Subjective Symptom Scores Research Articles

Complementary, Holistic, and Integrative Medicine

Complementary, Holistic, and Integrative Medicine

Complementary, Holistic, and Integrative Medicine: Acne

1. Anju Sawni, MD* 2. Amritpal Singh, MD† 1. *Pediatric Education, Hurley Children’s Hospital/Hurley Medical Center, Flint, MI. 2. †Department of Dravyaguna (Medicinal Plants), Sri Dhanwantry Ayurvedic College, Chandigarh, India. * Abbreviations: EFAs: : essential fatty acid LTB4: : leukotriene B4 Acne vulgaris is a common skin disorder that affects ∼70% to 87% of adolescents and young adults. (1) The pathogenesis of acne is multifactorial and complex, and is thought to be due to androgen-stimulated sebum production. This production leads to follicular occlusion and hyperkeratinization, with comedo formation, as well as microbial colonization of pilosebaceous follicles by Propionibacterium acnes , leading to inflammatory papules and pustules. Conventional treatments for acne include salicylic acid, benzoyl peroxide, retinoids, and antibiotics (topical and systemic). However, symptoms may not always improve, and patients may have adverse reactions to conventional treatments and thus seek alternative treatments. Antibiotic resistance in P acnes also has been rising, thus promoting the need to look at alternative therapies. (2) The influence of diet on acne has been debated for decades. One review of the literature looking at the evidence for diet, face washing, and sunlight exposure in acne management concluded that the evidence is incomplete at best. (3) Another review did not support any link between acne and foods such as dairy products, chocolate, and fatty foods. (4) However, with more recent focus on diet and nutritional supplements, emerging research suggests that diet may be a factor, particularly in mediating the inflammation and oxidative stress of the acne process. (5)(6)(7) Western diets, with characteristically high glycemic indices, can elevate insulin and insulin-like growth factor 1 levels acutely and chronically. (5) These hormones stimulate adrenal and gonadal androgen production, leading to increased sebum production and acne. Frequent consumption of high-glycemic-index carbohydrates may repeatedly expose adolescents to acute hyperinsulinemia. Therefore, a low-glycemic-load diet may have a beneficial effect on acne. (6) A review …

Influence of single-fraction Gamma-Knife radiosurgery on ocular surface and tear function in choroidal melanoma patients

AimTo evaluate ocular surface and tear function in patients with choroidal melanoma treated with single-fraction radiosurgery.Methods36 patients (median age 62 years; range 26–84 years) were enrolled between 2001 and 2006...

Clinical effect of catgut implantation at acupoints for allergic rhinitis: study protocol for a randomized controlled trial.

BackgroundCatgut implantation at acupoints has been used in China to treat allergic rhinitis (AR) for a long time. However, its efficacy and safety in the treatment of AR is controversial due to the poor quality of the clinical trial of this therapy. This study aims to identify whether catgut implantation at acupoints is indeed an effective and safe treatment for patients with persistent or intermittent allergic rhinitis (PER or IAR) by comparing with sham catgut implantation treatment.Methods and designThis study compares real versus sham catgut implantation at acupoints in 242 patients with a history of PER or IAR and with a positive skin prick test (SPT). The trial will be conducted in the Teaching Hospital of Chengdu University of Traditional Chinese Medicine. In the study, patients will be randomly assigned by computer-generated randomization list into two groups and assessed prior to treatment. Then, they will receive two sessions of treatments (once per 2 weeks) for 4 consecutive weeks and have a follow-up phase of 12 weeks. The administration of catgut implantation (or sham-control) at acupoints follows the guidelines for clinical research on acupuncture (WHO Regional Publication, Western Pacific Series No.15, 1995), and is performed double-blindly by a well-trained physician in acupuncture. The main outcome measures include the primary and secondary indicators. Primary indicators are subjective symptoms scores evaluated by visual analogue scales (VAS) and Rhinoconjunctivitis Quality of Life Questionnaires (RQLQ). The secondary indicators are the results of laboratory examinations, such as serum allergen-specific IgE, nasal inflammatory cells counts (mast cells, eosinophils, and T cells) and nitric oxide concentration in nasal excretion. The use of anti-allergic medication will also be recorded as one of the secondary indicators. Furthermore, adverse events will be recorded and analyzed. If any participants withdraw from the trial, intention-to-treat analysis (ITT) and per-protocol (PP) analysis will be performed.DiscussionThe important features of this trial include the randomization procedures, large sample, and a standardized protocol of catgut implantation at acupoints. This trial will be the first study with a high evidence level in China in order to assess the efficacy and safety of catgut implantation at acupoints in treatment of AR following a randomized, double-blind sham-controlled method.Trial registrationChinese Clinical Trial Registry: ChiCTR-TRC-12002191

