Significant Improvement In Symptoms Research Articles

Semen Cuscutae flavonoids activated the cAMP-PKA-CREB-BDNF pathway and exerted an antidepressant effect in mice.

Semen Cuscutae flavonoids (SCFs) constitute a class of metabolites of Semen Cuscutae, a botanical drug that was recently found to have an anti-depression effect. This study aimed to evaluate the anti-depression effects of SCFs in chronic unpredictable mild stress (CUMS)-induced mice and to interrogate the underlying mechanisms. The CUMS mice were used for assessing the effects of SCFs treatments on depression. Mice were randomly divided into five groups. Four groups were subjected to the CUMS induction and concomitantly administered orally with either the vehicle or with a high-, medium-, and low-dose of SCFs, once per day for 4weeks. One group was kept untreated as a control. The mice were then assessed for their statuses of a number of depression-related parameters, including body weight, food intake, sucrose preference test (SPT), open field test (OFT), tail suspension test (TST), and forced swim test (FST). In addition, a day after the completion of these tests, biopsies from the hippocampus were harvested and used to perform metabolomics by HPLC-MS/MS and to assess the levels of cAMP by ELISA and the levels of PKA, CREB, p-CREB, and BDNF by Western blot analyses. SCFs resulted in significant increases in both body weight and food intake and in the amelioration of the depressive-like behaviors in CUMS mice. A high-dose SCFs treatment led to significant alterations in 72 metabolites, of which 26 were identified as potential biomarkers for the SCFs treatment. These metabolites are associated with lipid, amino acid, and nucleotide metabolism. Among 26 metabolites, cAMP was positively correlated with body weight, SPT, OFT-total distance, and OFT-central residence time, while negatively correlated with immobility time in TST and FST, linking a change in cAMP with the SCFs treatment and the significant improvement in depressive symptoms in CUMS mice. Further analyses revealed that the levels of cAMP, PKA, CREB, p-CREB, and BDNF were reduced in the hippocampus of CUMS mice but were all increased following the SCFs treatments. SCFs could ameliorate hippocampal metabolic disturbances and depressive behaviors and cause the activation of the cAMP-PKA-CREB-BDNF signaling pathway in the hippocampus of CUMS mice.

Clinical and imaging outcomes of 100 patients with cerebrospinal fluid-venous fistulas treated by transvenous embolization

BackgroundCerebrospinal fluid-venous fistulas (CSFVF) are a common cause of spontaneous intracranial hypotension (SIH). Transvenous embolization has emerged as a reliable treatment option. We review the clinical presentation, imaging, and clinical...

Effects of Nurse-Led e-Health Interventions on the Health-Related Outcomes of Pregnant Women: A Systematic Review.

Pregnancy is a special time for women that involves substantial emotional, physical, social, and family changes, which can lead to physical and psychological harm. The rapid development of e-health has provided a favourable platform for managing health-related outcomes in pregnant women, and nurses are the professional group that is most likely to provide e-health services. Nurse-led e-health interventions have attracted increasing attention, but their effects are uncertain. To identify the effectiveness of nurse-led e-health interventions in improving health-related outcomes in pregnant women. A systematic review. The PubMed, PsycINFO, EMBASE, CINAHL, ProQuest, MEDLINE, Scopus, Web of Science and Cochrane Library databases were searched from inception to March 2023. Two reviewers independently assessed study eligibility and extracted data. The Cochrane risk of bias tool was used for quality assessment. The findings of this review are presented using a narrative synthesis. This review included 14 studies involving 2016 participants. Three out of five studies reported that nurse-led e-health interventions significantly reduced depressive symptoms. Four studies reported significant improvements in stress and self-efficacy after the intervention. Two studies reported significant improvements in anxiety symptoms, self-management ability, and quality of life after the intervention. One study showed that weight gain and physical activity significantly improved after the intervention. Due to the heterogeneity in the included studies, no meta-analysis was conducted. Nurse-led e-health interventions may be beneficial for improving anxiety symptoms, depressive symptoms, stress, self-efficacy, weight gain, self-management ability, physical activity, and quality of life in pregnant women. Nurse-led e-health interventions could provide individualised, economic, interactive, and convenient nursing modes for pregnant women. Rigorous and high-quality evidence confirming the long-term effects of these interventions on pregnant women is necessary. The patients had no direct involvement in the present study. PROSPERO registration ID: CRD42023401973.

