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Frontiers in Public Health 2023The clinical manifestations of tuberculosis (TB) range from asymptomatic to disseminated depending on the microbiological and immunological status, making the diagnosis...
OBJECTIVE
The clinical manifestations of tuberculosis (TB) range from asymptomatic to disseminated depending on the microbiological and immunological status, making the diagnosis challenging. To improve our understanding of the disease progression mechanism, we aimed to identify the characteristics of subclinical TB and important predictors of symptom development.
METHODS
From July 2018 to June 2019, we systemically collected data from the National Surveillance System of South Korea on patients with pulmonary TB, and compared the characteristics of subclinical and active symptomatic TB patients.
RESULTS
A total of 4,636 patients with pulmonary TB were included, and the prevalence of subclinical TB was 37.1% (1,720/4,636). In subclinical TB patients, the positivity rates of acid-fast bacilli (AFB) smear and culture were 16.2 and 50.2%, respectively. Subclinical TB patients were younger (55.6 ± 19.2 vs. 60.7 ± 19.5, < 0.001), had a higher body mass index (21.7 ± 3.1 vs. 21.0 ± 3.5, < 0.001), less under Medicaid support, and had lower rates of chronic lung disease, AFB smear and culture positivity, and bilateral disease. Regarding the characteristic differences of individual TB-related symptoms, age was positively associated with dyspnoea and general weakness but negatively associated with chest pain, haemoptysis, and weight loss. Male patients were more prone to weight loss. Chronic lung disease was related to symptoms including cough/phlegm, dyspnoea, and haemoptysis, while autoimmune diseases were associated with fever and weight loss.
CONCLUSIONS
The development of TB-related symptoms was associated with microbiological burden and clinical characteristics including underlying comorbidities, which should be evaluated carefully.
Topics: Humans; Male; Prospective Studies; Hemoptysis; Tuberculosis; Registries; Dyspnea; Weight Loss
PubMed: 38125851
DOI: 10.3389/fpubh.2023.1275125 -
Medicine Dec 2023Based on the real clinical data of Hospital Information System to explore the common clinical syndromes of traditional Chinese medicine after breast cancer surgery,...
Based on the real clinical data of Hospital Information System to explore the common clinical syndromes of traditional Chinese medicine after breast cancer surgery, analysis of traditional Chinese medicine in the treatment of breast cancer after the compatibility law. The real medical records of breast cancer patients after surgery in a tertiary hospital in Sichuan Province were collected and screened to build a medical record database. Python language was used for data preprocessing to remove outliers and fill in missing values. Using International Business Machines Corporation (IBM) Statistical Product and Service Solutions (SPSS) Modeler software, Apriori association rules algorithm for data analysis, mining Chinese medicine treatment of breast cancer after common syndromes and the corresponding medication rules. A total of 472 cases of clinical real medical record data were included. Data analysis showed that there were 42 TCM syndromes after breast cancer surgery, of which the highest frequency was liver depression and spleen deficiency, qi deficiency and blood stasis, qi stagnation and blood stasis, qi and blood deficiency, qi and yin deficiency, phlegm and blood stasis. A total of 416 kinds of traditional Chinese medicine were involved. High-frequency drugs included angelica sinensis, coix seed, bupleurum, ginger magnolia bark, keel, oyster, astragalus, platycodon grandiflorum, antler frost, vinegar tortoise shell, poria cocos, lily, Jianqu, Ophiopogon japonicus (Maidong), Shancigu, etc. A total of 18 pairs of commonly used drug combinations were excavated, such as Fushen-Gancao-Chaihu-Angelica, Huangqi-Baishao-Jianghoupu, Chaihu-Huanhua-Maidong-Lily, Baizhu-Huangqi-Maidong, Fuling-Baishao, etc. The clinical syndrome type of traditional Chinese medicine after breast cancer surgery is mainly liver depression and spleen deficiency syndrome. The clinical treatment is mainly soothing liver and relieving depression, and harmonizing liver and spleen. Analyze the syndrome type and the corresponding drug compatibility law, and provide decision support for the clinical dialectical prescription of traditional Chinese medicine after breast cancer surgery.