Immune-modulatory effect of probiotic Bifidobacterium lactis NCC2818 in individuals suffering from seasonal allergic rhinitis to grass pollen: an exploratory, randomized, placebo-controlled clinical trial

Probiotics are defined as 'living micro-organisms that when administered in adequate amounts confer a health benefit to the host'. Different probiotic strains have been investigated for beneficial effects on allergic disorders. The purpose of the current study was to evaluate the effect of orally administering the probiotic Nestlé culture collection (NCC)2818 Bifidobacterium lactis strain on immune parameters and nasal symptom scores in subjects suffering from seasonal allergic rhinitis (SAR). The study was a double-blinded, parallel, randomized placebo-controlled trial conducted during the peak of the pollen season. Adult subjects with clinical history of SAR and positive skin prick test to grass pollen were recruited. The subjects received B. lactis NCC2818 or placebo for 8 weeks and completed symptom questionnaires every week. Whole blood was collected at baseline (V1), 4 weeks (V2) and 8 weeks (V3) to measure immune parameters. Concentrations of Th-2 cytokines, secreted by stimulated blood lymphocytes, were significantly lower in the probiotic group compared with the placebo group at V3 (interleukin (IL)-5, P=0.016; IL-13, P=0.005). Total nasal symptom scores were significantly lower in the second month of the study (weeks 5-8) in the probiotic group compared with the placebo group (P=0.03). Also, percentages of activated CD63 expressing basophils were significantly lower in the probiotic group at V2 (P=0.02). Oral administration of the probiotic NCC2818 mitigates immune parameters and allergic symptoms during seasonal exposure. These promising results warrant that B. lactis NCC2818 be investigated further in large-scale trials for management of respiratory allergy.

Evaluation of serum-derived bovine immunoglobulin protein isolate in subjects with diarrhea-predominant irritable bowel syndrome.

BACKGROUNDThere is increased interest in combining nutritional modalities with pharmacological therapies for managing patients with diarrhea-predominant IBS (IBS-D).AIMA randomized, double-blind, placebo-controlled study to evaluate the impact of oral serum-derived bovine immunoglobulin/protein isolate (SBI) on gastrointestinal symptom scores and quality of life (QoL) in subjects with IBS-D.METHODSStudy subjects previously diagnosed with IBS-D according to ROME II criteria were recruited from London, Ontario, Canada and assigned to receive 5 g/day SBI, 10 g/day SBI, or placebo for 6 weeks. Daily symptom frequency and severity scores and a modified IBS-36 questionnaire assessed the impact of nutritional intervention. Laboratory assessments were performed at screening and end of treatment (EOT) to evaluate safety. Within-group comparisons of changes in number of days per week with symptoms and symptom severity were conducted on the per-protocol population of subjects using a t-test.RESULTSSubjects who received SBI at 10 g/day (N = 15) had statistically significant within-group reductions in abdominal pain (p < 0.01), loose stools (p < 0.01), bloating (p < 0.05), flatulence (p < 0.01), urgency (p < 0.05) and any symptom (p < 0.01) at EOT vs. baseline. Subjects receiving 5 g/day of SBI (N = 15) realized statistically significant within-group reductions in days with flatulence (p < 0.035), incomplete evacuation (p < 0.05), and any symptom (p < 0.01). There were no significant changes in QoL scores or in hematology or clinical chemistry among treatment groups.CONCLUSIONSThis pilot study showed that nutritional therapy with either 10 g/day or 5 g/day of SBI in 30 patients was well tolerated and resulted in statistically significant within group improvements in both symptom days and in daily symptom scores in subjects with IBS-D. Additional studies are underway with larger numbers of subjects to validate these findings.

