Management Of Syndrome Research Articles

An Exquisite Analysis on the Significance of Nutrient Supplementation in the Holistic Management of Poly-cystic Ovarian Syndrome

Abstract: The complex heterogeneous disorder known as polycystic ovarian syndrome (PCOS) includes endocrine, reproductive, metabolic, psychological, and other pathological aspects. Yet, nothing is understood regarding the cause of PCOS. Insulin resistance and hyperandrogenism are major contributors to the pathophysiology of PCOS, according to various studies. Because of this, a lot of PCOS treatment regimens include changing a person's lifestyle through practices, like exercise, nutrition, and vitamin supplementation. Recent studies have indicated a number of nutrients, including vitamins, minerals, and vitamin-like substances, for the therapy of PCOS since they all have at least one functional characteristic in the pathways that are affected by PCOS. As a result, it is claimed that PCOS may be caused by a vitamin or mineral deficiency. It is the goal of this review to conduct a critical literature analysis on nutritional supplementation for the management of PCOS.

Looking into the cholesterol crystal ball: is complement the answer?

Cholesterol crystal embolism (CCE) is a complication of atherosclerosis and can cause microvascular obstruction in multiple organs. Because the consequences may be fatal, and there is no specific treatment, it is crucial to understand the mechanisms and identify treatment strategies. In this issue, Zhao etal., using a mouse model of kidney CCE, demonstrated that inhibition of C5a/C5aR prevented and resolved CCE-induced renal thrombosis and angiopathy. Although these findings must be extended to human condition, they offer hope for management of CCE syndrome.

Clinical profile, demographic distribution, and management of Posner-Schlossman syndrome.

Clinical profile, demographic distribution, and management of Posner-Schlossman syndrome.

Response comment on "Clinical profile, demographic distribution, and management of Posner-Schlossman syndrome: An electronic medical record-driven data analytics from an eye care network in India".

Response comment on "Clinical profile, demographic distribution, and management of Posner-Schlossman syndrome: An electronic medical record-driven data analytics from an eye care network in India".

Clinical practices and treatment preferences in chronic coronary syndrome management among Indian physicians

Introduction: Chronic coronary syndrome (CCS) is a significant contributor to morbidity and mortality worldwide, particularly in India, where risk factors such as hypertension and diabetes are increasingly prevalent. Effective management of CCS typically involves lifestyle modifications, pharmacotherapy, and sometimes interventional procedures. Methods: A digital questionnaire-based survey was conducted across multiple sites in India, involving cardiologists and consultant physicians. The survey comprised nine questions addressing the prevalence of CCS, preferred treatments, and factors influencing prescribing decisions for novel oral anticoagulants (NOACs). Results: A total of 66 physicians were enrolled. Approximately 40.30% of physicians reported that more than 40% of their patients had CCS. The majority of physicians (57.81%) reported that dual antiplatelet therapy (DAPT) was most preferred treatment for CCS. Around 51% of physicians reported bleeding risk as the primary hindrance in prescribing rivaroxaban and aspirin for CCS patients. The majority of physicians (42.19%) preferred rivaroxaban with a prescription rate of 40%. Apixaban was most commonly prescribed at a rate of 30% by 33.87% of physicians, while dabigatran was typically prescribed at rates of 10% and 20% (41.82% each). Warfarin was prescribed for 10% of patients by 51.79% of respondents. In non-valvular atrial fibrillation cases, 73.13% preferred rivaroxaban primarily for its once-daily dosing advantage. Conclusion: The present study reveals current trends in the management of CCS and the utilization of NOACs among physicians in India. It underscores the growing significance of NOACs, particularly rivaroxaban, in enhancing treatment outcomes for patients with CCS.

Evaluating the Efficacy and Cost-Effectiveness of Plasmapheresis and Intravenous Immunoglobulin in Acute Guillain-Barre Syndrome Management in Emergency Departments

Evaluating the Efficacy and Cost-Effectiveness of Plasmapheresis and Intravenous Immunoglobulin in Acute Guillain-Barre Syndrome Management in Emergency Departments

Impact of a qualitative assessment approach for neonatal abstinence syndrome management: experience of a European reference center

