Improvement In Clinical Findings Research Articles

Salicylalazine: A novel therapeutic agent targeting TLR4/NLRP3/GSDMD-mediated pyroptosis in rheumatoid arthritis.

Joint pain and functional impairment are hallmarks of arthritis, a painful inflammatory disease. Salicylalazine (SAZ), an anti-inflammatory compound, has demonstrated promise in modulating inflammation, thereby being selected in the current study to unveil its anti-arthritic potential. The aim behind this study was to assess the anti-arthritic properties of salicylalazine via evaluating its impact on paw volume, arthritic scores, oxidative stress indicators, and significant inflammatory mediators. The arthritic potential of SAZ was estimated first through the formaldehyde (FA) model to screen the most effective dose of SAZ, followed by the Complete Freund's adjuvant (CFA) model. Over a 28-day period, we monitored parameters such as paw edema, arthritic index, body weight, flexion pain, mobility, and stance score. Oxidative stress markers (GSH, CAT, SOD, MDA), serological markers (CRP, RF, anti-CCP), and gene expression of key inflammatory mediators (TLR4, MyD88, NFκB, NLRP3, ASC, IL-1β, IL-18, caspase-1, GSDMD) were assessed. SAZ treatment led to a substantial decrease in paw volume in both arthritis models, with the most pronounced effects observed on day 10 for the formaldehyde model and day 28 for the CFA model (p<0.001). Additionally, SAZ helped to restore the body's weight and considerably relieved the flexion pain, which led to improvements in both mobility and stance. Moreover, SAZ substantially raised the levels of antioxidant enzymes (GSH, CAT, SOD) and decreased MDA levels, suggesting a reduction in oxidative stress. Also with SAZ, there was a substantial (p<0.001) decrease in the expression of pyroptotic mediators. Serological markers of inflammation, including CRP, RF, and anti-CCP levels, were also restored by SAZ administration. In a nutshell, SAZ achieved significant anti-arthritic benefits, most likely via the modulation of the TLR4/NLRP3/GSDMD-mediated pyroptosis pathway, lowering oxidative stress, and improvement of clinical findings. Taking into consideration these findings, it seems that SAZ has the potential to be an effective treatment alternative for the management of arthritis.

Surgical and regenerative treatment options for empty nose syndrome: A systematic review.

Patients with empty nose syndrome usually suffer from paradoxical nasal congestion, nasal dryness, epistaxis and suffocation. Conservative management is general option for the empty nose syndrome. However, there are several patients who continually complain of symptoms. If symptoms persist, surgical options are considered. Therefore, we reviewed surgical and regenerative treatment options of empty nose syndrome. PubMed, Embase, Scopus, Cochrane Register of Controlled Trials, and Google Scholar were searched from the earliest date provided in the database until December 2022. In the studies, treatment outcomes were measured by patient symptom scores such as Sino-Nasal Outcome Test (SNOT-20, 22, and 25), and Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) along with various clinical examiniations. Twenty-eight studies were analyzed. Submucosal injectable materials, allografts/xenografts/cadaveric implants, autologous implants, and synthetic implants were used. Among them, polyethylene implant was most commonly used (23.3%), followed by autologous, homologous, or cadaveric costal cartilage (20%). The most common administration site was the anterior-inferior lateral nasal wall. Most of the studies showed that surgical intervention brought significant improvements in clinical findings including endoscopic exam, acoustic rhinometry, and CT, as well as patients reporting nasal symptom-, psychological-, or overall health-related quality of life questionnaires. However, several studies did not confirm improvement effects in some psychological-related questionnaires or saccharin transit time. The average follow-up duration was 12.0 (2.0-27.6) months. Postoperative adverse effects were reported in only two studies. Several surgical options and recent tissue regeneration techniques have shown its positive efficacy in treating empty nose syndrome. However more detailed investigations with a larger number and a randomized control study are needed to establish a standardized protocol in treating empty nose syndrome patients.

