Significant Improvement In Symptoms Research Articles

A Randomized Controlled Trial of a Virtually Delivered Group Parent Training for Parents of Children with ADHD During an Intensive Summer Treatment Program

ABSTRACT Background Behavioral Parent Training (BPT) is a widely implemented evidence-based treatment for youth with Attention-Deficit/Hyperactivity Disorder (ADHD) and related behavioral problems. During the COVID-19 pandemic, BPT was rapidly scaled for remote delivery via video conferencing platforms to enhance reach and engagement among families in need. Objective The purpose of the present study was to conduct a randomized controlled trial of a remotely delivered group-based BPT implemented in tandem with the Summer Treatment Program (STP) during the summer of 2021, the first year our clinic returned to in-person services following initial pandemic-related lockdowns. Method Children ranged in age from 6 to 12 years (M = 8.23, SD = 1.51) and were primarily male (93%) and Hispanic/Latine (74.4%). Families were randomly assigned to either receive the virtually delivered BPT during the summer (N = 23) or to a wait-list control group (N = 20), who received virtually delivered BPT in the fall. Results All families reported significant improvements in ADHD symptoms, related impairments, negative parenting behaviors, and knowledge of effective parenting skills from pre- to post-STP. Parents in the BPT group demonstrated additional improvements in managing difficult home situations. Conclusions Results of the study suggest that participating in BPT alongside the STP produces unique benefits for families above the standard behavioral treatment. Additionally, this study demonstrates the feasibility and utility of virtual group-based BPT to reduce burden associated with in-person services while providing evidence-based care in an inclusive manner.

Case report: A suspected case of chronic pulmonary sparganosis characterized by migrating cavities and tunnel sign

A 20-year-old male patient with a 15-month history of recurrent cough and hemoptysis presented at our hospital with suspected pulmonary sparganosis. Computed Tomography (CT) revealed migratory and variable lesions ranging from patchy shadows to nodular and cavernous foci. Additionally, the location and morphology of the cavities changed rapidly. The patient’s peripheral blood eosinophil count remained within the normal range throughout the course of the infection, and antibiotics (moxifloxacin) alleviated the symptoms. At the early stage of admission, there was a slight increase in neutrophil and basophil counts. Initial treatment with a standard dose of praziquantel led to a significant improvement in symptoms, but the symptoms soon relapsed. However, doubling the dose 4 months later eventually cured the disease. The migratory nature of the CT lesion and the presence of tunnel signs were key to diagnosing a parasitic infection. The variability and rapid changes in the lesion further facilitated the differentiation of the disease, which rarely manifests as a granulomatous cavity.

A Case Report of JAK Inhibitors Therapy for Adult-Onset Still's Disease with Persistent Pruritic Lesions.

Adult-onset Still's disease (AOSD) is a recognized autoinflammatory disorder of unknown etiology. The standard initial management for AOSD includes conventional corticosteroids and disease-modifying antirheumatic drugs. In cases that are resistant to these treatments, additional therapeutic options such as immunosuppressants, biologics, and other alternative treatments may be considered. Yet, a significant proportion of patients remain unresponsive to these therapeutic interventions. Herein, a case is reported involving a patient with AOSD who had persistent pruritic lesions that did not respond to conventional therapy, but were alleviated with Janus kinase inhibitors (JAKi), namely baricitinib and upadacitinib. The objective is to expand the number of refractory AOSD cases treated with JAKi in clinical practice. Another aim is to offer potentially effective therapeutic options for AOSD patients who experience persistent pruritus. A case was reported involving AOSD characterized by persistent pruritic lesions that failed to respond to conventional treatment, but showed favorable outcomes with JAKi therapy. An analysis of the PubMed literature was performed to assess the medication's efficacy and explore possible mechanisms. The present case study is one of the few documented instances exploring the use of JAKi for treating AOSD, aligning with previously published research. After initiating JAKi therapy, the patient exhibited significant improvement in symptoms, most notably a reduction in persistent pruritus. Additionally, there was a substantial decrease in the patient's glucocorticoid dosage. Aside from minor renal function anomalies, no adverse reactions were observed. The present case illustrates that JAKi can provide rapid and sustained clinical improvement in patients with AOSD, especially those who have not responded to conventional treatment, and they have the ability to alleviate persistent itching. Further investigation is needed to ascertain the precise mechanism.

