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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]

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]

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]

AbstractBackgroundAims/ObjectivesMaterial and MethodsResultsConclusions and SignificanceThere 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.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.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.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.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]

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]

Aims Methods and results Conclusion 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.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.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]

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]

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.

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.

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

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]

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]

• 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]

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]

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]

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Purpose: To review the literature on the topic, to suggest a common line of treatment applicable across a wide community of specialists, and to contribute in maintaining the high level of interest in this disease. Methods: A comprehensive and exhaustive review of the literature was performed, identifying hundreds of articles on the topic. Results: Peyronie's disease is a condition that has been recognized, studied, and treated for centuries; despite this, if one excludes surgery in cases in which the deformity is stable, no clear treatment (or line of treatment) is available for complete relief of signs and symptoms. Treatment options were divided into local, oral, and injection therapy, and a wide variety of drugs, remedies, and options were identified. Conclusions: Low-intensity extracorporeal shock wave therapy, vacuum therapy, penile traction therapy, phosphodiesterase type 5 inhibitors, hyaluronic acid, and collagenase of Clostridium histolyticum may be recommended only in specific contexts. Further studies on individual options or potential combinations are required. [ABSTRACT FROM AUTHOR]

Ectopic pregnancies, occurring in approximately 1-2% of cases, are typically found within the fallopian tube. Among these instances, cervical ectopic pregnancies constitute less than 1% of cases, with the majority observed within the endocervical canal. This study presents a case of cervical ectopic pregnancy following in vitro fertilization (IVF), treated with a single dose of methotrexate. A 23-year-old woman who has been married for 4 years with a history of infertility presents with complaints of abdominal pain for 2 days and vaginal spotting as bleeding, following her last menstrual period, at 5 weeks and 3 days of pregnancy. In her medical history, the patient mentions having low ovarian reserve (AMH 6.73 pmol/L), which led to in vitro fertilization (IVF) transfer 22 days ago. Due to the patient's young age and it being her first pregnancy, medical treatment with methotrexate (MTX) was decided. MTX was administered at a dose of 50 mg/m²(100 mg of intravenous MTX in 100 ml of 0.9% NaCl). Experiences in cervical ectopic pregnancies predominantly stem from case-based experiences. Thus, when planning treatment for cervical ectopic pregnancy, a conservative or minimally invasive approach may be more appropriate, tailored to the patient's characteristics whenever possible [ABSTRACT FROM AUTHOR]

The present narrative review aims to discuss the available data on the incidence and the risk factors of uterine fibroids (UFs) recurrence after different types of conservative surgical or radiologic procedures in women wishing to preserve their uterus. UFs are the most common benign tumors in women all over the world. Clinical presentation, including abnormal uterine bleeding (AUB), pelvic pain, bulky symptoms, and infertility affect patients' quality of life, and a large variety of conservative treatments are available especially for those with desire of pregnancy. Fertility sparing surgery, by either laparoscopy, hysteroscopy or laparotomy, or radiological interventions (uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound), are the most common therapeutic approaches. However, the genetic or acquired predisposition to UFs remain despite the treatments, and the recurrences are frequently described in a large percentage of patients. The most relevant risk factors for recurrence of UFs are young age at the first surgery, incomplete fibroid resection, the presence of multiple lesions, an enlarged uterus, and the coexistence with other pelvic diseases. The discussion on the possible medical strategy to reduce the recurrence is an open field of clinical investigation, in particular by using hormonal drugs. [ABSTRACT FROM AUTHOR]

Disease diagnosis using the medical image is a very technical and tedious process. Small abnormalities in multiple medical images could be noticed by medical specialists but deep analysis of a medical image is still a complicated task due to the restricted ability of the human visual system. The limitations of the human visual system might lead to medical treatment impairment. This issue, however, may be handled by searching for similar cases in the preceding medical database using an effective content-based medical image retrieval (CBMIR) method. The CBMIR's main problem is efficient classification but also required retrieval from multi-modal medical imagery information. Most prior attempts at medical image retrieving and classification employ handmade features, that perform poorly across a large collection across multimodal datasets. Even though there has been a few earlier research on using deep characteristics for classification, the total count is quite modest. To address this issue, we offer an upgraded Inceptionv3 network, which is a genetic algorithm-based optimum retrieval system incorporating multimodal medical images from multiple forms of imaging systems. The experimental findings from 5 classes are showing accuracy and optimization with F1. score using our technique is 97.22%, and 89.56% with 98.53%, respectively, each of which is higher than either the accuracy but also F1. score from the prior solution of CBMIR. [ABSTRACT FROM AUTHOR]

Abstract This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.

