RESUMEN
AIM: Sleep disturbances are common in primary Sjögren's syndrome (pSS) patients and may lead to disease aggravation and decreased health-related quality of life (HRQoL). There are currently no known reported studies related to the prevalence, correlates, and impact of sleep disturbance in pSS patients from China. Therefore, this study aims to assess the sleep quality in Chinese pSS patients and evaluate its relationship with the disease activity, quality of life and mood disorders. METHODS: A self-report survey was administered to 221 pSS patients and 198 healthy individuals using the Pittsburgh Sleep Quality Index (PSQI) for sleep quality. Disease activity and damage were evaluated with the European League Against Rheumatism Sjögren's syndrome disease activity index (ESSDAI). Independent samples t tests, Chi-square analysis, logistic regression were used to analyze these data. RESULTS: Our results found that the prevalence of poor sleep (PSQI ≥ 6) was 57.5% and the mean global score of PSQI was 6.57 (SD 3.19) in patients, which were significantly higher than the controls (32.3% and 4.93 [SD 2.86], respectively). When trying to fall asleep, patients with pSS had some sleep disturbances, reduced sleep efficiency, increased number of awakenings than controls. There were significant correlations among dryness, ocular surface disease, HRQoL, pain, disease activity, anxiety/depression and sleep quality in pSS patients. Meanwhile, logistic regression models identified depression and Short Form-36 mental composite score as predictors of poor sleep quality. CONCLUSIONS: Sleep disturbances are commonly reported in pSS patients and sleep quality is lower in pSS patients than in healthy controls. The data suggested the need for holistic assessment and management of pSS patients.
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Síndrome de Sjögren/epidemiología , Trastornos del Sueño-Vigilia/epidemiología , Sueño , Adulto , Afecto , Estudios de Casos y Controles , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Calidad de Vida , Medición de Riesgo , Factores de Riesgo , Síndrome de Sjögren/fisiopatología , Síndrome de Sjögren/psicología , Trastornos del Sueño-Vigilia/fisiopatología , Trastornos del Sueño-Vigilia/psicologíaRESUMEN
BACKGROUND: Distal renal tubular acidosis is a relatively infrequent condition with complex pathophysiology that can present with life-threatening electrolyte abnormalities. CASE PRESENTATION: We describe a case of a 57-year-old Caucasian woman with previous episodes of hypokalemia, severe muscle weakness, and fatigue. Upon further questioning, symptoms of dry eye and dry mouth became evident. Initial evaluation revealed hyperchloremic metabolic acidosis, severe hypokalemia, persistent alkaline urine, and a positive urinary anion gap, suggestive of distal renal tubular acidosis. Additional laboratory workup and renal biopsy led to the diagnosis of primary Sjögren's syndrome with associated acute tubulointerstitial nephritis. After potassium and bicarbonate supplementation, immunomodulatory therapy with hydroxychloroquine, azathioprine, and prednisone was started. Nonetheless, her renal function failed to improve and remained steady with an estimated glomerular filtration rate of 42 ml/min/1.73 m2. The literature on this topic was reviewed. CONCLUSIONS: Cases of renal tubular acidosis should be carefully evaluated to prevent adverse complications, uncover a potentially treatable condition, and prevent the progression to chronic kidney disease. Repeated episodes of unexplained hypokalemia could be an important clue for diagnosis.
