Erratum: Evaluation of the Modified Naranjo Criteria for Assessing Causal Attribution of Clinical Outcome to Homeopathic Intervention as Presented in Case Reports

Homeopathy ◽  
2020 ◽  
Vol 109 (04) ◽  
pp. e1-e2
Author(s):  
Chetna Deep Lamba ◽  
Vishwa Kumar Gupta ◽  
Robbert van Haselen ◽  
Lex Rutten ◽  
Nidhi Mahajan ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Causal Attribution ◽  
Case Reports

Evaluation of the Modified Naranjo Criteria for Assessing Causal Attribution of Clinical Outcome to Homeopathic Intervention as Presented in Case Reports

Homeopathy ◽  
2020 ◽  
Vol 109 (04) ◽  
pp. 191-197
Author(s):  
Chetna Deep Lamba ◽  
Vishwa Kumar Gupta ◽  
Robbert van Haselen ◽  
Lex Rutten ◽  
Nidhi Mahajan ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Causal Relationship ◽  
Clinical Case ◽  
Assessment Tool ◽  
Causal Attribution ◽  
Case Reports ◽  
Face Validity ◽  
Rater Agreement ◽  
The Face ◽  
Selection Of

Abstract Objectives The objective of this study was to establish the reliability and content validity of the “Modified Naranjo Criteria for Homeopathy—Causal Attribution Inventory” as a tool for attributing a causal relationship between the homeopathic intervention and outcome in clinical case reports. Methods Purposive sampling was adopted for the selection of information-rich case reports using pre-defined criteria. Eligible case reports had to fulfil a minimum of nine items of the CARE Clinical Case Reporting Guideline checklist and a minimum of three of the homeopathic HOM-CASE CARE extension items. The Modified Naranjo Criteria for Homeopathy Inventory consists of 10 domains. Inter-rater agreement in the scoring of these domains was determined by calculating the percentage agreement and kappa (κ) values. A κ greater than 0.4, indicating fair agreement between raters, in conjunction with the absence of concerns regarding the face validity, was taken to indicate the validity of a given domain. Each domain was assessed by four raters for the selected case reports. Results Sixty case reports met the inclusion criteria. Inter-rater agreement/concordance per domain was “perfect” for domains 1 (100%, κ = 1.00) and 2 (100%, κ = 1.00); “almost perfect” for domain 8 (97.5%, κ = 0.86); “substantial” for domains 3 (96.7%, κ = 0.80) and 5 (91.1%, κ = 0.70); “moderate” for domains 4 (83.3%, κ = 0.60), 7 (67.8%, κ = 0.46) and 9 (99.2%, κ = 0.50); and “fair” for domain 10 (56.1%, κ = 0.38). For domains 6A (46.7%, κ = 0.03) and 6B (50.3%, κ = 0.18), there was “slight agreement” only. Thus, the validity of the Modified Naranjo Criteria for Homeopathy tool was established for each of its domains, except for the two that pertain to direction of cure (domains 6A and 6B). Conclusion The Modified Naranjo Criteria for Homeopathy—Causal Attribution Inventory was identified as a valid tool for assessing the likelihood of a causal relationship between a homeopathic intervention and clinical outcome. Improved wordings for several criteria have been proposed for the assessment tool, under the new acronym “MONARCH”. Further assessment of two MONARCH domains is required.

Homoeopathy—A Plausible Alternative Treatment of De Quervain's Tenosynovitis: Case Reports

2021 ◽  
Author(s):  
Ashish Kumar Dixit
Keyword(s):  
Marked Reduction ◽  
Analogue Scale ◽  
Causal Attribution ◽  
Case Reports ◽  
Treatment Assessment ◽  
De Quervain’S Tenosynovitis ◽  
Ligamentous Structure ◽  
Randomised Controlled ◽  
Computer Operator

Abstract Background De Quervain's tenosynovitis (DQT) is a disorder characterised by pain on the radial side of the wrist, impairment of thumb function and thickening of the ligamentous structure covering the tendons in the first dorsal compartment in the wrist. Methods Two patients—a 50-year-old housewife and a 43-year-old computer operator were treated with a homoeopathic medicine ‘Rhus toxicodendron’ prescribed in 1M potency. The assessment was done using a visual analogue scale (VAS) for pain, quality of life (QoL) and range of motion (ROM) at baseline and end of the treatment. Assessment of causal attribution of treatment effect was done with the Modified Naranjo Criteria. Result Both the cases showed a marked reduction in VAS (from +8 to 0 for both cases) and increase in QoL (from +5 to +10 & from +7 to +9) and ROM. The Modified Naranjo Criteria total score for each case was +7/13. Conclusion Homoeopathy can be an effective approach in the management of DQT. Randomised controlled trials are thus indicated.

