ABSTRACT
La valoración crítica de la seguridad de los medicamentos homeopáticos se ha desarrollado recientemente. Esta cuestión es relevante para la toma de decisiones de los médicos, pacientes y dependencias regulatorias de fármacos. A pesar de la aparente inverosimilitud de la acción de los medicamentos homeopáticos debido a los procesos farmacotécnicos de la dilución y agitación empleados para su preparación, existen reportes en la literatura médica convencional sobre la toxicidad de los medicamentos homeopáticos, incluyendo eventos que aparentemente ponen en riesgo la vida. Las revisiones sistemáticas de estudios clínicos controlados aleatorizados muestran que los medicamentos homeopáticos provocan más efectos adversos que el placebo, aunque leves y transitorios. El establecimiento de un sistema de monitoreo en línea para la recolección de datos sobre los efectos adversos de los medicamentos homeopáticos, herbolarios o convencionales, es relevante para una evaluación no sesgada de la información reunida a partir de los consumidores y proveedores de atención médica.
Critical appraisal of the safety of homeopathic medicines developed recently. This matter is relevant for decision making by doctors, patients and drug regulatory agencies. Despite the apparent implausibility of the action of homeopathic medicines due to the pharmacotechnical processes of dilution and agitation used for their preparation, there are reports in the conventional medical literature on the toxicity of homeopathic medicines, including apparently life-threatening events. Systematic reviews of randomized controlled trials show that homeopathic medicines cause more adverse effects than placebo, albeit mild and transient. Establishing an online monitoring terapéusystem for collection of data on the adverse effects of homeopathic, herbal or conventional medicines is relevant for non-biased assessment of the information gathered from consumers and health care providers.
Subject(s)
/drug effects , Homeopathic Remedy , Patient SafetyABSTRACT
La valoración crítica de la seguridad de los medicamentos homeopáticos se ha desarrollado recientemente. Esta cuestión es relevante para la toma de decisiones de los médicos, pacientes y dependencias regulatorias de fármacos. A pesar de la aparente inverosimilitud de la acción de los medicamentos homeopáticos debido a los procesos farmacotécnicos de la dilución y agitación empleados para su preparación, existen reportes en la literatura médica convencional sobre la toxicidad de los medicamentos homeopáticos, incluyendo eventos que aparentemente ponen en riesgo la vida. Las revisiones sistemáticas de estudios clínicos controlados aleatorizados muestran que los medicamentos homeopáticos provocan más efectos adversos que el placebo, aunque leves y transitorios. El establecimiento de un sistema de monitoreo en línea para la recolección de datos sobre los efectos adversos de los medicamentos homeopáticos, herbolarios o convencionales, es relevante para una evaluación no sesgada de la información reunida a partir de los consumidores y proveedores de atención médica.
Critical appraisal of the safety of homeopathic medicines developed recently. This matter is relevant for decision making by doctors, patients and drug regulatory agencies. Despite the apparent implausibility of the action of homeopathic medicines due to the pharmacotechnical processes of dilution and agitation used for their preparation, there are reports in the conventional medical literature on the toxicity of homeopathic medicines, including apparently life-threatening events. Systematic reviews of randomized controlled trials show that homeopathic medicines cause more adverse effects than placebo, albeit mild and transient. Establishing an online monitoring terapéusystem for collection of data on the adverse effects of homeopathic, herbal or conventional medicines is relevant for non-biased assessment of the information gathered from consumers and health care providers.