Improvement of Clinical Findings, Meibography and Tear Film Parameters in Pediatric Ocular Rosacea Patients After a Standard Treatment Protocol

ABSTRACT Purpose The objective of this study was to illustrate the changes in ocular findings, meibography, and tear break-up time (TBUT) values in pediatric patients with ocular rosacea following a standardized treatment. Methods The study included consecutive patients diagnosed with ocular rosacea, referred to a tertiary hospital between 2021 and 2023. Each patient underwent biomicroscopic examinations, non-invasive TBUT assessments, corneal fluorescein staining (evaluated using the Oxford scoring system), and meibography. The standard treatment protocol involved warm compresses, eyelid hygiene, preservative-free sodium hyaluronate eye drops (administered four times daily), topical azithromycin 1.5% (twice daily for 3 days), topical steroids (loteprednol 0.5%, four times daily for 2 weeks), and either doxycycline 100 mg/day for 14 days or oral suspension of azithromycin 10 mg/kg for 3 days followed by an additional three-day course of treatment administered 10 days later (for patients above and below 14 years of age, respectively). Results The study included 18 patients, with 10 (55.5%) being female and 8 (44.4%) being male, with a mean age of 9.7 ± 4.5 years (range: 3–18). Four patients displayed cutaneous involvement. The treatments resulted in significant improvements in the Oxford scores, reduction in corneal neovascularization, and increased TBUT (p < 0.001, p = 0.016, p < 0.001, respectively). Meibomian gland loss area also significantly improved post-treatment (27.4 ± 6.7% vs 39.2 ± 13.4%, p = 0.001). Conclusion This study demonstrated that pediatric ocular rosacea patients may exhibit improved meibomian gland function, regression of corneal neovascularization, and enhanced tear film parameters following a standardized treatment protocol that includes both topical and systemic approaches.

Multisistemski inflamatorni sindrom udružen sa COVID-19 u dece - etiopatogeneza, klinička manifestacija i terapija

Multisystem inflammatory syndrome in children (MIS-C), associated with coronavirus disease-19 (COVID-19), is a life-threatening condition resulting from a cytokine storm and hyperinflammation in genetically predisposed children after a symptomatic or asymptomatic infection caused by SARS-CoV-2. The etiopathogenesis of this inflammatory disorder has yet to be clarified. However, endotoxemia and significant micro-and macrovascular damage lead to increased synthesis of reactive species, reduced availability, and/or increased consumption of antioxidants, disrupting redox homeostasis. Given the severe clinical picture and potentially life-threatening condition, early application of immunomodulatory therapy is necessary. Although clear recommendations for MIS-C therapy have not been made, IVIG and corticosteroids play a crucial role. In addition to being anti-inflammatory, IVIG has also been shown to have an antioxidant effect. At the same time, there is still no data on corticosteroids modulating the degree of oxidative stress in patients with MIS-C associated with COVID-19. However, the use of corticosteroids showed a rapid improvement in clinical findings, hematological and biochemical parameters, ECG records and echocardiographic findings in patients with MIS-C associated with COVID-19.

Budd-Chiari syndrome in children: Radiological intervention and role of shear wave elastography in monitoring response.

