A comparative study of the common complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicines.

Osteoarthritis is the most common form of arthritis worldwide and progression of arthritis may lead to secondary complications. Osteoarthritis is the degradation of joint tissues from the effects of injury, grinding sensation and inflammation. There are three main systems of medicine including allopathic, homeopathic and herbal system for the treatment of osteoarthritis. Plants are the basis for traditional medicine which is still widely practiced today. The objective of the present study is to find out the complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicine. This study was conducted in Karachi from January 2019 to January 2020. Allopathic, Homeopathic and Herbal practitioners were consulted in the study (n=600, with= 200 in each study group). Data was analyzed by SPSS 22 version. Finding of the study suggest that after the treatment with allopathic medicines orthopaedician, family physician or rheumatologist / internal medicine specialist, there was no significant difference in complaints (Chi-square =0.598, p=0.742). Moreover, there was no significant difference in complications (Chi-square = 0.039, p=0.981). While treatment with homeopathic medicines either by orthologist or family physician significant difference in complaints were observed (Chi-square =4.86, p=0.027). The patient visiting family physicians have higher number of complications than orthologists. While treatment with herbal medicines either by orthologists or family physician there was significant difference in complaints. (Chi-square =5.404, p=0.020). The study reveals that there is no significant difference of complaints and complications in allopathic systems of medicine when treating osteoarthritis, while it is significant for homeopathic and herbal medicine.

Ten-day high-dose proton pump inhibitor triple therapy versus sequential therapy for Helicobacter pylori eradication.

BACKGROUND AND AIM: Eradication rates of Helicobacter pylori following standard triple therapy are declining worldwide, but high-dose proton pump inhibitor-based triple therapy (HD-PPI-TT) and sequential therapy (ST) have demonstrated higher cure rates. We aimed to compare the efficacy and tolerability of HD-PPI-TT and ST in H. pylori-associated functional dyspepsia (FD). METHODS: One hundred and twenty H. pylori-associated functional dyspepsia patients were randomized to receive 10-day HD-PPI-TT (60 mg lansoprazole/500 mg clarithromycin/1 g amoxicillin, each administered twice daily for 10 days) or 10-day ST (30 mg lansoprazole/1 g amoxicillin, each administered twice daily for 5 days followed by 30 mg lansoprazole/500 mg clarithromycin/400 mg metronidazole, each administered twice daily for 5 days). H. pylori status was determined in post-treatment week 4 by 14 C-urea breath test. Eradication and antibiotic resistance rates, dyspeptic symptoms, drug compliance, and adverse effects were compared. RESULTS: Intention-to-treat eradication rates were similar in the ST and HD-PPI-TT groups (85% vs. 80%; P = 0.47). However, the eradication rate was significantly higher following ST compared with HD-PPI-TT in per protocol analysis (94.4% vs. 81.4%; P = 0.035). ST achieved higher cure rates than HD-PPI-TT in clarithromycin-resistant H. pylori strains (100% vs. 33.3%; P = 0.02). Treatment compliance was similar in the HD-PPI-TT and ST groups, although nausea and dizziness were more common in the ST group. CONCLUSIONS: Sequential therapy achieved better H. pylori eradication than HD-PPI-TT in patients with FD. However, the eradication rate for ST fell from 94.4% in per protocol to 85% in intention-to-treat analysis. Adverse effects might result in poorer compliance and compromise actual ST efficacy (ClinicalTrials.gov: NCT01888237).

Transperineal prostate biopsies for diagnosis of prostate cancer are well tolerated: a prospective study using patient-reported outcome measures.

We aimed to determine short-term patient-reported outcomes in men having general anesthetic transperineal (TP) prostate biopsies. A prospective cohort study was performed in men having a diagnostic TP biopsy. This was done using a validated and adapted questionnaire immediately post-biopsy and at follow-up of between 7 and 14 days across three tertiary referral hospitals with a response rate of 51.6%. Immediately after biopsy 43/201 (21.4%) of men felt light-headed, syncopal, or suffered syncope. Fifty-three percent of men felt discomfort after biopsy (with 95% scoring <5 in a 0-10 scale). Twelve out of 196 men (6.1%) felt pain immediately after the procedure. Despite a high incidence of symptoms (e.g., up to 75% had some hematuria, 47% suffered some pain), it was not a moderate or serious problem for most, apart from hemoejaculate which 31 men suffered. Eleven men needed catheterization (5.5%). There were no inpatient admissions due to complications (hematuria, sepsis). On repeat questioning at a later time point, only 25/199 (12.6%) of men said repeat biopsy would be a significant problem despite a significant and marked reduction in erectile function after the procedure. From this study, we conclude that TP biopsy is well tolerated with similar side effect profiles and attitudes of men to repeat biopsy to men having TRUS biopsies. These data allow informed counseling of men prior to TP biopsy and a benchmark for tolerability with local anesthetic TP biopsies being developed for clinical use.

