Significant Improvement In Symptoms Research Articles

Cognitive behavioral therapy for the treatment of insomnia in patients with cardiovascular diseases: a meta-analysis with GRADE analysis.

Insomnia, as a difficulty in initiating and maintaining sleep, coupled with cardiovascular diseases (CVDs) increase the risk of aggravate daytime symptoms, mortality, and morbidity. Cognitive behavioral therapy (CBT) is thought to have a significant impact on insomnia treatment, but in patients with CVDs, there is a paucity of data. To provide a comprehensive appraisal on the impact of CBT on the treatment of insomnia in patients with CVDs. We searched Ovid, Scopus, Web of science, and Cochrane central, to randomized controlled trials (RCTs) from inception till November 2022. Outcomes of interest were insomnia severity index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep efficiency (SE), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and sleep disorders questionnaire (SDQ). Pooled data were analyzed using mean difference (MD) with its 95% confidence interval (CI) in a random effect model using STATA 17 for Mac. Nine RCTs comprising 365 patients were included in the analysis. CBT significantly reduced scores of ISI (MD = - 3.22, 95% CI - 4.46 to - 1.98, p < 0.001), PSQI (MD = - 2.33, 95% CI - 3.23 to - 1.44, p < 0.001), DBAS (MD = - 0.94, 95% CI - 1.3 to - 0.58, p < 0.001), SDQ (MD = - 0.38, 95% CI - 0.56 to - 0.2, p < 0.001). Also, it increased the score of SE (MD = 6.65, 95% CI 2.54 to 10.77, p < 0.001). However, there was no difference in terms of ESS. CBT is an easy and feasible intervention with clinically significant improvement in insomnia symptoms. Further large-volume studies are needed to assess sustained efficacy.

Scorpion Bite Mimicking Acute Coronary Syndrome/Myocarditis Later Detected to Have Preexcitation Syndrome—A Case Report and Review of Literature

Abstract Introduction: Scorpion sting-induced myocarditis is a strange and potentially life-threatening problem that merits careful clinical consideration and management. Case Details: Our case, a young male presented with history of scorpion bite over left foot sole associated with local burning an itching with subsequent development of systemic symptoms. The patient received supportive care, including pain management, fluid resuscitation, and close cardiac monitoring. Given the severity of the myocardial involvement, specific interventions targeting the venom’s impact on the heart were initiated. The patient showed significant improvement in symptoms and cardiac function with the implemented management strategies. We present a case report of a patient who suffered myocarditis following a scorpion sting, emphasizing the distinctive clinical features, diagnostic dilemma, and successful management. This case highlights the importance of heightened awareness among healthcare providers when faced with scorpion envenomation, particularly in regions where such encounters are prevalent. Conclusion: This case report contributes to the limited literature on scorpion bite-induced myocarditis, shedding light on the diagnostic intricacies and successful management.

Outcomes of surgical treatment of tracheobronchomalacia in children.

Tracheobronchomalacia (TBM) is characterized by excessive dynamic airway collapse. Severe TBM can be associated with substantial morbidity. Children with secondary TBM associated with esophageal atresia/tracheoesophageal fistula (EA/TEF) and vascular-related airway compression (VRAC) demonstrate clinical improvement following airway pexy surgery. It is unclear if children with severe primary TBM, without secondary etiologies (EA/TEF, vascular ring, intrinsic pulmonary pathology, or complex cardiac disease) demonstrate clinical improvement following airway pexy surgery. The study cohort consisted of 73 children with severe primary TBM who underwent airway pexy surgery between 2013 and 2020 at Boston Children's Hospital. Pre- and postoperative symptomsas well as bronchoscopic findings were compared with Fisher exact test for categorical data and Student'st-test for continuous data. Statistically significant improvements in clinical symptoms were observed, including cough, noisy breathing, prolonged respiratory infections, pneumonias, exercise intolerance, cyanotic spells, brief resolved unexplained events (BRUE), and noninvasive positive pressure ventilation (NIPPV) dependence. No significant differences were seen regarding oxygen dependence, ventilator dependence, or respiratory distress requiring NIPPV. Comparison of pre- and postoperative dynamic bronchoscopy findings revealed statistically significant improvement in the percent of airway collapse in all anatomic locations except at the level of the upper trachea (usually not malacic). Despite some initial improvements, 21 (29%) patients remained symptomatic and underwent additional airway pexies with improvement in symptoms. Airway pexy surgery resulted in significant improvement in clinical symptoms and bronchoscopic findings for children with severe primary TBM; however, future prospective and long-term studies are needed to confirm this benefit.

