Search

This article presents original analysis of sixteen years of reported case law concerning medical treatment disputes and children. These disputes often arise due to disagreement between healthcare professionals and family members about what healthcare is in the best interests of the child. We provide statistical analysis of a database of reported judgments, drawing out key themes arising from the cases. While much of the existing literature focuses on individual or high-profile judgments in this arena, our analysis takes a step back and looks at the broader themes that can only be understood by looking at the reported cases through an empirical lens. This broader view provides several new insights and we highlight key findings, including that: most cases are resolved in line with the public body’s preferred outcome rather than the family; there is a relationship between the instigator of litigation and the outcome; and there is a relationship between the presence of religious factors and the outcome of the case. Overall, the article reinforces the need for further analysis of how medical treatment disputes are resolved, specifically further understanding about the use of informal mechanisms of resolution such as mediation and how the other factors identified influence court judgments. [ABSTRACT FROM AUTHOR]

Context Medical treatment of acromegaly is currently performed through a trial-and-error approach using first-generation somatostatin receptor ligands (fgSRLs) as first-line drugs, with an effectiveness of about 50%, and subsequent drugs are indicated through clinical judgment. Some biomarkers can predict fgSRLs response. Objective Here we report the results of the ACROFAST study, a clinical trial in which a protocol based on predictive biomarkers of fgSRLs was evaluated. Methods This was a prospective trial (21 university hospitals) comparing the effectiveness and time-to-control of 2 treatment protocols during 12 months: (A) a personalized protocol in which the first options were fgSRLs as monotherapy or in combination with pegvisomant, or pegvisomant as monotherapy depending on the short acute octreotide test (sAOT) results, tumor T2 magnetic resonance (MRI) signal or immunostaining for E-cadherin; and (B) a control group with treatment always started by fgSRLs and the other drugs included after demonstrating inadequate control. Results Eighty-five patients participated; 45 in the personalized and 40 in the control group. More patients in the personalized protocol achieved hormonal control compared to those in the control group (78% vs 53%, P <.05). Survival analysis revealed a hazard ratio for achieving hormonal control adjusted by age and sex of 2.53 (CI, 1.30-4.80). Patients from the personalized arm were controlled in a shorter period of time (P =.01). Conclusion Personalized medicine is feasible using a relatively simple protocol, and it allows a higher number of patients to achieve control in a shorter period of time. [ABSTRACT FROM AUTHOR]

This outstanding image article delves into the intriguing instance of a 42-year-old woman grappling with persistent lumbosacral pain over 13 years, accentuated postpartum. Electromyography (EMG) and magnetic resonance imaging (MRI) uncovered sciatic endometriosis. The rarity of this manifestation prompted a biopsy for anatomopathological confirmation, underscoring the complexity of the case. Despite unsuccessful attempts with various interventions, the administration of gonadotropin-releasing hormone (GnRH) analogs led to significant improvement, emphasizing the efficacy of tailored treatments for uncommon endometriosis presentations. This case underscores the pivotal role of advanced imaging, particularly MRI, in precise diagnosis and personalized treatment planning, showcasing the transformative impact of well-tailored interventions on the intricate facets of endometriosis. The collaborative efforts of medical professionals, guided by imaging insights, not only alleviate symptoms but also contribute substantially to preserving neurological integrity, emphasizing the profound importance of tailored treatment in enhancing overall well-being. [ABSTRACT FROM AUTHOR]

Objective Primary appendagitis epiploica is a rare cause of abdominal pain. Generally, it can be treated conservatively, and radiological imaging is important for diagnosis. The present study aimed to report the diagnosis, treatment, and follow-up results of patients diagnosed with primary appendicitis epiploica. Methods This retrospective study included 31 patients diagnosed with primary appendagitis epiploica and treated medically between February 2015 and May 2021. The definitive diagnosis in all patients was made by computerized tomography (CT). The diagnosis of patients with suspected primary appendagitis epiploica on ultrasonography was confirmed by CT. The diagnosis, treatment, and follow-up results of the patients were evaluated. Results Of the 31 patients, 14 were female and 17 were male, with a mean patient age of 42.03±13.58 years. 10 patients were hospitalized and 21 were treated as outpatients. Inpatients stayed in the hospital for a mean of 2.8±1.03 days. Oral intake continued during hospitalization. None of the patients developed complications or were operated. Conclusion Primary appendagitis epiploica is a rare condition characterized by self-limiting abdominal pain. It can be treated conservatively with the correct diagnosis. Further investigation is required for recurrent cases. Keywords:Computarized tomography, epiploic appendagitis, medical treatment: [ABSTRACT FROM AUTHOR]

Background: Recurrent episodes of upper airway collapse during sleep cause obstructive sleep apnoea (OSA). Patients with OSA, a serious clinical condition, frequently halt or reduce their breathing while they are asleep. This results in non-restful, fragmented sleep, which exacerbates symptoms such as morning headaches and drowsiness during the day. Aims and objectives: This review article focuses only on the current medical treatment of OSA. It will also catalyse further study and better awareness of the current medical treatment of OSA. Materials and methods: A search was conducted for recent research articles on current medical treatment for OSA. We searched the PubMed, Scopus, Medline and Google Scholar online databases. Results: Heart arrhythmias, depression, hypertension and coronary artery disease are among the medical disorders linked to OSA. Clinical symptoms that are predictive include obesity, enlarged neck circumferences, gasping when sleeping and loud snoring. Those who are obese, hypertensive, frequent snorers and hyper-somnolent should be suspected of having OSA. An essential test for accurately diagnosing OSA is overnight polysomnography. Conclusion: As OSA is a chronic illness, a long-term, interdisciplinary strategy is required. The first step in managing OSA is patient education. For treatment of OSA, lifestyle changes including losing weight, switching to a different sleeping position, abstaining from alcohol and using certain drugs are crucial. When treating OSA, positive airway pressure is a crucial choice. Since OSA affects both the person and society as a whole, further investigation is needed to find novel treatment approaches for this morbid clinical condition. [ABSTRACT FROM AUTHOR]