Immunotherapy – 2067. FEL d 1 peptide antigen desensitization safety and efficacy in a double-blind, placebo-controlled environmental exposure chamber study

Background Allergic rhinoconjunctivitis is an increasing problem worldwide with significant impact on quality of life and productivity. Sensitivity to cats accounts for 10-15% of the disease burden. Previous immunotherapy studies with two 27aa peptides were unsuccessful as a result of early and late phase responses. Cat Peptide Antigen Desensitisation (Cat-PAD) is a mixture of seven T-cell epitopes (13-17aa) derived from Fel d1. This study evaluated safety and relationship between dose, dosing regimen and symptom scores in cat allergic subjects with rhinoconjunctivitis 1721weeks(wk) after starting treatment using a standardized allergen challenge in an Environmental Exposure Chamber (EEC).

Efficacy and safety of preservative-free latanoprost eyedrops, compared with BAK-preserved latanoprost in patients with ocular hypertension or glaucoma

AimTo compare efficacy (intraocular pressure (IOP) reduction) and safety of preservative-free latanoprost (T2345) to benzalkonium chloride (BAK)-preserved latanoprost (BPL; Xalatan) in ocular hypertension (OHT) or primary open angle glaucoma (POAG)...

The impact of mental health on chronic rhinosinusitis symptom scores

We aimed to assess whether anxiety and depression influence a patient's subjective symptom scores in chronic rhinosinusitis (CRS). Fifty-seven consecutive patients referred with CRS were asked to complete Sinonasal Outcome Test-22 (SNOT22) and Hospital Anxiety and Depression Score (HADS) questionnaires. Spearman's rank correlation was used to test association between SNOT22 and HADS. Linear regression was used to simultaneously analyse SNOT, HADS, patient age and gender. Mean anxiety score was 7.9 (range 0-19) with 32 % scoring over 11 (A score of ≥ 11 for either anxiety or depression is suggestive). Mean depression score was 5.0 (range 0-17), with 11 % scoring over 11. Five patients scored over 11 for both domains in the HADS questionnaire. Total SNOT22 and both anxiety (Spearman's ρ = 0.48, p = 0.0002) and depression scores (ρ = 0.44, p = 0.0007) revealed a strong association. We also identified a very strong association between psychological symptoms (questions 11-20) in SNOT22 and anxiety (ρ = 0.60, p = 0.0001) and depression scores (ρ = 0.341, p = 0.002). However, there was no association between nose-specific symptoms in SNOT22 and anxiety score in HADS (ρ = 0.18, p = 0.1775), but there was a strong association between nose-specific symptoms of SNOT22 and depression score in HADS (ρ = 0.32, p = 0.02). There is a strong association between total SNOT 22 and HADS score, but this appears to be due to the impact on generic quality of life items rather than disease-specific symptoms. This supports inclusion of global items in the SNOT22, but also use of two separate subscales when interpreting data.

Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull‐base surgery

Endoscopic anterior skull-base surgery has been previously suggested to cause a significant deterioration in olfactory function. Given the impact on quality of life, the objective of this study was to determine the effect of a unilateral middle-turbinate-sacrificing approach on olfactory function and sinonasal outcome. Prospective cohort study comparing olfactory and sinonasal outcomes pre- and post-transsphenoidal skull-base surgery. Olfaction was the primary outcome and was measured prospectively using the University of Pennsylvania Smell Identification Test (SIT). Sinonasal symptoms were assessed subjectively via sinonasal-specific questions from the 22-item Sino-Nasal Outcome Test (SNOT-22), and objectively via the Lund-Kennedy Endoscopic Scoring system (LKES). Twenty-two patients met study inclusion criteria and completed all data acquisition. The mean preoperative SIT score was 34.8 and the mean postoperative SIT value was 35.1 (p = 0.37). The average change in score (delta) was an increase of 0.3, with changes ranging from -3 to +4. When examined categorically, 91% of patients maintained their preoperative olfactory function classification. There was no significant difference in mean pre- and postoperative symptom scores. A small increase in the LKES was noted, from a mean of 0.6 to 2.5 (p = 0.001) in the early postoperative period. Olfactory function, as measured by the SIT test, was preserved with a middle-turbinate-sacrificing skull-base approach. Subjective sinonasal symptom scores were unaffected, but a slight worsening of objective endoscopic appearance was noted.

