Treatment Of Type Research Articles

Survivorship care plans and adherence to breast and cervical cancer screening guidelines among cancer survivors in a national sample

Abstract Purpose The impact of the components of survivorship care plans on adherence to cancer screening guidelines among cancer survivors is limited. We examined the association of receipt of treatment summaries, follow-up instructions, and type of doctor providing survivorship care with adherence to breast cancer screening (BCS) and cervical cancer screening (CCS) guidelines in female cancer survivors. Methods A cross-sectional analysis using Behavioral Risk Factor Surveillance System (BRFSS) data from 2014, 2016 and 2018 was conducted. BCS and CCS-eligible women were aged 40–74 and 30–64, respectively. BCS adherence was defined as a mammogram within 2 years and CCS adherence as a pap smear within 3 years or HPV test within 5 years. Univariate analysis with chi-square and multivariable logistic regression are reported. Results 5,001 BCS and 3,014 CCS-eligible survivors were identified. In the BCS group, recipients of treatment summaries and follow-up instructions were significantly more adherent with BCS (84.1% vs. 77.4%; 83.4% vs. 74%, respectively, p < 0.001). In the CCS group, recipients of follow-up instructions were significantly more adherent with CCS (78.1% vs. 67.7%, p < 0.001). In both groups, there was no significant difference in BCS or CCS based on type of physician providing care (p = 0.087). On multivariate analysis, receipt of follow-up instructions was the only factor significantly associated with BCS (OR:2.81; 95%CI:1.76–4.49) and CCS (OR:3.14; 95%CI:1.88–5.23). Conclusions Follow-up instructions, as part of survivorship care plans, have the strongest association with BCS and CCS among female cancer survivors. Additional research should focus on improving the distribution of survivorship care plans, particularly follow-up instructions, as a method to increase BCS and CCS among cancer survivors.

Abstract C033: Identifying and targeting prostate cancer therapy resistance mechanisms driven by the tumor microenvironment

Abstract Background: Prostate cancer is a prevalent malignancy in men, with treatment resistance posing a significant challenge to successful cure. Acquired Resistance to Therapy (ART) arises from two main components: (1) Tumor Microenvironment (TME) and (2) mutations or epigenetic changes at gene level within the tumor cells themselves. While most cancer therapies target the intrinsic biology of cancer cells, growing evidence indicates that these treatments can also harm the stromal cells within TME, potentially driving ART. The biology of ART may vary based on the types of treatments, cell types, and organ locations. Thus, this study aims to dissect ART components driven by TME-mediated cellular processes in a comprehensive manner. Hypothesis: We propose that cancer therapies induce stress responses in non-cancerous cells within the TME. These stress responses involve the secretion of cytokines, mediators, and growth factors, which we term Stress Response Secretory Programs (SRSPs). We further hypothesize that targeting SRSPs could overcome ART that helps to improve treatment specificity and efficacy. Materials and Methods: We employed comprehensive single-cell profiling of common metastatic sites included liver, prostate, lung, bone, lymph node and spleen in preclinical models to identify secreted proteins and dysregulated pathways caused by genotoxic therapies. In vitro, we evaluated treatment resistance in murine prostate epithelial cell lines (Myc-CAP) by exposing them to conditioned media (CM) from irradiated murine fibroblasts (F4M2), using cell growth assays. Results: Single-cell RNA sequencing of organ samples revealed significant expressions of SRSPs and increased inflammatory responses in liver and prostate fibroblasts as well as other stromal cells treated with carboplatin. In vitro, CM from irradiated F4M2 cells enhanced cell proliferation and survival of Myc-CAP cells in response to docetaxel treatment. Conclusion: Our findings highlight the crucial role of SRSPs in mediating ART through interactions within the TME, which alter tumor cell phenotypes. Targeting these SRSPs holds potential for overcoming treatment resistance and improving therapeutic outcomes, underscoring the need to consider TME complexity in cancer treatment strategies. Citation Format: Tony Lok Heng Chu, Armand Bankhead, Ilsa Coleman, Sander Frank, Peter S. Nelson, Tarana Arman. Identifying and targeting prostate cancer therapy resistance mechanisms driven by the tumor microenvironment [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C033.

Workplace-based prevention and management of knee pain: a systematic review.

