Good Treatment Outcomes Research Articles

Extramedullary Plasmacytoma of the Nasal Cavity, Paranasal Sinuses, and Nasopharynx: Report of Two Cases and Review of Literature

Abstract Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm occurring outside the bone marrow, predominantly in the head and neck region. Representing 3%–5% of all plasma cell neoplasms, EMP poses significant diagnostic and therapeutic challenges due to its rarity and,proximity to vital structures. We report two cases of EMP involving the nasal cavity, paranasal sinuses, and nasopharynx. A 30-year-old male presented with right diplopia, headache, and bilateral nasal blockage. Examination revealed a nasopharyngeal mass with bony erosion and multiple osteolytic lesions. Histopathology and immunohistochemistry confirmed plasmacytoma, and systemic involvement was excluded. The patient underwent chemoradiotherapy with satisfactory outcomes. A 27-year-old female presented with nasal bleeding, progressive nasal blockage, facial swelling, snoring, and anosmia. Imaging revealed a mass originating from the left maxillary sinus extending to adjacent structures. Histopathology and immunohistochemistry confirmed plasmacytoma. Systemic workup was negative. The patient was treated with radiotherapy, with a good treatment outcomes. EMP of the nasal cavity, paranasal sinuses, and nasopharynx is rare, particularly in younger patients. Accurate diagnosis and appropriate treatment, often involving radiotherapy, are crucial for favorable outcomes. Awareness and a high index of suspicion are essential for early diagnosis and management.

Management of head and neck cancer of unknown primary: A phase IV study by DAHANCA.

Diagnostic and therapeutic management of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remains a challenge. The aim of the present phase IV study was to assess adherence to the current Danish guidelines and evaluate the treatment outcome in HNSCCUP patients. Prospectively collected data in the DAHANCA database from patients treated between 2014 and 2020 was evaluated. The median follow-up was 6.7 years. Treatment included definitive neck dissection (dND), primary (chemo-)radiotherapy ((C-)RT), neck dissection (ND) followed by postoperative (C-)RT (ND + (C-)PORT). Outcome were reported as five-year estimates of loco-regional failure (LRF), ultimate LRF (ULRF), disease specific mortality (DSM), overall survival (OS), and toxicity scores ≥ 3. A total of 288 patients were treated, of which 254 (88 %) received treatment with curative intent and were eligible for adherence assessment. These were allocated to dND (n = 60), (C-)RT (n = 81) and ND + (C-)PORT (n = 113). The HPV/p16 status was known in 94 % of patients with 109 (43 %) positive cases. The 5-year LRF, DSM, and OS for patients treated with curative intent was 22 %, 15 % and 73 %, and in patients with p16 positive disease 16 %, 5 %, and 85 %. The overall guideline adherence was 76 % (192/254). In the adherent group the LRF, ULRF, DSM, and OS were 22 %, 11 %, 16 %, and 73 %, respectively. The study revealed good treatment outcome measures in HNSCCUP patients subject to the Danish guidelines, comparable to other head and neck cancer patients. The observed guideline-deviations did not affect outcome.

Treatment outcomes among children and adolescents with extensively drug-resistant (XDR) and pre-XDR tuberculosis: Systematic review and meta-analysis.

Extensively drug-resistant (XDR) and pre-XDR- tuberculosis (TB) account for approximately a third of pediatric MDR-TB cases globally. Clinical management is challenging; recommendations are based on limited evidence. We assessed the clinical outcomes for children and adolescents treated for XDR-and pre-XDR-TB. We performed a systematic review and meta-analysis of published studies reporting treatment outcomes for children and adolescents with XDR-and pre-XDR-TB. MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and trial registries up to 31 December 2023 were searched. Eligible studies included children and adolescents aged <18 years with XDR-or pre-XDR-TB. The primary outcome was treatment success, defined as a composite of cure and treatment completion. Secondary outcomes were death, failure/ lost to follow-up and adverse events. We identified 34 population-based studies and 14 case studies, which reported treatment outcomes for a total of 656 patients. Treatment durations ranged from 6 to 27 months; follow-up after treatment completion ranged from 2 months to 4 years. The pooled estimate for treatment success in XDR-and pre-XDR-TB was 88·9% (95%CI: 59·7-100%) and 65·4% (95%CI: 27·7-100%), respectively. Drug adverse effects were reported in 56.4% (95%CI: 9.9-100%) and 68.2% (95%CI: 0-100%) of children respectively. Few childhood XDR- and pre-XDR-TB cases are reported. The relatively good treatment outcomes in children compared to adults may be partly due to publishing bias. Drug adverse effects are common.

