Prescription of intermittent preventive therapy (IPTp) among doctors practicing in an army hospital in Lagos, Nigeria

Background: Malaria infestation in pregnancy is a major public health concern and ranks amongst the commonest complications of pregnancy in Nigeria. Approximately 50,000 Nigerian women die each year from largely preventable pregnancy related complications. Intermittent preventive therapy for malaria in pregnancy (IPTp) is a key recommendation in the National guideline for malaria treatment in Nigeria. This study assessed the prescription pattern of intermittent preventive therapy with Sulphadoxine-Pyrimethamine for pregnant women among doctors practicing in 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria. Methods: This was a retrospective study using case notes of pregnant women seen at antenatal clinic of 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria from January, 2008 to December, 2008. A total of 336 case notes were reviewed. The findings were precoded, data entry and analysis was done using EPI INFO 2002. Results: A good proportion of the women (82.9%) booked for antenatal clinic within the first and second trimesters of pregnancy. Most commonly prescribed by doctors was the weekly pyrimethamine (daraprim) for malaria prophylaxis in pregnancy (100.0%). Very few doctors prescribed intermittent preventive therapy with sulfadoxine-pyrimethamine, and the few who did prescribed just one dose. Conclusion: The study showed a very low level of prescription of IPTp among doctors practicing at 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria. There is a great need for training of these doctors and other health professionals on the recommendations of the current National Antimalarial Treatment Guidelines.

Dosimetric Comparison of Different Prescription Modes in Lung Stereotactic Body Radiation Therapy

The purpose of this study was to compare the dose-volume statistics of stereotactic body radiotherapy (SBRT) for lung cancer between planning target volume (PTV): D95 and gross tumor volume (GTV): D99 dose prescriptions using Monte Carlo (MC) calculation. Plans for 183 patients treated between October 2010 and April 2013 were generated based on four-dimensional (4D) computed tomography (CT) under free breathing. A uniform margin of 8 mm was added to the internal target volume (ITV) to generate PTV. A leaf margin of 2 mm was added to the PTV. The plans were calculated with two different dose prescription methods: 40 Gy to cover 95% of the PTV (PTV prescription) and 44 Gy to cover 99% of the GTV (GTV prescription). A 6-MV photon beam was used. A dose-volume histogram (DVH) analysis was performed for dose to the GTV using PTV and GTV dose prescriptions. For each treatment plan, we evaluated the minimum dose to 99% of the GTV (D99). The D99 of GTV was 44.5 ± 1.9 Gy and 44.0 ± 0.0 Gy for PTV and GTV prescriptions, respectively. The dose to the GTV had wide variations with PTV prescription. We recommend that GTV based dose prescription should be used to standardize dose to the tumor and to achieve highly conformal dose distributions in SBRT for lung cancer.

Pattern of Uncomplicated Malaria Treatment and Antimalarial Prescription Practices among Health Workers in the Littoral Region of Cameroon: An Assessment of Ten Years Post-Malaria Treatment Policy Change

Following highly prevalent Plasmodium resistant strains to antimalarial monotherapies in malaria endemic countries, uncomplicated malaria treatment policy changed to artemisinine-based combination therapies (ACTs). After adoption of this new treatment policy in a country, sufficient care is needed to be taken to prevent occurrence of resistance to the latest drugs. As Cameroon shifted to ACT in 2004, this study aimed to assess knowledge and practices of health workers in government health facilities of the Littoral region regarding mild malaria management in health facilities as well as according to prescription qualities of ACTs in leaflets received in pharmacies. A total of 66 physicians and 16 nurses were questioned in 10 health facilities and 503 medical leaflets with ACTs prescriptions were viewed in 17 pharmacies. All medical workers questioned correctly were defined mild malaria and were aware of the antimalarial policy change in Cameroon. Overall ACTs prescription for mild malaria management in children and adult patients was 72.2% and 87.8% respectively. An important proportion of health workers prescribed antimalarial monotherapies and non recommended antimalarial for uncomplicated malaria treatment. 31.7% of participants did not systematically recommend laboratory diagnostic test before antimalarial prescription. Of leaflets viewed in pharmacies, ACTs were prescribed by physicians, nurses and laboratory technicians. Age was the only criteria for ACTs prescription. Appropriate ACTs quality prescription ranged between 81.2% and 94.4%. Of the ACTs prescribed, blisters had the highest (92.9%) appropriate quality prescription and solutions the lowest (83.3%). According to qualification of prescribers, physicians had the highest score (93.1%) of appropriate quality prescription and laboratory technicians the lowest score (28.1%). For all ACTs containing medical leaflets, concomitant medications were recorded namely antipyretic (73.9%), antibiotic (21.9%), non steroid anti-inflammatory (19.9%) or vitamins (18.1%). Data gathered indicated that although health workers were aware of uncomplicated malaria treatment policy change in Cameroon, mild malaria mismanagement was prevailing in health facilities of the Littoral region and ACTs quality prescription in medical leaflets was not optimal. Therefore, awareness is still needed among prescribers in order to prevent or at least slow the occurrence of Plasmodium resistant strains to ACTs in Cameroon.