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Acidosis Tubular Renal/diagnóstico , Hipopotasemia/diagnóstico , Potasio/uso terapéutico , Síndrome de Sjögren/diagnóstico , Bicarbonato de Sodio/uso terapéutico , Oligoelementos/uso terapéutico , Equilibrio Ácido-Base , Acidosis Tubular Renal/tratamiento farmacológico , Acidosis Tubular Renal/fisiopatología , Progresión de la Enfermedad , Femenino , Tasa de Filtración Glomerular , Humanos , Hipopotasemia/tratamiento farmacológico , Inmunomodulación , Persona de Mediana Edad , Síndrome de Sjögren/tratamiento farmacológico , Síndrome de Sjögren/fisiopatología , Resultado del TratamientoRESUMEN
To evaluate the efficacy and safety of total glucosides of peony (TGP) in adults with primary Sjögren's syndrome (pSS). A multi-center, randomized, double-blinded, placebo-controlled study was conducted between March 2012 and July 2014 at ten Chinese hospitals. In total, 320 pSS patients-classified according to the 2002 American-European Consensus Group Criteria-were randomized (2:1 ratio) to receive TGP(600 mg, tid) in the TGP group or placebo for 24 weeks in the placebo group. Study personnel, investigators, and patients were blinded to the treatment grouping. The primary endpoint was the improvement of EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) at week 24. The secondary endpoints were dry eyes/mouth/skin/nose/throat/vagina visual analogue scale (VAS), pain and discomfort VAS, fatigue VAS, mental discomfort VAS, patient global assessment (PGA), EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), Schirmer's test, basal/stimulated salivary flow-rate values, and erythrocyte sedimentation rate (ESR). All adverse events were recorded during the trial period. ESSPRI improved more in the TGP than the placebo group (p < 0.001). Dry eyes/throat/vagina VAS, fatigue VAS, mental discomfort VAS, PGA, Schirmer's test, and ESR also improved more in the TGP group than in the placebo group (all p < 0.05). Stimulated salivary flow-rate values increased in the TGP group at week 12 but not at week 24. Adverse events in TGP group were 10.9%. TGP can alleviate some dryness symptoms as well as disease activity in pSS patients over 24 weeks. TGP was well tolerated by study subjects. TGP seems to be an effective and safe treatment for pSS.
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Paeonia , Fitoterapia , Extractos Vegetales/uso terapéutico , Raíces de Plantas , Síndrome de Sjögren/tratamiento farmacológico , Adulto , Diarrea/inducido químicamente , Método Doble Ciego , Fatiga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Eliminación Salival , Índice de Severidad de la Enfermedad , Síndrome de Sjögren/fisiopatología , Resultado del Tratamiento , Escala Visual AnalógicaRESUMEN
BACKGROUND: The aim of this study was to evaluate the effects of Pycnogenol® supplementation in otherwise healthy subjects with Sjögren syndrome (SS) in a remission phase, who experienced persisting symptoms impairing their quality of life. METHODS: The control group receiving only standard treatment was composed of 14 subjects, the supplement group included 16 subjects who used Pycnogenol® supplementation. RESULTS: ESR and oxidative stress levels were high in all subjects at inclusion; both decreased significantly with supplementation (P<0.05). Pycnogenol® significantly improved the majority of symptoms (dry eyes and mouth dryness), diminishing the need for corticosteroids and other treatments. CONCLUSIONS: Pycnogenol® supplementation in patients with SS in a remission phase may be effective to control inflammation and reduce symptoms.
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Antioxidantes/administración & dosificación , Flavonoides/administración & dosificación , Estrés Oxidativo/efectos de los fármacos , Extractos Vegetales/administración & dosificación , Síndrome de Sjögren/tratamiento farmacológico , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Calidad de Vida , Sistema de Registros , Síndrome de Sjögren/fisiopatologíaRESUMEN
PURPOSE: To evaluate the clinical outcomes of thermal pulsation treatment in patients with meibomian gland dysfunction (MGD) and dry eye secondary to Sjogren disease. METHODS: Twenty-four eyes from 13 patients with previously diagnosed Sjogren disease who presented to our institution with dry eye symptoms and had thermal pulsation treatment were prospectively followed up. Patients underwent comprehensive slit-lamp examination, including MGD grading, gland oil flow, corneal and conjunctival staining scores, and tear break-up time (TBUT). Tear osmolarity was tested before and after treatment. RESULTS: The average patient age was 62.4 years (range, 31-78 yrs); 12 were women and 1 a man. The average meibomian gland oil flow score showed an increase from pretreatment 0.71 to 1.75 at 1 year posttreatment (range 9-15 months) (P = 0.001). The average corneal staining score decreased from a pretreatment grade of 1.04 to a posttreatment grade of 0.36 (P < 0.001). The average conjunctival staining score decreased from a pretreatment grade of 1.5 to a posttreatment grade of 0.48 (P < 0.001). The average tear break-up time improved from 3.8 seconds before treatment to 7.5 seconds after thermal pulsation treatment (P < 0.001). There was no statistically significant change in the tear osmolarity or Ocular Surface Disease Index score. CONCLUSIONS: Our findings suggest that MGD is an important contributor to dry eye disease in patients with Sjogren disease and should not be overlooked when considering treatment options. Thermal pulsation is a therapeutic option for patients with Sjogren disease who have MGD and dry eye symptoms. After a single treatment, patients exhibited increased oil flow and tear break-up time with an associated decrease in corneal and conjunctival staining.
