Medical Treatment In Patients Research Articles

Challenges in the Marital Life of Women with Gynecological Cancers: A Qualitative Study

Background: Gynecological cancer is an unfortunate event. Due to cultural and social constraints, there is insufficient information as to the challenges of Iranian women with this cancer. Objectives: The aim of this study was explaining the marital life challenges of patients with gynecological cancer. Methods: A qualitative study was performed through semi-structured and face-to-face interviews, and the data was analyzed through conventional content analysis. The participants included 16 women with gynecological cancer referred to three medical centers in Mashhad, Iran. Results: By analyzing the data, three categories were obtained :1) concerns about losing their position in marital life (forcing to stop sexual intercourse, increasing the burden of life on the spouse and reducing the patient's presence in marital life), 2) effect of the disease on sexual relations (deterioration of intimacy, unpleasant experiences during sexual intercourse and the occurrence of gradual sexual frigidity), and 3) concerns about the possibility of divorce and separation (being out of favor with husband and marital conflicts). Conclusions: Women with gynecological cancer face numerous challenges. It is necessary to inform nurses and physicians about this issue to increase their understanding of these women's problems. Also, holding educational classes and counseling sessions along with medical treatment for patients can play an essential role in promoting the health of these women in various dimensions.

EFFICACY OF TRIMETAZIDINE IN PATIENTS WITH ACUTE CORONARY SYNDROMES AND CO-MORBIDITIES

Acute coronary syndrome (ACS) is a serious clinical manifestation of coronary artery disease and is the major cause of morbidity and mortality worldwide. Established, that ACS and sudden death cause most IHD-related deaths, which represent 1.8 million deaths per year, with similar numbers of men and women dying from CAD. It is estimated that nearly half of patients with acute coronary syndrome (ACS) have one or more comorbid conditions, which have been linked to poor prognosis. The complexity of clinical decision-making in the presence of multiple comorbidities and the lack of explicit guidelines has been linked to poorer adherence to treatment protocols and worse outcomes for ACS patients. Under-usage of medication and standard-of-care procedures due to the unknown effects of certain therapies for patients with multiple comorbidities (e.g. percutaneous coronary interventions, dual antiplatelet therapy) and worse in-hospital and one year outcomes as well as increased mortality rates have been reported in ACS patients with multiple co-morbidites.
 Trimetazidine is a second-line medication for treatment stable angina and microvascular angina in European and national guidelines. The efficacy and safety of trimetazidine in ACS patients are under investigation.
 The purpose of research: to assess the short-term potential benefits and safety of trimetazidine added to standard evidence-based medical treatment in patients with ACS and co-morbidities: arterial hypertension and/or 2 type diabetes mellitus.
 Material and Methods. We observed of 184 patients with ACS with arterial hypertension (AH) and / or 2 type diabetes (DM). The diagnosis was verified by laboratory and instrumental methods according to European Society of Cardiology guidelines (2017, 2020) [10, 11]. All patients were divided into four groups: 1st group - 42 patients with ACS without AH or DM; 2nd group – 56 patients with ACS and previous AH; 3rd group – 42 patients with ACS and 2 type DM; and 4th group – 44 patients with ACS and AH and DM. Due to the treatment strategy patients from each group were divided into 2 subgroups: a – with guidelines-recommended therapy (GRT) and b – with GRT and trimetazidine (TMZ) 35 mg twice a day. The following laboratory tests were performed, in our trial: blood glucose, HbA1c, serum urea, serum creatinine, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, serum sodium, serum potassium, CRP, cardiac troponin I, NT-proBNP.
 Results. The mean age of all observed patients with ACS was 64.6±11.9 years; 93 (50.5%) were males and 91 (49.5%) females among them (see table 1). ACS without persistent ST segment elevation was diagnosed in 44 (23.9%) cases; instead ACS with persistent ST segment elevation – in 140 (76.1%) cases. In all trimetazidine treatment groups, the weekly frequency of angina symptoms showed the significant reductions at 28-day visit compared with baseline (p<0.05). Similar, the short-acting nitrate consumption was significant low during the course of treatment with trimetazidine (p<0.05). Additional prescription of trimetazidine had significant effects for decrease of glucose, LDL cholesterol, CRP and NT-proBNP levels in patients with ACS and co-morbidities. Any serious adverse events were detected in the trimetazidine groups or in the placebo groups.
 Conclusions. Additional prescription of trimetazidine has significant effects for decrease of glucose, LDL cholesterol, CRP and NT-proBNP levels in patients with ACS and arterial hypertension and/or 2 type diabetes mellitus and has good safety.

