Intensive Protocol Research Articles

Novel Corona Turkish Novel Protocol

Aim: To share a novel corona treatment method that is effective on patients with the scientific community. Introduction: The new corona infection has caused a different fear all over the world, and many studies have been conducted to prolong the lives of patients who die from complications or while being treated. Materials & Methods: Among the 2000 patients who were admitted to the service(500), outpatient clinic(1420) and hospitalized in intensive care (80), 147 patients who were examined naively during the period 1.2.2021-1.4.2021 were included in the study cross-sectionally. Patients at risk of death in intensive care and pre-treatment protocols at varying rates depending on the different age. Regarding the diagnosis and treatment of the disease; Since it is known that even the effects of drugs that cause complications cause human death, it was prioritized to make the treatment plan accordingly and pay attention to the complications of these treatments. The patient, whose problems with hydroxychloroquine, favipiravir and other protocols are recovering, can lead to lung edema, intubation in the intensive care unit and subsequent death. Although the complications and mortality rate of the disease is not more than influenza, it seems possible to prevent some of the deaths. The age of patients’ distrubition 5 from 94 years old, avarage age 42 years old. drugs used in treatment planning, D vitamins single dose and zinc , tigacycline , vancomycin (renal function controlled), meropenem 1 gr (renal function controlled),enoxaparin (renal function controlled) pantoprasol , 4 gr ascorbic acid will be infused,dexamethasone , budesonide. If there is an increase in the response to antibiotherapy, ivermectine therapy, tocilisumab treatment should be added without delay. tocilisumab therapy ; tocilisumab and ivermectine treatment of patients will be consideredaccording to crp decrease. Result: The patient is treated and remains normal for three days, the patient can be discharged. There was no need for tocilizumab treatment on the patients did not use favipiravir treatment among were followed up. Longest treatment protocol is completed 21 days; shortest treatment protocol is completed 3 days. No additional complications were encountered in 800 cases treated and patient follow up completed. Discussion: While researching different treatment protocols in a new viral infection, it is a wrong practice to try new drugs rather than to cure the patients. Trying to treat patients with medications that have not been followed up and tried clearly makes more harm than normal. For this reason, it preparing protocols with known drugsare vital and not to use experimental antivirals (favipiravir, remdesivir, oseltamivir etc) that did not work in previous outbreaks.

Patterns of recurrent disease after neoadjuvant chemoradiotherapy and esophageal cancer surgery with curative intent in a tertiary referral center

BackgroundRecurrence is frequently observed after esophageal cancer surgery, with dismal post-recurrence survival. Neoadjuvant chemoradiotherapy followed by esophagectomy is the gold standard for resectable esophageal tumors in the Netherlands. This study investigated the recurrence patterns and survival after multimodal therapy. MethodsThis retrospective cohort study included patients with recurrent disease after neoadjuvant chemoradiotherapy followed by esophagectomy for an esophageal adenocarcinoma in the Amsterdam UMC between 01 and 01–2010 and 31-12-2018. Post-recurrence treatment and survival of patients were investigated and grouped by recurrence site (loco-regional, distant, or combined loco-regional and distant). ResultsIn total, 278 of 618 patients (45.0%) developed recurrent disease after a median of 49 weeks. Thirty-one patients had loco-regional (11.2%), 145 distant (52.2%), and 101 combined loco-regional and distant recurrences (36.3%). Post-recurrence survival was superior for patients with loco-regional recurrences (33 weeks, 95%CI 7.3–58.7) compared to distant (12 weeks, 95%CI 6.9–17.1) or combined loco-regional and distant recurrent disease (18 weeks, 95%CI 9.3–26.7). Patients with loco-regional recurrences treated with curative intent had the longest survival (87 weeks, 95%CI 6.9–167.4). ConclusionRecurrent disease after potentially curative treatment for esophageal cancer was most frequently located distantly, with dismal prognosis. A subgroup of patients with loco-regional recurrence was treated with curative intent and had prolonged survival. These patients may benefit from intensive surveillance protocols, and more research is needed to identify these patients.

Evidence for Using ACQUIRE Therapy in the Clinical Application of Intensive Therapy: A Framework to Guide Therapeutic Interactions.

