Effect of Conventional Medical Therapy or Laparoscopic Sleeve Gastrectomy on Urinary Albumin in Japanese Subjects with Severe Obesity: An Observational Study

<b><i>Introduction:</i></b> In patients with severe obesity, albuminuria can be improved by both conventional medical therapy and bariatric surgery. The purpose of this study was to compare the impact of weight loss achieved through conventional medical therapy or laparoscopic sleeve gastrectomy (LSG) on albuminuria in Japanese subjects with severe obesity and identify the factors involved. <b><i>Methods:</i></b> We retrospectively evaluated the clinical characteristics including the urinary albumin/creatinine ratio (UACR) of 340 consecutive subjects with a body mass index ≥35 who received LSG (<i>n</i> = 242) or medical therapy (<i>n</i> = 98) between 2010 and 2018 and were followed for at least 12 months. <b><i>Results:</i></b> The baseline of the UACR was not different between the 2 groups. At the 12-month follow-up, total weight loss (TWL) and decreases in glycosylated hemoglobin (HbA1c) and log_e UACR were greater in the LSG group than in the medical therapy group (body weight; −35.7 kg vs. −8.0 kg, <i>p</i> &#x3c; 0.001, HbA1c; −1.4% vs. −0.7%, <i>p</i> &#x3c; 0.001, log_e UACR; −0.3 vs. 0.9, <i>p</i> &#x3c; 0.001). The rate of complete remission of diabetes was significantly higher in the LSG group than in the medical therapy group. At 12 and 36 months (<i>n</i> = 111 in the medical therapy group, <i>n</i> = 56 in the LSG group at 36 months), log_e UACR increased in the medical therapy group, while it remained unchanged or decreased in the LSG group. In subjects with microalbuminuria and macroalbuminuria, changes in the log_e UACR correlated with percent total body weight loss (%TWL) in both groups at 12 months. Percent TWL contributed independently to the change in the log_e UACR, irrespective of whether LSG was performed. In receiver-operating characteristic analysis, a weight loss of 7.8% predicted a decrease in the UACR (∆UACR &#x3c;0 at 12 months). <b><i>Conclusion:</i></b> Our analysis suggests that albuminuria may increase over time if only medical therapy is continued. To improve albuminuria, weight loss may be more important than whether LSG is performed.

Persepsi Ibu Hamil tentang Terapi Komplementer dalam Kehamilan

Complementary therapy has been applied in various regions to accompany conventional / medical therapy. Pregnant women are a group that is encouraged to take advantage of complementary therapy or medicine in dealing with their perceived complaints, because complementary therapy can avoid the side effects of conventional medicine and have great control over their own health. The purpose of this study was to determine the perceptions of pregnant women about complementary therapies in pregnancy. This research is a quantitative study with a cross sectional approach. Primary data collection research using a questionnaire. The population in this study were all pregnant women at PuskesmasPutri Ayu Jambi City with a sample of 88 people. The sampling technique is accidental sampling. Data analysis was carried out by univariate. From the results of the research on the perceptions of pregnant women about complementary therapies in pregnancy, it was concluded that most pregnant women had a positive perception, namely 73.3%. The results of this study are expected to contribute to increasing the knowledge of pregnant women about complementary therapies that are safe for pregnant women, so that pregnant women can achieve optimal health by utilizing non-pharmacological therapies and the fetus can grow healthy

Therapy of rhinosinusitis in childhood

Introduction. The relevance of the problem of rhinosinusitis in different ages is due to their high prevalence. The article presents information with approaches of the treatment rhinosinusitis in children, which allow preventing irreversible changes in the mucous membrane of the nasal cavity and paranasal sinuses. The importance of eliminating dysregulation in biological networks underlying the disease is noted. Such capabilities are possessed by means of bioregulatory medicine.Aim of the study: To carry out a comparative analysis of the effectiveness of chronic rhinosinusitis treatment with Euphorbium compositum and conventional methods of therapy in children.Materials and methods: We conducted retro- and prospective study in children’s polyclinic No. 1 and homeopathic center “Homeopathic medicine” in Samara. There were 66 children aged 7 to 12 years old diagnosed with chronic rhinosinusitis under observation. The children were observed in two groups for 2 years. Results. In chronic sinusitis within 2 weeks after the beginning of the course of therapy significant symptomatic improvement was registered in 75.8% of the patients receiving Euforbium compositum and in 71.3% of the patients receiving conventional medical therapy. During the clinical observations there was not a single case of adverse effects against the background of Euphorbium compositum therapy, the patients’ general condition and nasal breathing parameters reliably improved.Results. Numerous scientific studies noted: the ability of nasal spray Euphorbium compositum to have a complex multi-target effect on the process of inflammation, on the state of nasal mucous membranes; safety and effectiveness.Conclusions. Complex bioregulating action of Euphorbium compositum Nasentropfen C allows to control and optimize the course of chronic inflammatory process in rhinosinusitis. Its application promotes restoration of structure and function of nasal cavity mucosa, it is not accompanied by complications. These characteristics in combination with good tolerability make it possible to use the drug for treatment of rhinosinusitis.

