Improvement In Subjective Symptoms Research Articles

Neurocognitive measures and self-reported symptoms following a short intensive multimodal neurorehabilitation program in individuals with post-concussion syndrome: Retrospective case-series study

This case-series study investigates the effect of a condensed multi-modal neurorehabilitation program on neurocognitive measures and self-reported symptoms using the C3Logix assessment tool on 137 individuals with diagnosed Post-Concussion Syndrome (PCS). In PCS, neurocognitive dysfunction is typically accompanied by symptoms of the physical, affective, and sleep domains. While most individuals recover within weeks of sustaining a head injury, evidence shows that those who do not recover in 3 months, may never. Recovery methods are usually prescribed with varying success, but the pathophysiologic complexity of concussion may require additional rehabilitation strategies that address the impaired neural networks to accelerate recovery. 137 individuals (M: 81, F: 56; mean (SD) age: 32.0 (14.0)) with a diagnosed PCS were treated at an outpatient rehabilitation center specializing in functional neurology. Using the C3Logix platform, individuals were evaluated at the intake and discharge of a 5-day program. Interventions included neuromuscular re-education, vestibular rehabilitation, orthoptics and cognitive training. Neurocognitive components and symptoms were exported and analyzed in Graphpad PRISM v. 8.4.3 using an rmANOVA. Results are reported as difference-of-means (95% CI). An alpha level of 0.05 was considered statistically significant. The C3Logix modified Graded Symptom Checklist score (0-150) decreased by 19.45 (15.16-23.75) (p < 0.0001), Trails A and B decreased 3.9 s (2.2-5.5) and 4.8 s (2.1-7.5) (p < 0.0001), respectively. Simple- and Choice Reaction Time decreased 31.3 ms (21.5-41.1) and 50.7 ms (37.9-63.6) (p < 0.0001), respectively. Static and Dynamic Visual Acuity decreased 0.03 LogMAR (0.0085-0.059) (p = 0.0021) and 0.05 LogMAR (0.021-0.073), respectively. Standardized Assessment of Concussion score (0-30) increased 0.8 (0.3-1.3) (p = 0.001) and digit-symbol coding increased 4.6 symbols (3.0-6.2) (p < 0.0001). The results of the present case-series study suggest clinically relevant improvements in neurocognitive measures and subjective symptoms in individuals with PCS following a multi-modal 5-day rehabilitation program.

Sleep and Marijuana Products in 2020

The growing availability, legality, and use of marijuana products in the USA has contributed to increased patient and clinician interest in the treatment of sleep disorders, especially insomnia and restless legs. What should clinicians know about these drugs and what should they tell patients that inquire about using them? Increasing numbers of studies are being published revealing clear subjective improvement of sleep-onset latency, subjective improvement of sleep disruptions, and subjective improvement of restless legs symptoms. However, objective findings are most often mixed, with some studies demonstrating improvement of sleep characteristics, and some demonstrating worsening. There is a trend for improvement in sleep with short-term use of marijuana products and a longer-term attenuation of effect, or possibly worsening. Evidence for their effectiveness in these disorders is robust from subjective patient reports but limited or mixed in objective measures. Discussions with patients should be individualized and risks and benefits weighed. Future large, randomized, placebo-controlled studies are needed to help clarify the discrepancy between subjective and objective measures.

Case Report of Dual-Site Neurostimulation and Chronic Recording of Cortico-Striatal Circuitry in a Patient With Treatment Refractory Obsessive Compulsive Disorder.

