Alternative therapies in health and medicine最新文献

Introduction: Palmoplantar keratoderma is an abnormal thickening of the skin on the palms of the hands and soles of the feet. The classification of palmoplantar keratoderma depends on the clinical characteristics and whether it is hereditary or acquired. The traditional approach tries to soften and minimize skin thickness. The usual treatment choices include emollients, keratolytics like salicylic acid or urea, antifungal cream or pills, as well as topical retinoids/calcipotriol and systemic retinoids. However, the persistent use of such medications frequently exhausts the patients because the problem returns as soon as the local applications are discontinued.

Methods: The case was recorded in the dermatological department of Dr DY Patil HMC & RC. A 27-year-old female patient prediagnosed with Palmoplantar Keratoderma was treated with individualized homeopathic medicine (iHOM) between 25th February 2021 to 22nd July 2021. During the follow-up visits outcome was assessed. To assess whether the changes were due to homeopathic medicine a modified Naranjo criteria was performed. Based on the totality of symptoms, individualized homeopathic medicine Petroleum 30C was given.

Results: The patient was successfully treated for palmoplantar keratoderma with homeopathic Petroleum 30C over five months. Cracks and thickening of skin on the palms and soles resolved completely with no pain and itching.

Conclusion: Individualized homeopathic treatment of palmoplantar keratoderma is possible and offers a gentle, non-invasive alternative to pharmaceutical use.

Objective: This study aimed to investigate the predictive value of the Duke Anesthesia Resistance Scale (DARS) for postoperative delirium in elderly patients following hip fracture surgery.

Methods: A retrospective study was conducted on 90 elderly patients with hip fractures who underwent surgical treatment from January 2018 to January 2021. Patients were categorized into delirium (n=22) and non-delirium (n=68) groups based on postoperative delirium occurrence. Qualitative and quantitative variables were compared between the groups to identify primary risk factors for postoperative delirium. The ability of DARS to predict postoperative delirium was assessed using the receiver operating characteristic (ROC) curve.

Results: Significant differences in age, number of underlying diseases, surgical blood loss, and DARS scores were observed between the delirium and non-delirium groups (P < .05). Multivariate logistic regression analysis indicated that DARS scores (OR=2.321), age (OR=2.476), number of underlying diseases (OR=2.209), surgical blood loss (OR=2.267), and postoperative pain (OR=2.287) were significant predictors of postoperative delirium (P < .05). Pearson correlation analysis revealed a negative correlation between DARS scores and age, number of underlying diseases, and surgical blood loss (P < .05). The ROC curve analysis demonstrated that the area under the curve (AUC) for DARS in predicting postoperative delirium was 0.8255 (95% CI: 0.726~0.924). At a DARS cutoff score of 38, the specificity was 80.28%, and the sensitivity was 81.45%.

Conclusion: The DARS score is a valuable tool for predicting postoperative delirium in elderly patients with hip fractures, with an optimal threshold of 38 points. The use of DARS in predicting postoperative delirium could significantly benefit healthcare providers and improve patient care.

Objective: This study aims to explore the predictive value of preoperative C-reactive protein (CRP) and other inflammatory biomarkers: platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) for postoperative complications (infection, diarrhea, etc.) in colorectal tumor patients.

Methods: A cohort of 109 colorectal tumor patients who underwent surgical resection for colorectal cancer at the hospital from January 2021 to December 2022 were selected as the research subjects. Patients' postoperative complications were tracked, and they were split into the complication group and the non-complication group. All patients underwent preoperative biochemical tests. Serum levels of CRP, PLR, and NLR were compared between the two groups. The relationship between these markers and postoperative complications in colorectal tumor patients was analyzed. A Logistic regression model was established to analyze their impact on postoperative complications, and a Receiver Operating Characteristic (ROC) curve was drawn to assess predictive value.

Results: Among the 109 colorectal tumor patients, 31 cases (28.44%) experienced postoperative complications. The complication group had larger tumor diameters and a higher proportion of open surgeries compared to the non-complication group (P < .05). Serum levels of CRP, PLR, and NLR were higher in the complication group compared to the non-complication group (P < .05). Correlation analysis showed that serum CRP, PLR, and NLR values were positively correlated with postoperative complications in colorectal tumor patients (r > 0, P < .05). The Logistic regression model revealed that high serum CRP levels (95%CI: 1.253-2.503), PLR (95%CI: 1.005-1.041), and NLR values (95%CI: 2.702-20.533) were risk factors for postoperative complications in colorectal tumor patients (OR>1, P < .05). The ROC curve demonstrated that serum CRP levels, PLR, and NLR values had certain predictive values for postoperative complications in colorectal tumor patients (AUC=0.811, 0.789, 0.870), the optimal predictive values were obtained when the cut-off values were set at 5.400 mg/L, 142.790, and 2.485, respectively and combined detection showed even higher predictive values (AUC=0.913). At 1 week post-surgery, the patient's CRP levels, PLR value, and NLR value were significantly lower than pre-surgery (P < .05).