Background/Objectives: Bowel endometriosis (BE) is characterized by the presence of endometrial-like tissue within the muscular layer of the bowel wall. When BE does not result in the severe obstruction to fecal transit and in the absence of (sub)occlusive symptoms, the decision to perform surgery can be challenging, as intestinal procedures are associated with higher complication rates and long-term bowel dysfunction. This cross-sectional study aims to evaluate the quality of life (QoL) in patients with BE who avoided surgery, as well as to investigate the impact of the characteristics of BE nodules on the QoL and intestinal function. Methods: A retrospective cross-sectional analysis was conducted involving 580 patients with BE who did not undergo surgery but were treated conservatively with medical therapy or expectant management between January 2017 and August 2022. The diagnosis of BE was established through transvaginal ultrasound and confirmed via double contrast barium enema. After at least one year of follow-up, the QoL and intestinal function were assessed using the Endometriosis Health Profile-5 (EHP-5) questionnaire and the Bowel Endometriosis Symptom (BENS) score, while pain symptoms were quantified with the Visual Analog Scale (VAS 0–10). Statistical analyses were performed to explore potential associations between the QoL and the characteristics of BE nodules (size, location, and evidence of stenosis), as well as the type and duration of medical therapy. Results: Patients with BE reported a satisfactory overall QoL, with a mean EHP-5 score of 105.42 ± 99.98 points and a VAS score below three across all pain domains. They did not demonstrate significant impairment in bowel function, as indicated by a mean BENS score of 4.89 ± 5.28 points. Notably, patients receiving medical therapy exhibited a better QoL compared to those not receiving treatment (p < 0.05), with the exception of postmenopausal patients, who reported the highest QoL overall (p < 0.05). Among the characteristics of BE, nodule location significantly impacted the QoL and symptom intensity, with low (rectal or rectosigmoid) nodules less tolerated compared to sigmoid nodules, particularly regarding non-menstrual pelvic pain (NMPP), dyschezia, and psychological impact on daily life (p < 0.05). Conclusions: Women can effectively manage BE conservatively in the absence of (sub)occlusive symptoms, even when large nodules are present, causing significant radiological stenosis. The characteristics of BE nodules do not significantly affect the QoL or symptom intensity; however, the location of BE nodules is a crucial factor negatively influencing these outcomes. Medical therapy may confer a beneficial impact on patients of reproductive age with BE, but its use should be carefully considered for those approaching menopause, weighing the risks and benefits. [ABSTRACT FROM AUTHOR]

Aims: In patients with heart failure, treatment patterns in the last years of life have not been assessed at large scale. We aimed to assess whether heart failure treatment patterns up to 5 years prior to death changed over time. Methods and results: In a cohort study covering the whole Swedish population, we assessed all heart failure patients who died between 1 July 2007 and 31 December 2020 for evidence‐based treatments. The proportion on the respective treatment at the time of death was examined by year of death using binomial regression. Looking back in time, treatment discontinuation rates were estimated using Poisson regression on time‐split data. Combining these models, the proportion on each medication was estimated up to 5 years prior to death. A total of 364 480 patients died with heart failure during the study period. Half were women, and the median (interquartile range) age at death was 86 (79–90). The use of all heart failure treatments decreased gradually closer to death, but the discontinuation rate of beta blockers decreased over time, resulting in an increasing proportion of patients on treatment at the time of death. Conclusion: In patients with heart failure, a changing pattern of medical treatment during the last years of life was observed, most notably with an increasing use of beta blockers. This may in part be due to a changing pattern of comorbidities over time, with an increase in e.g. hypertension and atrial fibrillation, but a decline in ischaemic heart disease. [ABSTRACT FROM AUTHOR]

Some patients with chronic thromboembolic pulmonary hypertension (CTEPH) exhibit exercise intolerance due to reduced cardiac output (CO) even after successful balloon pulmonary angioplasty (BPA). Medical therapy is a potential option for such cases; however, it is unclear which patients necessitate it even after BPA. This study included 286 patients with CTEPH who underwent BPA and right heart catheterization 1 year after the final BPA and classified them into no-medication and withdrawal groups. The no-medication group comprised patients without pulmonary hypertension (PH) medications before and after BPA, while the withdrawal group included patients who received PH medications before BPA and discontinued them after BPA. We assessed differences in the changes in CO after BPA from baseline (ΔCO) between the 2 groups. Additionally, we evaluated the ΔCO among different age categories within each group: younger (<60 years), middle-aged (60-70 years), and older adults (≥70 years). After adjusting baseline covariates, overall CO did not differ significantly. However, ΔCO was significantly positive in the no-medication group but negative in the withdrawal group (0.32 and −0.33, difference in ΔCO: −0.65, 95% confidence intervals: −0.90 to −0.40). A significantly positive effect on ΔCO was observed in younger and middle-aged individuals, with a significant interaction between age and ΔCO in no-medication groups. Increasing CO with BPA alone may be challenging with age in patients with CTEPH. Given that discontinuation of PH medication after BPA decreased CO more than the effect of BPA, medical therapy might be necessary even after successful BPA. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is identified by instances of either full or partial collapse of the airway during sleep, leading to reduced oxygen levels or awakening from sleep. This disruption causes interrupted and insufficient sleep, impacting cardiovascular well-being, mental health, and overall quality of life. Pediatric OSA is more challenging to diagnose and a single apnoea is considered to be significant in this age group. A hospital based prospective study with 100 children between the ages of 4 and 12 years with sleep disordered breathing. Evaluated for the severity of obstructive sleep apnea and also assessed if surgery was beneficial to treat OSA in mild cases. General physical examination, evaluation of facial/oral features were conducted to rule out adenoid facies. Additionally, ENT examination was conducted. Medical history and lateral neck radiographs were reviewed, and the paediatric sleep questionnaire was administered to evaluate neurobehavioral morbidities associated with OSA. These children were evaluated for sleep disorders by conducting the polysomnography. Pediatric sleep questionnaire was also administered. The scoring and results analysis were conducted according to standardised guidelines provided by the American association for sleep medicine. Furthermore, medical management protocols were outlined, including a 6-week course of intranasal steroids and leukotriene receptor antagonist therapy, with consideration of adenotonsillectomy for patients failing medical therapy. In our study on paediatric obstructive sleep apnea (OSA), medical treatment significantly reduced clinical symptom scores in cases of mild OSA, as evidenced by pre- and post-parental sleep questionnaire scores of 23.62 ± 8.24 and 13.55 ± 6.05, respectively (paired samples test, P = 0.00). Similarly, both the pre- and post-Apnoea/Hypopnoea Index (AHI) scores (2.278 ± 1.5658 and 1.19 ± 1.420) and central sleep apnea index scores (1.252 ± 0.8972 and 0.61 ± 0.815) significantly improved post-treatment (paired samples test, P = 0.03, respectively). Additionally, significant changes were observed in tonsillar grade after the 12-week medication course, and sleep architecture showed notable improvement during the repeat follow-up study. These findings highlight the efficacy of treatment interventions in alleviating symptoms and enhancing sleep efficiency in paediatric OSA. The findings of this study underscore the efficacy of a medical management using intranasal corticosteroids and oral montelukast in mitigating the severity of mild obstructive sleep apnea (OSA) in children. This research substantiates the therapeutic value of corticosteroids and oral montelukast in paediatric patients with mild OSA, offering compelling evidence for their use as beneficial interventions in this population. [ABSTRACT FROM AUTHOR]

