Treatment Modalities Research Articles

Role of immunotherapy in gastric cancer with liver metastasis

Gastric cancer continues to be a significant issue for public health, marked by its widespread occurrence and high mortality rates, even as the incidence of the disease shows a declining trend. The liver is the primary site for metastatic spread, with the peritoneum, lungs, and bones also being common targets. With the advent of biologic treatments and the introduction of immunotherapy for patients with metastatic conditions, the options to treat metastatic gastric cancer have expanded. This diversified therapeutic approach is designed to enhance patient quality of life and prolong survival, showcasing the progress in treatment modalities for individuals with gastric cancer and liver metastases.

Nodular vasculitis – Retrospective study of an uncommon disease in a non-tuberculosis endemic country with focus on treatment modalities and efficacy

Introduction Nodular vasculitis (NV) is a rare form of panniculitis primarily affecting middle-aged females, presenting as painful, sometimes ulcerated nodules on the dorsal lower legs. Erythema induratum Bazin (EIB) is a form of NV and is considered a manifestation of cutaneous tuberculin hypersensitivity. This retrospective study aims to analyze demographics, clinicopathological findings, laboratory results, and treatment outcomes of NV in a non-TB endemic country. Methods: Data of NV patients were extracted from the electronic hospital database of the University Hospital Zurich. Patients were included only if histopathologically confirmed diagnosis of NV and sufficient information on demographics, treatment, and follow-up was available. Results: We conducted a 20-year retrospective study , including 62 patients with NV. The most common site of involvement was the lower extremities. Disease duration varyied from several months to over 20 years. Histopathological examination revealed lobular panniculitis, with or without vasculitis, and granuloma formation. Tuberculosis association was assessed through the QuantiFERON test and Mycobacteria PCR, showing positive results in 22 or 37 (59%) tested cases and in 2 out of 27 cases (7.4%), respectively. . Comorbidities were found in over half of the patients. Treatment modalities included topical corticosteroids, antitubercular therapy, systemic steroids, and potassium iodide. Almost 50% of all patients experienced relapses despite treatment. Conclusion: Topical steroids, antitubercular therapy, systemic steroids, and potassium iodide showed similar response rates. Tuberculostatic therapy upon detecting latent TB is recommended. Considering the high recurrence rate and potential side effects of systemic therapies, we recommend first-line treatment with potent topical steroids and compression stockings.

Photodynamic Therapy in Acne Vulgaris: A Systematic Review

Acne is a multifactorial disorder of the pilosebaceous unit. Photodynamic therapy (PDT) is an energy-based treatment shown to be safe in acne vulgaris, although the mechanism of action of PDT in acne is incompletely understood. This review summarizes the clinical features of and treatment efficacy in acne patients treated with PDT. A systematic review of Medline, Embase, and the Cochrane Database of Systematic Reviews was conducted. Title, abstract, full-text screening, and data extraction were completed using Covidence. Studies reporting the use of PDT in patients with acne were included while clinical features and treatment responses were extracted. Treatment outcomes were scored as complete response, partial response, and no response. After screening a total of 1122 studies, 82 studies met the inclusion criteria, representing 56 prospective studies, 25 randomized controlled trials, and 1 retrospective study. Results representing 4340 patients with acne (mean age 24.4 years; 52% females) treated with PDT are summarized. Overall, 2154 (50%) participants underwent aminolevulinic acid PDT, 452 (10%) participants underwent methyl aminolevulinate PDT, 28 (<1%) participants underwent daylight PDT, and 1706 (39%) underwent other modalities of PDT. The average follow-up period after study completion was 3 months, ranging from 2 weeks to 13 months. A partial response was observed in treated patients with outcome measures including clinical response, lesion count, pain, recurrence, and patient satisfaction. This systematic review provides preliminary data summarizing the clinical features and treatment efficacy in patients with acne treated with PDT. Our results suggest a partial clinical response when using PDT to manage acne. Future studies should focus on standardizing study protocols and drawing direct comparisons between PDT and other modalities for acne treatment.

