An Evaluation of the Additive Effect of Natural Herbal Medicine on SARS or SARS-like Infectious Diseases in 2003: A Randomized, Double-blind, and Controlled Pilot Study.

Natural herbal medicine (NHM) has been used to control infectious diseases for thousands of years. In view of the possible beneficial effect of NHM on SARS, we conducted this study to examine whether NHM is of any benefit as a supplementary treatment of SARS or SARS-like infectious disease. This was a randomized, double-blind, placebo-controlled trial. Twenty-eight patients fulfilled the WHO inclusion criteria and our exclusion criteria. All enrolled patients received routine western-medicine treatment. Patients were randomly allocated to one of the three supplementary treatment groups: NHM A (Group A, n = 9) NHM B (Group B, n = 9) or placebo (Group C, n = 10). Chest X-ray was done every 1 or 2 days for every patient. Reading radiologists use a standard 0-3 scoring system (0: no infiltration; 1: focal haziness or even small patchy lesion; 2: ground glass picture; 3: lobar consolidation) according to the severity of infiltration in each lung field (three lung fields in both right and left lungs). The main outcome measurements were the improving chest radiographic scores (IRS) and the duration (days) till improvement (DI). One patient from the placebo group passed away. Patients from NHM A took less days before showing improvement (6.7 +/- 1.8) compared with placebo group (11.2 +/- 4.9), which showed statistical significance (P = 0.04). The cases were too few to be conclusive, the initial observations seem to indicate NHM appears to be safe in non-criticallly ill patients and clinical trials are feasible in the setting of pandemic outbreaks.

The lesson of supplementary treatment with Chinese medicine on severe laboratory-confirmed SARS patients.

Chinese medicine (CM) has been used to control infectious diseases for thousands of years. In 2003 outbreaks of severe acute respiratory syndrome (SARS) occurred in China, Hong Kong and Taiwan. In view of the possible beneficial effect of CM on SARS, we conducted this study to examine whether CM is of any benefit as a supplementary treatment of SARS. Four severe laboratory-confirmed SARS patients received routine western-medicine treatment plus different supplementary treatment: CM A, CM B and CM C (placebo control). We reported the course of the cases in terms of changes in chest radiographic scores. Case 1 treated as a placebo control passed away on the 9th day after onset of disease. The other three cases treated with CM A or CM B survived. The initial findings seemed to indicate a favorable effect of CM on management of SARS. The findings need to be verified with a larger sample. Using CM as a supplementary treatment of severe SARS seems to indicate that natural herbal medicine can be used against avian influenza. Hence, such related experience or clinical trials should be taken into consideration when facing the possible outbreak of avian influenza in the future.

Neutralizing antibody response and SARS severity.

Using the Taiwan nationwide laboratory-confirmed severe acute respiratory syndrome (SARS) database, we analyzed neutralizing antibody in relation to clinical outcomes. With a linear mixed model, neutralizing antibody titer was shown to peak between week 5 and week 8 after onset and to decline thereafter, with a half-life of 6.4 weeks. Patients with a longer illness showed a lower neutralizing antibody response than patients with a shorter illness duration (p = 0.008). When early responders were compared with most patients, who seroconverted on and after week 3 of illness, the small proportion (17.4%) of early responders (antibody detectable within 2 weeks) had a higher death rate (29.6% vs. 7.8%) (Fisher exact test, p = 0.004), had a shorter survival time of <2 weeks (Fisher exact test, p = 0.013), and were more likely to be > 60 years of age (Fisher exact test, p = 0.01). Our findings have implications for understanding the pathogenesis of SARS and for SARS vaccine research and development.

Electroacupuncture in obese women: a randomized, controlled pilot study.

OBJECTIVE: To compare the effects of electroacupuncture and sit-up exercise on reducing body weight (BW) and waist circumference (WC) among obese women. METHODS: A randomized, controlled clinical trial was conducted from July 1, 2002, to June 30, 2003, in the outpatient department of Taipei Hospital, Taiwan. The subjects were 72 obese women, with WC>90 cm and body mass index (BMI)>30 kg/m2 and who had not received any other weight control maneuver within the prior 3 months. The subjects were randomly divided into groups A, B, and C. Group A (n=22) received electroacupuncture, group B (n=20) was assigned sit-up exercises, and group C (n=21) received no intervention. All three treatments lasted for 6 weeks. The measurements of BW, BMI, and WC were performed in the beginning and after 6 weeks. The data were compared and expressed as percent reductions. RESULTS: Electroacupuncture showed significantly greater percent reductions in BW (p=0.009, 0.004), BMI (p=0.008, 0.016), and WC (p=0.013, 0.006) compared with sit-up exercises or no intervention. CONCLUSIONS: In this pilot study, electroacupuncture treatment was more effective than situp exercise or no intervention in reducing BW, BMI, and WC.

Comparison of predictive accuracy among six prognosis prediction systems for patient mortality in intensive care units.

BACKGROUND AND PURPOSE: This study compared the goodness-of-fit of six prognostic prediction systems. METHODS: A total of 1,170 patients in the medical and surgical intensive care units of a public tertiary care hospital were included in this study. Data from the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Simplified Acute Physiology Score II (SAPS II), Condition Index Score (CIS), and Mortality Probability Models II (MPM II; at admission MPM IIadm and 24-hours later MPM II24 h) prediction systems were collected. The scores or death-risks from these systems were compared between survivors and non-survivors. Lemeshow-Hosmer (LH) statistics, calibration curve, classification matrix, and receiver operating characteristic (ROC) curve for the whole study group were determined. Mortality ratio, LH statistics, and ROC curve for individual disease categories and operative states were compared. A model with good fit was defined as having an LH chi-square value close to the degrees of freedom and yielding a corresponding p value of greater than 0.05, conformation to the ideal calibration diagonal (low deviation value), high classification matrix overall accuracy, a large area under the ROC curve (> 0.8), and a mortality ratio close to 1. RESULTS: LH chi-square value was 12.37 for APACHE II and 8.61 for MPM II24 h. The calibration curve deviation value was 1.5069 for APACHE II and 1.4308 for MPM II24 h. Classification matrix overall accuracy was 78.88% for APACHE II and 79.54% for MPM II24 h. The area under the ROC curve was 0.779 for APACHE II and 0.790 for MPM II24 h. The mortality ratios of trauma were 1.00 for both APACHE II and MPM IIadm. The mortality ratios for respiratory diseases and rare diseases were both 1.02 for MPM II24 h. The other systems studied did not provide good-fit data. CONCLUSION: In this study, MPM II or APACHE II had the best predictive model of the tested systems for critically ill patients.