The Role of Chiropractic Care in the Treatment of Dizziness or Balance Disorders: Analysis of National Health Interview Survey Data.

The purpose of this study was to explore the role of chiropractic in the treatment of dizziness or balance disorders through an analysis of data from the 2008 National Health Interview Survey. Odds ratios and 95% confidence intervals (CIs) were used to assess the likelihood that respondents with dizziness or balance problems perceived that they were helped by specified practitioners. Eleven percent of respondents reported having had a balance or dizziness problem; more than 35% were aged 65 years and older. The odds ratio for perceiving being helped by a chiropractor was 4.36 (95% CI, 1.17-16.31) for respondents aged 65 years or older; 9.5 (95% CI, 7.92-11.40) for respondents reporting head or neck trauma; and 13.78 (95% CI, 5.59-33.99) for those reporting neurological or muscular conditions as the cause of their balance or dizziness.

Determinants of a positive response to carotid sinus massage and head-up tilt testing.

BACKGROUND: Orthostatic hypotension (OH) and carotid sinus hypersensitivity (CSH) are common causes of syncope in older people. The aim of this study was to determine if patient's age, sex and presenting symptoms influence the result of carotid sinus massage and head-up tilt testing. METHODS: Retrospective analysis of the database and reports was carried out between 1995 and 2006 at a tertiary referral centre. Patient's age, sex, presenting symptoms and test result were examined. Presenting symptoms were classified as syncope, falls or dizzy spells. RESULTS: Of the 1583 tests reported, OH was present in 402 patients (25.4%), of whom 175 (11.1%) were symptomatic. 188 of 1464 (12.8%) patients undergoing carotid sinus massage had evidence of CSH, of which 156 were symptomatic. Male patients were significantly more likely to have symptomatic CSH than female patients (odds ratio 2.28, 95% CI 1.54 to 3.04, p<0.01). There were non-significant trends to increased diagnosis of symptomatic OH with increasing age, male sex and referral with syncope. There were non-significant trends to increased diagnosis of symptomatic CSH with increasing age and referral with syncope. CONCLUSION: Male sex, increasing age and being referred with syncope were all associated with an increased likelihood of receiving a diagnosis of either OH or CSH. The overall prevalence of CSH was lower than in previous studies, which may reflect different patient populations.

[Frequency of dizziness-related diagnoses and prescriptions in a general practice database]. / Diagnosehäufigkeiten und Verordnungen bei Schwindel im Patientenkollektiv einer hausärztlichen Routinedatenbank.

INTRODUCTION: Dizziness can be due to multiple causes. However, the aetiology often remains unclear. At the same time, there is a lack of evidence-based treatment options. The aim of this study was to investigate the frequency of dizziness-related diagnoses, referrals and prescriptions in a general practice database. METHODS: Data from computerized patient records of 138 general practices participating in the MedViP project were used for cross-sectional analysis of the time period April 2001 until December 2002. The identification of dizzy patients was performed via ICD-10 diagnoses, free text fields and medication issued for dizziness. Frequencies were counted and odds ratios calculated to describe associations between diagnoses and medication. RESULTS: For the period of investigation, 10,971 patients (from a total of 317,042 documented patients) were given at least one diagnosis of dizziness (prevalence 3.4%; mean age 59 years, 67.2% female). In 80.2% of the cases dizziness was coded as a symptom (R42) rather than a discrete disease. Prescriptions for dizziness were rather uncommon. An analysis of ATC codes showed that 6.6% of all affected patients were prescribed a specific drug for dizziness, most frequently betahistine. Antiemetics were prescribed in 7.1%, and the homeopathic preparation "Vertigoheel" in 2.8% of the dizzy patients. Betahistine was significantly more often prescribed for "unspecified" dizziness, vestibular neuritis, and benign paroxysmal positional vertigo; but not for Meniere's disease. It was given less often in "other peripheral" and in central vertigo as well as in cases where the symptom was coded (R42). 3.9% of the dizzy patients had been referred to the neurologist (55.4%), ENT-specialist (30.5%) or to both specialists (14.1%). CONCLUSIONS: The manner of coding and prescribing reflects both a symptom-orientated classification used by general practitioners and the limitation of treatment options.

