New advances in medical management of dry eye: optimizing treatment strategies for enhanced relief.

PURPOSE: Dry eye disease (DED) is a prevalent ocular surface disease that is conventionally characterized by tear film hyperosmolarity and instability. This review presents a summarized classification of DED, followed by a comprehensive discussion of the most recent topical and systemic medications and clinical recommendations for selecting the most appropriate option for each patient. METHODS: An extensive literature search was conducted on electronic databases, such as PubMed, Scopus, and Web of Science, using keywords including "dry eye syndrome," "ocular surface disease," "medical management," "artificial tears," "topical immunomodulators," and "meibomian gland dysfunction." RESULTS: The underlying reasons for DED can range from insufficient aqueous tear production to increased tear evaporation. Recent literature has provided a more in-depth understanding of the pathophysiology of DED by examining the tear film's lipid, aqueous, and mucin layers. However, despite these advancements, medical management of patients with symptomatic DED has not fully reflected this modernized knowledge of its pathophysiology. CONCLUSION: To develop a rationalized strategy for treating DED, it is crucial to have updated knowledge of therapeutic options, their mechanisms of actions, and indications based on the DED type and underlying causes.

Clinical Metagenomic Sequencing for Diagnosis of Meningitis and Encephalitis.

BACKGROUND: Metagenomic next-generation sequencing (NGS) of cerebrospinal fluid (CSF) has the potential to identify a broad range of pathogens in a single test. METHODS: In a 1-year, multicenter, prospective study, we investigated the usefulness of metagenomic NGS of CSF for the diagnosis of infectious meningitis and encephalitis in hospitalized patients. All positive tests for pathogens on metagenomic NGS were confirmed by orthogonal laboratory testing. Physician feedback was elicited by teleconferences with a clinical microbial sequencing board and by surveys. Clinical effect was evaluated by retrospective chart review. RESULTS: We enrolled 204 pediatric and adult patients at eight hospitals. Patients were severely ill: 48.5% had been admitted to the intensive care unit, and the 30-day mortality among all study patients was 11.3%. A total of 58 infections of the nervous system were diagnosed in 57 patients (27.9%). Among these 58 infections, metagenomic NGS identified 13 (22%) that were not identified by clinical testing at the source hospital. Among the remaining 45 infections (78%), metagenomic NGS made concurrent diagnoses in 19. Of the 26 infections not identified by metagenomic NGS, 11 were diagnosed by serologic testing only, 7 were diagnosed from tissue samples other than CSF, and 8 were negative on metagenomic NGS owing to low titers of pathogens in CSF. A total of 8 of 13 diagnoses made solely by metagenomic NGS had a likely clinical effect, with 7 of 13 guiding treatment. CONCLUSIONS: Routine microbiologic testing is often insufficient to detect all neuroinvasive pathogens. In this study, metagenomic NGS of CSF obtained from patients with meningitis or encephalitis improved diagnosis of neurologic infections and provided actionable information in some cases. (Funded by the National Institutes of Health and others; PDAID ClinicalTrials.gov number, NCT02910037.).

Effectiveness of Online Versus Telephone Counseling of Rational-Emotional-Behavioral Therapy on Sexual Function of Women Undergoing Cardiac Rehabilitation: A Randomized Clinical Trial:.

Background:Sexual function in patients with cardiovascular disease (CVDs) is often associated with anxiety and irrational beliefs. Moreover, 60-78% of patients with CVDs report sexual problems. Some studies suggest that sexual counseling is necessary for these patients but is not usually provided for them. Online or telephone counseling may be helpful during the covid-19 pandemic, but studies on its application to sexual function appear to be limited. This study aimed to investigate the effectiveness of online vs. telephone counseling of rational-emotional-behavioral therapy (REBT) on the sexual function of women undergoing cardiac rehabilitation. Materials and Methods: In this randomized clinical trial study, 46 women diagnosed with CVDs under rehabilitation were assigned into online and telephone groups. Overall, eight 60-min intervention sessions were held (once a week). The Female's Sexual Function Index (FSFI) questionnaire was completed by the women at baseline, week 8th, and follow-up week 12th (main outcome). Results: FSFI scores between the two groups at baseline (online: 13.28±2, telephone: 12.68±1.52, P=0.254) compared to week 12th (online 28.86±2.44, telephone, 26.6±2.10, P=0.002) were significantly different. As for within-group comparison in baseline compared to week 12th statistically significant difference was observed in all subscales of FSFI (P=0.05). Conclusion: Online and telephone REBT counseling can improve the sexual function of women undergoing cardiac rehabilitation, but online counseling appears to be more effective. Thus, this method is recommended to improve the sexual function of these women during the covid-19 pandemic. [GMJ.2022;11:e2396].

The effect of group assertive training on the self-esteem and quality of life in the spouses of drug-abusing patients.

OBJECTIVE: The present study aimed to examine the effect of group assertive training on self-esteem and quality of life among spouses of drug-abusing patients. METHODS: This randomized clinical trial assignment study with a control group. The statistical population included all spouses of drug users referring to private addiction treatment centers in Tehran-Iran in 2020 and the sample included 50 spouses of drug users who were selected by simple random sampling from among the volunteers. They were randomly divided into two groups control and experimental, each group consisting of 25 people. RESULTS: The results of data analysis showed that group assertive training increased self-esteem and quality of life in spouses of drug-abusing patients in the experimental group compared to the witness group (p < .001). CONCLUSION: As a result, group assertive training is effective in increasing the self-esteem and quality of life among the spouses of drug-abusing patients.