Radiological intervention (RI) is the preferred treatment in children with Budd-Chiari syndrome (BCS). We studied the comparative long-term outcome of BCS children, with and without RI and utility of liver and splenic stiffness measurement (LSM, SSM) by 2-dimensional shear wave elastography (2D-SWE) in assessing response. Sixty children (40 boys, median age 10.5 [6.5-15.25] years) with BCS (29 newly diagnosed, 31 follow-up) were evaluated. LSM and SSM by 2D-SWE and vascular patency were monitored pre- and postprocedure (≥ 6 months postprocedure) in those undergoing RI. Medical therapy without anticoagulation and monitoring was done in subjects without RI. The RI and no-RI groups were compared. Ascites (54,90%), hepatomegaly (56,93%) and prominent abdominal-veins (42,70%), were the commonest features. The majority (46,78%) had isolated hepatic vein block. 44 (73%) cases underwent RI, while 16 (27%) were managed conservatively. Both groups were similar at baseline. Post-RI subjects showed significant improvement in clinical findings, liver functions and portal hypertension. LSM [33 (32-34.5) to 19.2 (18-20.67) kPa] and SSM [54.5 (52.3-57.6) to 28.9 (27.6-30.25) kPa] showed a significant decline from baseline value over a follow-up of 12 (6-13) months. Gradual reduction occurred in the LSM and SSM over 1-5 years, with near-normal LSM [10.2 (9.2-11.5) kPa] and SSM [22.3 (20.5-24.3) kPa] values in patients (n-16) with > 5 years follow-up. Patients without RI showed worsening in LSM and SSM. Hepatopulmonary syndrome and hepatocellular carcinoma developed in 4 (8%) and 1 (1.7%) cases respectively. RI leads to clinical recovery and reduction with near normalization of LSM and SSM over long-term follow-up in children with BCS. 2D-SWE is a promising tool to monitor outcomes.

Symptoms and Outcomes of COVID-19 in Elderly Recipients of Influenza and COVID-19 Vaccines

Background: Health providers and policymakers aim to prevent or reduce the severity of disease outcomes globally. Objective: The present study aimed to explore the outcomes and common symptoms of COVID-19 in the elderly population vaccinated against influenza and COVID-19 in hospitals of Ramsar and Tonekabon cities in Iran. Methods: To participate in the present cross-sectional descriptive study, 11 qualified subjects were selected through a census. The data collection instruments included the “Demographic and clinical questionnaire” and “Registration form of sampled patients with acute disease syndrome”. The data were analyzed in SPSS 24 using descriptive statistics (frequency). Results: The average age of the participants was 70.63±5.85 years. As the results showed, mild cardiovascular symptoms were found in 6 participants (54.5%), lower respiratory system symptoms in 5 (45.5%), nervous system symptoms in 4 (36.4%), and auxiliary symptoms in 4 (36.4%). No cardiac, renal, blood or central nervous system outcomes were observed in the elderly, and the mortality rate was 0%. The findings also showed a reduction in clinical symptoms and severity of outcomes, an improvement in clinical findings, and no mortality among the elderly. Conclusion: The present findings supported measures aimed at increasing the coverage of influenza and COVID-19 vaccination in people, especially the elderly.

194 Intraoperative Neurophysiology Clues to Predict Success from Selective Dorsal Rhizotomy for Spastic Diplegic and Hemiplegic Cerebral Palsy

INTRODUCTION: Selective dorsal rhizotomy (SDR) involves differential lesioning of divided sensory rootlets at the L1-S1 spinal levels based on interpretations of intraoperative neurophysiologic recordings. It has been shown to improve spasticity related to Cerebral Palsy, but the relationship of specific intraoperative neurophysiology measurements with clinic findings and improvements from surgery has not been investigated. METHODS: We performed a retrospective chart review of 39 consecutive SDRs on pediatric patients with spastic diplegia and hemiplegia, recording preoperative and postoperative toeing, scissoring, crouching, ability to walk, intraoperative stimulation frequencies, the spread of activated muscles, and whether a rootlet was lesioned. Improvement in clinical findings was analyzed as the correlate of surgical success. RESULTS: There was greater improvement in walking ability with more rootlets having a contralateral spread (p = .009), when more of the lesioned rootlets had contralateral spread (p = .005), and when some rootlets with contralateral spread were spared (p = .001). Among patients with preoperative toeing, there was more muscle activation intraoperatively (p &lt; .001), greater improvement in walking ability (p &lt; .001), and greater improvement of toeing when a lower percentage of rootlets were lesioned intraoperatively (p = .033). Among patients with preoperative crouching, there was greater improvement in crouching with smaller differences in stimulation frequency threshold between the motor and sensory roots (p = .041) and when some rootlets with contralateral spread were spared (p = .028). CONCLUSIONS: There is a correlation between preoperative clinical findings, intraoperative neurophysiology measurements, and postoperative clinical findings. These allow for the prediction of intraoperative recordings based on preoperative presentation. We have shown that success from SDR can be predicted using specific intraoperative measurements.

