First Month Of Treatment Research Articles

Impact of Fixed Orthodontic Appliances on Blood Count and High-Sensitivity C-Reactive Protein Levels

ABSTRACT Background: Fixed orthodontic appliances are widely used in dental practice to correct malocclusions and improving oral health. However, their impact on systemic inflammation and hematological parameters remains under-explored. Materials and Methods: A cohort of 60 patients, aged 12 –30 years, undergoing fixed orthodontic treatment, were enrolled in the study. Blood samples were collected at baseline, 1 month, and 6 months post-appliance placement. Hematological parameters, including white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin levels, and hs-CRP levels, were measured using standard laboratory techniques. A statistical analysis was performed to determine significant changes over time. Results: At 1-month post-appliance placement, a significant increase in WBC count (mean increase of 12%) and hs-CRP levels (mean increase of 18%) was observed compared to baseline (P < 0.05). RBC count and hemoglobin levels remained relatively unchanged. By 6 months, WBC count and hs-CRP levels showed a decreasing trend, approaching baseline values, though hs-CRP levels remained slightly elevated (mean increase of 5% from baseline, P > 0.05). Conclusion: The use of fixed orthodontic appliances induces a transient inflammatory response, as evidenced by elevated WBC count and hs-CRP levels within the first month of treatment.

Comparison between Liquid and Tablet Formulations in the Treatment of Congenital Hypothyroidism up to 3 Years of Age: The First Italian Study.

Background/Objectives: Levothyroxine (L-T4) is available for use in congenital hypothyroidism (CH) in three formulations: tablets, drops, and oral solution. This study aims to compare the efficacy and safety of all three L-T4 formulations. Methods: We enrolled 63 children born between January 2019 and April 2023 in the Emilia-Romagna Region (Italy) and diagnosed with CH by newborn screening. They were divided according to the L-T4 formulation used: drops (Group D), oral solution (Group S), and tablets (Group T). Clinical and laboratory data were collected up to 3 years after the start of replacement therapy. Results: Serum-free thyroxine (sFT4) and thyroid stimulating hormone (sTSH) normalization occurred within the first month of treatment in most patients of all groups. No negative effects on growth and cognitive development were observed. At 7-15 days we found higher median sTSH levels (p = 0.031) and a greater percentage of patients with sTSH > 5 µU/mL (p = 0.011) in Group S than in Group T, but comparable sFT4 levels. At 12 months, a greater percentage of patients of Group D showed sFT4 values below the normal range than Group S (p = 0.011) and Group T (p = 0.038); Conclusions: Overall, our study reported an equal efficacy of the L-T4 oral solution compared to drops and tablets in CH treatment. A larger series of patients and a long-term follow-up are needed.

Experiences of Muslim patients living with peritoneal dialysis: A qualitative study in Southern Thailand.

Living with peritoneal dialysis affects the patient's life. The experiences of peritoneal dialysis patients, especially Muslim patients, are incomprehensible. There is a need to explore this area further to foster nursing practice improvement through enhanced understanding. The purpose of this study was to understand the experiences of Muslim patients who are undergoing peritoneal dialysis. A qualitative descriptive design was employed to gain a deeper understanding of the experiences of Muslim patients undergoing peritoneal dialysis in a peritoneal dialysis unit in Southern Thailand. Participants were initially recruited through purposive sampling and then selected based on the inclusion criteria. Data saturation was reached from October 2019 to January 2020. Ten Muslim patients who had been receiving peritoneal dialysis for a minimum of one month participated in personalized, in-depth, face-to-face interviews, which were supplemented by field notes. Inductive content analysis was performed using open coding, categories, and abstractions. The experiences of Muslim patients undergoing peritoneal dialysis were grouped into two main categories: 1) Overwhelmed by change and 2) Learned to survive. Peritoneal dialysis has a significant impact on Muslim patients, especially during the first months of treatment. Recognizing religious teachings and strengthening religious commitment through participation in religious practices are central to living on peritoneal dialysis. The findings offer a more profound insight into the experiences of Muslim patients receiving peritoneal dialysis. These results can be foundational knowledge for establishing and improving culturally appropriate nursing practices for Muslim patients.

Prognostic role of albumin-bilirubin (ALBI) score and Child-Pugh classification in patients with advanced hepatocellular carcinoma under systemic treatment.

