Relief Of Clinical Symptoms Research Articles

Conversion surgery following immuno-chemotherapy in initially-unresectable esophageal squamous cell carcinoma: A real-world multicenter study.

e16045 Background: Currently, the real-world evidence is not available to support the practice of induction immunochemotherapy (iIC) plus conversion surgery for initially-unresectable esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the feasibility, safety and effectiveness of conversion surgery following iIC for advanced ESCC in a real-world scenario. Methods: In this multi-center, single-arm, real-world study (NCT04822103), patients who had unresectable cT4b ESCC tumors with evident involvement of the adjacent organs (aorta, trachea, or bronchus) or had multi-station, bulky lymphadenopathy were enrolled across eight medical centers in China. All patients received programmed death receptor-1 (PD-1) inhibitor plus chemotherapy every three weeks. Radiologcal assessment was performed for patients who completed at least two cycles of immunochemotherapy. In general, patients with significant relief of cancer-related clinical symptoms and radiological complete response/partial response disease were deemed surgical candidates. The primary endpoints were the objective response rate (ORR) per RECIST version 1.1 and safety profile per CTCAE version 5.0. Results: Between Nov 2019 and June 2021, 155 patients were enrolled in the final analysis. The numbers of patients with pre-treatment clinical stage III, and IVA were 21 (13.5%) and 134 (86.5%), respectively. Upon the completion of preoperative treatment, 6 (3.9%) patients achieved radiological complete response (CR), 92 (59.4%) achieved partial response (PR), and 45 (29.0%) achieved stable disease (SD), yielding an ORR and DCR of 63.3% and 92.3%, respectively. Esophagectomy was then offered to 116 patients who were considered suitable for surgery, yeilding a conversion rate of 74.8%. 109 out of 116 patients achieved R0 resection. Pathological complete response (pCR) of the primary tumor was observed in 26 (22.4%) patients, with 25 (21.6%) of them achieving pCR in both primary tumor and metastatic lymph nodes. Most patients (111/116, 95.7%) had a downstaging in tumor invasion depth. However, downstaging of nodal metastasis was observed in 48 (48/116, 41%) patients. Thirteen patients (13/116, 11.2%) had progressive nodal response. Among the treated patients, 69.0% (107/155) patients experienced at least one treatment-related adverse event (TRAEs), while 29% (49/155) had grade three or higher (G ≥ 3) TRAEs, including leukopenia (20/155, 12.9%), neutropenia (18/155, 11.6%), rash (12/155, 7.7%), diarrhea (6/155, 3.9%), and infection (6/155, 3.9%). Conclusions: We demonstrated that conversion surgery following immunochemotherapy is feasible, safe and effective for initially-unresectable ESCC patients. Further larger-scale studies are needed to establish the standard-of-care use of iIC in the preoperative settings for initially-unresectable ESCC patients.

Changes in brain network properties in major depressive disorder following electroconvulsive therapy: a combined static and dynamic functional magnetic resonance imaging study.

Major depressive disorder (MDD) is a common and intractable mood disorder. Electroconvulsive therapy (ECT) is a common means of brain electrical stimulation for the treatment of MDD, but the neurobiological mechanism of its clinical symptom relief effect is still to be explored. This study aims to explore how ECT plays a role in depression remissions by investigating the changes of static and dynamic brain network characteristics in MDD patients before and after ECT. Resting-state functional magnetic resonance imaging (fMRI) scans were obtained from nine MDD patients twice before and after a full course of ECT, all of whom responded to ECT as defined by at least a 50% reduction from baseline Hamilton Depression Scale (HAMD) scores. Both static and dynamic characteristics of the functional brain network were compared between the pre- and post-ECT scans for all participants, and the correlations between changes in clinical symptoms and altered network metrics were also investigated. The clustering coefficient and local efficiency in static brain networks were increased significantly, while the global flexibility of dynamic brain networks was decreased significantly after ECT. Several regions of interest (ROIs) that changed significantly at the local level were also identified, which involved regions of the cerebellum, hippocampus as well as frontal and temporal cortices. Although not significant, the decrease of HAMD scores were associated with trends of changed network metrics after ECT. Our results suggest that ECT may alleviate the depressive symptoms of MDD by decreasing the randomness of the brain network as reflected by changes in both static and dynamic network properties and that the temporal gyrus, frontal gyrus, hippocampus, and cerebellar regions may play key roles in such mechanisms. These findings have important implications for our understandings of ECT and depression. However, this study is limited by a relatively small sample size and the results should be confirmed in larger samples.

