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.

Contribution of homeopathy to the control of an outbreak of dengue in Macaé, Rio de Janeiro

Homeopathy has contributed throughout history to the control and eradication of epidemic diseases. Facing the challenge of controlling an outbreak of dengue, the Secretary of Health of the county of Macaé, Rio de Janeiro, Brazil, in early 2007 carried out a “Homeopathy Campaign against Dengue”. 156,000 doses of homeopathic remedy were freely distributed in April and May 2007 to asymptomatic patients and 129 doses to symptomatic patients treated in outpatient clinics, according to the notion of “epidemic genus”. The remedy used was a homeopathic complex against dengue containing Phosphorus 30cH, Crotalus horridus 30cH and Eupatorium perfoliatum 30cH. The incidence of the disease in the first three months of 2008 fell 93% by comparison to the corresponding period in 2007, whereas in the rest of the State of Rio de Janeiro there was an increase of 128%. While confounding factors were not controlled for, these results suggest that homeopathy may be an effective adjunct in Dengue outbreak prevention. Keywords: Homeopathy; Collective Health; Epidemics; Dengue.  Contribuição da Homeopatia para o controle da epidemia de dengue em Macaé, Rio de Janeiro, Brasil Resumo A Homepatia tem contribuído através da História no controle e erradicação de epidemias. Em face ao desafio de controlar uma epidemia de dengue, a Secretaria de Saúde do município de Macaé, Rio de Janeiro, Brasil, iniciou em 2007 a “Campanha da Homeopatia contra a Dengue”. 156,000 doses de medicamento foram gratuitamente distribuídas entre Abril e Maio de 2007 para pacientes assintomáticos e 129 doses para pacientes que já apresentavam os sintomas. Seguindo o conceito de “Génio Epidémico” foi usado um complexo homeopático contendo Phosphorus 30cH, Crotalus horridus 30cH e Eupatorium perfoliatum 30cH. A incidéncia da doença, nos primeiros 3 meses de 2008, revelou uma queda de 93% em comparação com o período correspondente em 2007, enquanto que no resto do estado do Rio de Janeiro houve um aumento de 128% dos casos. Apesar de alguns fatores não terem sido controlados, estes resultados sugerem que o tratamento homeopático pode ser um complemento efetivo na prevenção da epidemia de Dengue. Palavras-chave: Homeopatia; Saúde Pública; Epidemia; Dengue.  Contribución de la homeopatía para el control de un brote de dengue en Macaé, Río de Janeiro, Resumen La homeopatía ha contribuido a lo largo de la historia em el control y la erradicación de las enfermedades epidémicas. Al enfrentar el reto de controlar un brote de dengue, el Secretario de Salud de la provincia de Macaé, Río de Janeiro, Brasil, a principios de 2007, llevó a cabo una "Campaña de la homeopatía contra el Dengue". 156.000 dosis de remedio homeopático se distribuyeron libremente entre abril y mayo de 2007 a pacientes asintomáticos y 129 dosis a los pacientes sintomáticos tratados en ambulatorios, de acuerdo con la noción de "epidemia de género". El recurso utilizado fue un complejo homeopático contra el dengue que contiene Phosporus 30cH, Crotalus horridus 30cH y Eupatorium perfoliatum 30cH. La incidencia de la enfermedad en los tres primeros meses de 2008 se redujo 93% en comparación con el período correspondiente en 2007, mientras que en el resto del Estado de Río de Janeiro hubo un aumento de 128%. Si bien hay factores no controlados, estos resultados sugieren que la homeopatía puede ser un complemento eficaz en la prevención del brote de dengue. Palabras-clave: Homeopatía; Salud Colectiva; epidemias; dengue.  Correspondence author: Laila Aparecida de Souza Nunes, [email protected] How to cite this article: Nunes LAS. Contribution of homeopathy to the control of an outbreak of dengue in Macaé, Rio de Janeiro. Int J High Dilution Res [online]. 2008 [cited YYYY Mmm DD]; 7(25): 186-192. Available from: http://journal.giri-society.org/index.php/ijhdr/article/view/315/374. ÂÂÂ

