Unpleasant Symptoms Research Articles

PENGUJIAN AKTIVITAS DAYA ANALGETIK EKSTRAK n-HEKSANA, ETIL ASETAT DAN ETANOL DAUN KANGKUNG PAGAR (Ipomoea carnea Jacq)

Pain is unpleasant symptom and feeling in of the organs, caused by tissue damage such as inflammatory conditions, infection, or related to muscle spasms. Previous research, is known that leaves Ipomoea carnea can inhibit prostaglandins which are pain mediators. This research aims to determine the activity of analgesic leaves Ipomoea carnea. The leaves Ipomoea carnea macerated with 96% ethanol and partitioned with n-hexane and ethyl acetate. The three extracts tested on male white mice (Mus musculus) with a weight of 25-30 g. The research method used is the writhing test. The test animals were divided into 11 groups. Group 1 (Na CMC 0.5% positive control), Group 2 (Paracetamol as a comparison), Group 3-5 (Ipomoea carnea ethanol extract doses of 50 mg, 100 mg and 200 mg/Kg BW), Groups 6-8 (ethyl acetate extract of Ipomoea carnea leaves doses of 50 mg, 100 mg and 200 mg/kb BW) and groups 9-11 (n-hexane extract of Ipomoea carnea leaves dose 50 mg, 100 mg and 200 mg/kb BW). The pain inducer 0.5% acetic acid intraperitoneally. Observations were carried out for 1 hour every 5 minutes and the percentage of analgesic power was calculated. Ethanol extract provides effect than ethyl acetate and n-hexane extracts, dose of 50 mg/Kg BW 62.4%; 100 mg/Kg BW 70.42% and 200 mg/Kg BW 69.15%. The significant value of the Mann-Whitney test is 0.008 from the test sample against the positive control so it can be concluded that there is analgesic activity from the ethanol extract of Ipomoea carnea leaves.

A Preliminary Phenomenological Exploration of Experiences of the Empty Pelvis Syndrome Derived From a Modified-Delphi: The Price of Survival Following Pelvic Exenteration for Advanced Pelvic Cancer.

The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health-related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived-experiences of EPS complications. Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified-Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes. Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were 'Out of Options', depicting patients forced to accept complications or limited survival; 'The New Normal', with EPS potentially delaying adaptation to post-PE HrQoL; 'Information Influencing Adaptation,' emphasising the significance of patients understanding EPS to cope with its effects; and 'Symptoms,' reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves. EPS may influence patient decision-making, regret, adaptation, and information-seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes.

Management of triggering factor effects in sensitive skin syndrome with a dermo-cosmetic product.

Environmental factors are important in the generation or aggravation of sensitive skin syndrome (SSS). Creams can be useful for patients with SSS, particularly when triggering factors cannot be avoided. Several clinical studies have investigated the safety and efficacy of specific creams in patients with SSS, but the majority were assessed with a single type of triggering factor and were non-comparative. Therefore, this study's aim was to investigate, the benefit of a specific dermo-cosmetic product in response to physical and chemical factors in subjects with SSS. Three clinical studies were performed on subjects presenting SSS. The physical impact was assessed in a stripping test, and in a randomized intra-individual study with a newly developed heat-cold stress model. To assess chemical factors, a capsaicin test on the nasolabial fold was performed. The product significantly reduced the increase in skin microcirculation caused by stripping after 30 min versus. The untreated condition (45.8% vs. 62.0%; p < 0.01). Immediately and at D28, the product induced a significant increase in skin hydration even after a heat-cold stress, while the overall score of unpleasant symptoms significantly decreased compared with the control (8.1 vs. 10.7 and 3.7 vs. 8.0, respectively; p < 0.01). Regarding chemical factors, a significant difference in the sensation intensity (p < 0.001) was observed after capsaicin stress, also in terms of the sensation duration due to the product application versus the control (192 s vs. 403 s; p < 0.001). These studies show that topical application of a dermo-cosmetic product can prevent unpleasant symptoms and improve the skin state in SSS exposed to physical and chemical triggering factors.