Oral dydrogesterone versus oral micronized progesterone in threatened miscarriage: protocol paper for a randomized controlled trial.

Threatened miscarriage is a common complication of early pregnancy characterized by symptoms of vaginal bleeding with/without abdominal cramps/pain in the first trimester. Progestogens are often administered for the management of this condition. Presented herein is the protocol of an ongoing, multicentric clinical trial to investigate the efficacy and safety of micronized progesterone (natural progestogen) compared to dydrogesterone (synthetic isomer of progesterone). A total of 304 eligible pregnant women aged 20-39 years, diagnosed with threatened miscarriage, will be enrolled during 5-12 weeks of gestation and randomized equally to receive either oral dydrogesterone (40 mg stat, followed by 10 mg three times a day) or oral micronized progesterone (200 mg two times a day) up to one week after stoppage of bleeding or if bleeding does not stop, then treatment will be continued till a maximum of 14 weeks of gestation (unless miscarriage is confirmed earlier or the investigator decides to prolong treatment for better outcome or if bleeding relapses). Scheduled visits after enrollment will be conducted during 6-13, 8-14, 18-20 and 24-26 weeks of gestation, in addition to a visit at the end of treatment at 14 weeks and another after parturition. The primary endpoint of the study is the miscarriage rate before 20 weeks of gestation. Secondary endpoints include the ongoing pregnancy rate at 24 weeks, treatment-induced changes in serum levels of cytokines and time to symptom resolution. Apart from the incidence of treatment-emergent adverse events, safety endpoints include changes in complete blood count and the results of liver and kidney function tests from baseline to 14 and 24-26 weeks of gestation. Delivery outcomes are exploratory endpoints of the study. Almost one out of four women face miscarriage during the first trimester of pregnancy; initial symptoms include vaginal bleeding with/without abdominal cramps/pain. This paper presents the plan of how an ongoing, multicentric study will be conducted to compare the efficacy and safety of oral medications known to reduce chances of miscarriage: micronized progesterone (which is a natural female sex hormone) versus synthetic progesterone. Women aged 20-39 years who are at risk of miscarriage during the first trimester of pregnancy will be randomly treated with either medication till one week after stoppage of bleeding during early pregnancy. If bleeding does not stop, treatment will be continued till a maximum of 14 weeks of pregnancy (unless miscarriage is confirmed earlier). The participants will be monitored until delivery. The study will evaluate the proportion of participants who experience miscarriage before 20 weeks of pregnancy and those who have an ongoing pregnancy at 24 weeks. It will also look at the time taken for relief from symptoms such as vaginal bleeding and abdominal pain, outcomes of delivery and incidence of any untoward event. In addition to routine tests and scans, additional tests will check for levels of biochemical parameters in the body, which are regulated by the natural or synthetic progesterone. CTRI/2024/02/063174 [Registered on: 26/02/2024].

Features related to the presence of internet gaming disorder and their impact on the treatment outcomes.