Knee pain is highly prevalent and disabling among the general and working population. This systematic review explored the effectiveness of workplace-based interventions on knee pain among workers. A PICO-guided systematic search was performed in PubMed and Web of Science Core Collection for articles published from 2003 until January 2023. Eligible articles included randomized and non-randomized controlled trials assessing the effect of workplace-based interventions on knee pain among currently employed adult workers. The quality assessment and evidence synthesis adhered to the systematic review approach, which the Institute for Work & Health developed, and was focused on developing practical recommendations for stakeholders. Of the 13 identified studies, 11 medium- and high-quality studies were entered into the evidence synthesis. Importantly, none of the included studies specifically aimed at reducing of knee pain. Still, among the included studies, a strong level of evidence suggested no benefit of workplace-based physical exercise/activity intervention on knee pain. The level of evidence was deemed too uncertain to guide current policy/practices for ergonomic and multifaceted interventions. No intervention types were associated with negative effects on knee pain. The current evidence-base pertaining to workplace-based prevention and management of knee pain is insufficient to guide effective preventive workplace practice or policy development. Considering the global prevalence and health impact of knee pain, development and implementation of effective workplace interventions aimed at prevention and management of knee pain is needed.

Abstract C042: TMEM doorway score as a predictive biomarker for therapy selection in ER+/HER2- breast cancer

Abstract Background: Endocrine therapy is the standard of care for ER+/HER- breast cancer; but some patients need additional adjuvant chemotherapy to counter the risk of metastasis. While chemotherapy can reduce metastasis, some patients still relapse. Tumor cells metastasize through TMEM (Tumor Microenvironment of Metastasis) Doorways, consisting of a Mena-expressing tumor cell, a macrophage, and a vascular endothelial cell, all in direct contact. High TMEM doorway scores correlate with increased dissemination in mice and metastatic outcomes in ER+/HER2- breast cancer patients. Recent studies show that adjuvant chemotherapy may activate growth in disseminated tumor cells (DTCs). Thus, we hypothesized that patients with high TMEM doorway scores who receive endocrine plus chemotherapy will have worse distant recurrence-free survival (DRFS) than those with lower TMEM Doorway scores, or those who receive endocrine therapy alone. Methods: We conducted a retrospective study on 119 patients with stage I-III, ER+/HER2- unilateral invasive ductal breast carcinoma (age≥18) from 2005- 2018. All underwent surgery and received adjuvant endocrine treatment alone or with chemotherapy. We excluded patients who had metastatic disease at diagnosis, received neoadjuvant chemotherapy, or lacked treatment data. Formalin-fixed paraffin-embedded primary tumor tissues were stained for TMEM doorways. A pathologist categorized the TMEM doorway scores as low, intermediate, or high. Kaplan-Meier curves and Cox-proportional hazard models compared DRFS based on treatment type and TMEM doorway scores. Multivariate logistic regression analyzed the association between macrophage density or TMEM Doorway Score and metastatic outcomes, adjusting for tumor size, grade, and node positivity. Results: Of all patients, 72 received endocrine plus chemotherapy and 47 endocrine therapy alone. In the chemotherapy group, 34 (47.2%) developed metastases, while 38 (52.8%) remained disease-free. In the endocrine alone group, 37 (78.7%) remained disease-free and 9 (19.1%) developed metastases. There was no significant difference in TMEM Doorway Scores between groups (p=0.07). In patients who received endocrine plus chemotherapy, a high TMEM Doorway Score was associated with greater odds of metastasis (OR 6.8; 95% CI 1.35–33.76; p=0.02), controlling for tumor size, grade, and node positivity but not when endocrine therapy was used alone (p=0.817). Patients with high TMEM Doorway Scores had worse DRFS in the endocrine plus chemotherapy group (HR 2.61; 95% CI 1.08–6.27; p=0.03), but not in the endocrine therapy alone group (p=0.77) adjusted similarly. Conclusions: This study highlights potential clinical utility of TMEM Doorway Scores as a predictive biomarker for chemotherapy selection in ER+/HER2- breast cancer patients. Larger trials are needed to confirm these findings and with confirmation, physicians considering giving chemotherapy to ER+/HER2- breast cancer patients might consider pre-treatment stratification using TMEM Doorway Scores to mitigate the risk of chemotherapy-induced metastasis. Citation Format: Priyanka Parmar, Andrew Miller, Burcu Karadal-Ferrena, Suryansh Shukla, Cien Huang, Mindy Ginsberg, Chedva Rosenbaum, Malka Felder, Chenxin Zhang, John S. Condeelis, Xiaonan Xue, Thomas E. Rohan, Joseph A. Sparano, Jesus D. Anampa, David Entenberg, Maja H. Oktay. TMEM doorway score as a predictive biomarker for therapy selection in ER+/HER2- breast cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C042.

