Use Of Pharmacological Therapies Research Articles

A rare case of peritoneal tuberculosis mimicking peritoneal carcinomatosis: the ongoing challenge

Tuberculosis (TB) is a serious infection that can involve any organ system and present in various forms. About one-third of the world’s population are carriers of latent TB. Although most cases are from a pulmonary origin, there is a rising prevalence of abdominal TB. Patients with pulmonary or extrapulmonary TB are treated similarly through the use of pharmacological therapy. Nonspecific clinical manifestations of TB have made it difficult for clinicians to diagnose. Peritoneal tuberculosis (PTB) is a serious concern as its symptoms overlap with that of many other chronic conditions, especially in those who are immunocompromised. The lack of highly sensitive and specific testing methods has made early intervention difficult, therefore a high index of suspicion is crucial in the progression of the disease. Here, we present a case of a 71-year-old female with a history of abdominal pain, fever, and weakness. Initial investigation with computed tomography (CT) imaging revealed omental fat stranding that pointed towards peritoneal carcinomatosis (PC) from possible recurrence of her ovarian cancer. Further investigation with a peritoneal biopsy was remarkable for caseating granulomas with fat necrosis confirming extrapulmonary TB. This report highlights a rare case of PTB mimicking PC in an elderly patient who is immunocompromised from the use of long-term corticosteroids who continued to decline after pharmacological treatment of the disease.

Characterizing the journey of Rett syndrome among females in the United States: a real-world evidence study using the Rett syndrome natural history study database

BackgroundWith the advent of the first targeted therapy for Rett Syndrome (RTT), a comprehensive assessment of the journey of RTT is needed to elucidate on present unmet needs in this population. This study characterized females with RTT in the United States and their disease journey with respect to longitudinal treatment patterns, RTT-related outcomes, and changes in disease severity.MethodsThis retrospective cohort study used registry data of females with RTT from the 5211 RTT Natural History Study (RNHS) (November 2015–July 2021). Pharmacological and supportive therapy use, RTT-related outcomes, and RTT severity, as measured by the Clinical Severity Scale and Motor Behavioral Assessment scale, were evaluated following the first RNHS visit. Analyses were conducted overall and in subgroups by RTT type (classic and atypical RTT) and age at first visit (pediatric and adult).ResultsA total of 455 females with RTT were included in the study, of whom 90.5% had classic RTT and 79.8% were pediatric individuals. Over a median follow-up of 4 years, use of pharmacological therapies, including prokinetic agents (42.7% vs. 28.3%), and supportive therapies, including physical therapy (87.3% vs. 40.2%) and speech-language therapy (86.8% vs. 23.9%), were more common in pediatric than adult individuals (all p < 0.05). Nearly half (44.6%) of all individuals had a hospital or emergency room visit, with a higher proportion of visits in individuals with classic RTT than atypical RTT and pediatric than adult individuals (both p = 0.001). An increasing trend in clinical severity was observed in pediatric individuals (mean change per year: 0.24; 95% confidence interval [CI]: 0.03, 0.44), while an increasing trend in motor-behavioral dysfunction was observed in pediatric individuals (mean change per year: 1.12; 95% CI: 0.63, 1.60) and those with classic RTT (mean change per year: 0.97; 95% CI: 0.53, 1.41).ConclusionsFindings from this study highlight the considerable burden of RTT across disease subtype and age. Despite reliance on supportive therapies and healthcare encounters, individuals with RTT experience increasing disease severity and motor-behavioral dysfunction in childhood and adolescence, underscoring the unmet needs of this population and the value of early intervention to manage RTT in the long-term.

Consumption of Purple Sweet Potato Snack Bar and Self Help Group for Blood Glucose Levels in Patients Diabetes Mellitus Type 2

Background: Diabetes Mellitus is one of the most common chronic diseases in the world, occurs when insulin production in the pancreas is insufficient or when insulin cannot be used effectively by the body, so that blood sugar levels exceed the normal range. The increase in the prevalence of diabetes mellitus from year to year has increased significantly. Currently, diet management, exercise and the use of pharmacological therapy are options in the management of diabetes mellitus. In addition to this therapy, there is therapy by giving purple sweet potato snack bars and self help groups. Purpose: to prove the effectiveness of the intervention of a combination of purple sweet potato snack bar and self help group on fasting blood glucose levels of respondents with diabetes mellitus.Methods: This research is a true experimental study with a pretest-posttest design. This study had 60 respondents who were divided into 2 groups and were taken using non-probability sampling techniques with the stratified random sampling method. The study was conducted on March 12, 2022 – June 3, 2022. In this study, statistical analysis was carried out computerized. The pre-test post-test difference test uses the Wilcoxon test. Difference test between groups using Mann-Whitney. Results: This study showed that a significant difference before being given treatment with purple sweet potato snack bars 2x32 grams/3 days a week for 21 days and self-help group therapy for 3 meetings in 21 days showed a significant decrease from 173.30 mg/dl. to 130.03 mg/dl with a delta difference of - 43.267 mg/dl in the intervention group, while the control group also decreased after giving self help group therapy for 3 meetings in 21 days showing a decrease from 189.53 mg/dl to 163.83 mg/dl with a delta difference of -25,700 mg/dl (p = 0.033). Conclusion: Treatment in the form of purple sweet potato snack bar intervention and self help group had an effect on reducing fasting blood sugar levels of respondents with type II diabetes mellitus. type II diabetes mellitus patient.

