Improvement In Symptoms Research Articles

Gastric electrostimulation in refractory gastroparesis: results of a explorative observational study

High-frequency electrical stimulation therapy (gastric electrical stimulation, GES) is a treatment option for gastroparesis of various genesis. The best indication and prognostic parameters have not yet been conclusively determined.Retrospective analysis of all gastroparesis patients implanted with a GES device between 2011 and 2020. Clinical response was measured before and after implantation using a validated Gastroparesis Cardinal Symptom Index (GCSI) (maximum score: 5, minimum score: 0). Other study endpoints included: subjective symptom course (no improvement, partial improvement, or severe improvement) and change in gastroparesis medication.A GES device was implanted in 42 patients (16 M: 26 F, mean age 45 years). The etiology of gastroparesis was diabetic (n=23), idiopathic (n=10) or postoperative (n=9). Eleven patients (26%) had undergone one or more invasive treatments before. GCSI score of the total group was 3.23 preoperatively. The median follow-up time was 12 months. In the overall group, significant improvement in GCSI score was found 3, 6, 9, and 12 months postoperatively-regardless of indication. In multivariate analysis, disease duration of >30 months was associated with a significantly decreased GCSI score at 12 months (p<0.001). Approximately 40% of patients were able to discontinue or significantly reduce gastroparesis medication. At the end of follow-up, 81% of patients reported partial or major improvement in symptoms. During the follow-up period, three patients (7%) died.Gastric electrical neurostimulation is an effective and safe option for refractory gastroparesis-regardless of the underlying disease.

Association of Palliative Care Consultation in Patients With Heart Failure With Preserved Ejection Fraction With Symptom Burden and Health Care Use

BackgroundGuidelines recommend palliative care (PC) for patients with heart failure. However, little research has been performed assessing the effect of PC consultation in patients with heart failure with preserved ejection fraction (HFpEF). ObjectivesThe purpose of this study was to investigate the impact of PC consultation on symptom burden and health care utilization among individuals with HFpEF during the last 3 years of their lives. MethodsWe retrospectively analyzed electronic medical records from 72 centers, mainly in the United States. All patients with HFpEF, identified using International Classification of Diseases codes, who died within 3 years of the diagnosis were selected and then stratified based on receipt of PC consultation. Propensity score matching was used to control for between-group differences. ResultsTwo hundred twenty-six thousand nine hundred twenty-one patients with HFpEF died within 3 years, only 26.4% of whom received a PC consult. In the unmatched cohort, patients who received a PC consult were more likely to be female, Black, and had more comorbidities. After propensity matching, patients receiving PC consultation were less likely to experience an emergency room visit or hospitalization (2.2% vs 4.6%), surgery or anesthesia (1.1% vs 4.2%), critical care (0.7% vs 1.9%), or receive cardiovascular procedures or tests (1.7% vs 4.7%). Furthermore, they were also less likely to have cardiorespiratory symptoms (2.5% vs 5.7%), heart failure exacerbations (1.6% vs 3.3%), cognitive symptoms (1.7% vs 3.4%), falls (0.3% vs 0.6%), and depression or anxiety (1.3% vs 2.8%). ConclusionsPC consultation is associated with reduced potential unwanted health care utilization and improvement in symptoms in patients with HFpEF in their last 3 years of life. However, PC continues to be underused in this population.

A Retrospective review of Leave against Medical Advice (LAMA) cases in the Emergency Department: Factors and Solutions

