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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Kumar G, Tewari S. Acupuncture for Management of Endodontic Emergencies: a Review. J Acupunct Meridian Stud 2023; 16:1-10. [PMID: 36804816 DOI: 10.51507/j.jams.2023.16.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 05/18/2022] [Accepted: 10/19/2022] [Indexed: 02/22/2023] Open
Abstract
Root canal treatment (RCT) employed for painful endodontic conditions like apical periodontitis and irreversible pulpitis is associated with a high incidence of postoperative pain. Pharmacological management for this purpose is effective, but not entirely free from side effects and in some cases may fail to provide adequate relief. Furthermore, concerns have been raised regarding the transmission of coronavirus disease-2019 (COVID-19) as a result of the aerosols generated and prolonged chair side time required for RCT. Acupuncture is a traditional Chinese therapy commonly employed as an alternative for the treatment of pain. And what's more, the use of acupuncture has been recently reported as treatment for the management of endodontic pain as well as on the anesthetic success in patients with irreversible pulpitis. This review aims to evaluate the current evidence for acupuncture in endodontics and its potential role in emergency pain relief and management for patients. To combat this, a thorough search for literature within the field was performed in five electronic databases. Retrieved studies were screened according to the pre-defined eligibility criteria. After both an electronic and manual search, five studies were selected for review. These studies reported the beneficial effects of acupuncture in reducing the failure of nerve block in patients with irreversible pulpitis and in controlling both intraoperative and postoperative pain following RCT. In addition, it was also reported to reduce anxiety surrounding the dental procedure and minimized the intake of analgesics after the endodontic procedure, which can result in some unwanted side effects. However, more in depth clinical research is required before any recommendation regarding the application of acupuncture in endodontic patients can be made.
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Affiliation(s)
- Gaurav Kumar
- Department of Conservative, Endodontics and Aesthetic Dentistry, Dental College, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sanjay Tewari
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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3
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Abstract
Acupuncture is a well-known form of complementary medicine that is increasingly being used worldwide. Despite being rare, pneumothorax is the most common serious complication described in acupuncture. A 79-year-old woman was admitted to the emergency department with a pneumothorax. Two days before, she had undergone an acupuncture treatment for chronic back pain. She felt a sharp right shoulder pain as needles were inserted in the interscapular area. As the pain did not resolve, she consulted her general practitioner and had a chest radiography done, revealing a right-sided pneumothorax. At the hospital, a right chest tube was inserted with relief of the symptoms and lung expansion. The chest tube was removed on the second day of admission, and she was discharged on the third day. Both acupuncturists and clinicians need to be aware of the possibility of adverse events following acupuncture, especially in those who develop symptoms.
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Affiliation(s)
- Sofia Costa Corado
- Serviço de Cirurgia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | | | - Luísa Quaresma
- Serviço de Cirurgia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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4
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Kong DZ, Liang N, Yang GL, Zhang Z, Liu Y, Yang Y, Liu YX, Wang QG, Zhang F, Zhang HY, Nikolova D, Jakobsen JC, Gluud C, Liu JP. Acupuncture for chronic hepatitis B. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- De Zhao Kong
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine; Department of Cardiology; Beiling Street 33 Shenyang Liaoning Province China 110032
- Liaoning University of Traditional Chinese Medicine; Co-construct Key Laboratory of Theory of Visceral Manifestations and Applications; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
| | - Ning Liang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
- Beijing University of Chinese Medicine; Centre for Evidence-Based Chinese Medicine; Bei San Huan Dong Lu 11, Chaoyang District Beijing China 100029
| | - Guan Lin Yang
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Zhe Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine; Chong Shan East Street 79 Shenyang Liaoning Province China 110032
| | - Yue Liu
- Liaoning University of Traditional Chinese Medicine; Co-construct Key Laboratory of Theory of Visceral Manifestations and Applications; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Ye Yang
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Yu Xi Liu
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Qi Ge Wang
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Fan Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine; Chong Shan East Street 79 Shenyang Liaoning Province China 110032
| | - Hui Yong Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine; Chong Shan East Street 79 Shenyang Liaoning Province China 110032
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
- Holbaek Hospital; Department of Cardiology; Holbaek Denmark 4300
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
| | - Jian Ping Liu
- Beijing University of Chinese Medicine; Centre for Evidence-Based Chinese Medicine; Bei San Huan Dong Lu 11, Chaoyang District Beijing China 100029
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5
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Morozov VA, Lagaye S. Hepatitis C virus: Morphogenesis, infection and therapy. World J Hepatol 2018; 10:186-212. [PMID: 29527256 PMCID: PMC5838439 DOI: 10.4254/wjh.v10.i2.186] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/11/2018] [Accepted: 02/07/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is a major cause of liver diseases including liver cirrhosis and hepatocellular carcinoma. Approximately 3% of the world population is infected with HCV. Thus, HCV infection is considered a public healthy challenge. It is worth mentioning, that the HCV prevalence is dependent on the countries with infection rates around 20% in high endemic countries. The review summarizes recent data on HCV molecular biology, the physiopathology of infection (immune-mediated liver damage, liver fibrosis and lipid metabolism), virus diagnostic and treatment. In addition, currently available in vitro, ex vivo and animal models to study the virus life cycle, virus pathogenesis and therapy are described. Understanding of both host and viral factors may in the future lead to creation of new approaches in generation of an efficient therapeutic vaccine.