Topics: Humans; Female; Medicine, Chinese Traditional; Breast Neoplasms; Drugs, Chinese Herbal; Yin Deficiency; Data Management; Syndrome
PubMed: 38115283
DOI: 10.1097/MD.0000000000036642 -
Frontiers in Pharmacology 2023Evaluate the impact of adjusting the overall dose, Gypsum Fibrosum [Mineral; Gypsum] (ShiGao, SG) dose, and L. [Rosaceae; Semen Armeniacae Amarum] (KuXingRen, KXR)...
The rational dose for MaXingShiGan decoction is crucial for its clinical effectiveness in treating bronchial pneumonia: three randomized, double-blind, dose-parallel controlled clinical studies.
Evaluate the impact of adjusting the overall dose, Gypsum Fibrosum [Mineral; Gypsum] (ShiGao, SG) dose, and L. [Rosaceae; Semen Armeniacae Amarum] (KuXingRen, KXR) dose on the efficacy of MaXingShiGan Decoction (MXSG) in treating children with bronchial pneumonia (Wind-heat Blocking the Lung), in order to provide strategy supported by high-quality evidence for the selection of rational clinical doses of MXSG. Based on the basic dose of MXSG, we conducted three randomized, double-blind, dose parallel controlled, multicenter clinical trials, involving adjustments to the overall dose, SG dose, and KXR dose, and included 120 children with bronchial pneumonia (Wind-heat Blocking the Lung) respectively. And the patients were divided into low, medium, and high dose groups in a 1:1:1 ratio, with 40 cases in each group. The intervention period lasted for 10 days. The primary outcome was the clinical cured rate, while the secondary outcomes included the effectiveness in alleviating major symptoms of bronchial pneumonia (including fever, cough, dyspnea, and phlegm congestion). And the occurrence of adverse events was recorded. We first recorded and analyzed the baseline characteristics of the three studies, including age, gender, height, and so on. The results indicated that there were no significant differences among the dose groups within each study. For the study adjusting the overall dose of MXSG, the results showed that both the medium-dose group and high-dose group had significantly higher clinical cured rates compared to the low-dose group (Chi-square value 9.01, = 0.0111). However, there was no significant benefit between the high-dose group and the medium-dose group (81.58% vs. 81.08%). Regarding phlegm congestion, excluding fever, cough, and dyspnea, both the medium-dose group and high-dose group had significantly higher clinical cured rates than the low-dose group (Chi-square value 6.31, = 0.0426), and there was no significant benefit between the high-dose group and the medium-dose group (69.23% vs. 75.00%). A total of 5 adverse events were observed, of which only 1 case in the medium-dose group was possibly related to the experimental medication. For the study adjusted the SG dose in MXSG, the results showed that the high-dose group had the highest clinical cured rate, but the inter-group difference was not statistically significant (Chi-square value 3.36, = 0.1864). The area under the curve (AUC) for cough in the medium-dose group was significantly lower than in the low-dose group and high-dose group (F-test value 3.14, = 0.0471). Although no significant differences were observed in fever and dyspnea among the groups, the AUC in the high-dose group was lower than in the medium-dose and low-dose groups. In comparing the complete defervescence time, both the high-dose group ( < 0.0001) and the medium-dose group ( = 0.0015) achieved faster than the low-dose group. The high-dose group slightly outperformed the medium-dose group (0.50 (0.50, 0.80) vs. 0.80 (0.40, 1.40)), although the difference was not significant. In the medium-dose group, 1 adverse event was observed, but it was not related to the experimental medication. For the study adjusted the KXR dose in MXSG, the results showed that both the medium-dose group and high-dose group had significantly higher cured rates compared to the low-dose group (Chi-square value 47.05, < 0.0001). However, there was no significant benefit comparing the high-dose group to the medium-dose group (90.00% vs. 92.50%). Regarding