Search Results (44)

(1) Background: The occurrence, intensity, and characteristics of adverse drug reactions (ADRs) caused by anti-tuberculosis (TB) drugs have consistently been a subject of worry. There is a lack of published research from Pakistan regarding the negative effects of anti-TB treatment on children, specifically about ADRs. In this study, we aimed to investigate the ADR associated with anti-DR-TB treatment in children. (2) Methods: A prospective longitudinal study was conducted in the multicenter setting of Khyber Pakhtunkhwa, Pakistan. A total of 450 TB children in multicenter hospitals under ATT were assessed for ADRs. Naranjo Causality Assessment and Hartwig’s Severity Assessment Scale were used to evaluate the causality and severity. (3) Results: A total of 300 (66.66%) ADRs were reported in 450 people with DRTB. Anemia was the most frequently observed ADR (37.6%) followed by nausea and vomiting (18.6%). On multivariate analysis, the independent variables that had a statistically significant positive association with ADRs were participants aged, 5–14 years (AOR, 0.3 (0.1–0.5), p ≤ 0.001), normal weight (1.1 (2.0–1.9), p < 0.001), and children having comorbidities (AOR, 0.5 (0.1–0.8), p ≤ 0.001). (4) Conclusions: Our findings advocate for personalized treatment approaches, incorporating nutritional support, comprehensive comorbidity management, and vigilant monitoring to mitigate ADRs and improve treatment outcomes. Full article

Background/Objectives: Loss of appetite is a common symptom in patients with advanced cancer, and may contribute to patient deterioration. There is a lack of information about this issue, particularly in patients with advanced cancer admitted to an acute palliative care unit. The aims of this study were to assess appetite loss in patients admitted to an APCU and to investigate whether changes following comprehensive palliative care treatment are associated with survival. Materials and Methods: A consecutive sample of 520 patients admitted to the APCU was assessed. Patient characteristics and Edmonton Symptom Assessment Scale (ESAS) were measured at admission (T0) and after one week of comprehensive palliative care treatment (T7). Results: Of 381 patients screened, 208 (54.6%) had a poor appetite rating (≥4/10). Following comprehensive palliative care (T7), the number of patients with poor appetite significantly decreased to 116 (30%) (p < 0.0005). A multivariate regression analysis revealed that nausea (p = 0.002), weakness (p = 0.006), poor well-being (p = 0.017), and total ESAS score were correlated with poor appetite at T0. At T7, pain (p = 0.018), anxiety (p = 0.001), depression (p = 0.014), poor sleep (p = 0.047), drowsiness (p = 0.035), nausea (p = 0.018), weakness (p < 0.0005), poor well-being (p < 0.0005), and total ESAS score (p < 0.0005) were correlated with poor appetite. Survival was associated with a low Karnofsky (OR = 3.217(1.310–5.124), p = 0.001) and the presence of poor appetite at T7 (OR = −7.772(−14.662–−882), p = 0.027). Conclusions: A large proportion of patients admitted to an APCU present moderate-to-severe poor appetite. Clinical improvement of poor appetite is associated with improved survival. Full article

Many patients with head-and-neck cancer (HNC) suffer from speech or swallowing disorders. We investigated the impact of dysphagia on health-related quality of life (HRQOL), functioning, and distress in HNC survivors, and whether cancer rehabilitation can alleviate these conditions. Before admission (T0) and at discharge (T1) of three-week inpatient cancer rehabilitation, patient-reported outcomes were collected. HRQOL, symptoms, functioning, and psychological distress were assessed with EORTC QLQ-C30 and Hospital Anxiety and Depression Scale (HADS) questionnaires. Of 63 HNC patients, 22 had dysphagia, 23 needed no speech therapy (Control-1), and 18 needed speech therapy, but showed no symptoms of dysphagia (Control-2). Before rehabilitation, HRQOL, physical, social, and emotional functioning were significantly lower in dysphagia patients than in controls. Dysphagia patients reported more severe general symptoms including fatigue, pain, sleep disturbances, nausea/vomiting, diarrhea, and financial worries. Furthermore, the emotional and social functioning of Control-2 was significantly worse than Control-1. For all HNC patients, social, emotional, and role functioning, fatigue, nausea/vomiting, insomnia, and appetite loss significantly improved at T1. Improvements in HRQOL were most noticeable in dysphagia patients. Psychooncological counseling reduced depression in dysphagia and Control-2 patients to levels seen in the general population. In conclusion, dysphagia patients suffer severely from impaired functioning and systemic symptoms but benefit substantially from rehabilitation. Full article

