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Background: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease, which reduces the lung function and causes respiratory symptoms over time, and it is primarily associated with shortness of breath, cough and sputum production. Roflumilast, which is a long-acting selective inhibitor, reduces the anti-inflammatory effect of the main symptoms of COPD. The aim of this study was to compare the clinical effectiveness of adding roflumilast to the current treatment regimen of patients with severe COPD. Methods: To retrieve the marker studies, medical databases were searched up to February 2014. We included studies, which compared the clinical effectiveness and safety of roflumilast as concomitant to Long-acting ß2-agonist/Long-acting muscarinic antagonist (LABA/LAMA) regimen, in adult patients with severe COPD. The number of exacerbations, changes in the lung function FEV1, FEV1/FVC and quality of life were the major predefined outcomes. Meta-analysis of outcomes was performed by the RevMan software, with I2> 50%, representing considerable heterogeneity. Results: Seven randomized controlled trials and two systematic reviews were included. In terms of safety, participants were likely to experience more side effects from roflumilast compared to placebo, particularly gastrointestinal effects (diarrhea, nausea, vomiting), headache and weight loss. There was no significant difference in the risk of cardiac complications or flu-like symptoms or upper respiratory tract infection in the two groups. In terms of effectiveness, only a small improvement was observed in SGRQ (St George’s Respiratory Questionnaire) index. Roflumilast reduced moderate to severe attacks, and caused significant improvements in the lung function regardless of the severity of the disease and the concurrent use of other standard COPD therapies. Conclusion: Roflumilast anti-inflammatory therapy reduces the chronic bronchitis symptoms in patients with moderate to severe COPD, and it can be safely used with other drugs simultaneously.

Background: Hormone therapy is currently the mainstay in the management of locally advanced and metastatic prostate cancer. We performed a systematic review to compare safety, efficacy and effectiveness of degarelix, a new gonadotropin-releasing hormone (GnRH) antagonist (blocker), versus gonadotropin-releasing hormone (GnRH) agonists. Methods: MEDLINE, Web of Science and the Cochrane library were searched to identify all of the published Randomized Controlled Trials (RCTs) that used degarelix versus gonadotropin-releasing hormone agonists with or without anti-androgen therapy for the treatment of prostate cancer. We performed meta-analysis of extracted data on safety and efficacy of the target medication. Results: Six studies were included. They involved a total of 2296 patients which were used in the meta-analysis. Follow-up times after treatment were between 12 weeks and 12 months. Three of six RCTs compared degarelix with goserelin and the others compared it with leuprolide. Meta-analysis on safety outcomes revealed that the only statistically significant difference between the degarelix treated group and GnRH agonists treated group was complication in the injection site which was higher in degarelix-treated group (OR= 46.34, 95% CI: 15.79 to 136, p

Nortriptyline is indicated for use in the treatment of depression (FDA-approved). It can also be used off-label for conditions such as chronic pain, diabetic neuropathy, myofascial pain, orofacial pain, and postherpetic neuralgia. Nortriptyline has also shown to be useful in patients trying to quit smoking. Nortriptyline is not FDA approved for use in children. This activity covers nortryptyline's indications, mechanism of action, pharmacology, administration, adverse event profiles, eligible patient populations, contraindications, and monitoring, and highlights the role of the interprofessional team in the management of depression and other diseases with nortriptyline therapy., (Copyright © 2022, StatPearls Publishing LLC.)

Sumatriptan is FDA approved as an abortive treatment for migraine attacks with or without aura in adults. Acute treatment of cluster headache episodes can be relieved by the administration of subcutaneous therapy. According to clinical studies, sumatriptan is an effective and well-tolerated treatment for migraines when given intravenously, subcutaneously, or orally. It relieves photophobia, nausea, headache, and functional disability. Non-FDA-approved indications of sumatriptan include treatment of migraine in children and adolescents. This activity outlines the indications, mechanism of action, methods of administration, important adverse effects, contraindications, and monitoring, of sumatriptan, so providers can direct patient therapy in treating indicated disorders as part of the interprofessional team., (Copyright © 2022, StatPearls Publishing LLC.)