A real-life cohort of mepolizumab treatment in severe eosinophilic asthma.

Background. Mepolizumab, a monoclonal antibody that interacts with IL-5, was the first anti-IL-5 approved for uncontrolled severe eosinophilic asthma. In several randomised, placebo-controlled trials, treatment with mepolizumab has shown a significant improvement in asthma symptoms and the need to use of oral corticosteroids (OCS). Several studies have correlated blood levels of eosinophil cationic protein (ECP) with the degree of eosinophilic inflammation, which could make it an indirect marker of eosinophilic activity. Methods. This was a single-centre retrospective study that included all patients diagnosed with severe eosinophilic asthma under treatment with mepolizumab. We recorded the number of exacerbations, daily prednisone intake, asthma control test scores and forced expiratory volume in the first second. Results. We followed 22 patients, 14 of whom were OCS-dependent with a mean daily dose of 15.85 ± 15.62 mg prednisone. After 12 months, only five continued taking OCS and the mean daily dose was reduced by up to 2.50 ± 3.84 mg (p less than 0.007). The exacerbation rate at baseline was 2.91 ± 2.27 and decreased to 0.82 ± 1.14 in the following year (p less than 0.001). ACT scores increased significantly from 16.00 ± 5.85 to 20.71 ± 4.45 after six months (p = 0.003). We also observed a decrease in ECP from 81.46 ± 43.99 µg/L to 19.12 ± 18.80 µg/L (p > 0.001). Conclusions. These real-life results are consistent with previous clinical trials demonstrating the efficacy and safety of mepolizumab in routine clinical practice for severe uncontrolled eosinophilic asthma. We observed a significant decrease in blood eosinophil counts and in ECP levels, suggesting a reduction in eosinophil activity following mepolizumab treatment.

A Comparative Study of Outcomes of Submucosal Diathermy Versus Inferior Turbinoplasty in Patients With Deviated Nasal Septum With Inferior Turbinate Hypertrophy.

Introduction Nasal obstruction due to deviated nasal septum (DNS) and inferior turbinate hypertrophy (ITH) is a common problem necessitating surgical intervention. Submucosal diathermy (SMD) and inferior turbinoplasty (IT) are two commonly performed procedures aimed at improving nasal patency. Methods A prospective comparative study was conducted on 56 patients with DNS and inferior turbinate hypertrophy, divided into SMD and inferior turbinoplasty groups. Preoperative and postoperative assessments included symptom assessment using the 22-itemSinonasalOutcomeTest(SNOT-22) questionnaire. Results Both procedures led to significant improvements in nasal symptoms and quality of life. Inferior turbinoplasty showed slightly better outcomes in symptom improvement compared to submucosal diathermy. Conclusions Inferior turbinoplasty appears to offer slightly better outcomes in improving nasal symptoms compared to SMD in patients with DNS and inferior turbinate hypertrophy. However, both procedures are effective and safe options for surgical management. Individualized treatment decisions should consider patient preferences and surgeon expertise.

Effectiveness of vortioxetine in elderly patients with major depressive disorder in real-world clinical practice: Results from the RELIEVE study.