Subject(s)
Homeopathic Remedy , Symptomatology , Homeopathic Therapeutics , BrazilABSTRACT
Resumen La fibrosis epidural es un hallazgo clínico y radiológico el cual se encuentra relacionado directamente en su génesis con los procedimientos quirúrgicos realizados en la columna vertebral. Esta patología es la causa más frecuente del síndrome de cirugía fallida de columna, manifestada clínicamente como un dolor equiparable en severidad al presentado previo a la intervención quirúrgica realizada. La fibrosis epidural es parte del proceso de cicatrización usual de los tejidos circundantes de la columna vertebral, en otras palabras, es esperable que esta suceda, sin embargo, solo una mínima cantidad de las personas intervenidas desarrollan clínicamente la sintomatología. La importancia del análisis de esta patología radica en que estas valoraciones son ingresadas al Departamento de Medicina Legal por asunto de reagravación de alguna secuela ocasionada por algún evento traumático. Es imprescindible conocer a profundidad los diferentes aspectos etiológicos, fisiopatológicos, clínicos, radiológicos y terapéuticos que involucran esta patología vertebral, así como, el respectivo análisis médico legal en este tipo de casos, tomando en consideración todos los elementos de juicio que permitan relacionar este hallazgo con algún hecho denunciado. En el presente artículo se realizará un análisis médico legal de un caso de reagravación por fibrosis epidural valorado en el Departamento de Medicina Legal de Costa Rica, donde el peritado interpone una denuncia contra el ente asegurador al ser rechazada la posibilidad de reapertura del riesgo laboral presentado.
Abstract The epidural fibrosis is a clinical and radiological finding that is related with the surgical procedures performed on the spine. This pathology is the most frequent cause of failed back syndrome or post laminectomy syndrome, that is clinically manifested by an acute pain comparable in severity with the surgical intervention. Epidural fibrosis is part of the usual healing process of the surrounding tissues of the spine, in other words, it's to be expected as a result of this procedures, nevertheless, only a small number of people who have been intervened, actually develop the symptoms clinically. The importance of this pathology lies in the fact that these assessments are attended in the Legal Medicine Department due to the aggravation issues of any sequel caused by a traumatic event. It is essential to know such things as the etiology, pathophysiology, clinical manifestations, radiological findings, and the therapeutic aspects that involve this vertebral disease, as well as, the respective forensic analysis, in order to use all the elements of judgment that allows to relate what is documented with the denounced findings.
Subject(s)
Humans , Male , Adult , Fibrosis , Epidural Space , Costa RicaABSTRACT
Objective@#To understand the situation and characteristics of out-patient utilization of urban and rural pneumoconiosis patients in Jiangsu province, and to provide a reference for the formulation of relevant policies.@*Methods@#Using a questionnaire on patients with pneumoconiosis and their influencing factors, 120 patients with pneumoconiosis were randomly selected in Nanjing, Wuxi, Suzhou, Yancheng Vocational Defense Institute or CDC. The rate of outpatients with pneumoconiosis in urban and rural areas and the choice of out-patient hospitals were analyzed.@*Results@#Of the 75 patients with severe pneumoconi-related symptoms such as chest tightness and dyspnea in the first two weeks of the survey, 36 (48.0%) lived in cities and 39 (52.0%) lived in rural areas. Patients with pneumoconiosis who live in urban and rural areas have different aggravating conditions within two weeks. Two weeks of aggravated symptoms in outpatient consultations accounted for36 (48.0%) . Of the 36 patients who used outpatient treatment, rural residents mainly chose 8 people from a hospital and a township health hospital, accounting for 34.8%, while 10 people from urban residents chose a nursing home or nursing home, accounting for 40.0%. The main reason why urban and rural pneumoconiosis patients did not go to the doctor is "conscious symptoms are lighter" and "feel that the doctor is useless."@*Conclusion@#The rate of outpatients with pneumoconiosis in Jiangsu province within two weeks is lower than that of ordinary elderly residents. There may be differences in treatment behavior patterns of urban and rural pneumoconiosis patients.Economic factors have a certain influence on the outpatient treatment behavior of pneumoconiosis patients. The recognition of outpatient service is the main factor affecting the outpatient treatment of pneumoconiosis patients. It is very important to popularize the knowledge of pneumoconiosis and do a good job in propaganda of occupational diseases and health education for pneumoconiosis patients. Focusing on the outpatient treatment of pneumoconiosis patients and making targeted medical policies is very important to standardize and improve the rehabilitation of pneumoconiosis patients.
