Significant Improvement In Symptoms Research Articles

Characteristics of type 2 inflammation in nocturnal asthma and evaluation of the effectiveness of inhaled corticosteroids combination therapy

Objective: To investigate the characteristics of type 2 inflammation in patients with nocturnal asthma, and analyze the improvement of asthma symptoms after the use of inhaled corticosteroids (ICS) combined with different long-acting bronchodilators. Methods: Data of 231 asthma patients who first visited the Respiratory and Critical Care Medical Clinic of Nanfang Hospital of Southern Medical University from January 2020 to June 2023 and had positive bronchodilator tests (BDT), were retrospectively analyzed. These patients were divided into nocturnal asthma group and non-nocturnal asthma group based on the presence or absence of nocturnal symptoms. According to fractional exhaled nitric oxide (FeNO) levels, patients were divided into type 2 inflammatory group [FeNO≥20 ppb (×10-12)] and non-type 2 inflammatory group (FeNO<20 ppb). Patients were further divided into ICS+long-actingβ2 agonist (LABA) group and ICS+LABA+long-acting anticholinergic agent (LAMA) group based on medication regimens. Patients were followed-up at the 3rd, 6th, and 12th months after enrollment to evaluate the patient's asthma control test (ACT) questionnaire, actual medication status and number of acute attacks. The clinical characteristics, treatment and prognosis of different groups were compared. Results: A total of 231 asthma patients were included, including 152 males and 79 females, with a age[M (Q1, Q3)] of 52 (42, 60) years. There were 144 cases (62.3%) in the nocturnal asthma group and 87 cases (37.7%) in the non-nocturnal asthma group. Among the 144 patients with nocturnal asthma, 133 patients completed FeNO testing, of which 95 were classified into the type 2 inflammation group and 38 to the non-type 2 inflammation group. The eosinophil (EOS) count and FeNO level in the nocturnal asthma group were both higher than those in the non-nocturnal asthma group [(0.45±0.40) ×109/L vs (0.25±0.20)×109/L, 38 (18, 82) vs 29 (15, 48) ppb, both P<0.05]. Baseline ACT score was lower in nocturnal asthma group than in non-nocturnal asthma group [16 (14, 18) vs 21 (19, 23) scores, P<0.001]. There was no significant difference in the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) in the two groups (both P>0.05). During the follow-up at the 3rd, 6th, and 12th months, the improvement values of ACT scores (ΔACT) in the nocturnal asthma group were higher than the non-nocturnal asthma group [5 (3, 7) vs 2 (1, 3), 7 (4, 9) vs 3 (1, 4) and 7 (6, 9) vs 3 (1, 5) scores, all P<0.05]. The EOS count [0.40 (0.29, 0.80)×109/L vs 0.20 (0.12, 0.29)×109/L] and percentage [5.10% (3.55%, 9.10%) vs 2.20% (1.65%, 3.85%)] of the type 2 inflammation group were both higher than the non-type 2 inflammation group (both P<0.05). In the nocturnal asthma group, there was no significant difference in ΔACT between ICS+LABA and ICS+LABA+LAMA groups (both P>0.05). Conclusions: Patients with nocturnal asthma have more pronounced type 2 inflammation and the symptoms are often not well controlled or even worse. After one year of combined therapy with ICS, significant improvements in asthma symptoms can be observed. But there is no significant difference in symptom improvement among different medication regimens in the nocturnal asthma group.

An Evaluation of Iloperidone for Mania in Bipolar I Disorder.