Data demonstrating the real-world, long-term effectiveness of vortioxetine in elderly patients with major depressive disorder (MDD) are clinically useful to confirm findings from randomized trials. RELIEVE was a multinational, 24-week, observational, prospective study in outpatients with MDD initiating vortioxetine treatment in routine care settings (NCT03555136). Here, we report data from a subgroup of 130 patients aged ⩾ 65 years. The primary study outcome was changed from baseline in patient functioning assessed using the Sheehan Disability Scale (SDS). Other clinical outcomes included depression severity (Patient Health Questionnaire-9 [PHQ-9] and Clinical Global Impressions-Severity [CGI-S]), cognitive performance (Digit Symbol Substitution Test [DSST]) and symptoms (Perceived Deficits Questionnaire - Depression-5 item [PDQ-D-5]), and health-related quality of life (HRQoL) (EuroQoL 5 Dimensions 5 Levels [EQ-5D-5L]). Clinically meaningful and statistically significant improvements in patient functioning, depressive symptoms, cognitive function, and HRQoL were observed at week 24. Least squares mean SDS, PHQ-9, CGI-S, PDQ-D-5, DSST, and EQ-5D-5L scores improved from baseline by 6.5, 5.7, 1.2, 3.2, 4.4, and 0.11 points, respectively (p < 0.01 for all). Adverse events were observed in 23.1% of patients. Consistent with previous clinical studies of vortioxetine, this study supports the effectiveness and safety of vortioxetine in treating elderly patients with MDD in a real-world setting over a 6-month period. Patients showed clinically relevant and sustained improvements in psychosocial functioning, depressive symptoms, and cognitive function after receiving vortioxetine, which was generally well tolerated. Main study limitations include the open-label study design and lack of a placebo or comparator group.

Efficacy and Safety of Platelet-Rich Plasma on Bronchopleural Fistula: A Pilot Prospective Cohort Study

IntroductionBronchopleural fistula (BPF) is associated with high morbidity and mortality rates in patients undergoing pulmonary resections. Surgery, bronchoscopy, and conservative management have their limitations for small fistulas. Platelet-rich plasma (PRP) has regenerative properties, which might be efficient in enhancing tissue recovery and repairing small BPF. This study aimed to investigate efficacy and safety of PRP on BPF. MethodsThis is a pilot prospective cohort study. Patients whose fistulas smaller than 4mm were enrolled in this study, treated with PRP under bronchoscopy and followed up at 2 weeks and 4–6 weeks after the last PRP treatment. The cure rate, improvement rate and ineffectiveness rate were investigated. The severity of respiratory symptoms was evaluated by modified Medical Research Council dyspnea scale (mMRC) and COPD Assessment Test (CAT). The recurrence of fistula, new infection and mortality rate were examined. Adverse events were documented to explore the safety profile of PRP therapy. ResultsA total of 16 patients (mean age, 50.1 years) met the eligibility criteria. The median time from the first PRP treatment to the closure of the fistula was 12.0 (IQR 6.0, 21.5) days. Our findings indicate an effectiveness rate of 87.6%, with 68.8% of cure and 18.8% of improvement, along with significant improvement of respiratory symptoms evaluated by mMRC (P<0.001) and CAT (P<0.001). No recurrent of fistulas, newly developed infection, or death was observed. Adverse events of the procedure were most mild (82.6%) and temporary. ConclusionsPRP is a potential treatment for small BPF and is well tolerated.

Working with the inner critic in patients with depression using chairwork: a pilot study.

Individuals diagnosed with depression frequently experience self-criticism, leading to considerable psychological distress. Despite the availability of cognitive-behavioral treatments, a notable proportion of patients indicate that they solely experience cognitive improvements, without the corresponding emotional changes, following therapy. As a result, their psychological symptoms persist. Interventions that specifically target emotional experiencing, such as the chairwork technique, are exclusively included within long-term therapeutic procedures. Hence, the objective of this study is to assess the efficacy as well as the acceptability, feasibility, and safety of a brief intervention utilizing emotion-focused chairwork to treat self-criticism in individuals diagnosed with depression. A pre-post A-B design with two post-treatment assessments (one week- and one month post-intervention) was implemented. Seven patients received three sessions of manualized emotion focused chairwork. Symptomatic change was evaluated using the Beck Depression Inventory II (BDI-II), the emotion regulation questionnaire (SEK-27), the Forms of Self-Criticizing/Reassuring Scale (FSCRS), the Self-Compassion Scale (SCS-D), as well as the Rosenberg Self-Esteem Scale (RSES). Patient satisfaction was evaluated using a self-developed questionnaire. Safety was assessed by the Beck Suicidality Inventory (BSI). There was a significant improvement in depressive symptoms and self-compassion at both follow-up assessment time-points. Moreover, emotion regulation as well as self-esteem improved significantly. Self-criticizing decreased significantly, while self-reassuring increased. Patients were very satisfied with the intervention. Intervention safety was given at all time-points. There were no drop-outs. The implemented chairwork short-intervention is a feasible and safe therapeutic technique. The treatment was highly accepted revealing significant symptomatic improvements. Large-scale randomized controlled trials (RCTs) are necessary to investigate the treatment's effectiveness.

