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Introduction Hematologic abnormalities are frequent among persons living with HIV (PLWH). The bone marrow aspirate (BMA) and biopsy (BMB) are commonly performed in the diagnostic approach of patients with unexplained cytopenias. Changes in antiretrovirals, supportive therapy and increased life expectancy have modified the distribution and etiology of cytopenias, questioning their use. Our aim was to analyze the diagnostic yield of BMA, BMB and marrow cultures for the evaluation of cytopenias in PLWH. Methods This was a retrospective cohort of ≥ 18-year-old PLWH undergoing bone marrow assessment (MA) for the evaluation of cytopenias between January 2002 and December 2015. Results A total of 236 cytopenic events were analyzed, 47.9% being PLWH who had a longstanding diagnosis (≥ 1 year). Adherence to antiretrovirals was 63.5%. Anemia was seen in 91.9% and pancytopenia in 39%. Common presentations included fever (52.1%), weight loss (42.8%) and adenopathies (28.8%). Median days from detection to MA was 5 (0 – 63 days). Most common etiologies were non-HIV infectious diseases (31.4%) and benign/malignant hematologic diseases (26.3%). The diagnostic yield was 16.1% for BMA, 20.3% for BMB, 30.5% for both and 35.6% when cultures were added. Patients most likely to have conclusive MA were those with moderate/severe thrombocytopenia (p = 0.007). Fever, splenomegaly, and low CD4+ counts were associated with infectious etiologies, while hematologic diagnoses were related to the presence of adenopathies. Conclusion As a minimally invasive intervention, the MA has a high yield for identifying the etiology of cytopenic events in PLWH, being conclusive in one in three patients. Early performance could lead to prompt diagnosis and timely therapy initiation.

Background Medication errors may occur during chemotherapy and can have fatal consequences. Healthcare Failure Mode and Effects Analysis (FMEA) is a method used to detect potential risks and prevent them. Objective Aim of this study was to evaluate the medication process of intravenous tumor therapy in order to guarantee a high standard of patient safety. Methods The main part of the study was performed at the University Hospital of Bonn, Germany. After assembling a multidisciplinary team, the individual steps of prescription, compounding, transport, and administration of chemotherapy were mapped in a flow diagram. The possible failures were identified and analyzed by calculating the risk priority numbers (RPNs). Finally, corrective actions were developed and after hypothetical implementation re-analyzed to measure their effects on the process. Subsequently, a shortened FMEA based on the catalogue failure modes developed in Bonn was carried out at the University Hospital of Cologne in order to evaluate its transferability to another hospital. Results A total of 52 potential failure modes was identified in Bonn. Relating to the RPNs the most critically steps in the process were associated with the prescription, namely, incorrect information about individual parameters of the patient; non-standardized chemotherapy protocols; and problems related to supportive therapy. A significant risk reduction for most of the failure modes was assessed by implementing suitable corrective actions. The shortened FMEA in Cologne led to a different ranking of failure modes. Conclusion The implementation of this analysis has not only identified various safety gaps, but also shows how patient safety during chemotherapy can be enhanced. Moreover, it has sensitized the practitioners to failure modes potentially occurring in their work routine.

BackgroundSeveral evidence-based psychotherapeutic treatment options are available for depression, but the treatment results could be improved. The D*Phase study directly compares short-term psychodynamic supportive psychotherapy (SPSP) and cognitive behavioural therapy (CBT) for Major Depressive Disorder (MDD). The objectives are 1. to investigate if, from a group level perspective, SPSP is not inferior to CBT in the treatment of major depressive disorder, 2. to build a model that may help predict the optimal type of treatment for a specific individual; and 3. to determine whether a change of therapist or a change of therapist and treatment method are effective strategies to deal with non-response. Furthermore (4.), the effect of the therapeutic alliance, treatment integrity and therapist allegiance on treatment outcome will be investigated.MethodIn this pragmatic randomised controlled trial, 308 patients with a primary diagnosis of MDD are being recruited from a specialised mental health care institution in the Netherlands. In the first phase, patients are randomised 1:1 to either SPSP or CBT. In case of treatment non-response, a second phase follows in which non-responders from treatment phase one are randomised 1:1:1 to one of three groups: continuing the initial treatment with the same therapist, continuing the initial treatment with another therapist or continuing the other type of treatment with another therapist. In both treatment phases, patients are offered sixteen twice-weekly psychotherapy sessions. The primary outcome is an improvement in depressive symptoms. Process variables, working alliance and depressive symptoms, are frequently measured. Comprehensive assessments take place before the start of the first phase (at baseline), in week one, two and four during the treatment, and directly after the treatment (week eight).DiscussionWhile the naturalistic setting of the study involves several challenges, we expect, by focusing on a large and diverse number of research variables, to generate important knowledge that may help enhance the effect of psychotherapeutic treatment for MDD.Trial registrationThe study was registered on 26 August 2016 with the Netherlands Trial Register, part of the Dutch Cochrane Centre (NL5753),https://www.trialregister.nl/trial/5753

Acute liver failure (ALF) in the paediatric patient is a multisystem complex disorder, which occurs in the absence of chronic liver disease. Globally, viruses remain a common cause but drugs, metabolic and autoimmune conditions are important triggers. In up to half of cases no specific cause is identified. The definition entails a coagulopathy with a Prothrombin time (PT) ≥ 15seconds or International Normalized Ratio (INR) ≥ 1.5 not corrected by vitamin K in the presence of hepatic encephalopathy (HE) or a PT ≥ 20 or INR ≥2 or above regardless of HE. HE can be difficult to recognize in children and is defined differently than HE in adults. Timely recognition of ALF improves outcomes and allows time to undertake investigations, provide supportive therapy and arrange transfer to a specialist paediatric liver centre with transplant capacity. The purpose of this article is to review the aetiologies of ALF in children and outline an approach to investigation, management and treatment.

PURPOSE As part of the German interdisciplinary S3-guideline "Diagnosis, Treatment and Followup of Renal Cell Carcinoma", this article aimes to provide guidance regarding the use of supportive therapy and complementary medicine in patients with advanced or metastatic renal cell carcinoma. METHODS The German interdisciplinary S3-guidelines are national clinical practice guidelines that implement the highest methodological quality of evidence-based medicine. Recommendations and evidence-based statements are provided according to available evidence. RESULTS Supportive and palliative care are important areas of tumor treatment and require knowledge on the management of a variety of issues. This article outlines the management of tumor-related symptoms such as pain, undesired treatment-related effects, palliative care and end-of-life care in patients with renal cell carcinoma. CONCLUSION Patients with advanced or metastatic renal cell carcinoma should have access to supportive and palliative care according to their individual needs. There is very limited evidence regarding the impact of complementary medicine for the treatment of patients with renal cell carcinoma.

