Regular Treatment Research Articles

Analysis of determinant factors affecting treatment compliance of hypertensive patients

Introduction: Hypertension requires regular and controlled treatment to stabilize blood pressure and prevent complications. Many hypertensive patients do not comply with hypertension treatment procedures, including medication. Objective: This study aimed to analyze the determinant factors influencing medication compliance in hypertensive patients. Methods: The research method used was observational analytic with a cross-sectional design. Data collection using a questionnaire. The sample in this study was 67 hypertension patients. Data analysis used the chi-square test. Result: The results of this study indicate that there is an influence of the level of knowledge (p = 0.045), motivation to seek treatment (p = 0.000), and family support (p = 0.000) on medication compliance in hypertensive patients. Conclusion: Motivation to seek treatment is the most dominant variable on compliance with the treatment of hypertension patients. Health workers must develop an educational strategy focusing on increasing patient motivation.

Prevalence of caries disease in patients with Rheumatoid arthritis: Results of a comparative study

Objectives: This study aims to determine the prevalence of dental caries in rheumatoid arthritis (RA) patients and compare it with controls. Materials and Methods: We conducted a cross-sectional study between two departments of the Ibn Sina University Hospital in Rabat: the Conservative Dentistry Department at the Center for Consultation and Dental Treatment and the Rheumatology B Department at El Ayachi Hospital in Salé.We collected socio-demographic, disease, and oral health data for each patient, assessing caries prevalence using the DMFT index (Decayed, Missing, and Filled teeth ) along with gingival and plaque indices (Löe and Silness) Results: We recruited 61 patients, including 31 patients with rheumatoid arthritis (RA) and 30 control patients. The average age was 47.6 ± 13.1 years, mostly female, with 59.3% postmenopausal. RA patients had a higher number of missing teeth (8.3±7 [0; 19]), moderate to severe gingival inflammation in 64.6% of patients, and significant plaque buildup in 67.7% of cases. Only 38.7% of patients used proper brushing techniques, and 45.2% viewed their condition as a barrier to oral hygiene.The DMFT index in the RA group was 15.5, with an average of 2 [0; 4] filled teeth, compared to 0 [0; 2] in the control group (p=0.05). 67.7% of RA patients had visible plaque deposits, and 64.6% showed moderate to severe gingival inflammation Conclusion: Patients with rheumatoid arthritis exhibited poorer oral health compared to the control group, highlighting the importance of multidisciplinary care, including regular dental consultations and treatment

Treatment course of cavitary pulmonary tuberculosis combined with tuberculosis in a parotid Warthin's tumor: a case report and literature review.

Extrapulmonary tuberculosis (TB) is a relatively rare form of tuberculosis infection, accounting for approximately 15% of all tuberculosis infections. Lymph nodes are the most commonly affected sites, while involvement of the parotid gland is extremely rare. We present the case of a 65-year-old male patient with a one-month history of a left parotid mass. The patient has a history of diabetes and long-term smoking, and a chest X-ray revealed secondary fibrotic pulmonary tuberculosis, while sputum smears were culture-negative for Mycobacterium tuberculosis (Mtb). The parotid mass was surgically removed and subjected to routine HE staining, acid-fast staining, and PCR molecular testing for Mtb. The final diagnosis was Warthin's tumor of the parotid gland with concomitant tuberculosis. One month after removal of the parotid mass, the patient's chest CT showed cavitary tuberculosis. Subsequently, the patient received anti-tuberculosis treatment; however, due to severe gastrointestinal adverse effects, the patient stopped the medication in less than a month and did not receive regular treatment. Four months after stopping the medication, the patient's pulmonary tuberculosis progressed and worsened. Combined tuberculosis in Warthin's tumor is extremely rare, with only 14 cases reported to date. However, the specific pathogenesis of this condition is not yet fully understood, and the preliminary treatment and prognosis have not been conclusively determined. Early diagnosis of tuberculosis, standardized and effective use of anti-tuberculosis drugs, and personalized treatment are crucial in the management of tuberculosis. We have reviewed the treatment progress of this rare disease and analyzed the potential pathogenesis of the condition. Furthermore, we have summarized the current understanding of the pathogenesis of tuberculosis, drug resistance mechanisms, and the latest treatment advances. These studies have important clinical implications for better understanding and treating extrapulmonary tuberculosis and tuberculosis within Warthin's tumor of the parotid gland. This comprehensive analysis sheds light on the complexities of tuberculosis and provides valuable insights for improved management and care of affected individuals.

