Specific Treatment Research Articles

Wild Edible Fruits as a Source of Food and Medicine: A Study among Tribal Communities of Southern Khyber Pakhtunkhwa.

Botanical surveys in all parts of Pakistan are mainly focused on ethnomedicinal uses of plants, and very little attention has been paid to documenting edible wild fruit species (EWFs). Multiple methodologies and tools were used for data collection. In a recent survey 74 EWF species belonging to 29 families were documented, including their medicinal uses for the treatment of various diseases. The most cited (23%) preparation method was raw, fresh parts. The UV and RFC of EWF species ranged from 0.08 to 0.4 and from 0.02 to 0.18, respectively. In terms of specific disease treatments and their consensus, the ICF ranged from 0 to 0.38. Sexual, gastrointestinal, and respiratory disorders had the highest use reports, and 11 species of plants had the highest FL of 100%. On the basis of uses reported by the inhabitants of seven districts of Southern Khyber Pakhtunkhwa Province, the CSI ranged from the lowest 1.3 to the highest 41. It is concluded that the traditional uses of EWF species depend mainly on socio-economic factors rather than climatic conditions or the number of species. However, there is a gradual loss of traditional knowledge among the younger generations. The present survey is the first baseline study about the socio-economic dimension of local communities regarding the use of EWF species for food as well as medicine.

Comparison of the incidence of severe outcomes in outpatients with COVID-19 or seasonal influenza without risk factors: Retrospective analysis of a health insurance claims-database

BackgroundTo evaluate disease severity for coronavirus disease of 2019 (COVID-19), seasonal influenza (FLU) is often used as a control group for comparison. However, evidence regarding outpatients without risk factors for severe disease is insufficient to consider future treatment policies for these patients. ObjectivesTo compare the risk of severe disease in patients without risk factors for severe disease who are diagnosed with COVID-19 or FLU. Study designThis was a retrospective study analyzing a health insurance claims database (data collection: COVID-19, January 2020 through August 2022; FLU, October 2017 through September 2019). Outcome measures were incidences of severe events of hospitalization, respiratory and heart rate monitoring, oxygen therapy, ventilator use, and intensive care unit admission (within 28 days from diagnosis), and death (within the following month). ResultsData from 575,293 patients were included in the COVID-19 group and from 1,095,698 patients in the FLU group, without risk factors. Adjusted odds ratios for all study outcomes were significantly higher for patients with COVID-19 than with FLU (>3 times greater odds ratio for all severe events). For the population aged ≥18 years, there was also a significantly higher risk for all severe events with COVID-19 versus FLU. The incidence of severe events with COVID-19 among the population aged <18 years was greatly reduced (versus ≥18 years), and risk for severe events was not significantly different with COVID-19 versus FLU. ConclusionsThese findings suggest that the medical need for specific treatment for patients with COVID-19 may be as high as for FLU.

Risk factors in the delay of treatment of childhood tuberculosis in a Peruvian Hospital

To determine the risk factors associated with delayed initiation of tuberculosis (TB) treatment in children under 15 years of age. Case-control study. Patients <15 years of age with a diagnosis of childhood pulmonary tuberculosis (c-PTB) with delayed treatment initiation >24 hours were included. Clinical and epidemiological variables were evaluated: age, gender, guardian's education, poverty level, origin, family history of TB, altered imaging findings, symptomatic, PPD >10mm, histology, bacteriology, resistance to treatment, and healthcare network. Bi and multivariate logistic regression analysis was performed, through which odds ratios were calculated. We evaluated 116 patients with c-PTB with a delayed initiation of specific treatment of more than 24 hours, and 264 with start of treatment in the first 24 hours. The delay in anti-tuberculosis treatment had a median of 3 days with an interquartile range of 2 to 7 days. The patient with the least educated guardian had a delay in treatment initiation with an odds ratio of 7.47 (95%CI: 4.13 - 13.52). Belonging to the healthcare network A of Callao decreased the probability of having tuberculosis by 0.224 times (95%CI:0.11 - 0.46). Incomplete education level of the guardian is a risk factor associated with delayed initiation of c-PTB treatment in children under 15 years of age while belonging to the Callao healthcare network A is a factor that decreases the risk in the group under study.