SUMMARY OBJECTIVE: Exercise is a nonpharmacological supportive therapy which has been specifically identified to reduce postoperative complications or adverse events of cancer or treatments. Although there are few studies combining resistance and aerobic exercise in cancer survivors, exercise programs are very rare in different places in the literature. This study aims to investigate the effects of mixed-type exercise in different venues on weight, body mass index, fatigue, and quality of life in cancer survivors. METHODS: This is a descriptive, intervention study. Participants were included in the study, and the exercise process was between January and November 2019. The exercise group consisted of 32 patients who had just completed their breast cancer treatment and did not have distant metastases, and they applied a mixed exercise program including resistance at home and aerobic exercise in the fitness center for 12 weeks. The patients with breast cancer in the control group (30 patients) did not receive any exercise program. RESULTS: Subjective feelings of fatigue and decrease in concentration, motivation, and physical activity significantly decreased after exercise (p

Este artículo se encuentra disponible en la siguiente URL: https://www.sciencedirect.com/science/article/pii/S0022030221008584?via%3Dihub Retained fetal membranes (RFM), dystocia, and twinning are common postpartum events that increase the risk of metritis, impair reproductive performance, and contribute to antimicrobial use on dairies. The overall objective of this study was to describe treatment decisions after RFM, severe dystocia (cesarean section and fetotomy), nonsevere dystocia (nonmechanical and mechanical assistance to extract the calf), and twinning. A total of 44 dairies from California’s San Joaquin Valley (39 Holstein and 6 Jersey or crossbreed herds) with 450 to 9,500 lactating cows were enrolled in this study. Researchers visited each dairy once to observe cow-side fresh cow health evaluations and to interview health evaluators and maternity workers, using a standardized survey tool. The survey included questions about antimicrobial (class, dose, and duration) and nonantimicrobial therapies for calving-related events. Antimicrobial therapy was used in all 44 dairies to treat RFM at 24 (n = 23), 48 (n = 10), or 72 h (n = 5) after calving, or when puerperal metritis signs were observed (n = 6). Antimicrobial therapy was used after all severe dystocia cases, and after nonsevere dystocia (n = 27) and twinning (n = 15). Ceftiofur products were the most common antimicrobial class; they were used to treat RFM cases (n = 29), nonsevere dystocia (n = 13), and twinning (n = 10). Supportive therapy for calving-related events included nonantimicrobial intrauterine treatments, nonsteroidal antiinflammatory drugs, oxytocin, i.v. calcium, or oral drenches. Our study highlights opportunities to reduce extra-label use of antimicrobials in postpartum cows affected with RFM, and the need for education and outreach efforts on judicious use of antimicrobials. Furthermore, antimicrobial treatment choices differed largely across dairies, indicating a need to reach consensus and promote standardized practices within the industry.

Background: Respiratory tract infection is a disease that can result in high mortality and morbidity. Factors related with severe respiratory infections in children comprise the age of young children, male sex, malnutrition, incomplete vaccination status and breastfeeding only children. This analysis targets the Role of multi-strain probiotics as supportive therapy in reducing the frequency and severity of respiratory infections among children. Place and Duration: In the Pediatric Medicine department of Abbasi Shaheed Hospital, Karachi for six months duration from January 2021 to June 2021. Methods: This was a randomized controlled study in 74 children aged 2 months to 5 years with respiratory infections receiving standard therapy and multi strains probiotics versus standard therapy and placebo. The assessment regarding treatment was done in both groups. Results following 7 days of adjuvant treatment alienated into group I (n = 37) (standard therapy and multi strains probiotics) and II Group (n = 37) (placebo and standard therapy). The factors evaluated in this analysis included subject characteristics, duration of stay, duration of fever, dyspnea, withdrawal, C-reactive protein, rales, breast history and probiotics use. The analysis of data was accomplished using SPSS version 20.0. Results: The males were 51.4% and females were 49.6%), breastfeeding (83.8% in Group-I vs 67.6% in Group-II), children who were not malnourished (81.1% in Group-I vs 86.5% in Group-II), and children who completed vaccination history (91.9% in Group-I versus 78.4% in Group-II). As shown in Table 1 in groups I and II, correspondingly, the mean concentration of CRP in subjects diagnosed with respiratory infections was not statistically significant in 1st group (30.10 (20.01-44.60 mg / l), relative to Group II (28.23 (19.20-46.12 mg / l), respectively (P = 0.39).Multivariate analysis with Ancova showed that probiotics can significantly decrease the time of Rale by 5.84 hours (p = 0.021, CI 95% -10.90 - (- 0.87). Conclusions: In this study, it was found that multi strains probiotic therapy significantly reduced the duration of Rale among children with infections of the upper respiratory tract. Keywords: Respiratory tract infections, children, multi strain probiotics, efficiency.

Coronavirus disease 2019 (COVID‐19) is an important health problem that has a serious adverse impact on the global economy and healthcare systems. The virus is not only involved in the respiratory system, but also causes other systemic effects as well as several gastrointestinal and liver issues. Evidence has shown direct viral invasion into the gastrointestinal tissue and supporting vascular network, causing various manifestations such as diarrhea, nausea, gastrointestinal bleeding, and abnormal liver function tests. The degree of gastrointestinal injury, especially in terms of liver involvement, is correlated with disease severity. There is no specific treatment for gastrointestinal involvement, and the symptoms can be managed with supportive therapy. Moreover, increased liver decompensation and mortality can be found in COVID‐19‐infected patients with coexisting liver disease. As the virus can be identified in gastrointestinal contents, endoscopic procedures during the pandemic should be carefully selected and proper protection strategies should be encouraged to prevent viral transmission., Patients with coronavirus disease 2019 typically present with fever and respiratory symptoms; however, gastrointestinal symptoms and liver issues have also been reported. Endoscopic procedures during the pandemic should be carefully selected and proper protection strategies should be encouraged to prevent viral transmission.

Kidney replacement therapy (KRT) is used to provide supportive therapy for critically ill patients with severe acute kidney injury and various other non-renal indications. Modalities of KRT include continuous KRT (CKRT), intermittent hemodialysis (HD), and sustained low efficiency daily dialysis (SLED). However, circuit clotting is a major complication that has been investigated extensively. Extracorporeal circuit clotting can cause reduction in solute clearances and can cause blood loss, leading to an upsurge in treatment costs and a rise in workload intensity. In this educational review, we discuss the pathophysiology of the clotting cascade within an extracorporeal circuit and the use of various types of anticoagulant methods in various pediatric KRT modalities.

In most people, COVID-19 presents as a mild disease. However, in many people, especially those with comorbidities, profound inflammation manifesting as a cytokine storm may lead to acute respiratory distress syndrome and multi-organ failure. This novel study reports two severe COVID-19 patients from Koja Regional Hospital: a male aged 52 and a female aged 65. Both patients had poor prognoses based on prognostic biomarkers, disseminated intravascular coagulation, nosocomial infections, and were reintubated more than once. Both patients were treated with adjunct autologous activated platelet-rich plasma — a safe and promising therapy — and were ultimately discharged. Thus, this study reports the potential of autologous activated platelet-rich plasma as supportive therapy for severe COVID-19 patients.

Background: Systemic Lupus Erythematosus (SLE) disease is an evolutionary systemic disease affecting one or several organs of the body, such as the kidneys, skin, blood cells and blood system. In sick children, in addition to maintaining growth and development, fulfilling nutritional needs is very useful for accelerating the healing process, shortening the treatment period, reducing the occurrence of complications, reducing morbidity and mortality and preventing malnutrition due to medication or medical action. The purpose of this case is to report a case in Semarang and conduct a discussion of Systemic Lupus Erythematosus cases and the complication so that proper treatment can immediately start.Case Presentation: a 10-year-old girl came complaining of difficulty walking, patient's face was also swollen. Patients with a history of SLE, lupus nephritis, normotension on control, and had undergone 4 times CPA treatment but stopped since March 2020. The patient will continue the 2nd month of Cyclophosphamide (CPA) treatment, but the laboratory examination results show proteinuria +3, the patient also found good nutrition, short stature, and underweight, patient advised to be hospitalized.Conclusion: The patient was diagnosed with SLE, lupus nephritis, normotension on control, short stature, and underweight. Patients receive therapy in the form of methylprednisolone, CPA, anti-hypertensive supportive therapy and management of underweight and short stature children due the medication.

