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1.
JAMA Netw Open ; 4(6): e2110782, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061203

RESUMO

Importance: Vaccination against SARS-CoV-2 has the potential to significantly reduce transmission and COVID-19 morbidity and mortality. The relative importance of vaccination strategies and nonpharmaceutical interventions (NPIs) is not well understood. Objective: To assess the association of simulated COVID-19 vaccine efficacy and coverage scenarios with and without NPIs with infections, hospitalizations, and deaths. Design, Setting, and Participants: An established agent-based decision analytical model was used to simulate COVID-19 transmission and progression from March 24, 2020, to September 23, 2021. The model simulated COVID-19 spread in North Carolina, a US state of 10.5 million people. A network of 1 017 720 agents was constructed from US Census data to represent the statewide population. Exposures: Scenarios of vaccine efficacy (50% and 90%), vaccine coverage (25%, 50%, and 75% at the end of a 6-month distribution period), and NPIs (reduced mobility, school closings, and use of face masks) maintained and removed during vaccine distribution. Main Outcomes and Measures: Risks of infection from the start of vaccine distribution and risk differences comparing scenarios. Outcome means and SDs were calculated across replications. Results: In the worst-case vaccination scenario (50% efficacy, 25% coverage), a mean (SD) of 2 231 134 (117 867) new infections occurred after vaccination began with NPIs removed, and a mean (SD) of 799 949 (60 279) new infections occurred with NPIs maintained during 11 months. In contrast, in the best-case scenario (90% efficacy, 75% coverage), a mean (SD) of 527 409 (40 637) new infections occurred with NPIs removed and a mean (SD) of 450 575 (32 716) new infections occurred with NPIs maintained. With NPIs removed, lower efficacy (50%) and higher coverage (75%) reduced infection risk by a greater magnitude than higher efficacy (90%) and lower coverage (25%) compared with the worst-case scenario (mean [SD] absolute risk reduction, 13% [1%] and 8% [1%], respectively). Conclusions and Relevance: Simulation outcomes suggest that removing NPIs while vaccines are distributed may result in substantial increases in infections, hospitalizations, and deaths. Furthermore, as NPIs are removed, higher vaccination coverage with less efficacious vaccines can contribute to a larger reduction in risk of SARS-CoV-2 infection compared with more efficacious vaccines at lower coverage. These findings highlight the need for well-resourced and coordinated efforts to achieve high vaccine coverage and continued adherence to NPIs before many prepandemic activities can be resumed.


Assuntos
Vacinas contra COVID-19/farmacologia , COVID-19 , Controle de Doenças Transmissíveis , Vacinação em Massa , Cobertura Vacinal , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/estatística & dados numéricos , Simulação por Computador , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Vacinação em Massa/organização & administração , Vacinação em Massa/estatística & dados numéricos , Mortalidade , North Carolina/epidemiologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2 , Resultado do Tratamento , Cobertura Vacinal/organização & administração , Cobertura Vacinal/estatística & dados numéricos
2.
Arch Esp Urol ; 74(5): 503-510, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34080570

RESUMO

OBJECTIVES: The goal of current study was to evaluate prevalence of postoperative urinary tract infections (UTI) following flexible ureteroscopy (f-URS) and to determine predictive factors for those UTIs. METHODS: A total of 420 patients with urolithiasis that underwent f-URS between August 2018 and August 2019 were enrolled in the study. Peri-operative characteristics of patients with and without postoperative UTIs were compared using univariate analyses. Predictive factors for UTIs following f-URS were determined using multivariate logistic regression analysis. RESULTS: Forty-one (9.8%) out of 420 patients had postoperative urinary infection after f-URS and those patients were classified as group 1. Group 2 consisted of 379 patients that did not develop postoperative UTIs. The percentage of female gender was 58.5% vs 42% in groups 1 and 2, respectively (p=0.042). The preoperative UTI history rate was 51.2% vs 20.8% (p<0.001) and preoperative double J stent (DJS) insertion rate 39% vs 17.7% in groups 1 and 2, respectively (p=0.001). Univariate regression analyses showed that the female gender (OR=1.98), history of UTI (OR=3.99), and preoperative DJS insertion (OR=2.98) significantly increased the possibility of postoperative UTI (p<0.05). Multivariate regression analyses revealed that history of UTI (OR=3.41, 95%CI:1.73-6.72, p<0.001) and preoperative DJS insertion (OR=2.30, 95%CI:1.13-4.68, p=0.021) were independent risk factors for infectious complications following f-URS. If both factors are present, the probability of infection is 55.2%. CONCLUSIONS: Even if f-URS is considered a safe procedure, the risk of postoperative infectious complications is far from negligible. We found that the presence of UTI history and preoperative DJS were independent risk factors for UTI after f-URS.