Self-Induced Nasal Septal Perforation: Rhinotillexomania-A Different Entity From Nose Picking.

Nose picking is a common habit that rarely leads to mutilating self-injury. It is important to distinguish between rhinotillexomania (compulsive nose picking) as a disease and nose picking that results in or contributes to nasal septal perforation (NSP). The aim of this study is to investigate the impact of rhinotillexomania and NSP repair on sinonasal symptoms and quality of life (QoL). Patients with symptomatic NSP due to rhinotillexomania and candidates for surgical repair were included. Sinonasal symptoms and QoL were measured using a visual analogue scale (VAS), Sinus CT scan, Barcelona Smell Test 24 (BAST-24), Sinonasal outcome test (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE), NOSE-Perf, and Medical Outcome Study Short Form (SF-36). Healthy volunteers without sinonasal disorders (n = 43) were also included. A total of 37 patients with Rhinotillexomania (20 male [54.1%]; mean age, 49.2 years [SD 15.4]) were recruited. Totally 32 patients (86.5%) had NSP with the posterior border anterior to the incisive canal. Follow-up data were registered for 29 patients with a mean follow-up duration of 22.1 months (standard deviation, SD 16.7). The overall success rate of NSP repair was 96.6%. Patients experienced significant improvement in sinonasal symptoms and QoL after surgery. Rhinotillexomania is a distinct entity from nose picking. Multidisciplinary approach including behavior therapy and NSP repair are considered the best approaches to relieve sinonasal symptoms. Placing nasal silicone sheets is recommended when the diagnosis of rhinotillexomania is confirmed. The greater palatine artery flap combined with inverted edges appears to be the most effective approach. Level 3 Laryngoscope, 2024.

Efficacy and Safety of Sodium Oxybate in Isolated Focal Laryngeal Dystonia: A Phase IIb Double-Blind Placebo-Controlled Cross-Over Randomized Clinical Trial.

To examine the efficacy and safety of sodium oxybate versus placebo in a phase IIb randomized double-blind placebo-controlled 2-period cross-over clinical trial in patients with isolated laryngeal dystonia (LD). The study was conducted from January 2018 to December 2021, pausing during the COVID-19pandemic, at Massachusetts Eye and Ear in 106 patients with alcohol-responsive (EtOH+) and alcohol-non-responsive (EtOH-) LD (53 to receive 1.5g of sodium oxybate first, 53 to receive matching placebo first). The primary outcome was a change from baseline in LD symptom severity 40 minutes after drug intake. Safety was based on vital signs, cognitive function, suicidality, daytime sleepiness, and adverse events. Patients, investigators, and outcome assessors were masked to study procedures. Compared to baseline, EtOH+ but not EtOH- patients had a statistically significant improvement in LD symptoms following sodium oxybate versus placebo (EtOH+: 98.75% confidence interval [CI] = 0.6-26.9; p = 0.008; EtOH-: 98.75% CI = -6.2 to 18.7; p = 0.42). Statistically significant minimum drug efficacy in EtOH+ patients was found at ≥16% symptom improvement (OR = 2.09; 98.75% CI = 0.75-5.80; p = 0.036), with an average of 40.81% benefits (98.75% CI = 34.7-48.6). Drug efficacy waned by 300 minutes after intake without a rebound. No changes were found in cognitive function, suicidality, or vital signs. Common adverse events included mild dizziness, nausea, and daytime sleepiness. Sodium oxybate showed clinically meaningful improvement of symptoms in EtOH+ LD patients, with acceptable tolerability. Sodium oxybate offers the first pathophysiologically relevant oral treatment for laryngeal dystonia. ANN NEUROL 2024.

Ketamine for the Treatment of Psychiatric Disorders: A Systematic Review and Meta-Analysis.

