Symptomatic Treatment Research Articles

Paxlovid (Nirmatrelvir/ritonavir): An Innovative Method Method for Treating Covid-19?

Nirmatrelvir Ritonavir 3-c like protease COVID-19 SARS-COV-2Despite the need for innovative, efficient treatment for the Covid Pandemic, there is currently no curative regimen available, leaving patients to rely on supportive and general treatments. The 3C like-protease (3CLpro) and the main protease (Mpro), two SARS-COV-2 proteins, have been identified as potential targets for antiviral medications. The Mpro might be viable therapeutic target since it plays a significant role in both the pathogenesis of the virus and processing. Nirmatrelvir, an antiviral medication, prevents SARS-CoV-2 from reproducing by blocking Mpro. Another HIV protease inhibitor, ritonavir, was coupled with nirmatrelvir to develop. Ritonavir inhibits the cytochrome P450 3A metabolizing enzyme, extending the half-life of nirmatrelvir and serving as pharmacological enhancer. Despite major modification of the SARS-COV-2 viral genome, nirmatrelvir still has strong antiviral effectiveness against contemporary coronavirus strains. However, there are still a number of open issues. The effectiveness of nirmatrelvir and ritonavir in treating SARS-COV-2 infection, as well as their safety and potential adverse effects are discussed in this review of literature.

Efficacy and safety of precision-guided transjugular extrahepatic portosystemic shunt (TEPS) in the management of cavernous transformation of the portal vein with portal hypertension: a case series.

Performing a Transjugular intrahepatic portal system shunt (TIPS) in patients with portal vein cavernous transformation (CTPV) poses significant challenges. As an alternative, transjugular extrahepatic portal vein shunt (TEPS) may offer a potential solution for these patients. Nonetheless, the effectiveness and safety of TEPS remain uncertain. This case series study aimed to evaluate the efficacy and safety of TEPS in treating patients with CTPV portal hypertension complications. The study encompassed a cohort of 22 patients diagnosed with CTPV who underwent TEPS procedures. Of these, 13 patients manifested recurrent hemorrhagic episodes subsequent to conventional therapies, 8 patients grappled with recurrent or refractory ascites, and 1 patient experienced acute bleeding but refused endoscopic treatment. Comprehensive postoperative monitoring was conducted for all patients to rigorously evaluate both the technical and clinical efficacy of the intervention, as well as long-term outcomes. The overall procedural success rate among the 22 patients was 95.5% (21/22).During the TEPS procedure, nine patients were guided by percutaneous splenic access, three patients were guided by percutaneous hepatic access, five patients were guided by transmesenteric vein access from the abdomen, and two patients were guided by catheter marking from the hepatic artery. Additionally, guidance for three patients was facilitated by pre-existing TIPS stents. The postoperative portal pressure gradient following TEPS demonstrated a statistically significant decrease compared to preoperative values (24.95 ± 3.19mmHg vs. 11.48 ± 1.74mmHg, p < 0.01).Although three patients encountered perioperative complications, their conditions ameliorated following symptomatic treatment, and no procedure-related fatalities occurred. During a median follow-up period of 14months, spanning a range of 5 to 39months, we observed four fatalities. Specifically, one death was attributed to hepatocellular carcinoma, while the remaining three were ascribed to chronic liver failure. During the follow-up period, no instances of shunt dysfunction were observed. Precision-guided TEPS appears to be a safe and efficacious intervention for the management of CTPV.

Circadian Pattern in Restless Legs Syndrome: Implications for Treatment Posology

AbstractThe symptoms of restless legs syndrome (RLS) follow a circadian pattern, as inducated in the current RLS diagnostic criteria. Indeed, subjects with mild-to-moderate RLS suffer or not from RLS symptoms depending on the time of day, resembling an above-threshold state periodically followed by a below-threshold state. Although the circadian clock is crucial in the clinical features of RLS, research assessing the ultimate drivers of circadian rhythmicity is still very limited. In the present review, we show current evidence on circadian variations of neurotransmitters involved in the pathophysiology of RLS (systemic iron metabolism, brain iron homeostasis, adenosine, dopamine, glutamate, and endogenous opioids). Secondly, an overview of available therapies for RLS is presented, including information on current recommendations for symptomatic treatments in RLS.We discuss the importance of further research into the circadian oscillations that occur in RLS, so that they can be managed, and a protective below-threshold state can be established on an individualized basis. In addition, we also discuss the current dosing of the medications prescribed in RLS symptomatic treatments, and how circadian factors should be considered to better adjust dosing on an individualized basis and increase the therapeutic benefit.