The Association between the Type of Mental Health Treatment Received, Metropolitan Status and Gender.

The purpose of this study is to examine the relationship between the type of mental health care received and metropolitan status. We combined data from the National Survey for Drug Use and Health (NSDUH) to examine mental health treatment. We grouped participants by metropolitan status and receipt of mental health treatment. We conducted a logistic regression using interaction terms to compare the likelihood of receiving inpatient and/or outpatient treatment for mental health, relative to prescription medication alone. There was an association between the type of mental health treatment received and metropolitan status. For women, living outside a large metropolitan area was associated with a higher likelihood of receiving only prescription medication (p < 0.001). Policy makers may use these results to consider ways to increase access to care, including increasing funding for behavioral health or recruitment incentives for specialists.

Effect of Two Biofertilisers Based on Endophytic Fungi on Fall Armyworm Infestations in Maize Production in the Kara Region of Togo, West Africa

Aims: The aim of the study was to assess the efficacy of two biofertilisers based on endophytic fungi on infestation rates, foliar damage and maize yield losses caused by the armyworm, Spodoptera frugiperda, a worst maize pest. Study Design: Completely Randomized Design (CRD) with three types of treatments. Place and Duration of Study: Agronomic Experimentation Station of Tchitchao, Kara (Togo), between October 2019 and March 2020. Methodology: A complete randomized block design was used with three types of treatments: (i) maize seeds inoculated with Glomus sp. strain 142, (ii) maize seeds inoculated with Mycotri, (iii) maize seedlings fertilized with NPK and urea and finally (iv) a control consisting of seeds and/or seedlings of maize neither fertilized nor inoculated. Results: The results show that the plots treated with endophytic fungi recorded significantly lower infestation rates compared with the fertiliser treatments and the control. The highest infestation rates were 54% at 38 days after sowing (DAS) and 45% at 31 DAS for treatments with 5.35 x 105 spores/ha Glomus sp. and 0.38 kg/ha Mycotri, respectively, compared with 78% at 31 DAS and 62% at 38 DAS for fertiliser treatments and the control. The highest level of leaf damage, 2.92, was observed at 33 DAS on the plots fertilised with fertiliser, compared with scores of 2.53 and 2.38 for the plots mycorrhised with Glomus sp. and Mycotri, respectively. Yields were significantly higher in the fertilised plots (3.87 t/ha), followed by the mycorrhised plots (2.62-3.01 t/ha) and the control (1.73 t/ha). Conclusion: The endophytic fungi enabled the plants to tolerate fall armyworms attacks better than the controls, offering an alternative to chemical fertilisers and an effective option for managing soil fertility and controlling Spodoptera frugiperda.

How Built Environment Characteristics Influence Social Interactions During Neighbourhood Walks Among Urban Inhabitants

As an accessible and low-risk mode of transportation and recreational activity, walking both produces and is produced by socio-spatial urban features. The health benefits of walking transcend physical fitness, remaining integral to mental health and to fostering social connectedness in urban communities. Understanding what drives walking behaviour, therefore, warrants attention from a public health perspective. This qualitative case study focuses on the social interactions of inhabitants during neighbourhood walks and how built environment features influence walking patterns and experience. Using diaries, maps, and semi-structured interviews with 45 inhabitants of a mid-sized Canadian city, this research investigates the influence of permanent and temporary physical features on the perceived quality of inhabitants’ walks. The findings show the public visibility of urban modifications influences walking behaviour and improves social interactions, leading to a heightened sense of belonging and community. Inhabitant-led modifications in the urban space were mostly neighbourhood-bound and voyeuristic, whereas administrative interventions were more successful for collectivization. Both types of interventions are argued to foster social connectedness through different mechanisms, with positive impacts on inhabitants’ health and wellbeing. The findings underscore the relevance of community-led and administratively planned interventions in built environments in positioning public health policies associated with social cohesion and connectedness.