Values of Obese Male Patients Performed with Acupuncture

Obesity is a disease defined by excessive fat storage in the body. It is an energy balance problem; the increase in body fat is caused by an imbalance between energy intake and energy expenditure. The practice of acupuncture views the body as a combination of the soul and the body, not merely as a physical structure. This interpretation can lead to a successful therapy for the treatment of chronic pain. One of the factors for its success is the concept of the functional evaluation of the organ. According to acupuncture, the organs are alive and vitality is provided by the energy of life called ‘’qi’’ Pathogens that interrupt and obstruct the flow of qi form diseases. Acupuncture needles are inserted at specific points on the Bonghan channels and the qi stream is regulated by electron transfer. The present study was a cross-sectional study conducted in 2019 in xxx University’s GETAT Center. Patients aged between 18–65 years with a BMI > 25 were included in the study. Acupuncture was shown to be effective not only in the obese groups but also in the control groups. Therefore, it could be beneficial in preventing weight gain. Both ear and body acupuncture points were used effectively in obesity patients. Therefore, acupuncture may be recommended as an effective adjunct in the treatment of obesity. Acupuncture can reduce the stress of patients on diets and increase patient compliance.

Transforming training into practice with the conflict management framework: a mixed methods study

ObjectiveTo implement and evaluate the use of the conflict management framework (CMF) in four tertiary UK paediatric services.DesignMixed methods multisite evaluation including prospective pre and post intervention collection of conflict data alongside semistructured interviews.SettingEight inpatient or day care wards across four tertiary UK paediatric services.InterventionsThe two-stage CMF was used in daily huddles to prompt the recognition and management of conflict.ResultsConflicts were recorded for a total of 67 weeks before and 141 weeks after implementation of the CMF across the four sites. 1000 episodes of conflict involving 324 patients/families across the four sites were recorded. After implementation of the CMF, time spent managing episodes of conflict around the care of a patient was decreased by 24% (p<0.001) (from 73 min to 55 min) and the estimated cost of this staff time decreased by 20% (p<0.02) (from £26 to £21 sterling per episode of conflict). This reduction occurred despite conflict episodes after implementation of the CMF having similar severity to those before implementation. Semistructured interviews highlighted the importance of broad multidisciplinary leadership and training to embed a culture of proactive and collaborative conflict management.ConclusionsThe CMF offers an effective adjunct to conflict management training, reducing time spent managing conflict and the associated staff costs.

Posterior hip pericapsular neurolysis (PHPN) for inoperable hip fracture: an adjunct to anterior hip pericapsular neurolysis

BackgroundThe development of anterior hip neurolysis has made an appreciable impact on the management of patients with inoperable hip fracture. Nonetheless, suboptimal analgesic benefit was still observed in some patients. We therefore developed a novel posterior hip pericapsular neurolysis (PHPN) to complement anterior hip neurolysis in inoperable hip fracture.MethodsIn this retrospective review, we analyzed patients who responded suboptimally (defined as composite pain score moderate or higher on hip flexion 80°) to the anterior hip neurolysis from July 2019 to March 2021. The patients received additional PHPN if the composite pain score was suboptimal. The percentage of patients with dynamic composite pain scores on hip flexion to 80° and on gentle hip external and internal rotation on post-intervention day 5 was then evaluated.ResultsAmong the 70 patients who were reviewed in the study period, 20 patients who partially responded to anterior hip neurolysis received an addition of diagnostic posterior hip pericapsular block. Eighteen patients were the positive responders and PHPN was then performed. Among the PHPN recipients, a high percentage with satisfactory dynamic pain control was observed with 78% on hip flexion 80° and 83% on hip external/internal rotation on day 5 following the intervention. No procedural adverse event was noted.ConclusionsWhile most patients responded satisfactorily to anterior hip neurolysis, we concluded PHPN could be an effective adjunct to manage suboptimal pain control after anterior hip neurolysis in inoperable hip fracture.Trial registration numberNTWC/REC/21061.