A hospital and community-based violence intervention program for Black & Latino youth and their caregivers.

Black and Latino youth are disproportionately affected by trauma from community violence, but to date, few data support the benefit of evidence-based treatments for these youth or of including peer support to engage these youth in mental health services. From 2018 until 2020, a hospital and community-based violence intervention program in Philadelphia pilot tested the integration of home and community-based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with peer services and case management for youth impacted by community violence. This study describes the implementation of this intervention. Data was gathered by querying the program's database. The Child Post Traumatic Stress Symptom Severity Scale (CPSS-SR-5) and the Short Mood and Feelings Questionnaire (SMFQ) were utilized to evaluate the participants' pre- and post-intervention assessment of PTSD and depression. The sample (N = 50) consisted of Black and Latino youth, mean age 14. Twenty-nine (58%) completed TF-CBT, and 82% met peer and case management goals. Youth who completed therapy showed significant improvement in both PTSD and depression symptoms at post-test. To our knowledge, this is the first study describing the implementation of home and community-based TF-CBT with peer support and case management. The study's limitations and need for further research are discussed.

A Case Report of Mixed Connective Tissue Disease Predominantly Manifesting as Systemic Sclerosis in a Middle-Aged Nepali Woman

Introduction: Mixed connective tissue disease (MCTD) is a rare systemic autoimmune disorder, first described in 1972, that presents with overlapping features of systemic lupus erythematosus, systemic sclerosis, and polymyositis. The diagnosis of MCTD is complex and often delayed due to its varied clinical manifestations and the requirement of serological confirmation, particularly the presence of anti-U1 RNP antibodies. Despite its global prevalence, data on MCTD are limited, especially in the South Asian population.  Case Report: We present the case of a 42-year-old Nepali woman with a decade-long history of myalgia, muscle weakness, and joint pain, initially misdiagnosed as rheumatoid arthritis. Over time, she developed Raynaud phenomenon, dysphagia, and progressive muscle weakness, which prompted further investigation. Serological testing revealed elevated levels of anti-U1 RNP antibodies and a positive antinuclear antibody (ANA) titer, confirming the diagnosis of MCTD according to the Alarcón-Segovia criteria. The patient was successfully managed with a regimen of corticosteroids, hydroxychloroquine, and nifedipine, resulting in significant symptomatic improvement.  Discussion: This case underscores the diagnostic challenges associated with MCTD, a condition that may present with nonspecific symptoms and mimic other rheumatic diseases. The prolonged diagnostic journey of this patient highlights the need for heightened clinical suspicion and comprehensive serological testing in patients with overlapping connective tissue disease features. Furthermore, the case contributes to the limited body of literature on MCTD in the South Asian population, emphasizing the importance of early recognition and tailored management strategies to improve patient outcomes.  Conclusion: MCTD is a complex and under-recognized autoimmune disorder, particularly in the South Asian context. This case report highlights the importance of considering MCTD in the differential diagnosis of patients with multi-systemic involvement and underscores the role of serological testing in confirming the diagnosis. Early diagnosis and appropriate management are crucial in mitigating disease progression and improving the quality of life for patients with MCTD.

