Specific Therapeutic Procedures Research Articles

MANAGEMENT OF BELL’S PALSY - A CASE REPORT

Bell’s palsy is a disease affecting one side of the facial muscles abruptly due to compression or inflammation of the facial nerve. This case study explores the clinical presentation and Ayurvedic management of a 52-year-old female patient presenting with symptoms consistent with Bell's palsy, termed as Sopha/Kapha Anubanda Arddita in Ayurveda. The patient exhibited sudden onset facial deviation, speech difficulty, and other associated symptoms. The diagnosis was primarily clinical, supported by classical symptoms of Ardita and Bell's palsy. Treatment involved a combination of Kaphahara/Sophahara medications followed by Vatahara medicines, alongside specific therapeutic procedures tailored to address the underlying doshic imbalances. Critical interventions included the administration of Amrutotharam Kashayam, topical applications of Lepana, and Nasya with Ksheerabala Taila 101 Avartti, among others. The patient showed significant improvement in symptoms and motor functions over a 14-day inpatient treatment period, demonstrating the efficacy of Ayurvedic interventions in managing acute onset LMN Facial palsy. This case underscores the importance of individualised treatment approaches and the potential of Ayurveda in addressing complex neurological conditions.

Idiopathic pulmonary fibrosis and intestinal disorders: An observational study

Background and aimIdiopathic pulmonary fibrosis (IPF) is a chronic respiratory disease characterized by a progressive decline in lung function and a specific histopathologic pattern defined as usual interstitial pneumonia. Early diagnosis and new therapeutic protocols have contributed to a reduction in disease progression. Thus, some patients may develop extrapulmonary diseases including malignancies and chronic pathologies. The aim of this study was to investigate the frequency of intestinal disorders such as polyps, colorectal carcinoma (CRC), and chronic inflammatory bowel disease (IBD) in patients with IPF. MethodsFrom the database of 189 patients with IPF (148 males, 78.3 %; 41 females, 21.7 %) residing in the district of Modena, we identified 44 patients (36 males, 81.8 %; 8 females, 18.2 %) with a histologically confirmed intestinal disease. ResultsIntestinal polyps were detected in 41 cases (93.2 %), of which 4 were associated with CRC and 1 with IBD; 1 patient had only CRC (2.3 %), and 2 patients had only IBD (4.5 %). Both males and females developed bowel disease, but males seemed to have a higher number of polyps and high-grade adenomas with a predisposition to malignant transformation. ConclusionsAs patients with IPF may present with intestinal diseases that can evolve into malignancies in some cases, they should undergo appropriate follow-up and targeted colorectal screening. Thus, colorectal pathologies should not take a back seat. These preliminary results encourage further research to select suitable patients for specific diagnostic and therapeutic procedures in order to prolong survival and improve the quality of life.

Value-Based Healthcare, PROMs and Shared Decision-Making - How Are They Connected?

Value-Based Healthcare, PROMs and Shared Decision-Making - How Are They Connected? Abstract. The best possible healthcare delivery measured by the individually perceived value of a treatment at reasonable costs is the short formula of value-based healthcare (VBHC). Developed in 2006 by Harvard economists Michael Porter and Elizabeth Teisberg in their landmark book 'Redefining Healtcare' [1], this formula and its principles are currently under considerations as a comprehensive concept for transforming the healthcare system in many countries, including Switzerland. The aim is to focus on the value of a treatment from the patient's perspective as a measure for treatment quality. Standardized Patient-Reported Outcome Measurement (PROM) as a core element of the VBHC concept is the prime metric, which can only be optimized, when Shared Decision-Making (SDM) is an embedded part, thereby integrating the individually best choices regarding the 'value' (and harm!) of specific diagnostic and therapeutic medical procedures.

Long-COVID, Metabolic and Endocrine Disease.

In the aftermath of the corona pandemic, long-COVID or post-acute COVID-19 syndrome still represents a great challenge, and this topic will continue to represent a significant health problem in the coming years. At present, the impact of long-COVID on our health system cannot be fully assessed but according to current studies, up to 40% of people who have been infected with SARS-CoV-2 suffer from clinically relevant symptoms of long-COVID syndrome several weeks to months after the acute phase. The main symptoms are chronic fatigue, dyspnea, and various cognitive symptoms. Initial studies have shown that people with overweight and diabetes mellitus have a higher risk of developing long-COVID associated symptoms. Furthermore, repeated treatment of acute COVID-19 and long-COVID with steroids can contribute to long-term metabolic and endocrine disorders. Therefore, a structured program with rehabilitation and physical activity as well as optimal dietary management is of utmost importance, especially for patients with metabolic diseases and/or long-COVID. Furthermore, the removal of autoantibodies and specific therapeutic apheresis procedures could lead to a significant improvement in the symptoms of long-COVID in individual patients.