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Síndromes de Ojo Seco/terapia , Enfermedades de los Párpados/terapia , Hipertermia Inducida , Síndrome de Sjögren/complicaciones , Adulto , Anciano , Síndromes de Ojo Seco/etiología , Síndromes de Ojo Seco/fisiopatología , Enfermedades de los Párpados/fisiopatología , Femenino , Humanos , Masculino , Glándulas Tarsales/patología , Persona de Mediana Edad , Estudios Prospectivos , Síndrome de Sjögren/fisiopatología , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
Sjogren's syndrome (SS) is an autoimmune disease affecting the lacrimal glands resulting in dry eye disease (DED). Ophthalmologists may be the first line of detection of Sjogren's syndrome given the frequency of DED in SS and that dry eye is often the presenting symptom. Numerous symptom questionnaires and tests have been developed to help diagnose DED, but as of yet, there is no "gold standard." Minimally invasive objective metrics are needed for a reliable diagnosis of DED. Currently there is no single test to diagnose SS-associated DED. Although there are several approaches to treatment, none are specific for DED in SS, and, generally, several methods need to be tried to find what works best for a specific patient. Treatment for DED continues to be an unmet medical need, especially given that DED in SS is typically on the severe end of the spectrum.
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Síndrome de Sjögren/fisiopatología , Administración Oftálmica , Ciclosporina/uso terapéutico , Síndromes de Ojo Seco/diagnóstico , Síndromes de Ojo Seco/tratamiento farmacológico , Síndromes de Ojo Seco/fisiopatología , Ácidos Grasos Omega-3/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Gotas Lubricantes para Ojos/uso terapéutico , Agonistas Muscarínicos/uso terapéutico , Oftalmología , Fenilalanina/análogos & derivados , Fenilalanina/uso terapéutico , Pilocarpina/uso terapéutico , Tapones Lagrimales , Quinuclidinas/uso terapéutico , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/tratamiento farmacológico , Sulfonas/uso terapéutico , Tiofenos/uso terapéuticoRESUMEN
OBJECTIVES: Endogenous cognitive event-related potentials (CERPs) reflect higher-level processing of sensory information and can be used to evaluate cognitive functions. The aim of this paper was to determine whether there are any abnormalities in the electrophysiological parameters of CERPs in patients with primary Sjögren's syndrome (pSS) but without symptoms of central nervous system (CNS) involvement or mental disorder. The analysis of CERP parameters was then correlated with the clinical status of the patients and with some of the immunological parameters in the patient group. METHOD: Thirty consecutive patients with pSS (29 females, one male) were included in the study. All the patients underwent CERP examination. RESULTS: There was a significant prolongation of the latency of P300 and N200 potentials in patients with pSS. Abnormalities in electrophysiological parameters of CERPs correlated with the duration of the disease, salivary gland abnormalities, and elevated erythrocyte sedimentation rate (ESR) values. Patients with coexisting chronic fatigue syndrome (CFS) had larger P300 amplitudes. There were no statistically significant changes in the electrophysiological parameters of CERPs in patients with pSS dependent on the presence of peripheral nervous system (PNS) lesions, skin changes, arthritis, abnormalities in white blood cells and the immune system or the levels of blood lipids. CONCLUSIONS: The results of the study suggest the presence of a minor cognitive dysfunction in patients with pSS without symptoms of CNS involvement or mental disorder. Cognitive dysfunction correlated with the disease duration time and the severity of inflammatory changes (salivary gland abnormalities and inflammatory markers in the blood). Further and larger longitudinal studies are necessary for confirmation of this correlation.