SEROTONIN INFLUENCE ON THE CLINICAL COURSE OF PREGNANCY IN THE FIRST TREMESTER

Changes of melatonin and serotonin levels in the plasma can be associated with thedevelopment of the threatened abortion. Hormones of the pineal gland stimulate thesecretion of progesterone, which reduces the contractile activity of the uterus and preventsthe immunological rejection of the trophoblast. The real observations motivated us tostudy serotonin plasma concentrations in cases of the threatened abortion.The aim of the study – to study changes in serotonin levels in pregnant women withclinical manifestations of the threatened abortion before 12 weeks of gestation comparedto women with normal pregnancies.Research material and methods. Two groups were formed: the 1st main group –40 pregnant women with signs of threatened abortion, the 2nd control group – 44 healthypregnant women. An obstetric study, enzyme immunoassay to determine serotonin, andultrasound were carried out. Statistical analysis was conducted according to the generallyaccepted methods of variational statistics.The approval of the scientific work was obtained from the Bioethical Commission of theBukovinian State Medical University (Ukraine).Research results. Results of serotonin levels in venous blood showed their extremeincrease in women with threatened abortion 739.89±111.27 ng/ml compared to normalpregnancy 511.05±140.36 ng/ml (p˂ 0.003). In the pregnant women of the main group,consisting of 40 women, almost all of them had an increased serotonin, except 4 women(10%). This can be explained by hypoprogesteronemia in women with a threat of abortion.Therefore, we consider the change in serotonin concentration as a secondary process thatdoes not require specific treatment. Attention is also drawn to the fact of a reduced levelof serotonin in the control group in cases of further complicated course. Conclusions. Serotonin levels were higher in patients with threatened abortion comparedto uncomplicated pregnancies. Changes in serotonin plasma in cases of threatenedabortion are a consequence, not a cause of abortion, therefore pregnant women needtreatment of obstetric pathology, namely the prescription of progesterone.

Synergy and antagonism between azacitidine and FLT3 inhibitors

Synergetic interactions between drugs can make a drug combination more effective. Alternatively, they may allow to use lower concentrations and thus avoid toxicities or side effects that not only cause discomfort but might also reduce the overall survival. Here, we studied whether synergy exists between agents that are used for treatment of acute myeloid leukaemia (AML). Azacitidine is a demethylation agent that is used in the treatment of AML patients that are unfit for aggressive chemotherapy. An activating mutation in the FLT3 gene is common in AML patients and in the absence of specific treatment makes prognosis worse. FLT3 inhibitors may be used in such cases. We sought to determine whether combination of azacitidine with a FLT3 inhibitor (gilteritinib, quizartinib, LT-850-166, FN-1501 or FF-10101) displayed synergy or antagonism. To this end, we calculated dose–response matrices of these drug combinations from experiments in human AML cells and subsequently analysed the data using a novel consensus scoring algorithm. The results show that combinations that involved non-covalent FLT3 inhibitors, including the two clinically approved drugs gilteritinib and quizartinib were antagonistic. On the other hand combinations with the covalent inhibitor FF-10101 had some range of concentrations where synergy was observed.

Hybrid Therapies for Supporting Critically Ill Patients with Acute Kidney Injury: When, how, and for Whom?