Vitamin D Status in Supplemented Hemodialysis Patients

Introduction: Chronic kidney disease (CKD) causes decreased activity of the enzyme 1-alpha-hydroxylase and calcitriol deficiency with mineral and bone metabolism disorders or secondary hyperparathyroidism. Anticipation of the occurrence of these complications implies the systematic supplementation of all hemodialysis patients, with monitoring of biological parameters. It is in this context that this study was carried out, the general objective of which was to establish the profile of vitamin D concentration in hemodialysis and Ivorian public sector supplemented patients in Abidjan. Patients and Methods: In a cross-sectional study conducted from September to December 2022, we included 89 patients with end-stage CKD treated with hemodialysis at the CNPTIR in Cocody. The collection of epidemio-clinical data was done on the basis of a questionnaire on the one hand and the patients' medical records on the other. The vitamin D concentration was determined by the ELFA immunoassay method on mini Vidas (BIOMERIEUX). Results: The mean age of the patients was 45 ± 13 and 65.17% of them were men. 55.06% of the patients had been treated with dialysis for at least 5 years. 48.31% of the patients had regular supplementation treatment. Of the two types of vitamin D supplementation, 94.38% of the study population was supplemented with cholecalciferol compared to 18% for alfacalcidol with 12% of patients included, using both types. From a biological point of view, it appears that the average concentration of vitamin D in the patients was 26.9 ng/mL, and only 16% have a concentration of less than 20 mg/mL, corresponding to an deficiency vitamin D status. Conclusion: At the end of this cross-sectional study, it emerged that the average in adult hemodialysis subjects followed at the CNPTIR in Cocody had an insufficient vitamin D status. And 37% of the study population with normal vitamin D status. However, these results could be improved by better accessibility to the products, and regular compliance with supplementation.

Zoledronate Sequential Therapy After Denosumab Discontinuation to Prevent Bone Mineral Density Reduction: A Randomized Clinical Trial.

Discontinuation of denosumab without transitioning to another antiresorptive agent results in rapid bone loss and an increased risk of fracture. Previous randomized studies reported inconsistent results regarding the efficacy of zoledronate as sequential therapy. To investigate the use of sequential therapy with zoledronate to prevent bone loss and decreased bone mineral density (BMD) after denosumab discontinuation in the first year. The Denosumab Sequential Therapy prospective, open-label, parallel-group randomized clinical trial was conducted at a referral center and 2 affiliated hospitals in Taiwan. Recruitment was conducted from April 1, 2019, to May 31, 2021, and a 2-year follow-up was planned. The trial included postmenopausal women and men aged 50 years or older who received regular denosumab treatment for at least 2 years and did not have previous exposure to other antiosteoporosis medication or meet other exclusion criteria. Participants were assigned via stratified randomization to 1 of 2 groups: group A received continuous denosumab treatment (60 mg twice yearly) as the positive control, whereas group ZOL received 1 dose of zoledronate (5 mg) in the first year. The coprimary outcomes were BMD percentage changes in the lumbar spine (LS-BMD), total hip (TH-BMD), and femoral neck (FN-BMD), respectively. An intention-to-treat analysis was performed. This study included 101 patients (95 women [94.1%]; median age, 72.0 [IQR, 67.0-76.0] years). There were 25 patients in group A (23 women [92.0%]; median age, 74.0 [IQR, 70.0 to 78.0] years) and 76 in group ZOL (72 women [94.7%]; median age, 71.0 [IQR, 65.7 to 76.0] years). In the first year, group ZOL had a significant median decrease in LS-BMD (-0.68% [IQR, -3.22% to 2.75%]) compared with group A (1.30% [IQR, -0.68% to 5.24%]) (P = .03). No significant differences between groups A and ZOL were observed for TH-BMD (median, 1.12% [IQR, -0.06% to 2.25%] vs 0% [-1.47% to 2.15%]) (P = .24) and FN-BMD (median, 0.17% [IQR, -2.29% to 2.90%] vs 0.18% [-2.73% to 3.88%]) (P = .71). We observed a significant difference in the median LS-BMD percentage change for the ZOL subgroup with 3 or more years of denosumab treatment before enrollment (-3.20% [IQR, -7.89% to 0.68%]) compared with group A (1.30% [IQR, -0.68% to 5.24%]) (P = .003). In this randomized trial of sequential therapy after denosumab discontinuation, bone loss was observed in LS-BMD in the first year among patients receiving zoledronate. A longer duration of denosumab treatment was associated with a further decrease in LS-BMD after zoledronate sequential therapy. Further randomized clinical trials and large-scale studies that investigate the strategies of sequential therapy after long-term denosumab treatment are needed. ClinicalTrials.gov Identifier: NCT03868033.

