Main Goal Of Treatment Research Articles

Unraveling the Complexities of Severe Dengue: Exploring Transfusion Avoidance Strategies with Management of Hematological, Radiological Parameters, Clinical Features

Background: Dengue is an entity caused by mosquito bites in humans. It can change into a life-threatening entity within a very short time. Not every dengue case requires a blood transfusion. While plasma leakage and a drop in platelet count are possible side effects of severe dengue, not all patients suffer from them. The main goals of treatment are to control symptoms such as pain, fever, and dehydration by giving patients enough fluids and medicine. Aim: To identify the various clinical features associated with dengue along with the manifestations not warranting blood transfusion. Methods: This observational study includes a total of 300 laboratory-verified dengue patients who were admitted over two months. Patients with other causes of fever were excluded. Results: The majority of patients (80%) were discovered to be between the ages of 10 and 40, indicating that people in this age bracket are often more afflicted. Males were predominantly affected in comparison to females. Thrombocytopenia is the most prevalent anomaly, present in all the patients. Of these, 3.0 (1.0%) had platelet counts < 10,000/cmm, while 198 (66%) had platelet levels < 10,000–20,000/cmm. Conclusion: We conclude that the main factors influencing the prognosis are intra-abdominal visceral oedema as gall bladder wall edema, leucopenia (TLC count below 2000 cells/cmm), deranged liver functions, capillary leakage leading to peritoneal/pleural effusions as well as shock, and platelets. Platelets do not determine the severity and fatality of dengue infection.

Pediatric Chronic Heart Failure: Age-Specific Considerations of Medical Therapy

Chronic heart failure (CHF) is a rare entity in children but carries a burden of high mortality and morbidity. Medical treatment of pediatric CHF is largely based on guidelines for the adult population. In contrast to adults, evidence for the efficacy of medications in treating CHF in children is sparse. This may be due to the difficulty of conducting high-powered studies in children or to true differences in the mechanisms of CHF pathophysiology. Recent observations suggest that CHF in children differs from adults at the molecular and cellular levels. Different pathways are involved, leading to less fibrosis and hypertrophy than in adults, with potential implications for therapy. The main pathophysiological goals of medical treatment of pediatric CHF due to systemic left ventricular dysfunction are discussed in this review. These include preload and afterload optimization, diminishing cardiomyocyte apoptosis and necrosis as well as interstitial fibrosis, and optimizing myocardial oxygen consumption. The pediatric myocardium should be provided with optimal conditions to achieve its regenerative potential. The cornerstones of medical CHF therapy are angiotensin converting enzyme inhibitors (ACEI), beta blockers and mineralocorticoid receptor antagonists. There are potential benefits of tissue ACEI and β1-selective beta blockers in children. Angiotensin receptor blockers are an alternative to ACEI and their slightly different mechanism of action may confer certain advantages and disadvantages. Diuretics are employed to achieve a euvolemic state. Digoxin is used more frequently in children than in adults. Promising new drugs already routinely used in adults include angiotensin receptor-neprilysin inhibitors and sodium-glucose contransporter 2 inhibitors.

Efficacy and Safety of Fixed-Dose Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% Gel in Participants with Moderate-to-Severe Acne: The Patient Journey

