General Principles Of Treatment Research Articles

Treatment of urinary disorders in patients with multiple sclerosis: A review

Voiding disorders are one of the most common clinical manifestations of multiple sclerosis, significantly worsening the quality of life of patients. The review article provides information about the nature and symptoms of lower urinary tract dysfunctions, the reasons for their development and possible complications. The general principles of treatment of urinary disorders in patients with multiple sclerosis are presented, as well as features of the treatment of detrusor overactivity, detrusor-sphincter dyssynergia and detrusor hypoactivity. The possibilities of non-drug and drug therapy, botulinum therapy, and neuromodulation are described in detail. The role of intermittent catheterization in the treatment of patients with impaired evacuation function of the bladder is shown. Practical issues of choosing a treatment method depending on the clinical situation are considered.

Overview and Diagnostic Approach in Autoimmune Neurology.

The field of autoimmune neurology is rapidly evolving. This article reviews the epidemiology and pathophysiology as well as current approaches to clinical and paraclinical assessment, testing paradigms, and general principles of treatment. Improved recognition of autoimmune diagnoses among patients who have phenotypically diverse, subacute onset neurologic presentations is facilitated by disease-specific antibody biomarker discovery. These antibodies have varying associations with paraneoplastic causation (from no association to greater than 70% positive predictive value), immunotherapy responses, and outcomes. To simplify assessment in an increasingly complex discipline, neurologic phenotype-specific serum and CSF antibody evaluations are recommended. Clinical trials have led to the approval of monoclonal therapies for neuromyelitis optica spectrum disorder (NMOSD) and are underway for N-methyl-d-aspartate (NMDA) receptor and leucine-rich glioma inactivated protein 1 (LGI1) encephalitides. Autoimmune neurology is now a mainstream subspecialty, consisting of disorders with diverse presentations detectable using antibody testing of serum and CSF. Early and sustained immunotherapy (eg, corticosteroids, intravenous immunoglobulin [IVIg], plasma exchange) is recommended and may be supplemented by immune suppressants (eg, rituximab or cyclophosphamide) to sustain responses and optimize outcomes.

A Conceptual Study of Role of Vyadhikshamatava in Origin and Management of Diseases w.s.r. to Covid-19

The Ayurvedic approach to healthcare is distinct from the allopathic approach, as it is not primarily focused on using drugs. In Ayurveda, there are numerous drugs derived from plants, animals, and minerals that are believed to enhance the body's Vyadhikshamatava. However, to fully benefit from these substances, they must be used in accordance with the principles of Ayurveda. According to Ayurveda, the emergence of disease is intricately connected to distinct factors collectively referred to as Nidanadi Visheshas. These factors encompass Nidan, Doshas, and Dushyas. The pivotal determinants influencing whether a disease manifests or not lie in the Prativisheshas associated with Nidanadi Visheshas to the dynamic interplay of Vikaarvighaat Bhava-Abhava. Understanding Vikaarvighaat Bhava, Abhava, and Prativisheshas is crucial for assessing pathogenesis, determining the Sadhyasadhyata, and formulating an appropriate treatment protocol. Various principles are advocated for the management of diseases. In this sequence, the desired increase in the best Dhatu Saar and Oja by prior conditioning through the best diet, medicine, Rasaysana, etc. can be adopted along with altering the body through purification therapies such as emesis or purgation. Another approach involves using substances or medicines with properties and actions opposite to those causing the disease, adhering to the general principle of treatment. Additionally, refining the body using substances similar to the factors that could cause the disease is known as Purvaabhisanskaar.

II Brazilian Society of Rheumatology consensus for lupus nephritis diagnosis and treatment

