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RESUMEN Fundamento: el síndrome de Kounis se caracteriza por la aparición de eventos coronarios agudos en el contexto de una reacción de hipersensibilidad, descrito por Nicholas G Kounis y GM Zavras en 1991, los investigadores manifiestan que, aunque no es habitual su diagnóstico, pudiera no ser una afección rara, sino infradiagnosticada. En la actualidad se carece de guías de práctica clínica para su adecuado manejo. Objetivo: actualizar los conocimientos sobre el síndrome de Kounis. Métodos: se realizó una revisión bibliográfica a través de los motores de búsqueda en Internet, Google Scholar y ResearchGate, se consultaron las bases de datos Pubmed, SciELO y Clinicalkey. Se utilizó el descriptor en ciencia de salud: síndrome de Kounis para la obtención de la información en artículos de elevado índice de citación, publicados hasta mayo del 2019 en los idiomas español o inglés. Se seleccionaron 53 artículos como citas, la mayoría de los últimos cinco años, 30 fueron reportes de caso y se utilizaron cuatro libros. Resultados: se aborda la evolución histórica del síndrome de Kounis desde su descripción inicial hasta la actualidad, así como su clasificación, manifestaciones clínicas, exámenes diagnósticos y tratamiento. Conclusiones: el síndrome de Kounis pudiera no ser una afección rara, sino infradiagnosticada. Sus mecanismos fisiopatológicos son diversos, complejos y están en estudio. Para el diagnóstico, se debe tener un alto índice de sospecha en el contexto de un paciente con anafilaxia y síndrome coronario agudo, este se basará en una adecuada evaluación clínica y exámenes complementarios. El facultativo debe mostrar gran pericia a la hora de conciliar la terapia, pues los fármacos que se utilizan en el síndrome coronario agudo pueden empeorar la anafilaxia y viceversa. Se necesitan guías de práctica clínica para su adecuado manejo.
ABSTRACT Background: Kounis syndrome is characterized by the appearance of acute coronary events in the context of a hypersensitivity reaction, described by Nicholas G Kounis and GM Zavras in 1991, the researchers state that, although its diagnosis is unusual, it may not be a rare condition, but underdiagnosed. Currently, there are no clinical practice guidelines for proper management. Objective: to update knowledge about Kounis syndrome. Methods: a bibliographic review was performed through the Internet search engines, Google Scholar and ResearchGate, the Pubmed, SciELO and Clinicalkey databases were consulted. The descriptor in health science: Kounis syndrome was used to obtain the information in articles with a high citation index, published until May 2019 in the Spanish or English languages. From them, 53 quotes were selected for review, most of them from last five years, 30 were case reports, and four books were used. Results: the historical evolution of Kounis syndrome is addressed from its initial description to the present, as well as its classification, clinical manifestations, diagnostic tests and treatment. Conclusions: Kounis syndrome may not be a rare condition, but underdiagnosed. Its pathophysiological mechanisms are diverse, complex and are under study. For the diagnosis, a high index of suspicion must be taken in the context of a patient with anaphylaxis and acute coronary syndrome, this will be based on an adequate clinical evaluation and complementary examinations. The practitioner must show great expertise in reconciling therapy, since the drugs used in acute coronary syndrome can worsen anaphylaxis and vice versa. Clinical practice guidelines areneeded for proper management.
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@#Sjögren's syndrome(SS)is a complex connective tissue disease, with an incidence only secondary to rheumatoid arthritis. The initial record was case reports in the late 19th century. In 1930, Henrik Sjögren proposed the conception of “Keratoconjunctivitis Sicca”for the first time, and preliminarily realized that SS was a systemic disease. Subsequently, the discovery of specific autoantibodies and the application of labial biopsy technique significantly improved the accuracy for SS diagnosis. As the understanding the disease improving, different classification criteria were proposed to improve the diagnostic accuracy. However, there still no classification criteria that can be applied as diagnostic criteria so far due to uncovered pathological mechanism of the disease. Currently, comprehensive managements are required with the cooperation of rheumatology, ophthalmology, and stomatology department. Further exploration of the pathogenesis and development of new diagnostic tools are expected to improve the diagnosis of SS. The paper aims to review the development of the classification criteria and to propose new ophthalmic examinations in order to improve the diagnosis of SS.
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This study preliminarily discussed the TCM syndrome types of myasthenia gravis (or flaccidity) and its treatments and prescriptions through consensus method,providing evidence and level revision of the recommended expert consensus of myasthenia gravis in TCM clinical practice guideline.Literatures over TCM syndrome types,symptoms,therapeutic regime,medication and acupuncture were involved in the syndrome analysis of myasthenia gravis through literature retrieval.The common clinical syndromes were outputted by mentioned rate.Ten first-rate hospitals were finally included,such as The Affiliated Hospital of Changchun University of Traditional Chinese Medicine,Dongfang Hospital of Beijing University of Chinese Medicine,Guangdong Province Traditional Chinese Medical Hospital and Affiliated Hospital of Anhui University of Traditional Chinese Medicine.Twelve experts in aggregate were confirmed to participate in the discussion for the identification of the TCM syndrome types,treatments and prescriptions of myasthenia gravis.As a result,five TCM syndrome types,such as syndrome of spleen and stomach qi deficiency,syndrome of spleen-kidney deficiency,deficiency syndrome of both qi and yin,syndrome of deficiency and sinking of qi,were confirmed;while five therapeutic regimes were approved,including reinforcement of qi,tonification of spleen and stomach,tonification of spleen and kidney qi,tonification of qi and yin,the supplement of qi and restoration of yang for ascending qi collapse.In addition,five prescriptions were supported by the experts,such as Bu Zhong Yi Qi (BZYQ) decoction,BZYQ decoction combined with You Gui pills,BZYQ decoction combined with Sheng Mai powders and Sheng Xian decoction.In conclusion,the expert consensus method for the screen of TCM syndrome types of myasthenia gravis embodied the conception of literature research based on the clinical practice combined with the scientific methods in conformity with the current research approaches to TCM syndrome types.
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Objective To investigate the different immune status of TCM classification and the levels of T and B cells and the re-lationship between the NK cells .Methods Three different immune state of patients with chronic HBV were divided into asthenia syndrome(AS) group and sthenia syndrome(SS) group ,and then we detected the peripheral blood lymphocyte subsets and NK cells ,and compared the above each index analysis .Results In three different immune status ,all patients with AS and SS groups CD4+ T cell percentages are lower than normal control group (P control group> the AS group (P<0 .05) .Three different immune status ,the ratio of CD4+ /CD8+ SS group were significantly lower than the AS group or control group ,in a state of immune clearance the SS and the AS group B lymphocyte percentage were higher than the control group ,the percentage of NK cells was lower than the control group (P<0 .05) .Conclusion Chronic HBV infection have immune dysfunction ;HBV infected different immune status of TCM classification have relationship with T and B cell subsets and NK cells ,and the immune function test has certain clinical application value for the judgment of TCM syndrome type .
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The characteristics and advantages of traditional Chinese medicine ( TCM ) diagnosis and treatment of chronic liver diseases are conducted on the individualized treatment based on TCM syndrome classification . In this study , the analysis of systems biology was carried out for TCM syndrome classification in chronic hepatitis B and posthepatitic cirrhosis . The relationship between TCM syndrome classification and genetic polymorphism , the difference of genes and protein expression profiles , the difference of urine metabolite , and the molecular mechanism of Different TCM Syndrome for Same Disease and Same TCM Syndrome for Different Diseaseswere discussed . The results showed that there are molecular biological basis in TCM syndrome classification in hepatitis B and posthepatitic cirrhosis . The systems biology based syndrome identification methods may be bene-ficial to form a new classification , and provide reference for the diagnosis and individual therapy of hepatitis B and posthepatitic cirrhosis .
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Objective To study the classification and diagnosis of TCM syndromes of rheumatoid arthritis in the active stage by using variable clustering analysis. Methods Clinical data of 237 cases of rheumatoid arthritis in active stage, including symptoms, signs and manifestation of tongue and pulse, were recorded and dealt with cluster analysis. Results TCM syndromes in the patients were classified into four types, including pathogenic factor and depression in collaterals, intermingled phlegm and blood stasis, blokage due to damp-heat, blood stasis and qi deficiency, and main diagnostic points were determined for different syndromes initially. Conclusion The variable clustering analysis combined with expert’s opinion is helpful to study the classification of TCM syndromes and main diagnositic points of rheumatoid arthritis in active stage.
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Objective:To study the relationship between TCM constitution and differentiation of signs and symptoms for syndrome classification in patients with psoriasis vulgaris.Methods:According to associated standard in traditional and western medicine,psoriasis vulgaris patients were identified,the syndrome differentiation and PASI were performed.Results:Among 97 cases of psoriasis vulgaris,blood-heat syndrome was 45.4%,blood-dryness was 29.9%,blood stasis was 24.7%,the PASI of blood-heat was significantly more than that of blood-dryness(P
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The Subject of heart disease in TCM is a clinic subject specially to study heart system diseases.Because of its broad contents and complex syndromes,its treatment method is gradual and should follow the principle of individual symptom characteristics.In order to improve therapeutic effects for the treatment of these diseases,Professor Shen Shaogong raises a new method of "Modular Syndrome Classification" based on numbers of clinical experiences,and as well decides whole project.In this project,"Deficiency" includes three modules,and superficiality of Excess also includes three modules.In each unit,there are 1 host symptoms and 1 concurrently symptom,as well as tongue and pulse,especially tongue.In the treatment of heart system diseases,above items can be combined according to clinical appears to form symptom-complex.This combination method is called symptoms and signs differentiation and classification method,which can not only affect the actual pathological changes of diseases objectively,but also meet to various changes of diseases actively.So this method can make differentiation accuracy relatively.