Tuina massage combined with traditional Chinese prescription improves quality of life and motor symptoms in a spasmodic torticollis patient:A case report

Objective:A case study was performed to discuss the efficacy of traditional Chinese medicine(TCM)treatments on spasmodic torticollis.Materials and methods:A 28-year-old male was diagnosed with spasmodic torticollis due to twist and turn of neck after being frightened,who was unable to take care of himself for over 3 months.He once took an oral non-steroidal anti-inflammatory drug,but no significant improvement was seen in his symptoms.After a few months,his symptoms got worse,with onset of spasms.Therefore,he was treated at our hospital with traditional Chinese prescription and Tuina massage therapy for 3 months and followed up for 6 months.The Toronto Western Spasmodic Torticollis Rating Scale(TWSTRS)and the Craniocervical Dystonia Questionnaire(CDQ-24)scores were recorded before and after treatment and during follow-up observations to evaluate the therapeutic efficacy.Results:Compared to the baseline,the TWSTRS and CDQ-24 scores decreased significantly,and there was no evident recurrence of his symptoms for at least 6 months of follow-up.Moreover,no apparent discomfort or side effects were observed during the treatment.Conclusion:Jingu abdominal massage combined with traditional Chinese prescription has a certain efficacy in the treatment of spasmodic torticollis,with almost no side effects,which can be easily accepted by patients.

Clinical Effects of Bushen Culuan Prescription on Infertility Due to Decreased Ovarian Reserve of Kidney Deficiency and Liver Depression Pattern

Objective The objective of this study was to explore the clinical effects of Bushen Culuan prescription on infertility due to decreased ovarian reserve of kidney deficiency and liver depression pattern.Methods Totally 100 infertile patients with ovarian hypofunction treated from October 2019 to January 2022 were selected and divided into the observation group and the control group by a random number table.The control group was treated with estrogen sequential therapy,and the observation group was treated with Bushen Culuan prescription.The clinical efficacy,sex hormone levels including(follicle-stimulating hormone[FSH],luteinizing hormone[LH],and estradiol[E_(2)]),ovarian function,ovarian blood flow status(peak systolic velocity[PSV],antral follicle count[AFC],arterial pulse index[PI],and resistance index[RI]),and pregnancy outcome in the two groups were compared and analyzed.Results The total effective rate of the observation group(96.00%)was significantly higher than that of the control group(80.00%).The difference was statistically significant(p<0.05).Before treatment,there was no significant difference in sex hormone levels(FSH,LH,E_(2),and FSH/LH),ovarian function(number of primary follicles,number of dominant follicles,ovulation number,and endometrial thickness),and ovarian blood flow(PSV,RI,PI,and AFC)between the two groups(p>0.05).After treatment,the levels of serum hormones FSH,LH,E_(2),and FSH/LH decreased significantly in both groups.The number of primary follicles,dominant follicles,and ovulation increased significantly,and the thickness of endometrium decreased significantly;the indexes of PSV,RI,and AFC of ovarian blood flow increased significantly,and the PI index decreased significantly.The levels of each index in the observation group were better than those in the control group(p<0.05).In the control group,32 cases were pregnant within 1 year after treatment,and the pregnancy rate was 64.00%;21 cases in the observation group were pregnant within 1 year after treatment,and the pregnancy rate was 42.00%;the pregnancy rate in the observation group was higher than that in the control group,and the difference was statistically significant(χ^(2)=4.014,p=0.045<0.05).Conclusion Bushen Culuan prescription has a definite effect on infertility due to ovarian hypofunction.The action mechanism may involve multicomponent and multitarget stimulation to improve patients'ovarian function,regulate the level of sex hormones,and improve the pregnancy outcome.