KlasJakub, Kluz Natalia, Piwowar Klaudia. NSAIDs and PPIs - review of new reports. Journal of Education, Health and Sport. 2021;11(9):462-472. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.09.060 https://apcz.umk.pl/JEHS/article/view/JEHS.2021.11.09.060 https://zenodo.org/record/5524096 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 15.09.2021. Revised: 20.09.2021. Accepted: 23.09.2021. NSAIDs and PPIs - REVIEW OF NEW REPORTS Jakub Klas1, Natalia Kluz1, Klaudia Piwowar1 1Medical University of Lublin ORCID ID and E-mail: Jakub Klas https://orcid.org/0000-0002-4795-1909jakubklas99@gmail.com Natalia Kluz https://orcid.org/0000-0002-5801-5913nataliakluz99@gmail.com Klaudia Piwowar https://orcid.org/0000-0001-8232-003Xklaudiaklaudia66@gmail.com Abstract The aim of this study is to systematise knowledge on non-steroidal anti-inflammatory drugs (NSAIDs) - cyclooxygenase (COX) enzyme inhibitors and proton pump inhibitors (PPIs) inhibiting potassium hydrogen ATPase. A review of recent reports on possible side effects and new therapeutic options will be presented. Results: Over the last few years, reports of PPI side effects have been published: drug-induced thrombocytopenia, severe hypomagnesemia, hyponatremia or rhabdomyolysis. In the case of NSAIDs, ancillary therapeutic effects in the supportive therapy of multiple myeloma or in the reduction of adenoma formation in the colon stand out, but also cases of acute kidney injury in children. On the basis of meta-analyses, attempts were made to demonstrate the effect of individual NSAIDs on the occurrence of cardiovascular complications, stroke or myocardial infarction Conclusions: Despite the fact that the indicated preparations were admitted to the list of drugs several decades ago, still their pharmacological potential (on the example of NSAIDs, which can be successfully used even in complementary therapy) has not been fully exploited. The aforementioned reports on side effects must not be forgotten. It is possible that the examples presented in the review will raise awareness in order to use these drugs with greater respect, in accordance with the recommendations in the leaflet. Key words: Non-steroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs)

The threat posed by COVID 19 outbreak, which is considered to be a global pandemic, is immeasurably affecting all the communities worldwide. COVID-19 is a zoonotic disease, which can affect birds, humans and, other animals. The emergence of this pandemic has been creating a tragic situation worldwide by affecting more people through human-human transmission. The burden (both healthwise and economic) placed by the disease is so huge that any measures to improve the current situation, to fasten up the recovery of already affected patients and, to reduce the risk of death and health deterioration should be considered. Vaccination, being the hope in the scenario, helps in preventing the condition to an extent, but in the absence of availability of a proper drug regimen to fight off COVID 19, the requirement of the need to find a system to control the severity of the infection is a necessity Nutritional supplementation helps in boosting up the immune system especially, vitamins like vitamin C, Vitamin D, Zinc, Omega 3 fatty acids, etc. They also exhibit established immunomodulatory, antiviral as well as anti-inflammatory effects. Pieces of evidence have also highlighted the importance of supportive therapy using nutrient supplements in covid patients as it helps in prominent decreasing of SARS CoV2 load of the virus and also significantly reduces the hospitalization period. Hence the nutritional levels of each of the infected person must be assessed before initiating the anti-viral therapy. The search criteria used were PubMed, Medscape, google scholar, etc. The keywords used to search were COVID 19 Supportive therapy, Vitamin D, Vitamin C, Nutrient supplementation, Host immunity, etc. The range of years is between 1978 and 2021. © 2021 The Authors. Published by Innovare Academic Sciences Pvt Ltd.

In der supportiven Onkologie werden zunehmend Verfahren aus dem Bereich der Naturheilkunde erganzend eingesetzt, um Nebenwirkungen zu lindern. Dieser Artikel beschreibt am Beispiel der oralen Mukositis, welche naturheilkundlichen Therapien sich in der Praxis bewahrt haben. In supportive oncology, methods from the field of naturopathy are increasingly being used to alleviate side effects. Using the example of oral mucositis, this article describes which naturopathic therapies have been successfully proven in practice.

Background and objectives There is a lack of data regarding the situation of melanoma patients receiving systemic therapies in their last months of life. Patients and methods All melanoma patients who died in 2016 or 2017 and who had been treated by systemic therapies within the last three months of life were retrospectively analyzed. The study was conducted within the Committee "supportive therapy" of the Work Group Dermatological Oncology (ADO). Results 193 patients from four dermato-oncological centers were included. More than 60 % of the patients had ECOG ≥ 2 and most of them received immune checkpoint inhibitors (ICI) or targeted therapies (TT). 41 patients benefited from the last therapy in terms of radiological and laboratory findings or state of health. Although ECOG was worse in the TT cohort compared to the ICI group, the proportion of patients benefiting from the last therapy with TT was significantly higher and TT therapy could be carried out more often on an outpatient basis. Conclusions This study indicates that there is a tendency towards an overtreatment at the end of life. Nevertheless, TT might be a reasonable therapeutic option for advanced BRAF mutant melanoma, even in highly palliative situations.

OBJECTIVES Our aim was to identify factors associated with overall survival and the efficacy of postrelapse treatment protocols and to determine whether pretransplant consolidation therapy and minimal residual disease status pose a survival benefit. MATERIALS AND METHODS Patients with acute myeloid leukemia who underwent stem cell transplant between 2007 and 2018 were enrolled retrospectively. The effects of pretransplant cytogenetic and minimal residual disease status, pretransplant consolidation therapies, development of graft-versus-host disease, postrelapse treatment protocols, and type of con-ditioning regimens on overall survival were analyzed. RESULTS In 76 study patients, the cumulative overall 1- and 5-year relapse probabilities were 67.8% and 58.7%, respectively. Overall survival rates at 3 and 5 years in patients with and without relapse were 23.5% and 0% and 95.9% and 91.1% (P < .001), respectively. Although mean postrelapse overall survival was better with intensive salvage plus donor lymphocyte infusion, no significant differences were shown versus other therapies (intensive salvage, nonintensive salvage, intensive salvage or nonintensive salvage plus donor lymphocyte infusion, or supportive therapy). Twenty-three patients (30.3%) died during the study period with a median survival of 9.6 months. Patients with favorable, intermediate, and unfavorable cytogenetic status showed overall survival of 46.6 ± 10.4, 54.6 ± 4.4, and 36.9 ± 5.9 months (P = .807). Patients with and without minimal residual disease and patients who received or did not receive consolidation therapy had similar overall survival. Relapse was an independent predictor of overall survival (increased mortality risk of 26.22). Patients who developed graft-versus-host disease showed decreased relapse. CONCLUSIONS Relapse is the most important predictor of overall survival and is associated with poor prognosis. Pretransplant minimal residual status and cytogenetic status showed no effect on relapse rates and overall survival, and consolidation therapy did not improve outcomes.

Fatigue is an enervating symptom of prolonged dialysis of patients and significantly impacts the health related quality of life of dialysis patients. Reduction of fatigue in dialysis patients is a challenging task for any health care provider. Fatigue develops during long term dialysis usually due to chronic health conditions associated with prolonged dialysis. The contributing factors for fatigue in end stage renal disease (ESRD) patients may be broadly classified into physiological, psychological / behavioural, socio-demographic and dialysis related factors. It is known that some of these factors are modifiable leading to reduction in fatigue. A multidisciplinary health care strategy comprising alternative therapy such as acupressure; mind based therapy such as meditation, deep breathing and yoga; body based therapies such as physical activity, therapeutic exercise, body massage; biological based therapy such as diet and nutrition shall help to reduce the fatigue in dialysis population. Conclusion: To improve the patient care and health related quality of life in dialysis patients, nurses should develop a framework for decreasing the fatigue. This concept paper describes the various therapies available for reducing the fatigue and discusses the ways of including these supportive and alternative therapies into regular medical care. Key words: Fatigue, ESRD, hemodialysis, alternative and supportive therapy

Purpose of review Cognitive behavioral therapy (CBT) with exposure and response prevention is the first-line treatment for obsessive-compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD). We review here recent developments in CBT and related therapies in treating OCD and related disorders. Recent findings Superiority of CBT over medications in treating OCD is being questioned by some recent meta-analyses, nonetheless CBT continues to be the mainstay of treatment. Web-based therapies have been shown to be beneficial in treating at least mild-to-moderately ill patients. Mindfulness-based CBT, intensive residential treatment and Bergen 4-day concentrated exposure are also proving to be useful in treating OCD. Large well designed studies have demonstrated the efficacy CBT over supportive therapy in treating BDD. Research on the efficacy of CBT in treating hoarding disorder is accumulating. Summary Efficacy of web-based CBT has a potential public health importance in that CBT may now become accessible to all and benefit at least mild-to-moderately ill patients who form most of the clinically ill sample. Similarly, efficacy of Bergen 4-day concentrated exposure will have a huge public health implication if the findings can be replicated in other centers across the world.

