Rapid Relief Of Symptoms Research Articles

“Biceps femoris calcific tendinitis as a rare cause of lateral knee pain; a case report”

Introduction: Calcific tendinitis is a common cause of periarticular pain, though it rarely affects the distal biceps femoris tendon, leading to lateral knee pain. This case report highlights a rare instance of biceps femoris calcific tendinitis and its successful conservative management. Case presentation: A 40-year-old female presented with a one-week history of sharp lateral knee pain, which worsened with movement but persisted at rest. There was no history of trauma or systemic illness. On examination, tenderness was localized to the lateral knee, specifically over the fibular head and biceps femoris tendon. Blood tests were unremarkable. Radiographs and ultrasound revealed multifocal calcifications at the fibular head. Although MRI was recommended, it was not feasible in this resource-limited setting. The patient was initially treated conservatively with NSAIDs and physiotherapy but did not respond. She subsequently underwent ultrasound-guided barbotage and corticosteroid injection, resulting in complete resolution of symptoms within one week. Discussion: Calcific tendinitis is caused by the deposition of calcium hydroxyapatite crystals in periarticular tendons, leading to inflammation and pain. Biceps femoris calcific tendinitis is rare, and diagnosis can be made using cost-effective imaging modalities such as radiography and ultrasound. Conservative management, including NSAIDs, physiotherapy, and ultrasound-guided barbotage, is the preferred first-line treatment. In this case, the combination of barbotage and physiotherapy led to complete symptom relief. Conclusion: Biceps femoris calcific tendinitis, though rare, should be considered in cases of lateral knee pain. Early diagnosis and conservative treatment can result in rapid symptom relief.

Challenges in maintaining remission after ECT - Insights from a six-month follow up study.

Electroconvulsive therapy (ECT) is a widely recognized treatment for severe depressive disorders, particularly in cases of inadequate response to pharmacological interventions or when rapid symptom relief is essential. Although ECT demonstrates high efficacy, a notable proportion of patients relapse after a successful ECT course. This study investigated clinical baseline characteristics and residual depressive symptoms associated with relapse - defined as a Montgomery-Åsberg Depression Rating Scale (MADRS) score >15, restart of ECT, or suicide attempt - within six months after successful ECT. Data were obtained from the PROTECT study, a single-site, prospective cohort study conducted at the University Psychiatric Center Duffel, Belgium. - Among the 65 patients who completed the ECT course, 40 patients (62%) achieved remission. At six months, 32 patients were reassessed, and 18 (56%) of them experienced relapse. No significant associations were identified between relapse and baseline factors, including age, social circumstances, baseline depression severity, psychomotor symptoms, cognitive functioning, treatment resistance, lithium use, or the presence of psychotic or melancholic features. Residual depressive symptoms at the end of the ECT course also did not predict relapse. - The observed high relapse rate underscores the critical need for robust continuation and maintenance strategies following ECT. Future research should prioritize larger cohorts to better identify predictors of relapse and optimize post-ECT treatment protocols.

Neuroendoscopic surgery for acute presentation of cystic craniopharyngiomas.

Acute presentation of cystic craniopharyngioma is a potentially life-threatening condition, characterized by disability and increased mortality risk, often caused by large cysts with or without hydrocephalus. This study evaluated the applicability of minimally invasive neuroendoscopic surgery (NES) for rapid intracranial pressure relief and tumor control as an alternative to emergent microsurgical resection. A retrospective review of the electronic medical record database of patients with craniopharyngiomas treated at our institution between June 2007 and October 2024 identified 13 non-consecutive cases of acute presentation of cystic craniopharyngioma managed with NES. Interventions included pellucid septostomy (n = 2), ventriculoperitoneal shunt surgery (n = 2), and Ommaya reservoir placement (n = 6). Clinical and radiological data were analyzed to assess treatment outcomes. The most common acute symptoms were severe headache (69.2%), frequent vomiting (53.8%), sudden onset of consciousness disturbance (38.5%), visual impairment (46.2%), gait instability (23.1%), and cognitive dysfunction (15.4%). Ten patients had hydrocephalus at admission. All patients experienced symptom relief following NES, with no procedure-related mortality or complications. Hydrocephalus resolved in all cases, and subjective visual function improved in 83.3% of patients postoperatively. Endocrine function remained stable. At a median follow-up of 62 months (range, 38-130), local tumor control was achieved in 8 patients (61.5%) without requiring adjuvant therapy. NES is a safe, effective approach for managing acute presentation of cystic craniopharyngioma, particularly in patients with hydrocephalus. It offers rapid symptom relief and tumor control and is a potential staging treatment in selected cases.

