Need For Medication Research Articles

Efficacy and safety of neridronate in paediatric type I complex regional pain syndrome: a multicentre experience.

Evidence regarding the efficacy of neridronate in the treatment of complex regional pain syndrome type I (CRPS I) is increasing, however, very little data are available in paediatric age. Our aim was to analyse the safety and the efficacy of neridronate in a case series of children with CRPS I, according to the Budapest criteria, who did not respond to previous pharmacological and physical therapy. We collected data of children affected by CRPS I from three paediatric rheumatology centres who received neridronate. Efficacy was evaluated by changes in pain intensity, vasomotor changes, physical function, need for pain medications and MRI findings. Adverse effects were also documented. Five children (3 females and 2 males, mean age 10.4 years, range 7-13 years) who received neridronate (4 intravenous, 1 intramuscular) were included. All patients had failed previous medical treatments (NSAIDs in 4, local steroids in 2, gabapentin, vitamin D and calcium supplementation in 1) and non-medical therapies (physiotherapy in 4, magnetotherapy in 2, laser in 1). Four out of five patients reported a significant improvement in pain (average VAS pre-treatment 9.6, post-treatment 2.6), recovery of physical function, and a reduced need for pain medications. Before treatment, all patients underwent MRI which revealed bone oedema that disappeared in the three of them after treatment. Neridronate was well-tolerated as only one patient experienced mild flu-like symptoms. Our data suggest that in children as in adults with CRPS I, neridronate may represent an effective and safe treatment option, particularly in those who do not respond to other pain treatments.

Correlation of Vitamin D Levels with Severity of Asthma in Children Between 6 to 12 Years

Background: Millions of children worldwide suffer from chronic asthma, a serious respiratory disease that has a major influence on everyday living and health outcomes. There are significant public health concerns regarding the estimated 10-15% frequency of asthma in children in India. Vitamin D, which is recognized for its immunomodulatory qualities, according to recent studies reduces the severity. In this study, children aged 6 to 12 years old's vitamin D levels and the severity of their asthma were examined. Materials and Methods: At a tertiary care teaching hospital, 100 children between the ages of 6 and 12 who were presenting with acute exacerbations of bronchial asthma were the subjects of a prospective cohort study from August 2021 to August 2022. ELISA was used to evaluate serum 25-hydroxyvitamin D levels, and the GINA recommendations were used to determine the severity of asthma. Based on their levels of vitamin D, the kids were divided into three groups: sufficient (>30 ng/mL), insufficient (20–30 ng/mL), and deficient (<20 ng/mL). Children who were deficient in vitamin D were given supplements and monitored for three months. With SPSS 27, statistical analysis was carried out. Findings: The results of the study showed a strong correlation between increased asthma severity and inadequate asthma control and reduced vitamin D levels. Children with the most acute and uncontrollably asthmatic episodes were those with low vitamin D levels (<20 ng/mL). Significant improvements in asthma control, decreased activity limits, and decreased need for rescue medication were noted after three months of vitamin D administration. Conclusion: This study shows a clear link between children's asthma control issues and higher asthma severity when there is a vitamin D Deficiency. Supplementing with vitamin D significantly improved asthma outcomes, indicating a possible therapeutic role for this nutrient. Future studies with larger sample sizes and longer follow-up periods are recommended to validate these findings and further elucidate the underlying mechanisms.

Sleep disruption in patients with active and treated endogenous Cushing’s syndrome

ContextThe hypothalamic-pituitary-adrenal axis is a critical regulator of circadian rhythm in humans. Impaired sleep adversely affects metabolic, emotional, and cognitive health.ObjectiveTo characterize sleep disturbances in patients with active and treated Cushing’s syndrome (CS), and identify factors associated with impaired sleep in treated patients.DesignSingle-center cross-sectional study.MethodsPatients with pituitary or adrenal CS enrolled in an observational study completed Nottingham Health Profile (NHP), CushingQoL, and Hospital Anxiety and Depression assessments. Cross-sectional analysis was conducted including patients with active and treated disease.Results113 (94 female) patients with CS were included, 104 pituitary and 9 adrenal, with mean age at diagnosis of 43.9 ± 13.4 years. Mean and maximum duration of follow up was 5.1 and 23 years. Mean NHP sleep score was lower (i.e., improved) in patients with treated vs. active disease (29.6 ± 30.2 vs. 51.9 ± 30.9, p = 0.0005), as was CushingQoL sleep score (p = 0.015), but 41.5% of patients with treated disease stated they often or always had trouble sleeping. The proportion of treated vs. active patients taking medication for sleep, mood, or pain was not different. Neither NHP nor CushingQoL pain scores were lower in treated vs. active patients (p = 0.39 and 0.53). In patients with treated CS, anxiety and depression correlated with worse sleep scores.ConclusionsPatients with treated CS report improved sleep quality compared to those with active disease, but almost half of treated patients still report sleep challenges. The need for sleep medications, reported by one third of patients, was not different after CS treatment. Ongoing mood disturbances may play a role in persistent sleep disruption. Further work should focus on determinants of sleep impairments in treated CS patients.

