Search

The World Health Organization (WHO) declared the coronavirus outbreak as an international public health emergency (pandemic) on January 31, 2020. In line with WHO recommendations, in order to guide the Coronaviruse Disease-2019 (COVID-19) agent, transmission routes, case definitions, diagnosis and treatment methods, strategy and application methods, Turkish Ministry of Health, General Directorate of Public Health has prepared guidelines. Management of patients with COVID‐19 includes epidemiological risk assessment and patient isolation; general and optimized supportive care, symptomatic treatment, respiratory support, nutritional support, psychological intervention etc. for infection prevention and control. The prognosis of patients depends on the severity of the disease, the age of the patient, their underlying diseases and their general medical condition. Patients with severe COVID-19 should be treated in the critical care unit.

Introduction: Supportive therapy is considered an important element in the treatment of cancer patients which is often associated with efforts to overcome life-threatening problems. However, the application of this intervention in clinical practice has not yet been fully carried out. This systematic review summarizes the evidence regarding the effect of supportive therapy in improving the quality of life (QoL) of cancer patients. Methods: The review was performed according to PRISMA guidelines. We searched four electronic databases to identify studies comparing patients who received specific protocol interventions with the control group. The keywords used are "Supportive Therapy" AND "Palliative Supportive Care" AND "Quality of Life" OR "Health Quality" OR "Health-Related Quality of Life". Results: In the study, the average quality of life assessment was carried out at 12 weeks and six months after the intervention. Seven7 of the 15 studies used QLQ-C30 to measure the quality of life of patients with cancer, which was managed to validate and assess the quality of life in patients with cancer, whereas of the 15 studies evaluating results reported, patients reported differences in favor of the intervention group. Conclusion: The overall methodology quality is good. Several comparative studies have evaluated the impact of supportive therapy on the quality of life of cancer patients. The quality of this study is good and the results are acceptable in improving the quality of life of cancer patients undergoing chemotherapy treatment, and palliative care.

A review articles published in reputed journals of cancer suggests that patients under combined therapy (coordination of medical/radiation oncologist & surgeon) of cancer treatment experience adverse events included constitutional symptoms, gastrointestinal complications & pain. The most common reason for withdrawal was disease progression, followed by adverse effects. Complications during cancer treatment include- complications due to disease/ treatment & psychosocial problems. Ayurvedic formulations including single drugs like Gvarras, Panchatulasiras & combination drugs like Rasayan Churna, Yastimadhu Ghrita etc. have proven to be effective medicines when given in between consecutive chemo/radiation therapies. Ayurvedic interventions with combined therapies reduce cost of treatment with decrease in relapse of disease & decreased AEs.

Objective The aim of this review was to assess the benefits and harms of Chinese medicinal herbs for the treatment of rapidly progressive glomerulonephritis (RPGN) in adult patients. Methods Our study included only randomized controlled trials (RCTs). We designed a strategy for searching the EMBASE, CENTRAL, PubMed, CBM, CNKI, and VIP. All studies were analyzed using the criteria of the Cochrane Handbook. All studies included were assessed the risk of bias. Review Manager ver. 5.3.5 was used for the data analysis. GRADE profiler was used to evaluate quality. Results Two studies were studied (74 Chinese participants were included). We found that compared with supportive therapies combined with specific therapies, Chinese medicinal formulae plus supportive therapies combined with specific therapies significantly reduced the serum creatinine levels (SCr; two studies, 62 participants: mean difference (MD), -145.93 μmol/L; 95% confidence interval (CI), -236.75 to –55.11; I2=0%) and utilization number of methylprednisolone and prednisone (two studies, 74 participants: MD, -1.64 g; 95% CI, -1.87 to -1.40; I2=0%). Conclusion Our study suggested that there were insufficient evidences to confirm that the use of Chinese medicinal formulae for adults with RPGN was beneficial and safe.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), causing coronavirus disease-19 (COVID-19), has been responsible for approximately 75 million cases and 1.6 million deaths globally as of December 22, 2020. Currently, no treatment modalities or management options have been recommended by the National Institutes of Health (NIH) prior to patient hospitalization and supplemental oxygen requirement. This poses a unique challenge for outpatient primary care physicians, who are often tasked with initial care of patients early on in their disease course. During the pandemic, our family practice provided medical care to approximately 2,000 families located in the surrounding Brooklyn community. With only telemedicine at our disposal, our clinic was tasked with treating patients presenting remotely who may or may not have had COVID-19 - a large clinical diagnosis was made given the absence of in-person testing. Often co-administered, Azithromycin was considered a supportive agent that may or may not have increased the benefit of hydroxychloroquine. However, Azithromycin may perform well on its own for various reasons as it has been shown to have antiviral activity against other RNA viruses, anti-inflammatory properties, and antiviral effects within bronchial epithelial cells. Azithromycin has also shown efficacy as an add-on treatment for reducing asthma exacerbations - pertinent to the pro-inflammatory pulmonary conditions in COVID-19 progression - and may even prevent or treat bacterial co-infection in patients with SARS-COV-2. In order to investigate the association between Azithromycin and the COVID-19 disease process, our clinical study retrospectively identified patients who were prescribed Azithromycin (500 mg on day one + 250 mg on days two to five) during the peak months of the COVID-19 pandemic in New York City from March 2020 through May 2020. All patients prescribed Azithromycin with suspicion of COVID-19 infection were interviewed via telephone regarding their constellation of symptoms, compliance with the prescribed antibiotic for the intended course, symptom duration prior to and following antibiotic course initiation, as well as any further complications of their illness, if present. Ultimately, the majority of the patients who were interviewed over the phone concluded that a full course of Azithromycin helped improve their symptoms during their infection with COVID-19. Outcomes and complications in patients treated with Azithromycin were noteworthy in that there were no reports of pulmonary complications or deterioration of pulmonary function after treatment (e.g., no shortness of breath, wheezing, dyspnea, etc.), although some patients did experience residual coughing and nasal discharge post-treatment. We believe further study of this treatment in the setting of experimental, randomized controlled trials may reveal the benefits of Azithromycin in terms of reducing infection severity, length, and limiting the incidence of complications in patients with COVID-19.