Hepatitis delta is a public health concern in the community setting: The role of prison health care units in limiting the spread of infection in general population

Hepatitis D virus (HDV) is a public health concern for its severe medical consequences. The aim of this pilot study was to evaluate the prevalence of the main infectious disease between the detainees of the Veneto Region. The study consisted of a survey carried between the heads of the prison healthcare staff. The data showed that on 2,119 detainees the prevalence of hepatitis B (HBV) is the 6% and that the most relevant prevalence of HBV was revealed in the East Europe detainees (Ex USSR countries, Albania, Bosnia, Kosovo, Macedonia), being the 39% of all HBcAb positive subjects. The survey also revealed as the population less protected by HVB vaccination was that comes from East Europe. Moreover, the study indicates that hepatitis D diagnosis is not well known by clinician working inside prisons and that it should be improved through specific diagnostic and therapeutic procedures. Our data indicate that the prison setting may play an important and crucial role in term of public health both in intercepting patients that need of treatment and in preventing actions able to minimize the risk of infection. In prison settings screening, linkage to care and harm reduction measures should be improved in order to protect the general population from the impact of the emerging infectious diseases, including HDV.

Immunità innata come protezione dalle infezioni virali

Adequate preventive specific and unspecific and therapeutic procedures are urgently required for the new incoming generation of viruses;some strategies approached the infections with chemotherapies adopted from previous antiviral programs or with off label drugs. The optimal goal would be to practice a widespread treatment safe, effective, sustainable, cheap as much as possible. The enhancement of innate immunity defenses and the support of the trained immunity are very helpful aside of the incoming vaccines. Innate immunity is the most ancient ready and quick defense against pathogens of al the living species: it commits phagocytic cells to directly get rid of the infectious agents, while the trained immunity is expressed by the adaptive immunity a late evolutionary phase (2 million years after the innate one): the antibodies producing immunological memory is usually tailored against specific antigens but can be expanded eliciting an immune response against other infecting noxa. This paper deals with the clinical history and revival of C. parvum, a killed commensal bacterium located in the sebaceous glands with strong unspecific antitumoral and antiviral innate immunity enhancing properties that can profitably be updated in hazardous infectious emergencies.

Auditory Processing in People with Chronic Aphasia

The preconditions for successful voice communication are good hearing and listening, and auditory processing that includes the ability to process the audio signal. Damage or deceleration of sound signal processing at any level from the periphery to the central structures leads to disintegration and inability to process the signal effectively. Auditory processing in people with aphasia has not been examined in Croatia to date. Results of studies conducted in other languages point to negative effects of auditory processing difficulties on the receptive and expressive component of the language. This study was conducted on a sample of subjects with chronic aphasia and a group of control subjects with no neurological or any other disorders that can affect auditory processing. The inclusion criteria for persons with aphasia were impaired language skills as a result of cerebrovascular accident that occurred at least six months before the examination, regardless of severity and type of aphasia and normal hearing status. The study did not include persons with aphasia who were unable to repeat the six-word sentence, due to impaired comprehension or speech expression, and those whose comprehension was not sufficient to cooperate well during the test. The test was conducted individually for 30 minutes per subject using the Auditory processing test (PSP) that is standardized for the Croatian language. Results from this study showed statistically significant lower achievement on all subtests on PSP-1 (filtered words, speech in noise, dichotic words test, and dichotic sentence test) in people with aphasia compared with the control group. People with aphasia and control group subjects showed better results in favor of the left ear on variable speech in noise. Filtered words were easily processed through the left ear in people with aphasia while dichotic sentences were easily processed through the left ear in the control group. The results of this study confirm the hypothesis of the presence of auditory processing difficulties in people with aphasia and are consistent with previous studies conducted in other languages. In addition, the study points to the need of introducing specific therapeutic procedures in rehabilitation in order to improve the function of auditory processing in persons after a cerebrovascular accident.

Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study

BackgroundThe demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced Trauma Life Support (ATLS) and imply early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management.MethodsSingle-centre cohort study. We included all patients ≥65 years of age with an Injury Severity Score (ISS) ≥ 9 who were admitted to our hospital primarily via ER. A historic cohort was compared to a cohort after the implementation of the new SOPs.ResultsWe enrolled 311 patients who met the inclusion criteria between 2000 and 2006 (group PreSOP) and 2010–2012 (group SOP). There was a significant reduction in the mortality rate after the implementation of the new SOPs (P = .001). This benefit was seen only for severely injured patients (ISS ≥ 16), but not for moderately injured patients (ISS 9–15). There were no differences with regard to infection rates or rate of palliative care.ConclusionsWe found an association between implementation of new ER SOPs, and a lower mortality rate in severely injured geriatric trauma patients, whereas moderately injured patients did not obtain the same benefit.Trial registrationClinicaltrials.gov NCT03319381, retrospectively registered 24 October 2017.