To review the efficacy of iloperidone for mania associated with bipolar I disorder and discuss its safety profile (eg, QTc prolongation, orthostatic hypotension, and metabolic adverse effects). Literature was identified using PubMed (1966-September 2024), OVID (1984-November 2024), and clinicaltrials.gov. Search terms included iloperidone, bipolar disorder, and mania. The study included trials evaluating iloperidone for treating bipolar mania. In one phase 3 study, iloperidone demonstrated significant improvement in mania symptoms at day 28 on all primary (ie, Young Mania Rating Scale) and secondary outcomes (Clinical Global Impression-Severity/Change scales) compared to placebo. Iloperidone was well tolerated, with tachycardia, dizziness, dry mouth, alanine aminotransferase elevation, nasal congestion, increased weight, and somnolence reported as common adverse effects. Since there are no head-to-head studies comparing iloperidone with other second-generation antipsychotics for bipolar mania, other treatment considerations drive medication selection. Iloperidone is unavailable in a generic formulation; thus, its use will be associated with higher costs. It is dosed twice daily, which may negatively impact adherence. Iloperidone is associated with a moderate risk of QTc prolongation, metabolic adverse effects, and orthostatic hypotension, which will limit its use in certain patient populations. QTc prolongation is dose related, so drug interactions involving CYP2D6 and CYP3A4 inhibition can have serious consequences. In the pivotal trial, iloperidone was effective in treating adults with an acute manic or mixed episode associated with bipolar I disorder and was safe and well tolerated.

Patient-reported outcome measures to assess mental and physical health status, functionality, and quality of life in patients with major depression or schizophrenia

BackgroundPatient-reported outcomes measures (PROMs) are standardized self-administered tools that assess the patient’s opinion on the level of health, quality of life, and disability among other aspects. The objective of this study was to gather information on physical and mental health in patients with major mental illness using PROMs.MethodsThis was an observational, naturalistic, prospective study carried out in adult stabilized outpatients attended at nine Adult Mental Health Centers in Barcelona, Spain. All participants had a confirmed diagnosis of major depression disorder or schizophrenia (DSM-5) and were currently on drug treatment. Participants (n = 508) self-completed a baseline questionnaire for clinical data and PROMs scales (PHQ-19, SF-12, and WHODAS 2.0) at baseline and 9 months thereafter (n = 482).ResultsMean (SD) age was 50.9 (13.2) years, and 83% of patients lived with their families. Although 93.9% of patients recognized having a mental illness, 15.7% did not know their diagnosis. When asked if they considered that during the last year their treatment had offered some type of improvement, 83.9% answered affirmatively. Patients reported that their degree of adherence to treatment was high (77%) and most of them (80%) believed the medication had a beneficial effect. Depressed patients showed both at baseline and at follow up significantly more depressive symptoms than the group with schizophrenia. In the schizophrenia group, a statistically significant improvement in depressive symptoms was noted at 9 months follow-up. We did not find significant differences within or between groups in quality of life (SF-12 scores) obtained at baseline and after 9 months of follow-up Both at baseline and at follow-up, patients with depression reported a significantly higher degree of disability (WHODAS scores) than those with schizophrenia.ConclusionsPROMs can be used in real-world conditions to assess severity of disease, quality of life, and disability in major depression and schizophrenia. The present results are relevant for both patients and clinicians.

Pathogenic Variant in the 5'-Untranslated Region of GCH1 and Clinical Heterogeneity in a Chinese Family with Dopa-Responsive Dystonia.

Variants in the GCH1 gene, encoding guanosine triphosphate cyclohydrolase, are associated with dopa-responsive dystonia (DRD) and are considered risk factors for parkinson's disease. Comprehensive neurological assessments documented motor and non-motor symptoms in a Chinese family affected by DRD. Whole-exome sequencing (WES) was employed to identify potential mutations, with key variants confirmed by Sanger sequencing and analyzed for familial co-segregation. The proband, a 50-year-old woman with a 10-year history of limb rigidity, abnormal posture, and a 23-year history of neck deviation, showed significant symptom improvement with levodopa treatment. Family evaluation revealed similar motor symptoms in four additional affected members, all responding well to levodopa. WES identified a GCH1 variant (NM_000161.3: c.-22C > T) in the 5'-untranslated region (5' UTR) in four symptomatic individuals (excluding deceased II-3). This variant likely affects translation by introducing an upstream initiation codon and open reading frame (uORF), leading to decreased BH4 levels and disrupted dopamine synthesis. This study reports a pathogenic variant in the 5' UTR of GCH1 in a family with DRD, underscoring the phenotypic heterogeneity associated with this locus. A non-coding variant (c.-22C > T) in the 5' UTR of the GCH1 gene is identified in a Chinese family with DRD.The findings reveal significant clinical heterogeneity within the family, highlighting the complex genotype-phenotype relationship.