EHospitals and Parkinson’s disease care: audit insights from an EPIC-integrated Hospital

Abstract Introduction Parkinson’s disease (PD) is a neurodegenerative condition that affects approximately 145,000 individuals in the UK. PD symptoms are managed primarily through medications such as levodopa and dopamine agonists. Delays or omissions in administering these medications is the primary reason for increased length of stay in up to 73% of emergency admissions.1 This audit investigated the management of PD medications at Cambridge University Hospitals to identify areas for improvement in clinical practice. Aim This audit aimed to evaluate the pharmacological management of PD patients admitted to Cambridge University Hospitals NHS Trust. Specifically, it sought to assess the accuracy of drug histories, the quality of medication administration, and adherence to standards set by Parkinson’s UK ‘Get it on Time’ campaign and NICE.2,3 Methods A cross-sectional audit was conducted, reviewing the records of PD patients admitted over a three-month period. The sample included patients with a confirmed diagnosis of idiopathic PD who were prescribed at least one PD medication. Data were collected retrospectively from the electronic patient records, focusing on ten performance standards. Ethical approval was not required as the study involved a retrospective review of existing clinical records. Results The audit included 63 admissions, predominantly male (65%) with a mean age of 78.5 years. A significant portion of patients (81%) had their drug histories completed by a doctor after clerking, and 90% had orders for their regular treatment generated immediately post-clerking. Pharmacy staff completed drug histories within 24 hours for 81% of patients, though discrepancies between medical and pharmacy histories were noted in 70% of cases. Medication reconciliation within 24 hours was achieved for 83% of patients, yet only 29% received their PD medications on time for every dose. Additionally, 76% did not miss a dose or had a valid reason recorded for missed doses. 83% had PD listed in their electronic problem list after clerking. Alarmingly, just 5% were assessed for Self-Administration of Medicines (SAM), and 76% were assessed by a PD specialist during their stay. Discussion and conclusion The audit revealed substantial gaps in PD medication management, particularly regarding discrepancies between medical and pharmacy drug histories and delays in medication administration. The low rate of SAM assessments and inconsistent PD specialist consultations were also significant concerns. These findings highlight the need for improved documentation practices, such as standardized templates within the EPIC system, and increased pharmacy involvement during early stages of admission. Appropriate staffing levels and better interdisciplinary coordination are essential. The audit identified critical areas for improvement, emphasizing the need for better documentation, timely administration, and enhanced interdisciplinary coordination. Future audits should aim to randomize patient selection over a longer period to minimize bias and provide a more comprehensive assessment of medication management practices. The audit was limited by its retrospective design and the specific three-month timeframe, which may not fully represent broader trends. The exclusion of admissions shorter than 24 hours and the focus on a single hospital trust also limit the generalizability of the findings. Future studies should consider a larger, more randomized sample to validate and expand upon these results.

Beyond dialysis: Assessing therapeutic regimen compliance and sleep quality in chronic renal failure patients undergoing maintenance hemodialysis in Saudi Arabia.

Given its potential to impact physical and mental health, sleep quality is one of the most significant clinical outcomes among hemodialysis patients. Patients undergoing hemodialysis are required to adhere to an intricate treatment plan that consists of regular hemodialysis treatments, dietary and fluid restrictions, and a multi-drug regimen. Investigate the relationship between adherence to a therapeutic regimen and sleep quality among chronic renal failure patients undergoing maintenance hemodialysis. A descriptive correlational research design was followed. The study was conducted at the hemodialysis units in Hafr Albatin City, specifically at Hafr Albatin Central Hospital and King Khaled Hospital, Saudi Arabia. A convenience sample of 100 adult patients was selected for the study. The Hemodialysis Patients Adherence Questionnaire and Pittsburgh Sleep Quality Index were utilized to collect the data in 5 months from September 20, 2023 to February 15, 2024. The study revealed that more than half of the studied patients adhered to the therapeutic regimen, while (46%) did not adhere to it. More than half of the patients had poor sleep quality and were nonadherent to diet and fluid restrictions. Overall adherence score is negatively correlated with the global sleep quality score (r = -0.368, p < 0.001), indicating that poorer sleep quality is associated with lower overall adherence to the therapeutic regimen. While a significant proportion of the patients demonstrated adherence to overall therapeutic regimens, including dialysis sessions and medication intake, there was notable nonadherence to fluid and diet restrictions. Poor sleep quality, prevalent among two-thirds of the participants, correlates negatively with adherence to therapeutic regimens.