Clinical Presentation and Treatment Outcomes of Foreign Bodies in the Ear among Patients Attended at Bugando Medical Centre, Mwanza, Tanzania

Background: Globally, foreign bodies (FBs) in the ear are commonly encountered by otolaryngologists and its removal can result in complications if attempts of removal are made outside the healthcare setting by untrained personnel. This study describes the clinical presentation and treatment outcomes among patients presenting with FB s in the ear at Bugando Medical Centre (BMC). Methods: This was a cross sectional study that was conducted at BMC between May 2019 and October 2019. Results: A total of 70 patients (M: F ratio = 1.3:1) were studied. The mean age at presentation for children was 5.1[±2.2] years, whereas that of adults was 28.9 [±16.1] years. The FBs were found in the right ear in 44(62.9%) patients, left ear in 25(35.7%) patients and in both ears in 1(1.4%) patient. Cotton was the most common FB in 34.3% of cases. Previous history of failed attempted ear FB removal by peripheral hospitals was reported in 15(21.4%) patients. Methods used in the removal of ear FB were ear syringing in 42(60.0%) patients, forceps extraction in 15(21%) cases, FB removal by suctioning 4(6%) and hooks in 9(15%) patients. Complications observed were external ear canal laceration (n=13; 50.0%), tympanic membrane perforation (n=9; 34.6%), otitis externa (n=3; 11.5%) and chronic otitis media (n=1; 3.8%) and were significantly associated with late presentation (≥ 7 days) (p-value =0.021) and previous history of failed attempted ear FB removal (p-value < 0.001). The outcome of treatment was excellent as all of the ear FBs were successfully removed with good improvement in hearing and clinical relief of symptoms. Conclusion: Ear FBs are common at BMC with the highest incidence in children less than 10years. Removal attempts by peripheral hospitals and delayed attending to specialized hospitals predisposes to complications. Parental education on close monitoring of their children to avoid such incidences and the need to immediately seek otorhinolaryngologists to prevent ..............

Efficacy of secnidazole in the treatment of trichomoniasis and vaginal dysbiosis

Introduction. Trichomoniasis is a vaginal infectious and inflammatory disease, which falls into the category of sexually transmissible nosological entities. It is the profile of vaginal microecosystem changes in trichomoniasis that determines the vector of transformation of the vaginal microbiome towards the formation of bacterial vaginosis (BV), namely, a hypercolonized community of anaerobic microorganisms with underlying suppression of the dominant presence of the resident acidophilic microflora.Aim. To evaluate the clinical and bacteriological efficacy of 5-nitroimidazole drugs secnidazole and metronidazole in the therapy of acute trichomoniasis and concomitant vaginal dysbacteriosis.Materials and methods. As a comparison object, we used the therapy regimens for acute trichomoniasis with the 5-nitroimidazole drugs secnidazole and metronidazole, involving 2 grams (g) once as a single dose. The study included 64 patients diagnosed with acute trichomoniasis. The average age of the patients was 34 ± 7 years (95% CI 32–37). The patients were divided into two groups: group 1 (n = 32) used Secnidazole, group 2 (n = 32) used Secnidazole 2 g once as a single dose. Metronidazole was used at a dose of 500 mg 2 times a day for 5 days. Patients were observed by a doctor during two visits, and a follow-up assessment of the treatment results was carried out by way of remote interrogation.Results. The use of the drug therapy ensured removal of Trichomonas from the vagina. Both groups showed relief of clinical symptoms from B1 to B2: discomfort, itching, burning, dyspareunia, hyperemia of the mucosa with underlying tendency towards normalization of laboratory findings of the vaginal microbiocenosis condition. At the same time, it should be noted that the therapy efficiency was higher in group 1 (secnidazole).Conclusion. Thus, the administration of secnidazole provided greater therapeutic efficacy as compared with the use of the similar therapeutic dose and frequency of metronidazole to treat Trichomonas and, in combination with rehabilitation therapy, determined a more pronounced tendency towards normalization of the composition of the vaginal microflora.

