Treatment Priorities Research Articles

Patients' and Caregivers' Experiences Navigating the Burden of Atopic Dermatitis in Argentina.

Background and Objectives: Little is known about patients' and caregivers' experiences with atopic dermatitis (AD) in Argentina, so a survey was administered to learn more. Materials and Methods: A 53-item anonymous survey was administered in Spanish to adult AD patients (n = 334) and caregivers (n = 339) of pediatric AD patients in Argentina (total n = 673). Demographics, healthcare provider information, financial burden, disease severity, disease burden, level of disease-specific education, and experience with shared physician/patient decision making were collected. Linear and logistic regression models were used for statistical comparisons. Results: Survey respondents were overwhelmingly female (90.8%), as was the overall patient population (72.8%). Patients were seen mostly by healthcare specialists (66.8% dermatologists, 13.5% pediatricians, 7.7% allergists, and 7.2% general practitioners). Only 2.8% of respondents reported no symptoms, while 33.3%, 52.4%, and 11.5% reported mild, moderate, and severe AD disease, respectively. Anxiety/depression and pain/discomfort were the most impactful on respondents' quality of life. Caregivers of children with moderate to severe AD and adult patients with severe AD reported a significant financial burden, including using savings or not purchasing food or other essentials to afford medical care. Few people reported receiving disease-specific education or having their own treatment priorities taken into consideration. For adult patients, receiving disease education and being asked about treatment priorities were associated with higher treatment satisfaction and AD control. Discussion: Mental health, pain/discomfort, and financial worries are the most important burdens for adult AD patients and caregivers of children with AD in Argentina. We recommend prioritizing disease-specific education and shared decision making to improve AD care in Argentina.

How stable are moral judgements? A longitudinal study of context dependency in attitudes towards patient responsibility

BackgroundWhether patients' life-style should involve lower priority for treatment is a controversial question in bioethics. Less is known about clinicians' views.AimTo study how clinical doctors' attitudes to questions of patient responsibility and priority vary over time.MethodSurveys of doctors in Norway in 2008, 2014, 2021. Questionnaires included statements about patients' lifestyle's significance for priority to care, and vignettes of priority cases (only in 2014).ResultsAttitudes were fairly stable between 2008 and 2021. 17%/14% agreed that patients' lifestyle should count, while 19%/22% agreed that it should involve lower priority to scarce organs. 42/44% agreed that smokers should have lower priority. Substantially more agreed in 2014. Regression analyses showed that being male, working in hospital, and younger age increased the likelihood of agreeing.ConclusionA substantial minority of doctors agreed that lifestyle should be a priority criterion, possibly contrary to Norwegian legislation and professional ethics. The finding might be explained by the unspecified meaning of priority, increased scarcity-awareness, or socio-cultural trends towards individualism. The 2014 results indicate a framing effect; the vignettes may have primed the respondents towards accepting lifestyle as a criterion. We conclude that attitudes to normative questions are unstable and depend on context. A substantial minority of doctors seems to be positive to deprioritizing patients allegedly responsible for their illness. However, what deprioritization implies in practice is not clear.

Adaptive Stacking Ensemble Techniques for Early Severity Classification of COVID-19 Patients

During outbreaks of infectious diseases, such as COVID-19, it is critical to rapidly determine treatment priorities and identify patients requiring hospitalization based on clinical severity. Although various machine learning models have been developed to predict COVID-19 severity, most have limitations, such as small dataset sizes, the limited availability of clinical variables, or a constrained classification of severity levels by a single classifier. In this paper, we propose an adaptive stacking ensemble technique that identifies various COVID-19 patient severity levels and separates them into three formats: Type 1 (low or high severity), Type 2 (mild, severe, critical), and Type 3 (asymptomatic, mild, moderate, severe, fatal). To enhance the model’s generalizability, we utilized a nationwide dataset from the South Korean government, comprising data from 5644 patients across over 100 hospitals. To address the limited availability of clinical variables, our technique employs data-driven strategies and a proposed feature selection method. This ensures the availability of clinical variables across diverse hospital environments. To construct optimal stacking ensemble models, our technique adaptively selects candidate base classifiers by analyzing the correlation between their predicted outcomes and performance. It then automatically determines the optimal multi-layer combination of base and meta-classifiers using a greedy search algorithm. To further improve the performance, we applied various techniques, including imputation of missing values and oversampling. The experimental results demonstrate that our stacking ensemble models significantly outperform existing single classifiers and AutoML approaches, with improvements of 6.42% and 8.86% in F1 and AUC scores for Type 1, 9.59% and 6.68% for Type 2, and 11.94% and 9.24% for Type 3, respectively. Consequently, our approach improves the prediction of COVID-19 severity levels and potentially assists frontline healthcare providers in making informed decisions.

