Significant Reduction In Scores Research Articles

A 675 nm Laser in the Treatment of Facial Melasma in Dark Skin Types.

Background: Melasma therapy can be difficult and requires employing different treatment approaches. Laser therapy is a good alternative for treating melasma, especially for patients with refractory cases. Objective: To evaluate the efficacy and safety of newcomer wavelength 675 nm diode laser in treating melasma in darker skin types. Methods: Nineteen female patients with facial melasma were recruited. They received four sessions of 675 nm laser at one-month intervals using the following parameters: power 5-6 W, pulse duration 100-150 ms, spacing 2000 mm, and stack one up to 4 passes. One month after the last treatment session, the evaluation was done subjectively through the modified melasma area and severity index (mMASI) score and objectively using the Antera 3D camera. Results: After treatment, there was a highly statistically significant reduction in mMASI scores. In addition, the scores on the Antera camera recorded highly statistically significant differences in the treated areas' melanin and hemoglobin average levels. Conclusion: The novel 675 nm laser represents a safe and efficient approach in treating melasma in darker phototype patients.

The impact of antibiotic therapy in psoriasis patients with active streptococcal infection: A prospective study.

The association between psoriasis and streptococcal infection has been widely explored in both children and adults. However, the exact impact of Streptococcus pharyngeal infection on the course of psoriasis is not fully comprehended. This study explored the impact of Streptococcus pharyngeal infection on psoriasis and investigated the effectiveness of systemic antibiotic therapy in conjunction with standard topical treatment for psoriatic patients with concomitant streptococcal throat infection. The research involved 115 patients with mild-to-moderate psoriasis, clinically assessed using the Psoriasis Area and Severity Index (PASI). Patients with active streptococcal infection were administered adjunctive systemic antibiotic therapy along with standard local treatment for psoriasis, while psoriasis patients without evidence of infection received the local topical treatment only. Streptococcal infections were more common in psoriasis patients compared to healthy controls. A group of psoriasis patients with active streptococcal throat infections, treated with antibiotics in addition to standard topical psoriasis therapy, did not show any difference in PASI score reduction compared to those without evidence of active infection. While our study did not show a statistically significant reduction in PASI scores in psoriasis patients with streptococcal throat infections treated with antibiotics, it highlights the complex interaction between infection and psoriasis. Larger studies with longer follow-up may better clarify this relationship, contributing to stronger evidence for or against the use of antibiotics in managing psoriasis triggered by streptococcal infections.

Impact of cartoon-animated video, caregiver-supervised training, and pamphlet on plaque control, oral hygiene status, and oral hygiene knowledge, attitude, and practices in orphaned adolescents: A randomized controlled trial.

To evaluate the effectiveness of cartoon animated video, caregiver-supervised training, and pamphlet-based oral health education on plaque control, oral hygiene status, and oral health knowledge, attitude, and practice (KAP) among orphaned adolescents with plaque-induced gingivitis. A total of ninety adolescents were randomly selected and allocated into three different groups. Group A received the pamphlet (n=30), Group B received the cartoon animated video (n=30), and Group C received the caregiver-supervised training (n=30). A two-stage random sampling methodology was employed to select orphanages and the study population in Puducherry, India. Clinical examinations were conducted using the plaque index and simplified Oral Hygiene Index (OHI-S), and a pre-validated questionnaire was administered to assess oral hygiene KAP, which were recorded at baseline, 3-month, and 6-month intervals. All three groups experienced statistically significant reductions in plaque scores (from 3.7±0.8 to 0.9±0.2 in the pamphlet group, 3.9±0.8 to 0.4±0.2 in the animated video group, and 3.6±0.8 to 0.7±0.1 in the caregiver group) and OHI-S scores (from 3.9±0.6 to 1.3±0.3, 3.7±0.5 to 1.0±0.2, and 3.9±0.7 to 0.5±0.1, respectively). Notably, the caregiver-based training and animated video methods demonstrated superior outcomes in reducing dental plaque and improving oral hygiene, while also an increase in the KAP scores compared to the pamphlet method. Both caregiver-supervised training and cartoon animated video methods proved to be more effective than the pamphlet method on plaque control and improvement of oral hygiene status, oral health knowledge, attitude, and its application in oral hygiene maintenance.