Psychiatric disorders are increasingly understood as dysfunctions of hyper- or hypoconnectivity in distributed brain circuits. A prototypical example is obsessive compulsive disorder (OCD), which has been repeatedly linked to hyper-connectivity of cortico-striatal-thalamo-cortical (CSTC) loops. Deep brain stimulation (DBS) and lesions of CSTC structures have shown promise for treating both OCD and related disorders involving over-expression of automatic/habitual behaviors. Physiologically, we propose that this CSTC hyper-connectivity may be reflected in high synchrony of neural firing between loop structures, which could be measured as coherent oscillations in the local field potential (LFP). Here we report the results from the pilot patient in an Early Feasibility study (https://clinicaltrials.gov/ct2/show/NCT03184454) in which we use the Medtronic Activa PC+ S device to simultaneously record and stimulate in the supplementary motor area (SMA) and ventral capsule/ventral striatum (VC/VS). We hypothesized that frequency-mismatched stimulation should disrupt coherence and reduce compulsive symptoms. The patient reported subjective improvement in OCD symptoms and showed evidence of improved cognitive control with the addition of cortical stimulation, but these changes were not reflected in primary rating scales specific to OCD and depression, or during blinded cortical stimulation. This subjective improvement was correlated with increased SMA and VC/VS coherence in the alpha, beta, and gamma bands, signals which persisted after correcting for stimulation artifacts. We discuss the implications of this research, and propose future directions for research in network modulation in OCD and more broadly across psychiatric disorders.

Prognostic Factors in Patients with Differentiated Thyroid Cancers Metastatic to the Cervical Spine.

The spine is the most common site of bone metastases in differentiated thyroid cancer (DTC). The role of surgery in the management of cervical spine (C-spine) metastases (CSpM) has not been adequately explored. This is a retrospective cohort study at a tertiary referral center from 2002 to 2018. Inclusion criteria were pathologic diagnosis of DTC and imaging/pathologic diagnosis of CSpM. Statistical analysis utilized t tests for continuous variables and χ2 tests for categorical variables. Survival analysis was conducted using Kaplan-Meier curves with univariate and multivariate Cox regressions. Fifty patients with DTC and CSpM were identified. Of those, 16 underwent surgical resection of the C-spine, whereas 34 did not. The most common presenting symptom was neck pain (N = 37, 74%). Patients in the surgery group were more likely to report a subjective improvement of symptoms (P < .01) and to have local (P < .01) and systemic (P = .04) disease control. Five-year overall survival was 44.7% for the surgery group (95% confidence interval [CI]: 17.1-69.3) and 11.1% (95% CI: 2.1-28.8) for the nonsurgery group (P = .01). The strongest risk factor for improved overall survival after C-spine metastasis was local disease control at the C-spine (multivariate hazard ratio [HR] = 0.32, 95% CI: 0.12-0.85, P = .02). Surgical intervention was significantly associated with improved survival on both univariate (HR = 0. 35, 95% CI: 0.15-0.82, P = .02) and multivariate (HR = 0.37, 95% CI: 0.14-0.98, P = .04) analysis. Surgical management of CSpM in differentiated thyroid cancers is associated with significantly improved local disease control and overall survival. Referral to spine surgeons should be considered after diagnosis. IV. Laryngoscope, 131:E1741-E1747, 2021.

Clinical Outcome Study after External Approach Septoplasty

Background and Objectives This study aims to investigate the indications of external approach septoplasty and improvement in subjective symptoms and objective parameters in patients who underwent external approach septoplasty to correct septal deviation with various types of deformities.Subjects and Method Thirty-one patients who underwent external approach septoplasty from October 2014 to January 2019 were classified by direction, location, and degree of nasal septal deviation, septal shape and surgical techniques. Through acoustic rhinometry, the minimum cross-sectional area and nasal volume were measured before and after surgery. To evaluate the improvement in symptoms, the Nasal Obstruction Symptom Evaluation (NOSE) survey and nasal congestion visual analogue scale (VAS) were also measured.Results We found significant correlations between: the direction and degree of nasal septal deviation; the location and degree of nasal septal deviation; septal shape and location of the nasal septal deviation; septal shape and surgical techniques; and the degree of nasal septal deviation and presence of spreader grafts. The NOSE scale following external approach septoplasty improved from 14.7±4.4 to 3.1±3.2 (&lt;i&gt;p&lt;/i&gt;&lt;0.001), while the VAS score improved from 7.2±2.3 to 1.2±1.4 (&lt;i&gt;p&lt;/i&gt;&lt;0.001). Also, acoustic rhinometry showed that the minimum cross-sectional area and nasal volume at the convex side of nasal cavity significantly increased after surgery.Conclusion The external approach septoplasty is a surgical technique that is effective not only in improving subjective symptoms, but also in improving objective parameters. External approach septoplasty could be used in case of caudal and/or dorsal nasal septal deviation.