Introduction: COVID-19 is the infection caused by the new coronavirus. Specific treatment for COVID-19 has not been established, yet. It is important to determine the disease severity of the patients at the first admission. Therefore, the exploration of biomarkers is deemed necessary. We aimed to assess the diagnostic and early prognostic value of CRP and LDH levels in possible COVID-19 patients presenting with a severe clinical picture. Methodology: We evaluated the correlations of relevant routine laboratory test results with disease severity in COVID-19 patients admitted to our infectious diseases clinic. Patients were divided into severe and non-severe disease groups based on clinical findings, oxygen saturation levels in the arterial blood, biochemical test results, and radiological findings. Differences in the findings between the two disease severity groups were examined to determine potential biomarkers. Results: Median age and the CRP and LDH levels in the severe disease group were statistically significantly higher compared to the nonsevere group (p < 0.0001). No other parameters statistically significant differences have been observed between the two groups (P > 0.05). Conclusions: CRP and LDH levels were positively correlated with lung lesions in early-stage COVID-19, potentially reflecting disease severity. Because LDH and CRP levels can potentially reflect the pulmonary function, they can be potential predictors of COVID-19- related respiratory failure. For avoiding poor prognosis; LDH and CRP should be considered as potential predictors for identifying the need for thoracic CT scans, close monitoring of pulmonary function, and aggressive supportive therapy early in the course of COVID-19.

BACKGROUND: Non-pharmacological management is carried out by adjusting the lifestyle and non-pharmacological therapy for hypertension sufferers. They use herbal therapy, which is believed to have low side effects, easy, and inexpensive, such as Eleutherine americana Merr Tea. AIM: This study aimed to analyze Effect of E. americana Merr Tablet on blood pressure in hypertensive patients to be used as supportive therapy to reduce and stabilize blood pressure. METHODS: This study used a quasi-experimental research design pre-post-test with a control group design, involving 30 respondents. Data collection was carried out for 1 month. Then blood pressure observations were carried out every 1 week for a month after giving E. americana tablets. The sampling technique was purposive sampling method. The data analysis used was the Independent Sample T-Test with a significance level of p < 0.05. RESULTS: The majority of respondents according to age were in the final elderly age range; 15 people (50%) were 56–65 years old. Most of the respondents involved were female, about 18 people (60%). The respondents’ hypertension category included hypertension Grade 1 (57%) and hypertension Grade II (43%). The independent sample t-test obtained p = systole was 0.029 and diastole was 0.000 (p < 0.005). It showed a significant difference in blood pressure before and after being given E. americana tablets in hypertensive patients. CONCLUSION: Significant decrease in systolic and diastolic blood pressure in patients with suspected hypertension who obtained E. americana tablets.

Relevance. Adaptation to prostheses and their further wearing is often associated with traumatic injuries of the oral mucosa. Mechanical traumas of the oral mucosa with removable laminar dentures, toxic effects of plastic components, the allergic effects of the prosthesis on the oral mucosa and the prosthesis wearer's body as a whole, as well as a stress factor considerably contribute to the occurrence of prosthetic stomatitis. Most often, a removable laminar denture acts as a combined stimulus. The manifestations of diabetic microangiopathies in the oral mucosa enhance the severity of prosthetic stomatitis in individuals with diabetes mellitus. The clinical picture of prosthetic stomatitis also depends on the size and condition of denture supporting area, for instance, atrophy of the edentulous jaws, conditions for anatomical retention of dentures. Therefore, the treatment of stomatitis in patients who wear removable laminar dentures is still a challenging problem in orthopaedic and therapeutic dentistry. Purpose and objective: to investigate available treatment approaches and maintenance therapy for managing prosthetic stomatitis in patients with diabetes mellitus who wear removable acrylic laminar dentures; to offer our newly developed treatment and maintenance therapy of prosthetic stomatitis in diabetic patients. Material and methods. The existing approaches and methods of treatment and maintenance therapy for prosthetic stomatitis in patients with diabetes mellitus were thoroughly investigated with clear focus on their advantages and disadvantages. The available methods to manage the complications caused by laminar denture wearing in patients with diabetes mellitus include topical remedies and oral hygiene products. The treatment of prosthetic stomatitis in patients who wear dentures is often reported as ineffective. Therefore, at present, it is relevant to search for new methods of treating prosthetic stomatitis under diabetes mellitus with the use of agents that boost the body antioxidant protection, stimulate tissue regeneration and epithelialisation. Results. The method we have developed for the treatment of prosthetic stomatitis in individuals with diabetes mellitus includes the application of 2% Thiotriazolin ointment for local treatment, and Thiotriazolin preparation for systemic therapy. Thiotriazoline is a domestic drug of polytropic action. It has membrane-stabilizing, antioxidant and reparative properties. Thiotriazoline stimulates tissue regeneration and epithelialisation processes, somewhat reduces the intensity of the inflammatory process. In dental practice, 2% Thiotriazolin ointment is recommended to treat ulcerative lesions of the oral mucosa and periodontal tissues. Our treatment method includes the following steps: after the denture adjustment and sanitation of the oral cavity done, patients are prescribed to apply 2% Thiotriazolin ointment onto the denture supporting areas, which are the most often traumatized, in particularly, onto the maxillary tubercles, along the transitional fold, in the sublingual, retromolar and retroalveolar spaces, daily for 7-10 days. The patients are also recommended to apply 2% Thiotriazolin ointment onto the inner surface of the prosthesis base. For systemic therapy, “Thiotriazolin” is prescribed to be taken by mouth in a dosage of 1 tablet of 100 mg per day for 30 day course. Supportive therapy involves Quvertin, while Lizak tablets are used for local prophylaxis. Following the oral sanitation, patients are prescribed to Lizak tablets (should be held in the mouth until dissolved slowly) 3-4 times a day for 5-7 day course. As part of a comprehensive supportive therapy, patients are prescribed Quvertin tablets, 1 tablet twice a day 30 minutes before meals (chew the tablet) for 30 day course. Conclusion. The proposed method of the therapy of prosthetic stomatitis in people with diabetes mellitus is quite easy to use, causes no side effects, produces a positive effect on the clinical course of the conditions, and enabled to achieve a stable remission after the disease, and, thus, can be recommended for implementing into dental practice. The described maintenance therapy for diabetic patients with prosthetic stomatitis is clinically effective, has no side effects, and can increase the periods of remission after the disease. This combination therapy can be recommended as an effective treatment option in therapeutic and orthopaedic dentistry.

Current approaches to the treatment of patients with metastatic malignant tumors have changed significantly over the past decade. Instead of a purely palliative systemic or just supportive therapy, a large proportion of patients receive an aggressive local treatment directed not only to the primary tumor, but also to metastatic foci, and a number of studies demonstrate the advantage of such approach. This review provides information on the role of radiation therapy as a local method of treatment of cancer patients with oligometastases.