In the summer of 2016, delegates from the German Respiratory Society, the German Society of Cardiology and the German Society of Pediatric Cardiology met in Cologne, Germany, to define consensus-based practice recommendations for the management of patients with pulmonary arterial hypertension (PAH). These recommendations were built on the 2015 European Pulmonary Hypertension guidelines aiming at their practical implementation, considering country-specific issues, and including new evidence, where available. To this end, a number of working groups was initiated, one of which was specifically dedicated to general measures (i.e. physical activity/supervised rehabilitation, pregnancy/contraception, elective surgery, infection prevention, psychological support, travel) and supportive therapy (i.e. anticoagulants, diuretics, oxygen, cardiovascular medications, anaemia/iron deficiency, arrhythmias) for PAH. While the European guidelines provide detailed recommendations for the use of targeted PAH therapies as well as supportive care, detailed treatment decisions in routine clinical care may be challenging, and the relevance of supportive care is often not sufficiently considered. In addition, new evidence became available, thus requiring a thorough reevaluation of specific recommendations. The detailed results and recommendations of the working group on general measures and supportive therapy for PAH, which were last updated in the spring of 2018, are summarized in this article.

Objectives: We developed the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up of germ cell tumours (GCT) of the testes in adult patients. We present the guideline content in 2 separate publications. The present second part summarizes therecommendations for the treatment of advanced disease stages and for the management of follow-up and late effects. Materials and Methods: An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search in March 2018), were provided. Thirty-one experts, who were entitled to vote, rated the final clinical recommendations and statements. Results: Here we present the treatment recommendations separately for patients with metastatic seminoma and non-seminomatous GCT (stages IIA/B and IIC/III), for restaging and treatment of residual masses, and for relapsed and refractory disease stages. The recommendations also cover extragonadal and sex cord/stromal tumours, the management of follow-up and toxicity, quality-of-life aspects, palliative care, and supportive therapy. Conclusion: Physicians and other medical service providers who are involved in the diagnostics, treatment, and follow-up of GCT (all stages, outpatient and inpatient care as well as rehabilitation) are the users of the present guideline. The guideline also comprises quality indicators for measuring the implementation of the guideline recommendations in routine clinical care; these data will be presented in a future publication.

The novel coronavirus disease 2019 (COVID-19) is the third coronavirus outbreaks in the last two decades. Emerging and re-emerging infections like COVID-19 pose serious challenges of paucity of information and lack of specific cure or vaccines. This leaves utilisation of existing scientific data on related viral infections and repurposing relevant aetiologic and supportive therapies as the best control approach while novel strategies are developed and trialled. Many promising antiviral agents including lopinavir, ritonavir, remdesivir, umifenovir, darunavir, and oseltamivir have been repurposed and are currently trialled in the care for COVID-19 patients. Adjunct therapies for the management of symptoms and to provide support especially in severe and critically ill patients have also been identified. This review provides an appraisal of the current evidence for rational use of frontline therapeutics in the management of COVID-19. It also includes updates regarding COVID-19 immunotherapy and vaccine development., Highlights • In the absence of a definite treatment, management of COVID-19 depends on rational repurposing of drugs • Choice of pharmacologic agents for use in COVID-19 patients is based on presenting symptoms, severity and underlying conditions • Therapeutics in the management of COVID-19 can be categorised into antiviral drugs, supportive treatments and immunotherapeutic agents

Hematologic cancers are heterogeneous diseases, defined by hematopoietic myeloid or lymphoid cell tumors, derived from the bone marrow or the lymphatic system. The treatment is based on intensive chemotherapy and sometimes hematopoietic stem cell transplants. The damage caused by cancer and its treatments are responsible for a major deterioration in the quality of life, as well as chronic fatigue, anxiety, depression and difficulties performing social and professional activities. Adapted physical activity programs improve functional aptitudes and reduce perceived fatigue without causing adverse effects. It should be considered in the management of hematologic patients.

Background Cancer patients often receive multiple drugs to maximize their therapeutic benefit, treat co-morbidities and counter the adverse effects of chemotherapy. Concomitant administration of multiple drugs increases the risk of drug interactions leading to compromised therapeutic efficacy or safety of therapy. The purpose of this study was to identify the prevalence, levels and predictors of potential drug-drug interactions (pDDIs) among cancer patients. Methods Six hundred and 78 patients receiving chemotherapy from two tertiary care hospitals were included in this cross-sectional study. Patient medication profiles were screened for pDDIs using the Micromedex® database. Logistic regression analysis was performed to identify the predictors of pDDIs. Results The overall prevalence of pDDIs was 78%, majority of patients had 1–2 pDDIs (39.2%). A total of 1843 pDDIs were detected. Major-pDDIs were most frequent (67.3%) whereas, a significant association of pDDIs was found between > 7 all prescribed drugs (p p Conclusions Major finding of this study is the high prevalence of pDDIs signifying the need of strict patient monitoring for pDDIs among cancer patients. Patients at higher risk to pDDIs include those prescribed with > 7 any types of drugs or ≥ 3 anticancer drugs. Moreover, list of most frequently identified major and moderate interactions will aid health care professional in timely identification and prevention of pDDIs.

