Improving Clinical, Cognitive, and Psychosocial Dysfunctions in Patients with Schizophrenia: A Neurofeedback Randomized Control Trial.

Objectives: The aim of this study was to use neurofeedback (NF) training as the add-on therapy in patients with schizophrenia to improve their clinical, cognitive, and psychosocial condition. The study, thanks to the monitoring of various conditions, quantitative electroencephalogram (QEEG) and brain-derived neurotrophic factor (BDNF), was supposed to give an insight into mechanisms underlying NF training results. Methods: Forty-four male patients with schizophrenia, currently in a stable, incomplete remission, were recruited into two, 3-month rehabilitation programs, with standard rehabilitation as a control group (R) or with add-on NF training (NF). Pre- and posttherapy primary outcomes were compared: clinical (Positive and Negative Syndrome Scale (PANSS)), cognitive (Color Trails Test (CTT), d2 test), psychosocial functioning (General Self-Efficacy Scale (GSES), Beck Cognitive Insight Scale (BCIS), and Acceptance of Illness Scale (AIS)), quantitative electroencephalogram (QEEG), auditory event-related potentials (ERPs), and serum level of BDNF. Results. Both groups R and NF improved significantly in clinical ratings (Positive and Negative Syndrome Scale (PANSS)). In-between analyses unveiled some advantages of add-on NF therapy over standard rehabilitation. GSES scores improved significantly, giving the NF group of patients greater ability to cope with stressful or difficult social demands. Also, the serum-level BDNF increased significantly more in the NF group. Post hoc analyses indicated the possibility of creating a separate PANSS subsyndrome, specifically related to cognitive, psychosocial, and BDNF effects of NF therapy. Conclusions: Neurofeedback can be effectively used as the add-on therapy in schizophrenia rehabilitation programs. The method requires further research regarding its clinical specificity and understanding mechanisms of action.

The role of doctoral-educated nurses in the clinical setting: Findings from a scoping review.

AIMS AND OBJECTIVES: To map and summarise published studies on the career opportunities and roles of doctoral-educated (PhD and DNP) nurses in the clinical setting; to collate actions as proposed in the literature to promote career opportunities and roles for PhD and DNP nurses in the clinical setting. BACKGROUND: To improve healthcare outcomes and strengthen leadership in nursing practice, there is the need to place nurses with a doctorate in clinical settings. However, available evidence has never been summarised to map the state of the science in this field. DESIGN: A scoping review, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for scoping reviews statement (PRISMA-ScR). METHODS: An electronic database of literature was searched by accessing CINAHL Complete and Medline (on EBSCO Host) and SCOPUS to identify studies published between January 2009-December 2019. A thematic analysis was performed by identifying emerging patterns in the research questions. RESULTS: Ten studies were found with three types of clinical engagement: (a) a practice influencer/developer; (b) a clinical leader; and (c) a clinical teacher for students. Working in clinical areas, doctoral-educated nurses might influence several outcomes at the patient, research, staff and organisational levels. CONCLUSIONS: Clinical roles for doctoral-educated nurses are still uncommon. However, in the last ten years, a debate has started to identify the possible careers in clinical settings, the needs and the challenges encountered while developing clinical academic roles, as well as the outcomes and actions that should be undertaken. RELEVANCE TO CLINICAL PRACTICE: Academic nursing bodies, working with professional bodies and healthcare institutions at different levels, are called on to develop career frameworks, allowing the opportunity for doctoral-educated nurses to be involved in clinical practice and to influence its quality and performance; this might in turn lead to an increase in the quality of research.

Self-Regulatory Neuronal Mechanisms and Long-Term Challenges in Schizophrenia Treatment.

Schizophrenia is a chronic and relapsing disorder that is characterized not only by delusions and hallucinations but also mainly by the progressive development of cognitive and social deficits. These deficits are related to impaired synaptic plasticity and impaired neurotransmission in the nervous system. Currently, technological innovations and medical advances make it possible to use various self-regulatory methods to improve impaired synaptic plasticity. To evaluate the therapeutic effect of various rehabilitation methods, we reviewed methods that modify synaptic plasticity and improve the cognitive and executive processes of patients with a diagnosis of schizophrenia. PubMed, Scopus, and Google Scholar bibliographic databases were searched with the keywords mentioned below. A total of 555 records were identified. Modern methods of schizophrenia therapy with neuroplastic potential, including neurofeedback, transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation, virtual reality therapy, and cognitive remediation therapy, were reviewed and analyzed. Since randomized controlled studies of long-term schizophrenia treatment do not exceed 2-3 years, and the pharmacological treatment itself has an incompletely estimated benefit-risk ratio, treatment methods based on other paradigms, including neuronal self-regulatory and neural plasticity mechanisms, should be considered. Methods available for monitoring neuroplastic effects in vivo (e.g., fMRI, neuropeptides in serum), as well as unfavorable parameters (e.g., features of the metabolic syndrome), enable individualized monitoring of the effectiveness of long-term treatment of schizophrenia.