Therapeutic management of acute type A aortic intramural hematoma

ObjectivesThe proper therapeutic management for acute type A aortic intramural hematoma (IMH) is still controversial. The purpose of this study was to compare the outcomes following emergency surgery or conservative treatment for patients with this disease.MethodsFrom January 2015 to December 2018, 124 consecutive patients were diagnosed with an acute type A aortic IMH and were included in this study. According to our surgical indications, they were divided into two groups: an operation group (OG) and a conservative treatment group (CG).ResultsOf 124 patients, 83 (66.9%) patients accepted emergency surgery and 41 (33.1%) patients accepted strict conservative treatment. There were no differences between these two groups in early mortality and complications. However, the late mortality of patients in the CG was significantly higher than for patients in the OG. A maximum aortic diameter in the ascending aorta and aortic arch ≥ 45 mm and maximum thickness of IMH in the same section ≥ 8 mm were risk factors for IMH related death in patients undergoing conservative treatment.ConclusionsThe mortality associated with emergency surgery for patients with acute type A aortic IMH was satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than medical treatment for patients with acute type A aortic IMH.

Effectiveness of ozone therapy in addition to conventional treatment on mortality in patients with COVID-19.

AimIn this study, we aimed to investigate the effectiveness of ozone therapy, which is one of the integrative medicine applications that has been used safely for many years, on the prevalence of mortality in patients receiving COVID‐19 treatment.MethodsThis was a prospective, controlled study conducted on patients with COVID‐19 who were hospitalised. In this study, 55 patients were included. The patients were divided into two groups as the ozone and control group. Ozone therapy (major autohemotherapy) was applied to 37 patients who were being treated with the appropriate COVID‐19 treatment protocol determined by the infectious diseases committee of our hospital. The ozone treatment protocol consisted of seven sessions (one session per day) of intravenous ozone administration, applied in a volume of 100 mL and a concentration of 30 μg/mL. Only the conventional COVID‐19 treatment protocol was applied to 18 patients in the control group. Clinical follow‐up was performed until the discharge of the patients from the hospital with successful treatment or until the mortality occurred. Factors affecting mortality were analysed using univariate regression analysis.ResultsIntensive care unit (ICU) hospitalisation was required in 6 of the 37 patients who were treated with ozone (16.2%), while 4 of 18 patients in the control group required ICU treatment (22.2%) (P = .713). When the mortality rates between the two groups were compared, mortality was lower in the ozone group (P = .032). As a result of univariate logistic regression analysis performed to investigate the factors affecting mortality, treatment with ozone therapy was determined as a risk factor for mortality. Patients receiving ozone therapy appear to have a lower mortality risk (odds ratio [OR]: 0.149, 95% confidence interval [CI] 0.026‐0.863, P = .034).ConclusionIn this study, the findings suggested that the administration of ozone therapy along with the conventional medical treatment in patients hospitalised for COVID‐19 could reduce mortality.

Medical treatment of patients with gynecologic cancer during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, cancer care had to be reorganized; national and international recommendations were published to manage anticancer treatments safely and to reduce the risk of SARS-CoV-2 infection for...

Association between the Use of Alternative Medicine and Adherence to Treatment in Patients with Type 2 Diabetes

Background: Diabetes mellitus 2 (T2D) is the leading cause of morbidity and mortality in northern Mexico. Various treatments are used to control the disease; however, the cost of these and the difficulty of dietary management have as a consequence that the patient abandons them and looks for cheaper and easier-to-use alternatives. Aim: The purpose of this study is to determine the relationship between the use of alternative medicine and adherence to medical treatment in patients with T2D. Design and Setting: Analytic cross-sectional study. Methods: An analytical cross-sectional study was designed between March and July 2019 including 464 patients with T2D from the family medicine unit #48 Ciudad Juarez, Mexico. We used the Morisky-Green scale for adherence to treatment and the use of Alternative Medicine (CAM) was evaluated with a holistic complementary and alternative medicine questionnaire. The Chi-Square test was used for comparison of proportions and risk factors were calculated using odds ratio with 95% confidence intervals. Results: 53% of patients use CAM; biological therapy (herbs and supplements) is the most frequent (94%). The association between CAM use and adherence to medical treatment was 2.1 (95% CI 1.4-3.1, p= 0.001). The risk factors for the use of CAM were female sex, basic level education, uncontrolled disease and a time of evolution greater than 10 years. Conclusion: CAM users are 2.1 times more at risk of having a regular or bad adherence to medical treatment.