Ovarian hypofunction in cattle is reproduction disorder related to massive economic loss. Etiology of this ovarium disfunction are low quality feed, minimum health concern, poor sanitation and pen problem. Eighty-five (85) Peranakan Ongole (PO), Peranakan Limosin (PL) and Peranakan Simental (PS) cows from Prambanan Sub District of Daerah Istimewa Yogyakarta were diagnosed with ovarian hypofunction by rectal palpation and physical examination. The cows were then programmed for ovary condition recovery by administration of vitamine A,D,E (IM), per oral anthelminthic bolus (Klosantel) and premix mixture in feed given daily for 4 weeks. After 4 weeks, the cows were re-examined. Sixty-two (72,9%) cows were recovered from ovary hypofunction, however ovaries of 23 (21,9%) cows were palpated abnormal, which require another administration of A,D,E (IM). There were no significant difference between the type of cows (PO,PL,PS) with recovery percentages after one programme therapy (P>0.05). It can be concluded that single injection of vitamin A,D, E , per oral bolus of Klosantel, and addition of premix into feed daily for 4 weeks were able to reduce 72,9% ovary hypofunction in Peranakan Ongole, Peranakan Limosin and Peranakan Simental cows at Prambanan sub district, Daerah Istimewa Yogyakarta.

This study assessed the advantages of dextrose and amino acid mixture solution as parenteral nutrition (PN) therapy for diarrheic calves. Thirty diarrheic calves were randomly assigned to receive PN (PN group, n=15) or only dextrose solution (Dex group, n=15). The treatment period for the PN group (4.0 days; min-max, 2–10 days) was significantly shorter than that for the Dex group (6.0 days; min-max, 3–21 days) (P

Supportive (maintenance) therapy (ST) for hematopoietic stem cell transplantation (HSCT) is undergoing significant changes and development. The aim of the review was to summarise the basic data on methods and perspective of ST for HSCT and to analyse new opportunities and alternative approaches to enhance the antitumor potential of HSCT. The need for ST is constantly growing as a result of significant increase in the number of performed HSCT and an increase in patient survival. The review highlights traditional methods of ST which allowed to boost the success of HSCT: antibacterial, antifungal, and antiviral preventive treatment. The authors discuss preventing toxicity of dimethyl sulfoxide (cryopreserving agent); understudied aspects of vaccination of HSCT recipients, and effects on microbiota. The study demonstrates that many of the classic recommendations of ST are being constantly updated given the wide variability of approaches not only to post-transplant monitoring, but also to empirical antibiotic therapy and the use of hematopoietic growth factors and the appropriateness of the correction of the microbiota, constraints of the external environment and social contacts. Currently, HSCT is becoming more available, in conditions close to the out-patient clinics, which leads to improved outcomes and significantly decreases the cost of hospital stay. The future improvement of the cost effectiveness and quality of ST will be possible due to health information technologies, and digital infrastructure between doctor and patient. We report our own experience of ST for allo-HSCT in 19 patients and for auto-HSCT in 82 patients, and implementation of auto-HSCT in non-insulated wards without HEPA-filtration. The literature review shows both the increased demand for the various methods of ST at HSCT and its increasing efficiency. Despite the lack of uniform standards, introduction of new approaches of ST should significantly improve HSCT outcomes.

Background: Cancer-related fatigue is widely prevalent in cancer patients and affects quality of life in advanced cancer patients. Fatigue is caused due to both psychologic distress and physiological sequel following cancer progression and its treatment. In this study, we evaluate the effects of yogic intervention in managing fatigue in metastatic breast cancer patients. Methods: Ninety-one patients with metastatic breast cancer were randomized to receive integrated yoga program (n = 46) or supportive therapy and education (n = 45) over a 3-month period. Assessments such as perceived stress, fatigue symptom inventory, diurnal salivary cortisol, and natural killer cell counts were carried out before and after intervention. Analysis was done using an intention-to-treat approach. Postmeasures for the above outcomes were assessed using ANCOVA with respective baseline measure as a covariate. Results: The results suggest that yoga reduces perceived stress (P = 0.001), fatigue frequency (P < 0.001), fatigue severity (P < 0.001), interference (P < 0.001), and diurnal variation (P < 0.001) when compared to supportive therapy. There was a positive correlation of change in fatigue severity with 9 a.m. salivary cortisol levels. Conclusion: The results suggest that yoga reduces fatigue in advanced breast cancer patients.

The article considers supportive therapy in patients with head and neck tumors during radiotherapy and chemoradiotherapy. Special attention is given to nutritional support on every stage of patient care. The main methods of evaluation of nutritional status and risks are presented, as well as principles of clinical nutrition selection.

Background Diarrhoea remains an important cause of childhood mortality in Nigeria, with Rotavirus and Cryptosporidium reported to have the highest contribution. However, high use of antibiotics for treatment of paediatric diarrhoea has been observed, although World Health Organization guidelines discourage the use of antibiotics for treating acute diarrhoea. Here we investigated more closely management and treatment practices for acute paediatric diarrhoea, both in home and healthcare settings. Methods Children under 5 years of age (n = 199) presenting at healthcare centres in Abakaliki, Nigeria with acute watery diarrhoea were included in the study. Background information on the children was collected by questionnaire, including home treatments, and clinical information including symptoms and treatment were provided by the healthcare centres. Analysis of faecal samples from the children indicated that over 90% had Rotavirus infection and over 6% Cryptosporidium infection. Data were compiled in a spreadsheet and analysed for associations between variables and use of antibiotics using logistic regression analysis. Results Although most children were treated supportively (oral rehydration solution and intravenous fluids at home and in healthcare settings, respectively) over 15% were given anti-diarrhoea drugs at home and over 85% were also prescribed antibiotics at the healthcare centre, mostly ciproflaxin, but also metronidazole and gentamycin. The only variable positively associated with antibiotic prescription was diarrhoea more than three times per 24 h at admission. Conclusions It is clear that young children presenting with acute watery diarrhoea to healthcare centres in Abakaliki are likely to be prescribed antibiotics, despite there being no obvious reason that this treatment is appropriate. Our study results support the need for institution-based antimicrobial stewardship being implemented in Nigeria.