Bacteria-responsive drug release platform for the local treatment of bacterial vaginosis

Bacterial vaginosis (BV) is a common vaginal infection affecting millions of women. Vaginal anaerobic dysbiosis occurs whenLactobacillusspp., the dominant flora in healthy vagina is replaced by certain overgrown anaerobes, resulting in unpleasant symptoms such as vaginal discharge and odor. With a high recurrence rate, BV also severely impacts the overall quality of life of childbearing women by inducing preterm delivery and increasing the risks of pelvic inflammatory disease and sexually transmitted infections. Among various BV-associated bacteria,Gardnerella vaginalis(G. vaginalis) has been identified as a primary pathogen since it has been isolated from almost all women carrying BV and exhibits higher virulence potential over other bacteria. When dealing with BV relapse, intravaginal drug delivery systems are superior to conventional oral antibiotic therapies in improving therapeutic efficacy owing to more effective drug dose, reduced drug resistance and minimized side effects such as stomach irritation. Traditional intravaginal drug administration generally involves solids, semi-solids and delivery devices inserted into the vaginal lumen to achieve sustained drug release. However, they are mostly designed for continuous drug release and are not preventative therapies, resulting in severe side effects caused by excess dosing. Stimuli-responsive systems that can release drug only when needed ('on-demand') can help diminish these negative side effects. Hence, we developed a bacteria-responsive liposomal platform for the prevention and treatment of BV. This platform demonstrated sustained drug release in the presence of vaginolysin, a toxin secreted specifically byG. vaginalis. We prepared four liposome formulations and evaluated their responsiveness toG. vaginalis. The results demonstrated that the liposome formulations could achieve cumulative drug release ranging from 46.7% to 51.8% over a 3-5 d period in response toG. vaginalisand hardly any drug release in the presence ofLactobacillus crispatus(L. crispatus), indicating the high specificity of the system. Overall, the bacteria-responsive drug release platform has great potential, since it will be the first time to realize sustained drug release stimulated by a specific pathogen for BV prevention and treatment. This on-demand therapy can potentially provide relief to the millions of women affected by BV.

The effects of a symptom management program on symptom experience and physical function in Thai adults with chronic obstructive pulmonary disease: A single-blind randomized controlled trial study.

Adults with Chronic Obstructive Pulmonary Disease (COPD) experience a range of unpleasant symptoms, including fatigue, dyspnea, sleep disturbances, anxiety, and depression, that are interrelated and impact one another. Developing a program to handle simultaneous symptoms poses challenges but offers advantages for adults with COPD in efficiently managing symptoms. This study aimed to determine the effects of a symptom management program on symptom experience and physical function in Thai adults with COPD. A randomized controlled trial (RCT) with a Repeated Measures design was performed. One hundred and two participants were allocated randomly to either the control group (n = 51) or the experimental group (n = 51). The experimental group received eight weeks of the symptom management program and usual care, while the control care group received only usual care. Data were collected from January 2023 to August 2023 at baseline, 4th weeks, and 8th weeks using the demographic data, the modified Medical Research Council (mMRC), the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Assessment of Fatigue (MAF), the Hospital Anxiety and Depression Assessment Scale (HADS), the COPD Assessment Test (CAT), and 6-Minute Walk Distance (6-MWD). The hypotheses were analyzed using Repeated Measures Multivariate Analysis of Variance (MANOVA). The symptom management program significantly impacted the experimental group's symptom experience and physical function at Weeks 4 and 8 (F = 5.257, p <0.001). There were significantly improved mean scores for the mMRC, MAF, 6MWD, and CAT (p <0.001, p <0.05). No statistically significant differences were observed in the PSQI, HADS-Anxiety, and HADS-Depression over time. Implementing a symptom management program can help patients with COPD efficiently manage their symptoms. In clinical settings, nurses should integrate this program into routine nursing care to enhance the quality of life for patients suffering from COPD. The program can help patients preserve physical functionality while reducing dependence on family and society. Thai Clinical Trials Registry (TCTR20230111006).

Therapeutic intervention of vitamin B12 in mitigating chronic alcoholism induced alterations in adult zebrafish (Danio rerio): a holistic in vivo approach