Hepatocellular carcinoma (HCC) is a lethal malignancy associated with cirrhosis and liver dysfunction. The aim of this study is to characterize a cohort of patients with advanced HCC according to liver function-related variables and evaluate the prognostic significance of Child-Pugh (CP) and albumin-bilirubin (ALBI) scores. A database of 406 HCC patients treated between 2009 and 2023 was retrospectively evaluated. Clinical and laboratory parameters were collected to classify patients into ALBI and CP scores. Survival was estimated using the Kaplan-Meier method and multivariate models were used to evaluate prognosis prediction. In this cohort, 337 (83%) patients were classified as CP-A, while 69 (17%) as CP-B. Additionally, according to ALBI score, 159 (39.2%) individuals were categorised as ALBI-1, 233 (57.4%) as ALBI-2 and 14 (3.4%) as ALBI-3. A statistically significant association between both classifications was observed (p < 0.001). CP and ALBI scores were independently associated with prognosis (Hazard ratio = 2.93 and 1.66, respectively), with better survival for patients with CP-A (versus B) and ALBI-1 (versus -2 and -3). ALBI score showed better predictive performance versus CP (c Harrell´s C index = 0.65 versus 0.62; p = 0.008) and ALBI evolution during the first month of treatment was associated with overall survival. Additionally, ALBI score was able to define distinct prognostic subgroups within CP-A patients. In conclusion, liver function scores, such as ALBI and CP, have a clinically relevant prognostic role in patients with advanced HCC under systemic treatment. ALBI score is a more granular scoring scale than CP, and enables a more precise evaluation of patients with CP-A.

Ocular Involvement in Patients with Brucellosis: A Single-Center Prospective Study

ABSTRACT Purpose The aim of this study was to evaluate the prevalence, type and treatment outcomes of ocular involvement in patients with brucellosis. Methods This prospective, single-center study enrolled patients admitted to the infectious disease outpatient clinic with diagnosed brucellosis between July 15, 2022 and July 15, 2023. Diagnosis was based on clinical symptoms and a standard Brucella tube agglutination test (≥1/160) or a positive blood culture. Ophthalmologic examinations were performed at baseline and in the first month of treatment. Third and sixth month follow-up examinations were also performed for patients with ocular findings. Results Ocular involvement occurred in 60 (24.8%) of 242 patients. Conjunctivitis was the most common ocular involvement and was observed in 39 patients (16.1%). Uveitis was the second most common ocular involvement in 14 patients (5.8%). Scleritis was the least common ocular involvement and was observed in only one patient. Patients with ocular involvement were older (p = 0.027) and had higher rates of weight loss and spondylodiscitis (p = 0.044 and 0.001, respectively). Among laboratory parameters, erythrocyte sedimentation rate and lactate dehydrogenase levels were significantly higher in patients with ocular involvement (p = 0.001 and 0.036, respectively). There were no significant differences in other demographic, clinical, and laboratory characteristics between patients with and without ocular involvement. In 56 (93.3%) patients, the ocular findings improved during the follow-up examination. Conclusion Brucellosis, a systemic infection, can manifest with ocular involvement. Early detection and treatment through ophthalmological examination are crucial in managing brucellosis.

Thyroid hormone levels in children with Prader-Willi syndrome: a randomized controlled growth hormone trial and 10-year growth hormone study.