clinical symptoms, the results indicated that for cough (F-test value 3.16, = 0.0460) and phlegm congestion (F-test value 3.84, = 0.0243), the AUC for both the medium-dose group and high-dose group were significantly lower than in the low-dose group. Although there was benefit in the high-dose group compared to the medium-dose group, it was not statistically significant. No adverse events were observed during the study period. The synthesis of the three conducted clinical studies collectively indicates that for children with bronchial pneumonia (Wind-heat Blocking the Lung), the basic clinical dose of MXSG may represents an optimal intervention dose based on the accumulated clinical experience of doctors. If the dose is insufficient, the clinical effects might be compromised, but using a higher dose does not significantly enhance benefits. Concerning different symptoms, increasing the overall formula's dose has a favorable impact on improving phlegm congestion, increasing the SG is effective in improving symptoms such as fever, cough, and dyspnea, while higher dose of KXR is effective in alleviating cough and phlegm congestion. These findings suggest that for MXSG, achieving the optimal intervention dose is crucial to achieve better clinical efficacy. For the SG and KXR, if certain symptoms are more severe, increasing the dose can be considered within safe limits, can lead to significant clinical benefits in symptom improvement. This also explains why the dose of MXSG might vary among clinical doctors, while maintaining a balance between safety and effectiveness. Of course, our study is still exploratory clinical trials, and further studies are needed to confirm our findings. https://www.chictr.org.cn/index.html; Identifier: ChiCTR-TRC-13003093, ChiCTR-TRC-13003099.
PubMed: 38074138
DOI: 10.3389/fphar.2023.1279519 -
Journal of Public Health in Africa Oct 2023Occupational exposure to cotton dust is still an important cause of respiratory problems in textile workers particularly in less developed countries like Egypt. Evaluate...
Occupational exposure to cotton dust is still an important cause of respiratory problems in textile workers particularly in less developed countries like Egypt. Evaluate respiratory symptoms and diseases, and pulmonary function pattern among Egyptian textile workers. Cross sectional comparative study was conducted from December 2019 to September 2020 in a textile factory in Egypt; 364 male workers (184 cotton dust exposed workers, and 180 unexposed workers) were included. Participants were subjected to an interviewing questionnaire, British Medical Research Council questionnaire, anthropometric measurements, pulmonary function tests, and byssinosis grading format. Descriptive and analytic statistics were conducted. Chronic cough, phlegm production, and shortness of breath grade I, II and III were more reported in cotton dust exposed workers than unexposed workers (P#x003C;0.01, P#x003C;0.01, and P=0.02, respectively). Prevalence of chronic bronchitis was significantly higher among cotton dust exposed workers (12%) than unexposed workers (3.9%) (P#x003C;0.01). The mean percent predicted values of lung function indices reflecting large-1irway function (VC, FVC, FEV, FEV%, PEFR, and FEF) were significantly lower in cotton dust exposed workers (P#x003C;0.01). Prevalence of byssinosis was 22.8%. Workers with byssinosis had significantly higher prevalence of respiratory symptoms, chronic bronchitis, cross-shift reduction in PEFR and significant decrease in mean percent predicted values of FVC, FEV, PEFR, FEF, and FEF than workers without byssinosis. This study revealed a substantial association between cotton dust exposure at work and respiratory symptoms and morbidity. Regular measurement of cross shift change in PEFR is recommended among exposed workers for early diagnosis of byssinosis.
PubMed: 38020280
DOI: 10.4081/jphia.2023.2741 -
Medicine Nov 2023Rheumatoid arthritis is an autoimmune disease characterized by chronic polyarticular pain, for which no cure currently exists. In Chinese medicine, rheumatoid arthritis...