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Affiliation(s)
- Vladimir Alexei Morozov
- Center for HIV and Retrovirology, Department of Infectious Diseases, Robert Koch Institute, Berlin 13353, Germany
| | - Sylvie Lagaye
- Department of Immunology, Institut Pasteur, INSERM U1223, Paris 75015, France
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Hossain N, Puchakayala B, Kanwar P, Verma S, Abraham G, Ivanov Z, Niaz MO, Mohanty SR. Risk Factor Analysis Between Newly Screened and Established Hepatitis C in GI and Hepatology Clinics. Dig Dis Sci 2017; 62:3193-3199. [PMID: 28913613 DOI: 10.1007/s10620-017-4754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 06/11/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Several studies show inconsistencies in the rate of hepatitis C virus (HCV) detection among baby boomers (born 1945-1965). We conducted a cross-sectional HCV screening followed by a case-controlled comparison of the newly screened population with established HCV subjects. METHOD Enrollment was offered to subjects aged 40-75 at our gastroenterology and hepatology clinics. Demographic data and potential risk factors were obtained, and HCV antibody test was offered to those who had never been screened and compared with a group with established HCV. Logistic regression analysis and Fisher's exact test were performed. RESULTS Six hundred and seventy-five patients were offered participation, of whom 128 declined while 50 consented to participate but did not perform the HCV antibody test. Of 497 enrolled subjects, 252 patients had HCV, while 245 subjects (188 patients among "baby boomer") underwent screening for HCV. There were more females (62.4 vs. 41.7%) and immigrants (34.7 vs. 22.2%) among the newly screened group. Among the screened population, five patients had HCV antibody (2.04%), and two of them had positive viral load (0.82%) of whom only one fell in the baby boomer category (0.53%). Compared to HCV group, screened group had significantly lower-risk factors, such as IV drug use (1.22 vs. 43.3%), intranasal cocaine use (14.3 vs. 49.6%), and blood transfusion (18.8 vs. 32.5%). CONCLUSION We found a slightly lower but similar prevalence of HCV antibody when screening based on birth cohort as compared to larger baby boomer studies. Future studies evaluating addition of other screening strategies or possibly universal screening may be needed.
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Affiliation(s)
- Newaz Hossain
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Bharat Puchakayala
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Pushpjeet Kanwar
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Siddharth Verma
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA.,Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mt Sinai, Queens Hospital Center, 82-68, 164th Street, Queens, NY, 11432, USA
| | - George Abraham
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Zhanna Ivanov
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Muhammad Obaid Niaz
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Smruti R Mohanty
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA.
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Abstract
Acupuncture is increasingly used worldwide. It is becoming more accepted by both patients and healthcare providers. However, the current understanding of its adverse events (AEs) is fragmented. We conducted this overview to collect all systematic reviews (SRs) on the AEs of acupuncture and related therapies. MEDLINE and EMBASE were searched from inception to December 2015. Methodological quality of included reviews was assessed with a validated instrument. Evidence was narratively reported. Seventeen SRs covering various types of acupuncture were included. Methodological quality of the reviews was overall mediocre. Four major categories of AEs were identified, which are organ or tissue injuries (13 reviews, median: 36 cases, median deaths: 4), infections (11 reviews, median: 17 cases, median deaths: 0.5), local AEs or reactions (12 reviews, median: 8.5 cases, no deaths were reported), and other complications such as dizziness or syncope (11 reviews, median: 21 cases, no deaths were reported). Minor and serious AEs can occur during the use of acupuncture and related modalities, contrary to the common impression that acupuncture is harmless. Serious AEs are rare, but need significant attention as mortality can be associated with them. Referrals should consider acupuncturists’ training credibility, and patient safety should be a core part of acupuncture education.
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8
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Wen Y, Zhang C, Zhao XF, Deng SZ, He S, Huang LH, Tian G, Meng ZH. Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo. Neural Regen Res 2016; 11:1267-73. [PMID: 27651774 PMCID: PMC5020825 DOI: 10.4103/1673-5374.189191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Acupuncture at Fengchi (GB20) in the posterior neck improves vertigo. However, subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck. Therefore, in the present study, we assessed the safety of acupuncture at Fengchi. Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with vertigo. A total of 136 patients were randomly assigned to four groups. Verum acupuncture was conducted with different needle insertion directions (contralateral paropia or prominentia laryngea) and different needle twisting frequencies (60 or 120 times/minute) at Fengchi and matching acupoints (for example, Zhongwan [CV12], Qihai [CV6], Zusanli [ST36], and Fenglong [ST40]). The patients received 14 treatments over 3–4 weeks. Routine blood analysis, hepatic and renal function tests, urine and feces tests and electrocardiography were performed before the first treatment session and after the final session. Adverse events were recorded after every session. Of the 136 patients, 120 completed the study. There were no significant differences between pretreatment and posttreatment test results in any of the groups. Only five patients suffered from minor adverse events (needling pain, slight hematoma and transient chest tightness). No serious adverse events were found. Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with vertigo.
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Affiliation(s)
- Yan Wen
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chao Zhang
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao-Feng Zhao
- Institute of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shi-Zhe Deng
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Si He
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ling-Hui Huang
- Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
| | - Guang Tian
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhi-Hong Meng
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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10
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Bedlack RS, Joyce N, Carter GT, Paganoni S, Karam C. Complementary and Alternative Therapies in Amyotrophic Lateral Sclerosis. Neurol Clin 2015; 33:909-36. [PMID: 26515629 PMCID: PMC4712627 DOI: 10.1016/j.ncl.2015.07.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Given the severity of their illness and lack of effective disease-modifying agents, it is not surprising that most patients with amyotrophic lateral sclerosis (ALS) consider trying complementary and alternative therapies. Some of the most commonly considered alternative therapies include special diets, nutritional supplements, cannabis, acupuncture, chelation, and energy healing. This article reviews these in detail. The authors also describe 3 models by which physicians may frame discussions about alternative therapies: paternalism, autonomy, and shared decision making. Finally, the authors review a program called ALSUntangled, which uses shared decision making to review alternative therapies for ALS.
