Nevin Manimala

Cephalalgia. 2024 Mar;44(3):3331024231226196. doi: 10.1177/03331024231226196.

ABSTRACT

BACKGROUND: Hemicrania continua (HC) and paroxysmal hemicrania (PH) belong to a group of primary headache disorders called trigeminal autonomic cephalalgias. One of the diagnostic criteria for both HC and PH is the absolute response to the therapeutic dose of indomethacin. However, indomethacin is discontinued in many patients as a result of intolerance to its side effects. Melatonin, a pineal hormone, which shares similar chemical structure to indomethacin, has been reported to have some efficacy for HC in previous case reports and series. To our knowledge, there is no literature regarding the use of melatonin in PH. We aimed to describe the clinical use of melatonin in the preventive management of HC and PH.

METHODS: Patient level data were extracted as an audit from routinely collected clinical records in consecutive patients seen in outpatient neurology clinic at King’s College Hospital, London, UK, from September 2014 to April 2023. Our cohort of patients were identified through a search using the keywords: hemicrania continua, paroxysmal hemicrania, melatonin and indomethacin. Descriptive statistics including absolute and relative frequencies, mean ± SD, median and interquartile range (IQR) were used.

RESULTS: Fifty-six HC patients were included with a mean ± SD age of 52 ± 16 years; 43 of 56 (77%) patients were female. Melatonin was taken by 23 (41%) patients. Of these 23 patients, 19 (83%) stopped indomethacin because of different side effects. The doses of melatonin used ranged from 0.5 mg to 21 mg, with a median dose of 10 mg (IQR = 6-13 mg). Fourteen (61%) patients reported positive relief for headache, whereas the remaining nine (39%) patients reported no headache preventive effect. None of the patients reported that they were completely pain free. Two patients continued indomethacin and melatonin concurrently for better symptom relief. Eight patients continued melatonin as the single preventive treatment. Side effects from melatonin were rare. Twenty-two PH patients were included with mean ± SD age of 50 ± 17 years; 17 of 22 (77%) patients were female. Melatonin was given to six (27%) patients. The median dose of melatonin used was 8 mg (IQR = 6-10 mg). Three (50%) patients responded to melatonin treatment. One of them used melatonin as adjunctive treatment with indomethacin.

CONCLUSIONS: Melatonin showed some efficacy in the treatment of HC and PH with a well-tolerated side effect profile. It does not have the same absolute responsiveness as indomethacin, at the doses used, although it does offer a well-tolerated option that can have significant ameliorating effects in a substantial cohort of patients.

PMID:38518183 | DOI:10.1177/03331024231226196

Altern Ther Health Med. 2024 Mar 22:AT9833. Online ahead of print.

ABSTRACT

BACKGROUND: Low anterior resection syndrome (LARS) is a post-proctectomy consequence characterized by variable and unpredictable bowel function, including clustering, urgency, and incontinence, which significantly impacts the quality of life. Currently, there is no established gold-standard therapy for LARS.

PRIMARY STUDY OBJECTIVE: This study aimed to evaluate the effectiveness of the Paula method of exercise as part of an integrative treatment approach for patients with LARS.

DESIGN: This preliminary study utilized a single-arm pretest-posttest design.

SETTING: The study was conducted at a tertiary care medical center.

PARTICIPANTS: Five patients diagnosed with LARS completed the study.

INTERVENTION: Participants underwent twelve weeks of individualized Paula method exercise sessions. Two questionnaires were employed to assess the severity of LARS and quality of life.

PRIMARY OUTCOME MEASURES: (1) Low Anterior Resection Syndrome (LARS) Score; (2) Memorial Sloan Kettering Cancer Bowel Function Instrument (MSK-BFI); (3) Global Quality-of-Life (QOLS) Score ‎.

RESULTS: All participants completing the 12-week Paula exercise regimen reported no difficulty in engaging with the exercises. Statistically significant improvements were observed in both the LARS score and MSK-BFI (P = .039 and P = .043, respectively, Wilcoxon Rank Sum test). While there were improvements in the global quality-of-life score and functional scales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, these improvements did not reach statistical significance.

CONCLUSIONS: This preliminary study suggests that patients with LARS can successfully complete a 12-week exercise program using the Paula method, resulting in improved LARS scores. However, further investigation through larger, multicenter, randomized controlled trials is necessary to establish the efficacy of these exercises as a treatment for LARS.

PMID:38518172

Altern Ther Health Med. 2024 Mar 22:AT7604. Online ahead of print.

ABSTRACT

BACKGROUND: In cesarean delivery, factors such as general anesthesia affect bowel function, leading postpartum women to experience abdominal tenderness, gas, and constipation.