Several endocrine abnormalities were reported in children with Prader-Willi syndrome (PWS), including hypothyroidism. Growth hormone (GH) treatment may impact the thyroid hormone axis by direct inhibition of T4 or TSH secretion or by increased peripheral conversion of free T4 (FT4) to T3. The objective of this study is to evaluate thyroid function during GH treatment in a large group of children with PWS. Serum FT4, T3, and TSH are measured in a 2-year randomized controlled GH trial (RCT) and 10-year longitudinal GH study (GH treatment with 1.0 mg/m²/day [∼0.035 mg/kg/day]). Forty-nine children with PWS were included in the 2-year RCT (median [interquartile range, IQR] age: GH group 7.44 [5.47-11.80] years, control group 6.04 [4.56-7.39] years). During the first 6 months, median (IQR) FT4 standard deviation score (SDS) decreased in the GH group from -0.84 (-1.07 to -0.62) to -1.32 (-1.57 to -1.08) (P < .001) and T3 SDS increased from 0.31 (-0.01-0.63) to 0.56 (0.32-0.79) (P = .08), while in the control group, FT4 and T3 SDS remained unchanged. In our 10-year GH study, 240 children with PWS (median [IQR] age: 1.27 (0.54-4.17) years] were included. Between 2 and 10 years, median (IQR) FT4 SDS remained unchanged, being -0.87 (-0.98 to -0.77) after 2 years and -0.88 (-1.03 to -0.74) after 10 years (P = .13). TSH SDS decreased from -0.35 (-0.50 to -0.21) after 2 years to -0.68 (-0.84 to -0.53) after 10 years (P < .001). Our findings suggest that GH treatment decreases FT4 levels, due to increased peripheral conversion of FT4 to T3 in the first months of treatment, but thereafter, FT4 and T3 normalize and remain stable during long-term GH treatment in almost all children and adolescents with PWS.

Comparative Effects of Gymnema sylvestre and Berberine on Adipokines, Body Composition, and Metabolic Parameters in Obese Patients: A Randomized Study.

We performed a comparative study in 50 adult Mexican patients with obesity treated with GS or BBR for 3 months. The baseline and final biochemical parameters, body composition, blood pressure, gene expression of Res, Ome, Vis, and Ap, and safety parameters were evaluated. BBR significantly decreased (p < 0.05) body weight, blood pressure and Vis and Ap gene expression and increased Ome, while GS decreased fasting glucose and Res gene expression (p < 0.05). A comparative analysis of the final measurements revealed a lower gene expression of Ap and Vis (p < 0.05) in patients treated with BBR than in those treated with GS. The most frequent adverse effects in both groups were gastrointestinal symptoms, which attenuated during the first month of treatment. In patients with obesity, BBR has a better effect on body composition, blood pressure, and the gene expression of adipokines related to metabolic risk, while GS has a better effect on fasting glucose and adipokines related to insulin resistance, with minimal side effects.

Minimum Effective Duration of Laryngopharyngeal Reflux Disease Treatment: A Prospective Study.

To investigate the minimum therapeutic duration for patients with primary laryngopharyngeal reflux disease (LPRD) through the evaluation of symptom changes at multiple time points. Prospective uncontrolled. University medical center. Patients with LPRD at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring were recruited from the European Reflux Clinic. Depending on the type of LPRD, patients were treated with a combination of proton-pump inhibitors, alginate, or magaldrate. Symptoms were evaluated with the reflux symptom score (RSS) at baseline and throughout treatment (1-, 3-, 6-, and 9-month posttreatment). The most appropriate therapeutic duration was determined using the RSS changes. Signs were evaluated with the reflux sign assessment. A total of 159 patients completed the study. The mean age was 49.9 ± 15.7 years. At 1-month posttreatment, 97 patients (61.0%) were considered as early responders to treatment, and the treatment was stopped for 52 patients (32.7%). Of the 62 early nonresponders, 34 patients (21.4%) reached responded to treatment after 3 to 9 months. The cumulative therapeutic success rate at 1-month posttreatment (61.0%) progressively increased to reach a range of 82.4% to 99.3% at 9-month posttreatment. The RSS mainly decreased in the first month of treatment in early responders. In early nonresponders, RSS progressively decreased throughout the 9-month treatment period. The baseline severity of RSS is a strong predictor of therapeutic response. A therapeutic regimen of 1 month can be sufficient to treat one third of LPRD patients. The early nonresponders may require 3 to 9 months of treatment.

Characterization of remote symptom alerts generated from patient-reported outcome (PRO) symptom monitoring in a real-world breast cancer population.

