Effectiveness Of Various Therapies Research Articles

Efficacy and safety of adjuvant therapies in older patients with breast cancer: a systematic review and meta-analysis of real-world data.

Insufficient data available for older patients with breast cancer complicates decision-making regarding optimal treatment. A systematic review that uses real-world data is required for assessing the effectiveness and potential adverse effects of various therapies for this age group of patients. Databases of PubMed, Embase, and Cochrane Library were searched. We included clinical studies that evaluated various treatments for geriatric breast cancer, including adjuvant radiation therapy, hypofractionated radiation therapy (hypo-RT) and accelerated and partial breast irradiation (APBI), endocrine therapy, chemotherapy, and targeted therapy. A total of 71 studies were retrieved. Adjuvant radiation therapy significantly improved overall survival (OS) compared with no radiation [hazard ratio (HR) = 0.60, 95% confidence interval (CI) 0.54-0.67]. The pooled estimates of OS for hypo-RT and APBI demonstrated no inferiority compared with conventional radiation. Both endocrine treatment (HR = 0.63, 95% CI 0.43-0.92) and chemotherapy (HR = 0.76, 95% CI 0.65-0.88) significantly increased OS compared with no treatment. Trastuzumab monotherapy significantly enhanced OS compared with no trastuzumab use (HR = 0.23, 95% CI 0.07-0.73). Despite concerns about potential complications during treatment in older patients, proactive therapies significantly increase their survival rates. For patients who are frailer, hypo-RT and APBI offer survival rates comparable to traditional modalities. Additionally, targeted therapy as a monotherapy holds promise as a viable option for patients with HER2-positive breast cancer who cannot undergo chemotherapy. Therefore, by conducting thorough general assessments and clinical evaluations, the side effects of postoperative treatments can be effectively managed.

Managing Glycemic Control in Pregnancy: Comparing Antidiuretic Medications and Insulin Regimens"

Background: The disease known as gestational diabetes mellitus, or GDM, was first identified as a result of reduced glucose tolerance during pregnancy. Glycemic management must be maintained to prevent negative effects for both the mother and the foetus. We evaluate the efficacy of insulin and anti-diabetic regimens in the treatment of GDM in this research. Objectives: to assess the effectiveness of insulin regimens and anti-diabetic medications in controlling blood sugar levels during pregnancy in relation to the family objectives of the patient, such as a healthy baby, and to provide medical professionals with information on the best ways to treat gestational diabetes mellitus. Study design: A cross sectional study. Place and duration of study. Department of endocrinology hmc peshwar from 10-Feb 2022 to july Feb-2022 Methods:The study used a cross-sectional methodology. To locate relevant randomised controlled trials comparing different insulin regimens and antidiabetic drugs in pregnant women with gestational diabetes mellitus (GDM), a thorough search was carried out across major electronic databases. Included were studies that reported on glycemic control outcomes, such as HbA1c levels, fasting blood glucose levels, and the incidence of unfavourable outcomes for either the mother or the foetus. Both the quality evaluation and data extraction were carried out separately by two reviewers. To analyse the effectiveness of various therapies while taking both direct and indirect evidence into account, a network meta-analysis was carried out. Sensitivity analysis were carried out to evaluate how solid the results were. Based on variables such maternal health condition and gestational age, subgroup analyses were carried out. The objective of the synthesised data was to enhance the outcomes for women with gestational diabetes mellitus (GDM) by offering insights into the relative effectiveness of insulin regimens and antidiabetic drugs in glycemic management during pregnancy. Results:There were 100 participants in the research, with an average age of 28. The biggest impact on HbA1c levels was from insulin treatment (mean decrease = -1.5%), which was followed by oral hypoglycemic medications (mean reduction = -1.2%) and modifying one's lifestyle (mean reduction = -0.8%). The trends in fasting blood glucose levels were comparable. The results for mothers and foetuses, including birth weight and Apgar ratings, did not vary statistically across the treatment groups, suggesting that glycemic management is essential irrespective of the therapeutic approach. Conclusion: Our study emphasises the value of individualised methods to treating GDM, with a focus on the effectiveness of oral hypoglycemic medications, insulin therapy, and lifestyle changes in achieving glycemic control. Further investigation into the long-term impacts on maternal and foetal outcomes is necessary to enhance clinical practice. Keywords: gestational diabetes, glycemic control, antidiabetic medications, insulin therapy

