Improvement In Other Symptoms Research Articles

Medical Cannabis Prescription Practices and Quality of Life in Thai Patients: A Nationwide Prospective Observational Cohort Study.

The legalization of cannabis in Thailand has renewed interest in its traditional medical use. This study aimed to explore the prescribing patterns of traditional practitioners and assess the impact of cannabis oil on patients' quality of life, with a specific focus on comparing outcomes between cancer and non-cancer patients. We conducted a prospective observational cohort study across 30 sites in 21 Thai provinces to analyze the use of "Ganja Oil," a cannabis extract in 10% coconut oil, prescribed for symptoms like pain, anorexia, and insomnia across a diverse patient group, including cancer and migraines. Quality of life was assessed using the Edmonton Symptom Assessment Scale (ESAS) and EQ-5D-5L at baseline, 1, 2, and 3 months. The study included a predefined subgroup analysis to compare the effects on cancer versus non-cancer patients. Data management was facilitated through Research Electronic Data Capture (REDCap), with statistical analysis performed using Stata/MP. Among 21,284 participants, the mean age was 54.10 ± 15.32 years, with 52.49% being male. The baseline EQ-5D-5L index was 0.85 ± 0.24. Significant differences in EQ-5D-5L indices were seen between cancer patients (0.79 ± 0.32) and non-cancer patients (0.85 ± 0.23; p < 0.001). ESAS scores also differed significantly between these groups for all symptoms, except anxiety. The most frequent prescription of Ganja Oil was oral administration at bedtime (88.26%), with the predominant dosage being three drops daily, approximately 0.204 mg of tetrahydrocannabinol in total. Posttreatment, significant improvements were noted: the EQ-5D-5L index increased by 0.11 points (95% CI: 0.11, 0.11; p < 0.001) overall, 0.13 points (95% CI: 0.12, 0.14; p < 0.001) for cancer patients, and 0.11 points (95% CI: 0.10, 0.11; p < 0.001) for non-cancer patients. ESAS pain scores improved by -2.66 points (95% CI: -2.71, -2.61; p < 0.001) overall, -2.01 points (95% CI: -2.16, -1.87; p < 0.001) for cancer patients, and -2.75 points (95% CI: -2.80, -2.70; p < 0.001) for non-cancer patients, with similar significant improvements in other symptoms. Our study indicates potential benefits of Ganja Oil for improving quality of life among Thai patients, as a complementary treatment. These findings must be viewed in light of the study's design limitations. Further controlled studies are essential to ascertain its efficacy and inform dosing guidelines.

Writing to Keep on Living: A Systematic Review and Meta-Analysis on Creative Writing Therapy for the Management of Depression and Suicidal Ideation.

The purpose of this review and meta-analysis was to explore the effectiveness of creative writing therapies for the management of depression and suicidal ideation. Twenty one of the 31 reviewed studies showed that creative writing significantly improved depressive symptoms, while five studies suggested improvement in other symptoms. The results of meta-analyses showed that narrative writing significantly reduced depression compared to those in neutral writing or treatment as usual condition in both post intervention and follow-up. However, the number of studies exploring the effects of creative writing in suicidal ideation was too low to perform a meta-analysis. A structured and well-targeted intervention using creative writing could have beneficial results for the management of depressive symptoms. More studies are needed to explore the potential benefits of creative writing for reducing suicidal ideation.

Palliative Management of Inoperable Malignant Bowel Obstruction: Prospective, Open Label, Phase 2 Study at an NCI Comprehensive Cancer Center

ContextMalignant bowel obstruction (MBO) is a common complication of intra-abdominal cancer, frequently seen in advanced gastrointestinal and gynecologic cancer. Management of MBO can be challenging, particularly if the patient is not a surgical candidate. No consensus exists on how best to manage these patients medically. Retrospective studies suggest that the combination of dexamethasone, octreotide and metoclopramide may lead to relief of obstruction and improvement in symptoms associated with the obstruction. ObjectivesThis study seeks to prospectively evaluate the combination of drug “triple therapy” dexamethasone 4 mg BID, metoclopramide 10 mg Q6 and octreotide 300 mcg TID to assess tolerability, safety, and effect on symptoms and deobstruction. MethodsAdults admitted at Roswell Park Comprehensive Cancer Center with malignant bowel obstruction were eligible. Eligible patients who constented to the study were started on the triple therapy with close monitoring of symptoms and for adverse effects. ResultsA total of 15 patients enrolled in the study. Two patients experienced bradycardia as adverse effect and there was no incidence of bowel perforation. All patients who completed the study had complete resolution of their nausea, and improvement in other symptoms including pain, constipation, tolerance of oral intake and resumption of bowel movements. Only two of the 15 patients were alive to complete the six-month post study follow up. Conclusion“Triple therapy” with dexamethasone, metoclopramide, and octreotide for management of nonsurgical MBO in this small sample size appears safe and well tolerated however a diagnosis of inoperable MBO remains associated with poor prognosis and death within months.