Supported Mindfulness-Based Self-Help Intervention as an Adjunctive Treatment for Rapid Symptom Change in Emotional Disorders: A Practice-Oriented Multicenter Randomized Controlled Trial

Introduction: Rapid symptom relief is crucial for individuals with emotional disorders. The current study aimed to determine whether facilitator-supported mindfulness-based self-help (MBSH) intervention as an adjunctive treatment could provide rapid improvement for individuals with emotional disorders. Methods: A practice-oriented randomized controlled trial was conducted on a sample of 302 patients with emotional disorders from four centers. Participants were randomly assigned to either MBSH+TAU (treatment as usual; n = 152) or TAU-only group (n = 150). Assessments were conducted at baseline, week 3, week 5, immediately after intervention and at a 3-month follow-up. Primary outcomes included self-reported and clinician-reported anxiety and depression symptoms. Secondary outcomes included mindfulness, physical symptoms, perceived stress, sleep quality, and inner peace. Results: The MBSH+TAU group achieved significantly greater improvements in all primary and secondary outcome measures as compared with TAU-only immediately after intervention (Cohen’s d = 0.19–0.51). In addition, relatively greater improvements were observed in self-reported depression, mindfulness, physical symptoms, perceived stress, and inner peace as early as week 3 or 5, which were sustained at the 3-month follow-up (Cohen’s d = 0.20–0.34). Conclusions: Facilitator-supported MBSH offers a scalable and effective adjunctive treatment option for patients with emotional disorders in clinical practice, facilitating rapid improvements.

Rapid-release and user-friendly costunolide/dehydrocostuslactone hydrophilic nanofibers: Therapeutic effects on acute gastric ulcers.

Gastric ulcers often cause postprandial epigastric pain, especially in acute cases. Abnormal motility, with about 50 % of patients having delayed gastric emptying, contributes to ulcer development. Costunolide (COS) and dehydrocostuslactone (DEH), derived from "Mu xiang" herbs, show potential in treating ulcers and regulating gastrointestinal motility. However, their poor solubility and bioavailability limit in vivo use. This study uses electrospinning to develop hydrophilic nanofibers loaded with COS and DEH in a polyvinylpyrrolidone (PVP) matrix for treating acute gastric ulcers. The production process for costunolide / dehydrocostuslactone nanofibers (COS/DEH/NFs) was optimized, characterized, and tested in pharmacodynamic studies. The results showed that COS and DEH remained in a non-crystalline state within COS/DEH/NFs, enhancing their in vitro release. With 21 % drug incorporation, COS/DEH/NFs released over 70 % of COS and more than 50 % of DEH within 20 min in body fluids. In treatment, COS/DEH/NFs suppressed pro-inflammatory cytokines, resisted oxidative stress, promoted gastric mucosal repair, and enhanced gastrointestinal motility. In a mouse model of acute gastric ulcer, high-dose COS/DEH/NFs achieved a 77.09 % ulcer inhibition rate, and low-dose COS/DEH/NFs resulted in gastric residual and intestinal propulsion rates of 73.55 % and 69.89 %, respectively. The drug loading of COS/DEH/NFs is 14.76 ± 0.26 %, with an encapsulation efficiency of 68.77 ± 1.14 %. COS/DEH/NFs is a new choice for treating acute gastric ulcers with gastrointestinal bloating due to its convenience and swallow-free use, providing rapid symptom relief.

