Symptomatic Treatment Research Articles

Retrospective description of the clinical use of chloramphenicol in client-owned cats: 12 cases (2015-2023).

The study aimed to describe the clinical use of chloramphenicol in client-owned cats, examining the patient population, sites of infection, targeted pathogens, prescribed dosing regimen, outcomes and adverse effects. Between 2015 and 2023, a retrospective medical record review was undertaken to identify a case series of cats treated with chloramphenicol. Twelve client-owned cats with complicated infections were treated with chloramphenicol at a median dose of 13.3 mg/kg (range 9.1-34.7) administered orally every 12 h for a median duration of 14.5 days. Within 30 days before starting chloramphenicol, 11/12 cats had received treatment with at least one antibiotic. The sites of infection included skin, urinary tract and multisystemic. Multidrug-resistant pathogens, for which no alternative oral antibiotic therapy was available, were commonly targeted. These included meticillin-resistant Staphylococcus species and multidrug-resistant Enterococcus faecium. Of the 12 cats treated with chloramphenicol, nine effectively achieved either bacteriologic or clinical cure. Chloramphenicol adverse effects were uncommon and limited to gastrointestinal upset, which was self-limiting or manageable with supportive treatment in two cats. In these cats, the decision to treat with chloramphenicol was made because an alternative oral antibiotic was not available to target the multidrug-resistant pathogens. Infections of the skin or urinary tract were common. Overall, chloramphenicol was well tolerated, and treatment success was possible for most cats.

Clinical Performance and Safety of Cerviron® Vaginal Ovules in the Management of Symptomatic Cervical Lesions: A National, Multicentric Study

Background: Cervical ectropion is frequently associated with vaginal symptoms requiring therapeutic intervention. However, no scientific consensus has been reached regarding the use of local re-epithelialization therapy to prevent severe bleeding, wound inflammation, and infection of cervical lesions. Objectives: The aim of our study was to investigate the aspect of the cervix by colposcopy after a 3-month treatment with an intravaginal medical device in the context of postoperative care of the symptomatic ectropion. The study analyzed additional clinical parameters, such as the evolution of primary and secondary inflammation and the degree of cervical epithelialization as secondary objectives. Methods: Our pilot study included 27 participants with symptomatic cervical ectopy, with or without an associated Human Papillomavirus infection. The treatment protocol consisted of the monthly delivery of the medical device intravaginally, during Day 1- Day 15, with a total study duration of 3 months. Results: The medical device had a positive impact on cervical epithelialization, in terms of aspect of the cervix returning to normal for 100.00% of the participants. Between study visits, it was observed that primary inflammation was reduced by 85.19%, while vaginal ulceration, colpitis and leukorrhea, were improved by 70.37%, 81.48% and by 66.67% respectively. Conclusions: The degree of cervical epithelialization reflects how well the cervix has healed after an injury or infection. The device showed clinical performance in complete re-epithelialization after surgical procedures. Moreover, our study findings suggest that supportive treatment with this intravaginal medical device can be recommended for cervical wound healing in patients with Human Papillomavirus infection.

Key Aspects of Pediatric Liver Transplant Patient Visits to the Pediatric Emergency Department.