Vulvar Paget's disease and stromal invasion: Clinico-pathological features and survival outcomes

PURPOSETo evaluate clinico-pathological features, treatments and survival outcomes of vulvar Paget's disease (VPD). MethodsWe retrospectively reviewed VPD diagnosed between 1983 and 2018 at the Department of Surgical Sciences, Sant’Anna Hospital, Turin. Clinico-pathological characteristics and surgical treatment outcomes were investigated according to the depth of invasion. ResultsA total of 122 patients were identified. Eighty-seven patients were diagnosed with intraepithelial VPD, 22 with microinvasive (<=1 mm) VPD and 16 with invasive VPD. The median follow-up was 94.6 months (interquartile range 25th-75th, 26–120). Most of patients 95/122 (77%) were treated by surgery. Local recurrence was observed in 69/95 (73%) patients without significant difference between the 3 groups (p = 0.33), however, total vulvectomy showed better local control in microinvasive and invasive VPD than in intraepithelial tumors. At 120 months the cancer-specific survival was 100% for intraepithelial and microinvasive VPD versus 31% for invasive VPD (log-rank p = <0.0001) Age ≥65 years (OR: 4.17 CI 1.12–15.5, p = 0.03) and VPD's area ≥15 cm2 (OR: 5.83 CI 1.75–19.3, p = 0.004) were associated with risk of invasiveness. ConclusionMicroinvasive VPD has an identical prognosis to intraepithelial VPD, suggesting the omission of lymphadenectomy or adjuvant treatments are safe in this subset of patients. We recommend caution to propose medical treatment in patients who are ≥65 years old and with wide tumor area, as they are at the greatest risk of invasiveness.

Extreme gradient boosting machine learning method for predicting medical treatment in patients with acute bronchiolitis

Acute bronchiolitis is the most common lower respiratory tract infection of infancy. About 2% of infants under 12 months of age hospitalized with this condition each epidemic season. The choice of the correct treatment is important for the evolution of the disease. Therefore, a prediction model for medical treatment identification based on extreme gradient boosting (XGB) machine learning (ML) method is proposed in this paper. Four supervised machine learning algorithms including a k-nearest neighbours (KNN), decision tree (DT), Gaussian Naïve Bayes (GNB) and support vector machine (SVM) were compared with the proposed XGB method. The performance of these methods was then tested implementing a standard 10-fold cross-validation process. The results indicate that the XGB has the best prediction accuracy (94%), high precision (>0.94) and high recall (>0.94). The KNN, SVM, and DT approaches also present moderate prediction accuracy (>87), moderate specificity (>0.87) and moderate sensitivity (>0.87). The GNB algorithm show relatively low classification performance. Based on these results for classification performance and prediction accuracy, the XGB is a solid candidate for a correct classification of patients to be treated. These findings suggest that XGB systems trained with clinical data may serve as a new tool to assist in the treatment of patients with acute bronchiolitis.

The role of hyperbaric oxygen therapy in inflammatory bowel disease: a narrative review.

Inflammatory bowel disease is a group of chronic recurrent diseases in the digestive tract, including ulcerative colitis and Crohn’s disease. Over the past few decades, the treatment of IBD has made great progress but there is still a lot of room for improvement. Hyperbaric oxygen therapy (HBOT) was defined as the therapeutic effect of inhaling 100% oxygen higher than one atmosphere and reported to be used in stroke, decompression sickness and wound healing. Since several authors reported the role of HBOT as an adjunct to conventional medical treatment in patients with refractory IBD, the relevant research has shown an increasing trend in recent years. Clinical and experimental studies have revealed that HBOT may exert its therapeutic effect by inhibiting inflammation and strengthening the antioxidant system, promoting the differentiation of colonic stem cells and recruiting cells involved in repair. The purpose of this review is to summarize the past clinical and experimental studies and to understand the impact of HBOT in the treatment of IBD more deeply. In addition, we also hope to provide some ideas for future clinical and research work.