Inadequate response to first- and second-line pharmacological treatments for psychiatric disorders is commonly observed. Ketamine has demonstrated efficacy in treating adults with treatment-resistant depression (TRD), with additional off-label benefits reported for various psychiatric disorders. Herein, we performed a systematic review and meta-analysis to examine the therapeutic applications of ketamine across multiple mental disorders, excluding mood disorders. We conducted a multidatabase literature search of randomized controlled trials and open-label trials investigating the therapeutic use of ketamine in treating mental disorders. Studies utilizing the same psychological assessments for a given disorder were pooled using the generic inverse variance method to generate a pooled estimated mean difference. The search in OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), EBSCO CINAHL Plus, Scopus, and Web of Science yielded 44 studies. Ketamine had a statistically significant effect on PTSD Checklist for DSM-5 (PCL-5) scores (pooled estimate = ‒28.07, 95% CI = [‒40.05, ‒16.11], p < 0.001), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (pooled estimate = ‒14.07, 95% CI = [‒26.24, ‒1.90], p = 0.023), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores (pooled estimate = ‒8.08, 95% CI = [‒13.64, ‒2.52], p = 0.004) in individuals with PTSD, treatment-resistant PTSD (TR-PTSD), and obsessive compulsive disorder (OCD), respectively. For alcohol use disorders and at-risk drinking, there was disproportionate reporting of decreased urge to drink, increased rate of abstinence, and longer time to relapse following ketamine treatment. Extant literature supports the potential use of ketamine for the treatment of PTSD, OCD, and alcohol use disorders with significant improvement of patient symptoms. However, the limited number of randomized controlled trials underscores the need to further investigate the short- and long-term benefits and risks of ketamine for the treatment of psychiatric disorders.

Daily intake of a dairy-based nutritional supplement improved self-reported gastrointestinal symptoms and modulated microbiota in adult Chinese volunteers

Mild and persisting gastrointestinal symptoms (MPGS) as bloating, constipation or diarrhea are widespread in older adults and often accompanied by gut microbiota dysbiosis. Nutritional interventions help to regulate and restore microbiota and gut function. In this non-randomized continuous prospective cohort study, we evaluated the effects of a 21-day intervention using a dietary dairy-based supplement (AGIJOY™) on self-reported gastrointestinal (GI) symptoms, fecal microbiota composition and short chain fatty acids (SCFA) levels in a cohort of Chinese adults (N = 46, age 27–73) suffering from MPGS. Questionnaire data and fecal samples were collected at baseline (D0), on day 7 and 21 of intervention (D7 and D21). The results showed significant improvement in the self-reported GI symptoms on D21 and a gradual shift in the fecal microbiota composition. In the first week of intervention, the relative abundance (RA) of fecal bifidobacteria significantly increased and the RA of Bacteroides and Helicobacter decreased (p < 0.05). The levels of fecal SCFA remained unchanged during the study. To our knowledge, this is the first study testing the effect of this prebiotic and postbiotic containing milk-based supplement blend on gut microbiota and MPGS among Chinese population under a real living environment.

A COMPARATIVE STUDY BETWEEN DRY NEEDLING AND KINETIC CHAIN ACTIVATION TECHNIQUE WITH SPECIFIED EXERCISE PROGRAMME IN PAINFUL ARC SYNDROME

Objective: Many researcher have reported that painful arc syndrome arises from multiple lesion i. e. minor tear of supraspinatus tendon, supraspinatus tendinitis, calcified deposit in the supraspinatus tendon, subacromial bursitis, crack fracture of greater tuberosity of humerus and bicipital tenosynovitis. In this study, dry needling and KCAT technique with specific exercise programme has been done to reduce pain and improve functioning and their by prevent shoulder pathologies. The objective of the study is. 1) To evaluate the effectiveness of kinetic chain activation in painful arc syndrome. 2) To evaluate the effectiveness of dry needling therapy in painful arc syndrome. 3) To evaluate the effectiveness of a specific exercise program. Methods: 50 patient diagnosed with painful arc syndrome by the physiotherapy department orthopedic department OPD will be initially assessed for the inclusion or exclusion criteria. prior to the treatment procedure patients are oriented to the study and taken informed consent, patient is divided in to two groups(Group A and Group B) and both groups will be assessed for the pre-test parameter. Outcome measure – shoulder pain and disability scale and goniometry is used for measuring pre-test and post-test. Results: The study was significant in reducing pain level and improving function with the pretest. At the end of 6 w treatment program with, both group A (dry needling) and group B(KCAT) showed improvement in painful arc syndrome. Based on results, the study supports research hypothesis that there was a significant improvement in ROM and significant reduction in SPADI score associated with painful arc syndrome. Patient participated in group B shows more significant changes. Conclusion: The study showed that significant improvement in symptoms of group B as compared to group A from the initial level to week 6. At the end of 6 w training programme both group A and group B Shows improvements in symptoms but the result of study supports that group B (KCAT CONCEPT-finger fanning technique) B is more efficient compare to group A(dry needling).