Patients with liver transplant can present to a pediatric emergency department with short- and long-term complications of transplant. Here, we described clinical features of pediatric liver transplant patients admitted to the pediatric emergency department and identified risk factors that may lead to pediatric intensive care unit admission. We retrospectively evaluated pediatric liver transplant patients admitted posttransplant to Baskent University Hospital's pediatric emergency department in 2023. We noted symptoms, laboratory tests, hospitalization status, and final diagnoses. We compared clinical and laboratory features of patients admitted or not admitted to the intensive care unit. In 2023, 108 presentations of 33 liver transplant patients presented to our pediatric emergency department: 46.3% were girls, mean age was 7.79 ± 4.40 years, and median posttransplant day at time of emergency department visit was 622 days. Common symptoms were vomiting (48%), fever (46%), and rhinorrhea and cough (34%). Forty-nine visits (45.4%) resulted in hospitalization; 5 visits (4.6%) resulted in PICU admission, with 2 mortalities (1.8%). Final diagnoses included acute gastroenteritis and upper respiratory tract infections (23 patients) and lower respiratory tract infections (13 patients). Seven patients had cholangitis, 6 had intra-abdominal infection, and 5 had sepsis. Seizures and sepsis were significantly correlated with intensive care unit admission (P <.001). Patients admitted to the intensive care unit had significantly shorter time posttransplant versus other patients (518 ± 324 vs 1498 ± 1658 days; P < .001). Half of patients who presented to the emergency department required hospitalization mainly for observation and supportive treatment, with a small number requiring intensive care unit admission. Nevertheless, physicians caring for liver transplant patients should be aware of serious complications and monitor patients closely, especially early posttransplant when intensive immunosuppressive treatment regimens are used.

Clinical Analysis of Reversible Posterior Encephalopathy Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation in Children

To summarize the clinical features of reversible posterior encephalopathy syndrome (PRES) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children. The clinical data of six children who developed PRES after undergoing allo-HSCT in the Department of Hematology of Wuhan Children's Hospital from June 2016 to December 2022 were retrospectively analyzed, and their clinical characteristics, imaging examination, laboratory examination, and treatment regression were summarized. Among 281 children underwent allo-HSCT, 6 cases (2.14%) developed PRES, with a median age of 5.1(1.5-9.7) years old. 4 cases underwent related haploidentical donor transplantation, and 2 cases underwent sibling allografting and unrelated donor allografting donor transplantation, respectively. All six children had an acute onset of illness, with clinical manifestations of nausea and vomiting, seizures, psychiatric disorders, visual disturbances. The five cases elevated blood pressure. All children with PRES were treated with oral immunosuppressive drugs during seizures, and 3 cases were combined with different degrees of graft-versus-host disease. Most of the children showed effective improvement in clinical symptoms and imaging after adjusting/discontinuing suspected medications (cyclosporine, etc.) and symptomatic supportive treatments (oral antihypertensive, diazepam for antispasmodic, mannitol to lower cranial blood pressure), and one of them relapsed more than 8 months after the first seizure. PRES is rare after hematopoietic stem cell transplantation in children, and its onset may be related to hypertension, cytotoxic drugs, graft-versus-host disease, etc. Most of them can be recovered after active treatment, but not completely reversible, and the prognosis of those who combined with TMA is poor.

Specific phobias in children with moderate to severe intellectual disabilities: SPIRIT, an adaptation and feasibility study.

There is a lack of interventions for specific phobia in children and adolescents with moderate to severe intellectual disabilities. The objectives were to: (a) develop an intervention for specific phobia, together with an intervention fidelity checklist and logic model, and evaluate candidate outcome measures, together with parents/carers and clinicians; (b) describe treatment as usual; (c) model the intervention to determine the acceptability and feasibility for all stakeholders, judge the appropriateness of outcome measures, explore recruitment pathways, and examine the feasibility and acceptability of consent and associated processes; and (d) describe factors that facilitate or challenge the intervention. Phase 1a: using consensus methods, an Intervention Development Group was established who met to develop the intervention, review candidate outcome measures and contribute to the development of the intervention fidelity checklists and logic model. Phase 1b: a national online survey was conducted with parents and professionals to describe treatment as usual. Phase 2: a single-group non-randomised feasibility study was designed to model the intervention and to test intervention feasibility and acceptability, outcome measures and aspects of the research process. Phase 2: participants were recruited from National Health Service community child learning disabilities teams and special schools in England. Treatment was delivered in the child learning disabilities teams. Children aged 5-15 years with moderate to severe learning disability and specific phobia, and their parents/carers. The SPIRIT intervention comprised two half-day workshops and eight support sessions plus treatment as usual. The feasibility and acceptability of the intervention and research processes, recruitment, outcome measure completion rates and acceptability, and intervention adherence. Parents completed all of the outcome measures, with very low rates of missing data. The recruitment of sites and participants was impacted by the COVID-19 pandemic. The intervention was successfully developed and modelled with 15 participants with moderate to severe learning disabilities and their parents. The intervention was judged to be feasible and acceptable by parents/carers and therapists. Parents/carers and therapists suggested minor intervention revisions. Randomisation was not modelled within this feasibility study, although the majority of parents and therapists indicated that this would be acceptable. The SPIRIT intervention and associated study processes were judged to be feasible and acceptable. The intervention requires minor revisions. The SPIRIT intervention should be tested further within a clinical trial. Current Controlled Trials ISRCTN34766613. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130177) and is published in full in Health Technology Assessment; Vol. 28, No. 64. See the NIHR Funding and Awards website for further award information.

