Six-month Follow-up Period Research Articles

Effect of Hypnosis on Pain, Anxiety, and Quality of Life in Female Patients with Fibromyalgia: Prospective, Randomized, Controlled Study

ABSTRACT This prospective, randomized, controlled study aimed to investigate the effects of standardized adjuvant hypnosis on pain, depression, anxiety, aerobic exercise practices, quality of life, and disease impact score in female patients with fibromyalgia syndrome (FMS). This study included 47 female patients with FMS who had been under treatment for at least six months. The hypnosis group (n = 24) received a total of three hypnosis sessions and was taught to patients’ self-hypnosis. The patients in this group practiced self-hypnosis for six months. During this period, all patients also continued their medical treatment. The Visual Analogue Scale (VAS) was used to determine the intensity of pain. At the end of the six-month follow-up period, it was determined that the patients of FMS with hypnosis therapy had lower pain intensity, FMS symptoms, depression, and anxiety symptoms, and better well-being than those in the control group (p < .05). Standardized hypnosis is an effective method in reducing pain, depression and anxiety symptoms and improving quality of life in patients with FMS.

Recurrent ACPA-positive pericarditis, would it be a pre-clinical manifestation of RA?

Abstract Introduction Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease with an autoimmune component that preferentially affects the small joints of the hands and feet. Extra-articular manifestations may be associated with it. These are rather long-term complications compared to the inaugural forms of the disease. Observation We report the observation of a 62-year-old female patient with a history of high blood pressure under monotherapy by a conversion enzyme inhibitor, followed for recurrent pericarditis for three years, who was initially treated with anti-bacillary drugs without improvement. She presented two years ago an episode of pericarditis of great abundance requiring a pericardial drainage. The pericardial biopsy was non-specific. The etiological work-up revealed the presence of anti-citrullinated peptide antibodies (ACPA) and a rheumatoid factor (RF) at very high levels. The patient did not present any other systemic signs, especially articular ones. Joint imaging was normal. The evolution was marked by the persistence of a pericardial effusion of a small to medium size. RA could not be retained according to the American College of Rheumatology/ European League Against Rheumatism’s (ACR/EULAR) 2010 criteria. Glucocorticoids therapy at a dose of 0.5 mg/kg/day allowed the resolution of the pericarditis without recurrence, with a six-month follow-up period. Conclusion This is an extra-articular manifestation that would be inaugural of RA. It is an atypical presentation in the usual history of the disease. The inclusion of extra-articular involvement in the classification criteria and in the groups at risk of developing RA would be useful in these cases.

The Safety and Efficacy of Human Umbilical Cord-Derived Mesenchymal Stem Cells in Patients With Heart Failure and Myocardial Infarction: A Meta-Analysis of Clinical Trials.

Evidence from preclinical and clinical studies suggests that human umbilical cord-derived mesenchymal stromal cells (HUC-MSCs) may be useful in treating heart failure and acute myocardial infarction (MI). However, the effects of stem cell therapy on patients with heart failure remain the subject of ongoing controversy, and the safety and effectiveness of HUC-MSCs therapy have not yet been proven. To date, there has been no systematic overview and meta-analysis of clinical studies using HUC-MSCs therapy for heart failure and MI. The purpose of this study is to assess the safety and efficacy of HUC-MSC therapy versus a placebo in patients with heart failure and MI. While preparing this systematic review and meta-analysis, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer literature search of PubMed was performed. We considered randomized controlled trials (RCTs) that reported data on the safety and efficacy of HUC-MSC transplantation in patients with heart failure and MI. Two investigators independently searched the literature, extracted data, and rated the quality of the included research. Pooled data were analyzed using the fixed-effect model or the random-effect model in Review Manager 5.3. The Cochrane risk of bias tool was used to assess the bias of included studies. The primary outcome was ejection fraction (EF), whereas the secondary outcomes were readmission and mortality rates. Three RCTs (201 patients) were included in this meta-analysis. The overall effect did not favor either of the two groups in terms of risk of readmission (risk ratio = 0.5, 95% confidence interval (CI) = 0.22-1.15, p = 0.10) as well as mortality rate (risk ratio = 0.44, 95% CI = 0.14-1.44, p = 0.18). However, there was an improvement in EF in patients who received HUC-MSCs compared to placebo after 12 months of transplantation (mean difference (MD) = 3.21, 95% CI = 2.91-3.51, p < 0.00001). At the six-month follow-up period, there was no significant improvement in EF (MD = 1.30, 95% CI = -1.94-4.54), p = 0.43), indicating that the duration of follow-up can shape the response to therapy. Our findings indicate that HUC-MSC transplantation can improve EF but has no meaningful effect on readmission or mortality rates. Existing evidence is insufficient to confirm the efficacy of HUC-MSCs for broader therapeutic applications. Therefore, additional double-blind RCTs with larger sample sizes are required.