Conclusion: Preoperative serum CRP, PLR, and NLR values are closely related to postoperative complications in colorectal tumor patients, and they can be used to predict the risk of postoperative complications in colorectal tumor patients. Clinically, early prediction of postoperative complications in patients can be achieved by measuring the aforementioned indicators, allowing for the implementation of appropriate preventive measures such as detoxification and infection control to improve patient outcomes.

Background: Ovarian endometriomas, resulting from the invasion of endometriosis into ovarian tissue, can significantly affect ovarian reserve, potentially leading to infertility. When conservative treatments fail, it may further aggravate ovarian reserve decline by invading the ovarian cortex and, in severe cases, result in premature ovarian failure and infertility.

Objective: This study aimed to investigate the impact of various hemostasis methods on ovarian reserve function in cases of laparoscopic cystectomy for ovarian endometriomas.

Methods: We conducted a systematic review and meta-analysis to assess the effects of different hemostasis techniques used during laparoscopic cystectomy for ovarian endometriomas. A comprehensive analysis of relevant literature was performed, focusing on the impact of bipolar electrocoagulation, ultrasonic scalpel, and suture hemostasis on ovarian reserve function. The evaluation criteria included Anti-Müllerian hormone levels and antral follicle counts.

Results: Our analysis revealed significant variations in the impact of hemostasis methods on ovarian reserve function. While all methods aimed to stop bleeding during surgery, the thermal damage to surrounding tissues differed. Bipolar electrocoagulation, ultrasonic scalpel, and suture hemostasis showed varying effects on ovarian reserve, with implications for post-operative fertility.

Conclusions: The choice of the hemostasis method in laparoscopic cystectomy for ovarian endometriomas has a crucial influence on ovarian reserve function. Our findings emphasize the need to consider the potential consequences of thermal damage when selecting a hemostasis technique. Clinicians should weigh the benefits and risks of each method to protect ovarian reserve function effectively. This study offers valuable insights for guiding clinical practice, ensuring optimal outcomes for patients facing endometrioma-related fertility challenges.

Objective: Symptom Management Theory has been extensively used in guiding clinical practice to reduce patients' symptom burden, improve their outcomes and quality of life. However, concerning various participants, settings and methods, the effectiveness of practice and research based on the theory was inconsistent, which hindered the further implementation of this theory in clinical practice. Thus, this study aims to systematically evaluate the effectiveness of the Symptom Management Theory in guiding clinical practice.

Methods: Systematic review. An online search of Chinese and English databases, including SinoMed, CNKI, WanFang Library, VIP database, MEDLINE, PubMed, Embase, Web of Science database, and Cochrane Library up to December 2023. This systematic review was conducted in accordance with the Joanna Briggs Institute critical appraisal checklist for randomized controlled trials and controlled clinical trials. The literature appraisal and extraction were independently conducted by two researchers. The third person was consulted if there was any disagreement between the two researchers.

Results: A total of 20 articles (15 randomized controlled trials and five controlled clinical trials) were finally included. The overall quality of the articles was high. Additionally, the results showed that symptom management measurements based on the Symptom Management Theory could reduce the severity of patient's symptoms, alleviate their distress, relieve patients' anxiety and depression and improve their quality of sleep and quality of life.

Conclusion: The Symptom Management Theory positively influenced clinical symptom management. It could provide theory-based symptom management methods in clinical practice to reduce patients' severity and burden of symptoms, level of anxiety, depression and distress. More high-quality original research should be conducted to further explore the theory's influence in guiding clinical practice in the future.

Objective: To assess lower extremity deep vein thrombosis (DVT) risk factors after artificial femoral head replacement for elderly femoral neck fractures. A nomogram model was constructed to predict its risk.

Methods: In analyzing 144 participants who underwent artificial femoral head replacement for elderly femoral neck fractures, researchers collected clinical data to identify factors associated with lower extremity DVT. The study collected numerous variables ranging from age and sex to history of lower extremity DVT and use of anticoagulant drugs after surgery. The patients were in two groups: those who developed DVT (n = 62) and those who did not (n = 82). Multivariate logistic regression analysis helped to identify factors influencing the occurrence of DVT after artificial femoral head replacement. The software packages used were R 4.1.0 and RMS.