论基于“病、证、征结合”方剂的主治表述

目前对方剂主治的规范性研究较少,通过对方剂主治源流的梳理并分析《方剂学》教材中方剂主治描述中存在的问题,提出“病、证、征结合”3个层次的方剂主治描述规范,从而有利于临证依法用方、规范教材和规范方剂的科学研究。

乳腺熏洗方促进非哺乳期乳腺炎术后创面愈合的临床和机制研究

目的观察乳腺熏洗方熏洗对非哺乳期乳腺炎(NPM)术后创面愈合的影响,并探讨其作用机制。方法将98例NPM术后创面生肌收口期患者随机分为治疗组、对照组,每组49例,在常规换药的基础上,治疗组给予乳腺熏洗方熏洗治疗,对照组给予质量浓度为9 g/L的氯化钠溶液熏洗治疗,疗程为12 d。比较两组创腔体积缩小率、创口面积缩小率,以及创面肉芽组织状态评分、血常规[白细胞(WBC)、中性粒细胞(NEU)、中性粒细胞百分比(NEU%)、血小板(PLT)]、C反应蛋白(CRP)、红细胞沉降率(ESR)的变化情况;两组各选取5例病例,采用Western blot法检测创面组织白细胞介素-6(IL-6)、Janus激酶2(JAK2)、信号转导及转录激酶蛋白3(STAT3)蛋白表达的变化情况。结果(1)最终完成试验者94例,其中治疗组49例、对照组45例。(2)治疗组创腔体积缩小率、创口面积缩小率高于对照组(P<0.05)。(3)治疗前后组内比较,治疗组创面肉芽状态评分升高(P<0.05);组间治疗后比较,治疗组创面肉芽状态评分高于对照组(P<0.05)。(4)治疗前后组内比较,两组WBC、NEU、NEU%、PLT、CRP、ESR水平降低(P<0.05);组间治疗后比较,治疗组PLT、CRP水平低于对照组(P<0.05)。(5)治疗前后组内比较,对照组创面肉芽组织IL-6、JAK2、STAT3蛋白表达上调(P<0.05);组间治疗后比较,治疗组创面肉芽组织IL-6、STAT3蛋白表达水平低于对照组(P<0.05)。结论乳腺熏洗方熏洗能有效促进NPM术后创面愈合,其机制可能与抑制IL-6/JAK2/STAT3信号通路,进而抑制创面炎症反应有关。

基于伏邪理论的新冠病毒感染中医药防治思路与实践探索

探讨“伏邪理论”对新冠病毒感染等所致疫病的病机认识、防治思路的指导意义。“伏气”为温病病因,亦为人身阳热之气;阳热之气郁伏于内可成为伏热体质,伏热体质与温病的发生发展尤为密切,伏热体质更易致温邪为患。伏邪理论对中医防治新冠病毒感染所致疫病的启示主要为:气候反常是疫病发生的重要预警和外在条件;同气相求,伏邪与新感病邪性质相关,易内伤太阴,脾虚湿聚则成“伏湿”;从伏邪理论防治疫病,有助于辨识证候重点,制定针对病机的核心治法,截断病情。基于伏邪理论,针对伏湿的祛湿法为新冠病毒感染预防和早期治疗的重要治法。该课题组以燥湿、化湿、利湿、健脾等多种祛湿法组方,拟定了预防新冠病毒感染的中药方“五指防冠方”(由五指毛桃、薏苡仁、茯苓、火炭母、苍术、广藿香、甘草组成),该方可应用于新冠病毒感染的预防和早期治疗。祛湿法的疗效机制主要与改善机体的免疫紊乱状态、恢复机体抗病能力有关。