Characteristics, treatment, and outcomes of spontaneous renal artery dissection: a 10-year retrospective single-center experience.

Spontaneous renal artery dissection (SRAD) is a rare cause of renal failure and renovascular hypertension, with the diagnosis often being delayed and treatment varying across different centers. The objective of this retrospective cohort study was to scrutinize the characteristics, treatment modalities, and outcomes of patients with SRAD at our center over the past ten years. Furthermore, the study sought to identify the most suitable treatment options for different categories of patients with SRAD. Data from 21 consecutive patients who presented with symptoms of SRAD from December 2013 to December 2023 were collected. Lesion characteristics, treatment options, blood pressure (BP) control, serum creatinine and estimated glomerular filtration rate (eGFR) were analyzed. A paired t-test was used for comparisons of BP, serum creatinine, and eGFR. An independent samples t-test was used to analyze baseline BP and BP change in different treatment groups. The mean age, weight, and height of patients with SRAD was 49.2±13.0 (range, 18-69) years, 69.0±9.7 (range, 50-80) kg, and 1.7±0.1 (range 1.6-1.8) m, respectively. New-onset hypertension was found in 8 (38.1%) patients. Renal artery dissecting aneurysm and renal artery stenosis were found in 1 (4.8%) and 4 (19.0%) patients, respectively. Supportive medical treatment alone, endovascular intervention, and nephrectomy were required in 15, 4 and 2 cases, respectively. Stable renal function and satisfactory hypertension control were obtained in all treatment groups, with a median follow-up of 18.1 (range, 12-32) months. Medical management is a reasonable choice in most patients with SRAD. Interventional management is an efficacious strategy for the management of renovascular hypertension and the preservation of renal function.

The Impact Of The Family Support Network On Adherence And Continuity Of Treatment For Women With Breast Cancer

Background: Breast cancer is the second most common type of cancer in women in Brazil. If diagnosed and treated early, there is a significant increase in favorable prognoses and chances of cure. However, the stigma of the disease and the difficulties resulting from treatment directly impact all aspects of a woman's life. In this context, the family support network can be an essential factor for treatment adherence and continuity. The objective of this study was to investigate the influence of the family support network on treatment adherence in women diagnosed with breast cancer. Materials and Methods: This is an integrative literature review in which the search for articles was conducted in the PubMed and Virtual Health Library (VHL) databases between July and August 2023, using the combination of descriptors "breast neoplasm", "treatment", "treatment adherence", "breast cancer", "family", and "family support". The inclusion criteria were: articles published in the last five years, in Portuguese or English, focusing on women with breast cancer. After several filtering stages, 334 article titles and abstracts were reviewed, of which 24 articles were selected for full reading, and 10 were included in this review. Results: The analysis of the articles indicated that family support plays an essential role in breast cancer treatment adherence, particularly with regard to emotional support, but it also impacts other aspects of the patients' lives. Additionally, the results showed that a lack of adequate communication between patients, family members, and healthcare professionals can hinder coping with the diagnosis and treatment. Family support not only helps to alleviate emotional distress but also influences the continuity of treatment. Conclusion: Further studies are needed to better understand the relationship between the quality of family support and breast cancer treatment adherence.

