Recent Advances In Management Research Articles

Asthma prevention and recent advances in management

Asthma is the most frequent chronic disease of childhood, affecting up to 20 % of children worldwide. The authors present the current literature focusing on primary and secondary prevention of both early and late childhood asthma and the recent advances in management. The therapeutic tools for pediatric asthma have expanded significantly for both the non-severe and severe forms. The use of anti-inflammatory treatment, even for the mildest cases, and the withdrawal of symptomatic bronchodilation as monotherapy have been included in the most recent guidelines. The different biological therapies have revolutionized the therapeutical approach for severe uncontrolled asthma in children and adolescents.The main guidelines on asthma maintenance therapy in pediatrics suggest different approaches and describe different stages of asthma to determine the most appropriate treatment.

Clinicoradiological Parameters and Biochemical and Molecular Alterations Predicting Remission and Recurrence After Surgical Treatment of Corticotroph Adenomas—Cushing Disease

ObjectivesEndonasal endoscopic transsphenoidal surgery (TSS) and resection of pituitary adenomas is considered to be the gold standard treatment for Cushing’s Disease (CD). Even with various recent advances in management, disease persistence and recurrences are common in these patients. The remission rate in the global population after surgery has been reported to vary widely from 64 to 93%. This study aims to determine various clinical, biochemical, radiological and histological factors that correlate with persistence and recurrence in patients with CD. This study also aims to understand the clinicopathological significance of EGFR-MAPK, NF-kB and SHH pathway activation and to study the protein expression levels of activation markers of these pathways viz. c-Fos , c-Jun, GLI-1 , pMEK, NR4A1 and p44 in functioning corticotroph pituitary adenomas. MethodsFrom January 2009 to September 2022, the clinical data of 167 patients who underwent surgical treatment (n=174 surgeries) for Cushing’s disease was ambispectively analysed with a median follow up of 8.1 years (1-13.29 years). The preoperative clinical, biochemical, radiological features, operative findings, postoperative clinical and biochemical data, histopathological and molecular profile, were retrieved from electronic records. The patients were followed up to assess the remission status. ResultsAmong the 174 surgeries performed, 140 were primary surgeries, 22 were revision surgeries, 24 surgeries were for paediatric patients and 12 surgeries were performed in patients with Nelson syndrome. In the primary surgery cohort, 74.3% were females and the average age was 28.73 years (SD 10.15). 75% of the patients experienced remission after primary surgery compared to 47.4% in revision surgery. The remission rate in paediatric patients was 55.5%. Post-operative day 1 plasma cortisol (p<0.001; AUC 0.8894 [0.8087-0.9701]) and ACTH (p<0.001; AUC 0.9 [0.7386-1]) levels were seen to be strong independent predictors of remission in the primary surgery cohort. Remission rates after Endoscopic TSS were more than that after microscopic TSS, in patients undergoing primary surgery (81.08% vs 57.14%; p=0.008). Presence of adenoma on histopathological examination (HPE) was also a strong predictor of disease remission (p=0.020). On categorising based on surgical approach and HPE, microscopically operated patients without histopathological evidence of adenoma had significantly higher odds of non-remission (OR 38.1 95% CI 4.2-348.3) compared to endoscopically operated patients with adenoma on HPE. Lower immune reactivity score (IRS) of NR4A1 was found to correlate with higher remission rates (p=0.074). However, none of the molecular markers studied viz. c-Fos , c-Jun, GLI-1, pMEK and p44 showed a significant correlation with the preoperative cortisol values. ConclusionRemission rate after primary surgery is higher as compared to that after revision surgery, and that in paediatric patients is lower as compared to adults. Post-operative day 1 plasma cortisol and ACTH levels are strong independent predictors of remission in the primary surgery cohort. Endoscopic approach with histopathological evidence of adenoma is associated with a higher remission rate and thus endoscopy should be the approach of choice in these patients with the goal of identification of an adenoma on histopathological analysis.