Efficacy of a self-management program on quality of life in colorectal cancer patients: A randomized controlled trial

PurposeTo test the efficacy of a self-management program based on acceptance and commitment therapy on quality of life, emotional distress, fatigue, physical activity, and fruit and vegetable intake in patients with colorectal cancer. MethodsThe study was a randomized controlled trial. A sample of 156 patients with colorectal cancer (stage I–III) was recruited by convenience sampling and participants were allocated randomly assigned to control or intervention groups. The intervention included a colorectal cancer self-management information booklet, two personal skills training sessions, and 12 follow-up telephone calls. The control group received health education leaflets. Outcome variables were assessed in both groups at baseline and every two months thereafter during the six-month follow-up period. ResultThe mean age of participants was 62 years (range: 30–89 years). Generalized estimation equations analyses revealed significant differences over time in changes in anxiety (β = −2.22, p = 0.001), depression (β = −1.48, p = 0.033), fatigue (β = 4.46, p = 0.001), physical and functional measures (β = 6.16, p = 0.005), and colorectal-cancer–specific quality of life (β = 7.45, p = 0.012). However, there were no significant differences in changes in physical activity or fruit and vegetable intake over time. ConclusionThe self-management skills provided by oncology nurses, including symptom management, psychological adjustment, and relaxation exercises, help colorectal cancer patients to overcome the challenges of cancer survivorship, accelerate their recovery, and improve their quality of life. The trial numberNCT03853278 registered on ClinicalTrials.gov.

Online distribution of HIV self-testing kits to promote HIV testing among men who have sex with men discontinuing pre-exposure prophylaxis after demonstration project completion in China: a multicentre open-label randomized controlled trial

HIV self-testing (HIVST) offers potential solutions to challenges associated with site-based HIV testing (SBHT). However, the effectiveness of HIVST as an HIV prevention strategy for men who have sex with men (MSM) discontinuing pre-exposure prophylaxis (PrEP) after the completion of PrEP demonstration project has rarely been assessed. The China Real-world Study of Oral PrEP (CROPrEP) project was conducted in four cities in China. Participants were directed to community resources to continue their PrEP medication after the discontinuation of project-provided PrEP at the last CROPrEP visit. We conducted a multicentre open-label randomized controlled trial among MSM who had discontinued PrEP induced by the completion of CROPrEP. Eligible participants were randomly assigned to either the intervention group or the control group (1:1). Participants received regular health education and behavioural interventions throughout the trial. The intervention group was given a link to order free HIVST kits online, while the control group received information about free SBHT. Both groups completed internet-based follow-up surveys at three and six months. The primary outcome was the proportion of participants who underwent HIV testing during the six-month follow-up period. This trial was registered at chictr.org.cn (ChiCTR2000038416). Between November 2020 and January 2021, we recruited a total of 620 participants (300 in the intervention group and 320 in the control group). The follow-up completion rates were 99·0% and 95·0% in the intervention and control groups, respectively. At baseline, the median age of participants was 32 (interquartile range: 26-37), and 77·7% underwent HIV testing in the past three months. The proportion of participants who underwent HIV testing in the past three months was higher in the intervention group than in the control group at both the three-month (adjusted risk difference [RD]: 36·7, 95% confidence interval [CI]: 35·1-38·5, p<0·001) and six-month (RD: 26·7, 95% CI: 24·6-28·7 p<0·001) follow-up periods. Our study suggests that providing online distribution of HIVST kits for MSM with PrEP discontinuation induced by completion of the PrEP project effectively promoted HIV testing. This digital approach improves access to HIV testing for MSM and can be applicable to other settings where MSM turn to online public health services. The study was funded by the Fund of National Natural Science Foundation of China; the Mega-Projects of National Science Research for the 13th Five-Year Plan; and the Liaoning Revitalization Talents Program, China.