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Affiliation(s)
- Richard S Bedlack
- Department of Neurology, Duke University Medical Center, Durham, NC 27702, USA.
| | - Nanette Joyce
- Department of Physical Medicine and Rehabilitation, University of California, Davis School of Medicine, 4860 Y Street Suite 3850, Sacramento, CA 95817, USA
| | - Gregory T Carter
- Department of Physical Medicine and Rehabilitation, St. Luke's Rehabilitation Institute, 711 South Cowley, Spokane, WA 99202, USA
| | - Sabrina Paganoni
- Spaulding Rehabilitation Hospital, Boston VA Health Care System, Harvard Medical School, Massachussets General Hospital, Boston, MA 02114, USA
| | - Chafic Karam
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, Campus Box 7025, Chapel Hill, NC 27599-7025, USA
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11
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Gallinger ZR, Nguyen GC. Practices and attitudes toward complementary and alternative medicine in inflammatory bowel disease: a survey of gastroenterologists. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2015; 11:297-303. [PMID: 25294717 DOI: 10.1515/jcim-2014-0008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 08/29/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Use of complementary and alternative medicine (CAM) is increasingly prevalent among patients with inflammatory bowel disease (IBD). We sought to characterize the practices and attitudes of IBD physician providers toward CAM. METHODS A web-based survey was sent to non-trainee physician members of the American Gastroenterological Association with an interest in IBD. The survey included multiple-choice and Likert scale questions which queried physician perceptions of CAM and their willingness to discuss CAM with patients. RESULTS The vast majority of respondents (80%) considered themselves IBD subspecialists with 75% holding academic appointments. Nearly a third reported initiating conversations on CAM in the majority of their patient interactions, while 90% perceived that a majority of their patients were reluctant to bring up the topic of CAM. Nearly three quarters (72%) of respondents felt comfortable discussing CAM, while those that did not most frequently cited lack of knowledge as the reason. More than half (55%) stated they had no systematic approach to discussing CAM. Most gastroenterologists (65%) reported no formal training in CAM. Most gastroenterologists had recommended use of probiotics, and nearly half had recommended acupuncture. A vast majority believed that there was adjunctive role for CAM in treatment of IBD. CONCLUSIONS Academic IBD specialists were receptive to the use of CAM, and most felt that it had a role in the treatment of IBD, without necessarily compromising conventional therapy. Formal educational initiatives and societal recommendations on the use of CAM may facilitate a more systematic approach to its use in daily practice.
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Lemos MA, Silva JBG, Braga ACS, Carneiro BM, Rahal P, Silva RCMA. Acupuncture needles can carry hepatitis C virus. Infect Control Hosp Epidemiol 2015; 35:1319-21. [PMID: 25203197 DOI: 10.1086/678079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M A Lemos
- Rio Preto Medical School, São José do Rio Preto, Brazil
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Karavis MY, Argyra E, Segredos V, Yiallouroy A, Giokas G, Theodosopoulos T. Acupuncture-induced haemothorax: a rare iatrogenic complication of acupuncture. Acupunct Med 2015; 33:237-41. [PMID: 25791844 PMCID: PMC4483786 DOI: 10.1136/acupmed-2014-010700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/21/2022]
Abstract
This paper reports a rare iatrogenic complication of acupuncture-induced haemothorax and comments on the importance and need for special education of physicians and physiotherapists in order to apply safe and effective acupuncture treatment. A 37-year-old healthy woman had a session of acupuncture treatments for neck and right upper thoracic non-specific musculoskeletal pain, after which she gradually developed dyspnoea and chest discomfort. After some delay while trying other treatment, she was eventually transferred to the emergency department where a chest X-ray revealed a right pneumothorax and fluid collection. She was admitted to hospital and a chest tube inserted into the right hemithorax (under ultrasound guidance) drained 800 mL of bloody fluid (haematocrit (Hct) 17.8%) in 24 h and 1200 mL over the following 3 days. Her blood Hct fell from 39.0% to 30.8% and haemoglobin from 12.7 to 10.3 g/dL. The patient recovered completely and was discharged after 9 days of hospitalisation. When dyspnoea, chest pain and discomfort occur during or after an acupuncture treatment, the possibility of secondary (traumatic) pneumo- or haemopneumothorax should be considered and the patient should remain under careful observation (watchful waiting) for at least 48 h. To maximise the safety of acupuncture, specific training should be given for the safe use of acupuncture points of the anterior and posterior thoracic wall using dry needling, trigger point acupuncture or other advanced acupuncture techniques.
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Affiliation(s)
| | - Erifili Argyra
- Aretaieion Hospital, Athens Medical School, Athens, Greece
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15
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El-Ghitany EM, Abdel Wahab MM, Abd El-Wahab EW, Hassouna S, Farghaly AG. A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013): do they differ in Egypt? Liver Int 2015; 35:489-501. [PMID: 24923487 DOI: 10.1111/liv.12617] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/05/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The prevention and control of HCV infection is complex and challenging in terms of describing risk factors and modes of transmission. This meta-analysis was conducted to summarize the best available data on HCV risk factors worldwide and in Egypt. METHODS Through exhaustive literature searches (1989-2013) of HCV risk factors, 357 original eligible articles were included in this study. RESULTS The highest detected risk was intravenous drug users (IDUs) (OR = 9.6) followed by HIV infection (OR = 4.9), having an IDU partner (OR = 4.1), HBV infection (OR = 3.5), Caesarean section (CS) (OR = 3.35), blood transfusion (OR = 3.2) and having an HCV+ partner (OR = 3). Organ transplantation, hospital admission, haemodialysis and having a sexually transmitted infection carry 2.96, 2.4, 2.18 and 2 risks of having HCV respectively. Other significant risk factors included poor education, older age, sharing sharp or blunt objects, MSM, tattooing, hijama, body piercing, minor operations and medical procedures. Some risks showed a decrease over the previous decade, including blood transfusion, organ transplantation, IDUs, IDU partner and CS. Others showed rising risks, including having an HCV+ partner, MSM and suffering from STI. In Egypt, male gender, rural residence, acupuncture and receiving parenteral antischistosomal treatment were significant risks, while neither HIV nor HBV were found to carry a risk of HCV infection. CONCLUSION Blood transfusion, organ transplantation, CS, IDUs, haemodialysis, minor operations and medical procedures are established risk factors. Attention and urgent intervention should be given to the sexual route of transmission, as well as that through minor operations and medical procedures.