Identifying Factors That Might Affect Outcomes of Exercise-Based Therapies in Long-COVID

Background: Long-COVID, which might develop after a SARS-CoV-2 infection, is a rather new disease without standardized treatment strategies. A large number of approaches that integrate physical activity have been described in the literature, and this systematic review aims to examine changes in symptom severity, physical fitness, respiratory symptoms and quality of life during training and identify factors that might influence the respective outcomes. Methods: A literature search was conducted using the databases Pubmed, PEDro, BioMed Central, EBSCOhost, ProQuest and the ZBSport from 13 February 2024 to 27 February 2024, and 39 studies fulfilled the search criteria. Results: The analyzed study designs varied regarding the type of intervention (isolated vs. multidisciplinary), duration and intensity of training sessions and overall length of the program. Individualized holistic concepts of physical activity paralleled by additional approaches demonstrated high effectiveness. However, many of the participants continue to suffer from Long-COVID after the intervention. Conclusions: Long-COVID treatment should be individualized, multifactorial and not limited in time and should consider each patient’s pre-existing conditions and individual course of the disease to provide the best possible support and care.

A chewing gum containing ethylenediaminetetraaceticacid (EDTA), methyl sulfonyl methane (MSM) and xylitol works comparable to chlorehexidine mouthrinse.

Dental plaque provides a proper environment for the growth and activity of bacteria responsible for periodontal diseases and caries. As a result, it should be removed by individuals to prevent periodontal diseases and caries. There are different mechanical and chemical plaque control methods. In one study is shown that dental plaque removal efficacy of dentifrice containing Ethylenediaminetetraaceticacid(EDTA)/Methylsulfonylmethane(MSM) was nearly five times that of commercially available fluoride toothpaste. In another study, authors found that xylitol-containing chewing gums caused a marked reduction in the count of Streptococcus Mutans compared to conventional ones. This difference was highly prominent in individuals with poor oral hygiene. In this study we assessed the synergic effects of Xylitol, EDTA and MSM in a chewing gum in comparison with chlorhexidine mouthwash. This study was a crossover, randomized clinical trial. Twenty-four patients were divided in two groups randomly. At the baseline scaling and root planing was done for each patient. Group1 used chlorhexidine mouthwash twice a day. Group2 used novel chewing gum for 15min twice a day. After 14 days, for every patient O'leary plaque index, gingival index and sulcus bleeding index were reevaluated and recorded. Professional brushing was done for patients. 14 days were considered as wash-out period. After that, method of plaque control of groups was changed. After 14 days, all patients were reevaluated and recorded and were compared with previous data. Samples in 2 groups had no significant difference in age and sex. Paired sample t test revealed that there were significant differences between first and second period for O'leary plaque index, gingival index and sulcus bleeding index in Group1 (P < 0.05). But in Group2 there were no differences between first and second period for all indexes. Also independent sample t test showed that there were no significant differences between baseline, after first treatment and after second one for all indexes in both groups (P > 0.05). According to regression model results, type of treatment had no effect on mean of all indexes. According to our findings which showed the similar efficiency of novel chewing gum and chlorhexidine mouthwash in improving and reducing plaque and gingival indexes, we can conclude that novel chewing gum can be introduced as an effective, cheap and accessible tool for dental plaque control.

Age differences in the treatment of lung cancer-a cohort study among 42,000 patients from Germany.