Background: Immersive virtual reality has the potential to motivate and challenge patients who need and want to relearn movements in the process of neurorehabilitation. Objective: The aim of this study was to evaluate the feasibility and user acceptance of an innovative immersive virtual reality system (head-mounted display) used in combination with robot-assisted gait training in subjects suffering from neurological diseases. Methods: Fifteen participants suffering from cerebrovascular accident or spinal cord injury completed a single session of immersive virtual reality using a head-mounted display during a Lokomat® gait session. Training parameters and safety indicators were collected, and acceptance was investigated among participants and therapists. Results: The results suggest that an immersive virtual reality system is feasible in terms of safety and tolerance. Furthermore, the very positive overall acceptance of the system suggests that it has the potential to be included in a robot-assisted gait training session using Lokomat®. Conclusion: Overall, this study demonstrates that a fully immersive virtual reality system based on a head-mounted display is both feasible and well received by cerebrovascular accident and spinal cord injury patients and their therapists during robot-assisted gait training. This study suggests that such a virtual reality system could be a viable alternative to the screen-based training games currently used in neurorehabilitation. It may be especially suitable for enhancing patient motivation and adherence to training, particularly if the application is enjoyable and not mentally taxing. [ABSTRACT FROM AUTHOR]

Objective: Delayed facial nerve palsy (dFNP) secondary to head injury is definitely uncommon. Although the mechanism of immediate facial nerve paralysis is well‐studied, its delayed presentation remains debated. Given the dearth of available information, we reported herein our experience with 2 cases of posttraumatic dFNP. This systematic review aimed to evaluate all available information on dFNP and to assess treatment outcome also comparing conservatively and surgically approaches. Data Sources: Pubmed, Scopus, and Web of Science databases were systematically screened. Review Methods: The protocol of this investigation was registered on PROSPERO in April 2023 and the systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses statement. Results: Both patients in the case studies showed a complete recovery within 2 to 3 months after the head trauma. One of them still reported a subjective taste alteration at last control. After the application of the inclusion‐exclusion criteria, 9 manuscripts with adequate relevance to this topic were included in the systematic review. The study population consisted of 1971 patients with a diagnosis of posttraumatic facial nerve palsy, of which 128 with a dFNP. Conclusions: dFNP due to head trauma is a rarely encountered clinical entity, and optimal treatment still remains to be elucidated. Based on the reported data, it seems rational to propose a conservative approach for dFNP with steroid administration as a first line in most cases, indicating surgery in severe and/or refractory cases. [ABSTRACT FROM AUTHOR]

Introduction: Advance directives (ADs) promote patient autonomy in end-of-life (EOL) care, including an individual's EOL medical treatment preferences. This study aims to better understand preferences regarding EOL medical treatment among community-dwelling adults (18 and older) residing in the United States and examine the association between sociodemographic characteristics and EOL medical treatment preferences. Methods: Utilizing a cross-sectional study and snowball sampling methodology, community-dwelling adults completed a survey containing two different ADs and a questionnaire with sociodemographic information. Univariate analyses were used to summarize EOL medical treatment preferences among the sample, and bivariate analyses (Chi-square and Fisher's Exact tests) were performed to examine the association between sociodemographic characteristics (age, gender, and race/ethnicity) and EOL medical treatment preferences. Results: The mean age of the 166 participants was 50 (SD: 21.65, range: 18-93), with 58.4% being White and 61.4% being female. Generally, when EOL scenarios involved brain damage or a coma, more participants indicated that they did not want life-support treatment. Age and race were both associated with EOL medical treatment preferences, but no significant differences were observed in the bivariate results by gender. Largely, young and middle-aged adults, along with Black participants, were more likely to prefer more aggressive EOL medical treatments than older adults and White participants. Conclusion: Overall, EOL medical treatment preferences varied among participants. The study findings indicate that adults develop different preferences for EOL medical treatment, with some of the variation attributable to sociodemographic characteristics such as age and race. [ABSTRACT FROM AUTHOR]