Intensive therapies have become increasingly popular for children with hemiparesis in the last two decades and are specifically recommended because of high levels of scientific evidence associated with them, including multiple randomized controlled trials and systematic reviews. Common features of most intensive therapies that have documented efficacy include: high dosages of therapy hours; active engagement of the child; individualized goal-directed activities; and the systematic application of operant conditioning techniques to elicit and progress skills with an emphasis on success-oriented play. However, the scientific protocols have not resulted in guiding principles designed to aid clinicians with understanding the complexity of applying these principles to a heterogeneous clinical population, nor have we gathered sufficient clinical data using intensive therapies to justify their widespread clinical use beyond hemiparesis. We define a framework for describing moment-by-moment therapeutic interactions that we have used to train therapists across multiple clinical trials in implementing intensive therapy protocols. We also document outcomes from the use of this framework during intensive therapies provided clinically to children (7 months-20 years) from a wide array of diagnoses that present with motor impairments, including hemiparesis and quadriparesis. Results indicate that children from a wide array of diagnostic categories demonstrated functional improvements.

Lethal AML? Calcium signalling to the rescue!

Acute myeloid leukemia (AML) is characterized by genetic aberrations in hematopoietic precursors of the myeloid lineage which lead to their defective maturation/function. While intensive chemotherapy protocols result in complete remission in 50 % to 80 % of AML patients, relapse occurs in the majority of cases. While calcium signalling is a well-known contributor to cancer hallmarks, few AML related studies have focused on relevant calcium targets. Our purpose here is to highlight calcium channels and associated signalling pathways involved in AML, in order to promote the development of treatments specifically targeting these pathways.

Clinical programs for cardiometabolic health for South Asian patients in the United States: A review of key program components.

Medical literature shows that South Asians have approximately a 2-fold higher risk of atherosclerotic cardiovascular disease (CVD) compared with other populations. Given this high prevalence, clinical programs to promote cardiovascular health have emerged in the United States that are dedicated to clinical care for South Asian individuals. In this review, we have summarized the key characteristics of clinical programs in the U.S. dedicated to preventing and managing CVD in South Asian American patients. These clinical centers have many unique components in common that are catered to South Asian patient populations including ethnicity concordance of clinical providers, intensive cardiovascular screening protocols with laboratory studies and potentially genetic testing, dieticians and nutritionists who are familiar with South Asian-style dietary patterns, health coaches to support behavior change, community outreach programs, and involvement in clinical research to learn further about risk factors, prevention, and treatment of cardiovascular disease in South Asian populations. There are still many evidence and programmatic gaps left to uncover in the prevention, diagnosis, and management of CVD in South Asian. This review provides guidance for important features, barriers, and facilitators for future cardiovascular centers to develop in the United States where they can serve South Asian populations.

P293 An intensive protocol for bowel preparation in people with cystic fibrosis undergoing screening colonoscopy, a single centre experience

People with cystic fibrosis (pwCF) have 5–10 times higher risk of colorectal cancer (CRC) than the general population, and this risk is even higher in post-transplant patients. The Cystic Fibrosis Foundation (CFF) recommends colonoscopy as the screening examination for CRC in pwCF. An adequate bowel preparation is essential for optimal colonoscopy, however, the thick mucus lining on the colon makes their bowel preparation challenging. Our center had experienced suboptimal visualization of the colon using a standard bowel preparation.

Investigating the effect of exercise on the expression of genes related to cardiac physiological hypertrophy.

Physiological hypertrophy of the heart is associated with an increase in the normal function of the heart, and it directly relates to regular exercise, especially among elite athletes. Researches about special signaling pathways that create physiological hypertrophy have recently received more attention. As a result, the present study was conducted to investigate the effect of aerobic exercise intensity on the expression of genes involved in heart physiological hypertrophy. For this purpose, 30 male Wistar rats were prepared and randomly divided into three groups: control, intense intermittent training, and submaximal continuous training. The intensive intermittent training protocol included 30 minutes of intermittent running, each interval including 4 minutes of running with an intensity of 85-90% VO2max and 2 minutes of active recovery with an intensity of 50-60% VO2max three days a week for 8 weeks. Also, the submaximal continuous exercise group had activity intensity equal to 50-55% of the maximum oxygen consumption. The expression of genes related to cardiac hypertrophy such as MMP-I, TGF-ß1, and TIMP was evaluated through real-time PCR technique. The results showed that the expression of studied genes in the three groups had significant differences (p<0.05). Both training methods led to a significant increase in TGF-ß1 and TIMP gene expression in the heart of rats. But the changes in MMP-I in the intermittent group were not significant compared to the control group. In general, it seems that exercise leads to the improvement of the factors involved in the physiological hypertrophy of the heart. Therefore, the findings of the current research are expressed with caution and more research is needed in the future.