Rheumatoid arthritis is an autoimmune disease characterized by chronic polyarticular pain, for which no cure currently exists. In Chinese medicine, rheumatoid arthritis (RA) is believed to be caused by phlegm and blood stagnation. Shentong Zhuyu decoction can be used to treat RA, as it promotes blood circulation, resolves blood stasis, and relieves pain. In our study, we used network pharmacology and computer-aided drug design to evaluate the components, active compounds, and targets of Shentong Zhuyu decoction (STZY). Our results suggest that STZY contains active compounds such as quercetin, luteolin, and formononetin that regulate immune network targets. RA associated genes are enriched in pathways including those associated with nuclear factor kappa B, phosphatidylinositol-3-kinase/AKT, and hypoxia inducible factor 1 signaling. The main active compounds in STZY (quercetin and luteolin) were derived from Achyranthis Bidentatae Radix, Carthami Flos, licorice, Cyperi Rhizoma, and Myrrha and targeted the pro-inflammatory cytokines interleukin 2, interleukin 1 alpha, interleukin 1 beta, and interleukin 6. In addition, the compounds quercetin, luteolin, and formononetin in these herbs can target the anti-inflammatory cytokines interleukin 4 and interleukin 10. Our results suggest that STZY can balance the immune network, promote an anti-inflammatory environment, and reduce the clinical symptoms of RA. Based on the close relationship between inflammatory response and osteoclast formation, we hypothesized that STZY may inhibit inflammation and alleviate bone destruction in RA. Our findings indicate that STZY can treat RA through multiple components, targets, and pathways. This study may provide a reference for the clinical application of STZY in RA treatment.
Topics: Humans; Medicine, Chinese Traditional; Systems Biology; Luteolin; Quercetin; Drugs, Chinese Herbal; Arthritis, Rheumatoid; Anti-Inflammatory Agents; Pain; Drug Design
PubMed: 38013316
DOI: 10.1097/MD.0000000000036287 -
Medicine Nov 2023Acute cerebral infarction, characterized by a rapid onset and high fatality rate, presents a significant global challenge in terms of timely and effective treatment. In...
BACKGROUND
Acute cerebral infarction, characterized by a rapid onset and high fatality rate, presents a significant global challenge in terms of timely and effective treatment. In recent years, research focusing on the combined approach of traditional Chinese medicine (TCM) and Western medicine has demonstrated promising results in improving therapeutic outcomes in patients with acute cerebral infarction.
DIAGNOSIS
This study adhered to the latest edition of Internal Medicine of Traditional Chinese Medicine, published by the China Press of Traditional Chinese Medicine, as a reference. It selects eight commonly encountered TCM syndrome differentiations for accurate diagnosis.
METHODS
This study included 151 patients admitted to the hospital between 2019 and 2022 with acute cerebral infarction. Data on various diagnostic indicators were meticulously collected and subjected to single-factor analysis.
RESULTS
Among the multiple factors analyzed, those exhibiting a significance level of P < 0.05 included blood pressure, uric acid, glucose level, triglyceride level, total cholesterol level, homocysteine level, duration of disease, and cerebral infarction site. Subsequently, a binary logistic regression analysis was performed to assess the impact of these factors on different TCM syndrome types.
CONCLUSION
The findings of this study indicate that Wind Phlegm Obstruction syndrome, triglyceride levels, location of cerebral infarction, uric acid levels, and disease duration significantly influence the development and progression of acute cerebral infarction. Additionally, blood pressure and cerebral infarction site were found to have a statistically significant impact on the Wind Yang Disturbance syndrome. Uric acid level and blood pressure were also identified as statistically significant factors. Moreover, total cholesterol and homocysteine levels were found to significantly affect phlegm stasis-blocking collateral syndrome. The insights gained from this study will contribute to the advancement of integrated treatment approaches, combining traditional Chinese and Western medicine, for acute cerebral infarction. Furthermore, these findings can serve as a valuable reference for the general population in terms of preventive measures against this condition.
