Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in patients with BPSD

Background: The psychomotor agitation of the behavioural and psychological symptoms of dementia (BPSD) is one of the common issues in aged care facilities, leading to the poor functional and medical consequences. Psychotropic interventions are the preferred choice of treatment, but which medication should be the prescribers first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from Randomised Control Trials (RCTs) and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who have taken agitation treatments. Assessing the efficacy of selective serotonin reuptake inhibitors (SSRI) and antipsychotic treatments when compared to each other for the purpose of improving agitation outcomes. Methods: This review includes RCT that compared one or more active ingredient medications with another medication or with a placebo, along with systematic reviews comparing citalopram (SSRI) with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies were extracted by searching and accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and English language. Conclusion: There is still limited studies of SSRIs for the treatment of agitation in BPSD. SSRIs such as citalopram were associated with a reduction in symptoms of agitation, and lower risk of adverse effects compared to antipsychotics. Future studies are required to assess the long-term safety and efficacy of SSRI treatments for agitation in BPSD.

New Hope for Behavioural and Psychological Symptoms in Dementia (BPSD): A Narrative Review of Clinical Studies Conducted in the Symptomatic Treatments for Agitation and Psychosis Episodes in Alzheimer’s Disease/Dementia

Background: The psychomotor agitation of the BPSD is one of the common issues in aged care facilities, leading to the poor functional and medical consequences. Psychotropic interventions are the preferable choice of treatment. But which medication should be the prescribers first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from RCTs and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who had taken agitation treatments. Assessing the efficacy of antidepressants and antipsychotic treatments when compared to each other for the purpose of improving agitation outcomes. Methods: This narrative review includes RCTs and retrospective studies that were comparing one or more active ingredient medications with another or with a placebo, along with sys-tematic reviews comparing antidepressants with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies extracted by searching accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and English language. Quality of evidence: The quality of systematic reviews was judged against AMSTAR score, and RCTs were judged according to CONSORT checklist for RCT protocols. Conclusion: There are still few studies of serotonin targeting treatment of agitation in BPSD. The SSRIs such as citalopram were associated with a reduction in symptoms of agitation, and lower risk of adverse effects compared to antipsychotics. This review also illustrates brexpiprazole as a target of multimodal neurotransmitters such as dopamine, serotonin, and norepinephrine; and dextromethorphan, OR dextromethorphan associated with bupropion or quinidine as a blockade of NMDA receptors. The outcome of this review suggests that further studies involving more dementia/Alzheimer’s participants should be conducted. Future studies are required also to assess the long-term safety and efficacy of SSRI, brexpiprazole, dextromethorphan treatments for agitation in BPSD.

How I Treat Relapsed Multiple Myeloma

Despite recent advances multiple myeloma remains an incurable disease for most of the patients and initial remission will be followed by relapses requiring therapy. For many, there will be several remissions and relapses until resistance develops to all available therapies. With the introduction of several new agents, myeloma treatment has changed drastically and there are new options for the management of relapsed or refractory disease, including new drug classes with distinct mechanisms of action and cellular therapies. However, resistance to major drug classes used in first line remain the most critical factor for the choice of treatment at relapse. Continuous lenalidomide-based therapy is used extensively at first line and resistance to lenalidomide has become the key factor for the choice of salvage therapy. Daratumumab is increasingly used in first line and soon patients that relapse while on daratumumab will become a common challenge. Three-drug regimens are standard approach to manage relapsed disease. Adding drugs with new mechanisms of activity can improves outcomes and overcomes class resistance but, until now, while the biology is important, can offer only limited guidance for the choice of therapy.