Acute kidney injury (AKI) is common in critically ill patients. There is no specific pharmacological treatment for established severe AKI. Therefore, the conventional therapeutic strategy is limited to the use of kidney replacement therapy (KRT) to maintain homeostasis. Hybrid therapies optimize the advantages of intermittent and continuous modalities of KRT, combining lower hourly efficiency, longer application time, at lesser cost, but also adding different physicochemical principles of extracorporeal clearance. The sum of convection and diffusion, with or without adsorption or apheresis, and in different time combinations gives hybrid techniques great flexibility in prescribing a personalized treatment adapted to the needs of each patient at any given time. Hybrid therapies are increasingly being used due to their flexibility, which is determined by the combination of equipment, membranes, and available resources (machines and health-care personnel experience). The required technology is widely available in most intensive care units and uses low-cost consumables compared to other types of AKI treatment modalities, favoring its widespread use. Hybrid therapies are feasible and provide a viable form of KRT, either alone or as a transition therapy from continuous kidney replacement therapy to intermittent hemodialysis. (Rev Invest Clin. 2023;75(6):337-47).

Global Neuropsychopharmacological Prescription Trends in Adults with Schizophrenia, Clinical Correlates and Implications for Practice: A Scoping Review.

It is important to examine the psychotropic prescription practices in schizophrenia, as it can inform regarding changing treatment choices and related patient profiles. No recent reviews have evaluated the global neuropsychopharmacological prescription patterns in adults with schizophrenia. A systematic search of the literature published from 2002 to 2023 found 88 empirical papers pertinent to the utilization of psychotropic agents. Globally, there were wide inter-country and inter-regional variations in the prescription of psychotropic agents. Overall, over time there was an absolute increase in the prescription rate of second-generation antipsychotics (up to 50%), mood stabilizers (up to 15%), and antidepressants (up to 17%), with an observed absolute decrease in the rate of antipsychotic polypharmacy (up to 15%), use of high dose antipsychotic (up to 12% in Asia), clozapine (up to 9%) and antipsychotic long-acting injectables (up to 10%). Prescription patterns were mainly associated with specific socio-demographic (such as age), illness (such as illness duration), and treatment factors (such as adherence). Further work, including more evidence in adjunctive neuropsychopharmacological treatments, pharmaco-economic considerations, and examination of cohorts in prospective studies, can proffer insights into changing prescription trends relevant to different treatment settings and predictors of such trends for enhancement of clinical management in schizophrenia.

Treatment Goals of Adolescents and Young Adults for Gender Dysphoria.

With this study, we aim to describe transgender and nonbinary adolescents and young adults' stated gender treatment goals at the time of initial presentation to medical care. This is a retrospective chart review of transgender and nonbinary patients aged 10 to 24 seeking specific gender-affirming health care. Charts were reviewed for specifically stated goals of future hormonal or surgical care for gender and analyzed by the experienced or asserted gender (man, woman, nonbinary, eclectic) of participants. In total, 176 patient encounters were reviewed. Of these, 71% were assigned female at birth. Most participants experienced a masculine gender (46.6%), identified as white (65.3%), and had private health insurance (73.3%). Most patients had a goal of initiating hormone therapy (97.4%) and eventual surgery (87.1%). Of those who had a surgical goal, most (87.5%) desired surgery of the chest or breast, and a minority (29.3%) desired eventual genital surgery. The second-largest gender group was patients who either declined to state an asserted gender or felt unable to describe their gender experience (eclectic, 23.3%), and this group's treatment goals did not mirror any other group's goals. At the time of initial presentation to medical care for gender-specific needs, many adolescents are capable of asserting specific treatment goals. Most do not desire genital surgery. A large minority of patients decline to state an asserted gender or feel unable to assert a specific gender, and this population appears distinct from more traditional genders in terms of treatment goals.

Status epilepticus in BRAF-related cardio-facio-cutaneous syndrome: Focus on neuroimaging clues to physiopathology.