Introduction: The main goal of acne treatment is to clear lesions quickly to manage and/or mitigate sequelae. Topical clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel is the only fixed-dose, triple-combination approved for acne. In three published clinical studies of participants with moderate to severe acne, CAB gel demonstrated superior efficacy to vehicle and component dyads, with good safety/tolerability. Herein are presented detailed efficacy and safety data from 5 clinical study patients to document their CAB treatment journey. Methods: In two phase 3 (NCT04214652, NCT04214639), double-blind, 12-week studies, participants aged ≥9 years with moderate-to-severe acne were randomized to once-daily CAB or vehicle gel. Endpoints included percentage of participants achieving treatment success (≥2-grade reduction from baseline in Evaluator’s Global Severity Score and clear/almost clear skin) and percent change from baseline in inflammatory/ noninflammatory lesion counts. Dosing compliance, treatment-emergent adverse events (TEAEs) and cutaneous safety/tolerability were also assessed. Descriptive data from 5 selected cases who completed 12 weeks of CAB treatment are summarized. Results: Participants (n=5) ranged from 13-32 years. At week 12, 3 achieved treatment success, 1 achieved a 2-grade reduction from severe to mild, and 1 achieved a 1-grade reduction from moderate to mild. Reductions from baseline to week 12 in inflammatory/ noninflammatory lesion counts ranged from 74.7-100%. No participants reported TEAEs/serious AEs. Some cutaneous safety/tolerability scores increased at weeks 2, 4, or 8, but generally decreased back to/below baselines levels by week 12, similar to the overall study populations. Most scores at week 12 were 0 (none) or 1 (mild), with only one participant reporting scores of 2 (moderate) for itching, burning, and stinging. Conclusions: In the overall phase 3 clinical trials, fixed-dose, triple-combination CAB gel has demonstrated good efficacy, safety, and tolerability. All 5 cases presented here achieved substantial (>70%) acne lesion reductions, with 4/5 cases achieving treatment success or a 2-grade EGSS reduction by week 12. While patterns in cutaneous safety/tolerability were variable across cases, transient increases with CAB generally resolved to baseline values within two months of treatment. These clinical study cases reinforce the importance of patient education regarding efficacy and safety of acne treatment, including the importance of treatment adherence, managing patient expectations, and the potential for cutaneous effects, which are often transient. Support: Ortho Dermatologics

Autoimmune thyroiditis: an update on treatment possibilities.

Autoimmune thyroiditis (AIT) is due to an autoimmune process that destroys thyrocytes, leading to hormonal disorders. AIT is more common in women, and the aetiology is multifactorial. The destruction of thyroid cells may release free thyroid hormones into the bloodstream, causing hyperthyroid symptoms. With further destruction of thyroid cells, patients develop euthyroidism and eventually chronic hypothyroidism. The diagnosis of AIT is based on clinical symptoms, positive anti-thyroid antibodies, ultrasound, and histological features. The main goal of treatment is correcting hormonal disorders and achieving euthyroidism. Treatment of AIT involves replacing thyroid hormone deficiency with the use of synthetic hormones. Prophylactic levothyroxine (L-T4) treatment of euthyroid patients with AIT may reduce both serological and cellular markers of autoimmunisation. Attention should be paid to the starting dose of L-T4, potential drug interactions, and drug formulation. A follow-up should be planned to determine the optimal dose. The authors highlighted that a healthy lifestyle and supplementing selected vitamins and microelements appropriately are essential. In selected clinical conditions, thyroidectomy should be considered. There are also alternative therapeutic strategies, such as herbal medicine and acupuncture, but their effectiveness has yet to be conclusively confirmed in research studies. Monitoring the thyroid gland enlargement and the possibility of developing nodular goitre is integral to patient care over AIT patients. In conclusion, treating AIT is complex, involving thyroid hormone replacement therapy, taking care of a healthy diet and lifestyle, and proper supplementation. It requires an individual approach. Regular follow-up is necessary to control the disease and minimise its effects.

Artificial Microglia Nanoplatform Loaded With Anti-RGMa in Acoustic/Magnetic Feld for Recanalization and Neuroprotection in Acute Ischemic Stroke.

Ischemic stroke is a leading cause of death and disability worldwide, and the main goals of stroke treatment are to destroy the thrombus to recanalize blood vessels and protect tissue from ischemia/reperfusion injury. However, current recanalization therapies have serious limitations and there are few neuroprotection methods. Hence, an artificial nanoplatform loaded with anti-Repulsive Guidance Molecule a monoclonal antibody (anti-RGMa) and coated with microglia membrane (MiCM) is reported for stroke treatment, namely MiCM@PLGA/anti-RGMa/Fe3O4@PFH (MiCM-NPs). Tail vein injection of MiCM-NPs targeted the ischemia-damaged endothelial cells because of the MiCM, then superparamagnetic iron oxide (Fe3O4) and anti-RGMa are released after external low-intensity focused ultrasound (LIFU) exposure. The thrombus is destroyed by LIFU-induced "liquid-to-gas" phase transition and cavitation of perfluorohexane (PFH) as well as Fe3O4 movements induced by an external magnetic field. Anti-RGMa protected the ischemic region from ischemia/reperfusion injury. The nanoplatform enabled visualization of the thrombus by ultrasound/photoacoustic imaging when the clot is in an extracranial artery. Importantly, in vivo animal studies revealed good safety for MiCM-NPs treatment. In conclusion, this nanoplatform shows promise as an ischemic stroke treatment strategy combining targeted delivery, recanalization, and neuroprotection.