Immunoregulatory and/or Anti-inflammatory Agents for the Management of Core and Associated Symptoms in Individuals with Autism Spectrum Disorder: A Narrative Review of Randomized, Placebo-Controlled Trials.

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition with a so far poorly understood underlying pathogenesis,and few effective therapies for core symptoms. Accumulating evidence supports an association between ASD and immune/inflammatory processes, arising as a possible pathway for new drug intervention. However, current literature on the efficacy of immunoregulatory/anti-inflammatory interventions on ASD symptoms is still limited. The aim of this narrative review was to summarize and discuss the latest evidence on the use of immunoregulatory and/or anti-inflammatory agents for the management of this condition. During the last 10 years, several randomized, placebo-controlled trials on the effectiveness of (add-on) treatment with prednisolone, pregnenolone, celecoxib, minocycline, N-acetylcysteine (NAC), sulforaphane (SFN), and/or omega-3 fatty acids have been performed. Overall, a beneficial effect of prednisolone, pregnenolone, celecoxib, and/or omega-3 fatty acids on severalcore symptoms, such as stereotyped behavior, was found. (Add-on) treatment with prednisolone, pregnenolone, celecoxib, minocycline, NAC, SFN, and/or omega-3 fatty acids was also associated with a significantly higher improvement in other symptoms,such as irritability, hyperactivity, and/or lethargy when compared with placebo. The mechanisms by which these agents exert their action and improve symptoms of ASD are not fully understood. Interestingly, studies have suggested that all these agents may suppress microglial/monocyte proinflammatory activation and also restore severalimmune cell imbalances (e.g., T regulatory/T helper-17 cell imbalances), decreasing the levels of proinflammatory cytokines, such as interleukin (IL)-6 and/or IL-17A,both inthe blood and inthebrain of individuals with ASD. Although encouraging, the performance of larger randomized placebo-controlled trials, including more homogeneous populations, dosages, and longer periods of follow-up, are urgently needed in order to confirm the findings and to provide stronger evidence.

EFFECTIVE MANAGEMENT OF DUSHTA VRANA WITH PRAKSHALAN KARMA: A CASE REPORT

A condition where the tissues in the body are destroyed selectively and after repair, discoloration occurs leaving a scar for a lifetime is known as a wound or Vrana. The management and healing process of wounds regardless of their tissue types or the incite injury are described in Ayurveda. Through this knowledge the surgeons are able to manipulate wounds which helps in achieving optimal results in a short period. Non healing ulcers can be correlated with Dushta Vrana in Ayurveda. The word prakshalana means washing. Prakshalana karma is a procedure where medicated decoction is poured over the affected area. In dushta Vrana, this procedure helps in cleaning the wound from the dirt, infection, and germs. It also hastens the wound healing process as it helps in quick renewal of the cells. In the present case report of dushta vrana, a detailed history of the patient with all necessary clinical and physical examination and laboratory investigations were carried out. The patient was admitted in the hospital and treated with external procedure like prakshalana karma along with other internal medications. The wound showed maximum improvement after the Prakshalana karma with improvement in other symptoms as well as the healing of the wound.

Restlessness and an Increased Urge to Move (Drive for Activity) in Anorexia Nervosa May Strengthen Personal Motivation to Maintain Caloric Restriction and May Augment Body Awareness and Proprioception: A Lesson From Leptin Administration in Anorexia Nervosa.