Controversy in Managing Coronary Artery Anomaly with Co-Existing Coronary Artery Atherosclerosis in a Young

We read the case report by Singh at al. with interest [1]. They present a case of a 34-year-old hypertensive man with symptomatic 3 vessel coronary artery disease on invasive coronary angiography. He underwent myocardial perfusion scintigraphy with normal perfusion at high workload (12.8 METS and with a double product of 35,720 and had normal left ventricular systolic function on echocardiography. The subsequent CT coronary angiography (CCTA) has described non-occlusive plaques in the left anterior descending coronary artery and proximal Right Coronary Artery (RCA) with an incidental finding of the anomalous RCA originating from the left sinus of Valsalva (LSoV). After this reassuring finding patient underwent invasive coronary angiography that has revealed multivessel disease including 75% LAD, OM1 and OM2 85% and RCA 80% stenosis and coronary artery by-pass graft surgery was recommended. We would like to raise some points in arguing the appropriateness of this patient’s surgical management. ESC and ACC/AHA guidelines recommend optimized medical treatment in patients with low-risk presentation based on typicality of chest pain and the functional test results as in this patient [2]. CCTA is known to have low positive predictive accuracy and tends to overestimate the degree of CAD. It was therefore surprising to see that the degree of the diameter stenosis was underestimated as well as the extent of coronary artery disease in this patient by CCTA was not recognized. One may argue that based on the functional and the non-invasive anatomical test results the best medical practice would have been tight risk factors control and guidelines based optimal medical management. The incidental finding of the CCTA of the Congenital Coronary Artery Anomaly (CCAA) with the RCA originating from the LSoV with inter-arterial course, based on the current clinical evidence, should not have changed management. Indeed, several prospective and retrospective observational studies showed that this type of CCAA is not associated with premature or sudden cardia death in contrast with those when the left coronary artery arises from the right sinus of Valsalva with inter-arterial course [3,4]. Our case-controlled study of 10 patients with the anomalous RCA from the LSoV showed no objective evidence of inducible ischemia on different functional test modalities and showed no event free survival difference compared to age sex and coronary artery disease severity disease matched controls in agreement with other studies [3,4]. In addition, since coronary grafts especially venous grafts have limited life expectancy [5], and one would assume that this young patient would need to undergo further revascularization in the future. We would suggest that best guideline based clinical practice with additional supportive evidence should guide our daily clinical judgement even in cases with complex coronary anatomy to the best interest of our patients [6].

Ethical Aspects of Enforced Medical Treatment in Patients with Psychiatric Illness

Caring for patients who lack decision-making capacity raises a host of ethical challenges. These challenges may be amplified when a patient's lack of capacity is related to serious mental illness. In this article, we suggest an approach to the care of psychiatrically ill patients who are unable to make reasoned medical decisions. Special consideration is paid to the question of when it is appropriate to override a patient's treatment preferences. [ Psychiatr Ann . 2021;51(3):118–122.]

Predicting strategic medical choices: An application of a quantal response equilibrium choice model

Quantal response equilibrium choice (QREC) models are structural behavioral models that account for bounded rationality and strategic interactions in analyses of games where each player’s payoff is a vector. We revisit the question of how market competition affects pro-social behavior and fit a QREC model to data from an incentivized laboratory experiment, where participants make decisions on medical treatments for abstract patients in monopoly, duopoly, and quadropoly games. Our results demonstrate that competition can cause substantial behavioral responses without any changes in pro-social preferences if one allows for the possibility that competition influences the degree of randomness in decision making.We find that a QREC model with fixed preference parameters provides precise out-of-sample predictions of behavior in games with vector payoffs. A Monte Carlo study is performed to show that the two-step estimator is accurate.

Diagnosis and Treatment of Sarcopenic Dysphagia: A Scoping Review.