ObjectiveTo develop the second evidence-based Brazilian Society of Rheumatology consensus for diagnosis and treatment of lupus nephritis (LN).MethodsTwo methodologists and 20 rheumatologists from Lupus Comittee of Brazilian Society of Rheumatology participate in the development of this guideline. Fourteen PICO questions were defined and a systematic review was performed. Eligible randomized controlled trials were analyzed regarding complete renal remission, partial renal remission, serum creatinine, proteinuria, serum creatinine doubling, progression to end-stage renal disease, renal relapse, and severe adverse events (infections and mortality). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to develop these recommendations. Recommendations required ≥82% of agreement among the voting members and were classified as strongly in favor, weakly in favor, conditional, weakly against or strongly against a particular intervention. Other aspects of LN management (diagnosis, general principles of treatment, treatment of comorbidities and refractory cases) were evaluated through literature review and expert opinion.ResultsAll SLE patients should undergo creatinine and urinalysis tests to assess renal involvement. Kidney biopsy is considered the gold standard for diagnosing LN but, if it is not available or there is a contraindication to the procedure, therapeutic decisions should be based on clinical and laboratory parameters. Fourteen recommendations were developed. Target Renal response (TRR) was defined as improvement or maintenance of renal function (±10% at baseline of treatment) combined with a decrease in 24-h proteinuria or 24-h UPCR of 25% at 3 months, a decrease of 50% at 6 months, and proteinuria < 0.8 g/24 h at 12 months. Hydroxychloroquine should be prescribed to all SLE patients, except in cases of contraindication. Glucocorticoids should be used at the lowest dose and for the minimal necessary period. In class III or IV (±V), mycophenolate (MMF), cyclophosphamide, MMF plus tacrolimus (TAC), MMF plus belimumab or TAC can be used as induction therapy. For maintenance therapy, MMF or azathioprine (AZA) are the first choice and TAC or cyclosporin or leflunomide can be used in patients who cannot use MMF or AZA. Rituximab can be prescribed in cases of refractory disease. In cases of failure in achieving TRR, it is important to assess adherence, immunosuppressant dosage, adjuvant therapy, comorbidities, and consider biopsy/rebiopsy.ConclusionThis consensus provides evidence-based data to guide LN diagnosis and treatment, supporting the development of public and supplementary health policies in Brazil.

Obstetric perineal trauma

Obstetric perineal trauma is a common pathology that complicates up to 90% of vaginal deliveries. The true incidence of injuries (and their severity) is usually underestimated and higher than reported. Obstetric perineal injuries have a serious impact on a woman’s well-being and have medical, emotional, social and psychological aspects. Their negative consequences can persist for many years after childbirth and have a potentially devastating impact on a woman’s quality of life, lead to severe morbidity due to persistent pain, pelvic floor dysfunction, urinary and faecal incontinence, sexual problems, high risk of re-injury during future childbirth, etc. The article presents an overview of existing national guidelines for the prevention and treatment of perineal injuries. The data on the frequency and risk factors of perineal tears are systematized, and a modern classification is presented. Particular attention is paid to obstetric anal sphincter injuries (OASIS) for a better understanding of this pathology by partitional doctors. Training and awareness of obstetricians about OASIS should help to identify patients at risk, more accurately diagnose and choose the right tactics. The article also describes the main preventive interventions during pregnancy and childbirth, discussing the advantages and disadvantages of each. Given the high frequency of episiotomy for the prevention of OASIS, the advantages and disadvantages of various options, as well as the correct 45-60˚ technique, are presented. The emphasis is placed on the fact that it is necessary to perform selective episiotomy rather than routine episiotomy in the presence of clear indications according to the national standard. Reducing the frequency of episiotomies should lead to a decreased number of iatrogenic perineal injuries. The general principles of surgical treatment of perineal injuries, various suturing techniques, suture material characteristics, postoperative management of patients and counselling for future births are also presented.The use of these recommendations by obstetricians will be useful for their practice and will help improve the quality of medical care.

The Italian Consensus Conference on the role of rehabilitation for children and adolescents with leukemia, central nervous system tumors, and bone cancer, part 2: general principles for the rehabilitation treatment of motor function impairments

In Italy, 1400 children and 800 adolescents are diagnosed with cancer every year. About 80% of them can be cured but are at high risk of experiencing severe side effects, many of which respond to rehabilitation treatment. Due to the paucity of literature on this topic, the Italian Association of Pediatric Hematology and Oncology organized a Consensus Conference on the role of rehabilitation of motor impairments in children/adolescents affected by leukemia, central nervous system tumors, and bone cancer to state recommendations to improve clinical practice. This paper includes the consensus on the rehabilitation of children and adolescents with these cancers.