Background Chronic alcoholism refers to the unpleasant symptoms directly resulting from excessive drinking. Increased alcohol metabolites and an unbalanced oxidative state are likely to blame for the reported effects under these circumstances. According to preclinical and clinical research, vitamin B12 can act on several organ systems with demonstrated neuroprotective, antioxidant, and glutamate modulating properties. Objective This research sought to examine the ameliorative effects of vitamin B12 (VtB12) in persistent alcohol (AlOH) exposed adult zebrafish with the help of following parameters like the anxiety related behavior test, Oxidative stress, and antioxidant assays, histological and immunofluorescence analysis. Methods Zebrafish pretreated with 0.40% AlOH (v/v) for 120 min (+AlOH) or not (−AlOH), were exposed for 6 h to home tank water (−VtB12) or to 59 µg-VtB12/kg-fish food (+VtB12) to analyze anxiety behavior in the geotaxis (novel tank) test as well as the oxidative brain damage in the adult zebrafish. Results Adult zebrafish exposed to chronic AlOH showed a decrease in the distance travelled, average and mobility speed, and increased the average frozen time, the explored area, and total no. of the site explored in the trapezoid tank. AlOH exposure also resulted in oxidative damage, enhanced lipid peroxidation, advanced oxidative protein products, decreased enzymatic and non-enzymatic antioxidant activities, and enhanced reactive oxygen species generation. Additionally, VtB12 supplementation improved neurogenesis, evident in increased Nissl cell numbers and NeuN expression in the brain. Conclusion Chronic alcoholism may be effect on the brain cells as well as on the neuro-behavior of zebrafish. This research demonstrated that VtB12 shows promise as a neuroprotective agent against chronic alcoholism induced alterations in zebrafish’s brain.

Fabrication of Glucose Fluorescent Aptasensor Based on CdTe Quantum Dots.

Diabetes is a chronic metabolic disease characterized by high blood glucose (or blood sugar) levels, which harms the heart, blood vessels, eyes, kidneys, and nerves over time. So, it is crucial to regularly control glucose concentration in biological fluids to check its targets, reduce unpleasant symptoms of high and low blood sugar, and avoid long-term diabetes complications. This study developed a simple, rapid, sensitive, and cost-effective fluorescence system for glucose determination. The fluorescent Aptasensor was fabricated using cadmium telluride quantum dots (CdTe QDs) modified with thioglycolic acid and functionalized with thiol-glucose-aptamer through ligand exchange. The thiol-glucose-aptamer interacted directly with CdTe QDs, increasing fluorescence intensity. However, it decreased when the target molecules of glucose were introduced. The structural and morphological characteristics of the Aptasensor were confirmed by various analytical methods such as UV-visible spectroscopy, Fourier-transform infrared spectroscopy (FT-IR), field emission scanning electron microscopy (FESEM), energy dispersive x-ray spectroscopy (EDX), transmission electron microscopy (TEM), atomic force microscopy (AFM), and dynamic light scattering (DLS). According to the typical Stern-Volmer equation, the relationship between fluorescent quenching and target concentration was linear with a detection limit (LOD) of 0.13 ± 1.95 × 10-11 mol L-1 and a relative standard deviation (RSD) of 1.05%. The Aptasensor demonstrated high specificity towards the target and stability over 28 days. Furthermore, it detected glucose in human serum and urine with a recovery rate of up to 99.74%. The results indicate that the fluorescent Aptasensor could be valuable in developing robust sensing technology for low-concentrated analytes.

A Narrative Overview of Coronavirus Infection: Clinical Signs and Symptoms, Viral Entry and Replication, Treatment Modalities, and Management.

The global pandemic known as coronavirus disease (COVID-19) is causing morbidity and mortality on a daily basis. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV- -2) virus has been around since December 2019 and has infected a high number of patients due to its idiopathic pathophysiology and rapid transmission. COVID-19 is now deemed a newly identified "syndrome" condition since it causes a variety of unpleasant symptoms and systemic side effects following the pandemic. Simultaneously, it always becomes potentially hazardous when new variants develop during evolution. Its random viral etiology prevents accurate and suitable therapy. Despite the fact that multiple preclinical and research studies have been conducted to combat this lethal virus, and various therapeutic targets have been identified, the precise course of therapy remains uncertain. However, just a few drugs have shown efficacy in treating this viral infection in its early stages. Currently, several medicines and vaccinations have been licensed following clinical trial research, and many countries are competing to find the most potent and effective immunizations against this highly transmissible illness. For this narrative review, we used PubMed, Google Scholar, and Scopus to obtain epidemiological data, pre-clinical and clinical trial outcomes, and recent therapeutic alternatives for treating COVID-19 viral infection. In this study, we discussed the disease's origin, etiology, transmission, current advances in clinical diagnostic technologies, different new therapeutic targets, pathophysiology, and future therapy options for this devastating virus. Finally, this review delves further into the hype surrounding the SARS-CoV-2 illness, as well as present and potential COVID-19 therapies.

Impact of Alcohol-Induced Facial Flushing Phenotype on Alcohol Consumption Among Korean Adults: 2-Year Cross-Sectional Study.