Homeopathic Treatment of a Lower Leg Edema—A Case Report

Background Homeopathy is frequently and successfully used in daily clinical practice, so there is a need for well-documented case reports that illustrate its effectiveness. For this reason, we present a case in which homeopathy was used to treat an ankle and lower leg for spontaneous acute swelling and redness. Case Report A 54-year-old man presented with recurrence of a swollen left ankle and lower leg, which had previously been treated by conventional medicine. After case taking, a homeopathic treatment with Apis mellifica 200c led to a fast improvement. The patient was free of symptoms within 24 hours and has remained so for 3 years. Conclusion Homeopathic treatment with Apis mellifica led to a fast and long-lasting improvement of an acute ankle swelling and reddening that had recurred after conventional medical therapy of similar symptoms.

Consensus Recommendations for the Diagnosis and Management of X-Linked Hypophosphatemia in Belgium

X-linked hypophosphatemia (XLH) is the most common genetic form of hypophosphatemic rickets and osteomalacia. In this disease, mutations in the PHEX gene lead to elevated levels of the hormone fibroblast growth factor 23 (FGF23), resulting in renal phosphate wasting and impaired skeletal and dental mineralization. Recently, international guidelines for the diagnosis and treatment of this condition have been published. However, more specific recommendations are needed to provide guidance at the national level, considering resource availability and health economic aspects. A national multidisciplinary group of Belgian experts convened to discuss translation of international best available evidence into locally feasible consensus recommendations. Patients with XLH may present to a wide array of primary, secondary and tertiary care physicians, among whom awareness of the disease should be raised. XLH has a very broad differential-diagnosis for which clinical features, biochemical and genetic testing in centers of expertise are recommended. Optimal care requires a multidisciplinary approach, guided by an expert in metabolic bone diseases and involving (according to the individual patient’s needs) pediatric and adult medical specialties and paramedical caregivers, including but not limited to general practitioners, dentists, radiologists and orthopedic surgeons. In children with severe or refractory symptoms, FGF23 inhibition using burosumab may provide superior outcomes compared to conventional medical therapy with phosphate supplements and active vitamin D analogues. Burosumab has also demonstrated promising results in adults on certain clinical outcomes such as pseudofractures. In summary, this work outlines recommendations for clinicians and policymakers, with a vision for improving the diagnostic and therapeutic landscape for XLH patients in Belgium.

Haemangioma Successfully Treated in a Bitch with Mercurius solubilis: A Case Report

Conventional medical therapy for haemangioma usually consists of corticosteroids through oral administration, intralesional injection or topical application. Recently, propranolol has demonstrated to offer advantages because its therapeutic efficacy is comparable and fewer adverse effects are observed. This benign vascular tumour is not always so complicated to have to be removed surgically and many others remit without treatment. However, sometimes the unexpected can happen and evolve unfavourably. For these situations, homeopathy can also be evaluated. Here is a case report of an elderly bitch that developed a haemangioma on the pad of the left fifth toe. The lesion increased in size after applying a corticosteroid ointment and became an infected wound with suppuration when the bitch bit it (self-mutilation). A homeopathic approach to the treatment was proposed. Complete remission of the vascular tumour and improvement of behavioural and physical complaints was achieved with a high dilution of Mercurius solubilis. The homeopathic remedy Phosphorus, a phytotherapic ointment of Calendula officinalis, and the application of topical antibiotics did not have the efficacy of the previous one. Although homeopathy does not yet have a specific mechanism of action for each remedy, the pathogenesis of M. solubilis is compatible with a negative regulation of glutamine synthetase. Given that it has been shown that ultra-dilutions can stimulate gene expression, it is theoretically hypothesised here that Mercurius could stimulate glutamate-ammonia ligase gene, which expresses the aforementioned enzyme, and solve or improve diseases whose symptoms are due to their underexpression or inhibition (at gene and protein level). Hence, the aim of this article is to show the results of homeopathy in the clinical practice and to propose a line of research on the mechanism of action of the remedies.