Abstract Background In the intensive care unit (ICU), we may encounter patients who have completed a Do-Not-Resuscitate (DNR) or a Physician Orders to Stop Life-Sustaining Treatment (POLST) document. However, the characteristics of ICU patients who choose DNR/POLST are not well understood. Methods We retrospectively analyzed the electronic medical records of 577 patients admitted to a medical ICU from October 2019 to November 2020, focusing on the characteristics of patients according to whether they completed DNR/POLST documents. Patients were categorized into DNR/POLST group and no DNR/POLST group according to whether they completed DNR/POLST documents, and logistic regression analysis was used to evaluate factors influencing DNR/POLST document completion. Results A total of 577 patients were admitted to the ICU. Of these, 211 patients (36.6%) had DNR or POLST records. DNR and/or POLST were completed prior to ICU admission in 48 (22.7%) patients. The DNR/POLST group was older (72.9 ± 13.5 vs. 67.6 ± 13.8 years, p

Abstract Background There is a mutual influence between emotions and diseases. Thus, the subject of emotions has gained increasing attention. Objective The primary objective of this study was to conduct a comprehensive review of the developments in emotion recognition technology over the past decade. This review aimed to gain insights into the trends and real-world effects of emotion recognition technology by examining its practical applications in different settings, including hospitals and home environments. Methods This study followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and included a search of 4 electronic databases, namely, PubMed, Web of Science, Google Scholar and IEEE Xplore, to identify eligible studies published between 2013 and 2023. The quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) criteria. The key information from the studies, including the study populations, application scenarios, and technological methods employed, was summarized and analyzed. Results In a systematic literature review of the 44 studies that we analyzed the development and impact of emotion recognition technology in the field of medicine from three distinct perspectives: “application scenarios,” “techniques of multiple modalities,” and “clinical applications.” The following three impacts were identified: (i) The advancement of emotion recognition technology has facilitated remote emotion recognition and treatment in hospital and home environments by healthcare professionals. (ii) There has been a shift from traditional subjective emotion assessment methods to multimodal emotion recognition methods that are grounded in objective physiological signals. This technological progress is expected to enhance the accuracy of medical diagnosis. (iii) The evolving relationship between emotions and disease throughout diagnosis, intervention, and treatment processes holds clinical significance for real-time emotion monitoring. Conclusion These findings indicate that the integration of emotion recognition technology with intelligent devices has led to the development of application systems and models, which provide technological support for the recognition of and interventions for emotions. However, the continuous recognition of emotional changes in dynamic or complex environments will be a focal point of future research.

