Use Of Conventional Treatments Research Articles

Bacterial agents for controlling anthracnose and soft rot in strawberries: present status and perspectives

ABSTRACT Anthracnose and soft rot, caused by the fungal pathogens Colletotrichum spp. and Rhizopus spp., respectively, stand as prominent diseases impacting strawberries during the postharvest phase, resulting in significant economic losses. The use of conventional treatments involving chemical fungicides has been discouraged since they negatively impact the environment and human health. In this context, alternative strategies, such as biological control, have been required for organic and sustainable agriculture. While bacterial agents, such as Bacillus spp., are successfully used in commercial formulations to control postharvest diseases, there are other bacteria exhibiting antagonistic activities that hold potential in plant disease management. Hence, the current review aims to investigate studies developed over the past decade describing the primary bacterial genera with the potential to inhibit the causal agents of soft rot and anthracnose. Additionally, it aims to provide an overview of biocontrol mechanisms for suppressing these pathogens, detailing methods of application in both pre and postharvest phases, along with strategies for enhancing the efficacy of biocontrol agents. The findings of this review demonstrate that numerous bacterial species possess the ability to effectively control anthracnose and soft rot, both in growing plants and harvested strawberries. This expands the available forms of control and minimises the occurrence of resistant pathogens. Furthermore, the application of postharvest techniques such as edible coatings and bacterial encapsulation proves advantageous, extending fruit shelf life and reducing strawberry decay.

Comparison of Repeated Task Oriented Training for the improvement of motor function with mirror Therapy and Conventional Treatment On upper limb in patients with stroke - A Randomized Controlled Trial (RCT)

Background: This study's goal is to illustrate how mirror treatment can be used with someone who has upper-extremity hemiparesis three months after suffering a cerebrovascular accident (stroke). These patients frequently fail to use their affected upper extremity to its full extent, possibly as a result of the "learned nonuse phenomenon. On each weekday of the 9-day intervention period, the patient performed tasks with the paretic upper extremity for 6 hours while being closely watched. Methods: Study population was patients from Mayo hospital Lahore. Study design was Randomized Controlled Trial. RCT:. 34 patients who met the requirements for inclusion were examined in this study. Before beginning any physical examination, each participant in this study gave their written, informed consent. Patients were divided equally into two groups. The Wolf Motor Function Test and the Numeric Pain Scale were used to measure pain and motor function on the first day. Group A received treatment using mirror therapy, whereas Group B received traditional care. Results: Mirror therapy was significantly effective in lowering pain and boosting functional activity in stroke patients, as evidenced by the comparison of the pre- and post-treatment scores on the NPRS and WMFT for groups A and B. Practical Implication: Stroke leads to multiple dysfunctions depending upon severity of lesion. It may decrease the range of motion and leads to functional dependency or disability. Physical therapy is important in the management of stroke including Strengthening, Stretching, ROMs and Manipulation and Mirror Therapy. This study provided an opportunity to share my personal experience with community. This study was conducted purely in clinical setting of Physiotherapy Department Mayo Hospital, Lahore. Conclusion: The study has proved that mirror therapy is more effective when combined with conventional treatment in management of stroke as compared to only use of conventional treatment. Keywords: Task oriented training, Motor function, Mirror therapy, conventional therapy, stroke, RCT

Effect of mindfulness on anxiety and depression in insomnia patients: A systematic review and meta-analysis.

As a common clinical symptom, insomnia has a high incidence of combined mental illness and it is also a risk factor for the development of depression, anxiety and suicide. As a new concept in the field of health in recent years, mindfulness therapy can improve insomnia, anxiety and depression, which is a new way to solve such diseases. This study aims to systematically evaluate the effects of mindfulness compared with conventional treatment on scores of the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) in people with insomnia and anxiety-depressive symptoms. Articles published before October 2022 were searched from seven databases and included in randomized controlled trials (RCTs) to evaluate mindfulness therapy. The assessment tool of Cochrane bias risk was used to evaluate the methodological quality of the literature. The main outcome indicators were HAMD and HAMA scores, and the secondary outcome indicators were SDS and SAS scores. Ten randomized controlled trials including 1,058 subjects were systematically evaluated and meta-analyzed in this study. In the main outcome indicators, there was a significant difference between mindfulness therapy and conventional treatment in reducing HAMD score (MD: -3.67, 95% CI: -5.22-2.11, p < 0.01) and HAMA score (MD: -3.23, 95% CI: -3.90-2.57, p < 0.01). In the secondary outcome indicators, mindfulness therapy also showed a significant difference in reducing SDS scores (MD: -6.49, 95% CI: -6.86-6.11, p < 0.01) and SAS scores (MD: -7.97, 95% CI: -9.68-6.27, p < 0.01) compared with conventional treatment. For the people with insomnia, anxiety and depression, the use of conventional treatment with the addition of 4-12 weeks of mindfulness treatment can significantly improve anxiety and depression symptoms of patients. This is a new diagnosis and treatment idea recommended for insomniacs with or without anxiety and depression symptoms. Due to the methodological defects in the included study and the limited sample size of this paper, more well-designed randomized controlled trials are needed for verification.

