We aimed to develop the European Society of Cardiology (ESC) quality indicators (QIs) for myocardial infarction (MI), from one year after hospital discharge, corresponding to transition to the chronic coronary syndromes phase. We collaborated with the European Association of Preventive Cardiology (EAPC) and developed QIs for the long-term management of patients following MI. We applied the ESC methodology for QI development by: (i) determining key domains of post-MI care; (ii) developing candidate QIs by performing a systematic review of the literature, and (iii) selecting the final set of QIs using a modified Delphi approach. In total, 18 QIs were identified across seven domains of care including (1) structural framework, (2) risk assessment and follow-up, (3) pharmacological management, (4) rehabilitation, behavioral and preventive interventions, (5) coronary revascularization, (6) clinical outcomes and (7) patient-reported outcomes. We present the ESC QIs from one year after hospitalization for MI, to standardize and address gaps in care for this high-risk group. These QIs are supported by evidence from contemporary literature, endorsed by expert consensus and aligned with the 2024 ESC guidelines on the management of chronic coronary syndromes.

Impact of manual therapy on adhesion related symptoms post abdominal surgery: A systemic review.

Obesity Medicine Association statement regarding online pharmacologic management of obesity

The exact genetic mechanisms and link between obsessive-compulsive disorder (OCD) and tics/Tourette syndrome are not fully understood. This narrative review aims to summarize the literature examining whether the clinical phenotypes of OCD and OCD + tics (tic-related OCD) represent distinct entities and how this relates to their genetic underpinnings. Systematic searches were conducted in MEDLINE Complete and Embase databases to identify studies published since the Diagnostic and Statistical Manual 5th Edition introduced the category of OCD with and without tics in 2013. Articles reporting on family cohort studies, linkage and epigenetic analyses, and genome-wide association studies involving patients with OCD and/or tic-related OCD were included. While the studies have highlighted significant genetic heterogeneity, there is some evidence to suggest the role of serotonergic, glutamatergic, and dopaminergic systems, with the latter playing a significant role in the genesis of tic spectrum symptoms, which may have implications for choice of pharmacological management in those with OCD + tics. Given the significant genetic heterogeneity and consequent phenotypic variations, future research delineating homogeneous subgroups is needed, including longitudinal studies that examine whether the clinical phenotypes of the OCD/tic spectrum of conditions "breed true" in offspring, which may have implications for clinical assessment and management.

Introduction: Vulvodynia is defined as discomfort of the vulva that lasts for at least three months and is clinically considered an idiopathic pain syndrome, presenting both diagnostic and therapeutic challenges.While non-pharmacological interventions such as pelvic floor physical therapy and psychotherapy provide relief for some patients, many require pharmacological treatment for persistent discomfort. Despite the availability of various pharmaceutical options, standardized treatment protocols are lacking, and comparative efficacy data remain limited. This review examines current pharmacological approaches for vulvodynia and assesses their effectiveness in managing symptoms. Results: Following a rigorous selection process, 29 articles met the inclusion criteria. The available evidence supports the efficacy of oral medications, particularly amitriptyline as a first-line treatment, and topical lidocaine in managing vulvodynia. Furthermore, the integration of physiotherapy alongside pharmacological management appears to enhance patient outcomes. Botulinum toxin injections did not yield statistically significant improvement in the studies included in the review. Conclusions: Amitriptyline and topical lidocaine have demonstrated efficacy for vulvodynia, particularly when combined with physiotherapy. Future research should focus on investigating the long-term efficacy of combined therapies and exploring the underlying mechanisms of vulvodynia to develop targeted treatments.

From inflammation to intervention: exploring shared mechanisms and lifestyle strategies in diabetes mellitus and multiple sclerosis.