BackgroundThe management of infants at risk of neonatal abstinence syndrome (NAS) remains challenging. In 2000 Maternidade Bissaya Barreto implemented a strategy based on the qualitative assessment of neonates and in 2018 the Eat, Sleep, Console (ESC) approach, a tool based on similar concepts, was created. The aim is to assess the efficacy of a qualitative assessment of infants at risk, compare it with the ESC approach and report temporal trends of NAS in a European hospital.MethodsRetrospective cohort study of all infants of mothers with a history of drug abuse during pregnancy admitted to a tertiary European centre between January 2010 and December 2021. The therapeutical decision was guided by a qualitative assessment of the newborn’s well-being. The ESC approach was retrospectively determined. Pharmacologic treatment was used as a last resort. The clinical outcomes and therapeutic strategies employed were evaluated. Statistical association was evaluated. The incidence rate per 1000 births was calculated and temporal trend differences were identified.ResultsA total of 79 neonates at risk were included, of whom 40 (50.6%) developed NAS. Consolability was the most affected criterion (35.0%), followed by feeding difficulties (12.5%). Sleep was affected less frequently (5.0%). Overall, 37.5% of infants failed to meet at least one of the criteria. All neonates with a positive ESC failed the qualitative assessment (p = 1.000) After optimization of nonpharmacologic measures, drug therapy was still necessary in four cases (10.0% of infants with the syndrome). The incidence rate of NAS decreased from 3.9 per 1000 births in 2010 to 0.0 per 1000 births in 2021 (p = 0.025).ConclusionThe qualitative assessment of the infant based on the ability to feed, sleep and be consoled correctly identified neonates at risk and led to a significant reduction in the use of drug therapy. The incidence rate of NAS decreased during the study period.

The role of apheresis in the management of Philadelphia-negative chronic myeloproliferative syndromes following drug shortages

The role of apheresis in the management of Philadelphia-negative chronic myeloproliferative syndromes following drug shortages

Integrating international lifestyle management of acute coronary syndrome and type 2 diabetes mellitus: a rapid review of guidelines

Abstract Background The rising prevalence of comorbidity has been described as an international health priority. There has been a dramatic increase in the levels of Type 2 Diabetes Mellitus (T2DM) among those with Acute Coronary Syndrome (ACS), with approximately 25-40% of patients admitted to hospital for ACS, also having diabetes. Comorbid ACS-T2DM provides a more complex set of symptoms for patients and clinicians to manage, and health policy makers to plan for. Those living with comorbid ACS-T2DM are at increased risk of death, another heart attack, re-hospitalisation, heart failure, reduced physical and psychological health, increased health service use and poorer quality of life. Due to shared disease determinants such as obesity, low physical activity levels and poorer dietary habits; individuals with ACS are more likely to have a comorbid T2DM. Care for patients with comorbidities is fragmented, siloed and poorly organised as it reflects a tradition of single disease management meaning comorbidity is rarely considered. Robust evidence is required to shape provision and guidance for those with comorbid ACS-T2DM and the clinicians involved in their care; with an emphasis on redesigning service provision and practice to address the needs of this growing population. Purpose To identify opportunities in existing clinical guidance to improve integrated care strategies and streamline management for those with comorbid ACS-T2DM. Methods Following Cochrane rapid review recommendations, a Population, Concept, and Context (PCC) framework guided eligibility. Guidelines for adults with ACS, T2DM, or both conditions in high-income countries were considered. Nineteen guidelines from the UK, Australia, Canada, Europe, Ireland, New Zealand, and the USA were compared, covering ACS (n = 10), T2DM (n = 6), and comorbid ACS-T2DM (n = 3). Lifestyle factors examined included diet/nutrition, physical activity, weight management, clinical and psychological aspects. Results The review identified consistent lifestyle recommendations for both ACS and T2DM, with overlaps in guidance for diet, physical activity, weight management, clinical, and psychological factors. The findings offer opportunity for integrated care strategies, potentially reducing duplicated lifestyle management efforts. The results lay the groundwork for more cohesive management of comorbid ACS-T2DM. Conclusions This research is relevant for healthcare providers, policymakers, and patients living with comorbid ACS-T2DM. Understanding the shared lifestyle factors provides valuable insights into the potential for integrated care. Recognising the overlap in existing clinical guidelines points to opportunity for a more streamlined and effective approach to managing comorbid ACS-T2DM. This knowledge can contribute to improved patient outcomes and seek to optimise healthcare resources.

Genome sequencing in the management of myelodysplastic syndromes and related disorders.