The Impact of Probiotics on Clinical Symptoms and Peripheral Cytokines Levels in Parkinson's Disease: Preliminary In Vivo Data.

Introduction. Previous studies have shown that probiotics have positive effects on both motor and non-motor symptoms in Parkinson's disease (PD). Additionally, in preclinical settings, probiotics have demonstrated the ability to counteract neuronal loss and alpha-synuclein aggregation, important pathological hallmarks of PD. Notably, preliminary in vitro studies have revealed the immunomodulatory properties of probiotics. This study aims to evaluate the impact of probiotics on symptoms and peripheral cytokines levels in PD patients compared to placebo. Methods. Patients were enrolled and blindly randomized to receive either active probiotics (comprising Bifidobacterium animalis subsp. lactis BS01 LMG P-21384, Bifidobacterium longum BL03 DSM 16603, Bifidobacterium adolescentis BA02 DSM 18351, Fructo-oligosaccharides and Maltodextrin-Group A) or placebo (Maltodextrin-Group B). Clinical evaluations and plasma levels cytokines (TNF-α, IFN-γ, IL-6, and TGF-β) were also assessed at enrollment and after 12 weeks. Anti-parkinsonian therapy remained stable throughout the study. Results. Forty PD patients were recruited. After 12 weeks, Group A showed significant improvement in motor symptoms (UPDRS III: 13.89 ± 4.08 vs. 12.74 ± 4.57, p = 0.028) and non-motor symptoms (NMSS: 34.32 ± 21.41 vs. 30.11 ± 19.89, p = 0.041), with notable improvement in the gastrointestinal sub-item (3.79 ± 4.14 vs. 1.89 ± 2.54, p = 0.021). A reduction of IFN-γ levels was observed in both groups, but group A also showed a significant decrease in IL-6 and a slight increase in the anti-inflammatory cytokine TGF-β. Conclusions. Our data suggest that probiotics may modulate peripheral cytokines levels and improve clinical symptoms in PD patients. Probiotics may, therefore, represent a valuable adjunctive therapy to conventional anti-parkinsonian drugs.

Clinical Efficacy of Ultrasound-guided Iliopsoas Corticosteriod Injection for Hip Pain.

Iliopsoas bursitis and tendinopathy are common causes of hip pain and major contributors to snapping hip syndrome, which affects 5-10% of the general population. These conditions often are treated with conservative measures, including corticosteroid injections into the iliopsoas bursa. However, the clinical effectiveness of such injections has not been well studied. Through this study, the authors evaluated the efficacy of ultrasound-guided corticosteroid injections into the iliopsoas bursa. The study included 68 patients diagnosed with iliopsoas tendinopathy, iliopsoas bursitis, or snapping hip syndrome (coxa saltans), all of whom received corticosteroid injections into the iliopsoas bursa as a standard treatment. A single-sample, non-experimental design was employed, with participants completing assessments of pain, mechanical symptoms, physical function, activity level, and total hip score at baseline, and again at three- and six-month post-injection. Data were collected from January 1, 2023, to April 1, 2024, and changes in the outcome measures were analyzed using repeated measures ANOVA. Participants showed significant improvements in pain, mechanical symptoms, physical function, and activity level at both three-month and six-month follow-ups. Additionally, overall hip scores improved statistically by the end of the study. Our data suggest that ultrasound-guided corticosteroid injections into the iliopsoas bursa can effectively improve physical function, enhance the ability to perform daily activities and physical tasks, and reduce disability associated with iliopsoas tendinopathy. Further research with a longer follow-up period and more rigorous controls is warranted to confirm these findings and assess the long-term benefits and potential risks of the procedure.