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Sistema Nervioso Central/fisiología , Cognición/fisiología , Potenciales Relacionados con Evento P300/fisiología , Potenciales Evocados/fisiología , Síndrome de Sjögren/fisiopatología , Síndrome de Sjögren/psicología , Estimulación Acústica , Adulto , Anciano , Biomarcadores/sangre , Estudios de Casos y Controles , Progresión de la Enfermedad , Fenómenos Electrofisiológicos/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tiempo de Reacción/fisiología , Glándulas Salivales/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Síndrome de Sjögren/sangre , UltrasonografíaRESUMEN
Sjögren's syndrome (SS) is a multisystem autoimmune disease characterized by hypofunction of the salivary and lacrimal glands, frequently relieved with symptomatic treatments, such as saliva substitutes, eye lubricants, and cholinergic stimulators. The aim of this pilot randomized placebo-controlled study was to estimate the effects of laser acupuncture on salivary flow rates in patients with severe hyposalivation due to SS. A prospective cohort of 26 female patients affected by SS has been evaluated. The laser therapy equipment used was the Pointer Pulse, emitting light in the red visible spectrum (650 nm), with a power of 5 mW and an irradiation time of 120 s per acupoint, in an area of 3.14 mm(2) (fluence = 19.2 J/cm(2), power density = 0.16 W/cm(2), total dose = 0.6 J). The following acupuncture points were stimulated bilaterally: LI 2 Erjian, ST 5 Daying, ST 6 Jiache, ST 7 Xiaguan, SI 19 Tinggong, and BL 13 Feishu. True laser acupuncture led to a significantly higher amount of saliva production, measured after the end of the protocol (5 weeks), and during the 6-month follow-up period. The results are stable from the end of the protocol until the 3rd month of follow-up; during the last control, a slight but significant decrease in production has also been shown. This preliminary study proposes laser acupuncture as a possible treatment for improving salivary flow rates in patients with SS, but further validation on a larger sample is still necessary.
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Terapia por Acupuntura/métodos , Rayos Láser , Salivación/fisiología , Síndrome de Sjögren/fisiopatología , Síndrome de Sjögren/terapia , Puntos de Acupuntura , Anciano , Femenino , Humanos , Estudios Prospectivos , Saliva/fisiologíaRESUMEN
OBJECTIVE: To investigate the mechanism underlying the changes in the cardiac function in rat models of Sjogren's syndrome (SS) based on Kelch-like ECH-associated protein 1 (Keap1)-Nrf2/ARE signaling pathways. METHODS: Thirty male Wistar rats were randomly divided into two groups, normal control (NC) group and SS model group, with 15 in each. The rats in the model group were injected with the complete Freund's adjuvant plus homologous antigen of submandibular gland (0.2 mL mixture) into bilateral posterior paw metatarsus. The body mass, water intake, submandibular gland index, spleen index, and histological changes of the glands were observed 30 days after inflammation was induced. Cardiac function was assessed using invasive hemodynamic monitoring. Meanwhile, reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD) and total antioxidant capacity (TAC), IL-18, IL-35 were detected using ELISA; ROS and reactive nitrogen species (RNS), glutathione (GSH), thioredoxin (TrX) protein were determined using immunohistochemical staining. The expressions of Keap 1, nuclear factor erythroid 2-related factor (Nrf2), macrophage activating factor (Maf) antioxidant responsive element (ARE) mRNAs were detected using real-time fluorescent quantitative PCR (qRT-PCR); the levels of heme oxygenase-1 (HO-1), γ-glutamic acid and a half long glycine synthetase (γ-GCS) proteins in cardiac tissue were examined using Western blotting. RESULTS: Compared with the NC group, the model group presented reduced body mass, submandibular gland index and spleen index (P<0.05), increased water intake (P<0.01), heart rate (HR), heart index (HI), left ventricular systolic pressure (LVSP) and left ventricular diastolic pressure (LVEDP) (P<0.05), and decreased left ventricular ±dp/dtmax (P<0.05). Compared with the NC group, the model group had increased IL-18, MDA, RNS, TAC, ROS levels, and Keap1, Maf, Nfr2 mRNAs, HO-1, γ-GCS protein expressions in the heart tissue, while TrX, GSH, IL-5 and SOD levels decreased significantly (P<0.01). CONCLUSION: The immune imbalance in SS rats may be related with the up-regulated levels of Keap1, Maf, Nfr2 mRNAs, HO-1, γ-GCS.