Ex vivo study on the human blood neutrophil circadian features and effects of alpha1-antitrypsin and lipopolysaccharide

AimsNeutrophils perform various functions in a circadian-dependent manner; therefore, we investigated here whether the effect of alpha1-antitrypsin (AAT), used as augmentation therapy, is dependent on the neutrophil circadian clock. AAT is a vital regulator of neutrophil functions, and its qualitative and/or quantitative defects have significant implications for the development of respiratory diseases. MethodsWhole blood from 12 healthy women age years, mean (SD) 29.92 (5.48) was collected twice daily, 8 h apart, and incubated for 30 min at 37 °C alone or with additions of 2 mg/ml AAT (Respreeza) and/or 5 μg/ml lipopolysaccharide (LPS) from Escherichia coli. Neutrophils were then isolated to examine gene expression, migration and phagocytosis. ResultsThe expression of CD14, CD16, CXCR2 and SELL (encoding CD62L) genes was significantly higher while CDKN1A lower in the afternoon than in the morning neutrophils from untreated blood. Neutrophils isolated in the afternoon had higher migratory and phagocytic activity. Morning neutrophils isolated from AAT-pretreated blood showed higher expression of CXCR2 and SELL than those from untreated morning blood. Pretreatment of blood with AAT enhanced migratory properties of morning but not afternoon neutrophils. Of all genes analysed, only CXCL8 expression was strongly upregulated in morning and afternoon neutrophils isolated from LPS-pretreated blood, whereas CXCR2 expression was downregulated in afternoon neutrophils. The addition of AAT did not reverse the effects of LPS. SignificanceThe circadian clock of myeloid cells may affect the effectiveness of various therapies, including AAT therapy used to treat patients with AAT deficiency, and needs further investigation.

Use of Surface Electromyography to Evaluate Effects of Therapeutic Methods on Masticatory Muscle Activity in Patients with Temporomandibular Disorders: A Narrative Review

The presented narrative review aims to present the impact of therapeutic methods on the masticatory muscle activity measured using surface electromyography (sEMG) in patients with temporomandibular disorders (TMDs). Original interventional studies with baseline data for diagnosed TMD groups with full-text articles in English published in scientific journals in the last ten years were included in the evaluation process. The following narrative review considered only clinical, controlled, and randomized studies. Articles that included the following parameters were qualified for this review: adult participants, diagnosis of temporomandibular disorder, the presence of a musculoskeletal dysfunction, no other severe comorbidities, use of therapeutic interventions, and sEMG measurement before and after the intervention. Ten papers were accepted and analyzed for the final evaluation in the presented review. Several studies using surface electromyographic examination prove the effectiveness of various therapies to normalize the bioelectrical activity of the masticatory muscles, either reduction during rest or increase during a functional task in patients diagnosed with temporomandibular disorders. This narrative review shows the influence of manual and physical treatments on electromyographic masticatory muscle activity, including soft tissue mobilization, transcutaneous electrical nerve stimulation, low-level laser therapy, and moist heat therapy. Changes in masticatory muscle activity coincided with changes in TMD-associated pain and range of mandibular mobility.

Loneliness among University students as a growing concerne

This academic paper aims to discuss the issue of loneliness among university students and suggest strategies to combat it. Despite previous research exploring various aspects of loneliness, there has been a general neglect in examining the effectiveness of various therapies specifically for university students. The paper begins by defining loneliness, exploring its types and causes, and highlighting its effects on university students. It then offers suggestions for alleviating loneliness through various strategies. A secondary objective is to emphasize the importance of universities providing support by organizing various social activities to bring students together and to encourage further research into effective methods of combating loneliness. The paper will review existing research to identify the causes of loneliness among university students, assess its impact on their lives, and suggest potential strategies to address it.