Abordagem da Dor em Dermatologia (Parte I)

A dor é um sintoma universal em Medicina e, na Dermatovenereologia, é transversal ao domínio médico e cirúrgico da especialidade. O controlo da dor aguda peri-operatória é um indicador de qualidade dos cuidados de saúde, sendo um fator determinante de morbilidade e de satisfação do doente. O tratamento pouco eficaz da dor crónica tem repercussões significativas na qualidade de vida e a nível socioeconómico. Esta revisão contempla os princípios gerais do tratamento da dor aguda peri-operatória e da dor crónica em Dermatovenereologia. Pretende-se sensibilizar para a importância da dor e contribuir para a redução da dor não controlada e a humanização dos cuidados prestados ao doente dermatológico. Nesta primeira parte da revisão, são abordados os aspetos epidemiológicos, a definição e o modelo conceptual atual para a compreensão da dor, bem como os fundamentos do tratamento da dor aguda peri-operatória.

Changing character: A narrative review of personality change in psychotherapies for personality disorder

Objective: Personality disorder (PD) is a negative prognostic indicator for treatment, and absolute improvements in functioning among these patients are often modest. This may be because personality features that give rise to dysfunction in PD are not targeted optimally during most treatments. Method: Attachment, mentalization, core beliefs, and personality organization/defense use were identified as personality constructs that have been pursued in treatment studies and that are proposed to underlie PD. Results: All constructs correlate with psychiatric symptoms, PD diagnosis, and functioning. Defense mechanisms and core beliefs further distinguish specific PDs, whereas personality organization separates more versus less severe PDs. Evidence from treatment and naturalistic studies indicate that maturation of defense mechanisms temporally precedes improvements in symptoms and functioning. Changes in attachment and mentalization correlate with some outcomes, but mediation of improvement has not been established. In psychodynamic therapy, transference interpretations may promote amelioration of personality dysfunction. With the exception of attachment, the experimental literature is lacking that could explicate the mechanisms by which these personality constructs maintain psychosocial dysfunction. Conclusions: Future research should aim to identify changes in these mechanisms that mediate positive outcomes in PD, as well as the specific therapeutic procedures that best promote positive change in PD.

Bobath Concept Structural Framework (BCSF): Positioning Partial Aspects Within a Holistic Therapeutic Concept

Background: The Bobath concept is a complex, holistic approach to neurorehabilitation. This complexity presents difficulties for describing Bobath therapy in a comprehensible way. The purpose of this project was to develop an external structure to promote a better understanding of how specific therapeutic procedures are categorized, how partial aspects can be organized and how their interactions can be made more obvious. Method: A scoping review of the literature was undertaken and clustered for keywords. These data were assigned to four levels of a framework model: Conceptual level (leading thoughts), Principle level (essential characteristics of the system), Method level (systematic procedures) and Technique level (the execution tools). Drafts of the framework were presented at annual conferences of the International Bobath Instructor Training Association (IBITA). Feedback from members was sought informally and in questionnaires. Results: The BCSF was supported by 75% of IBITA members (N = 107). In the Conceptual level, three aspects were established; propositional knowledge, individual client context and professional practice knowledge. Seven components are represented in the Principle level; optimizing activity and participation, problem solving, interactive - dialogue approach, client goal oriented, identification of potential, ongoing interplay of assessment and intervention and 24 hours approach. In the Methods level, three systematic procedures were identified; activation, shaping and repetition. At the Techniques level, four execution tools were described; communication, facilitation, assignment of task and environmental arrangement. Discussion: The BCSF provides a structure for further research into the Bobath concept. At a qualitative level, this structure will allow different aspects to be explored whilst still viewing a single aspect as a component of the whole. At a quantitative level, the BCSF clarifies what kind of therapy constitutes a Bobath intervention and the factors that need to be present at all levels of the framework. Conclusion: The BCSF is a useful tool where partial aspects of the Bobath concept can be categorized into a comprehensive classification system. This classification makes it possible to focus on specific items without losing the big picture and to identify partial aspects and their interactions more clearly. Specific procedures can be presented in a structured and transparent manner and well documented core elements for rehabilitation of people with CNS disorders can be demonstrated.