ABSTRACT
PURPOSE: To investigate the various imaging factors associated with aggravation of lumbar disc herniation (LDH) and develop a scoring system for prediction of LDH aggravation. MATERIALS AND METHODS: From 2015 to 2017, we retrospectively reviewed the magnetic resonance imaging (MRI) findings of 60 patients (30 patients with aggravated LDH and 30 patients without any altered LDH). Imaging factors for MRI evaluation included the level of LDH, disc degeneration, back muscle atrophy, facet joint degeneration, ligamentum flavum thickness and interspinous ligament degeneration. Flexion-extension difference was measured with simple radiography. The scoring system was analyzed using receiver operating characteristic (ROC) analysis. RESULTS: The aggravated group manifested a higher grade of disc degeneration, back muscle atrophy and facet degeneration than the control group. The ligamentum flavum thickness in the aggravated group was thicker than in the group with unaltered LDH. The summation score was defined as the sum of the grade of disc degeneration, back muscle atrophy and facet joint degeneration. The area under the ROC curve showing the threshold value of the summation score for prediction of aggravation of LDH was 0.832 and the threshold value corresponded to 6.5. CONCLUSION: Disc degeneration, facet degeneration, back muscle atrophy and ligamentum flavum thickness are important factors in predicting aggravation of LDH and may facilitate the determination of treatment strategy in patients with LDH. The summation score is available as supplemental data.
Subject(s)
Humans , Atrophy , Back Muscles , Intervertebral Disc Degeneration , Ligaments , Ligamentum Flavum , Magnetic Resonance Imaging , Radiography , Retrospective Studies , ROC Curve , Zygapophyseal JointABSTRACT
Objective To investigate the clinical features of asthma at attack and chronic obstructive pulmonary disease (COPD) occurred at the same time (ACO),in elderly people for correct diagnosis and treatment of ACO.Methods A total of 102 elderly patients with either COPD or asthma who visited the Beijing Chaoyang Hospital from October 2010 to June 2016 were recruited for the study.Comparisons of clinical characteristics pulmonary function,airway inflammation and systemic inflammation,quality of life,acute aggravation,treatment and health care costs and comorbidity were carried out among the patients with COPD,asthma and ACO.Results ACO may present the features of both asthma and COPD.FEV1 and FEV1 FVC in ACO group (43.38±11.55)vs.(45.58±11.26) were significantly lower than those in asthma group(71.28±12.46) vs.(74.61±16.21) (P＜0.05),but there was no statistical difference between ACO group and COPD group (1.78±10.28)vs.(52.59±8.52)(P＞0.05).DLco in ACO group(61.86±13.53) was significantly lower than that in asthma group (86.28±16.54) (P＜0.05) and higher than that in COPD group(49.27±19.63) (P＜0.05).RV TLC in ACO group(49.85±12.59) was significantly higher than that in asthma group(29.58±1 5.43)(P＜0.05),but there was no statistical difference between ACO group and COPD group(52.65±1 1.58) (P＞＜0.05).Fractional exhaled nitric oxide(FeNO) in ACO group (29.37±10.85)was significantly lower than that in asthma group (40.18±11.86) (P＜0.05) and higher than that in COPD group(10.22±9.28) (P＜0.05).The proportion of patients with increased percentage of eosinophils in ACO group 25％ was significantly lower than that in asthma group 44.44％ (P＜0.05) and higher than that in COPD group 3.70％ (P＜0.05).The similar results were seen in IgE and C-reactive protein(CRP).There was significantly statistical difference in asthma control test(ACT) between ACO group and asthma group.There was significantly statistical difference in COPD assessment test(CAT) and the modified British Medical Research Council questionnaire (mMRC) scores between ACO group and COPD group;There was significantly statistical difference in six-minute walking distance (6MWD) among three groups(all P＜0.05).The number of acute exacerbations in ACO group (2.93±0.92) was significantly higher than that in asthma group(1.76±0.79)and COPD group(2.12±0.88) (F=14.09,P＜0.05).There was no statistical difference in treatment and health care costs among three groups(all P＞0.05).There were no statistically difference in comorbidity among three groups (all P＞0.05).Conclusions The clinical characteristics of ACO patients are different from those of COPD and asthma patients,It is necessary to understand the mechanism of ACO in order to improve the diagnosis and treatment.