The alcohol-induced facial flushing phenotype (flushing) is common among East Asians. Despite a small intake of alcohol, they experience heightened levels of acetaldehyde, a group-1 carcinogen, which, in turn, causes unpleasant symptoms such as redness, acting as a robust protective mechanism against consuming alcohol. However, some individuals with this genetic trait exhibit weakened alcohol restraint, which increases the risk of developing alcohol-related cancers, such as esophageal and head or neck cancer, by several times. Although this flushing phenomenon is crucial for public health, there is a paucity of studies that have comprehensively investigated the effect of flushing or its genotype on alcohol consumption in a large group of East Asians while controlling for various sociodemographic and health-related variables at a country level. This 2-year cross-sectional study aims to explore the effect of flushing on drinking behavior in Koreans and to examine whether the effect varies across sociodemographic and health-related factors. We used data from the Korea National Health and Nutrition Examination Survey (KNHANES) for 2019 and 2020 conducted by the Korea Disease Control and Prevention Agency. Our sample comprised 10,660 Korean adults. The study investigated the association of 26 variables, including flushing, with drinking frequency and amount. The effect of flushing was examined with and without adjusting for the other 25 variables using multinomial logistic regression analysis. In addition, we tested the interaction effect with flushing and conducted a simple effect analysis. We used complex sample design elements, including strata, clusters, and weights, to obtain unbiased results for the Rao-Scott χ2 test, 2-tailed t test, and multinomial logistic regression analysis. The suppressive effect of flushing was significant (P<.001) across all pronounced categories of alcohol consumption in 2019. The ranges of standardized regression slopes and odds ratios (ORs) were -6.70≥β≥-11.25 and 0.78≥OR≥0.50 for frequency and -5.37≥β≥-17.64 and 0.73≥OR≥0.36 for amount, respectively. The effect became somewhat stronger when adjusted for confounders. The effect also exhibited an overall stronger trend as the severity of alcohol consumption increased. The β values and ORs were consistently smaller in 2020 compared to the previous year. A simple effect analysis revealed a diminished alcohol-suppressive effect of flushing on alcohol consumption for specific groups (eg, those with low levels of education, limited family support, physical labor, or health-related issues). Our findings suggest that flushing suppresses drinking in Koreans overall but has little or no effect in certain susceptible populations. Therefore, health authorities should conduct targeted epidemiological studies to assess drinking patterns and disease profiles, particularly regarding alcohol-related cancers, and establish effective preventive measures tailored to this population.

Factors influencing parental fatigue in children with retinoblastoma based on the unpleasant symptoms theory

Parents of children with retinoblastoma, the most common primary ocular malignant tumour in childhood, bear a heavy caregiving burden and are very susceptible to fatigue. However, little is known about their current status of fatigue and factors influencing fatigue; therefore,this study, based on the theory of unpleasant symptoms, and included 317 parents of children with retinoblastoma in China, whose general demographic data were collected, and on whom the fatigue severity scale (FSS), the generalized anxiety disorder (GAD-7) and 2-item patient health questionnaire (PHQ-2) were administered, from 9 March to 1 June 2020. The parents’ FSS score and fatigue incidence were 4.41 ± 1.14 and 67.19%, respectively. The fatigue level was positively correlated with anxiety, depression, education, times of hospitalisations, and treatment types (r = 0.125–0.468, P < 0.05) and negatively correlated with health status, sleep quality, economic status, and family economic situation (r = − 0.120 to − 0.322, P < 0.05). Parent’s anxiety level, being an only child and female sex of child influenced parents’ fatigue. Healthcare personnel need to focus their attention on this high-risk fatigue group and implement appropriate interventions to reduce their fatigue level, promote their physical and mental health, and facilitate better care for children.

Exploring symptom clusters in Chinese patients with peritoneal dialysis: a network analysis

Background In recent years, the research on symptom management in peritoneal dialysis (PD) patients has shifted from a single symptom to symptom clusters and network analysis. This study collected and evaluated unpleasant symptoms in PD patients and explored groups of symptoms that may affect PD patients with a view to higher symptom management. Methods The symptoms of PD patients were measured using the modified Dialysis Symptom Index. The symptom network and node characteristics were assessed by network analysis, and symptom clusters were explored by factor analysis. Results In this study of 602 PD patients (mean age 47.8 ± 16.8 years, 47.34% male), most had less than 2 years of dialysis experience. Five symptom clusters were obtained from factor analysis, which were body symptom cluster, gastrointestinal symptom cluster, mood symptom cluster, sexual disorder symptom cluster, and skin-sleep symptom cluster. Itching and decreased interest in sex may be sentinel symptoms, and being tired or lack of energy and feeling anxious are core symptoms in PD patients. Conclusions This study emphasizes the importance of recognizing symptom clusters in PD patients for better symptom management. Five clusters were identified, with key symptoms including itching, decreased interest in sex, fatigue, and anxiety. Early intervention focused on these symptom clusters in PD patients holds promise for alleviating the burden of symptoms.