Research on general treatment principles and methods of bone fracture in Mongolian medicine

The Mongolian nomadic nation has created bone healing, or fracture healing, which is suitable for the extreme weather and territory, unique living conditions, and physical characteristics while struggling to fight diseases during a long historical period. Gradually, this treatment method has gradually developed into a more comprehensive theoretical system throughout history and has unique names due to the thinking scope of the Mongols, their cognition development, and thus their use of it in their everyday lives and continuing to enrich their knowledge. Mongols have rich experience healing bone fractures and injuries from ancient times. They are usually used to perform bone setting and massage therapy. On the other hand, they have experience using herbal and mineral medicines to heal bone fractures and injuries. During their practice, the knowledge of herbal and mineral medicines used for bone fractures and injuries became expansive. After Buddhism reemerged in the 16th century, Mongolian doctors and knowledgeable people wrote many medical books in Tibetan. One of the major representatives was Jambaldorj, who wrote Mongolian materia medica, called “The beautiful wondrous eye ornament,” based on “Four medical tantras.” In treating bone fracture and injury in traditional medicine, firstly, the four treatment methods mentioned in “Four medical tantras” are the main principles and methods, which are wind, bile and phlegm theory, dietary recommendations, advice on behavior, prescribing medicine, and accessory therapy. We concluded that the names of herbal and mineral medicines used to practice bone setting are the same, even though they are mentioned in various sources.

Professor FU Wenbin's experience of "acupuncture-moxibustion-consolidation" holistic idea in treatment of laryngeal herpes zoster with vocal cord paralysis.

This paper introduces professor FU Wenbin's clinical experience in the treatment of laryngeal herpes zoster with vocal cord paralysis, using the holistic mode of treatment, in which, acupuncture, moxibustion and consolidation regimens are integrated. Regarding the core pathogenesis of the disease, the invaded exogenous toxic heat is transformed into fire that flows to the throat. Soothing liver and releasing heat is the general principle of treatment, guiding the entire process of treatment. For acupuncture regimen, the filiform needling is used and the acupoint prescription is composed of Baihui (GV 20), Yintang (GV 24+), Lianquan (CV 23), the four-gate points (bilateral Hegu [LI 4] and Taichong [LR 3]), the group points for conducting qi back to the primary (Zhongwan [CV 12], Xiawan [CV 10], Qihai [CV 6] and Guanyuan [CV 4]), as well as bilateral Fengchi (GB 20), Wangu (GB 12) and Yifeng (TE 17). Besides, the pricking technique is delivered to the posterior wall of the pharynx for soothing the liver, regulating the spirit, reducing the heat and benefiting the throat. For the moxibustion regimen, moxibustion is applied to Fengchi (GB 20), Feishu (BL 13), the four-flower points (bilateral Geshu [BL 17] and Danshu [BL 19]), Shenshu (BL 23) and Mingmen (GV 4), which nourishes the spleen and stomach and reduces the heat pathogen through the heating action of moxibustion specially. In the stage of consolidation, the bloodletting and cupping technique is used at Xinshu (BL 15), Ganshu (BL 18) and Jianjing (GB 21) to eliminate the liver stagnation and the intradermal needling is delivered to sustain the needling stimulation and consolidate the therapeutic effect.

Involvement of Embryo-Derived and Monocyte-Derived Intestinal Macrophages in the Pathogenesis of Inflammatory Bowel Disease and Their Prospects as Therapeutic Targets.

Inflammatory bowel disease (IBD) is a group of intestinal inflammatory diseases characterized by chronic, recurrent, remitting, or progressive inflammation, which causes the disturbance of the homeostasis between immune cells, such as macrophages, epithelial cells, and microorganisms. Intestinal macrophages (IMs) are the largest population of macrophages in the body, and the abnormal function of IMs is an important cause of IBD. Most IMs come from the replenishment of blood monocytes, while a small part come from embryos and can self-renew. Stimulated by the intestinal inflammatory microenvironment, monocyte-derived IMs can interact with intestinal epithelial cells, intestinal fibroblasts, and intestinal flora, resulting in the increased differentiation of proinflammatory phenotypes and the decreased differentiation of anti-inflammatory phenotypes, releasing a large number of proinflammatory factors and aggravating intestinal inflammation. Based on this mechanism, inhibiting the secretion of IMs' proinflammatory factors and enhancing the differentiation of anti-inflammatory phenotypes can help alleviate intestinal inflammation and promote tissue repair. At present, the clinical medication of IBD mainly includes 5-aminosalicylic acids (5-ASAs), glucocorticoid, immunosuppressants, and TNF-α inhibitors. The general principle of treatment is to control acute attacks, alleviate the condition, reduce recurrence, and prevent complications. Most classical IBD therapies affecting IMs function in a variety of ways, such as inhibiting the inflammatory signaling pathways and inducing IM2-type macrophage differentiation. This review explores the current understanding of the involvement of IMs in the pathogenesis of IBD and their prospects as therapeutic targets.

