Hipo (singulto) persistente como manifestación clínica inicial de infección por SARS-COV-2 / Persistent hiccup as initial clinical manifestation of SARS-CoV-2 infection

Resumen La infección por SARS-CoV-2 se presenta generalmente como un síndrome respiratorio agudo, caracterizado por fiebre, tos, odinofagia y disnea. Sin embargo, desde el comienzo de la pandemia, a fines del año 2019, fueron reportados otros síntomas menos frecuentes, como manifestación inicial de la en fermedad, entre ellos la aparición de hipo (singulto). Se describe el caso de un varón de 62 años de edad con antecedentes de hipertensión arterial, diabetes e insuficiencia cardiaca, que sufrió hipo persistente como primer síntoma de COVD-19, seguido de síntomas respiratorios. Luego de efectuado el diagnóstico de infección por SARS-CoV-2, el paciente fue hospitalizado y recibió el tratamiento correspondiente. El singulto mejoró parcial mente con el uso de fármacos anti-dopaminérgicos (metoclopramida) y desapareció al sexto día de internación. Se requirió la corrección de la glucemia con insulina corriente. Evolucionó favorablemente y fue externado luego de 14 días de hospitalización.

Abstract SARS-CoV-2 infection usually manifests as an acute respiratory syndrome, characterized by fever, cough, sore throat and dyspnea. Nonetheless, since the beginning of the pandemic in December 2019, less frequent initial symptoms were reported, as the sudden appearance of hiccups (singultus). We describe a clinical case of a 62-year-old male with a medical history of arterial hypertension, diabetes and chronic cardiac insufficiency, who complained of persistent hiccups as initial manifestation of COVID-19, followed by respiratory symptoms. After the SARS-CoV-2 infection diagnosis was made, the patient was hospitalized, receiving the corresponding treat ment. The singultus partially improved with dopaminergic antagonists and it disappeared on the sixth day of hospitalization. Glycemic correction with regular insulin was required. He presented a favorable outcome, being discharged after 14 days of hospitalization.

Design and application of a push-pull adjustable artificial dead space / 中华危重病急救医学

Using artificial dead space to correct hypocapnia or induce hypercapnia is of particular significance for diagnosing and treating specific neurocritical diseases. At present, the above purpose is mainly achieved by adding an extension tube between the Y-type connector of the ventilator and the artificial airway in clinical practice. However, its volume is often fixed and cannot adapt to the individualized diagnosis and treatment in different clinical scenarios. The research group led by Professor Zhou Jianxin from the department of critical care medicine of Beijing Tiantan Hospital, Capital Medical University, has designed an artificial dead cavity with adjustable volume based on years of research in the respiratory field and has been granted a national utility model patent (patent number: ZL 2020 2 0496413.4). The artificial dead chamber is simple in structure, composed of a barrel body, a piston head, and a push-pull rod. By freely adjusting the size of the artificial dead chamber volume, it can accurately regulate the target carbon dioxide, correct the spontaneous hyperventilation, terminate intractable hiccup, and shorten the operation time of asphyxia test in clinical diagnosis of brain death while correcting hypocapnia or inducing hypercapnia. It has the advantages of solid reliability, convenient operation, and low production cost, which significantly facilitates scientific research and clinical diagnosis and treatment.

Analysis of Molecular Mechanism of Dingxiang Shiditang for Hiccup and Vomit Based on Integrated Pharmacology / 中国实验方剂学杂志

Objective: The classical formula of Dingxiang Shiditang can be used for hiccup and vomit which caused by many reasons,its molecular mechanism of this formula was investigated.Method: Based on the integrated pharmacology platform of traditional Chinese medicine,the potential molecular mechanism of Dingxiang Shiditang was revealed from the dimensions of multi-components and multi-targets.Result: There were 89 compounds related to hiccup and vomit of Dingxiang Shiditang,and there was 1 common target[cannabinoid receptor 1(CNR1)].On the one hand,CNR1 could inhibit the occurrence of hiccup and vomit by inhibiting the release of γ-aminobutyric acid(GABA),dopamine,5-hydroxytryptamine(5-HT);on the other hand,CNR1 could inhibit gastrointestinal motility and delay gastric emptying,and it was speculated that CNR1 may play a role in regulating gastrointestinal motility through brain-gut axis.Meanwhile,the mechanism of Dingxiang Shiditang may be related to nucleotide metabolism and nervous system.Conclusion: Dingxiang Shiditang may regulate gastrointestinal motility by affecting the release of neurotransmitters,mitochondrial energy metabolism,and achieve its effect on hiccup and vomit based on the joint intervention of multiple targets and multiple pathways.

Rule of acupoint combination in acupuncture treatment of hiccup: a study based on complex network analysis / 针刺研究

OBJECTIVE: To explore the rule of acupoint combination in acupuncture treatment of hiccups. METHODS: Original research articles on acupuncture treatment of hiccup were collected from databases of CNKI, Wanfang, VIP, and Pubmed by using key words of "hiccup", "acupuncture" "diaphragmatic spasm" "body acupuncture" "filiform needle" and "electroacupuncture". According to our inclusive and exclusive criteria, the collected data were extracted to establish an acupuncture prescription database for hiccup. Then, the regularities of acupoint combinations for hiccup were analyzed by using Gephi complex network analysis software. RESULTS: ;A total of 606 articles containing 634 acupoint prescriptions for acupuncture treatment of hiccups were brought into analysis. There were 133 single-acupoint prescriptions (20.98%), which was significantly lower than the multi-acupoint prescription (501, accounting for 79.02%). There were mainly acupoints in multi-acupoint prescriptions, and distal-proximal acupoint combination method were often used as the basis of acupoint selection (326, accounting for 65.07%). A total of 163 acupoints were involved, with a total frequency of 2 969. Among them, Neiguan(PC6) was used most frequently (400 times, accounting for 13.47%), followed by Zusanli (ST36), Zhongwan (CV12), Danzhong (CV17), and Taichong (LR3). The acupoints of the Conceptional Vessel(666 times, accounting for 22.43%), and Stomach Meridian, Pericardium Meridian and Liver Meridian were chiefly used. There were 67 specific acupoints, the frequency of use was 2 555 times(accounting for 86.05% of the total frequency), among which the frequency of the five Shu-points was the highest (875 times, accounting for 29.47% of the total frequency), and followed by eight confluence points. CONCLUSION: ;The core acupoints are PC6, ST36, CV12, etc. and the distal-proximal acupoint combination method found in this study are often used as the basis of acupoint selection and acupoint prescription for acupuncture treatment of hiccup.

Observations on the Efficacy of Scalp Acupuncture with Strong Stimulation in Treating Intractable Hiccup / 上海针灸杂志

Objective To investigate the efficacy of scalp acupuncture with strong stimulation plus oral hiccup decoction in treating intractable hiccup. Method One hundred patients with intractable hiccup were allocated, using a random number table, to treatment and control groups, 50 cases each. In addition to oral hiccup decoction in the two groups, the treatment group received scalp acupuncture with strong stimulation at the stomach and chest areas and the control group, electroacupuncture, for two courses of treatment. The times to produce the effect and the symptom frequency scores were compared between the two groups. Result After one course of treatment, the cure rate, the cure and marked efficacy rate and the total efficacy rate were 42％, 66％ and 78％, respectively, in the treatment group and 24％, 40％ and 68％, respectively, in the control group. There were statistically significant difference in the cure rate and the cure and marked efficacy rate (P<0.05) but no in the total efficacy rate (P>0.05) between the two groups. After two courses of treatment, the cure rate, the cure and marked efficacy rate and the total efficacy rate were 68％, 78％ and 88％, respectively, in the treatment group and 40％, 60％ and 74％, respectively, in the control group. There were statistically significant difference in the cure rate (P<0.05) but no in the cure and marked efficacy rate and the total efficacy rate (P>0.05) between the two groups. After one and two courses of treatment, there was a statistically significant difference in the hiccup frequency score between the treatment and control groups (P<0.05). The time to produce the effect was 2-5 hrs in the treatment group and 5-8 hrs in the control group. Conclusion The total efficacy rate of scalp acupuncture with strong stimulation for intractable hiccup is not significantly different from that of electroacupuncture, but the cure rate of the former was significantly higher than that of the latter. Scalp acupuncture with strong stimulation can produce a quick effect, reduce the frequency of hiccups and relieve symptoms accompanying hiccup.

Psychogenic Hiccups – a case report

Hiccups are a common occurrence which may be many a time organic in nature. We present herewith thecase of a 20 year old girl that presented with hiccups of a psychogenic in nature. The patient’s case isdiscussed as the patient responded to a combination of medical and psychological interventions.

Zoster Laryngitis with Multiple Cranial Nerve Palsy Progressed as Ascending Involvement

BACKGROUND: Herpes zoster of the head and neck commonly presents with Ramsay Hunt syndrome. However, vesicular eruptions may occur on the pharyngeal or laryngeal area with multiple lower cranial-nerve (CN) palsy. CASE REPORT: We report on the case of a 54-year-old man with herpes zoster of the pharynx and larynx with multiple CN palsy and persistent hiccups. He initially developed progressive dysphagia, hoarseness, and persistent hiccups (CN IX and X). After admission, Dizziness, hearing impairment, and peripheral facial palsy (CN VII and VIII) were complicated. The results of a polymerase chain reaction test of saliva and vesicular fluid from the ear and throat were strongly positive for varicella zoster virus. The progression of CN palsy was in an ascending sequence. CONCLUSION: We suggest that the sequence of CN palsy may be either ascending or descending, depending on the initial site of involvement.

Treatment of Lung Cancer-Related Intractable Hiccups Using Pulsed Radiofrequency: Clinical Experience / 한국호스피스완화의료학회지

While most benign hiccups can be controlled with empirical therapy, intractable hiccups lasting longer than one month tend to have significant adverse effects with obscure etiology. Treatment strategies for intractable hiccups have not been established. Only a few sporadic cases of bilateral phrenic nerve blockage have been reported. Here, we report a case of intractable hiccups that lasted five weeks in a 56-year-old male patient with a lung cancer above the right diaphragm. We hypothesized that his intractable hiccups were caused by irritation and mass effect caused by the lung cancer. We performed an ultrasound-guided right unilateral phrenic nerve pulsed radiofrequency treatment, and the patient's intractable hiccups were successfully managed without complication.

The Effects of Shiteito for Hiccups / 日本東洋医学雑誌

Persistent hiccups impair the quality of life of patients, and are sometimes difficult to treat. In our hospital, we usually use a shiteito decoction to treat hiccups, however, there are no published data about the effect of shiteito on hiccups. We retrospectively investigated patients with hiccups treated with a shiteito decoction as a first-line drug from February 1, 2014 to February 28, 2016. Twenty-seven patients were included (three women), and their ages ranged from 24 to 89 years (mean age : 65.4 ± 15.1 years). The shiteito decoction was completely or partially effective in 66.7% of all patients, and 59.3% of all patients completely recovered. In most cases, the hiccups disappeared within two days, and 88.9% of the patients with complete or partial recovery found the decoction to be effective within four days. Shiteito was an effective hiccup treatment, and since it could be easily administered at bedside, it would be useful regardless of patient pattern.

Therapeutic effect of cervical Jiaji electroacupuncture on postoperative intractable hiccup of liver neoplasms / 中华肿瘤杂志

Objective@#To evaluate the therapeutic effect of cervical Jiaji electroacupuncture on postoperative intractable hiccup of liver neoplasms.@*Methods@#A total of 39 patients with postoperative intractable hiccup of liver neoplasms in The First Affiliated Hospital of Heilongjiang University of Chinese Medicine from May 2013 to May 2017 were collected and divided into 2 groups randomly. The electroacupuncture group included 20 cases, the control group included 19 cases. Patients in the electroacupuncture group were treated by cervical Jiaji electroacupuncture (located in C3-5, sympathetic ganglion), while the control group were treated by metoclopramide combined with chlorpromazine for three days. The therapeutic effects of two groups were compared and the onset time were recorded.@*Results@#Total effective rates of electroacupuncture group and control group were 95.0% and 47.4%, respectively. The onset time in electroacupuncture group and control group were (14.8±3.3) h and (30.5±3.1) h, respectively (P<0.01). Ten cases who resisted the control treatment were then treated by electroacupuncture for 3 days, 6 cases were recovered, 3 cases became better, while 1 case demonstrated no response. No serious adverse reactions were appeared in each group.@*Conclusion@#Cervical Jiaji electroacupuncture is an effective and safe treatment for postoperative intractable hiccup of liver neoplasms, and it can be used as a remedy for intractable hiccup patients who don′t respond to drug treatment.

Stellate ganglion block for the treatment of intractable hiccups: A case report

Hiccups are an involuntary contraction of the diaphragm that may repeat several times per minute. In general, hiccups are very common, transient, and self-limited. However, if the condition persists longer than days or months, it impacts a patient's quality of life. Pharmacologic and non-pharmacologic methods are used for the treatment of persistent or intractable hiccups. Nerve block and stimulation have been shown to be effective through neural pathway interruption or stimulation of the hiccup reflex arc. Stellate ganglion block (SGB) is an injection of local anesthetic adjacent to a group of nerves in the neck known as the stellate ganglion. The authors report a case of SGB as an effective treatment for a patient with intractable hiccups resulting from right lateral medullary syndrome.

Phrenic Nerve Clipping in a Stroke Patient with Intractable Hiccup: a Case Report

Hiccup is an intermittent, involuntary and erratic contraction of the diaphragm, immediately followed by a laryngeal closure. Persistent and intractable hiccups are rare but severe, keeping a person from doing daily activities; these can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration. Therefore, proper treatments are necessary. We present a case with intractable hiccup treated with an unusual treatment. A 61-year-old man presented with intractable hiccups, which started 6 years ago after subarachnoid and intraventricular hemorrhage. Conventional pharmacologic treatments including metoclopramide, gabapentin, and baclofen were unsuccessful. Cooperating with cardiothoracic surgeons, phrenic nerve clipping operation was done under intraoperative electrophysiologic monitoring. This method was successful that the symptoms were relieved. Reversible clipping done under intraoperative electrophysiologic monitoring can be a promising therapeutic method for persistent and intractable hiccups in patients with stroke.

Two Cases of Refractory Hiccups Effectively Treated with Acupuncture at the Lump of Infraspinatus Muscle (Terasawa Point) / 日本東洋医学雑誌

Hiccups can sometimes become intractable. We report two cases of hiccups in which acupuncture practices to the lump of the infraspinatus muscle (Terasawa point) were effective. Case 1 was an 85-year-old male, an inpatient with bacterial pleuritis. His hiccups had persisted for 11 days. Several pharmacotherapeutic approaches were partially effective, but the hiccups were not completely abolished. In situ acupuncture therapy to bilateral Terasawa points was done, and his hiccups disappeared the next day. Case 2 was a 68-year-old male. He experienced insufficient sleep due to hiccups. We inserted needles into bilateral Terasawa points and heated the surrounding area with an electrothermo-acupuncture device using a curved heating plate. When this combination therapy was done, his hiccups disappeared during treatment. Acupuncture at the Terasawa point is one of the therapeutic approaches for hiccups and a rapid effect can be expected.

Clinical observation of integrated traditional Chinese and western medicine in the treatment of intractable hiccup caused by cerebrovascular disease Medicine / 中国基层医药

Objective To explore the clinical effect of integrated traditional Chinese and western medicine in the treatment of intractable hiccup caused by cerebrovascular disease.Methods A total of 74 patients with intractable hiccup caused by cerebrovascular disease were selected.The patients were randomly divided into observation group and control group according to random number table method.28 patients in the control group were given simple western medicine treatment.46 patients in the observation group were treated with integrated traditional Chinese and western medicine.The total effective rate and symptom improvement were observed after treatment.Results The total effective rate of observation group was 94.48%,that was 78.57% in the control group,the difference was statistically significant(x2=2.0,P<0.05).Conclusion Combined traditional Chinese and western medicine can significantly reduce intractable hiccup caused by cerebrovascular disease,improve total efficacy,improve the quality of life.

Ear-acupuncture therapy for intractable hiccups in the patients treated with endovascular embolization for bleeding from spontaneous rupture of liver cancer / 国际中医中药杂志

Objective To observe the therapeutic effect of ear-acupuncture therapy for intractable hiccups in the patients treated with endovascular embolization for bleeding from spontaneous rupture of liver cancer. Methods A total of 60 patients with intractable hiccups after endovascular embolization for bleeding from spontaneous rupture of liver cancer were randomly divided two groups using a random digit table, 30 in each group. The patients in the control group were treated breath holding combined with oral baclofen, and those in the observation group with ear-acupuncture therapy for 5 days, and then both groups were followed up for 1 week. The Karnofsky Performance Status Scale (KPS) was used for quality of life evaluation. The adverse events and recurrence during the treatment and the followed up were recorded. The therapeutic effect was evaluated. Results Total effective rate (100% vs. 76.7%; χ2=5.822, P=0.016)in the observation group was significantly higher than that in the control group. The rate of adverse events (6.7% vs. 33.3%; χ2=5.104, P=0.024)in the observation group were significantly lower than that in the control group. There was no significant difference in the KPS scores after treatment between the observation group and the control group (82.1 ± 12.6 vs. 76.5 ± 17.8; t=1.407, P=0.165). Conclusions Ear-acupuncture therapy may efficiently alleviate intractable hiccups in patients treated with endovascular embolization for bleeding from spontaneous rupture of liver cancer, and superior to breath holding combined with oral baclofen.

The clinical analyses of neuromyelitis optica spectrum disorder initially presenting with area postrema syndrome in 14 patients / 中华内科杂志

Objective To explore the clinical characteristics of the neuromyelitis optica spectrum disorders (NMOSD) with the area postrema syndrome as the initial symptom.Methods A total of 14 cases were enrolled in the study with the diagnose of NMOSD and the area postrema syndrome as the initial symptom.All the clinical data and imaging profiles by the contrasted magnetic resonance imaging (MRI) of the head and spinal cord were collected and analyzed.Results The median age of onset was (38.1 ± 17.0)years old and the gender ratio of female to male was 10:4.The serum aquaporin-4 (AQP4)-IgG was positive in 11 subjects and several autoimmune antibodies was positive in 7 subjects.The lesions revealed by MRI of the head mainly located in the area postrema and ependymal periphery which often presented as the linear medullary lesion,while linear lesions over three pieces of vertebra were shown by MRI of the spinal cord which mainly in the grey matter and with aH shape around the spinal central canal.Misdiagnose happened in 11 subjects with seven of gastroesophageal reflux disease,two of neurogenic vomiting,one of spinal cord tuberculosis and one of stroke.Conclusions NMOSD should be considered in patients with unexplained intractable nausea,vomiting and/or hiccups lasted for 48 hours or above,especially in those with positive nervous signs.Contrasted MRI and serum AQP4-IgG need to be performed in the suspected patients.Early detection is crucial for patients with NMOSD.

A study of lung protection in intensity?modulated radiotherapy with split field and fixed jaw techniques for peripheral lung cancer with mediastinal lymph node metastasis / 中华放射肿瘤学杂志

Objective To retrospectively design an intensity?modulated radiotherapy ( IMRT) plan with split field and fixed jaw techniques for peripheral lung cancer with mediastinal lymph node metastasis, to compare dosimetric characteristics between the IMRT plans with fixed jaw and dynamic jaw, and to study lung protection by the plan with split field and fixed jaw. Methods Treatment plans were collected from 12 patients with peripheral lung cancer and mediastinal lymph node metastasis who were treated with IMRT in our hospital. All plans used the dynamic jaw technique. The plans with split field and fixed jaw were designed based on the identical computed tomography images and planning target volume ( PTV) . Each jaw position in split field depended on each separate PTV. The prescription dose was 60 Gy in 30 fractions. 95%PTV was planned to receive 100% of the prescription dose. Dosimetric parameters of PTV, conformity index ( CI) , heterogeneity index ( HI) , number of monitor units ( MUs) , and dose?volume values of the lung and heart were obtained from dose?volume histogram. Comparison between the two plans was made by paired t test. Results Both plans met clinical requirements. There were no significant differences in D2 , D98 , CI, or HI of PTV between the two plans ( all P>005) . Compared with the dynamic jaw plan, the fixed jaw plan had MUs increased by 15%?20%( P=0010) . The V5 , V10 , V20 , V30 , and mean dose for the whole lungs were significantly lower in the fixed jaw plan than in the dynamic jaw plan ( P=0000, 0000, 0000, 0002,0000) . The V5 , V20 , and mean dose for the healthy lung were also significantly lower in the fixed jaw plan than in the dynamic jaw plan ( P=0000,0017,0000) . There were no significant differences in dose?volume values for the spinal cord or heart between the two plans ( all P>005) . Conclusions IMRT with split field and fixed jaw is recommended for patients with peripheral lung cancer and mediastinal lymph node metastasis. The therapy to a certain extent reduces low?dose volume for the lung and the incidence of radiation?induced pneumonitis.

Clinical observation of acupuncture combined with acupoint injection in the treatment of post -stroke intractable hiccup / 中国基层医药

Objective To observe the clinical therapeutic effect of acupuncture combined with acupoint injection in the treatment of post -stroke intractable hiccup.Methods 120 patients with post -stroke intractable hiccup were randomly divided into treatment group(60 cases)and control groups(60 cases)according to the digital table.The patients in the control group were treated with baclofen tablets and methloxetamine hydrochloride injection, and the patients in the treatment group were treated with acupuncture combined with acupoint injection therapy.The treating period was 1 week.The scores of hiccup symptoms,the total effective rate and side effect were recorded before and after the treatment in all patients.Results The scores of hiccup symptoms before treatment in the treatment group and the control group were (5.32 ±1.17)points and (5.25 ±0.65)points respectively,there was no statistically significant difference between the two groups(t =1.79,P =0.96).The scores of hiccup symptoms on the 1 day after treatment in the treatment group and the control group were (3.97 ±1.24)points and (3.85 ±1.02 )points respectively,there was no statistically significant difference between the two groups(t =1.93,P =0.48).The scores of hiccup symptoms on the 3 days after treatment in the treatment group and the control group were (2.80 ±0.73)points and (3.75 ±1.11)points respectively,there was significant difference between the two groups(t =2.66,P =0.00), that in the treatment group was lower than the control group.The scores of hiccup symptoms on the 5 days after treatment in the treatment group and the control group were (2.25 ±1.07)points and (3.43 ±0.81)points respec-tively,there was significant difference between the two groups(t =2.85,P =0.00),that in the treatment group was lower than the control group.The scores of hiccup symptoms on the 7 days after treatment in the treatment group and the control group were (1.27 ±0.66)points and (2.02 ±0.98)points respectively,there was significant difference between the two groups(t =1.07,P =0.00),that in the treatment group was lower than the control group.The total effective rates in the treatment group and the control group were 90%(54 /60)and 65%(39 /60)respectively,there was significant difference between the two groups(χ2 =10.75,P =0.00).The incidence rates of side effects in the treatment group and the control group were 1.7%(1 /60)and 6.7%(4 /60)respectively,there was no statistically significant difference between the two groups(χ2 =0.84,P =0.36).Conclusion Acupuncture combined with acu-point injection can significantly reduce the hiccup symptom score of post -stroke intractable hiccup patients on the 3, 5 and 7 days after treatment,and improve the total effective rate.

Persistent Hiccup Treated by Levetiracetam

No abstract available.

Hiccup Due to Aripiprazole Plus Methylphenidate Treatment in an Adolescent with Attention Deficit and Hyperactivity Disorder and Conduct Disorder: A Case Report

Our case had hiccups arising in an adolescent with the attention deficit and hyperactivity disorder (ADHD) and conduct disorder (CD) after adding aripiprazole treatment to extended-release methylphenidate. Actually, antipsychotics are also used in the treatment of hiccups, but studies suggest that they can cause hiccups as well. Within 12 hours of taking 2.5 mg aripiprazole added to extended-release methylphenidate at a dose of 54 mg/day, 16-year-old boy began having hiccups in the morning, which lasted after 3–4 hours. As a result, aripiprazole was discontinued and methylphenidate was continued alone because we could not convince the patient to use another additional drug due to this side effect. Subsequently, when his behavior got worsened day by day, his mother administered aripiprazole alone again at the dose of 2.5 mg/day at the weekend and continued treatment because hiccup did not occur again. But when it was administered with methylphenidate on Monday, hiccup started again next morning and lasted one hour at this time. In conclusion, we concluded that concurrent use of methylphenidate and aripiprazole in this adolescent led to hiccups.