Comparative clinical study of Mist Amen Fevermix and Edhec Malacure: two polyherbal products used for the treatment of uncomplicated malaria in Ghana against Artemether/Lumefantrine

The use of herbal products for the treatment of malaria, has increased globally. However, inadequate scientific studies about the safety and effectiveness of such herbal products have been raised. Also, the reduced sensitivity of the malaria parasites to artemisinin-based combination therapies is of concern. There is therefore the need for new antimalarial medications including those from alternative sources such as herbal medicinal products. In this study, a prospective, comparative parallel group randomized, clinical study was done to assess the safety and effectiveness of Mist Amen Fevermix and Mist Edhec Malacure with Artemether/Lumefantrine as control at the Tafo Government Hospital, Kumasi between July and November 2019, after Committee on Human Research, Publication and Ethics approval (CHRPE/AP/424/19). The study was conducted in accordance with Good Clinical and Laboratory Practice (GCLP) and registered with the Pan African Clinical Trials Registry with trial number PACTR202109664146698. Participant completed an informed consent form. Randomization was based on a single sequence to allocate participants to a group. SPSS version 19. One-way ANOVA test and exploratory statistics was used for data analysis. Total sample size was 150 participants with 50 on each arm of the group. Male and female patients aged 15–45 years and meet inclusion criteria with clinically established malaria were treated with Mist Amen Fevermix and Mist Edhec Malacure, at the specified doses of 45 mls (0.1063 g) and 30 mls (0.0521 g) three times daily after meals for three days. Artemether/Lumefantrine was administered at a dose of 80/480 mg/kg twice daily after meals for three days. Baseline data was taken on day 0. Patients were then followed up on Day 3, 7 and 28 to establish treatment outcomes and any side effect using a checklist for signs and symptoms and Karnofsky’s scale to assess the quality of life. Mist Amen Fevermix was effective with a cure rate of 95.89%. Mist Edhec Malacure was also effective with a cure rate of 91.87%. The cure rate of Artemether/Lumefantrine was 97.25%. Kidney and liver panels were within normal reference range at the end of the 28-day study. This study supports the use of Mist Amen Fevermix and Mist Edhec Malacure, two multi-component products as safe and effective for the treatment of uncomplicated malaria. Both products achieved a comparable clinical treatment outcome with Artemether/Lumefantrine.

Hypnosis support in anaesthesia is rarely used in German anaesthesia departments - a nationwide survey among leading physicians of anaesthesia departments

BackgroundThe aim of this study was to investigate whether and to what extent perioperative hypnosis and relaxation techniques are used in German anaesthesia departments, what they are, where any difficulties in their application lie and how great the interest in this type of therapy is. Another research question was to find out whether there are specialist areas in which these methods are used more frequently than in other specialist areas.MethodsA descriptive survey was conducted by means of a questionnaire in all hospitals with anaesthesia departments in Germany. 1124 questionnaires were sent out by post. The survey period was five months from 27/02/2023 to 31/07/2023. The clinic directors of all anaesthesiology departments in German hospitals were surveyed.Results476 departments (42%) responded by pre-paid envelope. Of these, only 39 (8%) use hypnosis and relaxation techniques perioperatively. These are mostly progressive muscle relaxation, hypnotic trance according to Erickson, calming words and suggestions or the use of virtual reality (e.g. using VR-glasses).ConclusionsHypnosis techniques have been shown in many studies to be effective in increasing patient comfort (less anxiety and stress) and reducing both the need for medication and perioperative pain. The therapy is rarely used in Germany, although once established it can be easily integrated into perioperative procedures. Many departments have shown great interest in the topic. In the interests of patients, a structural change should be considered to promote the use of hypnotic procedures.