Role of Pradhmana (Churna) Nasya and Shirolepa in Ardhavabhedaka w.s.r to Migraine - A Clinical Pilot Study

Ardhavabhedak is one of the Shiroroga which can be correlated with migraine in modern health care system. It is a type of Headache characterized by moderate to severe throbbing pain, generally associated with nausea, photophobia and phonophobia. Its cardinal feature is 'half sided headache' which is also explained by commentator Chakrapani as Ardha Mastaka Vedana. According to International headache society, Migraine constitutes 16% of the primary headache and affects about 10-20% of the general population. As per Acharya Sushruta Ardhavabhedaka occur due to vitiation of Tridosha. While Acharya Charaka had mentioned that vitiated Vata/Vata - Kapha are involved in manifestation of the disease, while Acharya Vagbhatta believed it occurs due to vitiated Vata. Till now there is no effective management present in modern science as they provides the symptomatic treatment. But Ayurveda acts on roots of the disease, it does Samprapti Vighatan and cures the disease. Nasya Karma (Errhine Therapy) is considered as the best therapeutic intervention in Shirogata Roga by Acharya Charaka. In present pilot study, an attempt is made to treat the patient of Ardhavabhedaka with Pradhmana Nasya along with Shirolepa.

Relugolix/Estradiol/Norethisterone Acetate: A Review in Endometriosis-Associated Pain.

An oral fixed-dose combination of relugolix/estradiol/norethisterone (also known as norethindrone) acetate [Myfembree® (USA); Ryeqo® (EU)] (hereafter referred to as relugolix combination therapy) has been approved in the USA for the management of moderate to severe pain associated with endometriosis in premenopausal women and in the EU for the symptomatic treatment of endometriosis in adult women of reproductive age with a history of previous medical or surgical treatment for their endometriosis. The gonadotropin-releasing hormone (GnRH) receptor antagonist relugolix decreases estradiol and progesterone levels, while the addition of estradiol/norethisterone acetate mitigates hypoestrogenic effects including bone mineral density (BMD) loss and vasomotor symptoms. In two pivotal phaseIII trials, relugolix combination therapy significantly improved dysmenorrhoea and non-menstrual pelvic pain in premenopausal women with moderate to severe endometriosis. The combination also reduced overall pelvic pain and dyspareunia, reduced analgesic and opioid use, and improved health-related quality of life. The efficacy of relugolix combination therapy was sustained over the longer term (up to 2years). Relugolix combination therapy was generally well tolerated and BMD loss over time was minimal. With the convenience of a once daily oral dosing regimen, relugolix combination therapy is a valuable addition to the options currently available for the management of endometriosis-associated pain.

Bioengineered Salivary Gland Microtissues─A Review of 3D Cellular Models and their Applications.

Salivary glands (SGs) play a vital role in maintaining oral health through the production and release of saliva. Injury to SGs can lead to gland hypofunction and a decrease in saliva secretion manifesting as xerostomia. While symptomatic treatments for xerostomia exist, effective permanent solutions are still lacking, emphasizing the need for innovative approaches. Significant progress has been made in the field of three-dimensional (3D) SG bioengineering for applications in gland regeneration. This has been achieved through a major focus on cell culture techniques, including soluble cues and biomaterial components of the 3D niche. Cells derived from both adult and embryonic SGs have highlighted key in vitro characteristics of SG 3D models. While still in its first decade of exploration, SG spheroids and organoids have so far served as crucial tools to study SG pathophysiology. This review, based on a literature search over the past decade, covers the importance of SG cell types in the realm of their isolation, sourcing, and culture conditions that modulate the 3D microenvironment. We discuss different biomaterials employed for SG culture and the current advances made in bioengineering SG models using them. The success of these 3D cellular models are further evaluated in the context of their applications in organ transplantation and in vitro disease modeling.

Sapovirus: an emerging pathogen in kidney transplant recipients?