Effects of low-dose aspirin in bipolar disorder: study protocol for a randomised controlled trial (the A-Bipolar RCT)

IntroductionAccumulating data support the association between increased inflammation and bipolar disorder (BD), and preliminary data suggest that augmentation with low-dose aspirin (LDA) may protect against the onset and deterioration of BD via anti-inflammatory pathways. The A-bipolar randomised controlled trial (RCT) aims to investigate whether adding LDA to standard treatment improves day-to-day mood instability (MI) in BD.Methods and analysisA two-arm, triple-blind, parallel-group, superiority RCT including 250 patients with newly diagnosed BD treated at the Copenhagen Affective Disorder Clinic, Denmark. Participants are randomised 1:1 to either 150 mg of acetylsalicylic acid daily (LDA) or a placebo for six months in addition to their regular treatment. Mood instability, calculated from daily smartphone-based mood evaluations, is the primary outcome measure due to its internal validity as a real-life measure for patients and external validity as it reflects patients’ illness severity and functioning. Analyses will be conducted as intention-to-treat analyses using a linear mixed model including time (categorical) and the time–treatment interaction as fixed effects and with an unstructured covariance pattern to account for repeated measurements on each study participant. The trial is Good Clinical Practice monitored.Ethics and disseminationThe Danish Research Ethics Committee (H-21014515) and the data agency, Capital Region of Copenhagen (P-2021-576) approved the trial. Results will be published in peer-reviewed journals.Trial registration numberNCT05035316.

The research of influence factors that possibly lead to cardiovascular disease

Abstract. The emergence of cardiac disease is influenced by numerous variables. Every year a large percentage of people around the world die from heart attacks. This study was to look at how important clinical variables are connected to the chance of having CVD. The analysis used a Kaggle dataset with details from 70,000 patients and 10 different variables. The study examined how factors such as age, gender and changes in cardiac activity during exercise affect overall heart health. Multiple linear regression models were used to analyze these effects. The results show a significant correlation between these factors and an increased risk of heart disease. This emphasizes the importance of these predictors in clinical assessments. It can be concluded from this study that regular medical check-ups, early prevention and treatment should be carried out for these vulnerable groups. The general prevalence of heart disease in the nation can be decreased by implementing these strategies. According to the study, personalized health strategies have the potential to improve CVD outcomes and strengthen preventive measures. All of the experimental results suggest that continued documentation and study of these pathogenic factors in medical diagnostics and experiments could aid in drug development as well as improve medical technology and help more patients with cardiovascular disease recover.

Monitoring of nematodes hosted by endangered Bonobo (Pan paniscus Schwartz 1929) at Lola ya Bonobo Sanctuary (Kinshasa, DRC)

Subject description: Infectious diseases are now recognized to have a significant impact on some populations of wildlife. Although many infectious agents are species-specific, several pathogenic organisms can cross the species barrier and cause severe clinical diseases in new hosts. It is critical to understand the role played by emerging infectious diseases and zoonoses transmitted between humans and great apes. Objective: The objective pursued by this study is to contribute to the sustainable conservation of bonobos (Pan paniscus), an endemic species of DRC that faces various threats including diseases such as parasites. Methods and Results: The lab analyses were carried out at the Central Veterinary Laboratory in Kinshasa based on two main methods including qualitative and quantitative coproscopy by flotation and counting the number of eggs per gram (OPG) by the McMaster method. In total 72 samples were analysed, 46 samples (64%), were infested by five species of nematodes, including Ankylostoma spp., Trichostrongylus spp., Ascaris lumbricoides, Trichuris trichiura and Oesophagostomum sp. The infestation with Trichostrongylus spp. was found to be higher compared to other nematodes. In addition, subadults were more infected compared to specimens of other age groups. Conclusion and application of results: In this study, nematodes hosted by endangered bonobos were monitored in a relatively large number of 72 bonobos samples. The study found that individuals that were more central in the social interaction such as Subadults had higher chances of contracting parasites. These results indicate that for bonobos, social behaviour and age influence the risk of contracting parasites. Two factors that can be taken into account when managing diseases outbreaks in captivity and regular monitoring and treatment of individuals must be done to protect the species. Keywords: Bonobo, Zoonotic, Nematodes, Parasites, Sanctuary, Democratic Republic of Congo.

