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Comparative Outcomes of Surgical and Conservative Management of Pediatric Intracranial Cavernous Malformations: A Systematic Review and Meta-analysis
No full textObjective: Pediatric cavernous malformations (CMs) represent a challenging condition in neurosurgery due to their unpredictable nature and potential for neurological deficits. This study aimed to explore the management strategies for pediatric CM, focusing on identifying the factors that influence the choice between conservative and surgical treatment.
Methods: A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. The review included a comparative meta-analysis to summarize patient characteristics and outcomes stratified by treatment modality.
Results: Thirteen comparative studies with 775 patients were included, with 56.5% (438 patients) in the surgically managed group and 43.5% (337 patients) conservatively managed. The mean ± SD methodological index for nonrandomized studies (MINORS) was 12.4 ± 3.3. Equal proportions of males were in both groups. The surgical group had higher prevalence rates of seizure (51.3% vs 21.0%), signs of elevated intracranial pressure (6.2% vs 0.7%), and hemorrhage (65.9% vs 28.8%). Seizure (OR 3.8, 95% CI 2.4-5.8, p \u3c 0.001, I2 = 2.0%) and hemorrhage (OR 4.6, 95% CI 1.5-13.7, p \u3c 0.001, I2 = 61.8%) were predictors of surgical management. Lesion characteristics included more isolated lesions (79.4% vs 68.5%) and larger mean lesion size (2.1 cm vs 1.4 cm) in the surgical group. Clinical improvement was reported in 83.8% of surgically treated and 72.6% of conservatively treated patients (p = 0.277), while 77.5% of surgical patients were symptom free compared to 50.5% of conservative patients (p = 0.033) at last follow-up. No deaths were reported in either group.
Conclusions: Conservative management is safe for asymptomatic pediatric CMs. Symptomatic cases, especially with seizures or hemorrhage, often benefit from surgery. Surgical decisions should be individualized, and further research is needed to clarify predictors of surgical benefit
Pica Syndromes and Iron Deficiency Anemia Treatment: A Mini Review
No full textBackground/Objectives: Pica, the compulsive ingestion of non-nutritive substances, has long been observed in patients with iron deficiency anemia (IDA). This behavior is particularly noted in adults, including pregnant women, and poses both diagnostic and management challenges. We conducted a review of studies from the past decade to evaluate the epidemiology and nature of pica in adult IDA patients and the outcome of various treatment strategies on anemia and pica behaviors. Methods: We searched PubMed, Scopus, and Cochrane Library for peer-reviewed articles (including observational studies, clinical trials, and reviews) published in English between 2015 and 2025. Inclusion criteria targeted studies of adult populations with IDA that reported on pica prevalence, characteristics, or treatment outcomes. We also reviewed clinical guidelines and meta-analyses on IDA treatment in adults for recommended management approaches. Results: Pica was found to be a prevalent symptom among individuals with IDA, but was readily treatable with appropriate iron deficiency treatment. Among treatment options, both oral and parenteral iron supplementation were found to be effective in resolving iron deficiency and pica. Choice of treatment depends on tolerance to oral iron, speed of resolution required, and comorbid conditions. Conclusions: Pica is closely intertwined with IDA; our review highlighted the prevalence of pica among individuals with IDA, which serves as both a clinical clue to underlying anemia and a potential source of complications. Crucially, the treatment of IDA is also effective for pica. We recommend oral iron therapy on alternate-day dosing as first-line therapy to minimize side effects, alongside dietary optimization. If IDA and pica are resistant to oral iron supplementation or oral iron cannot be tolerated, parenteral iron therapy can be considered
The Dorsal Forearm as a Novel Target for Intramuscular Injections: Clinical Pharmacokinetic Results With Naloxone
No full textThe dorsal forearm represents a potentially viable location for a convenient wearable device for the administration of intramuscular (IM) injections, but this site has not previously been formally targeted for this purpose. The objectives of this study were to administer naloxone via IM injection into the dorsal forearm, characterize the pharmacokinetic (PK) profile of this injection site, and compare it to that of a standard IM injection. The study was an outpatient, open-label, single period, single treatment, single dose proof of concept (PoC) trial in 12 healthy subjects. After screening, participants provided a time zero (pre-dose) blood sample and then were administered 2 mg naloxone HCl as an IM injection in the extensor digitorum communis (EDC) muscle of the dorsal forearm. Serial blood (plasma) samples were obtained from the contralateral arm prior to dosing and serially thereafter for PK analysis. Naloxone concentrations were determined using a validated assay. PK parameters were generated from the naloxone concentration-time data. The means and ranges of the PK profile of naloxone administered IM in the forearm were: Cmax 5.3 ng/mL; Tmax 0.29 h; AUC[0-∞] 7.96 ng * h/mL, and the relative bioavailability of naloxone administered into the dorsal forearm was 87% compared to IM naloxone administered in the thigh. The subjects noted minimal discomfort with the forearm injection, and there were no adverse neurovascular events. This represents the first study wherein a drug has been administered in the EDC of the dorsal forearm as an IM target muscle
Chapter 14 - Role of T-cells in Immunotherapy of Pancreatic and Colon Cancers
No full textOncological immunotherapy is a rapidly growing discipline that aims to treat many tumors. It has demonstrated promising results in the early identification and management of cancer. Gastrointestinal (GI) cancers, including colon and pancreatic cancer, are among the major cancer-related deaths worldwide. Surgical procedures, chemotherapy, radiation therapy, targeted therapy, and immunotherapy are many treatment modalities that are currently accessible. Nevertheless, these treatments are accompanied by other limitations, including challenges in detecting patients at an advanced stage, developing resistance to treatment, and adverse effects on patients’ quality of life. CAR-T cell therapy specifically offers a promising approach for treating GI tumors by using the body\u27s immune system to target cancer cells. Current research primarily focuses on selecting pertinent antigens, altering the tumor\u27s microenvironment, and addressing toxicity control. Although initial findings show promise, further research is necessary to enhance the effectiveness of CAR-T cell therapy and revolutionize the treatment of GI tumors. Several ongoing clinical trials are exploring its efficacy. However, some challenges must be confronted, such as issues related to toxicity and safety. Future clinical research may benefit from focusing on improving hybrid antigens’ technical details to target specific tumor locations and checkpoints. This has the potential to enhance patient outcomes and increase the quality of life
A Review of Osteopathic and Related Manipulative Treatments for Improving Symptoms of Gastrointestinal Distress in Neurological Disorders
No full textObjective
To determine the clinical utility of osteopathic manipulative treatments (OMT) and related manual therapies for improving gastrointestinal distress in patients with neurological disorders (ND).