Personalized lifetime prediction of survival and treatment benefit in patients with heart failure with reduced ejection fraction: The LIFE-HF model.

Although trials have proven the group-level effectiveness of various therapies for heart failure with reduced ejection fraction (HFrEF), important differences in absolute effectiveness exist between individuals. We developed and validated the LIFEtime-perspective for Heart Failure (LIFE-HF) model for the prediction of individual (lifetime) risk and treatment benefit in patients with HFrEF. Cox proportional hazards functions with age as the time scale were developed in the PARADIGM-HF and ATMOSPHERE trials (n = 15 415). Outcomes were cardiovascular death, heart failure (HF) hospitalization or cardiovascular death, and non-cardiovascular mortality. Predictors were age, sex, New York Heart Association class, prior HF hospitalization, diabetes mellitus, extracardiac vascular disease, systolic blood pressure, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and glomerular filtration rate. The functions were combined in life-tables to predict individual overall and HF hospitalization-free survival. External validation was performed in the SwedeHF registry, ASIAN-HF registry, and DAPA-HF trial (n = 51 286). Calibration of 2- to 10-year risk was adequate, and c-statistics were 0.65-0.74. An interactive tool was developed combining the model with hazard ratios from trials to allow estimation of an individual's (lifetime) risk and treatment benefit in clinical practice. Applying the tool to the development cohort, combined treatment with a mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor, and angiotensin receptor-neprilysin inhibitor was estimated to afford a median of 2.5 (interquartile range [IQR] 1.7-3.7) and 3.7 (IQR 2.4-5.5) additional years of overall and HF hospitalization-free survival, respectively. The LIFE-HF model enables estimation of lifelong overall and HF hospitalization-free survival, and (lifetime) treatment benefit for individual patients with HFrEF. It could serve as a tool to improve the management of HFrEF by facilitating personalized medicine and shared decision-making.

A network meta-analysis of 12,116 individuals from randomized controlled trials in the treatment of depression after acute coronary syndrome.

Post-acute coronary syndrome (ACS) depression is a common but not well understood complication experienced by ACS patients. Research on the effectiveness of various therapies remains limited. Hence, we sought to conduct a network meta-analysis to assess the efficacy of different interventions for post-ACS depression in improving patient outcomes. Three electronic databases were searched for randomised controlled trials describing different depression treatment modalities in post-ACS patients. Each article was screened based on inclusion criteria and relevant data were extracted. A bivariate analysis and a network meta-analysis was performed using risk ratios (RR) and standardized mean differences (SMD) for binary and continuous outcomes, respectively. A total of 30 articles were included in our analysis. Compared to standard care, psychosocial therapy was associated with the greatest reduction in depression scores (SMD:-1.21, 95% CI: -1.81 to -0.61, p<0.001), followed by cognitive behavioural therapy (CBT) (SMD: -0.75, 95% CI: -0.99 to -0.52, p<0.001), antidepressants (SMD: -0.73, 95% CI: -1.14 to -0.31, p<0.001), and lastly, combination therapy (SMD: -0.15, 95% CI: -0.28 to -0.03, p = 0.016). No treatment modalities was found to be more effective in reducing depression scores when compared to one another. Additional analysis showed that these treatment modalities did not have significant impact on the overall mortality, cardiac mortality and recurrent myocardial infarction. This network meta-analysis found that the treatment effect of the various psychological modalities on depression severity were similar. Future trials on psychological interventions assessing clinical outcomes and improvement in adherence to ACS-specific interventions are needed.

How do we help people regain control over their lives? An introduction to method of levels therapy

There are many different approaches to psychotherapy. Research indicates comparable effectiveness of various therapies, despite having different theoretical assumptions and using different therapeutic methods. In recent years, many researchers have attempted to understand such results by investigating specific and common factors in psychotherapy. It has been suggested that further developments in the field should aim to investigate factors underlying mental health problems and the principles informing the process of change in psychotherapy. In the current article, we will present perceptual control theory as a scientifically grounded approach that integrates theory and practice. Transdiagnostic principles explain the sources of emotional distress and the process of psychological change in psychotherapy. The main aim of the article is to introduce method of levels therapy, which has been created as a direct application of perceptual control theory principles. Description of the process of therapy is accompanied by clinical examples.