Dynamic tightrope fixation for the correction of the 1,2 intermetatarsal angle in hallux valgus surgery

Introduction Hallux valgus is a common foot deformity that causes forefoot widening, difficulty fitting shoes, bunion pain, and transfer metatarsalgia. Studies have shown that correcting the 1,2 intermetatarsal angle (IMA) can significantly reduce forefoot width and improve symptoms. This study aims to review the radiological and functional outcomes of hallux valgus reconstruction with IMA closure using mini-tightrope suture buttons. Methods A case series of 52 consecutive patients who underwent minimally invasive surgical reconstruction of hallux valgus deformity utilising the dynamic tightrope fixation was included. All patients had >1 year follow-up with interim assessments at baseline, 3 months, 6 months, and 1 year. Primary outcomes included IMA in weight-bearing feet X-rays, and secondary outcomes included the hallux valgus angle (HVA) and clinical function via the Foot and Ankle Outcome Score. Results Based on radiological analysis, the 1,2 IMA and the HVA significantly improved. Clinical function also showed significant improvement in symptoms, pain, activities of daily living, and quality of life subsection. No major intra-operative complications occurred in this series; however, ∼5% of the patients required revision surgery due to a recurrence of the hallux valgus or overcorrection into hallux varus. Conclusion Dynamic tightrope fixation is a simple surgical technique that effectively corrects the 1,2 IMA during hallux valgus surgery.

Interdisciplinary CBT treatment for patients with odontophobia and dental anxiety related to psychological trauma experiences: a case series

BackgroundWhile cognitive-behavioural therapy (CBT) is a well-established treatment for odontophobia, research is sparse regarding its effect on patients with dental anxiety related to psychological trauma experiences. This study aimed to evaluate changes in symptoms and acceptability of interdisciplinary Torture, Abuse, and Dental Anxiety (TADA) team treatment for patients with odontophobia or dental anxiety. We also wanted to describe the sample’s oral health status. The TADA teams offer targeted anxiety treatment and adapted dental treatment using a CBT approach.MethodsThe study used a naturalistic, case series design and included 20 consecutively referred outpatients at a public TADA dental clinic. Pre- and post-treatment assessments included questionnaires related to the degree of dental anxiety, post-traumatic stress, generalized anxiety, and depression. Patients underwent a panoramic X-ray before treatment. Before dental restoration, patients underwent an oral health examination to determine the mucosal and plaque score (MPS) and the total number of decayed, missing, and filled teeth (DMFT). Patients were referred to dentist teams for further dental treatment and rehabilitation (phase 2) after completing CBT in the TADA team (Phase 1). Results from the dental treatment in phase 2 is not included in this study.ResultsAll patients completed the CBT treatment. There were significant improvements in symptoms of dental anxiety, post-traumatic stress, and depression and moderate changes in symptoms of generalized anxiety. Dental statuses were heterogeneous in terms of the severity and accumulated dental treatment needs. The TADA population represented the lower socioeconomic range; 15% of patients had higher education levels, and half received social security benefits. All patients were referred to and started adapted dental treatment (phase 2).ConclusionsTADA treatment approach appears acceptable and potentially beneficial for patients with odontophobia and dental anxiety related to psychological trauma experiences. The findings suggest that further research, including larger controlled studies, is warranted to validate these preliminary outcomes.Trial registrationThe study was approved by the regional ethical committee in Norway (REK-Midt: 488462) and by the Data Protection Board at Møre and Romsdal County Authority.

Isoflavones obtained from red clover improve both dyslipidemia and menopausal symptoms in menopausal women: a prospective randomized placebo-controlled trial

Objective This study aimed to investigate the effects of red clover isoflavones on menopausal symptoms and the lipid profile in menopausal females. Methods This study included postmenopausal women with dyslipidemia. The red clover group (n = 39) received 40 mg isoflavone red clover capsule twice daily for 6 months, while placebo (n = 36) was 40 mg starch capsule twice daily. Data were collected at baseline, 3 months and 6 months. The Menopause Rating Scale (MRS) was applied to calculate subdimension and total scores. Results The two groups were similar in terms of age, MRS and lipid profile at baseline. In the red clover group, MRS scores decreased significantly at both 3 and 6 months. Similarly, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglyceride levels decreased at both 3 months and 6 months. High-density lipoprotein cholesterol increased significantly from baseline to 3 months and 6 months. Except for LDL-C and MRS urogenital score at 3 months, the improvements were significantly in favor of red clover isoflavone treatment. Conclusions Red clover treatment for 3–6 months demonstrated significant improvements in lipid profiles and menopausal symptoms. While promising, further research is crucial to ascertain long-term safety and recommend the use of red clover isoflavones during menopause.

