceptance-based behavior therapy (ABBT) on inflammatory biomarkers and their association with anxiety levels in GAD patients in comparison to supportive therapy as an active control. MethodsPeripheral inflammatory biomarkers (CRP, IL-1β, IL-4, IL-6, IL-10, TNF-α) were measured in 77 GAD patients who participated in a 14-week 10-session randomized clinical trial of group ABBT (experimental, n = 37) or supportive group therapy (ST: active control group, n = 40). ResultsThe concentrations of IL-1β decreased in the control group and the concentrations of IL-6 increased in the experimental group from baseline to post-treatment, whereas no difference was identified in IL-4, IL-10, TNF, or CRP. Although anxiety and depression levels decreased in both treatment conditions, no correlation with inflammation markers was found for most clinical and biological variables. A negative correlation between changes in IL-6 and IL-10 and anxiety symptom score changes was identified. ConclusionsThe present study results found that a short trial of acceptance-based behavior therapy did not change the proinflammatory profile which may be associated with GAD. Additional research is needed to evaluate the influence of other inflammation-related variables, longer periods of follow-up as well as the effect of supportive therapy on peripheral inflammatory biomarkers in GAD patients.

The Effect of Supportive Therapy in Reducing Anxiety in Juvenile Inmates in Class IIb Correctional Institutions, Purwakarta Regency, Indonesia

Anxiety is a mental health problem that is often experienced by teenagers, including juvenile inmates. Supportive therapy is one intervention that can be used to reduce anxiety in adolescents. This study aims to determine the effect of supportive therapy on reducing anxiety in juvenile inmates at the Class IIb Correctional Institution, Purwakarta Regency, Indonesia. This research uses a quasi-experimental design with a pretest-posttest control group design. The research sample consisted of 30 juvenile inmates who were divided into two groups, namely the intervention group (15 people) and the control group (15 people). The intervention group was given supportive therapy for 4 weeks, while the control group was given no intervention. The results of the study showed that there was a significant reduction in anxiety in the intervention group after being given supportive therapy. The average level of anxiety in the intervention group before the intervention was 2.67 (SD=0.488), while after the intervention, it was 1.53 (SD=0.516). This difference is statistically significant (p<0.001). Based on the results of this research, it can be concluded that supportive therapy can reduce anxiety in juvenile inmates. Supportive therapy can help juvenile inmates understand and address the causes of their anxiety, as well as increase their ability to use adaptive coping resources.

HNL Dimer in plasma is a unique and useful biomarker for the monitoring of antibiotic treatment in sepsis.

Sepsis is a growing problem worldwide and associated with high mortality and morbidity. The early and accurate diagnosis and effective supportive therapy are critical for combating mortality. The aim of the study was to compare the kinetics of four biomarkers in plasma in patients admitted to ICU including sepsis and during antibiotics treatment. The biomarkers evaluated were HBP (Heparin-binding protein), HNL Dimer (Human Neutrophil Lipocalin), HNL Total and PCT (Procalcitonin). Plasma was obtained at admission to ICU and during follow-up at days 2 and 3. Antibiotic treatment was started or reviewed on admission to ICU. The results were compared to SOFA and KDIGO-scores and to survival. 277 patients admitted to ICU were included of which 30% had sepsis. The other groups were categorized as miscellaneous, other medical and trauma. The plasma concentrations of all four biomarkers were highly elevated with the highest concentrations in sepsis patients. During the follow-up period HNL Dimer decreased already day 2 and further so day 3 (p<0.00001) in contrast to unchanged concentrations of the other three biomarkers. HNL Total showed the strongest relationships to the clinical scores (p<0.0001) and was by multiples regression analysis independently related to these scores. Our data supports and confirms our earlier findings of HNL Dimer being a novel and potentially useful clinical tool in antibiotic stewardship in sepsis. HNL Total reflects epithelial cell activity in the body and is an interesting biomarker for the management of organ failure in such patients.

Evaluation of Activity of Zinc Oxide Nanoparticles on Human Rotavirus and Multi-Drug Resistant Acinetobacter Baumannii.