Laparoscopic surgery reduces tissue trauma and accelerates recovery, but postoperative pain remains a concern. Opioids are effective but have adverse effects, highlighting the need for multimodal analgesia. Nefopam, a non-opioid analgesic, provides pain relief without respiratory depression or dependence. This study aims to investigate the efficacy of intravenous nefopam combined with a transversus abdominis plane (TAP) block in living liver donors undergoing laparoscopic hepatectomy. This retrospective cohort analysis was conducted on 452 adult living donors who underwent laparoscopic hepatectomy with a TAP block between August 2013 and August 2018 at a single tertiary medical center. After propensity score matching, 296 patients were included, with 148 in the nefopam group and 148 in the non-nefopam group. The primary outcomes assessed were pain scores using the Numeric Rating Scale (NRS) at 1, 4, 8, 12, and 24 h postoperatively, opioid consumption, postoperative nausea and vomiting, and nefopam-related adverse effects. Nefopam significantly reduced NRS at 1, 4, and 8 h postoperatively (p < 0.001) and decreased fentanyl use in the post-anesthesia care unit (26.0 ± 32.2 μg vs. 60.5 ± 37.9 μg, p < 0.001) and total intravenous patient-controlled analgesia volume (p < 0.001). The incidence of postoperative nausea and vomiting and severe opioid-related complications did not differ between groups. Nefopam-related side effects were mild and self-limiting. Nefopam combined with a TAP block effectively reduces postoperative pain and opioid consumption in living liver donors, supporting its role in multimodal analgesia. Further research is needed to explore its broader applications. Full article

Background: West Nile Virus [WNV] is a mosquito-borne flavivirus. It has spread globally, causing asymptomatic to severe neurological diseases in humans, with an increased risk in older adults and those with underlying conditions. This review examines WNV’s impact on pregnancy, focusing on maternal and neonatal symptoms and risks. Methods: This systematic review included primary studies from “PUBMED” and “SCOPUS” databases, as well as Google and Google Scholar, conducted in July 2024 using the appropriate keywords. This review adhered to PRISMA guidelines and utilized the Newcastle–Ottawa scale for bias assessment. Results: Seven primary studies were included in the systematic review. Fever was the predominating symptom, including neurological manifestations, respiratory symptoms, myalgia, weakness, nausea, vomiting, and rashes. Delivery, in most cases, progressed without any complications, while no infection was noted. Most of the neonates had a normal Apgar score, and their developmental functions did not seem to be affected. Even though, antibodies against WNV were detected in breast milk, no association with transmission to the neonate was observed. Conclusions: WNV infection is mostly associated with favorable outcomes during pregnancy. However, larger cohorts are needed to confirm our conclusions. Prompt diagnosis and public health surveillance are pivotal to eliminate disease transmission. Full article

Background and Objectives: In this study we analyzed the perceived effectiveness of cannabidiol (CBD) in adult women with inflammatory bowel disease (IBD). Materials and Methods: We conducted an online cross-sectional survey which assessed disease severity and quality of life (QOL) in women with IBD (Crohn’s disease and ulcerative colitis) who used CBD versus those who did not. The survey included: the Harvey–Bradshaw Index, Partial Mayo Score, Short Inflammatory Bowel Disease Questionnaire, Bristol Stool Scale, and the Prime Screen Short Food Frequency Questionnaire. CBD utilization practices were also examined. STROBE reporting outcomes were followed. Statistical methods included Pearson and Spearman’s correlations and chi-square analyses. Results: Seventy-one (n = 71) women were included. Twenty-five (n = 25) were CBD users and forty-six (n = 46) were past/never users. Most current users ingested CBD once per day (40%), acquired CBD from a dispensary (56%), and utilized an oral tincture (40%) at a dose of 25 mg or less (56%). There was no statistical association between CBD use and disease severity, quality of life (QOL), fecal consistency, or food intake. However, CBD users reported decreases in IBD-related pain and nausea (76% and 64%, respectively), and improvement in appetite (60%). Overall, disease severity and QOL were inversely correlated (past/never users: p = 0.000, r = −0.544; current users: p = 0.042, r = −0.427). Conclusions: Women with IBD who use CBD insignificantly trended toward improved disease-related symptoms, appetite, and QOL compared to non-users. Disease severity and QOL were inversely associated, regardless of CBD use. These preliminary outcomes indicate the need for further research on CBD use in women with IBD. Full article