Laparoscopic and Robotic Mesh-Free Suture Hysteropexy Versus Mesh Sacral Hysteropexy: A Non-Randomised Comparison

Study Objective To compare the laparoscopic and robotic mesh-free suture hysteropexy (SutureH) with mesh sling sacral hysteropexy (MeshH) for uterine prolapse. Design A retrospective clinical audit of consecutive women who underwent SutureH or MeshH by laparoscopic or robotic route by a single surgeon. Subjects were assessed at baseline, 5-weeks and 1-year. Setting N/A Patients or Participants N/A Interventions SutureH uses sutures to re-support the uterus from each uterosacral ligament. During MeshH, the uterus is suspended form the sacral promontory using a mesh sling placed around the cervix. All women had a post-operative surgical support pessary placed for 5 weeks. Measurements and Main Results The primary outcome was success defined as a composite of: POP-Q C-point above the hymen, absence of vaginal bulge symptom, and no repeat prolapse surgery or pessary placement. Secondary outcomes included subjective improvement in prolapse symptoms using PGI-I, POP-Q C-point change, change in POP-Q scores and complications. 228 women underwent laparoscopic or robotic hysteropexy between Sept 2010 and Oct 2018. The 1-year data was available for 191 women (MeshH n=120; SutureH n=71). Success was not different between MeshH and SutureH (P=0.114). For MeshH v's SutureH, C-point at or above -1cm, absence of bulge and no repeat surgery was 99.2% v's 95.8%, 90.8% v's 90.1% and 81.7% v's 84.5% respectively (NS). MeshH (mean C point -7.14 cm) provided better apical support than SutureH (mean C point -5.9) (P Conclusion Laparoscopic and robotic sutureH and meshH provide women with minimally invasive durable options for uterine preservation during pelvic organ prolapse surgery. When controlling for age, MeshH provided better anatomic support than SutureH although SutureH gives women a mesh-free option.

EVALUATION OF EFFICACY OF JALOUKAVACHARANA AND SIRAVYADHANA IN THE MANAGEMENT OF VATARAKTA: A COMPARATIVE STUDY

Vatarakta is the illness that exhibits different signs and symptoms based upon the Dosha, Utthana and Gambheera Avastha. Dietary habits and life style modalities play a major role in the causation of Vatarakta. Though various remedies are there to treat it, Raktamokshana is said to be an effective, and standard technique. Hence it is claimed to be an important affective tool in the management of Vatarakta. This study is undertaken to explore and compare the efficacy of Jaloukavacharana and Siravyadhana in Vatarakta.&#x0D; Randomized comparative clinical trial was adopted in this study. 40 subjects fulfilling diagnostic and inclusion criteria were selected and divided into two groups. The day on which the procedure was conducted was considered as first day of the trail. Follow up was on 8th &amp; 15th day. Total duration of Study was 15 days. In both the group there is a significant improvement of subjective and objective symptoms except on Vaivarnya. The collected data is statistically analysed Jaloukavacharana is found to be more effective in the features Daha and Shopha. Siravydhana is more effective in Shoola and Vivarnya. Both the procedure shows equal effect on Sparshaasahatva. The overall results of Group A are 82.11% and Group B is 82.76%. Both the treatments are equally effective in Vatarakta. Hence alternative hypothesis H3 is proved. This simple and cost-effective treatments are painless do not require any anaesthesia. Hence it can be easily performed in OPD level on day-care basis.