Thematic and intertextual analysis from a feasibility study of the Bonny Method of Guided Imagery and Music with clients in eating disorder treatment.

Eating disorders (ED) are characterized by serious and persistent disturbances with eating, weightcontrol, and body image. Symptoms impact physical health, psychosocial functioning, and can be life-threatening. Individuals diagnosed with an ED experience numerous medical and psychiatric comorbidities due to issues caused by or underlying the ED. Therefore, it is vital to address the complex nature of an ED, as well as the comorbid and underlying issues. This necessitates a psychotherapeutic approach that can help to uncover, explore, and support working through unresolved emotions and experiences. Guided Imagery and Music (GIM) is an in-depth music psychotherapy approach utilizing therapist-programmed music to support the client in uncovering and examining underlying and unresolved issues. The literature surrounding the use of GIM with clients in ED treatment is anecdotal and comprised primarily of clinical case studies. This secondary analysis, based on a descriptive feasibility study that integrated GIM sessions into the client's regular ED treatment and examined 116 transcripts from a series of sessions of eight clients. Thematic analysis of the transcripts identified nine subthemes and three themes that emerged. These themes include emotional landscape (feeling stuck, acknowledging emotions, and working through unresolved emotions), relationships (self, others, and eating disorders), and transformation and growth (finding strength, change, and empowerment). A short series of GIM sessions helped ED clients identify and address issues underlying the ED and to gain or reclaim a sense of self that enabled them to make choices for their life that support their recovery and sense of empowerment. Intertextual analysis revealed imagery indicative of the Hero's Journey. Further, how engagement in this embodied aesthetic experience stimulates perceptual, cognitive, and affective brain functions which are key in fostering behavioural and psychological change is explicated as it relates to ED treatment and recovery.

Health-related quality of life and associated factors among children with Transfusion-dependent β-thalassaemia: a cross-sectional study in Guangxi Province

BackgroundTransfusion-dependent β-thalassemia (TDT) is a severe inherited disorder. Without regular treatment, patients with TDT experience complications that can significantly shorten life expectancy and severely impact both their quality of life and that of their families. The condition has attracted significant attention in global health discussions. Due to the challenges of blood supply shortages, the high costs of iron chelation therapy, and hematopoietic stem cell transplantation (HSCT), TDT presents a serious health risk to patients and imposes a substantial burden on families and society. However, research on the health-related quality of life (HRQoL) of thalassemia patients in China remains limited. This study evaluated the factors affecting the HRQoL of these patients, with the goal of developing strategies to improve their quality of life.MethodsIn this cross-sectional study, children with TDT were recruited from five treatment centers in Guangxi, a province with a high prevalence of thalassemia in China. Structured questionnaires were employed to gather relevant data on sociodemographic variables, disease characteristics, treatments, and associated costs. The HRQoL was assessed using the Transfusion-Dependent Quality of Life (TranQoL) questionnaire, with a proxy version for patients aged 0–11 years and a child version for those aged 12–18 years.ResultsThe study included 418 participants, yielding an overall TranQoL score of 60.6 ± 16.3 among thalassemia patients. Multiple linear regression analysis revealed a negative correlation (P < 0.05) between overall TranQoL scores and several factors: increasing patient age, the presence of multiple thalassemia patients within a family, and undergoing HSCT. Conversely, adherence to regular treatment was positively correlated with higher TranQoL scores (P < 0.05).ConclusionThe study demonstrates that HRQoL among Chinese patients with TDT is at a low level. Age, treatment adherence, family support, and socioeconomic status were identified as key determinants influencing HRQoL. It is essential to further enhance and optimize health insurance policies and medical services to support comprehensive treatment strategies for these patients.