The treatment of patients with advanced breast cancer has developed further in recent years. In addition to therapeutic progress in the established subgroups (hormone receptor and HER2 status), there are now therapies which are geared to individual molecular characteristics, such as PARP inhibitor therapy in BRCA-mutated patients. In addition to this, tests are being developed which are intended to establish additional markers within subgroups in order to predict the efficacy of a therapy. PI3K mutation testing in HER2-negative, hormone-receptor-positive tumours and PD-L1 testing of immune cells in triple-negative tumours are expected to become established in clinical practice in order to select patients for the respective therapies. With new therapeutic approaches, new adverse effects also appear. The management of these adverse effects, just as those of classical therapy (supportive therapy), is essential with the introduction of new treatments in order to preserve patientsʼ quality of life. Knowledge regarding measures to preserve and improve quality of life has significantly increased in recent years. Lifestyle factors should be taken into account, as should modern therapeutic methods. This review summarises the latest studies and publications and evaluates them in regard to the relevance for clinical practice. Die Behandlung von Patientinnen mit fortgeschrittenem Mammakarzinom hat sich in den letzten Jahren weiterentwickelt. Zusätzlich zum Therapiefortschritt in den etablierten Subgruppen (Hormonrezeptor- und HER2-Status) gibt es nun Therapien, die sich an einzelnen molekularen Charakteristika orientieren, wie zum Beispiel die PARP-Inhibitortherapie bei BRCA-mutierten Patientinnen. Zusätzlich dazu sind Tests in der Entwicklung, die innerhalb von Subgruppen weitere Marker etablieren sollen, um die Wirksamkeit einer Therapie vorherzusagen. Die PI3K-Mutationstestung bei HER2-negativen, hormonrezeptorpositiven Tumoren, und die PD-L1-Testung von Immunzellen bei triple-negativen Tumoren werden voraussichtlich in der klinischen Praxis etabliert, um Patientinnen für die jeweiligen Therapien auszuwählen. Mit neuen Therapieansätzen treten auch neue Nebenwirkungen auf. Das Management dieser Nebenwirkungen ebenso wie die der klassischen Therapien (supportive Therapie) ist mit der Einführung neuer Behandlungen essenziell, um die Lebensqualität der Patientinnen zu erhalten. Das Wissen über Maßnahmen zur Erhaltung und Verbesserung der Lebensqualität hat in den letzten Jahren deutlich zugenommen. Lifestyle-Faktoren sollten dabei ebenso Berücksichtigung finden wie moderne Therapieverfahren. Diese Übersichtsarbeit fasst die neuesten Studien und Veröffentlichungen zusammen und bewertet sie in Bezug auf die Relevanz für die klinische Praxis.

Simple Summary During the recent years, the field of exercise and physical activity have expanded prominently, not only for the prevention but also for the management of different pathologies, including breast cancer. A broad range of studies have been conducted to analyze this relationship, in aim to find the best routines and use of exercise in breast cancer management. Although many works provide contradictory results in these terms, there is less doubt regarding the role of physical activity as a central support for breast cancer patients, due to the systemic benefits of exercise in these women, therefore decreasing the risk of breast cancer-related complications and increasing their quality of life and survival. Future research should be established in order to individualize the physical activity performed by these women based on the available scientific evidence in a multidisciplinary context to maximize the success of breast cancer management. Abstract Breast cancer (BC) is the most common malignancy and the second cause of cancer-related death among women. It is estimated that 9 in 10 cases of BC are due to non-genetic factors, and approximately 25% to 30% of total breast cancer cases should be preventable only by lifestyle interventions. In this context, physical activity represents an excellent and accessible approach not only for the prevention, but also for being a potential support in the management of breast cancer. The present review will collect the current knowledge of physical activity in the background of breast cancer, exploring its systemic and molecular effects, considering important variables in the training of these women and the evidence regarding the benefits of exercise on breast cancer survival and prognosis. We will also summarize the various effects of physical activity as a co-adjuvant therapy in women receiving different treatments to deal with its adverse effects. Finally, we will reveal the impact of physical activity in the enhancement of quality of life of these patients, to conclude the central role that exercise must occupy in breast cancer management, in an adequate context of a healthy lifestyle.

Background Ninjin'yoeito, a traditional Japanese herbal medicine, is used to prevent fatigue, loss of appetite, and coldness of limbs. Fatigue is an especially common issue during chemotherapy and can affect quality of life and the ability to complete scheduled treatment. Objectives This prospective exploratory trial evaluates the efficacy of ninjin'yoeito for fatigue in patients undergoing nab-paclitaxel plus gemcitabine therapy for unresectable pancreatic cancer. The primary end point was evaluation of fatigue according to Functional Assessment of Chronic Illness Therapy-Fatigue score during 2 courses of nab-paclitaxel plus gemcitabine therapy. Secondary end points included evaluation of dose intensity, appetite loss using numerical rating scale, and peripheral neuropathy using a patient neurotoxicity questionnaire. Methods We compared data from this interventional trial with a prior observational trial without administration of ninjin'yoeito with identical definition of end points (UMIN000021758). Thirty patients were required by the study. Results Threshold mean of Functional Assessment of Chronic Illness Therapy-Fatigue score across 8 weeks during chemotherapy was under 5.3 (P = 0.002). Secondary end points did not reveal any specific patterns in appetite loss or degree of pain. No significant changes in patient neurotoxicity questionnaire concerning sensory/motor disorders were observed, but the mean (SD) incidence of patients with sensory disturbance was higher between the fifth and eighth weeks (8.8 [1.26]) than during the first and fourth weeks (4.8 [0.96]) (P = 0.003). Clinically significant adverse reactions of ninjin'yoeito were not observed. Conclusions Ninjin'yoeito may be useful for improving the symptoms of fatigue caused by nab-paclitaxel plus gemcitabine in patients with unresectable pancreatic cancer. UMIN Clinical Trials Registry identifier: UMIN000025606. (Curr Ther Res Clin Exp. 2020; 81:XXX–XXX)

Parkinson’s disease is a common progressive neurodegenerative disease. Apart from pharmacological treatment, nonpharmacological management in the form of rehabilitation, counselling, and supportive care is an equally important therapeutic pillar. A MEDLINE search strategy using the following terms (1998–2019) was adopted for this review. Limits of “Human” and “English” were applied. Search terms included “Parkinson’s Disease” AND “rehabilitation,” “physical therapy,” “exercise therapy,” “physiotherapy,” and “dance.” Review articles, practice parameters, guidelines, systematic reviews, meta-analyses, randomized controlled trials, and cohort studies were included. Rehabilitation strategies in the management of Parkinson’s disease form a vital component of therapy. There is mounting evidence to support physical therapy in these patients. Rehabilitation should be offered to these patients right from the start to encourage an active lifestyle and to improve quality of life.