Background Research on predictors of treatment outcome in body dysmorphic disorder, a common and severe disorder, is very limited, and no prior studies have examined moderators of outcome. Because treatment is often but not always efficacious, it is important to identify who is more likely to benefit. We examined predictors and moderators of improvement with therapist-delivered cognitive-behavioral therapy versus supportive psychotherapy in the only study of these treatments for body dysmorphic disorder. This report presents secondary analyses from a study whose primary findings have previously been published (Wilhelm et al., 2019). Methods Participants (N=120) with DSM-IV body dysmorphic disorder were randomized to therapist-delivered weekly cognitive-behavioral therapy or supportive therapy for 24 weeks. Using reliable and valid measures, we tested baseline body dysmorphic disorder severity, insight/delusionality, and depression severity as predictors and moderators of overall and treatment modality-specific symptom change. We explored additional variables as predictors and moderators of outcome. Results Greater treatment credibility (p=0.02) and presence of obsessive-compulsive personality disorder (p=0.03) predicted greater improvement. Serotonin-reuptake inhibitor treatment at baseline (unchanged during the study) (p=0.01) predicted less improvement. No other variables predicted or moderated outcome (all p>0.05). Limitations The study was not powered a priori to detect predictor or moderation effects, which limited our ability to detect them unless they were strong. Conclusions Because greater treatment credibility predicted better outcomes, fostering credibility during therapy may maximize gains. Improvement was not impeded by more severe body dysmorphic disorder, depressive symptoms, or poorer insight. No variables moderated treatment-specific improvement.

Objective To determine the neurological outcome of targeted temperature management (TTM)for patients scoring lower than 8 on the Glasgow coma scale (GCS) upon return of spontaneous circulation (ROSC) after cardiac arrest. Study design Retrospective cohort study. Place and duration of study Department of Anaesthesiology and Reanimation, Sakarya University Education And Research Hospital, Sakarya, Turkey from January 2018 to October 2019. Methodology Data of patients hospitalised in the AnaesthesiaIntensive Care unit for cardiac arrest receiving TTM and standard supportive therapy were analysed. Neurological outcome was evaluated with cerebral performance category (CPC) scores. Hospital stay and 30-day mortality was also noted. Results Data from 58 patients were analysed; 31 had received standard supportive therapy (non-TTM group) and 27 were treated with TTM (TTM group). There was no significant difference in hospital stay and patients' 30-day mortality between the two groups. The number of patients in the TTM group with CPC scores of 1 and 2, rated as a good neurological result, was significantly higher (n=11,40.7%) than in the non-TTM group (n=2, 6.5%;p=0.002). The number of patients with CPC scores of 3 and 4, rated as having a neurological disability,was higher in the non-TTM group (n = 9, 29%) than in the TTM group (n=1, 3.7%). Conclusion Neurological results were better in the TTM group of patients with ROSC. However, there was no significant difference in mortality between the TTMand non-TTM groups. Key Words: Targeted temperature management, Cardiac arrest, Neurological outcome, Cerebral performance category.

Coronavirus Disease (COVID-19) has rapidly spread and caused a high number of mortalities. To this day, effective therapy to cure this virus is yet to be found. A number of treatments were tested; however, the result is not satisfactory. Therapeutic plasma exchange (TPE) is one of the supportive therapies applied to treat COVID-19 patients with moderate to severe symptoms. We reported 41 years old male patient diagnosed with severe COVID-19 infection, acute respiratory distress syndrome (ARDS), and thrombophilia. The patient received a therapy following the Ministry of Health’s guideline for COVID-19 handling. On the third day, respiratory failure occurred with a P/F ratio of 255 and the chest X-ray result showed vascular streak and ground-glass opacity; thus, the hospital decided to perform TPE. The TPE was performed twice in 5 days interval. After TPE was administered, clinical development is observed both subjectively in the form of reduced symptoms, normal respiration rate, and objectively, the improvement in blood gas analysis, increased O2 saturation, and a decrease in interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) level significant clinical laboratory and radiological improvement possibly due to cytokine storm which is remedied by TPE action.

Objective:The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A).Design:Longitudinal assessment of GAD symptoms pre- and posttreatment.Participants:Participants were 259 older adults aged 60–86 years with a diagnosis of GAD who were assessed before and after treatment.Intervention:Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions.Measurements:Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A.Results:Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status.Conclusions:Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.

Background Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 was first identified in Wuhan, China. All ages are susceptible to SARS-CoV-2 infection. Few studies had reported milder course in children however, severe course of illness has been reported. We aimed to describe the clinical features of COVID-19 in pediatric patients including diagnostic findings and therapeutic interventions in sever disease manifestation. Methods We retrospectively reviewed 742 patients with SARS-CoV-2 proven infection at King Abdullah Specialist Children’s Hospital, from April 2020 and July 2020. Inpatients, outpatient, including those with sever manifestation treated at the Intensive Care Unit (ICU) were included. We collected data including demographic data, comorbidities, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of patients with COVID-19. Results Among of 742 patients, 71 (9.6%) were hospitalized. The median age of patients was 75 months old and 53.6 were male. A total of 461 (62.1%) had close contact with confirmed cases, 45 (6.1%) had no contact history, and 236 (31.8%) with unknown exposure risk. The most common symptoms at the onset of illness were fever (32.5%), respiratory symptoms (21%) and gastrointestinal symptoms (10.3%). Among the entire cohort, 7 patients were admitted to PICU with COVID-19 related symptoms, five patients diagnosed with MIS-C, one patient with Kawasaki, and one patient with pneumonia. All patients received supportive therapy, no antiviral treatment had been used however, in MIS-C patients IVIG had been given to all patients, five patients received Anakinra; and one patient received tocilizumab. Conclusions In this study, children infected with SARS-CoV-2 are less likely to develop symptomatic or serious diseases. Among symptomatic children, the most common clinical features were fever and respiratory symptoms followed by gastrointestinal manifestations. The majority of infected children have reported contact with an infected individual. MIS-C associated with COVID-19 is a severe presentation of SARS-CoV-2 infection and of a major concern as an overlapping features with other diseases could happen, making the diagnosis challenging.

Coronavirus disease 2019 (COVID-19) has become a global pandemic affecting more than 200 countries with 87 million patients worldwide as of January 7, 2021. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) replicates in a large amount and reaches high-titer levels in a short time after the infection. COVID-19 caused by SARS-CoV-2 shows clinical symptoms mainly including fever, fatigue, dry cough, and dyspnea. In more severe COVID-19 patients, viral pneumonia characterized by bilateral ground glass or patchy opacity, may lead to acute respiratory distress syndrome (ARDS), cytokine storm, multi-organ damage, and even death. Unfortunately, there is no effective therapy for COVID-19 until now. Magnesium isoglycyrrhizinate (MgIG), a magnesium salt of 18-α glycyrrhizic acid stereoisomer, belongs to the fourth generation of glycyrrhizic acid preparation. MgIG has various pharmacological activities including anti-inflammation, anti-oxidation, anti-virus, and immunoregulation, showing the protection against the injury of the vital organs (such as kidney, heart, and lung). Clinically, MgIG injection is usually used as a hepatoprotective agent to treat liver diseases. This narrative review summarizes the research and application of MgIG, and provides the evidence supporting the recommended MgIG as supportive therapy in the "Management Standard for Mild and Common Patients of Coronavirus Disease 2019 (COVID-19) (Second Edition)", which is jointly issued by National Health Commission of People's Republic of China and National Administration of Traditional Chinese Medicine.

Mental disorders are behavioral or psychological patterns shown by individuals that cause distress, dysfunction; reduce the quality of life which becomes a psychosocial problem. Psychosocial problems that result in social changes in society can cause mental disorders. The prevalence of adolescents in Indonesia experiencing psychosocial problems is 8.7%. In West Sumatra Province, the population is 5.48 million with a number of teenagers around 511.8 people. Of these, one in five adolescents has psychosocial problems that require adequate and special treatment. The solution to this problem is by providing supportive therapy which aims to help deal with mental health problems that exist in the community. This activity was carried out on February 3, 2021 with a total of 20 teenagers. The results of the evaluation show that there is a change in anxiety in adolescents. Suggestions for the health center are to monitor the results of this education.