Cardio-facio-cutaneous syndrome (CFC) is a genetic disorder due to variants affecting genes coding key proteins of the Ras/MAPK signaling pathway. Among the different features of CFC, neurological involvement, including cerebral malformations and epilepsy, represents a common and clinically relevant aspect. Status epilepticus (SE) is a recurrent feature, especially in a specific subgroup of CFC patients with developmental and epileptic encephalopathy (DEE) and history of severe pharmacoresistant epilepsy. Here we dissect the features of SE in CFC patients with a particular focus on longitudinal magnetic resonance imaging (MRI) findings to identify clinical-radiological patterns and discuss the underlying physiopathology. We retrospectively analyzed clinical, electroencephalogram (EEG), and MRI data collected in a single center from a cohort of 23 patients with CFC carrying pathogenic BRAF variants who experienced SE during a 5-year period. Seven episodes of SE were documented in 5 CFC patients who underwent EEG and MRI at baseline. MRI was performed during SE/within 72 hours from SE termination in 5/7 events. Acute/early post-ictal MRI findings showed heterogenous abnormalities: restricted diffusion in 2/7, focal area of pcASL perfusion change in 2/7, focal cortical T2/FLAIR hyperintensity in 2/7. Follow-up images were available for 4/7 SE. No acute changes were detected in 2/7 (MRI performed 4 days after SE termination). Acute focal neuroimaging changes concomitant with ictal EEG focus were present in 5/7 episodes, though with different findings. The heterogeneous patterns suggest different contributing factors, possibly including the presence of focal cortical malformations and autoinflammation. When cytotoxic edema is revealed by MRI, it can be followed by permanent structural damage, as already observed in other genetic conditions. A better understanding of the physiopathology will provide access to targeted treatments allowing to prevent long-term adverse neurological outcome. Cardio-facio-cutaneous syndrome is a genetic disorder that often causes prolonged seizures known as status epilepticus. This study has a focus on electroclinical and neuroimaging patterns in patients with cardio-facio-cutaneous syndrome. During these status epilepticus episodes, we found different abnormal brain imaging patterns in patients, indicating various causes like brain malformations and inflammation. Understanding these patterns could help doctors find specific treatments, protecting cardio-facio-cutaneous syndrome patients from long-term brain damage.

Study on Therapeutic Dropout Rates of a Pediatric Population in South-Eastern Central Europe, Dependent on Individual Particularities

Specialized studies conducted in the last decade have shown that the therapeutic success of specific treatment with tuberculostatic drugs, along with the decrease in the risk of relapse are elements that can only be achieved by increasing patients’ adherence to treatment. This is of paramount importance, especially for pediatric populations, as they are subject to a higher rate of therapeutic dropout, dependent on a number of individual particularities (from socio-demographic characteristics, to the incidence of depressive disorders, to pathological personal history, etc.). When we talk about patient behavior, we refer to how he/she complies with the specialist’s recommendation regarding: medication administration; following a diet; lifestyle changes.

Tumor microenvironment-activatable nanocatalysts with chemodynamic therapy and enhanced autophagy for specific treatment of oral squamous cell carcinoma

Adjuvant therapy following surgery is imperative for enhancing the prognosis of patients with oral squamous cell carcinoma (OSCC) in the clinical setting. Nevertheless, challenges such as treatment resistance mediated by the tumor microenvironment (TME), systemic toxicity, and adverse side effects hinder the effectiveness of conventional adjuvant therapy. In this context, we introduce a novel nanocatalyst denoted as MnO2−x@HA-CCM (MnHA@CCM NC) designed specifically for treating OSCC. This nanocatalyst exerts targeted anti-tumor effects through TME-activatable chemodynamic therapy (CDT) and tumoricidal autophagy. The MnHA@CCM NCs exploit the biocompatibility of hyaluronic acid (HA) coating and the homologous targeting effect of cancer cell membrane (CCM) camouflage, ensuring safe in vivo delivery and specific accumulation at tumor sites. Following intracellular uptake, Fenton-like Mn2+ is generated by consuming glutathione (GSH) within the TME. Subsequently, Mn2+ catalyzes the overproduced H2O2 to generate reactive oxygen species (ROS), inducing cell apoptosis through mitochondrial damage. Additionally, phagocytized NCs and the resultant ROS accumulation in tumor cells elevate the autophagy flux, leading to autophagosome overload and consequent tumoricidal autophagy. Notably, normal cells without TME-catalytic CDT undergo mild protective autophagy to rebalance the stimulation of NCs. As a result, the TME-activatable MnHA@CCM NCs demonstrate a therapeutic efficacy in inhibiting cancer cell growth both in vitro and in vivo. This study presents a targeted treatment strategy for OSCC tumors while sparing normal cells, offering a potential alternative in the realm of adjuvant therapy.