Abstract Background: Leave against medical advice (LAMA) is a constant source of frustration for all emergency physicians irrespective of the setup. These patients have higher healthcare costs and readmission rates and even carry a higher morbidity and mortality. The literature on the subject from India is limited. We conducted this study to find the proportion of patients LAMA from the emergency medicine department (EMD). Materials and Methods: The study was conducted at an EMD of a tertiary care hospital attached to a medical college in western Maharashtra with an aim to estimate the incidence of LAMA cases and describe various characteristics of these patients. Results: A total of 28,802 patients visited EMD during the study period and 6582 patients (22.8%) left against medical advice. Majority of LAMA patients were male (58.3%) and belonged to the age group of 18–40 (52.9%) years. Maximum patients who left against medical advice belonged to the basic specialties such as internal medicine, general surgery, and orthopedics. Among LAMA patients, majority were discharged between 5 PM and 9 AM (n = 4490; 68.2%). Symptomatic improvement (46.8%) and financial constraints (17.3%) were the reason why majority of patients left against medical advice. Conclusion: LAMA remains a significant problem globally. There are very limited data from India on the demography of LAMA patients and reasons for patients choosing to LAMA. Our study provides a few insights into the issue, but large-scale prospective studies are required to plan policies which can help in reducing the LAMA burden.

The relationship of nasal mucus properties and symptoms in allergic and acute non-allergic rhinitis.

Allergic rhinitis (AR) and acute non-allergic rhinosinusitis (ARS) often present with similar symptoms. While these are generally differentiated by history and occasionally by secretion cell counts, there are few data temporally comparing these conditions. A prospective, observational study was conducted to assess nasal mucus properties, nasal obstruction, nasal secretion cells, and health related QOL during the acute phase (Day 5) and during a later phase of illness (Day 14/28). We screened 280 patients and enrolled 42 subjects (ARS, n=34; and AR, n=8) who were otherwise healthy and met eligibility criteria. Nasal secretions for cell count and rheology, and acoustic rhinometry were measured on days 5 and 14 of symptoms. SNOT-20 was administered on Day 5, 14, 10 and 28. In subjects with ARS, there was significantly improved SNOT-20 and major symptom score at day 28 in association with increased nasal cavity volume by acoustic rhinometry and decreased mast cells; all consistent with improvement. However, in subjects with AR there was no symptomatic improvement or change in nasal volume and although there were fewer mast cells and epithelial cells, there was no decrease in the number of eosinophils, neutrophils, or goblet cells in secretions. There was no change in in vitro secretion mucociliary clearability in either group, although values were normal at baseline. These results suggest that nasal symptoms in ARS are improved over 14-28days with the reduction of mast cells, and increased nasal volume, while in AR, symptoms persist.

Bilateral Extracranial Internal Carotid Artery Dissection: Interventional Management – A Case Report

Traumatic internal carotid artery dissection (ICAD), particularly in bilateral cases, is a rare but life-threatening condition that poses diagnostic and therapeutic challenges. The cervical segment of the internal carotid artery (ICA) is especially vulnerable to injury following blunt trauma, often leading to significant neurological sequelae. Despite established guidelines advocating conservative management as the initial approach, the optimal timing and criteria for endovascular intervention remain areas of ongoing investigation. We report the case of a 38-year-old female who presented with bilateral extracranial ICAD following a motor vehicle accident. Initially, the patient exhibited right hemiparesis and aphasia, and imaging confirmed left extracranial ICAD without critical stenosis or pseudoaneurysm formation. Conservative management with dual antiplatelet therapy was guided by imaging findings and risk assessment and led to temporary symptomatic improvement. However, the patient returned on the eighth day with left hemiplegia and loss of consciousness, prompting further imaging that revealed bilateral dissection and right anterior cerebral artery infarction. Given the failure of medical therapy, endovascular stenting was performed, achieving successful revascularization and symptomatic improvement. The management of traumatic ICAD, particularly bilateral cases, necessitates careful risk assessment and timely intervention. Our case highlights the importance of imaging in guiding the decision-making process and balancing conservative versus invasive management strategies. Endovascular stenting, although effective, should be reserved for cases with progressive symptoms or when medical management fails. This report contributes to the limited literature on bilateral traumatic ICAD and underscores the need for further research to establish evidence-based guidelines for the management of such cases. Future studies should compare the outcomes of conservative, surgical, and endovascular interventions to optimize patient care and improve prognostic outcomes.