Transcranial photobiomodulation for reducing symptoms of autism spectrum disorder and modulating brain electrophysiology in children aged 2–7: an open label study

BackgroundSmall pilot studies have indicated that transcranial photobiomodulation (tPBM) may help alleviate symptoms of neurological conditions like depression, traumatic brain injury and Autism Spectrum Disorder (ASD).ObjectiveTo examine the effect of tPBM on the behavioral symptoms of ASD and brain electrophysiology in children aged 2–7.MethodsWe conducted an open label, one-arm study with 23 participants, aged 2–7, previously diagnosed with ASD. We delivered non-invasively to all participants pulses of near-infrared light (wavelength 850 nm, pulse 40 Hz) to cortical nodes of Default Mode Network, Broca and Wernicke areas, and occipital lobe of the brain, twice weekly for 10 weeks. The tPBM was delivered using an investigational medical device designed for this purpose. Changes in ASD symptoms were measured using pre- and post-intervention scores on the Childhood Autism Rating Scale (CARS-2, 2nd Edition). We collected electroencephalogram (EEG) data after each treatment session from all children who tolerated wearing the EEG cap to monitor changes in brain activity.ResultsThe intervention resulted in a significant 7-point reduction in average CARS-2 scores (t = 10.23, p < .0001), along with decreased delta power and increased gamma and beta power in EEG readings. The increase in gamma power was statistically significant [t(14) = 2.30, p = 0.047]. Changes in EEG power were significantly correlated with the number of sessions (delta: r(192) = −0.18, p = .013; gamma: r(192) = .19, p = .007; beta: r(192) = .15, p = .04). Improvements in CARS-2 scores were negatively correlated with changes in delta and beta power (delta: r(15) = −.59, p = .020; beta: r(15) = −.54, p = .037). No moderate or severe side effects were reported.ConclusionThis study supports the potential of tPBM as a safe and effective treatment for ASD, and it suggests that EEG measurements may serve as a useful biomarker for future research. Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT04660552

P0780 Impact of Hyperbaric Oxygen Therapy on Perianal Fistulas in Crohn’s Disease: Clinical Outcomes and Remission Rates

Abstract Background Crohn's disease (CD) is a chronic inflammatory bowel disorder with debilitating complications such as perianal fistulas, affecting 14-38% of patients (1). Conventional treatments often achieve limited success, necessitating adjunctive approaches (2,3). Hyperbaric Oxygen Therapy (HBOT), known for its wound-healing and anti-inflammatory properties, has emerged as a potential therapy for complex CD cases (4,5). This study evaluates the efficacy of HBOT in combination with standard treatments for reducing perianal fistula activity and achieving clinical remission in patients with CD. Methods A cohort of 11 patients with CD-associated perianal fistulas underwent surgical preparation followed by 30 sessions of HBOT (2.5 ATA, 90 minutes per session). Disease activity was assessed using the Crohn’s Disease Activity Index (CDAI), Simple Endoscopic Score for Crohn’s Disease (SES-CD), Perianal Disease Activity Index (PDAI), and laboratory markers (CRP, fecal calprotectin, hemoglobin, and serum iron). Outcomes were evaluated at baseline, post-treatment (6 weeks), and follow-up (9 months). Results Clinical Improvement: 81.8% of patients demonstrated a significant reduction in CDAI scores. Remission Rates: 54.5% achieved remission (SES-CD, PDAI). 72.8% exhibited normalized fecal calprotectin levels (≤250 µg/g). Improvements were maintained 9 months post-treatment. Minimal side effects, including transient hearing impairment and headaches, were reported. Conclusion HBOT as an adjunctive therapy significantly improves clinical outcomes in CD patients with perianal fistulas. It enhances remission rates, reduces inflammation, and sustains benefits over long-term follow-up. This study highlights the potential of HBOT as a therapeutic option for refractory CD cases. Further randomized controlled trials are warranted to validate these findings.

Bifidobacterium animalis BD400 protects from collagen-induced arthritis through histidine metabolism

BackgroundRheumatoid arthritis (RA) is a common chronic and systemic autoimmune disease. Numerous clinical studies have indicated a correlation between alterations in gut microbiota and the onset and progression of RA. This research aims to restore intestinal microbiota to a healthy state through the oral administration of Bifidobacterium in the early stages with the goal of delaying the onset and progression of RA.MethodsCollagen-induced arthritis (CIA) rat model was constructed to assess the development of RA using arthritis clinical scores, paw thickness, pathological analysis of knee joint. The immune response was evaluated by determinating specific antibodies and cytokines in serum and synovial fluid. The expression of intestinal barrier protein was analyzed by qPCR to evaluate the intestinal barrier function. Alterations in gut microbiota and metabolites were assessed by 16S rDNA and non-targeted metabolomics.ResultsThe findings reveal that administering Bifidobacterium animalis BD400 orally led to a significant reduction in arthritis clinical scores and paw swelling thickness in CIA rats. Additionally, there was a decrease in osteo-facial fusion and calcified cartilage thickening in the knee joint. Furthermore, the oral administration of B. animalis BD400 resulted in the down-regulation of inflammatory factors TNF-α and collagenase MMP-13 in the knee joint. Levels of specific antibodies (anti-CII IgG, anti-CII IgG1, and anti-CII IgG2a) and cytokine IL-17A in serum, as well as cytokines (TNF-α and IL-1β) in the synovial fluid of B. animalis BD400-treated CIA rats, were significantly reduced (p < 0.05). The gene expression levels of intestinal barrier proteins (occludin-1, MUC-2, and ZO-1) showed a significant increase (p < 0.05) in B. animalis BD400-treated CIA rats. The oral administration of B. animalis BD400 altered the composition of intestinal microorganisms in CIA rats at the phylum and genus levels, particularly affecting the genus HT002. B. animalis BD400 alleviates RA by down-regulating 1-methyl-L-histidine and urocanate in the histidine metabolism, laying a foundation for the RA prevention.ConclusionBy affecting genus HT002 and histidine metabolism in the gut microbiota of CIA rats, B. animalis BD400 restored intestinal permeability, inhibited systemic inflammatory response, and ultimately slowed down the development of RA.