Anorexia nervosa (AN), a disorder of voluntary food restriction leading to severe weight loss in female adolescents, remains an enigma. In particular, the appropriation of the starved thin body into the self-concept in AN is a process insufficiently researched and still poorly understood. Healthy humans undergoing starvation experience a slowing of movements and avoid voluntary exercise. By contrast, AN tends to be not infrequently associated with voluntary, sometimes excessive and/or compulsive exercise. Such deliberate exercise, not reported in starvation, seems to be facilitated by an increased urge for movement and physical restlessness, particular to AN. The increased urge to move would reflect spontaneous daily activity, the energy expended for everything that is not sleeping, eating, or voluntary exercise. Our hypothesis is that the starvation-induced increased urge to move and restlessness may promote the development of AN. Reversal of the fasting state, by either high caloric food or by leptin administration, would be expected to reduce restlessness and the increased urge to move along with improvement in other symptoms in AN. This review explores the idea that such restless activation in AN, in itself and through accelerating body weight loss, might foster the integration of the starving body into the self-concept by (1) enhancing the person’s sense of self-control and sense of achievement and (2) through invigorating proprioception and through intensifying the perception of the changing body shape. (3) Tentative evidence from studies piloting leptin administration in chronic AN patients which support this hypothesis is reviewed. The findings show that short term administration of high doses of leptin indeed mitigated depressive feelings, inner tension, intrusive thoughts of food, and the increased urge to be physically active, easing the way to recovery, yet had little influence on the patients’ personal commitment to remain at a low weight. Full recovery then requires resolution of the individuals’ personal unresolved psychological conflicts through psychotherapy and frequently needs specialized treatment approaches to address psychiatric co-morbidities. AN might be conceptualized as a hereditary form of starvation resistance, facilitated by the effects of starvation on fitness allowing for an exceptionally intense personal commitment to perpetuate food restriction.

Using a Brief Mental Imagery Competing Task to Reduce the Number of Intrusive Memories: Exploratory Case Series With Trauma-Exposed Women.

BackgroundNovel interventions should be developed for people who have undergone psychological trauma. In a previous case study, we found that the number of intrusive memories of trauma could be reduced with a novel intervention. The intervention included a brief memory reminder, a visuospatial task and mental rotation, and targeted trauma memory hotspots one at a time in separate sessions.ObjectiveThis case series (N=3) extended the first case study with 3 new cases to determine whether a similar pattern of beneficial results is observed. We explored whether the brief intervention would result in reduced numbers of intrusive memories and whether it would impact symptoms of posttraumatic stress, depression and anxiety, and general functioning. Acceptability of the intervention was also explored.MethodsA total of 3 women completed the study: 2 with posttraumatic stress disorder and other comorbidities and 1 with subthreshold posttraumatic stress disorder. The primary outcome was the change in the number of intrusive memories from the baseline phase to the intervention phase and at the 1-month follow-up, with an assessment of the intrusion frequency at 3 months. Participants monitored the number of intrusive memories in a daily diary for 1 week at baseline, for maximum of 6 weeks during the intervention phase and for 1 week at the 1-month and 3-month follow-ups. The intervention was delivered in person or digitally, with guidance from a clinical psychologist. A repeated AB design was used (A was a preintervention baseline phase and B intervention phase). Intrusions were targeted individually, creating repetitions of an AB design.ResultsThe total number of intrusive memories was reduced from the baseline to the intervention phase for all participants. The total number for participant 3 (P3) reduced from 38.8 per week during the baseline phase to 18.0 per week in the intervention phase. It was 13 at the 3-month follow-up. The total number for P4 reduced from 10.8 per week at baseline to 4.7 per week in the intervention phase. It was 0 at the 3-month follow-up. The total number for P5 was reduced from 33.7 at baseline to 20.7 per week in the intervention phase. It was 8 at the 3-month follow-up. All participants reported reduction in posttraumatic stress symptoms in the postintervention phase. Depression and anxiety symptoms reduced in 2 of the 3 participants in the postintervention phase. Acceptability was favorable.ConclusionsWe observed good compliance with the intervention and intrusive memory diary in all 3 cases. The number of intrusive memories was reduced for all participants during the intervention phase and at the 1-month follow-up, with some improvement in other symptoms and functioning. Further research should explore the remote delivery of the intervention and whether nonspecialists can deliver the intervention effectively.

A Case Report of Chemotherapy-Induced Peripheral Neuropathy Treated with Modified &lt;italic&gt;Guibi-tang&lt;/italic&gt;

Objective: The purpose of this study was to report the effectiveness of modified &lt;i&gt;Guibi-tang&lt;/i&gt; in a patient suffering from chemotherapy-induced peripheral neuropathy (CIPN).Methods: A 54-year-old Korean female patient diagnosed with recurrent ovarian cancer had CIPN with other symptoms, such as anorexia, dyspepsia, insomnia, etc. She was diagnosed with Simbiyangheo and hence treated with a modified &lt;i&gt;Guibi-tang&lt;/i&gt;. Neuropathic symptoms were assessed using a numerical rating scale (NRS) and a sensory score. Quality of life was assessed using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity (FACT/GOG-Ntx).Results: After 14 days of treatment, the patients showed a decrease in NRS for bilateral limb pain and improvement in other symptoms, such as general weakness, insomnia, dizziness, and headache. Quality of life also increased.Conclusion: Modified &lt;i&gt;Guibi-tang&lt;/i&gt; may be considered an optional treatment for CIPN if the patient is diagnosed with Simbiyangheo. Further studies are needed to confirm this finding.