#2597 Dynapenia is associated with the frequency of fatigue in patients on hemodialysis: findings from the SARC-HD Study

Abstract Background and Aims Dynapenia is a musculoskeletal disorder characterized by low levels of muscle strength; being highly prevalent in patients undergoing hemodialysis. It may cause dialysis-related unpleasant symptoms and increase the risk of clinical adverse outcomes. Fatigue, a common dialysis-related feature, has been recently recognized as one of the most important patient-reported outcomes. However, whether dynapenia is a risk factor for fatigue remains poorly understood. Thus, we investigated the association between sarcopenia and the frequency of fatigue in patients in hemodialysis of the SARC-HD Study. Method This is a cross-sectional report of the multicenter SARC-HD study that included 19 dialysis units across Brazil and enrolled adult patients undergoing maintenance hemodialysis. Muscle strength was evaluated by handgrip strength (HGS) and 5-time sit-to-stand (STS-5). Dynapenia (i.e., low levels of muscle strength) was defined based on the revised European Working Group on Sarcopenia in Older People. Patients were stratified into four groups: i) no dynapenia; ii) dynapenia by low HGS; iii) dynapenia by low STS-5; and iv) severe dynapenia (low HGS + low STS-5). The frequency of fatigue was self-reported by the patients, divided into three groups; i) never/rarely; ii) sometimes; and iii) most of the time/always. The chi-square test was used to compare the prevalence of fatigue among dynapenia groups; while binary logistic regression tested the association between dynapenia and high frequency of fatigue (sometimes + always) adjusted for age, male sex, and body mass index. Results Nine hundred and fifteen patients were included, the mean age was 57.5 ± 0.5 years, 61.4% were men, and 50.6% black. The prevalence of dynapenia by low HGS, by low STS-5, and both (i.e., severe dynapenia) was 13.9%, 18.8%, and 12.1%, respectively. The frequency of self-reported fatigue as never/rarely was 39.3%, sometimes was 29.8%, and most of the time/always was 30.9%. High frequency of fatigue (sometimes + always) prevalence was 25.9% in patients without dynapenia, 35.4% in dynapenia by low HGS, 37.2 in dynapenia by low STS-5, and 37.8% in severe dynapenia (P = 0.005). Binary logistic regression showed a significant association between dynapenia by low HGS (OR = 1.86; 95% CI: 1.20 - 2.89), dynapenia by low STS-5 (OR=1.71; 95% CI: 1.16 - 2.52), and severe dynapenia (OR=1.97; 95% CI: 1.23 - 3.17) with the high frequency of fatigue compared to the no dynapenia group (Fig. 1). Conclusion Our results showed that patients with dynapenia had a higher risk of self-reported fatigue compared to those without dynapenia. This highlights the importance of recognizing low muscle strength as a potential modifiable factor for fatigue in this population. Therefore, future research may explore interventions that mitigate the impact of dynapenia on the frequency of fatigue.

Factors influencing menstrual regularity among female workers: a cross-sectional analysis study

BackgroundRegularity of menstrual cycles is an important indicator of women’s health and fertility, and female workers are exposed to several factors, such as sleep disorders, stress, and shift work, that affect their menstrual regularity. This makes it necessary to comprehensively identify the determinants of menstrual regularity. Therefore, this study identified the factors affecting menstrual regularity among female workers from physiological, psychological, and situational dimensions based on the theory of unpleasant symptoms.MethodsThis was a secondary analysis of the 2010–2012 Korea National Health and Nutrition Examination Survey and utilized the data of 2418 female workers. Based on the theory of unpleasant symptoms, physiological factors included age, age at menarche, childbirth experience, body mass index, and sleep duration. Psychological factors included stress level, depressive mood, and suicidal ideation. Situational factors included education level, household income, consumption of alcohol, engagement in smoking, and work schedule. The χ²-test and hierarchical logistic regression analysis were performed, reflecting the complex sample design.ResultsAge at menarche, childbirth experience, and body mass index among physiological factors and education level and work schedule among situational factors were found to be related to menstrual regularity. A higher risk of menstrual irregularities was found among those who had given birth (versus those who had not), had a high age at menarche (versus those with a low age at menarche), were obese (versus those who had a normal body mass index), had elementary school-level or lesser educational achievements (versus those with college graduate-level or higher educational achievements), and who had a shift work schedule (versus those with a fixed schedule).ConclusionsIntervention is needed for female workers who have these risk factors, and special attention must be paid to female workers who have a shift work schedule. Additionally, since body mass index can be controlled, intervention concerning body mass index is necessary to reduce menstrual irregularity.