We aimed to describe treatment of lung cancer patients in Germany based on health claims data, focusing particularly on differences by age. Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population) we identified lung cancer patients diagnosed in 2015-2018 based on a previously developed algorithm and followed them until death, end of continuous insurance or end of 2020. We described initial treatment patterns after diagnosis and survival, stratified among others by age. We included 42,629 incident lung cancer patients (58% male). Surgery within three months after diagnosis was performed in 36%, 31%, 29% and 18% of patients aged < 50, 50-69, 70-79 and ≥ 80, respectively. Among patients without surgery, systemic therapy was administered in 77%, 72%, 54% and 25% of patients aged < 50, 50-69, 70-79 and ≥ 80, respectively. Monoclonal antibodies were administered in 15-30% of patients across age groups, and 4% to 15% received protein kinase inhibitors. Overall, 21% of patients remained untreated. In the age groups < 50, 50-69, 70-79 and ≥ 80, this proportions was 9%, 12%, 22% and 48%, respectively. In conclusion, our study provides a comprehensive overview of the therapy of lung cancer patients in Germany and quantitatively demonstrates the considerable differences between age groups. In terms of clinical cancer registration, the results are useful to estimate the completeness of data for the different types of treatment.

Behavioral Addiction Treatment Centers in the Hospitals of Türkiye: A Web-Based Research.

This study investigates the current landscape of behavioral addiction treatment in Türkiye hospitals, considering both inpatient and outpatient approaches. The analysis involved examining the websites of 1393 hospitals across Türkiye based on various criteria. The review of the websites was conducted between June and September 2023. The findings reveal that out of these hospitals, comprising 822 public and 571 private institutions, only 51 provide treatment for behavioral addictions. Behavioral addiction treatments are available in 23 of the 81 provinces in Türkiye, and 24 out of the 51 hospitals offering treatment for behavioral addictions are located in İstanbul (47.1%), while three (5.9%) are located in Ankara. Among these 51 hospitals, 22 are public, and 29 are private. The primary focus of treatment revolves around internet and gambling addiction. Upon analyzing the patient groups served, it was observed that 49% (n = 25) of the hospitals specialize in treating adult patients, while 29.4% (n = 15) cater to pediatric patients. While the websites of 11 hospitals contain information about the behavioral addiction treatments offered, they lack any information on the patient groups to which they cater. The predominant treatment modalities include psychotherapy (25.49%), followed by psychopharmacotherapy (19.61%) and cognitive-behavioral therapy (17.65%). In conclusion, the treatment of behavioral addictions, such as those related to the internet, gaming, and shopping, are offered in hospitals across various regions and age groups. Considering that only 3.7% of hospitals in Türkiye treat behavioral addictions, this type of treatment is not widespread.

The Effectiveness of a Multimedia Educational Program on the Lifestyle and Perception of Patients with Atrial Fibrillation: A Study Protocol

Background: Atrial fibrillation is a globally common cardiac dysrhythmia and preventable with education. The study protocol aimed to investigate the effectiveness of a multimedia educational program on the lifestyle and perception of patients with atrial fibrillation. Methods: The present clinical trial protocol will be conducted to investigate the effect of multimedia training on the lifestyle and perception of patients with atrial fibrillation in two phases. The multimedia training (audio, video, image, and animation) was provided in the form of two 2-hour training sessions per week for patients on the coordinated date and time on a web platform. The patients also received a weekly phone call for one month through which some educational content was covered as a type of training intervention. The second phase included the administration of pre-test and post-test interventions using standard questionnaires by an intervention (who receive training) and a control (without training) group. Conclusion: The present study provides a useful protocol regarding the design of a multimedia educational intervention program on promoting the lifestyle and perception of patients with atrial fibrillation. It can also reduce treatment costs. The strategies of this program can be cost-effective therefore the success of such a program can be effective in improving the health status of atrial fibrillation patients.Registration of this randomized control trial has been completed with the Iranian Registry of Clinical Trials.

