Tertiary rehabilitation in acute ankle sprain caused by sports training

BACKGROUND: An ankle sprain is a common joint sprain in sports injury, which is closely related to its physiological position and anatomical characteristics, and may progress into chronic ankle instability after improper early treatment or premature exercise. OBJECTIVE: To analyze the tertiary rehabilitation effect of acute lateral ankle sprain caused by sports training. METHOD: Ninety-six athletes with acute lateral ankle sprain diagnosed from January 2019 to June 2020 were included and divided into the control group and the rehabilitation group using the random number table grouping method, with 48 cases in each group. The two groups received standardized treatment, and the rehabilitation group additionally received tertiary rehabilitation. The American Orthopedic Foot and Ankle Society (AOFAS ) scores, degree of ankle swelling, pain, and re-injury rate were compared between the two groups. RESULTS: The AOFAS scores of the two groups increased after treatment (P< 0.05). The degree of swelling in both groups after treatment was improved (P< 0.05). The Visual Analogue Scale (VAS) scores in both groups declined two weeks after treatment, with lower results observed in the rehabilitation group The two groups showed similar results of the follow-up visit (P< 0.05). CONCLUSION: Rehabilitation exercise on acute lateral ankle sprain effectively relieves ankle swelling and pain.

Regenerative medicine and traumatic brain injury: from stem cell to cell-free therapeutic strategies

Traumatic brain injury (TBI) is a serious health concern, yet there is a lack of standardized treatment to combat its long-lasting effects. The objective of the present study was to provide an overview of the limitation of conventional stem cell therapy in the treatment of TBI and to discuss the application of novel acellular therapies and their advanced strategies to enhance the efficacy of stem cells derived therapies in the light of published study data. Moreover, we also discussed the factor to optimize the therapeutic efficiency of stem cell-derived acellular therapy by overcoming the challenges for its clinical translation. Hence, we concluded that acellular therapy possesses the potential to bring a breakthrough in the field of regenerative medicine to treat TBI.

Primary Care Disease Management for Venous Leg Ulceration – Study Protocol for the Ulcus Cruris Care [UCC] Randomized Controlled Trial (DRKS00026126)

Background Venous leg ulcers (VLU) have a prevalence of 1–2% in developed countries and affected patients are severely and long-term impaired in daily activities, work and social participation. Evidence-based outpatient treatment based on compression therapy is frequently not implemented. The “Ulcus Cruris Care” project was established to develop a disease management concept to improve outpatient treatment for patients with VLU in German primary care. For this purpose, a multifaceted intervention was conceived consisting of an online training for general practitioners and medical assistants, standardized treatment recommendations, e-learning and print-based information for patients, and a software support for case-management. Main aims of the Ulcus Cruris Care intervention are to promote standardized treatment according to current scientific knowledge, to facilitate case management for VLU patients exerted by medical assistants and to support patient education and participation in the treatment process. The UCC trial was designed to evaluate the effectiveness of the Ulcus Cruris Care intervention. Methods The UCC trial is a prospective cluster-randomized controlled multicenter trial. Fifty GP practices are intended to be recruited and randomized 1:1 to intervention or control arm. Patients with venous leg ulcers will be recruited by participating GP practices, to include a total of 63 patients in each arm. The primary outcome is time to ulcer healing. Secondary outcomes comprise number and sizes of ulcers, recurrence, pain intensity according to the Visual Analogue Scale, health-related quality of life according to EQ-5D-5L, depressiveness according to Patient Health Questionnaire (PHQ-9), patient satisfaction according to the Patient Assessment of Chronic Illness Care (PACIC-5A) query and adherence to VLU treatment. The outcome analysis of the UCC trial is accompanied by a health economic analysis and a process evaluation. Discussion The UCC trial will evaluate whether the Ulcus Cruris Care intervention may lead to faster wound healing, higher health-related quality of life and lower use of medical resources. If the intervention turns out to have a positive impact on assessed outcomes, comprehensive implementation in primary care may be considered. Trial registration The trial protocol (version 1 as of July 19th, 2021) has been registered in the German Clinical Trials Register on August 30th, 2021 (DRKS000261265).