Disparities in the utilization of supportive care medications among older adults with metastatic pancreatic ductal adenocarcinoma.

51 Background: Inequities in cancer care delivery can profoundly affect access to high-quality treatments and patient outcomes. Supportive care medication use is important for preserving quality of life in older adults with metastatic pancreatic ductal adenocarcinoma (PDAC). Whether there are differences in supportive care medication use by race and sex is unknown. Our objectives were to assess the racial/ethnic and biological sex inequities in use of treatments for pain, depression, and pancreatic insufficiency-related treatments (PERT) among older adults with PDAC. Methods: We used the Surveillance, Epidemiology, and End Results-Medicare linked database, to identify Medicare beneficiaries aged 65 and older diagnosed with metastatic PDAC from January 2008 to December 2019. We included those continuously enrolled in Medicare prescription drug benefits in the 6 months before and month of diagnosis. Any use of opioid pain medications, antidepressants, and PERT was identified from diagnosis to the end of the study period (at death, disenrollment, or 12 months). Multivariable regression was used to compare supportive care medications use by racial/ethnic and biological sex groups. Results: There were 29,509 individuals in our sample, with12.9% Black patients, 3.9% Hispanic patients, and 83.2% White patients. The mean age was 76.5 (SD: 7.4) years. Mean follow-up time was 135.4 (SD:117.7) days overall, with the shortest follow-up among Black patients 124 (SD:111.1) days and longest for White patients 137.5 (SD: 118.8) days. Antidepressants were used by 23.8%, opioids by 60.3%, and PERT by 12.4% overall. Within race groups there were limited differences in medication use by sex. However, we observed differences in supportive care treatment use by race and ethnicity. Specifically, relative to White individuals, those who identified as Black were 20% less likely (adjusted risk ratio [aRR]: 0.8, 95% CI:0.74-0.85) to receive antidepressants, 14% less likely to receive opioids (aRR: 0.86, 95% CI:0.84-0.89), and 41% less likely to receive PERT (aRR: 0.59, 95% CI:0.53-0.65). Similar patterns were observed for patients of Hispanic ethnicity, with those individuals being 12% less likely (adjusted risk ratio[aRR]: 0.88, 95% CI:0.89-0.98) to receive antidepressants, 9% less likely to receive opioids (aRR: 0.91, 95% CI:0.87-0.96), and 42% less likely to receive PERT (aRR: 0.58, 95% CI:0.47-0.70). Conclusions: Our preliminary data showed differences in the uptake of supportive care drugs among Black and Hispanic patients relative to White patients. Specifically, these individuals were less likely to start opioid pain medications, antidepressants, and pancreatic enzyme replacement therapy compared to their White counterparts. These findings highlight potential gaps in treatment use that may better support patients facing life-limiting illnesses.

A Comparative Study of Surgical Approaches for Hepatocellular Carcinoma: Conversion versus Direct Resection.