Methods
A database search through PubMed, Embase, Scopus, and Ovid was conducted to identify randomized and non-randomized clinical trials that analyzed the effects of OMT and related manual therapies on gut health in patients with ND. Two independent reviewers screened articles for inclusion and extracted information related to participant characteristics, intervention details, outcome measures, and significant outcomes. Methodological quality of eligible studies was assessed using the Standard Quality Assessment Criteria.
Results
Twelve studies (nine randomized controlled trials, two pre-post trials, and one non-randomized controlled trial) with a total of 516 individuals with ND were analyzed. All twelve studies showed improvements in symptoms of gastrointestinal distress following OMT and related treatments. Findings may be limited by methodological variability (i.e., heterogenous disability types, treatment modalities) and language exclusions.
Conclusion
Evidence suggests that OMT and related treatments are effective interventions for improving symptoms of gastrointestinal distress like constipation and abdominal pain. Future randomized controlled trials should examine the dose-response of OMT and microbiome changes associated with these treatments
Optimizing Low-Level Light Therapy for Skin Rejuvenation: Efficacy of Wavelengths and Treatment Parameters in Collagen Synthesis and Aging Signs
Full text linkLow-level light therapy (LLLT), particularly using light-emitting diode (LED) devices, has been an effective and non-surgical option for skin rejuvenation, treating signs of aging such as wrinkles, collagen loss, and pigmentation. Despite promising clinical outcomes, variability in treatment parameters such as wavelength, power density, fluence, and treatment regimens remains a challenge in optimizing the therapy for optimal results. Recent studies, including a prospective, randomized, placebo-controlled, double-blinded, and split-face clinical trial by Lee et al. (2007), have demonstrated significant improvements in wrinkle reduction and skin elasticity using 830 nm and 633 nm LED wavelengths. These findings highlight the importance of wavelength selection and treatment protocols in achieving consistent and effective outcomes. This biphasic dose-response characteristic of photobiomodulation suggests that treatment outcomes, particularly in collagen synthesis and the reduction of aging signs, can be optimized by adjusting these parameters. Red and near-infrared wavelength applications, in particular, have been shown to stimulate collagen synthesis and enhance skin texture. Inconsistency in device specification, treatment protocols, and study design nevertheless still precludes standardization of treatment protocols. However, inconsistencies in device specifications, treatment protocols, and study design still preclude standardization of treatment protocols. Based on the literature present, there is moderate evidence for the efficacy of LLLT for skin rejuvenation, but further, randomized controlled trials involving larger populations and better design are required to help refine protocols and establish standardized treatment guidelines. As LED technology continues to evolve, it has vast potential to revolutionize skin care by offering cheap, non-invasive treatments for skin aging
Spin in the Titles and Abstracts of Allergy and Immunology Randomized Controlled Trials With Nonsignificant Outcomes
Full text linkIn scientific reporting, ‘spin’ refers to presenting neutral or negative outcomes in a manner that infers favorable results. Spin can be especially problematic in the abstracts of randomized control trials, leading to an incorrect interpretation of trial outcomes, and potentially impacting subsequent studies, patient care, and policy decisions. The present study aims to evaluate the presence of spin in the abstracts of registered randomized control trials published in allergy and immunology journals. A systematic search of the PubMed database was performed to identify randomized controlled trials of human subjects registered in a clinical trial registry with a test and control group and a nonsignificant primary endpoint. A total of 1,248 articles were screened and 66 abstracts met full inclusion criteria. Thirty-five of the 66 (53%) abstracts were found to contain one or more elements of spin, among which 11 (31.4%) had spin in the title, 29 (82.9%) in the abstract results, and 30 (85.7%) in the abstract conclusion. Industry-sponsored trials did not contain more spin compared to other funding sources (p=0.62). High rates of spin may adversely affect the interpretation and integration of new research. Careful evaluation is recommended when reviewing abstracts lacking statistically significant primary outcomes