Case Series and Literature Review of Up-to-date Surgical Management of Occipital Neuralgia

AbstractNerve decompression is an emerging surgical treatment option for patients with occipital neuralgia. However, limited research is available on the efficacy of this treatment in South Korea. This retrospective study evaluates the efficacy of nerve decompression surgery in patients with chronic migraines, specifically focusing on occipital neuralgia, in South Korea. Between January 2019 and December 2022, six patients diagnosed with occipital neuralgia, who had not responded to conservative treatments, underwent nerve decompression surgery. This procedure, performed under local anesthesia, involved decompression of the greater and/or lesser occipital nerves. Patient data were analyzed for headache frequency and intensity (using the Numeric Rating Scale [NRS]) and the decrease in oral medications needed postsurgery. Results showed significant improvement in headache symptoms postsurgery, with the average preoperative NRS score of 7.9 dropping to 3.7 postoperatively. Additionally, the average number of medications used decreased from 3.2 to 1.3. No significant surgical complications were reported. The study highlights the potential of nerve decompression as an effective treatment for occipital neuralgia, particularly in cases resistant to traditional medical management.

SP9.14 - Gastro-oesophageal reflux disease outcomes in patients with obesity following gastric bypass surgery: a systematic review and meta-analysis

Abstract Introduction Obesity is associated with increased incidence of gastro-oesophageal reflux disease (GORD). Gastric bypass is one of the most common bariatric procedures and has favourable weight loss outcomes leading to a decrease in morbidity and mortality. However, the exact impact of gastric bypass on GORD symptoms remains less well understood. This systematic review and meta-analysis aimed to investigate the relationship between gastric bypass surgery and GORD. Methods A literature search of MEDLINE, Embase, Emcare and CINAHL was performed for studies that reported on GORD outcomes following gastric bypass from January 2000 to June 2023. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed. The study was registered in the PROSPERO database (CRD42023495567). Results 16 studies with 28,438 patients (follow-up ranging from 6-100 months), with laparoscopic Roux-en-Y gastric bypass being the most common procedure performed (25,567; 90%). The mean operative time for gastric bypass was 101 ± 14.0 minutes, with a re-operation rate of 0.025% ± 0.005. Sixty percent of patients permanently stopped proton-pump inhibitors following surgery. Overall, gastric bypass surgery led to a significant improvement in GORD symptoms (OR 5.31%; 95% CI: 1.77-15.91; p<0.003), with a postoperative mortality rate of 0.037% ± 0.009. Conclusions The findings of this systematic review and meta-analysis showed that gastric bypass surgery is an effective and safe treatment for GORD. This has significant implications for counselling patients with obesity and GORD for bariatric surgery. Further research is required to understand the precise mechanism of the improvement in GORD symptoms following bariatric surgery.

Transcatheter aortic valve implantation for severe aortic regurgitation using the J-Valve system: A midterm follow-up study.