An investigational oral plasma kallikrein inhibitor for on-demand treatment of hereditary angioedema: a two-part, randomised, double-blind, placebo-controlled, crossover phase 2 trial

Guidelines recommend effective on-demand therapy for all individuals with hereditary angioedema. We aimed to assess the novel oral plasma kallikrein inhibitor, sebetralstat, which is in development, for on-demand treatment of hereditary angioedema attacks. In this two-part phase 2 trial, individuals with type 1 or 2 hereditary angioedema aged 18 years or older were recruited from 25 sites, consisting of specialty outpatient centres, across nine countries in Europe and the USA. Individuals were eligible if they had experienced at least three hereditary angioedema attacks in the past 93 days, were not on prophylactic therapy, and had access to and the ability to self-administer conventional attack treatment. In part 1 of the trial, participants were given a single 600 mg open-label oral dose of sebetralstat to assess safety, pharmacokinetics, and pharmacodynamics of the dose. Part 2 was a randomised, double-blind, placebo-controlled, two-sequence, two-period (2 × 2) crossover trial; participants were randomly assigned (1:1) to either sequence 1, in which they were given a single dose of 600 mg of sebetralstat to treat the first eligible attack and a second dose of placebo to treat the second eligible attack, or sequence 2, in which they were given placebo to treat the first eligible attack and then 600 mg of sebetralstat to treat the second eligible attack. Participants and investigators were masked to treatment assignment. The primary endpoint was time to use of conventional attack treatment within 12 h of study drug administration, which was assessed in all participants who were randomly assigned to treatment and who received study drug for two attacks during part 2 of the study. Safety was assessed in all participants who received at least one dose of study drug, starting in part 1. This study is registered with ClinicalTrials.gov, NCT04208412, and is completed. Between July 2, 2019, and Dec 8, 2020, 84 individuals were screened and 68 were enrolled in part 1 and received sebetralstat (mean age 38·3 years [SD 13·2], 37 [54%] were female, 31 [46%] were male, 68 [100%] were White). 42 (62%) of 68 participants completed pharmacokinetic assessments. Sebetralstat was rapidly absorbed, with a geometric mean plasma concentration of 501 ng/mL at 15 min. In a subset of participants (n=6), plasma samples obtained from 15 min to 4 h after study drug administration had near-complete protection from ex vivo stimulated generation of plasma kallikrein and cleavage of high-molecular-weight kininogen. In part 2, all 68 participants were randomly assigned to sequence 1 (n=34) or sequence 2 (n=34). 53 (78%) of 68 participants treated two attacks (25 [74%] in the sequence 1 group and 28 [82%] in the sequence 2 group). Time to use of conventional treatment within 12 h of study drug administration was significantly longer with sebetralstat versus placebo (at quartile 1: >12 h [95% CI 9·6 to >12] vs 8·0 h [3·8 to >12]; p=0·0010). There were no serious adverse events or adverse event-related discontinuations. Oral administration of sebetralstat was well tolerated and led to rapid suppression of plasma kallikrein activity, resulting in increased time to use of conventional attack treatment and faster symptom relief versus placebo. Based on these results, a phase 3 trial to evaluate the efficacy and safety of two dose levels of sebetralstat in adolescent and adult participants with hereditary angioedema has been initiated (NCT05259917). KalVista Pharmaceuticals.