Характеристика пацієнтів з ішемічною хворобою серця та стабільною стенокардією в Україні, оцінка підходів до їх лікування за даними багатоцентрового дослідження GO-OD

Treatment of coronary artery disease (CAD) and stable angina, includes lifestyle modification, pharmacological therapy and invasive interventions to achieve stabilization or regression of the disease. Knowledge of the current situation regarding the use of pharmacological therapy and evaluation of its effectiveness is necessary for further management optimization. Trimetazidine (TMZ) has previously been shown to reduce angina symptoms and increase exercise tolerance in patients with CAD and stable angina and may be among an option for optimizing antianginal treatment. However, the effectiveness of long-term treatment depends on patient adherence, so the use of TMZ once daily (OD) at a dose of 80 mg may improve satisfaction and adherence in patients with CAD and stable angina.Methods. The GO-OD study is a 3-month, non-interventional, observational, multicenter prospective study conducted in Ukraine in a real-world outpatient cardiology practice during February – August 2021. Physicians were instructed to continue monitoring and treating patients in accordance with usual practice and international guidelines. No additional diagnostic or monitoring procedures were performed. Clinical, instrumental and laboratory data, frequency of angina attacks, consumption of short-acting nitrates (SAN), adherence to antianginal drugs, as well as the overall efficacy, tolerability of TMZ OD 80 mg in real-world clinical practice were analyzed. The observation includes regular assessment of patients` clinical status, treatment optimization and its effectiveness at follow up visits.Results. The study included 1529 patients (mean age 62.5 years, 56 % men). In the absence of adequate control of risk factors, pharmacological control of symptoms, and limited use of interventional and surgical treatments, the frequency of angina episodes was high, most patients had a pronounced angina functional class according to the Canadian Society of Cardiology classification (10.5 % – CCS I, 60.1 % – CCS II, 29.5 % – CCS III). Thus, the average number of angina attacks per week in CCS I was 3.7, in CCS II – 5.2, and in CCS III – 7, 97 attacks. In addition to the severity of symptoms, the following pattern was observed: the higher the angina class, the more risk factors and comorbidities patients had. After 3 months of follow-up due to optimization of therapy, there was a significant (p&lt;0.001) decrease in the frequency of angina attacks – from (5.8±4.7 to 1.6±2.0)/week, and the use of SAN – from (4.2±4.3 to 0.8±1.6)/week). At the same time, in 3 month the % of patients with CCS II and III significantly decreased, while the % of patients with CCS I increased (48.4 % – CCS I, 45.7 % – CCS II, 6 % – CCS III). Adherence to medication was improved: 49 % of patients reported high adherence (vs. 18 % at baseline) and 12 % – low adherence (vs. 52 % at baseline). After 3 months of follow-up most of doctors rated the overall tolerability and effectiveness of the therapy as «very satisfied». Patients’ satisfaction with TMZ OD 80 mg therapy after 3 months of follow-up was 9.5 points [on a scale of 1 to 10 (very satisfied)]. Patients’ assessment of daily physical activity increased significantly: 2.42 versus 5.89 points at baseline (on a scale of 1 to 10 (severe limitation)).Conclusions. In general, the management of outpatients with CAD and stable angina in the current cardiologists’ practice, which was complicated by the COVID-19 pandemic, was not effective enough, resulting in a high frequency of angina attacks – almost 6 per week, and a significant limitation of daily activity due to angina symptoms.Significant deficiency in the management of studied population was insufficient correction of such important risk factors as hypertension, heart rate, dyslipidemia, and lifestyle-related risk factors (overweight and obesity, low level of physical activity). The baseline therapy of patients in the study was in line with current guidelines, but with an insufficient frequency of statin prescription (78 %) and ACE inhibitors (54.5 %); antianginal treatment with an average of 2 or more antianginal drugs was not optimal for controlling angina symptoms, and the frequency of coronary revascularization procedures was also insufficient, mostly during acute MI (58.0 %).Optimization of drug therapy as the first step in correcting the condition of patients with CAD and stable angina in accordance with all current recommendations with the inclusion of the original trimetazidine OD 80 mg once daily among antianginal drugs, as well as active monitoring of patients for 3 months allowed to reduce the frequency of angina attacks regardless of its initial FC, increase patient adherence to treatment and their functional activity.