Clinical characteristics, management, and malignancy rate of oral lichen planus: a European multicenter study.

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous condition that includes a spectrum of oral clinical manifestations ranging from mild painless white lesions to painful erosions and ulcers. The purpose of this European multicenter study is to describe the general characteristics of OLP lesions, the clinical and histopathological diagnosis, and the management of OLP at different European Oral Medicine and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the current trends in the treatment of OLP across Europe. Data and histopathological records of patients with OLP were retrospectives revised and only those patients that fulfilled the diagnostic criteria from the 2016 position paper by American Academy of Oral and Maxillofacial Pathology were included. The following data were recorded for each patient: gender, age, voluptuary habits, risk factors for OLP (psychological stress, medications, systemic diseases), location of OLP lesions, clinical presentation, patterns of clinical expression, symptoms, treatment, possible clinical improvement, and malignant transformation. A total of 565 OLP patients (422 females, 143 males) with fulfilled the inclusion criteria. The mean age of the study population at diagnosis was 60.11 years. In 262 patients (46.4%), just a site of OLP was identified: in 186 of these "one-site" patients, OLP was diagnosed just in buccal mucosa. The most frequently observed clinical pattern was reticular. When evaluating the treatment received, 294 patients were kept in follow up with a Wait-and-see approach. The most frequent treatment regimen was the use of topical corticosteroids (123 patients). A significant statistical association was found between the prescription of topical corticosteroids (P < .0005) or retinoids (P < .000005) and symptoms improvement. Squamous cell carcinoma associated with OLP lesions was observed during the follow-up in 9 OLP patients out of 565 (1.6 %). Reticular and mixed clinical patterns are the most frequent subtypes of OLP. The use of topical corticosteroids and retinoids for the management of OLP seems to allow good improvement results of symptoms and signs. A clinical long-term follow-up is fundamental due to the chronic nature of OLP and possible malignant transformation.

Endoscopic Surgery for Deeply Located Intracranial Cysts: Risk Factors for Re-Operation and Symptom Improvement

Endoscopic Surgery for Deeply Located Intracranial Cysts: Risk Factors for Re-Operation and Symptom Improvement

Blood-based diagnosis of pediatric tuberculosis: a prospective cohort study in South Africa and Dominican Republic.

Pediatric tuberculosis (TB) diagnosis is complicated by challenges in obtaining invasive respiratory specimens that frequently contain few Mycobacterium tuberculosis (Mtb) bacilli. We report the diagnostic performance of an Mtb antigen-derived peptide (MAP-TB) assay and its ability to monitor TB treatment response. Study cohorts enrolled children who presented with presumptive TB at two hospitals in South Africa from 2012 to 2017 (157 children aged <13 years) and at community-based clinics in the Dominican Republic from 2019 to 2023 (101 children aged <18 years). Children were evaluated for TB at enrollment and six months post-enrollment and assigned confirmed, unconfirmed, or unlikely TB diagnoses using the 2015 NIH diagnostic criteria for pediatric TB. MAP-TB assay performance was evaluated using serum collected at baseline and at regular intervals post-enrollment following STARD guidelines. MAP-TB sensitivity for confirmed and unconfirmed TB was comparable to culture and Xpert sensitivity for confirmed TB, but MAP-TB specificity revealed age-dependence, decreasing from 98·1% to 78·4%, when including children aged <1 year. MAP-TB values decreased by six months post-treatment initiation in children with symptom improvement. Serum MAP-TB results can effectively diagnose pediatric TB, including unconfirmed and extrapulmonary TB missed by current methods, and correspond to effective treatment.