A Case Report of Systemic Steroid Therapy for False Brain Tumors in Children

Study design: Case report. Purpose: to study the efficacy of systemic steroid in pediatric pseudotumor cerebri. Introduction: Pseudotumor cerebri is a condition caused by elevated intracranial pressure presenting most commonly with headache. It is a diagnosis of exculsion. Methods: A 15 year old girl presented in our OPD with headache since 3months, more in the posterior aspect, continuous type with severe intensity, non - radiating. On examination, her best corrected visual acuity in right eye was 6/9 and left eye was 6/6parts. She had normal anterior segment, normal IOP. Fundoscopy showed both optic discs edematous, pink in color with blurry disc margins, tortuous disc vessels, edematous peripapillary area. Rest of the retina was normal. Lumbar puncture showed elevated opening CSF pressure and normal CSF composition. Hence, she was diagnosed with IIH. She was started on oral prednisolone 1mg/kgbw once a day dosage, oral acetazolamide 250mg once a day, topical nepafenac 0.1% one drop thrice a day and timolol 0.5% eye drops twice a day. Discussion: The main goals of treatment are alleviation of symptoms, including headache, and preservation of vision. Steroids were commonly used for treating IIH in the past, but cause significant long - term side effects, such as weight gain, that are undesirable in IIH patients. Furthermore, withdrawal of steroids can cause rebound intracranial hypertension. Thus, steroids should not be used routinely for IIH treatment. Results: By the end of one month, patient was relieved of symptoms, best corrected visual acuity was 6/6 in both eyes with normal IOP, normal optic disc in both eyes. Conclusion: Steroids are an effective way of managing idiopathic intracranial hypertension in pediatric patients.

Review of Guideline Recommendations for Optimal Anti-VEGF Therapy in Age-Related Macular Degeneration.

Neovascular age-related macular degeneration is a progressive, blinding macular disease that has become a burden both in healthcare systems and the global economy. The vascular endothelial growth factor (VEGF) is the main agent involved in the pathogenic process of the disease. The main goal of the age-related macular degeneration treatment is to maintain and improve visual acuity by injecting intravitreal anti-VEGF agents in either a reactive or proactive manner. Subretinal and intraretinal fluids are the main biomarkers that should be considered when managing the frequency of the therapy. This review discusses both functional and morphological treatment criteria according to current recommendations as opposed to real-life situations encountered during day-to-day clinical practice and highlights situations in which the benefits of continuing therapy are arguable in terms of improving patients' quality of life. Optimizing the treatment regimen represents an important aim of current clinical ophthalmological practice, as age-related macular degeneration patients usually have a long follow-up period.

Congenital Adrenal Hyperplasia: A Review of Current Knowledge and Future Directions

Introduction: Congenital adrenal hyperplasia (CAH) is a group of diseases in which genetic defects occur that disturb the synthesis of cortisol. The most common variant of CAH (95%-99%) is caused by 21-hydroxylase deficiency as a result of mutations in the CYP21A2 gene and is one of the most common monogenic diseases. CAH is characterized by androgen overproduction along with variable degrees of cortisol and aldosterone deficiency. Age at diagnosis can provide some information about the underlying mutations, with those diagnosed at birth/early infancy being at greater risk of developing serious enzyme defects. Classic and non-classical forms of this disorder have been described in the literature. CAH diagnosis is based on the clinical presentation, hormonal panel, Adrenocorticotropic Hormone (ACTH) stimulation test, and genetic testing. The main goals of treatment for congenital adrenal hyperplasia are glucocorticoid/mineralcorticoid supplementation, control of high adrenal androgen levels, fertility control, genetic counseling, and optimization of patients’ quality of life. Purpose of the work: This study aims to review and characterize the clinical and pathophysiological aspects of congenital adrenal hyperplasia. Materials and methods: A comprehensive analysis of research papers available on PubMed, Google Scholar, Web of Science, Embase and Scopus was undertaken using the searchterms encompassing the following keywords: congenital adrenal hyperplasia, 21-hydroxylase deficiency, CYP21A2 Results: Congenital adrenal hyperplasia is a heterogeneous group of genetic disorders that can lead to serious and even fatal complications in the form of adrenal crisis. Therefore, screening tests and early diagnosis are crucial and can save the lives of newborns. Treatment should be individualized and allow patients to achieve normal growth, sexual development, fertility and a better quality of life.