Assuntos
Litotripsia , Infecções Urinárias , Feminino , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ureteroscópios , Ureteroscopia/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
3.
BMC Infect Dis ; 21(1): 522, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082705

RESUMO

BACKGROUND: Leptospirosis is a zoonotic spirochetal disease caused by Leptospira interrogans. The clinical presentation ranges from an asymptomatic state to a fatal multiorgan dysfunction. Neurological manifestations including aseptic meningitis, spinal cord and peripheral nerve involvement, cranial neuropathies and cerebellar syndrome are well recognized with varying frequencies among patients with this disease. Posterior reversible encephalopathy syndrome is a very rare occurrence in leptospirosis and only two cases are reported in the medical literature up to now. We report a case of posterior reversible encephalopathy syndrome in a patient with leptospirosis with rhabdomyolysis and acute kidney injury. CASE PRESENTATION: A 21 year-old male presented with fever and oliguric acute kidney injury with rhabdomyolysis. A diagnosis of leptospirosis was made and he was being managed according to the standard practice together with regular hemodialysis. The clinical condition was improving gradually. On day 8 of the illness, he developed headache and sudden painless complete bilateral vision loss followed by several brief generalized tonic clonic seizure attacks. Examination was significant for a Glasgow Coma Scale of 14/15, blood pressure of 150/90 mmHg and complete bilateral blindness. The findings of magnetic resonance imaging of the brain were compatible with posterior reversible encephalopathy syndrome. He was managed with blood pressure control and antiepileptics with supportive measures and standard treatment for leptospirosis and made a complete recovery. CONCLUSION: Posterior reversible encephalopathy syndrome, though very rare with leptospirosis, should be considered as a differential diagnosis in a patient with new onset visual symptoms and seizures, especially during the immune phase. Optimal supportive care together with careful blood pressure control and seizure management would yield a favourable outcome in this reversible entity.


Assuntos
Injúria Renal Aguda/complicações , Leptospirose/complicações , Síndrome da Leucoencefalopatia Posterior/etiologia , Rabdomiólise/complicações , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Leptospirose/diagnóstico , Leptospirose/fisiopatologia , Leptospirose/terapia , Imageamento por Ressonância Magnética , Masculino , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Síndrome da Leucoencefalopatia Posterior/terapia , Rabdomiólise/diagnóstico , Rabdomiólise/fisiopatologia , Rabdomiólise/terapia , Resultado do Tratamento , Adulto Jovem
4.
Zhonghua Yan Ke Za Zhi ; 57(6): 440-446, 2021 Jun 11.
Artigo em Chinês | MEDLINE | ID: mdl-34098693

RESUMO

Objective: To report the efficacy and safety of minimally invasive vitrectomy for the treatment of severe proliferative diabetic retinopathy (PDR) and the effect of preoperative retinal photocoagulation on prognosis. Methods: Case-series study and cohort study. This study included 48 severe PDR patients (53 eyes). There are 28 males and 20 females. The average age was 53.5 (range, 40.0 to 59.0) years old. Patients were divided into two groups according to whether preoperative retinal photocoagulation was performed. Under the guidance of the concept of minimally invasive vitrectomy, all patients received intravitreal injection of conbercept 3 days before standard pars plana vitrectomy with a 27G+ vitrectomy system. To relieve traction, the proliferative fibrovascular membrane was divided into islands as small as possible. It was not necessary to pursue a complete removal of the proliferative membrane. The 27G+ vitrector was flexibly applied as a multifunctional tool for membrane removal by reducing frequencies at which the device entered and left the eye. Intraocular retinal photocoagulation was performed in the main area. The primary outcome measures were best corrected visual acuity (BCVA) and retinal reattachment rate, and the secondary outcome measures were intraoperative and postoperative complications. Statistical analysis was performed using t test, rank sum test and χ² test. Results: All patients tolerated intravitreal conbercept, with no serious intraoperative or postoperative adverse events. Postoperative BCVA values were improved significantly compared with preoperative values (χ²=125.11, P<0.01). The mean logMAR BCVA improved from 1.90 (1.30, 2.30) preoperatively to 1.00 (0.70, 1.90) at 1 week postoperatively, 0.8 (0.5, 1.3) at 1 month postoperatively, 0.7 (0.40, 1.20) at 3 months postoperatively, and 0.70 (0.40, 1.20) at 6 months postoperatively. The visual function increased progressively with time. Postoperatively, the primary and final reattachment rates were 92.5% (50/53) and 96.2% (51/53), respectively. Abnormal intraocular pressure lasted for more than one week occurred in 2 eyes; Vitreous hemorrhage recurred in 5 eyes; Retinal detachment occurred in 4 eyes (7.5%); No postoperative endophthalmitis, choroidal detachment or incision related retinal hole occurred. The intraoperative and postoperative parameters in the preoperative retinal photocoagulation group were better than the preoperative non-photocoagulation group, but the difference was not significant (P>0.05). Conclusions: Minimally invasive vitrectomy is fully qualified for the management of severe PDR, with maximized benefits. (Chin J Ophthalmol, 2021, 57:440-446).