Outcomes Associated with a Pediatric Intensive Care Unit Sedation Weaning Protocol

Abstract Objective This article compares patient outcomes before and after implementation of a risk stratified pediatric sedation weaning protocol. Methods This observational cohort study, in a 30-bed tertiary care pediatric intensive care unit (PICU), included patients requiring opioid, benzodiazepine, and/or dexmedetomidine infusions. Outcomes (duration of wean, PICU length of stay [LOS], and Withdrawal Assessment Tool [WAT-1] scores) were collected by retrospective chart review for 12 months before and after protocol implementation. The influence of the protocol was assessed using an interrupted time series (ITS) analysis. Results There were 49 patients before and 47 patients after protocol implementation. Median opioid wean duration preprotocol was 10.5 days (interquartile range [IQR]: 4.25, 20.75) versus 9.0 days (IQR: 5.0, 16.75) postprotocol (p = 0.66). Median benzodiazepine wean duration was 11.5 days (IQR: 3.0, 19.8) preprotocol versus 5.0 days (IQR: 2.0, 13.5) postprotocol (p = 0.31). Median alpha-agonist wean duration was 7.0 days (IQR: 3.5, 17.0) preprotocol versus 3 days (IQR: 1.0, 14.0) postprotocol (p = 0.03). The ITS indicated a reduction in opioid wean by 6.7 days (p = 0.35), a reduction in benzodiazepine wean by 13.4 days (p = 0.12), and a reduction in alpha-agonist wean by 12.9 days (p = 0.06). WAT-1 scores &gt; 3 (12.6% preprotocol vs. 9.9% postprotocol, p = 0.569) and PICU LOS (16.0 days [IQR: 11.0, 26.0] vs. 17.0 days [IQR: 11.0, 26.5], p = 0.796) did not differ between groups. Conclusion Implementation of a risk stratified sedation weaning protocol in the PICU was associated with a significant reduction in alpha-agonist wean duration without a significant increase in withdrawal symptoms.

Optimizing intensive culture protocols for Atlantic cod (Gadus morhua) larvae

Larval cod require live prey as food, and prey concentration (PC) and feeding frequency (FF) often affect their growth and survival. Apart from this, water exchange rates/water flow (WER/WF) and water current (WC) also affect the prey resident time in the tank and larval/early juvenile behaviour, respectively. High water current is also known to induce stress in finfish larvae, and this stress response is believed to be dependent on larval developmental stage. Thus, we conducted a study to evaluate three larval rearing protocols varying in prey concentration, feeding frequency, and water current/exchange rate. Three protocols were used: low prey concentration (PC), low feeding frequency (FF), and low water flow (protocol 1); medium PC, medium FF, and medium WF (protocol 2); and high PC, high FF, and high WF (protocol 3) (see Table 1). Larvae were sampled periodically for growth and cortisol measurements. Cortisol extraction and radioimmunoassay (RIA) were conducted using methods previously validated for cod larvae. Larvae reared using protocols 2 and 3 were significantly bigger and heavier than larvae reared using protocol 1. Rearing protocol had a significant effect on the cortisol level in larval cod. Larvae showed a developmental stage-dependent stress response. Protocol 2 had significantly higher survival than protocols 1 and 3. Our results indicate that an intermediate PC, FF, and WF (protocol 2) is suitable during cod larval rearing.

Expiratory Muscle Strength Training in Multiple System Atrophy: A Pilot Study.