History of Hypertension is The Most Influential Factor in Increasing The Occurrence of Preeclampsia in Lumajang Regency

Hypertensive disorders of pregnancy, including preeclampsia, are significant contributors to maternal mortality and morbidity globally. The study's objective was to investigate the most important factors that contribute to preeclampsia. in Lumajang Regency. The research design is a case-control study. The research location is at Rogorunan Health Center and Kunir Health Center. The sample in this study was determined using saturated sample techniques or total sampling. samples at the Rogotrunan Health Center totaled 80 respondents and the Kunir Health Center which amounted to 75 respondents, totaling 155 respondents. Data collection using questionnaires. Analysis using logistic regression. The results of the study of variables that have a significant influence are on the variables of age (p-value = 0.070), history of hypertension (p-value = 0.000), pregnancy pause (p-value = 0.002), body mass index (p-value = 0.045), and hereditary hypertension (p-value = 0.000). A history of preeclampsia (p-value = 0.255) on the variable was excluded. Multivariate results between preeclampsia occurrence and history of hypertension obtained a value of p = 0.000, OR = 6.004 (1.549-5.065) meaning that The incidence of preeclampsia is influenced by a history of hypertension and history of hypertension affects 6.004 times the incidence of preeclampsia. Conclusion A history of hypertension is the most significant risk factor for preeclampsia, so the recommended advice is the importance of a healthy lifestyle, a balanced diet, exercise regularly, avoiding stress, avoiding smoking, not consuming harmful substances, monitoring blood pressure regularly, and regular treatment. All of these actions are a preventive effort so that during pregnancy preeclampsia does not occur.

The Role of Greek Olive Leaf Extract in Patients with Mild Alzheimer’s Disease (the GOLDEN Study): A Randomized Controlled Clinical Trial

Background: Olive leaves are a significant source of biophenols, which have a beneficial impact on cognitive performance. Objective: To examine, for the first time, in humans the effect of the daily consumption of a beverage containing olive leaf extract (OLE) versus a Mediterranean diet (MeDi) on patients diagnosed with mild Alzheimer’s Disease (AD), in addition to their regular treatment. Methods: A randomized clinical trial compared OLE’s effects on cognitive and functional performance in 55 mild AD patients. Each participant was randomly assigned to two groups: (1) Group 1 was given olive leaves for making a daily beverage and MeDi instructions through monthly diet programs; (2) Group 2 received only the MeDi instructions. After six months, all participants underwent a second neuropsychological evaluation. Results: Group 1 participants had statistically significantly higher MMSE scores compared to Group 2 with a p-value of 0.0135. Specifically, the mean MMSE difference in patients receiving OLE was close to 0, indicating no memory deterioration, whereas in controls it was −4.1, indicative of cognitive decline. The remaining neuropsychological assessments (FRSSD, FUCAS, ADAS-Cog, CDR, GDS, and NPI) revealed better results in the OLE group, except for GDS, which showed no change, but without statistically significant differences between the two groups.

IEHT vs. Regular Treatment - Are there Differences between the Two forms of Treatment in the Retrospective Course with regard to Individual Objective and Subjective Outcome Variables?

This retrospective follow-up study over one year (after discharge from the index treatment), compares the effects of inpatient-equivalent home treatment (IEHT) and regular psychiatric treatment using subjective and objective quality indicators. Using a 1:1 matching of cohorts (diagnosis, age, gender, number of previous treatments and severity of illness), 732 IEHT patients were assigned to a comparison group. Outcome data was taken from the routine data of the clinic database and the in-house basic documentation. In the subjective quality measure, patients and practitioners in regular psychiatric treatment reported a significantly higher improvement in condition. In terms of the objective quality measure, the number of further inpatient treatment days in the observation period, the two groups did not differ significantly, which can be interpreted as encouragement for the use of this new, increasingly established form of treatment.