Descriptive analysis of therapeutic outcomes between thoracoscopic and transsternal thymectomy in myasthenia gravis patients from 2011 to 2021

BackgroundMyasthenia gravis is an autoimmune disease with high prevalence of thymus disorders, in which, thymectomy is considered one of the therapeutic approaches in improving the patients’ clinical outcomes. Today, thoracoscopic thymectomy has received significant attention than the classic transsternal approach due to fewer complication. Therefore, this study was designed with the aim of investigating the therapeutic outcomes of thymectomy in patients with myasthenia gravis in the Afzalipour Hospital of Kerman between 2011 and 2021.MethodsThe current study is a descriptive analytical study on patients with myasthenia gravis who underwent surgical thymectomy within 2011–2021. Demographic and clinical characteristics of patients from the time of operation to three years of follow-up were extracted and recorded from clinical records or by phone calls. Data were analyzed using SPSS software.ResultsThe data of 70 patients who underwent surgical thymectomy were analyzed. Thymectomy caused a significant reduction in the severity of the disease according to the Osserman classification (P = 0.001). It also significantly reduced the use of corticosteroids (P = 0.001) and IVIG (P = 0.015) compared to the time before the surgery. Sixty-two patients (88.57%) needed to take less medicine than before surgery. Left VATS was associated with less post-operative severity of the disease (P = 0.023). There were only two deaths during the follow-up period.ConclusionOverall, the findings of the present study demonstrated that thoracoscopic thymectomy is a useful surgical approach that leads to faster recovery, reducing the severity of the disease, need for medication, and complications in patients with myasthenia gravis, In comparison with the transsternal approach.

Current clinical practice of prurigo nodularis in Japan: A cross-sectional web-survey among dermatologists.

Prurigo nodularis (PN) is a chronic inflammatory skin disease associated with intense pruritic nodules. The unclear patho-etiological mechanisms of PN cause difficulty in disease management; and there is a paucity of information on the current diagnosis and treatment options for PN in Japan. To describe the current management from a dermatologists' perspective we conducted a web-based survey (UMIN Clinical Trial Registry UMIN000047643) in 2022 among dermatologists from a Japanese commercially available physician panel, who had seen at least one patient with PN within the last 3 months. The survey included 117 dermatologists. The dermatologists diagnosed PN mainly by confirming clinical signs and patient interviews, while to assess the severity of PN, the number of pruritic nodules and the degree of itching were primarily utilized. Topical corticosteroids and antihistamines were the most used drugs, as recommended in the current guidelines on the diagnosis and treatment of prurigo. Dermatologists' treatment satisfaction decreased with increasing assumed severity of PN; almost 65% dermatologists were not satisfied with the treatment of severe PN. These results suggest the need of more effective medications and diagnostic tools for better management of PN in Japan.

Effects of fremanezumab on migraine-associated symptoms and medication use in Japanese and Korean patients with episodic migraine: Exploratory endpoint analysis of a multicenter, randomized, double-blind, placebo-controlled trial.