Topics: Humans; Medicine, Chinese Traditional; Logistic Models; Uric Acid; Brain Ischemia; Stroke; Cerebral Infarction; Syndrome; Triglycerides; Homocysteine; Cholesterol
PubMed: 37986281
DOI: 10.1097/MD.0000000000036080 -
Alternative Therapies in Health and... Nov 2023The objective of this study was to explore common TCM constitutions among gout patients and investigate the potential relationship between traditional Chinese medicine's...
OBJECTIVE
The objective of this study was to explore common TCM constitutions among gout patients and investigate the potential relationship between traditional Chinese medicine's (TCM) constitution and clinical parameters.
METHODS
A total of 219 gout patients with 195 participants were included in this study. All participants completed a baseline questionnaire on demographic characteristics, including age, weight, and family history. The biased constitution of TCM was identified by questionnaires surveyed with a TCM constitution table.
RESULTS
Of 195 patients with gout, phlegm-damp accounted for the majority of TCM constitution classifications, followed by Qi-deficiency, damp-heat, and Yang-deficiency constitutions. Besides, patients with these four constitutions have a higher BMI, blood sugar, and homocysteine.
CONCLUSION
The major types of constitution among these gout patients were phlegm-damp, Yang-deficiency, Qi-deficiency, and damp-heat. Gout symptoms with TCM constitutional theory may contribute to provide new insights into more rapid diagnosis and treatment for the effective prevention or therapy of gout. It is necessary to design more case-control studies and high-quality cohort in the future researches to provide a more helpful evidence-based basis for evaluating the relationship between TCM constitution and gout patients.
PubMed: 37971436
DOI: No ID Found -
Medicine Nov 2023Trichomonas vaginalis (T. vaginalis) is a common anaerobic parasitic protozoan. However, to the best of our knowledge, there are few reports documenting T. vaginalis...
RATIONALE
Trichomonas vaginalis (T. vaginalis) is a common anaerobic parasitic protozoan. However, to the best of our knowledge, there are few reports documenting T. vaginalis infection outside the genitourinary tract. Severe pneumonia caused by T. vaginalis infection has been rarely reported.
PATIENT CONCERNS
The 80-year-old female patient had a 20-year history of type II diabetes; however, she was not on regular medication. She was hospitalized due to a coma which continued 2 hours caused by trauma after a car accident. After her admission, she was provided with continuous mechanical ventilation; during the ventilation, she was still in a coma, accompanied by repeated fever and presence of much yellow sticky phlegm. The head CT scan indicated temporal lobe hematoma and subarachnoid hemorrhage. The lung CT scan showed bilateral pulmonary inflammatory consolidation and mass lesions.
DIAGNOSES
She was initially diagnosed with severe pneumonia and acute respiratory distress syndrome. Subsequently, fiberoptic bronchoscopy was conducted, and bronchoalveolar lavage fluid (BALF) was collected and sent for metagenomic next-generation sequencing (mNGS). The result indicated the presence of abundant sequences from the T. vaginalis genome. Thus, she was diagnosed with pulmonary T. vaginalis infection.
INTERVENTION
Anti-infective ornidazole treatment has significantly improved her symptoms.
OUTCOMES
After treatment, the patient regained consciousness and was able to communicate, and there was no obvious expectoration, fever, or positive bronchus sign in the lungs. Thereby, she was discharged from the hospital.
LESSONS
Special attention should be paid to infections other than common bacterial infections, such as T. vaginalis. Moreover, infection of rare pathogenic microorganisms might show symptoms similar to common bacterial infection, leading to misdiagnosis, further highlighting the usefulness of mNGS in detecting pathogens in a timely, sensitive, and accurate manner.