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Corazón/fisiopatología , Péptidos y Proteínas de Señalización Intracelular/genética , Factor 2 Relacionado con NF-E2/genética , Transducción de Señal/genética , Síndrome de Sjögren/genética , Animales , Antioxidantes/metabolismo , Antioxidantes/farmacología , Western Blotting , Modelos Animales de Enfermedad , Expresión Génica , Glutamato-Cisteína Ligasa/metabolismo , Glutatión/metabolismo , Hemo-Oxigenasa 1/metabolismo , Inmunohistoquímica , Interleucina-18/metabolismo , Proteína 1 Asociada A ECH Tipo Kelch , Masculino , Malondialdehído/metabolismo , Ratas , Ratas Wistar , Especies Reactivas de Oxígeno/metabolismo , Elementos de Respuesta/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Síndrome de Sjögren/metabolismo , Síndrome de Sjögren/fisiopatología , Superóxido Dismutasa/metabolismo , Tiorredoxinas/metabolismoRESUMEN
PURPOSE: To evaluate tear meniscus changes in patients with Sjögren syndrome (SS) receiving oral pilocarpine with Visante optical coherence tomography (OCT). METHODS: Eight patients with primary SS were recruited in this prospective interventional case series study. Patients received pilocarpine tablets twice a day for 3 months. Visual analog scale assessment for dry eye and dry mouth symptoms was carried out. Patients underwent OCT and slit-lamp microscopy graticule scale tear meniscus height (TMH) measurements, strip meniscometry testing, tear film breakup time measurement, fluorescein and Rose Bengal staining, and the Schirmer 1 test. The data were analyzed 1 week, 1 month, and 3 months after treatment. Mann-Whitney test was performed. RESULTS: Visual analog scale assessment showed a significant time-wise improvement (P < 0.05). OCT and graticule scale TMH measurements significantly improved after 1 week (P < 0.05), 1 month, and 3 months of treatment (P < 0.001). Strip meniscometry, mean tear film stability, and fluorescein and Rose Bengal scores remained improved 3 months after treatment (P < 0.001), whereas Schirmer 1 test values tended to improve without statistical significance. CONCLUSIONS: Visante OCT was effective in monitoring tear meniscus changes during the course of treatment noninvasively and quickly. Oral pilocarpine seemed to be effective in improving TMH, and the signs and symptoms of dryness in patients with SS.