Role of Hemodialysis in Acute Severe Alcohol Intoxication: A Meta-Analysis

Background: Hemodialysis therapy has been used in the treatment of acute alcohol intoxication for many years, especially acute severe alcohol intoxication. Objectives: This study aimed to evaluate whether the combination of conventional treatment and naloxone with hemodialysis has advantages over conventional treatment and naloxone alone in patients with acute severe alcohol intoxication. Methods: After searching 12 databases and 2 clinical trial centers. According to the established inclusion and exclusion criteria, the qualified literatures were screened. The outcome indicators were length of hospital stay, coma time, time of symptom disappearance, the overall complication rate, the incidence of pancreatitis, the incidence of aspiration pneumonia, the incidence of hepatic and renal dysfunction. Analysis was performed using Revman 5.3. Results: This meta-analysis included 13 studies, including 932 subjects. In the treatment of acute severe alcohol intoxication, the use of hemodialysis on the basis of conventional treatment and naloxone could reduce the length of hospital stay (WMD = −15.16, 95% CI: −17.45 to −12.86, p < 0.001) in hours and (WMD = −4.89, 95% CI: −5.53 to −4.25, p < 0.001) in days; coma time (WMD = −5.43, 95% CI: −6.43 to −4.43, p < 0.001); time of symptom disappearance (WMD = −3.92, 95% CI: −5.37 to −2.47, p < 0.001); the overall complication rate (RR = 0.39, 95% CI: 0.28–0.55, p < 0.001); the incidence of pancreatitis (RR = 0.14, 95% CI: 0.05–0.43, p = 0.0006); the incidence of aspiration pneumonia (RR = 0.15, 95% CI: 0.04–0.66, p = 0.01), and the incidence of hepatic and renal dysfunction (RR = 0.21, 95% CI: 0.06–0.72, p = 0.01). Conclusions: It can be concluded that compared with the use of conventional treatment and naloxone alone, the use of hemodialysis on the basis of conventional treatment and naloxone for acute severe alcohol intoxication can reduce the length of hospital stay, coma time, time of symptom disappearance, and the incidence of some complications rate. Large scale, multicenter, and well-designed RCTs are needed in the future to prove our conclusions.

Evaluation of Ulcer Protective Activity of Morus alba L. Extract-Loaded Chitosan Microspheres in Ethanol-Induced Ulcer in Rat Model.

Due to an unhealthy lifestyle, gastric ulcers have become a very common disease these days. Moreover, the side effects linked with the prolonged use of conventional treatments have shifted the paradigm towards herbal therapies. The leaves of Morus alba L. (Family-Moraceae) have been traditionally used for a large number of metabolic diseases. In the present research, we focused on the development of chitosan microspheres using extracts of leaves of Morus alba L. and their evaluation for gastroprotective efficacy against ethanol-induced ulcers in experimental rats. The process of development of M. alba extract microsphere (MEM) is also optimized using the Box-Behnken design. The formulation was prepared at optimized conditions (chitosan concentration (1.66% w/w), volume of glutaraldehyde (4.69 mL), and stirrer rotation per minute, RPM, 854.8), and the percentage yield (Y1) of the resulted microspheres is ∼95% with an encapsulation efficiency (EE) of (Y2(rutin)) ∼86%, Y2(quercetin)) ∼85%, and particle size (Y3) of ∼40 µm. The MEM prepared at optimized conditions can also be characterized for various parameters to ensure the uniformity of parameters. Also, the drug release studies indicated that the percentage release of rutin and quercetin from MEM was enhanced as compared to M. alba extract (ME) alone. Furthermore, in vivo analysis of the antiulcer potential of pretreatment with ME and MEM (500 mg/kg p.o.) in rats indicated that mucosal lesions, gastric juice volume, and total acidity were significantly altered as compared to ethanol-treated animals. Histopathology of tissue sections also confirmed the protection of gastric mucosa on pretreatment with MEM at 500 mg/kg p.o. On the basis of these findings, we can conclude that prepared microspheres can be used to develop a sustained release formulation of extract for the management of gastric ulcers. However, additional research is needed to establish the specific mechanisms of M. alba's antiulcer efficacy.