OS IMPACTOS DA TERAPIA ASSISTIDA POR ANIMAIS (TAA) NA IMUNIDADE DOS CÃES: BENEFÍCIOS E DESAFIOS

Animal-Assisted Therapy (AAT) is a specific type of intervention or treatment, working with the contribution of Veterinary Medicine, with the aim of promoting the social, cognitive, physical or emotional development of human beings who interact with animals. However, there is still no Federal Law in Brazil that regulates Animal Assisted Therapy (AAT), with certification to ensure the health and well-being of the animals involved. This article intends to have a scoping review of the literature, with the aim of contributing to new theoretical knowledge on the topic. Therefore, this research will demonstrate a brief report on therapeutic practice and the objective of this study is to identify the direct impacts that Animal Assisted Therapy (AAT) causes on the immunity of the dogs involved, highlighting benefits and challenges that this activity can bring into active practice. In view of the above, the practical performance of the Golden retriever therapy dog ​​called “Beacon Miller” and affectionately nicknamed “Goodest Boy” was reflected worldwide at the Paris 2024 Olympic Games, with a notable role of emotional and psychological support, which benefited not just the athletes, but also the coaches and family members, demonstrating the post-therapy challenges for the therapy dog. Thus, this present study aims to update future Veterinarians on the importance of the therapeutic practice carried out through dogs called Animal Assisted Therapy (AAT), demonstrating the essential role that the Veterinarian has in supervising and monitoring the animal. It is essential that this activity also benefits therapy dogs, preserving the health and well-being of the animal that contributed to a social and humanitarian activity. Therefore, the Veterinarian's frequent observation of dogs in therapeutic activity, before, during and after activities, is extremely important to detect impacts or extreme situations early, thus ensuring that the animal acts comfortably in this therapeutic practice.

Prognostic significance of serum inflammatory markers in patients with acute ischemic stroke undergoing revascularization therapy.

This study aimed to evaluate the prognostic significance of serum inflammatory factor levels in patients with acute ischemic stroke undergoing revascularization therapy. The study included 94 patients with acute ischemic stroke who underwent revascularization therapy at our hospital. The primary outcome was the modified Rankin scale (mRS) score assessed three months post-treatment. Patients were categorized into two groups: those with a poor prognosis (mRS score > 2) and those with a good prognosis (mRS score≤2). The patients were divided into two groups based on the type of revascularization treatment received: thrombus extraction or intravenous thrombolysis. Logistic regression analysis was used to identify independent risk factors associated with the prognosis of patients treated with recanalization for acute ischemic stroke. Among the 94 patients, 59 had a good prognosis, and 35 had a poor prognosis. At admission, the patients in the good prognosis group exhibited lower NIHSS scores, shorter hospital stays, fewer previous cardiac events, lower LDL levels, fasting glucose, IL-6, and TNF-a compared to those in the poor prognosis group (all P < 0.05). Logistic regression analysis identified TNF-a (odd ratio (OD), 1.623; 95% confidence interval (CI), 1.282-1.933; P = 0.035) and IL-6 (OD, 1.055; 95% CI, 1.024-1.088, P = 0.023) as independent risk factors for poor prognosis in patients after revascularization. Additionally, pre-hospital NIHSS scores, IL-6, and TNF-a levels were significantly lower in the good prognosis group compared to the poor prognosis group, with these differences being statistically significant. IL-6 and TNF-α may serve as prognostic markers for outcomes following revascularization therapy in patients with acute ischemic stroke, including those receiving intravenous thrombolysis.

Self-rated costs and benefits of conventional and alternative adult ADHD treatments.

Conventional treatments offered by healthcare providers for adult ADHD include pharmacological and non-pharmacological approaches or a combination of both. Both treatment types may have downsides like side effects or low efficacy, potentially leading to treatment dissatisfaction. Also, adults with ADHD explore non-prescribed, complementary and/or alternative medicine (CAM) on their initiative, including substances such as dietary supplements and activities such as physical exercise. This survey study aimed to investigate the types of conventional and CAM treatments adults with ADHD use and their self-rated effectiveness. Also, lifetime experience of negative effects across all treatment types and the motives to use CAM were explored. In total, 227 adults diagnosed with ADHD or reporting clinically elevated ADHD symptoms (without official ADHD diagnosis) were included in the analyses. Both lifetime and current use and experiencing negative effects were highest for conventional pharmacological treatments, followed by CAM activities, CAM substances, and conventional non-pharmacological approaches. The most common reason for using CAM was overall well-being. Conventional treatments were rated more effective in influencing cognition than CAM, but their self-rated effectiveness did not differ in other assessed domains. CAM activities were rated more effective than CAM substances in all assessed domains. This study highlights the high prevalence of CAM use by adults with ADHD, implying that some patients find value in such alternative treatments. Future studies should consider investigating alternative and/or complementary treatments for adult ADHD, alone or in combination with conventional treatments.

A longitudinal point prevalence survey of antimicrobial use and resistance in tertiary care hospitals in Kerman: results from the national Iranian multicenter point prevalence survey of antimicrobials in 2021.