e23193 Background: Women with breast cancer experience debilitating symptoms, yet the patient-reported symptom burden among patients on treatment remains largely uncharacterized. This study characterized electronic PRO (ePRO) symptom monitoring data of patients with breast cancer in real-world settings to assess differences in remote symptom alerts by clinical characteristics. Methods: We conducted a retrospective descriptive study of complete case ePRO data reported by patients at twelve US sites using Carevive PROmPT, a remote symptom monitoring platform. Participants consent to share de-identified, aggregate ePRO symptom data and sociodemographic and clinical characteristics from the electronic health record. We characterized PRO-CTCAE symptom data reported by breast cancer patients on active cancer treatment enrolled between 9/2020 and 11/2023. The PRO platform generates an algorithm-based alert if the combination of symptom severity, frequency, and interference is moderate or severe. We used descriptive statistics to characterize symptom severity and number of alerts by baseline patient-report ECOG status, age, cancer stage (Stage I-III vs. IV), and breast cancer subtype. Results: Of 646 patients, 519 (80%) generated alerts during treatment. Population characteristics were: median age 56 years-old (range 26-84), 72% White, 20% Black/African American, 62% Stage I-III, 15% HER2 positive, 47% ER and/or PR positive, HER2 negative,18% triple negative. Patients reported a total of 19,425 symptoms over a median of 12 weeks with 80% compliance rate, of which 39% resulted in alerts. Participants generated a median of 1 alert per week. About 50% of alerts occurred in the first 12 weeks of ePRO completion, with a higher proportion in Week 1-4 across all subgroups (range, 15-38%). On average, ECOG 2 or greater patients generated more alerts per week than ECOG 0-1, (mean 2.1, (SD 1.3) vs. 1.7 (SD 1.0). Younger patients ( &lt; 50 years) generated more alerts compared to those older than 50 years (87% vs. 77%). Patients with early-stage disease reported more alerts than the Stage IV group (81% vs. 78%). In the metastatic setting, triple negative patients reported a median of 3 (range 1-8) moderate/severe symptoms per week; the other subtypes reported a median of 1 (range 1-8). Conclusions: Women on breast cancer treatment reported their symptom experience with high compliance rates in the real-world setting. Nearly 40% of symptom reports generated an alert, with a higher proportion in the first month of treatment. Younger, early-stage, and metastatic triple negative patients with breast cancer reported a higher symptom burden compared to other groups. Future work will investigate symptom experience by sociodemographic and clinical characteristics to further identify patients who may benefit from more intensive symptom reporting and management.

Abemaciclib dose escalation to maintain intensity (ADE-MI).

TPS618 Background: Abemaciclib is a an oral CDK4/6 inhibitor that is FDA-approved as adjuvant therapy for certain patients with early-stage HR+HER2- breast cancer in combination with endocrine therapy. The major toxicity of abemaciclib is diarrhea, which often occurs within the first 6-8 days of treatment initiation. Across several registrational trials, roughly 25% of patients with diarrhea from abemaciclib treatment required dose interruptions with roughly 20% required dose reductions. Because diarrhea happens early in the treatment course, one concern is this might dissuade people from continuing on or being fully adherent to adjuvant therapy. Incorporating strategies to minimize diarrhea may improve adherence and permit more patients to stay on the target recommended dose of 150mg BID for the full 2 years of adjuvant therapy. Our trial-in-progress evaluates dose escalation to address diarrhea as a cause of dose interruptions, reductions, and discontinuations, a strategy that has worked with other therapeutic agents. Specifically, our study tests the hypothesis that gradual up-titration of abemaciclib dose over a course of 4 weeks will decrease the rate of grade 3 or worse diarrhea. Methods: This is a post-marketing, single arm, phase IV trial for patients with high-risk early-stage HR+HER2- breast cancer who are eligible for treatment with adjuvant abemaciclib in combination with endocrine therapy. Fifty (50) subjects will be enrolled. Patients will gradually up-titrate the dose of abemaciclib over the course of 4 weeks before reaching the FDA recommended dose of 150mg BID (Table). The primary objective of this study is to increase the proportion of patients on the FDA recommended dose of abemaciclib at 3 months of treatment. At the significance level of 0.05, a minimum of 43 patients will achieve a power of at least 80% to detect the improvement (80% vs the historical control of 60%), using a two sized exact binomial test. Additional objectives are determining the number of days with greater than grade 1 diarrhea in the first month of treatment, determining rates of grade 3 or greater diarrhea, determining DFS and OS, and to assess patient reported outcomes regarding adverse events. The trial opened to enrollment on 12/21/2023. The first patient on the study was enrolled 1/25/2024. Clinical trial information: NCT06169371 . [Table: see text]