In-office Eustachian Tube Dilation Reduces Symptoms Among Patients With Barometric Challenges.

Balloon dilation of the eustachian tube has gained ground in the treatment of chronic dysfunction. A new indication for a larger group of patients has emerged, which is characterized by barochallenge only, which affects even more patients. Given the recent validation of the balloon dilation, we set out to explore if this procedure could be useful in treating this specific sub-group of patients in an in-office setting. Balloon dilation was performed using inly nasal cottonoids soaked in 2% tretracainephenylephrine combined with xylocaine nasal spray and lidocaine/prilocaine gel and a mild oral sedative. The effect of eustachian tube balloon dilation on the function of the eustachian tube was evaluated by using the eustachian tube dysfunction questionnaire-7 (ETDQ-7) and a VAS score. The questionnaires were completed beforehand and 3 months and 12 months postoperatively to determine subjective surgical success. Two hundred and forty-six balloon dilation were performed in 132 participants. The results from the ETDQ-7 questionnaire and VAS scores showed a significant improvement in symptoms during pressurization after eustachian tube balloon dilation (p = 0.0001). A mean pain score during procedure in local anesthesia was 3.4 on a scale from 1 to 10. Eustachian tube balloon dilation significantly reduced symptoms of eustachian tube dysfunction during non-physiological pressure, which was determined by ETDQ-7 and Vas scores. Additionally, we found that the procedure is well suited for private practice or the outpatient clinic, using local anesthetics and a mild sedative. 4 Laryngoscope, 135:361-365, 2025.

Psilocybin-Assisted Group Psychotherapy + Mindfulness Based Stress Reduction (MBSR) for Frontline Healthcare Provider COVID-19 Related Depression and Burnout: A Randomized Clinical Trial.

This clinical trial sought to evaluate the safety and preliminary efficacy of psilocybin and MBSR for frontline healthcare providers with symptoms of depression and burnout related to the COVID-19 pandemic. This was a randomized controlled trial that enrolled physicians and nurses with frontline clinical work during the COVID-19 pandemic and symptoms of depression and burnout. Participants were randomized in a 1:1 ratio to either an 8-week MBSR curriculum alone or an 8-week MBSR curriculum plus group psilocybin-assisted psychotherapy (PAP) with 25mg psilocybin. Symptoms of depression and burnout were assessed at baseline, and 2-weeks and 6-months post intervention utilizing the Quick Inventory of Depressive Symptoms (QIDS-SR-16) and Maslach Burnout Inventory Human Services Survey for Medical Professionals (MBI-HSS-MP), respectively. Secondary outcome measures included the Demoralization Scale (DS-II) and the Watt's Connectedness Scale (WCS). Adverse events and suicidality were assessed through 6-month follow-up. 25 participants were enrolled and randomized. There were 12 study-related AEs recorded that were Grade 1-2 and no serious AEs. There was larger decrease in QIDS score for the MBSR+PAP arm compared to MBSR-only from baseline to 2-weeks post-intervention and significant between-group differences favoring MBSR+PAP on subscales of the MBI-HSS-MP as well as the DS-II and WCS. Group psilocybin-assisted therapy plus MBSR was associated with clinically significant improvement in depressive symptoms without serious adverse events and with greater reduction in symptoms than MBSR alone. Study findings suggest that integrating psilocybin with mindfulness training may represent a promising treatment for depression and burnout among physicians and nurses.

Therapeutic Efficacy of Reward Circuit‐Targeted Transcranial Magnetic Stimulation (TMS) on Suicidal Ideation in Depressed Patients: A Sham‐Controlled Trial of Two TMS Protocols