Internet gaming disorder (IGD) is a highly engrossing activity with the individual spending up to 10 h per day gaming, this causes issues in accomplishing their tasks and personal goals. Also, to generate in them increased anxiety, impulsivity and lack of social skills, this impacts the good personal development and individual's quality of life. Therefore, it is vital to better understand, in terms of treatment, which factors are associated with therapeutic outcomes (largely to achieve control over the use of video games and the lack of relapses) following a standardized Cognitive Behavioral Therapy (CBT) protocol. This study aimed to explore sociodemographic and personality variables and their relation to treatment outcome in patients with IGD. The sample included n = 105 patients with IGD, considered between January 2005 and December 2022 and recruited from the Behavioral Addictions Unit at the University Hospital of Bellvitge. Data at baseline was registered (sociodemographic and clinical measures), as well as the therapy outcomes (compliance with the guidelines, presence of relapses and dropouts). Patients were mainly males (n = 95) with a mean age of 24.97 (SD = 12.03). All patients included in this sample had individual CBT treatment in relation to their problematic gaming behavior. In terms of patients whorelapsed, they had higher interpersonal sensitivity, hostility and persistence with lower self-directedness. Patients who dropped out were males with an older age of IGD onset. When looking at treatment noncompliance, it was related to higher psychoticism and reward dependence, and lower cooperation. Patients with IGD show higher levels of treatment noncompliance. Thesefindings evidence a positive and promising effect of CBT on IGT. The factors identified as predictors of good and poor treatment outcomes should be considered for developing new evidence-based interventions focused on learning healthier key coping strategies to manage both cravings and triggers.

Menopausal Transition Period: Hormonal Changes, Clinical Symptoms, Diagnosis, and Modern Management Approaches

Background: The menopausal transition (MT) marks the end of a woman’s reproductive years, characterized by hormonal changes, irregular menstrual cycles, and various symptoms impacting health and quality of life. Objective: To understand the hormonal fluctuations during MT and the clinical implications for managing symptoms. Method and Materials: The article synthesizes findings from various studies and consensus workshops, particularly the Stages of Reproductive Aging Workshop (STRAW), detailing hormonal changes and clinical presentations during early and late MT. Results: MT involves erratic estradiol levels, decreased progesterone, and increased follicle-stimulating hormone (FSH), leading to irregular cycles, with notable events like luteal out-of-phase (LOOP) cycles. Symptoms often include abnormal uterine bleeding, hot flashes, sleep disturbances, and mood disorders. Hormonal therapies, including estrogen and selective serotonin reuptake inhibitors (SSRIs), are effective but should be administered cautiously due to associated risks. Discussion: The hormonal chaos of MT complicates infertility and symptom management. Non-hormonal therapies and lifestyle modifications are beneficial but often less effective than hormone therapy. Conclusion: A personalized approach to managing MT is crucial, integrating hormonal and non-hormonal strategies, lifestyle changes, and mental health support. Continuous research aims to optimize these interventions for better outcomes in women during MT.

Psychometric evaluation of the Autism Symptom Dimensions Questionnaire.

To replicate and extend previous psychometric findings for the Autism Symptom Dimensions Questionnaire (ASDQ). Using a cross-sectional design in two samples, including a total of 3366 children and adolescents (aged 2-17 years; 1399 with autism spectrum disorder) and a small case series, factor structure, measurement invariance, reliability, construct validity, screening and diagnostic efficiency, and detection of reliable change were examined for the ASDQ. Strong psychometric properties were observed, including replicable factor structure, strong measurement invariance, adequate-to-excellent scale and conditional reliability, strong convergent and discriminant validity, and good screening efficiency. Importantly, two crucial measurement aspects required for a good treatment outcome measure were found, that is, good test-retest stability and the potential to detect reliable change. As expected for an informant-reported questionnaire, diagnostic efficiency was weak. The ASDQ showed evidence of favorable and well-replicated psychometric properties in two samples. Good screening but weak diagnostic efficiency, coupled with good test-retest stability, suggest that optimal clinical use is in screening and in detailed clinical characterization beyond what is offered by current informant-reported measures, with the potential for monitoring response to intervention. Despite relative brevity, the ASDQ provides good coverage of broad and specific aspects of the autism behavioral phenotype, which is consistent with the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Clinical characteristics and prognosis of children with T-lineage acute lymphoblastic leukemia: a single-center study