To describe exploratory endpoints from a previous phase 2b/3 placebo-controlled trial conducted in Japan and Korea, specifically investigating the effect of fremanezumab or placebo on migraine-associated symptoms and acute headache medication use in patients with episodic migraine (EM). EM is associated with non-head pain symptoms, including nausea, vomiting, photophobia, or phonophobia, which contribute substantially to the disease burden, healthcare resource utilization, and impaired quality of life. Current EM treatments include a mix of nonspecific/migraine-specific acute headache medications, but medication overuse can induce headaches and progression from EM to chronic migraine (CM). In multiple phase 2b/3 trials, the monoclonal antibody fremanezumab significantly reduced the average number of monthly migraine days experienced by patients with EM/CM compared with placebo. This was a prespecified analysis of exploratory endpoints in a multicenter, randomized, double-blind, placebo-controlled, phase 2b/3 trial conducted in Japanese and Korean patients with EM (NCT03303092). Patients were randomized to receive fremanezumab, either monthly or quarterly, or matching placebo, administered subcutaneously at 4-week/28-day ("monthly") intervals to maintain blinding. Exploratory endpoints reported here were the mean change from baseline in the number of days/month with (i) the use of any acute headache medication, (ii) the use of any migraine-specific acute headache medication, (iii) nausea or vomiting, and (iv) photophobia and phonophobia. Overall, 357 Japanese and Korean patients with EM received either monthly (n = 121) or quarterly (n = 119) fremanezumab or placebo (n = 117). Compared with placebo, fremanezumab administered monthly or quarterly was associated with a significant reduction from baseline in the average number of days/month with acute headache medication use over three months (difference vs. placebo -2.81 [95% confidence interval (CI) -3.52, -2.11]; p < 0.001 and -2.79 [95% CI -3.50, -2.08]; p < 0.001, respectively). Similar findings were observed in the monthly average number of days with migraine-specific acute headache medications (difference vs. placebo with monthly and quarterly fremanezumab, -2.63 [95% CI -3.31, -1.95] for both; p < 0.001), the average number of days/month with nausea or vomiting (difference vs. placebo -1.09 [95% CI -1.60, -0.58]; p < 0.001 for monthly fremanezumab and -1.37 [95% CI -1.88, -0.86]; p < 0.001 for quarterly fremanezumab), and the average number of days with photophobia and phonophobia (difference vs. placebo -1.22 [95% CI -1.80, -0.65]; p < 0.001 and -1.64 [95% CI -2.22, -1.06]; p < 0.001, respectively). Monthly and quarterly administered fremanezumab effectively prevented EM in Japanese and Korean patients. Fremanezumab also improved other disease aspects including the need for acute headache medications and the frequency of migraine-associated symptoms.

Dexamethasone-Sparing Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting in Highly and Moderately Emetogenic Chemotherapy: The SHEILD Study.

Chemotherapy-induced nausea and vomiting (CINV) significantly impacts patient's quality of life and treatment adherence. This study investigated the efficacy of Generic Netupitant and Palonosetron tablets (Nykron) with dexamethasone single dose for CINV prophylaxis in patients receiving highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC).Additionally, this approach aligns with the principles of the SHIELD study (Sparing High Efficacy Intervention for Low Dose Dexamethasone), which focuses on maximizing antiemetic effectiveness while minimizing dexamethasone use. This multicenter retrospective study evaluates data from patients who received HEC/MECand were administered a fixed-dose combination of Generic NEPA (Netupitant 300 mg and Palonosetron 0.5 mg tablets, Nykron combi-pack) along with a single dose of dexamethasone (12 mg/8 mg) before chemotherapy. The data were collected from September 2022 till September 2023. Outcomes measuredincluded complete response (no vomiting and no need for rescue medications), complete protection (no significant nausea (<2.5 cm on VAS), no vomiting, and no use of rescue medication), and complete control (no emetic episodes, no rescue therapy, and no nausea [0 cm on VAS])during the acute phase (0-24 hours) and delayed phase (24-120 hours) post-chemotherapy. The data of 372 patients was evaluated in which breast cancer was the most common cancer with 223 (59.95%) patients for which doxorubicin and cyclophosphamide (192, 51.61%) was the most administered chemotherapy combination. The second most common cancer was gastrointestinal (GI) cancer with stomach cancer in 47 (12.6%), colorectal cancer in 4 (1%), and pancreatic cancer in 2 (0.54%). A total of 360 (96.8%) patients received an HEC regimen across the cycle, while only 5 (1.3%) received an MEC regimen. The regimen demonstrated exceptional efficacy with a 96.9% overall response rate across all cycles. Complete control rates for acute CINV were 92% and 90% for delayed CINV across chemotherapy cycles. Complete response rates remained consistently high (94%-98%) across all cycles and overall phases. Only 3% of patients experienced anticipatory CINV. This dexamethasone-sparing Generic NEPA regimen showed remarkable efficacy in CINV management for HEC/MEC regimen-receiving patients, maintaining high response rates in both acute and delayed across all cycles. These findings indicate a potential paradigm shift in CINV prophylaxis, necessitating further investigation through prospective, randomized controlled trials to validate long-term safety and efficacy.

Managing medications for patients with cancer and chronic conditions: It's time for collaboration between primary care and oncology pharmacists.

