Integrated Treatment Research Articles

Role of Ayurveda Medicine in the management of Pakshaghata vis a vis Hemiplegia

Pakshaghata (Hemiplegia) is caused due to Vikruta Vata Dosha which is characterized mainly loss or altered motor and sensory activity in one side of the body. Onset of the disease is usually insidious. According to modern literature it is usually caused due to either cerebral haemorrhage or cerebral thrombosis. Cerebral thrombosis cases show insidious onset and cerebral haemorrhage patients will be having sudden onset. Severe malignant hypertension, cerebral arterial atherosclerosis usually induces this disease. Severe hypertension causes aneurysm and rupture of one of the cerebral arteries and results in sudden Hemiplegia. Hemiplegia may be contrilateral or ipsilateral. After recovery from acute illness like altered sensorium or coma, Ayurveda or integrative treatment can be given, controlling comorbidities like Diabetes, Hypertension or Ischemic heart disease, Ayurveda medicines are given. Medicines having the actions like Medhya, Nadibalya, Rasayana, Vatahara, CNS stimulators, Anti-hypertensive, Pramehahara, Anti atherogenic, Thrombolytic, Anti platelet aggregating, Jeevaniya, Ojaskara, Vayasthapana, Anti stress adaptogenic, Hypochloestremic, Mala Vatanulomana, Virechana, Snehana (Taila Abhyanga), Swedana (Shasthika Shali Pinda Sweda) are given in these patients. The present paper highlights the role of Ayurveda and Integrative medicine in the management of Pakshaghata vis a vis Hemiplegia.

Enhancing Integrated Treatment Programs for Severe Concurrent Substance Use and Mental Disorders: Insights on Overdose from the ROAR CANADA Project: Améliorer les programmes de traitement intégré pour les troubles mentaux et les troubles liés à l'usage de substances psychoactives graves et concomitants : aperçu de la problématique des surdoses dans le cadre du projet ROAR CANADA.

This paper summarizes methods and initial overdose-related results from the Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction (ROAR CANADA) project. ROAR CANADA is a longitudinal observational study of individuals with severe concurrent substance use and mental disorders (also called dual disorders or dual diagnosis). The study sampled patients treated at two tertiary treatment centres in British Columbia, Red Fish Healing Centre and Heartwood Centre, along with a concurrent treatment unit at St. Joseph's in Ontario. These facilities have implemented evidence-based integrated treatment programs. Our first analysis explores selected baseline characteristics as potential risk factors for drug overdose in this population. Sociodemographic factors, trauma history, and impulsivity were part of a more comprehensive longitudinal assessment. In this first investigation, we use bivariate analysis and logistic and linear regression modelling to examine these variables in relation to overdose history. Overall, 291 of 450 participants (64.7%) reported a history of ≥1 overdose. Across the three centres, patients had a lifetime average of 7.6 (SD = 12.9) overdoses. The prevalence and mean number of overdoses were somewhat higher among Red Fish patients (74.5% and 8.5, respectively). Adverse childhood events, lifetime trauma history, and impulsivity were all high, but only lifetime trauma history emerged as significantly associated with overdose across all treatment centres. Impulsivity indicators were selectively associated with overdose by site, but not consistently within the overall sample. These results highlight the importance of prioritizing trauma-informed care in the treatment of individuals with severe concurrent substance use and mental disorders, who are at high risk of overdose. The integration of trauma treatment into existing programs may enhance patient outcomes and contribute to the ongoing evolution of effective care strategies for this complex population. These findings are particularly relevant in light of the overdose crisis.