Outcomes of reconstructive techniques in breast cancer using BCCT. core software

BackgroundSurgery remains a priority for breast cancer treatment. This study aimed to compare the cosmetic outcomes of oncoplastic patients who had undergone breast-conserving surgery, mini-LDF (latissimus dorsi flap), and immediate implant reconstruction using both the Japanese scale and the BCCT.core (The Breast Cancer Conservative Treatment cosmetic results software) program and to validate this program.Patients and methodsPatients who underwent surgery for breast cancer between 1997 and 2021 were retrospectively studied. Patients were divided into three groups: 1-those who had undergone breast-conserving surgery (245 patients, 71.3%), 2-those who had undergone mini-LDF after lumpectomy (38 patients, 11.02%), and 3- those who underwent reconstruction with implants after nipple-sparing mastectomy (61 patients, 17.68%). The patients were called for a follow-up examination, and their photos were taken. The photographs were shown to an independent breast surgeon and a plastic surgeon who was not included in the surgeries, and they were asked to evaluate and rate them according to the Japanese cosmetic evaluation scale. The same images were transferred to the computer and scored using BCCT.core.ResultsThe plastic and breast surgeon evaluation results showed no significant difference between the three cosmetic techniques (p = 0.99, 0.98).The results of BCCT.core software measurements were similar to the results of plastic and breast surgeons (p: 0.43).ConclusionPatients are more knowledgeable about cosmetic outcomes and expect more objective data. In this study, we used 3 different cosmetic evaluation scales. We found that these techniques give results that are compatible with each other in terms of evaluating the work done in a more concrete way. For this reason, we recommend the use of such software, which offers objective results in a subjective field such as aesthetics and is very easy to apply.

Occult endocrine disorders newly diagnosed in patients with post-COVID-19 symptoms

Determination of long COVID requires ruling out alternative diagnoses, but there has been no report on the features of alternative diagnoses. This study was a single-center retrospective study of outpatients who visited our clinic between February 2021 and June 2023 that was carried out to determine the characteristics of alternative diagnoses in patients with post-COVID-19 symptoms. In a total of 731 patients, 50 patients (6.8%) were newly diagnosed with 52 diseases requiring medical intervention, and 16 (32%) of those 50 patients (2.2% of the total) were considered to have priority for treatment of the newly diagnosed disorders over long COVID treatment. The proportion of patients with a new diagnosis increased with advance of age, with 15.7% of the patients aged 60 years or older having a new diagnosis. Endocrine and metabolic diseases and hematological and respiratory diseases were the most common, being detected in eight patients (16%) each. Although 35 of the 52 diseases (67%) were related to their symptoms, endocrine and metabolic diseases were the least associated with specific symptoms. Other disorders that require attention were found especially in elderly patients with symptomatic long COVID. Thus, appropriate assessment and differentiation from alternative diagnoses are necessary for managing long COVID.

Genetic diversity in hereditary axonal neuropathy: Analyzing 53 Brazilian children.

The genetic epidemiology of inherited neuropathies in children remains largely unknown. In this study, we specifically investigated the genetic profile of a Brazilian cohort of pediatric patients with pure or complex axonal neuropathies, a crucial knowledge in the near future for establishing treatment priorities and perspectives for this group of patients. Fifty-three pediatric patients who were assessed prior to reaching the age of 20, and who had clinical diagnoses of axonal hereditary neuropathy or presented with axonal neuropathy as the primary clinical feature, were included in the study. The recruitment of these cases took place from January 1, 2018, to December 31, 2020. The diagnosis was based on clinical and electrophysiological data. A molecular assessment was made using target-gene panel or whole-exome sequencing. Subsequently, segregation analysis was performed on available family members, and all candidate variants found were confirmed through Sanger. A molecular diagnosis was reached in 68% of the patients (n = 36/53), considering only pathogenic and probably pathogenic variants. Variants in MFN2 (n = 15) and GJB1 (n = 3) accounted for half of the genetically confirmed patients (50%; n = 18/36). The other 18 genetically diagnosed patients had variants in several less common genes. Apart from MFN2 and GJB1 genes, universally recognized as a frequent cause of axonal neuropathies in most studied population, our Brazilian cohort of children with axonal neuropathies showed an important genetic heterogeneity, probably reflecting the multi ethnicity of the Brazilian population. Diagnostic, counseling, and future interventions should consider this characteristic.