Efficacy of Amblyopia Treatments in Children Up to Seven Years Old: A Systematic Review.

Amblyopia is a neurodevelopmental disorder of the visual system that impairs the vision of millions of children worldwide. Amblyopia is best treated within the sensitive period of visual development when a child is up to seven years of age. Currently, the gold standard for early treatment of childhood amblyopia is patching, with new treatments emerging in recent years. We aim to evaluate the effectiveness of these newly developed treatments for amblyopia in children aged seven years and younger while comparing them to the current industry standard of patching. We searched online databases including PubMed, Google Scholar, and Cochrane Library for randomized controlled trials (RCTs), systematic reviews, meta-analyses, and narrative reviews relating to amblyopia treatment in children aged seven and younger. We only included articles and studies completed within the last five years and those written in the English language. After compiling a list of 297 articles, we removed duplicates, articles without an available full text, and those not relevant to our topic. Of the remaining 51 articles, we were left with 22 after reading abstracts and removing further irrelevant articles. We did a quality assessment on the remaining 22 articles and were left with 14 articles for our systematic review after removing eight low-quality articles. Of the 14 articles, we had eight RCTs, two systematic reviews, one comparative interventional study, and three narrative reviews. Seven of the articles contained data reinforcing the effectiveness of patching while comparing it to other treatment modalities. Three of the articles had data supporting spectacle correction, including a novel form called alternative flicker glass which delivers occlusion therapy via a spectacle frame with unique lenses, and ultimately deemed it at least as effective or more than patching. Data from three articles supported the use of surgery to successfully correct the angle of strabismus. Findings from five articles backed the use of pharmacologic therapy, specifically atropine when used alongside patching as a more effective alternative to patching solely. However, levodopa plus patching had no advantage over patching alone. Additionally, seven articles addressed the use of virtual reality (VR) and dichoptic therapy as prospective treatments for childhood amblyopia. VR therapy proved beneficial when used within one week after strabismus surgery. Dichoptic training was also effective in improving amblyopic-eye visual acuity when used on its own or in conjunction with spectacles. Furthermore, dichopticmovie therapy was found to be more effective than patching. Thus, we found multiple highly effective treatments for childhood amblyopia that are as effective or more than patching. Future studies should consider prescribing these treatments to larger cohorts while also performing a cost-benefit analysis for each treatment. In addition, more needs to be learned about the potential adverse side effects of these treatments, especially for pharmaceutical therapy.

The Use of Stem Cells in Cardiac Pathologies: A Review

Despite the use of pharmacological therapies, the morbidity and mortality of cardiac diseases remain high. This paper aims to review multiple promising therapies and highlight the innovative role that stem cells can play. Stem cells have been identified as a potential therapeutic alternative to current mainstay medical and surgical interventions for cardiac pathologies, as these cells possess multipotent capabilities that could aid in cardiac regeneration and remodeling without the detriment of scar tissue. Numerous studies have explored the preliminary safety and efficacy of stem cell treatments in cardiac diseases, specifically ischemic heart disease (IHD), congenital heart disease (CHD), and dilated cardiomyopathy (DCM). IHD studies utilized intracoronary and intramyocardial delivery of various stem cell types and found efficacy with intramyocardial delivery of autologous mesenchymal stem cells injected into infarcted cardiac tissue. Similarly, CHD studies utilized intracoronary delivery of cardiosphere-derived cells in conjunction with the well-established Norwood Procedure and found benefits in cardiac function and somatic cell growth. DCM studies in murine models and subsequent clinical trials showed that transplantation with CD34+ stem cells, a cell type marked by muscle satellite cells, improved cardiac function and increased exercise capacity when delivered via intracoronary or transendocardial transplantation methods. While these cumulative results show promise, longer follow-ups and larger sample sizes are needed to validate the efficacy of this therapeutic approach for cardiac diseases in the long term. Stem cells, when combined with existing therapies, have the potential to mitigate the grave morbidity and mortality associated with cardiac pathologies.