OBJECTIVE: This study aims to assess the impact of acupressure on bowel function after cesarean delivery.

DESIGN: A randomized-controlled experimental study was conducted.

PARTICIPANTS: The study population comprised postpartum women who underwent cesarean delivery at Ondokuz Mayıs University Health Practice and Research Hospital between July 2021 and January 2022. The sample consisted of 61 postpartum women (acupressure group: 31, control group: 30).

INTERVENTION: Participants were divided into two groups: the acupressure group and the control group. Women in the acupressure group received 14 minutes of acupressure application to the LI4 and TH6 points twice, once within the first postoperative hour and again three hours later. The control group received no acupressure intervention.

OUTCOME MEASURES: Data were collected using a Postpartum Information Form and a Post-cesarean Follow-up Form. Statistical analyses included the Mann-Whitney U test, Student’s t test, and chi-squared analysis.

RESULTS: The mean age of postpartum women in the acupressure group was 27.61±4.39, while in the control group, it was 28.50±3.85. The mean times for bowel sounds, flatulence, and bowel movements in the acupressure group (9.98±2.77, 19.43±10.25, and 27.13±10.77 hours, respectively) were significantly shorter than those in the control group (14.41±5.07, 23.33±4.20, and 46.16±17.95 hours, respectively) (P < .05).

CONCLUSIONS: Acupressure was found to be effective in improving bowel function after cesarean delivery, significantly reducing the time taken for participants to experience bowel sounds, flatulence, and bowel movements.

PMID:38518170

Altern Ther Health Med. 2024 Mar 22:AT7352. Online ahead of print.

ABSTRACT

Trichomonas tenax is an oral protozoan with an estimated global pooled prevalence of 17% in the human population.1 Observational studies have demonstrated a significant statistical correlation between oral colonization by T. tenax and the progression of periodontal disease.2 Proposed pathogenic mechanisms for this protozoan include the production of tissue-damaging enzymes, induction of apoptosis in human cells, and dysbiosis of the oral microbiome.3 In patients for whom metronidazole (MTZ) is contraindicated, phytochemicals may offer a viable alternative for controlling T. tenax. Various plant extracts have shown promising in vitro activity against other trichomonads, such as T. vaginalis and Tritrichomonas foetus, as reviewed by Friedman et al.4.

PMID:38518169

Altern Ther Health Med. 2024 Mar 22:AT10335. Online ahead of print.

ABSTRACT

OBJECTIVE: We studied the efficacy and safety of traditional Chinese medicine paiteling treatment of persistent human papillomavirus (HPV) infection in males.

METHODS: The study included 159 male patients with persistent HPV infection between January 2018 and July 2022, and categorized into the treatment group (n = 96) and control group (n = 63) based on the treatment. The treatment group was externally treated with paiteling diluent for 4 consecutive days and then stopped for 3 days. The total course of treatment was one month. The treatment group underwent a second test six months after treatment. The control group did not receive any therapy and underwent a second test in the seventh month.

RESULTS: 19 of the 159 patients were lost during the 6-month follow-up period, leaving 140 patients. The male HPV infection peaks between the ages of 26-35 years 73(52.14%), and its prevalence decrease with age. 84 (60.0%) were single type infections, and 22 (15.71%) had at least 3 types infections. There were 76 (54.29%) patients with the high-risk types, 34 (24.29%) with the low-risk types, and 30 (21.43%) with the mixed types. After 6 months, complete negative conversion rates and negative conversion rates were 74.7% and 90.8% in the treatment group respectively, compared to the control group (P < .01). A comparison of negative conversion rates among different types reveals that 16 type (89.5%) and 6 type (92.3%) had statistical differences, (P < .01) and (P < .05) respectively. Multivariate analysis revealed that the vaccine status of sexual partners was a protective factor (OR = 0.050-0.848) and multi-type infection was a risk factor (OR = 1.807-22.527) for the curative effect.

CONCLUSION: Paiteling is convenient, safe, and effective for the treatment of persistent HPV infection in males.

PMID:38518163

Altern Ther Health Med. 2024 Mar 22:AT10322. Online ahead of print.

ABSTRACT

OBJECTIVE: To systematically assess the impact of prone position ventilation on hypoxemia in patients following extracorporeal cardiac surgery and to establish a reference for further clinical investigation into effective post-surgery mechanical ventilation positions.

METHODS: A meta-analysis was conducted through extensive database searches, focusing on randomized controlled trials of cardiopulmonary bypass in hypoxic patients meeting specific inclusion and exclusion criteria. A total of 8 papers involving 442 patients were finally included in this study.