scholarly journals Clinical Presentation and Outcomes Associated With Fabellectomy in the Setting of Fabella Syndrome

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090372 ◽  
Author(s):  
Travis J. Dekker ◽  
Matthew D. Crawford ◽  
Nicholas N. DePhillipo ◽  
Mitchell I. Kennedy ◽  
W. Jeffrey Grantham ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Case Reports ◽  
Case Series ◽  
High Rate ◽  
Patient Satisfaction Score ◽  
Presenting Symptoms ◽  
Patient Reported ◽  
Outcome Scores

Background: Clinical outcomes pertaining to isolated lateral fabellectomy in the setting of fabella syndrome are limited to small case reports at this time. Purpose: To assess the most common presenting symptoms, clinical outcomes, and satisfaction after fabella excision in the setting of fabella syndrome. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients with a minimum of 21-month follow-up after isolated fabellectomy for fabella syndrome were reviewed retrospectively. Clinical outcome scores of the following domains were collected: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and Lysholm knee survey, along with a simple numeric patient satisfaction score (range, 1-10; 10 = “very satisfied”). Statistical analysis was performed using paired t tests for all clinical outcome data. Results: A total of 11 isolated fabella excisions were included in 10 patients with isolated lateral-sided knee pain in the setting of fabella syndrome (8 males, 2 females), with a mean age of 36.9 years (range, 23-58 years) and a mean follow-up of 2.4 years (range, 21-47 months). A total of 8 patients (80%) were able to return to full desired activities, including sports. Only 5 of 11 (45%) excisions had concomitant lateral femoral condyle cartilage pathology. There were significant improvements across multiple WOMAC domains, and the WOMAC total score improved from 28.5 ± 17.6 preoperatively to 11.6 ± 10.2 postoperatively ( P < .05). Lysholm scores significantly improved from 66.6 ± 23.1 preoperatively to 80.2 ± 13.9 postoperatively ( P = .044). Overall patient-reported satisfaction was 8.8 ± 1.6. Conclusion: Fabella excision in the setting of fabella syndrome demonstrated improvements in clinical outcome scores, high rate of returning to preinjury level of activities, and low risk of complications or need for additional surgical procedures.

scholarly journals Trisomy 21 with a Small Supernumerary Marker Chromosome Derived from Chromosomes 13/21 and 18

2010 ◽  
Vol 13 (1) ◽  
pp. 55-58 ◽  
Author(s):  
S Niksic ◽  
V Deretic ◽  
G Pilic ◽  
E Ewers ◽  
M Merkas ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Trisomy 21 ◽  
Healthy Subjects ◽  
Case Reports ◽  
Marker Chromosome ◽  
Partial Trisomy ◽  
Small Supernumerary Marker Chromosome ◽  
Trisomy 18P

Trisomy 21 with a Small Supernumerary Marker Chromosome Derived from Chromosomes 13/21 and 18We describe a trisomy 21 with a small supernumerary marker chromosome (sSMC) derived from chromosomes 13/21 and 18 in which the karyotype was 48, XY, +der(13 or 21)t(13 or 21;18)(13 or 21pter→13q11 or 21q11.1::18p 11.21→18pter),+21. Of the 35 case reports in the literature for a karyotype 48, XN, +21,+mar, in only 12 was the origin of the sSMC determined by fluorescence in situ hybridization (FISH), and only one was a der(13 or 21) and none were derived from two chromosomes. The influence of the partial trisomy 18p on the clinical outcome was hard to determine, however, there are reports on clinically healthy subjects for partial trisomy 18p.

Evaluation of Plasmapheresis in the Treatment of an Acute Overdose of Carbamazepine

1993 ◽  
Vol 27 (7-8) ◽  
pp. 866-870 ◽  
Author(s):  
Pramodini B. Kale ◽  
Peter A. Thomson ◽  
Robert Provenzano ◽  
Martha J. Higgins
Keyword(s):  
Clinical Outcome ◽  
Case Reports ◽  
Clinical Status ◽  
Rebound Effect ◽  
Volume Of Distribution ◽  
Carbamazepine Overdose ◽  
Case Summary ◽  
Acute Overdose ◽  
Body Load ◽  
Total Body