Background: Overactive bladder (OAB) is a common and distressing syndrome characterized by urinary urgency, frequency, nocturia, and urgency incontinence in the absence of urinary tract infection or other pathology. It significantly impacts physical comfort, emotional well-being, and social functioning. Pharmacologic management primarily involves antimuscarinic agents and β3-adrenergic receptor agonists, with Mirabegron offering comparable efficacy but a more favorable side-effect profile compared to antimuscarinics. Objective: To evaluate and compare the therapeutic efficacy and tolerability of Solifenacin and Mirabegron in women with overactive bladder. Methods: This comparative cross-sectional study was conducted at Chandka Medical Hospital between March and August 2025. A total of 161 female patients aged 18 years and above with OAB symptoms persisting for over three months were enrolled. Group A received Solifenacin 10 mg daily, and Group B received Mirabegron 25 mg daily. The duration of therapy was three weeks, after which symptom improvement was evaluated based on the number of micturition episodes, urgency episodes, and incontinence per 24 hours. Data were analyzed using SPSS version 20, with p < 0.05 considered statistically significant. Results: The mean age of participants was 41.8 ± 7.56 years. The mean duration of OAB symptoms was 4.6 ± 0.91 months. Baseline mean values included 9.2 ± 2.1 micturitions, 6.6 ± 1.3 urgency episodes, and 5.1 ± 1.51 incontinence episodes per 24 hours. After treatment, Mirabegron showed superior symptom reduction compared to Solifenacin, with significant improvement in nocturia (p < 0.05). Adverse effects such as dry mouth, constipation, and dizziness were more frequent in the Solifenacin group, whereas Mirabegron demonstrated better tolerability and lower discontinuation rates. Conclusion: Both medications effectively improved OAB symptoms, but Mirabegron offered superior therapeutic benefits with fewer side effects and greater tolerability, making it a preferable choice for managing overactive bladder in women.

This case report details a rare and severe presentation of refractory otomastoiditis caused by Mycobacterium abscessus in an immunocompetent pediatric patient who presented with a 1-month history of left ear pain, swelling, and fever unresponsive to antibiotics. Computed tomography imaging was suggestive of coalescent otomastoiditis, and she underwent urgent left mastoidectomy, subperiosteal abscess drainage, and myringotomy with tube insertion, followed by conventional antibiotic management. Despite these interventions, she remained symptomatic and cultures revealed M. abscessus 1 week later. Multidisciplinary management involved serial microdebridement and prolonged multidrug antimicrobial therapy with shared decision-making between otolaryngology, infectious diseases, and international experts. Pharmacological management was complicated by adverse effects including aminoglycoside-induced hearing loss, myelosuppression, and gastrointestinal intolerance requiring drug substitutions. Eighteen months after initial presentation, revision mastoidectomy, canaloplasty, mastoid obliteration, tympanoplasty, and ossiculoplasty were performed for the eradication of residual disease and reconstruction. At follow-up, there was no disease recurrence although left-sided moderate-to-severe mixed hearing loss persisted. This case highlights the importance of early recognition and coordinated medical-surgical interventions in atypical presentations of mastoiditis.

Practice variations in pharmacological management of acute renal colic pain: A cross-sectional survey study.

Background: Complex Regional Pain Syndrome (CRPS) is a chronic, neuropathic pain condition that may develop following tissue trauma such as burns, characterized by disproportionate pain, sensory disturbances, and motor dysfunction. Pediatric burn survivors are particularly vulnerable due to heightened inflammatory and neuroplastic responses that contribute to maladaptive cortical reorganization and central sensitization. Traditional pharmacological management often yields suboptimal outcomes, prompting interest in non-pharmacological approaches targeting neuromuscular and sensory recovery. Objective: This study aimed to compare the effectiveness of Myofascial Release (MFR), Graded Motor Imagery (GMI), and Desensitization Exercise Therapy (DET) in improving pain intensity, functional mobility, and sensory hypersensitivity among pediatric burn survivors diagnosed with CRPS. Methods: A single-blind randomized controlled trial was conducted on 90 pediatric burn survivors aged 6–18 years diagnosed with CRPS. Participants were randomly assigned to MFR, GMI, or DET groups (n=30 each) for six weeks of intervention, comprising two sessions per week. Outcome measures included pain intensity (Visual Analog Scale), functional mobility (Timed Up and Go test), and sensory hypersensitivity (Quantitative Sensory Testing). Data were analyzed using one-way and repeated-measures ANOVA with Bonferroni post hoc tests and effect size estimation (η²). Results: All interventions significantly improved pain, mobility, and sensory function (p<0.001). The GMI group exhibited the largest reductions in pain (ΔVAS −4.1, p<0.001) and mobility time (ΔTUG −5.1s, p<0.001), while the DET group showed the greatest improvement in sensory thresholds (+1.5°C, p<0.01). Effect sizes indicated strong treatment effects (η² = 0.18–0.20). No adverse events were reported. Conclusion: MFR, GMI, and DET each demonstrated efficacy in managing CRPS in pediatric burn survivors, with GMI showing superior outcomes in pain and mobility, and DET excelling in sensory desensitization. A multimodal rehabilitation approach integrating these techniques may offer optimal functional recovery.