Purpose of Review: Central post-stroke pain (CPSP) poses a multifaceted challenge in medical practice, necessitating a thorough and multidisciplinary approach for its diagnosis and treatment. This review examines current methods for addressing CPSP, highlighting both pharmacological and non-pharmacological therapies. It covers the mechanisms and clinical effectiveness of these treatments in managing CPSP and emphasizes the importance of personalized treatment plans, given the varied causes of CPSP. Recent Findings: Recent advancements have illuminated diverse treatment modalities for CPSP. Pharmacotherapy spans from conventional analgesics to anticonvulsants and antidepressants, tailored to mitigate the neuropathic characteristics of CPSP. Non-pharmacological interventions, including physical therapy and psychological strategies, are pivotal in managing CPSP's chronic nature. For cases resistant to standard treatments, advanced interventions such as nerve blocks and surgical procedures like deep brain stimulation (DBS) or motor cortex stimulation (MCS) are considered. Additionally, innovative technologies such as neuromodulation techniques and personalized medicine are emerging as promising avenues to enhance therapeutic outcomes and improve quality of life for individuals grappling with CPSP. Summary: Modern approaches in managing CPSP require an interdisciplinary and patient-centric approach. Customizing treatment plans to address the specific etiology and symptoms of CPSP is crucial. Pharmacotherapy remains fundamental, encompassing medications such as anticonvulsants and antidepressants tailored to manage neuropathic pain. Integrating non-pharmacological interventions is crucial for providing comprehensive care. Additionally, investigating innovative technologies and personalized medicine presents promising opportunities to enhance treatment results and elevate the quality of life for those suffering from CPSP. Ultimately, an integrated approach that acknowledges the multifaceted nature of CPSP is essential for effective management and patient well-being. [ABSTRACT FROM AUTHOR]

The case of Charlie Gard sparked an ongoing public and academic debate whether in court decisions about medical treatment for children in England & Wales the best interests test should be replaced by a harm threshold. However, the literature has scantly considered (1) what the impact of such a replacement would be on future litigation and (2) how a harm threshold should be introduced: for triage or as standard for decision-making. This article directly addresses these gaps, by first analysing reported cases in England & Wales about medical treatment in the context of a S31 order, thus using a harm threshold for triage and second comparing court decisions about medical treatment for children in England & Wales based on the best interest test with Dutch and German case law using a harm threshold. The investigation found that whilst no substantial increase of parental discretion can be expected an introduction of a harm threshold for triage would change litigation. In particular, cases in which harm is limited, currently only heard when there are concerns about parental decision-making, may be denied a court hearing as might cases in which the child has lost their capacity to suffer. Applying a harm threshold for triage in decisions about withholding or withdrawing life-sustaining treatment might lead to a continuation of medical treatment that could be considered futile. [ABSTRACT FROM AUTHOR]

Abstract Background Cystic neutrophilic granulomatous mastitis is a rare subtype of inflammatory mastitis characterized by a distinct histopathologic pattern, often associated with Corynebacterium species. This entity has been recently distinguished and should be differentiated from other types of chronic idiopathic mastitis due to its specific treatment. Case presentation A 44-year-old North African female patient, gravida 2, para 2, with no significant past medical history, presented with a 4-month history of a painful palpable mass in her left breast, with no history of trauma. Ultrasound imaging showed three lesions in the lower quadrant of the left breast, communicating with a superficial areolar abscess collection, creating a fistulous path to the skin. This ultrasound appearance was suspicious for suppurative mastitis; although, a necrotic tumor could not be ruled out. An ultrasound-guided needle biopsy revealed inflammatory and abscess features of the breast parenchyma without histological signs of malignancy. Steroid therapy and empirical antimicrobial treatment were started, and surgical excision was performed. Histologic features confirmed the diagnosis of cystic neutrophilic granulomatous mastitis. The patient recovered and was discharged due to clinical improvement. Conclusion Cystic neutrophilic granulomatous mastitis is a recently defined entity, and its association with infection by Corynebacterium species can be detected by Gram stain and/or microbiological culture. Various treatment modalities are suggested, but the optimal treatment still requires further investigation.

Acupuncture, moxibustion, and traditional Chinese medicine (TCM) have demonstrated good effects in treating refractory gynecological infertility. This case involved an advanced-stage patient diagnosed with an infantile uterus and categorized as having primary infertility. An in vitro fertilization (IVF) center initially declined treatment, suggesting adoption as an alternative. After six months of acupuncture, moxibustion, and Chinese herbal therapy, the patient achieved a successful pregnancy. She subsequently gave birth to a healthy baby boy via caesarean section at full term. The combined use of acupuncture and TCM significantly improved the constitution of this patient with an infantile uterus.

Anastasia Gkiala, Naima Zaheer, Saba Anwar, Shalika Perera, Ahmad Sharara, Peck Lin Lip Birmingham & Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital, Birmingham, B18 7QH, UKCorrespondence: Peck Lin Lip, Birmingham & Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QH, UK, Tel +44 121 5543801, Fax +44 121 5076791, Email pllipwoo@gmail.comPurpose: This review aims to understand the value of a carotid Doppler scan (CDS) when managing patients with clinical/suspected ocular ischaemic syndrome (OIS); correlations between internal carotid artery (ICA) stenosis reports; subsequent patterns of referral to vascular experts; and subsequent decisions concerning surgical versus medical management.Methods: A retrospective review of 402 CDS requests by a single eye center over 4 years (2016– 2019) for patients with a clinical suspicion of OIS was conducted. Data analysis included 344 patients who had reported CDS of both ICAs. We also studied referral patterns by ophthalmologists to other specialties.Results: CDS requests were related to the retina (53.2%), neuro/TIA problems (31.1%), glaucoma (10.5%) and other issues (5.2%). The majority of patients (209/344, 60.8%) had normal CDA results. Of the 688 ICAs reported, 469 (68.2%) were normal, 219 (31.8%) had atheroma present, and only 83 (12.1%) had significant stenosis. Of 83 ICAs with stenosis, 23 (27.7%) had ≥ 70% stenosis, 24 (28.9%) had 50– 69% stenosis, and 25 (30.1%) had < 50% stenosis. A total of 60/344 (17.4%) patients were referred to vascular/stroke teams: 15/60 (25%) referred had bilateral disease, and only 2/60 (3.3%) were offered carotid endarterectomy. All referred patients commenced statins and low-dose aspirin.Conclusion: Our cohort showed a low incidence of ICA stenosis according to CDS reports in patients with suspected OIS. There were very low rates of vascular and endarterectomy referral. Commencement of conservative treatment (mini aspirin+statin) by ophthalmologists could be beneficial even in the early stage of presenting clinical evidence of OIS.Plain Language Summary: Ocular ischemic syndrome (OIS) covers a wide spectrum of eye problems resulting from reduced blood flow to the eyes. OIS is commonly known to be a rapidly blinding disease due to late diagnosis. A high index of suspicion can lead to early investigation and perhaps prevent blindness with timely intervention. The fluorescein angiogram is a reliable eye test to confirm OIS disease affecting the retina. If reduced retina perfusion is confirmed, a carotid Doppler artery scan (CDS) is the next investigation to detect blood vessel lumen narrowing primarily affecting carotid arteries (neck arteries). The presence of carotid artery disease can indicate risk of stroke; hence, confirmed carotid artery disease merits a referral to vascular surgeons to consider carotid artery surgery aiming to unblock the artery and improve blood flow and hopefully reverse OIS.Our study aimed to investigate the prevalence of suspected OIS patients referred for carotid Doppler scans, correlations between carotid artery stenosis results and clinical OIS, and subsequent offers of carotid artery surgery versus conservative medical management.Our study showed that carotid artery disease severity defined by CDS has a poor correlation with clinical diagnosis of OIS. Conservative treatment is advised for all patients with carotid artery disease, whereas surgical options for carotid stenosis are rarely offered. Hence, this study questions the benefit of pursuing CDS tests in OIS patients, since the results do not change their management. Finally, we highlight the need for better guidance on carotid artery stenosis referral for carotid surgery.Keywords: carotid endarterectomy, internal carotid arteries, stenosis, medical treatment