How different soil surface treatments in urban areas affect soil pore structure and associated soil properties and processes

Soil water and temperature regimes in urban environments are greatly affected by different surface treatments, and these may lead even to changes in soil properties. The goal of this study was to find out how soil properties had changed after 8 years of soil surface modification. Five surface treatment scenarios were considered: bare soil (BS), bark chips (BC), concrete paving (CP), mown grass (MG), and unmown grass (UG). X-ray computed tomography and micromorphological analyses showed that character of pores in soils with grass (MG, UG), which were mainly influenced by organisms living in soils and roots, differed from pore character in soil covers BC or CP, which mostly were impacted by organisms living in soils. Both groups differed from BS, which was predominantly affected by the regular treatment consisting in weed removal and soil loosening. Soil under BC was more compact than for other treatments due to decomposition of the bark chips mulch and migration of mulch components. Organic matter content was greatest but its quality lowest in the BC soil, followed by UG, MG, CP, and BS. The highest aggregate stability assessed using the water-stable aggregates (WSA) index was found for UG, followed by MG, BC, CP, and BS. The greatest water retention ability was observed for BC followed by UG, MG, CP, and BS. The unsaturated hydraulic conductivities for pressure head of –2 cm measured for UG, MG, and BS were much higher than were those for CP and BC. Finally, the greatest net CO2 efflux was measured for BC and MG, followed by UG, CP, and BS. CO2 emission correlated negatively with soil physical quality expressed as slope of the soil water retention curve at its inflection point. In general, the best soil conditions were observed for UG. No treatment considerably aggravated soil condition.

Sub-Optimal Compliance to Long-Term Inhalation Strategies and Poorer Health Care Outcomes Associated with Extended Tattoos in Adolescents with Mild-to-Moderate Bronchial Asthma.

Patients' compliance to inhalation therapy is usually sub-optimal in young asthmatics. Adolescents poorly compliant to regular anti-asthma treatments and those with tattoos (and the associated attitude) can share some personality traits and maladaptive behaviors. This relationship has not been investigated. To assess if "extended" tattoos can predict long-term compliance to regular therapy of adolescents with mild-to-moderate asthma. A 12-month retrospective observational investigation was conducted on non-smoker asthmatic adolescents of both genders. Patients assuming <70% of prescribed vilanterol/fluticasone furoate o.d. were defined as "non-compliant". Tattoo surfaces were defined as "mild" or "extended" if they were < or ≥400 cm2, respectively. The relationship between tattoos and compliance on the evolution of resources consumption at 6 and 12 months was assessed by generalized estimating equation (GEE) models at the first and second semester of the treatment period. It was found that 13.2% of compliant adolescents had mild tattoos, while 47.2% of non-compliant adolescents had mild-to-extended tattoos (odds ratio (OR) 6.91, 95% CI 2.49 to 19.17, p < 0.001). The mean annual adherence to treatment was 57.8% ± 10.1 SD expected doses in non-compliant subjects with "mild tattoos" (54.8 cm2 ± 36.9 SD), but 38.6% ± 11.4 SD expected doses in those with "extended tattoos" (568.4 cm2 ± 111.6 SD, p < 0.001). Total cost proved to be a linear trend from the lowest values of compliant patients with no/mild tattoos (EUR 65.22 at 6 months and EUR 33.63 at 12 months) to the highest values of non-compliant adolescents with extended tattoos (EUR 330.75 at 6 months and EUR 297.34 at 12 months). Tattoo extension might be used as a reliable predictor of poor compliance and higher health care costs in adolescents with mild-to-moderate asthma. Patients characterized by poor compliance to a long-term therapeutic strategy and tattooing attitude likely share some aspects of their personality profile.

Quantitative Assessment of New Frontiers in Dermatochalasis and Periorbital Hyperpigmentation Treatment: The Role of Cross-Linked Porcine Collagen.

