A Clinical Study to Assess the Effectiveness of Oral Combination Kit Therapy in Syndromic Management of Abnormal Vaginal Discharge (FEMINE Study) in Kinshasa, Democratic Republic of Congo

Background: Vaginal discharge is one of most common and nagging problems that women face. About 20% - 25% of women who visit gynecology department complain of vaginal discharge and leucorrhoea. An orally administered combination kit, containing 2 g secnidazole, 1 g azithromycin and 150 mg fluconazole (Azimyn FS Kit), has been successfully evaluated in clinical trials and used in several countries for management syndromic vaginal discharge due to infections. Methods: This is a longitudinal study which aimed to verify the clinical efficacy of the combined oral kit containing secnidazole, azithromycin and fluconazole (Azimyn FS Kit®) in the syndromic treatment of abnormal vaginal discharge in patients received in outpatient consultations in Kinshasa/DR Congo from March to September 2023. Results: Majority of patients had whitish vaginal discharge (51.6%) of average abundance (56.2%), accompanied by pruritus in 72.1% of cases, and dyspareunia in 23.5% of cases and hypogastralgia in 40.2% of cases. One week after treatment with the Azimyn FS® combined kit, at the greatest majority of patients (97.3%), abnormal vaginal discharge had decreased by more than 50% (84.1%). Two weeks after treatment with the Azimyn FS® combined kit, almost all patients (97.3%) no longer had abnormal vaginal discharge which had completely disappeared. Conclusion: A single dose of secnidazole, azithromycin and fluconazole in the form of an oral combi-kit (Azimyn FS Kit) has shown excellent therapeutic effectiveness in the syndromic treatment of abnormal vaginal discharge wherein patients were treated without diagnostic confirmation.

Clinical Study on Improving Articulation Clarity in Spastic Cerebral Palsy with 120 Cases of Oral-Facial Acupressure Combined with Oral Placement Therapy

Objective:To observe the efficacy of oral-facial acupressure combined with oral placement therapy(OPT)in improving articulation clarity in 120 children with spastic cerebral palsy,and to explore effective therapeutic solutions for speech disorders associated with spastic cerebral palsy.Methods:A total of 120 children with spastic cerebral palsy and speech disorders,meeting the inclusion criteria,were randomly assigned into two groups:60 cases in the treatment group and 60 cases in the control group.The treatment group received orofacial acupressure combined with OPT,while the control group received only OPT.The Oral Motor Function Assessment Scale(OMFAS),developed by the China Rehabilitation Research Centre(CRRC),was used to evaluate the treatment outcomes before and after the intervention.Results:After the treatment,both the treatment and control groups showed improved mobility of the mandible,lips,and tongue.However,the treatment group exhibited significantly better improvement than the control group,with the difference between the two groups being statistically significant(P<0.05).Conclusion:Oral-facial acupressure combined with OPT can effectively improve articulation clarity in children with spastic cerebral palsy.This combined therapy is recommended for clinical promotion and application.

Changes in sleep parameters following biomimetic oral appliance therapy: A case report

BACKGROUND Mandibular advancement devices(MADs)are used to treat mild to moderate obstructive sleep apnea(OSA),but there is a risk that the underlying condition can worsen in the long-term.Therefore,this case report is based on biomimetic oral appliance therapy as an alternative to MADs,which was found to be beneficial in the treatment of a case with severe OSA.CASE SUMMARY An overnight sleep study was undertaken in a 50-year-old male with excessive daytime sleepiness that lead to a diagnosis of severe OSA as the apnea-hypopnea index(AHI)was found to be 32.8/h.Since the patient was unable to comply with continuous positive airway pressure therapy and declined surgical intervention,treatment with a MAD was initiated.Approximately 10 years later,another sleep study was performed with no MAD in the mouth,which revealed an AHI of 67.9/h.In view of the deterioration in sleep quality,the patient sought alternative treatment and elected on biomimetic oral appliance therapy,using a mandibular repositioning nighttime appliance(mRNA appliance®,Vivos Therapeutics,Inc.,United States).After 10 mo,another sleep study was performed with no device in the patient’s mouth,which revealed an AHI of 11.8/h,a mean oxygen saturation of 94%and a mean oxygen desaturation index of 5.3%while sleeping.Finiteelement analysis of the pre-and post-treatment study models of the upper jaw showed localized size increases of 15%-17%in the premolar regions and 15%-23%in the molar regions.CONCLUSION In adults with severe OSA that are unable to accept continuous positive airway pressure or surgical treatment,biomimetic oral appliance therapy may be preferable over MADs since biomimetic oral appliance therapy may be able to prevent worsening of sleep parameters by remodeling the nasomaxillary complex.Long-term follow up studies are required to verify these novel findings.