BackgroundPostoperative anxiety and depression are common following total hip arthroplasty (THA) and can negatively affect recovery. While pharmacological management is standard, non-pharmacological interventions may offer additional benefits without adverse side effects.ObjectiveTo assess the effectiveness of a nurse-led video-based intervention on anxiety and depression symptoms and perceived quality of life in patients undergoing THA, compared to standard care.MethodsA quasi-randomized controlled trial was conducted with 131 participants undergoing elective THA, randomly assigned to an intervention group (IG; n = 67) receiving a preoperative nursing intervention focused on emotional preparation and information, and a control group (CG; n = 64) receiving usual care. Psychopathological symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life was measured using the EQ-5D-5L. Assessments occurred at baseline (pre-surgery), post-intervention (hospital discharge), and one-month follow-up. General Linear Model (GLM) analyses were used for within- and between-group comparisons.ResultsNo significant differences in anxiety or depression symptoms were found between baseline and hospital discharge in either group. Both groups showed significant improvement in HADS scores and all EQ-5D-5L dimensions at one-month follow-up. Although the IG initially appeared to show greater improvement in depression symptomatology and in the ‘usual activities’ dimension compared to the CG, these differences were no longer statistically significant after adjusting for baseline depression. No other significant between-group differences were observed.ConclusionThe nurse-led video-based intervention did not produce immediate emotional benefits but was associated with improved functional recovery at 1 month; however, it has not been shown to be more effective than usual care. These findings suggest that targeted nursing interventions may support postoperative recovery, particularly in functional outcomes, while emotional effects remain inconclusive and warrant further investigation. Importantly, the video format offers a more sustainable and cost-effective approach compared to printed materials, reducing the need for physical handouts while maintaining structured patient education.

Abstract Endovascular therapy (EVT) has transformed acute ischemic stroke management, achieving successful vessel recanalization in approximately 70 to 80% of patients. Despite these advances, recommendations regarding medical management in the setting of EVT remain complex and variable across institutions. In keeping, this work presents a comprehensive overview of medical management in the setting of EVT is presented to provide direction and clarity regarding essential components of management, thus promoting positive outcomes and minimizing morbidity/mortality. In the preprocedural setting, intravenous thrombolysis remains standard therapy for eligible patients, while periprocedural anticoagulation and antiplatelet therapies are generally discouraged due to increased risk of hemorrhage and lack of functional benefit, with select exceptions such as emergency stenting for tandem lesions. Postprocedural blood pressure management should be individualized, with consensus favoring systolic blood pressure targets below 160 mm Hg after reperfusion, noting that higher targets (up to 180 mm Hg) may be considered in cases of incomplete reperfusion, and excessively low targets (<120 mm Hg) may be detrimental to maintaining adequate cerebral perfusion. Ongoing research is refining optimal management strategies to improve outcomes in this population further.

Postoperative pain management is a significant challenge in patients undergoing burn excision. Pharmacologic pain management strategies include both opioid and non-opioid medications. Given the national overuse of opioids and the associated negative effects, it is prudent we find ways to manage pain with fewer or no opioids. We hypothesize that intraoperative administration of intravenous methadone reduces total morphine milligram equivalents per weight used in the 36hours following surgery. This is a retrospective, single-center cohort study of adult burn patients who underwent a first excision of full thickness burn between January 2019 and January 2021. One group received intraoperative intravenous methadone while the non-exposure group did not. The primary outcome was total morphine milligram equivalents per weight utilized in the 36hours following surgery. Secondary outcomes included average pain scores in the PACU and for 36hours postoperatively, as well as discharge opioid prescriptions. The methadone group contained 104 subjects, and the non-exposure group contained 119 subjects. Poisson regression, with adjustment for covariates, showed that the methadone group required fewer 36-hour postoperative opioids (IRR = 0.89, p=.447) and were discharged with fewer opioid prescriptions (IRR = 0.86, p=.363) independent of the age and %TBSA differences. PACU pain scores were lower in the methadone group (IRR = 0.91, p=.350), as were 36-hour postoperative pain scores (IRR = 0.92, p=.310). These trends towards improved pain control and reduced opioid requirements in patients receiving intraoperative, intravenous methadone did not reach statistical significance. Prospective, adequately powered randomized studies are needed to advance these findings.