The Global Point Prevalence Survey (PPS) of antimicrobial consumption and resistance has been widely undertaken to combat the global threat of antimicrobial resistance (AMR). This study was conducted in alignment with the Global-PPS in three tertiary care hospitals in Kerman, Iran, to evaluate antimicrobial consumption patterns. The study was conducted from January 2020 to January 2021 in Afzalipour, Shafa, and Shahid Bahonar Hospitals. Data were collected using the standardized Global-PPS method at three different points throughout the year to minimize bias. Information on antimicrobial prescriptions, primary diagnosis, prophylaxis, therapy indications, and treatment type were documented. Antimicrobial prevalence was calculated using the total number of admitted patients as the denominator and those on antimicrobial regimens as the numerator. The point prevalence of antimicrobial consumption in adult wards was 65.6% in Afzalipour Hospital, 42.3% in Shafa Hospital, and 78.7% in Bahonar Hospital. Non-penicillin beta-lactams, macrolides, lincosamides, and streptogramins were the most frequently prescribed antibiotic classes. Approximately 80% of prescriptions had explicit reasons documented, and targeted antibiotic therapy rates varied between 7.7% and 44.8% across hospitals. Antimicrobial consumption in Kerman's tertiary care hospitals exceeded national and global levels, indicating an urgent need for interventions to promote rational antibiotic use. Infection control committees must implement rigorous monitoring measures to reduce antimicrobial resistance. Ongoing surveillance and targeted interventions are essential to curb the rising rates of antimicrobial resistance in the region.

Cryotherapy with carbon dioxide hydrate enhances immediate recovery of muscle function from neuromuscular fatigue

ABSTRACT This study investigated the effect of cryotherapy with carbon dioxide hydrate (CDH) on fatigue recovery of neuromuscular function and muscle blood circulation. Fourteen young males randomly received three types of 20-min recovery interventions (cryotherapy with CDH [CDH-condition] or normal ice [ICE-condition], or quiet sitting at room temperature [CON-condition]) 5 min following a fatiguing task (50 maximal effort isotonic contractions) on three separate days. The isotonic peak power of the knee extensors at 35 min after the fatiguing task in the CDH-condition (95% of baseline) was greater than that in the other conditions (82–89% of baseline; p ≤ 0.031). In addition, at 25 and 35 min after the fatiguing task, the changes in haemoglobin concentration of the knee extensors from before the fatiguing task in the CON-condition (2.5 and 3.0 μmol/L) were different from those in the ICE-condition (−1.4 and −1.3 μmol/L; p ≤ 0.004) but comparable to those in the CDH-condition (1.1 and 0.7 μmol/L; p ≥ 0.060), respectively. These findings suggest that cryotherapy with CDH did not lower the blood volume following the intervention, unlike that with normal ice, and promoted greater immediate recovery of muscle power from neuromuscular fatigue compared with cryotherapy with ice or passive rest.

CHALLENGES IN BRAIN METASTASES DIAGNOSIS AND TREATMENT

Although brain metastases are the most frequent type of intracranial tumors, their diagnosis and treatment is still challenging. They have poor prognosis and life expectancy is short, as brain metastases appear in advanced stage cancers. In U.S., the rate of recently discovered cancer that will evolve with brain metastases is considered to be 6-14%. Left untreated, brain metastases become lethal in less than 2 months. The most common primary cancers that develop brain metastases are lung, breast, melanoma and colorectal. In our department, approximately 60 patients with brain tumors were diagnosed after surgery with brain metastases in the last 10 years. The most common cancer to metastasize by far was lung cancer, with a mean age at diagnosis 60 years old, affecting mostly smoking men. The majority of patients presented with multiple metastases, unaware of the primary disease and without conducting any oncological treatment prior to admission in our departement. We observed that COVID-19 pandemic period highly affected patients with cancer. The number of patients with brain metastases operated on in our department has drastically decreased in that period. There were a lot of reasons why cancer patients among which being the imposibility to reach emergency rooms without having COVID-19 symptoms and difficulty of reaching radiology centers for early imaging. Most of the patients presented in the Emergency Department with multiple brain metastases, comatose or with focal neurological deficits installed long before presentation, regardless of their primary cancer, thus making neurosurgery an impractical option for most of these cases. Although there have been significant advances in systemic oncological treatment and radiotherapy, surgery remains an essential method of managing brain metastases, even in cases presenting with multiple lesions. Careful patient selection is essential in obtaining the best outcome.