Management of Warm Compresses in Typhoid Fever Children

School-age children are easily targeted for various diseases, especially gastrointestinal diseases because school-age children have not paid much attention to their health, including the snacks they eat. Digestive diseases that most often infect school-age children due to poor schoolchildren's snacks include typhoid fever. Typhoid fever is a disease caused by Salmonella Thypi bacteria. The priority of treatment in typhoid fever patients is hyperthermia management with the application of warm compresses that can help lower the body temperature of patients with typhoid fever. Purpose: From this case study, it is to help reduce body temperature against hyperthermy in school-age children with a medical diagnosis of typhoid fever at Arjawinangun Hospital Cirebon. Method: This scientific paper uses a descriptive qualitative design with the number of subjects as many as 2 respondents of school-age children with a medical diagnosis of typhoid fever who were given an intervention, namely a warm compress. Data collection techniques use interviews, observations and documentation studies. Conclusion: after the cooperative action, one experienced a temperature decrease of 1.1°C from 37.8°C to 36.7°C while patient 2 experienced a temperature decrease of 1.7°C from 38.3°C to 36.6°C. Suggestion: the patient's family can perform the very conflict act independently that has been taught by the nurse and in accordance with the standard operating instructions for warm compress procedures in the manual.

Significant risks that trigger cost overruns and delays in urban rail projects: a typical case study of Vietnam

PurposeUrban rail projects are typically large-scale transport infrastructure projects (megaprojects) which have many potential risks that can influence the strategic goals of owners. However, there is a paucity of studies which explore the impact of risks on both “urban rail” project time and cost together considering quantitative assessments. Therefore, this paper focuses on investigating critical risks and quantifying such risk impacts on urban railway project schedule and cost in practice.Design/methodology/approachA combination of qualitative and quantitative research methods comprising semi-interviews with five experts and a questionnaire survey of 132 professional respondents is used. The data were modeled using Monte Carlo Simulation to predict the probability of project schedule and cost.FindingsThe results show that 30 risk variables are categorized into seven main groups which have significant impacts on both project time and cost. Outstanding five risk variables were highlighted as follows: (1) project site clearance and land compensation; (2) design changes; (3) physical project resources; (4) contractors’ competencies and (5) project finance. Such findings were supported by Monte Carlo simulation which predicted in the worst case that the project may suffer 11.03 months’ delays and have cost overrun with a contingency of US$287.68 million.Originality/valueThis study expands our knowledge about time and cost contingency of urban metro railway implementation across developing economies and particularly within the context of Vietnam. Policymakers will not only gain an understanding about risk structure but will also recognize the significant impacts of critical risk through risk impact modeling and simulation. Such an approach provides insights into risk treatment priorities for planners so that they can proactively establish suitable strategies for risk mitigation in practice.

Exploring Perceptions of Biologic Therapies: A Qualitative Study Among Canadians Living with Severe Asthma.

Biologic therapies have demonstrated benefits for individuals with severe asthma, including reduced daily symptoms and severe exacerbations. However, data describing patient perspectives on these treatments are limited. This study sought to understand the preferences and priorities of Canadians with severe asthma in the context of novel biologic treatment options. Semi-structured, qualitative interviews were conducted among Canadians with severe asthma from July to August 2022. Purposeful sampling included individuals with and without biologic therapy experience. All participants described daily life with severe asthma, experiences and priorities related to asthma treatment and their impressions of biologics. Reflexive thematic analysis was used to explore patterns in the data. Among 18 individuals included, 10 were currently taking or had prior experience with biologic treatment for asthma. Those who had never been treated with biologics were unfamiliar with them, considering treatment, or believed that they may not be eligible. Four themes were developed to convey the perspectives of participants on biologics: (1) life-changing benefits, but not for all; (2) navigating barriers to being prescribed and remaining adherent to biologic treatments; (3) treatment administration preferences are not only about convenience; (4) concerns about safety and the unknown as a source of treatment hesitancy. Findings suggest that the clinical benefits of biologics align with patient perceptions of achieving good asthma control. However, treatment gaps persist among individuals who do not experience a meaningful improvement in their asthma symptoms and those who face barriers accessing biologics. People with severe asthma attributed importance to greater availability of at-home treatment options, improved access to financial support to cover treatment costs and support to address safety concerns. This research provides insight into patient-based treatment priorities and preferences for biologics, which may help inform decision-making related to emerging therapies for severe asthma.