Itraconazole Improved Bronchial Wall Thickness in Severe Persistent Asthma: A Double-blind Placebo-controlled Randomized Clinical Trial.

The purpose of this study was to evaluate the effect of 8 months of treatment with itraconazole on airway wall thickness in patients with severe persistent asthma. It was a double-blind, randomized, placebo-controlled clinical trial (IRCT20091111002695N9). Seventy-five subjects with severe persistent asthma received itraconazole (100 mg), prednisolone (5 mg), or placebo twice a day for eight months in three treatment groups (n=25 in each group). The primary objective was to improve the right upper lobe apical segmental bronchus (RB1) wall thickness percentage measured by high-resolution computed tomography scan of the lungs. Other morphometric measurements of RB1, asthma control test (ACT) score, presence of wheezing, dyspnea severity, rate of asthma exacerbation, fractional exhaled nitric oxide (FeNO), and expiratory volume in 1 second (FEV1) were set as the secondary outcomes. Wall thickness percentage reduced significantly from 46% to 43.7% from pre- to post-treatment in the itraconazole-treated subjects. Similarly, lumen area and radius increased significantly in both the prednisolone and itraconazole groups. Itraconazole led to a significant improvement in wheezing, dyspnea severity, FEV1, ACT score, and FeNO. Although prednisolone was also effective in improving pulmonary function tests and ACT scores, it was associated with significantly more side effects than itraconazole. Long-term treatment with itraconazole resulted in a significant reduction in bronchial wall thickness and improvements in clinical findings and pulmonary function tests. Thus, itraconazole could be a helpful add-on treatment option for severe persistent asthma patients to achieve better disease control.

Comparison of the effects of buparvaquone and paromomycin on oocyst excretion and clinical parameters in diarrheal calves naturally infected with cryptosporidiosis

Cryptosporidium is an obligate intracellular parasite that infects a wide variety of hosts. Twenty calves with cryptosporidiosis were divided into two groups. A single dose of 2.5 mg/kg buparvaquone was administered intramuscularly to one group, while 100 mg/kg/day paromomycin was administered orally to the other group. The results obtained from the study in which oocyst shedding and clinical parameters of sucking reflex, mental status, oocyst scattering were observed in both groups offer an effective control option with this study, which provides results that support the application of a single dose of buparvaquone injection against the complex treatment methods applied to calves with cryptosporidiosis in the field. In this study, a significant decrease in oocyst shedding and rapid improvement in clinical findings were observed in calves.

Twin Premature Infants With Riboflavin and Biotin Deficiency Presenting With Refractory Lactic Acidosis, Rash, and Multiorgan Failure During Prolonged Parenteral Nutrition.

We are reporting monochorionic, diamniotic twin premature infants born at 25 weeks and 6 days gestation with riboflavin (vitamin B2) and biotin (vitamin B7) deficiency, while on prolonged total parenteral nutrition (TPN) during vitamin shortage. They presented initially with skin rash, lactic acidosis, and thrombocytopenia. Both twins progressed to severe respiratory failure, severe lactic acidosis, with refractory vasodilatory shock, pancytopenia, ischemic bowel injury, acute kidney injury, liver injury, and capillary leak syndrome leading to death of twin A. The surviving twin B was diagnosed with riboflavin and biotin deficiency that presented with abnormal metabolic work up suggestive of maple syrup urine disease, glutaric acidemia type 2, and X-linked adrenoleukodystrophy. Twin B was started on riboflavin and biotin supplementation at 41 days of life, with rapid improvement in clinical findings and laboratory abnormalities within days of starting biotin and riboflavin supplementation. He was discharged home in stable condition at 49 weeks of postmenstrual age.

Machine learning approach to predict subtypes of primary aldosteronism is helpful to estimate indication of adrenal vein sampling.