The Effect of Diaphragmatic Breathing on Reducing Stress Levels in Nurses

Introduction: Stress is a common psychological problem faced by nurses in Indonesia during the pandemic, especially ER and ICU. This study aims to analyse the effect of diaphragmatic breathing exercises on reducing stress levels in nurses by using the NaDa Android Application.&#x0D; Methods: This study employed a quasi-experimental pre-test and post-test with a control group design. A total of 33 nurses in the Emergency room (17) and the Intensive Care Unit (16) were recruited by using purposive sampling. The control group was given health education and diaphragmatic breathing while the intervention group practiced diaphragmatic breathing using the NaDa Android application for 12 weeks. The data were collected by Perceived Stress Scale-10 and then analysed using a t-test.&#x0D; Result: The average stress level among nurses in the intervention group was 17.53 which reduced to 12,94. The average stress level among nurses in the control group was 21.06 which reduced to 19.88. There was no significant effect on the control group who practiced diaphragmatic breathing (p=0.061). In contrast with the intervention group who have a significant effect regarding stress reduction (p=0.000). The diaphragmatic breathing exercises by Nada Application had an effect on decreasing the stress levels among nurses compared to the respondents in the control group (p=0.000).&#x0D; Conclusion: Diaphragmatic breathing exercises can be recommended to nurses to help them cope with psychological stress and to provide relaxation responses. It also can be an alternative prevention of psychological disorders such as high stress, reducing the use of pharmacological therapy in preventing stress and anxiety.

Hush Little Baby: Promise of the Eat, Sleep, Console Approach

(N Engl J Med. 2023;388:2391–2392) In this editorial written on the recent article by Young et al, entitled “Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal,” Barfield reviews the findings while also discussing the study limitations and need for further investigations. The original study explored using a nonpharmacologic interventions called Eat, Sleep, Console for the treatment of neonatal opioid withdrawal syndrome. The Eat, Sleep, Console tool involves a greater emphasis on meeting the needs of the infant holistically. This approach is appealing due to rising rates of infants diagnosed with neonatal opioid withdrawal syndrome, which puts a greater stress on hospital staff due to the need of longer hospital stays to treat the neonates. Overall, the study found that the use of the Eat, Sleep, Console intervention reduced hospital stay lengths and reduced use of pharmacologic therapy, without significant differences in safety measures assessed at 3 months of age.

Principles of cardiovascular risk management in perimenopausal women with type 2 diabetes

Cardiovascular disease is the leading cause of death in patients with diabetes mellitus. It has been established that the period of menopause, associated with an increase in age and a change in the metabolic background, increases the risk of developing cardiovascular diseases in women with diabetes mellitus. Despite tentative expectations, a number of studies have shown conflicting evidence regarding the beneficial effects of menopausal hormone therapy on CV risk markers in diabetes mellitus. In this connection, therapy with hormonal preparations containing estrogen is currently not recommended for the prevention of cardiovascular diseases in the absence of specific indications. At the same time, estrogen therapy can be used in this group to minimize menopausal symptoms. At the same time, the risk of adverse events associated with the use of menopausal hormone therapy can be estimated using calculation methods for determining cardiovascular risk and breast cancer risk using specific calculators, especially in the group of women with type 2 diabetes.The main principles of cardiovascular risk management continue to focus on lifestyle modification and achieving target levels of cardiovascular risk parameters such as lipid levels, glycemia, and blood pressure. The use of pharmacological therapy to address these risk factors, especially some pleiotropic antihyperglycemic drugs, may provide additional options for the prevention of cardiovascular disease.

The underutilization of preventive cardiovascular measures in patients with cancer: an analysis of the Behavioural Risk Factor Surveillance System, 2011-22.

This study aimed to characterize the influence of a cancer diagnosis on the use of preventive cardiovascular measures in patients with and without cardiovascular disease (CVD). Data from the Behavioural Risk Factor Surveillance System Survey (spanning 2011-22) were used. Multivariable logistic regression models adjusted for potential confounders were applied to calculate average marginal effects (AME), the average difference in the probability of using a given therapy between patients with and without cancer. Outcomes of interest included the use of pharmacological therapies, physical activity, smoking cessation, and post-CVD rehabilitation. Among 5 012 721 respondents, 579 114 reported a history of CVD (coronary disease or stroke), and 842 221 reported a diagnosis of cancer. The association between cancer and the use of pharmacological therapies varied between those with vs. without CVD (P-value for interaction: <0.001). Among patients with CVD, a cancer diagnosis was associated with a lower use of blood pressure-lowering medications {AME: -1.46% [95% confidence interval (CI): -2.19% to -0.73%]}, lipid-lowering medications [AME: -2.34% (95% CI: -4.03% to -0.66%)], and aspirin [AME: -6.05% (95% CI: -8.88% to -3.23%)]. Among patients without CVD, there were no statistically significant differences between patients with and without cancer regarding pharmacological therapies. Additionally, cancer was associated with a significantly lower likelihood of engaging in physical activity in the overall cohort and in using post-CVD rehabilitation regimens, particularly post-stroke rehabilitation. Preventive pharmacological agents are underutilized in those with cancer and concomitant CVD, and physical activity is underutilized in patients with cancer in those with or without CVD. •This paper compared the use of preventive cardiovascular measures, both pharmaceutical and non-pharmaceutical, in patients with and without cancer.•In patients with cardiovascular disease and cancer, there is a lower use of preventive cardiovascular medications compared with those with cardiovascular disease but without cancer. This includes a lower utilization of blood pressure-lowering medications, cholesterol-lowering medications, and aspirin.•Patients with cancer reported lower levels of exercise but higher levels of smoking cessation compared with those without cancer.