Apert’s Disease: Three Case Reports and Review of the Literature

Apert's disease is an acrocephalosyndactyly, which is part of the craniofaciostenosis group. It is characterized by craniofacial dysmorphia and syndactyly of the hands and feet. It is a rare autosomal dominant condition, but sporadic cases are common. The pathogenesis is poorly understood. It is due to premature welding of the coronal sutures.
 Presently described are cases of three infants diagnosed with Apert syndrome based on symptomatic association with the help of medical imaging.
 Alpert syndrome requires treatment by a multidisciplinary team. The priority of treatment is to combat brain compression in children and to manage cardiorespiratory problems. Facial anomalies most often require several surgical interventions at different ages of life.

Priorities for efficacy trials of gender-affirming hormone therapy with estrogen: collaborative design and results of a community survey.

Treatment guidelines for gender-affirming hormone therapy with estrogen (GAHT-E) recommend specific dosing regimens based on limited data. Well-controlled efficacy trials are essential to tailoring treatment to patient goals as the guidelines recommend. The goal of this study was to take a foundational step toward designing community-centered effectiveness trials for gender-diverse individuals seeking GAHT-E. Our team developed a cross-sectional survey based on broad clinical experience and consultation with our community advisory board. The survey included 60 items covering demographics, transition history, goals and priorities for treatment, indicators of treatment success, sexual function goals, and future research priorities. The survey was distributed during the summer of 2021, primarily through social networks designed for gender-expansive individuals seeking treatment with estrogen. A total of 1270 individuals completed the survey. Overall treatment goals most frequently rated "extremely important" or "very important" were the following: (1) improved satisfaction with life (81%), (2) appearing more feminine (80%), (3) appearing less masculine (77%), (4) improved mental health (76%), and (5) being seen as your true gender by others (75%). The three body characteristics most frequently rated "highest priority" or "high priority" among changes were the following: (1) facial hair (85%), (2) breast shape or size (84%), and (3) body shape (80%). The highest-rated research priority was comparing feminization with different routes of estrogen administration. The goals and experiences of individuals seeking GAHT-E are diverse. Future clinical trials of GAHT-E should be grounded in the needs and priorities of community stakeholders.

Implication of self-organizing map, stable isotopes combined with MixSIAR model for accurate nitrogen control in a well-protected reservoir

Nitrogen pollution and eutrophication in reservoirs is a global environmental geochemical concern. Occasional algal blooms still exist in reservoirs that have undergone pollution treatment. The lack of quantitative evidence of nitrogen sources and fate limits long-term stable ecological safety management. This work applied an approach integrated zonal mapping, stable isotopes (δ18OH2O, δ15Nnitrate, δ18Onitrate, and δ13C-DIC) and a Bayesian isotope model to analyze regional and seasonal differences in the contribution and sources of nitrogen to a well-protected reservoir. The values of δ18Onitrate and the positive relationship between NO3− and δ13C-DIC suggested that nitrification was the primary NO3− production in the rivers. While Denitrification was present at only a few sites. Results of the MixSIAR model coupled the NO3−/Cl− indicator revealed that the domestic sewage contributed high riverine NO3− loading (68.6 ± 10.6 %) in the dry season. In the wet season, the main nitrate sources of upper watershed were ammonia and carbamide fertilizers (47.5 % and 40.3 %). While the domestic sewage was still the major contributor of downstream region (a dense residential area), indicating possible problems with rainwater and sewage drainage networks. The results implied that the colleting and treatment of sewages were the priority in downstream region, and non-point source pollution control and wastewater treatment plant upgrading were essential to control nitrate pollution in the two upstream regions. These findings provide new insights into precise nitrogen pollution traceability and identification of treatment priorities in the sub-region, and promote the management other well-protected watershed in similar need of further nitrogen contamination control.

