Atrial Fibrillation Caused by Intractable Hiccups: A Unique Cause and Cure

We present the case of a 61-year-old male who developed persistent hiccups concurrently with the onset of atrial fibrillation (AF). The hiccups were refractory to traditional treatment but resolved immediately upon electrical cardioversion (ECV) to normal sinus rhythm (NSR). The patient has remained in NSR and free of hiccups. The potential etiologies for hiccups are numerous and varied, and the management of persistent hiccups can be difficult. Cardiac associations including myocardial infarction and pericarditis have been described, while few cases of first-time onset of atrial fibrillation leading to hiccups have been documented. This case discusses a unique instance demonstrating a connection between hiccups and cardiac pathology and an overview of its management.

Supportive Care Program in CKD: from dream to reality

The number of older and frail patients has greatly increased in nephrology departments. Traditional treatment options have become inappropriate because they seem unable to achieve goals such as quality of life. Principles from palliative care have been brought to chronic kidney disease management with good results; thus a new way to approach these patients has been reported. In Portugal, in 2011, Direcção Geral de Saúde published a guideline to substantiate supportive care as an option, for certain patients, in certain circumstances. The best evidence known at the time was stated and the conditions that should be met were regulated, but limited information was given about practical implementation of what. In this article we describe our experience with a supportive care program from planning to the implementation steps, since 2015. We reflect on the flowchart, the barriers, the conquests, and the data up to the end of 2020.

INTENSE PULSED LIGHT (IPL) TREATMENT FOR DUPILUMAB INDUCED OCULAR SURFACE DISEASE (DIOSD)

PurposeTo report a case of dupilumab induced ocular surface disease (DIOSD) managed with intense pulsed light (IPL) as an effective adjunct therapy to topical steroids and topical immunomodulator lifitegrast.MethodsDiscussion of a patient’s case with accompanying anterior segment and meibography photos with diagnosed DIOSD for which adjunct therapy with IPL was an effective treatment after limited relief from and difficulty with adherence to traditional treatment with topical steroids and lifitegrast ophthalmic solutions. ConclusionThis case demonstrates the complexity of management required to treat patients with DIOSD and its chronic nature. IPL as a nonpharmaceutical adjunct therapy to topical steroids and immunomodulators in the treatment of DIOSD showed improved signs and symptoms of DIOSD.

Traditional Antipyretics from the text of Usada Wariga Dalem as an Ayurveda knowledge

Text Usada Wariga Dalem is one of Usada in Bali as a national cultural heritage which contains the knowledge system of traditional Balinese treatment which includes symptoms of disease, names of diseases, medicinal facilities, how to mix, and how to treat. One of the symptoms contained in the text of Usada Wariga Dalem usada is fever. Handling of fever can be done by using medicinal plants as contained in the text of Usada Wariga Dalem. Treatment with medicinal herbs is still one of the options for Balinese people in treating diseases. Traditional medicinal herbs for fever are often used as alternative and complementary medicines. This research examined what included fever in the text of Usada Wariga Dalem, what were the ingredients of fever medicine in the text of Usada Wariga Dalem and how the medicine could be a complementary and alternative medicine for the Balinese people. This research used a descriptive qualitative research method. literature study and ethnography method. The data needed in this study were collected using a library study, observation, and in-depth interviews. The data is sourced from the Usada Wariga Dalem lontar text, which was collected at the Lontar Study Center, Faculty of Cultural Sciences, Udayana University. The traditional medicine for fever contained in the Usada Wariga Dalem text can be used for complementary and alternative medicine. This traditional treatment using medicinal ingredients from processed plants, has been proven to reduce the patient's fever.

Exploration of Medicinal Plants: Tinuktuk Concoction in Simalungunese, Indonesia

Plant species have been applied in the traditional treatment of certain diseases since ancient history. The purpose of this study is to explore the efficacy of medicinal plants, specifically tinuktuk, in Simalungunese, North Sumatra, Indonesia. This effort shows the potentials of local knowledge in preparing herbal mixtures, based on geographical existence. The sample concoction was analyzed qualitatively for its health properties, using a pragmatic approach. Subsequent data were obtained from focus group discussions and field demonstrations to determine the plant types, processing mechanisms and efficacy. The results showed that the leaves, stems, fruits, seeds, tubers, and rhizomes of 18 herbal plant varieties were utilized, alongside the evaluation of 8 medicinal properties. Among the species, Zingiberaceae, Arecaceae, and Euphorbiaceae belonged to genera, while Areacaceae, Poaceae, Rutaceae, and Zingiberaceae families were predominantly applied. Therefore, the efficacy determination of tinuktuk concoction appears significant in terms of facilitating lactation during childbirth and subsequently eliminating the unclean blood, enhancing immunity, maintaining stamina and increasing the appetite. In summary, the sample is suitable as a herbal medicine and a product of local knowledge in the treating various ailments across generations.