To study the clinical characteristics and prognosis of T-lineage acute lymphoblastic leukemia (T-ALL) and related prognostic factors. A retrospective analysis was conducted on the children with T-ALL who were treated with the Chinese Children's Cancer Group Acute Lymphoblastic Leukemia (CCCG-ALL) regimen in Guangzhou Women and Children's Medical Center between April 2015 and December 2022. A total of 80 children were included, with a median age of 7 years and 3 months and a male/female ratio of 6:1. Among these children, the children with mediastinal mass accounted for 20% (16/80), those with central nervous system leukemia accounted for 4% (3/80), and those with testicular leukemia accounted for 1% (1/69). SIL/TAL1 was the most common fusion gene (22%, 18/80), and NOTCH1 was the most common mutation gene (69%, 37/54). The median follow-up time was 52 months, with a 5-year overall survival (OS) rate of 87.3%±4.0% and a 5-year event-free survival rate of 84.0%±4.3%. The non-central nervous system-1 group had a significantly lower 5-year OS rate than the central nervous system-1 group (66.7%±16.1% vs 90.3%±3.8%; P<0.05), and the group with minimal residual disease (MRD) ≥0.01% on day 46 of induction therapy had a significantly lower 5-year OS rate than the group with MRD <0.01% (68.6%±13.5% vs 94.8%±3.0%; P<0.05). Children treated with the CCCG-ALL regimen tend to have a good treatment outcome. Non-central nervous system-1 status and MRD ≥0.01% on day 46 of induction therapy are associated with the poor prognosis in these children.

Efficacy and Determinant Factors of Linezolid Containing Regimens in the Treatment of DR - TB Patients at Saint Peter Specialized Hospital, Addis Ababa, Ethiopia, 2023 A Retrospective Study

Background: A synthetic oxazolidinone antimicrobial medication called Linezolid is used to treat patients who are resistant to multiple drugs. Few studies have been done regarding the effectiveness of Linezolid-containing regimens in both developing and developed nations. This study aimed to determine the Efficacy and determinant factors of linezolid-containing regimens in the treatment of DR - TB Patients. Methods: An institution-based cross-sectional study design was conducted using SPSS version 26, and multivariable binary logistic regression analysis was used. Result: out of 345 patients that visited the outpatient clinic, 205 (59.4%) were males, and 126(36.5%) were between 30-39 years. MDR TB Patients&amp;apos; linezolid-containing regimen treatment efficacy success rate is 280(81.2%). MDR TB Patient Previously Treated TB by First Line Drug [AOR= 5.823(3.761-7.341)]. MDR TB Patient Previously Treated TB by First Line and treatment completed [AOR=2.351(1.34-3.214))], the adverse effect [AOR 0.842(0.674-2.431], tolerability of linezolid [AOR =2.543(2.41-4.532)] was significantly associated with linezolid containing regimen treatment efficacy rate. Conclusion: Linezolid-containing regimens have good efficacy and good treatment outcomes for DR-TB patients. The findings showed that Linezolid is a good choice for treating DR-TB, although patients ought to be monitored closely for the incidence of adverse effects.

Oxygen, angiogenesis, cancer and immune interplay in breast tumour microenvironment: a computational investigation.

Breast cancer is a challenging global health problem among women. This study investigates the intricate breast tumour microenvironment (TME) dynamics utilizing data from mammary-specific polyomavirus middle T antigen overexpression mouse models (MMTV-PyMT). It incorporates endothelial cells (ECs), oxygen and vascular endothelial growth factors (VEGF) to examine the interplay of angiogenesis, hypoxia, VEGF and immune cells in cancer progression. We introduce an approach to impute immune cell fractions within the TME using single-cell RNA-sequencing (scRNA-seq) data from MMTV-PyMT mice. We quantify our analysis by estimating cell counts using cell size data and laboratory findings from existing literature. We perform parameter estimation via a Hybrid Genetic Algorithm (HGA). Our simulations reveal various TME behaviours, emphasizing the critical role of adipocytes, angiogenesis, hypoxia and oxygen transport in driving immune responses and cancer progression. Global sensitivity analyses highlight potential therapeutic intervention points, such as VEGFs' role in EC growth and oxygen transportation and severe hypoxia's effect on cancer and the total number of cells. The VEGF-mediated production rate of ECs shows an essential time-dependent impact, highlighting the importance of early intervention in slowing cancer progression. These findings align with clinical observations demonstrating the VEGF inhibitors' efficacy and suggest a timely intervention for better outcomes.

