Magnesium alginate versus proton pump inhibitors for the treatment of laryngopharyngeal reflux: a non-inferiority randomized controlled trial

Purpose Proton pump inhibitors (PPIs) are commonly prescribed for laryngopharyngeal reflux (LPR), but their efficacy remains debated. Alginates is an option for the treatment of LPR with few adverse effects. The study aimed to investigate the non-inferiority of an alginate suspension (Gastrotuss®) compared to PPIs (Omeprazole) in reducing LPR symptoms and signs. Methods A non-inferiority randomized controlled trial was conducted. Fifty patients with laryngopharyngeal symptoms (Reflux Symptom Index -RSI- ≥ 13) and signs (Reflux Finding Score -RFS- ≥ 7) were randomized in two treatment groups: (A) Gastrotuss® (20 ml, three daily doses) and, (B) Omeprazole (20 mg, once daily). The RSI and the RFS were assessed at baseline and after 2 months of treatment. Results Groups had similar RSI and RFS scores at baseline. From pre- to 2-month posttreatment, the mean RSI significantly decreased (p = 0.001) in alginate and PPI group (p = 0.003). The difference between groups in the RSI change was not significant (95%CI: − 4.2–6.7, p = 0.639). The mean RFS significantly decreased in alginate (p = 0.006) and PPI groups (p = 0.006). The difference between groups in the mean change RFS was not significant (95%CI: − 0.8; 1.4, p = 0.608). Conclusion After 2 months of treatment, LPR symptoms and signs are significantly reduced irrespective of the treatment. Alginate was non-inferior to PPIs and may represent an alternative treatment to PPIs for the treatment of LPR.

Imaging of Type I Retroaortic Left Renal Vein & Nutcracker Syndrome

Retroaortic left renal veins are an often overlooked, but no so rare anatomic anomaly that might cause a few aspecific symptoms and signs, especially flank or inguinal pain, microscopic or even gross hematuria; in the vast majority of cases it is, thought, totally asymptomatic. The nutcracker syndrome that might arise in the case of RLRV is mainly due to the re- duced space between aorta and the vertebral body and the consequent compression on the venal rein; this might in turn cause upstream hypertension, hematuria, varicocele, pain. The compression of RLRV leads to hematuria because of renal venous hypertension, consequent left renal congestion. This upstream venous congestion might result, in some cases, in left-sided varicocele in men and pelvic congestion syndrome in women. From a radiologic point of view, the presence of RLRV and the precise reporting its subtypes is mandatory.

Precision Medicine and Childhood Asthma: A Guide for the Unwary

Many thousands of articles relating to asthma appear in medical and scientific journals each year, yet there is still no consensus as to how the condition should be defined. Some argue that the condition does not exist as an entity and that the term should be discarded. The key feature that distinguishes it from other respiratory diseases is that airway smooth muscles, which normally vary little in length, have lost their stable configuration and shorten excessively in response to a wide range of stimuli. The lungs’ and airways’ limited repertoire of responses results in patients with very different pathologies experiencing very similar symptoms and signs. In the absence of objective verification of airway smooth muscle (ASM) lability, over and underdiagnosis are all too common. Allergic inflammation can exacerbate symptoms but given that worldwide most asthmatics are not atopic, these are two discrete conditions. Comorbidities are common and are often responsible for symptoms attributed to asthma. Common amongst these are a chronic bacterial dysbiosis and dysfunctional breathing. For progress to be made in areas of therapy, diagnosis, monitoring and prevention, it is essential that a diagnosis of asthma is confirmed by objective tests and that all co-morbidities are accurately detailed.

Morphological and molecular identification of new records and new host plants of powdery mildews (Erysiphaceae) from Mexico

Powdery mildew is one of the most severe diseases affecting Cucurbitaceae. We identify the members of Erysiphaceae infecting cucurbits in three producing regions in Mexico. We determined that Golovinomyces ambrosiae, Neoerysiphe sechii, and Podosphaera xanthii infected cultivated and wild cucurbits species or subspecies. Leaf samples showing symptoms and signs of powdery mildew were collected from the northwestern, central western, and eastern regions of Mexico between 2017 and 2020. Species associated with the disease were identified based on morphology and ITS rDNA sequences. All powdery mildew specimens presented only the anamorph. Podosphaera xanthii was the predominant species; it was found in 85.7 % of the samples and in 13 out of 14 species or subspecies of cucurbits. Neoerysiphe sechii was found in 15.23 % of the samples and in only four cucurbit species from the central western and eastern regions of Mexico. Golovinomyces ambrosiae was documented for the first time in a Cucurbitaceae species (Sicyos deppei) from Central West Mexico. Three new hosts were registered for Neoerysiphe sechii (Cucurbita ficifolia, Echinopepon milleflorus, and Sicyos laciniatus) and eight for Podosphaera xanthii (Cucurbita argyrosperma, C. argyrosperma subsp. sororia, C. ficifolia, C. okeechobeensis subsp. martinezii, C. radicans, Sechium edule, Sicyos laciniatus, and S. deppei).