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Affiliation(s)
- Engy Mohamed El-Ghitany
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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16
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Melo ALSD, Gomes ELC, Ximenes VO, Montenegro EJN. The effects of different TENS frequencies applied to LU7 acupoint on cold-induced pain test. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.004.ao01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Pain represents a frequent phenomenon among the general population with great socio-economic impact. TENS is one of the most common forms of electroanalgesia. However, totally effective stimulation parameters remain uncertain. Thus, this study aims to assess the effects of 4 Hz, 10 Hz and 100 Hz TENS applied to the LU7 (Lieque) acupoint on cold-induced pain in young healthy subjects. Methods 100 volunteers, divided into five groups (three TENS groups, one electrode group and one placebo group), completed six experimental cycles. Each cycle comprised three phases: pretreatment, treatment and post-treatment. In each cycle, pain was induced by immersion of the hand into ice water and the pain threshold latency was measured. For the analysis of results, we used the one-way ANOVA test, followed by the Student-Newman-Keuls post hoc test. The level of significance was p < 0.05. Results The 4 Hz TENS group the pain showed elevation of the pain threshold during the treatment phase, when compared to pretreatment (p < 0.05). This elevation was maintained in the post-treatment phase. The other groups showed no changes in the pain threshold. Conclusion 4 Hz TENS applied with 1x1 cm electrodes to LU7 acupoint increases hypothermia-induced pain threshold latency in young healthy subjects.
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17
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Rosa RS, Martinelli ADLC, Passos ADDC. Risk factors for hepatitis C virus transmission in the municipality of Catanduva, State of São Paulo: a case-control study. Rev Soc Bras Med Trop 2014; 47:295-301. [PMID: 25075479 DOI: 10.1590/0037-8682-0054-2014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/19/2014] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is primarily transmitted via contact with the blood of infected patients, although the form of contact has not been identified for a significant percentage of carriers. The present study evaluated possible risk factors for HCV transmission in a medium-sized town located in the northwest region of the State of São Paulo. METHODS This was a case-control study, with the case group consisting of 190 chronic HCV carriers older than 18 years residing in the municipality of Catanduva. The control group also consisted of 190 individuals with HCV-negative serology. The groups were paired (1:1) for gender, age range (± five years), and place of residence. The same structured questionnaire was applied to all subjects, who gave written informed consent to participate in the study. The data were statistically analyzed using crude and adjusted logistic regression, and the results were expressed as odds ratios with a 95% confidence interval. RESULTS The demographic profiles of the groups indicated a predominance of males (68.9%) and mean ages of 47.1 years (case group) and 47.3 years (control group). After adjusting for conditional regression, the following factors were found to represent risks for HCV: history of sexually transmitted disease (STD) and blood transfusion; accidents with syringes and/or needles; tattoos; and the use of non-injectable drugs and injectable medications. CONCLUSIONS The transmission of HCV via the blood route has been well characterized. Other forms of contact with human blood and/or secretions are likely to transmit the virus, although with a lower frequency of occurrence.
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Affiliation(s)
| | - Ana de Lourdes Candolo Martinelli
- Departamento de Clínica Médica - Gastroenterologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Afonso Dinis da Costa Passos
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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KASL clinical practice guidelines: management of hepatitis C. Clin Mol Hepatol 2014; 20:89-136. [PMID: 25032178 PMCID: PMC4099340 DOI: 10.3350/cmh.2014.20.2.89] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 05/20/2014] [Indexed: 12/16/2022] Open
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Martins T, Machado DFGDP, Schuelter-Trevisol F, Trevisol DJ, Vieira e Silva RA, Narciso-Schiavon JL, Schiavon LDL. Prevalence and factors associated with HCV infection among elderly individuals in a southern Brazilian city. Rev Soc Bras Med Trop 2014; 46:281-7. [PMID: 23856863 DOI: 10.1590/0037-8682-0026-2013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 06/04/2013] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Few Latin American studies have assessed the prevalence of hepatitis C virus (HCV) infection in elderly individuals, in whom the highest rates are expected. We aimed to investigate the prevalence of and factors associated with HCV infection in elderly residents in the municipality of Tubarão, Santa Catarina. METHODS This cross-sectional study included 820 individuals (aged ≥ 60 years) who were selected by simple random sampling. The presence of anti-HCV antibodies was tested by chemiluminescence, and HCV RNA detection was performed for the anti-HCV-reactive subjects. Those individuals who were anti-HCV reactive but had undetectable HCV RNA levels were tested using a third-generation recombinant immunoblot assay. The variables were compared using the chi-squared test or Fisher's exact test, and those variables with p < 0.05 were included in the logistic regression model. RESULTS The mean patient age was 68.6 years (SD 7.0 years); 39% were men, and 92% were Caucasian. Eighteen subjects were anti-HCV positive. Among these individuals, 4 were characterized as false-positives, leaving 14 (1.7%) individuals with confirmed infections for analysis. HCV infection was associated with an age older than 65 years, households with 3 or more residents and the previous transfusion of blood products. In the logistic regression analysis, the following variables were independently associated with HCV infection: households with 3 or more residents (OR 7.9, 95% CI 1.7-35.9, p = 0.008) and previous blood transfusion (OR 6.2, 95% CI 2.1-18.6, p = 0.001). CONCLUSIONS The HCV prevalence in the elderly population in the municipality of Tubarão was higher than that found in previous studies of blood donors in the same region. Although exposure to contaminated blood products remained important, other transmission routes, such as household transmission, could play a role in HCV infection.