Results: Univariate and multivariate regression analysis identified age, ASA level, D-dimer of lower limb DVT, ALB, and PLT as predictive risk factors of lower extremity DVT after artificial femoral head replacement for elderly femoral neck fractures. Those risk factors were used to construct a clinical predictive nomogram. The calibration curves for hypertension in patients with OSAHS risk revealed excellent accuracy of the predictive nomogram model. The unadjusted concordance index (C-index) for the model was 0.877 [95% confidence interval (CI), 0.805-0.942]. The AUC was 0.8375002. Decision curve analysis showed that the predictive model could be applied clinically when the threshold probability was 20 to 80%.

Conclusions: The researchers constructed and validated a clinical nomogram to predict the occurrence of lower extremity DVT after artificial femoral head replacement in elderly patients with femoral neck fractures. Age, ASA level, D-dimer, and history of lower limb DVT, ALB, and PLT were demonstrated to be predictive risk factors of lower extremity DVT in this circumstance. This practical prognostic nomogram may help improve clinical decision-making.

Background: Although the level of medical care has been improved in recent years, the probability of patients contracting pathogens has increased greatly, with a rising incidence of invasive fungal infections. Deep-seated fungi have become common pathogens of nosocomial infections.

Objective: This study aims to systematically assess the effectiveness, mortality, survival rate, and adverse reactions (ARs) of high-dose (HD) liposomal amphotericin B (L-AMB) for human diseases.

Methods: Ten articles (1661 patients) of randomized controlled trials (RCTs; whether randomized, single-blind, or double-blind) from January 1, 1960, to December 31, 2020, of HD-L-AMB treatment of diseases were retrieved from the PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. The primary outcome measure was the overall therapeutic effect, and the secondary outcome measures were mortality, ≥10-week survival, and ARs. Data were meta-analyzed using RevMan 5.3.

Results: Ten RCTs involving 1661 patients were included. HD-L-AMB did not show a significant therapeutic advantage in anti-infection treatment. In addition, HD-L-AMB treatment of invasive Aspergillus infection led to high mortality and low survival (≥10 weeks, OR = 0.57, 95%CI 0.34-0.94, P = .03). According to subgroup analysis, the incidence of ARs and the incidence of renal dysfunction associated with invasive fungal infection treatment were higher with HD-L-AMB than with regular-dose L-AMB.

Conclusion: HD-L-AMB had no obvious advantage for the treatment of diseases and was accompanied by increased mortality, reduced long-term survival, and increased ARs (including renal insufficiency). Therefore, the use of HD-L-AMB to control infections is recommended with caution only when the preferred treatment is contraindicated.

Background: Nosocomial infections pose a significant global health challenge. Effective nursing management plays a pivotal role in hospital administration, with the quality of nursing closely linked to nosocomial infection rates.

Objective: This study explores the impact of implementing high-quality nursing practices on nosocomial infection control.

Design: A randomized controlled experiment was conducted.

Setting: The study was conducted at the Fourth Affiliated Hospital of Nanjing Medical University.

Participants: Between December 2021 and December 2022, 120 hospitalized patients were selected and randomly assigned to the control and research groups, each comprising 60 patients.

Interventions: The control group received routine nursing, while the research group received high-quality nursing.

Primary outcome measures: (1) Infection incidence rate, (2) psychological state of patients, (3) bacterial culture qualified rate, (4) health knowledge awareness, (5) nursing quality, (6) quality of life, and (7) patient satisfaction.

Results: The research group exhibited a significantly lower infection incidence rate compared to the control group (P < .05). No significant differences were observed between the groups before nursing (P > .05). Post-nursing, SAS, and SDS scores decreased in both groups, with a more pronounced reduction in the research group (P < .05). The research group demonstrated an increased qualified rate of bacterial culture in various environments compared to the control group (P < .05). After nursing, both groups showed higher scores in disease knowledge, nosocomial infection knowledge, treatment and rehabilitation knowledge, and self-care management knowledge, with the research group scoring higher than the control group (P < .05). Quality of life scores, nursing quality scores, and nursing satisfaction were all higher in the research group compared to the control group (P < .05).

Conclusions: High-quality nursing practices emerge as the preferred choice in nosocomial infection control and prevention. It prioritizes patients' wishes and needs, offers comprehensive services, and respects patient autonomy; these measures contribute to a substantial reduction in nosocomial infections.