Background: Currently, there is no clear consensus on whether medical treatment or endoscopic treatment should be used for peptic ulcer bleeding patients with adherent clot. The aim of this study is to investigate the hemostatic effects of medical treatment, single endoscopic treatment, and combination endoscopic treatment for peptic ulcer bleeding (PUB) patients with adherent clot. Methods: We retrospectively analyzed PUB patients with adherent clot who underwent endoscopic examination or treatment in our center from March 2014 to January 2023 and received intravenous administration of proton pump inhibitors. Patients were divided into medical treatment (MT) group, single endoscopic treatment (ST) group, and combined endoscopic treatment (CT) group. Subsequently, inverse probability of treatment weighting (IPTW) was performed to calculate the rebleeding rate. Results: A total of 605 eligible patients were included in this study. After IPTW, the rebleeding rate in the MT group on days 3, 7, 14, and 30 were 13.3 (7.3), 14.2 (7.8), 14.5 (7.9), and 14.5 (7.9), respectively; the rebleeding rates in the ST group were 17.4 (5.1), 20.8 (6.1), 20.8 (6.1), and 20.8 (6.1), respectively; the rebleeding rates in the CT group were 0.4 (0.9), 1.7 (3.3), 2.3 (4.5), and 2.3 (4.5), respectively. Although the rebleeding rate in the medical treatment group was higher, there was no significant difference among the three groups on days 3, 7, 14, and 30 (P = 0.132, 0.442, 0.552, and 0.552). Conclusions: Medical therapy has similar hemostatic efficacy with endoscopic treatment for PUB patients with adherent clot (FIIb ulcers). However, for patients with more risk factors and access to well-equipped endoscopy centers, endoscopic treatment may be considered. The choice of treatment approach should be based on the individual conditions of the patient, as well as other factors such as medical resources available. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcomes associated with each therapeutic option for patients diagnosed with interstitial pregnancy (IP). Methods: We conducted a multicentric retrospective cohort study within the departments of Gynecology and Obstetrics involved in the Francogent research group. Women treated for an interstitial pregnancy between January 2008 to December 2019 were included. Three therapeutic options were evaluated: surgical treatment (ST); in situ methotrexate combined with systemic methotrexate (IS‐MTX); and systemic methotrexate (IM‐MTX). Success of first‐line treatment was defined by hCG negativation (<5I U/L). Secondary outcomes included the need for secondary surgical procedure, secondary medical treatment, emergency surgery, postoperative complications, duration of hospitalization, and delay before hCG negativation. Results: A total of 98 patients were managed for IP: 42 (42.9%) patients had IM‐MTX; 34 (34.7%) had IS‐MTX; and 22 (22.4%) had ST. First‐line treatment was successful in all patients of the ST group (22/22, 100%), in 31% of patients within the IM‐MTX group (13/42) and 70.6% (24/34) in the IS‐MTX group. The sole parameter associated with the risk of treatment failure was the mode of methotrexate administration. The size of the gestational sac or the presence of fetal heartbeat was not associated with decreased medical treatment (IS or IM–MTX) efficiency. Conclusion: Either ST or IS‐MTX are good options for IP treatment associated with high success rates. A single‐dose regimen of IM‐MTX is less efficient than IS‐MTX or ST. Symptomatic patients with severity criteria should always undergo emergency surgery. IP remains a high‐risk condition that should be managed, whenever possible, in referral centers to potentialize the chances of favorable outcomes. Synopsis: Surgical treatment or in situ methotrexate is a good option for interstitial pregnancy treatment, and is associated with high success rates. [ABSTRACT FROM AUTHOR]

Androgenetic alopecia is a common type of hair loss, which is generally influenced by genetic factors and systemic androgens resulting in follicular miniaturization. It can cause cosmetic problems leading to psychological distress among affected men and women. Effective standard medical treatments available are topical minoxidil 2 to 5%, oral finasteride, oral dutasteride, and hair transplantation. However, some patients do not achieve favorable results with standard treatments. For these reasons, other novel treatments have been developed, including new medications, regenerative medicines (autologous platelet-rich plasma, adipose-derived stem cells, micrograft generation, and exosome), and low-level laser therapy [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD), a metabolic stress-induced liver injury, is characterized by excessive accumulation of fat in the liver, which is closely related to insulin resistance and genetic susceptibility. It is estimated that 25% of the world􀆳s population are currently diagnosed with NAFLD, which has a huge impact on socioeconomic development and people􀆳s health. The prevalence of NAFLD in different countries/regions is different based on the living customs and population genetic differences in different regions, and there are also certain differences in the diagnostic criteria and treatment plans of NAFLD in the recommendations given by the national/regional diagnosis and treatment guidelines. This article aims to compare the latest domestic and international guidelines on the diagnosis and treatment of NAFLD, as well as summarise the latest research advances in the treatment of NAFLD, in order to provide recommendations for the clinical management of NAFLD. [ABSTRACT FROM AUTHOR]

In the context of climate change, hospitals that use significant amounts of disposable products are undertaking sustainability initiatives. This can be supported by Life Cycle Analysis (LCA), in which an increase is noted in the medical domain to study and implement sustainable alternatives. However, the sustainable implementation of new technology such as 3D printing to generate personalized medical devices raises additional challenges. As common wrist injuries like a distal radius fracture, show a high prevalence (200-400 times per 100.000 persons), the department of trauma surgery at the Radboud University Medical Centre in Nijmegen, is focusing on implementing 3D printing of personalized splints. Simultaneously, a case study is initiated to assess the environmental impact of this innovation with conventional medical devices: mineral or plastic splints. This research enhances future work on sustainability implementation of the 3D printed splint treatment for wrist injuries, potentially expediting its adoption as the standard treatment. This project raises awareness about the environmental impact of medical products and treatments, while fostering collaboration for future sustainable projects in the hospital. [ABSTRACT FROM AUTHOR]