Myeloid neoplasms originate from the clonal proliferation of hematopoietic stem cells, which is driven by the acquisition of somatic genetic mutations. Within these disorders, myelodysplastic syndromes (MDS) are specifically characterized by morphologic abnormalities (dysplasia) and impaired maturation of myeloid precursors (ineffective hematopoiesis), resulting in peripheral blood cytopenia. Several studies have advanced the field of MDS, with a few landmark papers leading to a paradigm shift, opening new avenues of research and enabling a molecular revolution. These seminal papers include the first description of the 5q- syndrome, the identification of somatic mutations of TET2 in myeloid neoplasms, the detection of common pathway mutations in the splicing machinery, and the discovery of clonal hematopoiesis. The somatic genomic landscape of MDS is now well-defined. Genes that are recurrently mutated include epigenetic regulators, as well as genes of RNA splicing machinery, transcription regulation, DNA repair control, cohesin complex, and signal transduction. Furthermore, several disorders with a germline genetic predisposition to MDS have been identified, collectively accounting for up to 15% of all MDS cases. Genomic profiling can significantly improve the diagnostic approach to MDS, allowing the identification of distinct nosologic entities such as SF3B1-mutant or TP53-mutant MDS. The Molecular International Prognostic Scoring System for MDS (IPSS-M) has already proven to be a valuable tool for individualized risk assessment and treatment decisions. In addition, the recently developed molecular taxonomy of MDS will likely facilitate the implementation of precision medicine approaches for these disorders. This will necessitate the establishment of specialized infrastructures within public health systems, involving close collaboration between healthcare institutions, academia, and the life sciences industry.

Acupuncture for management of polycystic ovary syndrome: current evidence and future directions

Acupuncture for management of polycystic ovary syndrome: current evidence and future directions

Exploring the material basis and molecular targets of Changma Xifeng tablet in treating Tourette syndrome: an integrative approach of network pharmacology and miRNA analysis.

This study was to investigate the mechanism of Changma Xifeng tablet, a traditional Chinese medicine in the treatment of Tourette syndrome. Network pharmacology was utilized to pinpoint blood-entering constituents of Changma Xifeng and explore their potential targets. Additionally, differential microRNA expression analysis was conducted to predict Tourette syndrome-associated targets, complemented by molecular docking and dynamics simulations to support the interactions of the active compounds with these targets. The study identified 98 common targets between Changma Xifeng and Tourette syndrome, which may be involved in the treatment process. A protein-protein interaction network and a drug-active ingredient-disease target network highlighted the formulation's multi-component, multi-target therapeutic approach. Eight pivotal targets-AR, GRM5, MET, RORA, HTR2A, CNR1, PDE4B, and TOP1-were identified at the intersection of microRNA and drug targets. Molecular docking revealed 12 complexes with favorable binding energies below - 7kcal/mol, specifically: AR with Alfacalcidol, TOP1 with Albiflorin, GRM5 with Arachidic Acid, GRM5 with Palmitic Acid, AR with Arachidic Acid, AR with 2-Hydroxyoctadecanoic Acid, RORA with Pinellic Acid, RORA with Palmitic Acid, AR with Acoronene, AR with Epiacoronene, AR with 4,4'-Methylenediphenol, and HTR2A with Calycosin. Our molecular docking and molecular dynamics simulations suggest potential stable interactions between the formulation's active components and target proteins. These computational methods provide a preliminary theoretical framework that will guide our future experimental work. The study provides a scientific rationale for the use of traditional Chinese medicine in Tourette syndrome management and offers new insights for drug development.

Management of First Bite Syndrome: Systematic Review of Recent Evidence.

Management of First Bite Syndrome: Systematic Review of Recent Evidence.

Innovative approaches to the management of recurrent atrial fibrillation, aortic dilation, and Brugada syndrome.

Innovative approaches to the management of recurrent atrial fibrillation, aortic dilation, and Brugada syndrome.

Characterization of dipyridamole as a novel ferroptosis inhibitor and its therapeutic potential in acute respiratory distress syndrome management

Characterization of dipyridamole as a novel ferroptosis inhibitor and its therapeutic potential in acute respiratory distress syndrome management

Utilization and Effectiveness of Pectoralis Minor Tenotomy in the Surgical Management of Neurogenic Thoracic Outlet Syndrome.

Uncertainty exists concerning the optimal utilization and effectiveness of pectoralis minor tenotomy (PMT) in neurogenic thoracic outlet syndrome (NTOS). Between January 2020 and July 2023, 355 patients with NTOS underwent primary surgical treatment. Prospectively collected data were analyzed retrospectively. Overall mean patient age was 35.9 ± 1.9 years, 76% were female, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score at presentation was 60.3 ± 3.2, reflecting substantial disability. Surgical treatment was based on localized tenderness/symptoms to palpation, with 322 (91%) undergoing combined supraclavicular decompression and PMT (SCD + PMT) and 33 (9%) selected for isolated PMT when findings were solely confined to the subcoracoid space. Mean operative time (29 ± 5 vs 164 ± 9 min, P < .01) and hospital stay (0.3 ± 0.1 vs 4.0 ± 0.2 days, P < .01) were both lower after isolated PMT, with no significant differences in postoperative complications or rehospitalization. During follow-up of 26.7 ± 1.5 months, QuickDASH scores declined by 41.2% ± 2.3% (P < .0001) and patient-rated outcomes were excellent in 34%, good in 41%, fair in 22%, and poor in 4%. Fewer patients had poor-rated outcomes after SCD + PMT (2%) than after isolated PMT (19%) (P < .01). Recurrent symptoms requiring supraclavicular reoperation occurred in 16 patients after SCD + PMT (5%) and in 5 patients after isolated PMT (15%) (P < .05). Pectoralis minor tenotomy (PMT) has an important role in surgical treatment of NTOS, mainly as an adjunct in combination with SCD. While highly selected patients can do well after isolated PMT as a short outpatient procedure with rapid recovery, there is a greater potential for poor outcomes and supraclavicular reoperation than after SCD + PMT.