Abstract Background Cystic echinococcosis (CE) is a chronic disease considered a neglected one. Cystic echinococcosis is endemic in Uruguay and the region. Surgery, using various technical approaches, has the potential to safely remove the cyst(s) and lead to a complete cure in a high number of patients with simple forms of CE. However, surgery may be impractical in patients with multiple cysts in several organs, high surgical risk, or in patients with previous multiple surgeries. In these cases, the pharmacological treatment with the benzimidazolic drug Albendazole (ABZ) alone or combined with Praziquantel (PZQ), has been promising as the best choice to achieve improvement or cure. Methods In this study, we analyze the results obtained on the anti-parasitic treatment of 43 patients diagnosed with CE between the years 2003 and 2020. Patients were treated before and/or after surgery with ABZ or the combination ABZ/PZQ. The standardize protocol of the anti-parasitic drug treatment before surgery was 7 days, 15 days or 1 month depending on the urgency and availability of the surgical procedure. All cases that involved confirmed locations on lungs underwent immediate surgery with minimal pre-treatment when possible. After surgery, the standardize protocol of anti-parasitic drug treatment consisted of six cycles of 30 days each and resting intervals of 15 days in between. ABZ was used in all cases, administered orally, twice daily, at a total dosage of 15 mg/kg/day, with food high in fat content for improved absorption. The follow up was carried out according to WHO-IWGE guidelines for 5 years. Results Of the 43 patients fourteen were ≤ 15 years of age and had a differentiated pre-surgical treatment. From the ≥ 16 years of age, 36 completed the treatments and the 5 years follow up. Four patients changed geographical locations, without a forwarding contact, after the post-surgery treatment. No patient died during the study. Of the 36 patients that completed the study, 32 were treated only with ABZ; 93.75% achieved treatment success as determined by improvement or cure, and 6.25% treatment failure determined by no change or worsening. The last four patients received the ABZ/PZQ combination therapy and achieved 100% treatment success. Conclusion The pharmacological treatment resulted in a good option not only as palliative but also as potentially curative. The main relevance of its use was in cases with previous multiple surgeries or surgeries with potential life-threatening complications due to the number and location of cysts and concurrent comorbidities. A follow-up of at least 5 years would be recommended to assure remission and control of the transmission. More randomized trials are needed to provide clear clinical evidence of different pharmacological treatments for CE.

Objective Targeted therapy (TT) with BRAF/MEK inhibitors has emerged as a potential treatment in papillary craniopharyngiomas (PCPs). However, standardized data on large cohorts are lacking. Our study aimed to assess real-life efficacy and safety of BRAF/MEK inhibition in patients with PCPs. Design Retrospective French multicenter study involving BRAF V600E–mutated PCP patients, treated with BRAF/MEK inhibitor combination dabrafenib and trametinib, from April 2019 to July 2023. Methods Objective response and clinical and safety outcomes were assessed after 3 months and at the last available follow-up during TT. Results Sixteen patients (8 females, mean age 50.5 ± 15.75 years), receiving either neoadjuvant therapy (NEO) for non-resectable tumors (n = 6), post-surgical adjuvant therapy (ADJ; n = 8), or palliative therapy (PAL) following failure of multimodal treatment (n = 2), were included. At the last follow-up (mean 7.6 ± 5.3 months), 12 patients showed subtotal response, 3 exhibited partial response, and 1 maintained stable disease. Mean volume reduction was 88.9 ± 4.4%, 73.3 ± 23.4%, and 91.8 ± 4.3% in the NEO, ADJ, and PAL groups, respectively. Targeted therapy resolved headaches in 5/5 patients and visual impairment in 6/9; 2/3 patients had improved neurological symptoms, 1/4 presented weight loss, and 2/14 recovered endocrine function. Targeted therapy was well-tolerated in 62.5% of cases; adverse events led to treatment discontinuation in 5 patients and definitive discontinuation in 3 cases. Conclusions In this study, 94% of patients showed partial response or better to TT. Adverse events were acceptable. Further research is needed to establish standardized protocols; however, these results advocate for a NEO approach in invasive PCPs. [ABSTRACT FROM AUTHOR]