Allogenic Lysate Platelet on Deep Second Degree Burns

Despite the decline in burns incidence and mortality in recent years, its management remains complex. Surface burns usually receive conservative treatment due to their re-epithelizing potential. Regenerative therapies with platelet concentrate are used as physiological reservoirs of growth factors and proteins, capable of accelerating tissue regeneration. A quasi-experimental study was conducted, with two groups of 30 patients to determine the clinical effect of Lysate Platelet on tissue regeneration in patients with deep dermal burns. Differences were identified between the use of conventional treatment with Silver Sulfadiazine and Lysate Platelet, as well as determining the final outcome of both treatments, in the Plastic Surgery and Cosmetology Service, of the General Clinical-Surgical Hospital "Dr. Juan Bruno Zayas Alfonso" of Santiago de Cuba, Cuba in the period from February 2013 to February 2014. Percentages and totals were calculated as a summary measure for qualitative variables for statistical analysis of the data. For quantitative variables, the calculation of the average and the standard deviation was performed. The female sex prevailed at ages 18 to 45, with the lower limbs highlighting as the most affected region, in both treatment groups. The application of lysate platelet favored healing and epithelialization in a shorter time than conventional treatment with silver sulfadiazine, with minimal adverse events, without complications, achieving a better quality of the final scar and excellent satisfaction level perceived by the burnt patient.

Topical immunotherapy for alopecia areata: A successful diphenylcyclopropenone protocol

Alopecia areata (AA) is an autoimmune disorder that involves the destruction of anagenic hair follicles, resulting in non-scarring patchy hair loss. The patient presented in the following case had not seen improvement by use of conventional treatments and was started on topical immunotherapy, diphenylcyclopropenone (DPCP). This agent is commonly left as a last resort due to its constant need for follow-up, clinician-required administration, and risk of adverse effects. The following case presents a titration schedule using DPCP, resulting in minimal adverse effects and dramatic improvement in hair regeneration.

Antibiotic Resistance Genes and Potentially Pathogenic Bacteria in the Central Adriatic Sea: Are They Connected to Urban Wastewater Inputs?

Despite last decades’ interventions within local and communitarian programs, the Mediterranean Sea still receives poorly treated urban wastewater (sewage). Wastewater treatment plants (WWTPs) performing primary sewage treatments have poor efficiency in removing microbial pollutants, including fecal indicator bacteria, pathogens, and mobile genetic elements conferring resistance to antimicrobials. Using a combination of molecular tools, we investigated four urban WWTPs (i.e., two performing only mechanical treatments and two performing a subsequent conventional secondary treatment by activated sludge) as continuous sources of microbial pollution for marine coastal waters. Sewage that underwent only primary treatments was characterized by a higher content of traditional and alternative fecal indicator bacteria, as well as potentially pathogenic bacteria (especially Acinetobacter, Coxiella, Prevotella, Streptococcus, Pseudomonas, Vibrio, Empedobacter, Paracoccus, and Leptotrichia), than those subjected to secondary treatment. However, seawater samples collected next to the discharging points of all the WWTPs investigated here revealed a marked fecal signature, despite significantly lower values in the presence of secondary treatment of the sewage. WWTPs in this study represented continuous sources of antibiotic resistance genes (ARGs) ermB, qnrS, sul2, tetA, and blaTEM (the latter only for three WWTPs out of four). Still, no clear effects of the two depuration strategies investigated here were detected. Some marine samples were identified as positive to the colistin-resistance gene mcr-1, an ARG that threatens colistin antibiotics’ clinical utility in treating infections with multidrug-resistant bacteria. This study provides evidence that the use of sole primary treatments in urban wastewater management results in pronounced inputs of microbial pollution into marine coastal waters. At the same time, the use of conventional treatments does not fully eliminate ARGs in treated wastewater. The complementary use of molecular techniques could successfully improve the evaluation of the depuration efficiency and help develop novel solutions for the treatment of urban wastewater.

The importance of psychological and nutritional follow-up after bariatric surgery: Literature review

Obesity is a multifactorial chronic disease. The patient may present several clinical conditions associated with it. The clinical picture is complex, which can hinder the use of conventional treatments and methods. Bariatric surgery is an effective long-term treatment for this condition. Based on a literature review, the article aims to discuss the importance of post-bariatric psychological and nutritional follow-up. The fundamental question that underpits this study is: how can typical strategies in the postoperative period contribute to the individual undergoing surgery to give greater importance to his diet and mental health? The most effective treatment strategy has been bariatric surgery, however, the multidisciplinary evaluation that scores the patient’s biological, social and psychological status is fundamental, since psychopathological changes are common to obese individuals. Although bariatric surgery contributes to the improvement in the quality of life of patients, there needs to be greater attention to postoperative treatment. These individuals should be encouraged to continue with nutritional and psychological follow-up in the postoperative period, so that it is possible to prevent possible complications in the medium and long term.