Ketamine and Esketamine in Treatment of Resistant Depression

Aims: This review aims to explore the efficacy, mechanisms, administration routes, and safety profiles of ketamine and esketamine in the treatment of treatment-resistant depression (TRD). Methods: A comprehensive review of recent studies on ketamine and esketamine’s therapeutic applications in TRD was conducted. Sources included randomized controlled trials, systematic reviews, and meta-analyses from PubMed and Google Scholar. Results: Ketamine demonstrated rapid antidepressant effects within hours of administration, with symptom relief lasting several days to weeks. Esketamine, developed as an intranasal spray, provided an alternative route, improving accessibility while delivering therapeutic benefits. Additionally, ketamine has shown rapid effects on suicidal ideation, making it a viable option for crisis management in TRD patients. Both ketamine and esketamine enhance neuroplasticityby antagonizing NMDA receptors, leading to increased glutamate release, which activates AMPA receptors and promotes synaptogenesis. Clinical studies have shown that ketamine induces an immediate surge in brain-derived neurotrophic factor (BDNF) and upregulates the mTOR pathway, essential for the formation and strengthening of synaptic connections in mood-regulating brain regions. Although treatment is effective in the short-term, the data on long-term safety is scarce. Conclusions: Ketamine and esketamine represent significant advancements in the treatment of TRD, offering rapid symptom relief and neuroplastic benefits not achieved with traditional antidepressants. Future studies are required to establish long-term safety profiles and optimize dosing regimens. Overall, ketamine-based therapies provide a promising alternative for patients unresponsive to conventional treatments.

Comparison of Tegoprazan and Lansoprazole in Patients With Erosive Esophagitis up to 4 Weeks: A Multi-Center, Randomized, Double-Blind, Active-Comparator Phase 4 Trial.

The aims of this study were to confirm the non-inferiority of tegoprazan to lansoprazole up to week 4 in patients with erosive esophagitis (EE) and to evaluate its effectiveness in rapid mucosal healing and symptom relief at week 2. In this multi-center, randomized, double-blind, active-comparator non-inferiority trial, 218 patients with endoscopically confirmed EE (Los Angeles Classification Grades A-D) were randomly allocated to either the tegoprazan (50 mg) or lansoprazole (30 mg) group. The primary endpoint was the cumulative proportion of patients with healed EE up to week 4, as confirmed through endoscopy. The proportion of patients with healed EE at week 2 was also evaluated. Furthermore, CYP2C19 genotypes, symptoms, safety, and tolerability were assessed. In the full-analysis set, 103 and 109 participants in the tegoprazan and lansoprazole groups, respectively, were analyzed. The cumulative healing rates up to week 4 were 95.2% (98/103) and 86.2% (94/109) (difference [95% confidence interval], 8.91 [1.22-16.59]; p < 0.0001 for non-inferiority and 0.0266 for superiority), while those at week 2 were 88.4% (91/103) and 82.6% (90/109) (5.78 [-3.66-15.22], p = 0.0005 for non-inferiority) for tegoprazan and lansoprazole, respectively. Tegoprazan showed consistent healing rates regardless of CYP2C19 genotypes. Tegoprazan was superior to lansoprazole in the treatment of EE up to 4 weeks. Further studies are necessary to confirm these findings and clarify the superiority of tegoprazan, especially in the treatment of severe EE. ClinicalTrials.gov identifier: NCT05267743.

Expert consensus on the multifaceted utility of alginates in addressing diverse manifestations of acid reflux

Gastroesophageal reflux disease (GERD) is one of the most frequent reasons for seeking outpatient gastroenterology consultations. Current professional guidelines advocate the use of proton pump inhibitors (PPIs) as the primary medical approach to manage GERD. However, PPIs may not be as effective, especially for certain patients like those with non-erosive reflux disease (NERD). An alternative strategy for addressing symptomatic GERD involves obstructing the flow of acidic refluxate. Alginate-based pharmaceutical formulations have proven effective in alleviating symptoms of acid reflux for many years and provide rapid relief of symptoms with a long duration of action. Alginic acid derivatives, or alginates, combat acid reflux through a unique mechanism: they create a physical barrier that displaces the post-prandial acid pocket. Alginates have recently garnered renewed interest for promoting symptomatic relief especially when employed alongside antacids or PPIs. Here, the role of alginates is reviewed in the treatment of various profiles of acid reflux, including post-prandial acid reflux, nocturnal GERD, refractory GERD, and GERD during pregnancy, along with the opinion of expert gastroenterologists on the same. The experts believed that not all alginate formulations are equivalent and raft strength is the most important physicochemical property to be considered while selecting the alginate-based product. The physicochemical properties of the rafts eventually impact their effectiveness in relieving symptoms in clinical settings.

Outcomes of Gallbladder Drainage Techniques in Acute Cholecystitis: Percutaneous Versus Endoscopic Methods.