Rotaviruses are the cause of acute gastroenteritis and severe diarrheal diseases in children worldwide. Children under the age of five are more susceptible to rotavirus infections. Due to such as the lack of effective drugs and supportive therapy only, the development of new antiviral agents against rotaviruses. Multi-drug-resistant Acinetobacter baumannii is also one of the most challenging Gram-negative bacteria to control and treat due to its antibiotic resistance, particularly in intensive care units. This study aimed to investigate the activity of zinc oxide nanoparticles against human rotavirus and multi-drug resistant Acinetobacter baumannii. The standard 50% tissue culture infectious dose method and the real-time polymerase chain reaction assay were used to investigate the effects of zinc oxide nanoparticles on rotaviruses. The well diffusion and the minimum inhibitory concentration method were used to assess the antibacterial activity of zinc oxide nanoparticles against Acinetobacter baumannii. 300 μg/ml of zinc oxide nanoparticles demonstrated the highest anti-rotavirus effects, resulting in a 3.16 logarithmic decrease in virus infectious titer, and a four-unit increase in the cycle threshold value of the real-time polymerase chain reaction assay compared to the untreated control (P value <0.001 and P value = 0.005, respectively). The diameter of the inhibition zone of zinc oxide nanoparticles solution against Acinetobacter baumannii was 17 mm. The minimum inhibitory concentration results of the zinc oxide nanoparticles solution against Acinetobacter baumannii was 1.56 mg/ml. Our findings showed that zinc oxide nanoparticles could be considered a promising antimicrobial compound.

Comparison between hydroxychloroquine and systemic corticosteroids in IgA nephropathy: a two-year follow-up study

BackgroundHydroxychloroquine (HCQ) is recommended as a treatment for IgA nephropathy (IgAN) to control proteinuria. The long-term effects of HCQ compared to systemic corticosteroid therapy remain unclear.MethodsWe conducted a retrospective case‒control study at Peking University First Hospital. Thirty-nine patients with IgAN who received HCQ for at least 24 months without corticosteroids (CSs) or other immunosuppressive agents were included. Thirty-nine matched patients who received systemic CS therapy were selected using propensity score matching. Clinical data over a 24-month period were compared.ResultsIn the HCQ group, the level of proteinuria decreased from 1.72 [1.44, 2.35] to 0.97 [0.51, 1.37] g/d (-50.5 [-74.0, -3.4] %, P < 0.001) at 24 months. A significant decline in proteinuria was also found in the CS group, but no significant differences were found between the HCQ group and CS group in the levels of proteinuria (0.97 [0.51, 1.37] vs. 0.53 [0.25, 1.81] g/d, P = 0.707) and change rates (-50.5% [-74.0%, -3.4%] vs. -63.7% [-78.5%, -24.2%], P = 0.385) at 24 months. In addition, the decline rates of eGFR between the HCQ and CS groups were comparable (-7.9% [-16.1%, 5.8%] vs. -6.6% [-14.9%, 5.3%], P = 0.758). More adverse events were observed in the CS group.ConclusionsLong-term use of HCQ can maintain stable renal function with minimal side effects. In patients who cannot tolerate corticosteroids, HCQ might be an effective and safe supportive therapy for IgAN.

Anakinra and dexamethasone treatment of idarubicin-induced mucositis and diarrhoea in rats.

Chemotherapy-induced mucositis, characterised by diarrhoea and villous atrophy, is a severe side effect contributing to reduced quality of life and premature death in cancer patients treated with cytostatics. Despite its high incidence, there is no effective supportive therapy available. The main objective of this study was to determine if the anti-inflammatory drugs anakinra and/or dexamethasone - which have different mechanism-of-action - might be used to effectively treat idarubicin-induced mucositis in rats. Mucositis was induced through a single injection with 2 mg/kg idarubicin (with saline as control), followed by daily treatments of anakinra (100 mg/kg/day), dexamethasone (10 mg/kg/day), or both during three days. After 72 hours, jejunal tissue was collected for morphological, apoptotic, and proliferative analyses, and colonic faecal water content and body weight change were determined. The diarrhoea that was induced by idarubicin (from 63.5% to 78.6% water content in faeces) was completely reversed by anakinra alone, and the jejunal villus height reduction by 36% was prevented by a combination of anakinra and dexamethasone. Dexamethasone reduced apoptosis in the jejunal crypts, both alone and in combination with anakinra. These positive effects encourage further investigations into the use of anakinra and dexamethasone as supportive therapies for chemotherapy-induced intestinal mucositis and diarrhoea.

