Effective Course Of Treatment Research Articles

Clinical features and prognosis of patients with myeloid neoplasms harboring t(7;11)(p15;p15) translocation: a single-center retrospective study

BackgroundFor myeloid neoplasms with t(7;11)(p15;p15) translocation, the prognosis is quite dismal. Because these tumors are rare, most occurrences are reported as single cases. Clinical results and optimal treatment approaches remain elusive. This study endeavors to elucidate the clinical implications and prognosis of this cytogenetic aberration.MethodsThis study retrospectively analyzed 23 cases of myeloid neoplasm with t(7;11)(p15;p15). Clinicopathological characteristics, genetic alterations, and outcomes were evaluated, and the Kaplan-Meier method was employed to construct survival curves.ResultsOf these, nine cases were newly diagnosed acute myeloid leukemia (ND AML), seven presented with relapsed refractory AML (R/R AML), four had myelodysplastic syndrome (MDS), two had secondary AML, and one exhibited a mixed germinoma associated with MDS. Patients with t(7;11)(p15;p15) in AML were primarily younger females who preferred subtype M2. Interestingly, these patients had decreased hemoglobin and red blood cell counts, along with markedly elevated levels of lactic dehydrogenase and interleukin-6, and exhibited the expression of CD117. R/R AML patients exhibited a higher likelihood of additional chromosome abnormalities (ACAs) besides t(7;11). WT1 and FLT3-ITD were the most commonly found mutated genes, and 10 of those instances showed evidence of the NUP98::HOXA9 fusion gene. The composite complete remission rate was 66.7% (12/18), while the cumulative graft survival rate was 100% (4/4). However, the survival outcomes were dismal. Interestingly, the median overall survival for R/R AML patients was 4.0 months (95% CI: 1.7–6.4). Additionally, the type of AML diagnosis or the presence of ACAs or molecular prognostic stratification did not significantly influence clinical outcomes (p = 0.066, p = 0.585, p = 0.570, respectively).ConclusionMyeloid leukemia with t(7;11) exhibits unique clinical features, cytogenetic properties, and molecular genetic characteristics. These survival outcomes were dismal. R/R AML patients have a limited lifespan. For myeloid patients with t(7;11), targeted therapy or transplantation may be an effective course of treatment.

Surgical and local control outcomes after sequential short-course radiation therapy and chemotherapy for rectal cancer

BackgroundTotal neoadjuvant therapy (TNT) is an accepted approach for the management of locally advanced rectal cancer (LARC) and is associated with a decreased risk of development of metastatic disease compared to standard neoadjuvant therapy. However, questions remain regarding surgical outcomes and local control in patients who proceed to surgery, particularly when radiation is given first in the neoadjuvant sequence. We report on our institution's experience with patients who underwent short-course radiation therapy, consolidation chemotherapy, and surgery. MethodsWe retrospectively reviewed surgical specimen outcomes, postoperative complications, and local/pelvic control in a large cohort of patients with LARC who underwent neoadjuvant therapy incorporating upfront short-course radiation therapy followed by consolidation chemotherapy. ResultsIn our cohort of 83 patients who proceeded to surgery, a complete/near-complete mesorectal specimen was achieved in 90 % of patients. This outcome was not associated with the time interval from completion of radiation to surgery. Postoperative complications were acceptably low. Local control at two years was 93.4 % for all patients- 97.6 % for those with low-risk disease and 90.4 % for high-risk disease. ConclusionUpfront short-course radiation therapy and consolidation chemotherapy is an effective treatment course. Extended interval from completion of short-course radiation therapy did not impact surgical specimen quality.

A Quick Guide for Cellulitis Treatment

Cellulitis, a common bacterial skin infection, poses a clinical challenge in its management due to its varied etiology, ranging from streptococcal to staphylococcal species. This review delves into the intricate landscape of cellulitis treatment, exploring the nuances of antibiotic selection based on infection type, severity, and local epidemiology. The empirical use of antibiotics, guided by an understanding of likely pathogens, is crucial in balancing efficacy and preventing resistance. Special attention is given to the inclusion of MRSA coverage in high-risk scenarios. Tailoring antibiotic regimens to specific clinical situations, such as surgical site infections or diabetic foot complications, underscores the importance of flexibility in cellulitis management. Periodic reassessment, guided by culture results and clinical response, ensures a dynamic and effective treatment course. The review also emphasizes the critical role of antibiotic stewardship in combating resistance and sustaining effective cellulitis management.