Effect of Jiuwei Zhuhuang Powder on Cough Resolution in Children with Upper Respiratory Tract Infections: A Multicenter Randomized Controlled Trial.

ObjectiveTo assess the effectiveness of Jiuwei Zhuhuang Powder (JWZH), a Tibetan patent medicine in treating upper respiratory tract infection (URTI) associated cough in children.MethodsThe study was a multicenter, randomized, open-label, controlled trial. A total of 142 children aged 2 to 14 years old, with URTI-associated cough within 48 h of onset, were randomly assigned to two groups at a 1:1 ratio by computer-generated randomization sequence. Children were treated with JWZH (1 to 1.5 g, twice to thrice daily) in the treatment group or conventional treatment (Pediatric Paracetamol, Artificial Cow-bezoar and Chlorphenamine Maleate Granules, 0.25 to 1 g, thrice daily) in the control group for 5 days. The primary endpoints were the time to cough resolution and 4-day cough resolution rate. The secondary endpoints were the daily improvement in symptom scores and cough resolution rate during the study period.ResultsA total of 138 children were included in the intention-to-treat analysis, with 71 cases in the treatment group and 67 cases in the control group. Compared with the conventional treatment, the children receiving JWZH had a shorter time to cough resolution [hazard ratio, 2.10; 95% confidence interval (CI), 1.29–3.40; P=0.003]. The median time to cough resolution for children receiving JWZH was shorter than that of the conventional treatment (2 days vs. 3 days; P<0.001). The 4-day cough resolution rate in the JWZH group was higher than that of the control group (94.4% vs. 74.6%; risk difference: 19.8%, 95% CI: 8.1%–31.5%; relative risk: 1.265, 95% CI: 1.088–1.470; P=0.001). There were no statistically significant differences in the improvement of other symptoms caused by URTI (P>0.05). Adverse events was reported in 5.6% (4/71) and 4.5% (3/67) in participants of JWZH and PPACCM groups (P>0.05), respectively, which were all mild and resolved without treatment.ConclusionJWZH seemed to be a safe and effective therapy for URTI-associated cough in children. (Trial registration No. ChiCTR2000039421)Electronic Supplementary MaterialSupplementary material (Appendices 1–3) is available in the online version of this article at 10.1007/s11655-021-3462-x.

Qol-P-01 - Interviews with patients and their spouses to capture personal descriptions of early treatment experience with mogamulizumab for mycosis fungoides (MF) and Sézary syndrome (SS)

<h3>Background:</h3> Mycosis fungoides (MF) and Sézary syndrome (SS) are rare and chronic non-Hodgkin lymphomas that present in skin and can progress to involve extracutaneous sites. For many patients, skin lesions are disfiguring with an intractable itch. Other symptoms can include difficulty regulating body temperature and sleep disturbance. Symptomatic MF and SS can have a negative impact on health-related quality of life (HRQL). Mogamulizumab is approved in Europe for the treatment of adult patients with MF or SS after at least one prior systemic therapy based on the efficacy and safety demonstrated in the phase 3 MAVORIC trial (NCT01728805). <h3>Objectives:</h3> To capture personal descriptions from patients and their spouses of the burden of MF and SS before starting mogamulizumab treatment and their early treatment experience. <h3>Methods:</h3> Five patients and three spouses were recruited at two hospital clinics in the UK. Following informed consent, 1:1 semi-structured, 60-minute telephone interviews were conducted. Participants were asked about their experience of symptoms and impact of their condition on domains of HRQL prior to starting treatment with mogamulizumab, and any changes during the first six months of treatment. Spouses were also asked about any impact on their role as a carer since mogamulizumab treatment was initiated. Interviews were transcribed, responses coded, and narrative summary provided. <h3>Findings:</h3> Prior to treatment with mogamulizumab, patients and their spouses reported moderate-to-severe problems with all skin-related symptoms and regulating their body temperature. The majority described fatigue and sleep problems, with spouses also reporting patients' moderate-to-severe problems with those symptoms. On starting mogamulizumab, both patients and their spouses described rapid improvement in itching, with gradual improvement in skin flaking, redness, and pain/discomfort. Similarly, body temperature regulation, fatigue and sleep quality gradually improved in the first six months of treatment. There was a wide distribution in the reported level of disease impact on HRQL domains prior to treatment with mogamulizumab including emotional well-being, ability to self-care, activities of daily living, social well-being, and family relationships. Symptom presentation on hands and feet was associated with greater impact on these QoL domains. For those with moderate-to-severe problems pre-treatment, patients and spouses described a meaningful reduction in the level of impairment, sometimes within the first few months of treatment. Spouses reported that their everyday life as a carer had positively changed since their partner had received treatment with mogamulizumab. <h3>Conclusion:</h3> Participants described multiple symptoms and the detrimental impact on their HRQL prior to treatment with mogamulizumab. There was a rapid improvement in itching with improvement in other symptoms and overall HRQL in the first six months of mogamulizumab treatment.