Predictors for immediate and global responses to chiropractic manipulation of the cervical spine.

OBJECTIVE: Patients with nonspecific musculoskeletal disorders may vary in their response to treatment. This study set out to identify the predictors for either improvement or worsening in symptoms for which cervical spine manipulation is indicated. METHOD: A large prospective study recorded details on patients, their presenting symptoms, and type of treatment. At the end of the consultation, any immediate improvement or worsening in presenting symptoms was noted. At the follow-up visit, information was collected on the patients' self-reported improvement. RESULTS: Data were collected from 28,807 treatment consultations (in 19,722 patients) and 13,873 follow-up treatments. The presenting symptoms of "neck pain," "shoulder, arm pain," "reduced neck, shoulder, arm movement, stiffness," "headache," "upper, mid back pain," and "none or one presenting symptom" emerged in the final model as significant predictors for an immediate improvement. The presence of any 4 of these predictors raised the probability for an immediate improvement in presenting symptoms after treatment from 70% to approximately 95%. With regard to immediate worsening, "neck pain," "shoulder, arm pain, "headache," "numbness, tingling upper limbs," "upper, mid back pain," and "fainting, dizziness, light-headedness" emerged as predictors; and the presence of any 4 of these raised the probability for immediate worsening from 4.4% to approximately 12%. For global improvement, only 2 predictors were identified; but these did not enhance the postprediction probability. CONCLUSIONS: This study is the first attempt to identify variables that can predict immediate outcomes in terms of improvement and worsening of presenting symptoms, and global improvement, after cervical spine manipulation. The predictor variables were strongest for immediate improvement.

Dizziness: state of the science.

Dizziness is prevalent in all adult populations, causing considerable morbidity and utilization of health services. In the community, the prevalence of dizziness ranges from 1.8% in young adults to more than 30% in the elderly. In the primary care setting, dizziness increases in frequency as a presenting complaint; as many as 7% of elderly patients present with this symptom. Classification of dizziness by subtype (vertigo, presyncope, disequilibrium, and other) assists in the differential diagnosis. Various disease entities may cause dizziness, and the reported frequency of specific diagnoses varies widely, depending on setting, patient age, and investigator bias. Life-threatening illnesses are rare in patients with dizziness, but many have serious functional impairment. Dizziness can be difficult to diagnose, particularly in elderly persons, in whom it often represents dysfunction in more than one body system. Given the relatively underdeveloped state of the empirical literature on dizziness, investigators would benefit from use of consistent criteria to describe dizziness symptoms and establish diagnoses. Investigation of the effects of testing and treatment should focus on diagnoses that are life threatening or lead to significant morbidity. In the elderly, a function-oriented approach should be studied and compared with current diagnosis-focused strategies. Alternative therapies for chronic and recurrent dizziness also merit investigation.

Dizziness in primary care. Results from the National Ambulatory Medical Care Survey.

This study utilized data from the 1981 and 1985 National Ambulatory Medical Care Surveys to study dizziness, a frequently troublesome patient problem in family practice. These data indicate that family physicians and general practitioners see nearly 45% of all outpatients with dizziness. In primary care practices (family physicians, general practitioners, and general internists) the frequency of dizziness as a presenting complaint rises steadily with age, so that nearly 7% of patients aged 85 years and older present with that symptom. Women complain of dizziness more frequently than men, with this relationship being particularly prominent in older age categories. According to primary care physicians who gathered data for the 1981 and 1985 surveys, dizziness was the principal reason for visit (chief complaint) of 2.61% of patients aged 25 years and older (531 recorded encounters). Of these patients, 66.7% were women; 1.5% were hospitalized; 4.4% were referred to specialists; and 89.3% left with a drug prescription. Hypertension was the most frequent diagnosis recorded among these patients who complained of dizziness. Several of the most common diagnoses recorded for these visits (hypertension, diabetes, unspecified dizziness, and coronary arteriosclerosis) differ from common causes of dizziness reported by specialty clinics.