OBJECTIVE: To report the use of plasmapheresis in the treatment of an acute overdose of carbamazepine. CASE SUMMARY: A 21-year-old black man was admitted unresponsive and combative following a carbamazepine overdose. The total body load of carbamazepine was approximated at 5.91 g using an assumed volume of distribution of 1.4 L/kg. The patient underwent three plasmapheresis treatments. A total of only 335.82 mg of carbamazepine was removed by this process. DISCUSSION: Case reports in the literature were reviewed and compared. Carbamazepine concentrations lack correlation with the clinical outcome. Our patient's symptoms were consistent with the Weaver classification system. Carbamazepine clearance increased by almost 70 percent above its natural clearance during plasmapheresis. However, a significant rebound effect was observed after plasmapheresis: 40.1 percent after the first and 18.3 percent after the second treatment. CONCLUSIONS: Plasmapheresis did not seem to have a great impact on the patient's clinical status. Under the circumstances we find it extremely difficult to recommend plasmapheresis in the treatment of an acute overdose of carbamazepine.

Two Case Reports of Integrated Management of Antibiotic-Resistant Urinary Tract Infection

Homeopathy ◽  
2020 ◽  
Vol 109 (02) ◽  
pp. 097-106 ◽  
Author(s):  
Kusum S. Chand ◽  
Priya Kapoor
Keyword(s):  
Urinary Tract ◽  
Defense Mechanisms ◽  
Causal Attribution ◽  
Integrated Management ◽  
Case Reports ◽  
Antibiotic Use ◽  
Integrated Treatment ◽  
Antibiotic Resistant ◽  
High Prevalence ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are frequent in women. Cystitis after intercourse (post-coital cystitis) accounts for 60% of recurrent cases. Most physicians treat recurrent UTIs (R-UTIs) with multiple courses of antibiotics. The high prevalence indicates that this bacteria-oriented approach in the long term is ineffective for many women. A change in clinical behavior regarding use of antibiotics and recognizing the importance of a patient’s self-defense mechanisms are important considerations in combating antimicrobial resistance. Methods The intervention for each of two women with R-UTI was integrated treatment with a non-conventional and tailor-made homeopathy regimen, addressing multiple levels of disease simultaneously, for the prevention of recurrence as well as for treatment. Assessment of causal attribution of homeopathy treatment effect was carried out using the Modified Naranjo Criteria. Results Case 1 presented with chronic multi-morbid conditions, including R-UTI which had become multi-drug resistant. With regular homeopathic treatment, her antibiotic use reduced, her diabetic profile improved, and she did not need prophylactic antibiotics. Case 2 suffered from R-UTI with post-coital cystitis and burning sensation, despite following all conventional advice for treatment and prophylaxis. Addition of homeopathy improved her quality of life and prevented relapses. The Modified Naranjo Criteria total score for each patient was +10/13 and +9/13, respectively. Conclusions Addition of homeopathy can be an effective approach in integrated management of antibiotic-resistant R-UTIs. Controlled research on the topic is thus indicated.

scholarly journals Non-fatal Bihemispheric Penetrating Brain Injury from a Crossbow Arrow with Good Clinical Outcome: Case Report

2021 ◽  
Author(s):  
José Gonçalo de Oliveira Machado Saraiva Januário ◽  
Gonçalo Abreu Mesquita Borges de Almeida ◽  
Carlos José Rios Godinho Calado ◽  
Joaquim António Toscano Ferreira Monteiro
Keyword(s):  
Brain Injury ◽  
Clinical Outcome ◽  
Case Reports ◽  
Good Clinical Outcome ◽  
Low Velocity ◽  
Unique Type ◽  
Emergency Team ◽  
Penetrating Brain Injury ◽  
Parietal Lobes ◽  
Point Of Entry

AbstractCrossbow injuries to the head have seldom been reported in the literature, and they represent a unique type of penetrating brain injury (PBI) in which a low-velocity arrow results in an intracranial fragment larger than most high-velocity projectiles, usually with a lethal outcome. We present the case of a 34-year-old man who attempted suicide with a self-inflicted cranial injury from a crossbow arrow, with a right parietal point of entry and a palpable subcutaneous tip in the left parietal region. The emergency team reported a Glasgow coma scale (GCS) score of 15, and the patient was brought sedated and intubated. Computed tomography (CT) imaging scans showed that the arrow crossed both parietal lobes, with mild subarachnoid hemorrhage and small cerebral contusions adjacent to its intracranial path. Careful retrograde removal of the penetrating arrow was performed in the CT suite, followed by an immediate CT scan, which excluded procedure-related complications. The patient woke up easily and was discharged 3 days later with mild left hand apraxia and no other neurologic deficits. To the best of our knowledge, there are no similar case reports describing both good clinical outcome and rapid discharge after a bihemispheric PBI. Individualizing the management of each patient is therefore crucial to achieve the best possible outcome as PBI cases still represent a major challenge to practicing neurosurgeons worldwide.