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Objective:To probe the relationship between hepatitis B virus(HBV) variation and TCM syndrome types in HBeAg-negative patient of chronic hepatitis B.Methods:Eighty-four cases of HBeAg-negative patient of chronic hepatitis B were divided into 5 syndrome types according to TCM differentiation.C gene promoter (BCP area) and pre-C gene termination variation in HBV were detected with gene chip for HBV mutation detection.Results:There was no significant correlativity between generation of HBV variation and TCM syndrome types in HBeAg-negative patient of hepatitis B as compared with HBeAg-positive patient;The variation rate of the BCP area and/or the pre-C area was 34.5% in prevailing excess syndrome group and 65.5% in the prevailing deficiency group,the former being higher than the latter.Conclusion:There is correlativity between variation of BCP area and/or pre-C area and TCM syndrome types,with the variation rate of the excess syndrome being lower than that of the deficiency syndrome.
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Objective:To observe the ratio of the syndrome of deficiency in origin to the syndrome of excess in superficiality in chronic renal failure(CRF)and co-existent states,and to analyze the relationship between TCM syndrome types and related biochemical indexes.Methods:TCM syndrome differentiation was carried out and related biochemical indexes were determined in 146 cases of CRF.The data were compared and analyzed with single factor analysis of variance between groups.Results:(1)Deficiency of both qi and yin of spleen and kidney was the most frequently-appeared type in the deficiency syndrome,and damp-heat syndrome was the most frequently-appeared type in the excess syndrome;(2)Serum creatinine(SCr)and blood uria nitrogen(BUN)in the patient of damp-turbid syndrome in the excess syndrome were significantly higher than those in the patient of damp-heat and blood stasis syndrome;(3)Fibrin in the patient of blood stasis was significantly higher than that in damp-heat syndrome and damp-turbid syndrome.Conclusion:Generation and development of CRF are closely related with dampness syndrome,usually marked by syndrome of damp-turbid,damp-heat,blood stasis,damp-stagnation,and was mainly related with abnormal renal function and hemorheologic indexes in the biochemical indexes.
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Objective:To probe into relation between homocysteinemia and TCM syndrome types in the patient of coronary heart disease (CHD).Methods:60 cases of CHD were divided into following 3 syndromes:Qi-deficiency and blood stasis,stagnation of phlegm in heart vessels,deficiency of both Qi and Yin.Plasma hemotypic cysteine(Hcy)level in the patient of CHD and the normal person were detected with high pressure liquid chromatagraphy and fluorescent detector,and Hcy level of the various syndrome types was compared.Results:Hcy level in the patient of CHD was higher than that in the normal person(P
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Objective:To probe essence of TCM syndrome of gastric carcinoma from gene protein expression.Methods:Based on the collected data from pre-operative patients of gastric carcinoma,their TCM syndromes were determined by means of TCM syndrome classification criteria.E-cadherin gene protein expressions in tumor tissue after operation of gastric cancer were detected with EnVision two step immunohistochemical method.Results:The expression rate of E-cadherin was 90% in 100 cases of gastric carcinoma,with significant difference among different syndrome types(P
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Objective:To explore characteristics of TCM syndrome differentiation of graft versus host disease(GVHD)after transplantation of the hemopoietic stem cell,so as to provide basis of clinical syndrome differentiation for further studying on treatment of this disease.Methods:62 cases of GVHD were grouped according to acute or chronic GVHD,and a total of 85 cases-times were investigated for TCM syndrome differentiation.Results:in 50 cases-times of acute GVHD,damp heat type accounted for 68% and 50% have jaundice due to hepatic injury;blood-heat and Yin-deficiency accounted for 32%,with more patients of more severe condition.In 35 cases times of chronic GVHD,damp heat type accounted for 25.7% with more patients companied with Yin- deficiency,blood stasis and Yin-deficiency rate accounted for 74.3%.Conclusion:Commonly-seen basic TCM syndrome types of GVHD are damp-heat and Yin-deficiency types.Damp-heat type was more common in acute GVHD and blood-heat and Yin- deficiency type was.more frequently found in severe patients;chronic GVHD manifest mainly as Yin-deficiency type and with exacerbation of condition and prolongation of disease course,Yin-deficiency type tends to increase.