Changes in Carcinoid Syndrome Symptoms Among Patients Receiving Telotristat Ethyl in US Clinical Practice: Findings from the TELEPRO-II Real-World Study.

BackgroundInadequately controlled symptoms incur a substantial burden on patients with neuroendocrine tumors and carcinoid syndrome (CS). The effectiveness of telotristat ethyl (TE) with a somatostatin analog for uncontrolled CS diarrhea has been demonstrated in clinical trials and observational studies. TELEPRO-II was a prospective observational study evaluating TE’s effectiveness in clinical practice over the first 3 months of treatment.MethodsPatients initiating TE in 2018 participated in an optional nurse support program reporting CS symptoms during interviews at baseline and 1, 2, and 3 months after TE initiation. Eligible patients received TE for ≥3 months and reported symptom burden at baseline and ≥1 follow-up visit within the first 3 months. Daily bowel movement (BM) frequency and flushing episodes were reported as events/episodes per day. Stool consistency, nausea severity, urgency severity, and abdominal pain were reported on a severity scale (1–10). Symptom changes were evaluated using paired-sample t-tests and Wilcoxon signed-rank tests. Analysis of symptoms based on achievement of <30% or ≥30% reduction in daily BM frequency was conducted using a cumulative distribution function.ResultsA total of 684/1603 (43%) patients were eligible for analysis. At baseline, patients reported a mean of 6.3 BM/day, nausea severity of 8.4/10 and stool urgency of 8.2/10. Significant improvements in all CS symptoms were observed after 3 months of TE. Mean daily BMs were reduced 64% after 3 months of TE (mean reduction [SD], –3.99 [3.8]; P<0.0001). Most patients (74%, n=503) reported ≥30% reduction in daily BM frequency; these patients also reported improvements in other symptoms (76–87%). Patients with <30% reduction in daily BMs also reported improvements in nausea severity (62%, n=24), daily flushing episodes (66%, n=98), abdominal pain (50%, n=60), urgency severity (38%, n=64), and stool consistency (24%, n=44).ConclusionPatients treated with TE in a real-world setting experienced significant, clinically meaningful improvements in CS symptoms.

Nanovesicles delivery approach for targeting steroid mediated mechanism of antipsoriatic therapeutics

Psoriasis is a most devastating autoimmune condition of anomalously differentiating keratinocytes modifying the barrier function of skin for topical medication. A recurring supply of antiinflammatory therapeutics at a viable epidermal layer is needed to regulate the skin pathology in psoriasis. To meet these treatment targets, traditional modules such as creams, lotions, and gels have been found to be relatively ineffective. Vesicular delivery carriers such as first-generation vesicular structures like liposomes and their modified forms are being utilized for effectual topical delivery of numerous therapeutics for about centuries but remain a realm to be explored with innovation. To provide a controlled release and therapeutic retention at the desired site, the nanovesicular approach is most effective. Apart from that, nanovesicles have numerous advantages such as substantial penetration through the stratum corneum (SC), ease of production, stability, biocompatibility, and inertness. Therefore, in the current investigation, the Triamcinolone acetonide-loaded transfersomes (TA-TFS) have been developed and optimized for the delivery of corticosteroids. The nanovesicles were tested for different in vitro and ex vivo characterization criteria and optimized carriers were subsequently incorporated into a gel as the final formulation. Further, the psoriatic animal model was developed and preclinical studies were performed to evaluate permeation, histopathological evaluation, and cytokine level. The permeation study showed the significant transepidermal penetration and distribution of TA-TFS at viable epidermal layer with controlled drug release. The therapeutic efficacy tested against histological characters and cytokine levels were also evident in providing the anti-inflammatory activity and improvement in other symptoms. The overall investigation suggests that the currently developed formulation can efficiently target the steroid-mediated mechanism of antipsoriatic therapeutics for the effective management of skin conditions in the psoriatic animal model.