Background: Suicide is one of the leading causes of premature death, and dysfunctional reward processing may serve as a potential mechanism. However, effective treatment targeting reward circuits is rarely reported.Objective: The present study investigated the therapeutic efficacy of two individualized protocols, repetitive transcranial magnetic stimulation (rTMS) and intermittent theta burst stimulation (iTBS), targeting the left dorsolateral prefrontal cortex (lDLPFC)–nucleus accumbens (NAcc) circuit on suicidal ideation among patients with major depressive disorder (MDD).Methods: Here, 40 healthy controls (HCs) and 70 MDD patients (MDDs) were recruited for this double‐blinded, sham‐controlled clinical trial. The reward learning process during the Iowa gambling task (IGT) was initially measured at the baseline. Further, 62 MDDs were assigned to receive 15 daily sessions of individualized rTMS (n = 25), iTBS (n = 15), or sham treatment (n = 22) to the site of strongest lDLPFC–NAcc connectivity.Results: We found MDDs demonstrated abnormalities in both IGT performance and reward‐associated event‐related potential (ERP) components compared to HCs. MDDs in the rTMS and iTBS groups showed significant improvements in suicidal ideation and anhedonia symptoms compared to the sham group. The rTMS group also exhibited a more negative‐going N170 and feedback‐related negativity (FRN) after treatment, and the increase in N170 absolute amplitude posttreatment showed a trend of correlation with improved Temporal Experience Pleasure Scales (TEPSs) and TEPS‐anticipatory (TEPS‐ant) scores.Conclusion: The current study indicates that reward circuit‐based rTMS and iTBS showed comparable antisuicidal effects in depressive patients, suggesting that the lDLPFC–NAcc pathway may serve as a potential treatment target.Trial Registration: ClinicalTrials.gov identifier: NCT03991572

Innovative Nerve Root Protection in Full-Endoscopic Facet-Resecting Lumbar Interbody Fusion: Controlled Cage Glider Rotation Using the GUARD (Glider Used As a Rotary Device) Technique

This video presents a case of L4–5 unstable spondylolisthesis treated with full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF), emphasizing the GUARD (Glider Used as a Rotary Device) technique for nerve root protection. This innovative approach involves controlled rotation of the cage glider before cage insertion to minimize the risk of nerve root injury, a significant complication in Endo-TLIF procedures. The GUARD technique, validated in previous cadaveric studies, provides enhanced safety during cage insertion by protecting the nerve root. A 48-year-old woman with a 3-year history of progressive low back pain and bilateral lower extremity radiculopathy (right-sided predominance) was diagnosed with L4–5 unstable spondylolisthesis and spinal stenosis. After failure of conservative management, she underwent uniportal full-endoscopic facet-resecting transforaminal lumbar interbody fusion using the GUARD technique. Postoperatively, the patient experienced significant symptomatic improvement and resolution of radiculopathy, without any intraoperative nerve root injury or postoperative neurological deficits. This case demonstrates the effectiveness of the GUARD technique in reducing neurological complications and improving patient outcomes.

Practical Guidance of Full-Endoscopic Technique for Incidental Durotomy Repair: A Surgical Video Demonstration

This surgical video demonstrates the full-endoscopic repair of an incidental durotomy, offering practical guidance and insights into the technique. Incidental dural tears occur in up to 1% of lumbar endoscopic surgeries, with risk factors including interlaminar approaches, stenosis decompression, and power drill usage. Although many dural tears are managed with sealant or gel foam, no standard exists for when surgical repair is necessary. Complications such as cerebrospinal fluid leakage, radiculopathy, and neurological deficits can arise, prompting the need for effective repair techniques. A 50-year-old man presented with bilateral leg claudication due to lumbar stenosis (L4–S1). Full-endoscopic decompression was performed, during which an incidental 10-mm dural tear occurred at L5–S1. The nerve root was repositioned into the dural sac, and the tear was repaired using a 6-0 prolene suture with a knot pusher under endoscopic guidance. Gelfoam was applied to aid compression, and irrigation pressure was reduced to prevent increased intracranial pressure. The patient was mobilized after 48 hours and experienced significant symptom improvement without neurological deficits. We propose that dural tears should be repaired when possible to prevent complications. Surgeon experience, tear size, and location are critical factors. This case demonstrates a simple, effective endoscopic repair method, though further studies are needed to establish its long-term efficacy.