Evaluation of Alpha 1 Adrenoceptor Antagonist Dose Increase Therapy: An Essential Strategy for Patients with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

Introduction: There have been a number of reports on dose increase therapy (DI-T) with the alpha 1 adrenoceptor antagonists (α1-blockers) naftopidil and tamsulosin for lower urinary tract symptoms associated with benign prostatic hyperplasia. Methods and Results: The reports on DI-T (naftopidil 75 mg/d, tamsulosin 0.4 mg/d) in non-responders to low-dose initial therapy (LI-T, naftopidil 50 mg/d, tamsulosin 0.2 mg/d) were summarized. In each study, a non-responder was defined as a patient without sufficient improvements on the International Prostate Symptom Score (IPSS), IPSS Quality of Life, maximum flow rate of urine, or treatment satisfaction. These reports showed that 22.4-76.1% of patients were non-responders to LI-T, indicating that a novel treatment strategy for such patients is important. Moreover, 22.5-90.0% of non-responders to LI-T showed a response to DI-T, which achieved the same level of efficacy as low-dose maintenance therapy. Specifically, the improvements of the IPSS voiding symptom sub-score and maximum flow rate of urine were superior. The predictive factors for non-response to α1-blockers LI-T were insufficient improvement of subjective symptoms and objective findings during LI-T. These patients require high-dose initial therapy or DI-T at an early stage, since adverse events associated with naftopidil and tamsulosin do not show a dose-response relationship. Conclusions: DI-T with α1-blockers has high potential as an essential treatment strategy for lower urinary tract symptoms associated with benign prostatic hyperplasia.

Trazodone as an Alternative Treatment for Neuroleptic-Associated Akathisia: A Placebo-Controlled, Double-Blind, Clinical Trial.

Akathisia is a distressing extrapyramidal complication that follows the use of antipsychotic medications. Early treatment of neuroleptic-associated akathisia (NAA) is of great importance because it may lead to poor therapeutic response and ultimately treatment noncompliance. Considering the lack of adequate response of some patients to conventional treatments and the assumption that serotonin might be involved in the pathophysiology of the disease in addition to dopaminergic mechanisms, we aimed to evaluate the effectiveness of trazodone as an antidepressant agent with strong antagonistic effects on serotonin receptors in the treatment of akathisia. In a double-blind clinical trial, 52 patients receiving antipsychotic medications who were diagnosed to have mild to severe NAA using Barnes Akathisia Rating Scale were treated with trazodone 50 mg daily for 5 days and compared with the placebo control group. Patients receiving trazodone did not show a significant difference compared with the control group in terms of the severity of akathisia symptoms until the third day of the study. In contrast, at the end of the fifth day, there was a significant improvement in objective (P = 0.01) and subjective (P = 0.001) symptoms of akathisia and the global clinical assessment of akathisia scale (P = 0.001). Moreover, there was no clear difference between trazodone and placebo group in terms of adverse effects. Considering the antagonistic effect of trazodone on postsynaptic 5-hydroxytryptamine2A receptors as a possible mechanism of efficacy of this agent in the treatment of NAA, this study suggests that trazodone might be an effective and relatively safe drug.

Short-Term Evaluation of the Effectiveness of Concurrent Multi-Modal Conservative Therapy in Management of Temporomandibular Joint Dysfunction