In-hospital outcomes and postdischarge mortality in patients with acute coronary syndrome and atrial fibrillation

BackgroundIt is unclear whether advances in management of acute coronary syndrome (ACS) and introduction of novel oral anticoagulants have changed outcomes in patients with ACS with concomitant atrial fibrillation (AF). ObjectiveThis study aimed to examine the incidence of AF in patients admitted for ACS and to evaluate its association with adverse outcomes, given the recent advances in management of both diseases. MethodsNatural language processing search algorithms identified AF in patients admitted with ACS across 13 Northwell Health Hospitals from 2015 to 2021. Hierarchical generalized linear mixed modeling was used to assess the association between AF and in-hospital mortality, bleeding, and stroke outcomes; marginal Cox regression modeling was used to assess the association between AF and postdischarge mortality. ResultsOf 12,315 patients admitted for ACS, 3018 (24.5%) had AF with 1609 (53.3%) newly diagnosed. AF patients more commonly received anticoagulation with an oral anticoagulant (80.4% vs 12.3%) or heparin (61.9% vs 56.9%), had lengthier intensive care unit stay (72 vs 49 hours), and underwent fewer percutaneous coronary interventions (31.9% vs 53.1%). In-hospital bleeding, stroke, and mortality were higher in the AF group (15.3% vs 5.0%, 7.4% vs 2.4%, and 6.9% vs 2.1%, respectively). AF was an independent risk factor for all in-hospital outcomes (odds ratios of 2.5, 2.7, and 2.0 for bleeding, stroke, and mortality, respectively) as well as for postdischarge mortality (hazard ratio, 1.3; 95% CI, 1.2–1.5). ConclusionAF is present in 25% of ACS patients and increases risk of in-hospital and postdischarge adverse outcomes. Additional data are required to direct optimal management.

Evidence to Date on the Therapeutic Potential of Zolbetuximab in Advanced Gastroesophageal Adenocarcinoma.

Gastric adenocarcinoma (GAC) continues to be a prevalent worldwide malignancy and a leading cause of cancer death, and it is frequently cited as incurable. Targeted therapy in GAC has lagged behind other solid tumors. The human epidermal growth factor receptor-2 (HER-2) represented the single target in GACs for many years, seen in approximately 20% of patients with advanced GAC. Recent advances in management now include the addition of immunotherapy checkpoint inhibition to select front-line advanced GACs. Unfortunately, outcomes remain poor for most patients. We anticipate finding a key to future discoveries in GACs in next-generation sequencing and more targeted approaches. Claudin 18.2 (CLDN18.2) has emerged as a therapeutic target in GACs. CLDN18.2 is reportedly expressed in 14-87% of GACs, and CLDN18.2 is available for monoclonal antibody (mAb) binding as it is expressed on the outer cell membrane. Here, we review the exploration of CLDN18.2 as a target in GACs via the use of zolbetuximab (IMAB362). Zolbetuximab is now under priority FDA review for GACs, and we eagerly await the review outcome.

SURG-24. FACTORS PREDICTING REMISSION AND RECURRENCE AFTER SURGICAL TREATMENT OF ACTH SECRETING PITUITARY ADENOMAS - CUSHING’S DISEASE

Abstract Despite recent advances in management, disease persistence and recurrences are common in patients with ACTH secreting pituitary adenomas-Cushing’s disease (CD). The study aims to determine clinical, biochemical, radiological, histological factors that correlate with persistence and recurrence in patients with CD, and also aims to understand the clinico-pathological significance of EGFR-MAPK, NF-kB, SHH pathway activation. Clinical data of 167 patients who underwent surgical treatment (n = 174 surgeries) for CD was ambispectively analysed with median follow-up of 8.1years(1-13.29 years). Among the 174 surgeries performed, 140 were primary, 22 were redo, 24 were for paediatric patients and 12 surgeries were performed in Nelson syndrome. In the primary surgery cohort, 74.3% were females and the average age was 28.73years(SD = 10.15). 75% of patients experienced remission after primary surgery compared to 47.4% in redo surgery. The remission rate in paediatric patients was 55.5%. Post-operative day-1 plasma cortisol (p &amp;lt; 0.001;AUC = 0.8894[0.8087-0.9701]) and ACTH (p &amp;lt; 0.001;AUC 0.9[0.7386-1]) levels were seen to be strong independent predictors of remission in primary surgery cohort. Remission rates after endoscopic trans-sphenoidal surgery- TSS were more than those after microscopic TSS, in patients undergoing primary surgery (81.08%vs57.14%;p = 0.008). Presence of adenoma on histopathological examination(HPE) was also strong predictor of disease remission (p = 0.020). On categorising based on surgical approach and HPE, microscopically operated patients without histopathological evidence of adenoma had significantly higher odds of non-remission (OR 38.1;95%CI-4.2-348.3) compared to endoscopically operated patients with adenoma on HPE. Lower immune reactivity score (IRS) of NR4A1 was found to correlate with higher remission rates (p = 0.074). However, none of the molecular markers studied - NR4A1, c-Fos, c-Jun, GLI1, pMEK, p44 showed a significant correlation with the preoperative cortisol values. Post-operative day-1 serum cortisol and ACTH are reliable predictors of remission. Additionally, endoscopic approach and histopathological evidence of adenoma are associated with higher remission rate, with both features together raising the odds significantly.