Introduction. Chronic inflammation is frequently accompanied by enhanced lipid peroxidation and the development of oxidative stress, necessitating appropriate pharmacological management. Nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most widely used agents in the treatment of inflammatory conditions. These drugs differ considerably in their selectivity for cyclooxygenase isoforms, enzymes that play a central role in the progression of inflammation. However, the impact of NSAIDs with varying cyclooxygenase selectivity on the regulation of oxidative stress has not been fully elucidated. Objectives: to investigate the effect of non-steroidal anti-inflammatory drugs that differ in their selectivity for cyclooxygenase, celecoxib and diclofenac, on redox processes in experimental models of rheumatoid arthritis and tumor pathology. Materials and methods. The intensity of lipid peroxidation was assessed in blood serum, erythrocytes, and spinal cord homogenates of rats over a 60-day period following induction of pathological processes. The concentration of thiobarbituric acid (TBA)-reactive products in these biological substrates, measured under conditions of ascorbate-induced lipid peroxidation after 2 hours of incubation with TBA, was used as an indicator of oxidative stress. Results. Celecoxib, a highly selective cyclooxygenase-2 inhibitor, when administered orally at a dose of 15 mg/kg, is able toinfluence the intensity of lipid peroxidation, reducing its manifestations in the context of both experimental rheumatoid arthritis (adjuvant arthritis) and tumor pathology caused by sarcoma 45 overgrowth. Diclofenac, a non-selective cyclooxygenase inhibitor, when administered orally at a dose of 8 mg/kg, showed pro-oxidant activity in serum in both adjuvant arthritis and tumor pathology. At the same time, diclofenac reduced the intensity of lipid peroxidation in the erythrocytes of experimental animals. The pro-oxidant effect of diclofenac may be relevant in the treatment of tumors, when a sufficient amount of active oxygen forms is required to induce apoptosis of malignant cells. Conclusions. This study of the ability of non-steroidal anti-inflammatory drugs to control free radical processes in chronic inflammatory diseases may be important for improving the effectiveness of medical technologies.

Relevance. Pharmacological management of rheumatoid arthritis remains a highly complex and strategic challenge, not only due to the limited understanding of its etiological factors and pathogenetic mechanisms in modern medicine, but also because of the difficulty in selecting safe and effective drugs. The selection of such drugs is complicated due to unclear interactions between agents from different pharmacotherapeutic groups, which are necessary and appropriate in the context of this pathological process and comorbid conditions. Side effects, intolerance, and the insufficient efficacy of long-used drugs for rheumatoid arthritis (cytostatics, glucocorticoids, gold preparations, etc.), along with scientific discoveries uncovering previously unknown links in its pathogenesis, have driven the development and adoption of advanced pathogenetic therapies, particularly immunosuppressants of synthetic and biological origin. Immunosuppressants, including Leflunomide and TNFα inhibitors, have gained widespread clinical use. The frequent coexistence of rheumatoid arthritis with cardiovascular conditions, particularly arterial hypertension, necessitates the concurrent use of antihypertensive medications, especially dihydropyridine calcium antagonists, alongside immunosuppressants. Objectives. To investigate the anti-inflammatory activity of Leflunomide and Enbrel, both individually and in combination with Amlodipine, in rats with experimental rheumatoid arthritis comorbid with arterial hypertension. Materials and Methods. In a model of adjuvant-induced arthritis with concurrent arterial hypertension, changes in limb volume were measured at different stages of the inflammatory process. Rats received Leflunomide, Enbrel, or Amlodipine as monotherapy, or a combination of each immunosuppressant with Amlodipine. Results. In experimental rheumatoid arthritis, Leflunomide alone demonstrated anti-edematous activity of 13–18% (p ≤ 0.05). In contrast, Enbrel administered as monotherapy showed a pro-inflammatory effect under the same conditions. In rats with adjuvant arthritis comorbid with hypertension, Leflunomide did not exhibit anti-inflammatory activity, whereas Enbrel reduced limb edema by 16.5% during the resolution phase of inflammation. Combination therapy revealed pharmacodynamic interactions with Amlodipine. Leflunomide + Amlodipine reduced edema by 13.6% and 15% at different stages, while Enbrel + Amlodipine reduced edema by 18% (day 14, acute phase) and 13.6% (day 60, resolution phase) (p ≤ 0.05) in hypertensive rats with adjuvant arthritis. These findings suggest that Amlodipine potentiates the anti-edematous activity of immunosuppressants under comorbid conditions. Conclusion. Amlodipine exhibited significant anti-inflammatory activity in experimental rheumatoid arthritis but not in the comorbid model with arterial hypertension.