Tachycardiomyopathy Treated With Ablation by Using 3D Mapping System in a Patient With Friedreich Ataxia

ABSTRACTThis case report presents the management of tachycardiomyopathy (TCM) in a patient with Friedreich ataxia, a hereditary disorder characterized by progressive neurodegeneration and associated cardiac complications. The patient exhibited severe tachycardia‐induced cardiac dysfunction, complicating the clinical picture due to the overlapping neurological symptoms of Friedreich ataxia. Utilizing a 3D mapping system, catheter ablation was performed to accurately identify and target the arrhythmogenic foci contributing to the patient's TCM. The procedure resulted in significant symptom relief and improvement in cardiac function, underscoring the potential benefits of advanced electrophysiological techniques in managing complex cases. This report highlights the importance of a multidisciplinary approach in diagnosing and treating cardiac manifestations in patients with Friedreich ataxia, as well as the efficacy of 3D mapping technology in guiding successful ablation therapies.

Cerebral amyloid angiopathy-related inflammation (CAA-ri): A case report.

Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a treatable condition characterized by an acute or subacute onset, with its primary pathological hallmark being the deposition of amyloid, predominantly β-amyloid (Aβ), within intracranial microvessels. Despite its potential for treatment, CAA-ri is a rare disorder that is frequently underrecognized by clinicians in practice. This article provides a comprehensive overview of the clinical manifestations and therapeutic approaches associated with CAA-ri, aiming to enhance awareness among healthcare professionals. A 67-year-old male patient who suffered from a sudden decline in cognitive functioning, intermittent headache, and dysphoria underwent brain magnetic resonance imaging, susceptibility weighted imaging, and cerebrospinal fluid analysis and was considered probable CAA-ri. During the course of disease development, the patient suffered from a sudden decline in cognitive functioning, mainly in the form of unresponsiveness, decreased comprehension, and increased repetitive language, accompanied by intermittent headaches and dysphoria. Brain magnetic resonance imaging showed numerous white matter in both hemispheres. Susceptibility weighted imaging showed multiple spots of hypointensity in the bilateral cerebral and cerebellar hemispheres, a hypointensity signal in the left occipital lobe, and extensive zones of hypointensity in bilateral sulci. Cerebrospinal fluid analysis was abnormal with elevated levels of protein and low levels of P-tau, Aβ42, and Aβ1-42/Aβ1-40. The use of glucocorticoids greatly reduced his symptoms. This lends credence to the probable CAA-ri diagnosis. The symptoms can be successfully alleviated by administering methylprednisolone sodium succinate. During the patient's hospitalization, immunosuppressive therapy, primarily consisting of methylprednisolone sodium succinate and methylprednisolone, was administered, resulting in a significant improvement in symptoms. Post-discharge, the patient was monitored regularly, revealing a gradual enhancement in cognitive function without recurrence. Consequently, immunosuppressive therapy was discontinued 1 year following the patient's discharge. CAA-ri is a rare clinical condition, and timely diagnosis and early treatment are very critical for patient prognosis.

Creative Arts Therapy Reduces Psychological Distress in Non-Patient-Facing Healthcare Workers.

To assess the feasibility, acceptability, and efficacy of a 12-week in-person Creative Arts Therapy intervention in reducing psychological distress and burnout symptoms in non-patient-facing healthcare workers. Burnout and psychological distress among non-patient-facing healthcare workers are significant and understudied problems in healthcare systems. Non-patient-facing healthcare workers with burnout symptoms were randomly assigned to one of four Creative Arts Therapy modalities (art, music, creative writing, or dance/movement) or a control group. The intervention consisted of 12 weekly 90-minute sessions. All participants completed baseline and follow-up assessments post-intervention and at 4-, 8-, and 12-months. Primary outcomes were feasibility (session attendance) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Secondary outcomes included changes in psychological distress; symptoms of burnout, anxiety, and depression; and turnover intention. Of 168 active participants, 164 (98%) completed post-intervention surveys, with 90% follow-up at 12 months. Participants attended a mean of 10.7 sessions (SD=3.2). The median CSQ-8 score for the program was 31 [17-32]. Intervention group participants demonstrated significant improvements in symptoms of anxiety (-40.6%), depression (-29.0%), emotional exhaustion (-15.0%), and depersonalization (-14.3%), and reduced turnover intention (-6.1%) compared to the control group. At 12-months, improvements in depressive and anxiety symptoms persisted . and Relevance: The Creative Arts Therapy intervention was feasible, acceptable, and effective in reducing psychological distress and burnout symptoms among non-patient-facing healthcare workers.