Diarrhea is an important cause of morbidity and mortality in immunocompromised patients. After including sapovirus to the viral gastroenteritis screening of our institution's laboratory, we noticed an increase in sapovirus infections among kidney transplant recipients. Therefore, we assumed former gastrointestinal tract infections with unidentified pathogens could have been caused by sapovirus. To better understand the characteristics of a sapovirus infection in a high-risk group we initiated this study. Over a period of 6months, all transplant recipients with diarrhea and later identified viral/unknown pathogens were included. Kidney function, levels of immunosuppressants and c-reactive protein, acid-base balance, onset of symptoms and time of hospitalization were analyzed. Among 13 hospitalized kidney transplant recipients sapovirus was detected in four patients, while in the remaining nine, three were diagnosed with norovirus, one with cytomegalovirus, one with inflammatory bowel disease and in four patients no pathogen was identified. Even though statistically not significant, creatinine levels at admission tended to be higher in sapovirus patients (median: sapovirus: 3.3mg/dl (1.3; 5.0), non-sapovirus: 2.5mg/dl (1.1; 4.9), p = 0.710). Also, Tacrolimus levels showed the same trend (sapovirus: 13.6ng/ml (12.9; 13.6), non-sapovirus: 7.1ng/ml (2.6; 22.6), p = 0.279). On discharge creatinine levels improved equally in both groups (sapovirus: 1.7mg/dl (1.4; 3.2), non-sapovirus: 2mg/dl (1.0; 3.6), p = 0.825). In high-risk patients, early symptomatic treatment remains crucial to protect the transplant`s function. In our cohort all patients recovered well. Larger cohorts and longer follow-up times are needed to detect the long-term consequences and a potential need for further research regarding specific treatment. The study has been registered on DRKS (trialsearch.who.int), Reg. Nr. DRKS00033311 (December 28th 2023).

Identifying the process and challenge of drug administration during the Covid-19 pandemic within region in the absence of sufficient evidence: A qualitative study

BackgroundThe World Health Organization (WHO) has not identified a definitive cure for COVID-19, recommending supportive treatment or antimicrobial therapy based on individual patient needs. This study explores the processes and challenges emergency physicians at Rasul Akram Hospital in Tehran face when prescribing medications with insufficient evidence during the COVID-19 pandemic. MethodsA qualitative study using conventional content analysis. Purposeful sampling with maximum variation was employed until data saturation was achieved. Seventeen participants (5 women, 12 men) aged 32 to 55 underwent individual in-depth interviews. ResultsAnalysis of the data from the interviews revealed three main categories, 11 subcategories, and 20 themes. Patient-related factors, including mental conditions, fear, and reliance on rumors, significantly influence healthcare decision-making. Financial, cultural, and social challenges faced by patients also impact treatment choices. Factors related to hospitals and companies, such as economic advertising and restrictions, can affect patient care. Physician-related factors, such as adherence to protocols and consideration of traditional medicine, play a key role in treatment decisions. ConclusionPatient-related, hospital-related, and physician-related factors are essential in shaping treatment decisions in healthcare settings. Understanding and addressing these diverse influences are crucial for providing effective and personalized healthcare. The complexity of decision-making in healthcare, especially during the pandemic, underscores the importance of considering and navigating these various factors to deliver optimal care tailored to patients' needs and preferences.

Decrypting the multifaceted peripheral neuropathy based on molecular pathology and therapeutics: a comprehensive review.

Peripheral neuropathy (PN) is a multifaceted complication characterized by nerve damage due to oxidative stress, inflammatory mediators, and dysregulated metabolic processes. Early PN manifests as sensory changes that develop progressively in a "stocking and glove" pattern. A thorough review of literature has been done to find the molecular pathology, clinical trials that have been conducted to screen the effects of different drugs, current treatments and novel approaches used in PN therapy. Diabetic neuropathy occurs due to altered protein kinase C activity, elevated polyol pathway activity in neurons, and Schwann cells-induced hyperglycemia. Other causes involve chemotherapy exposure, autoimmune ailments, and chronic ethanol intake. Symptomatic treatments for neuropathic pain include use of tricyclic antidepressants, anticonvulsants, and acetyl-L-carnitine. Patients will have new hope if clinicians focus on novel therapies including gene therapy, neuromodulation techniques, and cannabidiol as an alternative to traditional medications, as management is still not ideal.