Stump Appendicitis with Diagnostic Dilemma: A Case Report

Stump appendicitis is a rare delayed complication of incomplete appendectomy. The clinical symptoms and signs are like acute appendicitis. The possibility of stump appendicitis is not clear to all clinicians. It represents a diagnostic dilemma with incidence of one in 50,000 cases. We report how we encountered diagnostic dilemma during the management of a 30 years old male patient of acute abdomen with history of appendectomy done for acute appendicitis even years back.

Transcutaneous Electrical Acupoint Stimulation (Teas) In The Treatment of Dry Eye Disease

Purpose: To assess effectiveness and safety of the Transcutaneous Electrical Acupoint Stimulation (TEAS) treatment in alleviating symptoms and signs of dry eye disease (DED).Methods: Patients diagnosed with DED at the Peking University Third Hospital Eye Center from December 2020 to February 2021 were randomly assigned in a 1:1:1 ratio to 5mA, 3mA, or 0mA Group respectively. DED signs and symptoms were evaluated before and 30min after treatment. We compared the clinical improvement among the three groups and between each two groups. Results: A total of 63 patients were included. 5mA Group had best efficacy in all the signs and most of symptoms (P<0.05), and the symptoms scores in 3mA Group were also significantly improved after treatment except pain, watering and increased secretions (P<0.05). In the comparisons between before and after treatment between each two groups, 5mA Group showed greater improvement in the signs and most of symptoms than other two groups(P<0.05). In addition, 3mA Group had greater improvement than 0mA Group in the symptoms of asthenopia (P=0.018) and blurred vision (P=0.001). During the treatment, we hadn’t gotten any adverse events from patients.Conclusions: TEAS treatment was effective in the treatment of DED, and 5mA provided greater signs and symptoms relief. TEAS might be a new therapeutic option for the treatment of DED.

Complications of Stroke

Stroke is one of the leading causes of disability and mortality and can cause a serious socioeconomic burden. Some of the comorbidities and secondary complications of stroke can threaten the patient's life or cause serious pain or negatively affect the patient's involvement in rehabilitation or worsen daily life activities or make it difficult to bring the patient into the community and workplace. This chapter focuses on the symptoms and signs, diagnosis, and management of these comorbidities and complications. It highlights diagnosis and treatment of cardiac problems, sleep disorders, deep vein thrombosis, pulmonary embolism, dysphagia, malnutrition, and pneumonia. Depression, central post-stroke pain, upper limb problems after stroke, spasticity, bladder dysfunction are also discussed in this chapter.

A method of seeing in homeopathy: methodological foundations of project "Understanding Homeopathy by Images"