Modern approaches to the management of patients with obesity (according to the materials of the Consensus of the American Gastroenterological Association in 2022)

Over the past few decades, the prevalence of obesity has increased dramatically worldwide. Obesity‑related complications such as cardiovascular disease, stroke, type 2 diabetes mellitus, nonalcoholic steatohepatitis, obstructive sleep apnea, osteoarthritis, and certain cancers (eg, colorectal cancer) have also increased, contributing to the high incidence and mortality. Lifestyle modification is the mainstay of long‑term treatment for obesity, but it has limited effectiveness and durability for most people. Pharmacotherapies developed and approved for the long‑term management of obesity are more effective in achieving weight loss, although the daily use of anti‑obesity medications is limited for many reasons. Prioritizing the development of clinical guidelines to inform the use of pharmacologic therapy for the long‑term treatment of obesity in adults, the American Gastroenterological Association published its consensus in 2022 that addresses the important desired (benefits) and undesired (harms) pharmacotherapy outcomes for patients. Outcomes of critical decision‑making included percent of total body weight loss (TBWL), proportion of patients achieving &gt;5%, &gt;10%, and &gt;15% TBWL, discontinuations due to side effects, and serious adverse events. The mean difference of 3% of TBWL between adjunctive pharmacotherapy and lifestyle modification alone, or an absolute 5% of TBWL above the baseline, was considered as a minimal clinically important difference in the effectiveness of pharmacotherapy in the treatment of obesity that corresponded to important benefits for patients. The strength of evidence for all outcomes was assessed using the GRADE system, in which evidence from randomized clinical trials was interpreted as high‑certainty, and confidence in the evidence conveyed confidence in the effect estimates. For each outcome, the evidence was divided into 4 categories (high, moderate, low or very low). According to the GRADE approach, recommendations were marked as «strong» when the phrase «we recommend» was used, or «conditional» when the phrase «we suggest» was used. The guideline panel made 9 recommendations and strongly recommended the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity who have an inadequate response to the lifestyle interventions. Four drugs have been approved by FDA for long‑term use in obesity: liraglutide 3.0 mg/day, semaglutide 2.4 mg/week, phentermine‑topiramate ER, and naltrexone‑bupropion ER. They are considered to have moderate to significant effects on weight loss and little or no harm, so these drugs have a positive balance in favor of their long‑term use. Unfortunately, the last three drugs are not registered in Ukraine.

Living with Type 2 Diabetes: Podcast of a Patient-Physician Discussion.

For patients with type 2 diabetes (T2D), the journey to diagnosis may not be straightforward. Patients can present with one of many diabetic complications before a diagnosis of T2D is made. These include heart disease and chronic kidney disease, in addition to cerebrovascular disease, peripheral vascular disease, retinopathy, and neuropathies, all of which can be asymptomatic in the early stages. In their clinical guidelines on standards of care in diabetes, the American Diabetes Association recommends regular screening for conditions such as kidney disease in patients with T2D. Furthermore, the frequent coexistence of diabetes and cardiorenal and/or metabolic conditions often requires a holistic approach to patient management, with specialists from multiple disciplines, including cardiologists, nephrologists, endocrinologists, and primary care physicians, working together. In addition to the use of pharmacological therapies, which can improve prognosis, the management of T2D should include attention to patient self-care, including appropriate dietary changes, consideration of continuous glucose monitoring, and advice on physical exercise. In this podcast, a patient and a clinician discuss a lived experience of the diagnosis of T2D, and the importance of patient education for understanding and managing T2D and its complications. The discussion highlights the central role of the Certified Diabetes Care and Education Specialist, and the role of ongoing emotional support in managing life with T2D, including patient education through reputable online resources and peer support groups. Podcast video with Pamela Kushner (PK) and Anne Dalin (AD) (MP4 92088 KB).