Ketamine plus Cervical Sympathetic Blockade (CSB) Seems to be Significantly More Effective in Reducing the Symptoms of PTSD and Depression than CSB alone in a PTSD Cohort

Purpose: A significant number of Americans have symptoms of Post-Traumatic Stress Disorder (PTSD) and depression. Cervical sympathetic block (CSB) combined with sub-anesthetic ketamine infusions (KI) have been shown to reduce the symptoms of PTSD and depression via a synergistic effect. We aim to report a significant improvement of PTSD and depressive symptoms by concordant use of CSB and KI as compared to CSB alone. Methods: 26 consecutive patients were recruited to study the effects of KI and bilateral CSB vs bilateral CSB alone on sleep via a WHOOP band analysis. Patients were randomized to receive CSB alone vs KI and CSB. Patients received KI and CSB via clinic protocol. Results: Patients (n=11) that received CSB only, demonstrated a PCL reduction of 56.1% and BDI reduction of 59.5%. Patients (n=12) that received CSB and KI together, demonstrated a PCL reduction of 76.9% and a BDI reduction of 83.7%. Conclusion: Bilateral CSB combined with KI seems to be more effective in treating PTSD and depression symptoms as compared to bilateral CSB alone. Considering the size of the study, a larger scale evaluation would be necessary to confirm our findings.

Comparative Effectiveness of different therapies for Convergence Insufficiency

Purpose: This study aimed to determine the effectiveness of different treatment options such as brock string, dot card, jump convergence and pencil push-up exercises for convergence insufficiency (CI). Methodology: After ethical approval, this quasi experimental study was conducted at District Head Quarter (DHQ) Bhakkar, Thel University Bhakkar, schools and collages of Bhakkar and district Layyah by selecting 140 patients presenting with symptomatic convergence insufficiency through non-probability convenient sampling. After informed consent, Positive Fusional Vergence (PFV), CI Symptom Survey (CISS) and near point of convergence (NPC) were measured. Then randomly divide into four groups of 35 patients by non-probability purposive sampling. Each group received one of the chosen therapy for 3 consecutive months. All patients were examined and self-structure proforma was filled as baseline data on each follow-up of therapy. Data was analyzed by IBM SPSS version 23. Results: After completion of three month of treatment, near point of convergence improved from mean 13.343 ±.219 to 8.757±.194; CI 95%: p&lt;0.001 respectively in brock string, mean 13.486 ±.197 to 7.729 ±.169; CI 95%: p&lt;0.001 in dot card exercise, in jump convergence mean 13.614 ±.214 to 9.057, ±.170; CI 95%: p&lt;0.001 improvement of NPC occur and in pencil push-up 13.243 ±.208 to 8.329 ±.143; CI 95%: p&lt;0.001. Conclusion: The dot card is most effective treatment to perform at home for CI, effective for achieving clinically significant improvements in signs and symptoms associated with CI in young adults.

CBT Intervention Post-2023 Southeast Türkiye Quake: A Case Study

This case study investigates the effectiveness of Cognitive Behavioral Therapy (CBT) in treating Post-Traumatic Stress Disorder (PTSD) in an individual survivor of the catastrophic 2023 Southeast Türkiye Earthquake. The study aims to provide detailed insights into the therapeutic process and outcomes of CBT applied in a post-disaster context. A 38-year-old female survivor, pseudonymously named Serpil, participated in an eight-week structured CBT program specifically tailored to address her severe PTSD symptoms following the earthquake. The therapeutic interventions included exposure therapy, cognitive restructuring, and relaxation techniques. Data collection was achieved using quantitative methods such as the Clinician-Administered PTSD Scale (CAPS) and the Beck Depression Inventory (BDI), supplemented by qualitative assessments through detailed therapy session notes and Serpil’s personal reflections. The intervention led to significant improvements in Serpil's PTSD symptoms, particularly a reduction in the frequency and severity of nightmares and flashbacks. Serpil reported enhanced coping mechanisms, which improved her overall psychological resilience and functionality. The data illustrate a notable decrease in PTSD symptomatology, corroborated by scores from CAPS and BDI, indicating an overall improvement in mental health and quality of life. This case study underscores the potential of CBT as a potent intervention for managing PTSD in survivors of natural disasters. It highlights the necessity of integrating specialized psychotherapeutic techniques in disaster response initiatives to address the psychological impacts effectively. The findings advocate for broader implementation and evaluation of similar interventions across diverse post-disaster settings to confirm these results and optimize treatment protocols. Further research with larger sample sizes and longer follow-up periods is recommended to enhance the generalizability and understanding of CBT's long-term effectiveness in disaster-stricken populations.