Efficacy and safety assessment of preservative‐free latanoprost (T2345) versus Xalatan™ in ocular hypertensive or glaucomatous patients

AbstractPurpose To assess the efficacy on intraocular pressure (IOP) and safety of preservative‐free latanoprost (T2345) versus BAK‐preserved latanoprost (Xalatan™) for the treatment of open‐angle glaucoma (POAG) and ocular hypertension (OHT), through 2 clinical trials (phase II and III).Methods A pilot phase II, cross‐over, 6‐week study with plasma samples was conducted in (2x15) patients. In an international investigator‐masked, phase III study, 402 patients with POAG or OHT already controlled by Xalatan™ were randomized to receive either T2345 or Xalatan™ for 3 months, after a 5‐week run‐in period with brinzolamide and a 5‐day wash‐out period so as to achieve an IOP ≥ 22 mmHg at baseline. The main primary endpoint was the change in IOP at 9:00 am between D0 and D84 in the worse eye. Safety parameters were also assessed.Results The mean IOP was reduced from baseline to D84 by 36% with T2345 (‐8.6 ± 2.6 mmHg) and 38% with Xalatan™ (‐9.0 ± 2.4 mmHg). These results met the limits set for non‐inferiority of T2345 to Xalatan™. Conjunctival hyperaemia was less frequent on T2345 at D42 and D84 (20% vs. 30% on Xalatan™). Upon instillation, the subjective ocular symptom score was lower on T2345 than on Xalatan™ (p=0.001). The phase II study showed comparable efficacy on IOP of both products during the whole day (8am, 12am, 4pm and 8pm). After instillation, AUC(0‐30) was 1086 ± 509 pg.min/mL on T2345 and 1379 ± 784 pg.min/mL on Xalatan™, suggestive of lower plasma concentrations of latanoprost on T2345 treatment (p=0.036).Conclusion T2345 is the first preservative‐free formulation of latanoprost, stable at room temperature, showing a non‐inferior IOP lowering efficacy compared to Xalatan™, with improved local tolerance.

Mometasone Furoate for Adenoidal Hypertrophy in Adolescents

Objective: 1) To find out whether the symptoms attributable to adenoid hypertrophy in adolescents may be treated with intranasal mometasone furoate (MF) application. 2) To learn if adenoid hypertrophy in adolescents may decrease in size with intranasal MF. Method: A prospective, double-blind, randomized, crossover study was conducted in 28 subjects (12-18 years) with adenoidal hypertrophy. Subjects used intranasal MF or placebo for a duration of 6 weeks with a washout period of 3 weeks. Subjective symptoms and adenoid size were evaluated. Results: At the initiation of the study, there was no significant difference between the mean symptom scores for any of the sinonasal symptoms between the 2 treatment groups. Placebo users had no statistically significant reduction in their sinonasal symptoms ( P &gt; .05 for all) other than snoring ( P = .011). MF users had a statistically significant reduction in all symptoms ( P &lt; .05 for all) other than coughing ( P = .527). There was a significant difference between the 2 treatment groups in the mean posttreatment scores for total subjective symptom scoring and rhinorrhea ( P = .031, P = .012 resp). There was no significant difference in baseline endoscopy scores between the 2 treatment groups ( P = .317). There was a significant reduction in nasal endoscopy scores in the MF group compared to placebo group ( P = .034). Conclusion: MF may have some advantage over placebo for the symptoms attributable to adenoid hypertrophy in adolescents. Intranasal MF decreases the size of the adenoid hypertrophy in this group of patients.