Primary aldosteronism (PA) is a common disease. Especially in unilateral PA (UPA), the risk of cardiovascular disease is high and proper localization is important. Adrenal vein sampling (AVS) is commonly used to localize PA, but its availability is limited. Therefore, it is important to predict the unilateral or bilateral PA and to choose the appropriate cases for AVS or watchful observation. The purpose of this study is to develop a model using machine learning to predict bilateral or unilateral PA to extract cases for AVS or watchful observation. We retrospectively analyzed 154 patients diagnosed with PA and who underwent AVS at our hospital between January 2010 and June 2021. Based on machine learning, we determined predictors of PA subtypes diagnosis from the results of blood and loading tests. The accuracy of the machine learning was 88% and the top predictors of the UPA were plasma aldosterone concentration after the saline infusion test, aldosterone to renin ratio after the captopril challenge test, serum potassium and aldosterone-to-renin ratio. By using these factors, the accuracy, sensitivity, specificity and the area under the curve (AUC) were 91%, 70%, 99% and 0.91, respectively. Furthermore, we examined the surgical outcomes of UPA and found that the group diagnosed as unilateral by the predictors showed improvement in clinical findings, while the group diagnosed as bilateral by the predictors showed no improvement. Our predictive model based on machine learning can support to choose the performance of adrenal vein sampling or watchful observation.

Ramal bone graft for management of infra-orbital rim fractures with defects – Technical note and a series of 16 cases

The purpose is to describe a technique of using ramal bone graft for reconstructing defects of the infra-orbital rim (IOR), assess outcomes and complications. This was a retrospective chart review of 16 patients who underwent ramal bone grafting for IOR fractures. Outcomes evaluated were improvement in clinical findings (lid/globe malposition, tethering of facial skin and implant extrusion) and complications. Data analysis included descriptive statistics. The sample included 15 males and 1 female, with a mean age of 31.6 years. Lid malposition, globe malposition and tethering of facial skin was seen in 16, 13 and 6 patients, respectively. One patient demonstrated extrusion of implant. The mean size of bone harvested was 14 × 7 mm. All patients demonstrated improved globe position post-treatment, while 3 had residual lid retraction. Two patients demonstrated wound dehiscence in the donor site. In conclusion ramal bone graft was found to be a viable alternative for IOR reconstruction.

Perkütan Transhepatik Biliyer Drenaj: Tek Merkezli Retrospektif Çalışma

Background: Percutaneous transhepatic biliary drainage is a procedure commonly used in malign and benign biliary pathologies. The aim of this study is to evaluate the effectiveness, complication rates and results of percutaneous transhepatic biliary drainage.Materials and Methods: 49 patients, to whom percutaneous transhepatic biliary drainage was performed due to different malignant and benign pathologies between April 2018 and April 2020 in the interventional radiology de-partment of our hospital, were included in the study. 26 of the patients were male, and 23 were female. The ages of the patients ranged between 8 and 87, and the mean age was 62.18±15.8. External drainage catheter was inserted in 11 patients, and internal-external drainage catheter in 38 patients. Metallic stent was inserted in two patients. The efficiency of the procedures was evaluated according to the comparison of preprocedural and postprocedural direct and total bilirubin values and the improvement in clinical findings. Procedure-related early and late complica-tions were obtained.Results: Technical success was achieved in all patients who underwent percutaneous transhepatic biliary drainage. The preprocedural and postprocedural total bilirubin median values were 16.2 mg/dl (0.6-30.5) and 6.3 mg/dl (0.7-26.9), respectively. The preprocedural and postprocedural direct bilirubin median values were 11.9 mg/dl (0.3-15) and 4.3 mg/dl (0.2-15) , respectively. The decrease in the total and direct bilirubin values was found to be significant (p&amp;lt;0.001). Major and minor complications developed in 13 patients in the early and late stages.Conclusions: Percutaneous transhepatic biliary drainage is an efficient method in decompression of malignant biliary obstructions, palliation of the disease and treatment of benign biliary pathologies.Key Words: Percutaneous, Biliary Drainage, Transhepatic

Our experience of laser lithotripsy under local anesthesia in the treatment of bladder stones in obese male patients