Sarcopenic dysphagia is a swallowing disorder due to sarcopenia involving the whole-body skeletal muscles and swallowing muscles. This scoping review aimed to explore the currently known information on the diagnosis and treatment of sarcopenic dysphagia and to clarify the types of research required to develop the field. We searched the PubMed, MEDLINE, CINAHL, and Cochrane databases from their inception to October 2020, using the search terms "(sarcopenia or sarcopenic or myopenia or dynapenia) and (dysphagia or swallowing or deglutition) and (diagnosis or treatment)". Articles reporting diagnosis method and treatment of sarcopenic dysphagia were included. Twenty-one and eight articles reported on the diagnostic and treatment method, respectively. A diagnostic algorithm for sarcopenic dysphagia was most frequently used (n = 10). Other diagnostic methods included consensus diagnostic criteria for sarcopenic dysphagia (n = 4), sarcopenia and dysphagia without other causes of dysphagia (n = 4), and both sarcopenia and dysphagia (n = 3). The medical treatments for patients with sarcopenic dysphagia were described in single-patient case reports (n = 8) only. There were six articles reporting on a combination of rehabilitation and nutritional support. These reports showed the importance of interdisciplinary rehabilitation nutrition for improving patients' nutritional status and sarcopenia. A reliable and validated diagnostic algorithm was the most widely used diagnostic method for sarcopenic dysphagia. Only case reports have been published for the medical treatment of patients with sarcopenic dysphagia. Interdisciplinary rehabilitation nutrition may be useful for treating patients with sarcopenic dysphagia.

Percutaneous Mitral Valve Repair: Outcome Improvement with Operator Experience and a Second-Generation Device.

Background and aim: Recent randomized data comparing percutaneous mitral valve repair (PMVR) versus optimal medical treatment in patients with functional MR (FMR) seemed to highlight the importance of the learning curve not only for procedural outcomes but also for patient selection. The aim of the study was to compare a contemporary series of patients undergoing PMVR using a second-generation Mitraclip device (Mitraclip NT) with previous cohorts treated with a first-generation system. Methods: This multicenter study collected individual data from 18 centers between 2012 and 2017. The cohort was divided into three groups according to the use of the first-generation Mitraclip during the first (control-1) or second half (control-2) or the Mitraclip NT system. Results: A total of 545 consecutive patients were included in the study. Among all, 182 (33.3%), 183 (33.3%), and 180 (33.3%) patients underwent mitral repair in the control-1, control-2, and NT cohorts, respectively. Procedural success was achieved in 93.3% of patients without differences between groups. Major adverse events did not statistically differ among groups, but there was a higher rate of pericardial effusion in the control-1 group (4.3%, 0.6%, and 2.6%, respectively; p = 0.025). The composite endpoint of death, surgery, and admission for congestive heart failure (CHF) at 12 months was lower in the NT group (23.5% in control-1, 22.5% in control-2, and 8.3% in the NT group; p = 0.032). Conclusions: The present paper shows that contemporary clinical outcomes of patients undergoing PMVR with the Mitraclip system have improved over time.

Studying the relationship between the Lund Mackay score and response to medical treatment in patients with chronic sinusitis.

One of the most common reasons for patients to visit a doctor is Sinusitis. Treatment of this disease involves a wide range of topical and systemic drugs, if it left untreated, surgery and sinus drainage will be the only choice. Due to symptoms and problems caused by chronic sinusitis and its treatment, as well as the need for an appropriate solution to reduce this, the present study was conducted to investigate the relationship between The Lund Mackay score and response to medical treatment in patients with chronic sinusitis. The present study was performed cross-sectionally on 150 patients referred to Khatamul- Anbia Hospital in Zahedan for whom the diagnosis of chronic sinusitis was confirmed and met the study criteria. Demographic data and clinical signs of patients were recorded and for based on CT scan, The Lund Mackay score was evaluated. Patients were treated for 4 to 6 weeks and finally re-evaluated for symptoms and response to treatment. Data were analyzed using SPSS software version 24, McNemar test, Mann-Whitney and other necessary tests for descriptive statistics. A significance level of 0.05 was considered. 3.55% of patients were male (83 patients) and 7.44% were female (67 patients). The mean score of the Lund Mackay in the present study was 92.11 with a standard deviation of 2.3. Symptoms of olfactory dysfunction, sinus pain, nasal obstruction and nasal discharge showed significant improvement after treatment (p <05.0). Based on the results obtained at the end of the study, the presence of nasal polyps (p = 001.0) and nasal obstruction (p = 003.0), after the end of the treatment period, showed a significant relationship with the response to treatment. In general, this study suggested that the mean score of The Lund Mackay had a significant positive relationship with the severity of patients' clinical symptoms and the severity of sinusitis. Therefore, it can be considered as a suitable criterion in diagnostic and therapeutic evaluations of patients.