Benefits and risks of drug combination therapy for diabetes mellitus and its complications: a comprehensive review.

Diabetes is a chronic metabolic disease, and its therapeutic goals focus on the effective management of blood glucose and various complications. Drug combination therapy has emerged as a comprehensive treatment approach for diabetes. An increasing number of studies have shown that, compared with monotherapy, combination therapy can bring significant clinical benefits while controlling blood glucose, weight, and blood pressure, as well as mitigating damage from certain complications and delaying their progression in diabetes, including both type 1 diabetes (T1D), type 2 diabetes (T2D) and related complications. This evidence provides strong support for the recommendation of combination therapy for diabetes and highlights the importance of combined treatment. In this review, we first provided a brief overview of the phenotype and pathogenesis of diabetes and discussed several conventional anti-diabetic medications currently used for the treatment of diabetes. We then reviewed several clinical trials and pre-clinical animal experiments on T1D, T2D, and their common complications to evaluate the efficacy and safety of different classes of drug combinations. In general, combination therapy plays a pivotal role in the management of diabetes. Integrating the effectiveness of multiple drugs enables more comprehensive and effective control of blood glucose without increasing the risk of hypoglycemia or other serious adverse events. However, specific treatment regimens should be tailored to individual patients and implemented under the guidance of healthcare professionals.

SVEGF-R1 in acute non-infectious toxicity syndromes after pediatric allogeneic hematopoietic stem cell transplantation

BackgroundAllogeneic hematopoietic stem cell transplantation (HSCT) is challenged by acute non-infectious toxicities, including sinusoidal obstruction syndrome (SOS), engraftment syndrome (ES) and capillary leak syndrome (CLS) among others. These complications are thought to be driven by a dysfunctional vascular endothelium, but the pathophysiological mechanisms remain incompletely understood, and the diagnoses are challenged by purely clinical diagnostic criteria that are partly overlapping, limiting the possibilities for progress in this field. There is, however, increasing evidence suggesting that these challenges may be met through the development of diagnostic biomarkers to improve diagnostic accuracy of pathogenetically homogenous entities, improved pre-transplant risk assessment and the early identification of patients with increased need for specific treatment. Soluble vascular endothelial growth factor receptor-1 (sVEGF-R1) is emerging as an important biomarker of endothelial damage in patients with trauma and sepsis but has not been studied in HSCT. ObjectivesTo investigate sVEGF-R1 as a marker of endothelial damage in pediatric HSCT patients by exploring associations with SOS, CLS, ES, and acute graft-versus-host disease (aGvHD). MethodsWe prospectively included 113 children undergoing myeloablative HSCT and measured sVEGF-R1 in plasma samples obtained weekly during the early period of transplantation and 3 months post-transplant. ResultsAll over, sVEGF-R1 levels were significantly increased from day +7 after graft infusion, peaking at day +30, most pronounced in patients receiving busulfan. Patients considered to be at increased risk of SOS and therefore commenced on prophylactic defibrotide had significantly elevated levels of sVEGF-R1 before start of conditioning (446 pg/mL vs. 281 pg/mL, p = 0.0035), and this treatment appeared to stabilize sVEGF-R1 levels compared to patients not treated with defibrotide. Thirteen (11.5%) children meeting the modified Seattle criteria for SOS at median day +8 (1–18), had significantly elevated sVEGF-R1 levels on day +14 (489 pg/mL vs. 327 pg/mL, p = 0.007). In contrast. sVEGF-R1 levels in the much broader group of patients (45.1%) meeting EBMT-SOS criteria, including patients with very mild disease, did not overall differ in sVEGF-R1 levels, but higher sVEGF-R1 levels were seen in EBMT-SOS patients with an increased need for diuretic treatment. Importantly, sVEGF-R1 levels were not associated with ES and CLS but were significantly increased on day +30 in patients with grade III-IV aGvHD (OR = 4.2 pr. quartile, p = 0.023). ConclusionVEGF-R1 levels are found to be increased in pediatric patients developing SOS, reflecting the severity of morbidity. sVEGF-R1 were unassociated with both CLS and ES. The potential of sVEGF-R1 as a clinically useful biomarker for SOS should be further explored to improve pre-transplant SOS-risk assessment, SOS-severity grading, and to guide treatment.