Acute cholecystitis, often caused by gallstones obstructing the cystic duct, is a potentially life-threatening condition that requires timely intervention. High-risk patients, particularly those with significant comorbidities, may not be suitable candidates for laparoscopic cholecystectomy, necessitating alternative drainage techniques such as percutaneous cholecystostomy (PC) and endoscopic gallbladder drainage (EGD). This systematic review aims to compare the efficacy, safety, and outcomes of PC and EGD in managing acute cholecystitis in high-risk surgical patients. A comprehensive literature search was conducted across multiple databases, including PubMed, Medline, Embase, Cochrane Library, and Scopus, from inception to October 2024. Studies were included if they assessed the outcomes of PC versus EGD in high-risk patients with acute cholecystitis. Data extraction focused on primary outcomes such as complication rates, reintervention needs, symptom resolution, hospital stay duration, and mortality. A qualitative synthesis was conducted due to heterogeneity in the study designs. Four randomized controlled trials and cohort studies were included, encompassing a total of 238 high-risk patients. Laparoscopic cholecystectomy showed significantly better outcomes compared to percutaneous drainage in reducing major complications, reintervention rates, and recurrent biliary disease. Endoscopic drainage techniques, including naso-gallbladder drainage and gallbladder stenting, demonstrated similar clinical success rates with fewer complications than percutaneous methods, particularly in patients with concurrent biliary conditions. The findings suggest that while percutaneous drainage provides rapid symptom relief, it is associated with higher reintervention rates. Endoscopic techniques offer fewer complications and are particularly beneficial for patients with suspected choledocholithiasis. However, the choice of drainage method should be based on individual patient profiles, taking into account overall health status and comorbidities. Both percutaneous and endoscopic drainage methods are effective in managing acute cholecystitis in high-risk patients, with distinct advantages depending on patient-specific factors. Further research is needed to explore long-term outcomes and hybrid approaches that may optimize care for these patients.

Acute purulent otitis media: key features of pathogenetic therapy

Acute purulent otitis media is an inflammation of the mucous membrane of the middle ear, a disease often encountered both in pediatric practice and in adult patients. The prerequisite for the development of this pathology is a violation of the function of the auditory tube, often occurring in inflammatory diseases of the upper respiratory tract, as well as in conditions of hypertrophy of the pharyngeal tonsil. Bacterial microflora, represented in most clinical cases by S. pneumoniae and H. influenzae, traditionally acts as an etiological factor of acute purulent otitis media. The authors of the article discuss the features of the clinical course of the disease, the causes of frequent recurrent course and the risk of developing purulent complications. The article highlights current problems of diagnosis and treatment of acute otitis media at different stages, including rational and justified use of antibacterial drugs. The authors consider the possibility of using topical anti-inflammatory and analgesic drugs as an alternative to the systemic use of non-steroidal anti-inflammatory drugs (NSAIDs) for rapid relief of the main symptoms of the disease. The authors conclude that ear drops containing lidocaine and phenazone, due to their combined action, are effective as a symptomatic treatment for acute otitis media, including its recurrent course, help reduce the frequency of prescribing antibacterial drugs, effectively relieve pain, reduce the duration of the disease and significantly improve the patient’s quality of life. Due to the high safety profile and the possibility of using ear drops with phenazone and lidocaine from birth, this dosage form finds its successful application in pediatric practice.

A possible alternative to antibacterial therapy in the treatment of acute rhinosinusitis