Brain-derived neurotrophic factor and matrix metalloproteinase-9 activity during rehabilitation therapy of schizophrenic patients - environmental pilot study.

INTRODUCTION AND OBJECTIVE: The aim of the study was to evaluate the peripheral level of brain-derived neurotrophic factor (BDNF) and matrix metalloproteinase-9 (MMP-9) during rehabilitation therapy, combined with neurofeedback in schizophrenic patients, and to investigate whether these biomarkers are related to psychopathological symptoms, changes in auditory evoked potentials (AEPs), and quantitative EEG (QEEGs) mapping. MATERIAL AND METHODS: The study involved two groups of patients diagnosed with paranoid schizophrenia in partial remission who participated in a 3-month structured rehabilitation programme combined with neurofeedback (REH group) and a standard support group (CON group). The following parameters were assessed: BDNF and MMP-9 serum levels, AEPs, QEEGs, and psychopathological symptoms (PANSS). RESULTS: A clinical improvement within the 3-month rehabilitation therapy course was correlated with the increase in BDNF and MMP-9 serum level. Despite the increase in BDNF and MMP-9 during the 3-month rehabilitation therapy, it was not possible to demonstrate any strong and significant correlation between the 2 examined neuropeptides. During the 3-month rehabilitation therapy, the theta waveform share reduction in QEEG, P50 latency reduction and amplitude increase correlated with PANSS Total and MMP-9 results. CONCLUSIONS: All clinical (PANSS Positive, Negative, General, Total) and biochemical results (BDNF, MMP-9) of the REH group changed significantly over the 3-month period. Positive symptoms improved only in the CON group.

Reelin Signaling and Synaptic Plasticity in Schizophrenia.

Recent research emphasizes the significance of studying the quality of life of schizophrenia patients, considering the complex nature of the illness. Identifying neuronal markers for early diagnosis and treatment is crucial. Reelin (RELN) stands out among these markers, with genetic studies highlighting its role in mental health. Suppression of RELN expression may contribute to cognitive deficits by limiting dendritic proliferation, affecting neurogenesis, and leading to improper neuronal circuits. Although the physiological function of reelin is not fully understood, it plays a vital role in hippocampal cell stratification and neuroglia formation. This analysis explores reelin's importance in the nervous system, shedding light on its impact on mental disorders such as schizophrenia, paving the way for innovative therapeutic approaches, and at the same time, raises the following conclusions: increased methylation levels of the RELN gene in patients with a diagnosis of schizophrenia results in a multiple decrease in the expression of reelin, and monitoring of this indicator, i.e., methylation levels, can be used to monitor the severity of symptoms in the course of schizophrenia.

Distribution of Iron, Copper, Zinc and Cadmium in Glia, Their Influence on Glial Cells and Relationship with Neurodegenerative Diseases.

Recent data on the distribution and influence of copper, zinc and cadmium in glial cells are summarized. This review also examines the relationship between those metals and their role in neurodegenerative diseases like Alzheimer disease, multiple sclerosis, Parkinson disease and Amyotrophic lateral sclerosis, which have become a great challenge for today's physicians. The studies suggest that among glial cells, iron has the highest concentration in oligodendrocytes, copper in astrocytes and zinc in the glia of hippocampus and cortex. Previous studies have shown neurotoxic effects of copper, iron and manganese, while zinc can have a bidirectional effect, i.e., neurotoxic but also neuroprotective effects depending on the dose and disease state. Recent data point to the association of metals with neurodegeneration through their role in the modulation of protein aggregation. Metals can accumulate in the brain with aging and may be associated with age-related diseases.

Intensive care nurse managers' experiences during the first wave of the Covid-19 pandemic: Implications for future epidemiological crises.