To provide a rationale for a collaborative care model involving oncology and primary care pharmacists to improve the coordination of care of medications for cancer patients with multiple chronic conditions. A review of selected literature and the authors' own research was used. Studies illustrating the gaps in care for medications and pharmacists' roles in oncology and primary care settings from PubMed were reviewed. There has been a substantial increase in the development and utilization of oral anticancer agents (OAAs). Although OAAs offer convenience and flexibility, they also introduce challenges related to medication adherence, monitoring, and managing side effects. Up to 17.5% of patients experience moderate to severe symptoms from OAAs and about 30% report less than excellent medication adherence. Further, studies showed that 30% to 53% of adult cancer patients have at least one chronic condition that complicates their treatment plan due to the need for medications, increasing the risk of drug interactions, side effects, and non-adherence. The Primary Care Oncology Model (PCOM) incorporates both primary care and oncology pharmacists with comprehensive medication review and patient-reported outcome measure, respectively, to enhance medication appropriateness and effectiveness, and improve overall patient experience. Implementing PCOM may improve the medication management of patients taking OAAs for active cancer treatment and chronic medications for their multiple chronic conditions. This collaborative approach can transform patient care by leveraging the expertise of both primary care and oncology pharmacists.

Antipsychotics and anesthetic drugs

Psychiatric illness is common, affecting up to 10% of the population, with around 1% diagnosed with a major psychiatric disorder. An increased mortality rate in the postoperative period for schizophrenic patients receiving chronic antipsychotic therapy has been demonstrated. According to the Diagnostic and Statistical Manual of Disease, schizophrenia-associated psychotic disorders are characterized by disturbances in emotional, behavioral and cognitive arenas, impeding on nearly every aspect of life functioning in the form of thought disorders, delusions and hallucinations. Chronic schizophrenic patients lack pain sensitivity, and have pituitary-adrenal and autonomic nerve dysfunction, abnormalities of the immune system, and water intoxication. These alterations may influence postoperative outcome. Psychotropic drugs often given in combination with each other or with other non-psychiatric drugs generally exert profound effects on the central and peripheral neurotransmitter and ionic mechanisms. The increased complications are associated with physical disorders, antipsychotic or hazardous health behaviour and interactions between antipsychotics and anaesthetic drugs. Adverse responses during anaesthesia include arrhythmias, hypotension, prolonged narcosis or coma, hyperpyrexia, post-operative ileus and post-operative confusion. Although drug interaction probably remains the most potentially serious problem current evidence suggests that psychiatric medication need not be discontinued prior to anesthesia.

Computer-aided molecular modeling and design studies of some N-(4-(dimethyl amino) phenyl)-4-methoxy-3-propionamidobenzamide derivatives as NS5B polymerase inhibitors

Hepatitis C Virus (HCV) is a stealthy ailment, and most people are unaware they have it in the early stages. Insilco modeling was used to develop a model with high predictive power for N-(4-(dimethyl amino) phenyl)-4-methoxy-3-propionamidobenzamide inhibitors. The inhibitors were optimized using Density Functional Theory (DFT) based on a notion of B3LYP/6–31 G* levels. The genetic function algorithm (GFA) was utilized to create the QSAR models. The best model was chosen based on its statistical fitness using the subsequent measurement parameters: R2trng = 0.828181, R2adj = 0.800468, Q2cv = 0.734795, R2test = 0.7028, and LOF = 0.613985, led to its selection and publication. The model underwent additional assessments, including the Y-scrambling test, and applicability domain, and was considered to have statistical significance. The docking results demonstrate that compound 17 has the greatest inhibitory effect on NS5B-polymerase of any drug in the dataset. Using this compound as a template, novel anti-hepatitis C compounds were developed by including a few beneficial substituents. The docking results of the proposed compounds yielded a high MolDock score (−152.12), indicating effective binding to the target's active sites. Two comparable compounds (SBD4 and SBD3) were shown to be superior to the food drug administration (FDA) approved medication, revibirin/pegylated interferon. The chemicals were determined to be orally accessible after passing Lipinski's criteria, a drug similarity test. Furthermore, the synthesized compounds were found to have favorable pharmacokinetic (absorption, distribution, metabolism, excretion, and toxicity) properties. In conclusion, using the QSAR model, a model with excellent prediction power for certain Biaryl amide inhibitors was constructed. The model was validated and determined to have good internal and external assessment criteria. According to the docking results, compound 17 inhibits NS5B-polymerase the most out of the compounds in the dataset. Furthermore, the compounds' oral bioavailability met drug-like standards. The ultimate goal of this research is to contribute to the development of new therapeutic agents for the treatment of HCV infections, addressing the pressing need for effective antiviral medications.