P671 Patient perspectives on symptoms and impacts in Crohn’s disease: Results from qualitative research

Abstract Background Patients’ perspectives on their Crohn’s disease (CD) symptoms and the impacts of CD on their daily lives can be used to inform clinical care and treatment development. This study aimed to elicit in-depth qualitative information on the symptom burden of CD and to quantify which symptoms patients considered most bothersome and most important to improve. Methods Individual, web-based interviews were conducted in adults and adolescents (aged 15–17 years) with moderately to severely active CD. Participants were asked open-ended questions to elicit their experiences with CD and CD-related impacts on their daily lives. Participants were then probed about symptom- and impact-related concepts of interest that they did not spontaneously report. Participants were asked which symptoms they considered most bothersome and which symptoms they considered most important to improve. Interview transcripts and field notes were analyzed using a standard thematic analysis approach. Results 17 adults and 3 adolescents participated between May and July 2023. Participants were 17–60 [mean=38] years old; 70% were female [n=14]; 70% were White [n=14]. Participants had been diagnosed, on average, 10 (range: 0.5–29) years ago. Over half (n=13, 65%) reported moderate CD severity. Nearly all participants reported fatigue (n=19, 95%), bowel urgency (n=18, 90%), diarrhea (n=18, 90%), abdominal pain (n=17, 85%), and frequent bowel movements (n=15, 75%). About a third reported nausea (n=7, 35%), bloating (n=6, 30%), joint pain (n=6, 30%), or blood in their stool (n=6, 30%). In total, nine different most bothersome symptoms or treatment priorities were reported across participants (Figure 1). Participants most commonly reported abdominal pain (n=6, 30%), bowel urgency (n=4, 20%), and diarrhea (n=4, 20%) as their most bothersome symptoms; these were also the symptoms most commonly reported as the most important to improve (abdominal pain: n=7, 35%; bowel urgency: n=5, 25%; diarrhea: n=4, 20%) (Figure 1). All participants reported that CD hinders their daily activities, and nearly all reported that CD affects their mood or emotions (n=19, 95%), social activities or relationships (n=19, 95%), work or school (e.g., loss of productivity) (n=18, 90%), and sleep (n=15, 75%) (Table 1). Participants described "feel[ing] left out", "want[ing] to stay home", and having to cancel or leave activities because of their CD. Several participants indicated that they "plan their day around [their CD]". Conclusion Patients with moderately to severely active CD were burdened by a variety of symptoms. Patients commonly considered abdominal pain, bowel urgency, and diarrhea symptoms to be the most bothersome and the most important to improve.

Patient, parent and carer perspectives surrounding expedited paediatric epilepsy surgery

ObjectiveMost paediatric epilepsies with MRI visible lesions do not respond to antiseizure pharmacotherapy. Such medication resistance, which often takes years to become formally defined, is commonly required for surgical candidacy. Expedited surgical referral at lesional epilepsy diagnosis may result in better seizure, cognitive and developmental prognoses. This study explored the views of patients, parents and carers regarding epilepsy surgery, treatment priorities, and participation in a proposed expedited surgery trial. Methods205 patients, parents and carers (61% UK-based, 26% North American) responded to electronic surveys from February to May 2022. Participants were recruited through social media sites, epilepsy charities and societies. Categorical choice and free-text questions were used to investigate participant perspectives, and Pearson’s chi-squared test was utilised to detect meaningful differences amongst respondent subgroups. ResultsAlmost 90% of respondents who had experienced epilepsy surgery (either themselves or their child) reported seizure cessation or reduction. Postoperative outcome measures prioritised most frequently were seizure freedom (66%), quality of life (47%), seizure severity (30%), seizure frequency (28%) and independence (27%). Most participants support expedited surgery in suitable patients (65%), with just over half (51%) willing to participate in the proposed trial. Many participants (37%) were undecided, often due to fears surrounding neurosurgery. Subgroup perspectives were broadly similar, with more parents and caregivers favouring expedited surgery compared to patients (p = .016) and more UK-based participants willing to take part in an expedited surgery trial compared to those from North America (p = .01). ConclusionsPatients, parents and carers are open to considering expedited surgery for lesional epilepsies and would support a trial exploring this approach. Priorities from treatment were largely similar between participant subgroups, with seizure, quality of life and neuropsychological outcomes ranked highly. Accounting for these preferences will facilitate the delivery of a trial that is patient- and caregiver-focused, enhancing feasibility, satisfaction and benefit for prospective participants.