Successful treatment of restless legs syndrome accompanied by headaches for 30 years with herbal prescriptions containing Paeoniae Radix: A case report

BackgroundRestless legs syndrome (RLS) is a neurological disorder that causes unpleasant symptoms in the legs when resting, which are relieved by movement. Pharmacotherapy is the standard treatment. However, current treatment provides only symptomatic relief and may result in adverse effects with long-term use. Treatment protocols using herbal medicines have emerged to compensate for this limitation. Case presentationA 70-year-old Asian woman visited our hospital with worsening headaches that had persisted for 30 years. Her headaches were aggravated by night-time lower-extremity discomfort. The patient was diagnosed with RLS based on the 2012 Revised International Restless Leg Syndrome Study Group Diagnostic Criteria (IRIS). The patient was prescribed herbal medicines, Shihogyeji-tang, Gyejibokryeong-hwan, and Jakyakgamcho-tang, all of which contain Paeoniae Radix. Fourteen days after starting herbal medicine treatment, the IRIS score decreased from 30 to 18. The patient experienced less leg discomfort. Moreover, her sleep time increased, and her headaches resolved. After 28 days of herbal treatment, the IRIS score decreased to 9. Importantly, the patient reported no sleep disturbance or headaches. Subsequently, conventional medications were discontinued. The patient remained stable (IRIS score: 9–10). Herbal treatment was discontinued on day 163. At the last follow-up, (day 364), the patient has not reported any symptom recurrence. ConclusionsWe described a female patient with a 30-year history of RLS symptoms and related sleep disturbances that induced chronic uncontrolled headaches, who experienced improvements shortly after using herbal medicines containing Paeoniae Radix. Conventional medications were discontinued and the patient had no recurrence of symptoms. Considering these, herbal medicines containing Paeoniae Radix may be a suitable alternative treatment for RLS and its related symptoms.

Clinical and cost-effectiveness of pessary self-management versus clinic-based care for pelvic organ prolapse in women: the TOPSY RCT with process evaluation.

Pelvic organ prolapse is common, causes unpleasant symptoms and negatively affects women's quality of life. In the UK, most women with pelvic organ prolapse attend clinics for pessary care. To determine the clinical effectiveness and cost-effectiveness of vaginal pessary self-management on prolapse-specific quality of life for women with prolapse compared with clinic-based care; and to assess intervention acceptability and contextual influences on effectiveness, adherence and fidelity. A multicentre, parallel-group, superiority randomised controlled trial with a mixed-methods process evaluation. Women attending UK NHS outpatient pessary services, aged ≥ 18 years, using a pessary of any type/material (except shelf, Gellhorn or Cube) for at least 2 weeks. Exclusions: women with limited manual dexterity, with cognitive deficit (prohibiting consent or self-management), pregnant or non-English-speaking. The self-management intervention involved a 30-minute teaching appointment, an information leaflet, a 2-week follow-up telephone call and a local clinic telephone helpline number. Clinic-based care involved routine appointments determined by centres' usual practice. Remote web-based application; minimisation was by age, pessary user type and centre. Participants, those delivering the intervention and researchers were not blinded to group allocation. The patient-reported primary outcome (measured using the Pelvic Floor Impact Questionnaire-7) was prolapse-specific quality of life, and the cost-effectiveness outcome was incremental cost per quality-adjusted life-year (a specifically developed health Resource Use Questionnaire was used) at 18 months post randomisation. Secondary outcome measures included self-efficacy and complications. Process evaluation data were collected by interview, audio-recording and checklist. Analysis was by intention to treat. Three hundred and forty women were randomised (self-management, n = 169; clinic-based care, n = 171). At 18 months post randomisation, 291 questionnaires with valid primary outcome data were available (self-management, n = 139; clinic-based care, n = 152). Baseline economic analysis was based on 264 participants (self-management, n = 125; clinic-based care, n = 139) with valid quality of life and resource use data. Self-management was an acceptable intervention. There was no group difference in prolapse-specific quality of life at 18 months (adjusted mean difference -0.03, 95% confidence interval -9.32 to 9.25). There was fidelity to intervention delivery. Self-management was cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year gained, with an estimated incremental net benefit of £564.32 and an 80.81% probability of cost-effectiveness. At 18 months, more pessary complications were reported in the clinic-based care group (adjusted mean difference 3.83, 95% confidence interval 0.81 to 6.86). There was no group difference in general self-efficacy, but self-managing women were more confident in pessary self-management activities. In both groups, contextual factors impacted on adherence and effectiveness. There were no reported serious unexpected serious adverse reactions. There were 32 serious adverse events (self-management, n = 17; clinic-based care, n = 14), all unrelated to the intervention. Skew in the baseline data for the Pelvic Floor Impact Questionnaire-7, the influence of the global COVID-19 pandemic, the potential effects of crossover and the lack of ethnic diversity in the recruited sample were possible limitations. Self-management was acceptable and cost-effective, led to fewer complications and did not improve or worsen quality of life for women with prolapse compared with clinic-based care. Future research is needed to develop a quality-of-life measure that is sensitive to the changes women desire from treatment. This study is registered as ISRCTN62510577. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/82/01) and is published in full in Health Technology Assessment; Vol. 28, No. 23. See the NIHR Funding and Awards website for further award information.