High incidence of acute rhinosinusitis in a population remains one of the topical issues in practical otolaryngology. Statistical data show an increasing trend towards transition of acute rhinosinusitis in patients into chronic rhinosinusitis. According to literary sources, the emergence of bacterial resistance to antibiotics is as a rule the major reason of protracted course of the disease. Unreasonable antibiotics prescription, irrational use and uncontrolled intake result in the rapid development of antibiotic resistance. In this context, the use of herbal medicines having not only antibacterial, but also mucolytic, fungicidal, antioxidant effects in the complex therapy is a modern solution for disease management. Respero Myrtol, a standardized myrtol-based medicine, has taken its rightful place in the therapy. This article is aimed to investigate the possibilities of the effective use of medicine containing standardized myrtol as its main ingredient in the treatment of acute rhinosinusitis (based on the review of literature). Research materials included scientific articles on aspects of acute rhinosinusitis in otorhinolaryngology practice that were published in domestic specialized periodicals of eLIBRARY and scientific databases Scopus, Web of Science, Medline from 2014 to 2024. The published literature was analysed using the cause-and-effect technique. A clinical example was dis-cussed. With regard to the analysis of scientific literature, a brief overview of the epidemiology, etiology, predisposing factors for the development, diagnosis and treatment of acute rhinosinusitis was provided. The article addresses relevant socio-economic issues related to acute rhinosinusitis, the problem of antibiotic resistance. The issues of improving acute rhinosinusitis treatments using a standardized myrtol medicine in complex therapy as an alternative to antibiotic therapy were brought to attention. As a result, the authors concluded that the use of Respero Myrtol contributes to the rapid relief of clinical symptoms of acute rhinosinusitis, improves the patient’s quality of life, and can be advised as an alternative to antibiotic therapy in uncomplicated course of the disease.

Effective correction of manifestations of vaginal microflora disorders

Pathological vaginal discharge is one of the main reasons for visiting gynecologists. Despite the abundance of drugs, not all are compliant and quickly effective for pronounced itching and swelling in the introitus area. One of the most common causes of pathological leukemia is vaginal infections, which are represented by three main clinical forms: bacterial vaginosis (BV) – up to 50% of all cases; vulvovaginal candidiasis (CVV) – 20–25% and trichomonas vaginitis (TV) – 15–20% of cases, respectively. In this regard, retrospective analysis shows that patients with BV, KV, TV most often actively turn to a gynecologist or venereologist However, the fact that the cause of pathological whites in more than 30% of cases can be a mixed infection creates problems in treatment with the use of monodrugs (many relapses up to 40% or more). Therefore, for their treatment, it is considered rational to use the concept of the etiotropic approach, based on the local effect of combined vaginal drugs. The role of a combined topical drug, including those with a rapid anesthetic effect, was evaluated. Neo-Penotran Forte L is a logical combination of antibacterial agents and a local anesthetic used to treat manifest forms of vaginal infections and provide rapid relief of intolerable symptoms.

Using Alma to Alleviate Tristeza Maternal: Preliminary Outcomes of a Peer-Led Behavioral Activation Program Among Latina Mothers

Spanish-speaking Latinas in the United States encounter significant barriers when seeking culturally responsive treatment for perinatal mental health disorders, resulting in treatment disparities and elevated rates of mental health symptoms. To address these challenges, peer-delivered support may be one promising strategy. This study examined the efficacy of Alma, a peer-delivered behavioral activation (BA) program comprising 6-8 sessions.Participants (N = 126) were Spanish-speaking Latina mothers experiencing elevated depressionsymptoms during the perinatal and early parenthood period. Participants were recruited through three community partner sites across rural and urban settings.Participants reported high satisfactionwith the program and experienced decreases in depressionsymptoms, anxietysymptoms, and perceived stress. Importantly, significant clinical improvements occurred early in the program, indicating a rapid relief of symptoms. This symptom reduction was associated with improvements in putative mechanisms of BA including activity level and environmental reward. Limitations of this study include participant attrition and the absence of a control group. Together, the findings indicate that Alma is a promising program to address depressed mood, anxiety, and stress among Spanish-speaking Latina mothers during the perinatal/early parenthood period, offering accessible and culturally responsive mentalhealth support. Moreover, by meeting the mental health needs of Spanish-speaking Latina mothers, Alma holds promise for mitigating mental health disparities in underserved communities.

Shifting the Landscape of Spine and Non-Spine Bone Metastases: A Review of Stereotactic Body Radiotherapy.

Both spine and nonspine bone metastases are frequent sites of spread from solid organ malignancies. As bone metastases frequently cause significant morbidity for patients, it is critical to offer a treatment that can achieve rapid and durable symptomatic relief and local control, without being associated with serious risks of toxicity. Conventional palliative radiation therapy has a key treatment component in the multidisciplinary management of these patients; however, over the past decade, it has evolved to routinely deliver high biologically effective doses with precision in the form of stereotactic body radiation therapy. This change in paradigm is a result of the shifting landscape in cancer care, such that short-term pain relief is no longer the sole therapeutic aim for selected patients, and durable symptom relief and local tumor control are the goals. This review discusses the randomized prospective evidence, ongoing trials, approach to surveillance imaging, and treatment delivery for stereotactic body radiation therapy, to both spine and nonspine bone metastases, with a specific section on sacral metastases.