Patients with hematological malignancies undergo intensive treatment and prolonged hospitalization, thus having a variety of physical and psychosocial symptoms and worse quality of life (QOL). This study aimed to assess the QOL and investigate the symptoms of hospitalized hematological cancer patients. A cross-sectional study was conducted in the hematology clinics and day units of two general hospitals of Heraklion, Crete. Adult patients with hematological malignancy and an adequate understanding of the Greek language participated. A demographic questionnaire, the European Organization for Research and Treatment for Cancer quality assessment questionnaire (EORTC QLQ-C30), and the MD Anderson Symptom Inventory (MDASI) were used. The sample consisted of 120 patients—42.5% were women, with a mean age of 65.6 years. The mean time from diagnosis was 33 months. The global health status of QoL had an average value of 47.1. The highest levels of QOL were found in the subscale of cognitive function (72.8) and the lowest in the role function (46.1). For the EORTC QLQ-C30 symptoms scale, the lowest score was found in nausea-vomiting (11.0) and the highest in fatigue (59.1). In the MDASI, in part I (core symptoms), higher levels but also medium intensities were reported at fatigue (78.3%, mean 3.5), drowsiness (65.0, mean 3.3), and distress (65.8%, mean 2.8). In part II, enjoyment of life (85.8%, mean 5.1) had the highest, and relation with other people (67.5%, mean 3.7) had the lowest scores. The increase in the severity of the core symptoms (part I) was related to females (rho = 0.193, p <0.05) and comorbidities (rho = 0.220, p < 0.05). It was also associated with a significant decrease in all functional domains and increased fatigue (rho = 0.571, p < 0.05) in the EORTC QLQ-C30 questionnaire. The increased global health status was related to males (rho = −0.185, p < 0.05) and physical functioning with younger age (rho = −0.331, p < 0.05), higher education (rho = 0.239, p < 0.05), fewer months from diagnosis (rho = −0.199, p < 0.05), and low comorbidity (rho = −0.209, p < 0.05). Finally, multiple linear regression analysis revealed that the total average symptom score of the MDASI was the most significant factor influencing the global health status of the EORTC QLQ-C30 (β = −4.91, p < 0.001). The increased global health status of the EORTC QLQ C30 was not significantly related (p > 0.05) to the social characteristics of the patients, such as education or employment, which requires further validation. The QoL of hematological cancer patients significantly decreases during treatments due to a considerable number of symptoms that must be taken into consideration for high-quality, individualized care. Full article

Appetite loss is prevalent in patients with advanced cancer and negatively affects their quality of life. However, understanding of the factors associated with appetite loss is limited. The current study aims to explore characteristics and therapeutic interventions used for patients with and without appetite loss admitted to an acute palliative care unit. Patient characteristics and patient-reported outcome measures (PROMs), using the 11-point numeric rating scale (NRS 0–10), were registered. Descriptive statistics, independent samples T-tests and chi-square tests were utilized for data analysis. Of the 167 patients included in the analysis, 62% (104) had moderate to severe appetite loss at admission, whereof 63% (66) improved their appetite during their hospital stay. At admission, there was a significant association between appetite loss and having gastrointestinal cancer, living alone, poor performance status and withdrawn anticancer treatment. Patients with appetite loss also experienced more nausea, depression, fatigue, dyspnea and anxiety. In patients with improved appetite during hospitalization, mean decrease in NRS was 3.4 (standard error (SE) 0.27). Additionally, patients living alone were more likely to improve their appetite. Appetite improvement frequently coincided with alleviation of fatigue. Understanding these associations may help in developing better interventions for managing appetite loss in patients with advanced cancer. Full article

Background: To evaluate analgesic practices in perioperative treatment during the SARS-CoV-2 pandemic; recording parameters collected in the PAIN OUT database, and to compare COVID and no-COVID data. Methods: Data were analyzed for 277 patients (87 COVID-19 confirmed diagnosis and 190 non-COVID): years aged, gender, minutes of surgery duration, Likert Scale punctuation, hours in severe pain, minimum and maximum pain intensity, interference with sleep quality, anxiety, need for help, nausea, drowsiness, itching, dizziness, perception of care, pain relief, participation, satisfaction, and information received. Results: Postoperative mortality 1 month after surgery was recorded at 25.3% in COVID-19. Significant differences were found in postoperative pain intensity (p = 0.019), time with severe pain (p < 0.01), lower sleep quality (p < 0.01), and better outcomes in functional items (p < 0.01); there were more side effects and satisfaction with pain relief (p < 0.01) in COVID-patients than with no COVID-19 patients. Conclusions: In conclusion, COVID-19 patients presented greater intensity and duration of severe postoperative pain, greater somnolence, pruritus, and dizziness, lower physical activity limitation, and higher quality index. Full article