ROLE OF ANTIOXIDANT THERAPY IN PREVENTION OF LIPOPEROXIDATION AND PROCOAGULANT ACTIVITY OF PLATELETS IN SARS-COV-2 VIRAL INFECTIONS

Based on a metanalysis of clinical observations in different countries with practical experience in the treatment of pneumonia complicated by the syndrome of multiple organ failure caused by the COVID-19 coronavirus, it is impossible to draw an unambiguous conclusion about the effectiveness of various therapies in patients. viruses modify the apparatus of biosynthesis of cells in the body as a whole. Therefore, finding drugs that have an exceptional effect on viruses without infecting the body is a difficult task. Various antiviral drugs (ribaverin, interferons and glucocorticosteroids, antiparasitic, antimalarials (Chloroquine, Hydroxychloroquine) are effective at certain stages of the infectious process, however, they are toxic and therapy with these drugs has risks of developing severe cytopenia, hepatotoxicity, neuropsychiatric disorders and severe ischemia Interleukin antagonists (Tocilizumab, Anakindra, Levilimab) are effective in severe cases with an increase in IL-6, as they limit the cascade of activation of cells of the immune system, reduce the effect of "cytokine storm" in the formation of acute respiratory distress syndrome and endothelial dysfunction of the pulmonary vessels.&#x0D; Discussion. In an experimental study R.G. Alborov, in the framework of the dissertation for the degree of candidate of medical sciences (2001), in which nonlinear white rats were used, it was demonstrated that: activators of lipid peroxidation (LPO), different in nature and biological activity, inhibition of the transformation of arachidonic acid in platelets reduces, along with proaggregant activity, the intensity of LPO processes in them. Based on the experimental data obtained, it can be considered appropriate to study the effect of antioxidants as agents that enhance the effects of antiplatelet inhibitors of the transformation of arachidonate and platelets. It can be expected that antioxidants, by reducing the procoagulant activity of platelets, due to inhibition of LPO, can enhance the effect of antiplatelet agents.&#x0D; Findings. 1. The effectiveness of antioxidant therapy for infection with SAPS-COV-2 viruses, including COVID-19, is beyond doubt. It is important that antioxidant therapy was prescribed before the development of lipid peroxidation and "cytokine storm" and an increase in the procoagulant activity of platelets, that is, at the initial stage of infection.&#x0D; &#x0D; Antioxidant therapy presupposes adequate dosages according to the type of "saturating phase of treatment" with subsequent transfer to maintenance doses.&#x0D; &#x0D; Currently, no drugs have been found that have an exceptional effect on viruses without affecting the body. Antioxidants are protective at the cellular level. In addition, they practically do not cause side effects. It is advisable to prescribe antioxidant drugs in large doses in the complex therapy of viral infections.

Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management.

Super-refractory status epilepticus (SRSE) is a life-threatening neurological emergency with high morbidity and mortality. It is defined as “status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthesia, including those cases in which SE recurs on the reduction or withdrawal of anesthesia.” This condition is resistant to normal protocols used in the treatment of status epilepticus and exposes patients to increased risks of neuronal death, neuronal injury, and disruption of neuronal networks if not treated in a timely manner. It is mainly seen in patients with severe acute onset brain injury or presentation of new-onset refractory status epilepticus (NORSE). The mortality, neurological deficits, and functional impairments are significant depending on the duration of status epilepticus and the resultant brain damage. Research is underway to find the cure for this devastating neurological condition. In this review, we will discuss the wide range of therapies used in the management of SRSE, provide suggestions regarding its treatment, and comment on future directions. The therapies evaluated include traditional and alternative anesthetic agents with antiepileptic agents. The other emerging therapies include hypothermia, steroids, immunosuppressive agents, electrical and magnetic stimulation therapies, emergent respective epilepsy surgery, the ketogenic diet, pyridoxine infusion, cerebrospinal fluid drainage, and magnesium infusion. To date, there is a lack of robust published data regarding the safety and effectiveness of various therapies, and there continues to be a need for large randomized multicenter trials comparing newer therapies to treat this refractory condition.