Цель исследования. Разработка методов сопроводительной терапии для защиты нормальных органов и тканей, входящих в зону облучения. Методы. В исследование включено 112 больных раком шейки и тела матки после комбинированного или самостоятельного лучевого лечения с 2012 по 2016 гг. У 71 пациентки основной группы в качестве терапии сопровождения применяли гидрогель с деринатом и у 41 больной группы контроля традиционные методы профилактики (масло оливковое, подсолнечное, метилурациловая мазь). Для профилактики эпителиита слизистой влагалища и шейки матки в основной группе использовали гидрогель в виде аппликаций с первого дня облучения. Для профилактики лучевого ректита гидрогель вводили в прямую кишку 1 раз в день с первого дня облучения. Инстилляции гидрогеля в мочевой пузырь начинали только при развитии первых признаков клинической картины цистита. Пациенткам контрольной группы для профилактики лучевых реакций проводились масляные, мазевые аппликации во влагалище, масляные микроклизмы в прямую кишку с первого дня облучения. Лечение лучевого цистита проводили с помощью растительных диуретиков, уросептиков. Результаты. Применение гидрогеля с деринатом позволило провести курс лучевой терапии без перерыва у 84,5 (60/71) больных, в контрольной группе лишь у 48,8 (20/41). Лучевые циститы возникали в 2,5 раза реже (25,3 3,3 против 63,4 2,7, р0,01). Анализ степени выраженности лучевого цистита по RTOG в двух группах показал, что у 75 больных основной группы наблюдалась I степень, у 25 II степень, III и IV степени не отмечено, тогда как в контрольной группе лучевой цистит I степени развился у 44 пациенток, II 40 и III 16 больных. Применение гидрогеля снизило частоту лучевых ректитов в 2 раза (26,7 3,3 против 53,7 3,2 р0,1).При использовании ежедневных аппликаций гидрогеля с деринатом со стороны слизистой оболочки влагалища и шейки матки преобладали эпителииты I степени (53,5), II степень наблюдалась у 29,5 и III степень лучевой реакции лишь в 16,9 случаев, IV степень реакции не отмечена. В контрольной группе эти показатели составили 26,8, 24,3, 31,7 и 17,2 соответственно. Разработаны цитологические критерии оценки течения лучевых реакций слизистой влагалища. Выделены три степени изменения цитограммы, которые коррелировали с клинической картиной. В основной группе лучевые изменения I степени зафиксированы в 4,5 раза чаще (52 9,9 против 11,5 6,3, р0,002), а III степень представлена в 3,8 раза реже, чем в контрольной группе (12 6,5 против 46,1 9,8, р0,003). Заключение. Применение гидрогелевого материала с деринатом в качестве препарата сопроводительной терапии во время курса облучения позволяет уменьшить частоту и степень выраженности лучевых повреждений со стороны слизистой влагалища, мочевого пузыря и прямой кишки, провести курс лучевой терапии без перерыва и улучшить качество жизни пациенток., Objective. Development of methods for accompanying therapy to protect normal organs and tissues in the irradiation zone. Method. The study included 112 patients with cervical and endometrial cancer after combined or independent radiotherapy from 2012 to 2016. In 71 female patients of the main group, Derinat with hydrogel was applied as a supportive therapy and in 41 patients of the control group, conventional prevention methods (olive oil, sunflower oil, methyluracyl ointment) were applied. For prevention of vaginal mucosal and cervical epitheliitis in the main group, hydrogel was used as applications from the first radiation day. For prevention of radiation proctitis, hydrogel was injected into the rectum once daily from the first radiation day. Hydrogel instillations into the bladder were started only with the first clinical signs of cystitis. For prevention of radiation reactions, vaginal oil and ointment and rectal oil microenema were administered to patients of the control group from the first day of irradiation. Radiation cystitis was treated with vegetable diuretics and uroseptic drugs. Results. Using the hydrogel with Derinat allowed to administer a course of radiotherapy without interruption in 84.5 (60/71) of patients and only in 48.8 (20/41) in the control group. Radiation cystitis occurred 60 less frequently (25.3 3.3 versus 63.4 2.7, p 0.01). Analysis of radiation cystitis severity in two groups (according to RTOG) showed that 75 of patients in the main group had grade I and 25 had grade II. Grade III and grade IV did not occur. At the same time, in the control group, grade I radiation cystitis developed in 44 of patients, grade II in 40, and grade III in 16 of patients. The hydrogel treatment halved the frequency of radiation proctitis (26.7 3.3 vs. 53.7 3.2 p 0.1). With daily application of the hydrogel with Derinat, grade I epitheliitis (53.5) predominated in vaginal and cervical mucosa, grade II was observed in 29.5, and grade III radiation reaction only in 16.9 of cases grade IV reaction was not observed. In the control group, these proportions were 26.8, 24.3, 31.7, and 17.2, respectively. Cytological criteria were developed to evaluate the course of radiation reactions in the vaginal mucosa. Three degrees of change in the cytogram were identified, which correlated with clinical picture. In the main group, incidence of grade I radiationinduced changes was increased by more than 350 (52 9.9 vs. 11.5 6.3, p 0.002), and incidence of grade III was decreased by more than 70 compared to the control group (12 6.5 vs. 46.1 9.8, p 0.003). Conclusion. Using the hydrogel material with Derinat as an accompanying therapy during the course of irradiation allows to reduce frequency and severity of radiation injuries of the vaginal mucosa, bladder, and rectum, administer an uninterrupted course of radiotherapy, and improve the quality of life of patients., №3 (2019)