The need of a comprehensive approach in a condition of poorly opioid-responsive cancer pain.

Spinal analgesia is often claimed as an effective strategy for patients with a poor response to systemic opioids. Despite the optimistic data reported in literature with intrathecal drug delivery systems (IDDS) for cancer pain, a critical analysis showed modest benefit. Indeed, intrathecal therapy may be potent means to be used in a very selected population. However, ability to manage spinal therapy combined with the use of opioids and other drugs in the general perspective of a comprehensive palliative care treatment may allow to resolve refractory cancer pain in a patient with a clinical profile of poor pain prognosis, according to the Edmonton staging system. A long-term management of patient who underwent different therapeuthic approaches, including multiple opioid lines, intrathecal analgesia, and a comprehensive palliative care treatment, is described. The case reported describes how the management of cancer pain may be complex, requiring a high level of expertise on using opioids, conversion ratios, different routes, particularly the intrathecal one, as well as providing a comprehensive palliative care treatment. No evidence-based treatment can be taken into consideration for such extreme conditions, where only experience and knowledge can guide to an effective course of treament along a period of about six months. Timely therapeutic strategies are needed to be performed in each challenging clinical situation along the course of disease.

Metformin combined with spironolactone vs. metformin alone in polycystic ovary syndrome: a meta-analysis.

Due to its high heterogenicity and unclear etiology, there is currently no specific treatment for polycystic ovary syndrome (PCOS). Metformin, as an insulin sensitizer, combined with spironolactone, an antiandrogen medication, may exert complementary effects on PCOS. We therefore performed a meta-analysis of trials in which metformin combined with spironolactone was applied to treat PCOS to evaluate the efficacy and safety of the combination therapy. We retrieved the PubMed, Embase, Scopus, Cochrane Library, CNKI, CBM, Wangfang, and VIP databases for literatures published from their inception to December 16, 2022 on the effects of metformin combined with spironolactone in the treatment of PCOS. Inclusion criteria according to P.I.C.O.S criteria were: PCOS patients, metformin combined with spironolactone interventions, metformin alone control group, and randomized controlled trials with the following outcome data: body mass index (BMI), hirsutism score, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), fasting blood glucose (FBG), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and side effects including nausea, vomiting, diarrhea and drug withdrawal. Our results revealed that metformin combined with spironolactone significantly reduced BMI and TT, but that it exerted no significant effects on hirsutism score, or on FSH or LH concentrations. Combined treatment also resulted in a significant diminution in FBG and insulin resistance using the HOMA-IR when the interventional time was greater than 6 months. In addition, the combination did not have a higher occurrence of adverse reactions than metformin alone. Compared with metformin alone, metformin combined with spironolactone therapy may be more effective in reducing BMI and serum androgen levels, but the combination showed no significant effect on the hirsutism score or gonadotropin hormone levels, and was not associated with an elevation in side-effects. Moreover, when the treatment course was greater than 6 months, combination therapy reduced FBG and improved insulin resistance more effectively than metformin alone. However, more research is needed to determine the most effective course of treatment. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022355515.

Combined Management of Wound Ulcers With Focus on Interventional Techniques

This review provides a summary of current practice patterns in managing venous ulcers. The authors will describe the workup for venous ulcers, including differentiation of symptoms, physical examination, and imaging to guide the most effective treatment course for each patient. An overview of conservative management and minimally invasive treatment options for venous ulcers will be provided with a specific focus on periulcer foam sclerotherapy to aid in preventing ulcer recurrence and promoting healing. We will give interventional troubleshooting techniques for challenging patient presentations.

Long-term results of chemotherapy of tuberculosis with a widespread drug-resistant pathogen using bedaquiline