The effect of urinary diversion on kidney function in posterior urethral valves and ureterovesical obstruction.

Posterior urethral valves (PUV) and ureterovesical junction obstruction (UVJO) are common etiologies of lower urinary tract obstruction. The primary objective of therapy is to alleviate the obstruction in the urinary system. Temporary urinary diversion may be necessary in certain situations, such as Urinary tract infection (UTI), sepsis, and unchanging hydronephrosis. This study, aims to assess kidney parameters after urinary diversion (either pyelostomy or ureterostomy) in patients with PUV and UVJO. We conducted a retrospective analysis of all patients diagnosed with PUV or UVJO and treated with urinary diversion following urinary undiversion at our facility between 2015 and 2020. The following variables were collected: demographic details, surgical interventions (type of diversion), serum creatinine throughout follow-up, anterior-posterior diameter of the pelvis (APP), anterior-posterior diameter of the ureter (APU), and sonographic findings of renal parenchymal thickness (PT) as documented by a pediatric radiologist. Additionally, before and after urinary diversion, a Dimercapto succinic acid (DMSA) nuclear renal scan was conducted to assess renal function. We analyzed 67 patients, with a mean follow-up of 38.3months, undergoing either ureterostomy (42 patients) or pyelostomy (25 patients). This included 38 patients with PUV and 29 with UVJO. In PUV patients, significant improvements were observed in APP (MD = 5.56 ± 11.6, p = 0.0194), APU (MD = 5.57 ± 7.28, p < 0.001), and PT (MD = 3.66 ± 2.75, p < 0.001). Similarly, UVJO patients experienced significant improvements in APP (MD = 12.18 ± 18.63, p = 0.005), APU (MD = 7.82 ± 8.98, p = 0.001), and PT (MD = 2.79 ± 3.33, p = 0.001). DMSA scores did not significantly change in either group (p > 0.05). Notably, APP improved more in UVJO patients compared to PUV patients (p = 0.047). Our study suggests that urinary diversion could improve APP, APU, and renal parenchymal thickness in PUV and UVJO patients. The improvement of APP in UVJO patients was greater than in the PUV group. We propose further multi-center studies with longer durations of follow-up and more detailed additional data to support and confirm our results.

Missing outcome data in randomised clinical trials of psychological interventions: a review of published trial reports in major psychiatry journals.

Missing outcome data can pose a serious threat to the validity of randomised clinical trial results. We aimed to study the extent of missing outcome data in randomised clinical trials of psychological interventions. We performed a retrospective study of randomised clinical trial reports of psychological interventions published in World Psychiatry, JAMA Psychiatry, Lancet Psychiatry, American Journal of Psychiatry, British Journal of Psychiatry, or Psychotherapy and Psychosomatics from 2017 to 2022. We assessed the proportion of missing outcome data, whether missing data patterns differed between types of outcomes, participants, intervention lengths, and psychological intervention types, how missing outcome data were handled in the statistical analyses, and whether trialists discussed missing outcome data in the discussion section of the manuscript. We identified 182 randomised clinical trials (233 primary outcomes), of which 206 outcomes (88.4%) were assessed at high risk of bias due to missing data. The overall mean percentage of missing outcome data was 18.3% (95% confidence interval (CI): 16.7-20%) for all outcomes. The percentages of missing data were 18.9% (95% CI: 17.1-20.6%; 180 outcomes) for symptom severity scales and 1.8% (95% CI: 2.3-3.3%; 6 outcomes) for 'hard' binary outcomes. Trials including participants with borderline personality disorder had the highest percentage of missing outcome data (33.1%; 95% CI: 22.3-43.9%) compared with other psychiatric disorders. Fisher's exact test showed that intervention lengths and psychological intervention types were associated with the proportion of missing outcome data (p < 0.001), but there were no clear patterns. Missing outcome data is a considerable problem in randomised clinical trials of psychological interventions, and trialists should consider the corresponding methodological limitations in the design and analysis to reduce the risk of bias due to missing outcome data. Not applicable.