Клинический случай острого иридоциклита на фоне неспецифического язвенного колита

Conducting adequate therapy for iridocyclitis (uveitis) remains an urgent problem in patients with ulcerative colitis (UC) due to the development of this complication in almost every fifth of them. Purpose. To present a clinical case of acute iridocyclitis (AI) in a patient with UC after suffering an acute respiratory disease (ARI) accompanied by a recurrence of Herpes labialis. Material and methods. Examination of a patient at the stage of remission of UC, who applied on the 5th day of the disease with a clinic of acute iridocyclitis and Herpes labialis after acute respiratory infections, suggested an etiological or trigger role of the herpes simplex virus in the development of inflammation in the choroid. Results. Conducting complex therapy with the inclusion of the drug valaciclovir led to the relief of clinical symptoms of OI already on the 16th day of the disease and increased visual acuity. Conclusion. Supplementing the treatment of acute iridocyclitis, which developed against the background of a relapse of a latent herpes infection in a patient with chronic UC in remission, with an antiherpetic drug is etiopathogenetically substantiated to achieve good visual results. Key words: acute iridocyclitis, nonspecific ulcerative colitis, herpes infection

An Ayurvedic Approach to Manage PCOD - A Case Study

Polycystic Ovarian Disease (PCOD) is an endocrine disorder that causes metabolic changes in women of reproductive age. PCOD has evolved into a lifestyle disorder as a result of sedentary habits, fast food consumption, and a poor lifestyle. The precise cause of PCOD is mysterious, but high levels of insulin, hyper androgen, and LH are the main causes. PCOD symptoms include irregular menstruation, oligomenorrhea, acne, hirsutism, hair loss, obesity, and constipation. PCOD is not directly stated in the Samhita, but clinically it is similar to Aartavavaha strotas dushti, Nastaartava, Granthi, Santarponnth vyadhi, and Yonivyapad. In this present case study, a 22 year old female patient came with symptoms of irregular, delayed menstruation, scanty menses, acne on the face and hair fall. The USG report reveals polycystic patterns of both ovaries with Right ovary volume 11.6cc and Left ovary volume 11cc, both ovaries are bulky in size with increased stromal echogenicity and multiple (10-12) small follicles (2-5mm) arranged in peripheral distribution. She had taken the medication so many times but she had not been completely cured. As a result she came to our hospital for Ayurvedic treatment. Result was made on the basis of Clinical symptoms relief and USG report. So in this case study, we will look at an Ayurvedic approach in the management of Polycystic Ovarian Disease.

Patient perspectives on symptoms, health-related quality of life, and treatment experience associated with relapsed/refractory multiple myeloma

PurposeThis study aimed to better understand the patient perspective and treatment experience of relapsed and/or refractory multiple myeloma (RRMM).MethodsThis qualitative study enrolled adult RRMM patients from 6 US clinics who had ≥ 3 months of life expectancy, ≤ 6 prior lines of therapy, and ≥ 1 treatment regimen with a proteasome inhibitor and immunomodulator, or a CD38 monoclonal antibody or an alkylating agent, and a steroid. In-person semi-structured qualitative interviews were conducted to capture concepts that were relevant and important to patients. Topics included RRMM symptoms and impacts and the mode of administration, frequency, duration, convenience, side effects, and overall experience with RRMM treatment.ResultsA total of 22 patients completed interviews. At enrollment, 59.1% of participants were using regimens containing dexamethasone, 36.4% daratumumab, 27.3% carfilzomib, and 18.2% lenalidomide. More participants had experience using intravenous or injectable therapy alone (40.9%) than oral therapy alone (18.2%). Back pain and fatigue were the most frequently reported symptoms (40.9% each); 27.3% reported no symptoms. Most participants reported physical function limitations (86.4%), emotional impacts (77.3%), MM-related activity limitations (72.7%), and sleep disturbances (63.6%). Most participants perceived treatment effectiveness based on physician-explained clinical signs (68.2%) and symptom relief (40.9%). Participants experienced gastrointestinal adverse events (59.1%), fatigue (59.1%), sleep disturbances (31.8%), and allergic reactions (31.8%) with treatment. Key elements of treatment burden included the duration of a typical treatment day (68.2%), treatment interfering with daily activities (54.5%), and infusion duration (50.0%).ConclusionsThese results provide treatment experience–related data to further understand RRMM treatment burden and better inform treatment decision-making.