Self-Healing: A Concept for Musculoskeletal Body Pain Management - Scientific Evidence and Mode of Action.

Traditionally, musculoskeletal pain management has focused on the use of conventional treatments to relieve pain. However, multi-modal integrative medicine including alternative/complementary treatments is becoming more widely used and integrated into treatment guidelines around the world. The uptake of this approach varies according to country, with generally a higher uptake in developed countries and in females aged more than 40 years. Integral to the concept described here, is that the body has an innate ability to self-heal, which can be optimized by the use of integrative medical strategies. Stress triggers for acute or recurring musculoskeletal pain are diverse and can range from physical to psychological. The mechanism by which the body responds to triggers and initiates the self-healing processes is complex, but five body networks or processes are thought to be integral: the nervous system, microcirculation/vasodilation, immune modulation, muscular relaxation/contraction and psychological balance. Multi-modal integrative medicine approaches include nutritional/dietary modification, postural/muscular training exercises, and cognitive behavioral mind/body techniques. This article will review the self-healing concept and provide plausible scientific evidence where available.

Quality of life in dental hygienists using complementary alternative medicine approaches for work-related musculoskeletal disorders.

The use of conventional treatment for work-related musculoskeletal disorders (WRMSDs) reduces the prevalence of pain, but with popularity of complementary alternative medicine (CAM) therapies for treatment, it is important to explore their use and impact on dental hygienists (DHs) quality of life (QoL). A cross-sectional survey research design was used with a non-probability sample of dental hygienists (n=85) with WRMSDs who used CAM therapies. The WHOQOL-BREF was used to assess quality of life and compared with CAM use and frequency. Analysis included descriptive, t-tests, correlation and chi-square tests of independence. The most commonly used CAM types were massage (81%) and chiropractic manipulation (67%) with 66% of respondents using two or more CAM therapies. Participants using five or less different CAMs (n=46), compared with those using more than five CAM types (n=35, M=2.3, SD=1.5), t (79)=2.7, p=0.01, had a higher average number of years before they noticed their WRMSD (M=3.3, SD=1.9). Participants reporting use of a higher number of CAM types also had lower QoL physical health domain scores (rho=-0.2, p=0.03). Dental hygienists used a variety of CAM approaches to manage WRMSDs and had a lower QoL across all domains (physical health, psychological health, social relationships and environment) than the normative mean. More research is needed to explore the use of CAM approaches, such as yoga, for prevention and management of WRMSDs to improve QoL.

Use of alternative therapy with Psilocybin in oncologic patients with depression and/or anxiety disorders - integrative review

Cancer is not limited to the physical dimension, but it also affects the entire biopsychosocial context in which the patient is inserted, making him more susceptible to psychiatric disorders such as depression and anxiety. These often require pharmacological intervention, and the use of psilocybin, a substance found in mushroom species, is one of the alternatives considered today. The present study aims to carry out an integrative review regarding the use of alternative therapies, in this case Psilocybin, in cancer patients suffering from anxiety and / or depression disorders. The type of study carried out was an integrative literature review, which was based on a bibliographic survey of texts published between 2010 and 2021 on the PubMed platform. This survey took place between December 2020 and February 2021, with a review of three articles in total. Studies show a potential new line of alternative treatment for anxiety and depression in cancer patients, the use of psilocybin. The treatment is done quickly, sustained and lasting, in conjunction with psychotherapy there is improvement in a single dose. All the studies analyzed so far have been shown to be effective for the treatment of anxiety and depression in cancer patients. With this, psilocybin can be an alternative therapy for those patients in psychological distress due to cancer, especially for those who did not obtain a satisfactory response with the use of conventional treatment, allowing that in the future the substance may become a definitive therapeutic modality for patients in psychological distress due to cancer.