Integrated Purification Systems for the Removal of Disinfectants from Wastewater

The efficiency of integrated treatment systems for wastewater generated during the washing of disinfectant production lines was investigated. The high organic load (COD 2000 mg/L, TOC 850 mg/L) and 300 mg/L of toxic benzalkonium chloride (BAC) make wastewater an environmental hazard that requires advanced treatment. Initial tests on model BAC solutions (in concentrations corresponding to those found in wastewater), using nanofiltration and ultrafiltration membranes, resulted in up to 70% retention of BAC. To enhance purification, ion exchange and adsorption were introduced as post-membrane treatment steps. In the second part of the investigation, membrane modules characterized by the best separation properties were integrated together with macroporous cation-exchange resin and activated carbon into the purification system to treat wastewater. The research carried out showed that the purification of multicomponent wastewater is a complex task. Significantly lower BAC removal (30%) was achieved in membrane processes compared to the model solutions treatment. In integrated systems, the BAC concentration was reduced to 100 mg/L, TOC to 200 mg/L, and COD to 120 mg/L.

What's Your Diagnosis? Generalized Anxiety with Thunderstorm Phobia in a 7-year-old Female Bull Terrier

A 7-year-old, female spayed Bull Terrier born in an animal rescue shelter was adopted by the first owner as an 8-week-old puppy. This owner crated the animal most of the day throughout the first year of life with no more than 30 minutes of exercise per day. The current owner adopted the dog when she was 1 year of age and noted she was severely anxious all day, every day. After one year of acclimation, the dog was started on daily trazodone, which successfully managed the dog's anxiety from 2 to 5 years of age. At 5 years-old, the anxiety worsened, especially during thunderstorms which was addressed with an increased dose of trazodone. The dog was also presented for TCVM assessment to address the generalized anxiety and severe thunderstorm phobia. The dog's conventional and TCVM physical examination findings are presented on one page for the reader to determine a TCVM pattern diagnosis and treatment strategy. Once these questions are answered, actual integrative veterinary treatment used for this case is presented on the following pages. The clinical outcome of the case along with suggestions for future management are also covered.

Decoding Neural Circuit Dysregulation in Bipolar Disorder: Toward an Advanced Paradigm for Multidimensional Cognitive, Emotional, and Psychomotor Treatment.

Bipolar disorder (BD) is characterized by a complex constellation of emotional, cognitive, and psychomotor disturbances, each deeply intertwined with underlying dysfunctions in large-scale brain networks and neurotransmitter systems. This manuscript integrates recent advances in neuroimaging, neuromodulation, and pharmacological research to provide a comprehensive view of BD's pathophysiology, emphasizing the role of network-specific dysfunctions and their clinical manifestations. We explore how dysregulation within the fronto-limbic network, particularly involving the prefrontal cortex (PFC) and amygdala, underpins the emotional instability that defines both manic and depressive episodes. Additionally, impairments in the central executive network (CEN) and default mode network (DMN) are linked to cognitive deficits, with hyperactivity in the DMN driving rumination and cognitive inflexibility, while CEN underactivity contributes to attentional lapses and impaired executive function. Psychomotor symptoms, which oscillate between hyperactivity in mania and retardation in depression, are closely associated with imbalances in neurotransmitter systems, particularly dopamine and serotonin, within the basal ganglia-thalamo-cortical motor pathway. Recent studies indicate that these psychomotor disturbances are further exacerbated by disruptions in network connectivity, leading to impairments in both motor control and emotional regulation. Emerging therapeutic strategies are discussed, with a focus on neuromodulation techniques such as transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS), which show promise in restoring balance within these critical networks. Furthermore, pharmacological interventions that modulate synaptic functioning and neuronal plasticity offer potential for addressing both the emotional and motor symptoms of BD. This manuscript underscores the need for an integrative treatment approach that simultaneously targets neural circuits and neurotransmitter systems to address the full spectrum of symptoms in BD. Drawing on recent advancements in neurobiological models and therapeutic frameworks, this proposal outlines a pathway for the development of precision-tailored interventions. These approaches are designed to optimize cognitive, emotional, and psychomotor outcomes, ultimately striving to elevate the quality of life for individuals living with bipolar disorder (BD), while remaining firmly grounded in the latest empirical evidence and theoretical insights.