Impact of Dry Eye Syndrome on Vision-Related Quality of Life in a Non-Clinic-Based General Population

BackgroundDry eye syndrome (DES) is a common ocular disorder occurring in general population. The purpose of this study is to evaluate the impact of DES on vision-related quality of life (QoL) in a non-clinic-based general population.MethodsThis population-based cross-sectional study enrolled subjects older than 40 years, who took part in an epidemiological study on dry eye in Sanle Community, Shanghai. Apart from the collection of sociodemographics, dry eye symptoms, and other clinical data, a Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was administered to all subjects. Comparisons of the NEI VFQ-25 subscale item scores and composite score were made among subgroups divided according to the presence of dry eye symptoms or signs. Multivariate regression analysis was performed to investigate the relationship between the clinical variables and the VFQ-25 composite score.ResultsA total of 229 participants were enrolled in the study, with an average age of (60.7 ±10.1) years old. Majority of these participants were female (59.8 %, 137/229). The total DES symptom scores (TDSS) in subjects either with definite DES or only with dry eye symptoms were significantly higher (F = 60.331, P < 0.001). The values of tear break-up time (TBUT) and Schirmer test were significantly lower in participants with DES and those with dry eye signs only (F = 55.158 and 40.778, P < 0.001). The composite score of the NEI VFQ-25 was significantly lower in subjects with DES (F = 4.901, P = 0.003). Moreover, the subscale scores of ocular pain and mental health were significantly lower in those with either DES or dry eye symptoms only (F = 10.962 and 7.362 respectively, both P < 0.001). The multiple regression analysis showed that the TDSS had a significant negative correlation with the VFQ-25 composite score as well as with the subscale score for ocular pain and mental health, even after the adjustment of all other factors (all P < 0.01).ConclusionsThe symptoms of dry eye are associated with an adverse impact on vision-related QoL in non-clinic-based general population, which is mainly represented as more ocular pain and discomfort, and impaired mental health as well. Apart from clinical examination, it is also important to refer to subjective symptoms and QoL scores when assessing the severity of DES.

Nasal obstruction following septorhinoplasty: how well does acoustic rhinometry work?

Septorhinoplasty aims to improve not only the esthetic appearance but also breathing function of the nose. Although the esthetic improvement can be judged by the patient and the surgeon easily, evaluation of nasal breathing is more complicated. Besides the subjective symptom scores given by the patient, some objective methods have been developed. One of the most widely used of these objective methods is acoustic rhinometry, which gives valuable information about the cross-sectional areas and volumes of the nasal airway as a function of distance from the nostril. Since the introduction of acoustic rhinometry, many papers were reported regarding its efficiency with some conflicting conclusions. Septorhinoplasty has the potential to narrow the nasal airway, especially if it includes lateral osteotomies and hump reduction. We aimed to evaluate the role of rhinoplasty on nasal obstruction with the help of subjective symptom scores and acoustic rhinometry. The study consisted of 26 patients who underwent septorhinoplasty. Before and after surgery, the symptom scores and findings of acoustic rhinometry were collected both before and after decongestion of the nasal mucosa. Symptom scores decreased on both sides, which were statistically significant (p < 0.05), however, the changes in cross-sectional areas of the nasal airway were not statistically significant (p > 0.05). The correlation between the symptom scores and acoustic rhinometry findings was not significant for all levels. The effect of septorhinoplasty on nasal airway and some important maneuvers to protect against nasal obstruction are discussed.