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Agonistas Muscarínicos/uso terapéutico , Pilocarpina/uso terapéutico , Síndrome de Sjögren/tratamiento farmacológico , Lágrimas/fisiología , Tomografía de Coherencia Óptica , Administración Oral , Anciano , Femenino , Colorantes Fluorescentes , Fluorofotometría , Humanos , Estudios Prospectivos , Rosa Bengala , Síndrome de Sjögren/fisiopatología , Comprimidos , Resultado del TratamientoRESUMEN
En el síndrome de Sjögren primario (SSP) no se ha descrito hasta el momento una terapia eficaz para las manifestaciones glandulares a pesar del desarrollo de múltiples agentes orales y biológicos en los últimos años. Varios fármacos empleados como tratamiento de fondo en otras enfermedades se han probado empíricamente y, reconocida la hiperactividad de la célula B en el SSP, también los moduladores de estas se han ensayado en esta enfermedad. En este artículo se revisan los datos existentes sobre el uso de tratamientos modificadores de la enfermedad exclusivamente en el síndrome seco, encontrando que los ensayos publicados con fármacos antirreumáticos orales han mostrado resultados contradictorios y desalentadores, mientras que algunos tratamientos biológicos han resultado esperanzadores. Los problemas encontrados se centran sobre todo en la falta de una correcta y homogénea metodología en los diseños de los ensayos (AU)
No effective treatment has been documented for the glandular primary Sjögren syndrome (PSS) despite the development of oral and biologic agents that have significant activity against other autoimmune disorders. Some disease-modifying agents have been empirically evaluated for the treatment of PSS. Targeting B cells also seems very promising in SSP because of the B-cell hyperactivity recognized in this desease. This article reviews existing data on the use of disease-modifying therapy for glandular of SSP. To date, published studies and trials of oral DMARDs for the treatment of SSP have shown disappointing results. B-cell modulation is clearly a promising therapy for PSS. Many challenges in trial design and execution are evident from the studies reviewed (AU)
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Humanos , Síndrome de Sjögren/tratamiento farmacológico , Terapia Biológica , Antirreumáticos/uso terapéutico , Síndrome de Sjögren/fisiopatología , Glándulas Exocrinas/fisiopatología , Corticoesteroides/uso terapéutico , Hidroxicloroquina/uso terapéutico , Linfocitos BAsunto(s)
Síndromes de Ojo Seco , Enfermería Holística/métodos , Educación del Paciente como Asunto/métodos , Síndrome de Sjögren , Síndromes de Ojo Seco/inmunología , Síndromes de Ojo Seco/enfermería , Síndromes de Ojo Seco/fisiopatología , Humanos , Síndrome de Sjögren/inmunología , Síndrome de Sjögren/enfermería , Síndrome de Sjögren/fisiopatologíaRESUMEN
Severe dysphagia in a 54 year-old woman with Sjogren's syndrome with involvement of multiple cranial nerves significantly improved after treatment with neuromuscular electrical stimulation (NMES) in combination with a swallowing rehabilitation program. The swallowing response was assessed in real time using a videofluoroscope. Immediate improvement in the tongue retraction force, clearing of the valleculae, increase in laryngeal elevation and shortening of pharyngeal transit time were noted during stimulation. The patient returned to independent oral feeding after 46 sessions of NMES. After follow-up for 1 year, we found that the patient maintained adequate oral feeding and did not show signs of pulmonary complications.
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Trastornos de Deglución/terapia , Deglución , Terapia por Estimulación Eléctrica , Síndrome de Sjögren/terapia , Trastornos de Deglución/fisiopatología , Femenino , Fluoroscopía , Humanos , Persona de Mediana Edad , Síndrome de Sjögren/fisiopatología , Grabación en VideoRESUMEN
Sjogren's syndrome (SS) is an autoimmune disorder that affects the salivary glands, leading to xerostomia, and the lacrimal glands, resulting in xerophthalmia. Secondary SS is associated with other autoimmune disorders such as systemic rheumatic diseases and systemic lupus erythematosis (SLE), which can affect multiple organs, including the epidermis. Recent studies have demonstrated that green tea polyphenols (GTPs) possess both anti-inflammatory and anti-apoptotic properties in normal human cells. Epidemiological evidence has indicated that, in comparison to the United States, the incidence of SS, clinical xerostomia and lupus is considerably lower in China and Japan, the two leading green tea-consuming countries.Thus, GTPs might be responsible, in part, for geographical differences in the incidence of xerostomia by reducing the initiation or severity of SS and lupus. Consistent with this, molecular, cellular and animal studies indicate that GTPs could provide protective effects against autoimmune reactions in salivary glands and skin. Therefore, salivary tissues and epidermal keratinocytes could be primary targets for novel therapies using GTPs. This review article evaluates the currently available research data on GTPs, focusing on their potential application in the treatment of the oral manifestations of SS and skin manifestations of SLE.