Sticking to the Rules: Outcome and Success Rate of Guideline-Based Diarrhea Management in Metastatic Breast Cancer Patients Treated with Abemaciclib.

In clinical trials testing abemaciclib in patients with hormone-receptor-positive (HR+), HER2-negative (HER2-) advanced breast cancer, diarrhea is a very common adverse event (occurring in approximately 85% of patients, any grade). Nonetheless, this toxicity leads to abemaciclib discontinuation in a small proportion of patients (approximately 2%) thanks to the use of effective loperamide-based supportive therapy. We aimed to determine whether the incidence of abemaciclib-induced diarrhea in real-world trials was higher than the one reported in clinical trials, where patients are highly selected, and to evaluate the success rate of standard supportive care in this setting. We conducted a retrospective, observational, monocentric study including 39 consecutive patients with HR+/HER2- advanced breast cancer treated with abemaciclib and endocrine therapy at our institution from July 2019 to May 2021. Overall, diarrhea of any grade occurred in 36 patients (92%), of whom 6 (17%) had diarrhea of grade ≥3. In 30 patients (77%), diarrhea was associated with other adverse events, including fatigue (33%), neutropenia (33%), emesis (28%), abdominal pain (20%), and hepatotoxicity (13%). Loperamide-based supportive therapy was administered to 26 patients (72%). Abemaciclib dose was reduced in 12 patients (31%) due to diarrhea, and treatment was permanently discontinued in 4 patients (10%). In 58% of patients (15/26), diarrhea was effectively managed with supportive care and did not require abemaciclib dose reduction and/or discontinuation. In our real-world analysis, we observed a higher incidence of diarrhea related to abemaciclib compared to data from clinical trials, and a higher rate of permanent treatment discontinuation due to gastrointestinal toxicity. Better implementation of guideline-based supportive care could help to manage this toxicity.

Prevalence of peste des petits ruminants and concurrent hematological, liver and kidney function test of Black Bengal goats reared in Jaintapur, Sylhet district in Bangladesh

Hemato-biochemical parameters aid in the formulation of effective treatment and supportive therapy for infectious diseases of animals such as peste des petits ruminants (PPR). The present study investigated the prevalence of PPR in Black Bengal goats reared in Jaintapur, Sylhet and concurrent hematology, liver and kidney function tests of PPR infected goats. Information of PPR infected goats was recorded according to age and sex by asking questions to the owner or farmers. Blood samples from 10 PPR-infected Black Bengal goats and 10 normal healthy goats were collected and analyzed using routine blood and biochemical tests. PPR positive cases were found in 60 of 125 goats examined based on clinical signs. The highest prevalence (50%) was recorded in young goats (below 12 months) followed by goats of 12-24 months of age and older goats (above 25 months). Older goats were less susceptible to PPR infection. Male goats were less susceptible to PPR infection (31.66%) compared to female goats (68.33%). PPR is more likely in goats with lower body condition score (BCS). PPR-infected goats had macrocytic hypochromic anemia, as evidenced by significantly lower TEC, Hb, and PCV levels and higher MCV and MCH levels. The total leucocyte count (TLC) was significantly (P&lt;0.05) decreased, neutrophils numbers were significantly increased but lymphocyte numbers were decreased in PPR infected goats. ALT, AST and creatinine reflect the liver and kidney functions. PPR-infected goats had significantly higher (P&lt;0.05) AST, ALT and creatinine values than normal healthy goats. A high level of AST and ALT in PPR-infected goats might be due to liver damage. The high creatinine level indicates functional damage to the kidney. In conclusion, Prevalence of PPR in higher in Black Bengal goats reared in Jaintapur, Sylhet and PPR virus altered the hematological parameters and liver and kidney function test of the PPR infected goats. Asian J. Med. Biol. Res. 2022, 8 (4), 270-276

Cardiotoxicity is mitigated after a supervised exercise program in HER2-positive breast cancer undergoing adjuvant trastuzumab.