A survey of preoperative surgical nutrition practices, opinions, and barriers across Canada.

Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCPs) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed (n=111 dietitians, n=72 physicians, n=42 allied HCPs), 96%-100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% (n=142/220; dietitians: 88%vs. physicians: 40%) reported screening for malnutrition, which mostly occured in the postoperative period (n=117) by dietitians (n=94). Just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n=121/212), time (40%, n=84/212) and support from others (38%, n=80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier.

Analysis Of The Priority Handling Of Enveromental Drainage Construction Project At Dinas Pekerjaan Umum Dan Penataan Ruang Banjarbaru City

Flood is one of the main problems of big cities in Indonesia, including Banjarbaru City. This is often caused by the not supportive existing drainage capacity when compared to the increasing of crowded urban conditions and reduced green open space. Handling of drainage including rehabilitation is necessary so that drainage can function properly as expected. On the other hand the Banjarbaru City Government has a limited budget each year that can be disbursed for drainage handling. The purpose of this thesis is to analyze criteria and subcriteria that are important in determining the priority of drainage handling. The ANP (Analytic Network Process) method is analyzed using the criteria in the Minister of Public Works regulation number 12/PRT/M/2014 tentang Penyelenggaraan Sistem Drainase Perkotaan to determine priorities for handling environmental drainage with important criteria, namely aspects of inundation, economic loss, social disruption and government facilities, loss of disturbance. transportation, loss to residential areas, and loss of personal property rights. Based on these 6 criteria, priorities for handling environmental drainage in Banjarbaru City are determined. Furthermore, an analysis is carried out to evaluate the priority of the choices that occur. This study suggests to decision makers that ANP can be used to analyze drainage management priorities in Banjarbaru City. This research focuses on variables consisting of criteria or considerations which form the background for priorities in handling the environmental drainage system in Banjarbaru City. The primary data results obtained from the field survey were followed by analysis using the ANP method with data tabulation calculations and assisted by Super Decisions software to determine the priority scale for handling environmental drainage in Banjarbaru City. The treatment priority scale in the Super Decisions software, the data of which is based on field survey results and data tabulation calculations, found that there are several locations that have a large priority scale but treatment has not been carried out due to several factors that are not contained in Minister of Public Works Regulation 12/PRT/M/2014 concerning Implementation of Urban Drainage Systems.

Hand function outcomes following surgical treatment of complete neonatal brachial plexus palsy.

Although re-innervation of the hand is considered a priority in the treatment of infants with complete brachial plexus injury, there is currently a paucity of publications investigating hand function outcomes following primary nerve reconstruction in infants with neonatal brachial plexus palsy (NBPP). This study therefore aimed to evaluate hand function outcomes in a series of patients with complete NBPP. This retrospective case series included all patients who underwent primary nerve surgery for complete neonatal brachial plexus palsy over an 8-year period. Outcomes were assessed using the Raimond Hand Scale. Classification of grade 3 or higher indicates a functional hand (assistance in bimanual activity). Nineteen patients with a complete NBPP underwent primary nerve reconstruction at a mean age of 3.7months. Periodic clinical evaluations were performed until at least 4years of age. According to the Raimondi hand scale, one patient did not recover (grade 0), three patients attained grade 1, four grade 2, ten grade 3, and in one grade 4. Overall hand functional recovery was achieved in 57.8% (11/19) of patients. Sufficient recovery of hand function to perform bimanual activity tasks in patients with complete NBPP lesions is possible and should be a priority in the surgical treatment of these infants.