Purpose of Review: Acute facial pain presents a complex challenge in medical practice, requiring a comprehensive and interdisciplinary approach to its management. This narrative review explores the contemporary landscape of treating acute facial pain, delving into pharmacological, non-pharmacological, and advanced interventions. The significance of tailored treatment strategies, rooted in the diverse etiologies of facial pain, such as dental infections, trigeminal neuralgia, temporomandibular joint disorders, sinusitis, or neurological conditions like migraines or cluster headaches, is underscored. We particularly emphasize recent advances in treating trigeminal neuralgia, elucidating current treatment concepts in managing this particular acute facial pain. Recent Findings: Recent research sheds light on various treatment modalities for acute facial pain. Pharmacotherapy ranges from traditional NSAIDs and analgesics to anticonvulsants and antidepressants. Non-pharmacological interventions, including physical therapy and psychological approaches, play pivotal roles. Advanced interventions, such as nerve blocks and surgical procedures, are considered in cases of treatment resistance. Moreover, we explore innovative technologies like neuromodulation techniques and personalized medicine, offering promising avenues for optimizing treatment outcomes in acute facial pain management. Summary: Modern management of acute facial pain requires a nuanced and patient-centric approach. Tailoring treatment strategies to the individual's underlying condition is paramount. While pharmacotherapy remains a cornerstone, the integration of non-pharmacological interventions is essential for comprehensive care. Advanced interventions should be reserved for cases where conservative measures prove inadequate. Furthermore, leveraging innovative technologies and personalized medicine holds promise for enhancing treatment efficacy. Ultimately, a holistic approach that considers the diverse needs of patients is crucial for effectively addressing acute facial pain. [ABSTRACT FROM AUTHOR]

Background: Cystic echinococcosis (CE) is a chronic disease considered a neglected one. Cystic echinococcosis is endemic in Uruguay and the region. Surgery, using various technical approaches, has the potential to safely remove the cyst(s) and lead to a complete cure in a high number of patients with simple forms of CE. However, surgery may be impractical in patients with multiple cysts in several organs, high surgical risk, or in patients with previous multiple surgeries. In these cases, the pharmacological treatment with the benzimidazolic drug Albendazole (ABZ) alone or combined with Praziquantel (PZQ), has been promising as the best choice to achieve improvement or cure. Methods: In this study, we analyze the results obtained on the anti-parasitic treatment of 43 patients diagnosed with CE between the years 2003 and 2020. Patients were treated before and/or after surgery with ABZ or the combination ABZ/PZQ. The standardize protocol of the anti-parasitic drug treatment before surgery was 7 days, 15 days or 1 month depending on the urgency and availability of the surgical procedure. All cases that involved confirmed locations on lungs underwent immediate surgery with minimal pre-treatment when possible. After surgery, the standardize protocol of anti-parasitic drug treatment consisted of six cycles of 30 days each and resting intervals of 15 days in between. ABZ was used in all cases, administered orally, twice daily, at a total dosage of 15 mg/kg/day, with food high in fat content for improved absorption. The follow up was carried out according to WHO-IWGE guidelines for 5 years. Results: Of the 43 patients fourteen were ≤ 15 years of age and had a differentiated pre-surgical treatment. From the ≥ 16 years of age, 36 completed the treatments and the 5 years follow up. Four patients changed geographical locations, without a forwarding contact, after the post-surgery treatment. No patient died during the study. Of the 36 patients that completed the study, 32 were treated only with ABZ; 93.75% achieved treatment success as determined by improvement or cure, and 6.25% treatment failure determined by no change or worsening. The last four patients received the ABZ/PZQ combination therapy and achieved 100% treatment success. Conclusion: The pharmacological treatment resulted in a good option not only as palliative but also as potentially curative. The main relevance of its use was in cases with previous multiple surgeries or surgeries with potential life-threatening complications due to the number and location of cysts and concurrent comorbidities. A follow-up of at least 5 years would be recommended to assure remission and control of the transmission. More randomized trials are needed to provide clear clinical evidence of different pharmacological treatments for CE. [ABSTRACT FROM AUTHOR]

Background: There is a need for a simpler and accessible intervention to heal tympanic membrane perforations than myringoplasty that is todaýs golden standard. Experimental studies have identified plasminogen as a promising agent for medical treatment of chronic tympanic membrane perforation. Aims/Objectives: This was a phase 1, prospective, randomized, placebo-controlled study with the main objective to evaluate the safety of injecting plasminogen in the vicinity of the tympanic membrane in subjects with chronic tympanic membrane perforation. Material and Methods: Adults diagnosed with a dry chronic tympanic membrane perforation were recruited for an injection schedule with Human plasminogen 10. Adverse events, audiometry, VAS fluctuations and size of perforation, were monitored throughout the length of the study. Results: It was possible to perform the injections according to schedule in all subjects. None of the subjects experienced any severe adverse events. Most common adverse event was ear pain. No signs of ototoxicity were reported. Conclusions and Significance: This pilot study suggests that plasminogen injections close to the tympanic membrane as treatment for chronic tympanic membrane injections are safe and feasible, encouraging further dose-escalating studies. [ABSTRACT FROM AUTHOR]

Numerous structural and conductive properties of barium cerate (BC) make this material a promising candidate for energy storage applications. In this work, we demonstrated that BC can be proficiently functionalized by incorporating trivalent samarium ions to give rise to optical properties. Single-phased BaCeO3:Sm3+ (BCS) phosphors were synthesized by gel combustion technique followed by calcination. The crystal structure, optical properties, and prospective applications in LEDs were investigated systematically. By linking the information acquired from the diffuse reflectance spectra with that of the PL spectra, we better understood the electronic level structure and energy transfer mechanism. Fine yellow-orange luminescence with 100% color purity (CP) and lower Correlated Color Temperature (CCT) has been achieved via energization at 348 nm wavelength. The x = 0.02 Sm3+ has been identified as the optimized content for the luminescence with a quantum efficiency of 34.2%. Obtained yellow-orange coordinates (0.564, 0.435) are proximate to commercialized L3 rank amber LED (Nichia corporation). The present results signify that UV light can suitably energize the BCS phosphor to get monochromatic amber light which can be used to guard medications during manufacture and storage. [ABSTRACT FROM AUTHOR]