BackgroundTrastuzumab is used, alone or in conjunction with standard chemotherapy, to treat HER2-positive breast cancer (BC). Although it improves cancer outcomes, trastuzumab. can lead to cardiotoxicity. Physical exercise is a safe and effective supportive therapy in the management of side effects, but the cardioprotective effects of exercise are still unclear.ObjectivesThe primary aim of this study was to test whether trastuzumab-induced cardiotoxicity [left ventricular ejection fraction (LVEF) under 50%, or an absolute drop in LVEF of 10%] was reduced after a supervised exercise program of 3 months in patients with HER2-positive breast cancer. Secondary endpoints were to evaluate (i) cardiotoxicity rates using other criteria, (ii) cardiac parameters, (iii) cardiorespiratory fitness and (iv) whether a change in LVEF influences the cardiorespiratory fitness.Methods89 women were randomized to receive adjuvant trastuzumab in combination with a training program (training group: TG; n = 46) or trastuzumab alone (control group: CG; n = 43). The primary and secondary endpoints were evaluated at the end of the supervised exercise program of 3 months (T3).ResultsAfter exercise program, 90.5 % of TG patients and 81.8% of CG patients did not exhibit cardiotoxicity. Furthermore, whatever the used criterion, percentage of patients without cardiotoxicity were greater in TG (97.6 and 100% respectively) than in CG (90.9 and 93.9% respectively). LVEF and GLS values remained stable in both groups without any difference between the groups. In contrast, at T3, peak VO2 (+2.6 mL.min−1.kg−1; 95%CI, 1.8 to 3.4) and maximal power (+21.3 W; 95%CI, 17.3 to 25.3) increased significantly in TG, whereas they were unchanged in CG (peak VO2: +0.2 mL.min−1.kg−1; 95%CI, −0.5 to 0.9 and maximal power: +0.7 W, 95%CI, −3.6 to 5.1) compared to values measured at T0. No correlation between LVEF changes and peak VO2 or maximal power was observed.ConclusionA 12-week supervised exercise regimen was safe and improved the cardiopulmonary fitness in particular peak VO2, in HER2-positive BC patients treated with adjuvant trastuzumab therapy. The study is under powered to come to any conclusion regarding the effect on cardiotoxicity.Clinical trial registrationwww.ClinicalTrials.gov, identifier: NCT02433067.

Effectiveness of Supportive Therapy and Economic Token Therapy in Reducing The Symptoms of Self-Care Deficit, Based on The Peplau Nursing Model