ABSTRACT
When rubric is covered by a single remedy, the remedy is very useful for selection of similimum. Here I have tried to collect all the rubrics of urticaria having single remedy from Complete repertory.
ABSTRACT
Polycythemia vera (PV) is a chronic myeloproliferative disorder that is characterized by increased production of leukocytes, erythrocytes, and platelets. Arterial and venous thromobotic complications are common in the clinical course of this disorder. There have been a few reports of acute ischemic stroke with PV. A case of PV associated with progression of middle cerebral artery stenosis and recurrent ischemic stroke is presented herein.
Subject(s)
Blood Platelets , Cerebral Infarction , Constriction, Pathologic , Erythrocytes , Leukocytes , Middle Cerebral Artery , Myeloproliferative Disorders , Polycythemia Vera , Polycythemia , StrokeABSTRACT
BACKGROUND AND OBJECTIVES: When a disability is superimposed on a previous disability, the concept of aggravation of disability should be applied. In rating the disability for hearing loss, we focused on the aggravation of disability and the methods of assessment. SUBJECTS AND METHOD: For the past 12 years, we have provided legal advisory for 111 cases of hearing injury, for which disability had to be rated. In 11 of those 111 cases, disability was assessed in consideration of aggravation of disability. We assessed disability using three rating methods: they were based on 1) a change of hearing level from assumed normal, 2) apportionment of new hearing injury in final hearing, and 3) a change in disability rating. We evaluated for significant differences and correlations between the values obtained by each method. RESULTS: There was a significant difference between the results by the methods 1 and 2. The disability rating by the method 2 showed good correlations with those assessed by the methods 1 and 3. CONCLUSION: When considering aggravation of disability in hearing, the method 2 could be a good alternative when the standard method 3 is inappropriate.
Subject(s)
Disability Evaluation , Hearing , Hearing LossABSTRACT
While acute anemia is regarded as a precipitating factor of ischemic stroke, there have been few reports on the evolution of infarction in the acute period of ischemic stroke by anemia. We describe a 71-year-old man with acute multiple territory infarction who had progressive neurologic deficits of paraparesis and dysarthria. This case suggests that sustained severe anemia due to intractable intestinal bleeding is an important cause of aggravation of ischemic stroke.
Subject(s)
Anemia , Dysarthria , Hemorrhage , Infarction , Neurologic Manifestations , Paraparesis , Precipitating Factors , StrokeABSTRACT
Geriatrics develops relatively late in medical education, but geriatric medical education is rapidly rising for aggravation of the aging of population.And geriatric medical education is desired of the properties medical sciences, and is also the need of the development itself. Therefore, geriatric medical education should be internationalized, to eventually form distinctive education.
ABSTRACT
As more rheumatologists and dermatologists have begun to use biological agents such as TNF-alpha blocker, they have confronted an unexpected complication: psoriasis was paradoxically aggravated or induced by the TNF-alpha blocker. Although it is not a common complication of TNF-alpha blocker, this aggravation may be more common than previously thought. To our knowledge, most reports about TNF-alpha blocker-induced psoriasis have been limited to western countries while only a few cases have been reported in Korea and Japan. In addition, new onset of pustular psoriasis by TNF-alpha blocker has been reported more commonly than worsening of preexisting psoriasis. Now we report a patient whose preexisting psoriasis vulgaris was aggravated repeatedly after using the TNF-alpha blocker, infliximab, to control Crohn's disease, which is a rare rheumatologic disease in Korea.