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Affiliation(s)
- Tatiana Martins
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
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A survey of perceptions and practices of complementary alternative medicine among Canadian gastroenterologists. Can J Gastroenterol Hepatol 2014; 28:45-9. [PMID: 24212913 PMCID: PMC4071899 DOI: 10.1155/2014/632627] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite a high prevalence of complementary alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients, there is a dearth of information about the attitudes and perceptions of CAM among the gastroenterologists who treat these patients. OBJECTIVE To characterize the beliefs, perceptions and practices of gastroenterologists toward CAM use in patients with IBD. METHODS A web-based survey was sent to member gastroenterologists of the Canadian Association of Gastroenterology. The survey included multiple-choice and Likert scale questions that queried physician knowledge and perceptions of CAM and their willingness to discuss CAM with patients. RESULTS Fifty-three per cent of respondents considered themselves to be IBD subspecialists. The majority (86%) of gastroenterologists reported that less than one-half of their patient population had mentioned the use of CAM. Only 8% of physicians reported initiating a conversation about CAM in the majority of their patient encounters. Approximately one-half (51%) of respondents were comfortable with discussing CAM with their patients, with lack of knowledge being cited as the most common reason for discomfort with the topic. Most gastroenterologists (79%) reported no formal education in CAM. While there was uncertainty as to whether CAM interfered with conventional medications, most gastroenterologists believed it could be effective as an adjunct treatment. CONCLUSION Our findings demonstrate that gastroenterologists were hesitant to initiate discussions about CAM with patients. Nearly one-half were uncomfortable or only somewhat comfortable with the topic, and most may benefit from CAM educational programs. Interestingly, most respondents appeared to be receptive to CAM as adjunct therapy alongside conventional IBD treatment.
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Chen CL, Kabiling CS, Concejero AM. Why does living donor liver transplantation flourish in Asia? Nat Rev Gastroenterol Hepatol 2013; 10:746-51. [PMID: 24100300 DOI: 10.1038/nrgastro.2013.194] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The success of liver transplantation worldwide has brought increased demand for the liver graft. Western and Asian countries have coped differently with the problems of the shortages in organ donation. In the West, efforts have focused on promoting deceased donor organ donation, whereas in Asia the focus has been on living donor liver transplantation (LDLT), as this procedure is more acceptable in most Asian cultures. LDLT, which was initially devised for paediatric liver transplant patients, has evolved from using a left lobe graft to a right lobe graft for an adult recipient. To widen the donor pool, dual grafts for a single recipient have been used in LDLT, and donors with hepatitis B core antibody positivity have been accepted, as well as ABO incompatible donors and recipients. The great advances in the field of LDLT have been dictated by the needs and the norms of Asian society. In this Perspectives article, we outline the reasons why LDLT flourishes in Asia.
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Affiliation(s)
- Chao-Long Chen
- Liver Transplant Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan 833
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22
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Affiliation(s)
- Tae-Hun Kim
- College of Korean Medicine, Gachon University, , Seongnam, South Korea
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23
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Brown L, Holmes M, Jones A. The application of transcutaneous electrical nerve stimulation to acupuncture points (Acu-TENS) for pain relief: a discussion of efficacy and potential mechanisms. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x405964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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24
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Spinal Epidural Abscess in a Medical Center in Taiwan. NEUROSURGERY QUARTERLY 2013. [DOI: 10.1097/wnq.0b013e318266c3fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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25
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Fernández A, Barreiro-de Acosta M, Vallejo N, Iglesias M, Carmona A, González-Portela C, Lorenzo A, Domínguez-Muñoz JE. Complementary and alternative medicine in inflammatory bowel disease patients: frequency and risk factors. Dig Liver Dis 2012; 44:904-8. [PMID: 22795615 DOI: 10.1016/j.dld.2012.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 06/12/2012] [Accepted: 06/14/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine in inflammatory bowel disease patients is progressively increased. AIM To evaluate the use of complementary and alternative medicine in inflammatory bowel disease patients and to know potential risk factors for their use. The subjective response of these therapies and the impact on treatment adherence were also evaluated. METHODS Prospective, descriptive and transversal study. Inflammatory bowel disease patients were classified according to demographic and clinical characteristics. A questionnaire about the use of complementary and alternative medicine was collected. RESULTS 705 patients were included. 126 patients (23%) had used complementary and alternative medicine. The most commonly used was herbal remedies (n=61), homoeopathy (n=36), acupuncture (n=31), kefir (n=31) and aloe vera (n=25). Factors associated with its use were extraintestinal manifestations (OR 1.69, CI 95% 1.11-2.57) and long-term evolution of the disease (OR 2.08, CI 95% 1.44-2.99). Most patients (74%) had the subjective feeling that use of complementary and alternative medicine had not improved their condition, 11 had adverse events related to its use and 11% of patients discontinued their conventional drugs. CONCLUSIONS Use of complementary and alternative medicine in inflammatory bowel disease patients is frequent, especially in those with extraintestinal manifestations and long-term evolution. The use of these therapies was not perceived as a benefit for patients.