Endogenous SIRT6 in platelets negatively regulates platelet activation and thrombosis.

Thromboembolism resulting from platelet dysfunction constitutes a significant contributor to the development of cardiovascular disease. Sirtuin 6 (SIRT6), an essential NAD+-dependent enzyme, has been linked to arterial thrombosis when absent in endothelial cells. In the present study, we have confirmed the presence of SIRT6 protein in anucleated platelets. However, the precise regulatory role of platelet endogenous SIRT6 in platelet activation and thrombotic processes has remained uncertain. Herein, we present compelling evidence demonstrating that platelets isolated from SIRT6-knockout mice (SIRT6-/-) exhibit a notable augmentation in thrombin-induced platelet activation, aggregation, and clot retraction. In contrast, activation of SIRT6 through specific agonist treatment (UBCS039) confers a pronounced protective effect on platelet activation and arterial thrombosis. Moreover, in platelet adoptive transfer experiments between wild-type (WT) and SIRT6-/- mice, the loss of SIRT6 in platelets significantly prolongs the mean thrombus occlusion time in a FeCl3-induced arterial thrombosis mouse model. Mechanistically, we have identified that SIRT6 deficiency in platelets leads to the enhanced expression and release of proprotein convertase subtilisin/kexin type 9 (PCSK9), subsequently activating the platelet activation-associated mitogen-activated protein kinase (MAPK) signaling pathway. These findings collectively unveil a novel protective role of platelet endogenous SIRT6 in platelet activation and thrombosis. This protective effect is, at least in part, attributed to the inhibition of platelet PCSK9 secretion and mitogen-activated protein kinase signaling transduction. Our study provides valuable insights into the intricate interplay between SIRT6 and platelet function, shedding light on potential therapeutic avenues for managing thrombotic disorders.

Possibilities and limitations of national guidelines based on the example of pediatric urology guidelines from the Pediatric Urology Working Group of the Austrian Society for Urology and Andrology (ÖGU)

Medical guidelines are defined as practical orientation and decision-making aids; they are legally defined as noncommittal recommendations. International guidelines are written in very general terms, especially in the case of heterogeneous clinical pictures (e.g., vesicoureteral reflux). Could national guidelines based on international recommendations become authoritative as specific treatment recommendations for the various specialist groups? The value of international and national guidelines was assessed using the example case history of achild affected with vesicoureteral reflux. Due to the various therapeutic possibilities according to various guidelines, the child received unfavorable, incongruent, delayed, and repeated unsuccessful attempts with different treatment regimes CONCLUSION: Due to the nonbinding nature of general guidelines, there is arisk of suboptimal therapy. National guidelines aimed at individualized treatment recommendations should aim for higher medical and legal status.

Management of Non-hospitalized patients with Acute SARS-CoV-2 (COVID-19) viral infection in among human adult population

The global corona virus disease outbreak, also known as the COVID-19 pandemic outbreak, caused a major health crisis around the world. The morbidity and mode of transmission of COVID-19 appear to be more severe and uncontrollable. The main pathophysiology of this deadly disease is respiratory failure and subsequent cardiovascular complications. From a pharmacological standpoint, several therapeutic strategies have been proposed for the development of safe and effective treatment against the SARS-CoV-2 virus, but no specific treatment regimen has been developed for this viral infection to date. The current review focuses on the role of herbs and herbs-derived secondary metabolites in inhibiting the SARS-CoV-2 virus as well as in the management of post-COVID-19 complications. This strategy will promote and protect the use of medicinal plant resources to support the healthcare system. Plant-derived phytochemicals have already been shown to prevent viral infection and to alleviate post-COVID complications such as parkinsonism, kidney and heart failure, liver and lung damage, and mental problems. We investigated mechanistic approaches of herbal medicines and their phytochemicals as antiviral and post-COVID complications by modulating immunological and inflammatory states in this review.