A Study on the Clinico-serological Features of Nail Psoriasis.

Nail psoriasis is a relatively unexplored clinical feature in the Indian population. Its correlation with cutaneous, musculoskeletal, and serological manifestations was analyzed. This study included 45 patients with clinically evident nail psoriasis. Clinical characteristics, Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Nail Psoriasis Quality of Life Index 10 (NPQ10) scores and serological markers, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), and Rheumatoid Arthritis factor (RA factor) were documented, calculated, and assessed to study their correlation. Mean age was 35.36 ± 13.26 years. Mean NAPSI and NPQ10 were 41.96 ± 29.38 and 5.44 ± 5.31, respectively. Common nail findings were onycholysis (80%), subungual hyperkeratosis (75.5%), and pitting (62.2%). Joint involvement was seen in 31.11% of patients. Positive associations of NAPSI with duration of illness (P < 0.001, β = 0.57) and PASI scores (P < 0.001, β = 0.56) were observed. NPQ10 demonstrated associations with NAPSI (P < 0.001, β = 0.83) and PASI (P = 0.001, β = 0.83). Elevated ESR and CRP levels were associated with higher NAPSI scores (P < 0.001, β = 0.55, and P = 0.003, β = 0.43, respectively). Furthermore, duration of illness, NAPSI, and NPQ10 scores were positively correlated with joint involvement (P < 0.05). A strong correlation between nail psoriasis severity, disease duration, skin involvement, and nail-specific quality of life was observed. Furthermore, severe nail psoriasis was linked to a higher likelihood of joint involvement and elevated serological markers. These findings emphasize the importance of integrated treatment strategies for affected patients.

Integrated treatment approach for recovering nutrients and reducing pollution load of landfill leachate: Targets towards a circular economy

Integrated treatment approach for recovering nutrients and reducing pollution load of landfill leachate: Targets towards a circular economy

Trait anxiety, depression, and insomnia among benign paroxysmal positional vertigo cases: A multidisciplinary cross-sectional study

Background: Benign paroxysmal positional vertigo is the most common peripheral vestibular disease and is often associated with psychiatric conditions, including anxiety, depression, and insomnia. Studies evaluating trait anxiety in benign paroxysmal positional vertigo cases are limited. Our study aimed to assess trait anxiety, depression, and insomnia levels among those cases to investigate and emphasize the clinical value of evaluating psychiatric comorbidities. Methods: Individuals who applied to an otorhinolaryngology outpatient clinic and were diagnosed with benign paroxysmal positional vertigo were consecutively invited to participate. An extensive psychiatric assessment, Beck Anxiety Inventory, Beck Depression Inventory, Insomnia Severity Index, and Penn State Worry Questionnaire, was applied. Results: Of 35 benign paroxysmal positional vertigo patients (21 females, 14 males, mean age: 51), almost half were diagnosed with anxiety disorders, and one-third were diagnosed with depressive disorders. 34.3% (n = 12) of the sample had mild anxiety, whereas 28.6% (n = 10) had moderate and 31.4% (n = 11) had severe anxiety. 25.7% (n = 9) of the cases reported mild depressive symptoms, while 22.9% (n = 8) had moderate, and 11.4% (n = 4) had severe depression scores. 77.1% (n = 27) of the patients had mild to severe insomnia severity. All 35 participants in the study showed higher trait anxiety levels than the cut-off values of the scale. Conclusions: Evaluating benign paroxysmal positional vertigo cases for psychiatric conditions could contribute to the practical and integrated treatment of the disease, reduce its triggering causes, and increase the quality of life of the patients.