An Empirical Analysis of Director Mingjun Zhao’s Experience in Treating Chronic Heart Failure

With the aggravation of an aging population, the prevalence of chronic heart failure is increasing. As a famous traditional Chinese medicine practitioner in Shaanxi Province, Mingjun Zhao is amicable at using traditional Chinese medicine to treat chronic heart failure. He believes that the pathogenesis of the condition is mainly due to the lack of heart Yang, deficiency of heart Qi, as well as the combination of water and blood stasis. Therefore, in treating this condition, it is essential to warm and nourish heart Yang, replenish Qi to benefit water, and promote blood circulation to remove blood stasis. Based on the standardized treatment used in western medicine, traditional Chinese medicine should be reasonably and accurately combined with it as a drug pair into a prescription, thus highlighting the advantages of the combination of traditional Chinese medicine in the treatment of chronic heart failure to a great extent.

Rapidly Progressive Lung Sarcomatoid Carcinoma Managed with Doxorubicin Plus Ifosfamide and Pemetrexed

Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of nonsmall-cell lung cancer (NSCLC). It carries a poor prognosis, even among other subtypes of NSCLC. Currently, most treatment strategies for PSC are derived from regimens aimed at managing soft tissue sarcomas or NSCLC. The use of doxorubicin plus ifosfamide and pemetrexed has been well established in the management of soft tissue carcinoma and other nonsmall-cell lung cancers, respectively. We report the case of a 69-year-old male diagnosed with PSC who was managed with doxorubicin plus ifosfamide and pemetrexed therapy. Our patient initially responded to the therapy but had rapid progression and died 8 months after the initiation of treatment. Upon genetic analysis, it was revealed the patient had overexpression of the MDM2 protein, which has been associated with poor response to therapy. This case highlights the need for a personalized treatment approach, as well as the need for a standardized treatment regimen for managing PSC.

Retinoblastoma in South Asia: A Scoping Review

Introduction: Pakistan, Indonesia, Bangladesh and the Philippines are listed as among the six Asian countries which will be the sources of 43% or almost 4000 new cases of the estimated world’s retinoblastoma cases in 2023. Materials and Methods: Scoping review of literatures using the databases of Pubmed, EMBASE, Scopus, Science Direct, Google scholar and Web of Science databases as well as local and regional databases on clinical features, treatment and outcomes of retinoblastoma patients from Pakistan, Indonesia, Bangladesh and the Philippines was done. A descriptive analysis using the 2017 retinoblastoma database of the Global Retinoblastoma Study Group (GRSG) was added to supplement data for Bangladesh, Indonesia and the Philippines. Results: A total of 17 articles were included in this review. There were 696 retinoblastoma patients involving at least 859 eyes seen in Pakistan from 1997 to 2018 and included in the 7 articles reviewed. There were 617 retinoblastoma patients involving at least 677 eyes seen in Indonesia from 2003 to 2018 and included in the 8 articles reviewed and the GRSG’s database. There were 161 retinoblastoma patients involving 221 eyes identified in the descriptive analysis of the GRSG’s database for Bangladesh. And there were 226 retinoblastoma patients involving 297 eyes seen in the Philippines from 1998-2020 from the 2 articles from the Philippines and the GRSG’s database. Discussion: Lack of awareness on the disease, distant centers, expensive service and cultural unacceptability of treatment were the commonly cited reasons for late consult. However, non-standardized and poor clinical reporting and monitoring, and non-standardized treatment protocols were also contributory to the low survival rates. The current management outcomes of retinoblastoma from the four countries are alarmingly below par with developed countries, India and China. Conclusion: Although advances had been made in the management of retinoblastoma, delay in consultation which often leads to advanced disease was still common. This contributes to low survival rates in the four countries.