Striking the Balance: Bipolar Disorder in the Perinatal Period.

The authors reviewed the literature, published between 2018 and 2023, on treating bipolar disorder in the perinatal period in order to summarize current treatment perspectives. Mood episodes occur during pregnancy and there are high rates of both initial onset and recurrence in the postpartum period. Bipolar disorder itself is associated with higher risks of adverse pregnancy outcomes, including gestational hypertension, hemorrhage, cesarean delivery, and small for gestational age infants. A general principle of perinatal treatment includes maintaining psychiatric stability of the pregnant person while reducing medication exposure risk to the fetus. A variety of factors can compromise psychiatric stability, including rapid discontinuation of stabilizing medications, decreased efficacy due to physiologic changes of pregnancy, and exacerbation of underlying psychiatric illness. Psychosocial interventions include optimizing sleep, increasing support, and reducing stress. The American College of Obstetricians and Gynecologists recommends against discontinuing or withholding medications solely due to pregnancy or lactation status. Individualized treatment involves a discussion of the risks of undertreated bipolar disorder weighed against the risks of individual medication choice based on available evidence regarding congenital malformations, adverse neonatal and obstetrical events, and neurodevelopmental outcomes. Valproate is not a first-line treatment due to higher risks. Data are lacking on safety for many newer medications. The authors review current safety data regarding lithium, lamotrigine, and antipsychotics, which are the most commonly used treatments for managing bipolar disorder in the perinatal period. Due to physiologic changes during pregnancy, frequent therapeutic drug monitoring and dose adjustments are required.

Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies

The prevalence of diabetes mellitus in acromegaly is significantly higher than that in the general population. Carbohydrate metabolism abnormalities often precede other phenotypic manifestations of acromegaly. The review presents data on the prevalence of carbohydrate metabolism disorders in acromegaly and describes their pathophysiological characteristics and approaches to treatment.&#x0D; Growth hormone (GH) excess is recognized as a key factor of glucose homeostasis abnormalities due to decreased insulin sensitivity (resulting from active lipolysis) and direct stimulation of insulin secretion. Insulin-like growth factor 1 (IGF1) improves insulin sensitivity; however, the GH diabetogenic effects prevail over the insulin-sensitizing impact of IGF1. Surgical and radiation treatment for somatotropinoma may indirectly improve carbohydrate metabolism, because they decrease the GH levels. Treatment with first generation somatostatin analogues can both improve glycemic control due to decreased GH levels and worsen it due to deterioration of postprandial insulin release, especially in patients with already manifest carbohydrate metabolism disorders. The GH receptor antagonist pegvisomant blocks the effects of excess GH on the target tissues without suppressing insulin secretion, which results in better glucose control; treatment with this agent can be preferred in patients with acromegaly and diabetes mellitus. Management of carbohydrate metabolism disorders in acromegaly is done in accordance with general treatment principles for type 2 diabetes mellitus.

The Principle of Equal Treatment in the Google Shopping Case

Abstract This article reflects on the principle of equal treatment as a constant feature that pervades the European Union’s legal order and its specific role in competition law. Throughout history, this principle has been a foundation stone for developing the characteristics, such as freedom of movement, that one would consensually recognise as distinctive features that make the European Union a sui generis political construction. After a brief analysis of the principle’s development and ever-expanding contours, with new instruments emerging along the way and contributing to its importance, we will focus on the application of this principle to competition law. Paying particular attention to the Google Shopping case, we will demonstrate how the general principle of equal treatment remains relevant when confronted with new types of discriminatory abuses.

Network medicine framework reveals generic herb-symptom effectiveness of traditional Chinese medicine.