Do Polish Nurses Have a Problem with Sleepiness during the Epidemiological Threat of the SARS-CoV-2 Virus?

Nurses may experience cumulative sleep deprivation in the current epidemiological situation, which is the COVID-19 disease. Lack of rest leads to decreased concentration. The research topic is important for improving patient safety in hospitals. Assessment and analysis of the level of sleepiness of nurses after 3 consecutive night shifts and its impact on functioning in social life. The study adopted the diagnostic survey method, which was conducted using a survey technique. The questionnaire consisted of 3 parts: personal particulars, the survey and the Karolinska Sleepiness Scale (KSS) version A. After the research, 164 correctly completed questionnaires were obtained. The level of somnolence in individual measurements after a night shift significantly increased among the nurses examined (P < .0001). Respondents who felt a higher level of drowsiness after a night shift thought that their work definitely influenced contact with their friends or family and had difficulty in performing household duties. There is no statistically significant relationship between the level of sleepiness and sociodemographic factors. After each night shift, the level of drowsiness in nurses increases. This may result in reduced alertness and attention levels on subsequent working days. Shift work has negative consequences in the form of depleted personal life. Further research into the effects of insufficient sleep among nurses should be conducted. This may be necessary for patient safety in healthcare centers. The awareness on the subject of healthy sleep among shift nurses should be raised. It is advisable to conduct research in order to assess the effectiveness of various therapies in dealing with sleep disorders among shift nurses. The interventions taken should be adapted to the current epidemiological situation, which is the COVID-19 disease.

Current treatment options for genitourinary syndrome

At the onset of menopause, the urogenital symptoms begin to develop simultaneously with vasomotor symptoms: vaginal soreness, itching and dryness, dyspareunia, etc. The development of atrophic changes in the urogenital tract greatly reduces the quality of life and is a risk factor for the development of recurrent urinary tract infections. More than 60% of postmenopausal women, who do not take systemic menopausal hormone therapy (MHT), suffer from vaginal atrophy experience symptoms. The article discusses and evaluates effectiveness of various therapies for genitourinary syndrome of menopause (GSM). Nonhormonal lubricating gels are recommended as the first-line therapy. Local intravaginal administration of estrogens is used in moderate to severe vulvovaginal atrophy and in the absence of contraindications. Women with estrogen-dependent cancers can use low doses of local estrogen against the background of Tamoxifen therapy. New promising therapies for GSM are presented: ospemifene, an oral active selective estrogen receptor modulator (SERM), laser therapy, dehydroepiandrosterone. Even though the urogenital atrophy is a common disease, administration frequency of local estrogens as therapy is low. Basic principles for treatment of urogenital atrophy include alleviation of symptoms and restoration of normal blood supply to the vaginal epithelium and urothelium wall and mucous membrane. The therapy should be initiated early and the response time to therapy will depend on the degree of baseline atrophy. Vaginal moisturizers and lubricants can be used in combination with or separately from natural estrogens in cases when patients have medical contraindications to estrogen treatment.

Gamification in rehabilitation of metacarpal fracture using cost-effective end-user device: A randomized controlled trial

Study DesignThis is a two-group randomized controlled trial. IntroductionFinger stiffness after treatment for metacarpal fractures often occurs due to poor compliance to the conventional rehabilitation programs. Gamification has shown success in improving adherence to and effectiveness of various therapies. Purpose of the StudyThe purpose of this study was to evaluate whether gamification, using cost-effective devices was comparable with conventional physiotherapy in improving hand functions and adherence to rehabilitation in metacarpal fractures. MethodsA 2-group randomized controlled trial involving 19 patients was conducted. Participants were randomized to a control (conventional physiotherapy, n = 10) or interventional group (gamification, n = 9). The grips strength and composite finger range of motion were measured at the baseline and each follow-up together with Patient-Rated Wrist and Hand Evaluation scores and compliance. ResultsThere were no significant differences on improvements of grip strength (means difference 24.38 vs 20.44, P = .289) and composite finger range of motion (means difference 50.50 vs 51.11, P = .886). However, the gamification group showed better results in Patient-Rated Wrist and Hand Evaluation (mean 0.44 vs 8.45, P = .038) and compliance (P < .05). No adverse events were reported. DiscussionOur results suggest that gamification using a cost-effective device demonstrated similar effectiveness as conventional physiotherapy in post–metacarpal fracture rehabilitation. ConclusionsGamification using a mobile device is an inexpensive and safe alternative to conventional physiotherapy for hand rehabilitation after metacarpal fractures. It effectively serves as a guide for future development of cost-effective technology–enhanced therapy.