Evaluation of a PTSD group intervention in a secondary care mental health service

Introduction: Secondary care mental health services in the United Kingdom are under increasing pressure to meet the demand for support for Post-Traumatic Stress Disorder (PTSD), however, there is a lack of clear guidance for treating complex cases of PTSD. Therefore, an evaluation was conducted to investigate the effectiveness of a pilot stabilisation group programme for clients with PTSD in a secondary care mental health service. Method: Attendees of the group (n = 64) were asked to complete routinely collected outcome measures of wellbeing (WEMWBS) and PTSD symptoms (PCL-5). A repeated-measures t-test analysed the pre and post group scores for statistical significance, whilst Reliable Change Indices analysed the data forreliable improvement and clinically significant change. Results: There was a significant difference between the pre and post group scores on the measures of wellbeing and PTSD symptoms. A large proportion of clients demonstrated reliable and clinically significant improvements in wellbeing. A small proportion of service users demonstrated clinically significant improvements in PTSD symptoms. Conclusion: The intervention shows promise as an initial stage of trauma treatment due to the improvements in wellbeing. However, a large proportion of clients are likely to require further intervention to reduce symptoms of PTSD.

Epicardial and endocardial surgical ablation of atrial fibrillation: outcomes from CASE-AF Registry.

The German CArdioSurgEry Atrial Fibrillation Registry is a prospective, multicentric registry analysing outcomes of patients undergoing surgical ablation for atrial fibrillation as concomitant or stand-alone procedures. This data sub-analysis of the German CArdioSurgEry Atrial Fibrillation Registry aims to describe the in-hospital and 1-year outcomes after concomitant surgical ablation, based on 2 different ablation approaches, epicardial and endocardial surgical ablation. Between January 2017 and April 2020, 17 German cardiosurgical units enrolled 763 consecutive patients after concomitant surgical ablation. In the epicardial group, 413 patients (54.1%), 95.6% underwent radiofrequency ablation. In the endocardial group, 350 patients (45.9%), 97.7% underwent cryoablation. 61.5% of patients in the epicardial group and 49.4% of patients in the endocardial group presenting with paroxysmal atrial fibrillation. Pre-, intra- and post-operative data were gathered. Upon discharge, 32.3% (n = 109) of patients after epicardial surgical ablation and 24.0% (n = 72) of patients after endocardial surgical ablation showed recurrence of atrial fibrillation. The in-hospital mortality rate was low, 2.2% (n = 9) in the epicardial and 2.9% (n = 10) in the endocardial group. The overall 1-year procedural success rate was 58.4% in the epicardial and 62.2% in the endocardial group, with significant symptom improvement in both groups. The 1-year mortality rate was 7.7% (n = 30) in epicardial and 5.0% (n = 17) in the endocardial group. Concomitant surgical ablation is safe and effective with significant improvement in patient symptoms and freedom from atrial fibrillation. Adequate cardiac rhythm monitoring should be prioritized for higher quality data acquisition.