BACKGROUND: Nurse managers play an important role in coordinating the multidisciplinary teamwork, which is specifically important in emergency and crises situations like the COVID-19 pandemic. The aim of this qualitative study is twofold: (1) to explore the experiences of the Intensive care units (ICU) nurse managers regarding their work during the first wave of the COVID-19 pandemic, and (2) to analyse what implications might be provided based on experiences of nurse managers for future possible epidemiological crises. METHODS: In-depth phone interviews were conducted to explore the experiences of ward managers-nurses (n = 15) working in different hospitals across Poland. Interviews were taped and transcribed verbatim, and then qualitatively analysed. RESULTS: Three main categories were identified: (1) Challenge of working with the unknown, (2) Nurse managers' expectations, and (3) Methods of coping and received support. The COVID-19 pandemic strongly affected the work of ICU nurse managers and uncovered the malfunctioning of the healthcare system. CONCLUSION: It is important to improve the knowledge and competence of hospital management personnel through exercises and in-service training on how to handle emergencies in order to improve the management of healthcare facilities, increase the safety of patients and employees, and the quality of healthcare.

Copper, zinc, and Cu/Zn ratio in transitional cell carcinoma of the bladder.

INTRODUCTION: Many epidemiological and experimental studies report a strong role of chemical carcinogens in the etiology of bladder cancer. However, involvement of trace elements in the tumorigenesis of transitional cell carcinoma of the bladder has been poorly investigated. The aim of this study was to examine the relationship between zinc, copper and bladder cancer. MATERIALS AND METHODS: Zinc and copper concentration and Cu/Zn ratio in two 36-sample series of bladder cancer tissue and sera from patients with this neoplasm were matched with those of the control group. The amount of trace elements in every tissue sample was determined using atomic absorption spectrometry. This was correlated with tumor stage. RESULTS: While the copper concentrations reached statistically higher values in the bladder cancer tissue, the zinc levels in the sera and bladder tissue of the patients with this carcinoma were substantially lower as compared to those of the control group. The serum Cu/Zn ratio was significantly higher in the bladder cancer group and this increase was greater in the patients with muscle-invasive neoplasm. CONCLUSIONS: The results obtained suggest a relationship between trace elements and the bladder cancer.

Galvanic Skin Response Features in Psychiatry and Mental Disorders: A Narrative Review.

This narrative review is aimed at presenting the galvanic skin response (GSR) Biofeedback method and possibilities for its application in persons with mental disorders as a modern form of neurorehabilitation. In the treatment of mental disorders of various backgrounds and courses, attention is focused on methods that would combine pharmacological treatment with therapies improving functioning. Currently, the focus is on neuronal mechanisms which, being physiological markers, offer opportunities for correction of existing deficits. One such indicator is electrodermal activity (EDA), providing information about emotions, cognitive processes, and behavior, and thus, about the function of various brain regions. Measurement of the galvanic skin response (GSR), both skin conductance level (SCL) and skin conductance responses (SCR), is used in diagnostics and treatment of mental disorders, and the training method itself, based on GSR Biofeedback, allows for modulation of the emotional state depending on needs occurring. Summary: It is relatively probable that neurorehabilitation based on GSR-BF is a method worth noticing, which-in the future-can represent an interesting area of rehabilitation supplementing a comprehensive treatment for people with mental disorders.

Can Neuropeptide S Be an Indicator for Assessing Anxiety in Psychiatric Disorders?

Neuropeptide S (NPS) is a neuropeptide primarily produced within three brainstem regions including locus coeruleus, trigeminal nerve nucleus, and lateral parabrachial nucleus. NPS is involved in the central regulation of stress, fear, and cognitive integration. NPS is a mediator of behavior, seeking food, and the proliferation of new adipocytes in the setting of obesity. So far, current research of NPS is only limited to animal models; data regarding its functions in humans is still scarce. Animal studies showed that anxiety and appetite might be suppressed by the action of NPS. The discovery of this neuromodulator peptide is effective considering its strong anxiolytic action, which has the potential to be an interesting therapeutic option in treating neuropsychiatric disorders. In this article, we aimed to analyze the pharmaceutical properties of NPS as well as its influence on several neurophysiological aspects-modulation of behavior, association with obesity, as well as its potential application in rehabilitation and treatment of psychiatric disorders.