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Descolamento Retiniano , Adulto , Estudos de Coortes , Retinopatia Diabética/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Descolamento Retiniano/cirurgia , Resultado do Tratamento , Acuidade Visual , Vitrectomia , Hemorragia Vítrea/cirurgia
5.
J Int Med Res ; 49(6): 3000605211020636, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34098752

RESUMO

To date, only a few reports have described the regression of lumbar disc herniation, which may be because of a failure to follow up patients treated conservatively. We report a case of a 25-year-old man who presented with a 2-month history of pain and soreness owing to lumbar disc herniation. He was managed conservatively, and his presenting symptoms and scoliosis gradually decreased over approximately 5 months. Two years later, he returned unexpectedly and was advised to undergo magnetic resonance imaging, which revealed regression of the disc herniation; the patient also confirmed that the pain had not recurred. After 8 months, he underwent repeat magnetic resonance imaging, and the findings pertaining to disc herniation were normal. Our findings suggest that previous cases should be retrospectively studied to establish a prediction model for the outcomes of conservative treatment in patients with lumbar disc herniation. We also emphasize the significance of selecting suitable patients for conservative treatment to obtain the best therapeutic outcomes. The CARE guidelines have been followed in the reporting of this case.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Adulto , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Resultado do Tratamento
6.
J Int Med Res ; 49(6): 3000605211016209, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34098766

RESUMO

OBJECTIVE: To explore the role of miR-223 and miR-126 in predicting treatment responses to dual antiplatelet therapy (DAPT) in patients with ST-elevation myocardial infarction (STEMI). METHODS: Plasma miR-223 and miR-126 levels were measured before treatment. Treatment responses and 2-year survival were determined. In vitro experiments were performed to explore the mechanism of action. RESULTS: Patients with resistance to DAPT had a lower level of miR-223 and miR-126. Cardiac-event-free survival was shorter in patients with lower miR-223 or miR-126 levels. MiR-223 and miR-126 independently predicted DAPT resistance. Modulating miR-223 or miR-126 in platelets in vitro significantly changed the response to clopidogrel by regulating platelet aggregation. CONCLUSION: MiR-223 and miR-126 play a role in DAPT resistance and may provide potential biomarkers in patients with STEMI.


Assuntos
MicroRNAs , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Plaquetas , Clopidogrel/uso terapêutico , Humanos , MicroRNAs/genética , Inibidores da Agregação Plaquetária/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/genética , Resultado do Tratamento
7.
BMJ Case Rep ; 14(6)2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099449

RESUMO

An 85-year-old man with a known history of abdominal aortic aneurysm (AAA) presented to a vascular surgery clinic with a severely swollen, tender and erythematous left leg. An urgent CT angiogram demonstrated a left-sided, proximal deep vein thrombosis, and a permanent, Bird's Nest inferior vena cava (IVC) filter (Cook, Inc., Bloomington, Ind.) penetrating his AAA. The patient was treated with a course of apixaban 5 mg two times per day and the decision was made to closely observe his IVC filter and AAA, given his numerous comorbidities and age. This case highlights the unique considerations associated with an approach to permanent IVC filter complications among patients with AAAs.


Assuntos
Aneurisma da Aorta Abdominal , Filtros de Veia Cava , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Humanos , Perna (Membro) , Masculino , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem
8.
Am J Case Rep ; 22: e930698, 2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34099613

RESUMO

BACKGROUND Crohn disease (CD) is an idiopathic chronic inflammatory disease that can present in the perianal area as perianal CD (pCD), which can present as fistulizing or non-fistulizing. Perirectal abscesses are common complications that are strongly associated with fistula formation. Draining an abscess and not treating the associated fistula leads to a high risk of disease recurrence. An extensive workup is needed to determine the nature and extent of disease and guide the appropriate treatment strategy. Endoscopic ultrasound (EUS) is an important modality for diagnosing CD-associated perianal or perirectal abscesses. It also has been used for treatment as an alternative to conventional surgical and percutaneous drainage techniques because it is minimally invasive and outcomes with it are good. The present report documents the case of a man with a history of CD who was diagnosed with a perirectal abscess that was managed with EUS-guided transrectal drainage. CASE REPORT A 58-year-old man with a history of CD presented with a 2-week history of chills, body aches, fatigue, and myalgia and a 1-week history of severe perirectal pain with worsening swelling. After a detailed history-taking, physical examination, and diagnostic workup, he was diagnosed with a CD-associated perirectal abscess. The patient and the attending physician decided to proceed with EUS-guided transrectal drainage. CONCLUSIONS Our case provides data regarding use of EUS for treatment of a CD- associated perirectal abscess.