The purpose of This study is exploring the intraoperative and perioperative differences between patients undergoing conversion surgery and those undergoing direct surgery, so as to improve preoperative preparation. The retrospective study was approved by an ethics review committee. A total of 232 patients with hepatocellular carcinoma who underwent surgical resection at the First Affiliated Hospital of Chongqing Medical University from September 2022 to December 2023 were included, comprising 210 operating patients and 53 conversion patients. Propensity score matching was employed for comparison in order to minimize bias. The conversion group had more intraoperative bleeding (each P=0.001), longer operation time (P=0.033; PSM p=0.025), and higher intraoperative blood transfusion rate (p=0.001; PSM p=0.044). The incidence of perioperative complications, including perioperative ascites formation (p=0.011; PSM p=0.005), moderate to severe anemia (p=0.001; PSM p=0.002), postoperative blood transfusion (p=0.004; PSM p=0.036), and postoperative ICU transfer (p=0.041; PSM p=0.025), was higher in the conversion group compared to the operation group. The postoperative hospital stay (p=0.001; PSM p=0.003) was prolonged in the conversion group. Post-conversion operations carry a higher risk of bleeding and are more likely to result in moderate to severe anemia and ascites formation in the perioperative period. However, the risk is reversible with adequate preoperative blood preparation and prompt postoperative symptomatic treatment. Conversion patients should be encouraged to undergo operating therapy when they can withstand surgical resection.

Distributed Opioids in Morphine Equivalent: A Global Measure of Availability for Palliative Care

ContextEstimates of serious health-related suffering (SHS) demonstrate immense unmet need for palliative care, predominately in low- and middle-income countries (LMICs). Because opioids are essential medicines in palliative care (PC), measuring their availability can be used to evaluate the capacity of health systems to meet need. ObjectivesPresent the methodology for calculating Distributed Opioids in Morphine Equivalents (DOME)— introduced in the Lancet Commission on Global Access to Palliative Care and Pain Relief report - and how it can be used as a simple indicator to quantify unmet pain relief and PC need. MethodsUsing International Narcotics Control Board (INCB) data, DOME applies relative potency estimates to convert the annualized quantities of clinically appropriate opioids procured by a country to oral morphine equivalent milligrams. To quantify unmet need, an expert group proposed health condition-specific estimates for opioid need and used available data on the burden of SHS to posit the annual opioid quantity required by country for symptomatic treatment of pain or breathlessness. Comparing this to DOME generates DOME%SHSNEED, the proportion of opioids needed for palliative care that can be fulfilled by the opioid procured by a country during a year. ResultsDOME and DOME%SHSNEED can be used to measure, over time, the capacity of countries to meet PC need, as a key component of universal health coverage. Identifying access gaps disproportionately impacting LMICs can promote better health system performance and guide countries and institutions in policy making. ConclusionDOME and DOME%SHSNEED can be used to monitor health system progress to redress disparities and promote access to medically indicated opioid therapy in palliative care.

Extracorporeal Membrane Oxygenation and Reperfusion Strategies in High-Risk Pulmonary Embolism Hospitalizations.

To investigate the contemporary use of extracorporeal membrane oxygenation (ECMO) in conjunction with reperfusion strategies in high-risk pulmonary embolism (PE). Observational epidemiological analysis. The U.S. Nationwide Inpatient Sample (NIS) (years 2016-2020). High-risk PE hospitalizations. Use of ECMO in conjunction with thrombolysis-based reperfusion (systemic thrombolysis or catheter-directed thrombolysis) or mechanical reperfusion (surgical embolectomy or catheter-based thrombectomy) with regards to in-hospital mortality and major bleeding. We identified high-risk PE hospitalizations in the NIS (years 2016-2020) and investigated the use of ECMO in conjunction with thrombolysis-based (systemic thrombolysis or catheter-directed thrombolysis) and mechanical (surgical embolectomy or catheter-based thrombectomy) reperfusion strategies with regards to in-hospital mortality and major bleeding. Among 122,735 hospitalizations for high-risk PE, ECMO was used in 2,805 (2.3%); stand-alone in 1.4%, thrombolysis-based reperfusion in 0.4%, and mechanical reperfusion in 0.5%. Compared with neither reperfusion nor ECMO, ECMO plus thrombolysis-based reperfusion was associated with reduced in-hospital mortality (adjusted odds ratio [aOR] 0.61; 95% CI, 0.38-0.98), whereas no difference was found with ECMO plus mechanical reperfusion (aOR 1.03; 95% CI, 0.67-1.60), and ECMO stand-alone was associated with increased in-hospital mortality (aOR 1.60; 95% CI, 1.22-2.10). In the cardiac arrest subgroup, ECMO was associated with reduced in-hospital mortality (aOR 0.71; 95% CI, 0.53-0.93). Among all patients on ECMO, thrombolysis-based reperfusion was significantly associated (aOR 0.55; 95% CI, 0.33-0.91), and mechanical reperfusion showed a trend (aOR 0.75; 95% CI, 0.47-1.19) toward reduced in-hospital mortality compared with no reperfusion, without increases in major bleeding. In patients with high-risk PE and refractory hemodynamic instability, ECMO may be a valuable supportive treatment in conjunction with reperfusion treatment but not as a stand-alone treatment especially for patients suffering from cardiac arrest.