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Camellia sinensis , Catequina/análogos & derivados , Lupus Eritematoso Sistémico/tratamiento farmacológico , Síndrome de Sjögren/tratamiento farmacológico , Té , Antiinflamatorios/uso terapéutico , Antioxidantes/uso terapéutico , Apoptosis/efectos de los fármacos , Catequina/farmacología , Catequina/uso terapéutico , Femenino , Humanos , Lupus Eritematoso Sistémico/fisiopatología , Sistema de Señalización de MAP Quinasas , Masculino , Fitoterapia , Glándulas Salivales/citología , Glándulas Salivales/metabolismo , Síndrome de Sjögren/fisiopatología , Xerostomía/tratamiento farmacológicoRESUMEN
AIMS: To evaluate the efficacy of 50% autologous serum drops against conventional treatment in ocular surface disorders refractory to normal treatments in a prospective randomised crossover trial. METHOD: Patients fulfilling ophthalmological and haematological entry criteria were randomised to either 3 months of autologous serum 50% followed by 3 months of their conventional treatment, or 3 months of conventional treatment, followed by 3 months of autologous serum. Clinical assessments, including Schirmer's test, rose Bengal, and fluorescein staining, were carried out on entry and at monthly intervals. Impression cytology was performed at entry, 3 and 6 months. Grading was carried out on degrees of squamous metaplasia and goblet cell density. Subjective comfort was recorded daily using the "faces" scale. These categorical scores were converted to linear measurement using Rasch analysis. Statistical analysis was carried out using Wilcoxon's signed rank test and ANOVA. RESULTS: 16 patients were recruited with 31 eyes studied. The ocular surface diseases chiefly included Sjögren's syndrome (n = 6) and keratoconjunctivitis sicca (n = 5). Impression cytology available in 25 of 31 eyes showed significant improvement on serum treatment, p<0.02. Rasch weighted faces scores were statistically significantly better with serum, p<0.01. CONCLUSION: The results of this randomised study provide further evidence of the beneficial effects of autologous serum in severe ocular surface disorders. For most of these patients, autologous serum was superior to conventional treatment for improving ocular surface health and subjective comfort.
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Síndromes de Ojo Seco/terapia , Suero , Adulto , Anciano , Análisis de Varianza , Estudios Cruzados , Síndromes de Ojo Seco/patología , Síndromes de Ojo Seco/fisiopatología , Femenino , Colorantes Fluorescentes , Humanos , Queratoconjuntivitis Seca/patología , Queratoconjuntivitis Seca/fisiopatología , Queratoconjuntivitis Seca/terapia , Masculino , Persona de Mediana Edad , Soluciones Oftálmicas , Satisfacción del Paciente , Rosa Bengala , Índice de Severidad de la Enfermedad , Síndrome de Sjögren/patología , Síndrome de Sjögren/fisiopatología , Síndrome de Sjögren/terapia , Resultado del Tratamiento , Agudeza VisualRESUMEN
The goal of this work is to propose novel acoustic parameters of voice for the purpose of providing a quantitative analysis of auscultation in traditional Chinese medical diagnosis. There is rare amount of available literature related to this topic. Four novel acoustic parameters, the average number of zero-crossings, the variations in local peaks and valleys, the variations in first and second formant frequencies, and the spectral energy ratio, are presented to analyze and identify the characteristics among non-vacuity, qi-vacuity, and yin-vacuity subjects. Among these acoustic parameters, two temporal parameters, the average number of zero-crossings and the variations in local peaks and valleys, outperformed other parameters in classifying both non-vacuity and deficient subjects. The spectral energy ratio was adequate for the classification between qi-vacuity and yin-vacuity patients. This research is a first step in an ongoing effort to modernize the auscultation in traditional Chinese medical diagnosis.
