Migraine is a debilitating condition that places a substantial economic burden on society and seriously affects patients' quality of life. Currently, there is no known "cure" for migraines, and pharmacologic treatments or prophylaxis carry many unwanted effects. Acupuncture has been accepted as an alternative treatment. However, its effectiveness is still debated. This is a systematic review of randomized controlled trials (RCT) that investigate acupuncture safety and efficacy in migraine versus various control groups. We searched PubMed, Google Scholar, Science Direct, and Cochrane library using keywords: migraines, migraine with aura, migraine without aura, headache, acupuncture, and needling therapy. Two independent reviewers participated in data extraction and assessment. Fifteen randomized controlled trials involving 2,056 participants that met the inclusion criteria were obtained and analyzed. Based on the findings, seven out of 10 trials that compared acupuncture with sham acupuncture showed a more significant reduction in the frequency of migraine attacks and headache intensity. Four studies revealed acupuncture is just as effective and has fewer side effects than any western medicine. Acupuncture can be recommended as an alternative or adjunct to drug treatment for patients suffering migraines. However, further clinical trials that utilized the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) recommendation are still needed to strongly present an evidence-based strategy.

Tuberculosis (TB) is a common infectious disease that is present all around the world. This insidious disease needs drastic measures for its eradication. One of the actions contributing to it is the timely diagnosis and offering suitable treatment options for latent tuberculosis patients. In this review, we will discuss and compare the variety of options available for this purpose. We searched PubMed/Medline, Cochrane library, Google Scholar, and Science Direct to find articles regarding the effectiveness, safety, and completion of any of the five regimens available for latent tuberculosis infection. These options are the most classic and standard nine months of isoniazid given daily, which is now more commonly given as six months course, three months of daily isoniazid and rifampin, three months of weekly isoniazid and rifapentine, and four months of daily rifampin. We looked into free full-text studies published from 2011 to 2021 available in English language and human studies. After applying inclusion/exclusion criteria and removing duplicates and screening, 34 articles were shortlisted for quality assessment check, after which we finalized nine studies. Cochrane risk-of-bias assessment tool was used for quality check of randomized control trials, New-Castle Ottawa tool for observational studies, and assessment of multiple systematic reviews (AMSTAR) tool for systematic reviews. Efficacy was checked by tracking down the new cases of TB in the sample population that took the treatment for latent tuberculosis infection. New rifamycin-based regimens were almost equal in effectiveness to isoniazid regimens. The side effect profile is different for both regimens, but short-duration courses tend to have a higher chance of completion.

Tourette's Syndrome (TS), in which patients have sudden, repeated, involuntary twitches and movements, called tics, is a condition of the nervous system. They can be motor, vocal, simple, or complex tics. It can be physically, emotionally, mentally, and socially distressing and challenging for those suffering from it. Usually, it is accompanied by various comorbidities like attention-deficit hyperactivity disorder, obsessivecompulsive disorder, and sleep disorders. A variety of environmental and genetic factors are also associated with tics in TS like the first-degree relatives are more at risk of developing TS.TS is heterogeneous with complicated patterns of inheritance and phenotypic manifestations. There is a strong association between common single nucleotide polymorphisms (SNP, s) in the SLITRK1 gene and TS. Environmental factors like prenatal, postnatal, and perinatal factors directly influence tics in TS. These factors are low birth weight, intrauterine growth retardation (IGR), and various infections. The treatment of TS can be broadly classified into non-pharmacological and pharmacological treatment. Non-pharmacological therapy includes various behavioural interventions that can be helpful in situations when patients are tolerant of medical treatments. Psychoeducation and counselling play an essential role in the treatment of TS. It is vital to give a proper understanding to the patient and their family about the disease. Cognitive-behavioral intervention for tics, cognitive-behavioral therapy, exposure and response prevention, relaxation techniques, deep brain stimulation, and habit reversal training are the commonly used therapies for tics. These therapies have shown good efficacy because it improves the Yale Global Tic Severity Scale score (YGTSS) significantly. And they show effectiveness in patients who are irresponsive to medical treatment. The main lines of medical treatment are antipsychotics and alpha agonists. Typical (haloperidol, pimozide) or atypical (aripiprazole, risperidone, olanzapine) Antipsychotics differ in their side effects, efficacy, and tolerance in different age groups of children. Haloperidol was the first drug approved by the Food and Drug Administration for tics, but later on, new developments and improvements were made as far as drug therapy is concerned. The alphaagonist most commonly used is clonidine which is also available in the form of adhesive patches. Another alpha agonist which is also widely used is guanfacine. Botulinum toxin and baclofen have also shown efficacy in dealing with tics in TS with other comorbidities. We will review in this article all the main lines of treatment and their effectiveness in TS.