Topics: Humans; Female; Aged, 80 and over; Bronchoalveolar Lavage Fluid; Trichomonas vaginalis; Coma; Diabetes Mellitus, Type 2; Pneumonia; High-Throughput Nucleotide Sequencing; Fever
PubMed: 37960810
DOI: 10.1097/MD.0000000000035777 -
Cureus Oct 2023Muco-obstructive lung disease is a new classification under the diseases of respiratory tract. A lot of discussion is still going on regarding this new group of... (Review)
Review
Muco-obstructive lung disease is a new classification under the diseases of respiratory tract. A lot of discussion is still going on regarding this new group of diseases. It is characterised by obstruction of the respiratory tract with a thick mucin layer. Usually in normal individuals, the mucus is swept out of the respiratory system while coughing in the form of sputum or phlegm, but if the consistency of the mucus is thick, or the amount is heavy or there is a certain defect in the ciliary function of the respiratory tract, the mucus is not cleared and it gets accumulated in the lungs alveoli, therefore blocking it. The mucus trapped in the distal airways cannot be cleared by coughing therefore forming a layer in the alveoli and bronchioles. Long-standing condition causes inflammation and infection. This new group of diseases specifically includes chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), primary ciliary dyskinesia (PCD) and non-cystic fibrosis bronchiectasis (NCFB). Asthma, although an obstructive disease of the lung, is not particularly included under muco-obstructive lung disease. The major symptoms with which these diseases present are sputum production, chronic cough and acute exacerbations of the condition. The mucus adheres to the lung parenchyma causing airway obstruction and hyperinflation. In this article, we will see how muco-obstructive lung diseases affect the normal physiology of the respiratory system and how is it different from other obstructive and restrictive lung diseases. We will individually look into all the four conditions that come under the category of muco-obstructive lung diseases.
PubMed: 37954759
DOI: 10.7759/cureus.46866 -
BMJ Open Nov 2023Cough as a symptom of renal cell carcinoma (RCC) was first described by Creevy in 1935, and despite one (unpublished) study suggesting it may affect 31% of these...
Protocol for a mixed-method study to assess chronic cough in patients with renal cell carcinoma: the prevalence, impact on quality of life, trigger and potential clinical application of chronic cough as an early screening tool in patients with kidney cancer.
INTRODUCTION
Cough as a symptom of renal cell carcinoma (RCC) was first described by Creevy in 1935, and despite one (unpublished) study suggesting it may affect 31% of these patients, as well as cough being discussed in forums for patients with kidney cancer, few clinicians are aware of this association. The cough has been described as unusual in nature, resolving rapidly after treatment with nephrectomy/embolisation but returning if the tumour recurs.
METHODS AND ANALYSIS
A prospective study using a questionnaire will identify the prevalence of cough in patients with suspected or confirmed RCC attending the Specialist Centre for Kidney Cancer (London, UK). A longitudinal study in a representative sample of these patients, using EQ-5D-5L and Leicester Cough Questionnaires, together with the use of semi-structured interviews with patients, will identify the impact of cough in addition to having a diagnosis of suspected or confirmed RCC on quality of life. To investigate cough mechanisms, a pilot study using cough hypersensitivity testing will be performed on patients with RCC, with and without a cough. Clinical samples (urine, blood, phlegm and breath condensate) from patients with RCC, with and without a cough, will be collected and analysed for the presence of substances known to trigger or enhance cough and compared with the results obtained from healthy volunteers.
ETHICS AND DISSEMINATION
Ethical approval has been granted (UK HR REC 22/PR/0791 dated 25/08/2022). Study outputs will be presented and published nationally and internationally at relevant conferences. This study will establish the prevalence of cough in patients with suspected or confirmed kidney cancer and support the education of clinicians to consider this diagnosis in patients with chronic cough (eg, recommending protocols to include both kidneys when investigating respiratory symptoms with chest CT scans). If substances known to trigger or enhance cough are identified and elevated in clinical samples, this research could offer potential targets for treatment for this distressing symptom.
TRIAL REGISTRATION NUMBER
NIHR CRN portfolio CPMS ID:53 372.
Topics: Humans; Carcinoma, Renal Cell; Cough; Longitudinal Studies; Prospective Studies; Quality of Life; Prevalence; Pilot Projects; Early Detection of Cancer; Kidney Neoplasms
PubMed: 37949629
DOI: 10.1136/bmjopen-2023-074077