Effect of Levothyroxine on Lipid Profile in Hypothyroid Patients Attending in a Tertiary Care Hospital

Background: Hypothyroidism is a common endocrine disorder in our country and is associated with many biochemical abnormalities.Clinical data suggest that levothyroxine replacement therapy has beneficial effect on lipid profile. Objective: The present study intends to find out the effect of levothyroxine replacement therapy on lipid profile in hypothyroid patients. Methods: A prospective analytical study was done in Endocrinology Outpatient Department of Dhaka Medical college and Hospital, Dhaka from January 2022 to December 2022. A total of 30 newly diagnosed hypothyroid patients were included according to selection criteria. The patient’s demographic, past, present history and relevant data needed for the study were collected by face-to-face interview by using structured questionnaire. Baseline data of serum free thyroxine (FT4), thyroid stimulating hormone (TSH), fasting lipid profile, Blood pressure and clinical features of hypothyroidism were recorded in a data collection form during first visit and after 3 months follow up. All patients were treated with tablet levothyroxine and dose was adjusted 4-6 weekly till patients were biochemically euthyroid. Results: 30 hypothyroid patients were followed up for 3 months. There was significant improvement in hypothyroid symptoms after thyroxine replacement. The mean age of the patient was 35.40±11.52 years. Mean FT4 level was significantly increased from 8.06±3.78 to 16.40±3.95(p&lt;0.001). There was significant reduction in mean TSH from 32.55±37.31 to 2.52±2.71(p&lt;0.001). Mean Total cholesterol, TG, LDL-C level was significantly decreased from 193.27±41.69, 173.33±63.71, 119.58±40.11 to 177.80±38.17, 155.87±58.25, 103.07±26.25 (p=0.022, 0.044, 0.042) respectively, but HDL has decreased from 45.04±13.14mg/dl to 43.11±10.78 mg/dl (p=0.415) though not significantly. Conclusion: Thyroxine replacement therapy improves lipid profiles and enhances quality of life. Levothyroxine directly reduces TC, LDL-C, and TG levels but not HDL-C. J Rang Med Col. September 2024; Vol. 9, No. 2: 61-66

Wolfberry Honey and Its Extract Alleviate Dextran Sodium Sulfate-Induced Ulcerative Colitis by Improving Intestinal Barrier Function and Reducing Oxidative Stress and Inflammation.

Inflammatory bowel disease (IBD) is a chronic condition characterized by gut inflammation causing persistent diarrhea and abdominal pain. Despite the nutritional benefits of wolfberry honey (from Lycium barbarum L.), its potential to alleviate IBD remains underexplored. This study evaluated the protective effects of wolfberry honey and its extract (wolfberry honey extract [WHE]) against dextran sulfate sodium (DSS)-induced ulcerative colitis (UC) using in vivo and in vitro models. Mice pretreated with wolfberry honey showed significant symptom improvement in DSS-induced UC, linked to reduced expression of proinflammatory markers (Il-1β, Il-6, Tnf-α, and Mcp-1) and increased antioxidant genes (Nrf2, Sod2). Increased Occludin levels indicated improved intestinal barrier function. In vitro, WHE protected DSS-treated Caco-2 cells by lowering reactive oxygen species (ROS), stabilizing mitochondrial membrane potential, and inhibiting TLR4/NF-κB signaling. It enhanced the expression of antioxidant genes and tight junction proteins (ZO-1, Occludin, and Claudin-1). Metabolomic analysis revealed that WHE modulated glycerophospholipid metabolism, increasing phosphatidylcholine and choline levels and decreasing lysophosphatidylcholine levels. These results highlight the potential of wolfberry honey and its extract as nutraceuticals for managing UC through their effects on inflammation, oxidative stress, and intestinal barrier function. Further research is warranted to elucidate their mechanisms of action and assess their long-term therapeutic benefits in IBD management.