A Comprehensive Review on Mustard-Induced Allergy and Implications for Human Health.

Mustard is widely used in a variety of foods/food products to enhance the flavor and nutritional value that subsequently raise the risk of hypersensitivity reactions. Mustard allergy has been reported for many years and is increasing gradually especially in the areas where its consumption is comparatively higher, and it may be considered among the most important food allergies. A number of relevant clinical studies focused on mustard-induced allergic manifestations are summarized in the current review. In addition, the knowledge regarding the immunological as well as biochemical characteristics of mustard allergens that have been known till date and their cross-reactivity with other food allergens have also been discussed here. Notably, mustard may also be present as a hidden allergen in foods; therefore, it is important to recognize food products that may contain mustard as it may pose potential risk for the allergic individuals. Additionally, the better understanding of the underlying mechanism in mustard allergy is a prerequisite for the development of specific therapeutic procedures. Conclusively, mustard sensitivity should be routinely tested in patients with idiopathic anaphylaxis for the safety of the allergic patients.

Phosphorylated mTOR and YAP serve as prognostic markers and therapeutic targets in gliomas

Glioma is the most prevalent type of tumor in the brain and is comprised of grades I–IV, according to the WHO classification system. Grade IV glioma is also known as glioblastoma multiforme (GBM), the most malignant type of glioma. Glioma is characterized by a complex molecular background, and gene profiling studies have disclosed critical genetic events in human gliomas, which make targeted therapies the most promising therapeutic strategy. However, crosstalk between the targeted signaling pathways may hinder the efficacy of targeted therapies in gliomas. Therefore, it is necessary to identify effective markers to stratify patients for specific therapeutic procedures. Although several mechanisms have been proposed based on the crosstalk between PI3K/AKT/mTORC1 and Hippo/YAP pathways, the clinical significance of the two pathways has not yet been assessed in a combinatorial manner. In this study, we evaluated the two pathways in human glioma specimens and observed the positive correlation between protein levels of p-mTORS2448 and YAP in gliomas. The findings indicated that high expression of p-mTORS2448 and YAP correlated with poor overall survival of glioma patients. As p-mTORS2448 is a specific marker of mTORC1 activation, our results reveal a potential interaction between mTORC1 and YAP, which might functionally participate in the development and progression of gliomas. In support of this hypothesis, a combination of inhibitors targeting mTORC1 and YAP showed a better inhibitory effect on growth of glioma cell lines. Altogether, our work, for the first time, reveals that p-mTORS2448 and YAP can be used as markers of PI3K/AKT/mTORC1 and Hippo/YAP pathway activity to predict prognosis and are target candidates for personalized medicine.

Clinical evidence on visceral pain. Systematic review

ABSTRACT BACKGROUND AND OBJECTIVES: Visceral pain is induced by abnormalities of organs such as stomach, kidneys, bladder, gallbladder, intestines and others and includes distension, ischemia, inflammation and mesenteric traction. It is responsible for physical and psychic incapacity, absenteeism and poor quality of life. This study aimed at discussing major aspects of pain with regard to prevalence, etiology and diagnosis. CONTENTS: According to Evidence-Based Medicine concepts, pain etiology, diagnosis and prognosis were reviewed in LILACS, EMBASE and Pubmed databases. Therapeutic studies were not selected. The following terms were used as search strategy: (visceral pain[MeSH Terms] OR (visceral[All Fields] AND Fields]) OR visceral pain[All Fields]). Only studies published in Portuguese, English or Spanish were included. Narrative reviews with opinionated content and specific therapeutic procedures of medical specialties were excluded. Studies on pain related to heart, cancer and musculoskeletal diseases and pregnancy were also excluded. CONCLUSION: Visceral pain is a heterogeneous condition where most frequent presentation is abdominal pain in the course of irritable bowel syndrome. Other diseases induce pain and adequate diagnosis is critical for effective treatment.

Historical Patterns in the Types of Procedures Performed and Radiation Safety Practices Used in Nuclear Medicine From 1945-2009.