Temporomandibular joint dysfunction (TMD) affects 4.6% of adults in the United States.1 Though surgical techniques are available for management, non-surgical regimens should be considered first. Studies have evaluated the effectiveness of non-surgical therapies, showing improvement in around 80% of individuals.2 To our knowledge, evaluation of a concurrent multi-modal approach to conservative management of TMD remains limited. The purpose of the present study was to evaluate the effectiveness of concurrent multi-modal conservative therapy in the management of TMD. A retrospective chart review was carried out to evaluate all patients presenting to a TMD practice of a single oral and maxillofacial surgeon for 1 year. Patients who underwent a course of multi-modal conservative therapy for at least 1 month concurrently were evaluated. Therapy consisted of a soft chew diet, flat-plane occlusal splint, pharmacotherapy with an NSAID and muscle relaxant, as well as consultation with a physical therapist. The outcomes measured included subjective improvement in symptoms, change in maximum incisal opening (MIO) with and without pain, and the need for additional surgery. Statistical data analysis was utilized to evaluate the rate of subjective improvement and changes in the pre- and post-treatment MIO with and without pain. The Wilcoxon rank sum test and Wilcoxon signed rank test were used to evaluate for significant differences between pre- and post-treatment MIO with and without pain. Logistic regression was used to evaluate for factors associated with subjective improvement after treatment. A significance value of 0.05 was chosen for all analyses. Fifty-four patients presented from February 2018 to February 2019 with TMD. Of these patients, 19 met the inclusion criteria. Subjective improvement was found in 58% of patients; 68% of patients did not require any further surgical intervention; 74% of patients experienced improvement of MIO without pain. MIO without pain increased by an average of 4.947mm (SD 6.924) for all patients. In the patients who improved, MIO without pain increased by 7.545mm (SD 7.367). The Wilcoxon rank sum test suggests a significant difference in the post-treatment MIO without pain between the group that showed subjective improvement and the group that did not. The Wilcoxon signed rank test suggests that there is a significant difference between the pre- and post-treatment MIO without pain in all participants, regardless of improvement (P-value .005), and in the improvement group alone (P-value .008). Finally, logistic regression showed that a 1mm increase in post-treatment MIO without pain was associated with a 23% increase in the odds of a patient improving. Our analysis shows that multi-modal conservative therapy is effective in management of patients with TMD. Over half of the patients followed showed subjective improvement. Those that subjectively improved showed an increase in MIO without pain to an average of greater than 40mm. It is also important to note that patients who did not subjectively improve also revealed a lack of improvement in MIO with and without pain. Additionally, despite reporting subjective improvement, a few patients still went on to undergo additional surgical intervention. Finally, if we consider lack of follow-up as a possible indicator of improvement, the rate of subjective improvement rises to 82%. A multi-modal approach to conservative therapy in the management of TMD is a reasonable treatment course and has a good chance of eliminating the need for surgical intervention. Additional studies with larger samples are needed to further evaluate the effectiveness of this concurrent multi-modal approach.

Functional outcome of conservative treatment of acute type 3 Acromioclavicular joint dislocation

Background and Objectives: Acromioclavicular joint dislocation corresponds to 8.6% of all joint dislocations. Non operative treatment is considered the standard of care for type I and II Acromio - clavicular joint dislocation. But the treatment of acute type III and above injuries is still controversial. The purpose of this study is to determine the functional outcome of conservative treatment of Type III severity of acromioclavicular dislocations with respect to pain, range of movements, cosmesis and radiological displacement. Materials and Methods: 25 patients with Acromioclavicular joint dislocation of type 3 were included in our study conducted between August 2018 and July 2020. Stress X-Rays were taken to diagnose type 3 acromioclavicular joint dislocation. All patients were treated conservatively with strapping for three weeks and gradual mobilization over next three weeks. Patients were evaluated at 6 weeks, 3months and 6months. At each follow up patients were assessed subjectively for pain, objectively for range of abduction and radiographs were taken to note any displacement. Results: Sixteen patients had excellent results with no pain or limitation of movements. Six patients had good results with pain only on excessive activity and terminal restriction of movements. Two patients had fair results and no poor results. Improvement in subjective and objective symptoms was highly significant (p

Ultra-low-pressure hydrocephalic state in NPH: benefits of therapeutic siphoning with adjustable antigravity valves.

Idiopathic normal-pressure hydrocephalus (NPH) is a condition of the elderly treated by ventriculoperitoneal shunt (VP) insertion. A subset of NPH patients respond only temporarily to shunt insertion despite low valve opening pressure. This study aims to describe our experience of patients who benefit from further CSF drainage by adding adjustable antigravity valves and draining CSF at ultra-low pressure. Single-centre retrospective case series of patients undergoing shunt valve revision from an adjustable differential pressure valve with fixed antigravity unit to a system incorporating an adjustable gravitational valve (Miethke proSA). Patients were screened from a database of NPH patients undergoing CSF diversion over 10 consecutive years (April 2008-April 2018). Clinical records were retrospectively reviewed for interventions and clinical outcomes. Nineteen (10F:9M) patients underwent elective VP shunt revision to a system incorporating an adjustable gravitational valve. Mean age 77.1 ± 7.1 years (mean ± SD). Eleven patients (58%) showed significant improvement in walking speed following shunt revision. Fourteen patients/carers (74%) reported subjective improvements in symptoms following shunt revision. Patients presenting symptoms relapse following VP shunting may represent a group of patients with ultra-low-pressure hydrocephalus, for whom further CSF drainage may lead to an improvement in symptoms. These cases may benefit from shunt revision with an adjustable gravitational valve, adjustment of which can lead to controlled siphoning of CSF and drain CSF despite ultra-low CSF pressure.