A Re-Consideration of Money Demand Theory

Abstract Portfolio models typically ignore precautionary transactions demands for liquid assets, and models of precautionary demands typically ignore asset rate-of-return risk. If asset-holders are risk-averse, however, both transactions risk and rate-of-return risk affect demands for both liquid and illiquid assets, even when the two risks are independent of each other. We demonstrate this in a four-asset framework, and show that our integrated treatment produces unexpected and instructive results and insights. For example, (a) an increase in the expected return to risky securities increases the demand for M1, even when M1 is used entirely for transactions purposes, (b) an increase in the variance of securities returns reduces the demand for M1, and (c) an increase in the asset-holders’ wealth reduces her demand for M1. A broader framework for the study of money demand is thus called for.

A Case-Control Study of Trichotillomania Patients Using a National Database

Introduction: Trichotillomania (TTM) is a body-focused repetitive disorder linked to psychiatric comorbidities. Comprehensive studies mapping its associations with a range of conditions remain limited. This study examines TTM’s associations with psychiatric, neurodevelopmental, substance-related, reproductive, and social factors using a national database. Methods: We performed a case-control study using the All of Us Research Program database. TTM cases (n=40) were matched to controls (n=400) based on age, sex, and ethnicity. Multivariate logistic regression was used to examine associations with comorbidities and lifestyle factors, controlling for demographic variables. Results: TTM was significantly associated with OCD (OR 18.3), BPD (OR 15), anxiety disorders (OR 10.2), alcohol abuse (OR 6.13), depression (OR 5.89), and vitamin D deficiency (OR 4.2) (all p &lt; 0.01). Other significant associations included fatigue, social anxiety, PTSD, ADHD, and difficulty running errands alone. Conclusion: Our findings highlight the strong association between TTM and a wide range of psychiatric and behavioral conditions, emphasizing the need for integrated treatment strategies addressing both psychiatric and physical aspects.

Tumor Metabolism as a Factor Affecting Diversity in Cancer Cachexia.

Cancer cachexia is a multifaceted metabolic syndrome characterized by muscle wasting, fat redistribution, and metabolic dysregulation, commonly associated with advanced cancer but sometimes also evident in early-stage disease. More subtle body composition changes have also been reported in association with cancer, including sarcopenia, myosteatosis, and increased fat radiodensity. Emerging evidence reveals that body composition changes including sarcopenia, myosteatosis, and increased fat radiodensity, arise from distinct biological mechanisms and significantly impact survival outcomes. Importantly, these features often occur independently, with their combined presence exacerbating poor prognoses. Tumor plays a pivotal role in driving these host changes, either by acting as a metabolic parasite or by releasing mediators that disrupt normal tissue function. This review explores the diversity of tumor metabolism. It highlights the potential for tumor-specific metabolic phenotypes to influence systemic effects, including fat redistribution and sarcopenia. Addressing this tumorhost metabolic interplay requires personalized approaches that disrupt tumor metabolism while preserving host health. Promising strategies include targeted pharmacologic interventions and anti-cachexia agents like GDF-15 inhibitors. Nutritional modifications such as ketogenic diets and omega-3 fatty acid supplementation also merit further investigation. In addition to preserving muscle, these therapies will need to be evaluated for their capability to improve survival and quality of life. This review underscores the need for further research into tumor-driven metabolic effects on the host and the development of integrative treatment strategies to address the interconnected challenges of cancer progression and cachexia.

Global trends in surgically based treatment of anal fistula in Crohn's disease: a bibliometric and visualization analysis.