Targeted 308-nm Excimer Laser A Safe and Effective Solution for Inflammatory Skin Disorders

Background: The 308-nanometer excimer laser is a targeted ultraviolet B (UVB) light therapy that delivers high-intensity UVB rays directly to affected skin. It has shown considerable efficacy in managing various inflammatory skin conditions, including Psoriasis, Vitiligo, Atopic dermatitis (Eczema), Leukoderma, Alopecia Areata, Chronic recalcitrant dermatitis, Lichen planus, Cutaneous T-cell Lymphoma (e.g. Mycosis fungoides/ Sezary Syndrome), Parapsoriasis, Pityriasis lichenoides chronica, Pruritus, Urticaria pigmentosa, Superficial mycoses (e.g., dermatophytosis [ringworm]. The patient demographic of some of these conditions (e.g. Vitiligo) tends to skew towards patients with darker skin tones. Results: The excimer laser is particularly effective for treating resistant areas, such as the scalp, palmoplantar psoriasis, and hand and foot dermatitis, which often do not respond well to conventional therapies. It has also demonstrated notable success in promoting repigmentation in facial vitiligo, especially in patients with Fitzpatrick skin types IV–VI. Treatment results are typically observed quickly after 5-10 sessions, with sustained improvement and psoriasis clearance evident even at 1-year follow-up. Over the years, access to the Excimer laser procedures has expanded with the availability of these procedures in many private clinics as well as academic facilities. That has increased the availability of the treatment modality and patient choice of therapy. Conclusions: The excimer laser provides a safe, non-invasive treatment option with a strong record of efficacy for multiple inflammatory skin conditions. It is a viable alternative to systemic therapies and can be used either alone or in conjunction with other treatments for optimal patient outcomes.

Microwave Energy for Managing Hidradenitis Suppurativa

Title: Microwave energy for managing Hidradenitis Suppurativa Nicole Bielecki PA-C and Aaron Hoover MD Front Range Dermatology, Greeley, CO 80634 Introduction: Treating hidradenitis suppurativa (HS) is challenging due to its chronic, recurring nature and resistance to conventional therapies like antibiotics, anti-inflammatories, and surgery. Even with new biological treatments, there are challenges with injection site reactions. The associated pain, drainage, malodor, and scarring also significantly impact patients' mental well-being, underscoring the need for novel treatments. Four cases presented here suggest that microwave energy (ME) therapy can reduce pain, erythema and inflammation in HS lesions and even assist to resolve moderate and smaller lesions. Precise and brief surface-based applications of microwave energy to HS lesions from an FDA-cleared microwave device intended for the coagulation of soft tissue were used to generate localized hyperthermic conditions in HS and pre-HS lesions. The rapid heating of the tissues led to subsequent clearance of moderate and small HS lesions. This was accompanied with a reduction in inflammation, draining and pain associated with these HS cases. While the outcomes are promising, the exact mechanism of action needs further investigation. These cases strongly support further research and demonstrate that ME holds promise as a novel, non-invasive treatment modality for the management of HS. Procedure: A total of 25 HS lesions from five patients were treated with ME energy. Five repetitive 2-second pulses of 3 to 4W of ME operating at 8GHz were applied to the full area of these lesions. Three to four treatment sessions were given ranging from 7 to 14 days apart. Two patients received ME as a monotherapy, whereas the others began regimens of isotretinoin, adalimumab, or secukinumab at the same time as the first ME treatment. Results: These five patient cases demonstrate how ME treatments can lead to a rapid reduction in reported pain and erythema as well as clinical-assessed clearance of several early and moderate state HS lesions. Two of these patients only received ME as a monotherapy. However, based on clinical experience, even patients typically on medications will not typically show improvements within 7-14 days, suggesting that ME was having a rapid impact to manage pain and inflammation associated with HS lesions and in some cases assisting to resolve these lesions entirely. Conclusions: These cases report the first step in clinical feasibility and safety of microwave energy and shows promise as a novel modality for the management of HS. Although still in the early days of feasibility work, this non-invasive, fast, well-tolerated and simple treatment of microwave energy shows promise as a novel modality for the management of HS. Financial support: This work was supported by Emblation Ltd.