To evaluate the effect of hormonal suppression of endometriosis on the size of endometriotic ovarian cysts. The authors searched MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov from January 2012 to December 2022. We included studies of premenopausal women undergoing hormonal treatment of endometriosis for ≥3 months. The authors excluded studies involving surgical intervention in the follow-up period and those using hormones to prevent endometrioma recurrence after endometriosis surgery. Risk of bias was assessed with the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. The protocol was registered in PROSPERO (CRD42022385612). The primary outcome was the mean change in endometrioma volume, expressed as a percentage, from baseline to at least 6 months. Secondary outcomes were the change in volume at 3 months and analyses by class of hormonal therapy. The authors included 16 studies (15 cohort studies, 1 randomized controlled trial) of 888 patients treated with dienogest (7 studies), other progestins (4), combined hormonal contraceptives (2), and other suppressive therapy (3). Globally, the decrease in endometrioma volume became statistically significant at 6 months with a mean reduction of 55% (95% confidence interval, −40 to −71; 18 treatment groups; 730 patients; p <.001; I2 = 96%). The reduction was the greatest with dienogest and norethindrone acetate plus letrozole, followed by relugolix and leuprolide acetate. The volume reduction was not statistically significant with combined hormonal contraceptives or other progestins. There was high heterogeneity, and studies were at risk of selection bias. Hormonal suppression can substantially reduce endometrioma size, but there is uncertainty in the exact reduction patients may experience. [ABSTRACT FROM AUTHOR]

Objective: This single-center retrospective study evaluated early and midterm outcomes of 100 consecutive patients with type A intramural hematoma. Methods: Initial watch-and-wait strategy was indicated if the maximum aortic diameter was < 50 mm, pain score was < 3/10 on the numerical rating scale, and no ulcer-like projection was observed in the ascending aorta. The primary endpoints of this study were all-cause and aorta-related deaths, and the secondary endpoint was aortic events. Results: Initial watch-and-wait strategy was indicated in 52 patients. Emergency aortic repair was indicated in the remaining 48 patients; 2, 31, and 15 patients died before surgery, underwent emergency surgery, and declined emergency surgery, respectively. Among the watch-and-wait group, 11 (21%) patients underwent aortic repair during hospitalization. In-hospital mortality rates, 5-year survival rates, and 5-year freedom from aorta-related death were not significantly different between the initial watch-and-wait strategy and emergency surgery (2% vs. 6%, 92% vs. 82%, and 100% vs. 94%, respectively). In the initial watch-and-wait strategy group, 5-year freedom from aortic events and freedom from aortic events involving the ascending aorta were 60% and 66%, respectively. Conclusions: The early and midterm outcomes with the initial watch-and-wait strategy in patients with type A intramural hematoma with a maximum aortic diameter of ≤ 50 mm, pain score of ≤ 3/10, and no ulcer-like projection in the ascending aorta were favorable with no aorta-related death. [ABSTRACT FROM AUTHOR]

The purpose of this research was to find the right strategy for developing new medical services in PT. Erha during the COVID-19 pandemic. The study used qualitative research methods. The subjects were eight employees of PT. Erha in the Medical Service Development division. Data collection was done through semi-structured interviews by asking concept questions that were prepared. The results of this study showed that Medical Treatment in Erha had decreased during the COVID-19 pandemic. Therefore, it was necessary to develop a new medical treatment. To market this new product, a more effective digital marketing strategy was needed. Other results showed that the development of new products must adapt to current consumer conditions as well as regulations, government, and economic situations. The results of this study were also homogeneous between the informants. [ABSTRACT FROM AUTHOR]