Characterizing community mental health (CMH) treatment duration and discharge is an important step toward understanding how to better meet client needs. This report describes patterns of treatment duration and discharge among clinicians participating in a state-funded evidence-based treatment (EBT) training initiative. After training and consultation, clinicians (N = 376) reported on treatment duration and discharge for their "most complete case." On average, clinicians delivered 12.4 sessions (SD = 5.1) of the treatment. After completing treatment, half of clinicians (58.7%) continued with regularly scheduled therapy, either using EBT elements or switching to supportive therapy. Clinicians who continued with regularly scheduled therapy delivered treatment in approximately the same number of sessions. Results revealed that CMH clinicians often do not discontinue therapy after completing a treatment protocol. These findings suggest it may be essential to better understand clinician decision-making around applying EBTs to their caseloads.

Background Little data exist on remission rates following psychotherapy for body dysmorphic disorder (BDD). Methods Using data from a large study of therapist-delivered cognitive behavior therapy (CBT) versus supportive psychotherapy (SPT) for BDD (N = 120), we estimated remission rates at treatment endpoint, and rates of delayed remission, sustained remission, and recurrence at 6-month follow-up. We also examined improvement in broader mental health outcomes among remitters. Results Full or partial remission rates at end-of-treatment were significantly higher following CBT (68%) than SPT (42%). At 6-month follow-up, an additional 10% (CBT) and 14% (SPT) experienced delayed remission, 52% (CBT) and 27% (SPT) experienced sustained remission, and 20% (CBT) and 14% (SPT) experienced recurrence. Remission was never achieved by 18% (CBT) and 45% (SPT). Participants in remission at end-of-treatment experienced significant improvements in functional impairment, depression severity, BDD-related insight, and quality of life compared to nonremitters. Conclusions Full or partial remission rates are high following CBT for BDD and higher than after SPT.

Objectives Acute respiratory distress syndrome (ARDS) constitutes a major factor determining the clinical outcome in polytraumatized patients. Early prediction of ARDS is crucial for timely supportive therapy to reduce morbidity and mortality. The objective of this study was to develop and test a machine learning–based method for the early prediction of ARDS derived from the first computed tomography scan of polytraumatized patients after admission to the hospital. Materials and methods One hundred twenty-three patients (86 male and 37 female, age 41.2 ± 16.4) with an injury severity score (ISS) of 16 or higher (31.9 ± 10.9) were prospectively included and received a CT scan within 1 h after the accident. The lungs, including air pockets and pleural effusions, were automatically segmented using a deep learning–based algorithm. Subsequently, we extracted radiomics features from within the lung and trained an ensemble of gradient boosted trees (GBT) to predict future ARDS. Results Cross-validated ARDS prediction resulted in an area under the curve (AUC) of 0.79 for the radiomics score compared to 0.66 for ISS, and 0.68 for the abbreviated injury score of the thorax (AIS-thorax). Prediction using the radiomics score yielded an f1-score of 0.70 compared to 0.53 for ISS and 0.57 for AIS-thorax. The radiomics score achieved a sensitivity and specificity of 0.80 and 0.76. Conclusions This study proposes a radiomics-based algorithm for the prediction of ARDS in polytraumatized patients at the time of admission to hospital with an accuracy that competes and surpasses conventional scores despite the heterogeneous, and therefore more realistic, scanning protocols. Key Points • Early prediction of acute respiratory distress syndrome in polytraumatized patients is possible, even when using heterogenous data. • Radiomics-based prediction resulted in an area under the curve of 0.79 compared to 0.66 for the injury severity score, and 0.68 for the abbreviated injury score of the thorax. • Highlighting the most relevant lung regions for prediction facilitates the understanding of machine learning–based prediction.

Hydrogen sulfide (H2S) is a toxic gas produced via breakdown of organic matter. Hydrogen sulfide exposure can cause symptoms ranging in severity from mild effects (dizziness, headache, nausea) to severe lactic acidosis, respiratory failure, pulmonary edema, cardiac arrhythmias and death. Treatment modalities include oral countermeasures and 100% FiO2 with supportive therapy. However, case studies utilizing hyperbaric oxygen (HBO2) therapy have been reported with general benefit seen in severe cases of toxicity. In this report, cases of mild to moderate H2S toxicity occurred aboard a U.S. Navy ship, resulting in a mass casualty incident of more than 30 patients. Patient symptoms included dizziness, headaches, nausea, vomiting, and one patient with altered mental status. Most patients’ symptoms resolved after several hours of supportive therapy, but six patients had symptoms refractory to 100% FiO2 at 1 atm. These six patients received HBO2 therapy with a USN Treatment Table 9 after consultation with the local emergency room and hyperbaric assets. Four separate chambers were utilized, including two chambers onboard USN ships and the local explosive ordnance disposal (EOD) chamber. Complete resolution of symptoms in all six patients was achieved within the first breathing period. Patients were monitored after treatment aboard the USN ship medical department. No patients required emergency department care. These cases demonstrate an expanded use of HBO2 to include moderate cases of H2S toxicity refractory to first-line therapy.

Background: Vitamin D deficiency have serious medical, social and economic consequences for human health and require timely diagnosis and adequate correction.Aim: Evaluation of the efficacy and safety of therapy with Fortedetrim soft capsules (MEDANA PHARMA AO, Poland) using saturating and maintenance doses compared to therapy with Vigantol®, an oily solution for oral administration (Merck KGaA, Germany) in patients with vitamin D deficiency.Materials and methods: The study included 150 patients with vitamin D deficiency (less than 20 ng/ml) aged 18 to 75 years, who were randomized into 3 groups in a 1:1:1 ratio (50 people each). Fortedetrim capsules were used in two groups during the first four weeks 50,000 IU once a week (5 capsules 10,000 IU each) and 56,000 IU — 8,000 IU daily (2 capsules 4000 IU), and Vigantol® was used in the comparison group 1000 IU daily (2 drops). Over the next 12 weeks, patients received supportive therapy — in the first group, Fortedetrim 10,000 IU was used once a week, in the second — Fortedetrim 2,000 IU daily (14,000 IU per week); the comparison group continued to take Vigantol® 1000 IU daily.Results: As a result of evaluating the data on the results of stages I and II of the clinical study Fortedetrim in comparison with Vigantol®, the hypothesis was proved that the high-dose drug Fortedetrim (capsules of 2000, 4000 and 10000 IU) is superior to the drug Vigantol® (drops, 1000 IU daily). Nevertheless, it should be noted that long-term intake of colecalciferol at a dose of 1000 IU daily by 20 weeks allowed 36% of participants to reach a level of 30 ng/ml, but this is significantly less than in groups using high-dose drugs. There were no differences in the number of adverse events during the study, their degree and the relationship with drug intake between the treatment and comparison groups.Conclusion: The use of the drug Fortedetrim in saturating doses is effective and safe for the treatment of adult patients with vitamin D deficiency. However, an individual approach to its replenishment is required (taking into account compliance, the degree of obesity, impaired absorption of calcium and vitamin D), since not all patients in the applied saturation regimes, the target values of vitamin D in the blood were reached.