小针刀疗法联合自拟接骨活血方治疗高龄膝关节骨性关节炎

目的探讨小针刀疗法联合自拟接骨活血方治疗高龄膝关节骨性关节炎的效果。方法选取2021年11月-2023年3月本院收治的84例高龄膝关节骨性关节炎患者为研究对象,利用随机数字表法将其分为2组,观察组和对照组,各42例,对照组采用小针刀疗法治疗,观察组采用小针刀疗法联合自拟接骨活血方治疗,比较2组患者的中医证候积分、膝关节功能评分、炎症因子、骨代谢指标及临床疗效。结果治疗前,2组中医症状积分、莱氏(Lysholm)评分、血清肿瘤坏死因子-α(TNF-α)水平、白介素-6(IL-6)水平、骨特异性碱性磷酸酶(BALP)水平、胰岛素样生长因子1(IGF-1)水平、骨钙素(BGP)水平差异无统计学意义(P>0.05)。治疗后,观察组中医症状积分、TNF-α水平、IL-6水平低于对照组(P<0.05),观察组Lysholm评分、BALP水平、IGF-1水平、BGP水平高于对照组(P<0.05);观察组总有效率高于对照组(P<0.05);2组患者不良反应发生率差异无统计学意义(P>0.05)。结论小针刀疗法联合自拟接骨活血方能够有效降低患者中医证候积分,改善膝关节功能,降低疼痛程度,提高临床疗效,值得推广。

补阳还五汤合升降散治疗糖尿病肾病临床观察

目的观察补阳还五汤合升降散加减对Ⅲ、Ⅳ期糖尿病肾病(DKD)的治疗效果,为临床实践提供理论依据。方法将80例DKD患者随机分为2组,治疗组采用补阳还五汤合升降散加减治疗,对照组给予盐酸贝那普利片治疗。治疗12周后,观察治疗前后2组中医临床症状积分、血糖、肾功能、24 h尿蛋白定量等的变化。结果对于Ⅲ、Ⅳ期DKD患者,治疗12周后,治疗组中医临床症状积分、血糖、肾功能、24 h尿蛋白定量等均较对照组改善明显(P<0.05)。结论补阳还五汤合升降散加减治疗DKD效果满意,可以更好地降低尿蛋白、延缓DKD进程、改善生活质量。

济复汤内服兼药渣烫熨治疗癌性便秘临床观察

目的观察济复汤内服兼药渣烫熨对癌性便秘的疗效。方法选取2019年1月—2022年1月癌性便秘患者62例,均给予一般干预和整体护理,随机分为对照组30例和观察组32例。对照组予乳果糖口服溶液及双歧杆菌三联活菌胶囊。观察组予济复汤内服兼药渣烫熨。2周后观察2组患者便秘改善情况。结果观察组患者的总有效率为90.62%(29/32),高于对照组的66.67%(20/30),差异有统计学意义(P<0.05),观察组便秘改善情况优于对照组。结论济复汤内服兼药渣烫熨在癌性便秘中的应用效果显著,操作简便,安全节约,值得推广应用。

经方寒热并用法治疗甲状腺结节临证初探

甲状腺结节常由多种因素相互影响所致,其病因病机错综复杂,多寒热并存,可通过调整寒热,施以寒热并用之法。医圣张仲景立经方,将方药寒热并用法首现于临床。借鉴张仲景的经方思路,在临床实践中,以寒热经方为基础,结合脏腑寒热,运用柴胡桂枝干姜汤、乌梅丸、栀子干姜汤等,治疗甲状腺结节,疗效显著,能有效减轻患者症状,提高生活质量。

活血化瘀方治疗子宫肌瘤临床观察

目的分析活血化瘀方辨证对子宫肌瘤的治疗效果及安全性。方法选取2020年1月—2022年1月江西省乐安县人民医院收治的60例子宫肌瘤患者临床资料,分为对照组与治疗组,各30例。对比两组治疗3周后的临床效果、性激素水平[卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E_(2))、孕激素(P)]、中医证候积分、不良反应。结果治疗组总有效率为93.33%(28/30),对照组为80.00%(24/30),两组比较差异无统计学意义(P>0.05)。治疗前两组性激素水平比较差异无统计学意义(P>0.05);治疗后两组FSH、LH、E2、P均降低,且治疗组均低于对照组(P<0.05)。治疗前两组中医证候积分比较差异无统计学意义(P>0.05),治疗后治疗组经期异常、下腹胀痛、乳房胀痛、肛门下坠评分均低于对照组(P<0.05)。治疗组不良反应发生率为6.67%(2/30),对照组为16.67%(5/30),两组比较差异无统计学意义(P>0.05)。结论活血化瘀方辨证对子宫肌瘤的治疗效果好,可改善患者临床症状及性激素水平,用药安全性高。