Background: Rheumatic heart disease remains the most common cardiovascular disease in children and young adults. The outcome of interventional versus medical therapy on the long term is not fully elucidated yet. This study provides contemporary data on the clinical profile, treatment and follow up of patients with rheumatic mitral stenosis (MS) in Tanzania. Methods: Patients' medical information, investigations and treatment data were recorded in this prospective cohort study. They were followed up for 6–24 months to determine the long‐term outcome. Interventional therapy was defined as a combination of surgery and percutaneous balloon mitral valvuloplasty. Kaplan–Meier curves and Cox proportional hazards model were used in analyses. p‐Value < 0.05 was considered statistically significant. Results: We enrolled 290 consecutive patients. Interventions were done in half of the patients. Median follow up was 23.5 months. Mortality was higher in the medical than interventional treatment (10.4% vs. 4%, log‐rank p = 0.001). Median age was 36 years, females (68.3%) and low income (55.5%). Multivalvular disease was found in 116 (40%) patients, atrial fibrillation (31.4%), stroke/transient ischaemic attack (18.9%) and heart failure class III–IV (44.1%). Median (IQR) duration of disease was 3 (4) years, secondary prophylaxis (27.7%) and oral anticoagulants use (62.3%). In multivariable analysis, the risk of death among patients on medical was 3.07 times higher than those on interventional treatment (crude HR 3.07, 95% CI 1.43–6.56, p = 0.004), 2.44 times higher among patients with arrhythmias versus without arrhythmias (crude HR 2.44, 95% CI 1.19–4.49, p = 0.015) and 2.13 times higher among patients with multivalvular than single valve disease (crude HR 2.13, 95% CI 1.09–4.16, p = 0.026). Conclusions: Intervention is carrying low mortality compared to medical treatment. Arrhythmias and multivalvular disease are associated with a high mortality. Rheumatic MS is more prevalent in young people, females and individuals with low income. There is a late hospital presentation and a low use of both secondary prophylactic antibiotics and anticoagulants. [ABSTRACT FROM AUTHOR]

Glaucoma is currently considered one of the leading causes of severe visual impairment and blindness worldwide. Topical medical therapy represents the treatment of choice for many glaucoma patients. Introduction of latanoprost, 25 years ago, with an entirely new mechanism of action from that of the antiglaucoma drugs used up to that time was a very important milestone. Since then, due mainly to their efficacy, limited systemic side effects and once daily dosing, prostaglandin analogues (PGAs) have become as the first‐choice treatment for primary open‐angle glaucoma. PGAs are in general terms well tolerated, although they are associated with several mild to moderate ocular and periocular adverse events. Among them, conjunctival hyperemia, eyelash changes, eyelid pigmentation, iris pigmentation and hypertrichosis around the eyes are the most prevalent. The objective of this paper is to review the role of PGAs in the treatment of glaucoma over the 25 years since the launch of Latanoprost and their impact on clinical practice outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of Dienogest versus surgical management of endometriomas on ovarian reserve. Methods: This randomized clinical trial was conducted at Suez Canal university hospital from November 1st, 2020, to July 31st, 2022. We recruited patients with endometriomas according to particular inclusion and exclusion criteria. The study population was allocated into two groups: group one received Dienogest, and group two had laparoscopic cystectomy. Eligible patients were subjected to history and examination to evaluate pelvic pain using the Biberoglu and Behrman score and the visual analogue scale. Ultrasound examination was done to diagnose ovarian endometrioma and its diameter. Ovarian reserve was evaluated by the antral follicle count and serum anti-mullerian hormone. After 3 months, patients were reevaluated regarding cyst diameter, antral follicle count, pain scores, and the anti-mullerian hormone. The primary outcome measure was to evaluate the ovarian reserve before and after intervention in both groups. Results: The antral follicle count and anti-mullerian hormone increased significantly after Dienogest therapy and decreased significantly after surgical excision (p < 0.001). Only induration was significantly decreased in the medical treatment group (p < 0.001). Both management options resulted in a noticeable reduction in the visual analogue scale scores in each group individually. Conclusion: Dienogest rescued ovarian reserve in women with endometriomas. [ABSTRACT FROM AUTHOR]