2023 Guidelines of the Taiwan Society of Cardiology on the Diagnosis and Management of Chronic Coronary Syndrome.

Coronary artery disease (CAD) covers a wide spectrum from persons who are asymptomatic to those presenting with acute coronary syndromes (ACS) and sudden cardiac death. Coronary atherosclerotic disease is a chronic, progressive process that leads to atherosclerotic plaque development and progression within the epicardial coronary arteries. Being a dynamic process, CAD generally presents with a prolonged stable phase, which may then suddenly become unstable and lead to an acute coronary event. Thus, the concept of "stable CAD" may be misleading, as the risk for acute events continues to exist, despite the use of pharmacological therapies and revascularization. Many advances in coronary care have been made, and guidelines from other international societies have been updated. The 2023 guidelines of the Taiwan Society of Cardiology for CAD introduce a new concept that categorizes the disease entity according to its clinical presentation into acute or chronic coronary syndromes (ACS and CCS, respectively). Previously defined as stable CAD, CCS include a heterogeneous population with or without chest pain, with or without prior ACS, and with or without previous coronary revascularization procedures. As cardiologists, we now face the complexity of CAD, which involves not only the epicardial but also the microcirculatory domains of the coronary circulation and the myocardium. New findings about the development and progression of coronary atherosclerosis have changed the clinical landscape. After a nearly 50-year ischemia-centric paradigm of coronary stenosis, growing evidence indicates that coronary atherosclerosis and its features are both diagnostic and therapeutic targets beyond obstructive CAD. Taken together, these factors have shifted the clinicians' focus from the functional evaluation of coronary ischemia to the anatomic burden of disease. Research over the past decades has strengthened the case for prevention and optimal medical therapy as central interventions in patients with CCS. Even though functional capacity has clear prognostic implications, it does not include the evaluation of non-obstructive lesions, plaque burden or additional risk-modifying factors beyond epicardial coronary stenosis-driven ischemia. The recommended first-line diagnostic tests for CCS now include coronary computed tomographic angiography, an increasingly used anatomic imaging modality capable of detecting not only obstructive but also non-obstructive coronary plaques that may be missed with stress testing. This non-invasive anatomical modality improves risk assessment and potentially allows for the appropriate allocation of preventive therapies. Initial invasive strategies cannot improve mortality or the risk of myocardial infarction. Emphasis should be placed on optimizing the control of risk factors through preventive measures, and invasive strategies should be reserved for highly selected patients with refractory symptoms, high ischemic burden, high-risk anatomies, and hemodynamically significant lesions. These guidelines provide current evidence-based diagnosis and treatment recommendations. However, the guidelines are not mandatory, and members of the Task Force fully realize that the treatment of CCS should be individualized to address each patient's circumstances. Ultimately, the decision of healthcare professionals is most important in clinical practice.

669: IMPACT OF A DELIRIUM PREVENTION STANDING ORDER SET IN A SINGLE-CENTER PICU

Introduction: Delirium is a syndrome of acute and fluctuating mental disturbance characterized by inattention, unawareness and confusion. Delirium is highly prevalent in the pediatric intensive care unit (PICU) and could potentially develop in all critically ill patients. The 2022 SCCM pediatric PANDEM guidelines recommends nonpharmacologic measures to prevent delirium prior to initiating pharmacologic therapy such as antipsychotics. The purpose of this study is to evaluate the need for pharmacologic therapy to treat delirium after implementation of a delirium prevention standing order-set at a freestanding children’s hospital. Methods: A retrospective chart review was conducted for patients admitted to the PICU at a free standing children’s hospital between September 2020 and September 2021. Patients were included in the study if they were less than 18 years of age and required the sedation protocol for mechanical ventilation. Orders for non-pharmacologic delirium prevention strategies and the use of the order-set were recorded in addition to the description of the pharmacological regimens prescribed, side effects, and clinical outcomes such as days of mechanical ventilation, ICU length of stay and mortality. Descriptive statistics were utilized to assess results. Results: There were a total of 193 patients assessed with 158 included for analysis, 60 (38%) prior to the standing order-set and 98 (62%) after. The average age was 5.8 years old, with the majority of patients being male (57%) and admitted with respiratory failure (41.1%). Prior to the standing order-set, 10% of patients needed pharmacologic therapy to prevent delirium with 30% of patients having orders for non-pharmacologic delirium prevention strategies. After the standing order-set was implemented, only 9.2% of patients needed pharmacologic therapy and 52% had the non-pharmacologic strategies ordered. Days of mechanical ventilation (6.6 days vs 6.4 days), ICU length of stay (13.9 days vs 13.8 days) and mortality (5% vs 7.1%) were similar between the pre order-set and post order-set groups, respectively. Conclusions: Since creating the delirium prevention standing order-set, non-pharmacologic strategies were ordered more often and there were less patients requiring the use of pharmacologic therapy to treat delirium.