Опыт лечения депрессивных расстройств вортиоксетином после гистерэктомии

Relevance. Antidepressants are widely used in clinical practice for neurological disorders. Vortioxetine refers to the latest generation of drugs, the appointment of which is appropriate for depressed patients after hysterectomy. Objective: to evaluate the effectiveness of vortioxetine in combination with menopausal hormone therapy in correcting depressive symptoms after hysterectomy. Materials and methods. 136 patients with depressive disorder after hysterectomy (average age 44.7±1.3 years) were examined and treated, who were divided into two groups. The main group consisted of 74 (54.4%) patients who were prescribed divigel with vortioxetine in combination. The control group included 62 (45.6%) patients who used only divigel. All underwent clinical and laboratory monitoring, psychological assessment on the Hamilton Depression scale (HDRS-21). Results. In the main group according to the Hamilton scale (HDRS-21), 26 (35.1%) patients showed mild depression, 48 (64.9%) moderate depression, in the control group 20 (32.2%) and 42 (67.8%) respectively. Against the background of complex therapy, a decrease in the indicators of the mental and somatic component was revealed. After a month, 16 (21.7%) patients of the main and 22 (35.4%) of the control group complained of depression, depression, a sense of self-worth, 21 (28.3%) and 27 (43.5%) of guilt, 9 (12.1%) and 11 (17.8%) slow thinking, 25 (33.8%) and 29 (46.8%), respectively, for a decrease in motor activity. Before the start of treatment, 49 (66.2%) patients of the main and 40 (64.5%) control groups complained of headache of varying intensity, 11 (14.9%) and 8 (13.0%) of pain in the lumbar region, 17 (23.0%) and 15 (24.1%), respectively, of body aches and soreness in small joints. During the first month of treatment, pain in the lumbar region decreased, followed by headaches, and soreness in the body and joints lasted longer. Conclusions. Against the background of taking an antidepressant in the examined patients, positive dynamics of the disease was noted, both in the subjective assessment of the condition and in the objective result of psychological symptoms. Vortioxetine, which has high clinical efficacy and good tolerability, can be recommended in the treatment of depression after hysterectomy.

Extended Treatment with Micron-Size Oral Palmitoylethanolamide (PEA) in Chronic Pain: A Systematic Review and Meta-Analysis.

Palmitoylethanolamide (PEA) emerged over the years as a promising approach in the management of chronic pain. Despite the fact that the efficacy of micron-size PEA formulations appears to be time-dependent, the optimal timing has not yet been elucidated. This systematic review and meta-analysis aim to estimate the possible advantage of an extended treatment in the relief of chronic pain. The literature search was conducted consulting scientific databases, to identify clinical trials in which micron-size PEA was administered for at least 60 days, and pain assessed by the Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS). Nine studies matched the required criteria, for a total of 742 patients involved. The meta-analysis showed a statistically and clinically significant pain intensity reduction after 60 days of micron-size PEA supplementation, compared to 30 days (1.36 points, p < 0.01). The secondary analysis revealed a weighted NRS/VAS score decrease of 2.08 points within the first month of treatment. These two obtained scores corresponded to a 35.1% pain intensity reduction within the first month, followed by a further 35.4% during the second month. Overall, these results confirm the clinically relevant and time-depended pain-relieving effect of micron-size PEA and therefore the advantage of an extended treatment, especially in patient with incomplete pain management.