THE CUMULATIVE INCIDENCE OF POUCHITIS AND POUCH-RELATED COMPLICATIONS IN PEDIATRIC PATIENTS WITH ULCERATIVE COLITIS

Abstract Background &amp; Aims Despite highly effective therapies, many children develop medically refractory ulcerative colitis (UC) and undergo proctocolectomy with ileal pouch anal anastomosis (IPAA). There is little real world evidence regarding IPAA outcomes in pediatric UC patients. We sought to determine the risk of pouchitis, recurrent pouchitis, and change in diagnosis to Crohn’s disease (CD) within two years of IPAA surgery among pediatric patients with UC using a large, geographically diverse insurance claims database. Methods Within the IQVIA Legacy PharMetrics Adjudicated Claims Database, we identified pediatric patients (age &amp;lt;18 years) with UC who underwent proctocolectomy with IPAA between January 1, 2007 and June 30, 2015. We utilized International Classification of Diseases (ICD-9-CM or ICD-10-CM) codes to identify patients with UC and Current Procedural Terminology III codes to identify IPAA. The primary outcome was the development of pouchitis in the first 2 years following surgery, as identified by a previously validated case-finding definition. Secondary outcomes included the incidence of recurrent pouchitis, and the cumulative incidence of a new diagnosis of Crohn’s disease (CD) in the first two years post-IPAA. A change in diagnosis to CD was identified by an ICD-9-CM or ICD-10-CM code for CD on at least three separate occasions. Bivariate analyses were used for all comparisons, utilizing chi-square and t-test as appropriate. Results A total of 68 patients with an IPAA with at least two years of continuous health plan enrollment following surgery were identified. Among all patients undergoing surgery, the median age was 15 years (interquartile range 11.5–16), with 29 (43%) female patients. In the first 2 years following IPAA, the cumulative incidence of pouchitis was 54%. Characteristics and prior medical treatments in patients without pouchitis and with ≥ one episode of pouchitis were similar (Table 1). The cumulative incidence of recurrent pouchitis during this period was 22%. The cumulative incidence of a new diagnosis of CD in the two years after IPAA for UC was 9%. Conclusions In a geographically diverse cohort from the United States, 54% of pediatric patients undergoing proctocolectomy with IPAA for UC developed pouchitis within the first two years after surgery. Furthermore, 9% had a change in diagnosis to CD. These data indicate that for many pediatric UC patients, surgery is non-curative and patients continue to have a substantial burden of illness. Future efforts should attempt to identify novel, actionable, predictors of pouchitis in this population.

Tudying the Relationship between the Lund Mackay Score and Response to Medical Treatment in Patients with Chronic Sinusitis

The present study was conducted to investigate the relationship between the Lund Mackay score andresponse to medical treatment in patients with chronic sinusitis. The present study was performed crosssectionally on 150 patients referred to Khatam-ul-Anbia Hospital in Zahedan for whom the diagnosis ofchronic sinusitis was confirmed and met the study criteria. Demographic data and clinical signs of patientswere recorded and for based on CT scan, The Lund Mackay score was evaluated. Patients were treated for 4to 6 weeks and finally re-evaluated for symptoms and response to treatment. Data were analyzed using SPSSsoftware version 24, McNemar test, Mann-Whitney and other necessary tests for descriptive statistics. Asignificance level of 0.05 was considered. 3.55% of patients were male (83 patients) and 7.44% were female(67 patients). The mean score of the Lund Mackay in the present study was 92.11 with a standard deviationof 2.3. Symptoms of olfactory dysfunction, sinus pain, nasal obstruction and nasal discharge showedsignificant improvement after treatment (p &lt;05.0). Based on the results obtained at the end of the study, thepresence of nasal polyps (p = 001.0) and nasal obstruction (p = 003.0), after the end of the treatment period,showed a significant relationship with the response to treatment. In general, this study suggested that themean score of The Lund Mackay had a significant positive relationship with the severity of patients’ clinicalsymptoms and the severity of sinusitis. Therefore, it can be considered as a suitable criterion in diagnosticand therapeutic evaluations of patients.

Occurrence of Colorectal Cancer and the Influence of Medical Treatment in Patients With Inflammatory Bowel Disease: A Danish Nationwide Cohort Study, 1997 to 2015.