The efficacy of henna (Lawsonia inermis L.) mouthwash versus chlorhexidine gluconate 0.2% mouthwash as adjuvant therapy of oral lichen planus: A randomized double-blind clinical trial

Ethnopharmacological relevanceIn modern medicine, some traditional remedies are introduced to be effective in treatment. Accordingly, the henna plant (Lawsonia inermis L.) is studied more than before. Previous studies have shown many medical properties for henna, such as anti-inflammatory and anti-fungal properties. Aim of the studyOral lichen planus (OLP) is a common mucocutaneous disease with chronic immunomodulatory disruptions. Topical corticosteroids are the first line of OLP treatment. Previous studies have suggested different adjunctive therapies for preventing the side effects of corticosteroids overuse. This study aimed to compare the effects of henna and chlorhexidine mouthwashes as adjunctive therapy. Materials and methodsThis parallel-group, double-blind, randomized controlled study was conducted on forty OLP patients. Luteolin content was determined in Henna mouthwash composed of 2% aqueous extract of henna, 2% ethanol, 10% glycerol, and 0.1% methylparaben distilled water. Henna or chlorhexidine mouthwashes were prescribed twice daily as an adjuvant to the topical corticosteroid treatment. Visual analog scale (VAS) index and Thongprasom rating were used to measure pain intensity and clinical signs of patients at days 0,7, and 14. The collected data were analyzed using SPSS software (version 26.0; SPSS). Ordinal logistic regression was used to investigate the effect of independent variables on Thongprasom and VAS scores. ResultsIn this clinical trial, 82.6% of the participants were women. There was no difference between the two study groups in terms of VAS scores (p = 0.404) and clinical features (p = 0.305) in the second follow-up visit. All drug regimens caused clinical signs and symptoms relief. ConclusionsThere was no significant difference between the groups receiving topical corticosteroid supplementation, neither henna mouthwash nor chlorhexidine mouthwash. The therapeutic effects of henna mouthwash in the main or adjuvant treatment of OLP need more evaluation in future research. Henna mouthwash can be a good alternative to chlorhexidine mouthwash if no side effects are reported.

Application of Kissing Technique for the Treatment of Superior Vena Cava Syndrome

Superior vena cava syndrome is a series of symptoms caused by compression of the superior vena cava and its main branches. Endovascular therapy is now widely accepted because it offers rapid, safe and effective relief of clinical symptoms. Few reports have described the application of kissing technique for the treatment of superior vena cava syndrome. In this report, we review a series of cases in which superior vena cava syndrome was treated by kissing technique and we share our experience. Our institute treated 22 patients with SVCS by endovascular intervention from November 2016 to June 2021; among them, the kissing technique was used in 10 cases and achieved satisfactory results. This is a retrospective evaluation and analysis of 10 patients with superior vena cava syndrome who were treated by endovascular intervention using the kissing technique from May 2018 to April 2021 in Hwa Mei Hospital, University of Chinese Academy of Sciences. Based on literatures, we summarize the diagnosis, treatment, and surgical experience. All patients underwent the implantation of the kissing stents, and the technical success rate was 100%. The symptoms and signs of intravenous obstruction in all patients were alleviated or disappeared within 1-3 days after the procedure. During the follow-up period, 9 patients remained free from any clinical signs or symptoms, and 1 patient died 1 month after the procedure due to the progression of malignant tumors. As a palliative intervention, the kissing technique for the treatment of superior vena cava syndrome caused by malignant tumors is safe, rapid, and effective. Successful endovascular therapy can quickly relieve symptoms, improve the patient's quality of life, and provide more opportunities for subsequent antitumor treatment.

Relationship of remedies: A key to success

Aim: Utility of Relationship of remedies in effective Homoeopathic management.Materials and Methods: The subjects for this study have been selected from outpatient department, in-patient department and peripheral centres as per the inclusion criteria. Total number of 30 cases was selected by random sampling technique. The data was collected based on the chronic cases and followed by remedies related during the second prescription and recorded in the required case format. According to the case format, cases were analyzed, synthesized and management was instituted and treated Homoeopathically.Follow ups were watched and interpreted as per criteria set up in each case. Total duration of study for each case was been kept for 4-6 months unless the patient shows dramatic improvement before the scheduled time. All the patients were directed to continue with the same diet as earlier. No specific supplementary diet advised. Effectiveness of the treatment was assessed on the basis of Clinical improvement, disappearance or relief of symptoms, improvement of general health of the patient.Result: Thirty patients, who attended the OPD and rural centers, were taken for the study. This study has been conducted during the period of 1 year. The statistical analysis made here is based on the data’s obtained from these thirty patients. A total of 30 cases were taken for the study for a period of 4- 6 months in the case records were maintained.Out of 30 cases16 cases were follow well, out of which 3 were males (10%) and 13 were females (43.33%), of which all 16 cases improved (53.33%).6 cases were complement, out of which 3 were males (10%) and 3 females (10%), of which all 6 cases improved (20%).5 cases were follow well as well as complement, out of which 1 was male (3.33%) and 4 females (13.33%), all the 5 cases improved (16.67%).1 case (3.33%) was antidote, which was a female, it didn’t show perceptible difference.2 cases (6.67%) were inimical, both females, didn’t show perceptible difference So the result was, improvement of 27 cases (90%) and 3 cases (10%) didn’t show perceptible difference.