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Artritis Reumatoide/diagnóstico , Auscultación/estadística & datos numéricos , Lupus Eritematoso Sistémico/diagnóstico , Medicina Tradicional China , Síndrome de Sjögren/diagnóstico , Calidad de la Voz/fisiología , Acústica , Adulto , Artritis Reumatoide/fisiopatología , Análisis Discriminante , Femenino , Humanos , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Cómputos Matemáticos , Síndrome de Sjögren/fisiopatologíaRESUMEN
The diagnosis and treatment of Sjögren's syndrome, which poses many severe complications, should be of critical interest to dentists, who are often the first practitioners to detect symptoms. Dentistry is an integral part of health care delivery for patients with this condition. Management of Sjögren's syndrome can be seen as a model for the expanded scope of dental care in the future.
Asunto(s)
Atención Odontológica/tendencias , Síndrome de Sjögren/terapia , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/fisiopatología , Enfermedades Autoinmunes/terapia , Prestación Integrada de Atención de Salud/tendencias , Odontólogos , Diagnóstico por Imagen , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Saliva/metabolismo , Saliva/fisiología , Enfermedades de las Glándulas Salivales/fisiopatología , Enfermedades de las Glándulas Salivales/terapia , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/fisiopatologíaRESUMEN
Presentamos una revision de las actualidades fisiopatologicas y terapeuticas del sindrome de Sjogren(SS), enfermedad autoinmune que se considera la segunda en prevalencia en los Estados Unidos, solo por detras de la Artritis Reumatoidea(AR). Asimismo incluimos un planteamiento teorico acerca de los medicamentos homeopaticos que pudiesen ser utiles en la terapia de esta enfermedad con base en el conocimiento de sus componentes y los mecanismos patologicos que estos producen, ademas de los resultados observados en un grupo de 6 pacientes con SS y manejados con homeopatia por un periodo de 3 a 6 meses posteriores al tratamiento. El resultado ha sido una remision total de los sintomas durante el tiempo que se tomo el medicamento, y en algunos casos, 6 meses despues de suspenderse este.
Asunto(s)
Síndrome de Sjögren/fisiopatología , Síndrome de Sjögren/terapia , Atropa belladonna , Enfermedades Autoinmunes/terapia , Bryonia/uso terapéutico , Euphrasia officinalis/uso terapéutico , Queratoconjuntivitis Seca/terapiaRESUMEN
Presentamos una revision de las actualidades fisiopatologicas y terapeuticas del sindrome de Sjogren(SS), enfermedad autoinmune que se considera la segunda en prevalencia en los Estados Unidos, solo por detras de la Artritis Reumatoidea(AR). Asimismo incluimos un planteamiento teorico acerca de los medicamentos homeopaticos que pudiesen ser utiles en la terapia de esta enfermedad con base en el conocimiento de sus componentes y los mecanismos patologicos que estos producen, ademas de los resultados observados en un grupo de 6 pacientes con SS y manejados con homeopatia por un periodo de 3 a 6 meses posteriores al tratamiento. El resultado ha sido una remision total de los sintomas durante el tiempo que se tomo el medicamento, y en algunos casos, 6 meses despues de suspenderse este.(AU)
Asunto(s)
Informes de Casos , Síndrome de Sjögren/fisiopatología , Síndrome de Sjögren/terapia , Bryonia/uso terapéutico , Atropa belladonna/uso terapéutico , Euphrasia officinalis/uso terapéutico , Enfermedades Autoinmunes/terapia , Queratoconjuntivitis Seca/terapiaRESUMEN
Twenty-one patients with Sjögren's syndrome were given four different kinds of acupuncture stimulation, at acupuncture points previously used to treat xerostomia. The local blood flux in the skin overlying the parotid gland was measured with laser Doppler flowmetry before, during and after the acupuncture stimulation. The results showed that the local blood flux increased significantly during and after both manual acupuncture and low-frequency (2 Hz) electro-acupuncture as compared with superficial acupuncture. These results indicate that acupuncture induced an increase in the local blood flux which was more pronounced for those patients who had previously reacted with increased salivary flow to acupuncture.