Effectiveness of proactive health interventions in reducing symptoms and enhancing self-efficacy and self-management in prostate cancer survivors: a randomized controlled trial.

To evaluate the effectiveness of a proactive health intervention in reducing symptoms, enhancing self-efficacy, and improving self-management capabilities in prostate cancer survivors. A single-blind randomized controlled trial was conducted with 200 prostate cancer survivors at a tertiary hospital in Zhejiang Province. Participants were randomly assigned to either the intervention group (n = 95), which received a 3-month proactive health management program based on five health modules with online and telephone follow-up, or the control group (n = 97), which received routine telephone follow-up care. Outcomes were assessed at baseline, 1month, and 3months post-discharge, focusing on prostate cancer symptoms, self-care ability, self-efficacy, and psychological well-being. Compared to the control group, the intervention group showed significant improvements in prostate cancer symptoms (95% CI = [- 5.898, - 1.756], p < 0.001), self-care ability (95% CI = [14.427, 20.878], p < 0.001), and self-efficacy (95% CI = [0.078, 0.408], p = 0.004) after the intervention. Anxiety and depression (95% CI = [- 2.408, - 1.404], p < 0.001) were significantly reduced at the 3-month follow-up compared to baseline, although no significant difference was observed between the groups. The 3-month proactive health management intervention significantly reduced symptoms, anxiety, and depression in prostate cancer survivors, while improving self-care ability and self-efficacy. Further studies with larger samples and longer follow-up periods are needed to confirm these findings. Rehabilitation for prostate cancer survivors should integrate both physical and psychological recovery to address comprehensive health needs. Enhancing survivors' proactive health management skills supports sustained recovery. ClinicalTrial.gov Identifier: ChiCTR2300076594.

Treatment and Early Outcomes of Capitellar Osteochondritis Dissecans.

Treatment for osteochondritis dissecans (OCD) of the humeral capitellum has been predominantly guided by fragment stability and articular cartilage integrity. Nonoperative management is recommended for stable lesions, whereas surgical intervention is indicated for unstable lesions and those that fail nonoperative care. Several surgical options may be considered, although limited information is available regarding indications for specific surgical techniques and comparative postoperative results. To assess surgical outcomes of patients with capitellar OCD treated according to a decision-making approach focused on subchondral bone involvement. Cohort study; Level of evidence, 3. Patients diagnosed with capitellar OCD at a tertiary academic center were enrolled in a prospective longitudinal cohort study. Patient information was collected at the time of enrollment, and OCD lesions were classified according to the Nelson grade. Clinical and radiologic data were collected both pre- and postoperatively for those undergoing surgical treatment. Surgical procedures were performed based on an evolving treatment framework that included considerations specifically for lesion containment and depth of subchondral bone disease. Timmerman scores were obtained to assess patient functional outcomes. A total of 154 patients were prospectively enrolled, 19 of whom had bilateral disease. The mean age at presentation was 13.7 years; 39% were gymnasts and 28.5% were primary baseball or softball athletes. Surgery was performed on 145 elbows, including 43 drilling/microfracture procedures, 21 internal fixations, and 63 autologous osteochondral grafting (OG) procedures. Clinically, there were significant improvements in pain, elbow motion, and mechanical symptoms. Timmerman scores significantly improved after each type of surgical procedure. A total of 76% of patients returned to their primary sport. When stratified by the Nelson grade, patients with OG had lower revision surgery rates than those treated with drilling/microfracture and fixation. Furthermore, for Nelson grade 2 lesions, patients treated with OG had significantly better postoperative elbow motion and higher Timmerman scores compared with those treated with other procedures. Using a treatment framework incorporating lesion containment and depth of subchondral bone disease, surgery for capitellar OCD provides clinical, radiologic, and functional improvements. Patients treated with OG may have lower revision rates and better functional outcomes compared with those treated with other surgical techniques, with OG warranting consideration even for lower-grade OCD lesions.

INTRACRANIAL ARTERIAL LOOP WITH A COMPLEX PARTIALLY THROMBOSED LARGE ANEURYSM ON THE POSTERIOR CIRCULATION: WHAT TO DO NEXT?