Relationship of Neuropeptide S with Clinical and Metabolic Parameters of Patients during Rehabilitation Therapy for Schizophrenia.

Neuropeptide S (NPS) is a factor associated with the central regulation of body weight, stress, anxiety, learning, memory consolidation, wakefulness-sleep cycle, and anti-inflammatory and neuroplastic effects. Its stress-reducing, anti-anxiety, arousal without anxiety, and pro-cognitive effects represent an interesting option for the treatment of neuropsychiatric disorders. The purpose of the study was to examine the potential associations of NPS levels in the blood with clinical and metabolic parameters during the rehabilitation therapy of patients with schizophrenia. Thirty-three male subjects diagnosed with schizophrenia were randomly divided into two groups. The rehabilitation group (REH, N16) consisted of patients who were subjected to structured, 3-month intensive rehabilitation therapy, and the control group (CON, N17) consisted of patients who were subjected to a standard support mechanism. Both groups continued their pharmacological treatment as usual. The NPS concentration, as well as clinical and metabolic parameters, were compared in both groups. Additionally, a group of healthy (H) males (N15) was tested for NPS reference scores. To look for the specificity and selectivity of the NPS relationship with clinical results, various factor models of the positive and negative syndrome scale (PANSS) were analyzed, including the original PANSS 2/3 model, its modified four-factor version, the male-specific four-factor model, and two five-factorial models validated in large groups in clinical and multi-ethnic studies. Results and conclusions: (1) Structured rehabilitation therapy, compared to unstructured supportive therapy, significantly reduced the level of schizophrenia disorders defined by various factor models derived from PANSS. (2) The clinical improvement within the 3-month rehabilitation therapy course was correlated with a significant decrease in neuropeptide S (NPS) serum level. (3) The excitement/Hostility (E/H) factor, which included schizophrenic symptoms of the psychotic disorganization, was specific and selective for the reduction in serum NPS, which was stable across all analyzed factor models. (4) The long-term relationship between serum NPS and clinical factors was not accompanied by basic metabolic parameters.

Relationship of Neuropeptide S (NPS) with Neurocognitive, Clinical, and Electrophysiological Parameters of Patients during Structured Rehabilitation Therapy for Schizophrenia.

INTRODUCTION: Neuropeptide S is a biomarker related to various neuropsychiatric and neurocognitive functions. Since the need to improve cognitive functions in schizophrenia is unquestionable, it was valuable to investigate the possible relationships of plasma levels of NPS with neurocognitive, psychopathological and EEG parameters in patients with schizophrenia. AIM: Relationships between the serum NPS level and neurocognitive, clinical, and electrophysiological parameters were investigated in patients diagnosed with schizophrenia who underwent structured rehabilitation therapy. METHODS: Thirty-three men diagnosed with schizophrenia were randomized into two groups. The REH group (N16) consisted of patients who underwent structured rehabilitation therapy, the CON group (N17) continued its previous treatment. Additionally, the reference NPS serum results were checked in a group of healthy people (N15). In the study several tests assessing various neurocognitive functions were used: d2 Sustained-Attention Test (d2), Color Trails Test (CTT), Beck Cognitive Insight Scale (BCIS), Acceptance of Illness Scale (AIS), and General Self-Efficacy Scale (GSES). The clinical parameters were measured with Positive and Negative Syndrome Scale (PANSS) and electrophysiological parameters were analyzed with auditory evoked potentials (AEPs) and quantitative electroencephalography (QEEG). The NPS, neurocognitive, clinical, and electrophysiological results of REH and CON groups were recorded at the beginning (T1) and after a period of 3 months (T2). RESULTS: A decreased level of NPS was associated with the improvement in specific complex indices of d2 and BCIS neurocognitive tests, as well as the improvement in the clinical state (PANSS). No correlation was observed between the level of NPS and the results of AEPs and QEEG measurements. CONCLUSIONS: A decreased level of NPS is possibly related to the improvement in metacognition and social cognition domains, as well as to clinical improvement during the rehabilitation therapy of patients with schizophrenia.

The Relationship between Mental Disorders and the COVID-19 Pandemic-Course, Risk Factors, and Potential Consequences.