Introduction: Self-care deficit is a nursing diagnosis in which the client experiences an inability to independently perform personal hygiene, dress, eat and defecate. Therefore, interventions are needed to address clients with self-care deficits. One of the interventions carried out is supportive therapy and token economy using the Peplau interpersonal nursing model approach. The purpose of this study was to analyse the effectiveness of supportive therapy and token economy in reducing signs and symptoms of self-care deficits based on the Peplau interpersonal nursing model. Methods: The research design was a quasi-experimental study using a two group pre-post design. The sample in this study amounted to 40 respondents, 20 intervention groups, and 20 control groups according to the research criteria. This research was conducted in July-August 2021. The sampling technique was carried out by purposive sampling. The data was analysed by univariate and bivariate with a t-dependent test. Results: The results of the study showed that there was an increase in self-care before and after being given supportive therapy and economic tokens in the intervention group with a value before 133.60 to 140.05. A statistical test obtained p-value = 0.000 which means that there is an effect of supportive therapy and economic tokens in reducing signs of symptoms Of self-care deficit. The results obtained in the control group after being given supportive therapy with values before 128.85 to 138.55 and statistical tests obtained p-value = 0.041, meaning that there is an effect of supportive therapy in reducing symptoms of self-care deficits. Conclusion: There is an effect of supportive therapy and token economy on improving self-care in self-care deficit clients. Supportive therapy and token economy are recommended for self-care deficit clients to improve self-care abilities.@font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;}@font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-536858881 -1073732485 9 0 511 0;}@font-face {font-family:"Gill Sans MT"; panose-1:2 11 5 2 2 1 4 2 2 3; mso-font-charset:77; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:3 0 0 0 3 0;}p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-priority:1; mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin:0cm; mso-pagination:none; text-autospace:none; font-size:11.0pt; font-family:"Arial",sans-serif; mso-fareast-font-family:Arial; mso-ansi-language:EN-US; mso-fareast-language:EN-US; mso-bidi-language:EN-US;}p.Default, li.Default, div.Default {mso-style-name:Default; mso-style-unhide:no; mso-style-parent:""; margin:0cm; mso-pagination:widow-orphan; mso-layout-grid-align:none; text-autospace:none; font-size:12.0pt; font-family:"Times New Roman",serif; mso-fareast-font-family:Calibri; color:black; mso-ansi-language:EN-US; mso-fareast-language:EN-US;}span.jlqj4b {mso-style-name:jlqj4b; mso-style-unhide:no;}.MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-size:11.0pt; mso-ansi-font-size:11.0pt; mso-bidi-font-size:11.0pt; font-family:"Calibri",sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi; mso-ansi-language:EN-US; mso-fareast-language:EN-US;}.MsoPapDefault {mso-style-type:export-only; margin-bottom:10.0pt; line-height:115%;}div.WordSection1 {page:WordSection1;}

Oral Preparation of Hyaluronic Acid, Chondroitin Sulfate, Curcumin, and Quercetin (Ialuril® Soft Gels) for the Prevention of LUTS after Intravesical Chemotherapy.

Intravesical chemotherapy may cause chemical cystitis and related lower urinary tract symptoms (LUTS). The aims of this study were to evaluate the efficacy and safety of an oral preparation of hyaluronic acid (HA), chondroitin sulfate (CS), curcumin, and quercetin (Ialuril® Soft Gels) to reduce the severity of LUTS in patients with a history of bladder cancer (BCa) undergoing intravesical chemotherapy. We designed a monocentric, randomized, double-blind, placebo-controlled pilot trial. Patients referred to our institute between November 2016 and March 2018 were enrolled. All subjects had non-muscle-invasive BCa and received intravesical chemotherapy with mitomycin C (MMC). Patients were randomized 1:1 in two groups (intervention vs. control). All subjects underwent oral administration (Ialuril® Soft Gels or placebo) starting one week before the first weekly instillation and ending 30 days after the last one, subsequently starting one week before each monthly instillation and ending 14 days after it. International prostate symptom score (IPSS) and 0-100 visual analogue scale (VAS) were used to assess the efficacy of the treatment. Adverse events were also described. Patients were evaluated at baseline and after 1, 4, 7, and 13 months of intravesical chemotherapy. A total of 34 patients were enrolled. The median IPSS score was significantly lower in the intervention group compared to the control group at 4 (13 vs. 17 points; p = 0.038), 7 (10 vs. 18 points; p < 0.001), and 13 (10 vs. 17 points; p = 0.002) months. The median VAS score was significantly lower in the intervention group compared to the control group at 7 (22 vs. 37 points; p = 0.021) and 13 (20 vs. 35 points; p = 0.024) months. No AE specifically related to supplement or placebo was recorded. Oral formulation of HA, CS, quercetin, and curcumin could be an effective and safe supportive therapy against chemical cystitis in patients receiving intravesical chemotherapy for BCa.