Role of Corticosteroids in Tubercular Pleural Effusion: A Prospective Interventional Study from a Tertiary Care Teaching Hospital, Telangana, India

Introduction: Tuberculosis is a major public health problem in majority of the developing countries. Pleural effusion develops when fluid accumulates between the parietal and visceral pleura. Aim: To evaluate the efficiency of corticosteroids in rapid clinical and radiological resolution of TPE. Also to study the recurrence of pleural effusion and find incidence of pleural fibrosis in patients treated with corticosteroids. Materials and Methods: This prospective interventional study was conducted at Government Chest Diseases and TB hospital (tertiary care teaching hospital), Telangana, India, from October 2014 to October 2016. Total 80 patients with TPE were divided into two groups. Steroid group (n=40), patients received standard Antitubercular Treatment (ATT) that was alternate day regimen along with prednisolone 0.75 mg/kg body weight per day for 2 weeks there after tapering of the dose done every 2nd weekly in next 4 weeks. Non steroid group (n=40), patients received standard ATT alone that was alternate day regimen under Directly Observed Treatment Short course (DOTS) therapy based on Revised National TB Control Programme (RNTCP) guidelines respectively. All patients were followed in the Outpatient Department at the end of second, fourth, sixth, 24th week. At every follow-up visit, history obtained from patients regarding symptoms and chest radiographs for comparison of reabsorption of pleural fluid between two groups. At the end of treatment ultrasound of the chest was performed to confirm the presence of pleural thickening seen on chest radiograph. Descriptive measures obtained included as mean and standard deviation. The association between two categorical variables done by using Chi-square test. The p-values<0.05 was considered as statistically significant. Results: There was early initiation of symptomatic relief in patients treated with steroid group as compared to non steroid group (p-value <0.001). Average duration for symptomatic relief in steroid group was 3.42 days (range 1-7 days) and in non steroid group 8.3 days (range 1-42 days). There was significant difference between two groups in duration taken for symptomatic relief (p-value <0.001). Conclusion: Results of the present study suggest that corticosteroids still play some role in the treatment of TPE. Addition of the corticosteroids to the standard ATT exerts more rapid relief of clinical symptoms. The rapidity in pleural fluid absorption is not influenced significantly by adding corticosteroids to the ATT. There was no recurrence of pleural effusion after addition of corticosteroids to ATT. The incidence of pleural thickening was not influenced by steroids.

Therapeutic effect of a combination of montelukast and vitamins A and D drops in children with bronchial asthma, and its influence on quality of life

Purpose: To investigate the efficacy of a combination of montelukast and vitamins A and D drops in bronchial asthma children, and its effect on quality of life.Methods: Sixty bronchial asthma children from June 2018 to June 2020 were collected and randomized into study group and control group (30 cases in each group). Control group received montelukast sodium (chewable tablets), while the study group received vitamins A and D drops (capsules) plus. Clinical efficacy, lung function, serum inflammatory factors, and quality of life were evaluated and compared.Results: Compared with control group, total treatment effectiveness was higher and the symptom remission period was shorter in the study group (p < 0.05). Post-treatment, the parameters of FEV1 and FVC increased in both groups, but higher in the study group (p < 0.05). Serum levels of CRP and IL-4 in both groups decreased after treatment, while serum IL-10 levels were significantly up-regulated. Compared with control group, the levels of these indicators were improved in the study group (p < 0.05). Post-treatment Chinese Version of Pediatric Quality of Life Asthma Specific Scale (PedSQL) score was higher than before treatment, with higher values (for all indicators) in the study group (p < 0.05).Conclusion: The combination therapy of montelukast and vitamins A and D drops produces good clinical efficacy in children with bronchial asthma. It significantly shortens the time taken for relief of clinical symptoms, improves lung function, reduces inflammatory response, controls asthma, and improves the quality of life of the patients.

Percutaneous Endoscopic Lumbar Discectomy for Huge Lumbar Disc Herniation with Complete Dural Sac Stenosis via an Interlaminar Approach: An Observational Retrospective Cohort Study.

PurposePercutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive spinal surgery for huge lumbar disc herniation (HLDH). The aim of this study was to investigate the short-term clinical effectiveness of PELD for HLDH with complete dural sac stenosis via an interlaminar approach.MethodsWe retrospectively analyzed 56 patients diagnosed with HLDH with complete dural sac stenosis and treated with PELD via an interlaminar approach. Numerical rating scale (NRS), Oswestry disability index (ODI), and modified Japanese orthopedic association (mJOA) were used to evaluate preoperative conditions as well as outcomes at 1, 3, 6 and 12 months postoperatively. At the final follow-up, the clinical effects were evaluated using modified MacNab criteria.ResultsAll patients were followed for at least 12 months. At 1, 3, 6, and 12 months postoperatively, the NRS and ODI scores were significantly decreased, and the mJOA score significantly increased compared with preoperative results (P<0.001). According to the Macnab criteria at the final follow-up, it was excellent in 42 patients (75%), good in 9 (16.1%), and fair in 5 (8.9%). The overall clinical satisfactory rate was 91.1%.ConclusionOur study results suggest that percutaneous endoscopic interlaminar discectomy (PEID) is available for the treatment of HLDH with complete dural sac stenosis, whose benefits are rapid recovery, complete removal of the herniated disc, effective spinal canal decompression, fewer complications, and significant relief of clinical symptoms.

The incidence of myocarditis in patients with COVID-19 and in-hospital mortality.

Objective: To determine the Incidence of myocarditis in patients with COVID-19 and in-hospital mortality. Study Design: Observational Cohort study. Setting: Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat. Period: 15 to 30 March 2020. Material &amp; Methods: Patients with positive PCR results for COVID-19 were included in this study after informed consent; patients with prior history of any cardiovascular, pulmonary or other co-morbidity were excluded while patients having history of hypertension, diabetes or smoking were included in the study. All the patients remain admitted for 14 days. Patients were evaluated clinically, by ECG, troponins and echocardiographically for diagnosis of myocarditis. Patients were managed conservatively. Incidence of myocarditis and in-hospital mortality was noted. Successful treatment towards hospital discharge was relief of clinical symptoms, a-febrile, clear chest X-Ray and at least two consecutive negative PCR for covid-19. P-value &lt;0.05 was considered as significant. Data was analyzed with SPSS -23. Results: Out of fifty five, 5(9%) patients were diabetics and 4 were hypertensive. Five (9%) developed mild pneumonia which recovered conservatively and three (5.4%) patients developed myocarditis. One (1.8%) patient expired having myocarditis. Duration of follow up was only during hospital stay. So our in-hospital mortality was 1.8%, p value was calculated as significant &lt; 0.05. Conclusion: Myocarditis is a known but less common complication of COVID-19. Cardiac injury is more in those with previously having cardiovascular or other co-morbidities. In healthy and immunocompetent population its incidence is quite low.

RELIEF: A Digital Health Tool for the Remote Self-Reporting of Symptoms in Patients with Cancer to Address Palliative Care Needs and Minimize Emergency Department Visits.

The lack of timely symptom reporting remains a barrier to effective symptom management and comfort for patients with cancer-related palliative care needs. Poor symptom management at home can lead to unwanted outcomes, such as emergency department visits and death in hospital. We developed and evaluated RELIEF, a remote symptom self-reporting app for community patients with palliative care needs. A pilot feasibility study was conducted at a large, community hospital in Ontario, Canada. Patients self-reported their symptoms each morning using validated clinical symptom measures and RELIEF would alert for worsening or severe symptoms. RELIEF alerts were monitored by palliative care nurses who would then contact patients to determine if appropriate clinical intervention could be initiated to avoid unnecessary emergency department visits. A total of 20 patients were recruited to use RELIEF for two months. Patients completed 80% of daily self-report assessments; 133 alerts were trigged, half of which required clinical intervention. No patient visited the emergency department for symptom management during the study. Clinical staff estimated five emergency department visits were avoided because of RELIEF—saving an estimated cost of over CAD 60,000. RELIEF is a feasible and acceptable method for the remote monitoring of patients with palliative care needs through regular symptom self-reporting.