#535 Roxadustat as a treatment of anemia after kidney transplantation

Abstract Background and Aims Roxadustat is a recently approved hypoxia-inducible factor prolyl hydroxylase inhibitor that has demonstrated favourable safety and efficacy in the treatment of renal anaemia. The goal of this study is to analyse the effect of roxadustat on the level of hemoglobin in a group of patient with chronic kidney disease with or without kidney transplantation. Method This is a monocentric study conducted on the patients of Transplant-nephrology department and/or Transplant-nephrology out-patient clinic of University Hospital Martin, Slovakia who have been treated with roxadusat since August 1st, 2022. Results 33 patients were included in the study. The average follow up of treatment with roxadustat was 4.2 months. The following parameters were recorded at the baseline: age, gender, estimated glomerular filtration rate—eGFR (CKD-EPI), treatment with iron and level of iron in serum, level of C-reactive protein, level of hemoglobin, starting dose of Roxadustat. We discovered a significant improvement in the levels of hemoglobin after one month of roxadustat treatment (P &amp;lt; 0.0001) and another significant improvement in follow-up (P ‚0,0373). There was no significant difference in eGFR, CRP or iron levels during follow up, so hemoglobin levels were not affected by inflammation or kidney function. In the next step the group of patients was divided based on history of kidney transplantation. Again, we confirmed significant improvement in hemoglobin levels in kidney transplantation group in first month of treatment (P &amp;lt; 0.0001) as well as in follow up (P &amp;lt; 0.0001). There was a significant improvement in hemoglobin levels in the first month of roxadustat treatment in the group of patients who did not undergo kidney transplantation (P = 0.0261). However, there was no significant difference between hemoglobin levels in month 1 and follow up in this group. Conclusion Roxadustat—as a new treatment option of anaemia for patients with chronic kidney diseases. Our first analysis confirmed that roxadustat is very effective not only in patients with CKD, but also in patients with anaemia after kidney transplantation.

#2460 Haemodialysis-related periarticular calcifications as cause of recurrent severe inflammatory state

Abstract Background and Aims End stage chronic kidney disease (CKD) and haemodialysis (HD) are associated with disturbances in mineral and bone turnover ultimately leading to chronic kidney disease–mineral and bone disorder (CKD-MBD), which affects more than 90 % of patients with stage 5D CKD. The primary changes observed in CKD–MBD involve elevated phosphorus levels, decreased calcium levels, insufficient serum vitamin D, and heightened release of parathyroid hormone from the parathyroid glands, leading to secondary hyperparathyroidism. CKD-MBD leads to vascular calcification, increasing cardiovascular risk. There is also a correlation between abnormal bone remodeling activity in CKD-MBD and the likelihood of calcification in soft tissues. In rare instances, profound calcification occurs in periarticular tissues, resulting in severe inflammation and manifesting as systemic disease with articular involvement clinically. The objective of this case report is to demonstrate a recurrent inflammatory condition caused by severe periarticular calcification in a patient on HD. Case report We present a case of a middle-aged white male diagnosed with hypertension, hypercholesterolemia, chronic obstructive pulmonary disease, hepatitis C, and end-stage renal disease caused by hydronephrosis. He was undergoing HD since July 2020. From summer 2021 the patient experienced recurrent fever and arthralgias in the hips, elbows, and shoulders. Frequent acute hospitalizations were needed due to recurring fevers and severe inflammatory response with markedly elevated acute phase reactants (CRP was repeatedly &amp;gt;200 mg/l), raising suspicion of infection. Laboratory and imaging tests however showed no clear signs of infection, and antibiotic therapy was ineffective. An x-ray of the right AC-joint showed multiple periarticular calcifications dorsally from the AC-joint. Later, due to severe pain and swelling an MRI-scan of right elbow joint was conducted, revealing an osteomyelitis-suspect finding of the olecranon, and olecranon bursitis. No bacteria were detected in the punctate of olecranon bursa. X-ray scans of the elbows revealed bilateral soft tissue calcification dorsally from the proximal ulna. The x-ray scan of the right shoulder revealed calcific expansion in the AC-joint area, leading to total destruction of the lateral part of the clavicle. MRI and CT scans showed severe periarticular calcification around AC- and glenohumeral joints without inflammatory involvement of the synovium. Bony erosions were observed due to the pressure of calcified tissue on the bone. Whole-body CT-scan showed no sites of infection but there was a periarticular calcification observed around the hip joints. A PET-CT scan of the whole body, neck, and upper extremities revealed no signs of malignancy or infections, but there was an increased uptake of 18F-fluorodeoxyglucose detected in several periarticular sites, indicating a multi-site inflammatory process resulting from severe periarticular calcifications. A dual-energy CT-scan of upper extremities was performed, excluding the accumulation of monosodium urate crystals. The cycle of multiple hospitalizations and antibacterial therapies was broken with the diagnosis of CKD and HD-related inflammatory periarticular calcification. Initially, the inflammation was addressed with high-dose glucocorticoids. However, the dose was successfully tapered during the first month of treatment, and the patient continued to do well on a maintenance dose of 5 mg/day of prednisolone. Subsequently, hospitalizations, antibiotics, or surgical procedures were no longer required. Conclusion Severe CKD and HD cause disturbances in mineral and bone metabolism, that can lead to periarticular calcification. Like in our presented case, multi-site calcifications may mimic infection or autoimmune rheumatoid conditions making the way to correct diagnosis cumbersome and costly. Imaging techniques help us distinguish periarticular deposits from inflammatory and infectious arthritis. In our case low-dose prednisolone effectively reduced inflammation, obviating hospitalizations and minimizing healthcare burden.