Effect of adding telerehabilitation home program to pharmaceutical treatment on the symptoms and the quality of life in children with functional constipation: a randomized controlled trial

Painful defecation, the passage of hard stools, unpleasant or irregular bowel deviation/movements from regular rate, and/or the feeling of not enough elimination of stool are common symptoms of functional constipation. The goals in treating constipation are to produce soft, painless stools and to prevent the re-accumulation of feces. This study looked at how the telerehabilitation home program (TRP) affected the symptoms of FC and the children who were constipated in terms of their quality of life. A randomized controlled trial included 400 children aging 4–18 years with functional constipation distributed in two groups: control group consisted of 200 children receiving pharmaceutical treatment and the intervention group consisted of 200 children receiving the telerehabilitation home program in addition to pharmaceutical treatment. Both groups received the interventions for 6 months. The outcomes in terms of functional constipation symptoms and quality of life are measured and compared pre- and post-interventions. Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in the condition; there is a significant difference between the intervention and control group in all Rome criteria which assess symptoms of functional constipation except rush to the bath-room to poop which showed non-significant difference; there is also a significant difference between the intervention and control group in all domains of the SF-36 questionnaire which assess quality of life except the mental health domain which showed non-significant difference.Conclusion: Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in symptoms of functional constipation and quality of life.Trial registration: Our study was registered retrospectively with Clinicaltrials.gov under the identifier NCT06207721 on 5 January 2024.What Is Known:• Painful defecation, passage of hard stools, unpleasant or irregular bowel movements, feeling of incomplete stool elimination are common symptoms of functional constipation.• Goals in treating constipation include producing soft, painless stools and preventing re-accumulation of feces.What Is New:• Adding telerehabilitation home program to pharmaceutical treatment resulted in significant improvement in functional constipation symptoms and quality of life.• Significant differences between intervention group (200 children receiving telerehabilitation home program in addition to pharmaceutical treatment) and control group (200 children receiving pharmaceutical treatment) were observed in all Rome criteria except for rush to the bathroom to poop, and in all domains of SF36 questionnaire except for the mental health domain.

Ultrasound-Guided PRP and SVF Therapy Shows Sustained Improvement in Severe Knee Osteoarthritis: A 12-Month Retrospective Study.

BACKGROUND Knee osteoarthritis (OA) is a chronic disease caused by cartilage degeneration in the joint accompanied by joint deformities, pain, and stiffness. This study assessed the changes over time in the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS) values of patients after the combined application of stromal vascular fraction (SVF) and platelet-rich plasma (PRP). MATERIAL AND METHODS A retrospective clinical study was designed. Thirty-four patients (8 males, 26 females, mean age 65.21±10.71, range 30-83 years) with pain due to knee osteoarthritis received SVF and PRP between 2019 and 2020. During and after the procedure, ultrasound-guided intra-articular spread was checked. RESULTS PRP+SVF injection provided significant improvement in the clinical symptoms of the patients measured according to their VAS and WOMAC scores, and this improvement continued until the twelfth month. The change in VAS scores of the patients was 1.76±1.18 (P=0.000) in the first month, 1.50±1.46 (P=0.000) in the sixth month, and 1.53±1.41 (P=0.000) in the twelfth month. VAS scores decreased 6.6 to 1.6 point at the end of the twelfth month. The WOMAC scores of the patients were 23.20±12.12 (P=0.000) in the first month, 19.48±12.0 (P=0.000) in the sixth month, and 20.01±10.48 (P=0.000) in the twelfth month. WOMAC scores decreased 51.99 to 20.48 point at the end of the twelfth month. CONCLUSIONS Applying ultrasound-guided PRP+SVF injection into the knee joint once in OA patients improved VAS and WOMAC scores.

Improvement and Maintenance of Clinical Outcomes in a Digital Mental Health Platform: Findings From a Longitudinal Observational Real-World Study.

