Treatment Modalities for Internet Addiction in Children and Adolescents: A Systematic Review of Randomized Controlled Trials (RCTs).

BACKGROUND: In recent years, the use of the internet among children and adolescents has dramatically increased, leading to growing concerns regarding the potential risks of excessive internet use and addiction. Addressing these concerns, this systematic review aims to summarize current evidence on the effectiveness of treatment interventions for internet addiction among children and adolescents. METHOD: We performed a systematic review using PubMed, Web of Science, PsycInfo, and Google Scholar with search terms including "internet addiction", "problematic internet use", "children" or "adolescents", "treatment" and "randomized controlled trial". We found 10 Randomized Controlled Trials (RCTs) meeting the criteria and included them in this systematic review. RESULTS: This systematic review analyzed 10 randomized controlled trials focused on treatment interventions for internet addiction in adolescents and young adults. The interventions used were diverse, including cognitive-behavioral therapy (CBT), medication, electro-acupuncture (EA), and solution-focused approaches. The measures used to assess the effectiveness of the interventions also varied, but most studies reported moderate to large effect sizes for at least some outcomes. Overall, the studies suggest that interventions such as CBT and EA can be effective in reducing symptoms of internet addiction, internet gaming disorder, and unspecified internet use disorders. School-based programs and brief manualized CBT programs also show promise, though more research is needed to determine their long-term effectiveness. CONCLUSION: Promising treatment approaches for internet addiction are emerging, but inconsistencies in conceptualization, language, and diagnostic criteria present some challenges. The growing recognition of problematic internet use, as shown by the DSM-5's recognition of Internet Gaming Disorder, highlights the need for a multidisciplinary approach and standardized criteria to facilitate accurate reporting across studies. Continued research is needed to identify effective treatments and diagnostic criteria for internet addiction, with the potential to offer practical insights into effective medications and therapies.

Syphilitic Hepatitis: A Rare Cause of Elevated Liver Function Tests.

Syphilitic hepatitis is a rare manifestation of syphilis with an incidence of 0.2-38%. We describe a case of a healthy, immunocompetent male patient with elevated liver function tests (LFTs) who was found to have syphilitic hepatitis. A 28-year-old male with no past medical history presented with abdominal pain for two to three weeks. He also reported diminished appetite, intermittent chills, weight loss, and fatigue. His history was positive for high-risk sexual behavior including multiple partners and absence of using protection. His physical examination was remarkable for right-sided abdominal tenderness and a painless chancre on his penile shaft. His workup revealed elevated aspartate aminotransferase (AST: 169 U/L), alanine transaminase (ALT: 271 U/L), and alkaline phosphatase (ALP: 377 U/L). His abdominal CT scan was unremarkable except for the abdominal and pelvic lymphadenopathy. A thorough serology panel revealed negative hepatitis A, B, C, human immunodeficiency virus (HIV) (including HIV RNA), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). His immunological workup was negative as well. His rapid plasma reagin (RPR) was reactive with positive IgG/IgM treponemal antibodies. He was managed as secondary syphilis and received 2.4 million units of benzathine penicillin. Upon follow-up after one week, he reported a complete resolution of his symptoms, and his LFTs were normalized on a repeat checkup. Given the significant morbidity associated with a missed diagnosis, syphilitic hepatitis should be considered an essential part of the workup for evaluating elevated LFTs in an appropriate clinical setting. This case also highlights the importance of obtaining a comprehensive sexual history and performing a thorough genital examination.

Reactive Infectious Mucocutaneous Eruptions (RIME) in COVID-19.

Reactive infectious mucocutaneous eruptions (RIME) is a relatively novel terminology describing postinfectious mucocutaneous eruptions that usually affect 2 or more mucosal sites. To our knowledge, we describe the first case of RIME secondary to COVID-19 infection in an elderly 64-year-old immunocompetent male patient. This contrasts with previous case reports that have identified cases of RIME post-COVID-19 infection among the pediatric population and young adults. Our patient had characteristic mucosal involvement and required hospitalization and treatment with systemic steroids. This report also reviews the clinical features, treatment modalities, and outcome of RIME secondary to COVID-19 infection in other published case reports. We emphasize the need for further prospective studies to better elucidate the use of steroids in the management of RIME.

Restless Legs Syndrome among Pakistani Population: A Cross-Sectional Study.

Objective. Restless leg syndrome (RLS) is a chronic distressing disease characterized by an urge to move the legs with an unpleasantsensation during periods of rest. The global prevalence estimates of RLS range from 2.5% to 15%. Method. This cross-sectional study was conducted at various hospitals in Karachi during August 13 to March 14. The visitors who had accompanied patients to Outpatient Department or had come to visit admitted patients were approached conveniently. Subjects were interviewed regarding the essential criteria of RLS and its attributes. Results. The sample size was 390 with 56% being females. The point prevalence of RLS was estimated to be 23.6%. The prevalence in females was twice as high as compared to males. Smoking and low level of education were associated with RLS (P < 0.001). Among RLS positive individuals, 50.1% reported frequency of their symptoms to be greater than 16 days per month and 64.1% graded their symptom severity as mild to moderate. About 37% of RLS positive individuals consulted a general physician for their symptoms. Conclusion. RLS is highly prevalent and underdiagnosed condition among Pakistani population. Efforts must be directed to raise the awareness of this condition among physicians and general population.