Extradural Motor Cortex Stimulation might improve episodic and working memory in patients with Parkinson\u2019s disease

Electric Extradural Motor Cortex Stimulation (EMCS) is a neurosurgical procedure suggested for treatment of patients with advanced Parkinson’s disease (PD). We report two PD patients treated by EMCS, who experienced worsening of motor symptoms and cognition 5 years after surgery, when EMCS batteries became discharged. One month after EMCS restoration, they experienced a subjective improvement of motor symptoms and cognition. Neuropsychological assessments were carried out before replacement of batteries (off-EMCS condition) and 6 months afterward (on-EMCS condition). As compared to off-EMCS condition, in on-EMCS condition both patients showed an improvement on tasks of verbal episodic memory and backward spatial short-term/working memory task, and a decline on tasks of selective visual attention and forward spatial short-term memory. These findings suggest that in PD patients EMCS may induce slight beneficial effects on motor symptoms and cognitive processes involved in verbal episodic memory and in active manipulation of information stored in working memory.

The correlation between the degree of anxiety/depression and the improvement of subjective and objective symptoms after functional endoscopic sinus surgery in chronic sinusitis

Objective: To explore whether the improvement of subjective symptoms and objective grades after endoscopic sinus surgery in patients with chronic sinusitis (CRS) are related to the degree of preoperative anxiety or depression and to provide reference for improving the effects of clinical treatment. Methods: The clinical data of one hundred and sixty patients with CRS treated by endoscopic sinus surgery in the First Affiliated Hospital of Chongqing Medical University from April 2018 to August 2019 were collected prospectively. The visual analogue scale (VAS) scores, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, Lund-Kennedy scores of nasal endoscopy and the Lund-Mackay scores of CT before and 6 months after surgery were used to analyse the correlation between the scores of anxiety or depression and the subjective and objective scores of patients before and after operation by grouping and layering. One hundred and one males (63.1%) and 59 females (36.9%) with an average age of 47.3 years (18-75 years) were included. Single-sample, independent or paired t-test, one-way ANOVA and rank-sum test were used for comparison and Pearson correlation analysis was used for the correlation between groups. Results: There was no statistical difference of anxiety or depression between different groups in terms of age, gender and course in the 160 effective patients (t values were -0.151, -0.487, -0.846, all P values>0.05; t values were -0.473, -1.302, -1.069, all P values>0.05). And the degree of preoperative anxiety or depression was positively correlated with the subjective scores, including overall discomfort, nasal obstruction, runny nose and olfactory decline (r values were 0.515, 0.606, 0.424, 0.306, all P values<0.01; r values were: 0.518, 0.584, 0.448, 0.308, all P values<0.01), but not significantly correlated with objective scores of Lund-Mackay and Lund-Kennedy (all P value>0.05). Moreover, as far as the symptoms of overall discomfort, nasal obstruction, headache and runny nose, the results of one-way ANOVA showed that the improvement of symptoms in patients with serious anxiety or depression was worse than that of the normal, mild and moderate patients (all P values<0.05). However, there was no significant difference in the scores of Lund-Kennedy 6 months after surgery between them (both P values>0.05). Conclusion: The state of anxiety or depression affects the improvement of symptoms after endoscopic sinus surgery for CRS patients. Compared with the patients with normal and mild to moderate anxiety or depression, the improvement of symptoms in patients with severe anxiety and depression is worse. It is necessary to evaluate the anxiety or depression of the patients with CRS who are going to undergo endoscopic sinus surgery.