Application of Accelerated Rehabilitation Surgery in Gastrointestinal Surgery

Adding timely rehabilitation surgery is an optimized perioperative measure that can reduce physical stress, reduce surgical risks, and postoperative complications and promote the recovery of organ function. Therefore, it is of great value to study its application in gastrointestinal surgery (GS). To this end, this article applies retrospective analysis and statistical methods to conduct targeted investigations and studies on GS patients. The results of the survey showed that 26.7% of patients were effective in ARS and 40% were effective in treatment. Compared with traditional treatment methods, its effective treatment rate is 13.4% higher.

Plasmapheresis: Is it a potential alternative treatment for chronic urticaria?

Background Chronic urticaria is a common disease. Plasmapheresis is an alternative treatment that can be appropriate for patients who are resistant to treatment with 2nd generation antihistamines or for whom treatment with omalizumab is unsuitable. Objective To investigate the effect of plasmapheresis treatment in chronic urticaria. Methods A retrospective analysis was performed based on the data of 98 patients suffering from refractory chronic urticaria who received plasmapheresis as an alternative treatment in Vilnius University’s Hospital Santaros Clinics from 2000 to 2020. The efficiency of the treatment was evaluated by clinical judgment. Results 58.2% of the patients exhibited a complete or significant response; of these, 37.8% had temporary relief of symptoms and 20.4% achieved disease remission; 41.8% showed no response to the plasmapheresis. Men (34.8%) had a tendency to achieve disease remission more often than women (16%) (p < 0.05). One patient did not finish the plasmapheresis treatment due to the symptoms’ exacerbation and treatment with omalizumab was initiated. Conclusion Plasmapheresis is a safe and effective alternative treatment when traditional treatment is unavailable or does not relieve symptoms completely. Our data showed that plasmapheresis was effective in more than half of our patients.

Therapeutic Options for Childhood Absence Epilepsy

Childhood absence epilepsy (CAE) is a common pediatric generalized epileptic syndrome. Although it is traditionally considered as a benign self-limited condition, the apparent benign nature of this syndrome has been revaluated in recent years. This is mainly due to the increasing evidence that children with CAE can present invalidating neuropsychological comorbidities that will affect them up to adulthood. Moreover, a percentage of affected children can develop drug-resistant forms of CAE. The purpose of this review is to summarize the most recent studies and new concepts concerning CAE treatment, in particular concerning drug-resistant forms of CAE. A Pubmed search was undertaken to identify all articles concerning management and treatment of CAE, including articles written between 1979 and 2021. Traditional anticonvulsant therapy of CAE that is still in use is based on three antiepileptic drugs: ethosuximide which is the drug of choice, followed by valproic acid and lamotrigine. In the case of first line treatment failure, after two monotherapies it is usual to start a bi-therapy. In the case of absence seizures that are refractory to traditional treatment, other antiepileptic drugs may be introduced such as levetiracetam, topiramate and zonisamide.

In-Situ Ocular Gel Pharmaceutical Delivery System: A Recent Review

Ocular Drug Delivery has been a key challenge and attractive field for the pharmaceutical scientist due to peerless anatomy and physiology of eye. Glaucoma, dry eye syndrome, keratitis, endophthalmitis, trachoma, and conjunctivitis are just a few of the conditions that can affect the eye. In order to accomplish efficient ocular treatment within the eye, At the point of action, an appropriate supply of active substances must be given and sustained. Due to fast precorneal medication loss, traditional treatment has a low bioavailability. The bioavailability of a medicine is also influenced by static and dynamic barriers. To address the limitations of traditional treatment, significant efforts are being made to develop innovative medication systems for ocular delivery. When a drop is injected into the eye, it goes through a sol-gel transition and forms a cul-de-sac. The in-situ gel system, which comprises thermally triggered, pH triggered, and ion cross linking systems, is the subject of this review. It includes a step-by-step procedure for preparing the pH-triggered system as well as assessment parameters. Keywords: Conventional dosage form, Anatomy and physiology in eye, In-situ gel.