Treatment of patients with advanced diabetes type 2 and hypertension without the use of conventional treatment is possible: white matter alterations and treatment of diabetes and hypertnsion as a new medical hypothesis

Diabetes has been described for 3500 years. Therapeutic options vary but they involve giving insulin or lowering glucose such as metformin. The objective of this study was to report how diabetes type 2 and hypertension can be treated successfully without using the diabetes conventional treatments. A 50 years male with high glucose level (330 mg/dl), HBA1c (9.6%). Blood profile was altered. Hypertension was elevated (145/100) mm hg. The patient expressed his tension and desire not to commit conventional diabetic and hypertension treatment and asked for other therapeutic alternatives. Based on our experience, we recommended him to use two spoon of ground Urtica pilulifera (U. p)/ day, and to use two capsules of Ammi visnaga (A.V) following each meal. Further, the patient followed the dietary restrictions by replacing white bread with a spoon and followed some exercise programs by walking for 30 minutes a day. The results of this program were shown as continuous lowering blood glucose to the level of 117 mg/dl, and blood pressure was 123/79 after 5 days. Taken together, both diabetes type 2 and hypertension can be successfully treated naturally

Successful Medical Management of Neurological Disease in Three Dogs Treated with Acupuncture and Chinese Herbal Medicine

Traditional Chinese veterinary medicine (TCVM) including acupuncture, Chinese herbal medicine, food therapy and Tui-na is focused on providing a unique group of strategies for therapy of neurological disorders. Recent studies have looked at improved treatment of neurological disease by optimizing strategies using traditional Chinese veterinary medicine versus the sole use of conventional treatments. In this case series, successful management of brain and spinal cord disease with acupuncture as the sole treatment or acupuncture and Chinese herbal medicine combined is documented in 3 dogs.

TEXTURE PROFILE OF FILMOGENIC SOLUTIONS WITH POTENTIAL APPLICATION FOR SEED BIODEGRADABLE COATINGS / PERFIL DE TEXTURA DE SOLUÇÕES FILMOGÉNICAS COM POTENCIAL APLICAÇÃO DE REVESTIMENTOS BIODEGRADÁVEIS DE SEMENTES

Seed coating has been used in order to minimize environmental and human health damage generated by the use of conventional treatments. Therefore, the aim of this work was to evaluate the influence of the contents of cassava starch (0.5 and 5% (m m -1 )), glycerol (5 and 50% (m m -1 )) in relation to the starch mass, and pH (5.5 and 6.5) on the texture parameters (hardness, adhesiveness, fracture, cohesiveness, elasticity and gumminess) of filmogenic solutions with the potential to prepare seed coatings. The adhesiveness, cohesiveness, elasticity and gumminess, were influenced by the variables in the studied range. In order to evaluate the coatings produced on seed germination, future work is necessary.

Clinical Burden and Unmet Need in Recurrent Pericarditis: A Systematic Literature Review.

Inflammation of the pericardium (pericarditis) is characterized by excruciating chest pain. This systematic literature review summarizes clinical, humanistic, and economic burdens in acute, especially recurrent, pericarditis, with a secondary aim of understanding United States treatment patterns and outcomes. Short-term clinical burden is well characterized, but long-term data are limited. Some studies report healthcare resource utilization and economic impact; none measure health-related quality-of-life. Pericarditis is associated with infrequent but potentially life-threatening complications, including cardiac tamponade (weighted average: 12.7% across 10 studies), constrictive pericarditis (1.84%; 9 studies), and pericardial effusion (54.7%; 16 studies). There are no approved pericarditis treatments; treatment guidelines, when available, are inconsistent on treatment course or duration. Most recommend first-line use of conventional treatments, for example, nonsteroidal antiinflammatory drugs with or without colchicine; however, 15-30% of patients experience recurrence. Second-line therapy may involve conventional therapies plus long-term utilization of corticosteroids, despite safety issues and the difficulty of tapering or discontinuation. Other exploratory therapies (eg, azathioprine, immunoglobulin, methotrexate, anakinra) present steroid-sparing options, but none are supported by robust clinical evidence, and some present tolerability challenges that may impact adherence. Pericardiectomy is occasionally pursued in treatment-refractory patients, although data are limited. This lack of an evidence-based treatment pathway for patients with recurrent disease is reflected in readmission rates, for example, 12.2% at 30 days in 1 US study. Patients with continued recurrence and inadequate treatment response need approved, safe, accessible treatments to resolve pericarditis symptoms and reduce recurrence risk without excessive treatment burden.