ANALOGY OF THE USES OF MEDICINAL SPECIES IN CUBA AND THE STATE OF BAHIA, BRAZIL IN THE LAST DECADE

Since the dawn of humanity, plants have been used to alleviate and cure diseases. Since biological diversity is precisely different in each location as it depends mainly on the climate and relief and therefore it is assumed that the development of phytotherapy or alternative medicine based on plants developed unevenly from the plants that had their disposal as well as the treatment priorities needed. Taking into account that Cuba and the state of Bahia have a similar climate, as well as a similar number of inhabitants, they were taken as the objective in this study, with a greater discrepancy in terms of territorial extension. The main purpose of this study is to understand the relationships of ethnobotany in medicinal plants in the state of Bahia, Brazil and Cuba. The method of bibliographical review of publications available from the last decade and which were accessible in the Scopus, Google Scholar, SciELO, PubMed databases was used, taking into account that these must be free and refer to the subject of study in question to be selected. The result shows that the publications place Cuba well above the number of studies published on the subject when the comparison is made. There are also coincidences in both territories in relation to the diseases most treated with medicinal plants, the most used parts of the plants and the families that cover most of the species described in the reviewed research. Obtaining a total of species (247), 111 in Cuba and 136 mentioned in the studies reviewed in the Brazilian state. Leaves are the most used parts and the Lamiaceae family is the most popular..

Synergistic integration of histone deacetylase inhibitors apparently enhances the cytokine-induced killer cell efficiency in multiple myeloma via the NKG2D pathway.

The rapid recognition of epigenetic manipulation's potential in restricting cancer cell capabilities spurred translational initiatives, including histone deacetylase inhibitors (HDACis). Clinical trials on multiple myeloma (MM) demonstrated substantial benefits of HDACis, coupled with promising outcomes from cytokine-induced killer cell (CIK) immunotherapy. Intriguingly, the unexplored synergy of HDACis and CIK cell immunotherapy in MM prompted our study. We examined clinically relevant HDACis (panobinostat/LBH589 and romidepsin) alongside CIK cells derived from peripheral blood mononuclear cells across diverse MM cell lines (U266, RPMI8226, OPM-2 and NCI-H929). Utilising various in vitro methodologies, we investigated how HDACis enhance CIK cell lysis of myeloma cells through NKG2D/NKG2D ligand interactions. The results of our analysis indicated several key findings. (1) Enhanced cytotoxicity of CIK cells in MM cells when combined with HDACis. (2) Significant increase in apoptosis, suggesting HDACis and CIK may together enhance apoptotic effects in specific MM cell lines. (3) Elevated IFN-γ secretion and alterations in granzyme Bsecretion because of the independent activity of HDACis. (4) Notably, HDACis increased the expression of MICA/B and ULBP2, crucial for inducing antitumor cytotoxicity of NKTcells. Validation through NKG2D receptor blocking in CIK cells with a purified mouse antihuman NKG2D antibody further supported our findings. Our analyses provide sufficient evidence to consider this clinically forgotten instance (HDACis-CIK cell combination) as a therapeutic priority for MM treatment. Furthermore, we suggest that NKG2D/NKG2D-ligand interactions activating NK/NKTcells may contribute to enhanced myeloma cell lysis in response to HDACis treatment by CIK cells.

Differences in the Effectiveness of Infrared Therapy for Reducing Musculoskeletal Pain in the Elderly

Objective: A health problem that is a priority for medical care and treatment for the elderly is pain in the musculoskeletal system. Non-pharmacological management in the form of treating musculoskelatal pain in the elderly, one of which is infrared therapy. Infrared therapy is able to reduce pain in the elderly and requires close supervision because the elderly experience a decrease in skin sensitivity to heat. The effectiveness of reducing pain varies in the elderly. One of the influencing factors is age. This study’s objective is to determine differences in the effectiveness of infrared therapy to reduce musculoskeletal pain in the elderly group.
 Materials and methods: This study used an experimental research method with a nonrandomized pretestposttest control group design. The research location was conducted at the Posbindu Institut Teknologi Sains dan kesehatan PKU Muhammadiyah Surakarta, in September - October 2022. A sample of 50 elderly people was divided into elderly (> 60 years: 30) and pre-elderly (45-60 years: 20) selected using a purposive technique sampling. The dependent variable is musculoskeletal pain. The independent variable is infrared therapy. Data were analyzed by Wilcoxon and Mann-Whitney test.
 Results and Discussion: The Wilcoxon test showed that there was an effect of infrared therapy in reducing musculoskeletal pain in the elderly and preelderly groups (p value <0.001 and <0.001). The average reduction in pain in the elderly group = 3.1; SD = 1.3 and pre-elderly = 2.95; SD = 1.2. The Mann-Whitney test showed no difference in reducing musculoskeletal pain using infrared therapy in the elderly and pre-elderly (p = 0.712).
 Conclusion: Infrared therapy is effective in reducing musculoskeletal pain and reducing musculoskeletal pain for the two elderly groups are similar
 Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 108-114