Subject(s)
Humans , Antibodies, Monoclonal , Biological Factors , Crohn Disease , Japan , Korea , Psoriasis , Tumor Necrosis Factor-alpha , InfliximabABSTRACT
Many new antiepileptic drugs (AEDs) have been developed in the last two decades, contributing to the optimal treatment for childhood epilepsy. The goal of the treatment is to achieve seizure-free without any side effects, that deteriorates the quality of life by causing negative consequences. The new AEDs have not shown better efficacy, but generally seem to be better tolerated, having fewer systemic reactions and better pharmacokinetics than the established AEDs. The new AEDs have a broad spectrum of activities, which offer new opportunities to patients who have not shown any favorable responses to the established ones. There are more choices when trying to select AEDs for epileptic seizures and syndromes. Majority of the new AEDs have more than one action mechanism. AEDs acting selectively through the GABAergic system are tiagabine and vigabatrin; acting by inhibition of voltagedependent Na+ and Ca2+ channels are lamotirigine, oxcabarbazepine and topiramate; and acting by inhibition of glutamate-mediated excitation are felbamate, topiramate. The pharmacokinetic parameters of the new AEDs compared to the established AEDs, new AEDs have improved in terms of longer half-lives, permitting less frequent daily dosing, reduced potential for drug interactions. Considerations in selecting an AEDs are not only dependent on seizure types or syndromes, side effect profile, action mechanism, drug interaction, pharmacokinetic profile, facility of drug initiation, but also on age and sex of patients. Patients with worsened seizurefrequency or development of new types of seizure after the introduction of AEDs, should be questioned on the previously diagnosed seizure types or syndromes.
Subject(s)
Humans , Anticonvulsants , Drug Interactions , Epilepsy , Fructose , Nipecotic Acids , Phenylcarbamates , Propylene Glycols , Quality of Life , SeizuresABSTRACT
PURPOSE: To evaluate the relationship between focal aggravation of the macular edema on retinal thickness change analysis (RTCA) of optical coherence tomography (OCT) and fluorescein angiographic findings in patients after an intravitreal triamcinolone injection (IVTA). METHODS: From May 2004 to April 2005, RTCA in a fast macular thickness map (FMTM) of OCT was performed before and 4 weeks after IVTA in patients who had macular edemas caused by diabetic retinopathy and retinal vein occlusion. Patients underwent IVTA, and focal aggravation of the edema was detected. After overlapping the OCT findings onto angiographic pictures, the relationship between the focal aggravation on OCT and the leaking point on angiography was investigated. RESULT: In the patient group, focal aggravation was found in 5 of 27 eyes (18.5%); in the control group, only 2 of 30 eyes (6.7%) showed focal aggravation. As compared with angiographic pictures, 4 eyes with focal aggravation showed no relation to the leakage on angiography. CONCLUSIONS: Focal aggravation of macular edemas after IVTA on RTCA are not related to the leakage on angiography and could be an error from several artifacts.
Subject(s)
Humans , Angiography , Artifacts , Diabetic Retinopathy , Edema , Eye , Fluorescein , Macular Edema , Retinal Vein Occlusion , Retinaldehyde , Tomography, Optical Coherence , TriamcinoloneABSTRACT
Acoustic neurinoma are the most frequent tumors in the region of the cerebellopontine angle. They usually present with a gradual onset of symptoms and slow progression. Development of spontaneous hemorrhage with sudden aggravation of symptoms is rare. The authors present a case of acoustic neurinoma associated with a spontaneous intratumoral hemorrhage. Sudden aggravation of symptoms was noticed. The cranial computed tomography revealed multiple blood-fluid levels within the cysts of the tumor which was located in the region of the right cerebellopontine angle. Operation was performed, which confirmed recent hemorrhage within the tumor. Pathological study revealed a typical neurilemmoma associated with hemorrhage, vascular proliferation and macrophages which phagocytosed hemosiderin pigments. The rare sudden aggravation of symptoms in cases of acoustic neurinoma may suggest hemorrhage.