Safety of outpatient commencement of sotalol

Inpatient monitoring is recommended for sotalol initiation. The purpose of this study was to assess the safety of outpatient sotalol commencement. This is a multicenter, retrospective, observational study of patients initiated on sotalol in an outpatient setting. Serial electrocardiogram monitoring at day 3, day 7, 1 month, and subsequently as clinically indicated was performed. Corrected QT (QTc) interval and clinical events were evaluated. Between 2008 and 2023, 880 consecutive patients who were commenced on sotalol were evaluated. Indications were atrial fibrillation/flutter in 87.3% (n = 768), ventricular arrhythmias in 9.9% (n = 87), and other arrhythmias in 2.8% (n = 25). The daily dosage at initiation was 131.0 ± 53.2 mg/d. The QTc interval increased from baseline (431 ± 32 ms) to 444 ± 37 ms (day 3) and 440 ± 33 ms (day 7) after sotalol initiation (P < .001). Within the first week, QTc prolongation led to the discontinuation of sotalol in 4 and dose reduction in 1. No ventricular arrhythmia, syncope, or death was observed during the first week. Dose reduction due to asymptomatic bradycardia occurred in 3 and discontinuation due to dyspnea in 3 within the first week. Overall, 1.1% developed QTc prolongation (>500 ms/>25% from baseline); 4 within 3 days, 1 within 1 week, 4 within 60 days, and 1 after >3 years. Discontinuation of sotalol due to other adverse effects occurred in 41 patients within the first month of therapy. Sotalol initiation in an outpatient setting with protocolized follow-up is safe, with no recorded sotalol-related mortality, ventricular arrhythmias, or syncope. There was a low incidence of significant QTc prolongation necessitating discontinuation within the first month of treatment. Importantly, we observed a small incidence of late QT prolongation, highlighting the need for vigilant outpatient surveillance of individuals on sotalol.

Trends in Use and Evidence of Adherence to Risk Evaluation and Mitigation Strategy Pregnancy Testing Requirements for Thalidomide, Lenalidomide, and Pomalidomide in the USA, 2000-2020.

Lenalidomide, pomalidomide, and thalidomide are effective treatments for multiple myeloma but are teratogenic. To mitigate this risk, the US Food and Drug Administration (FDA) required risk evaluation and mitigation strategy (REMS) programs for these drugs, which include pregnancy testing among women of childbearing potential-twice before initiation, weekly in the first month on treatment, and every 2-4 weeks thereafter. We evaluated dispensing trends of lenalidomide, pomalidomide, and thalidomide and assessed adherence to REMS pregnancy testing requirements among at-risk patients taking these drugs. Using three US health insurance claims databases (Optum Clinformatics® [2004-2020], Merative Marketscan [2003-2019], and Medicaid [2000-2018]), we assessed monthly use of the drugs, patient characteristics and treatment persistence among drug initiators, and claims-based evidence for adherence to pregnancy testing requirements among initiators with child-bearing potential. Lenalidomide was the most prescribed agent following its approval in 2006 and through the end of the study period. A total of 48,311 lenalidomide (mean age = 59 years [standard deviation (SD) = 16]), 17,550 thalidomide (mean age = 65 years [SD = 12]), and 6560 pomalidomide initiators (mean age = 65 years [SD = 11]) were identified; 45% of initiators of each drug were women. Among initiators under follow-up on day 90, 70% were still on therapy. Initiators of childbearing potential comprised 3% (N = 1,920) of all initiators; among this cohort, 12% had evidence in claims data of two pregnancy tests before initiation, and 9% with at least 33 days of follow-up of four tests during the first month of treatment. By contrast, 52% who received a refill had claims-based evidence of a pregnancy test within 7 days of dispensing. Although most patients who initiated lenalidomide, pomalidomide, and thalidomide were not of child-bearing potential, further investigation into actual non-adherence to pregnancy testing is needed.