Comparative effectiveness of extracorporeal shock wave, ultrasound, low-level laser therapy, noninvasive interactive neurostimulation, and pulsed radiofrequency treatment for treating plantar fasciitis: A systematic review and network meta-analysis.

Plantar fasciitis is one of the most common causes of adult heel pain. The aim of this study is to comprehensively compare the effectiveness of various therapies for plantar fasciitis using network meta-analysis. Studies were comprehensively searched on Embase, MEDLINE via PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) up to December 4, 2017. Randomized controlled trials that used extracorporeal shock wave therapy, ultrasound, ultrasound-guided pulsed radiofrequency treatment (UG-PRF), intracorporeal pneumatic shock therapy (IPST), low-level laser therapy (LLLT), and noninvasive interactive neurostimulation (NIN) for the treatment of plantar fasciitis were included. The primary outcome is change in pain relief. Risk of bias was assessed using the Cochrane risk of bias tool. Quality assessment was performed using the GRADE system. Nineteen trials with 1676 patients with plantar fasciitis plantar fasciitis were included. In the pair-wise meta-analysis, radial extracorporeal shock wave therapy (RSW), LLLT, and IPST showed a significant pooled reduction in the visual analogue scale (VAS) compared with placebo at 0 to 6 weeks [mean difference (MD) = 6.60, 95% confidence interval (CI): (6.04, -7.16); MD = 2.34, 95% CI: (1.60, 3.08); MD = 2.24, 95% CI: (1.44, 3.04), respectively]. Compared with placebo, UG-PRF [MD = 2.31, 95% CI: (1.26, 3.36)] and high-intensity focused extracorporeal shock wave (H-FSW) [MD = 0.82, 95% CI: (0.20, 1.45)] showed superior pain-relieving effects at 2 to 4 months; UG-PRF [MD = 1.11, 95% CI: (0.07, 2.15)] and IPST [MD = 4.92, 95% CI: (4.11, 5.73)] showed superior effects at 6 to 12 months. In the network meta-analysis, only RSW induced significant pain reduction compared with placebo at 0 to 6 weeks [MD = 3.67, 95% CI: (0.31, 6.9)]. No significant differences were found for the 2 to 4-month and 6 to 12-month periods because of the wide 95% CIs. We recommend treating plantar fasciitis with RSW. The commonly used ultrasound and focused extracorporeal shock wave (FSW) therapies can be considered as alternative treatment candidates. IPST, NIN, and LLLT may potentially be better alternatives, although their superiority should be confirmed by additional comprehensive evidence.PROSPERO registration number: PROSPERO (CRD42015017353).

Treatment of Ciprofloxacin-resistant Ear Infections.