Molecular Docking and Dynamic Simulation Studies of Bioactive Compounds from Traditional Medicinal Compounds Against Exfoliative Toxin B from Staphylococcus aureus

Background Staphylococcal scalded skin syndrome (SSSS) is a dermatological condition caused by Staphylococcus aureus, characterized by exfoliative toxin B, and its increasing resistance to conventional antibiotics necessitates the search for new therapeutic options. Aim The study aimed to investigate the potential of traditional medicinal compounds (TMCs) as potential pharmaceuticals against SSSS using molecular-level research. Introduction Staphylococcus aureus, commonly known as S. aureus, is the main cause of SSSS. These infections are a major concern for public health because they are becoming resistant to antibiotics. There is an urgent need for new medications to effectively fight against this infection. The main objective of this study was to assess the interaction between TMC compounds and S. aureus exfoliative toxins ETA and ETB utilizing computational approaches. Materials and Methods The investigation selected TMC compounds based on their potential to combat S. aureus infections. To predict binding affinities with the ETB toxin, molecular docking simulations were performed using AutoDock and AutoDock Vina. In order to evaluate the stability and interaction dynamics with the toxins, the most promising compound was subjected to a 100 ns molecular dynamics simulation. Stability was evaluated through various methods. Results Liquiritin showed the highest binding affinity, with a docking score of −7.6 kcal/mol. MD simulation confirmed the complex’s stability, and the binding free energy of −17.76 kcal/mol indicated potent inhibitory activity against S. aureus ETB. Conclusion Liquiritin, a TMC, effectively inhibits S. aureus toxins ETB, with promising potential for treating SSSS and antibiotic-resistant infections, requiring further research.

CADD Methods for Developing Novel Compounds Synthesized to Inhibit Tyrosine Kinase Receptors.

Growth factors and their receptor tyrosine kinases play a central role in regulating vital cellular processes such as proliferation, differentiation, division, and cell survival, and they are closely associated with the development of various types of cancer, particularly in the context of angiogenesis. Although several small chemical compounds targeting tyrosine kinase receptors have been approved by the FDA for cancer treatment by inhibiting angiogenesis, there is still a need for more effective medications. in silico studies are now crucial tools for the design of new drugs, offering considerable advantages such as cost and time reduction. In this review, we examined recent in silico research carried out between 2022 and 2024, focusing on new drug candidates synthesized to fight cancer, in particular by targeting tyrosine kinase receptors involved in the process of angiogenesis.

Comparing embolic particles for prostatic artery embolization to treat lower urinary tract symptoms in patients with benign prostatic hyperplasia.

Compare the safety and efficacy of polyvinyl alcohol particles (PVA) versus trisacryl gelatin microspheres (Embospheres) versus hydrogel microspheres coated with polyzene-F (Embozenes) for prostatic artery embolization (PAE) to treat patients with benign prostatic hyperplasia (BPH). A single-center prospective cohort study from 2019 to 2023, including patients with international prostate symptom score (IPSS) ≥ 15 and/or quality of life score (QoL) ≥ 4. Allocation to embolic agents was performed chronologically: 100-300 µm PVA (n = 53), followed by 300-500 µm Embospheres (n = 50), and finally, 400 µm Embozenes (n = 50). All patients were evaluated at baseline and at 1 and 6 months after PAE with IPSS/QoL; peak urinary flow rate, post-void residual volume, and prostate volume with ultrasound and prostate-specific antigen. Adverse events and the need for prostatic re-interventions were assessed. There were no significant baseline differences between the three groups except for patient age (62.5 years PVA; 66.1 years Embospheres and 66.6 years Embozenes; p = 0.019). There were no major adverse events and no differences between groups regarding minor adverse events. All outcome measures improved significantly from baseline, with no significant differences between groups. Mean ± standard deviation IPSS/QoL improvement at 6 months: -10.7 ± 7.9/-2.2 ± 1.7 PVA; -10.4 ± 7.3/-2.0 ± 1.5 Embospheres; -10.4 ± 7.0/-2.2 ± 1.6 Embozenes (p = 0.987). Re-intervention rates after 6 months: 9% (n = 5/53) PVA; 14% (n = 7/50) Embospheres; 8% (n = 4/50) Embozenes (p = 0.591). PAE with PVA particles, Embospheres, and Embozenes is equally safe and effective in treating BPH-related lower urinary tract symptoms. This is the first prospective study showing equivalence between the most frequently used embolic agents for prostatic artery embolization. Different particles can be used interchangeably for prostatic artery embolization. The improvements in measured metrics were the same between groups, with no differences in adverse events. The need for prostatic medication and re-intervention rates were the same at 1 and 6 months after embolization.