Outcomes of Transoral Incisionless Fundoplication (TIF 2.0): A Prospective, Multicenter Cohort Study in Academic and Community Practices (with video)

BACKGROUND AND AIMSTransoral incisionless fundoplication (TIF) is an established safe endoscopic technique for the management of GERD but with variable efficacy. In the last decade, the TIF technology and technique have been optimized and more widely accepted but data on outcomes outside clinical trials are limited. We tracked patient-reported and clinical outcomes of GERD patients after TIF 2.0. METHODSPatients with BMI < 35, hiatal hernia < 2cm, and confirmed GERD with typical and/or atypical symptoms from 9 academic and community medical centers were enrolled in a prospective registry and underwent after TIF 2.0 performed by gastroenterologists and surgeons. The primary outcomes were safety and clinical success (response in >2 of 4 endpoints). Secondary endpoints were symptom improvement, acid exposure time (AET), esophagitis healing, proton pump inhibitor (PPI) use, and satisfaction. Outcomes were assessed at last follow-up within 12 months. RESULTS85 patients underwent TIF 2.0, 81 were included in the outcomes analysis. Clinical success was achieved in 94%, GERD-HRQL scores improved in 89%, and elevated RSI score normalized in 85% of patients with elevated baseline. Patient satisfaction improved from 8% to 79% (p <0.0001). At baseline, 81% were taking at least daily PPI, while 80% were on no or occasional PPI after TIF 2.0 (p<0.0001). Esophageal AET was normal in 72%, greater with an optimized TIF 2.0 valve >300 degree circumference, >3cm length (94% vs 57%, p=0.007). There were no TIF 2.0-related serious adverse events. CONCLUSIONTIF 2.0 is a safe and effective endoscopic outpatient treatment option for select patients with GERD.

Short-term Postoperative Complications of Lymphatic Malformation Surgical Excision: A 20-Year Institutional Review.

To evaluate outcomes and postoperative complications following surgical resection of lymphatic malformations (LMs) at a single multidisciplinary vascular anomalies center. A single-center retrospective review of all patients ≤21 years old who underwent surgical resection of a lymphatic malformation at a quaternary referral center with a multidisciplinary vascular anomalies team from 2004 to 2024. Data pertaining to postoperative outcomes and treatments was abstracted. A total of 109 surgical procedures were included and examined. The most common 30-day postoperative complications included: seroma (18.3%), superficial surgical site infection (18.3%), and wound dehiscence (12.8%), with lower rates of nerve palsy/injury (5.5%), lymphedema (2.8%), hematomas (3.7%), and abscesses (4.6%). An interventional radiology procedure within 30-days postoperatively was required for management of seroma in 8 patients (7.3%), while 7 (6.4%) patients required reoperation. Among patients who underwent attempted complete resection, recurrence of the LM was documented in 32.0% (16/50). Subjective quality of life improvement was noted in 69.7%. There was no difference in incidence of postoperative complications reported in patients who underwent preoperative sclerotherapy vs those that did not (p=0.980). Seroma and surgical site infection were the most reported short-term postoperative complications followed by wound dehiscence with low rates of other complications in surgical resection of LMs. Few patients required postoperative procedural intervention. Despite a relatively high rate of short-term complications, patients reported high satisfaction and symptom improvement following LM resection, which underscores the important role for surgical management of LMs in select patients. III. Cohort study.

Multi-center, prospective, non-interventional, observational study on the efficacy and safety of Mirabek® in adult patients with overactive bladder.

Mirabegron, the first-in-class beta-3 agonist, is the mainstay medication for overactive bladder (OAB). The aim of this study was to investigate the efficacy and safety of generic drugs of mirabegron (Mirabek®) in adults diagnosed with OAB through a multicenter, prospective, non-interventional observational study. Adult patients with OAB prescribed Mirabek® SR Tab. 50 mg for the first time were recruited from hospitals between September 2021 and September 2022. Participants underwent baseline registration followed by two follow-ups at 4- and 8-week intervals. Data on demographics, medical history, OAB symptoms, vital signs, medication administration, and adverse events were collected. Among 1,714 patients, Mirabek® SR Tab. 50 mg effectively improved OAB symptoms over an 8-week treatment period, with significant differences in symptom improvement between baseline and both 4- and 8-week time points as well as between 4 weeks and 8 weeks. The incidence rate of adverse events was 0.70%; most cases were mild with no severe reactions. This study demonstrated that Mirabek®, a generic drug of betmiga, is an effective and safe treatment option for adults with OAB. Furthermore, the introduction of generic drug reduced the costs of prescription drugs and expanded the opportunity for many patients to access mirabegron.