Predictive Value of Ambulatory Objective Movement Measurement for Outcomes of Levodopa/Carbidopa Intestinal Gel Infusion

Patients with Parkinson’s disease that may benefit from device-assisted therapy can be identified with guidelines like Navigate PD. The decision to offer advanced treatment and the choice of treatment modality are, however, not straightforward, and some patients respond less favorably to a chosen therapy. Measurements with the Parkinson Kinetigraph (PKG) can detect motor fluctuations and could therefore predict patients that respond better or worse to intestinal levodopa/carbidopa gel infusion (LCIG). In a retrospective analysis of 45 patients that had been selected to start LCIG between 2014 and 2020, the effects of baseline PKG and clinical characteristic on the outcome were determined with ordinal regression. Although all patients had been found to have handicapping medication-related symptom fluctuations, patients without clear objective off fluctuations in the baseline PKG had low odds ratio for success. Lower odds for success were also found with increasing age, whereas gender, medication intensity and baseline PKG summary scores (median bradykinesia and dyskinesia scores, fluctuation dyskinesia score and percent time with tremor) had no significant effect. Absence of easily identified off-periods in the PKG has a negative prognostic value for the effect of LCIG and could prompt noninvasive infusion evaluation before surgery.

The Perceptions and knowledge of Physiotherapist regarding exercise and joint health in India

BACKGROUND: A physiotherapist plays a key role in assessing, monitoring, educating and prescribing exercise for RA. A few previous surveys across the goble emphasized on the lack of evidence to guide physiotherapist recognizing the early signs of RA, in knowledge of disease course, and in evidence-based interventions and therefore the ability to manage an individual with RA over the course of the disease. The study aims to investigate physiotherapists’ current practice in specific disease-related Knowledge and clinical skills required managing people with RA and extent to which they promote physical activity and exercise. METHOD: A cross-sectional national e-survey was sent to physiotherapists regarding their confidence in managing RA patients. Questionnaire Data developed from previous literatures included the following details: years of clinical experience, current RA clinical caseload, and professional qualifications, primary clinical area of practice, relevant treatment options in established or newly diagnosed cases and management goals. RESULT: A total of 478 physiotherapist responses were received.84% agreed to the fact that exercises does play an important role in joint health promotion. Almost 70% strongly agreed to factor that FIIT principal has to be taken in consideration while prescribing exercises. Approximately 48% were familiar with Index that measures disease activity and ACR-preferred tools for functional status assessment in RA. Moreover, 98% were having a clear perspective of different guidelines of management in RA and Osteoarthritis (OA).While considering the choice of treatment physical activity and educational advice were more preferred as compared to the modalities or manual therapy. CONCLUSION: The present practices are in lines with the current guidelines for RA management, but still most of them never prescribed high-intensity exercise and lacked knowledge of when to advice appropriate splints/orthoses. Even the recommendations regarding splints were not clear. So, there's a requirement to develop education and training for constantly upgrading physiotherapists within for the promotion of physical activity in rheumatoid arthritis patients.

The Role of Conventionally Fractionated Radiotherapy and Stereotactic Radiotherapy in the Treatment of Carcinoid Tumors and Large-Cell Neuroendocrine Cancer of the Lung

The occurrence of neuroendocrine tumors among the diagnosed neoplasms is extremely rare and is associated with difficulties in undertaking effective therapy due to the histopathological differentiation of individual subtypes and the scarce clinical data and recommendations found in the literature. The choice of treatment largely depends not only on its type, but also on the location and production of excess hormones by the tumor itself. Common therapeutic approaches include surgical removal of the tumor, the use of chemotherapy, targeted drug therapy, peptide receptor radionuclide therapy, and the use of radiation therapy. This article reviews the current knowledge on the classification and application of radiotherapy in the treatment of lung NETs. Case reports were presented in which treatment with conventional radiotherapy, radical and palliative radiochemotherapy, as well as stereotactic fractionated radiotherapy in the treatment of typical (TC) and atypical (AT) lung carcinoids and large cell neuroendocrine carcinoma (LCNC) were used. We hope that the solutions presented in the literature will allow many radiation oncologists to make the best, often personalized decisions about the therapeutic qualifications of patients.

“Heroic Medicine” in the Management of a Child with Spinal Muscular Atrophy Type 1: A Fair Choice of Treatment?

Medicine is a rapidly changing field. The use of new drugs has given hope for patients’ survival and comfort for the family, especially in cases of children with life-limiting conditions. This has influenced the clinical decision on the options of care and treatment by either the caregivers or healthcare professionals. Medical management for these patients is threaded on many ethical discussions to determine the best choice for these patients. We illustrated a case of a baby with spinal muscular atrophy (SMA) type 1 who was started on a new medication, leading to a renewed hope for the family but a challenging task for the managing team to decide on the highest ceiling of care for the patient.