Vesicovaginal fistula post-vaginal delivery late revelation: A case report

Introduction: This study presents a compelling clinical case involving a 43-year-old woman who encountered a vesicovaginal fistula subsequent to vaginal delivery. The narrative encompasses the occurrence, diagnosis, and subsequent management of this rare postpartum complication. Case Report: A 43-year-old woman with an unscarred uterus experienced the conventional signs of postpartum recovery but developed hematuria and vaginal urinary leakage on the seventh postpartum day. Clinical assessment confirmed a vesicovaginal fistula due to partial uterine dehiscence. Diagnostic procedures and the subsequent successful surgical intervention are detailed, followed by the postoperative surveillance strategy and a one-month post-surgery evaluation. Conclusion: This case study demonstrates the successful management of a postpartum vesicovaginal fistula through surgical intervention, resulting in complete closure of the fistula and significant improvement in urinary symptoms. It highlights the importance of timely diagnosis and appropriate surgical intervention in managing such rare complications following vaginal delivery.

Stereoelectroencephalographic thermocoagulation in FLNA-positive heterotopia: Is it an effective treatment?

Periventricular nodular heterotopia (PVNH) is a neuronal migration disorder often associated with drug-resistant epilepsy. The epileptogenic zone network (EZN) in PVNH is generally large, contraindicating surgery. Stereoelectroencephalography (SEEG) can be proposed to map the EZN and perform radiofrequency thermocoagulation (THC) with an efficacy rate of approximately 65%. There are genetic forms of PVNH, particularly with mutations in the filamin A gene (FLNA). However, data on SEEG-guided THC in these patients still have not been described. We report four patients with FLNA-positive PVNH who underwent SEEG-guided THC. All were women with several types of seizures and psychiatric comorbidities. EZN was extensive and often bilateral, including a part of the heterotopias. The outcomes of SEEG-guided THC varied; two patients experienced significant seizure reduction and improvement in psychiatric symptoms (Engel class I-II), one showed partial improvement (Engel class III), and one had no significant benefit (Engel class IV). Psychiatric comorbidities, including posttraumatic stress disorder, depression, and anxiety, were present in all cases, with some patients showing symptom improvement alongside seizure reduction. Despite genetic origin, SEEG-guided THC can be proposed in FLNA-positive PVNH-related epilepsy, although outcomes vary. The presence of FLNA mutations should not contraindicate surgical intervention but may influence the therapeutic response. Further research is needed to understand the impact of genetic variants on epilepsy outcome.

The effect of neurofeedback-assisted emotion regulation-based psychotherapy on psychological symptoms in individuals with trauma experiences

Research Aim: The aim of this study is to explore the effects of emotion regulation-based psychotherapy, supplemented by neurofeedback, on psychological symptoms, while considering the brain's neurological alterations resulting from trauma. Method: The study was conducted with a total of ten trauma-exposed individuals between the ages of 8-15, consisting of three males and seven females. The participants were assigned to two groups at random: an experimental group and a control group. The experimental group received neurofeedback-supported emotion regulation sessions, while the control group received only emotion regulation-based therapy sessions. The psychological symptoms of the participants were assessed using the SCL-90-R scale. The pre-test, post-test, and follow-up test scores were analyzed through a Mixed Design ANOVA, with two factors (experimental group, control group) and three time points (pre-test, post-test, follow-up test). Findings: The results indicated a significant improvement in psychological symptoms for both groups across pre-test, post-test, and follow-up test measures. This suggests that emotion regulation-based therapy was effective for trauma-exposed individuals. However, the experimental group, which received neurofeedback in addition to emotion regulation therapy, showed greater symptom reduction across all sub-dimensions. Notably, the reduction in symptoms for the depression and hostility sub-dimensions was statistically significant, with a large effect size, suggesting that neurofeedback contributed to the improvement in these areas. Furthermore, these improvements were more permanent in the experimental group during the follow-up measures. Conclusions: The research concluded that while emotion regulation therapy was impactful in alleviating psychological symptoms associated with trauma, the addition of neurofeedback in the experimental group led to a greater and more sustained reduction, particularly in the depression and hostility sub-dimensions. The permanence of the effects observed in the neurofeedback group underscores the potential value of incorporating neurofeedback into therapy for trauma-exposed individuals.