Clear Cell Adenocarcinoma of the Young Woman's Cervix: About A Case

This report presents a case study of a patient diagnosed with clear cell adenocarcinoma of the cervix without a history of in utero exposure to diethylstilbestrol (DES). It is important to note that despite being an uncommon occurrence, clear cell adenocarcinoma should be considered a potential diagnosis for young women with cervicovaginal lesions, even if they have no prior history of in utero DES exposure. We present a case report of a 33-year-old woman who sought medical attention for menometrorrhagia, leucorrhoea, and the discovery of a vegetative tumour. The patient was diagnosed with clear cell carcinoma of the cervix. The patient was treated with concurrent radiochemotherapy combined with endocavitary uterovaginal brachytherapy and showed a favorable progression during a six-month follow-up period.

Age differences in acceptance and commitment therapy for chronic pain

ObjectiveChronic pain is prevalent and debilitating, especially among older adults. Acceptance and commitment therapy (ACT) is an evidence-based treatment for chronic pain that, in a prior study, has shown greater benefit among older adults. Critical questions remain regarding the time course and extent of age differences in ACT for chronic pain. The current study sought to inform clinical decision-making by addressing these remaining questions. MethodsThis study reanalyzed data from a prior trial of ACT for chronic pain in US Veterans. We estimated piecewise latent curve models to capture the time course of change in pain intensity, pain interference, pain acceptance, and depression during and after ACT. Then, we examined age as a moderator of longitudinal effects and used pick-a-point models to generate age-specific trajectory predictions. ResultsOlder age was associated with significantly greater improvement in pain intensity (p = .003) and marginally greater improvement in pain interference (p = .078) at posttreatment. However, during the six-month follow-up period, older adults relapsed on these outcomes (ps ≤ .029), whereas younger adults maintained their gains or even continued to improve. Older age was only marginally associated with greater depression improvement during the intervention (p = .069), and other moderation effects on depression and pain acceptance were nonsignificant. ConclusionOlder adults may experience greater initial improvement than younger adults during ACT for chronic pain. However, older adults may then need adjunctive maintenance treatment. Future studies are needed to characterize the mechanisms driving this moderation effect.

A Prospective Study of the Age at Menarche in North Indian Girls, Its Association With the Tanner Stage, and the Secular Trend.

Background Menarche is an important event in a female's reproductive health. However, the age at menarche is variable and has implications on the future health of the girl. The purpose of this study was to estimate the mean age at menarche of North Indian adolescent girls and its association with the Tanner stageand to study the trend of menarcheal age in India in the 21st century. Materials & methods A longitudinal descriptive study was conducted on 470 healthy girls aged nine to 16 years in expectant menarche (Tanner stage II). They were followed for six months to check for the attainment of menarche. Those who achieved menarche were grouped in Group I and the rest in Group II. The data were analyzed using the independent t-test. Results Menarche was achieved by 263 girls in the six-month follow-up period. The mean (SD) age of menarche was 13.13 (1.23) years. Group I girls were mostly in Tanner stage IV and above. Group II girls had a mean (SD) age of 11.53 (1.1) years and were mostly in Tanner stage III or below. The estimated decline in the age of menarche in the 21st century was about 0.41 years per decade. Conclusion The girls who achieved menarche had a significantly higher age and Tanner stage of sexual maturity than girls who did not achieve menarche in the study period. Tanner stage is a better measure to estimate the pubertal onset than age. The studies on the age of menarche in the current century reveal that the declining trend in the menarcheal age is continuing in India.

Effect of SGLT2 inhibitors on the proteinuria reduction in patients with IgA nephropathy.