Current Advances in Diagnosis, Therapeutics, and Surgical Interventions for the Management of Refractory Gastroesophageal Reflux Disease (GERD): An Update.

Gastroesophageal reflux disease (GERD) is a chronic illness characterized by complications arising from the reflux of stomach contents, which significantly lower the quality of life, increase morbidity, and increase medical expenses associated with treating the condition. The main goal of treatment in GERD is symptomatic relief, relapse prevention, and healing of erosive esophagitis. The treatment mainly involves lifestyle changes to control acid production and proton pump inhibitors (PPIs) as the first line of treatment. Endoscopic interventions or anti-reflux surgery may be beneficial in relieving symptoms in people whose symptoms are triggered by reflux. In this review, we discuss the pathophysiology and newer diagnostic and treatment modalities including available surgical management options to manage refractory GERD.

Looking for the ideal medication for heart failure with reduced ejection fraction: a narrative review.

The main goals of the pharmacological treatment of Heart failure with reduced ejection fraction (HFrEF) are the reduction of mortality and the prevention of hospitalizations. However, other outcomes such as improvements in cardiac remodeling and clinical status, functional capacity and quality of life, should be taken into account. Also, given the significant inter-individual and intra-individual variability of HF, and the fact that patients usually present with comorbidities, an appropriate treatment for HFrEF should exert a clinical benefit in most patient profiles irrespective of their characteristics or the presence of comorbidities, while providing organ protection beyond the cardiovascular system. The aim of this narrative review is to determine which are the proven effects of the guideline-directed treatments for HFrEF on five key clinical outcomes: cardiovascular mortality and hospitalization due to HF, sudden death, reverse cardiac remodeling, renal protection and evidence in hospitalized patients. Publications that fulfilled the pre-established selection criteria were selected and reviewed. Renin-angiotensin system (RAS) inhibitors, namely angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) or angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), sodium-glucose co-transporter 2 inhibitors (SGLT2i) show a benefit in terms of mortality and hospitalization rates. ARNI, BB, and MRA have demonstrated a significant positive effect on the incidence of sudden death. ARB, ARNI, BB and SGLT2i have been associated with clear benefits in reverse cardiac remodeling. Additionally, there is consistent evidence of renal protection from ARB, ARNI, and SGLT2i in renal protection and of benefits for hospitalized patients from ARNI and SGLT2i. In conclusion, the combination of drugs that gather most beneficial effects in HFrEF, beyond cardiovascular mortality and hospitalization, would be ideally pursued.

Current concept of osteoporosis diagnosis and treatment in children

Osteoporosis (OP) is a disease characterized by a decrease in bone strength, leading to an increased risk of fractures. Bone fragility in children may be due to genetic disorders, chronic underlying conditions or taking medications that negatively affect bone metabolism. The article considers the modern classification of OP in children, approaches to its diagnosis, the role of dual-energy X-ray absorptiometry for diagnosis.The main goal of OP prevention and treatment is to achieve a higher peak of bone mass, improve bone microarchitectonics, and, as in adults, reduce the risk of fractures, prevent skeletal deformities, improve mobility, independence and quality of life. Recommendations for lifestyle changes are presented, including adequate calcium intake and vitamin D, taking antiresorptive drugs, as well as prospective management of children with OP.

Drugs for COPD.