Irinotecan hydrochloride (CPT-11) is used to treat a wide spectrum of malignant tumors. Hangeshashin-to (Japanese herbal medicine TJ-14) is reportedly effective in preventing and controlling diarrhea associated with CPT-11. However, the effect of TJ-14 on tolerability of chemotherapy with CPT-11 has not been fully investigated. We used the Japanese Diagnosis Procedure Combination inpatient database to retrospectively identify patients who had received CPT-11 on their first admission with and without TJ-14. Patients who did receive TJ-14 (N = 7092) received CPT-11 more often and in larger doses than those who did not receive TJ-14 (N = 82,019). The incidence rate ratio of CPT-11 administration was 1.34 for frequency (95% confidence interval [CI], 1.31&ndash, 1.38, p &lt, 0.001), and 1.16 for total dose (95% CI, 1.14&ndash, 1.19, 0.001) according to stabilized inverse probability treatment weighting using propensity scores. Instrumental variable analysis showed similar trends. In-hospital mortality was significantly lower in patients who received TJ-14 than in those who did not. Odds ratios of in-hospital death in patients receiving TJ-14 was 0.81 (95% CI, 0.71&ndash, 0.93, p = 0.002) according to stabilized inverse probability treatment weighting using propensity scores and 0.42 (95% CI, 0.22&ndash, 0.81, p = 0.009) according to instrumental variable analysis. Our findings indicate that TJ-14 improve the tolerability of CPT-11.

Background: Toxic epidermal necrolysis and Stevens–Johnson syndrome comprise life-threatening, drug-induced mucocutaneous disease spectrum. Interest in cyclosporine, a calcineurin inhibitor that can block the function of T-cells, has increased with the discovery of the importance of granulysin in apoptosis in toxic epidermal necrolysis. In our hospital, cyclosporine is given to Stevens–Johnson syndrome/toxic epidermal necrolysis patients as an adjunctive therapy. Aims: This study is an observational, record-based study comparing the effectiveness and safety of patients receiving cyclosporine versus only supportive therapy. Methodology: Medical records as bed-head tickets and laboratory investigation reports of Stevens–Johnson syndrome/toxic epidermal necrolysis patients admitted in the hospital over a period of 1 year were collected. Data regarding clinico-demographic profile, suspected drug causing Stevens–Johnson's syndrome/toxic epidermal necrolysis, SCORTEN, body surface area involved, treatment received and outcome were obtained. Results: Twenty-eight patients were analyzed. Nineteen belonged to the cyclosporine group (supportive treatment + cyclosporine), nine to supportive treatment only group. Among the suspected drugs, antiepileptics formed the major group (28.6%). Five patients in the supportive only group and one in the cyclosporine group died. Time for stabilization and reepithelialization and duration of recovery were significantly lower in the cyclosporine group (P < 0.001, P= 0.007, P= 0.01, respectively). The standardized mortality ratio was 0.32 in cyclosporine group which is nearly 3.3 times lower than the only supportive treatment. Limitations: As it was a record-based study, certain confounding factors (serum blood urea nitrogen) could not be adjusted. Conclusion: Cyclosporine (5 mg/kg/day) for 10 days from onset of Stevens–Johnson syndrome/toxic epidermal necrolysis may decrease the risk of dying, may provide faster healing of lesions and might lead to early discharge from hospital.

Altres ajuts: Plan Nacional 2013-2016 with a Miguel Servet Research Contract (MS14/00041). We acknowledge also the generous support by the Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. Up to 60% of patients with bipolar disorder (BD) have a history of traumatic events, which is associated with greater episode severity, higher risk of comorbidity and higher relapse rates. Trauma-focused treatment strategies for BD are thus necessary but studies are currently scarce. The aim of this study is to examine whether Eye Movement Desensitization and Reprocessing (EMDR) therapy focusing on adherence, insight, de-idealisation of manic symptoms, prodromal symptoms and mood stabilization can reduce episode severity and relapse rates and increase cognitive performance and functioning in patients with BD. This is a single-blind, randomized controlled, multicentre trial in which 82 patients with BD and a history of traumatic events will be recruited and randomly allocated to one of two treatment arms: EMDR therapy or supportive therapy. Patients in both groups will receive 20 psychotherapeutic sessions, 60 min each, during 6 months. The primary outcome is a reduction of affective episodes after 12 and 24 months in favour of the EMDR group. As secondary outcome we postulate a greater reduction in affective symptoms in the EMDR group (as measured by the Bipolar Depression Rating Scale, the Young Mania Rating Scale and the Clinical Global Impression Scale modified for BD), and a better performance in cognitive state, social cognition and functioning (as measured by the Screen for Cognitive Impairment in Psychiatry, The Mayer-Salovey-Caruso Emotional Intelligence Test and the Functioning Assessment Short Test, respectively). Traumatic events will be evaluated by The Holmes-Rahe Life Stress Inventory, the Clinician-administered PTSD Scale and the Impact of Event Scale. The results of this study will provide evidence whether a specific EMDR protocol for patients with BD is effective in reducing affective episodes, affective symptoms and functional, cognitive and trauma symptoms. The trial is registered at ClinicalTrials.gov, identifier: . Registered on 3 December 2015. The online version of this article (doi:10.1186/s13063-017-1910-y) contains supplementary material, which is available to authorized users.

Treatment of pulmonary hypertension (PH) patients is challenging and should only be initiated after a comprehensive diagnostic evaluation. Such treatment should ideally be done in specialized centers with full capability for hemodynamic measurements, having access to a broad range of PAH therapies, and adequate experience in the management of critically ill patients. The following discussion is intended to review the general measures and the non-specific (supportive) therapy used in managing PH patients, while the specific therapy will be discussed in a subsequent different article.