Assuntos
Abscesso , Doença de Crohn , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Abscesso/cirurgia , Doença de Crohn/complicações , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia de Intervenção
9.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34083189

RESUMO

A 7-year-old boy with Marfanoid habitus presented with sudden and painless decrease in the vision of the right eye. Ocular examination revealed rhegmatogenous retinal detachment with 360° giant retinal tear in the right eye and small peripheral retinal breaks with lattice degeneration in the left eye. The patient underwent a 23-gauge pars plana vitrectomy with scleral buckling in the right eye and laser around the breaks in the left eye. At 1-week follow-up visit, the child presented with similar complaints in the left eye as were seen in the right eye. This was later managed effectively with 23-gauge pars plana vitrectomy only. So, with our case report, we would like to highlight the need for aggressive screening in children who are diagnosed with Marfan's syndrome and the need for prophylactic treatment in the unaffected eye.


Assuntos
Síndrome de Marfan , Descolamento Retiniano , Perfurações Retinianas , Criança , Humanos , Masculino , Síndrome de Marfan/complicações , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Recurvamento da Esclera , Resultado do Tratamento , Acuidade Visual , Vitrectomia
10.
Zhen Ci Yan Jiu ; 46(5): 416-20, 2021 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-34085466

RESUMO

OBJECTIVE: To observe the curative effect of joint administration of acupuncture, western and herbal medicines and bamboo-jar-cupping in the treatment of locomotor dysfunction in patients with apoplexy (acute phase) of wind-phlegm blocking meridian-collateral type in acute stroke patients, and its influence on some relevant laboratory indexes. METHODS: A total of 100 cases of acute stroke patients of wind-phlegm blocking meridian-collateral type were recruited, and equally and randomly divided into control group and treatment group according to the random number table. The patients of both groups received treatment of conventional western medicines (for anti-platelet aggregation, blood-lipid regulation, arterial plaque-stabilization, cerebral cell protection and blood pressure-lowering), Chinese herbal medicines (for promoting blood circulation to dredge the meridian-collaterals), and acupuncture of Neiguan (PC6), Chize (LU5), Zusanli (ST36), Binao (LI14) and Sanyinjiao (SP6); and in addition, the patients of the treatment group also treated by cupping with bamboo-jar (kept for 10 min). The treatment was conducted once a day for 2 weeks. After the treatment, the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA), Barthel Index (BI), and traditional Chinese medicine (TCM) syndrome score were used to assess the state of neurofunction, locomotor function, daily living ability, and TCM symptoms. The contents of serum C-reactive protein, D-dimer and blood homocysteine were detected using radical immunodiffusion, immunoturbidimetry, and enzymic methods, respectively. RESULTS: After the treatment, of the 50 and 50 cases in the control and treatment groups, 5 and 6 were cured, 7 and 18 experienced marked improvement, 23 and 20 were effective, and 15 and 6 ineffective, with the effective rate being significantly higher in the treatment group (88.0%) than in the control group (70.0%, P<0.05). Self-comparison showed that the FMA and BI scores were significantly increased (P<0.01), and the NIHSS score and TCM syndrome score notably decreased in both groups ( P<0.01) in comparison with their own pre-treatment. Comparison between the two groups showed that the FMA and BI scores were obviously higher in the treatment group than in the control group (P<0.05), whereas the NIHSS score and TCM syndrome score as well as the C-reaction protein content evidently lower in the treatment group than in the control group (P<0.05, P<0.01). CONCLUSION: Joint administration of acupuncture, western and Chinese herbal medicines and cupping can promote the recovery of nerve function, improve locomotor function, activities of daily living and quality of life, and reduce inflammatory state in acute stroke patients with wind-phlegm blocking collaterals.


Assuntos
Terapia por Acupuntura , Acidente Vascular Cerebral , Atividades Cotidianas , Humanos , Qualidade de Vida , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Vento
11.
Zhen Ci Yan Jiu ; 46(5): 431-8, 2021 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-34085469