The effects of expiratory muscle strength training (EMST) has not yet been investigated in MSA patients. The primary objective was to test the effects of EMST on expiratory muscle strength and voluntary peak cough flow (vPCF) in patients with multiple system atrophy (MSA). The secondary objective was to assess the suitability of the pulmonary dysfunction index as a tool for identifying MSA patients with expiratory muscle weakness and reduced voluntary peak cough flow. This was an open label, non-controlled study, with an 8-week intensive home-based EMST protocol. The outcome measures included: maximal expiratory pressure (MEP) and vPCF. The sensitivity and specificity of the index of pulmonary dysfunction in the respiratory diagnostic process were assessed using receiver operating characteristic (ROC) analysis. Fifteen MSA patients were enrolled in the study. Twelve MSA patients completed the training period. After the training period, MEP significantly increased (P = 0.006). Differences in vPCF were not significant (P = 0.845). ROC analysis indicated that the overall respiratory diagnostic accuracy of the index of pulmonary dysfunction had an outstanding capability to detect patients at risk of less effective coughing and an acceptable capability of detecting patients with decreased expiratory muscle strength. These findings indicate non-significant differences in vPCF after 8 weeks of EMST. The index of pulmonary dysfunction appears to be a promising prognostic screening tool for identifying altered cough efficacy in MSA patients. Test cut-offs may be used to select an appropriate respiratory physiotherapy technique.

Efeitos dos exercícios físicos sobre a neurogênese do cérebro de ratos adolescentes

Introduction. The neurogenesis of the brain of young rats can be affected by several factors in their development, with the practice of physical exercises being an important factor in the neurogenesis of nervous tissue. Objective. To investigate the effects of different physical exercise protocols of medium and high intensity on neurogenesis in the brain of adolescent rats. Method. The experimental study, where three groups of animals were used: a control group (RC), a group that performed medium-intensity physical exercise (R1) and a group that performed high-intensity physical exercise (R2). Each group with 8 animals, totaling 24 animals. The progressive resisted physical exercise program on the vertical ladder was carried out for 4 weeks, 5 days a week with a duration varying between 30 and 45 minutes. After the end of the experiments, the animals were euthanized for removal of the brain and subsequent processing, staining using the Nissl method and histomorphometric analysis by counting neurons in the dentate gyrus of the hippocampus and subventricular zone. Results. The data demonstrated that there was no significant difference in the area and height of the apex of the hippocampal dentate gyrus between the groups (p=0.2474 and p=0.3337; respectively). The results of the length of the apex of the hippocampal dentate gyrus showed significant differences (p=0.0172). Conclusion. The practice of medium and high intensity progressive resisted physical exercises did not modify the morphology and neuronal density in the hippocampal dentate gyrus and subventricular zone of young rats.

Intensive oral hygiene programme for the diagnosis and (pre-)treatment of gingival mucosal redness and swelling

Imposing redness and swelling of the gingiva repeatedly cause uncertainty in the dental practice. Insufficient oral hygiene plays a dominant modifying role here. An intensive oral hygiene protocol as an initial screening procedure can therefore often prevent complex diagnostic or therapeutic steps.

Case report on an outbreak of theileriosis in a dairy herd: Could it be a co-infection of a virulent strain of Theileria mutans with Theileria parva?

This case report aimed to alert veterinarians of the possibility of simultaneous infections with more than one Theileria species in cattle herds in Zimbabwe. Cows (N=7) and a postmortem specimen from a dairy farm located in Chivhu, Mashonaland East province, Zimbabwe were presented for clinical and postmortem examination, respectively. On history taking, the herd had a decrease in milk yield and high cow mortalities. The presented live animals had a heavy tick burden and were febrile and lethargic. Post-mortem findings revealed strong evidence suggestive of theileriosis. Theileria schizonts and piroplasms were identified in stained lymph node aspirate, impression, and blood smears. The herd was managed using tetracyclines and buparvaquone together with an intensive dipping protocol until deaths had stopped. Both the clinical and postmortem findings were strongly suggestive of the possibility of a simultaneous infection with more than one Theileria species in this herd. Thus, these finding highlight the need to characterise the Theileria species profile in Zimbabwe.

Palliative Care in Patients with Hematological Malignancies.