Introduction Managing intracranial aneurysms in the posterior circulation is particularly challenging due to anatomical complexities and the high risk of rupture. The presence of a large, partially thrombosed aneurysm adds another layer of difficulty. This report details the case of a 66-year-old female patient presenting with a symptomatic intracranial arterial loop and a large, partially thrombosed aneurysm in the posterior circulation, successfully treated through microsurgical clipping. Material and Methods A 66-year-old female with a history of intermittent headaches, vertigo, and diplopia underwent neuroimaging, including computed tomography angiography (CTA) and magnetic resonance imaging (MRI). Imaging revealed a large aneurysm in the posterior circulation, with partial thrombosis and an associated intracranial arterial loop. The patient was scheduled for a craniotomy to perform microsurgical clipping of the aneurysm. Two titanium aneurysm clips were applied to achieve complete occlusion. Results Intraoperative findings confirmed the large, partially thrombosed aneurysm arising from the basilar artery, with a complex arterial loop intricately intertwined with the aneurysm and adjacent neurovascular structures. The first clip was placed to secure the primary inflow, and the second clip provided additional reinforcement. Postoperative imaging demonstrated successful clipping with no residual aneurysm filling. The patient had an uneventful recovery with no immediate postoperative complications. Clinically, the patient reported significant improvement in symptoms, with a complete resolution of headaches and vertigo. Conclusions This case highlights the challenges and considerations in managing large, partially thrombosed aneurysms in the posterior circulation, particularly in the presence of an intracranial arterial loop. Successful management requires precise microsurgical technique and careful intraoperative decision-making. Further research is needed to optimize treatment strategies, potentially incorporating adjunctive endovascular techniques to enhance surgical outcomes.

Management of Spinocerebellar Ataxia through Ayurveda—A Case Report

ABSTRACT Spinocerebellar ataxias (SCA) are neurodegenerative disorders marked by progressive cerebellar ataxia, impacting balance, motor coordination, and ocular function due to degeneration. This study evaluated Shodhana Chikitsa and Shaman Chikitsa (purification and symptomatic treatments) for SCA. A 27-year-old man with SCA, showing symptoms like swaying, poor balance, and slurred speech, was referred to the Panchakarma OPD at Ayurveda Hospital, Salod, Wardha. He underwent a comprehensive regimen, including full-body massage with herbal poultices (Patrapottali and Shashtishali Swedana), nasal instillation with medicated oil (Marsha Nasya), and a medicated enema with decoctions and oil, along with oral medications, such as Yogaraja Guggulu, Rasnasaptaka Qwath, Cap Neuron Plus, Agnitundi Vati, and Mahavatavidhwansa Rasa, for two months. Panchtikta Ksheer Vasti (medicated milk enema) was given for eight days. Significant improvements in symptoms and the Scale for Assessment and Rating of Ataxia (SARA) score were observed, suggesting that Ayurvedic treatments may be effective for SCA, warranting further research.

A03 - BN Long Term Quality of Life Outcomes Following the Surgical Management of Complete Intrathoracic Stomach (CIS)

Abstract Background Surgery is indicated for symptomatic patients with complete intrathoracic stomach (CIS) to avoid complications (volvulus, obstruction and strangulation) associated with high morbidity. There remains limited evidence of the long-term outcomes and improvement in symptoms from this procedure. Previous large studies have been unable to compare pre-operative symptoms with their post-operative data. Although it appears the procedure has favourable outcomes, further data is required to demonstrate a significant improvement in quality of life (QoL). We therefore aim to assess the long-term outcomes, including changes to QoL and satisfaction, for patients who underwent laparoscopic biological hiatal mesh reconstruction for CIS (100%). Method Prospective data was collected from 154 consecutive GPEH (Giant Hiatus Hernia) patients intervened between March 2008- December 2023 in a large DGH. Retrospective analysis of this identified a subgroup of 34 patients with CIS. All patients underwent a laparoscopic repair with biological mesh, apart from one patient who underwent gastropexy. Outcome measures included both pre-operative and post-operative standardised GERD-Health Related Quality of Life Questionnaire (GERD-QOL) scores; complications; and patient satisfaction. Results Thirty-four patients were included (11 male:23 female) with a mean age 72 (45-83) years. All patients were symptomatic pre-operatively with heartburn (59%), dysphagia (59%), retrosternal discomfort (53%), vomiting (41%), weight loss (41%) or shortness of breath (35%). There were 4 (12%) complications and 3 (9%) 30-day mortalities. Follow up GERD-QOL questionnaires displayed 32/34 (94%) excellent scores (defined as total &amp;lt;5) at 6 months and 15/21 (71%) excellent scores after a median follow up of 8.5 years (72% response rate, 2 further mortalities). This demonstrated a significant improvement in scores following the procedure and long term (p&amp;lt;0.001). Nineteen patients (90%) were satisfied with the procedure after long term follow up (median 8.5 years). Conclusion Laparoscopic repair of complete intrathoracic stomach in this large single-centre study has demonstrated a significant improvement in symptoms and satisfaction over a median 8.5 year follow-up.