RESUMO

OBJECTIVE: To systematically evaluate the efficacy and safety of thrombolysis combined with acupuncture therapy in the treatment of acute cerebral infarction (ACI) in the light of evidence-based medicine. METHODS: Randomized controlled trials (RCT) for acupuncture and thrombolysis treatment of acute cerebral infarction published from the inception of databa-ses to March 2020 were searched from PubMed, Cochrane Library, Embase, Web of science, CNKI, Wanfang, VIP, and CBM Database. According to the inclusion and exclusion criteria, two reviewers independently screened the RCTs and extracted the data. The quality of the included literature was evaluated, and the Meta-analysis was performed by using Revman 5.3 software. RESULTS: A total of 330 studies were identified, and 14 RCTs (including 604 cases of the treatment group, 598 cases of the control group) met the inclusion criteria. The Meta-analysis showed that the thrombolysis combined with acupuncture therapy was better than acupuncture therapy alone in the clinical effective rate (risk ratio ï¼»RRï¼½=1.19, 95% confidence interval ï¼»CIï¼½ ï¼»1.13, 1.25ï¼½), NIHSS score (mean difference ï¼»MDï¼½=-3.51, 95% CI ï¼»-4.54, -2.48ï¼½), BI index (MD=12.26, 95% CI ï¼»8.07, 16.46ï¼½), and in lowering C-reaction protein levels (MD=-3.99, 95% CI ï¼»-4.35, -3.63ï¼½). The rate of complete recanalization (RR = 1.20, 95% CI ï¼»1.00, 1.44ï¼½), adverse reaction (RR = 0.76, 95% CI ï¼»0.41, 1.41ï¼½) and hemorrhagic conversion (RR = 0.72, 95% CI ï¼»0.14, 3.62ï¼½) was not statistically significant. CONCLUSION: The current effective evidence shows that acupuncture has certain advantages in improving the therapeutic effect and safety of thrombolysis in the treatment of ACI patients.


Assuntos
Terapia por Acupuntura , Acidente Vascular Cerebral , Infarto Cerebral/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Resultado do Tratamento
12.
Zhongguo Zhen Jiu ; 41(6): 583-7, 2021 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-34085471

RESUMO

OBJECTIVE: To evaluate the clinical effect of acupuncture for the improvements in various dyspeptic symptoms of postprandial distress syndrome. METHODS: The secondary analysis on the data of a multi-center randomized controlled trial (RCT) was conducted. 278 patients with postprandial distress syndrome were randomized into an acupuncture group (138 cases) and a sham-acupuncture group (140 cases). In the acupuncture group, acupuncture was applied to Baihui (GV 20), Danzhong (CV 17), Zhongwan (CV 12), Qihai (CV 6), Neiguan (PC 6), Zusanli (ST 36), etc. In the sham-acupuncture group, 6 sites, neither located on meridians nor belonged to meridian acupoints, were selected and punctured shallowly. The duration of treatment was 20 min each time, 3 times a week, for 4 weeks totally in the two groups. The follow-up visit lasted for 12 weeks. The scores of dyspeptic symptoms were compared between the two groups before treatment, during treatment (in week 1, 2, 3 and 4) and during follow-up (in week 8, 12 and 16) separately. RESULTS: Besides the scores of early satiety and vomiting in the sham-acupuncture group in week 1, the scores of the other dyspepsia symptoms during treatment and follow-up were all reduced in the two groups as compared with those before treatment (P<0.05). In week 2 and 3, the score of early satiety in the acupuncture group was lower than that in the sham-acupuncture group (P<0.05). In week 3, the scores of postprandial fullness, upper abdominal bloating and belching in the acupuncture group were lower than those in the sham-acupuncture group (P<0.05). In week 4 and during follow-up, the scores of postprandial fullness, early satiety, upper abdominal bloating and belching in the acupuncture group were all lower than those in the sham-acupuncture group (P<0.05). CONCLUSION: Acupuncture remarkably relieves postprandial fullness, early satiety, upper abdominal bloating and belching in patients with postprandial distress syndrome.


Assuntos
Terapia por Acupuntura , Dispepsia , Meridianos , Pontos de Acupuntura , Dispepsia/terapia , Humanos , Resultado do Tratamento
13.
Zhongguo Zhen Jiu ; 41(6): 589-92, 2021 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-34085472