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Omata M, Kanda T, Yu ML, Yokosuka O, Lim SG, Jafri W, Tateishi R, Hamid SS, Chuang WL, Chutaputti A, Wei L, Sollano J, Sarin SK, Kao JH, McCaughan GW. APASL consensus statements and management algorithms for hepatitis C virus infection. Hepatol Int 2012; 6:409-435. [PMID: 26201405 DOI: 10.1007/s12072-012-9342-y] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 01/21/2012] [Indexed: 12/13/2022]
Abstract
The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the "APASL Consensus Statements and Management Algorithms for Hepatitis C Virus Infection" in December, 2010, in order to revise "Asian Pacific Association for the Study of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection (J Gastroenterol Hepatol 22:615-633, 2007)". The working party consisted of expert hepatologists from the Asian-Pacific region gathered at Makuhari, Chiba, Japan on 19 December 2010. New data were presented, discussed and debated to draft a revision. Participants of the consensus meeting assessed the quality of cited studies. Finalized recommendations are presented in this review.
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Affiliation(s)
- Masao Omata
- Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu-shi, Yamanashi, 400-8506, Japan.
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuo Kanda
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ming-Lung Yu
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Osamu Yokosuka
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seng-Gee Lim
- National University Hospital, Singapore, Singapore
| | | | - Ryosuke Tateishi
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | | | - Wan-Long Chuang
- Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Lai Wei
- Peking University People's Hospital, Beijing, China
| | - Jose Sollano
- University Santo Tomas Hospital, Manila, Philippines
| | | | - Jia-Horng Kao
- National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Geoffrey W McCaughan
- Royal Prince Alfred Hospital, Centenary Institute, University of Sydney, Sydney, Australia
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Pilkington K, Boshnakova A. Complementary medicine and safety: a systematic investigation of design and reporting of systematic reviews. Complement Ther Med 2011; 20:73-82. [PMID: 22305252 DOI: 10.1016/j.ctim.2011.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 09/30/2011] [Accepted: 10/05/2011] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The objective of this study was to examine the methods used in systematic reviews of safety across a range of complementary therapies to assess the variation in approach and the potential for developing guidance on conduct and reporting. DESIGN Systematic reviews focusing on safety were retrieved from NHS Evidence and searches of major databases. A pre-prepared template was used for data extraction. Information extracted included details of search strategies, sources, participants, interventions, reported adverse event/effect(s) and causality assessment. Data extraction was carried out by one researcher and a check for accuracy by a second researcher. Methods were assessed against criteria based on guidance provided by the Cochrane Adverse Effects Methods Group. RESULTS A total of 2563 citations were screened and 88 systematic reviews were selected for inclusion. The majority focused on the safety of herbs and nutritional supplements. Approximately half the reviews covered all aspects of safety; other reviews addressed specific adverse effects or interactions. Types of data included in the reviews did not always reflect the focus of the review. Search strategies, sources used, quality assessment and assessment of causality also varied. CONCLUSIONS Detailed examination and comparison of the methods has highlighted several areas in which there is potential for development of guidelines and consensus on standards. These include search strategies, sources of information, data extraction and assessment of causality. The value of systematic reviews in relation to large outcome studies requires further consideration.
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Affiliation(s)
- Karen Pilkington
- School of Life Sciences, University of Westminster, 115 New Cavendish Street, London W1W 6UW, UK.
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Blundell L, Cains T, Ressler KA, Ferson MJ. Compliance with sharps waste standards by a sample of Sydney acupuncture premises. NEW SOUTH WALES PUBLIC HEALTH BULLETIN 2011; 22:149-153. [PMID: 21982259 DOI: 10.1071/nb10073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM To examine current practices with regard to the safe collection, storage and disposal of sharps waste in acupuncture premises and to determine compliance with the NSW Public Health (Skin Penetration) Regulation 2000 and the NSW Health Skin Penetration Code of Best Practice. METHODS A random sample of acupuncturists in the City of Sydney local government area was selected and surveyed using a structured questionnaire. RESULTS All 26 acupuncturists surveyed had sharps disposal bins and complied with the Regulation, but the following elements of the Code were not uniformly followed: regular disposal of sharps (77%), disposal through a waste contractor (23%) and placement of bins out of reach of visitors (8%). CONCLUSION Regular disposal of sharps containers in acupuncture premises could be improved.
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Affiliation(s)
- Louise Blundell
- Aboriginal Environmental Health Officer Training Program, NSW Department of Health
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Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain 2011; 152:755-764. [PMID: 21440191 DOI: 10.1016/j.pain.2010.11.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 11/01/2010] [Accepted: 11/03/2010] [Indexed: 12/17/2022]
Abstract
Acupuncture is commonly used for pain control, but doubts about its effectiveness and safety remain. This review was aimed at critically evaluating systematic reviews of acupuncture as a treatment of pain and at summarizing reports of serious adverse effects published since 2000. Literature searches were carried out in 11 databases without language restrictions. Systematic reviews were considered for the evaluation of effectiveness and case series or case reports for summarizing adverse events. Data were extracted according to predefined criteria. Fifty-seven systematic reviews met the inclusion criteria. Four were of excellent methodological quality. Numerous contradictions and caveats emerged. Unanimously positive conclusions from more than one high-quality systematic review existed only for neck pain. Ninety-five cases of severe adverse effects including 5 fatalities were included. Pneumothorax and infections were the most frequently reported adverse effects. In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain. Serious adverse effects continue to be reported. Numerous reviews have produced little convincing evidence that acupuncture is effective in reducing pain. Serious adverse events, including deaths, continue to be reported.