Revolutionizing the Treatment of Idiopathic Pulmonary Fibrosis: From Conventional Therapies to Advanced Drug Delivery Systems.

Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive interstitial lung disease that has been well-reported in the medical literature. Its incidence has risen, particularly in light of the recent COVID-19 pandemic. Conventionally, IPF is treated with antifibrotic drugs-pirfenidone and nintedanib-along with other drugs for symptomatic treatments, including corticosteroids, immunosuppressants, and bronchodilators based on individual requirements. Several drugs and biologicals such as fluorofenidone, thymoquinone, amikacin, paclitaxel nifuroxazide, STAT3, and siRNA have recently been evaluated for IPF treatment that reduces collagen formation and cell proliferation in the lung. There has been a great deal of research into various treatment options for pulmonary fibrosis using advanced delivery systems such as liposomal-based nanocarriers, chitosan nanoparticles, PLGA nanoparticles, solid lipid nanocarriers, and other nanoformulations such as metal nanoparticles, nanocrystals, cubosomes, magnetic nanospheres, and polymeric micelles. Several clinical trials are also ongoing for advanced IPF treatments. This article elaborates on the pathophysiology of IPF, its risk factors, and different advanced drug delivery systems for treating IPF. Although extensive preclinical data is available for these delivery systems, the clinical performance and scale-up studies would decide their commercial translation.

TREATMENT OF SCABIOSIS AND TOXOCARIOSIS IN DOMESTIC CAT

Skin and digestive diseases are the most common problems encountered in cats. A six-month-old domestic cat with a body weight of 1.42 kg experienced problems with the skin and digestive system at the same time. Cases of cats complain that they often scratch and excrete worms when defecating, the feces are yellow and have a paste-like consistency. This research aims to determine the disease agent and intensity of infection that attacks cats so that appropriate treatment can be provided. On physical examination, alopecia, hyperkeratosis, crusting and scales were found on the head, bilateral ears, neck and elbow area. Supporting examinations carried out were skin examination using skin scraping, trichogram, cytological examination using the tape acetate method and otic swab with diffquick staining as well as fecal examination using the floating method and counting worm eggs using the Mc Master method. The diagnosis is confirmed based on the history, physical examination, and examination with results of scabiosis and toxocaryosis. The causative therapy used in this case was ivermectin (Ivomec®) injection at a dose of 300μg/kg BW subcutaneously given three times on days 0, 7 and 14 and pyrantel pamoate (Combantrin®) therapy at a dose of 25 mg/kg BW orally. Symptomatic therapy uses intramuscular injection of diphenhydramine HCl (2 mg/kg BW) and (chlorpeniramine maleate®) at a dose of 2 mg/head given 2x¼ orally given for three days, followed by supportive therapy given multivitamins and minerals (Caviplex®) given once a day orally for seven days. Topical therapy is given with sulfur soap to bathe cats at least once a week. The cat showed good progress starting from the third day, the level of pruritus decreased, then on the fourth day the cat did not expel worms from the anus and the stomach did not look as enlarged as when it was first examined, and on the sixth day it started to show hair growth, alopecia, crusting and hyperkeratosis began to decrease. After administering ivermectin the second time, the cat's case began to improve with the level of pruritus decreasing and the hair slowly growing. After the third injection, namely on the fourteenth day, the cat named Bolu was returned to its owner with improved skin condition and no longer scratching. Based on the history, physical examination and laboratory examination, the cat was given therapy by administering antihistamines, antiparasitics, worm medicine, as well as support by administering vitamins and topical use of sulfur soap. It is important for cat owners to consistently bathe their cats and give them regular deworming medication to prevent recurrent infections.