Relevance. Long-term results of treatment of patients with widespread drug-resistant tuberculosis are not presented in the medical literature. Objective. Study the efficacy and long-term results of treatment of patients with widespread drug-resistant tuberculosis using bedaquiline. Material and methods. Two groups of patients with widespread drug-resistant tuberculosis were formed, who received bedaquiline as the base drug of the chemotherapy course: bedaquiline in the main group (49 people) and moxifloxacin in the control group (76 people). The results of treatment at the end of the course of chemotherapy and after three years of follow-up were studied. Results. 87.8±9.2% of patients from the main group completed an effective course of treatment with sputum culture control. In 67.3±13.1%, the cessation of bacillus excretion was achieved at 1–2 months of treatment. Undesirable effects of chemotherapy were noted in 10.2–32.7% of cases, with prolongation of the QT interval only in 8.2±7.7% of patients. After a three-year dispensary follow-up, there was no recurrence of tuberculosis in the main group, chronic obstructive pulmonary disease was less common for the fifirst time, no cases of treatment by a cardiologist and gynecologist were found, the transfer of patients from the second disability group to the third was more often observed. Conclusion. The use of bedaquiline for the treatment of patients with widespread drug-resistant tuberculosis makes it possible to achieve early cessation of bacillus excretion with transfer to outpatient treatment, reduce the frequency of adverse reactions of chemotherapy. The long-term results of dispensary observation indicate a low risk of reactivation of tuberculosis, a significant reduction in the need for dispensary observation by other specialists, including a cardiologist, and improvement in the results of complex rehabilitation.

Common peroneal neuroma in continuity with complete foot drop secondary to a bullet fragment injury

Background. Common peroneal nerve (CPN) injuries are generally common but they are uncommon due to gunshot injuries and are associated with poor motor outcomes. Managing neuroma-in-continuity is still challenging because there are currently no accepted standards for deciding on the most effective course of treatment or estimating the time needed for repair. Treatment options for a neuroma-in-continuity include neurolysis, neuroma resection with interposition, end-to-side nerve grafting, and bypass grafting. Case presentation. A 40-year-old man presented with findings of complete right foot drop due to an 8-month-old firearm injury to his right distal thigh. Following baseline investigations, imaging, and anaesthesia fitness, he underwent surgical exploration under general anaesthesia. A neuroma-in-continuity was found in the CPN, resected, and an end-to-end nerve repair was performed. Along with the neuroma-in-continuity, a bullet fragment was also removed. The neurological status remained unchanged postoperatively. Conclusion. Regardless of the cause of the lesion, patients should be urged to seek surgical therapy if there is no spontaneous recovery within four months after the CPN injury. Sharp injuries and knee dislocations have a better chance of recovery than crush injuries and gunshot wounds.

Gout: A Case Report

Gout is a common clinical condition, usually seen with typical manifestations of swelling, erythema, tophi, and heat at joint(s). However, in rare circumstances, gout can present atypically, and it is important to recognize and manage it with appropriate medical therapy. This case study dives into a particularly atypical presentation of tophaceous gout in a patient with numerous comorbidities that complicate management. Visually appreciating the tophi, in this case, allows one to get an idea of their distribution on the digits, their unique chalky-white appearance, and how the presentation changed after therapy was initiated. Additionally, learning about the in-depth management and step-wise escalation of treatment is a crucial takeaway from this case, especially in the backdrop of the patient’s CKD3b and CHF - making selecting pharmacotherapy a challenge. After some trial and co-consultation with nephrology, the final effective treatment course for this patient involved using a combination of Allopurinol and Pegloticase (Krystexxa) together; this provided both a clinical improvement and a decrease in lab values of uric acid, dropping from 11.4mg/dL at peak to 4.4mg/dL.

Peculiarities of the course of tuberculosis in military women and women – family members of military personnel

Relevance. It is noted that incidence of tuberculosis among population and the military increased with perfect regularity during wars and social upheaval. Therefore the health care system and the medical service of the Armed Forces of Russia should be ready for new challenges.Intention. To assess the characteristics of the course of tuberculosis in female servicemen and female members of military families, the specificity in the organization of specialized medical care for them and of treatment results.Methodology. According to the data of studied and analyzed medical documentation (medical histories, medical service reports), characteristic features of tuberculosis course in female servicemen and female members of military families (who were treated in tuberculosis military medical organization in the period of 2012 to 2021) have been revealed. The 1st group consisted of 62 female servicemen, the 2nd – of 63 female members of military families. Mathematical and statistical data processing was carried out using Statistica 22.0 application software packages.Results and Discussion. New cases of tuberculosis are detected among female military personnel every year. Statistically significant differences have been established in various age groups (p < 0.05), in groups with frequently detected disseminated tuberculosis (p < 0.05). Generalized forms of tuberculosis have been detected only in patients of the 2nd group; these patients were more often prescribed an individual course of treatment (p < 0.05). Tuberculosis pleurisy was significantly more common in 1st group (p < 0.05) due to the younger age of patients. Bacterial excretion was observed in 27.4 % of patients in 1st group and 34.9 % in 2nd group. The proportion of multidrug-resistant tuberculosis reached 9.7 %. As appears from the above, the patients of the 2nd group had clinically more severe forms of tuberculosis and the treatment have required more diagnostic effort and resources.Conclusion. Treatment efficacy in the 1st and 2nd groups was 100 and 93.7 %, respectively. Despite the effective course of treatment, 46.7 % of female servicemen cured of tuberculosis were subject to dismissal from the Russian Armed Forces.