Modified negative pressure wound therapy as an adjunct to antibiotics in the treatment of orthopaedic infected metalwork

Purpose Infected orthopaedic metalwork is challenging to treat. Negative pressure wound therapy (NPWT) with irrigation is an emerging therapy for infected wounds as an adjunct to antibiotic therapy. The senior author had devised a modified technique to augment its efficacy, utilising high-flow rate irrigation and skin closure over the standard NPWT dressing. This novel technique was originally evaluated in a different centre and produced 100% success in metalwork retention. The present study is a reproducibility test of the same technique. Methods A retrospective review was performed on 24 patients with infected orthopaedic metalwork, including 3 upper limb and 21 lower limb cases, for outcomes relating to implant retention and infection resolution. Patients underwent a modified NPWT technique as an adjunct to antibiotic therapy and surgical debridement. Detailed medical and microbiology information were obtained from the patient records. Results 23 of 24 (96%) patients had successful metalwork retainment with healed wounds and resolution of infection, allowing fracture union. 27 infective organisms were identified in this cohort, and the antibiotic regimens for each patient are provided. The average follow-up was 663 days. No adverse effects were observed. Conclusion This series supports the modified NPWT technique as a safe, reliable and effective adjunct therapy to resolve metalwork infection. The same results have been reproduced as the previous cohort in a different centre.

Values of Obese Male Patıents Performed Wıth Acupuncture

Obesity is a disease defined by excessive fat storage in the body. It is an energy balance problem; the increase in body fat is caused by an imbalance between energy intake and energy expenditure. The practice of acupuncture views the body as a combination of the soul and the body, not merely as a physical structure. This interpretation can lead to a successful therapy for the treatment of chronic pain. One of the factors for its success is the concept of the functional evaluation of the organ. According to acupuncture, the organs are alive and vitality is provided by the energy of life called ‘’qi’’ Pathogens that interrupt and obstruct the flow of qi form diseases. Acupuncture needles are inserted at specific points on the Bonghan channels and the qi stream is regulated by electron transfer. The present study was a cross-sectional study conducted in 2019 in xxx University’s GETAT Center. Patients aged between 18–65 years with a BMI > 25 were included in the study. Acupuncture was shown to be effective not only in the obese groups but also in the control groups. Therefore, it could be beneficial in preventing weight gain. Both ear and body acupuncture points were used effectively in obesity patients. Therefore, acupuncture may be recommended as an effective adjunct in the treatment of obesity. Acupuncture can reduce the stress of patients on diets and increase patient compliance.

Nonpharmacologic Management of Procedural Pain in Pediatric Burn Patients: A Systematic Review of Randomized Controlled Trials

Pain following burn injury is associated with long-term health consequences in the pediatric population. Literature suggests nonpharmacologic treatment may provide improved pain control as an effective adjunct for these patients. This study aims to summarize randomized controlled trials on nonpharmacologic procedural pain management in pediatric burn patients. A systematic review was conducted on nonpharmacologic procedural pain management techniques used in the pediatric burn population. Fifteen studies were included and involved virtual reality, distraction devices, child life therapy, directed play, digital tablet games, cartoons, hypnosis, and music therapy. Treatment was effective in 8 out of 15 studies. Compared to controls, nonpharmacologic treatments reduced mid procedure pain by 19.7% and post procedure pain by 20.1%. This study demonstrates nonpharmacologic therapy can be an effective adjunct in pediatric procedural burn pain management, however further studies are needed to develop standardized algorithms to integrate nonpharmacologic treatments with pharmacologic therapies.

A-131 Treating Parkinson’s Disease with Mindfulness: A Systematic Review

Objective Mindfulness has been recognized as an evidence-based treatment in a range of psychological and medical (i.e., chronic pain, dementia, diabetes) conditions. Despite several randomized and non-randomized control trials, there continues to be a lack of consensus regarding mindfulness as an effective treatment for individuals with Parkinson’s disease (PD). Methods PsychINFO, Medline, ProQuest, and Embase, were searched using a combination of terms such as “Parkinson’s” and “Mindfulness” or “Meditation.” Studies were included if they reported method, participants, interventions used, and outcomes. Results were extracted and assessed for quality and relevance. Data Synthesis The systematic analysis revealed that mindfulness was primarily effective in reducing non-motor symptoms of PD, except for one survey study of PD patients, which indicated that mindfulness was associated with improved motor symptoms. Otherwise, mindfulness resulted in decreased anxiety and distress while also improving social support. Of the two studies that included caregivers in treatment, mindfulness was associated with reduced caregiver burden. Conclusion The results supported the use of mindfulness as an effective adjunct to PD treatment, with the strongest effects on non-motor symptoms and caregiver distress. Notably, the studies included were limited by small sample sizes and patients with mild to moderate symptoms of PD. Further random controlled trials with larger sample sizes and differing degrees of PD severity are needed to conclusively determine the effects of mindfulness in treating PD.