This paper presents the results of conceptual research on the nature and operation of visual signs in homeopathic clinical practice. Aims: to analyze the role of visual signs in homeopathy together with their specific semiotic structure in correlation with the codes leading to possible significations and then to assess the possibility of establishing coherence between the symptoms and signs of patients. Methodology: Sign-complexes are approached through a four-stage model including: 1) delimitation; 2) decomposition; 3) correlation and; 4) reintegration of signs. Data for analysis were collected along 15 years of homeopathic clinical practice and recorded by visual means; theoretical foundations derive from Jakobson’s theory of communication and Peirce’s semiotics. Results: stages of delimitation and decomposition are illustrated by a homeopathic semiology of the tongue; analysis of correlation allowed to identify 9 different possible patterns; reintegration requires a first phase of extension of the connotation and denotation of signs followed by a phase of contraction of meaning leading to decision-making. Conclusion: application of the model proposed results in highly qualified and individual visual signs that bring new elements to reconsider the role of objective signs in homeopathic practice. Keywords: Homeopathy; Semiotics; Semiology; Visual signs  Método de observação em Homeopatia: Fundamentos metodológicos do projeto “Entendendo a Homeopatia através de imagens” ResumoEste artigo apresenta os resultados da pesquisa conceitual sobre a natureza e operação de sinais visuais na prática clínica homeopática. Objetivos: analisar a função de sinais visuais na homeopatia juntamente com a sua estrutura semiótica semiótica, correlacionando-os com os códigos, conduzindo a possíveis significações e, em seguida, para avaliar a possibilidade de estabelecer coeréncia entre os sinais e sintomas dos pacientes. Metodologia: o conjunto de sinais são abordados através de um modelo com quatro fases: 1) delimitação; 2) decomposição; 3) correlação; 4) reintegração de sinais. Os dados para análise foram coletados ao longo de 15 anos de prática clínica homeopática e registrados por recursos visuais; os fundamentos teóricos derivam da teoria da comunicação de Jakobson e semiótica de Peirce. Resultados: as fases de delimitação e decomposição são ilustradas pela semiologia homeopática da língua; a análise de correlação permitiu identificar 9 diferentes padrões; a reintegração exige uma primeira fase de interpretação da conotação e denotação de sinais, seguida por uma fase de contração do significado, levando àtomada de decisão. Conclusão: a aplicação do modelo proposto resulta em sinais visuais altamente qualificados e individualizados, que trazem novos elementos para repensar o papel dos sinais objetivos na prática homeopática. Palavras-chave: Homeopatia, Semiótica, Semiologia, Sinais visuais  Un método de observación en Homeopatía: Bases metodológicas del proyecto "Entendiendo la homeopatía por imágenes" ResumenEste artículo presenta los resultados de la investigación conceptual sobre la naturaleza y el funcionamiento de las señales visuales en la práctica clínica homeopática. Objetivos: analizar el papel de la homeopatía en los signos visuales, junto con su estructura específica semiótica en correlación con los códigos para posibles significaciones y, a continuación, para evaluar la posibilidad de establecer la coherencia entre los signos y síntomas de los pacientes. Metodología: Registro complejos se abordan a través de un modelo de cuatro etapas que incluyen: 1) delimitación, 2) descomposición; 3) correlación y, 4) reintegración de los signos. Datos para el análisis fueron recogidos a lo largo de 15 años de práctica clínica y homeopáticos registrados por medios visuales; los fundamentos teóricos se derivan de la teoría de la comunicación de Jakobson y la semiótica de Peirce. Resultados: las etapas de la delimitación y la descomposición se ilustra con una semiología homeopática de la lengua; la análisis de correlación permitió identificar 9 posibles patrones diferentes; la reinserción requiere una primera fase de ampliación de la connotación y la denotación de los signos seguidos por una fase de contracción de sentido que conducen a la toma de decisiones. Conclusión: la aplicación del modelo propuesto resulta en resultados altamente calificados y signos visuales que aportan nuevos elementos a reconsiderar el papel de los signos objetivos de la práctica homeopática. Palabras-clave: Homeopatía; Semiótica; Semiología; signos visuales  Correspondence author: Gheorghe Jurj, [email protected] How to cite this article: A Method of Seeing in Homeopathy: Methodological Foundations of Project “Understanding Homeopathy by Images”. Int J High Dilution Res [online]. 2009 [cited YYYY Month dd]; 8 (27): 53-69. Available from: http://journal.giri-society.org/index.php/ijhdr/article/view/333/386. ÂÂÂ

A new indication for elective induction of labor COVID-19 pandemic effect

Background: Induction of labour is performed in certain circumstances which involve greater risks of waiting for the onset of spontaneous labour than the risks due to shortening the duration of pregnancy by induction. The objective of this study was to evaluate the maternal and fetal outcome in patients undergoing elective induction during COVID-19 pandemic.Methods: This prospective observational study was conducted on 60 ANC patients with singleton pregnancy and POG >39 weeks coming to OPD with negative COVID-19 RT-PCR report. To avoid the burden of repeat testing after one week and risk of exposure to COVID-19 virus from community, patients were induced. All the data was recorded and analyzed.Results: Most of the patients were in age group of 20-25 years (50%) and only 6.7% of the patients were older than 30 years. 32 (53.3%) patients were multiparous and 50% of the patients were having Bishop score between 2-5 and only 8.3% had bishop score of more than 5. 47 patients (78.3%) underwent normal vagina delivery whereas 12 patients (20%) underwent LSCS. Failure of Induction was the indication for LSCS in 5 patients (41.7%).Conclusions: Elective induction was found to be better option in COVID-19 negative patients. All pregnant women should be monitored for development of symptoms and signs of COVID-19 particularly if they have had close contact with a confirmed case. Pregnancy and childbirth generally do not increase the risk for acquiring SARS-CoV-2 infection but may worsen the clinical course of COVID-19 compared with nonpregnant individuals of the same age.

Sex-Related Factors in Cardiovascular Complications Associated to COVID-19

Coronavirus disease 2019 (COVID-19), the pandemic infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents with an extremely heterogeneous spectrum of symptoms and signs. The clinical manifestations seem to be correlated with disease severity. COVID-19 susceptibility and mortality show a significant sex imbalance, with men being more prone to infection and showing a higher rate of hospitalization and mortality compared to women. Such variability can be ascribed to both sex-related biological factors and gender-related behavioral cues. This review will discuss the potential mechanisms accounting for sex/gender influence in vulnerability to COVID-19. Cardiovascular diseases play a central role in determining COVID-19 outcome, whether they are pre-existent or arose upon infection. We will pay particular attention to the impact of sex and gender on cardiovascular manifestations related to COVID-19. Finally, we will discuss the sex-dependent variability in some biomarkers for the evaluation of COVID-19 infection and prognosis. The aim of this work is to highlight the significance of gendered medicine in setting up personalized programs for COVID-19 prevention, clinical evaluation and treatment.