Transcatheter aortic valve implantation (TAVI) is a well-established intervention for severe aortic valve stenosis. However, its application for severe aortic regurgitation (AR) is still under evaluation. This study aims to present the 3-year follow-up outcomes of the J-Valve system in managing severe AR. The aim of this study was to evaluate the mid-term efficacy and durability of the J-Valve system in the treatment of severe AR and to provide new information on this intervention. In this retrospective, single-center study, we evaluated the prognostic outcomes of patients with AR, who underwent treatment with the J-Valve system at Nanjing Drum Tower Hospital. Consecutive patients who were treated with the J-Valve were included in the analysis. The study focused on the echocardiographic follow-up to assess the effectiveness and durability of the J-Valve system in managing AR. From January 2018 to December 2022, 36 high-risk AR patients treated with the J-Valve system had a procedural success rate of 97.2%, with one case requiring open-heart surgery due to valve displacement. Significant improvements were observed in left ventricular diameter (from 63.50 [58.75-69.50] mm to 56.50 [53.00-60.50] mm, p < 0.001) and left atrial diameter (from 44.00 [40.00-45.25] mm to 39.00 [36.75-41.00] mm, p = 0.003) postsurgery. All patients completed the 1-year follow-up, with an overall mortality rate of 2 out of 36 (5.6%). Among the surviving patients, there was one case of III° atrioventricular block and one case of stroke, both occurring within 90 days postsurgery. After a 3-year follow-up, 15.0% of patients had mild or moderate valvular regurgitation, with no cases of moderate or severe paravalvular leak. Additionally, 89.5% of patients were classified as New York Heart Association class I or II, showing significantly enhanced cardiac function. The J-Valve system has shown positive therapeutic outcomes in treating AR, with notable effectiveness in managing the condition and significant improvements in heart failure symptoms and cardiac remodeling. However, due to the limited sample size and partial follow-up data, it is important to emphasize the need for further research with comprehensive long-term follow-up, to fully validate these results.

Prospective results of the minimally invasive laser enucleation of the prostate (MiLEP).

The objective of the present study is to prospectively analyze the prostate enucleation procedure with Holmium Laser using the minimally invasive technique (MiLEP), comparing the outcomes and their variables pre- and postoperatively. We studied men aged 40 years or over, with prostate volumes greater than or equal to 35 cm³ with lower urinary tract symptoms due to BPH. We performed flowmetry and administered the IPSS questionnaire before and 6 months after the MiLEP procedure. The patients were operated on with a 60 W Holmium Laser (Cyber-Ho Quanta System®) using 54 W of power (energy 1.8 J and frequency of 30 Hz). Enucleation was performed using the en bloc technique with early sphincter release. After enucleation, the tissue was morcellated using a 22 Fr morcescope (RZ-Medizintechnik GmbH, Tuttlingen, Germany) and Piranha (Richard Wolf) morcellator. The final Hemostasis after morcelation was made using laser with 30wW power, energy at 1,0 joules and frequency at 30 Hertz. Student's T test and Man-Whitney was used to statistical analysis (p < 0.05). After selection we submitted 73 patients (mean age= 68.2 years) to MiLEP procedure with a follow up of 6 months. The prostate volume presented an average of 94.53 cm³ (65 to 112 cm³, SD = 5.363) preoperatively. The urinary continence rate after the procedure was greater than 95% after 1 week and 99% in the 1st month. All patients were continent after 6 months. The IPSS questionnaire before (mean = 21.18 points/SD = 6.557) and after (mean = 7.92 points/SD = 2.408) the MiLEP had statistical significance (p < 0.001). The flowmetry(ml/s) before (9.02/SD = 2.842) and after (21.07/SD = 6.228) the MiLEP had statistical significance (p < 0.001). The average time of the procedure was 78.5 min and the bladder catheter was removed after 18 h in mean. In 4 patients (5.8%) we observed hematuria and in 1 case (1.47%) the patient needs urinary catheterization. MiLEP is a safe and effective procedure, with significant improvement in urinary flow and symptoms in the short term. Although the results of this study were satisfactory and the urinary incontinence rate was lower compared to HoLEP data found in the literature, multicenter studies with longer follow-up are needed to confirm these findings.