Pharmacist-directed Mavacamten Treatment For Obstructive Hypertrophic Cardiomyopathy Is Associated With Symptom Improvement And Reduction In Left Ventricular Outflow Tract Obstruction

Pharmacist-directed Mavacamten Treatment For Obstructive Hypertrophic Cardiomyopathy Is Associated With Symptom Improvement And Reduction In Left Ventricular Outflow Tract Obstruction

Psilocybin-Assisted Group Psychotherapy + Mindfulness Based Stress Reduction (MBSR) for Frontline Healthcare Provider COVID-19 Related Depression and Burnout: A Randomized Clinical Trial.

This clinical trial sought to evaluate the safety and preliminary efficacy of psilocybin and MBSR for frontline healthcare providers with symptoms of depression and burnout related to the COVID-19 pandemic. This was a randomized controlled trial that enrolled physicians and nurses with frontline clinical work during the COVID-19 pandemic and symptoms of depression and burnout. Participants were randomized in a 1:1 ratio to either an 8-week MBSR curriculum alone or an 8-week MBSR curriculum plus group psilocybin-assisted psychotherapy (PAP) with 25mg psilocybin. Symptoms of depression and burnout were assessed at baseline, and 2-weeks and 6-months post intervention utilizing the Quick Inventory of Depressive Symptoms (QIDS-SR-16) and Maslach Burnout Inventory Human Services Survey for Medical Professionals (MBI-HSS-MP), respectively. Secondary outcome measures included the Demoralization Scale (DS-II) and the Watt's Connectedness Scale (WCS). Adverse events and suicidality were assessed through 6-month follow-up. 25 participants were enrolled and randomized. There were 12 study-related AEs recorded that were Grade 1-2 and no serious AEs. There was larger decrease in QIDS score for the MBSR+PAP arm compared to MBSR-only from baseline to 2-weeks post-intervention and significant between-group differences favoring MBSR+PAP on subscales of the MBI-HSS-MP as well as the DS-II and WCS. Group psilocybin-assisted therapy plus MBSR was associated with clinically significant improvement in depressive symptoms without serious adverse events and with greater reduction in symptoms than MBSR alone. Study findings suggest that integrating psilocybin with mindfulness training may represent a promising treatment for depression and burnout among physicians and nurses.

Effect of Caloric Restriction and Aerobic Exercise on Premenstrual Syndrome, Anthropometric, and Hormonal Parameters in Obese Females: A Randomized Controlled Trial.

Premenstrual syndrome (PMS) affects physical, psychological, and behavioral symptoms in women. Obesity may worsen PMS, but the impact of caloric restriction and aerobic exercise on PMS in obese women is unclear. This study examines their effects on PMS, anthropometric, and hormonal parameters in obese females. This randomized controlled trial involved 40 obese females with PMS. They were randomly divided into two groups of 20 each. The control group (A) received medical treatment in the form of Brufen 400mg: one tablet daily for 5days before menstruation and two tablets daily during menstruation for 12weeks. The study group (B) received the same medical treatment and additionally engaged in a program of caloric restriction and aerobic exercise for 12weeks. Outcome measures included the premenstrual syndrome scale (PMSS), weight, body mass index (BMI), waist and hip circumferences, waist-hip (W/H) ratio, and serum levels of progesterone and cortisol. At baseline, no significant between-group differences were observed in PMSS scores, anthropometric measures (weight, BMI, waist and hip circumferences, W/H ratio), or hormonal parameters (serum cortisol and progesterone). Post-treatment, the study group (B) demonstrated significantly greater improvements compared to the control group (A), including reductions in PMSS scores, weight, BMI, waist and hip circumferences, W/H ratio, and serum cortisol, along with significantly higher serum progesterone levels (p<0.05). A 12-week program of caloric restriction and aerobic exercise resulted in substantial improvements in PMS symptoms, anthropometric parameters, cortisol levels, and progesterone levels in obese females with PMS.