Crohn's disease (CD) is a chronic, recurrent gastrointestinal disorder characterized by a complex etiology. Among its perianal complications, anal fistulas represent a challenging comorbidity. With the increase of surgical options, a comprehensive bibliometric analysis was deemed necessary to consolidate the vast array of research in this field. We extracted 1608 articles spanning from 1 January 1994, to 1 May 2024, from the Web of Science Core Collection. Using VOSviewer, CiteSpace, and Scimago Graphica for visual analytics, we synthesized key trends across multiple bibliometric indicators, encompassing geographic and institutional contributions, individual authorship, journal prominence, citation metrics, and thematic prevalence. From the delineated corpus, we identified publications from 325 countries and 5110 research institutions, with the US and UK at the forefront of publication volume and academic impact. The data indicated a leading role for institutions like the Cleveland Clinic and Imperial College London. "Diseases of the Colon and Rectum" emerged as a central journal due to its high publication and citation frequency. Distinctly, the analysis uncovered trending keywords, signifying the field's prioritization on surgical intervention, biologic therapy, imaging modalities, and emerging biological treatments. Our findings elucidate a trajectory toward prominent advancements in CD fistula research. This analysis underscores the field's shift towards integrative treatment strategies, spotlighting the pressing need for comprehensive comparative studies of surgical approaches. It underscores the imperative for robust clinical trials to standardize treatments and extend care to a broader CD patient population.

Antibiotic-free responsive biomaterials for specific and targeted Helicobacter pylori eradication.

Gastric cancer is highly correlated with Helicobacter pylori (H. pylori) infection. Approximately 50 % of the population worldwide is infected with H. pylori. However, current treatment regimens face severe challenges including drug resistance and gut microbiota disruption. An integrative treatment with slight negative influences on intestinal flora, conforming with concepts of integrative prevention of gastric cancer, is urgently needed. Non-antibiotic responsive biomaterials can respond to different stimuli, including pH, enzymes, light, ultrasound and magnetism, under which biomaterials are specifically activated to perform antibacterial capabilities, while neutral intestinal microenvironments differ from gastric microenvironments or inflammatory sites and have no or minimal irradiation via precisely controlled exogenous stimuli, which may not only overcome antibiotic resistance but also avoid gut microbiota disorders. First, the latest progress in responsive biomaterials against H. pylori without gut microbiome disturbance and their anti-H. pylori performances are profoundly summarized. Second, the mechanisms against planktonic bacteria, biofilms and intracellular bacteria are discussed respectively. Finally, the strategies of specific and targeted H. pylori elimination by responsive biomaterials are introduced. Additionally, the challenges and the focus of future research on translation into clinical application are fully proposed. Antibiotic-free responsive biomaterials for specific and targeted H. pylori eradication represent an innovative approach.

Acceptance of Illness and Health-Related Quality of Life in Patients After Myocardial Infarction—Narrative Review

Introduction: Cardiovascular diseases, particularly myocardial infarction (MI), significantly impact patients’ lives, causing stress and prompting varied responses to illness. Aim and methods: We conducted a narrative review concerning the acceptance of illness and quality of life in post-MI patients. Based on an extensive search of the available literature, this review consolidates current evidence on the proposed topic. Conclusions and implications: While some patients struggle with acceptance and face emotional distress, others who accept their condition are more likely to engage in treatment and lifestyle changes, leading to an improved health-related quality of life (HRQoL). Following an MI, patients often experience depression, anxiety, and stress, complicating their acceptance of the illness. Risk factors, such as hypertension, diabetes, and smoking, play a significant role in influencing HRQoL in post-MI patients. An accurate assessment of HRQoL is crucial for tailoring effective treatments and support strategies to enhance patient outcomes and identify those most at risk of developing post-MI depression or anxiety. Effective physician–patient and nurse–patient communication and support from family might be helpful in recovery. Cardiac rehabilitation improves patients’ outcomes and HRQoL. This review underscores the importance of integrating psychological support with optimal medical care to improve patient prognosis and enhance the HRQoL of individuals recovering from MI. The healthcare system could implement routine psychological assessments for MI patients at admission and discharge to establish a baseline for follow-up. Future research should explore effective psychological interventions, the interplay of CVD risk factors and psychosocial aspects, the emerging role of artificial intelligence in personalized care, and the cost-effectiveness of integrated treatment models.

Synergistic effects of estrogen deficiency and articular disk derangement on condylar bone loss.