Efficacy and Safety of Diquafosol Ophthalmic Solution in Patients with Dry Eye Syndrome: A Japanese Phase 2 Clinical Trial

To investigate the dose-dependent efficacy and safety of diquafosol ophthalmic solution for the treatment of dry eye syndrome. Randomized, double-masked, multicenter, parallel-group, placebo-controlled trial. A total of 286 Japanese patients with dry eye who were prescribed topical diquafosol (1%, n = 96; 3%, n = 96) or placebo ophthalmic solution (n = 94). After a washout period of 2 weeks, qualified subjects were randomized to receive a single drop of 1% or 3% diquafosol or placebo ophthalmic solutions 6 times per day for 6 weeks. The primary outcome measure was fluorescein corneal staining score assessment. The secondary outcome measures were Rose Bengal corneal and conjunctival staining scores, tear break-up time (BUT), and subjective symptom assessment. Safety measures were clinical blood and urine examination and recording of adverse events. Fluorescein corneal staining scores significantly improved with both 1% and 3% topical diquafosol compared with placebo at 4 weeks, respectively (P = 0.037, P = 0.002). There was a dose-dependent effect among the groups. Rose Bengal corneal and conjunctival staining scores also improved significantly with both 1% and 3% diquafosol compared with placebo (P = 0.007 and P = 0.004, respectively). Subjective dry eye symptom scores significantly improved with both diquafosol ophthalmic solutions (P ≤ 0.033), although there were no significant differences in BUT compared with placebo. No significant differences between the treatment groups were observed in relation to the occurrence of adverse events. Both 1% and 3% diquafosol ophthalmic solutions are considered effective and safe for the treatment of dry eye syndrome.

P02.14. Efficacy of ah shi point acupuncture on acne vulgaris

Methods Thirty-six subjects were recruited and randomised in a double-blind (patient-blind and observer-blind) controlled trial to receive acupuncture either at general acupuncture points only or at both general acupuncture points and ah shi points 12 times over 6 weeks. The subjects were evaluated using the following outcome measurements: an inflammatory lesion count; a quality-of-life scale (Skindex29); and a subjective symptom score.

Correlation Between Optical Coherence Tomography–Derived Assessments of Lower Tear Meniscus Parameters and Clinical Features of Dry Eye Disease

To measure the correlation between subjective symptom score, conventional clinical tests, and Fourier-domain optical coherence tomography (FD-OCT) of lower tear meniscus parameters in patients with dry eye disease. Eighteen patients with dry eye disease requiring medical therapy and/or punctal occlusion were recruited for this prospective, nonrandomized, observational case series. Severity of symptoms of dry eye disease was assessed using the Indiana University Dry Eye Questionnaire 2002. Clinical assessments were completed using slit-lamp biomicroscopy, rose bengal dye staining, fluorescein tear breakup time (TBUT), and a 5-minute Schirmer test with topical anesthesia. The lower tear meniscus was imaged using an FD-OCT system with 5-μm axial resolution and measured manually by a masked grader using computer calipers. Correlation was assessed using Spearman correlation coefficient (ρ). The mean (±SD) scaled symptom score was 58 ± 21, with a range of 0 to 100. Vital staining test averaged 1.7 ± 3.4, TBUT averaged 4.4 ± 1.8 seconds, and Schirmer tests averaged 10.2 ± 8.1 mm. As determined by optical coherence tomography, the meniscus height was 228 ± 153 μm, depth was 127 ± 79 μm, and cross-sectional area was 0.018 ± 0.021 mm. Optical coherence tomography meniscus area was negatively correlated with the symptom questionnaire score (P < 0.01) and positively correlated with Schirmer test results (P < 0.01). There was no significant correlation between symptom score and rose bengal staining, TBUT, or Schirmer test results (P > 0.01). Lower tear meniscus measurement with FD-OCT is an objective noninvasive test that correlates well with symptoms of dry eye disease and the Schirmer test.