In this review the authors discuss that COVID-19 has already had a direct impact on the physical health of many people and that it appears to have put at risk the mental health of large populations. In this review, we also discuss the relationship between mental disorders and the SARS-CoV-2 infection. We convey the disorders' risk factors and the more serious mental disorder consequences of COVID-19. People with mental health disorders could be more susceptible to the emotional responses brought on by the COVID-19 epidemic. The COVID-19 pandemic may adversely influence the mental health of patients with already diagnosed mental disorders. For the aim of dealing better with the psychological problems of people afflicted by the COVID-19 pandemic, new psychological procedures are required.

Initial Results of Tests Using GSR Biofeedback as a New Neurorehabilitation Technology Complementing Pharmacological Treatment of Patients with Schizophrenia.

Galvanic skin response (GSR) Biofeedback uses training to reduce tension and anxiety and improve concentration and self-regulation. The study was aimed to evaluate this method as a form of rehabilitation and quantify the outcomes achieved by patients undergoing training using this technique. Six schizophrenic patients were enrolled in the study and underwent training based on the relaxation training module (CENTER), concentration training module (BALANCE), and self-regulation training module (INSECTS). Training sessions were held twice a week for 6 weeks. From the total group of subjects involved in the study, two patients had a statistically significant increase in measured values after the CENTER exercise, indicating that relaxation was achieved. Four patients showed a statistically significant decrease in measured values after the BALANCE exercise, which was reflective of an improvement in concentration. Three patients had a statistically significant decrease in measured values after the INSECTS exercise, which indicated an improvement in self-regulation. GSR Biofeedback may be used to complement the pharmacological treatment of patients diagnosed with schizophrenia.

Reinforcement of Self-Regulated Brain Activity in Schizophrenia Patients Undergoing Rehabilitation.

The experiment was aimed to compare the effects of different forms of rehabilitation applied in patients with schizophrenia. Verification of the obtained results was based on the analysis of the level of cognitive and social functioning of the subjects. For this purpose, the following clinical tools were used: Positive and Negative Syndrome Scale (PANSS), Beck Cognitive Insight Scale (BCIS), Color Trial Test (CTT-1, CTT-2), d2 psychological tests, Acceptance of Illness Scale (AIS), Self-efficacy Scale (GSES), Quantitative Electroencephalogram Biofeedback (QEEG-BF), auditory event-related potentials (ERPs), and serum levels of brain-derived neurotrophic factor (BDNF). The subjects were mentally stable male schizophrenia patients who had been in remission. They were divided into two groups which received different types of rehabilitation for three months. Group 1 patients followed a standard rehabilitation and Group 2 patients received GSR Biofeedback (galvanic skin response Biofeedback, GSR-BF) training. Pretherapy and posttherapy measurements were made for each group. Experimental rehabilitation based on GSR-BF training resulted in regulatory control of neurophysiological mechanisms, and the parameters obtained demonstrated improvement in the subjects' cognitive and social function. The following therapy outcomes were observed: (1) reduce psychopathological symptoms (2) improving cognitive (concentration, attention) and social functions (3) increase in the neurotrophic factor BDNF. GSR-BF can be used as an alternative to conventional rehabilitation in schizophrenia patients.

Cognitive and Social Rehabilitation in Schizophrenia-From Neurophysiology to Neuromodulation. Pilot Study.

The aim of this pilot study was to analyse the influence of Galvanic Skin Response (GSR) Biofeedback training in a group of 18 men with schizophrenia at the remission stage. The results were verified according to: Positive and Negative Syndrome Scale (PANSS), Acceptance of Illness Scale (AIS), Self-efficacy Scale (GSES), Beck Cognitive Insight Scale (BCIS) scales, Colour Trial Test (CTT-1, CTT-2), d2 psychological tests, Quantitative Electroencephalogram (QEEG) Biofeedback, auditory event-related potentials (ERPs), and serum levels of brain-derived neurotrophic factor (BDNF). The results were compared in the same patients after 3 months. Statistically significant changes were noted in results for the variables on the PANSS scale. For the BDNF variable, a statistically significant increase occurred, indicating that GSR Biofeedback training may influence serum levels of the neurotrophic factor. Statistically significant changes were noted in results for the variables on the BCIS, AIS, and GSES indicating an improvement in the cognitive and social functioning. Changes were noted for results for theta/beta and theta/Sensory Motor Rhythm (SMR) ratios, which indicate an improvement in concentration and attention. Changes were noted for the N1 wave amplitude in the frontal brain region (F-z), and for the P2 wave latency in the central brain region (C-z), which indicates an improvement in the initial perceptual analysis. The use of GSR Biofeedback in a group of patients with schizophrenia gives interesting results, but requires further in-depth research.