Weekend effect in emergency laparotomy: a propensity score-matched analysis.

The 'weekend effect' is the term given to the observed discrepancy regarding patient care and outcomes on weekends compared to weekdays. This study aimed to determine whether the weekend effect exists within Aotearoa New Zealand (AoNZ) for patients undergoing emergency laparotomy (EL), given recent advances in management of EL patients. A cohort study was conducted across five hospitals, comparing the outcomes of weekend and weekday acute EL. A propensity-score matched analysis was used to remove potential confounding patient characteristics. Of the 487 patients included, 132 received EL over the weekend. There was no statistically significant difference between patients undergoing EL over the weekend compared to weekdays. Mortality rates were comparable between the weekday and weekend cohorts (P = 0.464). These results suggest that modern perioperative care practice in New Zealand obviates the 'weekend' effect.

Pediatric brain tumors in low- and middle-income countries: available evidence on recent advancements in management, challenges, and recommendations – editorial

Pediatric brain tumors in low- and middle-income countries: available evidence on recent advancements in management, challenges, and recommendations – editorial

Recent Advances in Management of Scorpion Sting - An Updated Synopsis

Recent Advances in Management of Scorpion Sting - An Updated Synopsis

Recent Advances in Management of Amblyopia

Amblyopia is the most common cause of monocular vision loss in children. Global incidence is 3.7%. It may be due to early deprivation of vision or defocus in one eye, reflects an imbalance of input from the eyes to visual cortex .Not only monocular vision is reduced but binocular vision is also affected. Fellow Human brain is designed to allow both eyes to work together. If signals from one eye are blurred, brain blocks the visual input from that eye. In the visual pathway, the synapses are broken due to disuse of amblyopic eye. Along with visual coordination deficit, eye to hand and reading can be affected and selfperception may be diminished. A variety of amblyopia therapy options have been developed to treat amblyopia in children and adults. Amblyopia therapy options have traditionally been limited to penalization of non-amblyopic eye with either patching or medicinal penalization. Traditional approaches to diagnose and treatment have limited effectiveness, are uncomfortable for the patients and their families. Recent evidences shows that amblyopes possess binocular cortical mechanisms for both threshold and supra-threshold stimuli. Hence strategy may be based on binocular stimulation methods, aims to stimulate either eye leading to a concomitant improvement in monocular vision with reduction in suppression and strengthening of binocular vision.

Risk factors and management of postpartum depression

ABSTRACT Background: After giving birth, some women experience the common and complex mood disorder known as postpartum depression (PPD). PPD has multiple etiological factors, including hormonal fluctuations, genetic susceptibility, and psychosocial stressors. Objective: Detailed overview of PPD standard of care effectiveness in management with pharmacological interventions. Method: To gather pertinent publications about the most recent advancements in management, a Pubmed search for PPD articles was conducted. Result: PPD is characterized by a variety of emotional and psychological symptoms, such as irritability, persistent sadness, anxiety, and hopelessness. These symptoms can have a serious negative effect on a new mother’s quality of life and capacity to care for her child. Conclusion: Effective management and the avoidance of long-term detrimental effects for the mother and her child depend on early detection and intervention.

Ranula of the tongue – Recent advances in management

The treatment of ranula ranges from conservative in congenital ranula to non-operative management like laser, radiotherapy, cryosurgery or sclerotherapy and finally the best and time tested surgical management with minimal or negligible recurrence. Surgical management should be recommended to all in case of plunging ranula with symptoms.