Effects of daily mindfulness practice on fatigue, kinesiophobia, and quality of life in patients with acute myocardial infarction: a randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: None. Background and Aim Mindfulness meditation (MM) leads to controlled blood pressure and positive improvements in other symptoms which may trigger acute coronary diseases. The present randomized controlled study was aimed to investigate the effect of the MM on fatigue, kinesiophobia, and the quality of life (QoL) in patients with acute MI. Method The study was carried out with 56 MI patients. Participants were randomly assigned to meditation group (MG; n = 28) or control group (CG; n = 28). The MG patients received a 15 min MM session comprising sitting and breathing for a total of eight weeks, while the CG patients received only a single-time attention-matched education. Piper Fatigue Intervention, Tampa Scale for Kinesiophobia-Heart and MacNew Quality of Life scales were utilized for data collection. Results After completion of the 8-week MM, any significant difference was not found in the fatigue scores of the patients (p &amp;gt; 0.05). On the other hand, kinesiophobia scores in the MG were significantly lower in the 4th, 8th and 12th weeks (p &amp;lt; 0.05). Similarly, the QoL scores were significantly higher in the MG in 8th week (p &amp;lt; 0.05). Significant change in the emotional function sub-dimension of QoL continued in the follow-up assessment at 12th week (p &amp;lt; 0.05). Conclusion The MM can significantly improve the QoL and decrease kinesiophobia in patients with MI. Beneficial effect of MM is maintained particularly in the emotional aspect. Based on the results of the study, MM may be recommended as a mind-body based complementary approaches within the scope of secondary protection after MI. Comparison of the study groupsGroupBaseline(Mean ± SD)4th week(Mean ± SD)8th week(Mean ± SD)12th week(Mean ± SD)PFSMM2.08 ± 1.870.90 ± 0.990.47 ± 0.780.44 ± 0.76CG1.56 ± 2.011.12 ± 1.590.98 ± 1.520.76 ± 1.33tp1.004 0.32-0.6210.54-1.5840.12-1.0850.28TSK-HMM40.25 ± 5.0436.18 ± 4.4934.39 ± 4.6134.96 ± 4.71CG41.71 ± 7.2841.89 ± 6.7441.82 ± 5.8441.00 ± 5.54tp-0.8750.39-3.7340.001-5.279 0.000-4.3900.00MacNewMM5.04 ± 0.715.53 ± 0.455.76 ± 0.475.77 ± 0.47CG5.17 ± 0.855.32 ± 0.605.37 ± 0.525.53 ± 0.46t; p-0.640; 0.531.436; 0.162.933; 0.0051.964; 0.06(Mean ± SD): Mean ± Standard Deviation; PFS: Piper Fatigue Scores; TSK-H: Tampa Scale for Kinesiophobia-Heart; MacNew: MacNew Quality of life Scale; EFS: emotional functioning sub-dimension; PFS: physical functioning sub-dimension; SFS: social functioning sub-dimension; t= Student T Test value; p&amp;lt; 0.05

Children experienced new or worsening tic issues when they were separated from their parents during the Italian COVID-19 lockdown.

Decades of research have confirmed that children develop best when they are in safe, supportive, nurturing relationships (1). Positive relationships with parents are essential for children's growth, health and wellbeing (1,2), as they protect them and help them to regulate their emotions during stressful times. If children are unnecessarily and traumatically removed from their parents, their physical and mental health and wellbeing will suffer (1,2).

S2926 Isolated Gastritis Secondary to Immune Checkpoint Inhibitors Complicated With Superimposed CMV Infection