Management of Carcinoma of Esophagus in Old Patient with Panchagavya Therapy as a Palliative Care-A Case Report

ABSTRACT Esophageal cancer is a male-dominant, aggressive malignancy with a five-year survival rate of 15%-20%, predominantly affecting developed nations. Esophageal squamous cell carcinoma (ESCC) is the most common subtype. This case study involves a 70-year-old man with ESCC, who was suffering from difficulty swallowing, inability to burp, constant nausea, and occasional trouble swallowing water for two months. He was successfully treated with Panchagavya Chikitsa, which included Panchagavya Ghrita, Gomutra Arka, Kwath of Amla-Yashtimadhu-Shatpushpa, Haritaki Churna, Haridra Ghanvati, and Vibhitaki Avaleha, along with Nasya, Nabhipurana with Panchagavya Ghrita, and Matra Vasti with Tila Taila over six months. Significant symptom improvement was observed, attributed to the Rasayana (rejuvenative), Balya (strengthening), and Jeevaniya (vitality-enhancing) properties of the treatments. These properties inhibit cancer growth, nourish tissues, and restore balance due to their antioxidant effects. Panchagavya formulations showed promising results without adverse effects, highlighting their efficacy in improving the quality of life for this geriatric patient with ESCC.

Scrub typhus masquerading as acute acalculous cholecystitis in a child - a case report.

We describe a case of scrub typhus in a 12-year old boy who presented with symptoms mimicking acute acalculous cholecystitis. He tested positive for anti-scrub typhus IgM antibodies. Treatment with oral azithromycin led to significant improvement and resolution of symptoms. Thus it is important to consider scrub typhus as a differential diagnosis for an acute abdomen in endemic areas. Timely diagnosis may avoid unnecessary suffering.

Abstract 4143239: Extracorporeal Shockwave Therapy Improves Physical Outcomes and Quality of Life In Patients With Symptomatic Peripheral Arterial Disease: Results from a Meta-analysis of Randomized Controlled Trials

Introduction: Extracorporeal shockwave therapy (ESWT) is a non-invasive procedure that may be useful to treat symptomatic peripheral arterial disease (PAD). Trials comparing ESWT with control groups have shown promising results. Methods: PubMed, Cochrane, EMBASE, and Google Scholar were searched for randomized controlled trials reporting the efficacy of extracorporeal shockwave therapy versus control in patients with symptomatic PAD. Data from eligible studies was analyzed using the Review Manager 5.4 software. Mean difference (MD) and 95% Confidence intervals (CI) were calculated for continuous outcomes. Inverse variance method and a random effects model were used for pooled estimates. A p-value &lt; 0.05 (Z-test) was considered significant. Results: 5 randomized controlled trials with 264 patients were included in our analysis. A significant increase in the mean walking distance (MD: 54.13, 95% CI 9.34 to 98.92, p=0.02), pain-free walking distance (MD: 54.13, 95% CI 14.19, 57.88, p= 0.001), SF-36 physical component summary (MD: 11.97, 95% CI 0.26 to 23.69, p=0.05), EQ-5D-3L index score (MD; 0.08, 95% CI: 0.00 to 0.15, p=0.05) and VascuQoL index ((MD: 0.48, 95% CI 0.03 to 0.92, p= 0.04) was seen with ESWT. A slightly higher ankle brachial pressure index was seen in the control group (MD: -0.01, 95% CI: -0.02 to -0.00, p=0.04). There was no difference in SF-36 physical functioning domain score (MD: 18.58, 95% CI: -0.29 to 37.45, p=0.05) and SF-36 bodily pain score (MD: 9.17, 95% CI: -2.885 to 21.19, p=0.13). Conclusions: There was significant improvement in walking distances, exertional symptoms, and quality of life with ESWT. However, ESWT did not translate to an increase in post-treatment ankle-brachial index which was slightly higher in the control group. There is a need for larger randomized controlled trials to substantiate the efficacy of ESWT in treating symptomatic PAD.