Background: Nausea and vomiting in pregnancy (NVP), or emesis gravidarum, is a frequent complication of early gestation with unclear causes, suspected to involve genetic, hormonal, and gastrointestinal factors. Our study investigated the association of human chorionic gonadotropin (hCG), histamine, diamine oxidase (DAO), thyroxine and pyridoxine and the severity of NVP symptoms and assessed the efficacy of a vitamin C-containing chewing gum as a potential NVP treatment. Methods: In this prospective, double-blinded, randomized, controlled trial, 111 participants were assigned to receive vitamin C-containing chewing gum, placebo gum, or no treatment at two follow-ups during early pregnancy. Maternal serum levels of hCG, histamine, DAO, thyroxine, and pyridoxine were measured and correlated with NVP severity using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24) score. Results: Elevated maternal hCG levels were significantly associated with an increased PUQE-24 score (p < 0.001), while histamine levels showed no significant correlation (p = 0.68). Maternal DAO levels negatively correlated with NVP symptoms (p < 0.001) and elevated thyroxine (p < 0.001) and pyridoxine levels (p < 0.001) were associated with increased PUQE-24 scores. The vitamin C-containing chewing gum did not demonstrate efficacy in alleviating NVP symptoms compared to placebo gum or no treatment during the first (p = 0.62) and second follow-up visits (p = 0.87). Conclusions: Our study underscores the complexity of factors contributing to NVP, highlighting the significant roles of hCG and DAO, while histamine levels appear unrelated. Maternal thyroxine and pyridoxine levels also significantly correlate with NVP symptoms. Vitamin C-containing chewing gum was not effective as a treatment for NVP. Further large-scale studies are needed to better understand these interactions and develop targeted treatments in the future. Full article

Chronic pancreatitis (CP) is a rare but debilitating condition with an 8-fold increased risk of developing pancreatic cancer. In addition to the symptoms that come from the loss of endocrine and exocrine function in CP, the management of chronic pain is problematic. We previously showed that the CCK-receptor antagonist called proglumide could decrease inflammation, acinar-ductal metaplasia, and fibrosis in murine models of CP. We hypothesized that proglumide would be safe and diminish pain caused by CP. A Phase 1 open-labeled safety study was performed in subjects with clinical and radiographic evidence of CP with moderate to severe pain. After a 4-week observation period, the subjects were treated with proglumide in 400 mg capsules three times daily (1200 mg per day) by mouth for 12 weeks, and then subjects returned for a safety visit 4 weeks after the discontinuation of the study medication. The results of three pain surveys (Numeric Rating Scale, COMPAT-SF, and NIH PROMIS) showed that the patients had significantly less pain after 12 weeks of proglumide compared to the pre-treatment observation phase. Of the eight subjects in this study, two experienced nausea and diarrhea with proglumide. These side effects resolved in one subject with doses reduced to 800 mg per day. No abnormalities were noted in the blood chemistries. A blood microRNA blood biomarker panel that corresponded to pancreatic inflammation and fibrosis showed significant improvement. We conclude that proglumide is safe and well tolerated in most subjects with CP at a dose of 1200 mg per day. Furthermore, proglumide therapy may have a beneficial effect by decreasing pain associated with CP. Full article