Diagnostic Uncertainty in Cervical Radiculopathy.

Cervical radiculopathy is defined as a pathological process affecting the cervical nerve root(s). While not an uncommon entity, this report describes a case of cervical radiculopathy in an active duty Marine with unique features to include the C5 nerve root as the primary point of injury with corresponding severe motor weakness that warranted expedited workup. This expedited workup included early referral to Neurology for nerve conduction and electromyography (EMG) studies that were ultimately diagnostic in the setting of equivocal Magnetic Resonance Imaging findings. This highlight of this case is the demonstration of the utility of EMG in cervical radiculopathy evaluation, which aided in an efficient and effective treatment course. We contend that in cases of cervical radiculopathy with a focal deficit of profound weakness with shoulder abduction and elbow flexion, obtaining nerve conduction studies and EMGs within the first 4 to 6 weeks of presentation should be viewed as essential for the long-term recovery and effective management of the injured service member, particularly when injury to the upper trunk of the brachial plexus can also account for these specific motor deficits. This report will cover a brief review of the pathophysiology, evaluation, and natural history of cervical radiculopathy with special attention paid to the timing and efficacy of EMG.

Adjunct treatment with ketamine enhances the therapeutic effects of extinction learning after chronic unpredictable stress

Post-traumatic stress disorder (PTSD) is a debilitating illness characterized by dysfunction in the medial prefrontal cortex (mPFC). Although both pharmacological and cognitive behavioral interventions have shown some promise at alleviating symptoms, high attrition and persistence of treatment-resistant symptoms pose significant challenges that remain unresolved. Specifically, prolonged exposure therapy, a gold standard intervention to treat PTSD, has high dropout rates resulting in many patients receiving less than a fully effective course of treatment. Administering pharmacological treatments together with behavioral psychotherapies like prolonged exposure may offer an important avenue for enhancing therapeutic efficacy sooner, thus reducing the duration of treatment and mitigating the impact of attrition. In this study, using extinction learning as a rat model of exposure therapy, we hypothesized that administering ketamine as an adjunct treatment together with extinction will enhance the efficacy of extinction in reversing stress-induced deficits in set shifting, a measure of cognitive flexibility. Results showed that combining a sub-effective dose of ketamine with a shortened, sub-effective extinction protocol fully reversed stress-induced cognitive set-shifting deficits in both male and female rats. These effects may be due to shared molecular mechanisms between extinction and ketamine, such as increased neuronal plasticity in common circuitry (e.g., hippocampus-mPFC), or increased BDNF signaling. This work suggests that fast-acting drugs, such as ketamine, can be effectively used in combination with behavioral interventions to reduce treatment duration and potentially mitigate the impact of attrition. Future work is needed to delineate other pharmacotherapies that may complement the effects of extinction via shared or independent mechanisms.

Clinical characteristics and antimicrobial susceptibility of Klebsiella pneumoniae, Klebsiella variicola and Klebsiella quasipneumoniae isolated from human urine in Japan