Do People Respond to the Climate Impact of their Behavior? The Effect of Carbon Footprint Information on Grocery Purchases

Food production is a primary contributor to climate change, and one way to mitigate its effect is through consumption choices. Finding the most effective way to achieve emissions reduction via consumers behavioral change has recently raised policy-makers' interest but experimental evidence about this is still scarce. In this study, we examine the impact of individualized information about greenhouse gas emissions on grocery purchases. Using a randomized field experiment, we compare the effects of individualized information on the carbon footprint of grocery purchases to individualized information on grocery spending provided through a smartphone app. Compared to the spending information, the carbon footprint information decreases emissions from groceries by 27% in the first month of treatment, with 45% reductions in emissions from beef, the highest emissions food group. Treatment effects fade in the longer run along with app engagement but persist among those engaged with the app. Our results suggest that the provision of emissions information, in particular when paired with sufficient engagement, is a promising avenue for policies to turn food consumption greener.

Clinical effect of digitalized designed and 3D-printed repositioning splints in the treatment of anterior displacement of temporomandibular joint disc

ObjectiveTo compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior displacement of the temporomandibular joint disc.MethodsThis retrospective study included 96 patients with disc displacement of the anterior temporomandibular joint. They were treated with either digitally designed and 3D-printed repositioning splints or traditional splints and followed up for at least six months. Changes in signs and symptoms such as pain and mouth opening before and after treatment were recorded to evaluate treatment outcomes.ResultsDuring the first month of treatment, both the digitally designed and 3D-printed repositioning splint groups (Group B) and the traditional repositioning splint group (Group A) showed significant increases in mouth opening, with increases of 4.93 ± 3.06 mm and 4.07 ± 4.69 mm, respectively, and there was no significant difference between the two groups. Both groups had a significant reduction in visual analog scale (VAS) pain scores, with Group B showing a greater reduction of 1.946 ± 1.113 compared to 1.488 ± 0.978 in Group A (P < 0.05). By the sixth month, Group B’s mouth opening further improved to 38.65 ± 3.22 mm (P < 0.05), while Group A’s mouth opening did not significantly improve. Regarding pain, Group A’s VAS score decreased by 0.463 ± 0.778 after one month, and Group B’s score decreased by 0.455 ± 0.715; both groups showed significant reductions, but there was no significant difference between the two groups.ConclusionCompared with traditional repositioning splints, digitally designed and 3D-printed repositioning splints are more effective at reducing patient pain and improving mouth opening. 3D-printed repositioning splints are an effective treatment method for temporomandibular joint disc displacement and have significant potential for widespread clinical application.

Favorable impact of PD1/PD-L1 antagonists on bone remodeling: an exploratory prospective clinical study and ex vivo validation

BackgroundSkeletal morbidity in patients with cancer has a major impact on the quality of life, and preserving bone health while improving outcomes is an important goal of modern antitumor treatment...

Early change in gastric-specific anxiety sensitivity as a predictor of eating disorder treatment outcome.

Eating disorders (EDs) are often accompanied by gastrointestinal (GI) distress. Anxiety sensitivity is the tendency to interpret sensations of anxiety as threatening or dangerous, and includes both broad physical symptoms (e.g., elevated heartrate) and GI-specific symptoms. Physical and GI-specific anxiety sensitivity may be important risk and maintaining factors in EDs. This study tested the hypothesis that greater reductions in both types of anxiety sensitivity during the first month of treatment would predict lower ED symptoms and trait anxiety at discharge and 6-month follow-up. Patients (n=424) in ED treatment reported physical and GI-specific anxiety sensitivity, ED symptoms, and trait anxiety at treatment admission, 1-month into treatment, discharge, and 6-month follow-up. Analyses were conducted with hierarchical linear regression with imputation, controlling for relevant covariates. Results indicated that early reduction in GI-specific but not general physical anxiety sensitivity predicted both lower ED symptoms and lower trait anxiety at discharge and 6-month follow-up. These findings demonstrate the importance of GI-specific anxiety sensitivity as a potential maintaining factor in EDs. Developing and refining treatments to target GI-specific anxiety sensitivity may have promise in improving the treatment not only of EDs, but also of commonly co-morbid anxiety disorders.