Digital mental health services are increasingly being provided by employers as health benefit programs that can improve access to and remove barriers to mental health care. Stratified care models, in particular, offer personalized care recommendations that can offer clinically effective interventions while conserving resources. Nonetheless, clinical evaluation is needed to understand their benefits for mental health and their use in a real-world setting. This study aimed to examine the changes in clinical outcomes (ie, depressive and anxiety symptoms and well-being) and to evaluate the use of stratified blended care among members of an employer-sponsored digital mental health benefit. In a large prospective observational study, we examined the changes in depressive symptoms (9-item Patient Health Questionnaire), anxiety symptoms (7-item Generalized Anxiety Disorder scale), and well-being (5-item World Health Organization Well-Being Index) for 3 months in 509 participants (mean age 33.9, SD 8.7 years; women: n=312, 61.3%; men: n=175, 34.4%; nonbinary: n=22, 4.3%) who were newly enrolled and engaged in care with an employer-sponsored digital mental health platform (Modern Health Inc). We also investigated the extent to which participants followed the recommendations provided to them through a stratified blended care model. Participants with elevated baseline symptoms of depression and anxiety exhibited significant symptom improvements, with a 37% score improvement in depression and a 29% score improvement in anxiety (P values <.001). Participants with baseline scores indicative of poorer well-being also improved over the study period (90% score improvement; P=.002). Furthermore, over half exhibited clinical improvement or recovery for depressive symptoms (n=122, 65.2%), anxiety symptoms (n=127, 59.1%), and low well-being (n=82, 64.6%). Among participants with mild or no baseline symptoms, we found high rates of maintenance for low depressive (n=297, 92.2%) and anxiety (n=255, 86.7%) symptoms and high well-being (n=344, 90.1%). In total, two-thirds of the participants (n=343, 67.4%) used their recommended care, 16.9% (n=86) intensified their care beyond their initial recommendation, and 15.7% (n=80) of participants underused care by not engaging with the highest level of care recommended to them. Participants with elevated baseline depressive or anxiety symptoms improved their mental health significantly from baseline to follow-up, and most participants without symptoms or with mild symptoms at baseline maintained their mental health over time. In addition, engagement patterns indicate that the stratified blended care model was efficient in matching individuals with the most effective and least costly care while also allowing them to self-determine their care and use combinations of services that best fit their needs. Overall, the results of this study support the clinical effectiveness of the platform for improving and preserving mental health and support the utility and effectiveness of stratified blended care models to improve access to and use of digitally delivered mental health services.

Modulation of Gut Microbiome and Autism Symptoms of ASD Children Supplemented with Biological Response Modifier: A Randomized, Double-Blinded, Placebo-Controlled Pilot Study.

The etiology and mechanisms of autism and autism spectrum disorder (ASD) are not yet fully understood. There is currently no treatment for ASD for providing significant improvement in core symptoms. Recent studies suggest, however, that ASD is associated with gut dysbiosis, indicating that modulation of gut microbiota in children with ASD may thus reduce the manifestation of ASD symptoms. The aim of this pilot study (prospective randomized, double-blinded, placebo-controlled) was to evaluate efficacy of the biological response modifier Juvenil in modulating the microbiome of children with ASD and, in particular, whether Juvenil is able to alleviate the symptoms of ASD. In total, 20 children with ASD and 12 neurotypical children were included in our study. Supplementation of ASD children lasted for three months. To confirm Juvenil's impact on the gut microbiome, stool samples were collected from all children and the microbiome's composition was analyzed. This pilot study demonstrated that the gut microbiome of ASD children differed significantly from that of healthy controls and was converted by Juvenil supplementation toward a more neurotypical microbiome that positively modulated children's autism symptoms.

Therapeutic Efficacy of Ultrasound-Guided Selective Nerve Block on Chronic Cervical Radiculopathy.