Phytochemical Components, Hindering Abilities on Cell Proliferation, Cell Migration and Three-Dimensional Spheroids’ Formation Capacity of Micromeria fruticosa Infusion

Objectives The objective of this study was to investigate the potential anti-cancer effects of Micromeria fruticosa plant infusion on uterine cervix cancer cells, aiming to explore its potential as an alternative or supportive therapeutic approach to conventional treatments. Methods Micromeria fruticosa plant infusion was prepared and administered to uterine cervix cancer cells in vitro. Various assays were conducted to assess its impact on cell migration, proliferation, and tumorigenicity. Additionally, the phytochemical composition of the infusion was analyzed by using LC-MS to identify major functional compounds. Results The study revealed that Micromeria fruticosa plant infusion exhibited significant anti-migratory, anti-proliferative, and anti-tumorigenic effects on uterine cervix cancer cells. Analysis of the infusion identified several major functional phytochemicals, which likely contribute to its anticancer properties. Conclusion This research suggests that Micromeria fruticosa plant infusion possesses promising anti-cancer properties against uterine cervix cancer cells. The identified phytochemicals present in the infusion highlight its potential as a source of functional ingredients with anticancer effects. These findings support further exploration of Micromeria fruticosa as a potential therapeutic agent in both nutraceutical and pharmaceutical applications, offering new avenues for the development of alternative or supportive treatments for cervical cancer.

A rare case of peripheral facial paralysis associated with meningococcal meningitis - case report

Introduction. Meningococcal meningitis is a severe form of bacterial meningitis caused by the bacterium Neisseria meningitidis (N. meningitidis). It is a medical emergency and requires prompt treatment to prevent severe complications or death. Peripheral facial paralysis is one of the rare complications that can occur in this condition. Aim. This paper aimed to draw attention to the possibility of an unexpected complication in a child with meningococcal meningitis, which requires prompt clinical and paraclinical management. Materials and methods. We present the case of a 2-year and 8-month-old female patient who, in the context of meningococcal meningitis, develops peripheral facial paralysis, a very rare complication, especially in the pediatric population. Results. The patient initially presented with clinical and paraclinical signs of a respiratory viral infection. However, in a febrile context, she has two generalized tonic-clonic paroxysmal episodes, characterized by gaze fixation, each lasting 2-3 minutes, followed by spontaneous recovery. Laboratory tests revealed neutrophilia, anemia, and elevated inflammatory markers, while the cranio-cerebral CT scan showed no structural changes. Blood cultures were also collected, and treatment was initiated with third-generation cephalosporin antibiotics, along with supportive and symptomatic therapy. The following day, the patient exhibited signs of right-sided peripheral facial paralysis, and intravenous corticosteroid therapy was added to the treatment. Approximately 24 hours after admission, the blood culture tested positive for gram-negative cocci, suggesting meningococcal meningitis. A cerebral MRI was performed, revealing changes indicative of acute meningoencephalitis. The clinical and paraclinical course was slowly favorable, with a slight persistence of facial asymmetry and intermittent ataxic syndrome. Conclusions. Meningococcal meningitis remains a relevant pathology in the pediatric population, able of causing severe complications that can result in long-term disability for the patient. Prompt treatment is crucial when this condition is suspected.