Effects of Mesenchymal Stem Cell-conditioned Media with Natural Immunomodulatory Agent Resveratrol on Type 1 Diabetes.

Type 1 diabetes mellitus (T1DM) is a condition marked by elevated blood sugar levels and primarily recognized by the destruction of beta cells caused by an autoimmune attack, which is a significant characteristic of T1DM. Recent studies have demonstrated the regenerative potential of conditioned medium therapy. In light of this, the current research sought to assess the impact of Mesenchymal Stem Cell conditioned media (CM) and CM with resveratrol (CM+ Resveratrol) on the management of T1DM in Swiss albino mice. By leveraging and modifying existing conditioned medium therapy, this study aims to evaluate its effectiveness in treating T1DM. Diabetes was induced in animals using the diabetes-inducing agent streptozotocin (STZ). The animals were then divided into five groups: Normal control, Disease Control, Resveratrol, Condition Media, and CM + Resveratrol. Treatments were given to the animals accordingly. The study period was 28 days. During this time, the animals were monitored for foodwater intake twice a week, blood glucose levels, and body weight. At the conclusion of the 28-day study period, biochemical estimations were performed for serum insulin levels, C-peptide levels, anti-inflammatory cytokines levels and pro-inflammatory cytokines levels. Additionally, histopathology of the pancreas was performed. The test groups showed a significant decrease in blood glucose levels, an increase in Cpeptide levels, and a decrease in pro-inflammatory cytokine levels compared to the disease group. However, no statistically significant change within groups was observed in terms of serum insulin and anti-inflammatory cytokine levels. The improvement in diabetic symptoms, such as polyphagia, polydipsia, and weight loss, was observed in the treatment group, along with pancreatic regeneration, which indicated improved insulin secretion. In the current investigation, we concluded that CM and CM+ Resveratrol, as natural immunomodulators, have the capacity to regenerate injured pancreatic beta cells and have antidiabetic action, together with immunomodulating impact. Nonetheless, future studies on this therapy appear to be promising.

Real-World Treatment Outcomes of an Artificial Tear Containing Arabinogalactan, Hyaluronic Acid and Trehalose Among Subjects with Dry Eye.

To assess the efficacy, adherence, and tolerability of a new artificial tear based on arabinogalactan, hyaluronic acid, and trehalose in a population with dry eye disease (DED). A retrospective, real-world, post-marketing study identified 96 adult patients (aged 18-80 years) with signs and symptoms of dry eye. These patients received fixed combination therapy with eye drops containing arabinogalactan, hyaluronic acid, and trehalose at various dosing schedules. The data for this study were collected from April 2022 to June 2023. Patients underwent evaluation at baseline (T0) and after a follow-up period of two-three months (T1) using a patient-reported questionnaire. In 96 adult patients (71 women and 25 men) with dry eye due to various conditions, the results indicated a 98% positive response to therapy. This response included improvements in vision (13%), comfort (39%), redness (13%), itching (16%), photophobia (4%), and tearing (14%). Additionally, 61% of the patients experienced 1-2hours of comfort following instillation. This real-life post-marketing study demonstrated clinical improvement of signs and symptoms in patients with dry eye disease using a new artificial tear medical device based on arabinogalactan, hyaluronic acid, and trehalose.