Introduction: Our century has witnessed a significant increase in obesity, which in its turn, bears several major risks in management of systemic anesthesia. In this context, use of this treatment without general or regional anesthesia is of critical importance for patients under this group. &#x0D; Aim: In present study, it was aimed to analyze the efficacy and safety of holmium laser lithotripsy (HLL) under local anesthesia in obese male patients with bladder stones.&#x0D; Material and Method: In our study, we evaluated a total of 64 obese male patients with body mass index (BMI) ≥ 30 kg/m2, diagnosed with bladder stones and treated HLL under local anesthesia. Demographic data, stone size, operative time, urethral catheterization time and length of hospital stay of the patients were analyzed. Visual Analogue Scale (VAS) scores was calculated for each patient during the procedure. Complications were graded according to modified Clavien classification system.&#x0D; Results: The mean age of patients was 50.58 ± 13.04 years and BMI was 33.46 ± 2.59 kg/m2. Mean stone size was 2.51 ± 1.04 cm and operative time was 43.91 ± 15.92 minutes. None of the patients had severe pain and the mean VAS score was calculated as 2.31 ± 1.02. Mean length of hospital stay was 1.25 ± 1.04 days. Grade 3 or higher complications were not observed according to modified Clavien classification system. Mean urethral catheterization time was 1.56 ± 1.45 days, although varying due to underlying etiological factor. All patients were stone-free and there was a marked improvement in clinical findings.&#x0D; Conclusion: Use of HLL under local anesthesia is a safe and efficacious approach in obese male patients with bladder stone.

Syrup Hedera helix Extract Poisoning in Dog: a Clinical Report

This clinical report describes a 1-year-old Golden Retriever dog weighing 24 kg that developed gastroenteritis as a result of the unprescribed and random use of a syrup Hedera helix extract, which is for human use only. Diagnosis was made after ruling out other factors that could cause gastroenteritis. An improvement in clinical findings was observed as a result of supportive treatment. It is already widely recognized that triterpene saponins, biological active compounds of Hedera helix, cause gastroenteritis in dogs and it is considered that unprescribed and random use of syrup Hedera helix at high doses, may cause severe gastroenteritis symptoms that will endanger life. It is concluded that successful management of Hedera helix extract poisoning depends on a good anamnesis, physical exams, and laboratory tests, rapidly ruling out other causes of gastroenteritis, quitting the use of syrup immediately and a supportive treatment

Akut Dissemine Ensefalomiyelite Bağlı Periferik Fasiyal Sinir Felci Gelişen Bir Çocuk Hasta

Akut dissemine ensefalomiyelit (ADEM), nörogörüntülemede multifokal demiyelinasyon lezyonlarının kanıtıyla birlikte yaygın nörolojik belirti ve semptomlarla karakterize, santral sinir sisteminin monofazik akut demiyelinizan bir bozukluğu olarak kabul edilir. Yaygın görülen semptomlar letarji, ateş, kusma, baş ağrısı, meningeal belirtiler ve nöbetlerdir. Nörolojik belirtiler arasında duyusal değişiklikler, çoklu kraniyal sinir tutulumu, kuadripleji ve parapleji, distoni ve koreiform hareketler, ataksi, nistagmus, mesane tutulumu, konuşma bozukluğu ve çift görme vardır. Periferik fasiyal sinir felci nadiren eşlik eder. Akut dissemine ensefalomiyelit ile sağ periferik fasiyal sinir felci gelişen 7 yaşındaki bir kız çocuğu olgusunu sunuyoruz. Hastaneye görme azlığı, depresif ruh hali, yürüme bozukluğu ve yüz ifadelerinde bozulma yakınmaları ile başvurdu. Horizontal ve vertikal nistagmus, sağ periferik yüz felci, ataksik yürüyüş ve derin tendon reflekslerinde artış vardı. Beyin omurilik sıvısı (BOS) incelemesi normaldi. Serebral manyetik rezonans görüntülemede (MRG) çoklu beyaz cevher lezyonları görüldü. Yüksek doz metilprednizolon pulse tedavisi ile klinik bulgularda belirgin bir iyileşme gözlemledik.