Dentatorubral-pallidoluysian atrophy: a case report and review of literature

BackgroundDentatorubral-pallidoluysian atrophy is a rare autosomal dominant neurodegenerative disease. It is a rare disease in the world. Therefore, sharing clinical encounters of this case can deepen global awareness and understanding of the disease.Case presentationThe patient was a 34-year-old male of Han nationality who was unmarried. The patient was admitted owing to weakness of the left lower limb with walking instability for 2 months and aggravation for 1 month. There was no dizziness, headache, numbness of limbs, convulsions, nausea, vomiting, abdominal pain, ataxia, nausea, vomiting, or abdominal pain. No nausea, vomiting, diarrhea, abdominal distension, tinnitus, hearing loss, fever, cough, expectoration. Personal history: worked in Cambodia 5 years ago, worked in Dubai 3 years ago, engaged in computer work, smoking or drinking habits. The patient was unmarried. Family history: the mother had symptoms similar to walking unsteadily (undiagnosed). Positive signs include a wide-base gait with a rotatory nystagmus that jumps upward in both eyes. Bilateral finger-nose instability test was quasi-positive, rapid alternating test was negative, and eye closure tolerance test was positive. Tendon reflexes were active in both upper limbs and hyperreflexia in both lower limbs. Stability of the heel, knee, and tibia. Genetic testing showed that the number of repeats in the dentatorubral-pallidoluysian atrophy ATN1 gene was 18 and 62, and the (CAG)n repeat sequence in the ATN1 gene was abnormal, with a repeat number of 62, and the patient was a pathogenic variant. The patient was diagnosed with dentatorubral-pallidoluysian atrophy. Dentatorubral-pallidoluysian atrophy remains a progressive neurodegenerative disease with no effective treatment. At present, the proband is taking 5 mg of buspirone three times a day, which has been reported to improve the symptoms. The patient was followed up for 6 months after taking buspirone, and there was no significant improvement in the temporary symptoms. At present, there are few cases of dentatorubral-pallidoluysian atrophy, and the characteristics of nystagmus in this disease have not been proposed in the past. This case reported the unusual presentation of nystagmus.ConclusionDentatorubral-pallidoluygur atrophy is a rare neurodegenerative disease with autosomal dominant inheritance. To the best of our knowledge, our present case report is the first case report of dentatorubral-pallidoluygur atrophy with specific nystagmus. We describe the special eye shake and its positive signs to increase dentatorubral-pallidoluysian atrophy clinical positive signs.

The peptide regulator Vezusten in the management of overactive bladder syndrome: an efficacy evaluation

Introduction. Overactive bladder (OAB) remains one of the most difficult-to-treat conditions in neurourology. The number of patients seeking help for OAB symptoms does not decrease each year, while a pathogenetic treatment has not yet been developed. This motivates the search for new approaches.Objective. To assess the efficacy of the peptide regulator Vezusten for women with idiopathic OAB based on their health condition and urodynamic assessment of bacterial detrusor overactivity (DO).Materials &amp; methods. A prospective cohort study included 20 patients diagnosed with OAB, which was confirmed by a comprehensive urodynamic study of DO. The patients visited the clinic three times a week. Each patient received ten intramuscular injections of the peptide regulator Vezusten. Within one month after the last injection, the women were given a monitoring voiding diary, a validated Continental Society OAB Symptom Questionnaire, the Overactive Bladder Questionnaire (OAB-q), and a follow-up urodynamic study (UDS).Results. We obtained statistically significant differences in the following indicators: the number of daily urinations according to the urination diary decreased from 14.0 [13.0; 16.3] to 11.0 [8.8; 12.0] (p &lt; 0,001), patient’s episodes of urge incontinence began to be noted for the first time (p = 0.004). At the same time, the urodynamic maximum cystometric capacity (MCC) increased from 267 [158; 332] to 320 [267; 433] ml. Subjectively, participants noted an improvement in the scores of the OAB questionnaire (OAB-q) — the score decreased from 28 [22; 30] to 19 [14; 24] (p = 0.001), and the number of episodes of nocturia decreased from 4 to 2 (p &lt; 0.001). No side effects from therapy were observed in any of the patients.Conclusion. This study demonstrated a statistically significant improvement in subjective symptoms of OAB in DO-women treated with the peptide regulator Vezusten, but further large placebo-controlled studies are required for confirmation.