Efficacy and safety of SQ house dust mite sublingual immunotherapy-tablet (12 SQ-HDM) in children with allergic rhinitis/rhinoconjunctivitis with or without asthma (MT-12): a randomised, double-blind, placebo-controlled, phase III trial

Allergic rhinitis/rhinoconjunctivitis (AR/C) induced by house dust mites (HDM) often begins in childhood and negatively impacts a child's quality of life. The daily burden can be further compounded by comorbid asthma. Allergen immunotherapy is the only available treatment targeting the underlying cause of allergic disease. Efficacy and safety of the SQ HDM sublingual immunotherapy (SLIT)-tablet has been demonstrated in adults and adolescents with HDM AR/C with or without asthma, but data are lacking for younger children. Phase III, randomised, double-blind, placebo-controlled trial in younger children (5-11 years) with HDMAR/C with or without asthma. Eligible subjects were randomised 1:1 to SQ HDM SLIT-tablet or placebo for ∼1year and had free access to AR/C symptom-relieving medications. The primary outcome was the total combined rhinitis score (TCRS) during the final 8 weeks of the treatment period (∼1 year). Secondary outcomes included the rhinitis daily symptom score (DSS) and medication score (DMS), the rhinoconjunctivitis total combined score (TCS), and the Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) score. Efficacy analyses were conducted on the full analysis set (observed cases). Asthma-related outcomes were also explored. The trial was registered on ClinicalTrials.gov: NCT04145219 and EudraCT: 2019-000560-22. A total of 1460 subjects were randomised to SQ HDM SLIT-tablet (n=729) or placebo (n=731). The primary outcome, TCRS, was statistically significantly different for SQ HDM SLIT-tablet (n=693) versus placebo (n=706), with an absolute difference of 1.0 (95% CI: 0.5, 1.4; p<0.0001) corresponding to a relative reduction of 22.0% (95% CI: 12.0, 31.1). Key secondary outcomes (DSS, DMS, TCS, PRQLQ) showed statistically significant reductions in symptoms and medication use, and improved disease-related quality of life for SQ HDM SLIT-tablet versus placebo. Improvements in asthma symptoms and reduced asthma medication use indicated an additional effect of SQ HDM-SLIT tablet versus placebo. The SQ HDM SLIT-tablet showed a higher event rate for treatment-related adverse events (AEs) than placebo. Most events were of mild or moderate severity and few subjects discontinued due to AEs (2.5%). The trial confirmed the efficacy and safety of the SQ HDM SLIT-tablet for treating HDM AR/C in younger children (5-11 years) with or without asthma. The safety profile supports daily self-administration of the SQ HDM SLIT-tablet in children. ALK-Abellό, Hørsholm, Denmark.

Effectiveness and safety of oral vancomycin for the treatment of inflammatory bowel disease associated with primary sclerosing cholangitis: a systematic review and pooled analysis.

Inflammatory bowel disease (IBD) occurs in up to 70%-80% of patients with primary sclerosing cholangitis (PSC). Oral vancomycin therapy (OVT) has been reported to be effective in the treatment of IBD associated with PSC (IBD-PSC). To examine the effectiveness and safety of OVT in the treatment of IBD-PSC by performing a systematic review and pooled analysis of the literature. We performed a systematic review and pooled analysis of studies reporting IBD clinical response to OVT in IBD-PSC. A systematic search was conducted in Cochrane Library, Embase, Google Scholar, Medline, PubMed, Scopus, and Web of Science from database inception to June 3, 2024. We included adult and pediatric studies that reported on clinical response (defined as any improvement in IBD-related clinical symptoms) of IBD-PSC patients treated with OVT (including pre- and post-liver transplantation cohorts). Pooled analyses of OVT response and safety were performed. A total of 21 (open-label, non-controlled) studies including 290 patients with IBD-PSC treated with OVT were included. The median duration of OVT to treat IBD-PSC was 32.5 weeks (interquartile range (IQR): 19-83 weeks). The total daily dose of OVT ranged from 250 to 1500 mg. Concomitant treatment included the following: mesalamine in 14.5% (n = 42), advanced therapies in 10.7% (n = 31), and immunosuppressive agents in 14.1% (n = 41). Clinical response was noted in 47.6% (138/290) and clinical remission in 43.5% (100/230). The biochemical remission rate post-OVT was 68.8% (55/80) and endoscopic remission was 39.4% (80/203). Three studies (n = 11) reported no episodes of acute cholangitis while on OVT. Five studies (n = 69) reported an incidence rate of 8.7% of vancomycin-resistant enterococci post-OVT to treat IBD-PSC. OVT was associated with clinical response/remission in almost half of patients with IBD-PSC with a favorable side effect profile. Further prospective randomized trials are needed to confirm the dosing, efficacy, treatment duration, and long-term safety of OVT for the treatment of IBD-PSC. The study protocol was registered with PROSPERO a priori (no. CRD42023438341).