TREATMENT OF ARTERIAL TRAUMA IN PATIENTS OF VARIOUS AGES

Aim. To identify the differences in arterial trauma (AT) treatment in patients of different ages. Materials and methods. The hospital medical records of 222 patients with AT who were treated in the Lviv Regional Clinical Hospital between 1992 and 2019 were studied. The following patterns were analyzed: age, etiology and mechanism of injury, type of AT, topography, symptoms, type of diagnosis, method of treatment. Patients were divided into seven age groups according to V. Quinn (1994): infants, early childhood, childhood, adolescents, young adults, adults and the elderly. Patients received one of three types of treatment – conservative, surgical or endovascular. Surgical treatment was further divided into simple operations (ligation or suture repair) and complex operations (end-to-end anastomosis or replacement). Results. Conservative treatment was used in 7.66±1.78%, surgical in 90.99±1.92% and endovascular in 1.35±0.77% of clients. The percentage of conservative treatment was higher among the infants (88.9±10.48%) and lower among the young adults (0.9%), as compared to the average. Among the operated patients, simple operations were performed in 48.45±3.59%, and complex operations in 51.55±3.59%. The distribution of different types of simple and complex operations between different age groups was similar. Regression analysis confirmed the influence of age factor, along with the type of AT, on the choice of treatment of patients. In addition, atherosclerotic changes were found in 20% of the adults and 50% of the elderly patients in the AT area. Conclusions. The age category of the patient makes an impact of the treatment method for patients with AT. Differences were related to the children of their first years of life, who were often managed conservatively. In the adults and the elderly, arterial damage may coincide with atherosclerotic changes in the blood vessels

ОСОБЛИВОСТІ БОЛЬОВОГО СИНДРОМУ У ХВОРИХ НА КРИЛОПІДНЕБІННИЙ ГАНГЛІОНІТ

Relevance of the research. The features of complex anatomical and functional organization of the maxillofacial area, peripheral nervous system, as well as autonomic structures determine a variety of pathogenetic mechanisms of prosopalgia, among which the lesions of the pterygopalatine node are the most common. Despite the presence of a significant variety of clinical manifestations of pterygopalatine ganglionitis, the prevalence and variety of autonomic manifestations in this disease, the main complaint of patients is pain, the characteristics of which are quite different. The aim of our research was to study the nature of pain in patients with pterygopalatine ganglionitis. Material and methods of research. We examined 105 patients with pterygopalatine ganglionitis aged from 30 to 74 years. Patients were examined for the nature of pain and its intensity, the predominant time of onset and duration of pain attacks, the place of primary localization of pain and the area of its spread. A visual analog scale (VAS) was used to assess pain intensity. Based on the intensity of pain and depending on the severity of the disease, all patients were divided into three groups: mild, moderate and severe pterygopalatine ganglionitis. With a mild severity of pterygopalatine ganglionitis, the intensity of pain attacks is 4-5 points, lasting up to 30 minutes and with a frequency of 1-3 times a day with localization within one or two anatomical areas. With moderate severity, the intensity of pain attacks is 5-7 points, lasting from 30 minutes to 1-2 hours and with a frequency of 4-5 times a day with the gradual spread of pain from one area to half of the face. The severe course is characterized by pain attacks of 8-10 points, lasting for 2 hours or more and with a frequency of attacks from 4 to 6-10 per day. In addition, the pain, occurring in one anatomical area, gradually spread to half of the face, radiating to neighboring areas. Thus, analyzing the features of the pain syndrome in patients with pterygopalatine ganglionitis, we can conclude: 1. The intensity of pain, which was determined by VAS, increases depending on the severity of ganglionitis and ranges from 4.3 points in mild to 8.75 in severe ganglionitis. 2. The duration and frequency of pain attacks increase from 30 minutes with a frequency of 1-3 seizures per day in patients with mild pterygopalatine ganglionitis, to 2 or more hours and 4-10 seizures per day in patients with severe ganglionitis. 3. The localization of pain attacks extends from one anatomical area in mild ganglionitis to half of the face with the possibility of irradiation of pain in severe ganglionitis. 4. These clinical symptoms should be used in determining the severity of pterygopalatine ganglionitis and the choice of treatment tactics in the future.