The Trend in Cesarean Myomectomies and The Risk of Obstetrical Complications in Korea

Background To evaluate the pregnancy outcomes and the risk of adverse obstetrical outcomes from cesarean myomectomy (CM) compared to cesarean section (CS)-only and to investigate the trend of surgeons in choosing CM. Methods A retrospective cohort study was done of all patients who underwent CS that was complicated with leiomyoma at two university hospitals from January 2010 to May 2020. All patients were categorized into the CM group or the CS-only group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups. Results A total of 438 women in the CS-only group and 341 women in the CM group were included. Women who underwent CS-only had significantly more history of a previous myomectomy and multiple leiomyomas compared to women who underwent CM. The gestational days at delivery and the pregnancy complications were significantly higher in the CS group. The mean size of the leiomyomas was larger in the CM group than in the CS only group (5.8 ± 3.2 cm vs 5.2 ± 3.1 cm, P = 0.005). Operation time and history of previous CS and preterm labor were higher in the CM group. It seems that preterm labor and abnormal presentation were relatively higher in the CM group than in the CS group due to the presence of leiomyoma. There were no significant differences in the pre and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07 – 1.25; P < 0.001) and operation time > 60 minutes (OR = 2.461; 95% CI: 1.45 – 4.15) were significant independent predictors of adverse outcomes after CM. Conclusions Cesarean myomectomy is a reliable and safe approach to prevent the need for another operation for remnant leiomyoma. In this study, surgeons seemed to perform CM when uterine leiomyomas were large, the subserosal type, or few in number. Standardized treatment guidelines for myomectomy during cesarean section in pregnant women with uterine fibroids should be established.

AN OBSERVATIONAL STUDY OF THE CLINICAL PROFILE AND OUTCOMES OF PATIENTS WITH MILIARY TUBERCULOSIS (TB).

Objectives: This study aimed to evaluate the clinical prole and outcome of the patients with miliary tuberculosis (TB). Methods: This was a retrospective observational study which involved evaluation of medical records of 44 patients with miliary TB in the department of respiratory medicine and internal medicine from 2016-2019. Miliary TB in these patients had been diagnosed on the basis of clinical symptoms, radiology and microbiology. The clinical prole of the patients in terms of age, gender, clinical presentations were recorded. Time duration for resolution of symptoms was noted. Radiological outcome was also studied. Final outcome was treatment success and mortality. Results: The mean age of the patients were 37.07 years with 27 males. Most common complaints were fever (86.36%), cough (72.73%), expectoration (65.91%) and anorexia (45.45%). Laboratory ndings showed hypertransaminasemia, anemia, and hyponatremia in 75.00%, 70.45%, and 43.18% patients, respectively. Standardized treatment (RHEZ) was given in 70.45% patients, and non-standardized treatment in 29.55% patients. Median duration of fever was relieved in 15 days. Mortality rate was 11.36% and drug induced liver injury (DILI) was seen in 4(9.09%) patients. Radiological resolution was seen in almost all of the patients except in 3 and in majority of patients clearing was seen within the rst two months of initiation of treatment. Among all variables, hyperbilirubinemia showed signicant association with mortality (OR=14.6, 95% CI 1.86 to 114.615, P=0.013). Conclusion: In conclusion, in our series miliary TB presents most commonly in the third decade of life and is predominant among males. The clinical features were similar to pulmonary tuberculosis. There was frequent association with derangements in liver function, electrolyte, and hemoglobin. Hyperbilirubinemia was associated with signicantly increased the odds of mortality. Non-standardized treatment regimens were associated with poorer outcome. Mortality rate in miliary TB was as high as 11.3% in our series.

Symbrachydactyly

Symbrachydactyly is a rare congenital hand malformation in which a child is born with abnormally short digits that may be webbed, misshaped, or missing, and it is usually a unilateral condition. There is no standardized treatment algorithm for the management of symbrachydactyly. The function of the hand is often not adequate and requires early surgical intervention to restore useful prehension and appearance. This CME article presents a brief review of the embryology, history, classification and clinical presentation, and author’s experience of treating 19 children with symbrachydactyly over 10 years. Creation of thumb web, lengthening of thumb, and creating an opposition post results in prehension of hand with an improved quality of life.

New therapies for alopecia areata

Over the past few years, better understanding of the explicit pathomechanism of alopecia areata provides new treatment opportunities for effective therapy of the disease, which may revolutionize therapeutic strategies. This exceedingly heterogeneous disease with unpredictable outcome, severely affects the quality of life. Currently, there are no standardized treatment protocols approved by the European Medicines Agency (EMA), resulting a challenge for the therapists in the choice of treatment.In this paper, the authors summarize recent and emerging therapies for severe cases of alopecia areata.