Hydroxychloroquine (HCQ) has been used as a supportive therapy for IgA nephropathy (IgAN). We aimed to determine the long-term efficacy and safety of HCQ therapy in patients with IgAN. A total of 180 patients with IgAN who had received HCQ therapy for at least 1 year were enrolled in this study. The changes in proteinuria and the estimated glomerular filtration rate (eGFR) were analyzed during the follow-up period. The level of proteinuria decreased from 1.69 [1.24, 2.30] to 1.01 [0.59, 1.74] g/day (− 37.58 [− 57.52, 8.24] %, P

Objective: With the rapid increase in the rate of infection, repurposing use of many drugs like antivirals, antibiotics, LMWH, steroid, oxygen therapy were considered as an option to find promising anti-COVID therapeutics. In this study, we aim to observe the extent and variety of drugs used in different clinical categories of COVID-19 patients admitted to hospital in Bangladesh. To observe the requirement of oxygen therapy according to severity was also a prime objective to reveal the overall trend, frequency, and pattern of pharmacotherapy in a COVID-dedicated hospital. Materials and method: A total of 1348 patients were admitted, of whom 473 were included in this single-center retrospective study. The critical group consists of 99 ICU patients, the severe group has 38, moderate was 82 and mild group 254 cases, admitted in the general ward. Hospital records of each patient were screened and information about drug and supportive therapy were collected manually by the researchers in the data collection sheet. Data express in MS excel spreadsheet and result expressed in percentage. Results: Critical group received remdesivir (85.86%), favipiravir (27.28%), meropenem (92.93%), moxifloxacin (87.88%) dexamethasone (41.48%), Low Molecular Weight Heparin (98.99%). They also received supportive O2 therapy like High Flow Nasal Cannula (67.68%), Non-Invasive Ventilation (26.67%), and mechanical ventilator (6.06%). A severe group of patients receives the same group of drugs 97.27%, 5.26%, 60.53%, 47.37%, methylprednisolone (55.26%), and 100% LMWH. A moderate group of the patient received favipiravir (97.56%), cephalosporin (64.67%), LMWH (89.02%) and low flow O2 (97.36%) in a higher percentage. All patients of the mild group received doxycycline, ivermectin. Total 33 patients transfuse convalescent plasma. Conclusion: Antiviral, broad-spectrum antibiotics, anti-protozoal, LMWH, corticosteroid, and oxygen therapy are the available treatment option against different clinical categories of admitted COVID-19 patients. Keywords: COVID-19, antiviral, antibiotic, steroid, O2 therapy

Urinary retention in children can have varied etiology ranging from anatomic to functional causes. Functional causes include neuropathies, including rare central nervous system (CNS) involvement, such as acute disseminated encephalomyelitis (ADEM). ADEM is usually preceded by acute viral infection and commonly presents with multifocal neurological deficits. The ADEM diagnosis is mainly based on the clinical presentation and its correlation with characteristic CNS findings on magnetic resonance imaging (MRI). Here, we report an adolescent boy who presented with acute urinary retention preceded by an acute febrile illness. The patient was worked up thoroughly, including an MRI of the brain and spine, which revealed ADEM's characteristic features. The bladder function was evaluated periodically. The voiding dysfunction persisted for a long time. Treatment with steroids and other supportive therapy ultimately lead to a complete recovery over 6 months.

COVID-19 is caused by SARS-CoV-2, which originated in Wuhan, Hubei province, Central China, in December 2019 and since then has spread rapidly, resulting in a severe pandemic. The infected patient presents with varying non-specific symptoms requiring an accurate and rapid diagnostic tool to detect SARS-CoV-2. This is followed by effective patient isolation and early treatment initiation ranging from supportive therapy to specific drugs such as corticosteroids, antiviral agents, antibiotics, and the recently introduced convalescent plasma. The development of an efficient vaccine has been an on-going challenge by various nations and research companies. A literature search was conducted in early December 2020 in all the major databases such as Medline/PubMed, Web of Science, Scopus and Google Scholar search engines. The findings are discussed in three main thematic areas namely diagnostic approaches, therapeutic options, and potential vaccines in various phases of development. Therefore, an effective and economical vaccine remains the only retort to combat COVID-19 successfully to save millions of lives during this pandemic. However, there is a great scope for further research in discovering cost-effective and safer therapeutics, vaccines and strategies to ensure equitable access to COVID-19 prevention and treatment services.

Objective Since the beginning of the COVID‐19 epidemic, a large number of guidelines on diagnosis and treatment of COVID‐19 have been developed, but the quality of those guidelines and the consistency of recommendations are unclear. The objective of this study is to evaluate the quality of the diagnosis and treatment guidelines on COVID‐19 and analyze the consistency of the recommendations of these guidelines. Methods We searched for guidelines on diagnosis and/or treatment of COVID‐19 through PubMed, CBM, CNKI, and WanFang Data, from January 1, 2020 to August 31, 2020. In addition, we also searched official websites of the US CDC, European CDC and WHO, and some guideline collection databases. We included diagnosis and/or treatment guidelines for COVID‐19, including rapid advice guidelines and interim guidelines. Two trained researchers independently extracted data and four trained researchers evaluated the quality of the guidelines using the AGREE II instruments. We extracted information on the basic characteristics of the guidelines, guideline development process, and the recommendations. We described the consistency of the direction of recommendations for treatment and diagnosis of COVID‐19 across the included guidelines. Results A total of 37 guidelines were included. Most included guidelines were assessed as low quality, with only one of the six domains of AGREE II (clarity of presentation) having a mean score above 50%. The mean scores of three domains (stakeholder involvement, the rigor of development and applicability) were all below 30%. The recommendations on diagnosis and treatment were to some extent consistent between the included guidelines. Computed tomography (CT), X‐rays, lung ultrasound, RT‐PCR, and routine blood tests were the most commonly recommended methods for COVID‐19 diagnosis. Thirty guidelines were on the treatment of COVID‐19. The recommended forms of treatment included supportive care, antiviral therapy, glucocorticoid therapy, antibiotics, immunoglobulin, extracorporeal membrane oxygenation (ECMO), convalescent plasma, and psychotherapy. Conclusions The methodological quality of currently available diagnosis and treatment guidelines for COVID‐19 is low. The diagnosis and treatment recommendations between the included guidelines are highly consistent. The main diagnostic methods for COVID‐19 are RT‐PCR and CT, with ultrasound as a potential diagnostic tool. As there is no effective treatment against COVID‐19 yet, supportive therapy is at the moment the most important treatment option.

Based on personal experiences, recommendations for physicians treating patients with multiple myeloma (MM) in low- and middle-income countries (LMICs) are proposed. (1) Implement strategies to keep the patient in the best possible condition for the longest time, in addition to focusing on ways to avoid financial toxicity; (2) if lenalidomide is unavailable, start treatment with thalidomide and dexamethasone, include, if possible, bortezomib; (3) conduct an outpatient-based autologous stem cell transplantation (ASCT) in all eligible patients; (4) use thalidomide as post-ASCT maintenance treatment if lenalidomide is unavailable for the standard risk patients; (5) monitor monoclonal proteins with serum protein electrophoresis and free light chain measurements; (6) employ novel drugs in cases of relapsed or refractory disease; and (7) do not forget supportive therapy. The therapeutic recommendations to treat patients with MM are somewhat different for physicians working in LMICs, compared with those treating patients in high-income countries. These are relevant since more than 50% of the inhabitants of the world live in LMICs, thus indicating that the vast majority of patients with MM are being treated in resource-constrained settings. As time goes by, physicians may acquire the ability to analyze and express their feelings and experiences about topics in the practice of medicine in which they could have learned lessons (1). Since 1980, we have been treating patients with multiple myeloma (MM); to date, we have been personally involved in the study and treatment of more than 300 patients with this disease (2). Having gained experience dealing with MM patients in underprivileged circumstances, such as those prevailing in our country: Mexico, having explored different ideas, treatments, and methods, and being aware of the financial implications which may impact our selection of therapeutic strategies and recommendations, we felt that it was appropriate to share in this article some of these ideas with practitioners around the world who are involved in the treatment of patients with MM in low- and middle-income countries (LMICs).