SCABIOSIS BY SARCOPTES SCABIEI AND NOTOEDRES CATI IN DOMESTIC CATS

Scabiosis is a skin disease caused by mites from the genus Sarcoptes scabiei and Notoedres cati which is zoonotic. Sarcoptes scabiei and notoedres cati are ectoparasites that often attack cats. These mites live on the skin by making tunnels in the stratum corneum. This article aims to provide information regarding the causes and impacts of scabiosis infections in cats caused by mites of the species Sarcoptes scabiei and Notoedres cati, appropriate treatment and care. Puto cats experience clinical symptoms of pruritus. Clinical examination revealed alopecia, erythema and crusting lesions on the face, ears and back. The results of supporting examinations using the tape smear method, skin scraping or skin scrapings found the presence of Sarcoptes scabiei and Notoedres cati mites. The results of a hematological examination showed an increase in the number of white blood cells (leukocytosis). Based on the history, clinical examination and supporting examinations, the case cat was diagnosed as suffering from scabiosis. The case cat was given causative therapy in the form of ivermectin at a dose of 0.4 mg/kg subcutaneously, repeated 14 days for 1 month. Symptomatic therapy was given diphenhydramine HCI (Vetadryl®) at a dose of 1 mg/kg subcutaneously at a repetition interval of once a week for 1 month. Supportive therapy is given in the form of 1 teaspoon of Nutri-Plus Gel 120g 2-3 times a day for 1 month and continued daily. Supportive therapy is also given in the form of fish oil given 1 capsule/day for 1 month. The case cat was also bathed with shampoo containing sulfur at a repetition interval of once a week for 1 month. The therapy given to Puto cats showed good results as indicated by the growth of hair as well as the disappearance of lesions in the ear area and the disappearance of itching in the cat. Environmental sanitation needs to be paid attention to in order to break the life cycle of mites so that cats do not suffer from scabiosis again.

HAEMOBARTONELLOSIS IN DOMESTIC SHORT HAIR CATS

Haemobartonellosis is a disease caused by Mycoplasma haemofelis, previously called Haemobartonella felis, causing lethargy, fever, pale mucosa, and anemia of varying severity in cats. M. haemofelis is a small, gram-negative bacterium without cell walls that lives on the edge or surface (epicellular) of erythrocytes. The animal used as a case report is a domestic short-haired cat, ± 9 months old, an unsterilized female with a body weight of 3.3 kg. The results of the clinical examination and praesens status showed that the case cat experienced vomiting, loss of appetite, lethargy, mild ectoparasite infestation, pale mucosa, a CRT of more than two seconds, and increased respiratory frequency and body temperature. Routine hematological examination on the first day showed normochromic normocytic anemia, leukopenia, neutropenia, monocytopenia, and thrombocytopenia. Blood biochemical examination on the first day showed hypophosphatemia, hyponatremia, and hyperglycemia. A blood smear examination shows a round or ring-shaped formation on the edge or surface of the erythrocytes, which is morphologically identified as M. haemofelis. Based on the history, physical examination, and supporting examinations, the case cat was diagnosed as having haemobartonellosis. The case cat was treated for five days, and then on the sixth day, the case cat was sent home and underwent outpatient therapy because it showed an improving condition. Causative therapy for M. haemofelis is given oxytetracycline antibiotics for five days, followed by doxycycline antibiotics for 28 days during outpatient therapy. Frontline Plus® antiparasitic is given once to treat ectoparasites. The symptomatic therapy given is tolfenamic acid, once administered. The supportive therapy given is Lactate Ringer's infusion fluid therapy for 5 days and multivitamin, mineral, and hematopoietic supplements, namely Hematodin® by injection for five days, followed by Caviplex Syrup® for 28 days. Therapy for vulnus morsum is enrofloxacin for 8 days. After 28 days of outpatient therapy, the case cat showed clinical improvement and was actively playing.

CASE OF HEPATITIS IN SIAMESE CAT

Hepatitis is inflammation of the liver which can be caused by viruses, bacteria, parasites, fungi, and drugs. However, there are several cases of hepatitis in animals whose cause is unknown, such as what happened to the male Siamese cat in this case report. Therefore, several examinations are carried out to find out the cause and appropriate treatment. Before carrying out the examination, recording the signs and anamnesis is very important. The examination is carried out systematically, namely by clinical and laboratory examination. Laboratory examinations carried out include lesion and cytology examinations (impression tests), hematology examinations, ultrasonography (USG), and anatomical pathology and histology examinations. The results of the ulcer cytology examination using the impression test method found large numbers of neutrophils. CBC examination results revealed that the cat had an infection, anemia, and thrombocytopenia. Blood biochemistry results also revealed that the cat had liver damage with increased AST and ALT values. Abdominal ultrasonography also confirms liver damage. Damage to the liver, spleen and kidneys is also visible on microscopic examination (histopathology). Symptomatic therapy is carried out to reduce clinical symptoms, namely by administering Ornipural®, Viamin 34 inject, and Enbatic powder. The cat died after 1 week of administration of Viamin and Enbatic powder, as well as 1 administration of Ornipural®. From the results of the examination that was carried out, the cat had hepatitis. Early treatment by observing clinical symptoms in animals can reduce the severity of a disease.