Nicotine replacement therapy (NRT) is for those who want to quit smoking, as abruptly stopping can cause withdrawals and cravings. Nicotine withdrawal occurs after person smoking cigarettes discontinues the use of cigarettes suddenly. Using NRT helps reduce the motivation to smoke cigarettes because the body still gets nicotine from another safer method. Nicotine comes in a patch, lozenge, inhalers, spray, and gum forms and can provide the body the dose of nicotine that it previously got from cigarettes. This activity outlines the indications, mechanism of action, methods of administration, significant adverse effects, contraindications, monitoring, and toxicity of NRT, so providers can direct patient therapy to help them in smoking cessation., (Copyright © 2022, StatPearls Publishing LLC.)

Asperger syndrome (AS) was first described by Hans Asperger in 1944, as the behavioral characterization of individuals who have difficulties in communication and social interaction.[1] Since then, AS has always been a topic of significant interest and debate. Although AS was introduced as a discrete diagnostic category in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4, 1994), almost 20 years later, its diagnostic label was removed in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), and it was encompassed in a more general category of autism spectrum disorders (ASD).[2] According to the DSM-5, there are varying degrees of ASD that are categorized based on the severity of symptoms and the required levels of support, and what was formerly called Asperger syndrome shall now be regarded as ASD.[3] Autism spectrum disorders (ASD) include a group of neurodevelopmental abnormalities with broadly varying degrees and manifestations, usually begin in early childhood, and are characterized by problems in social communication and interaction, along with behavioral problems such as restricted interests and repetitive behaviors.[4][5] DSM-5 changes on ASD classification led to some controversy about the loss of the unique Asperger identity,[6] and literature continue to debate about AS and its formulation within ASD.[7] Due to Asperger syndrome's extensive history, rich semiology, and relatively characteristic clinical presentations, specialists continue to use this diagnosis as a subtype of ASD with no language delay and a normal or superior IQ.[6] In this topic review, we will describe the essential aspects of autism spectrum disorder and Asperger syndrome. For greater transparency, we refer to (1) Asperger syndrome (AS) as a subpopulation of pervasive developmental disorders (PDD) according to DSM-IV-TR, (2) ASD according to DSM-5, and (3) Autism spectrum disorder of an Asperger syndrome type (ASD-AS) as a subpopulation that is included in the DSM-5 as ASD of level 1 severity without intellectual impairment. Historical Perspective In 1944, and about a year after Leo Kanner described infantile autism, Hans Asperger introduced autistic psychopathy in the form of a case report. In 1980, the American Psychiatric Association (APA) recognized autism as a distinct category in the DSM-3 and introduced it as infantile autism. In 1981, Wing L. restarted Asperger researches and renamed autistic psychopathy Asperger syndrome. A few years later and in 1989, the first diagnostic criteria for AS was proposed,[7] and the 10th Revision of the International Classification of Diseases (ICD-10) was the first major classification system that recognized AS (1993). Finally, in 1994, AS was introduced in DSM-4 as a specific entity along with autistic disorder, within pervasive developmental disorders (PDD). While during this period, researchers were focused on the development of measures with the ability to diagnose AS and differentiate it from high functioning autism (HFA), the DSM-5 removed the diagnostic category of AS in 2013.[5] The World Health Organization (WHO) also followed a similar approach in ICD-11, which will come into effect in 2022.[2] DSM Classification The systematic description of psychiatric disorders is quite complicated, particularly in child and adolescent psychiatry. Asperger syndrome was included in the DSM-IV-TR in the large family of pervasive developmental disorders (PDD). PDD had five subtypes: Autistic disorder. Asperger syndrome. Childhood disintegrative disorder. Pervasive developmental disorder-not otherwise specified (PDD-NOS). Rett syndrome. Symptoms and clinical specifiers for autistic disorder of PDD were described to fall into three broad categories in DSM IV-TR: (1) social interaction, (2) communication, and (3) restricted, repetitive behavior.