Understanding natural and traditional medicine can lead to world-changing drug discoveries. Despite the therapeutic effectiveness of individual herbs, traditional Chinese medicine (TCM) lacks a scientific foundation and is often considered a myth. In this study, we establish a network medicine framework and reveal the general TCM treatment principle as the topological relationship between disease symptoms and TCM herb targets on the human protein interactome. We find that proteins associated with a symptom form a network module, and the network proximity of an herb's targets to a symptom module is predictive of the herb's effectiveness in treating the symptom. These findings are validated using patient data from a hospital. We highlight the translational value of our framework by predicting herb-symptom treatments with therapeutic potential. Our network medicine framework reveals the scientific foundation of TCM and establishes a paradigm for understanding the molecular basis of natural medicine and predicting disease treatments.

Overweight and obesity in adults: general principles of treatment and conservative management

The prevalence of overweight and obesity is steadily increasing in Austria as well as internationally. Obesity in particular is associated with multiple health risks, comorbidities, functional disability, and social stigma. Obesity is an independent, complex, chronic disease and should be treated as such by amultidisciplinary team of appropriately qualified personnel. In addition to recent international guidelines, this consensus paper outlines the overall principles of the management of overweight and obesity and provides guidance for the diagnosis and conservative treatment, focusing on lifestyle modifications and pharmacotherapy. Using the "5A" framework of behavioral health intervention, guidelines for astructured, pragmatic, and patient-centered medical care of adults with overweight or obesity are presented.

The importance of improving the legal regulation of animal treatment in terms of preventing cruelty

The subject of this article is a set of legal acts in Ukraine that regulate the general procedure and principles of animal treatment and the forms/methods of ensuring their welfare in the modern world. For a long time, the issues of protection and maintenance of normal conditions for the existence of the animal world have been somewhere “alongside” the need to regulate social relations, although everyone knows that the model of animal treatment is a prototype of a human behavioural algorithm in society.&#x0D; The purpose of the article is to provide a general analysis of the essence and content of the regulatory provisions governing the process and procedure of animal treatment, with a view to further clarifying the forms and means of preventing such treatment. Achieving this goal requires solving a number of tasks, including: providing a general description of the regulatory framework for the existence of animals in modern Ukraine; developing a specific direction for improving the national legislation of Ukraine, the purpose of which should be to more effectively regulate human-animal relations in all areas, with the maximum possible exclusion of cruelty to animals.&#x0D; The article presents arguments and draws conclusions on improving the classification of animals in national legislation and systematising regulations in this area, which should ultimately ensure normal conditions for the existence of animals in Ukraine. The issue of defining the concept of fauna in modern Ukraine is rather limited and does not correspond to the concept of modern interaction between humans and animals in many areas of public life.&#x0D; In a state governed by the rule of law, all spheres of public life must be effectively regulated, which explains the need to consolidate all existing legal acts in Ukraine in the field of animal welfare and protection and bring them into line with international standards. This issue is extremely important precisely because humanity cannot exist without the animal world. Such improvements are aimed at clearly defining procedural algorithms for detecting, recording, preventing and suppressing cruelty to animals.

Femoral fractures in the immature skeleton: Characterization, risk factors, and treatment options in a developing country

IntroductionFemur fracture is one of the most frequent reasons for admission to paediatric trauma units and has a bimodal incidence. The trauma mechanism varies according to the patient's age. Non-operative treatment continues to be performed, although surgical treatment has gained popularity in recent years. Paediatric orthopaedic traumatologists should always bear in mind the already known general principles of treatment. In this study, we aimed to provide a general characterization of femoral fractures, risk factors, and current definitive treatment methods in a developing Latin American country. Materials and methodsThis is an observational, analytical, retrospective study with a non-probabilistic sample of consecutive cases of skeletally immature patients with femoral fractures treated at a trauma hospital in Asunción, Paraguay, from January to December 2022. Patients with diseases fragile bones and femoral fractures were excluded. Demographic and clinical characteristics of the study population were analysed. ResultsTraffic accidents were the most frequent cause of femoral fractures in our population. Femur fractures were more common in males. The femoral shaft was the most frequent fracture site. Age was one of the most important criteria for defining the treatment approach, considering non-operative management in children younger than 4 years. ConclusionsFracture of the femoral shaft in male patients is the most frequent presentation at our Institution. Summer vacations and traffic accidents are the main risk factors identified in Paraguayan children who suffer a femoral fracture. Non-operative treatment is preferred in children under 4 years of age, while surgical treatment is preferred in children aged 5 years and above. Paediatric orthopaedic traumatologists should be involved in parent education to promote children's safety, especially by increasing care and vigilance during school vacations and dangers related to traffic accidents.