How to Utilize University Nursing Clinic Resources Successfully to Transition Autistic Adolescents into Higher Education

ABSTRACTAutism Spectrum Disorder (ASD) is complex neurodevelopmental disorder that is exhibited through a wide‐range of symptoms including social interactions, communication deficits, limited interests, and repetitive behaviors (e.g., stimming). The prevalence of autism amongst children and adolescents continues to grow with 1 in 36 diagnosed annually (CDC, 2024). Because autism often comes with a myriad of comorbidities (e.g., sleep disorders, seizure activity, nutritional imbalances, gastrointestinal issues, and mental health disorders), children and adolescents are often prescribed medications and/or treatments to help with the management of these chronic diseases. Croen et al., (2006) found that adolescents are six times more likely to be hospitalized than their neuro‐typical peers. Managing autism takes a multi‐disciplinary approach. Navigating a large university system, academics, and being away from home can be challenging for any teenager. But, adding the complexity of managing a chronic neurodevelopmental disorder on top of the new environment could potentially be overwhelming for the autistic adolescent. It makes sense to use all available resources when transitioning into a college setting. Registered nurses (RN) and advanced practice nurses (APN) are employed at university clinics to help manage student healthcare issues including acute healthcare problems (e.g., viruses), traumatic issues, and chronic healthcare issues. This paper will examine how nursing professionals can assist autistic adolescents when they are entering into a college environment by managing medications and other treatment modalities while being a student advocate within a multi‐disciplinary team.

Abstract PR004: Age-induced chronic accumulation of glucocorticoids drives therapy resistance in lung cancer

Abstract Non-small cell lung cancer (NSCLC), a highly aggressive cancer, is the leading cause of cancer- related deaths in the U.S. While chemotherapy and targeted therapy are the main treatment modalities in the clinic, many patients do not respond to these treatments. Strikingly, the median age for lung cancer diagnosis is 71. Yet, preclinical and clinical research have largely been skewed towards young mice and patients. Here, we address this gap in knowledge and evaluate if old age affects the response to standard of care NSCLC therapies in KRAS-driven NSCLC. Using human sera from young and old healthy subjects to treat NSCLC cell lines, we show that age-driven circulatory changes are sufficient to drive a state of profound resistance to both chemotherapies as well as KRASG12C targeted therapies. We confirmed the relevance of our findings in vivo, by transplanting cancer cells derived from the K-rasLSL-G12D/+; p53fl/fl genetically engineered mouse model of lung cancer into young and old C57BL/6 mice. Using this model we showed that unlike young lung tumor-bearing mice on chemotherapy, old tumor-bearing mice do not respond to treatment and have a poor prognosis. Mechanistically, we found that old age drives a transcriptional reprogramming that favors drug resistance and identified the glucocorticoid receptor as a major driver of these transcriptional changes. We traced this to an age-induced chronic accumulation of glucocorticoids in circulation and within the tumor interstitial fluid. Chronic treatment with age-relevant concentrations of cortisol alone was sufficient to drive glucocorticoid receptor activation and induce resistance to therapies mirroring the effects of old age. Further supporting a driving role for glucocorticoids in driving age- induced drug resistance, blocking the glucocorticoid receptor genetically or pharmacologically rescues the drug resistance state imposed by old age in NSCLC cells. Lastly, using TCGA patient data we show an inverse correlation between glucocorticoid receptor activation (GR score) and progression-free survival of lung cancer patients. Together, our work demonstrates a role for age-induced glucocorticoids in circulation in promoting therapy-resistance in NSCLC patients and supports the use of therapeutic agents that block the glucocorticoid receptor as a strategy to increase therapy efficacy in NSCLC patients. Citation Format: Devesh Raizada, Felicia Lazure, Stanislav Drapela, Nadir Sarigul, Joanne Tejero, Didem Ilter, Ana Da Silva Gomes. Age-induced chronic accumulation of glucocorticoids drives therapy resistance in lung cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr PR004.

Oesophageal cancer.

Oesophageal cancer is the seventh leading cause of cancer mortality worldwide. Two major pathological subtypes exist: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Epidemiological studies in the last decade have shown a gradual increase in the incidence of oesophageal adenocarcinoma worldwide. The prognosis of oesophageal cancer has greatly improved due to breakthroughs in screening, surgical procedures, and novel treatment modalities. The success achieved with combined modality therapies, including surgery, chemotherapy, and radiotherapy, to treat locally advanced oesophageal cancer is particularly notable. Immunotherapy has become a crucial treatment for oesophageal cancer, with immune checkpoint inhibitor-based therapies now established as the standard of care in adjuvant and metastatic first-line settings. This Seminar provides an overview of advances in the screening, diagnosis, and treatment of oesophageal squamous cell carcinoma and oesophageal adenocarcinoma, with a particular focus on neoadjuvant therapies for locally advanced oesophageal cancer and immune checkpoint inhibitor-based therapies.

Evidence Supporting Conservative Scar Management Interventions Following Burn Injury: a review article.