P0844 Real-world effectiveness of vedolizumab in managing refractory pouchitis: a multicenter study on intravenous to subcutaneous transition

Abstract Background Chronic refractory pouchitis (RP) is a complication of ileal pouch-anal anastomosis (IPAA). Vedolizumab (VDZ) has been used in RP management, but real-world data on its effectiveness are limited. Additionally, information on switching from intravenous (IV) to subcutaneous (SC) VDZ in this context is scarce. Aims To evaluate the efficacy and safety of VDZ in RP treatment in a real-world clinical setting, to assess outcomes following a transition from IV to SC VDZ, and to compare treatment persistence and safety between IV and SC administration. Methods A multicenter Spanish study was conducted in patients with RP receiving VDZ for active pouchitis. Clinical outcomes were evaluated using the modified Pouch Disease Activity Index (mPDAI), and biomarkers such as faecal calprotectin (FC), C-reactive protein (CRP), and VDZ serum levels were monitored over one year. Patients who transitioned from IV to SC VDZ were assessed post-switch. Results A total of 47 patients were included (31 (66%) male; median age 51 [43, 64] years). Of these, 25 (53%) switched from IV to SC administration. Baseline characteristics are shown in Figure 1. Significant reductions in mPDAI scores were observed with IV VDZ, from 5 (3-7) at baseline to 3 (2-5), 3 (2-5), (2-5.8) at weeks (W) 12, 24 and 52 respectively (p<0.05). FC decreased significantly over time, from 443 µg/g (213, 746) to 329 µg/g (145-701), 193 µg/g (91-412) and 178 µg/g (101-640) at W12, 24 and 52, respectively (p<0.05), although no significant changes were observed in CRP levels. VDZ serum levels were 16,9 μg/dl (10.3-25.7), 12 μg/dl (7.3-23), 9 μg/dl (6.7-13.9) at W12, 24 and 52 respectively. After switching from IV to SC VDZ, there were no significant differences in terms of mPDAI, FC and CRP at W12 and W24. However, a significant decrease in mPAI (p=0.04) and FC levels (p=0.038) was observed at W52. FC levels also dropped significantly from 550 µg/g (145-1163) pre-swich to 264 µg/g (52-989), 129 (101-448) and 62 (31-211) at W12, 24 and 52, respectively. Notably, SC VDZ serum levels increased significantly, from 8.5 μg/dl (7.2-14) at time of switch to 22.7 μg/dl (21-27.3), 19.6 μg/dl (16.5-21), 21.6 μg/dl (17-26.2) over time. Fewer prior advanced therapies correlated with better outcomes, whereas use of corticosteroids and immunosuppressants at baseline did not. VDZ persistence was high (Figure 2) and adverse event rates were similar for IV and SC VDZ (8.5% and 12%, respectively). Conclusion VDZ was effective in achieving clinical and biological remission in patients with RP following IPAA for ulcerative colitis, particularly with early intervention. Switching from IV to SC VDZ effectively sustained long-term remission, demonstrating safety and persistence in routine clinical practice.

Qualitative and quantitative analysis of reduced bed position acquisition time on FDG PET image quality.