Ciprofloxacin resistance has been reported in 4.5% of patients with otorrhea and is increasing in prevalence. Due to ototoxicity, only fluoroquinolones are Food and Drug Administration approved for topical therapy in the middle ear. Furthermore, there is an assumption that antibiotic resistance is less relevant to topical therapy due to in vivo concentrations much higher than the minimum inhibitory concentration used to determine resistance. This study investigates ciprofloxacin-resistant infections and seeks to develop a better understanding of treatment options and outcomes. Retrospective review of 141 ciprofloxacin-resistant otologic infections. Tertiary-care hospital. Patients with culture-proven ciprofloxacin-resistant infections from 2008 to 2017. Antibiotic treatment with ciprofloxacin topical drops, ciprofloxacin plus oral antibiotics, and nonciprofloxacin therapy. Bacteriology for ciprofloxacin-resistant infections and treatment effectiveness of various therapies. Methicillin-resistant Staphylococcus aureus (33%), Corynebacterium striatum (19%), and non-Methicillin-resistant Staphylococcus aureus (11%) are the most frequent causes of ciprofloxacin-resistant infections. Topical ciprofloxacin monotherapy was successful in 2.7% of infections compared with a 64.7% success rate with the addition of an oral antibiotic (p < 0.001). Nonciprofloxacin drops are more effective with a 70% cure rate compared with the 2.7% of the ciprofloxacin drops p < 0.001. There was no difference in treatment efficacy when comparing nonciprofloxacin topical therapy (70% cure) to nonciprofloxacin topical therapy plus oral antibiotic (83% cure, p = 0.17). Using ciprofloxacin drops to treat ciprofloxacin-resistant bacteria is ineffective and patients do significantly better with alternative therapy. This finding supports the conclusion that high concentrations achieved in topical applications are not sufficient to overcome antibiotic resistance.

Therapeutic Approaches to Atrophic Vaginitis in Postmenopausal Women: A Systematic Review with a Network Meta-analysis of Randomized Controlled Trials.

ObjectivesAtrophic vaginitis (AV), which is common in postmenopausal women, is characterized by vaginal dryness, dyspareunia, and discomfort. There are a variety of therapeutic agents for the treatment of AV, besides hormone replacement therapy. We performed this systematic review to compare the effectiveness of various therapies for symptom improvement in AV patients.MethodsWe searched the Cochrane Library, EMBASE, MEDLINE, and other literature (Google Scholar, Web of Science, and hand search) for studies published between January 2010 and March 2015. AV was evaluated by the following outcomes: vaginal pH, dyspareunia, vaginal dryness, or cytological change (endometrial thickness, percentages of superficial cells and parabasal cells). They measured treatment efficacy with various outcomes pertaining to AV symptoms.ResultsMeta-analysis suggested that ospemifene was effective against dyspareunia, vaginal dryness, endometrial thickness, and percentage changes in superficial and parabasal cells. Vaginal pH was most affected by soy isoflavone vaginal gel. Ospemifene was effective for AV symptoms.ConclusionsThis systematic review compared the effects of several therapeutic agents on symptoms of AV through a network meta-analysis. This study provides objective evidence for clinical treatment and efficacy management in AV.

REVIEW OF APPROACHES TO IMMUNOTHERAPY IN ONCOLOGY

The article discusses modern ideas about the immune therapy of cancer — methods of treatment of oncological diseases based on immunological reactions of the organism to the appearance of malignant cells in it. This area is actively studied in clinical practice in the last decade, and some therapy has already been approved for use by regulators after promising results of clinical trials 3 phase.Immune therapy is based on antitumor immune cycle — the cascade of processes responsible for the immune system’s response to tumor cells. Involved regulatory mechanisms are targets for various therapies, the overall goal is to restore proper functioning of the cycle and to achieve the elimination of cancer cells.Currently, the most studied two types of immune therapy — checkpoint inhibitors and adaptive cell therapy. Checkpoint inhibitors increase the activity of body immune cells, reducing the inhibitory influence of the tumor microenvironment and the tumor cells themselves, which allowed them to get out from under the pressure of the immune system during the development of the disease. Adaptive cell therapy, in turn, allows to compensate the lack of active immune against tumor cells.Mechanisms of action determine the effectiveness of various therapies for different diseases, and for patients inside of one diagnosis. To determine the effectiveness of other treatment prior to a particular patient it is necessary to use the latest achievements in precision medicine, based on the search for new biomarkers and analyzing each patient separately. This approach will significantly reduce costs and save precious time for the patient.

Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study

BackgroundPyogenic spondylodiscitis is a form of spinal infection that can result in severe back pain and even death. However, information is lacking on the relative effectiveness of various therapies. A retrospective chart review was conducted to investigate whether early surgical treatment of pyogenic spondylodiscitis coupled with intravenous antibiotics results in better patient prognoses than intravenous antibiotics therapy alone.MethodsAll patients treated for pyogenic spondylodiscitis at a single medical center from July 2006 to July 2011 were retrospectively reviewed. The inclusion criteria consisted of diagnosis of an early stage infection without neurological deficit, and patients without severe sepsis who were suitable candidates for early surgery as determined by a Pittsburgh bacteremia score < 4, and patients with delayed diagnosis and lost to outpatient follow-up were excluded. Clinical outcomes included patient demographic data, kyphosis angle, length of treatment, Oswestry Disability Index and visual analogue pain scale were analyzed.ResultsOf 90 enrolled patients, Group 1 (n = 47) received only antibiotic therapy and Group 2 (n = 43) received early surgery with post-surgery antibiotics for 2 to 4 weeks. Group 2 exhibited significantly better results than Group 1 for mean antibiotic administration period, mean hospitalization period, kyphotic angle correction. Of 61 patients who participated in telephone follow-up after discharge, Group 2 (n = 26) had significant lower mean ODI score, and mean back pain score than Group 1 (n = 35).ConclusionsWhile infection control was similar for both groups, patients treated with early surgery and antibiotics were hospitalized for fewer days and required less antibiotics than those treated with antibiotics alone, also having better functional outcomes. In short, early surgical treatment of pyogenic spondylodiscitis typically achieves a better prognosis, shorter hospitalization period, and subsequent significant improvement in kyphotic deformity and quality of life.

Smartphone-Based Geofencing to Ascertain Hospitalizations.

Ascertainment of hospitalizations is critical to assess quality of care and the effectiveness and adverse effects of various therapies. Smartphones, mobile geolocators that are ubiquitous, have not been leveraged to ascertain hospitalizations. Therefore, we evaluated the use of smartphone-based geofencing to track hospitalizations. Participants aged ≥18 years installed a mobile application programmed to geofence all hospitals using global positioning systems and cell phone tower triangulation and to trigger a smartphone-based questionnaire when located in a hospital for ≥4 hours. An in-person study included consecutive consenting patients scheduled for electrophysiology and cardiac catheterization procedures. A remote arm invited Health eHeart Study participants who consented and engaged with the study via the internet only. The accuracy of application-detected hospitalizations was confirmed by medical record review as the reference standard. Of 22 eligible in-person patients, 17 hospitalizations were detected (sensitivity 77%; 95% confidence interval, 55%-92%). The length of stay according to the application was positively correlated with the length of stay ascertained via the electronic medical record (r=0.53; P=0.03). In the remote arm, the application was downloaded by 3443 participants residing in all 50 US states; 243 hospital visits at 119 different hospitals were detected through the application. The positive predictive value for an application-reported hospitalization was 65% (95% confidence interval, 57%-72%). Mobile application-based ascertainment of hospitalizations can be achieved with modest accuracy. This first proof of concept may ultimately be applicable to geofencing other types of prespecified locations to facilitate healthcare research and patient care.

Synthesis of oxidant prone nanosilver to develop H2O2 responsive drug delivery system.

Our immune system uses toxicity of hydrogen peroxide to kill off bacterial invaders. In this contribution, we intended to integrate ROS producing capability of immune system with oxidant-sensitive nature of antibacterial silver nanoparticles (Ag NPs) to develop an oxidant drug delivery system. Prior to execute this strategy, we have developed an efficient one-pot synthetic protocol to produce ultrasmall (5 nm), water-stable, and oxidant-prone Ag NPs. Notably, the yield of as-synthesized Ag NPs is 10-fold higher than standard citrate reduction route. The resulting therapeutically active and well-dispersed Ag NPs are used as nanolids to cap the drug loaded nanochannels of porous silica. Upon exposing to H2O2, dissolution-accompanied aggregation of Ag nanolids unleashes the encapsulated therapeutic entities from channels of nanocarrier. Combination of antibacterial and anti-inflammatory drugs in single nanocarriers can potentially augment the effectiveness of various therapies.