Homeopathy and Antibiotic Resistance

Summary Antibiotic resistance (AR) has long been a problem for doctors and healthcare organizations worldwide. In recent years the issue has become even more pressing: the Global Antimicrobial Surveillance System (GLASS), launched by the World Health Organization in October 2015, bears witness to the growing emergence of antibiotic-resistant microorganisms. In Italy, AR levels are still among the highest in Europe. This is presumably due to over-use of antibiotics. According to the recent Italian National Surveillance Report on bacteriemia, the incidence of AR is on average, for the most widespread bacteria, 25-30%. The causes of the development of AR are complex, but undoubtedly include the excessive and inappropriate use of antibiotics then each strategy to correct these misconducts will be effective. Complementary and alternative medicine (CAM) offers a conceptual alternative to the use of conventional treatments, but in recent years a different model, that of integrated medicine (IM), has been gaining ground. Several studies show that CAM can allow to reduce the recourse to antibiotics in the treatment of respiratory symptoms, without increasing the incidence of complications. A recent study conducted by our Italian Paediatric Society's CAM research group investigated the efficacy of homeopathy in the treatment of acute otitis in children. Ninety children were enrolled and randomized to a homeopathy treatment group or to a control group, each of 45 patients. Antibiotics were prescribed in 33.3% of children in the treatment group and 62.2% of children in the control group (p = 0.006). In conclusion, there is evidence in the literature demonstrating that the use of CAM in general, and homeopathy in particular, can reduce recourse to antibiotics, with positive repercussions for strategies to combat antibiotic resistance.

Enhancing Breast Cancer Treatment Using a Combination of Cannabidiol and Gold Nanoparticles for Photodynamic Therapy.

Indisputably, cancer is a global crisis that requires immediate intervention. Despite the use of conventional treatments over the past decades, it is acceptable to admit that these are expensive, invasive, associated with many side effects and, therefore, a reduced quality of life. One of the most possible solutions to this could be the use of gold nanoparticle (AuNP) conjugated photodynamic therapy (PDT) in combination with cannabidiol (CBD), a Cannabis derivative from the Cannabis sativa. Since the use of Cannabis has always been associated with recreation and psychoactive qualities, the positive effects of Cannabis or its derivatives on cancer treatment have been misunderstood and hence misinterpreted. On the other hand, AuNP-PDT is the most favoured form of treatment for cancer, due to its augmented specificity and minimal risk of side effects compared to conventional treatments. However, its use requires the consideration of several physical, biologic, pharmacologic and immunological factors, which may hinder its effectiveness if not taken into consideration. In this review, the role of gold nanoparticle mediated PDT combined with CBD treatment on breast cancer cells will be deliberated.

Plasma exchange and early thyroidectomy in thyroid storm requiring extracorporeal membrane oxygenation

SummaryThyroid storm with multi-organ failure limits the use of conventional treatment. A 44-year-old male presented with thyroid storm and experienced cardiovascular collapse after beta-blocker administration, with resultant fulminant multi-organ failure requiring inotropic support, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy. Hepatic and renal failure precluded the use of conventional thyroid storm treatment and early plasma exchange was instituted. The patient underwent emergency thyroidectomy after four effective exchanges, with subsequent rapid reversal of multi-organ failure. The challenges of institution of plasma exchanges with ongoing ECMO support, dialysis and timing of thyroidectomy are discussed. This case highlights the important role of early therapeutic plasma exchange (TPE) as an effective salvage therapy for lowering circulating hormones and stabilization of patients in preparation for emergency thyroidectomy in patients with thyroid storm and fulminant multi-organ failure.Learning points:Administration of beta-blockers in thyroid storm presenting with congestive cardiac failure may precipitate cardiovascular collapse due to inhibition of thyroid-induced hyperadrenergic compensation which maintains cardiac output.TPE can be an effective bridging therapy to emergency total thyroidectomy when conventional thyroid storm treatment is contraindicated.End-organ support using ECMO and CRRT can be combined with TPE effectively in the management of critically ill cases of thyroid storm.The effectiveness of plasma exchange in lowering thyroid hormones appears to wane after 44–48 h of therapy in this case, highlighting the importance early thyroidectomy.