升阳泻湿法治疗非酒精性脂肪性肝病初探

非酒精性脂肪性肝病是目前的多发病,为多因素所致,严重影响公共健康,目前对于该病的证治报道较多。该病的临床表现多数不典型,病机证候复杂,笔者汲取李东垣理论思想中升发脾之清气,以及黄元御理论思想中泻湿疏木的治法,把二者进行优化组合,拟定了升阳化湿,培土疏木为治疗大法运用于临床,立足于“湿”,分为“湿浊内蕴”和“脾虚湿困”2个证型,驭繁就简,取得了理想的临床疗效。

肺癌分子靶向治疗EGFR-TKI患者证候及中医处方用药研究进展

表皮生长因子受体酪氨酸激酶抑制剂(Epidermal growth factor receptor tyrosine kinase inhibitor,EGFR-TKI)是肺癌治疗领域的里程碑,中医药与分子靶向治疗EGFR-TKI相结合是肺癌综合治疗的新模式。辨证论治是中医的特色,中医药的精准配合,可以贯穿于分子靶向治疗EGFR-TKI的全程。通过查阅、归纳及分析近年来不同专家学者对分子靶向治疗EGFR-TKI相关肺癌患者不同治疗阶段的中医证候及中医处方用药研究的文献,总结肺癌分子靶向治疗EGFR-TKI患者在不同治疗阶段的证候分布及中医处方用药特点,促使中医辨证论治更加精准,旨在进一步提高临床上中医药配合分子靶向治疗EGFR-TKI的效果。

三维打印导板在残冠残根根管治疗中的应用

目的:探讨三维打印导板在残冠残根根管治疗中的应用疗效。方法:选取72例残冠残根患者作为研究对象,随机分为两组。导板组三维打印导板重建残冠残根冠方平面,确定参照点;对照组在残冠残根剩余牙体边缘或邻牙边缘找寻参照点,两组均采用Protaper Gold器械预备结合热牙胶垂直加压充填。对两组各项指标及疗效进行分析。结果:导板组患者主尖就位率、恰充率、成功率、充填精确性均优于对照组,且平均治疗时间也短于对照组,差异均具有统计学意义(P<0.05);同时导板组患者前磨牙与磨牙的精确性差异无统计学意义(P>0.05),而对照组患者前磨牙与磨牙的精确性差异有统计学意义(P<0.05)。结论:残冠残根根管治疗中采用三维打印导板恢复冠方参照点,能有效减小根管治疗误差,提高治疗效率和成功率,增加患牙远期留存率。

健脾益胃通络方联合四联疗法治疗脾胃虚弱型慢性萎缩性胃炎临床研究

目的:观察健脾益胃通络方联合四联疗法治疗脾胃虚弱型慢性萎缩性胃炎(CAG)伴幽门螺杆菌(Hp)阳性患者的临床疗效。方法:选择104例CAG伴Hp阳性患者,随机分为联合组和西药组各52例。西药组予以四联疗法治疗,联合组给予健脾益胃通络方联合四联疗法。连续治疗8周后,比较2组临床疗效、中医证候评分、病理组织学指标评分、中文版健康调查简表(SF-36)评分及血清胃蛋白酶原水平。结果:治疗后,联合组总有效率为94.23%,西药组为80.77%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组胃脘胀满或隐痛、喜温喜按、食后脘闷、食少纳呆、倦怠乏力、气短懒言等中医证候评分均较治疗前降低(P<0.05),且联合组各项评分均低于西药组(P<0.05)。治疗后,2组异型增生、肠化程度、萎缩程度、慢性炎症、活动性、Hp感染评分均较治疗前降低(P<0.05),且联合组上述各项组织病理学指标评分均低于西药组(P<0.05)。治疗前,2组SF-36评分比较,差异无统计学意义(P>0.05);治疗后,2组SF-36评分较治疗前升高(P<0.05),且联合组SF-36评分高于西药组(P<0.05)。治疗后,2组胃蛋白酶原Ⅰ水平较治疗前升高(P<0.05),且联合组胃蛋白酶原Ⅰ水平高于西药组(P<0.05);2组胃蛋白酶原Ⅱ水平较治疗前降低(P<0.05),且联合组胃蛋白酶原Ⅱ水平低于西药组(P<0.05)。结论:健脾益胃通络方联合四联疗法治疗脾胃虚弱型CAG伴Hp阳性患者效果良好,可加快临床症状和胃黏膜病理组织恢复,调节胃蛋白酶原分泌,提高患者生活质量。