Stroke and mortality risk after atrial fibrillation ablation: lesson from the CABANA trial

The CABANA trial is a randomized controlled study comparing catheter ablation vs. conventional medical therapy in atrial fibrillation (AF) patients. The results of the study showed that catheter ablation did not have a significant reduction of strokes, deaths, serious bleeding, or cardiac arrest compared to medical therapy. However, a significant improvement in AF recurrences, quality of life, and symptom relief has been shown after catheter ablation compared to drug therapy. The mixed results of the study emphasized an active controversy in the cardiology community on the interpretation of the data and their use in current clinical practice. In this review, we summarized the principal controversy points of the trial describing the strengths and weaknesses of the study design and analysis.

Long-term outcomes for Asian patients with X-linked hypophosphataemia: rationale and design of the SUNFLOWER longitudinal, observational cohort study

IntroductionX-linked hypophosphataemic rickets/osteomalacia (XLH) is a chronic, debilitating genetic disease characterised by skeletal abnormalities and growth disorder. The burden of XLH begins in childhood and continues throughout life. Conventional medical therapy with phosphate, active vitamin D and surgery do not address the underlying pathophysiology of the disease. While treatment during childhood may improve bone deformity and growth retardation, a large proportion of adult patients still fail to reach normal stature. Furthermore, adult patients with XLH report comorbidities associated with unresolved childhood disease, as well as newly developed disease-related complications and significantly impaired quality of life (QOL). Despite the multiple negative aspects of XLH, Asian consensus statements for diagnosis and management are lacking.Methods and analysisThe Study of longitUdinal observatioN For patients with X-Linked hypOphosphataemic rickets/osteomalacia in collaboration With Asian partnERs study is a longitudinal observational cohort study of patients with XLH, designed to determine the medical characteristics and burdens (physical, emotional and financial) of this progressive disease and to evaluate the impact of treatment (including the use of burosumab) on clinical outcomes. The study was initiated in April 2018, and registration will remain open until 30 April 2022. The sample size planned for analyses is 160 patients, consisting of 100 patients in Japan and 60 patients in Korea. Up to 5 years of observation are planned per patient, from enrolment through to April 2023. Prospective and retrospective data will be collected to evaluate variables, including height/growth, rickets severity score, QOL, motor function and biomarkers for phosphate metabolism and bone turnover.Ethics and disseminationEthics approval was obtained from the Ethics Committee of Osaka University, the Ethics Committee of Kyowa Kirin Co and by the Ethics Committee of each participating medical institution. Two interim analyses and associated publications are planned using retrospective and enrolment data at year 1 and results at year 3.Trial registration numbersNCT03745521; UMIN000031605.

Lumbar Sympathetic Plexus Radiofrequency Ablation for Chronic Non-Cancer Pain: A Brief Review and Two Case Reports

Background: Lumbar sympathetic plexus (LSP) has been described as a target for managing chronic pain with a sympathetic component in the lower limbs such as complex regional pain syndrome (CRPS) or pain of ischemic origin. LSP neurolysis with phenol or ethanol has been applied; more recently, radiofrequency (RF) lesioning has been proposed as an alternative. RF denervation has the advantage of avoiding the complications associated with ethanol/phenol spread. Case Report: We describe 2 cases in which RF denervation of LSP was performed in patients suffering from chronic pain from CRPS and chronic ischemic disease of the lower limb. Conclusion: RF denervation of LSP could be considered as a treatment for CRPS and chronic ischemic pain when conventional medical therapy fails. Compared to chemical neurolysis, RF denervation carries less risk for postprocedural deafferentation pain. Key words: Complex regional pain syndrome; ischemic pain; lumbar sympathetic plexus; neurolysis; radiofrequency; sympathetically maintained pain