RESULTS: The meta-analysis revealed that the oxygenation index was significantly higher in the prone position ventilation group compared to the supine position ventilation group [MD=51.24, 95% CI (46.14, 56.35), P < .001]. The partial pressure of oxygen in prone patients was also significantly higher than in supine patients [MD=-2.96, 95% CI (1.78, 4.14), P < .001]. Regarding oxygen saturation, blood oxygen saturation in the prone position group surpassed that in the supine position group, showing a statistically significant difference [MD=4.81, 95% CI (3.83, 5.79), P < .001]. Additionally, patients ventilated in the prone position exhibited a shorter duration of mechanical ventilation compared to those in the supine position, with a statistically significant difference [MD=-57.31, 95% CI (-66.57, -48.06), P < .001].

CONCLUSIONS: In the absence of significant hemodynamic changes, prone position ventilation significantly enhances the oxygenation index and reduces the duration of mechanical ventilation in patients undergoing extracorporeal circulation surgery. However, the observed heterogeneity across studies may be attributed to variations in breathing styles, respiratory techniques, and physiological parameters among different patient groups.

PMID:38518160

Altern Ther Health Med. 2024 Mar 22:AT10313. Online ahead of print.

ABSTRACT

OBJECTIVE: Maxillofacial-neck hyperplastic scars have long been a persistent concern among individuals in both Western and Eastern countries. These scars exhibit rapid growth within 3-6 months following wound healing, subsequently receding at a slower pace, leading to skin redness, tension, and potential itching. The lack of comprehensive understanding regarding the formation mechanism and biological attributes of these scars has made them a prominent subject of research both domestically and internationally.

METHODS: Research data from 2010 to 2023 was selected, and relevant literature on the efficacy of botulinum toxin in the treatment of facial and neck hypertrophic scars was searched until August 2023. The literature on the incidence of facial-neck hypertrophic scars included in PubMed, the Cochrane Library, EMbase, and Web of Science was searched. Two researchers independently screened and extracted the data according to strict inclusion and exclusion criteria.Risk bias in Review Manager 5.4, provided by the Cochrane Collaboration, was used for methodological quality assessment and meta-analysis of the included literature. In case of any disagreement, the decision shall be made through consultation with the third party. Scar width, patient satisfaction, and visual analogue scale (VAS) were evaluated. Weighted mean difference (WMD), odds ratio (OR), and 95% confidence interval (95%CI) were used for evaluation. Publication bias was intuitively determined by funnel plot, and sensitivity analysis was conducted by removing literatures one by one for risk assessment.

RESULTS: After reading the title, abstract, and full text, a total of 237 patients were included in 7 articles. Scar width was only studied in 6 literatures, and the heterogeneity test of the included studies (χ2 = 148.95, P < .001, I2 = 98%) showed significant heterogeneity among the studies. Therefore, the random effects model was used to merge the data. Combined effect value WMD =-2.85 [95% CI :(-6.51, 0.81), P < .001], the difference between the two groups was statistically significant. The combined OR of the random-effects model was 8.52 [95%CI: (7.96, 9.08), P < .001], and the difference between the two groups was statistically significant. Among them, the heterogeneity test (χ2 = 2.69, P = .44, I² = 0%) was carried out in two studies, indicating good homogeneity among the studies, so the combined WMD was 0.68 [95%CI: (0.38, 0.99), P < .001] by using the fixed-effect model. The median VAS was described in the other two literatures, and the mean scores in the experimental group were 8.9 and 8.25, respectively, while the mean scores in the control group were 7.2 and 6.28, respectively, indicating that local injection of botulinum A toxin at the early stage of wound healing can significantly improve scar quality. Sensitivity analysis suggested that the meta-analysis results were stable and reliable, and publication bias was not analyzed using funnel plots.

CONCLUSION: Botulinum toxin has a positive effect on preventing hyperplastic scars in the maxillofacial and neck areas, and it can also help fade existing scars.

PMID:38518155

Altern Ther Health Med. 2024 Mar 22:AT10133. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aimed at explore the correlation between the CT-based Peritoneal Carcinomatosis Index (PCI) and pathological parameters of rectal cancer, as well as the correlation with short-term postoperative prognosis.

METHODS: A retrospective analysis was performed on 198 rectal cancer patients treated in our institution from January 2017 to December 2022. Based on preoperative CT-PCI, patients were classified into a normal and low CT-PCI groups. Baseline characteristics and short-term postoperative outcomes were compared between the two groups. Univariate and Multivariable logistic regression analyses were conducted to ascertain the independent risk factors for postoperative complications (Clavien-Dindo classification ≥ Grade II) following neoadjuvant treatment and radical rectal cancer surgery.