Introduction. The three Klebsiella species K. pneumoniae, K. variicola and K. quasipneumoniae are difficult to distinguish, owing to their similar biochemical properties, and are often confused in medical practice.Gap statement. There is a scarcity of data comparing the clinical characteristics and antimicrobial susceptibility of K. pneumoniae, K. variicola and K. quasipneumoniae. We believe that knowledge of the characteristics of each species will help in their better identification. Further, knowing the antimicrobial susceptibility of the species will help physicians in prescribing an effective treatment course for Klebsiella infections.Aim. This study aimed to determine the clinical characteristics and antimicrobial resistance of K. pneumoniae, K. variicola and K. quasipneumoniae isolated from human urine samples.Methodology. This study included 125 K. pneumoniae strains isolated from human urine samples. Multiplex polymerase chain reaction was performed to identify K. pneumoniae, K. variicola and K. quasipneumoniae. We retrospectively investigated the patient background, complications of bacteraemia, antimicrobial susceptibility and extended-spectrum β-lactamase (ESBL).Results. We identified 84 (67.2 %), 31 (24.8 %) and 10 strains (8 .0%) of K. pneumoniae, K. variicola and K. quasipneumoniae, respectively. There was no difference in patient background and frequency of bacteraemia complications among these species. K. pneumoniae was significantly less susceptible than K. variicola to ampicillin/sulbactam (P=0.03) and piperacillin (P<0.01). Furthermore, K. pneumoniae (79.8 %) was less susceptible to trimethoprim/sulfamethoxazole than K. variicola (96.8 %) and K. quasipneumoniae (100 %). There were nine ESBL-producing strains (7.2 %), all of which were K. pneumoniae.Conclusion. There was no difference in patient background and frequency of bacteraemia complications between K. pneumoniae, K. variicola and K. quasipneumoniae isolated from urine. The three Klebsiella species showed a varying extent of antimicrobial susceptibility and ESBL production, and accurate identification is needed to understand the epidemiology of these species.

The Predictive Value of Shock Index versus Modified Shock Index in Critically Ill COVID-19 Infected Patients

Background/Aim: Having reliable indicators and markers that would help in prognosticating the survival are invaluable and would consequently assist in the course of effective treatment. Our objectives in this study were to compare the ability of SI and mSI to predict the primary outcomes of overall 28-day mortality rate in SARS-CoV-2 infected hemodynamic unstable critically ill patients. Methods: This study was retrospectively conducted and both of confirmed and suspected affected critically ill COVID-19 patients were included in our study. Hemodynamics variables of SI and mSI were mathematically calculated after dividing HR over SBP and MAP. All tested variables and others were comparatively compared across the two studied affected COVID-19 patients; Survivors Cohort (Cohort I) and Non-Survivors Cohort (Cohort II) using One Sample and Independent-T Tests in addition to Chi Square Test for categorical retrievable data. ROC curves were constructed for SI and mSI, and the area under the ROC curves (AUROCs) were statistically compared using proposed Delong Method. The optimal operating cutoffs on each ROC curve for the two tested prognosticators were also investigated by picking the highest youden’s index. Results: The mean age of the whole study cohort was 51.88±16.22 years, and the Non-Survivors Cohort were significantly older than the Survivors Cohort. Significantly, males were distributed in the study in approximately 2.57: 1 ratio compared to female. There were statistically significant differences regarding serum albumin levels profile during the 1st admission week, among the 3 serial albumin day levels. The overall incidences of NOPST were assessed at 65.9% during an average of 14.08±4.06 days. The Non-Survivors Cohort had also significantly higher SI and mSI compared to Survivors Cohort [1.16±0.14 bpm/mmHg and 1.67±0.23 bpm/mmHg versus 0.92±0.04 bpm/mmHg and 1.30±0.07 bpm/mmHg; +0.24±0.01 bpm/mmHg and -0.37±0.01 bpm/mmHg, respectively, p-Value=0.001]. SI had a higher AUROC than mSI with Area±SEM (95% CI; Range) of 0.983±0.002 (95% CI; 0.978-0.987) versus 0.959±0.004 (95% CI; 0.950-0.967) and the best cut-off values for SI and mSI were 0.99 bpm/mmHg and 1.43 bpm/mmHg, respectively. Conclusion: In summary, our stated hemodynamic based mortality prognosticators may be an early effective, no-cost bedside, realistic, reliable triaging modalities with high sensitivity, specificity, performance. Also, SI may be used as an additional or readily available red flag bedside assessment tool for severe disease.

The Predictive Value of Shock Index versus Modified Shock Index in Critically Ill COVID-19 Infected Patients