Risk Factors and Clinical Outcomes of Perioperative Hypotension in the Neck of Femur Fracture Surgery: A Case-Control and Cohort Analysis.

Introduction Neck-of-femur (NOF) fractures have high prevalence rates and require prompt surgical intervention for better outcomes. Perioperative hypotension (POH) in the geriatric population has poor outcomes with several contributing factors. The study intends to explore these risk factors and their correlation with patient outcomes. Methodology We studied a total of 276 patients who underwent surgical fixation of the NOF fracture at St Peter's Hospital, Surrey, from June 1, 2022, to June 1, 2023. Patients with POH were identified; the risk factors and one-year outcome were studied to obtain the results. We used odds ratio (OR), relative risk (RR), and multivariate regression to analyse the statistical association within the data. Results The incidence of POH was 68% (188/276) which included preoperative hypotension (9.78%), intraoperative hypotension (48.55%), and postoperative hypotension with a mean arterial pressure (MAP) of <65 mmHg (24.63%) and fall of systolic blood pressure to less than 80% (34.42%). Statistically significant risk factors were hypertension (OR: 1.330), heart disease (OR: 2.768), and hemoglobin (Hg) drop (OR: 1.42). The outcomes we studied were all statistically significant, with an RR of more than one. It includes postoperative delirium (RR: 2.037), postoperative 30-day morbidity (RR: 4.008), postoperative 30-day mortality (RR: 6.12), 365-day mortality (RR: 2.224), postoperative delay in mobilisation (RR: 1.329), and prolonged length of stay (RR: 1.273). Conclusion The study shows a clear association between POH and increased postoperative complications, highlighting the need for prompt intervention. This case-control study identified hypertension, history of heart disease, and perioperative blood loss as significant risk factors for developing POH. Also, this study demonstrates that POH is significantly associated with adverse outcomes, including the increased risk of delirium, prolonged hospital stays, and elevated 30-day morbidity in elderly patients undergoing hip fracture surgery.The findings also indicated that the duration of hypotension did not directly influence the outcomes; its occurrence alone is a significant factor in developing these complications.

Trends in malignant neoplasm of bone and articular cartilage related mortality among older adults in United States (1999-2020).

Malignant neoplasms of bone and articular cartilage, although rare, are associated with substantial morbidity and mortality, posing a serious health burden. Understanding the trends in mortality related to these cancers is crucial for developing targeted interventions and improving patient outcomes. This study aims to analyze long-term mortality trends, identify demographic and geographic disparities, and uncover potential factors driving changes in mortality rates. This retrospective study analyzed mortality rates among individuals aged 65 and older from 1999 to 2020 using CDC WONDER death certificate data, abstracting demographics, geographic factors, and urban/rural status. From 1999 to 2020, 18,205 adults aged 65 and older died from malignant neoplasms of bone and cartilage. The age-adjusted mortality rate (AAMR) started at 20 per 100,000 in 1999 and steadily declined until 2012 (APC: -1.12). However, from 2012 onwards, there was a notable reversal, with the AAMR rising sharply to 23.8 by 2020 (APC: 4.73). Men had higher mortality rates than women, with NH Black individuals showing the highest rates among races. Southern states and nonmetropolitan areas had elevated AAMRs, suggesting targeted interventions for better outcomes and lower death rates. The findings highlight significant inequities, with Southern states and nonmetropolitan areas showing elevated age-adjusted mortality rates (AAMRs). These geographic disparities underscore the urgent need for targeted public health interventions in these regions to improve cancer outcomes and reduce mortality. Addressing these gaps is essential for achieving more equitable health outcomes, particularly in high-risk populations.