Progress in Pathogenesis of Pancreatitis with Acute Kidney Injury

Acute pancreatitis (AP) is a common gastrointestinal disease. About 20% of patients with acute pancreatitis develop severe acute pancreatitis, often with multiple organ dysfunction and poor prognosis. In the process, about 10% of patients develop acute renal injury (AKI). Acute renal injury (AKI) is a major complication of severe pancreatitis with a case fatality rate of up to 75%. AP associated AKI (AP-AKI) has both common and significant differences from other AKIs associated with intensive care. Although its pathogenesis is not clear, systemic and regional inflammatory responses play a key role. Early detection, early and effective support and pathogen treatment can significantly improve the results.

Emerging therapies for childhood-onset movement disorders.

We highlight novel and emerging therapies in the treatment of childhood-onset movement disorders. We structured this review by therapeutic entity (small molecule drugs, RNA-targeted therapeutics, gene replacement therapy, and neuromodulation), recognizing that there are two main approaches to treatment: symptomatic (based on phenomenology) and molecular mechanism-based therapy or 'precision medicine' (which is disease-modifying). We highlight reports of new small molecule drugs for Tourette syndrome, Friedreich's ataxia and Rett syndrome. We also discuss developments in gene therapy for aromatic l-amino acid decarboxylase deficiency and hereditary spastic paraplegia, as well as current work exploring optimization of deep brain stimulation and lesioning with focused ultrasound. Childhood-onset movement disorders have traditionally been treated symptomatically based on phenomenology, but focus has recently shifted toward targeted molecular mechanism-based therapeutics. The development of precision therapies is driven by increasing capabilities for genetic testing and a better delineation of the underlying disease mechanisms. We highlight novel and exciting approaches to the treatment of genetic childhood-onset movement disorders while also discussing general challenges in therapy development for rare diseases. We provide a framework for molecular mechanism-based treatment approaches, a summary of specific treatments for various movement disorders, and a clinical trial readiness framework.

Botulinum toxin and hyperhidrosis of the amputation stump in war amputees.

Stump hyperhidrosis is a common condition after lower limb amputation. It affects the prosthesis use, and the quality of life of patients. Several case reports tried to prove benefit of using Botulinum toxin in its treatment. This study was to conduct a larger workforce clinical trial and to demonstrate benefits of botulinum toxin injection in the treatment of stump hyperhidrosis. A prospective study was conducted. War amputees who complained of annoying excessive sweating of the stump were included. They received intradermal injection of botulinum toxin A in the residual limb area in contact with prosthetic socket. Abundance of sweating and degree of functional discomfort associated with it were assessed before, after 3 weeks, 6 and 12 months. Seventeen male patients, followed for post-traumatic limb amputation were included in the study. Discomfort and bothersome in relation to Hyperhidrosis did decrease after treatment (p<0,001). Reported satisfaction after 3 weeks was 73,33%. Improvement of prothesis loosening up after 3 weeks was 72,5% [±15,6]. Mean injection-induced pain on the visual analogue scale was 5.17/10 (±1.58). The mean interval after the onset of improvement was 5.13 days [min:3, max:8]. The mean time of improvement was 10.4 months after the injection [min:6, max:12]. No major adverse events were reported following treatment. Intradermal injections of botulinum toxin in the symptomatic treatment of stump hyperhidrosis are effective and have few adverse effects. It improves the quality of life of our patients thanks to a better tolerance of the prosthesis.