Temporomandibular joint osteoarthritis (TMJ-OA) with condylar resorption is a multifactorial condition involving hormonal imbalance and articular disk dysfunction, often leading to severe TMJ degeneration. This study investigated the combined effects of estrogen deficiency and anterior articular disk derangement (ADD) on condylar bone resorption in a mouse model. Female C57BL/6J mice underwent ovariectomy (OVX) to induce estrogen deficiency and ADD was surgically induced for stress. The animals were divided into the control, OVX, ADD, and OVX + ADD groups. Microcomputed tomography and histological analyses were conducted to evaluate condylar bone structure, trabecular architecture, and osteoclast activity. OVX and ADD caused significant condylar bone loss, characterized by reduced bone volume fraction (BV/TV) and abnormal trabecular architecture. The OVX + ADD group exhibited exacerbated bone resorption, with decreased BV/TV and increased trabecular separation compared to OVX or ADD alone. Histological analyses revealed increased osteoclast activity in the OVX + ADD group, suggesting a synergistic effect of estrogen deficiency and ADD on condylar degradation. Estrogen deficiency amplifies the bone-resorptive and inflammatory effects of ADD, accelerates TMJ degeneration, and underscores the interplay between hormone imbalance and articular disk dysfunction in the pathophysiology of TMJ-OA. There is a need for integrated treatment strategies, such as effective hormone replacement therapy and articular disk repositioning, to effectively manage temporomandibular joint disorders, particularly in postmenopausal women or those with hormonal imbalances. Further research is required to elucidate these molecular pathways and evaluate long-term therapeutic interventions.

Deep learning-based synthetic CT for dosimetric monitoring of combined conventional radiotherapy and lattice boost in large lung tumors

PurposeConventional radiotherapy (CRT) has limited local control and poses a high risk of severe toxicity in large lung tumors. This study aimed to develop an integrated treatment plan that combines CRT with lattice boost radiotherapy (LRT) and monitors its dosimetric characteristics.MethodsThis study employed cone-beam computed tomography from 115 lung cancer patients to develop a U-Net + + deep learning model for generating synthetic CT (sCT). The clinical feasibility of sCT was thoroughly evaluated in terms of image clarity, Hounsfield Unit (HU) consistency, and computational accuracy. For large lung tumors, accumulated doses to the gross tumor volume (GTV) and organs at risk (OARs) during 20 fractions of CRT were precisely monitored using matrices derived from the deformable registration of sCT and planning CT (pCT). Additionally, for patients with minimal tumor shrinkage during CRT, an sCT-based adaptive LRT boost plan was introduced, with its dosimetric properties, treatment safety in high dose regions, and delivery accuracy quantitatively assessed.ResultsThe image quality and HU consistency of sCT improved significantly, with dose deviations ranging from 0.15% to 1.25%. These results indicated that sCT is feasible for inter-fraction dose monitoring and adaptive planning. After rigid and hybrid deformable registration of sCT and pCT, the mean distance-to-agreement was 0.80 ± 0.18 mm, and the mean Dice similarity coefficient was 0.97 ± 0.01. Monitoring dose accumulation over 20 CRT fractions showed an increase in high-dose regions of the GTV (P < 0.05) and a reduction in low-dose regions (P < 0.05). Dosimetric parameters of all OARs were significantly higher than those in the original treatment plan (P < 0.01). The sCT based adaptive LRT boost plan, when combined with CRT, significantly reduced the dose to OARs compared to CRT alone (P < 0.05). In LRT plan, high-dose regions for the GTV and D95% exhibited displacements greater than 5 mm from the tumor boundary in 19 randomly scanned sCT sequences under free breathing conditions. Validation of dose delivery using TLD phantom measurements showed that more than half of the dose points in the sCT based LRT plan had deviations below 2%, with a maximum deviation of 5.89%.ConclusionsThe sCT generated by the U-Net + + model enhanced the accuracy of monitoring the actual accumulated dose, thereby facilitating the evaluation of therapeutic efficacy and toxicity. Additionally, the sCT-based LRT boost plan, combined with CRT, further minimized the dose delivered to OARs while ensuring safe and precise treatment delivery.