A challenging case of an adolescent and young adult patient with high-risk acute lymphoblastic leukemia: the need for a multidisciplinary approach: a case report

BackgroundAdolescents and young adults diagnosed with acute lymphoblastic leukemia are treated according to pediatric-based regimens to achieve better results. However, implementation of intensive chemotherapy protocols in this age group is associated with increased treatment-related toxicities, affecting almost every organ and system. In this case, the focus of our interest was on rather rare entities: steroid-induced psychosis that seldom develops in children and adolescents, and choroid plexus hemosiderosis, infrequently identified as a first sign of iron overload.Case presentationThe aim of this paper is to present a challenging case of a 15-year-old Caucasian male patient treated for high-risk acute lymphoblastic leukemia and who experienced various adverse incidents during intensive chemotherapy, thus necessitating a high-quality multidisciplinary approach. Slow minimal residual disease clearance was an additional concerning issue. Induction and re-induction were complicated by steroid-induced hyperglycemia that required multiple-week insulin. During consolidation, acute kidney injury on the basis of chronic kidney disease was verified, demanding subsequent drug dose modifications. By the end of re-induction, after dexamethasone cessation, infrequent steroid-induced psychosis, presented as incoherent speech, aggressive behavior, and mood swings, required intensive psychiatric support. Neurological evaluation of seizures revealed uncommon choroid plexus hemosiderosis by brain magnetic resonance imaging, warranting appropriate selection of iron chelation therapy in the context of preexisting nephropathy. Ultimately, iron deposits of moderate intensity were verified by liver magnetic resonance imaging, while heart tissue remained intact. The early diagnosis and adequate treatment of aforementioned difficult toxicities resulted in complete recovery of the patient.ConclusionsTreating adolescents with high-risk acute leukemia and multiple therapy-related morbidities remains a challenge, even in the era of extensive and effective supportive therapy. Superior survival rates might be achieved by prompt recognition of both frequent and rarely encountered adverse episodes, as well as well-timed and appropriate management by a well-coordinated multidisciplinary team.

The outcomes of children with acute myeloid leukemia treated in accordance with the AML–MM-2006 protocol

Over the past years, the outcomes of patients with acute myeloid leukemia (AML) have significantly improved due to the use of intensive chemotherapy, more effective supportive therapy, and the availability of allogeneic hematopoietic stem cell transplantation. This article presents the outcomes of children with AML treated in accordance with the AML-MM-2006 protocol. Our study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. The study included 233 patients with a median age of 6.5 years (7 days – 18 years) who were stratified into the following risk groups: standard risk, intermediate risk, and high risk. The 5-year event-free survival (EFS) was 0.64 ± 0,14, 0.49 ± 0.05, and 0.43 ± 0.05 for standard-risk (n = 12), intermediate-risk (n = 106), and high-risk (n = 115) patients, respectively (p = 0.14), while the 5-year overall survival (OS) was 1.0 year, 0.7 ± 0.05 and 0.55 ± 0.05, respectively (p = 0.001). The OS in the entire cohort was 0.68 ± 0.032. Factors associated with poor prognosis included hyperleukocytosis, the presence of extramedullary lesions, and age &lt; 1 year. The overall survival rates in these patient groups were 0.55 ± 0.08, 0.39 ± 0.09 and 0.49 ± 0.08, respectively. The worst prognosis was for patients with monosomy 7 and t(7;12) whose OS rates were 0.25 ± 0.2 and 0.4 ± 0.2, respectively. For non-responders and patients with relapsed AML, the OS was 0.33 ± 0.08 and 0.54 ± 0.06, respectively. Early death (before remission could be achieved) occurred in 4% of patients, and 3.8% of patients died in first remission. Sixtytwo percent of deceased patients died of disease progression. In the entire cohort of patients, the five-year EFS was 0.53 ± 0.047, the cumulative risk of relapse after 3 years of remission was 40%, the confidence interval was 23–89%.