RESUMO

OBJECTIVE: To observe the effect of conventional acupuncture combined with row-like puncture at sternocleidomastoid on peripheral facial palsy at recovery stage. METHODS: A total of 60 patients with peripheral facial palsy at recovery stage were randomized into an observation group and a control group, 30 cases in each one. Acupuncture was applied at affected Cuanzhu (BL 2), Yangbai (GB 14), Sibai (ST 2), Quanliao (SI 18), Jiache (ST 6), Dicang (ST 4), Hegu (LI 4), Taichong (LR 3) and Zusanli (ST 36) in the control group. On the basis of the treatment in the control group, row-like puncture was applied at sternocleidomastoid (1 needle was punctured at muscle origin and insertion respectively, 3 to 4 needles were row-like punctured at the connection line of muscle origin and insertion). The treatment was given once a day, 5 times were as one course, with 2-day interval, totally 4 courses were required in the both groups. The house-brackmann (H-B) facial nerve function grade, facial nerve function rating system-dynamic view rating scale score and facial disability index (FDI) scale score [including scores of FDI physical function (FDIp) and FDI social life function (FDIs)] before and after treatment were observed, and the clinical efficacy was evaluated in the two groups. RESULTS: After treatment, the H-B facial nerve function grades were improved compared before treatment in the both groups (P<0.05), and that in the observation group was superior to the control group (P<0.05). After treatment, the scores of dynamic view rating scale and FDIp were increased (P<0.05), FDIs scores were decreased compared before treatment in the both groups (P<0.05); compared with the control group, the scores of dynamic view rating scale and FDIp were increased (P<0.05), FDIs score was decreased in the observation group (P<0.05). The total effective rate was 93.3% (28/30) in the observation group, which was superior to 73.3% (22/30) in the control group (P<0.05). CONCLUSION: Compared with conventional acupuncture, combination therapy with row-like puncture at sternocleidomastoid can improve the therapeutic effect of peripheral facial palsy at recovery stage.


Assuntos
Terapia por Acupuntura , Paralisia Facial , Pontos de Acupuntura , Paralisia Facial/terapia , Humanos , Agulhas , Punções , Resultado do Tratamento
14.
Zhongguo Zhen Jiu ; 41(6): 608-12, 2021 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-34085476

RESUMO

OBJECTIVE: To observe the clinical efficacy of ZHU Lian's type-Ⅰ inhibition acupuncture combined with Zhuang medicinal thread moxibustion for acute herpes zoster (HZ), and explore the possible analgesic mechanism. METHODS: Sixty-six patients with acute HZ were randomly divided into an observation group (33 cases, 1 case dropped off) and a control group (33 cases, 1 case dropped off). The patients in the control group were treated with valaciclovir hydrochloride tablets, mecobalamin tablets and vitamin B1 tablets for 14 days. The patients in the observation group were treated with ZHU Lian's type-Ⅰ inhibition acupuncture and Zhuang medicinal thread moxibustion. ZHU Lian's type-Ⅰ inhibition acupuncture was given at ashi points (around herpes site), Qimen (LR 14), Geshu (BL 17), Quchi (LI 11), Xuehai (SP 10) and Neiguan (PC 6); Zhuang medicinal thread moxibustion was given at Changzi point, Kuihua point, Xionglongji point, Zhuang medicine Jiaji points; both the treatment was given once every other day for 14 days. The symptom improvement (blister stopping time, scab forming time, scab removing time) in the two groups were observed. The pain visual analogue scale (VAS) score and serum levels of interleukin (IL)-6, IL-8, substance P (SP) in the two groups before and after treatment were compared. The clinical efficacy of the two groups and the recurrence rate of neuralgia 1, 2, 3 months after treatment were evaluated. RESULTS: The blister stopping time, scab forming time and scab removing time in the observation group were earlier than those in the control group (P<0.05). Compared before treatment, VAS scores and serum levels of IL-6, IL-8 and SP in the two groups were decreased after treatment (P<0.05), and those in the observation group were lower than those in the control group (P<0.05). The total effective rate in the observation group was 96.9% (31/32), which was higher than 84.4% (27/32) in the control group (P<0.05). The recurrence rates of neuralgia 1, 2, 3 months after treatment in the observation group were 9.7%, 6.5%, 3.2%, which were lower than 29.6%, 22.2%, 14.8% in the control group (P<0.05). CONCLUSION: The ZHU Lian's type-Ⅰ inhibition acupuncture combined with Zhuang medicinal thread moxibustion have better analgesic effect and lower recurrence rate of neuralgia in patients with acute HZ, and this effect might be related to the reduction of serum IL-6, IL-8 and SP levels.


Assuntos
Terapia por Acupuntura , Acupuntura , Herpes Zoster , Moxibustão , Pontos de Acupuntura , Herpes Zoster/terapia , Humanos , Resultado do Tratamento
15.
Zhongguo Zhen Jiu ; 41(6): 615-20, 2021 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-34085477