Made available in DSpace on 2019-09-12T16:56:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2012 Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Fapemig) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: The purpose of this study is to investigate the association of the periodontal risk assessment (PRA) model with the recurrence of periodontitis and tooth loss during periodontal maintenance therapy (PMT). Methods: In a prospective PMT program, 75 regular complier (RC) and 89 erratic complier (EC) patients were selected. A periodontal examination and PRA were performed after active periodontal therapy and after 3 years of PMT. Risk profiles (low, moderate, or high) of participants were evaluated, and the recurrence of periodontitis and tooth loss were analyzed using univariate and multivariate analyses. Results: RCs showed less recurrence of periodontitis and tooth loss than ECs (P

Made available in DSpace on 2019-09-12T16:56:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Fapemig) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Lorentz TCM, Cota LOM, Cortelli JR, Vargas AMD, Costa FO. Prospective study of complier individuals under periodontal maintenance therapy: analysis of clinical periodontal parameters, risk predictors and the progression of periodontitis. J Clin Periodontol 2009; 36: 58-67. doi: 10.1111/j.1600-051X.2008.01342.x. This prospective study aimed to evaluate the progression of periodontitis and the influence of risk variables among individuals attending a programme of periodontal maintenance treatment in an academic environment. A total of 150 individuals diagnosed with chronic moderate-advanced periodontitis, and who had finished active periodontal treatment, were incorporated into the periodontal maintenance therapy. Social, demographic and biological variables of interest from subjects were collected at quarterly recalls, over a 12-month period. The effect of variables of interest and confounding on the periodontal status and progression of periodontitis was tested by univariate and multivariate logistic analysis. A total of 130 subjects (86.7%) showed stable periodontal status, whereas 20 subjects (13.3%) presented periodontitis progression. Twenty-eight subjects (18.66%) presented tooth loss that resulted in a total of 47 lost teeth (1.38%). Diabetes was not found to be associated with periodontitis progression (p=0.67). Smoking was significantly associated with a greater progression of periodontitis (OR=2.7, 95% CI 1.01-7.22). Periodontal maintenance programmes in academic environment can stabilize the periodontal condition obtained after active periodontal therapy as well as control the action of risk variables for the progression of periodontitis. [Medeiros Lorentz, Telma Campos; Miranda Cota, Luis Otavio; Duarte Vargas, Andrea Maria; Costa, Fernando Oliveira] Univ Fed Minas Gerais, Dept Periodontol, Sch Dent, BR-31270901 Belo Horizonte, MG, Brazil [Cortelli, Jose Roberto] Universidade de Taubaté (Unitau), Dept Dent, Periodont Res Div, Sao Paulo, Brazil

Johannes Wohlrab,1 Nikola Bangemann,2 Anke Kleine-Tebbe,3 Marc Thill,4,5 Sherko Kümmel,6 Eva-Maria Grischke,7 Rainer Richter,8 Sophie Seite,9 Diana Lüftner10 1Martin Luther University Halle-Wittenberg, Department of Dermatology and Venereology, Halle (Saale), 2Interdisciplinary Breast Centre, University Hospital Charité Berlin, Campus Benjamin Franklin, Berlin, Germany, 3Breast Centre DRK Hospital, Berlin, 4Breast Centre University of Lübeck, Department of Gynaecology and Obstetrics, Lübeck, 5Department of Gynaecology and Obstetrics, Agaplesion Markus Hospital, Frankfurt am Main, 6Breast Centre and Clinic of Senology, Hospital Essen-Mitte, Essen, 7Breast Centre University of Tübingen, Department of Gynaecology, Tübingen, 8L'Oréal, Deutschland GmbH, Düsseldorf, 9La Roche-Posay, Dermatological Laboratories, Asnières, France; 10University Hospital Charité Berlin, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin, Germany Purpose: Chemotherapy with anthracyclines, taxanes, or alkylating agents often causes cutaneous side effects. Nonspecific inhibition of the proliferative activity of keratinocytes has antidifferentiation effects that lead to defects in the barrier function and, thus, to dry, itchy, and irritable skin. These cutaneous symptoms reduce the quality of life of the patients considerably. Conditioning with topical application of niacinamide uses the cytoprotective and barrier stabilizing effect of vitamin B3. Patients and methods: A multicenter randomized crossover study investigated the influence of the test preparation on the quality of life compared to standard care for 73 patients with breast cancer undergoing adjuvant or neoadjuvant cytostatic therapy. Primary target parameter was the Dermatology Life Quality Index with its respective subscales after 6 weeks of a twice-daily application of the respective preparations. Additionally, specific symptoms such as pruritus, dryness, and irritability have been assessed using visual analog scales. Results: Regarding the total score of the Dermatology Life Quality Index, no relevant differences could be observed. However, the results for the "symptoms and feelings" subscale show a significant advantage in favor of the test preparation. Significant superiority of the test preparation could also be observed in the secondary target parameters, the visual analog scales (P

Background: Practice-based studies have found substantial effects of psychological treatment in routine care, often equivalent between treatment methods. Factors that moderate treatment outcome may be important to assess. Aim: The purpose of this study was to evaluate treatment outcome in psychological treatment in primary care, and to compare outcome between the most frequently used methods. An additional aim was to study factors that might moderate outcome differences. Method: The Clinical Outcome in Routine Evaluation (CORE) system was used to evaluate psychological treatment at Swedish primary care centers. Treatment methods were coded by the therapists after treatment. Three major treatment orientations-directive (cognitive, behavioral and CBT), reflective (psychodynamic and relational) and supportive therapy were compared. Patient and therapist variables were studied as treatment moderating factors. Results: Analyses of 733 therapies, delivered by 70 therapists, showed good results in short psychological treatments (median session number = 6). Forty-three percent of the patients were remitted, 34% recovered. For patients receiving at least five sessions, the figures were 50% and 40%. Directive therapy and reflective therapy had comparable outcome, and better than supportive treatment. Patients in supportive therapy had higher age and received fewer therapy sessions. The patients' motivation, alliance capacity and reflective ability, as rated by the therapist after treatment, were lower for patients in supportive treatment. Conclusions: Psychological treatment in primary care obtains god results. Supportive therapy should be studied more systematically, particularly with regard to variables that may moderate treatment outcome.