Assessment of various treatment modalities with recent advancements in management of gingival recession: A scoping review

Assessment of various treatment modalities with recent advancements in management of gingival recession: A scoping review

Assessment of various treatment modalities with recent advancements in management of gingival recession: A scoping review

This article gives information regarding various etiological factors that can lead to recession, the pathogenesis behind the recession, under which type it can be classified, the diagnostic criteria for recession, how to assess the root coverage, rationale for the necessary treatment with suitable non-surgical and surgical treatment options, concluding with post-operative care which has to be given to the patients after surgical procedures.

PO-620-08 SYSTEMATIC REVIEW AND META ANALYSIS OF CURRENTLY AVAILABLE LEFT ATRIAL APPENDAGE CLOSURE DEVICES

Recent advancements in management of atrial fibrillation and high risk bleeding patients with devices, are calling for a direct comparison of the left atrial appendage closure (LAAC) devices. This meta analysis compares the available LAAC devices and their success rate in relation to peri device leak at 45 day follow up.

EFFECT OF CRUDE GLYCEROL SUPPLEMENTATION VIA DRINKING WATER ON LAMBS PERFORMANCE, SOME BLOOD HAEMATOLOGY, AND BIOCHEMICAL METABOLITES

EFFECT OF CRUDE GLYCEROL SUPPLEMENTATION VIA DRINKING WATER ON LAMBS PERFORMANCE, SOME BLOOD HAEMATOLOGY, AND BIOCHEMICAL METABOLITES

Comparative analysis of LVAD patients in regard of ischaemic or idiopathic cardiomyopathy: A propensity-score analysis of EUROMACS data.

Despite recent advances in management of patients with advanced heart failure, mortality remains high. Aim of this study was to compare impact of different aetiology of ischaemic and idiopathic cardiomyopathy on early outcomes and long-term survival of patients after left ventricular assist device implantation. European Registry for Patients with Mechanical Circulatory Support (EUROMACS) gathers clinical data and follow-up parameters of LVAD recipients. Patients enrolled in the EUROMACS registry with primary diagnosis of either ischaemic (n = 1190) or idiopathic (n = 812) cardiomyopathy were included. Primary Endpoints were early mortality as well as long-term survival. Secondary endpoint were major postoperative adverse events, such as need for rethoracotomy. Additionally, a propensity-score matching analysis was performed for patients with ischaemic (n = 509) and idiopathic (n = 509) cardiomyopathy. In terms of basic demographics and baseline parameters the two groups significantly differed as expected before propensity-score matching due to different aetiology of cardiomyopathy. Seven-day (52 (4.4%) versus 18 (2.2%); p = 0.009), 30-day (153 (12.9%) versus 73 (9.0%); p = 0.008) and in-hospital mortality (253 (19.7%) versus 123 (15.1%); p = 0.009) were significantly lower in the idiopathic cardiomyopathy group compared to the ischaemic cardiomyopathy group, whereas after propensity-score matching 30-day (p = 0.169) was comparable and in-hospital mortality (p = 0.051) was almost significant. Kaplan-Meier survival analysis revealed no significant difference in regard of long-term survival after propensity-score matching (Breslow-test p = 0.161 and LogRank-test p = 0.113). Though patients with ischaemic and idiopathic cardiomyopathy suffer from different cardiomyopathy aetiologies, 30-day-mortality and long-term survival of both groups were similar leading to the conclusion that covariates predominately influence mortality and survival of ischaemic and idiopathic cardiomyopathies.

Abstract WP201: Increasing Mortality From Ischemic Stroke In The US, Racial And Etiological Analysis