Association between intra-articular hyaluronic acid injections in delaying total knee arthroplasty and safety evaluation in primary knee osteoarthritis: analysis based on Health Insurance Review and Assessment Service (HIRA) claim database in Republic of Korea

BackgroundThe prevalence of knee osteoarthritis (KOA), a progressive degenerative disease, is gradually increasing, and it is a progressive degenerative disease. In patients with mild-to-moderate KOA, intra-articular hyaluronic acid (IA-HA) has been shown to be an effective non-operative treatment option that can provide significant pain relief and symptom improvement by increasing intra-articular viscoelasticity. This study aimed to evaluate the efficacy of IA-HA injections in delaying total knee arthroplasty (TKA) and the safety of IA-HA according to IA-HA type and combination with intra-articular corticosteroid (IA-CS) using a large health insurance claim database.MethodsFor this retrospective cohort study, the study population included patients aged ≥ 50 years with a first diagnosis of KOA between 2009 and 2014, who underwent TKA by 2020, using the Health Insurance Review and Assessment Service claim database in Republic of Korea. IA-HA injections were categorized as single or multiple injection regimen agents. Cox proportional hazard models estimated hazard ratios (HR) for TKA risk, adjusted for covariates. Logistic regression assessed the occurrence of adverse events after IA-HA administration.ResultsIn all, 36,983 patients were included. Patients who received IA-HA injections had a significantly longer time to TKA compared to those who did not (mean delay of approximately 1 year). The IA-HA group had a significantly lower risk of TKA (HR: 0.61, 95% CI: 0.60–0.62) than non-IA-HA group after adjusting for covariates, which included age, sex, medical history, number of hospital beds, and CS injection. Single injection IA-HA regimen agents showed the longest time to TKA and lowest risk (HR: 0.56, 95% CI: 0.53–0.59). TKA risk decreased with the number of IA-HA cycles. Adverse events occurred in 6.7% of IA-HA cases without CS, with very low incidence of infection. Multiple injection regimen agents (multiple injection regimen 7.0% vs. single injection regimen 3.6%) and concurrent IA-CS use (concurrent IA-CS use 13.9% vs. IA-HA only 6.7%) were associated with higher infection risk.ConclusionIA-HA injections were associated with a significant delay in TKA among patients with KOA. Single-injection regimen agents had the lowest TKA risk. Infection risk increased with multiple injections and concurrent IA-CS use. These findings could suggest the use of IA-HA as an effective non-operative intervention option for managing KOA and delaying TKA. Careful selection of IA-HA type and consideration of concurrent IA-CS use could play a role in delaying the time to TKA and reducing complications.

Use of bovine-derived collagen matrix in the surgical treatment of empty nose syndrome.

Bovine-derived collagen matrix (BDCM) is a safe augmentation material in patients with empty nose syndrome. BDCM augmentation results in clinically and statistically significant improvement in nasal symptoms. Improvements in nasal symptoms with BDCM augmentation may be durable and can be seen up to 2 years postoperative.

Comparative Study on Symptomatic Response and Toxicity of Concurrent Chemo-Radiotherapy and Radiotherapy Alone in the Treatment of Cervical Cancer

This prospective observational study was carried out to compare the symptomatic response and acceptable toxicity in concurrent chemo-radiotherapy and radiotherapy alone in the treatment of cervical cancer. A total of 60 patients (30 patients in arm A &amp; 30 patients in arm B) who have biopsy proven cervical carcinoma with no history of previous treatment were selected from the Department of radiotherapy Rajshahi Medical College Hospital, Rajshahi &amp; in the department of Radiation &amp; Oncology, National Institute of Cancer Research &amp; Hospital. All patients in both arms received external beam radiation with 50Gy in 25 daily fractions over five weeks. Followed by three insertions (one insertion per week) of Intracavitary brachytherapy each 700 cGy. Patients in arm-A received Inj. Cisplatin 40mg/m2 in IV infusion on the first day of each treatment per week in addition to radiotherapy. In this study it was observed that a significant symptomatic improvement was found in arm-A after treatment than arm-B and no severe unwanted reaction was noted in most of the patients. Systematic toxicity developed in both groups and comparatively more in arm-A (chemo radiation) but that was not statistically significant and well managed with conservative treatment. Regarding performance status patients treated with concurrent chemo radiation showed better performance status than the patient treated with radiotherapy alone. In this study it was observed that patients of carcinoma cervix treated with concurrent chemo radiotherapy was effective for symptomatic improvement and feasible with acceptable toxicity for advanced cancer of the uterine cervix than those with radiation alone.