This article extends and builds upon our previous research concerning Virtual Reality (VR) with bilateral stimulation as an automated stress-reduction therapy tool. The study coincided with Russia's invasion of Ukraine, thus the software was tailored to reduce the stress of war refugees. We created a 28 minutes relaxation training program in a virtual, relaxing environment in the form of a cozy apartment in the mountains. An integral part of this tool is a set of sensors, which collects and records objective physiological measures to evaluate the system's effectiveness. A pilot treatment programme, incorporating the VR system mentioned above was carried out on the experimental group of 55 Ukrainian refugees who participated in up to five relaxation training sessions. Before starting the session, baseline features such as subjectively perceived stress, mood, galvanic skin response, and EEG were registered. The monitoring of physiological indicators was continued during the training session. Before and after the session, volunteers were asked to fill in questionnaires regarding their current stress level and mood. The obtained results were analyzed in terms of variability over time: before, during, and after the session. [ABSTRACT FROM AUTHOR]

Different interventions have been evaluated for the treatment of depression in heart failure (HF) patients. However, clear and established recommendations are lacking. PubMed, Scopus, and Web of Science databases were systematically searched for randomized controlled trials (RCT) evaluating the effect of various treatment options on depression scores in heart failure patients. The primary outcome was a change in depression scores presented as standardized mean difference (SMD). A Bayesian network for meta-analysis was constructed. Twenty-five RCTs were included, randomizing 6014 patients with confirmed heart failure and depression between 2003 and 2022. Compared to treatment as usual (TAU), only cognitive behavioral therapy (CBT) (SMD − 0.60, CI95% [− 1.0, − 0.17]) leads to a significant reduction in depression scores. Other interventions did not improve depression scores significantly. Our results show that for patients with HF and depression, CBT can significantly improve measures of depression, being the most efficacious treatment. [ABSTRACT FROM AUTHOR]

Best medical therapy (BMT) for acute uncomplicated type B intramural hematoma (TBIMH) is the current treatment guideline, but there is considerable controversy about subsequent clinical course and outcome, which may be associated with a significant failure rate. The purpose of this study was to identify potential risk factors for BMT failure and to develop a risk score to guide clinical decision making. Patients with acute uncomplicated TBIMH between 2011 January and 2020 December were retrospectively studied. Logistic regression was applied to univariately assess potential risk predictors, and multivariable model results were then used to formulate a simplified predictive model for BMT failure. In a total of 61 patients, the overall rate of BMT failure was 57.4% (35/61), of which 48.6% (17/35) occurred within 28 days of onset. Logistic regression identified maximum descending aortic diameter (HR ​= ​1.99 CI ​= ​1.16–3.40, p ​= ​0.012), initial IMH thickness (HR ​= ​3.29, CI ​= ​1.28–8.46, p ​= ​0.013) and presence of focal contrast enhancement (HR ​= ​3.12, CI ​= ​1.49–6.54, p ​= ​0.003) as potential risk predictors of BMT failure. A risk score was calculated as follows: [Max DTA diameter (mm)∗0.6876 ​+ ​Max IMH thickness (mm)∗1.1918 ​+ ​PAU/ULP ∗1.1369]. Freedom from BMT failure at 1 year was 72% in patients with a risk score ​< ​4.12, compared with only 35.1% in those with a risk score ​≧ ​4.12. In a substantial proportion of patients with acute uncomplicated TBIMH, initial BMT failed. Based on the three initial computed tomographic imaging variables, this risk score could help stratify patients at high or low risk for BMT failure and provided additional information for early intervention. • Acute type B IMH is not a benign condition. • Several key features on CT images are useful in predicting medical failure. • Important features include aortic diameter, IMH thickness and presence of FCE. • Clinical risk scores incorporating these features may aid clinical decision making. [ABSTRACT FROM AUTHOR]

Objective: To understand what concerns and experiences people with vaginismus share online anonymously but may not share with clinicians. Methods: Two researchers compiled all comments and posts made from November 2019 to April 2020 within an online vaginismus forum (n = 311) for content analysis. Two researchers separately performed inductive coding, categorized quotes into overarching categories and codes, and resolved inconsistencies with a third-party adjudicator. Results: Our analysis highlighted three key categories: "psychosocial concerns" (34%), "discussion of pain" (33%), and "lack of access to vulvovaginal healthcare" (34%). The category "psychosocial concerns" comprised of the codes "shame and/or social isolation" (12%), "mental health comorbidities" (9%), "fear of partner separation" (7%), "cultural/religious stigma" (2%), "partner separation" (2%), and "fear of infertility or vaginal delivery" (1%). The category "discussion of pain" comprised of the codes "successful therapies" (16%), "sexual pain" (9%), "nonsexual pain" (6%), and "unsuccessful therapies" (2%). The category "lack of access to vulvovaginal healthcare" comprised of the codes "lack of standardized therapy guidelines" (8%), "self diagnosis" (7%), "fertility testing and/or treatments limited by vaginismus" (5%), "clinicians dismissing symptoms" (4%), "inadequate clinician knowledge about vaginismus" (2%), "inadequate health and sex education in schools" (2%), "geographical barriers" (2%), and "COVID-19" (2%). Conclusion: This novel qualitative study of an online vaginismus forum highlights the need for a patient-centered approach to inform future research, medical education, and clinical practice. Our findings suggest we reevaluate the standard of care for patients with vaginismus and expand on existing knowledge of the impact of sexual health stigma on social and health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Acute heart failure (AHF) is associated with high morbidity and mortality, and the prognosis is particularly poor in older patients. Although the application of guideline-directed medical therapy (GDMT) has shown a positive impact on prognosis, the effects are less clear in older age groups. The aim of this study was to analyze real-world data regarding GDMT and outcomes in older HF patients. Methods: This is a prospective cohort study from a secondary care hospital in central Switzerland. A total of 97 consecutive patients aged ≥60 years were enrolled between January 2019 and 2022. The main outcome parameters were prescribed GDMT at discharge, and in case of rehospitalization, GDMT at readmission, and survival in terms of all-cause mortality and HF-related hospitalizations during a 3-year follow-up period. Results: Follow-up data were available for 93/97 patients. The mean age was 77.8 ± 9.8 years, 46% being female. The mean left ventricular ejection fraction (LVEF) was 35.3 ± 13.9%, with a mean BNP level of 2204.3 ± 239 ng/L. Upon discharge, 86% received beta-blockers and 76.3% received renin–angiotensin system (RAS) inhibitors. At rehospitalization for AHF, beta-blockers use was significantly lower and decreased to 52.8% (p = 0.003), whereas RAS inhibitor use increased slightly to 88.9% (p = 0.07), and SGLT-2 inhibitors showed a significant increase from 5.4% vs. 47.2% (p = 0.04). GDMT prescription was not dependent on LVEF. Overall, 73.1% of patients received two-stage or three-stage GDMT at discharge, whereas this percentage decreased to 61% at rehospitalization (p = 0.01). Kaplan–Meier analysis for the combined outcome rehospitalization and death stratified by LV function showed significant differences between LVEF groups (aHR: 0.6 [95% CI: 0.44 to 0.8]; p = 0.0023). Conclusions: Our results indicate that first, the majority of older AHF patients from a secondary care hospital in Switzerland were not on optimal GDMT at discharge and even fewer at readmission, and second, that prognosis of the population is still poor, with almost half of the patients having been rehospitalized or died during a 3-year follow-up period under real-world conditions, without significant difference between women and men. Our findings underline the need for further improvements in the medical treatment of AHF, in particular in older patients, to improve prognosis and to reduce the burden of disease. [ABSTRACT FROM AUTHOR]