Recent trials suggest sodium-glucose cotransporter 2 inhibitors (SGLT2i) significantly reduced proteinuria in patients with IgA nephropathy (IgAN). While little was known its efficacy in clinical practice especially in those already received full dose reninangiotensin-aldosterone system (RAAS) inhibitors. A cohort of 93 Chinese patients with biopsy-proven IgAN and persistent proteinuria underwent full supportive therapy, including optimal blood pressure control and full dose angiotensin-converting enzyme-inhibitor or angiotensin receptor blocker therapy. Proteinuria reduction at three and six months after initiating SGLT2i therapy was analyzed. A total of 93 patients were enrolled in this study and 62 of them completed the six-month follow-up. After SGLT2i administration, a significant reduction in proteinuria was observed, with a decrease of 22.9% (p < 0.001) at three months and 27.1% (p < 0.001) at six months. During the six-month follow-up period, a decline of 3.0 mL/min/1.73m2 in estimated glomerular filtration rate (eGFR) (p = 0.012) and an increase of 0.8 g/L in albumin (p = 0.017) were observed. The anti-hypertensive effect of SGLT2i was not significant (p > 0.05). Notably, a consistent antiproteinuric effect of SGLT2i was observed across various settings, including different age groups, baseline levels of proteinuria/eGFR, use of immunosuppressive agents, and the presence of comorbid diabetes and hypertension (all p values >0.05). The proteinuria was significantly reduced after SGLT2i administration in IgAN patients with full dose angiotensin-converting enzyme-inhibitor or angiotensin receptor blocker therapy. Importantly, the antiproteinuric effect of SGLT2i was observed independently of immunosuppressive agent therapy, age, baseline eGFR and proteinuria levels, as well as the history of hypertension and diabetes.

Pilot randomized controlled trial of a brief strategy to prevent suicide after discharge from residential addiction treatment

IntroductionVeterans are at greater risk for suicide and veterans with substance use disorder (SUD) have an even greater risk. Little research has looked into brief interventions to prevent suicide in this population in residential substance use treatment programs. MethodWe conducted a pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients participating in the Residential Recovery Center (RRC) SUD 28-day program and deemed at risk for suicide. We measured changes in symptoms at 1-, 3-, and 6-months. We looked at social connectedness, suicidal ideation, hopelessness, thwarted belongingness, perceived burdensomeness, and treatment engagement. ResultsThe study enrolled twenty patients. One participant withdrew immediately after baseline. We found that adherence to VA BIC components was high, as 100 % of patients (N = 10) completed 70 % or more of the VA BIC visits. Furthermore, 80 % of intervention group patients (N = 8) completed all VA BIC components. During the six-month follow-up, suicidal ideation improved in patients assigned to VA BIC, while it worsened in the standard care arm. Similarly, patients assigned to VA BIC reported a reduction in perceived burdensomeness over the six-month follow-up period while it worsened in the standard care arm. Additionally, VA BIC may modestly improve treatment engagement in the first month postdischarge. ConclusionWe were able to recruit and enroll patients from a residential SUD treatment program into a clinical trial of the VA BIC intervention. Our preliminary results suggest that VA BIC may be useful in reducing suicidal ideation and perceived burdensomeness in patients who are discharged from residential SUD treatment programs and increasing treatment engagement. Future trials of VA BIC should determine whether VA BIC can reduce the risk of suicide in patients who are discharged from residential SUD treatment programs.

Uncovering the Role of Epstein-Barr Virus Infection Markers for Remission in Rheumatoid Arthritis.

Epstein-Barr virus (EBV) infection has been shown as a potential risk factor for the development of rheumatoid arthritis (RA). This prospective research aimed to investigate whether EBV infection markers changed during the six-month follow-up period in 133 RA patients (80 newly diagnosed on methotrexate (MTX)-RA-A, and 53 on biologic therapy-RA-B) and whether it was related to a disease outcome. Reduction of disease activity and inflammation was obtained. A significant decline in seroprevalence and titer for anti-VCA-IgM (p = 0.022 and p = 0.026) and anti-EA(D)-IgM (p = 0.022 and p = 0.006) in RA-A, and in seroprevalence and titer of anti-EA(D)-IgG in the RA-B subgroup (p = 0.021 and p = 0.006) were detected after the follow-up. A lower titer of anti-EBNA1-IgG could be considered a significant marker of RA remission in all RA patients regardless of age and gender (OR = 0.99, 95% CI OR = 0.98-0.99, p = 0.038), and also in RA-B patients separately (OR = 0.988, 95% CI OR = 0.98-0.99, p = 0.041). This study supported the basic hypothesis that the immune response to EBV infection is involved in the RA pathogenesis, at the beginning of the disease or during the RA evolution. Moreover, the potential influence of MTX or TNF-alpha inhibitors on the impairment of the host to control EBV infection was indirectly refuted.