Increase in plasma CCL11 (Eotaxin-1) in patients with alcohol dependence and changes during detoxification

BackgroundAlcohol is known to modulate the immune system. Neuroinflammatory cytokine dysregulation plays an essential role in the pathophysiology of alcohol dependence (AD). Preclinical studies have indicated that alcohol consumption upregulates the pro-inflammatory cytokine CC motif ligand 11 (CCL11, also known as eotaxin-1). We examined CCL11 levels in patients with AD and in mice administered alcohol. MethodsThe plasma CCL11 levels of 151 patients with AD and 116 healthy controls were measured. In addition, we followed the CCL11 levels, alcohol cravings and psychological symptoms in patients with AD after 1 and 2 weeks of detoxification. Furthermore, we examined CCL11 changes in mice administered alcohol for 5 days. ResultsCCL11 levels were higher in patients with AD than in controls and declined during detoxification. CCL11 levels were positively correlated with AD severity (p < 0.001). Furthermore, mice exposed to alcohol exhibited a higher CCL11 level. The receiver operating characteristic curve revealed that a CCL11 level of 72.5 pg/mL could significantly differentiate patients with AD from controls (area under the curve: 0.77; p < 0.001). Reductions in CCL11 levels during detoxification were correlated with reductions in alcohol craving, depression, and anxiety. ConclusionsOur data from humans and mice suggest that chronic alcohol consumption is associated with an increase in CCL11 levels. CCL11 levels are correlated with AD severity and may be a potential indicator of AD. The CCL11 reduction after alcohol discontinuation is associated with alleviation of clinical symptoms. Collectively, our findings suggest that CCL11 is involved in the neurobiological mechanisms underlying AD.

Питання терапії біліарної патології у дітей: вибір оптимального рішення

Актуальність. Захворювання гепатобіліарної системи — одна з найбільш поширених проблем педіатричної гастроентерології. Захворювання біліарного тракту (БТ) супроводжуються стійкими змінами обміну ліпідів, що сприяє тривалому холестазу і прогресуванню біліарної патології. Мета дослідження — вивчити ефективність застосування препарату Урсофальк® у комплексній терапії захворювань БТ і коморбідних станів у дітей. Матеріали та методи. У міському гастроентерологічному відділенні м. Харкова обстежено 55 дітей віком від 5 до 18 років (31 дівчинка та 24 хлопчика). Критерії включення пацієнтів у дослідження: захворювання БТ, що супроводжуються біліарним сладжем (БС) і порушенням ліпідного профілю (ЛП) сироватки крові. Діагностичний комплекс включав: аналіз клінічних даних, УЗД органів черевної порожнини, біохімічне дослідження сироватки крові («печінкові проби», ЛП). Усі діти отримували комплексне лікування з урахуванням коморбідної патології. Тривалість курсу терапії — 1 місяць. Пацієнти були розділені на дві групи залежно від жовчогінної терапії: 1-ша (основна) група отримувала традиційні жовчогінні засоби, 2-га (група порівняння) — препарат Урсофальк®. При статистичній обробці використані ліцензовані програмні продукти (Statistica, Excel). Результати. Клінічні прояви у дітей груп спостереження були представлені больовим і диспептичним синдромами. У всіх обстежених виявлено коморбідні стани і наявність БС до початку лікування. Після закінчення курсу лікування відзначалася позитивна динаміка клінічних симптомів, лабораторних показників і гомогенності структури жовчі. Застосування в комплексній терапії Урсофальку® дозволило повністю компенсувати відчуття тяжкості та іррадіацію болю, тоді як у дітей групи порівняння зберігалися больовий синдром, тяжкість у правому підребер’ї, диспептичні скарги. Слід зазначити, що застосування Урсофальку® дозволяє також нормалізувати структуру жовчі і біохімічні показники, що характеризують ліпідний обмін. Зареєстровано вірогідно (p &lt; 0,05) більш виражений ефект зменшення частоти порушень гомогенності жовчі в основній групі — на 65,5 % порівняно з групою порівняння — 27,3 %. Позитивна динаміка біохімічних показників при контрольному обстеженні відзначалася в обох групах пацієнтів, при цьому вірогідно (p &lt; 0,05) більш вираженими були зміни в групі дітей, які приймали Урсофальк®. Висновки. Застосування урсодезоксихолевої кислоти (УДХК) патогенетично обґрунтоване для корекції функціональних, метаболічних порушень при біліарній патології та коморбідних станах, що підтверджують результати спостереження. При призначенні Урсофальку® в комплексній терапії захворювань жовчовивідної системи у дітей відзначається швидка регресія і купіювання клінічних симптомів, нормалізація лабораторно-інструментальних показників. Урсофальк® є референтним препаратом УДХК. Наявність офіцінальної форми препарату Урсофальк® у спеціальній лікарській формі для дітей у вигляді суспензії дозволяє застосовувати УДХК в дитячому віці, починаючи з перших днів життя.