Conservative management for hypertrophic scars (HSc) and scar contractures is of utmost importance to optimally reintegrate burn survivors into society. Many conservative treatment interventions have been described in the literature for the management of HSc. Recent advancements in the literature pertaining to post-burn scarring and HSc formation, have advanced our understanding of the mechanisms that support or refute the use of common rehabilitation treatment modalities after burn injury. This is particularly relevant for recent advancements in the fields of mechanotransduction and neurogenic inflammation resulting in the need for rehabilitation clinicians to reflect upon commonly employed treatment interventions. The aim of this review article is to summarize and clinically apply the evidence that supports or refutes the use of common conservative treatment interventions for scar management employed after burn injury. The following treatments are discussed and mechanotransduction and neurogenic inflammation concepts are highlighted: 1) edema management (compression, positioning/elevation, pumping exercises, retrograde massage, manual edema mobilization), 2) pressure therapy (including custom fabricated pressure garments, inserts, face masks, and other low-load long duration orthotic devices), 3) gels or gel sheets, 4) combined pressure therapy and gels, 5) serial casting, 6) scar massage, and 7) passive stretching. This review supports the following statements: 1) Compression for edema reduction should be initiated 48-72 hrs post-injury and continued for wounds that require longer than 21 days to heal until scar maturation; 2) Elevation, pumping exercises and retrograde massage/MEM should be used in combination with other edema management techniques; 3) Custom fabricated pressure garments should be applied once the edema is stabilized and adequate healing has occurred. Garments should be monitored on a regular basis to ensure that optional pressure, >15mm Hg, is maintained, adding inserts when necessary. The wearing time should be >16 hrs/day; 4) Gels for post-burn scar management should extend beyond the scar; 5) Serial casting should be applied when contractures interfere with function; 6) Forceful scar massage should be avoided early in the wound healing process or when the scar is inflamed or breaks down; 7) Other treatment modalities should be prioritized over passive stretching for scar management.

Periodontal and orthodontic management of impacted canines.

The maxillary and mandibular canines are described by many clinicians as the "cornerstone" of the arch. When in their optimal position, they play a critical role in providing a well-balanced occlusal scheme that contributes toward functional as well as neuromuscular stability, harmony, esthetics, and dentofacial balance. When an aberration is noted with the normal eruptive and development process, early diagnosis with strategic intervention is critical and may often require a multidisciplinary approach. A proper diagnosis, risk assessment, and management of the soft tissues, hard tissues, and adjacent structures are vital for a successful outcome. This review highlights the diagnostic and treatment modalities that require consideration for the orthodontic as well as the periodontal management of impacted canines. The reader is guided through the etiology, diagnosis, prevention, and intervention of clinical cases that were managed with different approaches.

Common complications in spinal muscular atrophy (SMA) type 1 after nusinersen treatment

Background. Spinal muscular atrophy (SMA) is an inherited disease with progressive muscle weakness and atrophy. Despite the new treatments developed recently, primary and secondary effects of muscle weakness in patients with SMA cause mortality and morbidity. The aim of this study is to identify common problems in the follow-up of patients after new treatment modalities and to examine the difficulties in management of these problems. Methods. The study included 16 patients diagnosed with SMA type 1 according to clinical findings and genetic results between 2017 and 2022. The patients were divided into two groups as living and deceased, and complications were examined and compared between the groups. Results. The patients comprised 8 (50%) females and 8 (50%) males with a median age at diagnosis of 3 months. The patients had a history of gastrointestinal problems, orthopedic problems, infection and sepsis, and especially respiratory distress. Death occurred in 8 (50%) patients during follow-up (median age 38 months). Mortality was higher in patients who needed tracheostomy and had gastroesophageal reflux. The survival rate was better in patients who received more nusinersen treatment and had a higher CHOP-INTEND score. Conclusions. Despite new-generation treatments for SMA type 1, morbidity and mortality rates remain very high. As the survival rate in SMA type 1 increases, the incidence of complications similar to those frequently seen in SMA type 2 and type 3 patients also increases. The follow-up and treatment of patients with SMA should be undertaken by a multidisciplinary team.

Contemporary review of the evolution of various treatment modalities for mitral regurgitation.