scholarly journals Treatment of Congenital Microgastria

2020 ◽  
Author(s):  
Larissa I. A. Ruczynski ◽  
Sanne M. B. I. Botden ◽  
Horst E. Daniels-Scharbatke ◽  
Maarten Schurink ◽  
Ivo de Blaauw
Keyword(s):  
Clinical Outcome ◽  
Body Length ◽  
Case Reports ◽  
Group Versus ◽  
Gastric Surgery ◽  
Oral Feeding ◽  
Treatment Modalities ◽  
Invasive Treatment ◽  
Chi Square ◽  
Medline Search

Abstract Introduction Congenital microgastria is an extremely rare birth defect. The aim of this study was to present an overview of existing literature on the treatment of microgastria. Materials and Methods The term “microgastria” was used in a PubMed and Medline search. Since merely case reports were found, only a narrative synthesis with limited statistical analysis can be given. Data of different treatment modalities were collected and divided into two groups: conservative or less invasive treatment (C/LT, i.e., modified diet or a gastrostomy/jejunostomy) and extensive gastric surgery (EGS, i.e., Hunt–Lawrence pouch or total esophageal gastric dissociation). Clinical outcome parameters (nutrition, growth pattern, and mortality) were compared. Results Out of 73 articles published from 1973 to 2019, 38 articles describing 51 cases were included. In four patients, microgastria was an isolated anomaly (8%). Type of treatment was described in only 46 patients, 19 were treated by C/LT. Mortality was 9/19 (47%) in the C/LT group versus 4/27 (15%) in the EGS group (chi-square = 5.829, p = 0.016, Fisher = 0.022). There was a negative correlation between the invasiveness of the treatment and both mortality (r = −0.356, p = 0.015) and comorbidity (r = −0.506, p <0.001). Patients in the C/LT group had significantly more comorbidity than in the EGS group (mean = 4.32 vs. 2.26, p = 0.001). There was a positive correlation between comorbidity and mortality (r = 0.400, p = 0.006). Median follow-up was 42 months (range: 1–240). Type and way of nutrition were poorly described. In at least 9 of the 33 surviving patients, oral feeding was reported as normal, of whom 8 belonged to the EGS group. In all patients, growth could be acknowledged, but in comparison to peers, final body length was less. There was no difference in final body length between the two treatment groups. Conclusion In patients with congenital microgastria, only minimal differences in clinical outcome in terms of type of nutrition and body growth were found when C/LT was compared with treatment by EGS. Mortality was significantly higher in the first group as well as the amount of comorbidities.

scholarly journals Cisternostomy in Traumatic Brain Injury for a Novel Approach to Treatment: Review of Current Status

2021 ◽  
Author(s):  
Manish Agrawal ◽  
Keshav Mishra ◽  
Rohit Babal ◽  
Devendra Purohit
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Outcome ◽  
English Language ◽  
Small Sample Size ◽  
Case Reports ◽  
Controlled Trial ◽  
Small Sample ◽  
Current Status ◽  
Level Of Evidence

AbstractCisternostomy (CS) is a recently introduced procedure to mitigate the cerebrospinal fluid shift edema and secondary injury in traumatic brain injury patients. There have been numerous reports describing its efficacy in various cohorts of traumatic brain injury (TBI) patients; therefore, we review the current evidences examining its utility for the same. The systematic review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline including all human studies published in English language indexed with MEDLINE and Google Scholar since 2013 evaluating CS as a standalone or as an adjuvant procedure. The studies were graded according to the Oxford center for evidence-based medicine levels of evidence. Case reports were excluded from the analysis. A total of 107 articles were found by using the given search criteria. Finally, three oxford level 3 study and one level 4 study were included in the analysis. CS in combination with decompressive craniectomy was seen to confer mortality benefit and better outcome at discharge. It led to statistically significant improvement in clinical outcome at 6 months in the patients for whom it was performed as a primary procedure. CS is a promising procedure in TBI leading to survival benefit as well as better clinical outcome. But the level of evidence supporting its effectiveness is still weak owing to the methodological limitations and small sample size. A well-designed multicentric randomized controlled trial is needed to critically examine its role in TBI patients.

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