The study aim was to evaluate whether reducing bed position acquisition time would result in significant detriment to image quality. Secondary aims were to compare effect of time of flight (TOF) and Q.Clear reconstructions and patient BMI on image quality. Fluorodeoxyglucose PET-CT performed in 30 patients on a new scanner at our institution between March and May 2024 was retrospectively evaluated. Four PET reconstructions were performed: (a) 1 min 45 s TOF, (b) 2 min TOF, (c) 1 min 45 s Q.Clear, and (d) 2 min Q.Clear. For qualitative analysis, four maximum intensity projection images were evaluated side-by-sideusing a five-point visual score (1 = non-diagnostic, 5 = excellent). For quantitative analysis, liver signal-to-noise ratio (SNR) was calculated. A statistically significant reduction in visual score occurred when reducing bed position time from 2 min to 1 min 45 s (mean TOF scores 0.24 reduction, P = 0.0002; mean Q.Clear scores 0.04 reduction, P = 0.02. There was also a statistically significant difference in liver SNR when reducing bed position time. Deterioration in image quality was minimised when bed position acquisition time was reduced if Q.Clear construction was utilized. This could facilitate increased scanning capacity without clinical detriment.

Efficacy and safety of abhal (Juniperus communis L). on pain intensity, uterine artery doppler flow, and quality of life in primary dysmenorrhea: A double-blind, randomized controlled trial.

Incorporating ancient wisdom from Unani Medicine, this study delves into the therapeutic efficacy of Juniperus communis L. in primary dysmenorrhea. By seamlessly merging traditional knowledge with modern scientific evaluation, this research illuminates Juniperus communis L. (Juniper) potential. This study stands as a testament to the value of exploring ethnopharmacological insights and bridging the gap between ancient healing traditions and evidence-based medicine. To assess the efficacy and safety of Juniper berry compared to mefenamic acid in menstrual cramps and its associated symptoms, and overall quality of life in women with PD. Additionally, the study aimed to explore the impact of these interventions on uterine blood flow using Doppler evaluation. This was a double-blind, standard-controlled study conducted on 62 participants aged 18-35 years. They were randomly assigned to receive either two capsules (750mg) of Juniper berry or 250mg mefenamic acid thrice daily from day 1 to day 3 of menstruation, spanning two menstrual cycles. Primary outcomes were measured using the Visual Analogue Scale (VAS) for pain intensity and the Numerical Rating Scale (NRS) for systemic symptoms. Pelvic Doppler flow indices and responses to the SF-12 questionnaire were analyzed as secondary outcomes. After the intervention in cycle 2, both the juniper and standard groups exhibited a significant reduction in mean VAS scores from 8.1±1.3 to 2.87±1.17 and 8.1±1.13 to 3.61±1.14, respectively (p=0.012). Intergroup comparisons revealed no statistically significant differences in systemic symptoms at baseline, and cycle 2 (C2) follow-up (p>0.05). Similarly, there were no significant differences in the SF-12 questionnaire scores at baseline, C2, and C4 (p>0.05). However, intragroup comparisons for VAS, NRS, and SF-12 in both groups showed significant differences at C2 and C4 compared to the baseline (p<0.001). In the juniper group, intergroup and intragroup comparisons indicated a small effect size for the right uterine artery (Rt UtA) RI and SD at C3 compared to C1 (0.2 and 0.33). Left UtA-PI and RI also demonstrated a medium effect size (0.482 and 0.501), respectively, between C3 and C1. Juniper demonstrated significant efficacy and safety in reducing menstrual cramps, and its associated symptoms and improving health-related quality of life. Further, changes in pelvic uterine artery flow indices were also observed.

Desvenlafaxine with mindfulness-based cognitive therapy reduces Hamilton anxiety scores compared to escitalopram with mindfulness-based cognitive therapy in treatment-resistant generalized anxiety disorder.

This study aims to assess the effectiveness of low-dose Escitalopram (10 mg) or low-dose Desvenlafaxine (25 mg) combined with mindfulness-based cognitive therapy (MBCT) in addressing challenges in treating generalized anxiety disorder (GAD), particularly in patients resistant to conventional therapies. A prospective cohort study was conducted with individuals diagnosed with treatment-resistant GAD. group A included patients unresponsive to citalopram, imipramine, paroxetine, and sertraline, who were then treated with low-dose Escitalopram (10 mg) combined with MBCT. group B comprised those unresponsive to venlafaxine and duloxetine, who were treated with Desvenlafaxine (25 mg) alongside MBCT. Participants were monitored over 24 weeks for changes in Hamilton Anxiety Rating Scale (HAM-A) and Mindful Attention Awareness Scale (MAAS) scores, with medication adherence measured using the Medication Adherence Rating Scale (MARS). The primary outcomes focused on the improvement in anxiety symptoms and overall mental well-being. Comparative analysis between the groups showed significant improvement in HAM-A and MAAS scores at week 16 in group B compared to group A (P < 0.01). Within-group analysis also demonstrated a significant reduction in scores at week 12 in group B compared to group A at week 16 (P < 0.01). No significant difference was observed in medication adherence between the two groups (P = 0.122). Patients treated with low-dose Desvenlafaxine combined with MBCT exhibited greater improvements in managing treatment-resistant GAD compared to those treated with low-dose Escitalopram. This approach highlights the potential for more inclusive and effective mental health strategies, contributing to enhanced quality of life and well-being.