Background The ultra-high risk (UHR) paradigm allows early contact with patients developing acute psychosis and the study of treatment effects on the underlying pathology. Methods 29 patients with first acute psychosis according to CAARMS criteria (transition patients, TP) (T0) and thereof 22 patients after two-year follow-up (mean 788 d) (T1) underwent 1H-/31P-MR spectroscopy of the prefrontal (DLPFC) and anterior midcingulate (aMCC) cortices and the thalamus. N-acetylaspartate (NAA), glutamate (Glu, Glx), energy (PCr, ATP) and phospholipid metabolites (PME, PDE) were compared to 27 healthy controls by ANCOVA and correlated with patients' symptom ratings (BPRS-E, SCL-90R). For longitudinal analysis, linear mixed model (LMM) and ANCOVA for repeated measures were used. Results DLPFC : In patients, NAA and PME were decreased bilaterally and Glu on the left side at T0. Left-sided Glu and NAA (trend) and bilateral Glx increased during follow-up. Thalamus : In TP, bilateral NAA, left-sided Glu and right-sided Glx were decreased at T0; bilateral NAA and left-sided Glx increased during follow-up. aMCC : In TP, bilateral NAA, right-sided Glu, and bilateral PME and PDE were decreased, while left-sided PCr was increased at T0. No changes were observed during follow-up. Conclusion Regardless of the long-term diagnosis, the psychotic state of illness includes disturbed neuronal function in the DLPFC, thalamus and aMCC. Treatment-as-usual (TAU), including antipsychotic/antidepressant medication and supportive psychotherapy, had an effect on the thalamo-frontal area but not or less pronounced on the neurometabolic deficits of the aMCC.

The National Institute for Health and Care Excellence (NICE) recently published its draft updated guideline on the diagnosis and management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). NICE concluded that ME/CFS is a complex multisystem chronic medical condition for which graded exercise therapy should not be used and cognitive behavioural therapy is only a supportive therapy and not a treatment or cure. The draft guidance also highlighted the unreliability of subjective outcome measures in non-blinded trials. High quality randomised controlled ME/CFS trials are now needed to find pharmacological treatments that lead to substantial objective improvement and restore the ability to work.

Thyroid eye disease (TED) is a debilitating, vision threatening disease that dramatically alters patients' quality of life. Until recently, the management of TED is a long arduous course with supportive therapy, followed by an extensive surgical treatment plan to reverse the disease endpoints. Teprotumumab offers an early, safe therapeutic intervention to help reverse disease end points such as diplopia and proptosis and improve quality of life.

There is an increasing in admitted patients with cases of gender identity disorder in the daycare clinic of the Child and Adolescent Psychiatry Division Dr. Soetomo, it is necessary to increase understanding and clinical ability in relation to gender identity disorders through psychiatry consultation discussion, so that management can be achieved properly and comprehensively. Disorder of sex development (DSD) is a medical disorder that is associated with an incompatibility between chromosomes, gonads, phenotypes and anatomy which is characterized by the development of external genital organs that are incompatible with whether it is male or female. Genetalia ambiguos can cause significant psychological stressors for patients or their families, where as a result of the conditions experienced, it will lead to gender dysphoria with the resulting effects, among others, in the form of anxiety, depression and low self-esteem, to affect the quality of life of children as adolescents and adults. . The method of preparing this report is a case analysis and the role of CLP which is given based on the results of the examination and references to management in the field of psychiatry of children and adolescents in cases of DSD from children aged 12 years. Conducted to strengthen the adaptation of patients to problems identifying gender development and to their families by emphasizing the importance of achieving optimal quality of life for children. The results of the case reports describe the role of Consultation Liason Psychiatry through communication and consultation between related areas of expertise, supportive psychotherapy and continuous Cognitive Behavior Therapy (CBT) techniques along with psychoeducation in families providing good development results with results in reducing patient anxiety and depression, based on children's scoring Depression Inventory (CDI) of patients with Mosaicism, Mixed Gonadal Dysgenesis (MGD). The conclusion of this case report is that the problem of psychological stressors that arise in DSD requires psychiatric assistance according to the stages of child development. The important role of psychiatrists in the management of DSD cases has been recognized and stated in the joint consensus for the treatment of individuals with DSD since 2006. CLP needs to be built because of the complexity of treatment and therapy in DSD cases, which involve subspecialty pediatric endocrinology, urology, psychiatry, gynecology, genetics, workers. social nurse and medical ethics. described in the algorithm below in the management of cases of gender dysphoric. Keywords: disorder of sex development; mixed gonadal dysgenesis; consulation liason psychiatry disorder of sex development; mixed gonadal dysgenesis; consulation liason psychiatry

COVID-19 presentations range from cold-like symptoms to severe symptoms with the development of acute respiratory distress syndrome (ARDS). We report on a severe COVID-19 patient who was mechanically ventilated and who developed ARDS and bacterial infection. Because of rapid clinical deterioration and the exhaustion of other treatment options, the family and attending physicians requested a compassionate use of adult allogeneic bone marrow-derived mesenchymal stem cells (MSC) in addition to commonly used immunosuppressive, antiviral, and supportive therapy. The clinical course is discussed thoroughly, with a special emphasis on the safety and effect of MSC therapy. Compassionate MSC treatment, given in three rounds, affected ARDS regression. The patient was discharged from the intensive care unit after 31 days and from hospital after 49 days in a good general condition. MSC treatment was not associated with any side effects and was well tolerated in a three-week period; therefore, it should be studied in larger trials and considered for compassionate use

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.

Distant abscesses are uncommon during the episode of acute pancreatitis (AP). However, these are possible sequalae of necrotizing pancreatitis and should be treated appropriately to prevent serious septic complications. We demonstrate a case of a 56-year-old male patient who presented with severe necrotizing pancreatitis and distant retroperitoneal abscess that reached femoral region and was detected on diagnostic imaging scans. Combination of surgical and supportive therapy was employed, and the patient recovered well with no permanent consequences. Our article highlights the importance of quick and accurate diagnosis and timely intervention in this rare type of pancreatitis complication.

Abnormalities of corpus callosum are one of the most common brain anomalies. Fetuses with isolated corpus callosum agenesis (CCA) have a better prognosis than those with additional anomalies. However, unpredictable neurodevelopmental outcomes of truly isolated CCA make prenatal counseling a challenge. The aim of this review is to evaluate neurodevelopmental outcomes in children with prenatal diagnosis of isolated CCA. Controlled clinical trials published between May 23, 2009, and May 23, 2019, using the MeSH term “agenesis of corpus callosum” were reviewed. A total of 942 articles were identified, and 8 studies were included in the systematic review depending on the inclusion criteria. These studies included 217 fetuses with isolated CCA and no other anomalies at prenatal assessment. Neurodevelopmental outcome was reported to be normal in 83 children with a prenatal diagnosis of isolated CCA confirmed at birth within 128 completed assessments. About 45 children presented borderline, moderate, or severe neurodevelopmental outcome. In this review, neurodevelopment was favorable in two-thirds of the cases, but mild disabilities emerged in older children. Despite this, disabilities can occur later beyond school age and a low risk of severe cognitive impairment exists. Our study highlights the essential early diagnosis and proper supportive therapy.

Patients who were contracted with COVID-19 are reported to have a variety of symptoms affecting neuromuscular, psychological, cardiac, and respiratory systems. A significant proportion of patients present with prolonged symptoms even weeks to months including minor illness. The lung is the most common and important organ affected in COVID-19 and sequela can result in exertional breathlessness, cough, hypoxia, or pulmonary fibrosis. Along with medical and supportive therapy, a multidisciplinary pulmonary rehabilitation program is essential to improve the quality of life and reduce symptoms in post-COVID-19 patients. We report a case series of three cases who presented with diverse manifestations after COVID-19 recovery, who were treated with a multidisciplinary pulmonary rehabilitation program. This case series, with early experiences from Kerala which had its peak of COVID-19 pandemic in late October 2020, shows a substantial improvement of symptoms in patients even with initial rehabilitation sessions itself, which shows promising hope in post-COVID-19 management.