The Efficacy of Zinc Supplementation for Accelerate Bone Healing and Reduce Edema, Trismus and Pain as Post-Operative Sequelae in Maxillofacial Surgery: A Literature Review

Maxillofacial surgery involves an operation to correct a disease, injury or defect of face, jaw or mouth. Recently some strategies have been developed for minimizing postoperative discomfort after maxillofacial surgery, including the use of pharmacological therapy and alternative medicine. However, patients still suffer some pain, swelling, and limitation in mouth mobility and other symptoms after surgery. Reducing malaise and postoperative complications is a critical issue for Plastic Reconstructive doctors. Zinc is a group II b metal that is involved in diverse physiological processes such as growth, immune system modulation and tissue repair, significant reduction in the use of analgesics for oral pain, acts as anti- inflammatory agent can promote wound healing, increases the number of osteoblasts by stimulating protein synthesis in the osteoblastic cells and has many impact on the bone healing process.

Comparative effectiveness of sacubitril/valsartan versus angiotensin converting enzyme inhibitors/angiotensin receptor blockers in de novo heart failure patients

Abstract Introduction Effective use of pharmacological therapy in de novo heart failure (HF) patients is key for slowing down the progression of HF. Randomised clinical trials have shown sacubitril/valsartan (sac/val), providing superior benefit over renin angiotensin system (RAS) blockade with angiotensin converting enzyme inhibitors (ACEi) in patients with HF with reduced ejection fraction (HFrEF) including de novo HF patients. However, real world evidence is scarce. Purpose To compare the rate of all-cause hospitalisations in a real world de novo HFrEF US patient population after initiating sac/val or initiating or continuing RAS blockade with ACEi or angiotensin receptor blockers (ARB) within one year of index date. Methods This retrospective, non-interventional cohort study included adult de novo HFrEF patients (left ventricular ejection fraction ≤40%), from the Optum Electronic Health Records, from Jan 2016 to Mar 2020 (study period: Dec 2013–Mar 2021) who were prescribed sac/val or ACEi/ARB within 30 days of a new HF diagnosis. Patients either with any history of HF in the prior two years or with prior sac/val treatment were excluded. Index date was defined as the first prescription of sac/val or ACEi/ARB after a new HF diagnosis (≤30 days prior to index). One-to-two greedy propensity score matching was used to balance the study arms on demographics and clinical covariates (medications, LVEF, selected comorbidities). Negative binomial models were used to compare the primary endpoint between treatment groups and across subgroups of interest. The primary endpoint was the rate of all-cause hospitalisations within one year from index. Treatment groups were stratified by age, sex, race, ethnicity, history of myocardial infarction, comorbidities and prior ACEi/ARB treatment. Statistical analyses were conducted using R and SAS software. Results Prior to matching, 3,290 patients were initiated on sac/val, 47,678 on ACEi/ARB and post-matching there were 3,290 patients on sac/val and 6,580 patients on ACEi/ARB. Patients with prior ACEi/ARB treatment in both the groups were 1,597 and 2,806, respectively. Mean age was 63.5 in sac/val and 63.7 years in ACEi/ARB groups. After propensity-score matching, the annual rate (per person-year) of all-cause hospitalisation was lower in sac/val compared with ACEi/ARB group, with incidence rate ratio (IRR) of 0.81 (95% confidence interval [CI]: 0.74–0.90) ≤1 year from index. Similarly, in the ACEi/ARB treatment naïve subgroup, sac/val treatment led to 20% reduction in the primary endpoint (IRR: 0.80, 95% CI: 0.69–0.92) compared with ACEi/ARB. Amongst subgroups, results were consistent for most, with significant reduction seen in all-cause hospitalisation rates with sac/val treatment vs. ACEi/ARB. Conclusion Treatment with sac/val vs. ACEi or ARB significantly reduced the risk of all-cause hospitalisations in this real-world study supporting the first-line use of sac/val in treating de novo HFrEF patients. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novartis Pharma AG

Identify the Impact of an Innovative Evaluation Strategy on the Care of Babies Having Neonatal Abstinence Disorder

Aim: The prevalence of neonatal abstinence disorder is increasing, which places a huge strain on the nation's healthcare infrastructure. It's possible that using the usual Finnegan Neonatal Abstinence Scoring System diagnostic technique might result in newborns with NAS receiving needless opioid medication. Researchers came up with a whole new evaluation strategy, and in this paper, we will discuss how it influences the treatment of babies who have NAS. Methods: Researchers took a historical look at the therapy choices made for sixty babies who had been exposed to opioids and were being cared for in the inpatient ward at Sir Ganga Ram Hospital in Lahore. While the FNASS scores of all newborns were monitored and recorded every three to seven hours, the Eat, Sleep, and Console assessment strategy were used to control them. Researchers evaluated the actual medical decisions that have been made using the ESC method with the projected treatment decisions that were based on the recorded FNASS scores. The administration of morphine upon delivery was the main outcome. Results: When employing the ESC method, morphine was administered to 8 newborns, which is a sixteen percent success rate. In comparison, the FNASS method predicted that morphine would be administered to 32 infants, which represents a sixty-four percent success rate (P, .002). When compared to the FNASS method's prediction of 90 days (26.8 percent), the ESC method's prediction of starting or increasing morphine administration was accurate 10 days (3.8 percent) earlier (P, .002). It was noted there were no other possible complications or readmissions that occurred. Conclusion: The frequency with which morphine was administered to infants who were handled using the ESC strategy was much lower than the frequency with which it will be administered if FNASS approach had been used. The ESC method is an efficient strategy for care of newborns diagnosed through NAS. This method restricts the use of pharmacologic therapy and has the potential to result in significant decreases in the amount of time spent in the hospital. Keywords: Neonatal Abstinence Syndrome, Nation's Healthcare Infrastructure.