Tea Extract Vaginal Ovule for Intermediate Flora: Randomized Blinded Vehicle-Controlled Multicenter Pilot Clinical Trial with Microbiome Analysis

Although tea contains antioxidant and antibacterial compounds, it has not yet been clinically tested in the context of abnormal vaginal flora. Our aim was to determine the safety and efficacy of vaginal ovule with 2 mg tea extract once-daily for 5-7 days for symptoms of intermediate vaginal flora. This was randomized blinded vehicle-controlled multicenter clinical trial with composite primary endpoint (drop in the Nugent score (NS), vaginal pH, or improvement of subjective symptoms) compared between the active and vehicle arm using Fisheŕs exact test at α=0.05. Wet mounts were taken from 274 participants from 14 centres, 97 + 95 participants fulfilled the inclusion criteria. In the active and vehicle arm, composite scores improved in 51.8 % (43/83) and 38.3 % (31/81) participants, respectively, representing an odds ratio = 1.73 (CI 0.93- 3.23, p=0.082). In all 274 participants, 7 mild adverse reactions were recorded of which 6 occurred in the passive arm. Intention-to-treat analysis showed more frequent improvement of subjective symptoms (p=0.047) and reduction in burning (p=0.006) in the active arm. The results suggest that as little as 2 mg of tea extract have the capacity to relieve subjective symptoms, notably the perception of genital burning. Tolerability of the tea ovule seems at least as good as that of the vehicle alone. Tea extract deserves further evaluation in larger doses.

Is Gelfoam Necessary for Middle Ear Surgery: A Comparative Study of the Results of Tympanoplasty With and Without Gelfoam in the Middle Ear.

Absorbable gelatin sponge (Gelfoam) has been used for many years in middle ear surgeries. It not only provides support to the graft and ossicular reconstruction materials but also helps in haemostasis and aeration of the middle ear. Although gelfoam is generally well tolerated but fibrosis and granulations in the mesotympanum have been attributed to its usage in some studies. This study was conducted to compare the results of middle ear surgeries with and without gel foam in terms of both objective and subjective improvements of symptoms. To study the outcome of tympanoplasty with and without gel foam in the middle war by measuring following attributes (for measuring outcomes) at an intervals of 6weeks, 12weeks and 6months after surgery. (a) Graft take up rate as evaluated by otoscopy. (b) Pre and post-operative hearing levels as measured on Pure Tone Audiogram. (c) Subjective improvement in symptoms of ear discharge, heaviness in ears, hearing loss and tinnitus. Study design-prospective clinical study. patients undergoing tympanoplasty type 1 between August 2018 to July 2019 were included in the study. Group A (n = 36) consisted of patients who underwent tympanoplasty with gel foam in the middle ear and Group B (n = 36) consisted of patients who underwent tympanoplasty without any gel foam inside the middle ear. The uptake of graft after tympanoplasty was almost similar in the patients using gelfoam (89%) and those without gelfoam (84%) at the end of 6months. The improvement in the subjective symptoms of ear discharge and hearing loss at 6weeks following the surgery was better in patients without gelfoam whereas, at the end of 6months the improvement in these symptoms was similar in both the groups. The improvement in hearing 6months following tympanoplasty as assessed by pure tone audiometry and was found to be the same in both the groups. Tympanoplasty can be performed safely without using any gelfoam in the ear. This not only makes patients comfortable early but also avoids any gelfoam induced fibrosis or granulations in the middle ear.

Clinical Characteristics of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: A Retrospective Analysis

Clinical Characteristics of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: A Retrospective Analysis

Endoscopic treatment of proton pump inhibitor-refractory gastroesophageal reflux disease with anti-reflux mucosectomy: Experience of 109 cases.