Background/Aim: Having reliable indicators and markers that would help in prognosticating the survival are invaluable and would consequently assist in the course of effective treatment. Our objectives in this study were to compare the ability of SI and mSI to predict the primary outcomes of overall 28-day mortality rate in SARS-CoV-2 infected hemodynamic unstable critically ill patients. Methods: This study was retrospectively conducted and both of confirmed and suspected affected critically ill COVID-19 patients were included in our study. Hemodynamics variables of SI and mSI were mathematically calculated after dividing HR over SBP and MAP. All tested variables and others were comparatively compared across the two studied affected COVID-19 patients; Survivors Cohort (Cohort I) and Non-Survivors Cohort (Cohort II) using One Sample and Independent-T Tests in addition to Chi Square Test for categorical retrievable data. ROC curves were constructed for SI and mSI, and the area under the ROC curves (AUROCs) were statistically compared using proposed Delong Method. The optimal operating cutoffs on each ROC curve for the two tested prognosticators were also investigated by picking the highest youden’s index. Results: The mean age of the whole study cohort was 51.88±16.22 years, and the Non-Survivors Cohort were significantly older than the Survivors Cohort. Significantly, males were distributed in the study in approximately 2.57: 1 ratio compared to female. There were statistically significant differences regarding serum albumin levels profile during the 1st admission week, among the 3 serial albumin day levels. The overall incidences of NOPST were assessed at 65.9% during an average of 14.08±4.06 days. The Non-Survivors Cohort had also significantly higher SI and mSI compared to Survivors Cohort [1.16±0.14 bpm/mmHg and 1.67±0.23 bpm/mmHg versus 0.92±0.04 bpm/mmHg and 1.30±0.07 bpm/mmHg; +0.24±0.01 bpm/mmHg and -0.37±0.01 bpm/mmHg, respectively, p-Value=0.001]. SI had a higher AUROC than mSI with Area±SEM (95% CI; Range) of 0.983±0.002 (95% CI; 0.978-0.987) versus 0.959±0.004 (95% CI; 0.950-0.967) and the best cut-off values for SI and mSI were 0.99 bpm/mmHg and 1.43 bpm/mmHg, respectively. Conclusion: In summary, our stated hemodynamic based mortality prognosticators may be an early effective, no-cost bedside, realistic, reliable triaging modalities with high sensitivity, specificity, performance. Also, SI may be used as an additional or readily available red flag bedside assessment tool for severe disease.

Recent Progress in the Development of Novel Mycobacterium Cell Wall Inhibitor to Combat Drug-Resistant Tuberculosis.

Despite decades of research in drug development against TB, it is still the leading cause of death due to infectious diseases. The long treatment duration, patient noncompliance coupled with the ability of the tuberculosis bacilli to resist the current drugs increases multidrug-resistant tuberculosis that exacerbates the situation. Identification of novel drug targets is important for the advancement of drug development against Mycobacterium tuberculosis. The development of an effective treatment course that could help us eradicates TB. Hence, we require drugs that could eliminate the bacteria and shorten the treatment duration. This review briefly describes the available data on the peptidoglycan component structural characterization, identification of the metabolic pathway, and the key enzymes involved in the peptidoglycan synthesis, like N-Acetylglucosamine-1-phosphate uridyltransferase, mur enzyme, alanine racemase as well as their inhibition. Besides, this paper also provides studies on mycolic acid and arabinogalactan synthesis and the transport mechanisms that show considerable promise as new targets to develop a new product with their inhibiter.

Current Trends in Prostate Cancer Etiology, Pathogenesis and Diagnostics

Abstract Prostate cancer (PCa) remains the second most commonly diagnosed cancer in men, with an estimated 1.1 million diagnoses worldwide in 2012, accounting for 15% of all cancers diagnosed. In many cases, successful treatment of prostate cancer is difficult due to late detection and rate of metastasis. Importantly, the tumours of many patients with prostate cancer become refractory to androgen therapy and progress to metastatic castration-resistant disease. An effective treatment course of prostate cancer patients requires predictive biomarkers in metastatic castration-resistant prostate cancer that support individual treatment. Different risk classification tools have been developed to distinguish patients with early PCa according to the prognosis, including the D’Amico classification system, the Cancer of the Prostate Risk Assessment score, and the National Comprehensive Cancer Network risk groups classification. Unfortunately, there is still no single, universal, cheap, non-invasive, early prostate cancer diagnostic tool, as serum prostate specific antigen (PSA) has not approved expectations and is not implemented in standardised prostate cancer screening. The aim of this review was to provide current state of art knowledge of prostate cancer screening, diagnosis, staging and future perspectives and directions.

Nutritional Supplementation of Naturally Occurring Vitamin D to Improve Hemorrhagic Stroke Outcomes.