Comparison Between the Efficacy of Spinal Cord Stimulation and of Endovascular Revascularization in the Treatment of Diabetic Foot Ulcers: A Retrospective Observational Study

ObjectiveWe aimed to compare the effects of spinal cord stimulation (SCS) with those of endovascular revascularization on the treatment of diabetic foot ulcers. Materials and MethodsA total of 104 patients with diabetic foot ulcers who met the inclusion criteria were retrospectively analyzed and classified to the SCS treatment group (n = 46) and endovascular revascularization treatment group (n = 46). The quality-of-life scores (Quality of Life Scale for Patients with Liver Cancer v2.0), visual pain analog scale score, lower limb skin temperature, lower limb arterial ultrasound results, and lower extremity electromyography results were analyzed to compare the efficacy of the two treatments for diabetic foot ulcers in the two groups before surgery and six months after surgery. ResultsA total of 92 patients (men: 73.9%, mean age: 66.51 ± 11.67 years) completed the six-month postoperative follow-up period. The patients in the SCS treatment group had a higher quality-of-life score (25.54% vs 13.77%, p < 0.05), a larger reduction in pain scores (69.18% vs 37.21%, p < 0.05), and a larger reduction in foot temperature (18.56% vs 7.24%, p < 0.05) than those of the endovascular revascularization treatment group at six months after surgery. The degree of vasodilation in the lower limbs on color Doppler arterial ultrasound and the nerve conduction velocity were higher in the SCS treatment group than in the endovascular revascularization treatment group at six months after surgery (p < 0.05). ConclusionSCS was more effective than endovascular revascularization in improving quality of life, relieving pain, improving lower limb skin temperature, increasing lower limb blood flow, and improving nerve conduction in patients with diabetic foot ulcers at six months after surgery.

Manual cervical therapy and vestibular migraine: A case series.

Vestibular migraine (VM) is a relatively new diagnostic entity with incomplete knowledge regarding pathophysiological mechanisms and therapeutic guidelines. By reporting the effect of manual cervical therapy (MCT) on people with VM, we suggest a possible role for upper cervical afferents in VM treatment and/or pathogenesis. The objective was to describe the change in clinical presentation and self-reported symptoms of VM corresponding to MCT and followed up to six months. A nonrandomised *ABA design was utilised to consecutively and prospectively evaluate selected patients with diagnosed VM. Symptom characteristics (frequency and intensity) were recorded along with standardised patient-reported outcomes (PROs) to document the response to MCT. Three patients were recruited who met the diagnostic criteria for VM. All three patients demonstrated improvement in both migraine attack and interictal symptom frequency. These improvements mirrored changes in PROs and were sustained over a six-month follow-up period. The improvement that coincided with the intervention including MCT was rapid, observable and sustained. This suggests that the upper cervical spine could be a therapeutic target in VM and may have implications for future research into the pathogenesis of VM.

Effect of pioglitazone on proteinuria and cardiovascular events in patients with diabetic nephropathy

Introduction: Slowing the progression of diabetes to DN has established a great deal of interest in recent years. Objectives: Considering the enormous costs of managing patients with diabetes and the lack of similar studies on the Iranian population, the present study aimed at investigating the effect of pioglitazone on the progression of DN and the prevalence of cardiovascular events. Patients and Methods: The present prospective study was undertaken on 55 patients with type 2 diabetes who were divided into two groups. The group 1 patients received 30 mg of pioglitazone daily in addition to other blood sugar-controlling drugs. Patients in the group 2 recieved other anti-diabetic medications. During a six-month follow-up period, proteinuria and the occurrence of cardiovascular events were assessed. Results: The 24-hour urinary proteinuria decreased within the group 1 and these intragroup differences were significant (P&lt;0.001) during six months of follow-up compared to month two. There was no significant difference in the ratio of cardiovascular events in the group 1 compared to the group 2. Conclusion: Adding 30 mg of pioglitazone to other blood sugar-lowering medications could lower proteinuria in individuals with type 2 diabetes; however, it had no impact on the risk of cardiovascular events.