Unusual Lifespan of Edwards' Syndrome in COVID-19 Era

Edwards' syndrome is caused by an extra chromosome on the 18th chromosome. Patients with this diagnosis have median survival of only 3-14.5 days, with the majority of infants with full trisomy 18 type die before or shortly after they are born. There is only supportive treatment available for Edwards’ syndrome. During the COVID-19 pandemic, providing health services was challenging, leading to less than optimum treatments added by patients’ reluctance to visit healthcare facilities due to the fear of COVID-19 transmission. This case study presented an infant with Edwards’ syndrome with major malformation. The patient had several organ problems, was admitted to the NICU, and continued with home care for monitoring for 6 months. Patient then died at 9 months of age. Maintaining the best quality of life for this patient was very challenging for parents and healthcare providers. Since the management for this type of sydnome is more palliative, good education, information, and psychosocial supports for the parents are needed to prepare them with the worst conditions, which was especially more challenging during the COVID-19 pandemic.

Differential White Blood Cell Count and COVID-19 Hospital Length of Stay: A Post-hoc Analysis

Objective: To explore the association between differential white blood cell count and hospital length of stay (LOS) in COVID-19 patients.Methods: This study is a post-hoc analysis of two prospective cohort studies involving hospitalized COVID-19 patients who received standard therapy, including antiviral and supportive treatments at Persahabatan Hospital, Jakarta, Indonesia, during the Delta and Omicron dominant pandemic periods. Baseline differential white blood cell count before initiation of therapy were documented. LOS was categorized as ≤10 days and &gt;10 days.Result: Data from 463 subjects were included with most subjects were males (62.2%) with a median age of 54 (14–93) years. The average LOS for subjects was 12.7 (12.1–13.4) days. Bivariate tests showed that lymphocytes, neutrophils, monocytes, neutrophil-lymphocyte ratio (NLR), and neutrophil-monocyte ratio (NMR) had significant association (p &lt;0.05) to LOS. Logistic regression showed that higher monocyte counts were associated with shorter LOS (adjusted OR 0.89; 95% CI 0.840 - 0.943; p &lt; 0.001). ROC curve showed that higher monocyte counts (&gt;8.35 × 10^3/µL) at admission may predict shorter hospitalization (&lt;10 days).Conclusion: Monocyte count may serve as a potential marker for length of stay in COVID-19 patients, offering key insights for optimizing patient management and resource allocation.

Ifosfamide-Induced Encephalopathy in Relapsed Lymphoma: Report of Two Cases

Objective: Ifosfamide is a chemotherapeutic drug available for various malignancy, including lymphoma. Ifosfamide has adverse effects including myelosuppression, nephrotoxicity, hemorrhagic cystitis, and neurotoxicity. Encephalopathy is a severe manifestation of neurotoxicity due to ifosfamide, with an incidence of 10-40%. This study aimed to report two cases of ifosfamide-induced encephalopathy. Case: This case studies reported two relapsed lymphoma patients with almost similar characteristics who received ifosfamide chemotherapy. The first case of 48-year-old woman with relapsed High-Grade B-cell lymphoma stage IIIBE while the second case of 38-year-old woman with relapsed non-hodgkin lymphoma.Results: The first case showed a good outcome with improvement in consciousness 48 hours after stopping ifosfamide and thiamine, while the second case experienced tumor lysis syndrome, leading to the death of the patient.Conclusion: Mechanism of ifosfamide-induced encephalopathy remains unclear, with the hypothesis from the neurotoxic effects of the resultant metabolite chloracetyldehide. Radiology examination of the brain and electroencephalography is required to rule out other differential diagnoses. Early recognition of adverse effects, followed by immediate discontinuation of ifosfamide, administration of therapy, such as methylene blue and/or thiamine, and supportive treatment usually produced good outcomes.