Made available in DSpace on 2019-09-12T16:56:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2014 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background and objective: Tooth loss (TL), one of the most visible results of the evolution of periodontitis, causes physiological and psychological impacts on a patient's life. This prospective study aimed to evaluate the incidence, underlying reasons and influence of risk predictors for the occurrence of TL in a program of periodontal maintenance therapy (PMT) over 5 years. Methods: The sample comprised 212 individuals diagnosed with chronic moderate-severe periodontitis, who had finished active periodontal treatment, were incorporated in a PMT program. Individuals were divided in to two groups: 96 regular compliers (RC) and 116 irregular compliers (IC). Full-mouth periodontal examination was performed. Social, demographic, behavioral and biological variables of interest were collected at all PMT visits. The effect of risk predictors and confounders for TL, as well as the underlying reasons of TL, were assessed by univariate and multivariate analysis. Results: TL was significantly lower among RC (0.12 teeth lost/year) in comparison to IC (0.36 teeth lost/year; p < 0.01). Individuals that were > 55 years old, males and smokers lost significantly more teeth in both groups (with IC > RC). The number of teeth lost due to periodontal reasons was significantly higher than TL for other reasons in both groups (p < 0.01). The final linear and logistic model for TL included: male gender, smoking, probing depth 4-6 mm in up to 10% of sites and irregular compliance. Conclusion: IC individuals undergoing PMT presented higher rates of TL when compared to RC individuals. Findings demonstrated the influence of irregular compliance and the importance of monitoring other risk predictors for TL such as smoking, male gender and severity of probing depth during PMT. [Costa, F. O.; Lages, E. J. P.; Cota, L. O. M.; Lorentz, T. C. M.] Univ Fed Minas Gerais, Sch Dent, BR-31270901 Belo Horizonte, MG, Brazil [Soares, R. V.] Pontificia Univ Catolica Minas Gerais, Belo Horizonte, MG, Brazil [Cortelli, J. R.] Universidade de Taubaté (Unitau), Periodont Res Div, Sao Paulo, Brazil

Made available in DSpace on 2019-09-12T16:56:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2012 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: This prospective study aims to evaluate and compare the periodontal status, periodontitis progression, tooth loss, and influence of predictable risk variables of two periodontal maintenance therapy programs over a 12-month period. Methods: A total of 288 individuals diagnosed with chronic moderate-to-advanced periodontitis, who had finished active periodontal treatment, were evaluated in a public academic environment (AG) (n = 138), as well as in a private clinic (PG) (n = 150). A full-mouth periodontal examination was performed at baseline and at quadrimestral recalls, evaluating plaque index, probing depth, clinical attachment level, furcation involvement, bleeding on probing (BOP), and suppuration. Individuals' social, demographic, and biologic data, as well as compliance with recalls, were recorded. The effect of variables of interest and confounders were tested by univariate and multivariate analysis. Results: The PG demonstrated lower rates of periodontitis progression and tooth loss than did the AG. After adjusting for confounders, the risk variables of BOP (P=0.047), smoking (P = 0.003), and diabetes (P = 0.028) for the PG and smoking (P=0.047) for the AG showed a negative influence on periodontal status. Conclusions: In both groups, the periodontal maintenance therapy minimized the negative effect of the risk variables. However, PG showed significantly less progression of periodontitis and tooth loss compared to AG. J Periodontol 2012;83:301-311. [Costa, Fernando Oliveira; Santuchi, Camila Carvalho; Pereira Lages, Eugenio Jose; Miranda Cota, Luis Otavio; Medeiros Lorentz, Telma Campos; Costa, Jose Eustaquio] Univ Fed Minas Gerais, Dept Periodontol, Sch Dent, BR-31270901 Belo Horizonte, MG, Brazil [Cortelli, Sheila Cavalca; Cortelli, Jose Roberto] Universidade de Taubaté (Unitau), Dept Dent, Periodont Res Div, Sao Paulo, Brazil

The present study was designed to evaluate the polyherbal topical aerosol spray Wisprec and reg; Advanced (M/S. Natural Remedies Private Limited, India) as a supportive therapy for clinical mastitis in dairy cows. A total of 41 dairy cows suffering from clinical mastitis were selected, and Wisprec and reg; Advanced was sprayed on mastitis affected quarters of udder two times a day along with a parenteral antibiotic till complete recovery. The rectal temperature, pain on palpation of udder, swelling of udder, consistency of milk, recovery period and product satisfaction score were assessed to evaluate the efficacy of Wisprec and reg; Spray. Topical application of Wisprec and reg; Advanced Spray have shown a significant improvement (p

Zika virus (ZIKV) has two lineages: African and Asian. Mosquito-borne flaviviruses are thought to replicate initially in dendritic cells and then spread to lymph nodes and the blood stream. Risk for infection through blood transfusion, sexual practices and perinatal transmission exists. The possible routes of perinatal transmission are during delivery, breastfeeding and by close contact between the mother and her newborn. Also, mucocutaneous exposures to the virus by infected blood or monkey bite, organ transplantation or hemodialysis are the other routes of ZIKV transmission. There are two types of ZIKV infection; Zika fever and congenital infection. Clinical presentation of Zika fever varies from asymptomatic infections to a self-limiting febrile disease with low grade fever, conjunctivitis, maculopapular rash, headache, retro-orbital pain and arthritis/arthralgia with periarticular edema, myalgia, vertigo, vomiting and asthenia. This clinical feature could be mistaken for dengue or chikungunya fevers. Microcephaly is the most important and frequently reported clinical picture of suspected congenital Zika syndrome. Laboratory tests are needed for diagnosis of ZIKV infection, because there is no known pathognomonic clinical, biochemical or radiological features. RT-PCR is the most well-liked assay. Serum samples are tested by immunoglobulin G ELISA with ZIKV antigen. Samples are also tested by immunoglobulin M ELISA. There is no certified vaccine or therapeutic medication. In asymptomatic or uncomplicated patients, treatment is not necessary.