Background and Self-selected Music Listening in Pulmonary and Cardiac Rehabilitation Programs

Purpose: Music is recognized as a useful distractor from unpleasant symptoms during exercise and provides motivation; however, little is known about its application during pulmonary or cardiac rehabilitation programs, including its use, genres, and influences on genre selection. This study aimed to determine the current practice of background and self-selected music listening during exercise training in pulmonary and cardiac rehabilitation programs in Australia. Methods: This was a cross-sectional study, using 2 anonymous, electronic surveys. Participants were program contacts (clinicians) listed on national databases. Results: There were 17 of 100 (17%) and 31 of 250 (12%) respondents for pulmonary and cardiac rehabilitation programs, respectively. A total of 15 respondents (88%) reported using background music for pulmonary rehabilitation, whereas 29 respondents (94%) reported using background music for cardiac rehabilitation. Clinicians and participants had input into the selection of background music genres. Background music was preferentially upbeat and energizing, selected to motivate participants. Use of self-selected music listening by participants for individual use was uncommon in pulmonary (24%) and cardiac rehabilitation (32%). Conclusions: Background music is played during exercise training sessions within a limited proportion of pulmonary and cardiac rehabilitation programs surveyed in Australia. A wide range of genres were applied in background music listening, with selections predominantly based on their potential to motivate participants to exercise. There is little use of self-selected, individualized music listening among participants in these environments.

A taste alteration-related scale assesses megestrol to improve chemotherapy-induced anorexia.

We evaluated the efficacy of megestrol in improving chemotherapy-related anorexia by analyzing the related scales of taste alteration. We conducted the current study on a group of advanced patients with cancer with two or more chemotherapy cycles. The chemotherapy-induced taste alteration scale (CiTAs) scale helped assess the megestrol effects on basic taste perception, aversive taste changes, unpleasant symptoms, and associated concerns. Furthermore, the Short Nutritional Assessment Questionnaire scale (SNAQ) helped measure the impact of megestrol on malnutrition likelihood in patients experiencing chemotherapy-induced anorexia. The World Health Organization Quality of Life (WHOQOL)-BREF Scale was used to evaluate the quality of life of participants, producing scores related to physical health, psychological well-being, environmental factors, and social relationships. The CiTAs scale assessment indicated that administering megestrol significantly enhanced taste perception among advanced patients with cancer undergoing chemotherapy. Notably, the megestrol group patients showed significantly higher Short Nutritional Assessment Questionnaire (SNAQ) scores than the control group. The megestrol group patients also exhibited higher physiological (PHYS) scores than their control group counterparts. However, this distinction was not statistically significant. The study findings indicate that patients who received megestrol demonstrated significantly higher scores in psychological (PSYCH) and environmental(ENVIR) domains than the control group. Furthermore, megestrol administration was associated with significantly elevated SOCIL and ENVIR levels in patients. The proficient efficacy evaluation of megestrol in enhancing appetite, mitigating malnutrition likelihood, and improving the quality of life of chemotherapy-induced anorexic patients can be achieved through taste-related scales.