The brain, rapid eye movement sleep, and major depressive disorder: A multimodal neuroimaging study

BackgroundEvidence has established the prominent involvement of rapid eye movement (REM) sleep disturbance in major depressive disorder (MDD). However, the neural correlates of REM sleep in MDD and their clinical significance are less clear. MethodsCross-sectional and longitudinal polysomnography and resting-state functional MRI data were collected from 131 MDD patients and 71 healthy controls to measure REM sleep and voxel-mirrored homotopic connectivity (VMHC). Correlation and mediation analyses were performed to examine the associations between REM sleep, VMHC, and clinical variables. Moreover, we conducted spatial correlations between the neural correlates of REM sleep and a multimodal collection of reference brain maps to facilitate genetic, structural and functional annotations. ResultsMDD patients exhibited REM sleep abnormalities manifesting as higher REM sleep latency and lower REM sleep duration, which were correlated with decreased VMHC of the precentral gyrus and inferior parietal lobe and mediated their associations with more severe anxiety symptoms. Longitudinal data showed that VMHC increase of the inferior parietal lobe was related to improvement of depression symptoms in MDD patients. Spatial correlation analyses revealed that the neural correlates of REM sleep in MDD were linked to gene categories primarily involving cellular metabolic process, signal pathway, and ion channel activity as well as linked to cortical microstructure, metabolism, electrophysiology, and cannabinoid receptor. ConclusionThese findings may add important context to the growing literature on the complex interplay between sleep and MDD, and more broadly may inform future treatment for depression via regulating sleep.

Effect of Vaginal Cream with the Combination of Honey, Olive, and Propolis on the Symptoms of Uterine Cervicitis Symptoms in Women: A Double-Blind Randomized Controlled Clinical Trial Study

Background: Uterine cervicitis in women requires careful selection of a suitable and straightforward treatment. This study aimed to examine the effect of Nika vaginal cream on the symptoms of uterine cervicitis in women. Materials and Methods: This double-blind, randomized, controlled clinical study was conducted on 66 women who where reffered to Hamadan health centers in 2021(33 people in each group). The participants in the intervention group were instructed to use Nika vaginal cream every night for 14 nights, along with a single dose of one gram of azithromycin, 400 mg of cefixime, and 500 mg of metronidazole twice a day for both the patient and her husband. The control group received a placebo cream and the same drugs as the intervention group. After the 14-day treatment period, clinical signs were assessed through examinations, and participants completed questionnaires again. Results: The study found that participants in the Nika user group experienced a 69.70% improvement in symptoms related to uterine cervicitis. This improvement was significantly higher than the control group, which only showed a 45.50% improvement. Although the Risk Ratio (RR) between the two groups was 53% higher in the intervention group, this difference was not statistically significant (p=0.06). However, the Risk Difference (RD) of 0.24 between the groups was found to be statistically significant (p=0.04). Additionally, participants in the intervention group reported a 76.00% reduction in dyspareunia (p=0.03) and an 84.00% reduction in urinary frequency (p=0.05). Conclusions: According to the result of RD, Nika vaginal cream had a significant effect on the improvement of cervicitis symptoms.