Brucellar cervical epidural abscess (CEA) is a rare condition with potentially permanent neurological damage if left untreated. This study aims to define the clinical presentation of brucellar CEA and evaluate the outcome of surgical treatment, specifically decompression and fusion surgery. The findings will contribute to understanding whether all patients with brucellar CEA could benefit from this surgical intervention. A retrospective study on brucellar spondylitis was conducted at the First Hospital of Jilin University from August 2018 to August 2022. During this period, a total of 37 patients were diagnosed with brucellar spondylitis at the hospital. Out of the 37 cases, six patients (16.2%) were confirmed to have CEA through cervical magnetic resonance imaging examination and serology test results.. Six patients were diagnosed with brucellar CEA (16.2%), of whom 5 successfully underwent anterior cervical decompression and fusion surgery. One patient had a large prevertebral abscess that could only be drained. In combination with effective antibiotic therapy, the clinical performance of the 5 patients who underwent surgery improved after the surgery. The remaining one patient required delayed surgery due to instability of the cervical spine. The follow-up period of all the 6 patients was 6 months. Brucellosis should be considered as a potential cause of CEA, especially in endemic areas. Timely detection and effective management of this condition are crucial in order to minimize the associated morbidity and mortality. For patients with detectable brucellar CEA, we recommend decompression and fusion surgery. [ABSTRACT FROM AUTHOR]

Except when surgery is the only option because of organ damage, the presence of suspicious lesions, or the desire to conceive, women with endometriosis-associated pain often face a choice between medical and surgical treatment. In theory, the description of the potential benefits and potential harms of the two alternatives should be standardized, unbiased, and based on strong evidence, enabling the patient to make an informed decision. However, doctor's opinion, intellectual competing interests, local availability of specific services and (mis)information obtained from social media, and online support groups can influence the type of advice given and affect patients' choices. This is compounded by the paucity of robust data from randomized controlled trials, and the anxiety of distressed women who are eager to do anything to alleviate their disabling symptoms. Vulnerable patients are more likely to accept the suggestions of their healthcare provider, which can lead to unbalanced and physician-centred decisions, whether in favour of either medical or surgical treatment. In general, treatments should be symptom-orientated rather than lesion-orientated. Medical and surgical modalities appear to be similarly effective in reducing pain symptoms, with medications generally more successful for severe dysmenorrhoea and surgery more successful for severe deep dyspareunia caused by fibrotic lesions infiltrating the posterior compartment. Oestrogen–progestogen combinations and progestogen monotherapies are generally safe and well tolerated, provided there are no major contraindications. About three-quarters of patients with superficial peritoneal and ovarian endometriosis and two-thirds of those with infiltrating fibrotic lesions are ultimately satisfied with their medical treatment although the remainder may experience side effects, which may result in non-compliance. Surgery for superficial and ovarian endometriosis is usually safe. When fibrotic infiltrating lesions are present, morbidity varies greatly depending on the skill of the individual surgeon, the need for advanced procedures, such as bowel resection and ureteral reimplantation, and the availability of expert colorectal surgeons and urologists working together in a multidisciplinary approach. The generalizability of published results is adequate for medical treatment but very limited for surgery. Moreover, on the one hand, hormonal drugs induce disease remission but do not cure endometriosis, and symptom relapse is expected when the drugs are discontinued; on the other hand, the same drugs should be used after lesion excision, which also does not cure endometriosis, to prevent an overall cumulative symptom and lesion recurrence rate of 10% per postoperative year. Therefore, the real choice may not be between medical treatment and surgery, but between medical treatment alone and surgery plus postoperative medical treatment. The experience of pain in women with endometriosis is a complex phenomenon that is not exclusively based on nociception, although the role of peripheral and central sensitization is not fully understood. In addition, trauma, and especially sexual trauma, and pelvic floor disorders can cause or contribute to symptoms in many individuals with chronic pelvic pain, and healthcare providers should never take for granted that diagnosed or suspected endometriosis is always the real, or the sole, origin of the referred complaints. Alternative treatment modalities are available that can help address most of the additional causes contributing to symptoms. Pain management in women with endometriosis may be more than a choice between medical and surgical treatment and may require comprehensive care by a multidisciplinary team including psychologists, sexologists, physiotherapists, dieticians, and pain therapists. An often missing factor in successful treatment is empathy on the part of healthcare providers. Being heard and understood, receiving simple and clear explanations and honest communication about uncertainties, being invited to share medical decisions after receiving detailed and impartial information, and being reassured that a team member will be available should a major problem arise, can greatly increase trust in doctors and transform a lonely and frustrating experience into a guided and supported journey, during which coping with this chronic disease is gradually learned and eventually accepted. Within this broader scenario, patient-centred medicine is the priority, and whether or when to resort to surgery or choose the medical option remains the prerogative of each individual woman. [ABSTRACT FROM AUTHOR]