鼻疗法治疗偏头痛发作期的用药规律研究

目的:基于数据挖掘探讨鼻疗法治疗偏头痛发作期的用药规律。方法:检索中国知网数据库(CNKI)、万方医学网、维普中文科技期刊数据库(VIP),双人筛选文献并录入数据,建立数据库。采用数据挖掘技术(频数分析、关联规则、聚类分析)对纳入文献药物进行分析。结果:共筛选出鼻疗法治疗偏头痛发作期的临床研究文献38篇,涉及中药处方38首和32味中药,药物总使用频次181次。7味中药使用频次≥6次,依次是川芎、冰片、白芷、细辛、羌活、薄荷、制远志,药物功效以解表药、活血化瘀药、开窍药、温里药最为多见,性味以辛温多见,药物归经多见肺经。关联规则分析中,支持度大于40%,得出关联药对5组,均以川芎为后项,配伍白芷、冰片、细辛。核心药物聚类分析大致分为2个类别。结论:通过数据挖掘鼻疗法治疗偏头痛发作期的用药规律,一定程度上为临床用药及新药研发提供思路。

中医文化视域下运动处方的理念演变及局限

中医文化中的运动防治疾病理念自原始社会便已经开始萌芽,随着中医学理论实践的不断完善而逐步系统化,逐渐形成了以中医文化为基石的“辨体施动”特色运动医学概念。萌芽时期的中医“运动”以治疗为主,随着中医运动疗法的不断发展,目前已经形成了从“治疗、预防、健身、康复”多方位维护人体身体健康的医疗方式。与此同时,源于古籍的“法于阴阳”“形与神俱”“动以养身”等等中医运动处方原则也在不断完善中医运动疗法体系。而随着现代运动理念的融入,体医融合的趋势更加明显,中医运动处方也开始融入现代运动医学的运动要素概念,使其更加趋于系统性、规范性、合理性。然而,目前中医运动处方依旧还存在理法体系验证不完善、处方要素界定模糊、定量研究限制较多以及特色优势不明显等局限性,但是随着其不断完善,它将会成为现代运动处方体系的重要组成部分,并且具有更为广泛而有效的实际应用价值。

炔雌醇环丙孕酮片联合二味妙方治疗功能失调性子宫出血临床观察

目的探讨炔雌醇环丙孕酮片联合二味妙方治疗功能失调性子宫出血的临床效果。方法选择2023年1月—2023年12月于南昌市洪都中医院就诊并经过检查明确诊断为功能失调性子宫出血的患者40例作为观察对象,采用随机数字表法将其纳入对照组、治疗组,各20例。对照组给予炔雌醇环丙孕酮片,治疗组给予炔雌醇环丙孕酮片联合二味妙方。连续服药3个月经周期后,对比两组患者临床治疗效果、出血控制时间、完全止血时间及治疗前后的子宫内膜厚度、月经周期与经期天数。结果治疗组临床总有效率为95.00%(19/20),高于对照组的70.00%(14/20),差异有统计学意义(P<0.05)。治疗组出血控制时间、完全止血时间均短于对照组,差异有统计学意义(P<0.05)。治疗组治疗后的子宫内膜厚度小于对照组,月经周期长于对照组,经期天数短于对照组,差异有统计学意义(P<0.05)。结论炔雌醇环丙孕酮片与二味妙方联合治疗功能失调性子宫出血的效果确切,此方案可以缩短出血控制时间及止血时间,还可以降低患者子宫内膜厚度,促使月经周期规律,缩短经期天数。