Lay-health workers-led physical activity counseling in Ugandan people living with HIV and suicidal ideation

The aim of this one-group quasi-experimental study was to assess the efficacy of 8-week physical activity (PA) counseling program delivered by lay health workers (LHWs) in reducing suicidal ideation among people with HIV in Uganda. The counseling, based on the self-determination and motivational interviewing frameworks, consisted of 15-20 minute individual sessions for individuals from remote areas or 60-90 minute group sessions within the health center. Thirty-five (26 women, median age = 29.5years) participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), HIV/AIDS Stress Scale (HSS), World Health Organization Disability Assessment Schedule-2 (WHODAS-2) and Simple PA Questionnaire pre- and post-intervention. Post-intervention only 2 of the 35 participants reported suicidal ideation (PHQ-9 item 9 ≥ 1) (p < 0.001). Significant reductions in GAD-7, PHQ-9, HSS, SIMPAQ sedentary and WHODAS-2 scores and an increase in SIMPAQ PA score were observed. LHWs-led PA counselling is promising in reducing suicidal ideation in most people with HIV in low-resourced settings.

Multicomponent Dietary Supplementation: Impact on Tear Secretion and Ocular Surface Inflammation in Dry Eye Syndrome Patients.

Dry eye syndrome (DES) is a prevalent ocular condition characterized by tear film instability, inflammation, and discomfort, affecting millions worldwide. DES is related to oxidative stress imbalance and ocular surface inflammation, which are important factors in the development of the condition. Recent studies have demonstrated that fish oil, lutein, and zeaxanthin possess anti-inflammatory and antioxidant properties. This study investigated the efficacy of a multicomponent dietary supplement in improving tear secretion and mitigating ocular surface inflammation in patients with DES. It was an open-label intervention trial. In total, 52 participants were randomly assigned to control (n = 23) and supplement (45 mg/day eicosapentaenoic acid, 30 mg/day docosahexaenoic acid, 30 mg/day lutein, and 1.8 mg/day zeaxanthin; n = 29) groups for 12 weeks. The participants were evaluated using Schirmer's test and the ocular surface disease index (OSDI) as ocular surface parameters. Moreover, blood or tear oxidative stress, antioxidant capacities, and tear inflammatory indicators were measured at weeks 0 and 12. The results indicated a significant increase in tear secretion and a significant reduction in OSDI scores in the supplement group. Additionally, inflammatory markers, such as interleukin (IL)-6 and IL-8, significantly decreased after the intervention. However, the OSDI of the supplement group significantly improved by 6.60 points (β = -6.60, p = 0.01). These findings support the potential of targeted nutritional supplementation as a safe and effective strategy for alleviating DES symptoms, offering an alternative to conventional treatments that exclusively focus on symptom management. This study highlights the role of specific nutrients in modulating tear production and inflammation, thereby providing a foundation for dietary approaches to DES treatment. Future research should explore the long-term benefits of such interventions and their impact on overall ocular health.

Longitudinal Improvement of Quality of Life in Children With Legg-Calve-Perthes Disease Treated With Proximal Femoral Varus Osteotomy.

Proximal femoral varus osteotomy (PFVO) is commonly performed to improve femoral head containment and decrease deformity in Legg-Calve-Perthes disease (LCPD). Little is known about how PFVO impacts the quality of life after surgery. The purpose of this study was to determine the longitudinal changes to patient-reported physical, mental, and social health measures after PFVO. This is a retrospective review of prospectively collected Patient-Reported Outcomes Measurement Information System (PROMIS) data from 20 patients with unilateral LCPD treated with a PFVO. We collected seven PROMIS measures (mobility, anxiety, fatigue, depressive symptoms, pain interference, anger, and peer relationships) before and approximately 1, 3, 8, 12, and 18 months after surgery. We compared PROMIS scores across different time points using repeated measures ANOVA and multiple pairwise comparisons with Tukey adjustment. The relationship between presurgery and postsurgery mental health scores was analyzed using a Spearman correlation. The mean age at PFVO was 8.2 ± 1.6 years. The mean length of follow-up was 17.0 ± 2.1 months. There was a significant improvement in the mobility score between preoperation and 12 months (P=0.0031) and 18 months postoperation (P<0.0001). Anxiety scores significantly improved from preoperation and 18 months postoperation (P=0.0014). A significant reduction in the pain interference score between preoperation and 12 and 18 months postoperation (P<0.0001) was observed. Peer relationships significantly improved from one month postoperatively to 18 months postoperation (P=0.0355). Individual variations were also observed with some patients having elevated depressive symptoms and anxiety scores. Moderate correlations between preoperative and postoperative anxiety and depressive symptoms scores were observed. PROMIS mobility, anxiety, pain interference, and peer relationship scores improved significantly after PFVO. While the mean anxiety, depressive symptoms, peer relationships, and anger scores were in normal ranges at each visit, individual variations with elevated anxiety and depressive symptom scores were observed. This new longitudinal PROMIS data will better inform patients and families about the quality of life and recovery experience after PFVO. Level IV-therapeutic study.