Efficacy and safety of Pranabb® syrup to reduce cough and improve sleep quality in children compared to usual recommended hydration measures

Background: Coughing is crucial for protecting the airways, but associated to unpleasant symptoms that often lead to pediatrician visits. Natural remedies like honey and essentials oils are being increasingly used to effectively relieve symptoms associated with cough. Objectives: Evaluate the efficacy and safety of Pranabb® cough syrup, an organic honey-based natural formulation tailored for pediatric patients, in relieving cough symptoms. Methods: One-week multicenter comparative clinical study of 50 children, 28 in the treatment group and 22 in the control group with supportive measures (increased hydration). Pediatrician appointments were scheduled at the baseline and on day 7, with a progress check call on day 3. Parents kept a daily cough diary. Results: Day 3 results show a significant decrease in daytime cough, night-time cough and global score more pronounced and statistically significant in the study group, although the more severe baseline level in the study group. On day 7, decrease in daytime and overall cough scores was greater in the study group (p&lt;0.05). The frequency of awakenings due to coughing decreased on day 3 only in the study group (p&lt;0.05) and on day 7 for both groups, although it was higher and more significant in the study group (-1.82 p&lt;0.01 vs -1.25 p&lt;0.05). In addition, the safety analysis confirms that the syrup is not toxic to children. Conclusion: Pranabb® Cough Syrup is safe and effective, reducing cough severity and nighttime awakenings in children and improving parents’ ability to sleep. More randomized clinical trials will be interesting to get more homogeneity between the two groups at baseline.

Buprenorphine Enhanced Taper Tolerability Evaluation Report (BETTER): A Case Series.

Discontinuing sublingual buprenorphine (SL-BUP) has been identified by some patients as a potential outcome of success for opioid use disorder treatment. The process of tapering SL-BUP can be lengthy as unpleasant opioid withdrawal symptoms limit the pace of dose adjustments. Uncontrolled withdrawal symptoms pose a risk for return to illicit opioid use and more patient-centered options for tapering SL-BUP are needed. Previous case reports have identified using extended-release subcutaneous buprenorphine (ER-BUP) to minimize withdrawal symptoms as the dose self-decreases very gradually. Ideal dosing strategies, appropriate patient characteristics, and duration of buprenorphine release with the ER-BUP injection are not well described. We present 8 cases where a single 100 mg ER-BUP injection was administered to patients experiencing intolerable withdrawal symptoms during SL-BUP taper. Patients were taking between 2 and 6 mg SL-BUP daily prior to injection. Three patients experienced mild adverse effects the day after receiving injection, all of which were taking lower SL-BUP doses (2-3 mg). In the 12 months following injection, 3 patients experienced mild, but tolerable withdrawal symptoms at variable intervals. Two patients returned to taking SL-BUP and no patients returned to illicit opioid use. Buprenorphine urine toxicology showed elimination of buprenorphine occurred after 24 weeks. Findings from these cases support current evidence-based guidance that ER-BUP tapering is better tolerated than traditional SL-BUP tapering. These patient cases and pharmacokinetic modeling of ER-BUP suggest that a target preinjection dose of 2 to 6 mg SL-BUP will minimize the risk of more severe adverse effects or withdrawal symptoms. Patients and providers should ensure that remission is well-established before initiating SL-BUP taper. A shared decision-making approach can help support patient autonomy and understanding safety risks of discontinuing SL-BUP. Future prospective studies with larger populations could further refine dosing strategies with various SL-BUP preinjection doses and newer ER-BUP formulations.

The status and influencing factors of fatigue in kidney transplant recipients based on the theory of unpleasant symptoms: A cross-sectional study in China.

This study describes the incidence of fatigue in kidney transplant recipients and analyses the relationship between physiological factors, psychological factors, situational factors and fatigue in kidney transplant recipients. Fatigue, as a common symptom after kidney transplantation, is affected by many factors, but the influence of some factors on the fatigue of kidney transplant recipients is still controversial. This cross-sectional study was designed based on the theory of unpleasant symptoms. Our survey involved 307 participants attending the kidney transplant outpatient clinic of a tertiary Class A hospital (Changsha, Hunan, China). Data were collected between February and April 2021 using a structured questionnaire and electronic medical records. Data were analysed using IBM SPSS 25.0 (SPSS Inc.) RESULTS: It was found that the incidence of fatigue in kidney transplant recipients was 53.1%. According to the binary logistic regression analysis, sleep quality, hypokalemia, anxiety, depression and education level were independent risk factors for fatigue in kidney transplant recipients. The incidence of fatigue in kidney transplant recipients was high and was influenced by physical, psychological and situational factors. Clinical nurses should assess fatigue levels in a timely and multidimensional manner in clinical practice and provide effective and scientific guidance about fatigue self-coping and symptom management for kidney transplant recipients.