Surgical treatment strategies for gastroesophageal reflux after laparoscopic sleeve gastrectomy.

Bariatric surgery has emerged as an effective therapeutic approach for combating obesity. As the most commonly performed bariatric surgery, laparoscopic sleeve gastrectomy (LSG) has a long-term and effective outcome in weight reduction. However, studies have reported an increased incidence of gastroesophageal reflux disease (GERD) among patients after LSG. For those who fail to respond to conventional oral acid-suppressing medication, surgical intervention comes into consideration. The most commonly performed revisional surgery for sleeve gastrectomy is the Roux-en-Y gastric bypass, which can effectively alleviate the symptoms of reflux in patients and also continues to promote weight loss in patients who have not achieved satisfactory results or have experienced weight regain. In addition to this established procedure, innovative techniques such as laparoscopic magnetic sphincter augmentation (MSA) are being explored. MSA is less invasive, has good reflux treatment outcomes, and its safety and efficacy are supported by the literature, making it a promising tool for the future treatment of gastroesophageal reflux. This article also explores the role of endoscopic interventions for GERD treatment of post-sleeve gastrectomy patients. Although these methods have shown some therapeutic effect, their efficacy still requires further study due to a lack of support from more clinical data. For patients with preoperative hiatal hernia or gastroesophageal reflux symptoms, some experts now consider performing LSG combined with hiatal hernia repair or fundoplication to alleviate or prevent postoperative reflux symptoms. Both of these surgical approaches have demonstrated favorable outcomes; however, the addition of fundoplication requires further investigation regarding its long-term effects and potential postoperative complications. This article gathers and examines the current laparoscopic and endoscopic treatments for refractory gastroesophageal reflux following LSG, as well as the concurrent treatment of LSG in patients with preoperative gastroesophageal reflux or hiatal hernia.

Vertical dysplasia

In orthodontics, vertical dysplasia is complex and the most difficult problem to treat because most methods to control vertical dimensions are patient-dependent. They have multifactorial etiology. Vertical dimension problems are the last to treat out of all the dimensions. Careful diagnosis and examination of this malocclusion will help the orthodontist to gain good treatment outcomes. Inadequate treatment mechanics leads to improper treatment outcomes. Thereby compromising the patient’s facial esthetics. This article reviews the detailed description of vertical dysplasia.

The Innate Immune Landscape of dMMR/MSI Cancers Predicts the Outcome of Nivolumab Treatment: Results from the Drug Rediscovery Protocol.

The treatment efficacy of nivolumab was evaluated in patients with advanced, treatment-refractory solid mismatch repair deficiency/microsatellite-instable (dMMR/MSI) tumors, and in-depth biomarker analyses were performed to inform precision immunotherapy approaches. Patients with dMMR/MSI tumors who exhausted standard-of-care treatment options were enrolled in the Drug Rediscovery Protocol, a pan-cancer clinical trial that treats patients with cancer based on their tumor molecular profile with off-label anticancer drugs (NCT02925234). Patients received nivolumab (four cycles of 240 mg every 2 weeks, thereafter 480 mg every 4 weeks). The primary endpoint was clinical benefit (CB: objective response or stable disease ≥16 weeks). Whole-genome sequencing and RNA sequencing were performed on pretreatment tumor biopsies. A total of 130 evaluable patients were enrolled with 16 different cancer types. CB was observed in 62% [95% confidence interval (CI), 53-70], with an objective response in 45% (95% CI, 36-54). After a median follow-up of 14.5 months (95% CI, 13-19), the median progression-free survival was 18 months (95% CI, 9-not reached), and the median overall survival was not reached. Whereas CB was not, or only weakly, associated with markers of adaptive immune cell infiltration, CB was strongly associated with expression of a broad set of innate immune receptors/ligands. This clearly contrasted findings in melanoma, in which markers of adaptive immunity dominated the biomarker landscape. Nivolumab proved highly effective in advanced dMMR/MSI tumors. Expression of key innate immune receptors/ligands was the main predictor of a good treatment outcome, contrasting findings in melanoma and strengthening the rationale for tumor type-specific biomarkers for guiding immunotherapy.