• The disease modification concept is arbitrary. • The level of therapeutic causality cannot be objectified. • There is a continuum of treatment and disease outcomes. • Biomarkers are required as actionable tools for treatment personalization. [ABSTRACT FROM AUTHOR]

This article analyses Australian law and literature to identify the key cultural and legal considerations that can arise in medical treatment decision-making with Aboriginal and Torres Strait Islander peoples at the end-of-life. The authors explore how First Nation peoples' cultural values, connection to Country, family, and community, history, and health care experiences, intersect with end-of-life medical treatment laws, providing valuable insights for lawyers, policymakers and health practitioners. [ABSTRACT FROM AUTHOR]

Copyright of Androloji Bülteni (Andrology Bullettin) is the property of BAYT Ltd. Co and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives of the study: to evaluate the effectiveness of the progestogens for the treatment of uterine fibroids (UF) in women in the premenopausal period. Materials and methods. 42 patients aged 45–50 years with UF were examined. The diagnosis of UF was verified according to clinical and instrumental research methods. The effectiveness of the therapy was evaluated according to clinical and ultrasound examination data before and during the course of treatment. All patients with diagnosed symptomatic UF received progestogen dienogest 2 mg ones a day continuously for a year, with clinical and sonographic control every 3 months. Results. UF was symptomatic in all examined patients. According to the International Federation of Gynecology and Obstetrics (FIGO) classification system for UF, 42.8% (18) of women had type III–IV nodes, 54.8% (23) had type II–V nodes, and 2.4% (1) of women had type VI nodes. In all patients were 2 or more nodes. Already after 6 months of therapy, bleeding complaints decreased by more than 8 times, moderate pain syndrome and urination disorders were noted in only one (2.4%) patient. After 12 months, pelvic pain and bladder dysfunction were absent in 100% of cases. One (2.4%) patient had spotting bleeding for 2 days during the 8th month of treatment. After 6 and 12 months of treatment, the size of the endometrium decreased significantly to 3.6–7 and 3.2–4.6 mm, respectively. The total volume of the uterus also underwent positive changes: it decreased by 10–40% in each patient during the course of treatment. Conclusions. It should be preferred progestogens in the treatment of UF in women aged 45–50 years who wish to preserve the uterus. Therapy with dienogest in a continuous long-term regimen showed high clinical effectiveness, confirmed the active antiproliferative, antiovulatory effect of the drug in the absence of estrogen deficiency symptoms, which is important for this age group of patients.

Background: Cystic neutrophilic granulomatous mastitis is a rare subtype of inflammatory mastitis characterized by a distinct histopathologic pattern, often associated with Corynebacterium species. This entity has been recently distinguished and should be differentiated from other types of chronic idiopathic mastitis due to its specific treatment. Case presentation: A 44-year-old North African female patient, gravida 2, para 2, with no significant past medical history, presented with a 4-month history of a painful palpable mass in her left breast, with no history of trauma. Ultrasound imaging showed three lesions in the lower quadrant of the left breast, communicating with a superficial areolar abscess collection, creating a fistulous path to the skin. This ultrasound appearance was suspicious for suppurative mastitis; although, a necrotic tumor could not be ruled out. An ultrasound-guided needle biopsy revealed inflammatory and abscess features of the breast parenchyma without histological signs of malignancy. Steroid therapy and empirical antimicrobial treatment were started, and surgical excision was performed. Histologic features confirmed the diagnosis of cystic neutrophilic granulomatous mastitis. The patient recovered and was discharged due to clinical improvement. Conclusion: Cystic neutrophilic granulomatous mastitis is a recently defined entity, and its association with infection by Corynebacterium species can be detected by Gram stain and/or microbiological culture. Various treatment modalities are suggested, but the optimal treatment still requires further investigation. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is becoming all-pervasive, impacting our lives in ways that are sometimes visible, but at other times hidden. Algorithms that learn from data—be it consumer preferences, medical imaging data, or any other dataset—are influencing decisions and choices in every industry, and health care is no exception. When patient outcomes are at stake this raises questions of ethics, accountability, and accuracy. This article looks at how AI is currently being put to work in cardiology, how its range of applications might expand, and how health care professionals and technologists can work together to ensure that it is deployed in a way that is safe, efficient, and beneficial for all patients. [ABSTRACT FROM AUTHOR]

A career that spans the 37 years since “tissue engineering” was coined is chronicled, including selected research and translation highlights of the author in cardiovascular applications. [ABSTRACT FROM AUTHOR]