Manual cervical therapy and vestibular migraine: A case series

Background: Vestibular migraine (VM) is a relatively new diagnostic entity with incomplete knowledge regarding pathophysiological mechanisms and therapeutic guidelines. By reporting the effect of manual cervical therapy (MCT) on people with VM, we suggest a possible role for upper cervical afferents in VM treatment and/or pathogenesis. The objective was to describe the change in clinical presentation and self-reported symptoms of VM corresponding to MCT and followed up to six months. Methods: A nonrandomised *ABA design was utilised to consecutively and prospectively evaluate selected patients with diagnosed VM. Symptom characteristics (frequency and intensity) were recorded along with standardised patient-reported outcomes (PROs) to document the response to MCT. Results: Three patients were recruited who met the diagnostic criteria for VM. All three patients demonstrated improvement in both migraine attack and interictal symptom frequency. These improvements mirrored changes in PROs and were sustained over a six-month follow-up period. Conclusions: The improvement that coincided with the intervention including MCT was rapid, observable and sustained. This suggests that the upper cervical spine could be a therapeutic target in VM and may have implications for future research into the pathogenesis of VM.

MRI-guided stereotactic ablative radiation therapy for metachronously recurrent pulmonary oligometastases from hepatocellular carcinoma after failure of systemic therapy

Objectives. This article aims to evaluate the feasibility and effectiveness of MRI-guided stereotactic ablative radiotherapy (SABR) for metachronously recurrent pulmonary oligometastases from hepatocellular carcinoma (HCC) when systemic therapies prove ineffective. Case Presentation. A 47-year-old male with metastatic HCC underwent unsuccessful chemotherapy, targeted therapy, and immunotherapy. The patient had a history of 14 lung metastases, previously treated with respiratory non-gated SABR. However, five new lung metastases emerged, raising concerns about potential pulmonary toxicity. After administering oral capecitabine, tumor growth persisted. To address this, the patient received MRI-guided respiratory-gated SABR using a recently installed system. Outcome. MRI-guided respiratory-gated SABR was well-tolerated, with no radiation-induced adverse events reported during treatment and a six-month follow-up period. Imaging follow-up demonstrated complete tumor regression, and no new recurrences were observed. Conclusions. This case report suggests that MRI-guided SABR could be a viable option for managing metachronously recurrent pulmonary oligometastases from HCC, particularly after failed systemic therapies. The precise targeting achieved with minimal toxicity, utilizing a 1 mm margin without an internal target volume, showcases the potential of this approach. However, further scientific investigation is warranted to validate these findings, given the limited scope of this single case report. Nonetheless, MRI-guided SABR holds promise as a safe and effective local treatment modality for lung metastases in HCC patients.

Factors Informing the Development of a Clinical Pathway and Patients' Quality of Life after a Non-Union Fracture of the Lower Limb.

Patients with non-union fractures spend extended periods of time in the hospital following poor healing. Patients have to make several follow-up visits for medical and rehabilitation purposes. However, the clinical pathways and quality of life of these patients are unknown. This prospective study aimed to identify the clinical pathways (CPs) of 22 patients with lower-limb non-union fractures whilst determining their quality of life. Data were collected from hospital records from admission to discharge, utilizing a CP questionnaire. We used the same questionnaire to track patients' follow-up frequency, involvement in activities of daily living, and final outcomes at six months. We used the Short Form-36 questionnaire to assess patients' initial quality of life. The Kruskal-Wallis test compared the quality of life domains across different fracture sites. We examined CPs using medians and inter-quantile ranges. During the six-month follow-up period, 12 patients with lower-limb non-union fractures were readmitted. All of the patients had impairments, limited activity, and participation restrictions. Lower-limb fractures can have a substantial impact on emotional and physical health, and lower-limb non-union fractures may have an even greater effect on the emotional and physical health of patients, necessitating a more holistic approach to patient care.