INTRODUCTION: This case highlights the clinical manifestations and management of a patient with gastritis that occurred after nivolumab and was complicated by superimposed cytomegalovirus (CMV) infection. CASE DESCRIPTION/METHODS: A 55-year-old male with metastatic renal cell carcinoma on nivolumab, was seen in consultation for epigastric pain, hematemesis, melena, weight loss, nausea, vomiting and food intolerance. He denied diarrhea or hematochezia. Physical exam was notable for ill appearance and epigastric tenderness. Computed tomography showed diffuse gastric wall thickening. EGD revealed diffuse severely erythematous, friable mucosa with mucosal sloughing in the entire examined stomach. Also, a group of nummular lesions were seen in the body (Figure 1). The esophagus and duodenum were normal. Gastric biopsy showed infiltration of the lamina propria with inflammatory cells and erosive mucosa, suggestive of immune checkpoint inhibitor-related gastritis. Helicobactor pylori and CMV immunostain were negative. Nivolumab was discontinued. Prednisone 140 mg and pantoprazole 40 mg oral daily were started; a dose of infliximab 5 mg/kg was administered. His symptoms initially improved but recurred within 3 weeks. A repeat EGD showed diffuse severe inflammation characterized by adherent blood, erosions, erythema, friability, granularity and confluent ulcerations in the entire stomach (Figure 2). Biopsies were notable for severe ulceration and granulation with CMV cytopathic changes, suggestive of superimposed CMV gastritis. Steroids were tapered and intravenous ganciclovir was started, resulting in resolution of hematemesisand melena and partial improvement of other symptoms. EGD was repeated and showed diffuse moderately erythematous, granular and friable mucosa with nodularity and contact oozing in entire stomach (Figure 3). Biopsies showed ulcerative gastric mucosa with dense organized granulation tissue and reactive changes. CMV immunostain was negative. Symptoms gradually improved and at 2 months follow up patient reported near complete resolution of all symptoms. DISCUSSION: Gastritis is a rare complication of nivolumab treatment. The mainstay of treatment is discontinuing nivolumab. Steroids and infliximab have been used for ICI-related colitis. However, data regarding their efficacy in patients with ICI-related gastritis is sparse. Superimposed CMV made the management of this case more challenging. Further studies are needed to better characterize the natural history and outcome of ICI-related gastritis.Figure 1Figure 2Figure 3

Evaluation of the Effect of Endoscopic Sinus Surgery with Medialization of Middle Turbinate

Background: The main goals and key points of endoscopic sinus surgery are providing a sufficient drainage and ventilation for the diseased paranasal sinus groups. Method: A total of 44 patients (males 22 & 22 females) were included in this study, all of them complaining of chronic rhinosinsitis with or without polyposis not responding to maximal medical treatment and were assigned for ESS. Patients were classified into three groups; Group A: ESS with bolgarization, Group B: ESS with suture medialization of middle turbinate, Group C: ESS without medialization Postoperatively, patients were followed up with subjective (nasal obstruction, nasal discharge, headache, fascial pressure and smell disturbance) and objective (endoscopic evaluation of middle meatal MM patency) parameters in 2 weeks, I month, 3 months, 6 months and 1 year. Result: There improvement in nasal obstruction was reported by patients in all the three groups. Improvement in other symptoms was significantly higher in group A as compared to other groups. MM patency was evaluated by endoscopy and showed improvement of 100% in group B.

Structure and Connectivity of Depressive Symptom Networks Corresponding to Early Treatment Response

BackgroundThere are suggestions that denser network connectivity (i.e., the strength of associations between individual symptoms) may be a prognostic indicator of poor treatment response in depression. We sought to examine this aspect of depressive symptom networks in the context of early responses to treatment in adolescents. MethodsRoutine psychiatric data were obtained for child/adolescent service users who underwent at least three treatment sessions in publicly funded services in England between 2011 and 2015 (N = 3017, 78% female; mean age [SD] = 14.43 years [1.75]). Depressive symptoms were assessed using the Revised Children's Anxiety and Depression Scale at presentation, and again after three treatment sessions. Treatment response was determined using the Reliable Change Index. Network analysis was used to compare the depressive symptom structure and connectivity of sub-samples who, after three treatment sessions had: 1) positively responded (n = 566), 2) not reliably changed (n = 2277), and 3) reliably deteriorated (n = 174), using matched samples to control for baseline severity. FindingsOverall connectivity (i.e., the summed total of weighted connections) was significantly weaker for the positive treatment response group at baseline (compared with unchanged and deteriorated groups), however, this group saw the largest increase in connectivity over the course of treatment. With regard to the overall importance of specific symptoms within the networks, fatigue was highest in strength for the unchanged and deteriorated groups, whereas low mood was highest in strength for the improved group. InterpretationThis study demonstrates that adolescents who respond early to treatment for depression are characterised by symptom networks that are less densely connected initially, yet increase in connectivity over the course of treatment. This may be indicative of ‘positive spirals’ whereby improvement in one symptom triggers improvements in other symptoms, thereby increasing symptom–symptom associations even as severity decreases. FundingThe study was supported by the Wellcome Trust grant 204366/Z/16/Z. The funders had no role in the study design, data collection, data analysis, interpretation, or writing of the report.