Collagen dermal fillers have shown efficacy in addressing age-related changes in facial appearance. However, their potential in rejuvenating the periorbital region remains unexplored. The aim of this study was to evaluate the effectiveness, clinical safety, and patient satisfaction associated with the utilization of collagen dermal fillers in individuals with dermatochalasis and periorbital hyperpigmentation. This study was reviewed and approved by the institutional review board of China Medical University Hospital (IRB No. CMUH107-REC2-157). Adults diagnosed with dermatochalasis or periorbital hyperpigmentation received periorbital injections of a sterile cross-linked highly-purified specific antigen free porcine dermal collagen (FACIALGAIN® Collagen Implant with Lidocaine, Sunmax Biotechnology Co. Ltd., Taipei, Taiwan) and were assessed for hydration, elasticity, pigmentation index, redness index, lightness value, and density with the DermaLab® Combo Multiparameter Skin Analysis System (Cortex Technology, Hadsund, Denmark) and Cutometer® Dual MPA 580 (Courage+Khazaka electronic GmbH, Köln, Germany). Data was collected prior to injection and at 1 week, 4 weeks, and 12 weeks after injection. Patient satisfaction on volume augmentation, decrease in hyperpigmentation, persistence, and overall satisfaction were also recorded. A total of 12 samples each were recruited for dermatochalasis and periorbital hyperpigmentation. For dermatochalasis subjects, hydration of the periorbital tissue significantly increased at week 1 and 4 (p = 0.011 and p = 0.015). Elasticity decreased by week 4 and persisted until week 12 (p = 0.001 and 0.014). For periorbital hyperpigmentation patients, lightness value increased significantly starting week 1 (p = 0.016), tapering off at week 12. Elasticity decreased by week 4 and persisted until week 12 (p = 0.002 and p = 0.002). Median overall patient satisfaction was 4 out of 5 for the dermatochalasis group and 4.5 out of 5 for the periorbital hyperpigmentation group, with a mild but insignificant decrease by week 12. DermaLab® Combo and Cutometer® Dual MPA 580 are considered effective methods for evaluating patients undergoing dermal filler injections. The utilization of cross-linked porcine collagen dermal filler injections can serve as a minimally invasive approach to enhance skin laxity in dermatochalasis and address discoloration in periorbital hyperpigmentation. However, it is important to note that regular treatments may be necessary to sustain the desired outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/0026 .

Multiple relocation cases in disaster-related deaths after the Fukushima nuclear accident

IntroductionRelocation after a disaster often has negative health effects on vulnerable people, particularly older adults. However, little is known about the number of repeated evacuations and relocations after disasters among those experienced disaster-related deaths. This case series aimed to summarize the secondary problems and mortality risks in patients involved in relocation after disasters.MethodsWe analyzed and summarized the data on 520 disaster-related deaths in Minamisoma City, a municipality near the Fukushima Daiichi Nuclear Power Plant, focusing on the number of relocations. Herein, we describe the cases of three individuals over 80 years old, who died after eight or more relocations, which were certified as disaster-related deaths.ResultsWe discuss following three cases, which are (1) a female patient in her 90s who had a stroke and was completely disabled, (2) a female patient in her 80s whose cancer was detected later due to her failing to see her family doctor, and (3) a male patient in his 80s whose regular postoperative treatment was disrupted following cancer recurrence.DiscussionOur findings indicate that evacuation led to the worsening of chronic diseases and eventually to post-disaster death. Prolonged wide-area evacuation and repeated relocation likely interrupted the continuum of care and led to the failure of adequate care provision. To reduce the loss of human life, it is necessary to review the number of wide-area evacuations and relocations over the medium to long term after large-scale disasters, including nuclear disasters, which may occur in the future. Simultaneously, it is important to establish a medical system at the evacuation site so that disaster victims can continue to receive medical care even after evacuation or relocation.

"Y appearance" infarction: caused by essential thrombocythemia.

Essential thrombocythemia (ET) is a myeloproliferative malignancy caused by the excessive proliferation of megakaryocytes in the bone marrow, resulting in the overproduction of peripheral platelets. ET can lead to thrombotic events, such as ischemic stroke (IS), though it is a rare cause of IS. Bilateral medial medullary infarction (BMMI), also known as "Y appearance" infarction due to its distinctive imaging morphology, is a rare clinical subtype of IS which typically has a poor prognosis and a high mortality rate. Herein, we report the case of a 43-year-old male with a history of ET. The patient's platelet count was poorly controlled, and he did not receive regular treatment. After developing symptoms such as dizziness, dysphagia, choking on water, slurred speech, blurred vision, and bilateral limb numbness. Head magnetic resonance imaging revealed a "Y appearance" infarction in the bilateral medial medulla. After admission, the patient was administered intravenous antiplatelet therapy with tirofiban. However, when he was switched to oral aspirin after three days, he experienced decreased muscle strength and worsening symptoms. Therefore, tirofiban was continued for 14 days. Upon discharge, the patient experienced residual limb numbness. His National Institutes of Health Stroke Scale score was 1, Modified Rankin Scale score was 0, and platelet count had decreased to the normal range. During the 9-month follow-up period after discharge, the patient still had only mild limb numbness. Our report presents a special case of "Y appearance" infarction due to ET. Owing to fluctuations in the patient's condition, he received long-term high-dose tirofiban, which ultimately led to a significant improvement in his symptoms.