The effect of cervical mobilization on joint position sense, balance and gait in patients with multiple sclerosis: a randomized crossover study

ABSTRACT Objective To investigate the effect of cervical mobilization on joint position sense, balance and gait in multiple sclerosis (MS) patients. Methods Sixteen MS patients received traditional rehabilitation and traditional rehabilitation+cervical mobilization treatments in different orders, 2 days a week for 4 weeks. For the cervical mobilization, joint traction and shifts with myofascial release techniques were applied. Joint position sense was evaluated from the bilateral knee and ankle joints with a digital goniometer, balanced with the Berg Balance Test (BBT), the Functional Reach Test, and gait with the Dynamic Gait Index (DGI) and the Timed 25-Foot Walk Test. Results Improvements were determined in joint position sense, balance, gait with both treatment methods (p < 0.05). With the addition of cervical mobilization to traditional treatment, there was observed to be an increased effect carried over in knee joint position sense and BBT (p < 0.05). The BBT and DGI scores improved in the group applied with cervical mobilization following the washout period (p < 0.05). Conclusions Cervical mobilization could be effective in improving joint position sense, balance and gait, and accelerated improvements in a short time. The application of cervical mobilization could be a supportive treatment method to improve position sense, balance and gait in patients with MS.

Illumina and Nanopore sequencing in culture-negative samples from suspected lower respiratory tract infection patients.

To evaluate the diagnostic value of metagenomic sequencing technology based on Illumina and Nanopore sequencing platforms for patients with suspected lower respiratory tract infection whose pathogen could not be identified by conventional microbiological tests. Patients admitted to the Respiratory and Critical Care Medicine in Shanghai Ruijin Hospital were retrospectively studied from August 2021 to March 2022. Alveolar lavage or sputum was retained in patients with clinically suspected lower respiratory tract infection who were negative in conventional tests. Bronchoalveolar lavage fluid (BALF) samples were obtained using bronchoscopy. Sputum samples were collected, while BALF samples were not available due to bronchoscopy contraindications. Samples collected from enrolled patients were simultaneously sent for metagenomic sequencing on both platforms. Thirty-eight patients with suspected LRTI were enrolled in this study, consisting of 36 parts of alveolar lavage and 2 parts of sputum. According to the infection diagnosis, 31 patients were confirmed to be infected with pathogens, while 7 patients were diagnosed with non-infectious disease. With regard to the diagnosis of infectious diseases, the sensitivity and specificity of Illumina and Nanopore to diagnose infection in patients were 80.6% vs. 93.5% and 42.9 vs. 28.6%, respectively. In patients diagnosed with bacterial, Mycobacterium, and fungal infections, the positive rates of Illumina and Nanopore sequencer were 71.4% vs. 78.6%, 36.4% vs. 90.9%, and 50% vs. 62.5%, respectively. In terms of pathogen diagnosis, the sensitivity and specificity of pathogens detected by Illumina and Nanopore were 55.6% vs. 77.8% and 42.9% vs. 28.6%, respectively. Among the patients treated with antibiotics in the last 2 weeks, 61.1% (11/18) and 77.8% (14/18) cases of pathogens were accurately detected by Illumina and Nanopore, respectively, among which 8 cases were detected jointly. The consistency between Illumina and diagnosis was 63.9% (23/36), while the consistency between Nanopore and diagnosis was 83.3% (30/36). Between Illumina and Nanopore sequencing methods, the consistency ratio was 55% (22/42) based on pathogen diagnosis. Both platforms play a certain value in infection diagnosis and pathogen diagnosis of CMT-negative suspected LRTI patients, providing a theoretical basis for clinical accurate diagnosis and symptomatic treatment. The Nanopore platform demonstrated potential advantages in the identification of Mycobacterium and could further provide another powerful approach for patients with suspected Mycobacterium infection.

Infective endocarditis and antithrombotic therapy.

Incidence of infective endocarditis (IE) is progressively raising because of the increasing number of cardiovascular invasive procedures, support treatment and devices, awareness in the medical community and improved diagnostic modalities. IE pathophysiology is a unique model of immunothrombosis and the clinical course is often complicated by either thromboembolic or hemorrhagic events. Managing antithrombotic treatment is challenging and the level of supporting evidence scant. Aim of this review was to discuss and present the thromboembolic and bleeding complication associated with IE and review the available evidence on anti-thrombotic treatment in patients with IE with and without a previous indication to anti-thrombotic drugs.