Treatment Outcomes of Tuberculosis Among Artisanal and Small-Scale Miners in Zimbabwe: A Follow-Up Observational Study Using Secondary Data.

In Zimbabwe, artisanal and small-scale miners (ASMs) are a key vulnerable group with high risk for tuberculosis (TB), HIV, and silicosis. The main purpose of this study was to investigate treatment outcomes of TB among ASMs. We conducted a follow-up observational study using secondary data. We analyzed data from 208 ASMs treated for TB at two occupational health clinics. We found a high treatment success rate of 87%, comparable to the national average for drug-sensitive TB. Unsuccessful outcomes were due to death (5%) and loss to follow-up (7%). Over a quarter of ASMs had unknown HIV status. Our study is the first to document treatment outcomes of TB among ASMs in Zimbabwe. Encouragingly, this study demonstrates the possibility of achieving good TB treatment outcomes even among highly mobile populations like ASMs. Further research is needed to analyze leakages across the whole TB patient pathway among ASMs. Additionally, addressing the high rate of unknown HIV statuses among ASMs is crucial to further improve overall TB treatment outcomes in this population.

The association between neurological symptoms and the outcomes of N-methyl-D-Aspartate receptor encephalitis treatment

Objective: To analyze the relationship between neurological symptoms and treatment outcomes of anti-NMDA receptor encephalitis at the Neurology Center of Bach Mai Hospital. Subjects: We selected 50 who were diagnosed with encephalitis at Bach Mai Hospital from January 1st, 2020, to October 31st, 2023. Methods: Cross-sectional descriptive study. Results: Among the 50 patients studied, 48% achieved good treatment outcomes, while 52% had poor outcomes. There was evidence of a significant difference in treatment outcomes between the group with symptoms such as consciousness disorders, dyskinesia and movement disorders, speech disorders, and dysautonomia compared to the group without these symptoms (p&lt;0.05). There was no significant difference in treatment outcomes between the group with symptoms such as seizures, memory impairment, and sleep disorders compared to the group without these symptoms (p&gt;0.05). Conclusion: In our study, 48% of patients achieved good treatment outcomes at discharge. Symptoms of consciousness disorders, dyskinesia and movement disorders, speech disorders, and dysautonomia were associated with treatment outcomes.

Colorectal cancer screening in Tuzla canton: Project and strategy for patients with average cancer risk

Background: Screening for colorectal cancer (CRC) can identify premalignant lesions and detect asymptomatic malignant tumors at an early stage that have a better chance of healing, but also longer-term better treatment outcomes. Screening has been shown to reduce mortality from CRC. The aim of this paper is comprehensive education of health care professionals in the Tuzla Canton about this disease, adoption of new guidelines and simpler route from diagnosis to surgical treatment,which ultimately leads to reduced mortality and better outcomes in treatment. Material and methods:The project included family medicine specialists, surgeons and gastroenterologists, 100 of them. The education project was led by two surgeons, who implemented the guidelines ofthe American College of Gastroenterology (ACG) 2021, when it comes to screening CRC. Results: None of the participants offered all correct answers in tests, prior to the training, in both groups of doctors. For a post-educational test, data suggest that there has been a noticeable improvement in the results. In a group of doctors with over 10 years of service, 71 (98.61%) answered correctly all the questions offered and only 1 (1.39%) between 5 and 9 correct answers. For a group of doctors with less than 10 years of service, 26 (92.86%) provided all correct answers and only 2 (7, 14%) between 5 and 9 correct answers.Conclusion: This project pointed to the necessary education of healthcare professionals in this area, who are involved in early detection programmes for CRC, especially family medicine specialists, surgeons and gastroenterologists.