Pathophysiology, diagnostics and treatment of slow-transit constipation: a review

Introduction. The work is a review article that examines the pathophysiology, diagnostics and treatment options for slow-transit constipation.Aim. The main goal of this study is to define slow-transit constipation, describe the primary pathophysiological mechanisms involved in its development, identify key aspects of diagnosing the condition, and thoroughly examine the existing treatment methods and their clinical efficacy.Methods. A systematic search of the literature in electronic databases PubMed, EMBASE and Cochrane covering the past 20 years was conducted. Studies on clinical outcomes and pathophysiological mechanisms of slow-transit constipation were included in this review prepared in accordance with PRISMA guidelines.Results. It has been established that, despite the widespread use of conservative therapy for idiopathic chronic constipation, its effectiveness in treating slow-transit constipation is low. Conversely, surgical treatment shows high effectiveness in improving symptoms and quality of life. This brings up the question about making surgical approach the method of preference in treating slow-transit constipation. Yet, aspects related to the frequency of postoperative complications and the selection of the most appropriate surgical approach remain underexplored, leaving the question of the preferred option open for further investigation.Conclusion. Despite the limited efficacy of conservative therapy for slow-transit constipation, radical surgical treatment shows significant improvement in symptoms and quality of life, requiring further studies to optimise treatment approaches and investigate postoperative complications.

Dysplastic ganglion cell tumor of the right cerebellum: A case report and literature review.

This study aims to present a case of cerebellar dysplastic ganglioneuroma, which is commonly referred to as Lhermitte-Duclos disease (LDD). Furthermore, the study aims to provide an extensive review of the essential aspects of LDD, thereby providing essential information for its accurate diagnosis and effective treatment. A 54-year-old woman was admitted with symptoms of headache, facial numbness, and a visible cerebellar mass. Imaging studies revealed specific features such as the "tiger stripe sign" on magnetic resonance imaging, including hydrocephalus compression and abnormal vasculature. The diagnosis of LDD was made. The cerebellar mass was resected via a paracentral approach. The patient underwent surgery for a cerebellar dysplastic ganglion cell tumor (WHO grade I), confirmed by postoperative pathology. Despite sub-complete resection with minor residuals, the patient experienced significant improvement in symptoms. A postoperative computed tomography scan revealed a large cavity with frontal lobe hemorrhage. PTEN gene testing was recommended but declined due to financial constraints. The patient was discharged without complications. LDD presents both benign and tumor characteristics, with a low likelihood of malignancy. Total resection is the recommended treatment, although challenges in complete excision may lead to recurrence. The importance of considering Cowden syndrome and genetic testing, particularly the PTEN gene, in patients with LDD, is emphasized. Long-term follow-up care is crucial for monitoring recurrence and related conditions.

Coronary-subclavian steal syndrome: A case series and review of the literature.

To report a case series of three patients with symptomatic coronary-subclavian steal syndrome (CSSS) and to review the literature on published case series. We retrospectively reviewed three cases of CSSS patients treated with open and endovascular surgery at a single center over a period of three decades (1996-2024). A comprehensive review of case series involving more than three patients was also performed. The first patient was a 65-year-old male with a 12-year history of coronary artery bypass grafting (CABG), presenting with unstable angina. Coronary angiography revealed a patent left internal mammary artery (LIMA) graft with retrograde flow through the left subclavian artery (LSA) and occlusion at the LSA ostium. He underwent a successful carotid-subclavian bypass, which significantly improved his symptoms. He died 6years later from heart failure. The second patient was a 73-year-old woman with a 15-year history of CABG and balloon angioplasty of the grafts. She presented with dyspnea, stable angina, and progressive functional decline. Critical stenosis in the LSA was identified, and her symptoms resolved after successful stent placement. She died 6years later from progressive heart failure. The third patient was a 75-year-old woman with diabetes, hypertension, and heart failure, who also had a history of CABG. She presented with worsening dyspnea, orthopnea, and edema. Imaging revealed occlusion of the circumflex artery graft and severe LSA stenosis. Successful stenting of the LSA alleviated her symptoms and restored normal blood flow from the LIMA graft. She was discharged after 2days and remains well at the six-month follow-up. CSSS should be considered in the differential diagnosis of patients with a history of CABG who present with angina or heart failure. Prompt treatment can lead to significant symptom improvement.