The main goals of treatment of chronic obstructive pulmonary disease (COPD) are to relieve symptoms, reduce the frequency and severity of exacerbations, prevent disease progression, and reduce mortality. GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines for treatment of COPD were updated recently.1 Treatment of acute exacerbations is not discussed here. Drugs available for treatment of COPD are listed in Tables 1 and 3.

Osteoarthritis in athletes – surgical and non-surgical aspects of treatment

Introduction: Osteoarthritis (OA) is a degenerative chronic process that primarily affects the elderly, but there are also reports of OA in the young and sports-active population. Symptoms of OA usually include pain, joint stiffness, and crepitation. Physical, radiologic, and laboratory tests are required for diagnosis. The main goal of OA treatment is to restore normal function to the joint affected by OA. Methods: A literature search on PubMed was used to collect facts about the relationship between sports and OA and possible treatment methods. All forms of articles were considered in the literature search. Articles that were not written in English were not included. Literature from the library of the Faculty of Medicine in Mostar was an additional source of information. Results: OA occurs more frequently in people who play or have played professional sports. On the other hand, daily exercise has a positive effect on cartilage metabolism. Most articles reported the occurrence of OA in former professional athletes. The joint most commonly affected by OA was the knee. Injuries were a predictive factor for the occurrence of OA, and most studies talk about anterior cruciate ligament injuries. Running and football were the most commonly studied sports. Treatment options include conservative treatment, surgical methods, and biological therapy. Conclusion: Frequent strain and injury in athletes can cause cartilage damage and potentially lead to the development of OA. The benefits of exercise far outweigh the risks of developing OA. In addition, some studies report a significant stimulating effect of exercise on cartilage cell metabolism. Treatment of OA consists of the use of analgesics, intra-articular therapy, and physiotherapy. Surgical methods are considered when conservative approaches are unsuccessful. Biological therapy and similar treatments are the new potential treatments.

ОСОБЛИВОСТІ ФІЗИЧНОЇ ТЕРАПІЇ У ПРОЦЕСІ РЕАБІЛІТАЦІЇ ОСІБ ПОХИЛОГО ВІКУ З ПОРУШЕННЯМ ФУНЦІЙ ХРЕБТА

According to literary sources, osteochondrosis of the cervical and thoracic spine is one of the most common diseases. This disease affects 22% of the world's population and ranks first in the group of diseases of the musculoskeletal system. The main goal of restorative treatment of elderly patients with cervical and thoracic osteochondrosis is to reduce muscle spasticity, decrease the level of heart rate, arterial systolic and diastolic pressure, reduce pain, facilitate the performance of household tasks, etc. In the program of physical therapy, we included therapeutic physical culture, therapeutic massage, and physiotherapeutic means. Therefore, the purpose of the study was to study of the peculiarities of physical therapy in the rehabilitation process of elderly people with osteochondrosis. Research methods. 28 people (12 men and 16 women) with osteochondrosis of the cervical-thoracic spine took part in the study. The average age of the patients was 64.5 years. The pedagogical experiment was aimed at determining the effectiveness of the program of physical therapy developed by us for elderly people with osteochondrosis on indicators of mobility in the cervical spine, intensity of pain sensations. Results and conclusions. The results of the conducted research indicate the positive impact of classes in the complex program of physical therapy for the elderly with cervicothoracic osteochondrosis. Thus, after the completion of the formative study, we established an improvement in the functional state of the cervical spine in elderly persons with cervical-thoracic osteochondrosis. The average group value of the pain intensity index in patients at the end of the study corresponded to the assessment of «very mild pain», while at the beginning of the study it corresponded to the assessment of «pain above average».