Integrating digital behavioural therapy for insomnia into primary care: A feasibility mixed-methods study.

Digital cognitive behavioural therapy for insomnia has been developed to increase capacity and scalability for patients with insomnia, but implementation in primary care remains limited. The aim of the trial was to evaluate the implementation of digital insomnia therapy into primary care practice for patients with insomnia. We conducted a single-arm feasibility trial of digital behavioural therapy for insomnia (SleepFix) providing sleep restriction therapy with insomnia patients in primary care. Healthcare professionals (comprising General Practitioners, community pharmacists and nurses) were enrolled into the trial and, when deemed clinically appropriate, prescribed SleepFix to patients with insomnia. The primary outcome was uptake assessed by the number of downloads of SleepFix. Interviews with primary care healthcare professionals explored their attitudes towards implementing/using insomnia digital therapeutics in clinical practice, and patients about their experiences with SleepFix. Insomnia symptoms, mood and sleep quality were measured before and after the trial. This trial was prospectively registered (ACTRN12620000055909). Thirty healthcare professionals and 105 patients were enrolled into the trial. Fourteen healthcare professionals administered at least one insomnia digital therapeutic prescription between November 2021 and March 2022. Fifty patients downloaded and used SleepFix (47.6% uptake). In post-trial interviews, healthcare professionals felt they could incorporate digital sleep health into clinical practice and patients found SleepFix acceptable. There were significant improvements in insomnia symptoms, mood and sleep quality at week 6 (all p < 0.05). This trial shows a real-world implementation of a digital insomnia therapy into primary care that could provide a framework for prescribing digital sleep interventions.

Clinical efficacy of low-dose Perampanel correlates with neurophysiological changes in familial adult myoclonus epilepsy 2.

Familial adult myoclonus epilepsy (FAME) management relies on antiseizure medications (ASMs), which inadequately address myoclonus and cortical tremor. This study evaluates Perampanel (PER), an AMPA-receptor antagonist, for treating FAME symptoms. Fifteen FAME2 patients participated in an observational prospective study. They received up to 6 mg daily of PER and underwent Unified-Myoclonus-Rating-Scale (UMRS) before and after treatment. Neurophysiological evaluations, including somatosensory evoked potentials (SEPs) and transcranial magnetic stimulation (TMS), assessed PER's impact on cortical glutamatergic excitatory and GABAergic inhibitory circuits. PER treatment significantly reduced UMRS total scores (p = 0.001) and action-myoclonus subscores (p = 0.002), irrespective of disease duration, age at onset, or testing time (p >0.05). Patients with more severe baseline myoclonus demonstrated significant improvements. Neurophysiological assessments revealed a PER-induced decrease in sensorimotor hyperexcitability, characterized by diminished N33 amplitudes, attenuated glutamatergic facilitation, and enhanced GABAergic inhibition in the motor cortex. In conclusion, low-dose PER is well tolerated and effective in alleviating myoclonus in FAME2 patients, supported by its modulatory effects on glutamatergic and GABAergic neuronal circuits. Plain Language Summary: This study investigated the effects of low-dose perampanel in individuals with Familial Adult Myoclonus Epilepsy2 (FAME2), a hereditary condition characterized by epilepsy and tremors. Perampanel, an antiepileptic drug, blocks AMPA receptors in the brain, reducing excessive neural activity that causes seizures and abnormal movements. The results showed significant symptom improvement, which correlated with changes in brain activity as measured by neurophysiological tests. This study suggests that perampanel helps regulate abnormal brain signals and may help managing FAME2 symptoms.