Vitamin D deficiency, if left untreated, is associated with bone disorders, cardiovascular damage, and an increased risk of ischemic stroke. While there are various nutritional options for the natural intake of vitamin D, we hope to elucidate the potential mechanisms dietary vitamin D may play in hemorrhagic stroke pathology. This scoping review outlines findings from studies relevant to the biochemical activity of vitamin D, the impact of vitamin D deficiency on hemorrhagic stroke outcomes, and the potential benefit of nutritional vitamin D on hemorrhagic stroke outcomes. Here, we analyze the relevant factors that can lead to vitamin D deficiency, and subsequently, a higher risk of hemorrhagic stroke incidence with worsened subsequent outcomes. The neuroprotective mechanisms through which vitamin D works to attenuate hemorrhagic stroke onset and post-stroke outcomes have not yet been thoroughly examined. However, researchers have proposed several potential protective mechanisms, including reduction of blood brain barrier disturbance by inhibiting the production of reactive oxygen species, mitigation of inflammation through a reduction of levels of proinflammatory cytokines, and prevention of cerebral vasospasm and delayed cerebral ischemia following subarachnoid hemorrhage and intracerebral hemorrhage. While more research is needed and there are limitations to vitamin D supplementation, vitamin D as a whole may play a significant role in the dynamics of hemorrhagic stroke. Further research should focus on expanding our understanding of the neuroprotective capacity and mechanisms of vitamin D, as well as how vitamin D supplementation could serve as an effective course of treatment of hemorrhagic strokes.

Computational Technique for Effectiveness of Treatments Used in Curing SARS-CoV-2

COVID-19 pandemic has unleashed an unprecedented humanitarian crisis in the world at present. With each passing day, the number of patients afflicted with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is rising at an alarming pace, so much so that some countries are now combating the second wave of the contagion. As the death ratio due to the Virus increases, the medical fraternity and pharmacologists are working relentlessly to identify and prescribe a standardized and effective course of treatment for treating COVID-19 patients. However, medical specialists are confused about opting for the most efficacious course of treatment because the patients infected with this virus have varied symptoms at different stages. In this league, our research study attempts to conduct an empirical analysis to identify which course of treatment is the most effective and preferred one for the treatment of SARS-CoV-2. The study proposes to achieve this objective by employing a scientific computation based symmetrical methodology. The present study has adopted a well-established and highly effective Multi Criteria Decision Making (MCDM) approach named Hesitant Fuzzy Linguistic Term Sets based Analytical Hierarchy Process-Technique for Order of Preference by Similarity to Ideal Solution (HFLTS-AHP-TOPSIS) Methodology. The computation based symmetrical methodology evaluates the various selected course of treatments identified through different research articles and guidelines suggested by different countries, and evaluates them on the basis of opinions suggested by medical experts (including doctors, industry experts, and others) and practitioners. Thus, the results drawn are highly corroborative and can be used as an authentic reference for future initiatives being undertaken in this domain. Our research investigation outlines a systematically assessed and scientifically validated ranking for various courses of treatments used in SARS-CoV-2 treatment and proposes to be an effective reckoner in the attempts to dispel the ambiguities surrounding the cure of SARS-CoV-2. Additionally, to authenticate the results of our analysis, we performed the sensitivity analysis (robustness analysis), marginal mean assessment and comparison analysis.

Factors influencing treatment efficacy in patients with multiple and extensive drug resistant tuberculosis

The objective: to determine factors influencing treatment efficacy in patients with multiple (MDR) and extensive (XDR) drug resistant tuberculosis. Subjects and methods. The medical files of 107 tuberculosis patients (men – 75, women – 32) were analyzed, 17 of them were HIV positive. Those 107 patients were registered for treatment as per chemotherapy (CT) regimens IV-V in 2017 in Kaluga Region. 99 (92.5%) patients suffered from tuberculosis with lung tissue destruction. 60.7% (65 patients) had MDR, while 20.8% (22 patients) had XDR. Only 58.2% of patients had MDR TB confirmed by polymerase chain reaction before treatment start.Results. In 24 months, the effective course of treatment was registered in 64/107 (59.8%). The highest level of effective treatment was expectedly registered among new cases – 21/30 (70%); and the lowest level was among patients starting chemotherapy again after treatment interruption – 4/10 (40%), p &gt; 0.05. Among 64 patients with effective treatment course, 25 (39.1%) had surgery and 39 (60.9%) had chemotherapy only. Surgical activity among the cohort of 2017 made 26/107 (24.3%). The effective treatment outcome was achieved in 8 (47%) out of 17 patients with TB/HIV co-infection, and among HIV negative patients it was reached in 56/90 (62.2%), p &gt; 0,05.