High fiber diet versus polyethylene glycol in management of chronic constipation in children with cerebral palsy: A randomized controlled trial

ABSTRACT Background: Constipation is one of the most common gastrointestinal symptoms in patients with cerebral palsy. This study was conducted with the aim to compare the efficacy of a high fiber diet and polyethylene glycol in the management of chronic constipation in children with cerebral palsy. Methodology: An open-label randomized controlled trial was conducted in the Department of Pediatrics of a tertiary care hospital in Northern India among cerebral palsy children aged 1–6 years having chronic constipation. Seventy children were enrolled in the study (35 in each group). Group A children received high fiber diet as per the diet chart prepared by the dietician. Group B received polyethylene glycol (0.5–1 g/kg/day) for a period of three months. At the end of four weeks and three months, all children were assessed for clinical improvement and both groups were compared in terms of stool frequency, consistency of stool, fecal incontinence, palpation of hard stool per abdomen, blood in stool, pain on defecation and overall satisfactory outcome. Satisfactory outcome was defined as defecation &gt; two times weekly, soft stool, no pain on defecation, no palpation of hard stool on abdominal examination, no fecal incontinence, and no blood in stools. Children were also assessed for any adverse effects. Results: Baseline parameters and GMFCS were comparable in the two groups. Both group patients showed significant improvement in symptoms of constipation at the end of four weeks and three months compared to baseline. However, there was no significant difference between the two groups in terms of satisfactory outcome and parameters like frequency of stool, consistency of stool, palpation of hard stool, fecal incontinence, and blood in stools. Conclusion: A high fiber diet can be considered a good alternative to polyethylene glycol for the management of chronic constipation in children with cerebral palsy.

Classical ayurveda management of TCH (taxane, carboplatin, and herceptin) based chemotherapy induced peripheral neuropathy- A case report

Although empirical data on the influence of Ayurveda on Chemo/Radiotherapy-induced side effects are limited, its methodological framework, grounded in a 'systems thinking' perspective, enables the precise delineation of the pathogenic stage of these side effects. This, in turn, facilitates the development of a strategy to address the decline in the quality of life parameters commonly associated with cancer treatment. Ayurveda personalized approach to disease management typically involves providing customized diets, lifestyle adjustments, medications, and detoxification therapies that target the entire body.We present a case involving a patient with numbness and pain in the right hand after undergoing chemotherapy who was referred to us by an oncologist for symptom management. This case report demonstrates the Ayurveda approach for establishing the etiology, pathogenesis, pathophysiology, and treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) resulting from taxane-based chemotherapy. Following Ayurveda intervention, the patient exhibited significant improvements in symptoms and quality of life parameters.This case report systematically illustrates the application of Ayurveda approach in CIPN management.

Suture-Less and Glue-Less Amniotic Membrane Graft for Keratopathy and Early Keratinization in Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome

Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can cause significant keratopathy and lead to lasting visual effects. The main objective of this study was to describe an ocular presentation of DRESS treated with a modified suture-less and glue-less amniotic membrane graft technique. This study also provides a literature review of ocular DRESS manifestations and ocular management of the other severe cutaneous adverse reactions. Methods: This is a case review about an 82-year-old man with sepsis due to recent Mycobacterium tuberculosis, who presented with DRESS based on clinical findings. Results: The patient was treated with a modified suture-less and glue-less amniotic membrane graft technique along with a Prokera corneal bandage placement. The patient had significant improvement of visual acuity and symptoms with this technique. Conclusions: Patients with significant corneal and conjunctival involvement associated with DRESS, similar to Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), may benefit from more aggressive treatment with amniotic membrane transplantation and Prokera corneal bandage placement to prevent scarring and subsequent vision loss. The modified technique described in this article can be used for patients who may be poor candidates for the operating room.