Diffuse large B-cell lymphoma and follicular lymphoma: problem state in Russia

Background. Non-Hodgkin's lymphomas (NHL) are a heterogeneous group of hematological malignancies, the vast majority of which are B-cell tumors. The most common variant of NHL is diffuse large B-cell lymphoma (DLBCL), characterized by an aggressive course, which accounts for 30–40% of all NHL. The second most common is follicular lymphoma (FL), traditionally classified as an indolent variant accounting for up to 25% of all NHL. Current therapies for these lymphoproliferative disorders which includes innovative drugs in the 1st line of therapy (LT) have demonstrated high efficacy. However, some patients develop a relapse or a refractory disease. Despite recent significant progress in the development and implementation of innovative targeted drugs, in most cases, it is not possible to achieve persistent long-term remissions after disease relapse, which leaves patients with an unmet need for effective and well-tolerated treatment options. Aim. To obtain objective data on the incidence, clinical course, and effectiveness of therapy for the most common variants of NHL in real-world practice in Russia. Materials and methods. From February to March 2023, 130 hematologists and oncologists from 30 regions of Russia were surveyed to update the data on DLBCL and FL. Results. Over the past 12 months, 5,689 patients with NHL were observed, of which 56% had DLBCL; 62% of them received the 1st LT, 22% received the 2nd LT, 10% received the 3rd LT, and only a few reached later lines. Analysis of the administered treatment options in the 2nd and 3rd LTs shows that there is no standard of care for this population, and the effectiveness of the regimens used in real-world Russian practice is extremely low. FL accounted for 23% of all 5,689 patients with NHL, of which 56% were newly diagnosed and 44% received treatment for relapse. The majority of patients with FL who received ≥3 LTs had an inferior prognosis and rapid disease progression: the median time from diagnosis to the beginning of the 3rd LT was only 26.4 months. The analysis of treatment options for patients with relapsed FL indicates a lack of standard and effective therapies. Conclusion. Relapsed and refractory DLBCL and FL represent a complex clinical situation where the main goal of treatment is disease control due to the impossibility of achieving stable remissions with existing treatment options. Clinicians with great hope are looking to the emergence of new classes of drugs that will be able to improve the prognosis for this complex population.

Algorithm of complex therapy and prevention of emotional burnout in doctors-psychiatrists during the war and its effectiveness

Abstract. The purpose - to develop and determine the effectiveness of the algorithm of complex therapy and prevention of emotional burnout (EB) among psychiatrists during the war, to resolve the issue of its recommendation for wide implementation in the system of mental health care institutions. The research sample, which was formed in compliance with the principles of biomedical ethics and based on informed consent, included 120 psychiatrists who worked in the city of Kyiv in the period from February 24, 2022. During 2022, the persons under examination were divided into three groups: the first group included 37 persons (30.8%) – doctors with no signs of professional maladjustment (PMA), and a low level of EB; the second group consisted of 57 persons (47.5% ) with signs of professional PMA, and a moderate level of EB; the third group consisted of 26 persons ( 21.7%) and they were respondents with clinically established and pronounced PMA, and a high level of EB. As a result of the study, the personal, psychopathological, psychosocial, professional and emotional-interpersonal factors of the formation and progression of EB among psychiatrists during the war were established, and their interrelationships in its genesis, on the basis of which the basic principles of a comprehensive approach to the therapy and prevention of EB were formulated for psychiatrists (complexity, personalization, phasing and availability), the main goals of treatment and prevention measures are defined and 4 therapeutic strategies of diagnosis, therapy and prevention are proposed within the framework of providing specialized medical care to psychiatrists during the war. These are recommended to be implemented taking into account the degree PMA as a key descriptor of EB, and in accordance with the key vectors of pathological changes in the respondents. The implementation and further evaluation of the effectiveness of the mentioned measures proved their effectiveness in eliminating manifestations of EB and PMA, normalization of mental state with levelling of psychopathological symptoms, improvement of social and psychological adaptation and quality of life of psychiatrists. The results obtained make it possible to recommend this algorithm for wide implementation in the practice of mental health care institutions.