The effects of diet on selenium concentration in serum in patients with cancer.

The aim of this study was to determine serum levels of selenium (Se) in patients with larynx and urinary system cancers. We also estimated the influence of dietary habits on Se status in examined patients. The mean content of Se in serum of patients with urinary system cancer (48.94 +/- 16.3 mu/l) and larynx cancer (51.00 +/- 18.6 mu/l) was lower than the mean content of Se in the control group (68.25 +/- 15.6 mircog/l; P = 0.000006 or 64.03 +/- 16.8 microg/l; P = 0.0112, respectively). In tissue only, the mean level of Se in patients with kidney cancer (75.37 +/- 40.3 mircog/l) was lower to compare with the dead body control group (220.68 +/- 83.6 microg/l). We have observed the correlation between the content of Se in serum and tissue (r = 0.297; P = 0.002). Patients with studied cancers have deficiency of Se in serum and kidney tissue, and it depends on the diet in about 30%. Frequent consumption of eggs, ham, and wine has the biggest influence on the content of Se in serum of patients in Poland, whereas frequent consumption of pulses, eggs, bacon, and lard is connected with the content of Se in tissue.

Lead concentration in the bladder tissue and blood of patients with bladder cancer.

OBJECTIVE: To investigate the relationship between lead and bladder cancer. MATERIAL AND METHODS: The levels of lead concentration in blood and bladder cancer tissue from a sample set of 36 bladder cancer patients were measured and then compared with those of a normal group. The levels of lead obtained in the bladder cancer tissue were evaluated depending on the stage of the tumour. The level of lead concentration in each tissue sample was determined by atomic absorption spectrometry. RESULTS: The lead concentration reached statistically higher values in both the bladder cancer tissue and the blood of patients with this carcinoma compared with those of the control group. No relationship between lead concentration levels in the bladder cancer tissue and blood of patients with this neoplasm on stage of tumour was demonstrated. CONCLUSION: The results suggest that there is a relationship between exposure to lead and the initialization and development of bladder cancer.

[Hexosoaminidase gene expression in cholesteatoma in adults]. / Ekspresja genów heksozoaminidazy w perlaku ucha srodkowego u doroslych.

BACKGROUND: Middle ear cholesteatoma is a cyst like structure composed of keratinizing squamous epithelium that contains keratin debris and subepithelial connective tissue. Bone resorption may lead to destruction of ossicular chain and temporal bone. The higher activity of N-acetyl-beta3-glucosaminidase (HEX) was noted in cholesteatoma tissue, compared to the controls. It is supposed, that HEX takes part in bone resorption in middle ear cholesteatoma. Using of HEX inhibitors in cultured fibroblasts and evaluation HEX mRNA expression may contribute to showing new ways of understanding cholesteatoma pathogenesis. THE AIM OF THE STUDY: was to elaborate cholesteatoma fibroblast cell culture (CF) technique and evaluate in vitro inhibition potential of pyrimethamine. MATERIAL AND METHODS: Cholesteatoma and normal retroauricular skin sample obtained during surgical treatment were used in the study. CF served as a study group and fibroblast derived from skin specimens--as controls. Pyrimethamine was used at the concentrations of 1.5, 3, 10 and 20 microg/ml. The reverse transcriptase-polymerase chain reaction (RT-PCR) was carried out for the determination of HEX gene expression. RESULTS: RT-PCR established the elevated expression of HEXA and HEXB mRNA in cholesteatoma. HEXA mRNA in CF was six times higher than in the controls. HEX mRNA expression found to be regulated by pyrimethamine. Inhibition of HEXA and HEXB mRNA expression was achieved when the highest concentration of PYR was used. Low concentrations of pyrimethamine upregulated HEX gene in CF. CONCLUSIONS: Pyrimethamine, depending on its concentration, contributes to regulating the HEX gene expression in CF and controls. Pyrimethamine may be regarded as a new future research direction on factors, that may limit development of cholesteatoma.

The RELIEF study: Tolerability and efficacy of preservative-free latanoprost in the treatment of glaucoma or ocular hypertension.

PURPOSE:: To assess tolerability and efficacy following a switch from benzalkonium chloride-latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension. METHODS:: A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability. RESULTS:: Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0-10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001). CONCLUSION:: Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride-latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.