Transurethral Bipolar Plasmakinetic Resection Combined with 2 μm Continuous Wave Laser Vaporization: A New Method for the Treatment of Large Volume Benign Prostatic Hyperplasia

The aim of this study was to evaluate the safety and efficiency of transurethral bipolar plasmakinetic resection of the prostate (PKRP) combined with 2 μm laser vaporization in the management of large prostates (>80 mL). The safety and efficiency of transurethral vaporesection of the prostate with benign prostatic hyperplasia (BPH), using a 2 μm laser system, have been verified. However, this method does still not manage large volume prostates efficiently. From October 2009 to June 2010, 120 BPH patients with a median prostatic volume of 106.7 (±16.7) mL (range, 82.5-156.8 mL) were randomized for surgical treatment with PKRP combined with 2 μm laser vaporization (n=58) or PKRP only (n=62). All patients were preoperatively assessed with subjective symptoms score. Preoperative and perioperative parameters at 3-, 6-, and 9-month follow-up were also evaluated. All complications were recorded. PKRP combined with 2 μm laser vaporization was significantly superior to PKRP alone in terms of operative time, irrigation time, catheterization time, hospital stay, and hemoglobin decrease. The blood transfusion and urinary tract infection observed in the PKRP combined with 2 μm laser vaporization group was significantly less than that of the groups that received PKRP only. Both groups were similar with respect to resected tissue weight, transient incontinence, urethral stricture and retrograde ejaculation in the postoperative period. Both groups showed a significant improvement from baseline in terms of International Prostate Symptom Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and pulmonary vascular resistance unit (PVRU) values. However, no significant difference was found between them. PKRP combined with 2 μm laser vaporization, which combines the advantages of both PKRP and 2 μm laser, is superior for its shorter operation time, less bleeding, and better efficiency. It may be a safer and more effective method for the treatment of BPH in large prostates.

Surgical management of lacrimal punctal cauterization in chronic GVHD-related dry eye with recurrent punctal plug extrusion

We investigated the efficacy of lacrimal punctal occlusion surgery with a cautery device in patients with chronic GVHD (cGVHD)-related dry eye, with recanalization of puncta and recurrent punctal plug extrusion. A total of 23 puncta from 14 eyes of 10 patients with chronic GVHD (cGVHD)-related dry eye underwent punctual thermal cauterization with a high-temperature disposable cautery device. All patients were refractory to conventional treatment, including artificial tear eye drops, autologous serum eye drops and vitamin A eye drops, and had a history of recanalization and recurrent punctal plug extrusion. The effect of lacrimal punctal cauterization by thermal cautery device was evaluated by changes in subjective symptom scores, corrected distance visual acuity, Schirmer's test values, fluorescein staining scores, rose bengal staining scores, and tear-film break-up time before and 3 months after the surgery. Subjective symptom scores, Schirmer's test values, fluorescein and rose bengal scores, and tear-film break-up time improved significantly 3 months after the surgery. Recanalization of puncta was not observed in all the cases (0 of 14 eyes, 0%). Lacrimal punctal cauterization was effective with no recanalization and significant improvements in subjective symptoms and the ocular surface environment in cGVHD-related dry eye patients who had been refractory to conventional treatments.

Efficacy of Dose Escalation of Tamsulosin for the Treatment of Lower Urinary Tract Symptoms.

The aim of this study was to compare the efficacy of low (0.2 mg) and intermediate (0.4 mg) dose tamsulosin in treating lower urinary tract symptoms (LUTS). Patients were treated with low-dose tamsulosin for an initial run-in period of 12 weeks, then divided into two groups based on their clinical improvement. Patients were measured for objective parameters of peak flow rate and postvoid residual urine volume, as well as subjective symptom scores and perceived patient benefit of treatment. The items were then integrated as the LUTS Outcome Score to determine dose increase or maintenance. Overall outcome was determined at 36 weeks. One hundred and seventy-four patients were enrolled and started on 0.2 mg tamsulosin treatment. One hundred and fifty-five patients completed the 36-week study. Sixty patients required dose increase to 0.4 mg at the 12th week. Baseline characteristics showed that a patient who would benefit from 0.4 mg dosage had higher age, daytime frequency, and lower peak urine flow rate. Patients receiving both 0.2 and 0.04 mg both showed improved clinical outcome measures. Higher improvement was found in voiding component symptom scores and urine flow rate improvement in patients receiving an increased dose. Both low- and intermediate-dose tamsulosin are effective treatment regimens. Increasing from low to intermediate dose should follow assessment of both objective and subjective improvements.