Medicina
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Coeliac disease (CD) affects almost of 1% of the population, yet remains undiagnosed in the majority. Though the demonstration of enteropathy in duodenal biopsy was traditionally the essential criterion for the diagnosis of coeliac disease, the guidelines published by the European Society of Paediatric Gastroenterology and Nutrition (ESPGHAN) in 2012, and revised in 2020, paved the way to a no-biopsy approach to diagnosis. In a select group of children meeting certain criteria, a definitive diagnosis of CD can now be made without the need for duodenal biopsies. ⋯ The advances in our understanding of the pathogenesis of CD have led to a search for alternative treatment agents. Several investigational agents are in various phases of clinical trials at present. In this review, we outline the clinical aspects of coeliac disease and summarise various investigational treatment agents.
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Comparative Study Observational Study
Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes.
Background and Objectives: The selection of an appropriate anesthesia method is a critical factor in the surgical treatment of proctological diseases, significantly impacting patient outcomes and comfort. Pudendal nerve block (PNB) and spinal anesthesia (SA) are commonly employed in these surgeries, yet the optimal choice between the two remains debated. This study aims to compare the efficacy and safety of PNB and SA in patients undergoing surgical treatment for various proctological conditions, with a focus on postoperative pain management, functional outcomes, and complication rates. ⋯ PNB should be considered a viable alternative to SA, particularly in cases where rapid recovery and minimizing complications are priorities. Exceptions to this include specific proctological surgeries, such as those for malignant tumors in the region, complex anal fistulas, proctological conditions arising from inflammatory bowel diseases, and patients on immunosuppressive therapy. Further research is needed to confirm these results and optimize anesthesia selection in this context.
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Background and Objectives: The objective of this paper is to determine the rate and predictors of non-adherence to antiseizure medications in Saudi Arabia. Materials and Methods: A cross-sectional study which involved questionnaires and data collection from patients' medical records was conducted at neurology clinics. The rate of non-adherence to antiseizure medications was measured using "the Medication Adherence Rating Scale" (MARS). ⋯ Conclusions: The significance of this study is that it reveals that adherence to antiseizure medications is suboptimal in Saudi Arabia. Poor seizure control, forgetfulness, dosing frequency, and social stigma were the primary patient-reported predictors of non-adherence in epilepsy. This emphasizes the importance of routine evaluation of adherence in practice to identify and address what individual patients perceive as a barrier to adherence with antiseizure medications.
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Self-efficacy is an important ingredient in successful disease management, especially in patients with chronic conditions such as rheumatoid arthritis (RA). However, the information on self-efficacy and its influencing factors among RA patients is scarce. This study investigated the level of self-efficacy and its pertinent predictors among RA patients in Taiwan. ⋯ The mean ASES score among enrollees was 1607.1, indicating a moderate level of self-efficacy (score range of 200-2000). The regression model displayed that those with higher disease activity scores, Taiwanese Depression Questionnaire scores, fatigue level, shorter disease duration, swollen upper limb joints, and no regular exercise regimen reported lower ASES scores, accounted for 46% of the total variance. The study findings may be useful for healthcare providers in identifying RA patients with low self-efficacy attitudes, a trait that appears to be linked to several medical indicators, and thus facilitating the provision of future tailored healthcare regimens.
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Background and Objectives: Sex differences are unclear in geriatric sleep medicine, and most evidence comes from inference from preclinical bases or clinical studies conducted on younger people. The aim of this study is to explore sex differences in sleep quality and daytime sleepiness in a cohort of elderly people. Materials and Methods: This cross-sectional study involved subjects aged 65 years or older undergoing multidimensional evaluation, including sleep quality and daytime sleepiness assessment with validated tools. ⋯ It initially showed that men were about half likely as women to have poor sleep quality (OR 0.48, 95%CI 0.27-0.86). Nonetheless, after adjusting for cognitive status and mood, the difference became smaller and insignificant (OR 0.72, 95%CI 0.38-1.38). Conclusions: Sex differences in elderly people's sleep quality seem to not be independent, appearing to be affected by alterations in cognitive status and mood.