Long-Term Outcome after Canaloplasty and Phacocanaloplasty in Primary Open-Angle Glaucoma.

Canaloplasty and phacocanaloplasty achieve a statistically significant IOP-reduction for up to 11 years and decrease the long-term need for glaucoma medications. Both procedures have a low long-term complication rate. To evaluate the long-term outcome of canaloplasty with and without cataract surgery in primary open-angle glaucoma (POAG) patients. 48 eyes of 34 patients with POAG who successfully received canaloplasty alone (group A, n=28) or with phacoemulsification (group B, n=20) were retrospectively analyzed. Demographic data, intraocular pressure (IOP) and IOP-lowering medication were recorded pre- and post-surgery with a follow-up of up to 14 years. The mean follow-up time in group A was 91.4±45.0 months. Mean IOP dropped from 22.0±3.8mmHg at baseline to 14.0±3.3mmHg, 14.3±3.1mmHg, 14.4±3.8mmHg and 16.5±1.2mmHg at 1, 4, 7, 10 years, respectively. IOP-lowering medication count decreased from 1.5±1.0 at baseline to 0.1±0.4, 0.3±0.6, 0.6±0.9 and 0.9±1.1 at 1, 4, 7, 10 years, respectively. The mean follow-up time in group B was 109.1±25.7 months. Mean IOP dropped from 24.5±6.0mmHg at baseline to 13.8±2.9mmHg, 14.9±3.6mmHg, 15.3±2.9mmHg and 14.8±2.0mmHg at 1, 4, 7, 10 years, respectively. IOP-lowering medication count decreased from 2.2±1.2 before surgery to 0.0, 0.1±0.3, 0.1±0.2 and 0.5±0.9 at 1, 4, 7, 10 years, respectively. Canaloplasty and phacocanaloplasty achieved a comparable decrease in IOP and glaucoma medication count with a low complication rate. Both procedures showed a high long-term success rate.

Pre- to Postbiotics: The Beneficial Roles of Pediatric Dysbiosis Associated with Inflammatory Bowel Diseases.

Probiotics are "live microorganisms which, when administered in adequate amount, confer health benefits on the host". They can be found in certain foods like yogurt and kefir and in dietary supplements. The introduction of bacterial derivatives has not only contributed to disease control but has also exhibited promising outcomes, such as improved survival rates, immune enhancement, and growth promotion effects. It is interesting to note that the efficacy of probiotics goes beyond the viability of the bacteria, giving rise to concepts like paraprobiotics, non-viable forms of probiotics, and postbiotics. Paraprobiotics offer various health benefits in children with intestinal dysbiosis, contributing to improved digestive health, immune function, and overall well-being. In this review, the potential of these therapeutic applications as alternatives to pharmacological agents for treating pediatric intestinal dysbiosis will be thoroughly evaluated. This includes an analysis of their efficacy, safety, long-term benefits, and their ability to restore gut microbiota balance, improve digestive health, enhance immune function, and reduce inflammation. The aim is to determine if these non-pharmacological interventions can effectively and safely manage intestinal dysbiosis in children, reducing the need for conventional medications and their side effects.

Psychosocial and functional impact of successful digital replantation – A cohort study of 36 patients with a median follow-up of 6 years