Comparative analysis of warm needle moxibustion and gua sha nursing care on sleep quality and psychological stress in insomnia patients undergoing eszopiclone tablet treatment: A retrospective study.

This retrospective study aims to assess the adjunctive efficacy of warm needle moxibustion and gua sha care in the treatment of eszopiclone tablets on sleep quality and psychological stress in insomnia patients. Data of 138 insomnia patients from Gansu Baoshihua hospital between January and December 2022 were collected. Patients were bifurcated into 2 groups: those solely treated with eszopiclone (n = 71) and those administered a combined regimen of eszopiclone, warm needle moxibustion, and gua sha (n = 67). Sleep quality, psychological stress, and daytime drowsiness were assessed using the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale-10 (PSS-10), and Epworth Sleepiness Scale (ESS), respectively. Adverse effects were also monitored. Baseline demographics and clinical characteristics were comparable between the 2 groups. Post-intervention, the intervention group exhibited significant reductions in PSQI and ESS scores (P < .05), whereas the control group showed no significant changes. The PSS-10 scores remained unchanged in both groups post-intervention. The intervention group reported a significant decrease in the prevalence of nausea and dizziness posttreatment (P < .05), with a notably lower post-intervention nausea prevalence compared to the control group (P < .05). Incorporating warm needle moxibustion and gua sha nursing care into the eszopiclone treatment regimen potentially amplify sleep quality while reducing side effects in patients with insomnia.

Efficacy of vidian neurectomy in treating chronic rhinosinusitis with nasal polyps combined with allergic rhinitis: A systematic review and meta-analysis.

To evaluate the impact of additional vidian neurectomy or posterior nasal neurectomy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and allergic rhinitis (AR), compared to the outcomes of conventional endoscopic sinus surgery alone. Up to May 2024, six databases were systematically searched. We evaluated studies that compared the clinical improvement of chronic sinusitis-related symptoms and endoscopic findings between the neurectomy group (endoscopic sinus surgery plus vidian neurectomy or posterior nasal neurectomy) and the control group (endoscopic sinus surgery only). The neurectomy group showed a significant reduction in the Lund-Kennedy endoscopic score (SMD = -1.3163 [-1.6519; -0.9807]; I² = 53.3 %). However, this treatment did not have a significant effect on the Quality-of-life score (SMD = -0.1222 [-0.3427; 0.0983]; I² = 27.5 %) or patient-reported nasal symptom-related VAS scores (SMD = -1.6690 [-3.7062; 0.3682]; I² = 96.3 %). In the subgroup analyses of these results according to time points of measurement, the Lund-Kennedy endoscopic score was statistically lower in the treatment group during treatment periods (postop 6months, 12months, and 24months). However, there were no statistically significant differences in Quality-of-life score and VAS between the treatment and control groups during all treatment periods. There was no significant difference in the recurrent rate of CRS during the following up periods (odds ratio=0.5263 [0.1518; 1.8254], I2 = NA) between two groups. Regarding the adverse effect of neurectomy, this additional procedure did not induce the postoperative bleeding (odds ratio=0.8886 [0.3411; 2.3150]; I2 = 0.0 %) and dry eye related discomfort (odds ratio=65.3560 [0.1044; 40,908.1619]; I2 = 88.9 %) significantly compared to control group. Additional neurectomy shows better efficacy in improving endoscopic findings and is safer in patients with CRSwNP combined with AR; however, more clinical studies are needed to evaluate its long-term symptomatic effects and disease recurrence.

Impact of Nasal Anatomical Variation Subtype on Surgical Outcomes for Rhinogenic Contact Point Headache.