Real world effectiveness of early ensitrelvir treatment in patients with SARS-CoV-2, a retrospective case series

BackgroundEnsitrelvir, a 3C-like protease inhibitor, received emergency approval in Japan in November 2022 for treating non-hospitalized patients with mild-to-moderate COVID-19. However, confirmation of its real-world clinical effectiveness is limited. MethodsThis retrospective study evaluated 18 vaccinated outpatients (15 men; median age, 39.5 years; range, 26–56), treated with a 5-day oral ensitrelvir regimen (375 mg loading dose, followed by 125 mg daily) between December 1, 2022, and January 31, 2023. Nasal swabs were collected on days 0, 3, 6, and 9 for RT-qPCR to assess viral load. Variants were identified by Sanger sequencing, and outcomes were compared to historical controls. Patients were followed for 60 days to monitor for post-acute sequelae of COVID-19 (PASC). ResultsSymptoms such as mild fever and sore throat improved rapidly after one day of ensitrelvir treatment, with 66 % of patients recovering within six days. All individuals were infected with the BA.5 Omicron variant. Viral loads, as measured by Ct values, increased significantly from 21.82 at symptom onset to 37.65 b y day 6, with SARS-CoV-2 RNA undetectable in most patients by day 9. Those treated within 48 h of symptom onset showed the viral load reduction. Compared to historical controls, where symptom resolution took 8.5 days, ensitrelvir shortened recovery time to as little as 1.4 days for over 66 % of patients. ConclusionEnsitrelvir treatment resulted in rapid symptom relief and significant viral load reduction, with no adverse events, viral rebound, or PASC symptoms, demonstrating its potential efficacy and safety. Larger studies are needed for further confirmation.

Y Reverse: Modified technique in challenging airway management.

Self-expanding Y-metal stents (SEMS) are best suited lesions with involvement of the carina and proximal main bronchi; however, Y-stents can be difficult to place. These difficulties guided us to develop a modification of the classic technique that addresses some of the challenges during positioning. We present the Y reverse technique for Y stent insertion using a combination of rigid and flexible bronchoscopy. This retrospective study included 15 consecutive patients, suffering from tracheal-carina-lower main bronchi complex, hospitalized at the Thoracic Surgery Unit of the Vanvitelli University of Naples between October 2021 and October 2023. patients in which the length of the stenosis of the right bronchi was greater than that of the left bronchi, advanced oncological conditions, severe respiratory failure; exclusion criteria: Karnofsky scale with <40 points. All patients were admitted to the hospital and treated with Y-stent insertion using the modified technique Y reverse. The comparison between the group undergoing the Y reverse technique with the group undergoing the traditional positioning of the Y prosthesis has shown an improvement in respiratory function; prolongation of the mean survival time; improvement in SpO2 in spontaneous breathing; reduction mean time procedure. p < 0.05 was considered as statistically significant. Y Reverse is a safe and effective procedure that provides rapid symptom relief in individuals who have critical central airway obstruction near the distal portion of the trachea, carina, and main right and left bronchi.

Role of Sleep in Depressive Disorders and the Potential Therapeutic Role of Short-Term Sleep Deprivation and Light Therapy: A Review.

Depression affects about 280 million people globally and is marked by persistent sadness and impaired daily functioning. Sleep disturbances are prevalent in major depressive disorder, affecting roughly 90% of patients, and are linked to the severity and progression of depression. This review emphasizes the critical role of sleep in depressive disorders and evaluates the alternative treatments bright light therapy and sleep deprivation. Sleep disturbances are not only symptoms but also mediators in the relationship between depression and other conditions, such as anxiety, chronic inflammation, emotional dysregulation, and cognitive decline. Effective management of depressive disorders must address these sleep issues. Bright light therapy, which uses artificial light to mimic natural sunlight, is effective for treating seasonal affective disorder and non-seasonal major depressive disorder. It is well tolerated, can be used alone or with antidepressants, and often improves both mood and sleep quality. In contrast, sleep deprivation, which involves enforced wakefulness, can provide rapid symptom relief. However, its effects are generally short-lived, and there is a risk of inducing mania in patients with bipolar disorder. In conclusion, sleep significantly impacts the severity and progression of depressive disorders. Bright light therapy and sleep deprivation offer promising alternatives to conventional treatments. The aim of this review is to underscore the importance of sleep in depression and advocate for the consideration of these alternative treatment methods to improve patient outcomes.