Treatment strategies for vertical maxillary excess: Cases with and without anterior open bite

This comprehensive review investigates the treatment of vertical maxillary excess (VME) with and without anterior open bite (AOB) in seven unique case studies. These cases illustrate the implementation of advanced orthodontic techniques, such as miniscrew-assisted intrusion of the maxillary and mandibular arches. The multifaceted nature of AOB must be considered, highlighting the need for clear diagnostic criteria and an understanding of the long-term impacts of treatment strategies. The main goal of treatment is to reduce the vertical dimension of the maxillomandibular complex. A single miniscrew in the midpalatal region for the maxillary arch and two miniscrews in the buccal areas of the mandibular arch can be applied for the effective intrusion of the posterior teeth. The review then delves into the specific challenges and treatment modalities for managing VME without AOB, stressing the critical role of individualized intervention plans. Each case study demonstrates a different aspect of the treatment approach: from differential intrusion of molars to address esthetic concerns and functional issues to comprehensive strategies involving the intrusion of entire dental arches to correct severe malocclusions. The outcomes emphasize the importance of controlled orthodontic mechanics in achieving and maintaining optimal posttreatment stability. This review underscores the effectiveness of these treatment strategies in significantly improving facial profiles and dental function while highlighting the adjunctive use of myofunctional therapy and other retention techniques to prevent relapse. Collectively, these cases provide valuable insights into the tailored treatment of complex orthodontic conditions, offering guidance on achieving long-term success in clinical practice.

Current treatment approaches in the management of the heart failure

Heart failure is a clinical syndrome in which the function of the heart muscle and neurohormonal regulation are impaired, resulting in an inability to meet the metabolic needs of tissues. Many different mechanisms are involved in the pathophysiology of heart failure. Therefore, this disease is defined as a chronic disease in which treatment management is difficult for both the patient and the physician. Therefore, although the main goal is to take the necessary precautions before the disease develops, this may not always be possible. The management of the disease and the treatment options are being provided by finding drugs that are effective against existing mechanisms or against new mechanisms that have been discovered. The main goal of treatment is to stop the chain of events that cause and worsen heart failure based on the physiopathology. For this reason, there are various treatment modalities accepted in current guidelines to manage the current process. The aim of these treatments is to reduce symptoms, improve quality of life, and reduce mortality and morbidity rates. Recently, many important developments in the field of heart failure have started to come one after another. In this article, the mechanisms of action of the current treatment options and their effects on mortality have been mentioned, but rather than the current pharmacologic treatments, promising new treatment options, especially phase 3 and phase 4 trials, have been evaluated.

Understanding the enigma of neurobehavior in children with epilepsy and the need for mandatory screening: a prospective case control study

Background: In epilepsy management, control of seizures is the prime objective and reduction in seizure frequency is the main goal for successful treatment. There is a high prevalence of neurobehavioral problem. Hence, there is a need to screen, and intervene. Aim was to identify the neurobehavioral profile and the impact on children with epilepsy Methods: After IRB clearance, 100 consecutive school-aged children 4-17 years with normal IQ attending epilepsy clinic were enrolled as cases, and 102 age, gender and socio-economic status-matched children without epilepsy were chosen as controls. The strength and difficulties questionnaire are administered to both groups. It addresses five domains: emotional, conduct, hyperactivity, and peer problems which contribute to the total difficulties score, and fifth dimension prosocial behaviour. Results: Among the children with epilepsy, emotional issues were observed in 41%, conduct issues in 67%, hyperactivity behaviour in 54%, and peer problems in 64% while pro-social behaviour was only 27%, and total difficulty score was 60%, which was statistically significant with p<0.001 in all domains when compared to control. The impact of the disease was 73%, home environment was affected in 67%, classroom learning 45%, 28% in leisure activities, and 10% in friendship, which was statistically significant with p<0.001 in all domains when compared to control. Conclusions: We have identified emotional, conduct, hyperactivity and peer problems having significant impact on children with epilepsy. Hence a screening in various behavioural domains helps in early identification and prompt intervention of neurobehavior.

Можно ли вылечить ревматоидный артрит, изучив факторы, препятствующие выздоровлению?

Remission is the current goal of treatment for rheumatoid arthritis (RA). However, the ultimate goal should be complete cure of the disease and not just lifelong control of inflammation. Moreover, on the one hand, there is a certain saturation effect of anti-inflammatory drugs in RA, and on the other hand, there is increasing evidence that the pathological processes underlying the development of RA are independent of modern therapeutic agents. Therefore, in the future, the main goal of RA treatment should be considered to be the cure of the disease, i.e. recovery, not just suppression of symptoms