Semi-quantitative analysis of 18F fluorodeoxyglucose uptake in the assessment of disease activity and therapeutic response in rheumatoid arthritis: An institutional experience.

18F fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) can be used to image synovial inflammation in patients with rheumatoid arthritis (RA). Recently, clinical application of novel therapies for RA, such as tumor necrosis factor-α (TNF-α) inhibitor and anti-interleukin-6 receptor antibody, has been introduced. The radiological assessment of disease activity changes of patients who underwent these therapies will help the clinicians to obtain more information about the patients and to decide drug withdrawal or change of medication. It is considered that 18F-FDG PET scan is generally very expensive; however, the information from 18F-FDG PET about patients during biological treatments helps discontinuation of these treatments with incomplete response despite its high costs and with possible side effects such as malignant lymphoma. In this study, we evaluated if the 18F-FDG uptake of the affected joints represented by standardized uptake value (SUV) correlated with the clinical assessment of patients with RA. In addition, we would like to evaluate if there was a correlation between the difference of SUV and improvement of clinical findings in RA patients undergoing anti TNF therapies. RA patients who underwent anti-TNFα therapies in a tertiary care hospital were assessed using whole-body 18F-FDG PET/computed tomography (CT). PET assessments were performed on hip joints, knees, shoulders, wrists, ankles, MCP, and PIP for a total of 28 joints in each patient. The 18F–FDG uptake was then quantified using the maximum SUV (SUVmax) prior to, and 6 months after the initiation of treatment with anti-TNF-α drugs. Disease activity score (DAS28 and DAS28-C-reactive protein [CRP]) were recorded and white blood cell, matrix metalloproteinases (MMP-3) and rheumatoid factor (RF) were examined in all patients. The average of SUVmax among measured joints, or the sum of these joints (total SUVmax), correlated with DAS28 (r = 0.671, P < 0.001), DAS28-CRP (r = 0.623, P < 0.001), ESR (r = 0.542, P < 0.001), CRP (r = 0.411, P = 0.002), MMP-3 (r = 0.399, P = 0.006), and RF (r = 0.447, P = 0.002). There were correlations between ΔSUV and ΔDAS28 (r = 0.651, P < 0.001), ΔSUV and ΔDAS28-CRP (r = 0.682, P < 0.001), ΔSUV and ΔESR (r = 0.449, P = 0.023), and ΔSUV and ΔMMP-3 (r = 0.457, P = 0.027), respectively. The number of PET-positive joints and the cumulative SUV significantly correlated with the DAS28, which is a composite disease activity score (DAS) that combines the swollen and tender joint counts, the erythrocyte sedimentation rate (DAS28-ESR) or CRP serum levels (DAS28 − CRP) or RF (DAS28 − RF) or metalloproteinases-3 (DAS28-MMP-3). At baseline and at 6 months' post-treatment with anti-TNFα drugs, there was a significant correlation between the PET results, either visual, the cumulative SUVs or the composite SUV index, and the comprehensive clinical assessment (DAS28), the CRP levels and the number of joints positive for RA, and cumulative synovial thickness. By reflecting inflammatory activity, 18F-FDG PET may enhance the diagnostic performance and expectation of disease prognosis in RA, especially with early synovial inflammation. The intensity of uptake varied from mild to intense (SUVmax values from 3.10 to 6.0). Overall, these values correlated well with the clinical evaluation of involved joints. 18F–FDG PET imaging data provided a distribution of joint involvement with varying degrees of severity and phase of disease activity (moderate, low, and remission) in the same patient. PET/CT imaging with 18F-FDG shows better image quality, provides more confirmative diagnostic information, and will be promising imaging modality in diagnosis and management of RA.