IntroductionThis study aims to evaluate the long-term psychosocial and functional outcomes of successful digital replantation following traumatic amputation. MethodsPatients that underwent successful replantation (i.e. no secondary amputation following replantation) of one or more traumatically amputated digits between January 2009 and April 2019 were invited to participate in this study. In addition to a custom questionnaire on psychosocial and socioeconomic aspects of life, various Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires regarding global health, upper extremity function, and depressive symptoms were completed. Bivariate analyses were performed to identify significant associations between outcomes and explanatory variables. ResultsThirty-six patients were successfully enrolled and completed the questionnaires at a median follow-up of 6.1 years. The median PROMIS score for Upper Extremity Function (40.6) was considerably different from the score that is typically found in the general population (all PROMIS instruments are calibrated with a control group score of 50.0), but the median PROMIS scores for Global Health – Physical (49.0), Global Health – Mental (50.7), and Depression (45.6) were comparable to those among the general population. Dominant hand injury, a greater number of injured digits, higher age at the time of injury, and the need for neuropathic pain medication were associated with lower Upper Extremity Function scores (all p < 0.05). Additionally, the presence of neuroma was associated with negative changes in both household finances and mental well-being (p < 0.05). ConclusionsAt long-term follow-up, a majority of patients that underwent replantation of traumatically amputated digits seem to cope well based on psychosocial and functional outcomes. However, neuropathic pain and the presence of neuroma are strong negative factors. Specific attention to digital nerves at the time of surgery is crucial in the management of traumatic amputations.

Comparing the efficacy of adrenaline, clonidine, and dexmedetomidine in enhancing local anesthesia for impacted third molar extraction: a randomized controlled trial.

In human dentition, the most commonly impacted teeth are the mandibular third molars (M3M). The removal or extraction of these teeth often causes anxiety in patients due to the perceived pain involved in the process. Therefore, pain must be effectively managed using anesthesia. The use of newer local anesthetic drugs can help minimize side effects and drug interactions. Traditionally, adrenaline is used as a vasoconstrictor along with lignocaine. When combined with lignocaine, the alpha agonists dexmedetomidine and clonidine can extend the duration of anesthesia, thereby reducing the need for additional pain-relieving medications. This study used a randomized, triple-blind, parallel-arm design. Sixty patients were screened, and 45 systemically healthy patients requiring unilateral surgical removal of impacted mandibular third molars with similar difficulty (moderate-to-difficult according to the Modified Pederson's Index) were included in the study. Patients were allocated into three groups as follows: Group A: 2% Lignocaine Hydrochloride with 1:100,000 Adrenaline, Group C: 2% Lignocaine Hydrochloride with 15 µg/mL Clonidine, and Group D: 2% Lignocaine Hydrochloride with 1 µg/mL Dexmedetomidine. The evaluated parameters were the time of onset of anesthesia, depth of anesthesia, hemodynamic parameters, and duration of postoperative analgesia. Group D had a faster onset of action and prolonged duration of postoperative analgesia compared with Groups A and C. No statistically significant differences were observed between the three groups in terms of the depth of anesthesia and hemodynamic parameters. Group D exhibited a significantly more rapid onset of anesthesia than Groups A and C, and the postoperative analgesic effect in Group D was significantly prolonged (7.22 hours) compared with that in Groups A (4.54 hours) and C (2.1 hours). Patients receiving the Group D solution experienced an extended period of comfort without the need for analgesics for up to 7.22 hours post-procedure.

From chaos to kaleidoscope: Exploring factors in psychedelic self-treatment for mental health conditions.

This study explores how individuals self-treat psychiatric conditions with psychedelics outside medical guidance bridging the gap in understanding unregulated therapeutic use. The primary objective was to extract specific factors underlying the effects of psychedelics, exploring their relationship with the need for medication, particularly for mental health conditions like depression and anxiety. Additionally, we aimed to understand how the likelihood of being prescribed pharmacological medication varies based on mental health diagnoses and demographic factors. This research utilised the Global Drug Survey 2020, an annual online survey focused on substance use patterns and demographics, incorporating modules addressing mental health and psychedelic use. The study employed Exploratory Factor Analysis to discern latent factors underlying the self-reported effects of psychedelics. Bivariable and multivariable logistic regressions were conducted to investigate the association between identified factors and the likelihood of current prescribed medication usage. In all, 2552 respondents reported using psychedelics for self-treatment of mental health conditions. Three significant factors were identified: Improved Mental Health, Improved Self-Awareness and Neuro-Sensory Changes. The majority of the sample reported a history of depression (80%) or anxiety (65.6%), with a significant association observed between reported factors of psychedelics' effects and current medication usage for mental health, especially notable in cases of depression or comorbid depression and anxiety. Perceived symptom improvement following psychedelic self-treatment may reduce the need for medically supervised pharmacological interventions. These findings highlight the potential of psychedelics to positively influence mental health and self-awareness, paving the way for further research into their therapeutic application.