Implementation of Acupressure as Adjunct Therapy to Reduce Postoperative Nausea and Vomiting

<h3>Background Information</h3> Postoperative nausea and vomiting (PONV) is a common surgical issue that can result in complications such as, electrolyte imbalance, dehydration, pulmonary aspiration, and wound dehiscence. Additionally, PONV can delay hospital discharge, subsequently affecting hospital costs. Substantial research suggests that utilizing a multimodal approach combining prophylactic pharmacologic antiemetics with non-pharmacological therapies can reduce PONV, therefore decreasing the need to utilize multiple doses of rescue antiemetic therapy. Studies have also demonstrated that acupressure can shorten the time from extubation to "ready for discharge" from PACU. Acupressure can produce additive effects with minimal side effects and without potential for adverse drug reactions. <h3>Objectives of Project</h3> The objectives of the project include: (1) Provide education to nursing staff regarding the benefits of acupressure therapy for patients; (2) Educate nurses on the application of acupressure (3) Reduce patient's nausea by adding acupressure into treatment regimen <h3>Process of Implementation</h3> Six perioperative nurses designated as super-users, were instructed by a licensed acupressure provider on the utilization of acupressure for postoperative nausea and vomiting. Instruction was provided on the application of stimulation to specific points or defined pathways on the body (acupressure) that can relieve nausea. Educational sessions with the licensed acupressure provider were comprised of Zoom interactive web sessions, live in-person training, and evaluation of technique at patient bedside. Once deemed competent, the super-users provided acupressure for ambulatory PACU patients who were identified as being at high risk for PONV or for patients who were reported to be experiencing PONV. Super-users assessed severity of nausea before and after the implementation of acupressure to determine effectiveness by using the Edmonton scale. <h3>Statement of Successful Practice</h3> 45 out of 48 patients who received acupressure stated that "they felt less nauseous after acupressure". The evaluation of their Edmonton scores indicated that acupressure, along with nausea medications, reduced PONV. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Acupressure is a non-invasive nursing intervention that provides a non-pharmacologic alternative in the treatment of PONV. Application of acupressure could be incorporated into new-hire orientation for perianesthesia nurses, in education for the treatment of PONV. Utilization of acupressure could decrease the use of pharmacologic therapy, reduce the postoperative complications, and ultimately improve patient outcomes.

Pharmacologic Therapies to Promote Recovery of Consciousness.

Pharmacologic interventions are commonly used to support rehabilitation efforts of patients with disorders of consciousness (DoC). The 2018 practice guidelines recommend amantadine in adults with traumatic DoC to promote functional recovery, though several other stimulants are used off-label in clinical practice and trials, such as methylphenidate, bromocriptine, levodopa, and zolpidem. Differences in the mechanisms of action, adverse effects, pharmacokinetics, and drug-drug interactions should be considered when selecting the best agent for each individual patient. Overall, pharmacologic stimulants may provide a safe and inexpensive pathway to increased functionality and participation in rehabilitation. This article provides a concise summary of scientific evidence supporting the use of pharmacologic therapies to stimulate recovery of consciousness in patients with DoC.

Pharmacological Approaches to the Treatment of Dementia in Down Syndrome: A Systematic Review of Randomized Clinical Studies.

Down Syndrome (DS) is considered the most frequent form of Intellectual Disability, with important expressions of cognitive decline and early dementia. Studies on potential treatments for dementia in this population are still scarce. Thus, the current review aims to synthesize the different pharmacological approaches that already exist in the literature, which focus on improving the set of symptoms related to dementia in people with DS. A total of six studies were included, evaluating the application of supplemental antioxidant therapies, such as alpha-tocopherol; the use of acetylcholinesterase inhibitor drugs, such as donepezil; N-methyl-d-aspartate (NMDA) receptor antagonists, such as memantine; and the use of vitamin E and a fast-acting intranasal insulin. Two studies observed important positive changes related to some general functions in people with DS (referring to donepezil). In the majority of studies, the use of pharmacological therapies did not lead to improvement in the set of symptoms related to dementia, such as memory and general functionality, in the population with DS.