Intraoperative circulatory arrest secondary to high-risk pulmonary embolism. Case series and updated literature review

BackgroundIntraoperative pulmonary embolism (PE) with cardiac arrest (CA) represents a critical and potentially fatal condition. Available treatments include systemic thrombolysis, catheter-based thrombus fragmentation or aspiration, and surgical embolectomy. However, limited studies are focused on the optimal treatment choice for this critical condition. We present a case series and an updated review of the management of intraoperative CA secondary to PE.MethodsA retrospective review of patients who developed high-risk intraoperative PE was performed between June 2012 and June 2022. For the updated review, a literature search on PubMed and Scopus was conducted which resulted in the inclusion of a total of 46 articles.ResultsA total of 196 174 major non-cardiac surgeries were performed between 2012 and 2022. Eight cases of intraoperative CA secondary to high-risk PE were identified. We found a mortality rate of 75%. Anticoagulation therapy was administered to one patient (12.5%), while two patients (25%) underwent thrombolysis, and one case (12.5%) underwent mechanical thrombectomy combined with thrombus aspiration. Based on the literature review and our 10-year experience, we propose an algorithm for the management of intraoperative CA caused by PE.ConclusionThe essential components for adequate management of intraoperative PE with CA include hemodynamic support, cardiopulmonary resuscitation, and the implementation of a primary perfusion intervention. The prompt identification of the criteria for each specific treatment modality, guided by the individual patient’s characteristics, is necessary for an optimal approach.

Early Intervention Programs for Adolescents and Young Adults With Eating Disorders

What Is the Problem? How Might Early Intervention Help Fix the Problem?&#x0D; &#x0D; The number of adolescents and young adults living with eating disorders is on the rise. This increase was especially noticeable during the height of the COVID-19 pandemic, with more than a 50% increase in the number of young women being hospitalized with an eating disorder.&#x0D; Early intervention programs are those delivered by community or health care–based organizations that offer interventions to treat adolescents and young adults living with eating disorders within the first 3 years of diagnosable disorder, with the intention of providing earlier access and preventing disease progression.&#x0D; &#x0D; What Did We Do?&#x0D; &#x0D; Advisors with lived experience of eating disorders shared their perspectives and priorities to help reviewers contextualize the evidence and interpret the findings in the literature. Advisors highlighted their treatment experiences and priorities for early intervention, highlighting equity considerations and challenges.&#x0D; We conducted a literature search to identify, gather, synthesize, and summarize relevant evidence to inform our understanding of the clinical effectiveness and clinical harms of early intervention programs.&#x0D; A search of the economic literature was conducted to identify economic evaluations of early intervention programs to treat adolescents and young adults living with eating disorders. Based on an assessment of the clinical evidence, the uncertainty and heterogeneity of the information precluded a de novo cost-effectiveness analysis (CEA). As such, a narrative summary of the health care resources required to implement an early intervention program for adolescents and young adults living with eating disorders was conducted.&#x0D; &#x0D; What Did We Find?&#x0D; &#x0D; Advisors with lived experience of eating disorders described a need for greater access to specialized services focused on eating disorder treatment, equity, capacity building, and culture change. Specific treatment approaches mentioned included family-based treatment, cognitive behavioural therapy, peer support, and group therapy.&#x0D; We identified 14 studies related to the clinical effectiveness of early intervention programs. We did not identify any studies evaluating clinical harms.&#x0D; The findings from included studies suggest that earlier engagement and access to eating disorder support could have clinical benefits; however, interpretation of these findings are uncertain due to various factors.&#x0D; No evidence was identified in the search for information on the cost-effectiveness of early intervention programs for the treatment of adolescents and young adults living with an eating disorder.&#x0D; The resources needed to run early intervention programs (or other similar interventional programs) to treat eating disorders may include administration, staffing, training, IT support and infrastructure, and other overhead costs related to the location in which the service is provided.&#x0D; &#x0D; What Does This Mean?&#x0D; &#x0D; The clinical evidence suggests that investment of health care resources into early intervention programs shows potential for overall benefit and may help address challenges with access to treatment, which was identified as an issue by those with lived experience.&#x0D; The human and financial resources required to implement early intervention programs will vary depending on the treatment options and treatment frequency chosen.&#x0D; The demands on an already limited pool of specialized health care resources in eating disorder care are important considerations when choosing whether to implement any new eating disorder treatment programs. Training and recruiting of specialized health care providers will be a key implementation consideration for any new early intervention program for the treatment of eating disorders.&#x0D; Further consultation with a diverse group of adolescents and young adults with lived experience with eating disorders might be beneficial to inform implementation of early intervention programs within the Canadian context.&#x0D;