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Affiliation(s)
- E Ernst
- Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK Division of Standard Research, Korea Institute of Oriental Medicine, Daejeon, South Korea
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30
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Buckley D. Staphylococcus aureus endocarditis as a complication of acupuncture for eczema. Br J Dermatol 2011; 164:1405-6. [DOI: 10.1111/j.1365-2133.2011.10276.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Zhao L, Zhang FW, Li Y, Wu X, Zheng H, Cheng LH, Liang FR. Adverse events associated with acupuncture: three multicentre randomized controlled trials of 1968 cases in China. Trials 2011; 12:87. [PMID: 21435214 PMCID: PMC3072923 DOI: 10.1186/1745-6215-12-87] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 03/24/2011] [Indexed: 12/04/2022] Open
Abstract
Background In order to evaluate the safety of acupuncture in China objectively, we investigated the adverse events associated with acupuncture based on three multicentre randomized controlled trials (RCTs) to assess the safety of acupuncture, identifying the common types of acupuncture adverse events, and analysing the related risk factors for their occurrence. Methods This observational study included patients who received acupuncture from three multicentre RCTs respectively for migraine, functional dyspepsia and Bell's palsy. The 1968 patients and their acupuncturists documented adverse events associated with acupuncture after treatment. We collected data about adverse events due to acupuncture treatment from their case report forms. We analysed the incidence and details of the adverse effects, and studied the risk factors for acupuncture adverse events with non-conditional logistic regression analysis. Results Among the 1968 patients, 74 patients (3.76%) suffered at least one adverse event throughout the treatment period. We did not observe the occurrence of serious adverse events. 73 patients with adverse events recovered within 2 weeks through effective treatment such as physiotherapy or self-treatment. A total of 3 patients withdrew because of adverse events. There were 9 types of adverse events related to acupuncture, including subcutaneous haematoma, bleeding, skin bruising and needle site pain. Subcutaneous haematoma and haemorrhage in the needling points were the most common adverse events. Age and gender were related to the occurrence of acupuncture adverse events. The older the patients were, the higher the risk of adverse events was. In addition, male patients had slightly higher risk of an adverse event than female patients. Conclusions Acupuncture is a safe therapy with low risk of adverse events in clinical practice. The risk factors for adverse events (AEs) were related to the patients' gender and age and the local anatomical structure of the acupoints. AEs could be reduced and mitigated by improving the medical environment, ensuring a high technical level of the acupuncture practitioners and establishing a good relationship of mutual trust between doctor and patient. Trial Registration ClinicalTrials.gov: NCT00599586, NCT00599677, NCT00608660
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Affiliation(s)
- Ling Zhao
- College of Acupuncture and Massage, Chengdu University of TCM, Chengdu, Sichuan 610075, China
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Zhang J, Shang H, Gao X, Ernst E. Acupuncture-related adverse events: a systematic review of the Chinese literature. Bull World Health Organ 2010; 88:915-921C. [PMID: 21124716 DOI: 10.2471/blt.10.076737] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 07/21/2010] [Accepted: 08/04/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE to systematically review the Chinese-language literature on acupuncture-related adverse events. METHODS we searched three Chinese databases (the Chinese Biomedical Literature Database, 1980-2009; the Chinese Journal Full-Text Database, 1980-2009; and the Weipu Journal Database, 1989-2009) to identify Chinese-language articles about the safety of traditional needle acupuncture. Case reports, case series, surveys and other observational studies were included if they reported factual data, but review articles, translations and clinical trials were excluded. FINDINGS the inclusion criteria were met by 115 articles (98 case reports and 17 case series) that in total reported on 479 cases of adverse events after acupuncture. Fourteen patients died. Acupuncture-related adverse events were classified into three categories: traumatic, infectious and "other". The most frequent adverse events were pneumothorax, fainting, subarachnoid haemorrhage and infection, while the most serious ones were cardiovascular injuries, subarachnoid haemorrhage, pneumothorax and recurrent cerebral haemorrhage. CONCLUSION many acupuncture-related adverse events, most of them owing to improper technique, have been described in the published Chinese literature. Efforts should be made to find effective ways of monitoring and minimizing the risks related to acupuncture.
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Affiliation(s)
- Junhua Zhang
- Research Centre of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Tianjin, 300193, China.
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Reynolds L, McKee M. Possible risks of transmission of bloodborne infection via acupuncture needles in Guizhou province, southwest China. J Altern Complement Med 2009; 14:1281-5. [PMID: 19072660 DOI: 10.1089/acm.2008.0269] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acupuncture is in widespread use in China, a country where the prevalence of infection with hepatitis B (HBV) is high and that of other bloodborne viruses is growing. Policies to reduce iatrogenic transmission have so far focused on injections, overlooking the risks connected with acupuncture. OBJECTIVE To assess knowledge, attitudes, and practice relevant to the potential iatrogenic transmission of bloodborne viruses in Guizhou province, southwest China. MATERIALS AND METHODS Semi-structured interviews and focus groups were conducted (in 2005) with 80 health care workers, patients, and other key informants in health facilities at provincial, county, and village levels. RESULTS In village clinics, reusable acupuncture needles were disinfected with alcohol rather than being sterilized, because of concerns that sterilization might blunt the needles. Sterilization of equipment by acupuncturists in the informal sector may be inadequate, but official monitoring of their practice appears not to be taking place. Acupuncturists working in hospitals are not included in formal training on bloodborne diseases and do not routinely receive HBV immunization. Some health workers lack clear understanding of asymptomatic infections. CONCLUSION Policy on iatrogenic transmission of bloodborne viruses in China needs to place a greater emphasis on safe acupuncture, taking account of prevailing beliefs that may lead to hazardous practices, while enforcing safe procedures.