Inferior vena cava thrombosis during extracorporeal membrane oxygenation: a case report and review of the\xa0literature

BackgroundExtracorporeal membrane oxygenation (ECMO) is an effective cardiopulmonary support therapy, which can provide temporary cardiopulmonary support for critically ill patients whose condition cannot be reversed by conventional therapy. However, there are many complications in the use of ECMO, such as bleeding, thrombosis, and so on. Among them, inferior vena cava (IVC) thrombosis which can cause pulmonary embolism is a rare complication, which may be life-threatening.Case presentationA 75-year-old female patient (Han Chinese ethnicity) with acute heart failure due to acute myocardial infarction in our department was retrospectively analyzed. After regular treatment was unsuccessful, she was treated with venoarterial ECMO (VA-ECMO). After her condition improved, she was withdrawn from ECMO and experienced a complication of IVC thrombosis. Enoxaparin was given immediately for 1 mg/kg every 12 hours hypodermic injection. The thrombus disappeared after anticoagulant therapy. She was discharged on the 60th day. Her level of consciousness returned to normal without residual central nervous system-related complications.ConclusionsIVC thrombosis is one of the possible serious complications in the process of ECMO therapy. Prevention of thrombosis and optimization of the anticoagulant regimen are the main preventive measures. Anticoagulant therapy is still the main treatment of IVC thrombosis in the process of ECMO therapy. Other interventional strategies need to accumulate clinical experience.

A Five-year Review of Puerperal Sepsis and Its Complications at the Federal Medical Centre, Yenagoa, South-South Nigeria

Background: Puerperal sepsis is a significant cause of maternal morbidity and mortality, especially in developing countries, Nigeria inclusive. It complicates 1% – 8% of all deliveries, and is responsible for 15% of maternal deaths.&#x0D; Objective: To determine the incidence of puerperal sepsis, and its associated complications at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria, over a five-year period.&#x0D; Materials and Methods: This retrospective survey was carried out between 1st January, 2016, and 31st December, 2020. Data were retrieved, entered into a pre-designed proforma, and analyzed using IBM SPSS version 25.0. Results were presented in frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables.&#x0D; Results: A total of 66 women were managed for puerperal sepsis out of 4,571 obstetric patients seen in the five-year period under review. Most women were unbooked (81.8%), and were delivered at home/unorthodox faith-based delivery units by traditional birth attendants (75.8%). Staphylococcus aureus, Escherichia coli and Klebsiella spp were cultured in 54.8%, 12.9% and 12.9% of cases, respectively. There was no maternal mortality.&#x0D; Conclusion: Puerperal sepsis remains an important public health problem in developing countries. While encouraging antenatal care and supervised hospital delivery is important for its primary prevention, early diagnosis, prompt and effective antibiotic and supportive therapy will prevent its complications.

A Biomimetic Polynucleotides–Hyaluronic Acid Hydrogel Promotes Wound Healing in a Primary Gingival Fibroblast Model

Polynucleotides (PN) have long been known as an effective supportive therapy for wound healing. The present study investigated whether a hydrogel formulation containing PN and hyaluronic acid (PN + HA) could promote wound healing in an in vitro model of gingival fibroblasts. PN promoted cell growth and viability as assessed by different assays, and PN + HA, though not significantly further increasing cell growth as compared to PN, supported the formation of dense multilayered cell nodules. PN promoted fibroblasts’ clonogenic efficiency and PN + HA further enhanced the formation of more numerous dense colonies. PN + HA appeared to significantly increase the expression of collagen 1a1 and 3a1, while not affecting proteoglycans deposition. Interestingly, when tested in a scratch assay, PN + HA achieved gap closure after 48 h, while cells in the comparison groups had not completely bridged the scratch even after 96 h. Taken together, these results demonstrate that PN + HA is a promising candidate for a supportive therapy to promote soft tissue healing in the oral cavity.