MODERN APPROACHES TO THE SYSTEMIC TREATMENT OF RECURRENT OVARIAN CANCER

Introduction: Introduction: Recurrent ovarian cancer is one of the most challenging issues in medical oncology. Being the fifth in the cancer mortality list among women, ovarian cancer is the reason of more deaths than any other cancer of the female reproductive system. A meta-analysis was conducted to investigate the optimal treatment options for recurrent platinum-sensitive and platinum-resistant ovarian cancer. Methods: Data for writing this article was collected from the publications in English, Russian and Italian from 2002 to 2023. PubMed and Web of Science were searched for the relevant articles. Survival rates, particularly overall survival (OS), progression-free survival (PFS), and adverse events (AEs) of the chemotherapy regimens were discussed. We analyzed the literature data comparing the effectiveness and safety of chemotherapy, antiangiogenic therapy, the use of poly-ADP ribose polymerase (PARP) inhibitors, and checkpoint inhibitors in the treatment of recurrent ovarian cancer. Results: An overview of the literature devoted to modern approaches to the systemic treatment of recurrent ovarian cancer is given in the article. General principles of classification and treatment of recurrent ovarian cancer are analyzed. The existing regimens of chemotherapy in combination with targeted therapy are given separately for various types of ovarian cancer relapses. Chemotherapy with doublet platinum compounds (carboplatin or cisplatin) continues to be the standard of care in platinum-sensitive relapsed ovarian cancer with or without targeted therapy. Treatment with poly-ADP ribose polymerase inhibitors, vascular endothelial growth factor inhibitors, immunotherapy with checkpoint inhibitors, and antibody-drug conjugate for patients with folate receptor alpha-positive, can be considered in platinumresistant epithelial ovarian cancer. Conclusion: In summary, we can conclude that despite the success of the primary treatment of ovarian cancer, the majority of patients with a widespread tumor process develop a relapse of the disease over the next two years, which is the cause of death of these patients. The development of effective treatment regimens for recurrent ovarian/fallopian tube/primary peritoneal cancer remains particularly acute and important in gynecological oncology and requires further study.

Hyperactive Bladder in Men: Modern Recommendations and Practical Approaches to Diagnosis and Treatment

An analysis of modern recommendations of the European Association of Urologists (EAU) regarding diagnosis and treatment options for overactive bladder (OAB) in men was carried out, taking into account real practice. The article discusses the general principles of diagnosis and treatment of non-neurogenic male lower urinary tract symptoms (LUTS) in the case where the predominant clinical features are urgency, pollakiuria, nocturia, which can be combined with urinary incontinence – complaints typical of GSM. Approaches to the treatment of such patients are still not clearly defined, and the effectiveness of treatment does not always satisfy both doctors and patients. It is indicated that in recent years, doctors have received completely new treatment options for this disease in men. In addition to adrenoblockers (AB) and cholinolytics (HL), phosphodiesterase-5 inhibitors (IPDE) and beta-3 adrenomimetics (BAM) were added, which showed their effectiveness and safety not only in women, but also in men. In addition, new options for combined treatment appeared in the recommendations – in addition to AB+HL, a combination of AB+IPDE and HL+BAM is possible. The article discusses various groups of drugs and their combinations recommended for the treatment of LUTS, the specifics of their use and possible side effects, especially the risks of urinary retention in men with infravesical obstruction. It is emphasized that the EAU currently recommends the use of HL in men with moderate and severe LUTS, who mainly have symptoms of accumulation with a residual urine of no more than 150 ml. It is recommended to determine the patient’s residual urine after a week of taking HL. The practical aspects of choosing the category of patients to be treated with certain drugs (or their combinations) are discussed, taking into account the possible side effects of each of the treatment options.

General Principles for Treatment, Prevention and Control of Zoonotic Diseases

General Principles for Treatment, Prevention and Control of Zoonotic Diseases

Lower Extremity Malformations.

Lower Extremity Malformations.