RESUMO

OBJECTIVE: To observe the effect of five-element acupuncture on the cognitive function repair of migraine patients with depression/anxiety disorder. METHODS: The migraine patients with depression/anxiety disorder (19 cases, 5 cases dropped off) were taken as the observation group, and received five-element acupuncture twice a week for 8 weeks. Healthy subjects (19 cases) were selected by demographic data matching as the control group. The cognitive function was evaluated with the event related potential (ERP) technique, and the latency and amplitude of visual evoked potential P300 were adopted as the observation indexes. The headache days (every 4 weeks), headache intensity [visual analogue scale(VAS) score], and headache impact test-6 (HIT-6) score, Hamilton depression scale (HAMD) score and Hamilton anxiety scale (HAMA) score were used as the observation indexes for curative effect. RESULTS: Before the treatment, latency of target stimulus at Fz [ (417.5±34.3) ms] in the observation group was extended compared with the healthy subjects of the control group [(388.6±42.1) ms, P<0.05]. In the observation group, the latency of each point target stimulus [Fz: (376.1±36.2) ms, F3: (374.8±37.6) ms, F4: (372.0±37.6) ms] after treatment were shorter than those [Fz: (417.5±34.3) ms, F3: (417.4±33.8) ms, F4: (416.0±36.6) ms] before treatment (P<0.05). Before and after treatment, there was no significant difference in the amplitude of each point between the observation group and the control group (P>0.05). In the observation group, the headache days was shorter than that before treatment (P<0.01), and the VAS score, HIT-6 score, HAMD score and HAMA score were all lower than before treatment (P<0.01). CONCLUSION: There are some cognitive impairments in migraine patients with depression/anxiety disorder. Five-element acupuncture not only relieves headache, anxiety and depression effectively, but also improves the activation level of the frontal lobe. It significantly repairs the impaired cognitive function.


Assuntos
Terapia por Acupuntura , Transtornos de Enxaqueca , Pontos de Acupuntura , Transtornos de Ansiedade , Cognição , Depressão/terapia , Potenciais Evocados Visuais , Humanos , Transtornos de Enxaqueca/terapia , Resultado do Tratamento
16.
Zhongguo Zhen Jiu ; 41(6): 623-7, 2021 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-34085478

RESUMO

OBJECTIVE: To explore the efficacy and action mechanism of penetrating moxibustion at governor vessel for persistent allergic rhinitis of deficiency-cold syndrome. METHODS: Ninety patients with persistent allergic rhinitis of deficiency-cold syndrome were randomly divided into an observation group (n = 45) and a control group (n = 45). The patients in the control group were treated with momethasone furoate nasal spray, 2 sprays per side per time, once a day. On the basis of treatment in the control group, the patients in the observation group were additionally treated with penetrating moxibustion at governor vessel, 2 h per treatment, once a week. Both groups were treated for 4 weeks. The TCM symptom score, visual analogue scale (VAS) score and rhinoconjunctivitis quality of life questionnaire (RQLQ) score were observed in the two groups before and after treatment. The serum level of immunoglobulin E (IgE) and complete blood count of eosinophil (EOS) were measured before and after treatment, and the clinical effects were compared. RESULTS: Compared before treatment, the TCM symptom scores, VAS scores, RQLQ scores, serum levels of IgE and complete blood count of EOS in the two groups were all reduced after treatment (P<0.05), and those in the observation group were lower than those in the control group (P<0.05). The total effective rate in the observation group was 95.6% (43/45), which was higher than 82.2% (37/45) in the control group (P<0.05). CONCLUSION: Based on the momethasone furoate nasal spray, the adjuvant treatment of penetrating moxibustion at governor vessel could significantly improve the clinical symptoms in patients with persistent allergic rhinitis of deficiency-cold syndrome, and its mechanism may be related to the regulation of immune disorder.


Assuntos
Moxibustão , Rinite Alérgica , Pontos de Acupuntura , Humanos , Qualidade de Vida , Rinite Alérgica/tratamento farmacológico , Síndrome , Resultado do Tratamento
17.
J Orthop Surg Res ; 16(1): 356, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074300

RESUMO

BACKGROUND: The coronavirus disease (COVID-19) pandemic has had a massive impact on individuals globally. The Chinese government has formulated effective response measures, and medical personnel have been actively responding to challenges associated with the epidemic prevention and control strategies. This study aimed to evaluate the effect of the implementation of a care transition pathway on patients that underwent joint replacement during the COVID-19 pandemic. METHODS: A quasi-experimental study was designed to evaluate the effect of implementing a care transition pathway for patients who underwent joint replacement during the COVID-19 pandemic in the orthopedic department of a tertiary care hospital in Beijing, China. Using a convenient sampling method, a total of 96 patients were selected. Of these, 51 patients who had undergone joint replacement in 2019 and received treatment via the routine nursing path were included in the control group. The remaining 45 patients who underwent joint replacement during the COVID-19 epidemic in 2020 and received therapy via the care transition pathway due to the implementation of epidemic prevention and control measures were included in the observation group. The quality of care transition was assessed by the Care Transition Measure (CTM), and patients were followed up 1 week after discharge. RESULTS: The observation group was determined to have better general self-care preparation, written planning materials, doctor-patient communication, health monitoring, and quality of care transition than the control group. CONCLUSIONS: A care transition pathway was developed to provide patients with care while transitioning through periods of treatment. It improved the patient perceptions of nursing quality. The COVID-19 pandemic is a huge challenge for health professionals, but we have the ability to improve features of workflows to provide the best possible patient care.