Microorganism microneedle micro-engine depth drug delivery

As a transdermal drug delivery method, microneedles offer minimal invasiveness, painlessness, and precise in-situ treatment. However, current microneedles rely on passive diffusion, leading to uncontrollable drug penetration. To overcome this, we developed a pneumatic microneedle patch that uses live Enterobacter aerogenes as microengines to actively control drug delivery. These microbes generate gas, driving drugs into deeper tissues, with adjustable glucose concentration allowing precise control over the process. Our results showed that this microorganism-powered system increases drug delivery depth by over 200%, reaching up to 1000 μm below the skin. In a psoriasis animal model, the technology effectively delivered calcitriol into subcutaneous tissues, offering rapid symptom relief. This innovation addresses the limitations of conventional microneedles, enhancing drug efficiency, transdermal permeability, and introducing a creative paradigm for on-demand controlled drug delivery.

Intraarticular corticosteroid injections in pediatric rheumatology: insights from specialists.

IACIs are widely utilized in pediatric rheumatology for oligoarticular JIA, yet practice variability exists. Standardized protocols through randomized studies can enhance IACI efficacy and patient outcomes. • Intraarticular corticosteroid injections (IACIs) are a widely utilized and effective treatment modality in managing oligoarticular and polyarticular juvenile idiopathic arthritis (JIA), offering rapid symptom relief and the potential to prevent long-term joint deformities. • Despite their widespread use, there is significant variability in the indications, techniques, and anesthetic methods employed for IACI administration among pediatric rheumatologists, and much of the supporting evidence remains anecdotal. • This study highlights the diverse clinical practices and preferences regarding IACI use in pediatric rheumatology across two different countries, revealing considerable variations in the use of ultrasound guidance, anesthetic approaches, and corticosteroid formulations. • The findings underscore the need for standardized treatment protocols and further research to optimize IACI procedures, aiming to reduce variability and improve outcomes in the management of JIA.

Anakinra-Dependent Recurrent Pericarditis: The Role of the R202Q Variant of the MEFV Gene.

Background: the role of the R202Q (c.605G>A, p.Arg202Gln) missense variant of the MEFV gene has been debated as either a benign polymorphism or a potentially pathogenic mutation. We report and discuss here the case of a young female with corticosteroid-dependent recurrent pericarditis carrying the homozygous R202Q variant, exhibiting distinctive clinical features possibly influenced by this genetic variant. Methods: a 30-year-old woman with a previous diagnosis of cancer and recent respiratory infection presented with severe pleuritic chest pain, hypotension, tachycardia, and fever. Initial diagnostic evaluation indicated cardiac tamponade, and emergent pericardiocentesis was performed. Despite initial treatment with NSAIDs, colchicine, and corticosteroids, the patient experienced multiple recurrences. Genetic testing identified homozygous R202Q variant in the MEFV gene. Given the corticosteroid dependency and recurrent nature of her condition, IL-1 inhibitor anakinra was introduced, leading to significant improvement, although tapering below 150 mg per week failed to prevent recurrences. Results: the introduction of anakinra resulted in rapid symptom relief and resolution of pericardial effusion. However, attempts to taper or discontinue anakinra led to pericarditis recurrences. Ultimately, a maintenance dose of 50 mg every three days was established, which maintained remission for 18 months without recurrence. Despite multiple tapering attempts, further reduction in anakinra dosage was unsuccessful without triggering relapses. Conclusions: the R202Q variant, although typically considered benign, may contribute to an autoinflammatory phenotype resembling familial Mediterranean fever. This case underscores the potential pathogenicity of the homozygous R202Q variant in recurrent pericarditis and its responsiveness to IL-1 inhibition. In patients with corticosteroid-dependent recurrent pericarditis, genetic testing for the R202Q variant should be considered when anti-IL-1 drugs cannot be withdrawn. Further studies are warranted to elucidate the variant's role in pericardial inflammation and guide personalized treatment strategies.