Erratum: Diagnosis, Evaluation, and Management of Ascites and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases.

Erratum: Diagnosis, Evaluation, and Management of Ascites and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases.

Implantable loop recorder via subscapular approach in 2.7kg neonate.

Implantable loop records allow continuous heart rhythm monitoring with the ability to be stored and viewed remotely. The limited use in the pediatric population stems from the unknown indications of use and feasibility of implantation. We describe the case of a 2.7kg female with Long QT3. A loop recorder helped identify breakthrough tachycardia and helped her transition to the next stage of care. Placement was at the left subscapular region with no complications. Implantable loop recorder placement is achievable in a 2.7kg patient at corrected gestational age 38weeks for LQT3 syndrome monitoring and management.

Health care disparities in complication and mortality rates following surgical management of cauda equina syndrome in New York State

Context While healthcare disparities related to race and ethnicity are well reported for non-emergent conditions, the literature on disparities in outcomes of emergent spinal conditions such as cauda equina syndrome (CES) remains sparse. Objective To evaluate racial disparities in complication, mortality, and readmission rates following surgical intervention for CES. Methods This retrospective analysis of The Statewide Planning and Research Cooperative System (SPARCS) database demonstrates that among patients surgically treated for CES in New York between 2015 and 2020. Bivariate and multivariate logistic regression analysis was performed to analyze the association of race and outcome variables after controlling for age, sex, comorbidities, length of stay, insurance, and hospital characteristics. Results Overall, 2,114 patients who underwent lumbar surgery for CES were identified. The study population was comprised of Black patients (177, 8%), White patients (79%, 1680), and Asian patients (257, 12%). Options for surgery included lumbar decompression (821, 38.8%), fusion (746, 35.3%), or both (547, 25.9%). On multivariate analysis, the odds of 30-day mortality were 2.98-fold greater in Black patients than in other patients (P = 0.029). By 180 and 360 days, the odds of mortality were 4.27 and 3.05-fold greater in Black patients than in other patients, respectively (P < 0.001 each). Thirty-day readmissions were 1.87-fold greater in Black patients than others (P = 0.004). No difference in overall complication rate was found between Black patients and all other race groups (P = 0.306). Conclusions Black patients surgically treated for CES face significantly higher rates of mortality and readmission than their non-Black counterparts.

Postprandial Symptoms in a Mixed-Meal-Test after Bariatric Surgery - Clinical Experience and a Critical Review of Dumping Syndrome Definition and Management.

Introduction Despite recent attempts to reach a consensus on the diagnostic criteria and treatment of Dumping Syndrome (DS) after bariatric surgery, many questions about the clinical applicability and significance of standardized provocation tests remain unanswered. The objective of this study is to retrospectively evaluate a mixed-meal-test (MMT) based on general nutritional recommendations after bariatric surgery and its clinical value in diagnosing DS. Methods The MMT contained 15.5g of protein, 10g of fat, 20.7g of carbohydrates, and 3.1g of dietary fiber, totaling 241 kcal. Symptoms based on the Sigstad Score, along with blood sugar, hematocrit, pulse rate, and blood pressure, were collected as primary readouts. The analysis included 58 MMTs from 56 patients who reported postprandial symptoms indicative of DS and were referred to the clinic by surgeons or general practitioners. Results Although all individuals reported significant symptoms at home, the MMT showed a positive symptom score (Sigstad Score ≥7) in only 16 cases (28%). Neither a heart rate increase &gt;10 BPM nor the 3% hematocrit increase suggested as cut-offs for early DS by the consensus paper were associated with the Sigstad Score or individually reported symptoms. None of the participants had a glucose decrease below 50 mg/dl; one fell below 60 mg/dl and 14 fell below 70 mg/dl. A blood glucose decrease below 70 mg/dl was not associated with symptoms. Conclusion The MMT showed that only a minority of patients reported classical DS symptoms under controlled conditions. Changes in hematocrit, heart rate, and blood sugar decrease below 70mg/dl did not help to predict symptoms in the individuals studied. The data, in the context of existing evidence, suggest that provocation tests have little value in clinical practice and that DS as a clinical entity after bariatric surgery should be reevaluated.