Mitral regurgitation is one of the commonest valvular heart diseases for which there have been several innovative treatment strategies that have developed over the last several decades. We describe the various treatment modalities that have been used for the last several decades. All articles in PubMed, Cochran and Embase were screened from inception to August 2024 for the following - 'Mitral valve regurgitation' 'Mitral valve repair' 'Mitral valve replacement' 'Robotic mitral surgery' 'Transcatheter mitral valve repair.' Mitral regurgitation (MR) is classified into primary and secondary MR. Causes of primary MR include degenerative disease, rheumatic heart disease, and infective endocarditis. Secondary MR is observed in the setting of left ventricle (LV) pathology, including ischemic or dilated cardiomyopathy. In secondary MR, annular dilation, papillary muscle displacement, tethering of chordae tendineae and/or mitral valve (MV) leaflets result in leaflet restriction and malcoaptation. In this review, we discuss various modalities for treatment of mitral regurgitation, as well as newer treatment options for MR including robotic MV repair and other minimally invasive procedures. Several ongoing randomized controlled trials in this topic will help shed more light and provide guidance to deliver the optimal care for our patients.

The clinical impact of EGFR alterations in elderly glioblastoma patients: results from a real-life cohort.

The incidence of glioblastoma in the elderly population is increasing as the worldwide population ages. The differential and poorer survival in the elderly population compared to younger patients is partially explained. The present study aimed to investigate the clinical impact of epidermal growth factor receptor EGFR-altered glioblastoma in a real-life elderly glioblastoma population. A bicentric and retrospective study was conducted. Patients were 70years or older and suffering from histomolecularly confirmed glioblastoma. Single nucleotide variants (SNV), amplification, or chromosome 7 polysomy were sought. The primary endpoint was the comparison of overall survival (OS) in patients with or without EGFR alteration. Secondary objectives were to determine other clinical parameters correlated with EGFR alteration status. Seventy-three patients were analyzed: 41.1% had at least one EGFR alteration. The presence of EGFR alteration did not impact overall survival: HR 0.97 [0.6-1.57], p = 0.9; the median overall survival was 6.5months [5.3-9.3] in the EGFR-altered group versus 7months [4.5-10] in the EGFR wild-type group, p = 0.75. In multivariate analysis, tumor resection was associated with a significant overall survival improvement: the median OS in the resected group (n = 20) was 11months [95% CI 7.8-22] versus a median OS of 5.5months [4.6-7.8] in the unresected group (n = 53), without correlation to EGFR alteration status. In the modern era of molecular characterization and improved treatment modalities, the presence of at least one EGFR alteration did not influence survival outcomes in an elderly population of glioblastoma patients.

Comparative Analysis of Cellulite Treatment Modalities: A Systematic Review.

Cellulite is a highly prevalent and aesthetically distressing skin condition. Whilst there are a variety of treatment modalities, none are definitively established. This systematic review aims to assess invasive and noninvasive treatment modalities for cellulite management. The review protocol was published and registered a priori (PROSPERO CRD42022359334). A comprehensive electronic search for relevant randomised controlled trials, (RCTs) was performed in CENTRAL, MEDLINE, Embase and Web of Science databases. Study quality and risk of bias were assessed using Cochrane's risk of bias tool, respectively. Overall, 753 studies were initially identified, of which 24 randomised controlled trials (RCTs) satisfied the eligibility criteria with a total of 2084 patients with a mean follow-up of 3.33 ± 13.4weeks. Evaluated interventions included mechanical stimulation, topical therapy, shock wave therapy (SWT), laser and light-based devices, radiofrequency therapy, subcutaneous injectables, and ultrasound. SWT emerged as a standout intervention, demonstrating a consistent cellulite reduction score of 2.07 ± 0.39 across four studies. Radiofrequency therapy exhibited a statistically significant reduction of thigh circumference (- 2.09cm, p < 0.001) and subcutaneous tissue thickness (- 2.23cm, p < 0.001). Subcutaneous injectables, specifically collagenase Clostridium histolyticum-aaes, demonstrated a statistically significant improvement in the clinician-reported photonumeric cellulite severity scale (17.0%) and patient-reported photonumeric cellulite severity scale (25.7%) (p < 0.001). The overall quality of the studies using the grading of recommendations, assessment, development and evaluation approach was moderate. This is the first methodologically robust systematic review evaluating interventions for cellulite. SWT, radiofrequency therapy, and subcutaneous injectables have shown promising findings in cellulite treatment. The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