[8] The diagnosis of AS required:[7]: At least two symptoms of social interaction impairment and at least one each from symptoms of communication and restricted, repetitive behavior (RRB). Delays or abnormal functioning in at least one of the areas of (1) social interaction, (2) language as used in social communication, or (2) symbolic or imaginative play with onset prior to age 3 years. Diagnostic criteria for autistic disorder (or another specific PDD) should not be met (otherwise, the AS diagnosis is excluded, and autistic disorder diagnosis should have precedence). AS contrasted from autistic disorder in:[9]: Absence of diagnostic criteria in the communication domain. Absence of a requirement for onset before age 3. Addition of criteria specifying the absence of a language delay. Addition of criteria specifying the absence of a deficit in cognitive development. This classification suggested a differential diagnosis between AS and the type of Autistic disorder associated with normal cognitive functioning, also known as high functioning autism (HFA). As a result, it sparked substantial debate over uncertainty in defining AS criteria and the clinical overlap between AS and HFA, which has appeared in literature with contradictory results. Although there has been a considerable number of researches showing some fine differences between the two disorders, most studies have emphasized the meaningful similarities between AS and HFA.  Ultimately, the DSM-5 removed PDD and its categorization and merged four of its subtypes into one unifying category with the concept of a continuum named autistic spectrum disorders (ASD). This major alteration was mostly due to the assumption that PDD subgroups cannot be differentiated from one another certainly and reliably.[7] These changes include the following:[2][8] Another major alteration was the inclusion of social communication and social interaction-related deficits in one criterion and exclusion of deficit specifically related to spoken language. Elimination of PDD and its subtypes. Creation of a new diagnostic category called autistic spectrum disorders (ASD), encompassing autistic disorder, Asperger syndrome, childhood disintegrative disorder, and PDD-NOS. Addition of three levels of severity, and clinical specifiers about the presence of cognitive and language impairment, to better characterize the diagnosis. Changing from previous PDD 3-domain criteria to ASD 2-domain criteria, composed of impaired social communication/interaction and restricted, repetitive behavior, interest, and activities (merging domains of social interaction and communication). Addition of sensory symptoms in the RRB component of diagnostic criteria. Changing the specification of the age of onset from age 3 to "early childhood.". Creation of a new diagnostic category called "social communication disorder" (SCD) to include individuals who have difficulties in social communication/interaction but do not meet RRB criteria found in ASD. Removal of Rett syndrome from the classification, on the basis of recent genetic data. Controversy over the New Classification of ASD The new classification of ASDs has been criticized in the literature in different ways. Some authors have suggested that the new classification will narrow the criteria for ASD; thus, some patients may no longer meet the criteria for ASD, in particular, cognitively able individuals and individuals diagnosed with AS and PDD-NOS. In short, the argument is although this reduced sensitivity is associated with higher specificity, it has the potential to exert negative effects on the service eligibility, as well as the ability of researchers to integrate information and data from researches conducted under these criteria.[9][6] Other authors claim that the elimination of the specific diagnostic category for Asperger syndrome will increase stigma towards individuals previously diagnosed with AS, based on the assumption that autism-phobic societies perceive autism as a significant disability, whereas AS is associated with more positive stereotypes.[10][2] In addition, previous research has demonstrated the association of autism with disability and dysfunction and the association of AS with positive features. Thus, the new inclusion of AS in the category of ASD may have a negative effect on the identity of the individuals who have adopted this label as an identity. However, the literature on the potential impact of the DSM-5 changes on individuals previously diagnosed with AS is limited, and the results can be categorized into those who are supportive, those who are opposed, and those who express mixed feelings concerning the changes.[2], (Copyright © 2022, StatPearls Publishing LLC.)