Assuntos
Artroplastia de Substituição/tendências , COVID-19/epidemiologia , Ensaios Clínicos Controlados não Aleatórios como Assunto/tendências , Procedimentos Ortopédicos/tendências , Centros de Atenção Terciária/tendências , Cuidado Transicional/tendências , Idoso , Artroplastia de Substituição/métodos , Artroplastia de Substituição/reabilitação , Pequim/epidemiologia , COVID-19/prevenção & controle , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto/métodos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/reabilitação , Pandemias , Resultado do Tratamento
18.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34083197

RESUMO

Coral reef aorta (CRA) is a rare condition with potentially devastating complications. It is characterised by atherosclerotic calcification and stenosis of the visceral part of the aorta, usually occurring at the juxtarenal or suprarenal locations, and causing refractory hypertension and renal dysfunction. Surgical intervention, which is the recommended definitive treatment, is associated with significant morbidity and mortality. Endovascular stenting has been reported to be an alternative management option. To the best of our knowledge, this is the first case report to describe medical management of a patient with CRA with diuretics and angiotensin receptor blockade without surgical treatment.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Doenças da Aorta , Diuréticos/uso terapêutico , Aorta , Humanos , Receptores de Angiotensina , Stents , Resultado do Tratamento
19.
BMC Ophthalmol ; 21(1): 247, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34088281

RESUMO

BACKGROUND: No studies have been reported on the efficacy and safety of long-term (≥12 months) use of topical tacrolimus for refractory ocular surface inflammation in pediatric patients. METHODS: Medical records of pediatric patients who were prescribed topical 0.02% tacrolimus ointment for refractory ocular surface inflammation between January of 2010 and March of 2018 were reviewed retrospectively. Changes in ocular surface signs during slit-lamp examination, clinical symptoms and concurrent steroid use were graded with a scoring system. The presence of side effects was also assessed. The changes in disease severity and patient symptoms were compared between baseline and after the treatment. RESULTS: Among 72 patients (55% males, mean age 10.8 ± 3.9 years, range 3 to 17 years), 25 patients (48% males, mean age 11.4 ± 3.9 years) fully recovered, resulting in discontinuance of the ointment treatment before 12 months. Six patients experienced intolerable burning sensation, which required treatment cessation. Cessation days of those who quit were 1,5,14,20,26, and 35 days. Seven patients were lost during follow-up. Thirty-four patients (56% males, mean age 11.2 ± 4.2 years, range 3 to 17 years) were treated with tacrolimus ointment for over 12 months (average 23.1 ± 19.1 months, range 12 to 98 months). During the follow-up period, all patients showed improved clinical signs and symptoms, and no adverse reaction was noted. CONCLUSIONS: Long-term maintenance of topical tacrolimus 0.02% ointment is safe and effective in improving refractory ocular surface inflammation in pediatric patients.


Assuntos
Imunossupressores , Tacrolimo , Criança , Feminino , Humanos , Lactente , Inflamação , Masculino , Pomadas , Estudos Retrospectivos , Resultado do Tratamento
20.
J Pak Med Assoc ; 71(5): 1420-1423, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34091626

RESUMO

OBJECTIVE: To evaluate the success rate of endoscopic endonasal dacryocystorhinostomy. METHODS: The prospective cohort study was conducted at the Ophthalmology and Otorhinolaryngology departments, Shifa Foundation Community Health Centre, Islamabad, Pakistan, from October 2017 to September 2019, and comprised chronic dacryocystitis patients who underwent endoscopic endonasal dacryocystorhinostomy. Endoscopic dacryocystorhinostomy with or without lacrimal intubation was performed under general anaesthesia. The patients were followed up post-operative at 1 week, 1 month, 6 months and 12 months. Data was analysed using SPSS 20. RESULTS: Of the 47 patients, 41(87.2%) were females. The overall mean age was 40.70±10.84 years (range: 25-66 years). Lacrimal intubation was performed in 31(66%) patients. Surgical success was achieved in 46(97.9%) patients. Of them, 37(78.7%) patients were completely symptom-free, while 9(19.1%) were partially symptomatic and were managed conservatively. Treatment failure requiring repeat surgical procedure was the case with 1(2.1%) patient. Procedure failure was more likely in patients with previous attacks of acute dacryocystitis (p=0.003). CONCLUSIONS: Endoscopic dacryocystorhinostomy was found to be a safe procedure with good anatomical and functional outcomes in chronic dacryocystitis patients.


Assuntos
Dacriocistorinostomia , Adulto , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Estudos Prospectivos , Resultado do Tratamento
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