Therapeutic Plasma Exchange (TPE) as an effective supportive therapy for COVID-19 case with Acute Respiratory Distress Syndrome (ARDS) and thrombophilia: A case report

Coronavirus Disease (COVID-19) has rapidly spread and caused a high number of mortalities. To this day, effective therapy to cure this virus is yet to be found. A number of treatments were tested; however, the result is not satisfactory. Therapeutic plasma exchange (TPE) is one of the supportive therapies applied to treat COVID-19 patients with moderate to severe symptoms. We reported 41 years old male patient diagnosed with severe COVID-19 infection, acute respiratory distress syndrome (ARDS), and thrombophilia. The patient received a therapy following the Ministry of Health’s guideline for COVID-19 handling. On the third day, respiratory failure occurred with a P/F ratio of 255 and the chest X-ray result showed vascular streak and ground-glass opacity; thus, the hospital decided to perform TPE. The TPE was performed twice in 5 days interval. After TPE was administered, clinical development is observed both subjectively in the form of reduced symptoms, normal respiration rate, and objectively, the improvement in blood gas analysis, increased O2 saturation, and a decrease in interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) level significant clinical laboratory and radiological improvement possibly due to cytokine storm which is remedied by TPE action.

Fenugreek Seeds as a Therapeutic Supplement for Patients with Noninsulin Dependent Diabetes Mellitus: A Cross-sectional Study

Introduction: Diabetes mellitus is a metabolic disorder, for which there is no known cure except in very specific situations. Management of diabetes is based on keeping blood sugar levels as close to normal as possible, without causing hypoglycaemia. Usually, this can be accomplished with diet, exercise and use of appropriate medications. In India, herbs are used in treatment to maintain normal blood glucose and lipid levels. In any form of management of diabetes with drug or insulin, diet is a common factor. Besides diet, many plants and foods of medicinal value have proved to be very useful in which one of them is fenugreek seed. Aim: The present study was aimed to evaluate the blood glucose modulating effect of Fenugreek Seed Powder (FSP) in patients of Noninsulin Dependent Diabetes Mellitus (NIDDM). Materials and Methods: A cross-sectional study was conducted on 25 patients of NIDDM of age group 40 to 50 years. A 5 gm Fenugreek seed powder was given to the patients on empty stomach early in the morning every day. Before beginning the study and at the end of every month, the blood glucose level (fasting and postprandial) was measured consecutively for three months. Statistics Program for Social Sciences (SPSS, version 17.0) computer software package was used for statistical analysis of the data. Results: Administration of FSP lowered the blood glucose levels in patients of NIDDM and a significant reduction in blood glucose level (fasting and postprandial) was observed in the study. Conclusion: Present study suggested that FSP might have potential to modulate blood glucose level which can serve as an effective supportive therapy in the prevention and management of long-term complications of diabetes.

Music therapy as an adjunct in cardiac device lead extraction procedures: A randomized controlled trial

BackgroundEvidence of music therapy as an effective supportive therapy in invasive cardiac procedures is increasing, but more research is needed. AimsTo evaluate the impact of music therapy on stress responses during cardiac device lead extraction procedures performed in local anaesthesia. MethodsSixty-four patients undergoing cardiac implantable electronic device lead extraction at Oslo University Hospital Ulleval from March 2018 to September 2019 were randomized to music therapy (n = 32) or control (n = 32). Primary endpoints were patient satisfaction with pain management and average pain intensity during the procedure. Secondary endpoints were average anxiety intensity, need for analgesic/anxiolytic drugs, blood pressure, heart and respiration rate. ResultsAll patients in the music therapy group completed the intervention. Patient satisfaction with pain management was 10.00 (8.00, 10.00) in the music therapy vs. 10.00 (9.00, 10.00) in the control group (p = 0.85), and average level of pain 0.89 (0.22, 1.13) vs. 0.96 (0.36, 1.58), respectively (p = 0.38). Average anxiety score was 1.00 (0.33, 2.17) in the music therapy vs 1.67 (0.71, 3.35) in the control group (p = 0.056). The use of analgesic/anxiolytic drugs and physiological parameters were similar across groups. ConclusionsIn this study of music therapy during cardiac device lead extractions, no effect was found on patient satisfaction with pain management or average pain level. A decrease in patient anxiety of borderline significance was observed in the music therapy group. More studies with more sensitive measures of pain and anxiety are needed to determine the value of music therapy in invasive cardiac procedures.