Background and Objectives: Cervical radiculopathy (CR) manifests as pain and sensorimotor disturbances in the upper extremities, often resulting from nerve root compression due to intervertebral disc herniation, degenerative changes, or trauma. While conservative treatments are initially preferred, persistent or severe cases may require surgical intervention. Ultrasound-guided selective nerve root block (SNRB) has emerged as a promising intervention for alleviating symptoms and potentially obviating the need for surgery. This study evaluates the therapeutic efficacy of ultrasound-guided SNRB in managing chronic CR, aiming to determine its potential in symptom relief and delaying or avoiding surgical procedures. Materials and Methods: A retrospective analysis was conducted on 720 outpatients treated for CR between October 2019 and March 2022. After excluding patients with traumatic CR, previous surgeries, malignancies, progressive neurological symptoms requiring immediate surgery, or inadequate conservative treatment, 92 patients who had experienced cervical radicular pain for more than three months and had failed to improve after more than six weeks of conservative treatment with VAS scores ≥ 5 were included. The patients underwent single or multiple ultrasound-guided SNRB procedures, involving the injection of dexamethasone and lidocaine under real-time ultrasound guidance. Symptom severity was assessed at the baseline, and at 4, 8, and 12 weeks post-procedure using the Visual Analog Scale (VAS). The data collected included age, sex, presence of neck and/or radicular pain, physical examination findings, recurrence of symptoms, improvement in symptoms, and whether surgical intervention was ultimately required. Statistical analyses were performed to identify the factors associated with symptom improvement or recurrence. Results: Significant symptom improvement was observed in 69 (75.0%) participants post-SNRB, with 55 (79.7%) showing improvement at 4 weeks, 11 (15.9%) at 8 weeks, and 3 (4.4%) at 12 weeks. Symptom recurrence, defined by an increase in VAS score accompanied by a pain flare lasting at least 24 h after a pain-free interval of at least one month, was noted in 48 (52.2%) patients. The presence of combined neck and radicular pain was a significant predictor of recurrence (p = 0.008). No significant associations were found between symptom relief and factors such as age, gender, initial pain severity, or MRI findings. Conclusions: Ultrasound-guided SNRB effectively manages chronic CR, providing substantial symptom relief and potentially reducing the need for surgical intervention. This technique offers a promising conservative treatment option, especially given its real-time visualization advantages and minimal radiation exposure.

Treatment Outcome Post Endoscopic Sinus Surgery(ESS) in Patients with Chronic Rhinosinusitis (CRS).

Chronic rhinosinusitis (CRS) is one of the most prevalent conditions in medicine causing a considerable amount of healthcare expenditure. This study was performed to clinically diagnose chronic rhinosinusitis with or without polyps and to measure the intensity of patients' symptoms and treatment outcomes. This was a prospective cohort study, which included 70 patients diagnosed with CRS according to the EPOS-2012 and were given SNOT-22 questionnaire preoperatively, which was repeated on 1st, 4th, and 12th weeks post-op to determine the treatment outcome. Patients were divided into three groups according to their predominant histopathological features and the treatment outcomes were assessed based on SNOT-22 scoring system. According to our study, ESS effectively raised the quality of life for CRS patients, and one week after surgery, there was a significant improvement in total symptoms (from 49.01 ± 14.83 to 21.91 ± 8.88). it was noted that there was a decrease in SNOT-22 scores at various intervals from baseline to week 12. The four subscales of the SNOT-22 test (rhinological symptoms, ear and facial symptoms, sleep function, and psychological difficulties) showed significant improvements in quality of life across all groups, and this relationship extended beyond the relationship with rhinological symptoms. These improvements were statistically significant after three months of post operative medical therapy. SNOT-22 is determined to be reliable and convenient to use. After ESS, all of the symptoms in our study showed a drop in SNOT-22 scores from week 1 to week 12, indicating an improvement in overall symptoms. Therefore, it can be used to monitor the success of surgical intervention in addition to medicinal therapy.

The Efficacy of Onion Extract on the Prevention or Treatment of Scars: A Systemic Review.

Scars are common and debilitating outcomes of burn injury, with no current consensus regarding the gold standard in scar management. Non-invasive interventions such as silicone gels are popular adjuvant treatments due to ease of application. Onion extract (OE) has been proposed as a potential scar treatment modality due to its anti-microbial and anti-inflammatory properties. A systematic search of the literature was conducted using PubMed, Scopus, and Cochrane for articles published between January 2000 and December 2021. Inclusion criteria were studies: (a) involved OE gel or OE treatment, and (b) those assessing scar prevention or treatment outcomes. Patient and physician reported scar outcomes after treatment and adverse effects were recorded. A total of 21 articles were included in the final review. Five studies found statistically significant improvements in overall scores and individual VSS components in the OE treatment group compared to the silicone groups. Several studies found combined treatment of OE with other topical treatment modalities such as triamcinolone or silicone gel produced significant improvements in scar symptoms. In this review, reported adverse effects were minimal, often consisting of self-resolving pruritus, irritation, and erythema. This review supports OE's potential utility in scar prevention and treatment. Most studies reported minimal adverse events with OE application and significant benefits in specific scar characteristics. Further research is needed to investigate scar outcomes after treatment with OE with larger sample sizes and a follow up period greater than a year.