Acupuncture for olfactory dysfunction in infected COVID-19 patients:Study protocol for a randomized,sham-controlled clinical trial

Background:Olfactory dysfunction(OD)is a common symptom of Corona Virus Disease 2019(COVID-19).It is defined as the reduced or distorted ability to smell during sniffing(orthonasal olfaction)and represents one of the early symptoms in the clinical course of COVID-19 infection.A large online questionnaire-based survey has shown that some post-COVID-19 patients had no improvement 1 month after discharge from the hospital.Objective:To explore the efficacy of acupuncture for OD in COVID-19 infected patients and to determine whether acupuncture could have benefits over sham acupuncture for OD in post-COVID-19 patients.Methods:This is a single-blind,randomized controlled,cross-over trial.We plan to recruit 40 post-COVID-19 patients with smell loss or smell distortions lasting for more than 1 month.Qualified patients will be randomly allocated to the intervention group(real acupuncture)or the control group(sham acupuncture)at a 1:1 ratio.Each patient will receive 8 sessions of treatment over 4 weeks(Cycle 1)and a 2-week follow-up.After the follow-up,the control group will be subjected to real acupuncture for another 4 weeks(Cycle 2),and the real acupuncture group will undergo the 4-week sham acupuncture.The primary outcomes will be the score changes on the questionnaire of olfactory functioning and olfaction-related quality of life at week 6,8,12,and 14 from the baseline.The secondary outcomes will be the changes in the olfactory test score at week 6 and 12 from the baseline measured by using the Traditional Chinese version of the University of Pennsylvania Smell Identification Test(UPSIT-TC).Discussion:The results of this trial will help to determine the effectiveness of acupuncture for OD in post-COVID-19 patients.This may provide a new treatment option for patients.

Evidence-Based Chinese Medicine Clinical Practice Guideline for Stomach Pain in Hong Kong

Stomach pain in Chinese medicine（CM） is a very common disorder in clinical practice and it has been listed as one of the pilot three conditions in Hong Kong to develop evidence-based CM clinical practice guidelines（CM CPGs）. The aim of this stomach Pain CPG is to summarize the treatment methods of stomach pain with CM and evaluate reasonably, then to guide local licensed CM practitioners and provide beneficial reference for social medical decision makers and patients. In this manuscript, we defined stomach pain in CM and the category of chronic gastritis in Western medicine. The clinical manifestation, CM pattern classification, and CM intervention including herbal medicine treatment based on pattern differentiation, symptomatic treatment, acupuncture treatment, regulation and nursing were illustrated.

Acupuncture for low back pain:a clinical practice guideline from the Hong Kong taskforce of standardized acupuncture practice

OBJECTIVE:To develop a clinical practice guideline to guide the treatment of low back pain by acupuncture.METHODS:An integrative approach of systematic review of literature,clinical evidence classification,expert opinion surveying,and consensus establishing via a Delphi program was utilized during the developing process.Both evidence-based practice standards and the personalized features of acupuncture were taken into considerations.RESULTS:Based on clinical evidence and expert opinions,we developed a clinical practice guideline for the treatment of low back pain with acupuncture.These recommendations have a wide coverage spanning from Western Medicine diagnosis and Traditional Chinese Medicine syndrome differentiation,to acupuncture treatment procedures,as well as post treatment care for rehabilitation and follow-ups.The recommendations for acupuncture practice included treatment principles,therapeutic regimens,and operational procedures.The levels of evidence and strength of recommendation were rated for each procedure of practice.CONCLUSION:A clinical practice guideline for acupuncture treating low back pain was developed based on contemporary clinical evidence and experts'consensus to provide best currently agreeable practice guideline for domestic and international stakeholders.

Doubling over ten years of central obesity in Hong Kong Chinese working men

Obesity is now an epidemic in most parts of the world. In this cross sectional study, we report the most recent data on obesity in Hong Kong Chinese working population and compare the changes over 10 years. Methods Between July 2000 and March 2002, 5882 adult subjects from the working class in Hong Kong were recruited （2716 men （46.2%） and 3166 women （53.8%））. They were randomly selected using computer generated codes according to the distribution of occupational groups. Results of this study were compared with the data collected from a prevalence survey for cardiovascular risk factors in a Hong Kong Chinese working population conducted in 1990 （1513 subjects, 910 men （60.1%） and 603 women （39.9%））. Results Standardized percentages of overweight, obesity, and central obesity, in Hong Kong Chinese working population were 59.7%, 35.0%, 26.7% in men and 32.0%, 21.7%, 26.7% in women. Compared to the data collected in 1990, the percentage of obesity increased by 5% in men and reduced by 6% in women. The percentage of central obesity doubled in men （from 12.2% to 26.7%） but remained stable in women.Conclusions There is a doubling of the percentage of central obesity in Hong Kong Chinese working men over previous decade. Education and proper lifestyle modification program to tackle this social health issue are urgently indicated.

My mother is looking blue

Dear editor,A 76-year-old Chinese female presented by ambulance to the Emergency Department complaining of dizziness,headache and fatigue.Her son claimed that the patient“turned blue”three hours prior to onset of the patient’s symptoms.Paramedics noted the patient’s SpO2 was 83%on room air with no improvement with a nonrebreather mask.Past medical history was signifi cant for diabetes and hypertension.Family,social and medication history were non-contributory.

A red herring: An unusual case of pneumothorax

Dear editor,A 67-year-old Chinese man presented to our emergency department (ED) complaining of right-sided chest wall pain.He noticed these symptoms three hours prior to arrival. He denied any shortness of breath or recent injury. Past medical history was significant only for hypertension. Social history was significant for a history of smoking (40 packs per year).

Appraisal of Clinical Practice Guidelines for Ischemic Stroke Management in Chinese Medicine with Appraisal of Guidelines for Research and Evaluation Instrument:A Systematic Review

Objective： To systematically review the clinical practice guidelines （CPGs） for ischemic stroke in Chinese medicine （CM） with the Appraisal of Guidelines for Research and Evaluation （AGREE II） instrument. Methods： CM CPGs for ischemic stroke were searched in 5 online databases and hand-searches in CPG- related handbooks published from January 1990 to December 2012. The CPGs were categorized into evidence based （EB） guideline, consensus based with no explicit consideration of evidence based （CB-EB） guideline and consensus based （CB） guideline according to the development method. Three reviewers independently appraised the CPGs based on AGREE II instrument, and compared the CPGs＇ recommendations on CM pattern classification and treatment. Results： Five CM CPGs for ischemic stroke were identified and included. Among them, one CPG was EB guideline, two were CB guidelines and two were CB-EB guidelines. The quality score of the EB guideline was higher than those of the CB-EB and CB guidelines. Five CM patterns in the CPGs were recommended in the EB CPG. The comprehensive protocol of integrative Chinese and Western medicine recommended in the EB CPG was mostly recommended for ischemic stroke in the CPGs. The recommendations varied based on the CM patterns. Conclusion： The quality of EB CPG was higher than those of CB and CB-EB CPGs in CM for ischemic stroke and integrative approaches were included in CPGs as major interventions.

Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support. We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease.