Diplejía facial en paciente con nefropatía por virus de inmunodeficiencia humana

Introducción: El síndrome de Guillain-Barré comprende un grupo heterogéneo de polirradiculoneuropatías inflamatorias agudas autoinmunes, las cuales se caracterizan por debilidad simétrica de extremidades con pérdida de reflejos miotáticos. Presenta gran variabilidad clínica, donde la afectación facial es habitual, sin embargo, incluye manifestaciones atípicas que dificultan el diagnóstico temprano de la enfermedad. Objetivo: Describir el comportamiento de un caso atípico de diplejía facial en un paciente con nefropatía por virus de inmunodeficiencia humana. Caso clínico: Se presentó el caso de un paciente portador de nefropatía por virus de la inmunodeficiencia humana, que comenzó con parálisis facial bilateral, como forma de presentación atípica de este síndrome. Acudió a los servicios de salud refiriendo decaimiento marcado, náuseas, vómitos, hipo y dos deposiciones líquidas. Se realizaron estudios que corroboran el diagnóstico. El tratamiento empleado facilitó la recuperación paulatina de la afección. Conclusiones: El diagnóstico precoz de las variantes atípicas de presentación del síndrome, permite un tratamiento oportuno, donde las posibilidades de complicaciones en el paciente son reducidas, así como la mortalidad asociada a la enfermedad.

Introduction: Guillain-Barré Syndrome comprises a heterogeneous group of autoimmune acute inflammatory polyradiculoneuropathies, which are characterized by symmetrical limb weakness with loss of stretch reflexes. It presents great clinical variability, where facial involvement is common; however, it includes atypical manifestations that make early diagnosis of the disease difficult. Objective: To describe the behavior of an atypical case of facial displejía in a patient with nephropathy due to Human Immunodeficiency Virus. Case report: A case of a patient with HIV nephropathy is presented, which begins with bilateral facial paralysis, as an atypical presentation of this syndrome. The patient went to the health services reporting marked weakness, nausea, vomiting, hiccups and two liquid stools. Studies were performed that corroborate the diagnosis. The treatment used facilitated the gradual recovery of the condition. Conclusions: Early diagnosis of the atypical presentation variants of the syndrome allows timely treatment, where the chances of complications in the patient are reduced, as well as the mortality associated with the disease.

Is it Always Laryngopharyngeal Reflux? How Voice Disorders Can Manifest as LPR

Introduction: Laryngopharyngeal reflux (LPR) manifests with a constellation of common throat symptoms and inconclusive signs on laryngoscopic exam. It is a diagnosis, often made clinically, that can lead to prescriptions of proton pump inhibitors that are unnecessary and potentially harmful. Glottic insufficiency (GI) and the accompanying hyperfunctional laryngeal behaviors can also present with similar, common throat complaints that may or may not include a qualitative change to the voice. Methods: This is a reflection article. It is written to summarize, explain, and support with evidence the opinion of the author on the topic of how symptoms of voice disorders can easily be mistaken for symptoms of LPR. The offered reflection is based on his experience, research and the available literature. Reflection: This article intends to explore the similarities between GI and LPR, how to ultimately differentiate them and how to approach treatment with a broader differential diagnosis. Conclusion: LPR and GI can present with identical, vague throat, and voice symptoms. Empiric medication trials, behavioral interventions and objective laryngovideostroboscopy, impedance-based reflux, and esophageal motility testing may all be needed, sometimes in a trial and error fashion, to correctly diagnose and treat a patient's symptoms.

Introducción: El reflujo laríngeo-faríngeo (LPR, por sus siglas en inglés) se manifiesta con una serie de síntomas comunes en la garganta y signos no concluyentes en el examen larinoscópico. Es un diagnóstico que a menudo se realiza clínicamente y que puede llevar a la prescripción de inhibidores de la bomba de protones que son innecesarios y potencialmente perjudiciales. La insuficiencia glótica (IG) y los comportamientos laríngeos hiperfuncionales que la acompañan también pueden presentar síntomas de garganta comunes similares, que pueden o no incluir un cambio cualitativo en la voz. Métodos: Este es un artículo de reflexión. Está escrito para resumir, explicar y respaldar con evidencia la opinión del autor sobre cómo los síntomas de los trastornos de la voz pueden confundirse fácilmente con los síntomas del LPR. La reflexión ofrecida se basa en su experiencia, investigación y la literatura disponible. Reflexión: Este artículo tiene la intención de explorar las similitudes entre la IG y el LPR, cómo diferenciarlos finalmente y cómo abordar el tratamiento con un diagnóstico diferencial más amplio. Conclusión: El LPR y la IG pueden presentar síntomas idénticos y vagos en la garganta y la voz. Puede ser necesario realizar ensayos de medicación empírica, intervenciones conductuales y pruebas objetivas de laringovideostroboscopia, reflujo basado en impedancia y motilidad esofágica, a veces de manera experimental, para diagnosticar y tratar correctamente los síntomas de un paciente.

Caracterización de complicaciones por otitis media aguda en el Hospital Clínico de la Pontificia Universidad Católica de Chile / Characterization of complications of acute otitis media at the Clinical Hospital of Pontificia Universidad Católica de Chile

Introducción: las complicaciones por otitis media aguda tienen una incidencia menor a un 1%. Aun así, se describe en literatura una mortalidad de un 5%. Actualmente existe escasa evidencia sobre estas complicaciones en nuestra realidad local. Objetivo: describir las de complicaciones de otitis media aguda según tipo, sexo, síntomas de ingreso, exámenes solicitados y tratamiento. Material y Métodos: estudio descriptivo retrospectivo de revisión de fichas clínicas que incluyó pacientes que ingresaron al Hospital Clínico de la Pontificia Universidad Católica de Chile con diagnóstico de otitis media aguda entre el 1 enero de 2000 hasta el 30 de julio de 2022. Resultados: se obtuvieron 71 pacientes ingresados por complicación de otitis media aguda. La edad media fue de 26,79 años, con 46 mujeres y 25 hombres. Se observaron complicaciones extracraneales, intracraneales y complicaciones simultáneas. Las complicaciones más frecuentes fueron la laberintitis y mastoiditis sin reportar casos de mortalidad. Discusión: actualmente existe escasa información sobre complicaciones de otitis media aguda y su epidemiología a nivel local. Las complicaciones extracraneales fueron más frecuentes: de ellas, la laberintitis y la mastoiditis agudas. El diagnóstico es clínico con apoyo de exámenes tanto de laboratorio, audiovestibulares e imágenes. Con respecto al tratamiento quirúrgico, se debe evaluar caso a caso y debe incluir miringotomía con o sin instalación de tubo de ventilación y mastoidectomía en casos refractarios. Es importante la sospecha y la derivación precoz

Introduction: Complications due to acute otitis media have an incidence of less than 1%. Nevertheless, it is described in the literature as having a 5% mortality rate. Currently, there is little evidence of these complications in our local reality. Objective: Describe the complications of acute otitis media based on its type, patient gender, admission symptoms, requested exams, and treatment. Material and Methods: Retrospective and descriptive study of patients' medical records admitted at the "Hospital Clínico de la Pontificia Universidad Católica de Chile" who were diagnosed with acute otitis media from January 1st, 2000, to July 30th, 2022. Results: There were 71 patients admitted due to complications of acute otitis media. On average, they were 26.29 years old; 46 were women, and 25 were men. Extracranial, intracranial, and simultaneous complications were observed. The most frequent ones were labyrinthitis and mastoiditis, without any mortality cases reported. Discussion: Currently, there is scarce information about the complications of acute otitis media and its local epidemiology. Extracranial complications were the most frequent: acute labyrinthitis and mastoiditis. The clinical diagnosis is supported by laboratory, audiovestibular, and image tests. Regarding surgical treatment, each patient must be evaluated independently. It should include myringotomy with or without a ventilation tube and mastoidectomy in refractory cases. It is crucial to detect it early and proceed with a medical referral.

Síndrome de Ramsay Hunt en paciente epiléptico en Santander, Colombia: Reporte de caso / Ramsay Hunt Syndrome in an epileptic patient in Santander, Colombia: Case report

El Síndrome de Ramsay Hunt es una entidad infrecuente, con una incidencia de 5 por cada 100.000 personas por año. Esta condición se caracteriza por una reactivación del virus de la varicela-zoster en el nervio facial. Su diagnóstico implica un reto para el médico puesto que suele ser netamente clínico, con la aparición de una triada consistente en: otalgia, parálisis facial ipsilateral y vesículas en el canal auditivo. El objetivo del artículo es presentar el caso de una mujer de 49 años de edad, con antecedente de epilepsia en tratamiento anticonvulsivante, quien ingresa con la triada clínica antes descrita, asociada a visión borrosa derecha y vértigo. La paciente fue tratada con antivirales y corticoides orales, presentando una resolución clínica favorable dado una reducción de más del 50% de las lesiones cutáneas. No se identificaron diferencias respecto a la presentación clínica de este síndrome al compararse con pacientes no epilépticos.

Ramsay Hunt Syndrome is a rare entity, with an incidence of 5 per 100,000 people per year. This condition is characterized by a reactivation of the varicella-zoster virus in the facial nerve. Its diagnosis implies a challenge for the physician since it is usually a clinical diagnosis, with the appearance of a clinical triad consisting of: otalgia, ipsilateral facial paralysis and vesicles in the ear canal. The objective of the article is to present the case of a 49-year-old woman, with a history of epilepsy receiving anticonvulsant treatment, who was admitted with the aforementioned clinical triad, associated with blurred right vision and vertigo. The patient was treated with oral antiviral management and oral corticosteroids, presenting a favorable clinical resolution given a reduction of more than 50% of the skin lesions. No differences were identified regarding the clinical presentation of this syndrome when compared with non-epileptic patients.

Split cricoideo anterior posterior: una novedosa técnica para evitar la traqueotomía en parálisis cordal bilateral en pacientes pediátricos / Posterior anterior cricoid split: a cutting-edge technique to avoid tracheostomy in bilateral cordal paralysis in pediatric patients

Introducción: La parálisis cordal bilateral en aducción es la segunda causa de estridor congénito y genera una grave obstrucción de la vía aérea, debutando con estridor. La traqueotomía ha sido durante mucho tiempo el gold estándar para el tratamiento de esta afección, no exenta de complicaciones. Existen procedimientos que intentan evitar la traqueotomía, como el split cricoideo anterior posterior endoscópico (SCAPE). Objetivo: Presentar experiencia con SCAPE en pacientes pediátricos como tratamiento alternativo de parálisis cordal bilateral en aducción. Material y Método: Análisis retrospectivo de los resultados quirúrgicos obtenidos en pacientes con parálisis cordal bilateral en aducción tratados con SCAPE entre enero de 2016 y diciembre de 2019 en el Hospital Guillermo Grant Benavente de Concepción, Chile. Resultados: Siete pacientes se sometieron a SCAPE. Todos los pacientes presentaban insuficiencia respiratoria severa, cinco requirieron asistencia ventilatoria mecánica. Seis pacientes tenían el diagnóstico de parálisis cordal bilateral (PCB) congénita y uno PCB secundaria a tumor de tronco cerebral. Cuatro pacientes presentaron comorbilidad de la vía aérea: dos pacientes presentaron estenosis subglótica grado I y dos pacientes presentaron laringomalacia que requirió manejo quirúrgico. Los días promedio de intubación fueron once días. Ningún paciente requirió soporte ventilatorio postoperatorio, sólo un paciente recibió oxigenoterapia nocturna debido a hipoventilación secundaria a lesión de tronco. Ningún paciente ha presentado descompensación respiratoria grave. Un 40% ha recuperado movilidad cordal bilateral. Conclusión: Split cricoideo anteroposterior endoscópico es una alternativa eficaz para tratar el PCB en pacientes pediátricos. Nuestro estudio evidencia que es una alternativa a la traqueotomía, con excelentes resultados y menor morbimortalidad.

Introduction: Bilateral vocal fold paralysis in adduction is the second cause of congenital stridor and generates a serious obstruction of the airway. Tracheostomy has long been the gold standard for the treatment of this condition, but it has inherent complications. There are procedures that try to avoid tracheotomy, such as the endoscopic anterior posterior cricoid split (EAPCS). Aim: Present our experience with EAPCS in pediatric patients as a treatment for bilateral vocal fold paralysis in adduction. Material and Method: Retrospective analysis of the surgical results obtained in patients with bilateral vocal cord paralysis in adduction treated with EAPCS between January 2016 and December 2019 at Guillermo Grant Benavente Hospital in Concepción, Chile. Results: Seven patients underwent EAPCS. All patients had severe respiratory failure, five required mechanical ventilation assistance. Six patients were diagnosed with congenital bilateral cord palsy (BCP) and one BCP secondary to a brainstem tumor. Four patients had airway comorbidity: two patients had grade I subglottic stenosis and two patients had laryngomalacia that required surgical management. The average days of intubation were eleven days. No patient required post op invasive/non-invasive ventilation, only one patient received nocturnal oxygen therapy due to hypoventilation secondary to trunk injury. None of the patients has presented severe respiratory decompensation. Forty percent have recovered bilateral chordal mobility. Conclusion: SCAPE is a cutting-edge and effective alternative to treat PCB in pediatric patients. Our study shows that it is an alternative to tracheotomy, with excellent results and lower morbidity and mortality.

Outcomes of endoscopic percutaneous suture lateralization for neonatal and infantal bilateral vocal ford paralysis

Abstract Objective: Bilateral Vocal Fold Paralysis (BVFP) is a rare but significant resource of respiratory distress in neonates and infants. The objective of this study was to evaluate the efficacy and functional outcomes of Endoscopic Percutaneous Suture Lateralization (EPSL) for the treatment of BVFP in neonates and infants. Methods: A case series study of nine patients undergoing EPSL for BVFP between January 2019 and June 2021 was conducted. All patients were candidates for tracheostomy prior to EPSL. Demographic features including gender, age at diagnosis and surgery, main symptoms, airway comorbidities, airway support, and etiology were collected preoperatively. Patients were evaluated for breathing, swallowing and phonation postoperatively. Surgical success was defined as the ability to avoid tracheostomy. Functional Endoscopic Evaluation of Swallowing (FEES) was conducted to identify aspiration. Voice evaluation was based on clinical observation. Results: Nine patients underwent ten EPSL procedures (one in the left vocal fold, and nine in the right vocal fold). Eight patients (8/9) were able to successfully avoid tracheostomy and feed orally without aspiration after the procedure. One patient experienced clinical improvement in respiratory support requirements and underwent laparoscopic nissen and gastrostomy tube placement. At the last follow-up, two patients regained normal voice, two patients had mild dysphonia, and five patients had moderate dysphonia. Five patients showed partial return of the contralateral vocal fold function. Conclusion: EPSL is an effective and safe treatment for neonatal and infantal BVFP, which enables patients free from tracheostomy without significant impact on swallowing function or phonation. Level of evidence: Level 4.

Rehabilitación del nervio recurrente laríngeo postiroidectomía / Recurrent laryngeal nerve rehabilitation after thyroidectomy

El carcinoma papilar tiroideo es el tipo de cáncer más común de esta glándula, y su tratamiento de elección es la tiroidectomía. Entre las complicaciones asociadas resalta la parálisis de las cuerdas vocales, la cual ocurre por una lesión directa del nervio laríngeo recurrente durante la cirugía. Se presenta una paciente de 22 años de edad con este diagnóstico, a la cual se le realizó una tiroidectomía total; en el postoperatorio inmediato la paciente comenzó con estridor laríngeo intenso que requirió una traqueotomía de urgencia. En el examen físico se constató una parálisis bilateral de las cuerdas vocales y se decidió comenzar un tratamiento de rehabilitación del nervio recurrente laríngeo con laserterapia y HIVAMAT-200 como modalidades combinadas. Los resultados alcanzados con la fisioterapia fueron satisfactorios y la paciente se reintegró rápidamente a su ámbito familiar, escolar y social.

Papillary thyroid carcinoma is the most common type of cancer of this gland, and its treatment of choice is thyroidectomy. Vocal cord paralysis stands out among the associated complications, in which a direct injury to the recurrent laryngeal nerve occurs during surgery. We present a 22-year-old female patient with this diagnosis, who underwent a total thyroidectomy; in the immediate postoperative period the patient began with intense laryngeal stridor requiring an emergency tracheotomy. Physical examination revealed bilateral vocal cord paralysis and it was decided to begin rehabilitation treatment of the recurrent laryngeal nerve with laser therapy and HIVAMAT-200 as combined modalities. The results achieved with physiotherapy were satisfactory and the patient was quickly reintegrated into her family, school and social environment.

Parálisis de Todd: un diagnóstico diferencial a tener siempre presente

La parálisis de Todd (PT) o parálisis postictal es un fenómeno descrito desde hace más de 100 años. La fisiopatología, sin embargo, sigue en la penumbra. Datos observados recientemente sugieren una mayor incidencia, probablemente como consecuencia del aumento de las publicaciones acerca de la PT. En este trabajo, se presenta un caso clínico de un joven de 39 años, con lesión orgánica en el hemisferio cerebral izquierdo. Manifiesta debilidad de hemicuerpo derecho y afasia. Para el diagnóstico, se condujo un cuidadoso análisis de la historia clínica del paciente, apoyado en una exhaustiva revisión de la literatura. Esta última sugiere que el fenómeno está subdiagnosticado a escala mundial.

Todd's paralysis (TP) or postictal palsy is a phenomenon described for more than 100 years. The pathophysiology, however, remains obscure. Recently observed data suggest a higher incidence, probably as a consequence of the increase in publications about TP. In this work, a clinical case of a 39-year-old man with organic lesion in the left cerebral hemisphere is presented. He manifests weakness of the right hemi-body and aphasia. For the diagnosis, a careful analysis of the patient's clinical history was conducted, supported by an exhaustive review of the literature. The latter suggests that the phenomenon is underdiagnosed on a global scale.

Molecular characterization & recombination analysis of complete enterovirus-88 isolated from acute flaccid paralysis cases in India

Background & objectives: Focus on non-polio enteroviruses (NPEVs) causing acute flaccid paralysis (AFP) due to myelitis has increased with the containment of the poliovirus. Enterovirus-B88 (EV-B88) has been associated with the AFP cases in Bangladesh, Ghana, South Africa, Thailand and India. In India, EV-B88 infection was linked to AFP a decade ago; however, to date, no complete genome has been made available. In this study, the complete genome sequence of EV-B88 was identified and reported from two different States (Bihar and Uttar Pradesh) in India using the next-generation sequencing technique. Methods: Virus isolation was performed on the three AFP suspected cases as per the WHO-recommended protocol. Samples showing cytopathic effects in the human Rhabdocarcinoma were labelled as NPEVs. Next-generation sequencing was performed on these NPEVs to identify the aetiological agent. The contiguous sequences (contigs) generated were identified, and reference-based mapping was performed. Results: EV-B88 sequences retrieved in our study were found to be 83 per cent similar to the EV-B88 isolate from Bangladesh in 2001 (strain: BAN01-10398; Accession number: AY843306.1). Recombination analyses of these samples demonstrate recombination events with sequences from echovirus-18 and echovirus-30. Interpretation & conclusions: Recombination events in the EV-B serotypes are known, and this work reconfirms the same for EV-B88 isolates also. This study is a step in increasing the awareness about EV-B88 in India and emphasizes future studies to be conducted in the identification of other types of EV present in India.

New Onset Facial Nerve Palsy : A Part of Post COVID Mucormycosis Disease Spectrum — A Descriptive Observational Study

Introduction : COVID Associated Mucor (CAM) is a well known entity with defined symptomatology. Cranial Nerve Palsy involving II, III, IV, V, VI th Nerve is common. Facial Nerve involvement is an out of tract presentation. The study was aimed to find the incidence of Facial Nerve involvement in CAM and document their route of involvement. Material and Method : Descriptive observational study was done in an Apex Centre for CAM in West Bengal between April, 2021 to January, 2022. CAM having Rhino-orbital-cerebral Mucormycosis (ROCM) and new onset Facial Palsy were considered. Participants were included following stipulated inclusion and exclusion criteria. Collected data was analysed. Observations : Total 11 patients of new onset Facial Palsy in COVID-19-Associated ROCM were included. 81.8% had coexisting other Cranial Nerve involvement. Facial Palsy was one of the primary presentations in the patients of ROCM. Discussion : CAM is angioinvasive and can cause concomitant hypoxic neural damage due to involvement of the vasa nervorum. Skull base involvement can be hypothesized to be the predominant route of Facial Nerve involvement. Facial palsy can be an important initial presentation of CAM. Conclusion : Facial Nerve Palsy may be a part of the spectrum of disease presentation in CAM.

Innovative strategies developed to mitigate the impact of COVID-19 pandemic on polio surveillance in Nigeria, 2020

Introduction: following the spread of the COVID-19 pandemic to Nigeria, the Federal Government of Nigeria restricted human and vehicular movements to curb the spread of the disease. This action had a negative impact on Acute Flaccid Paralysis (AFP) surveillance, with a resultant reduction in the number of AFP cases reported. This paper describes the impact of the COVID-19 pandemic on poliovirus surveillance in Nigeria and the proactive interventions by Nigeria´s polio program to mitigate the impact of COVID-19 on polio surveillance. Methods: nine innovative strategies were implemented in all 774 Local Government Areas (LGA) of the 36 states and Federal Capital Territory (FCT) of the country. These strategies were developed by the national surveillance officers and operationalized by sub-national surveillance officers with different strategies starting at different epidemiological weeks from week 14 to 23, 2020. Many of the strategy innovations were technology-based and included: the use of mobile phones to send the AFP case definition and video by WhatsApp or by SMS, the use of state-specific toll-free numbers and Mobile Telephone Network (MTN) (mobile service provider) CallerfeelTM to community informants (CI) who were the main targets of the interventions to increase case detection and reporting. Others included the use of abridged e-surveillance integrated supportive supervision (ISS) checklists, virtual monthly DSNO meetings, and batched AFP stool specimen transportation network. Results: compared to the same period in 2019, the cumulative rate of AFP case detection and reporting had gradually declined from 39.1% in January to 16.7% before the commencement of the interventions in week 20, 2020. However, the detection and reporting increased by 57.% from week 20 to week 47 compared to the same period in 2019. This is because with COVID-19, hospital visitation dropped, and the sick remained in the communities, so the CI network was relied on to detect and report AFP cases. The cumulative proportion of AFP cases reported by community informants as of week 47 increased from 13% in 2018 to 21% in 2020. This indicates an increase of 38%. Thirty-five AFP cases were detected and reported using the MTN Caller Feel strategy, while 15 cases were reported through state-specific toll-free numbers. Conclusion: the implementation of the innovative strategies was able to mitigate the low AFP case detection and reporting observed at the initial stage of the COVID-19 pandemic. The use of technology facilitated reaching the CI network, which was more instrumental in detecting and reporting the cases.

An epidemiological investigation on vaccine-hypervariable poliovirus in a case with acute flaccid paralysis in Zhejiang Province / 预防医学

Abstract@#Vaccine-hypervariable poliovirus type Ⅲ was detected in an acute flaccid paralysis infant at age of 6 months in Zhejiang Province in June, 2021, and the isolated and incubated virus had six nucleotide variations in the VP1 region as compared to the poliovirus Sabin vaccine strain. The infant had a history of three-dose poliovirus vaccination, and grade 2 muscle strength of the left upper limb upon onset. He was clinically diagnosed with cellulitis of the left shoulder, and recovered to normal following treatment. No abnormality was detected in the nervous system, and the infant was cured and discharged from hospital. No vaccine-hypervariable poliovirus was detected in subsequent infant' clinical samples or in close contacts, and no similar cases were identified during the active case detection by county/district medical institutions and among community populations. Since the infant did not present poliomyelitis-related clinical symptoms caused by vaccine-hypervariable poliovirus, poliomyelitis was excluded. The vaccine-hypervariable poliovirus was not spread because of timely identification and effective responses, suggesting the urgent need to maintain the sensitivity of the acute flaccid paralysis surveillance system and improve the coverage of poliovirus vaccination, so as to inhibit the transmission of poliovirus.

The consensus among experts on the diagnosis and treatment of pediatric vocal cord paralysis / 临床耳鼻咽喉头颈外科杂志

Pediatric vocal ford paralysis is a vocal cord movement disorder caused by damage to the pediatric laryngeal motor nerves.It is mainly characterized by voice, breathing,and swallowing difficulties,and in severe cases,it can lead to choking in affected children. Currently, the diagnosis and treatment of this condition pose a significant challenge for pediatric otolaryngologists, as the goal is to minimize damage to the vocal folds and laryngeal framework.In order to standardize the diagnosis and treatment of pediatric vocal cord paralysis, the Pediatric Otolaryngology Committee of the Chinese Medical Association,in collaboration with multiple children's medical centers nationwide, have formulated this consensus document.

Acupoint selection rules of staging, syndrome types, and symptoms of acupuncture for peripheral facial paralysis based on data mining / 中国针灸

OBJECTIVES@#To analyze and explore the acupoint selection rules of different staging, syndrome types, and symptoms of acupuncture for peripheral facial paralysis based on data mining.@*METHODS@#Literature regarding acupuncture for peripheral facial paralysis was retrieved in CNKI, VIP, Wanfang, SinoMed, and PubMed from January 1, 2012, to December 31, 2021. The Traditional Chinese Medicine Inheritance Assistant Platform (V 3.0), SPSS Modeler 18.0, and Cytoscape software were used to analyze the selection of acupoints based on staging, meridian distribution of acupoints, the selection of acupoints based on syndrome types, syndrome types based on staging, and symptom-based acupoint selection. Association rule analysis was performed for each stage and major syndrome types, and co-occurrence network diagrams were generated.@*RESULTS@#A total of 1 695 articles were included, involving 124 acupoints with a total frequency of 5 456 times. Among 1 080 articles related to staging-based acupoint selection, the acute stage had the highest acupoint use frequency (2 224 times) and number (88 acupoints). Among all stages, the acupoints of the stomach meridian of foot-yangming were most frequently used, with Dicang (ST 4)-Yangbai (GB 14) and Dicang (ST 4)-Jiache (ST 6) being the high-frequency acupoint pairs in each stage. The top four syndrome types in terms of acupoint usage frequency were wind-cold syndrome, wind-heat syndrome, qi-blood deficiency syndrome, and liver-gallbladder damp-heat syndrome. Among 521 articles combining staging with symptoms or syndrome types with symptoms for acupoint selection, the symptom "nasolabial groove becoming shallow or disappearing" had the highest frequency of occurrence. The symptoms with the highest acupoint usage frequency and number were "forehead wrinkles becoming shallow or disappearing" and "pain behind the ear" respectively.@*CONCLUSIONS@#Acupoint selection for peripheral facial paralysis primarily focuses on the yang meridians in each stage, supplemented by local acupoints and based on the pathological characteristics. Syndrome differentiation and treatment should be prioritized, combined with local acupoint selection. Clinical acupoint selection can be based on a combination of staging, syndrome types, and symptoms.

Features of different contemporary acupuncture and moxibustion schools in the treatment of post-stroke spastic paralysis / 中国针灸

Acupuncture and moxibustion has certain advantages in the treatment of post-stroke spastic paralysis，but the treatment methods and diagnosis and treatment ideas are complicated. This paper sortes out the representative contemporary acupuncture and moxibustion schools in the treatment of post-stroke spastic paralysis, analyzes their academic origins，summarizes and compares the theory，acupoint selection and technique characteristics of different schools in the diagnosis and treatment of this disease，so as to provide some references for guiding optimal treatment schemes selection in clinic.

Diagnosis and Treatment of Familial Hypokalemic Periodic Paralysis with Acidosis / 中山大学学报(医学科学版)

ObjectiveTo investigate the diagnosis and treatment of familial hypokalemic periodic paralysis with acidosis. MethodsThe proband's medical history， clinical manifestations， laboratory examinations and imaging characteristics were retrospectively analyzed， and prevalence situation of family members was investigated in detail. Next generation sequencing technology was used to detect the pathogenic gene loci related to periodic paralysis， and the relevant literatures were summarized. ResultsThe proband was definitely diagnosed as familial hypokalemic periodic paralysis. There was a heterozygous mutation in the SCN4A gene of the proband， which was c.2006G>A， resulting in amino acid changes R669H.The proband's grandfather， father and uncle shared the same variation. ConclusionsFamilial hypokalemic periodic paralysis with paroxysmal acidosis is rare， which is easily misdiagnosed as renal tubular acidosis. c 2006G>A mutation in SCN4A gene is the molecular basis of the disease in this family. The clinical phenotypes of different gene mutations are different， and gene screening is helpful for diagnosis and treatment.