Helicobacter cholecystus Bacteremia in an Adult with Acute Cholecystitis.

We report the isolation of Helicobacter cholecystus from a positive blood culture of a 58-year-old male with bacteremia and acute cholecystitis, in China. The patient's condition improved after symptomatic support treatment and subtotal cholecystectomy. This suggests that H. cholecystus should be considered a potential human pathogen.

Side-effects of Phytotherapeutics in Cancer Care - A Review of Inconsistencies in National and International Databases.

The interest in phytotherapy in patients with cancer is immensely high. When using herbal medicine, knowledge of potential side-effects is essential as part of counselling the patient. The aim of this study was therefore to collect information on the side-effects of popular medicinal plants and to compare different official and the most popular sources of information reporting the side-effects of phytotherapeutics. Four different databases were reviewed from 09 February 2021 to 01 March 2022. These were the German monographs of the German Federal Institute for Drugs and Medical Devices, the European monographs of the European Medicines Agency, the website About Herbs (https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs) and the German Red List. A total of 171 medicinal plants were chosen from the German monographs. These plants were relevant for supportive cancer treatment, targeting symptoms e.g. pain, nausea, vomiting, mucositis or fatigue. Out of the 171 selected plants, only 20 were found in all four sources. The compilation of the data showed there to be a huge disparity in the number of plants listed by each database and the type and frequency of the side-effects described. The reasons for this are manifold: Lack of interest, different interest groups, different origins (Europe versus America) and no standardized terminology. Physicians should not rely exclusively on one source to inform themselves about potential side-effects of phytotherapeutics but should use several sources to ensure the best possible safety of the patient. Since there seems to be too few data on certain medicinal plants for which no side-effects have been documented, more clinical studies are needed.

Nanoparticle Formulations for the Improvement of Symptomatic Treatments of Neurodegenerative Disorders

Neuronanomedicine merges nanotechnology and neuroscience in the pursuit of engineering therapeutic interventions for neurological disorders, including Alzheimer’s disease (AD) and Parkinson’s disease (PD). While no nanoparticle‐based drug delivery systems (NDDSs) are yet approved for use for targeting the central nervous system, this review critically analyses the development of NDDSs for the improvement of currently approved therapeutics for the symptomatic treatment of AD and PD. It showcases how NDDSs can help therapeutic payloads overcome existing limitations, such as insufficient drug accumulation in the brain and limited effectiveness, by enhancing their pharmacokinetics, bioavailability, brain penetration and accumulation, and overall therapeutic efficacy through drug encapsulation, manipulation of nanoparticle properties, and nanoparticle surface functionalisation. However, we also draw attention to widespread issues in the field that impede progress, including the poor selection of in vitro models and the inadequate design of pre‐clinical in vivo studies. We further advocate for greater standardisation of study design and reporting requirements in the future, which would likely enhance outcomes and expedite the translation of neuronanomedicines.

Design, Synthesis and Cholinesterase Inhibitory Activity of Novel 1,3,4-Thiadiazole Derivatives

Inhibition of the cholinesterases (AChE and BChE) plays a pivotal role in the symptomatic treatment of Alzheimer’s disease. The present study reports the synthesis and anticholinesterase activity of five novel thiadiazole analogs in search of anti-Alzheimer agents. The structures of the newly synthesized compounds were characterized using 1H NMR, 13C NMR and HRMS. Tested compounds inhibited acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) enzymes with IC50 values in the range of 8.250-20.382 μM and 14.143-0.986 μM, respectively. N-(4-Chlorophenyl)-2-[(5-(allylamino)-1,3,4-thiadiazol-2-yl)thio]-N-(3-nitrobenzyl)acetamide (6e) was determined as the most potent inhibitor against both tested enzymes when compared with standard drug tacrine. Molecular docking study was carried out to reveal the binding interactions between compound 6e and the active site of AChE