Palliative care is an attempt to improve the quality of life of patients and their relatives who have lost the chance of a cure. Interventions to improve the quality of life of patients include physical, mental, and psychosocial problems. It is known that symptoms such as pain, fatigue, loss of appetite, and feeling unwell, which often cause deterioration in quality of life, are improved with palliative care support. It is seen that palliative care support, which is mostly recommended in the end-of-life period of patients with solid tumors, is not recommended for patients with hematological malignancies. In fact, patients with hematological malignancies face physical, mental, and economic difficulties due to the intense treatment protocols required for their disease and the side effects of the treatments. Compared to patients with solid tumors, patients with hematological malignancies have a higher frequency of hospitalization and intensive care unit admission. For these reasons, our aim is to define the palliative care needs of patients with hematologic malignancies, understand the barriers to palliative care and end-of-life care, and offer solutions to improve the quality of life and care of patients with hematologic malignancies.

Early intensive mobilization after acute high-risk abdominal surgery: a nonrandomized prospective feasibility trial.

Mobilization after emergency abdominal surgery is considered essential to facilitate rehabilitation and reduce postoperative complications. The aim of this study was to evaluate the feasibility of early intensive mobilization after acute high-risk abdominal (AHA) surgery. We conducted a nonrandomized, prospective feasibility trial of consecutive patients after AHA surgery at a university hospital in Denmark. The participants followed a predefined, interdisciplinary protocol for early intensive mobilization during the first 7 postoperative days (PODs) of their hospital admission. We evaluated feasibility in accordance with the percentage of patients who mobilized within 24 hours after surgery, mobilized at least 4 times per day and achieved daily goals of time out of bed and walking distance. We included 48 patients with a mean age of 61 (standard deviation 17) years (48% female). Within 24 hours after surgery, 92% of the patients were mobilized and 82% or more were mobilized at least 4 times per day over the first 7 PODs. On PODs 1-3, 70%-89% of the participants achieved the daily goals of mobilization; participants still in hospital after POD 3 were less able to achieve the daily goals. Patient reported that the primary factors limiting their level of mobilization were fatigue, pain and dizziness. Participants not mobilized independently on POD 3 (28%) had significantly (p ≤ 0.04) fewer hours out of bed (4 v. 8 h), were less able to achieve the goals of time out of bed (45% v. 95%) and walking distance (62% v. 94%) and had longer hospital stays (14 v. 6 d) than participants mobilized independently on POD 3. The early intensive mobilization protocol seems feasible for most patients after AHA surgery. For nonindependent patients, however, alternative mobilization strategies and goals should be investigated.

Establishment of an optimized guinea pig model of cisplatin-induced ototoxicity.

Cisplatin is among the most effective antineoplastic agents and has revolutionized the treatment of many cancer diseases. However, one of its serious side effects is a progressive and irreversible hearing loss, occurring in both adults and children. For the development of otoprotective therapies that prevent this side effect, cisplatin-induced hearing loss animal models are indispensable. Due to the high toxicity of cisplatin, the establishment of such animal models is a difficult and time-consuming task. Here we introduce the detailed protocol of a sophisticated guinea pig model with a sufficient and permanent hearing loss induced by cisplatin. This manuscript is intended to provide guidance in the development of future cisplatin guinea pig models which may reduce the mortality rate of the animals and help to gain more reproducible results. Pigmented and unpigmented guineapigs were treated with an intravenous single application of 8 mg/kg cisplatin under general anesthesia. An extensive and long-term intensive care protocol consisting of scheduled application of fluids, antiemetics, analgesics, glucose and supportive feeding among others, was used to ensure wellbeing of the animals. Hearing tests were performed prior to and 5 days after cisplatin application. Animals were then euthanized. The ABR audiometry 5 days after cisplatin application revealed a hearing threshold ranging from 70 dB to 90 dB in the frequencies from 1 kHz to 32 kHz respectively.All animals presented a good health condition despite the treatment with cisplatin. The introduced care protocol in this manuscript is intended to serve as a guidance for the establishment of a stable guinea pig model for short- and long-term investigation regarding the inner ear and its protection in the frame work of cisplatin-induced damage.

Exploring barriers and enablers of self-management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care.

Exploring barriers and enablers of self-management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care.