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Affiliation(s)
- Lucy Reynolds
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
Over 2 million people in the United States are estimated to use acupuncture annually, primarily for musculoskeletal complaints and pain management, evidence that the integration of acupuncture into Western health care is increasing. Despite the increase in the quality of trials demonstrating the efficacy and safety of acupuncture in medicine, the pediatric acupuncture literature lacks the quantity and quality of the same body of evidence. Contributing to this paucity of evidence may be the acceptability of acupuncture in pediatric patients. There is an urgent need for high-quality randomized controlled trials on the use of acupuncture in the pediatric population. This review aims to highlight the evidence for use of acupuncture in pain and symptom management.
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Affiliation(s)
- Anjana Kundu
- Department of Anesthesiology and Pain Medicine, Complementary and Integrative Medicine Program, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, WA 98105, USA.
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48 Treatments used in complementary and alternative medicine. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0378-6080(06)29048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
Complementary and alternative medicine includes a wide range of practices and therapies outside the realms of conventional western medicine. Despite a lack of scientific data in the form of controlled trials for either efficacy or safety of complementary and alternative medicine, use by patients with inflammatory bowel disease, particularly of herbal therapies, is widespread and increasing. There is limited controlled evidence indicating efficacy of traditional Chinese medicines, aloe vera gel, wheat grass juice, Boswellia serrata and bovine colostrum enemas in ulcerative colitis. Encouraging results have also been reported in small studies of acupuncture for Crohn's disease and ulcerative colitis. Contrary to popular belief, natural therapies are not necessarily safe: fatal hepatic and irreversible renal failure have occurred with some preparations and interactions with conventional drugs are potentially dangerous. There is a need for further controlled clinical trials of the potential efficacy of complementary and alternative approaches in inflammatory bowel disease, together with enhanced legislation to maximize their quality and safety.
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Affiliation(s)
- L Langmead
- Department of Gastroenterology, University College London Hospitals, NHS Foundation Trust, London, UK.
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Abstract
Even though widely used in today's clinical practice, acupuncture has remained a controversial subject. Many reviews are currently available but most lack a critical stance and some are overtly promotional. The aim of this overview is to provide a balanced, critical analysis of the existing evidence. Some of the original concepts of traditional acupuncture are not supported by good scientific evidence. Several plausible theories attempt to explain how acupuncture works but none are proved beyond doubt. The clinical effectiveness of acupuncture continues to attract controversy. Many controlled clinical trials and numerous systematic reviews of these studies have been published. Considerable problems are encountered when interpreting these data. Heterogeneity is a significant drawback of both clinical trials and systematic reviews. Some of the controversies may be resolved through the use of the new 'placebo needles' which enable researchers to adequately control for placebo effects of acupuncture. The majority of studies using such devices fails to show effects beyond a placebo response. Acupuncture has been associated with serious adverse events but most large-scale studies suggest that these are probably rare. Nonserious adverse effects occur in 7-11% of all patients. In conclusion, acupuncture remains steeped in controversy. Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response.
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Affiliation(s)
- E Ernst
- Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK.
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Abstract
PURPOSE OF REVIEW To review recent studies that have examined the efficacy of natural and complementary therapies as treatments for substance use disorders and their complications. RECENT FINDINGS Despite increasing interest in natural and complementary therapies for substance use disorders, rigorous clinical studies in this area are few in number. Recent clinical studies, although preliminary, have reported potential therapeutic effects for hypericum in the treatment of smoking cessation, for prickly pear extract in the prevention of alcohol hangover and magnesium supplementation as an adjunct to methadone treatment. Other clinical studies have reported negative findings for ginkgo as an adjunctive treatment for cocaine dependence, for artichoke in prevention of alcohol hangover, and acupuncture for alcohol withdrawal. Relevant findings from animal studies are also discussed. Neither vitamin E nor Liv 52 had a useful effect in alcohol-related liver disease. A study of silymarin in baboons, which was undertaken in an attempt to untangle the conflicting findings of human studies, reported a potential for this compound to prevent liver injury. There is increasing awareness of safety issues associated with complementary therapies. Safety issues pertinent to substance use treatment are discussed in this review. SUMMARY Several pharmacological and psychosocial treatments for substance use disorders are solidly evidence-based and improve both individual and public health outcomes. At this stage, there remains insufficient evidence to support the use of natural and complementary therapies as a primary intervention for substance use disorders. Further clinical trials are required to clarify the potential role of particular agents.
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Affiliation(s)
- Angela J Dean
- Kids in Mind Research, Mater Child and Youth Mental Health Service and Mater Pharmacy Services, Mater Hospital, South Brisbane, Queensland, Australia.
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Matthews JD, Bini EJ. Epidemiology, Diagnosis, and Treatment of Chronic Hepatitis C. J Pharm Pract 2004. [DOI: 10.1177/0897190004268869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The hepatitis C virus (HCV) is a leading cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma and is also a common indication for liver transplantation. Interferon alfa monotherapy leads to a sustained virologic response in only 10% to 15% of HCV-infected patients. The sustained virologic response rates can be increased to approximately 40% with interferon alfa-2b and ribavirin combination therapy for up to 48 weeks. However, recent clinical trials demonstrated that pegylated interferon in combination with ribavirin can improve the response rates even further, with more than 50% of patients having a sustained virologic response to treatment. Although new therapies are emerging, significant progress must be made to reduce the morbidity and mortality from HCV infection.
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Affiliation(s)
- Jason D. Matthews
- Department of Medicine and Division of Gastroenterology, VA New York Harbor Healthcare System and NYU School of Medicine, New York, NY 10010
| | - Edmund J. Bini
- Department of Medicine and Division of Gastroenterology, VA New York Harbor Healthcare System and NYU School of Medicine, New York, NY 10010.,
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