Ayurveda management of alcoholic liver disease with acute hepatitis B: A case report

Hepatitis B is a viral infection affecting millions of people across the globe. It is one of the common causes of liver cirrhosis and hepatocellular carcinoma and there is no specific treatment available. In Ayurveda, such conditions can be managed in line of Kamala (~jaundice). A 44 year old male patient with jaundice and abnormal liver functions (high transaminases and hyper bilirubinemia) positive hepatitis B marker and fatty liver. The patient was elsewhere diagnosed to be suffering from viral hepatitis and visited to the outpatient department with reports suggesting of acute viral hepatitis B and Alcoholic Liver Disease (ALD). He was administered Ayurvedic medications along with dietary advices for 72 days. There was a significant improvement in clinical findings, reduction in liver transaminases, and fatty infiltration during the treatment. The patient became hepatitis B surface antigen negative, though no studies on reduction in viral load of Hepatitis B Virus (HBV) and anti-HBc (Hepatitis B core antibody) was done, but the clinical improvements and reduction in transaminase and fatty liver indicate a possible role of Ayurvedic therapy in hepatic injury due to HBV and ALD. This case report also warrants further study of Ayurvedic therapy in other liver conditions.

Effects of Rapid and Ultra-Rapid Fluid Resuscitation Guided by Blood Lactate Clearance Rate in Diarrheic Calves

The assessment of the results of intravenous fluid treatment in diarrheal calves is difficult under field conditions. To determine the effects of ultra-rapid (1 h) and rapid (3 h) intravenous infusions with 0.9% NaCl and 1.3% NaHCO3 solutions at a dose of 60 ml/kg on lactate clearance (LC) in calves with diarrhea. Sixty calves, including a healthy control group (n=20) and a group of calves with diarrhea (n=40), were used. Diarrheic calves were divided into two groups (n=20) according to solution type, and each group was then divided into two equal subgroups according to the infusion rate (n=10). Clinical and laboratory inspections of diarrheic calves were performed pre- and post-infusion, and the healthy control group was examined once. LC rates were calculated in the 1 h and 3 h subgroups. Marked improvements in clinical findings related to dehydration were observed in all groups with neonatal diarrhea that were given intravenous infusions with 0.9% NaCl and 1.3% NaHCO3 solutions. End of the infusion, the LC of the 0.9% NaCl and 1.3% NaHCO3 solutions in the ultra-rapid groups was significantly increased by 36.4% and 31.8%, respectively. However, for rapid infusion of the same solutions, 13.6% and 31.8% increases were observed, but the differences were not significant. Under field conditions, the LC of L- and D-lactate varied with the infusion rate, and these variations were significant in ultra-rapid subgroups for both solutions. Further studies will be designed for fluid therapy in calves based on the calculation of LC.

Comparison of therapeutic response of lycopene and curcumin in oral submucous fibrosis: A randomized controlled trial.

To evaluate and compare the therapeutic response of lycopene and curcumin with placebo in patients suffering from oral submucous fibrosis (OSMF) and to correlate the habit variables of smoked and smokeless tobacco products in OSMF. A randomized placebo-controlled parallel clinical study was conducted on ninety OSMF patients, who were divided into three treatment groups using computer-generated randomization. Group A patients (n=30) were given curcumin tablet (300mg) twice daily, Group B patients (n=30) received lycopene capsules (8mg) twice daily, and for Group C (n=30), placebo capsules were given once daily for a period of six months. Both the participant and outcome assessor were blinded. Pre- and post-treatment comparison of mouth opening, burning sensation, tongue protrusion, and cheek flexibility was analyzed at periodic follow-up of 9months. The overall improvement in mouth opening, burning sensation, tongue protrusion, and cheek flexibility was 3.9±4.9mm, 4.8±2.6, 5.0±7.2mm, & 0.36±0.71mm, respectively, for curcumin and 4.1±4.2mm, 5.0±2.3, 2.4±3.5mm, & 0.66±0.80mm, respectively, for lycopene with the p value <0.05. Statistically significant improvement in clinical findings was observed in both curcumin and lycopene treatment groups in comparison with placebo. However, the therapeutic efficacy of curcumin and lycopene was found to be almost equal in OSMF patients.