The authors evaluated historical patterns in the types of procedures performed in diagnostic and therapeutic nuclear medicine and the associated radiation safety practices used from 1945-2009 in a sample of U.S. radiologic technologists. In 2013-2014, 4,406 participants from the U.S. Radiologic Technologists (USRT) Study who previously reported working with medical radionuclides completed a detailed survey inquiring about the performance of 23 diagnostic and therapeutic radionuclide procedures and the use of radiation safety practices when performing radionuclide procedure-related tasks during five time periods: 1945-1964, 1965-1979, 1980-1989, 1990-1999, and 2000-2009. An overall increase in the proportion of technologists who performed specific diagnostic or therapeutic procedures was observed across the five time periods. Between 1945-1964 and 2000-2009, the median frequency of diagnostic procedures performed substantially increased (from 5 wk to 30 wk), attributable mainly to an increasing frequency of cardiac and non-brain PET scans, while the median frequency of therapeutic procedures performed modestly decreased (from 4 mo to 3 mo). Also a notable increase was observed in the use of most radiation safety practices from 1945-1964 to 2000-2009 (e.g., use of lead-shielded vials during diagnostic radiopharmaceutical preparation increased from 56 to 96%), although lead apron use dramatically decreased (e.g., during diagnostic imaging procedures, from 81 to 7%). These data describe historical practices in nuclear medicine and can be used to support studies of health risks for nuclear medicine technologists.

Fußtumoren

Despite the compact anatomy with thin soft tissue coverage, diagnosis of both benign and malignant tumors of the foot is often delayed. Diagnostic errors are more common than in other body regions, as neoplasias are rarely considered. Barring a few exceptions the foot is not a typical predilection site for malignant musculoskeletal tumors, although, basically any tumor entity of the musculoskeletal system can affect the foot. Delays in specific diagnostic and therapeutic procedures of these lesions can entail serious consequences for patients as tumor size is a major prognostic factor for recurrence-free survival. In cases of an indistinct persistent swelling or bone lesion a tumorous process should always be considered to ensure early diagnosis and therapy of foot tumors.

Fußtumoren: Diagnostik und Therapie

Despite the compact anatomy with thin soft tissue coverage, diagnosis of both benign and malignant tumors of the foot is often delayed. Diagnostic errors are more common than in other body regions, as neoplasias are rarely considered. Barring a few exceptions the foot is not a typical predilection site for malignant musculoskeletal tumors, although, basically any tumor entity of the musculoskeletal system can affect the foot. Delays in specific diagnostic and therapeutic procedures of these lesions can entail serious consequences for patients as tumor size is a major prognostic factor for recurrence-free survival. In cases of an indistinct persistent swelling or bone lesion a tumorous process should always be considered to ensure early diagnosis and therapy of foot tumors.

Yield and impact of emergency capsule enteroscopy in severe obscure-overt gastrointestinal bleeding

Patients with obscure-overt gastrointestinal bleeding (OOGIB) are defined by overt hemorrhage and negative upper and lower endoscopy findings. At present, the place of emergency capsule enteroscopy in patients with severe OOGIB is unknown. The aim of this study was to assess the diagnostic yield and the impact of emergency capsule enteroscopy on further management in patients with severe OOGIB. Between 2003 and 2010, we retrospectively included all patients with severe OOGIB who underwent emergency capsule enteroscopy in the 24-48 h following negative urgent upper and lower endoscopy. Severe OOGIB was defined by ongoing bleeding with hemodynamic instability and/or the need for significant red blood cell transfusion. Out of 5744 patients hospitalized in our Gastrointestinal Bleeding Unit, 55 (1%) presented with severe OOGIB and underwent emergency capsule enteroscopy. Capsule enteroscopy showed blood in 41 patients (75%) and lesions in 37 patients (67%). Findings included small bowel angiodysplasia in 19 patients (35%), ulcers in 7 (13%), tumors in 5 (9%), small-bowel varices in 2 (3%), cecum angiodysplasia in 4 (7%), fresh blood in small bowel without identified lesion in 12 (22%). Specific diagnostic and therapeutic procedures were undertaken in 78 % of patients. Further management included endoscopy (54%), surgery (22%), and radiology (2%). Emergency capsule enteroscopy identified bleeding lesions in 67 % of patients with severe OOGIB. Emergency capsule enteroscopy seems to be a promising diagnostic tool with a subsequent impact on clinical management in patients with severe OOGIB.

The need for a benchmark of the practice of cardiology

The need for a benchmark of the practice of cardiology

Colangiopatía asociada a SIDA: Cuando la sola imagen no basta

In HIV-infected patients, liver and biliary tract may be affected by different entities, such as AIDS- cholangiopathy, which is usually associated with CD4+T lymphocytes count below 100 cells/mm 3 along with non-specific symptoms. Although imaging studies play a major diagnostic role they should always be evaluated according to patients clinical context. While ultrasound and CT scans provide relevant diagnostic information, specialized studies such as MRI and MRCP have become increasingly valuable due to their ability to demonstrate parietal as well as stenotic biliary changes. Despite ERCP remains the gold-standard for diagnosis of AIDS-related cholangiopathy, currently it is usually reserved to clearly exclude the presence of malignancy, or as a specific invasive therapeutic procedure, when indicated.