Patient Attitudes and Perceived Barriers Toward Mental Health Treatment Options in a Rural Student-Run Clinic.

Background While the prevalence of mental health conditions is similar in rural areas and non-rural areas, access to mental health care is more limited in rural areas. Patient attitudes toward specific mental health treatment options in rural populations have been understudied. Some previous studies indicate potential positive outcomes using osteopathic manipulative treatment (OMT) as an adjunct for mental health care. Physicians using OMT are more heavily represented in rural areas. Hence, understanding the mental health treatment needs and option preferences of the rural could inform policies that increase underserved population's access to various mental health treatment modalities including OMT. This study aims to characterize patient attitudes toward, beliefs regarding, and perceived barriers to treatment options for mental health treatment, access, and care in a rural, underserved clinical setting. Methods Adult patients attending a single outpatient rural clinic over a four-month period in 2022 were screened for participation. The survey consisted of Likert scale graded questions about mental health treatment options, access, knowledge, and perceived barriers including qualitative questions about OMTs. Versions of the survey were created in English and Spanish languages. Results Out of 46 respondents, 25 were English-speaking and 21 were Spanish-speaking. The most popular mental health treatments by respondents were indicated as therapy, spiritual guidance, and modifying diet and exercise. Considering barriers to care, 61% of respondents indicated cost of treatment as a logistical barrier. Finally, 80.5% of respondents did not have a good understanding of OMT. Conclusions The knowledge and understanding of patients' perceived attitudes and barriers toward mental health care, inclusive of OMT, can provide insight to clinicians to improve patient outcomes and guide efforts in overcoming barriers to increase and expand mental health treatment availability and utilization by patients.

Dual path sub-type diagnostic model based on the anatomic morphological feature

Intracranial hematoma can compress the brain tissue, resulting in increased cranial pressure and a high fatality rate. Therefore, providing a rapid and accurate clinical diagnosis and treatment plan is a crucial step. Intracranial hematoma can be classified into clinical sub-types such as cerebral lobes, ventricular, basal ganglia, pons, and cerebellum hemorrhage based on the location of the hemorrhage. To accurately identify different sub-types and provide targeted treatment, this paper proposes a dual path sub-type diagnosis model based on the anatomic morphological feature. It extracts anatomic morphological features of hematoma based on clinical prior knowledge to achieve prior feature enhancement. Then, a dual-path input model is constructed, and the dual-path module is used to analyze and integrate various features of different sub-types of intracranial hematoma. The model is validated on the clinical data set of the Second Affiliated Hospital of Dalian Medical University, and the corresponding accuracy can reach 0.993. This model can automatically recognize the sub-type of the clinical intracranial hematoma cases and improve diagnostic efficiency. Besides, it further aid in image analysis and enable specific treatment planning.