This systematic review focuses on different genetic mutations identified in studies on natural short sleepers, who would not be ill-defined as one type of sleep-related disorder. The reviewed literature is from databases such as PubMed, PMC, Scopus, and ResearchGate. Due to the rare prevalence, the number of studies conducted on natural short sleepers is limited. Hence, searching the search of databases was done without any date restriction and included animal studies, since mouse and fly models share similarities with human sleep behaviors. Of the 12 articles analyzed, four conducted two types of studies, animal and human (crosssectional or randomized-controlled studies), to testify the effects of human mutant genes in familial natural short sleepers via transgenic mouse or fly models. The remaining eight articles mainly focused on one type of study each: animal study (four articles), cross-sectional study (two articles), review (one article), and case report (one article). Hence, those articles brought different perspectives on the natural short sleep phenomenon by identifying intrinsic factors like DEC2, NPSR1, mGluR1, and β1-AR mutant genes. Natural short sleep traits in either point-mutations or single null mutations in those genes have been examined and confirmed its intrinsic nature in affected individuals without any related health concerns. Finally, this review added a potential limitation in these studies, mainly highlighting intrinsic causes since one case study reported an extrinsically triggered short sleep behavior in an older man without any family history. The overall result of the review study suggests that the molecular mechanisms tuned by identified sleep genes can give some potential points of therapeutic intervention in future studies.

e13113 Background: Breast cancer (BC) is the 2nd most common cause of cancer related deaths in women. Antibody-drug conjugates are monoclonal antibodies conjugated to the cytotoxic payload and are directed towards cell surface proteins specific to tumor cells. This systematic review and meta-analysis aims to assess the efficacy of ADCs in breast cancer and comparison of different ADCs. Methods: A literature search was performed on PubMed, Embase, WOS, and clinicaltrials.gov with key words “breast neoplasms,” and “immunoconjugates” from the inception of data till 6/6/2022. Cochrane and PRISMA guidelines were followed to establish guidelines registered on Prospero (CRD42022329529). Out of 4,570 articles, seven randomized clinical trials (RCTs, N=5,302) were included. R programming language software with “meta” package was used for this meta-analysis. Results: In 7 RCTs (N=5,302), 4,834 patients had HER-2 positive disease while 468 patients were triple negative BC (TNBC). 1,486 patients had residual invasive disease while 3,816 patients had metastatic breast cancer (mBC). 3,389 patients were treated with ADC (235 with sacituzumab govitecan (saci-gov), 2,339 with trastuzumab emtansine (T-DM1) and 261 trastuzumab deruxtecan (T-der)), 2,105 patients were treated with chemotherapy regimens. In 4 RCTs on HER-2 patients (N=2,825), pooled HR of PFS and OS were 0.72 (95% CI=0.61-0.84, I2=71%) and 0.73 (95% CI=0.64-0.84, I2=20%), respectively, in favor of ADC. Risk of ORR was 1.48 (95% CI=0.84-2.60, I2=91%) in favor of ADC. In RCT on TNBC (N=468), HR of PFS and OS were 0.55 (95% CI=0.51-0.61) and 0.59 (95% CI=0.54-0.66), respectively, in favor of saci-gov (ADC). In RCT on HER-2 positive residual invasive breast cancer, HR of recurrence/death was 0.61 (95% CI=0.54-0.69) in favor of T-DM1. In an RCT by Cortes et al. (N=524) comparing two ADCs in HER-2 mBC, the HR of PFS and OS were 0.28 (95% CI= 0.22-0.37) and 0.55 (95% CI=0.36-0.86), respectively, in favor of T-der as compared to T-DM1. The RR of ORR and CR were 2.33 and 1.28, respectively, in favor of T-der. Conclusions: ADCs are significantly more effective than chemotherapy in patients with HER-2 positive mBC, HER-2 positive residually invasive BC, and metastatic TNBC in terms of improving survival and response rates. Among ADCs, T-der was significantly more effective than T-DM1 in patients with HER-2 positive mBC. More double blinded multicenter RCTs are needed to confirm these results.