Some patients with gastroesophageal reflux disease (GERD) are refractory to proton pump inhibitor (PPI) therapy. Anti-reflux mucosectomy (ARMS) is a minimally invasive endoscopic procedure for treatment of GERD. In this study, we retrospectively evaluated the outcomes of ARMS performed in patients with PPI-refractory GERD at our institution. A total of 109 patients with PPI-refractory GERD who underwent ARMS were retrospectively reviewed. Pre- and post-ARMS questionnaire scores, acid exposure time (AET), DeMeester score, proximal extent, and PPI discontinuation rate were compared. There was a significant improvement in the symptom score (P<0.01) and 40-50% of patients were able to discontinue PPI after ARMS. In patients who were followed up for 3years, sustained improvement in subjective symptoms was observed. AET and DeMeester score significantly improved after ARMS (P<0.01); however, there was no significant improvement in proximal extent (P=0.0846). Anti-reflux mucosectomy is an effective minimally invasive therapy for patients with PPI-refractory GERD. The therapeutic efficacy is attributable to suppression of acid backflow due to contraction of the scar tissue in cardia.

Subjective Symptoms in Patients with Eosinophilic Esophagitis Are Related to Esophageal Wall Thickness and Esophageal Body Pressure.

Endoscopic ultrasonography (EUS) and high-resolution manometry (HRM) can be used in the evaluation of eosinophilic esophagitis (EoE) for frequent symptoms such as dysphagia. However, the role of these examinations is not clear. The aim of this study was to objectively evaluate the subjective symptoms of EoE patients with EUS and HRM. Patients who had endoscopic findings indicative of EoE and matched the number of eosinophil infiltrates used as diagnostic criteria were recruited between September 2018 and August 2019. Evaluable subjects underwent EUS and HRM and completed the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. The esophageal wall thickness (evaluated with EUS) and HRM parameters between patients with and without symptoms were retrospectively compared. Symptomatic patients were re-examined using EUS and HRM 6months after treatment. A total of 35 patients (29 males, median age of 49years) were divided into symptomatic (20 patients) and asymptomatic groups (15 patients). The esophageal wall was thicker, and the distal contractile integral (DCI) values were higher in the symptomatic group (P < 0.001). In addition, DCI values were positively correlated with esophageal wall thickness. After treatment, the GSRS scores showed an improving trend for each item. Esophageal wall thickness and DCI values were significantly decreased (Ps < 0.001). Esophageal wall thickening and increased esophageal body pressure may be involved in subjective symptoms. In addition, treatment may reduce esophageal thickness and pressure along with improvement of subjective symptoms.

Systematic Review and Meta-Analyses Assessment of the Clinical Efficacy of Bismuth Subsalicylate for Prevention and Treatment of Infectious Diarrhea

BackgroundA large number of studies have evaluated the pharmacology, safety, and/or efficacy of bismuth subsalicylate for the relief of common gastrointestinal symptoms, diarrhea and vomiting due to acute gastroenteritis. In addition, short-term (48 h) medication with bismuth subsalicylate is known to be effective against infectious gastroenteritis such as travelers’ diarrhea.AimsPrevious studies have documented the bacteriostatic/bactericidal effects of bismuth subsalicylate against a variety of pathogenic gastrointestinal bacteria. However, meta-analyses of the clinical efficacy of bismuth subsalicylate for both prevention and treatment of travelers’ diarrhea have not yet been published.MethodsA total of 14 clinical studies (from 1970s to 2007) comprised the core data used in this assessment of efficacy of bismuth subsalicylate against infectious (including travelers’) diarrhea. These studies allowed for statistical meta-analyses regarding prevention (three travelers’ diarrhea studies) and treatment of infectious diarrhea (11 studies [five travelers’ diarrhea]).ResultsThe results show that subjects treated with bismuth subsalicylate for up to 21 days have 3.5 times greater odds of preventing travelers’ diarrhea compared with placebo (95% CI 2.1, 5.9; p < 0.001). In addition, subjects with infectious diarrhea treated with bismuth subsalicylate had 3.7 times greater odds of diarrhea relief (recorded on diaries as subjective symptomatic improvement) compared to those receiving placebo (95% CI 2.1, 6.3; p < 0.001).ConclusionsThis systematic review and meta-analysis suggests that bismuth subsalicylate can be beneficial for those at risk or affected by food and waterborne diarrheal disease such as traveler’s (infectious) diarrhea, and may decrease the risk of inappropriate antibiotic utilization.