Exploring perspectives on how to improve psychological treatment for women from minoritised ethnic communities: A qualitative study with service users.

Women are disproportionately impacted by depression and anxiety disorders and in particular, women from minoritised ethnic communities experience inequalities in access to outcomes of psychological treatment for these disorders. Better understanding from the views of service users about the factors that impact their access to, and experiences of care could help to optimise treatment for these groups. This study explored experiences of treatment and gathered suggestions about treatment improvement, from the perspectives of women currently using psychological therapy services. Semi-structured interviews were conducted with 12 female NHS Talking Therapies for anxiety and depression (NHSTTad) service users from minoritised ethnic communities. Data were analysed using thematic analysis. Four high-order themes were identified: (1) cultural identity and experiences of mental health and treatment, (2) challenges associated with treatment, (3) facilitators of good treatment experiences and outcomes and (4) improvements for women from minoritised ethnic communities. Findings showed that cultural sensitivity and awareness are important to minoritised ethnic women receiving therapy. Challenges included access difficulties and limitations of treatment options offered, alongside personal challenges of engaging in therapy. Facilitators of good treatment experiences and outcomes included flexibility on the part of the service, as well as therapist-related factors such as identity characteristics (age, gender and culture of therapist), a good therapeutic relationship and the therapist's ability to deliver person-centred care. Improvements included ensuring care is culturally sensitive, reducing waiting times or providing better support for people on waiting lists, providing a flexible service that takes individual needs into account, increasing workforce diversity and reaching out to underserved communities. Many of the suggested improvements are generalisable to underserved minoritised ethnic groups, regardless of gender and could be applied to other psychological therapies services other than NHSTTad.

Psychological Risk Factors for Delayed Recovery Among Active Duty Service Members Seeking Treatment for Musculoskeletal Complaints at a Navy Shore-Based Military Medical Treatment Facility.

Musculoskeletal injuries (MSIs) are a leading cause of separation from the U.S. Navy. Data have shown that several psychological responses to MSI are associated with treatment outcomes. Yellow flags are maladaptive psychological responses to injury and predict delayed recovery, whereas pink flags indicate resilience after MSI and are associated with good treatment outcomes. Identifying these factors in patients with MSI would permit early targeted care to address factors that may delay their readiness for deployment and enhance factors that support recovery. Active duty service members with MSI who reported to physical therapy outpatient services at a naval hospital were recruited for the study. Yellow flags were assessed at baseline as part of a larger study. Participants completed the Fear Avoidance Beliefs Questionnaire (with two subscales, physical activity and work), the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. Clinically relevant cut-off scores were used to indicate risk factors of delayed recovery. Pink flags were assessed with the Pain Self-Efficacy Questionnaire and a measure of positive outcome expectations for recovery. Two hundred and ninety participants responded to some or all of the questionnaires. Of these, 82% exceeded the cut-off scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire, and 39% did so on the work subscale. Pain catastrophizing exceeded the cut-off in only 4.9% of the sample. Forty-three percent of these exceeded the cut-off for the anxiety subscale of the Hospital Anxiety and Depression Scale; 27% exceeded the cut-off on the depression subscale of the Hospital Anxiety and Depression Scale. Additionally, 54% endorsed scores greater than 40 on the Pain Self-Efficacy Questionnaire, and 53% endorsed a high score on the positive outcome expectations. A substantial portion of the sample endorsed elevated scores on one or more indicators of delayed recovery from MSI. Most participants showed a fear of physical activity, and approximately half reported pain-related distress (anxiety and depression). In addition, feelings of self-efficacy and positive outcome expectations of treatment were endorsed by only about half of the participants, indicating that the remaining half did not report adaptive responses to MSI. Early identification of these risk factors will allow for targeted treatment approaches that incorporate these yellow flags into treatment and support a psychologically informed approach to physical therapy. This approach is likely to reduce delayed recovery and improve deployment readiness.