Schizophrenia spectrum disorders (SSD) are debilitating psychiatric illnesses that require extensive pharmacologic, cognitive, and functional management. SSD patients are often prescribed different medications, most commonly antipsychotics, which bear numerous side effects. Recently, accumulating evidence has shown epigenetic aging changes in SSD. However, the effects of antipsychotic medications on this phenomenon remain unexplored.We investigated whether antipsychotic medications are associated with epigenetic age acceleration (EAA) in 153 SSD patients. EAA was estimated using six different epigenetic clocks, based on the methylation patterns of peripheral blood cells.The analysis revealed some evidence of aging deceleration based on the Hannum DNAm Age in individuals on antipsychotic polypharmacy, relative to their monopharmacy counterparts (mean difference=-0.59 years, p=0.0109), which was only nearing significance after adjusting for multiple comparisons (padjusted=0.0654). In sex-specific analysis, only females displayed significantly decelerated epigenetic aging in the polypharmacy group in three of the six clocks. Furthermore, we observed no dose-dependent effects of antipsychotics on EAA in all clocks using three dose standardization methods (daily defined dose, chlorpromazine equivalents, and percent of maximum allowed dose).The findings suggest that antipsychotic treatment may modulate biological aging in SSD; however, this effect is not dose-dependent. Moreover, there appears to be an interplay between sex, polypharmacy, and epigenetic aging. These findings contribute to our understanding of the biological effects of antipsychotic treatment, and future research in this area is key for weighing the benefits and the risks of pharmacological management of SSD.

Type 2 diabetes (T2D) increases fragility fracture risk despite normal/elevated aBMD, attributed to compromised bone microarchitecture. However, evidence guiding pharmacologic management of diabetic bone disease remains limited. To evaluate interim effects of zoledronate, denosumab, or teriparatide on bone microarchitecture in postmenopausal women with T2D at high fracture risk. 72-week, randomized, open-label, blinded-endpoint (PROBE) pilot clinical trial (CTRI/2022/02/039978). Single tertiary care center in India. Total of 129 postmenopausal women with T2D>5 years and high fracture risk (prior fragility fracture and/or T-score<-2.5 (corrected for T2D) with elevated FRAX®). Participants were randomized in 1:1:1:1 ratio to receive zoledronate 5 mg annually, denosumab 60 mg every 6 months, teriparatide 20 µg daily, or only standard of care (calcium/cholecalciferol) for 72 weeks. Pre-specified 24-week interim exploratory analysis focusing on changes in bone microarchitecture assessed by second-generation HR-pQCT at distal tibia and radius. Bone turnover markers (BTMs) were also evaluated. Baseline demographic, biochemical, aBMD and HR-pQCT parameters were comparable across groups. Teriparatide significantly improved total and trabecular vBMD (tibia/radius), trabecular number (Tb.N), BV/TV (tibia), and trabecular thickness (radius). Denosumab improved tibial trabecular vBMD and Tb.N. Zoledronate improved only tibial total vBMD. Micro finite element analysis-derived strength parameters were unchanged, except for modest increase in tibial stiffness with denosumab. BTMs decreased with anti-resorptives, increased with teriparatide and showed an anabolic window by 6 weeks. Teriparatide demonstrated early improvements in bone microarchitecture in postmenopausal women with T2D while denosumab showed a modest increase in bone stiffness at distal tibia. Larger, adequately powered studies are needed to clarify the relative effects of anabolic and anti-resorptive therapies in this population.

The management of anger is problematic for many people and it is a particularly important issue for persons with substance use disorders (SUD). The paper reviews the research studies dating back to 2005 on how to help persons with SUD manage anger. The literature reveals that various pharmaceutical and non-pharmacological approaches have been studied to help persons with SUD manage their anger. In chronic and lower risk situations non-pharmacological are the first line approaches, they include anger management training, cognitive-behavioral based treatments, exercising and relaxing, music therapy and empathy. Atypical antipsychotic and medications for opioid use disorders (MOUD) are also widely used. In acute and high risk of violence situations physical restraint and pharmacological management are the first line intervention. Various nursing frameworks provide a useful basis for integrating various approaches. Current approaches have their advantages and disadvantages and are discussed in this paper.

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Rural Missourians' perspectives on pain: "I like to be in control of my life".