ADVANCEMENTS IN UNDERSTANDING AND MANAGING ALCOHOL WITHDRAWAL SYNDROME: A COMPREHENSIVE REVIEW

Alcohol withdrawal syndrome (AWS) is a clinically significant condition that can arise upon abrupt cessation or reduction of alcohol consumption in individuals with alcohol dependence. This review article provides a comprehensive overview of AWS, encompassing its epidemiology, pathophysiology, clinical manifestations, assessment tools, and management strategies. We discuss the neurobiological mechanisms underlying AWS, including the role of neurotransmitter systems such as gamma-aminobutyric acid (GABA) and glutamate, as well as neuroadaptive changes that occur with chronic alcohol use. Furthermore, we explore the spectrum of clinical manifestations associated with AWS, ranging from mild withdrawal symptoms to severe complications such as delirium tremens and seizures. Diagnostic tools and scoring systems commonly used for assessing AWS severity are examined, along with evidence-based approaches for pharmacological and non-pharmacological management of AWS. Additionally, we highlight emerging research areas and future directions in the field of AWS, including novel treatment modalities and potential biomarkers for predicting withdrawal severity and treatment response. This comprehensive review aims to provide clinicians, researchers, and healthcare professionals with a thorough understanding of AWS to facilitate early recognition, appropriate management, and improved outcomes for individuals affected by this condition.

Economic Burden of Haemophilia from a Societal Perspective: A Scoping Review.

Haemophilia is a rare genetic bleeding disorder that leads to musculoskeletal complications. The high cost of haemophilia treatment necessitates a thorough evaluation of its economic burden. However, due to the difficulty of estimating direct non-medical, indirect, and intangible costs, studies often underestimate the actual economic burden of haemophilia. This scoping review aims to summarise economic studies in haemophilia conducted from a societal perspective. A systematic search across eight scholarly databases, grey literature, and reference lists until the5th of July 2023 was conducted to identify relevant studies. The inclusion criteria encompassed full-text, English-language publications of economic analyses in congenital haemophilia from a societal perspective. Model-based studies and those adopting a payer perspective were excluded. Costs were adjusted to international dollars (I$) and US dollars (US$) in 2022 for comparability. Out of 2993 potential sources identified, 25 studies met the inclusion criteria, covering 7226 persons with haemophilia across 22 countries. All studies reported direct medical costs, with four excluding the cost of haemostatic therapy. Fifteen studies reported direct formal non-medical costs, while eight reported direct informal non-medical costs. All but one study reported the indirect costs. The average annual costs of haemophilia varied widely based on treatment modality, disease severity, geographical location, and included cost categories. When including the cost of clotting factor replacement therapy (CFRT), the total cost for severe haemophilia without inhibitors ranged from 1566 I$ to 700,070 I$ per person per year (lowest value reported in India and highest in the United States). CFRT represented up to 99.9% of the total cost for those receiving prophylaxis and up to 95.1% for episodic treatment. Haemostatic therapies accounted for 82% of the total cost in patients with inhibitors. There is a significant heterogeneity in defining cost categories required for a comprehensive economic analysis from a societal perspective. While haemostatic therapies constitute a substantial portion of the overall cost, direct non-medical and indirect costs are crucial as they are often paid out-of-pocket and may impede access to treatment. It is essential for haematologists and economists to establish a standardised costing framework for future studies, particularly in the era of novel therapies.

Mandibular pitching in management of severe open bite– A case report

This case report outlines the management of severe skeletal open bite with SFOA. Different treatment modalities are available to treat Class III Skeletal open bite. But the best treatment outcome can be achieved only when the treatment plan is individualized for every patient. A 18-year-old male patient with an Open bite and a class III skeletal base. Treated by Surgery first approach followed by Orthodontic treatment to transform the patient profile and smile.SFOA can be considered as a good option in patients with mandibular prognathism. Mandibular anterior pitch-up surgery offers an immediate solution in patients with severe skeletal open bite.