New Deconstruct Elliptical sports machine and Elliptical machine

The objective of this article was to compare different cardiovascular training machines and their effects on the body, as well as to determine their suitability for people with low intensity or high intensity training needs. A total of 8 physically active and healthy male subjects (mean ± standard deviation; age: 28.45 ± 1.75 years; height: 1.84 ± 0.07 m; body weight 76.42 ± 8.62 kg; body mass index: 25.5 ± 2.6) were evaluated through of an incremental exercise test at different intensities on two different machines: Elliptical Domyos 680 (BED) and Deconstruct Elliptical 331-EF (DEC). To compare both machines against the two mentioned training needs, two different protocols were carried out: Low Intensity Protocol (LIP) and High Intensity Protocol (HIP). In addition, a thermographic analysis was carried out in order to determine the temperature differences reached in the musculature. No significant differences were found in HR and EE (p &lt; .05) between the two machines. However, a greater and more progressive activation of the muscles of the upper extremities was observed in the DEC machine. In the HIP, HR and EE were measured, obtaining significant differences (p &lt; .05) higher in the DEC machine. Therefore, in our comparison, the Deconstruct Elliptical machine produced more appropriate results for both low and high intensity training compared to the Elliptical machine. These results and the novel nature of the Deconstruct Elliptical raise the need for further studies to better understand this machine.

A single case series of imagery rescripting of intrusive autobiographical memories in depression

Background and objectivesIntrusive memories are a common feature of depression, thought to be related to the onset and maintenance of the disorder. Intrusive memories have been successfully targeted in posttraumatic stress disorder through imagery rescripting. Yet there is limited evidence for the effectiveness of this technique in depression. We examined whether 12 weekly sessions of imagery rescripting was associated with reductions in depression, rumination and intrusive memories in a sample of patients with major depressive disorder (MDD). MethodsFifteen clinically depressed participants completed 12 weeks of imagery rescripting treatment while completing daily measures of depression symptoms, rumination and intrusive memory frequency. ResultsThere were significant reductions on pre-post treatment and daily assessment measures of depression symptoms, rumination and intrusive memories. Reductions in depression symptoms represented a large effect size, while 13 participants (87%) showed reliable improvement and 12 participants (80%) demonstrated clinically significant improvement and no longer met diagnostic criteria for MDD. LimitationsThe sample size was small, however the intensive daily assessment protocol ensured the viability of within-person analyses. ConclusionsImagery rescripting as a stand-alone intervention appears to be effective at reducing depression symptoms. Additionally, the treatment was well tolerated by clients and observed to overcome several traditional treatment barriers in this population.

Is a less-intensive follow-up for colon cancer in early stages reasonable?

PurposePatients with colon cancer are usually included in an intensive 5-year surveillance protocol after curative resection, independent of the tumor stage, though early stages have a considerably lower risk of recurrence. The aim of this study was to analyze the adherence to an intensive follow-up and the risk of recurrence in patients with colon cancer in UICC stages I and II.MethodsIn this retrospective study, we assessed patients who underwent resection for colon cancer in UICC stages I and II between 2007 and 2016. Data were collected on demographics, tumor stages, therapy, surveillance, recurrent disease, and oncological outcome.ResultsOf the 232 included patients, 43.5% (n = 101) reached the 5-year follow-up disease-free. Seven (7.5%) patients in stage UICC I and sixteen (11.5%) in UICC II had a recurrence, with the highest risk in patients with pT4 (26.3%). A metachronous colon cancer was detected in four patients (1.7%). The therapy of recurrence was intended to be curative in 57.1% (n = 4) of UICC stage I and in 43.8% (n = 7) of UICC stage II, but only in one of seven patients over 80 years. 44.8% (n = 104) of the patients were lost to follow-up.ConclusionA postoperative surveillance in patients with colon cancer is important and recommended as a recurrent disease can be treated successfully in many patients. However, we suggest that a less intensive surveillance protocol is reasonable for patients with colon cancer in early tumor stages, especially in UICC stage I, as the risk of recurrent disease is low. With elderly and/or frail patients in a reduced general condition, who will not endure further specific therapy in case of a recurrence, the performance of the surveillance should be discussed: we recommend a significant reduction or even renunciation.