Background/Objectives: Rhinogenic contact point headache (RCPH) is a controversial secondary headache disorder involving mucosal contact points in the nasal sinuses. The efficacy of surgical versus medical management has been debated, with some studies showing excellent long-term outcomes but others citing placebo effects. This study aimed to clarify the correlation with nasal anatomical variation detected by CT and RCPH treatment outcomes. Methods: A prospective cohort study was conducted on 90 RCPH patients undergoing surgery or medical therapy. Patients were diagnosed using CT scans, endoscopy, and lidocaine testing. The surgery group had endoscopic procedures to remove contact points. The medical group received intranasal steroids. Outcomes were measured by visual analog scale (VAS) for pain and headache frequency. Predictors like age, gender, and nasal anatomical variations were analyzed. Results: The surgery group showed significant reductions in VAS scores (6.02 to 2.51, p < 0.001) and headache frequency (9.11 to 3.04, p < 0.001). The medical group did not improve significantly. All nasal subtypes improved with surgery but concha bullosa had worse VAS outcomes (4.0) than septal deviation (1.8, p < 0.001) or spur (1.73, p < 0.001). Multivariate analysis found nasal anomalies predicted postoperative VAS scores (p < 0.001) but not headache frequency (p = 0.255). Conclusions: Surgery demonstrated superiority over medications for RCPH. This study provides new evidence that preoperative CT scans should be considered a non-invasive gold standard for analyzing nasal subtypes as they significantly influence surgical success, with concha bullosa associated with worse pain relief. Larger studies should validate these findings to optimize RCPH management.

Efficacy and safety of Jianpi Qinghua granules for non-erosive reflux disease with spleen deficiency and damp-heat syndrome: a multicenter, randomized, double-blind, placebo-controlled clinical trial.

Non-erosive reflux disease (NERD), the most frequent phenotype of gastroesophageal reflux disease, presents without visible esophageal mucosal damage but significantly impacts patients' quality of life. Current treatments like proton pump inhibitors show limited efficacy for many NERD patients, necessitating alternative approaches. Jianpi Qinghua (JQ) granules, a traditional Chinese medicine, have shown promise in treating NERD by targeting symptoms of spleen deficiency and damp-heat syndrome. This study aims to evaluate the efficacy and safety of JQ granules in treating patients with NERD characterized by spleen deficiency and damp-heat syndrome. A multicenter, randomized, double-blind, placebo-controlled clinical trial was conducted with a total of 78 NERD patients randomly assigned to receive either JQ granules or placebo for 4 weeks, followed by a 4-week follow-up period. Seventy-eight NERD patients with spleen deficiency and damp-heat syndrome were recruited and randomly assigned to receive either JQ granules (n = 39) or placebo (n = 39). The trial included a 1-week lead-in, followed by a 4-week double-blind treatment, and a 4-week follow-up. Primary endpoints were the improvement rates of reflux and heartburn symptoms and VAS score changes. Secondary endpoints included atypical symptom scores, total TCM syndrome scores, GERD Health-Related Quality-of-Life (HRQL), and self-rated depression and anxiety scales. Safety assessments involved routine blood, urine, and liver and kidney function tests. After 4 weeks, the improvement rate for reflux or heartburn symptoms was 79.49% in the JQ group vs. 58.97% in the placebo group (P < 0.05). VAS scores showed significant reductions in both groups but without notable inter-group differences. Total TCM syndrome scores significantly decreased in both groups, with the JQ group showing greater improvement trends. The JQ group had higher rates of effective TCM syndrome improvement and better GERD-HRQL scores. Both groups saw significant reductions in self-rated depression and anxiety scores, with trends favoring JQ granules. Safety assessments were comparable between groups. JQ granules significantly outperform placebo in treating NERD symptoms and display long-term effectiveness. They effectively address spleen deficiency and damp-heat syndrome, improving patients' social functioning, and have a favorable safety profile. https://clinicaltrials.gov/study/NCT04324138?term=NCT04324138&rank=1, identifier: NCT04324138.

Preference for On-Demand Fexuprazan Therapy in Gastroesophageal Reflux Disease: A Prospective Cohort Study.

Introduction: Maintenance therapy is crucial in managing and preventing symptom relapse in gastroesophageal reflux disease (GERD), with continuous and on-demand therapy being the common approaches. However, maintenance therapy using potassium-competitive acid blockers (P-CABs), such as fexuprazan, remains incompletely evaluated. Methods: This single-center, single-arm, prospective cohort study enrolled individuals with weekly heartburn or acid regurgitation and confirmed erosive esophagitis. The participants received 40 mg fexuprazan daily for 4 weeks as initial therapy, followed by 4 weeks of maintenance therapy. Patients chose either continuous or on-demand therapy for maintenance, according to their preference. The primary endpoint was the proportion of patients selecting on-demand therapy. The symptom scores were assessed using the GERD questionnaire (GERD-Q) and patient assessment of upper-gastrointestinal-disorders symptoms questionnaire (PAGI-SYM). Results: The 31 included participants showed a significant reduction in symptom scores after initial treatment (baseline vs. 4-week: GERD-Q, 9.0 vs. 6.5, p < 0.001; PAGI-SYM, 29.0 vs. 10.8, p < 0.001). Twenty-one (67.7%) patients chose on-demand therapy after initial treatment. The symptom scores did not differ significantly before and after maintenance therapy (4-week vs. 8-week: GERD-Q, 6.5 vs. 6.0, p = 0.225; PAGI-SYM, 10.8 vs. 9.0, p = 0.354). Although this relation was not significant, patients experiencing larger decreases in symptom scores tended to prefer on-demand therapy. After maintenance therapy, the symptom scores did not differ between continuous and on-demand therapy (GERD-Q, 5.3 vs. 6.3, p = 0.342; PAGI-SYM, 9.4 vs. 8.8, p = 0.611). Conclusions: Fexuprazan was effective as an initial and maintenance therapy in patients with GERD who showed typical symptoms. Approximately 68% of the patients preferred on-demand therapy as a maintenance treatment. Based on the patient's preference for maintenance therapy, symptom control did not differ between continuous and on-demand therapy.