Assessment of Laparoscopic Mini-Gastric Bypass (LMGB) as A Treatment for Failed Vertical Band Gastroplasty (VBG); Safety and Outcome

AbstractBackground: Bariatric surgery is one of the most successful methods for sustained weight loss in morbid obese patients. Despite the initial success of Vertical Band Gastroplasty (VBG) 10-25% of patients will require re-operation for un-satisfactory results. Re-operation carries the risk of high morbidity and mortality. The Laparoscopic Mini-Gastric Bypass (LMGB) for revision of failed VBG will be evaluated in this study.Methods: Between January 2015 and March 2017 in Ain Shams University Hospitals 50 patients with failed VBG were enrolled in this prospective study evaluating LMGB as an option for revision.Results: In our study 50 patients underwent LMGB for revision of failed open VBG, the incidence of intra-operative complications was 6% and post operative complications was 22% with significant improvement of BMI after one year of the operation and marked improvement of other symptoms of failure.Conclusion: At our study LMGB appears to be a safe and sound option as a revisional surgery after open VBG with satisfactory weight loss and less incidence of complications.

A PRISMA-compliant systematic review of the endpoints employed to evaluate symptomatic treatments for primary headaches

BackgroundPrimary headache are prevalent and debilitating disorders. Acute pain cessation is one of the key points in their treatment. Many drugs have been studied but the design of the trials is not usually homogeneous. Efficacy of the trial is determined depending on the selected primary endpoint and usually other different outcomes are measured. We aim to critically appraise which were the employed outcomes through a systematic review.MethodsWe conducted a systematic review of literature focusing on studies on primary headache evaluating acute relief of pain, following the PRISMA guideline. The study population included patients participating in a controlled study about symptomatic treatment. The comparator could be placebo or the standard of care. The collected information was the primary outcome of the study and all secondary outcomes. We evaluated the studied drug, the year of publication and the type of journal. We performed a search and we screened all the potential papers and reviewed them considering inclusion/exclusion criteria.ResultsThe search showed 4288 clinical trials that were screened and 794 full articles were assessed for eligibility for a final inclusion of 495 papers. The studies were published in headache specific journals (58%), general journals (21.6%) and neuroscience journals (20.4%).Migraine was the most studied headache, in 87.8% studies, followed by tension type headache in 4.7%. Regarding the most evaluated drug, triptans represented 68.6% of all studies, followed by non-steroidal anti-inflammatories (25.1%). Only 4.6% of the papers evaluated ergots and 1.6% analyzed opioids.The most frequent primary endpoint was the relief of the headache at a determinate moment, in 54.1%. Primary endpoint was evaluated at 2-h in 69.9% of the studies. Concerning other endpoints, tolerance was the most frequently addressed (83%), followed by headache relief (71.1%), improvement of other symptoms (62.5%) and presence of relapse (54%). The number of secondary endpoints increased from 4.2 (SD = 2.0) before 1991 to 6.39 after 2013 (p = 0.001).ConclusionHeadache relief has been the most employed primary endpoint but headache disappearance starts to be firmly considered. The number of secondary endpoints increases over time and other outcomes such as disability, quality of life and patients’ preference are receiving attention.

Effectiveness of Japanese Kampo treatment in dysmenorrhea: Single‐center observational study

ABSTRACTAimKampo medicine, a Japanese traditional medicine, is a leading candidate in alternative medicine for treating dysmenorrhea. The efficacy of some formulas has been reported in randomized placebo‐controlled trials, but the effectiveness and safety of Kampo treatment with regard to specialist selection of an appropriate formula remain unclear. We therefore conducted a single‐center observational study to evaluate the effectiveness and safety of Kampo treatment for dysmenorrhea.MethodsA retrospective chart review was performed of patients with dysmenorrhea at Keio University Hospital between May 2008 and March 2015. Exclusion criteria were age &gt;50 years and failure to attend follow up. Patients with any degree of improvement in dysmenorrhea by ≤90 days after the first consultation were categorized in the effective dysmenorrhea treatment group. We also examined any improvement in other symptoms after the prescription of medicine for the patients not included in the aforementioned group. Adverse reactions were also investigated.ResultsWe examined 157 patients, with a median age of 33 years (range, 12–49 years) at the time of the first consultation. A total of 122 patients (77.7%) were diagnosed with primary dysmenorrhea, 99 of whom (63.1%) were categorized in the effective dysmenorrhea treatment group. In addition, loss of appetite, premenstrual symptoms, and cold sensations were improved in the patients not in the effective dysmenorrhea treatment group. Adverse, but mild, reactions were reported in 15.9% of patients.ConclusionKampo treatment by specialists can be a safe treatment option for dysmenorrhea.