Guidelines for management of pediatric acute hyperextension spinal cord injury / 中华创伤杂志(英文版)

Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.

Application status and analysis of Fu's subcutaneous needling in the treatment of peripheral facial paralysis / 中国针灸

This paper summarizes the status of application and research of Fu's subcutaneous needling for peripheral facial paralysis, and the characteristics of different stages of peripheral facial paralysis treated with Fu's subcutaneous needling are analyzed from the aspects of intervention timing, protocol design, needle insertion point, sweeping and reperfusion activity, tube retaining time and acupuncture frequency. It is found that there are no norms and standards in sweeping and reperfusion, tube retention and acupuncture frequency in clinical application，and the exploration of staged treatment is insufficient in the research. In the future, it is necessary to form standardized operation to promote clinical promotion, and improve the research on treatment rules and mechanism according to the characteristics of disease stage.

Basic and Clinical Research Review of the Effects of Acupuncture and Moxibustion on Peripheral Facial Nerve Paralysis / 全日本鍼灸学会雑誌

There is little common understanding among acupuncturists regarding the poor prognosis for peripheral facial paralysis, evaluation methods, precautions during treatment, including acupuncture and moxibustion treatment. Cooperation among relevant occupations is also a major issue. Currently, the treatment of paralysis is focused on how to minimize sequelae during the recovery process of paralysis in cases with poor prognosis. The goal is to prevent sequelae and improve patient quality of life (QOL). For that purpose, it is important to understand the guidelines for medical treatment of paralysis, and like other medical staff, the acupuncturist should provide appropriate medical examination, treatment, self-care guidance, etc., and cooperate with other medical specialists. We hope that this seminar will provide a common understanding of the pathophysiology and evaluation methods of paralysis, precautions for acupuncture and moxibustion treatment, and a consensus of clinical research and the future possibility of using acupuncture and moxibustion in the treatment of paralysis.

Case report of acupuncture and medication for a patient with bilateral peripheral facial paralysis as suspected case of neurosarcoidosis / 全日本鍼灸学会雑誌

[Objective] This report describes a patient with bilateral peripheral facial paralysis who was strongly suspected to have neurosarcoidosis and whose facial paralysis improved after acupuncture treatment.[Case] A 73-year-old man developed right facial nerve paralysis on July 24, X followed by left facial nerve paralysis three days later. The patient visited our Department of Neurology on August 2 and was hospitalized the next day. Upon examination, neurosarcoidosis was strongly suspected, and steroid pulse therapy was performed until he was discharged from the hospital on August 26. On September 13, still experiencing bilateral facial paralysis, the patient was referred to our department for acupuncture treatment. The patient's height was 159 cm and weight was 48.6 kg. Valley signs and pathologic reflexes were negative, and deep tendon reflexes and sensory tests of the upper and lower extremities were normal. MMT was fair only for the dorsiflexion movement of the left ankle. The Yanagihara score was 26 on the right and 10 on the left. Facial muscle contraction response to electrical acupuncture stimulation targeting the facial nerve showed contraction at 0.04 mA on the right side and no contraction at 0.30 mA on the left side. According to these examinations, the right side was considered to be mildly paralyzed and the left side was considered to be severely paralyzed, and acupuncture was performed to improve the symptoms of paralysis and prevent sequelae.[Treatment] Acupuncture was applied to GB2 and ST7 on the right side of the face. On the left side, acupuncture needles were placed on the frontalis muscle, orbicularis oculi muscle, elevator muscle of upper lip and wing of nose, nasalis muscle, zygomaticus major and minor muscle, orbicularis oris muscle, depressor angle oris muscle, and platysma muscle. From the 106th day of illness, asynchronous electroacupuncture was applied to the left side only. Acupuncture was performed once or twice a week for 10 minutes per session. The degree of paralysis was assessed by the Yanagihara score.[Progress] Acupuncture was combined with corticosteroids prescribed by the Department of Neurology. As a result, the right side had a score of 38 points after 170 days after start of illness and the left side had a score of 38 points after 204 days.[Discussion and Conclusion] The combined treatment of medication and acupuncture was effective and showed excellent results for this patient taking into account the degree of facial nerve damage. Acupuncture may be considered as an effective treatment option for bilateral peripheral facial paralysis.