Comparative evaluation of intralesional platelet rich plasma versus tranexamic acid (50mg/ml) in the treatment of facial melasma

: Melasma is a recalcitrant hyperpigmentary condition. The pathogenesis of melasma is complex and not fully understood. Although many treatment modalities have been tried for melasma but no modality is considered as gold standard.: This study aimed to compare efficacy of intralesional platelet rich plasma with tranexamic acid (50mg/ml) in the treatment of facial melasma.: Total 64 patients were enrolled in the current study from July 2023 to March 2024. In group A, 31 patients were treated with intralesional PRP and in group B, 33 patients were treated with intralesional TXA (50mg/ml). Intralesional injections were given every 4 weekly till lesions resolve or a maximum of 6 sessions followed by monthly follow up for 3 months. Grade of clinical improvement was measured by percentage reduction in mMASI score at baseline, at every session and at follow up. Patient satisfaction score was assessed using a five-point Likert scale at the end of the study.: In the PRP group, 64.52% patients showed moderate to good response whereas in the TXA group, 72.72% patients showed good to very good response. Only 41.94% patients were satisfied in group A while 81.81% patients were satisfied with their recovery after treatment in group B.: TXA was effective in all types of melasma. PRP was significantly effective only in female patients whereas TXA was significantly effecacious in both male and female patients. We suggest monthly therapy with intralesional TXA at a higher dosage of 50 mg/ml as an efficient and time-saving treatment modality over intralesional PRP.

Antibiotics as adjunct to non-surgical periodontal therapy in diabetic patients.

A comprehensive literature search was performed via MEDLINE/PubMed, Scopus, and Web of Science, including all relevant publications accessed on March 2023 and subsequently updated up to July 2024. Additionally, grey literature was searched, and there was no restriction on publication data and languages. All randomized clinical trials comparing topical/systemic antibiotics as an adjunct to scaling and root planning (SRP) with SRP alone for the treatment of diabetic patients with periodontitis were included. Literature reviews, case reports and series, preclinical studies or studies lacking periodontal data were excluded. Clinical attachment level was considered as the primary outcome. Bleeding on probing, pocket depth, and gingival index were the secondary outcomes. The risk of bias was evaluated using the Cochrane Collaboration Tool, and for each domain, bias risk was judged as low, unclear and high risk of bias. Selection, removing duplicates, screening, extracting data, and assessing the quality of studies were done by two investigators and findings were tabulated. Meta-analysis was conducted, generating forest plots to compare different treatment modalities, time periods, and antibiotic types. Key periodontal parameters such as probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BoP) were analysed. Upon screening and further evaluation of 690 articles, 43 were considered for full-text eligibility. Finally, 30 studies were included in the systematic review, and 27 were included in meta-analysis. Out of 30 randomized clinical trials, 9 studies focused on topical and antibiotics, and 21 involved systemic administration of antibiotics. Five of the nine studies focussing on topical administration of antibiotics, were classified as having a low risk of bias and four as having a high risk of bias. Out of 21 studies on systemic antibiotics, eight were classified as having a low risk of bias, two were undefined, and eleven showed a high risk of bias. Authors concluded that adjunctive use of antibiotics could lead to improvement in periodontal clinical parameters CONCLUSION: The findings showed that the adjunctive use of antibiotics led to slight improvements in clinical outcomes. However, keeping in mind antibiotic resistance, and side effects of antibiotics, their use should be approached cautiously and only when necessary.

Evaluation of prevalence of body dysmorphic disorder among patients seeking orthodontic treatment in marathwada population

Body Dysmorphic disorder (BDD) is a psychological complaint that has visions concerning faults in overall well-being of an individual for which cases explore different treatment modalities. Cases with BDD commonly consult for cosmetological procedures amongst which orthodontic treatment considered commonly. The study was adopted to assess the occurrence of Body Dysmorphic Disorder in Marathwada population. A sample size of 183 patients with different degree of malocclusive traits answered the given the BDD-YBOCS questionnaire form, while the acuteness of malocclusion was assessed with a rating scale. From total of 183 patients No BDD was seen among 58 (31.7%) patients while 116 (63.4%) had mild BDD, 9 (4.9%) reported with moderate BDD and none of the patients had severe Body Dysmorphic Disorder. Significantly higher number of BDD positive patients [98 (78.4%)] as opposed to 15 (29.3%) BDD negative patients were concerned with teeth as compared to face, hair or other body parts with statistically highly significant difference between the groups (χ2=49.219, p&amp;#60;0.001**). This study concluded that Body Dysmorphic Disorder can be diagnosed with its prevalence being 4.9% in the total sample of 183 patients. Face and Dentition are majorly affected. BDD affected samples in study population were majorly males (63%) and even reported previous history of orthodontic consultations. While treating patients with Body Dysmorphic Disorder Orthodontists should be accustomed to the clinical variations encountered in BDD and should always include certain questions regarding BDD during history taking.