The risk of colorectal cancer (CRC) for patients with inflammatory bowel disease (IBD) has previously been investigated with conflicting results. We aimed to investigate the incidence and risk of CRC in IBD, focusing on its modification by treatment. All patients with incident IBD (n = 35,908) recorded in the Danish National Patient Register between 1997 and 2015 (ulcerative colitis: n = 24,102; Crohn's disease: n = 9739; IBD unclassified: n = 2067) were matched to approximately 50 reference individuals (n = 1,688,877). CRC occurring after the index date was captured from the Danish Cancer Registry. Exposure to medical treatment was divided into categories including none, systemic 5-aminosalicylates, immunomodulators, and biologic treatment. The association between IBD and subsequent CRC was investigated by Cox regression and Kaplan-Meier estimates. Of the IBD patients, 330 were diagnosed with CRC, resulting in a hazard ratio (HR) of 1.15 (95% confidence interval [CI], 1.03-1.28) as compared with the reference individuals. However, when excluding patients diagnosed with CRC within 6 months of their IBD diagnosis, the HR decreased to 0.80 (95% CI, 0.71-0.92). Patients with ulcerative colitis receiving any medical treatment were at significantly higher risk of developing CRC than patients with ulcerative colitis who were not given medical treatment (HR, 1.35; 95% CI, 1.01-1.81), whereas a similar effect of medical treatment was not observed in patients with Crohn's disease or IBD unclassified. Medical treatment does not appear to affect the risk of CRC in patients with IBD. The overall risk of developing CRC is significantly increased in patients with IBD as compared with the general population. However, when excluding patients diagnosed with CRC within 6 months of their IBD diagnosis, the elevated risk disappears.

Long-Term Efficacy and Safety of Anti-Obesity Treatment: Where Do We Stand?

Purpose of ReviewAs a chronic and relapsing disease, obesity impairs metabolism and causes cardiovascular diseases. Although behavioral modification is important for the treatment of obesity, it is difficult to achieve an ideal weight or sustain the process of long-term weight loss. Therefore, the obesity control guidelines strongly recommend lifestyle interventions along with medical treatment for patients who are overweight. There is sufficient evidence supporting that pharmacotherapy in combination with behavior-based interventions can result in significant weight loss and improved cardiometabolism.Recent FindingsRecent meta-analyses of new anti-obesity drugs and their weight-loss efficacy have shown that the overall placebo-subtracted weight reduction (%) for at least 12 months ranged from 2.9 to 6.8% for the following drugs: phentermine/topiramate (6.8%), liraglutide (5.4%), naltrexone/bupropion (4.0%), orlistat (2.9%), and lorcaserin (3.1%). However, very recently, on February 13, 2020, the US Food and Drug Administration (FDA) ordered the withdrawal of lorcaserin from markets, as a clinical trial to assess drug safety showed an increased risk of cancer. Currently, the anti-obesity medications that have been approved by the FDA for chronic weight management are orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide. However, they are costly and may have adverse effects in some individuals. Therefore, drug therapy should be initiated in obese individuals after weighing its benefits and risks.SummaryOne of the strategies for long-term obesity control is that anti-obesity medications should be tailored for specific patients depending on their chronic conditions, comorbidities, and preferences.

Upfront surgery is not advantageous compared to more conservative treatments such as observation or medical treatment for patients with desmoid tumors

BackgroundThis study compared the clinical and functional outcomes of patients initially treated with observation or medical treatment with those of patients treated with local treatment (surgery alone or surgery with adjuvant radiotherapy) to confirm whether observation or medical treatment is an appropriate first-line management approach for patients with desmoid tumors.MethodsWe retrospectively reviewed the medical records of 99 patients with histologically confirmed primary desmoid tumors treated between 1978 and 2018. The median follow-up period was 57 months. We evaluated event-free survival, defined as the time interval from the date of initial diagnosis to the date of specific change in treatment strategy or recurrence or the last follow-up.ResultsAn event (specific change in treatment strategy or recurrence) occurred in 28 patients (28.3%). No significant difference in event-free survival was found between the first-line observation/medical treatment and local treatment groups (p = 0.509). The median Musculoskeletal Tumor Society score of the patients treated with first-line local treatment was 29 (interquartile range [IQR], 23–30), whereas that of the patients managed with first-line observation or medical treatment was 21 (IQR, 19–29.5). First-line observation or medical treatment was more frequently chosen for larger tumors (p = 0.045). In the patients treated with local treatment, local recurrence was not related to the surgical margin (p = 0.976).ConclusionUpfront surgery is not advantageous compared to more conservative treatments such as observation or medical treatment for patients with desmoid tumors.