Background: Ischemic stroke is the fifth leading cause of death in the United States. In spite of the recent advances in the management of ischemic stroke, mortality rates remain high and have increased in recent years. Importantly, mortality differs by race, with African Americans more likely to die from stroke. To better understand stroke mortality we examined data from 1999 through 2018 with respect to both race and stroke subtype. Methods: Using the Multiple Cause Of Death Database, we identified all patients who died of cerebral infarction (CI) using the International Classification of Diseases, 10th revision code I63. Age-adjusted mortality rates (AAMR) standardized to the 2000 US census data were used. Data for continuous variables were examined using simple linear regression models and multivariable linear regression models controlling for relevant covariates. All tests were two-tailed and p &lt; 0.05 was considered significant. Results: A total of 201,157 CI deaths were identified between 1999 and 2018. AAMR showed a U-shaped trend, such that compared to 1999-2004 (4.52±0.60) AAMR decreased from 2005-2014 (2.06±0.20), p &lt; 0.001, and increased from 2015-2018 (3.63±1.32), p &lt; 0.001. AAMR differed significantly by race, p = 0.045. Rates were 3.05+1.26 for Caucasians and 4.04+1.74 for African Americans. AAMR decreased between 1999 and 2018 for thrombotic strokes, p &lt; 0.001, while AAMR increased over this time for embolic stroke, p &lt; 0.001. Amongst Caucasians, there was no significant differences in AAMR for each stroke subtype from 1999 to 2018, p = 0.081. However, for African Americans, there was a significantly higher AAMR for thrombotic strokes (0.56±0.33) compared to embolic strokes (0.33±0.15), p = 0.006. Conclusion: Despite recent advances in ischemic stroke management, AAMR has increased in the last 4 years by 1.8 times. AAMR in African Americans is 1.3 times that of Caucasians with African American mortality from thrombotic stroke being 1.7 times higher than from embolic stroke. Mortality from CI caused by embolism increased by 2.8 times over the study period while that due to thrombosis decreased by 5 times. Further studies are needed to clarify the reasons behind the recent increase in AAMR.

Recent Advances in Long-Term Management of Asthma.

Asthma is one of the most common chronic diseases of childhood with significant morbidity. Management of asthma has evolved from inhaled corticosteroids to personalized therapy in recent years. This article summarizes the recent advances in the management of asthma. The severity of asthma is assessed retrospectively by the level of treatment required to control asthma symptoms.Recently, there has been an emphasis on not to use short-acting beta-2 agonist (SABA) alone, even for intermittent or mild asthma. Single maintenance and reliever therapy (MART) is increasingly being recommended. Asthma therapy should be personalized based on phenotype (clinical presentations) and endotypes (distinct mechanistic pathways) of asthma and by a continuous cycle of assessment of asthma control and risk assessment, treatment, and reviewing the response in children on treatment. Various add-on therapy like tiotropium and biological monoclonal antibodies have been approved for use in a subset of children with severe asthma. Before considering biologicals, it is vital to have a proper diagnosis, good compliance and inhaler technique, and treatment of comorbidities.

Management of Horticultural Genetic Resources in India: Recent Advances

Horticultural crops comprise diverse economic species ranging from the fruits/nuts, vegetables, spices and condiments, ornamental plants, aromatic and medicinal plants. Besides the tangible materials, horticultural genetic resources (HGR) also encompass the indigenous knowledge accumulated over ages among gardeners, and which surround the use of such biological resources. Global climate change is causing challenges in productivity with the rise in global temperature and reduced amount of precipitation. It is crucial to develop strategies for effective conservation and judicious use of HGR to improve nutritional security and food safety for human health. This paper describes the present status of HGR in India, its scientific management aspects, including their diversity, conservation and sustainable use. It also addresses crucial concerns regarding conservation in India vis-à-vis recent advances in management of the HGR.

Parkinson’s disease – a review of pathogenesis, recent advances in management, and challenges of care in sub-Saharan Africa

Parkinson’s disease (PD) remains a common neurodegenerative movement disorder with significant morbidity, which is expected to increase worldwide in the coming decades. Since its initial description, much has been elucidated about its etiology, pathogenesis, and the role of genetic and environmental risk factors. Effective treatments, including surgical therapies, have been discovered. Despite these strides, many questions remain unanswered; PD remains an active research area with ongoing efforts to discover newer treatment modalities and identify neuroprotective strategies. As with many neurological conditions, there is an unequal distribution of health resources, resulting in some management challenges in low resource settings, especially sub-Saharan Africa (SSA). In this communication, we provide an overview of PD etiopathogenesis, including genetics and management strategies, including some recent advances with respect to treatment options and disease modification approaches. Finally, we discuss some challenges of PD management in low-resource settings and highlight efforts to turn the tide.