RESULTS: There were significant statistical differences between the two groups regarding age, ASA score, and surgical method (P < .05). Variations in overall postoperative complications and complications of Grade II or higher among patients with differing preoperative CT-PCI were statistically significant (P < .05). No significant statistical difference was found in the time to first liquid intake post-surgery between the preoperative low CT-PCI group and the normal CT-PCI group (P > .05); however, differences in the time to first flatus, duration of postoperative hospital stay, and total hospital expenditure were statistically meaningful (P < .05). Multivariate logistic regression revealed that CT-PCI (OR=2.254) was an influential factor for postoperative complications (Clavien-Dindo classification ≥ Grade II) (P < .05). The ROC curve demonstrated an AUC of 0.854 for CT-PCI in predicting postoperative complications (Clavien-Dindo classification ≥ Grade II).

CONCLUSION: Preoperative CT-PCI may be utilized to evaluate the short-term prognosis of patients who undergo radical surgery for rectal cancer after neoadjuvant therapy. This evaluation assists in guiding clinical diagnostic and therapeutic decision-making, allowing for prompt interventions and enhancing short-term patient outcomes.

PMID:38518149

Altern Ther Health Med. 2024 Mar 22:AT9172. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to comprehensively examine and assess the changes and significance of irisin levels in individuals with carotid atherosclerosis (CAS) who are concurrently dealing with obesity.

METHOD: A total of 156 CAS patients admitted between March 2020 and March 2022 were categorized into CAS normal weight (C1), CAS overweight (C2), and CAS obesity (C3) groups based on BMI. Simultaneously, 80 healthy adults from the same period comprised the control group (C0). The study conducted a comparative analysis of biochemical indexes, serum irisin levels, and carotid artery ultrasounds across all groups. Correlation analyses and diagnostic assessments for serum irisin in obesity with carotid atherosclerosis were executed using ROC curves.

RESULTS: Statistically significant differences were observed in cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), serum homocysteine (Hcy), and irisin levels among all groups (P < .05). Obese CAS patients exhibited higher levels of TC, TG, LDL-C, and Hcy, with notably lower levels of HDL-C and irisin compared to other groups (P < .05). Significant variations in carotid artery ultrasound intima-media thickness (IMT) and Crouse scores were also evident among all groups (P < .05). Specifically, IMT and Crouse scores were higher in obese CAS patients compared to other groups (P < .05). Correlation analysis results indicated a significant negative correlation between irisin and TC, TG, LDL-C, Hcy, IMT, and Crouse score (P < .05). Conversely, irisin exhibited a significant positive correlation with HDL-C levels (P < .05). The ROC curve analysis for the diagnostic value of irisin in obesity with CAS revealed an area under the curve of 0.957.

CONCLUSIONS: Serum irisin levels are significantly reduced in CAS patients, particularly those with overweight and obese. Additionally, irisin levels are closely associated with patients’ blood lipids, homocysteine levels, and the severity of atherosclerosis.

PMID:38518138

Hum Vaccin Immunother. 2024 Dec 31;20(1):2322795. doi: 10.1080/21645515.2024.2322795. Epub 2024 Mar 22.

ABSTRACT

Coronavirus disease 2019 (COVID-19) was extraordinarily harmful, with high rates of infection and hospitalization. This study aimed to evaluate the impact of COVID-19 vaccination status and other factors on hospitalization and disease severity, using data from Nagasaki Prefecture, Japan. Confirmed cases of COVID-19 infection with vaccination status were included and the differences in characteristics between different vaccination statuses, hospitalization or not, and patients with varying levels of disease severity were analyzed. Furthermore, logistic regression was used to calculate odds ratio (ORs) and 95% confidence intervals (CI) to evaluate the association of various factors with hospitalization and disease severity. From March 14, 2020 to August 31, 2022, 23,139 patients were unvaccinated 13,668 vaccinated the primary program with one or two doses, and 4,575 completed the booster. Vaccination reduced the risk of hospitalization with an odd ratio of 0.759 (95% CI: 0.654-0.881) and the protective effect of completed booster vaccination was more pronounced (OR: 0.261, 95% CI: 0.207-0.328). Similarly, vaccination significantly reduced the risk of disease severity (vaccinated primary program: OR: 0.191, 95% CI: 0.160-0.228; completed booster vaccination: OR: 0.129, 95% CI: 0.099-0.169). Overall, unvaccinated, male, elderly, immunocompromised, obese, and patients with other severe illness factors were all risk factors for COVID-19-related hospitalization and disease severity. Vaccination was associated with a decreased risk of hospitalization and disease severity, and highlighted the benefits of completing booster.

PMID:38517220 | DOI:10.1080/21645515.2024.2322795