Abdominal lymphatic malformations in children: case series.

Lymphatic Malformations (LMs) are benign congenital malformations of the lymphatic system that commonly involve the abdomen in children (mesentery of the small intestine and omentum). The management of these malformations is not unique. 7 children with different ages (range: newborn to 14 years), diagnosis was incidental in some cases, while in others for abdominal pain. All patients underwent abdominal ultrasound and Magnetic Resonance Imaging (MRI). Laparoscopy for diagnosis was useful in 4 cases. Treatment was: conservative in 1 child, laparoscopic excision in 3 patients, laparotomic excision in 3 cases. At follow up we observed recurrence in a case that required integrated treatment and bowel occlusion after excision in 1 case. This benign malformations may not cause any symptoms to patient. The goal of treatment is to maintain organ function, preserve aesthetic integrity and complications control. Management of these patients could be varied: the best approach should be evaluated on the basis of the patient.

Extra-Pulmonary Hydatid Cyst from Afghanistan: A Case Report

Hydatid cysts, caused by the larval stages of Echinococcus tapeworms, are a significant parasitic infection primarily affecting the liver and lungs. This case report presents a rare instance of an extrapulmonary hydatid cyst located in the pleural of a 45-year-old housewife female patient from Afghanistan. The patient exhibited symptoms of chest pain, headaches, dizziness, and a dry cough over three years. Diagnostic CT imaging revealed a mass in the right thoracic region. Following thorough surgical preparation, a right posterior-lateral thoracotomy was performed, leading to the excision of the hydatid cyst. Postoperatively, the patient was prescribed albendazole to facilitate cyst degradation. This case underscores the importance of early diagnosis and an integrated treatment approach, combining medical therapy and surgical excision, to improve patient outcomes and manage the complications of hydatid disease effectively.

Advancing the research on management of global airway disease: insights from a post hoc analysis.

Chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) frequently coexist, forming a complex multimorbid condition often referred to as "global airway disease." This concept reflects shared pathophysiological mechanisms of eosinophilic inflammation and underscores the need for integrated treatment strategies targeting both upper and lower airway manifestations (1). The burden of severe CRSwNP, asthma, and N-ERD is substantial, particularly in terms of reduced quality of life, recurrent exacerbations, revision endoscopic sinus surgeries (ESS), and healthcare utilization (2). Biologics represent a significant advancement in the treatment of global airway diseases.

Real-world evidence in extensive disease small cell lung cancer: The missing piece of the puzzle.

Small cell lung cancer (SCLC) is a highly aggressive disease, often diagnosed at an advanced stage and with limited treatment options. In recent years, immunotherapy has been approved in combination with chemotherapy in the first line setting of extensive stage disease (ES-SCLC). However, only 10-15 % of patients with ES-SCLC treated with chemoimmunotherapy (CT-IO) experience a long-term benefit. In addition, patients are often clinically frail due to advanced age, comorbidities, and disease-related symptoms, making SCLC a challenging condition. Real-world evidence (RWE) becomes particularly valuable in this scenario, not only to confirm the results of pivotal trials, but also to evaluate the outcomes of CT-IO in populations that are generally excluded from clinical trials. RWE could also define the role of integrative treatments such as thoracic consolidation radiotherapy and prophylactic cranial irradiation, which are used in selected patients in the clinical practice but were scarcely applied in pivotal trials. In this review, we focused on RWE in ES-SCLC, with the aim of improving clinical decision making. Notably, real-world data have largely confirmed the efficacy and safety of CT-IO observed in pivotal clinical trials, with a possible benefit even in more fragile patients. However, these studies also highlight that a significant proportion of the ES-SCLC population remains untreated due to poor clinical conditions.