The effects of blood purification combined with antibiotics on extravascular lung water index, inflammatory factors, and prognosis of patients with severe acute pancreatitis complicated with acute respiratory distress syndrome.

To retrospectively analyze the effects of routine treatment and blood purification combined with antibiotics on the extravascular lung water index (EVLWI), inflammatory factors, and treatment outcomes in patients with severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). A total of 131 SAP patients admitted to the intensive care unit of Suzhou Ninth Hospital Affiliated to Soochow University from January 2019 to December 2020 were retrospectively enrolled in this study. Patients were divided into two groups according to the treatment methods. In addition to conventional treatment, 60 patients in group A received continuous blood purification (CBP) treatment and 71 patients in group B did not. The EVLWI, inflammatory factors, remission time of clinical symptoms, curative effect, and patient outcomes were recorded at admission and after 1, 3, 5, and 7 days of treatment. There was a statistically significant difference in the clinical symptom relief time and the clinical efficacy between the two groups of patients (P<0.05). The mortality rate of patients in group A was 3.33%, which was significantly lower than the 14% mortality rate observed in patients in group B (P<0.05). The EVLWI, as well as the C-reactive protein (CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α levels were significantly lower in group A patients compared to group B patients on day 1, 3, and 7 post-treatment (P<0.05). There was also a significant difference in APACHE II scores between the two groups (P<0.05). The incidence of adverse reactions in group A was 6.7%, which was significantly lower than the 22.5% incidence observed in group B (P<0.05). Continuous blood purification combined with antibacterial drugs is safe and has a significant effect on the treatment of SAP patient complicated with ARDS, including effectively relieving clinical symptoms and signs, reducing the level of inflammatory factors, and promoting early disease outcomes.

Acute oral colchicine caused gastric mucosal injury and disturbance of associated microbiota in mice

Colchicine (COL), an ancient and well-known drug, has been used in clinical practice for centuries. On the other hand, COL has also attracted extensive concerns for its potent toxic effects, especially gastrointestinal adverse reactions (nausea, vomiting, and diarrhea) before clinical symptoms relief. In this study, we used a rodent model to study the effects of COL on gastric mucosa and associated microbiota. The mice were exposed to various concentrations of COL (0.1, 0.5, and 2.5 mg kg−1 body weight per day) for 7 days, and the results showed that COL treatment caused severe gastric mucosal damage, accompanied by a significant decrease in gastric mucosal proinflammatory cytokines (IL-1β, IL-6, and TNF-α). The 16S rRNA gene sequencing revealed that COL significantly perturbed the gastric microbiota composition and reduced the gastric microbiota diversity in mice. Also, we identified bacterial biomarkers associated with diarrhea, including phylum Firmicutes, class Bacilli, order Lactobacillales, family Lactobacillaceae, genu Lactobacillus, and genu Blautia, suggesting that COL-triggered adverse reactions are closely related to gastric microbial perturbations. Our findings open new paths for understanding the mechanism of COL-related adverse gastrointestinal reactions, broadening the scientific view on the interaction between drugs and host gastrointestinal microbiota.

The Effect of Sodium Thiosulfate on Coronary Artery Calcification in Hemodialysis Patients.

This study aimed to effectively control the disease process of hemodialysis outpatients. Hemodialysis secondary hyperparathyroidism patients were randomly divided into the control group and treatment group. The control group was treated with routine treatment, and the treatment group was treated with sodium thiosulfate based on the control group. The changes of serum calcium, phosphorus, whole parathyroid hormone, calcium-phosphorus product and coronary artery calcification (CAC) score, as well as the relief of clinical symptoms, postoperative complications and recurrence in the preoperative and postoperative periods were observed. The levels of C-reactive protein and CAC scores were significantly decreased in the treatment group after treatment. While there was no significant difference in blood calcium, blood phosphorus, PTH, calcium-phosphorus product, and CAC score in the control group after treatment. And after treatment, the proportion of skin pruritus, myasthenia, bone pain, insomnia, restless legs syndrome, and other symptoms in the treatment group was significantly decreased compared with those before treatment, but there was no significant change in the control group before and after treatment. Sodium thiosulfate can reduce the high level of CAC in hemodialysis patients obviously.