Purpose: This study sought to investigate changes in quality of life (QoL) and symptom burden among palliative care patients undergoing one week of inpatient care in a specialized palliative care unit (PCU). The patient population was stratified into two groups, with one group pretreated from pre-admission palliative care (PC) provided by an outpatient multidisciplinary PC team, while the other group did not receive such support prior to admission. Although the average duration of treatment at a PCU in Germany is 1–2 weeks, the question also arises as to whether a significant improvement in symptom burden and QoL can be expected after just one week of PC in a PCU. Methods: PC patients with various cancer entities were prospectively included in a non-randomized study. Patients in group 1 received outpatient specialized PC prior to admission, while patients in group 2 did not. Over an 8-month period, we gathered data from one academic cancer center, utilizing the EORTC QLQ-C30, one of the most widely used patient-reported outcome (PRO) instruments to assess health-related QoL in cancer patients. Patients completed the QLQ-C30 at T0 (admission or one day later) and T1 (one week later), enabling the assessment of potential changes in their QoL and symptom burden over time. Results: A total of 103 patients (51.5% male) were enrolled (group 1: 42%, group 2: 58%). At T0, there were no significant differences regarding QLQ-C30 scores between groups 1 and 2, except from global health/QoL (group 1 mean 20.7, group 2 mean 25.6, p = 0.026). Over the course of one week several significant and clinically relevant changes were found: Emotional functioning demonstrated an uplift in both groups (group 1: mean 41.5 IQR 33 vs. 53.1 IQR 50, p = 0.014, group 2: mean 48.2 IQR 46 vs. 56.8 IQR 58, p = 0.029), as did the global health status (group 1: M 20.7 IQR 17 vs. 36.2 IQR 33, p < 0.001, group 2: M 25.6 IQR 25 vs. 35.3 IQR 33, p < 0.001). Nausea and vomiting showed a reduction (group 1: M 29.9 IQR 17 vs. 6.8 IQR 0, p < 0.001, group 2: M 22.6 IQR 17 vs. 8.2 IQR 0, p < 0.001), along with a notable decline in pain (group 1: M 67.4 IQR 67 vs. 25.3 IQR 17, p < 0.001, group 2: M 73.1 IQR 83 vs. 29.7 IQR 17, p < 0.001). A decrease was observed in insomnia (group 1: M 63.6 IQR 67 vs. 27.6 IQR 33, p < 0.001, group 2: M 60.1 IQR 67 vs. 27.6 IQR 33, p < 0.001). There were no significant differences between groups 1 and 2 in the extent of improvement in the various symptom scales from T0 to T1. Conclusion: The findings of our study demonstrate that QoL and several symptoms prevalent in cancer patients cared for in the PCU experienced significant enhancement over the span of just one week. Both groups, patients receiving specialized outpatient PC prior to admission and those without, equally benefited from inpatient PC. All mentioned changes from T0 to T1 are considered not only significant but clinically relevant. Full article

Introduction: We conducted a head-to-head comparison of step 2 (tramadol) and step 3 (oxycodone) of the WHO pain ladder in older adults with moderate to severe acute locomotor pain. Materials and methods: Multi-center prospective randomized study. Patients were 70 years or older, admitted to the acute geriatric ward of three hospitals, suffering from acute moderate to severe locomotor pain, and opioid-naive. Patients were randomized into two treatment groups: tramadol versus oxycodone. The Consort reporting guidelines were used. Results: Forty-nine patients were included. Mean numeric rating scale (NRS) decreased significantly between day 0 and 2 of the inclusion in both groups. A sustained significant decrease in mean NRS was seen at day 7 in both groups. Nausea was significantly more prevalent in the tramadol group, with a trend towards a higher prevalence of delirium and falls and three serious adverse events in the same group. Conclusions: Opioid therapy may be considered as a short-term effective treatment for moderate to severe acute locomotor pain in older adults. Oxycodone may possibly be preferred for safety reasons. These results can have implications for geriatric practice, showing that opioids for treatment of acute moderate to severe locomotor pain in older patients are effective and safe if carefully monitored for side effects. Opioid therapy may be considered as a short-term treatment for moderate to severe acute locomotor pain in older adults, if carefully monitored for (side) effects, while oxycodone may possibly be preferred for safety reasons. These results can have implications for daily practice in geriatric, orthopedic, and orthogeriatric wards, as well as in terminal care, more precisely for the treatment of moderate to severe acute locomotor pain in older adults. Full article

Background: Antenatal depression is common and has significant consequences. The literature suggests that antibiotic exposure may be associated with depression. Many individuals are exposed to antibiotics during pregnancy. Further investigation of the association between antenatal antibiotic use and the development of depression during pregnancy is needed. Methods: A national prospective observational cohort study of pregnant individuals was undertaken using an online survey, completed during the third trimester. Antenatal depressive symptoms (ADSs) were defined as having an Edinburgh Postnatal Depression Scale score of ≥13 and/or receiving a clinical diagnosis of depression. Results: One in six individuals (16.5%, n = 977) experienced ADSs during their pregnancy, of whom 37.9% received a depression diagnosis. There was no relationship between antibiotic use and the development of ADSs. Four factors were identified as significant independent predictors of ADSs: personal history of depression, severe nausea and vomiting causing an inability to eat, emotional abuse from an intimate partner within the prior 12 months, and not having a university degree. Conclusions: Antenatal antibiotic use was not associated with the development of ADSs. Given the high incidence of undiagnosed depression, new strategies and models of care that prioritise individuals with risk factors may be required to optimise antenatal care. Full article

Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0–6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild–moderate disability (i.e., EDSS in the range of 2.5–6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0–2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild–moderate disability) and COP path length relating to the use of VR (pwMS with mild–moderate disability and unaffected individuals), thus suggesting a sort of “balance training effect”. Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants. Full article