Efficacy and safety of dual therapy with daclatasvir and asunaprevir in elderly patients

To survey the efficacy and safety of dual therapy with daclatasvir and asunaprevir in the elderly hepatitis C virus (HCV) patients multicentricity. METHODSInterferon-ineligible/intolerant patients and non-responders to previous pegylated-interferon/ribavirin therapy with chronic HCV genotype 1b infection were enrolled. Child B, C cirrhotic patients were excluded. Patients received oral direct acting antiviral treatment consisting of 60 mg daclatasvir once daily plus 200 mg asunaprevir twice daily for 24 wk. We divided the patients into two groups of 56 elderly patients (≥ 75 years-old) and 141 non-elderly patients (< 75 years old) and compared the efficacy and safety. RESULTSNinety-one point one percent of elderly patients and 90.1% of non-elderly patients achieved sustained virological response at 24 wk (SVR24). In the former, 1.8% experienced viral breakthrough, as compared with 3.5% in the latter (not significant). Adverse events occurred in 55.4% of the former and 56.0% of the latter. In the former, 7 cases (12.5%) were discontinued due to adverse events, and in the latter 9 cases were discontinued (6.4%, not significant). CONCLUSIONDual therapy with daclatasvir and asunaprevir achieved the same high rates of SVR24 in HCV elderly patients without more adverse events than in the non-elderly patients.

Significance of feeding dysfunction in eosinophilic esophagitis

Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis(EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth.

Changes in pneumatization of the maxillary air sinuses in Korean adults following biomimetic oral appliance therapy

Objective:For the treatment of obstructive sleep apnea in adults,mandibular advancement devices(MADs)are often used.Since adults with a prognathic mandibular phenotype are at risk of developing an unfavorable facial profile,midfacial development using biomimetic oral appliance therapy might provide a suitable alternative.However,the effect of this procedure on the maxillary air sinuses is unknown;therefore,changes in sinus pneumati-zation were investigated in this study.Methods:After obtaining informed consent,16 consecutive Korean adults with midfacial hypoplasia had 3D cone-beam(CB)CT scans taken,and biomimetic upper appliances(DNA appliance■,Vivos Therapeutics,Inc.,USA)were constructed.All subjects were instructed to wear the device 12-16 h/day.Each month,examination for the progress of midfacial development was recorded.Post-treatment,a follow-up 3D CBCT scan was undertaken with no device in the patienfs mouth.Pre-and post-treatment linear and volumetric measurements were obtained using appropriate software,and compared statistically using t-tests.Results:The mean age of the sample was 25.0 yrs±8.7.The mean treatment time was 15.5 mths±5.2.Post-treatment,the transpalatal bone width increased from 35.3 mm±3.0 to 38.5 mm±2.0(P<0.001);the maxillary air sinus volume on the left side increased from 18.8 cm^(3)±6.5 to 20.0 cm^(3)±6.0(P<0.05),and from 18.5 cm^(3)±5.7 to 19.7 cm^(3)±5.8(P<0.05)on the right side.Conclusions:Biomimetic oral appliance therapy may be able to increase the maxillary air sinus volume in adults.In view of these preliminary findings,further studies on the effect of enhanced pneumatization on paranasal sinus function and sleep parameters are warranted.

Why the Partnership of OAT Italian Patients Association in Cosenza＇s Hospital Matters？

The activism of patients associations, in decision making, about health and social services, is an expanding phenomenon in Italy and elsewhere. But the civic roles of these patients associations, in health care settings, remain largely unexplored, especially in the case of patients assuming oral anticoagulant therapy （OAT Patients） for various chronic and severe diseases （stroke, chronic arthritis, maintenance or substitution of cardiac valves）. This is a qualitative study, on a Civic Health Organization, the Italian Association of Anti Coagulant Patients （Associazione ltaliana Pazienti Anticolagulati, hereinafter A.I.P.A.） which promotes the rights of OAT patients. The study was carried out in the south of Italy at Cosenza＇s Hospital. Cosenza is a city in the north of Calabria, a poor Southern Italian region. The research, done between March 2010 and December 2012, involved focus groups, key-informant interviews with volunteers from the local A.I.P.A. unit and the hospital professionals （physicians, nurses, managers） of Cosenza＇s Annunziata Hospital. This essay mainly analyzes a micro-form of co-deliberative health care democracy： a stable partnership between AIPA members and the cited hospital professionals, based on a mix of advocacy, planning, and co-delivery service roles. In doing this, the paper sketches the development, aims, activities, internal structure and resources, and the role played by this specific citizen-user/patient/career organization in promoting and/or representing the interests of anti-coagulated patients within the legal arena of the Italian health policy. Finally, the paper comes to the point in which OAT patients refer their perceptions of relational rights.