Aggression in crime and sports: a study on prisoners and amateur combat athletes in Türkiye

BackgroundThis research focuses on examining and comparing the aggression levels of prisoners incarcerated for intentional injury and amateur combat athletes. The study aims to explore the differences in aggression levels among these groups to understand the impact of incarceration and sports participation on aggression.MethodsThe participants included in the analysis consist of prisoners (n = 363) housed in Marmara No. 7 and No. 3 Type L Closed Penal Institutions, who have been incarcerated for intentional injury, with an average age of 36.64 ± 10.30 years and an average custody period of 980.47 ± 1335.27 days. Amateur combat athletes (n = 203) with an average age of 25.17 ± 10.09 years have been actively engaged in sports for an average of 11.83 ± 9.53 years. The control group (n = 329) has an average age of 32.65 ± 7.56 years. Data collection instruments included a personal information form and the Buss-Perry Aggression Questionnaire. The data were analyzed using IBM SPSS Statistics 23.0, with a significance level set at p < 0.05.ResultsAnalysis of the Buss-Perry Aggression Questionnaire scores revealed that the aggression levels of prisoners incarcerated for intentional injury were statistically significantly lower than those of both amateur combat athletes and control group participants (p < 0.001). Additionally, a significant reduction in overall aggression scores was observed among prisoners as the number of days in custody increased (p = 0.045). No significant differences were found among amateur combat athletes concerning the discipline variable, and no meaningful relationship was identified between years of active sports participation and aggression scores.ConclusionThe findings indicate that educational, social, and sports activities organized in correctional facilities can be effective in reducing aggression levels among inmates. Systematic planning, professional implementation, and continuous evaluation of such programs can make significant contributions to the rehabilitation of prisoners and their successful reintegration into society.

The Significance of Psychological Support in Managing Depression in Parkinson's Disease: Combining Venlafaxine with Pramipexole and Psychological Care.

Depression is a common comorbidity in patients with Parkinson's disease (PD) and can significantly impact their overall well-being. The combination of venlafaxine and pramipexole is a standard treatment approach for depression in PD. However, the effects of incorporating psychological care into the treatment regimen remain unclear. This study aimed to investigate the impact of psychological intervention in the treatment of depression in Parkinson's disease, using a combination of venlafaxine and pramipexole. The clinical data of 151 patients with both Parkinson's disease (PD) and depression, treated in Geriatric Hospital of Hainan from May 2021 to May 2023, were analyzed retrospectively. Among the 151 patients, 71 received routine nursing care and were allocated to the control group, while the remaining 80 patients received psychological nursing care based on routine nursing care and were assigned to the study group. The Hamilton Depression Rating Scale (HAMD) and the Hamilton Anxiety Scale (HAMA) were used to evaluate the degree of depression and anxiety in both groups before and after care. The MOS 36-Item Short-Form Health Survey (SF-36) was employed to assess the quality of life of both groups before and after care. The efficacy and adverse reactions in both groups were also analyzed. Before care, the HAMD and HAMA scores did not significantly differ between the two groups (p > 0.05). However, after care, both groups exhibited a significant reduction in HAMD and HAMA scores (p < 0.0001), with a more pronounced decrease observed in the study group (p < 0.0001). Prior to care, there was no significant difference in SF-36 scores between the two groups (p > 0.05). However, following care, the SF-36 scores markedly increased in both groups (p < 0.0001), with a more pronounced increase in the study group (p < 0.0001). Additionally, a significantly lower overall response rate was noted in the control group compared to the study group (p = 0.013), while no significant difference was observed in the total incidence of adverse reactions between the two groups (p = 0.273). Utilizing venlafaxine combined with pramipexole in the treatment of depression in PD, supplemented by psychological nursing care, significantly enhances therapeutic efficacy. This combined approach effectively alleviates symptoms of depression and anxiety in patients without introducing additional side effects. Hence, it emerges as a valuable clinical treatment option.