An Online Intervention Promoting HIV Testing Service Utilization Among Chinese men who have sex with men During the COVID-19 Pandemic: A quasi-experimental Study.

The COVID-19 pandemic created disruptions in HIV testing service utilization among men who have sex with men (MSM). The present study was to evaluate the effectiveness of an online health promotion program implemented by a community-based organization (CBO) in increasing the uptake of any type of HIV testing and home-based HIV self-testing (HIVST) over a six-month follow-up period. Participants of an observational prospective cohort study conducted during the same period served as the comparison group. This study was conducted between September 2020 and December 2021. Participants were Chinese-speaking adult MSM who were HIV-negative/unknown sero-status recruited through multiple sources in Hong Kong, China. Participants in the intervention group were exposed to the following health promotion components: (1) viewing an online video promoting HIVST, (2) visiting the project webpage, and (3) having access to a chargeable HIVST service implemented by the CBO. Among 400 and 412 participants in the intervention group and the comparison group, 349 (87.3%) and 298 (72.3%) completed follow-up evaluation at Month 6. Multiple imputation was used to replace missing values. At Month 6, participants in the intervention group reported significantly higher uptake of any type of HIV testing (57.0% versus 49.0%, adjusted odds ratios [AOR]: 1.43, p = .03) and HIVST (25.8% versus 14.8%, AOR: 2.04, p = .001), as compared to those in the comparison group. Process evaluation of the health promotion components for the intervention group was positive. Promoting HIVST is a potentially useful strategy to increase HIV testing service utilization among Chinese MSM during the pandemic.

Manual cervical therapy and vestibular migraine: A case series

Background: Vestibular migraine (VM) is a relatively new diagnostic entity with incomplete knowledge regarding pathophysiological mechanisms and therapeutic guidelines. By reporting the effect of manual cervical therapy (MCT) on people with VM, we suggest a possible role for upper cervical afferents in VM treatment and/or pathogenesis. The objective was to describe the change in clinical presentation and self-reported symptoms of VM corresponding to MCT and followed up to six months. Methods: A nonrandomised *ABA design was utilised to consecutively and prospectively evaluate selected patients with diagnosed VM. Symptom characteristics (frequency and intensity) were recorded along with standardised patient-reported outcomes (PROs) to document the response to MCT. Results: Three patients were recruited who met the diagnostic criteria for VM. All three patients demonstrated improvement in both migraine attack and interictal symptom frequency. These improvements mirrored changes in PROs and were sustained over a six-month follow-up period. Conclusions: The improvement that coincided with the intervention including MCT was rapid, observable and sustained. This suggests that the upper cervical spine could be a therapeutic target in VM and may have implications for future research into the pathogenesis of VM.

Management of Complex Posterior Horseshoe Anal Fistula by The Modified Hanley’s Procedure -Clinical Experience and Review of 25 Patients

This is a prospective study carried out with the aim to document clinical experience in the surgical management of posterior horseshoe fistula of cryptoglandular origin using the modified Hanley procedure as a one-stage procedure. In this study, A modified Hanley procedure was used in 25 patients (20 males and 5 females) who had presented with posterior horseshoe anal fistula (mean age 41 years) for the period from February 2020 to December 2022, and the results of surgical outcomes were analysed. In this procedure, after optimization and anaesthesia, a malleable probe is inserted into the primary Fistulous tract and directed toward the posterior anal space. A straight transverse incision is placed at the primary opening, towards the tip of the coccyx and posterior anal space. The anal portion of the fistulous tract is unroofed. The side fistula tracts are unroofed and removed in toto. It is noted complete healing was achieved in all 25 patients within three months postoperative period. Recurrence was found in only three patients after six-month follow-up period. All patients were discharged on the 5th post-operative day None required readmission and post-operative pain was mild and bearable. Narcotic analgesics were not needed after discharge. After undergoing the procedure, the patients fully recovered and within 2-3 weeks all patients were able to return to their work and daily activity. In conclusion, the posterior complex horseshoe anal fistula, though it has a treacherous fistulous tract can be safely and successfully treated using the modified Hanley's procedure.