Perspectives on "chronic Lyme disease"

There is much controversy about the treatment of Lyme disease with respect to 2 poorly defined entities: “chronic Lyme disease” and “posttreatment Lyme disease syndrome.” In the absence of direct evidence that these conditions are the result of a persistent infection, some mistakenly advocate extended antibiotic therapy (≥6 months), which can do great harm and has resulted in at least 1 death. The purpose of this brief report is to review what is known from clinical research about these conditions to assist both practicing physicians and lawmakers in making sound and safe decisions with respect to treatment.     

Outcome of “indeterminant” colitis following ileal pouch-anal anastomosis

To establish whether patients with indeterminant colitis (patients with ulcerative colitis whose surgical specimens also show features of Crohn's colitis) have an adverse outcome after ileal pouch-anal anastomosis (IPAA), the authors reviewed the pathologic reports and postoperative status of 514 consecutive patients who underwent IPAA for chronic ulcerative colitis (CUC). Twenty-five patients (5 percent) had features of indeterminant colitis (IC), including unusual distribution of inflammation, deep linear ulcers, neural proliferation, transmural inflammation, fissures, creeping fat, and retention of gobletcell population. The clinical and functional outcome of these 25 IC patients was compared with that of the remaining 489 CUC patients. The mean follow-up was 38±18 months. No significant differences in complication rates, pouch function, incidence of “pouchitis,” or requirement for pouch excision were detected in the two groups at follow-up. Although the authors are continuing to perform IPAA on patients with IC, a better definition of the IC patient and a more objective, prospective analysis of outcome of IC following IPAA is required before confident and specific treatment policies can be recommended. Read at the meeting of the American Society of Colon and Rectal Surgeons, Washington, D.C., April 5 to 10, 1987. This article received the Northwest Society of Colon and Rectal Surgeons Award.     

Selective phytochemicals targeting pancreatic stellate cells as new anti-fibrotic agents for chronic pancreatitis and pancreatic cancer

Activated pancreatic stellate cells (PSCs) have been widely accepted as a key precursor of excessive pancreatic fibrosis, which is a crucial hallmark of chronic pancreatitis (CP) and its formidable associated disease, pancreatic cancer (PC). Hence, anti-fibrotic therapy has been identified as a novel therapeutic strategy for treating CP and PC by targeting PSCs. Most of the anti-fibrotic agents have been limited to phase I/II clinical trials involving vitamin analogs, which are abundant in medicinal plants and have proved to be promising for clinical application. The use of phytomedicines, as new anti-fibrotic agents, has been applied to a variety of complementary and alternative approaches. The aim of this review was to present a focused update on the selective new potential anti-fibrotic agents, including curcumin, resveratrol, rhein, emodin, green tea catechin derivatives, metformin, eruberin A, and ellagic acid, in combating PSC in CP and PC models. It aimed to describe the mechanism(s) of the phytochemicals used, either alone or in combination, and the associated molecular targets. Most of them were tested in PC models with similar mechanism of actions, and curcumin was tested intensively. Future research may explore the issues of bioavailability, drug design, and nano-formulation, in order to achieve successful clinical outcomes with promising activity and tolerability.     

IL-27 impact on NK cells activity: Implication for a robust anti-tumor response in chronic lymphocytic leukemia

Interleukin 27 (IL-27) belongs to IL-12 cytokine family, has shown anti-tumor potential in several solid tumors, as well as hematologic malignancies. IL-27 can inhibit tumor growth and progression through direct and indirect mechanisms, such as inhibition of proliferation, angiogenesis, induction of apoptosis in tumor cells, and anti-tumor immune response. B-CLL is characterized by remarkable immune perturbation, which leads to disease complications and reduced effectiveness of the treatment. Natural killer cells (NK) are considered as an important arm for the elimination of transformed cells. However, NK cells have shown significant impairment in patients with CLL. Here we analyzed the activity of recombinant human (rh) IL-27-stimulated NK cells in bone marrow (BM) and peripheral blood (PB) of CLL patients using cell surface flow cytometry assessment, and cytotoxicity assay. We showed that rhIL-27 can increase CD69 on NK cells both in BM and PB. Interestingly, BM-NK cells treated with rhIL-27 exhibited a significant increase in degranulation and NK cell-mediated cytotoxicity as compared with untreated NK cells, whereas it did not improve NK cell activity of PB. These observations added further explanation to the anti-tumor activity of IL-27 and also could pave the way to adoption immunostimulatory adjuvant for therapies in CLL.     

Integrating pharmacists into Aboriginal Community Controlled Health Services (IPAC project): Protocol for an interventional,non-randomised study to improve chronic disease outcomes

BackgroundAboriginal and Torres Strait Islander peoples experience a higher burden of chronic disease yet have poorer access to needed medicines than other Australians. Adverse health outcomes from these illnesses can be minimised with improved prescribing quality. This project aims to improve quality of care outcomes for Aboriginal and Torres Strait Islander adult patients with chronic disease by integrating a pharmacist within primary health care teams in Aboriginal Community Controlled Health Services (ACCHSs).MethodologyThis non-randomised, prospective, pre and post quasi-experimental study, will be pragmatic, community-based and participatory, comparing outcomes and costs using paired patient data. Pharmacists will be integrated at 22 sites for approximately 15 months to conduct patient-related and practice-related activities through 10 core roles: providing medication management reviews, assessing adherence and medication appropriateness, providing medicines information and education and training, collaborating with healthcare teams, delivering preventive care, liaising with stakeholders, providing trnsitional care, and undertaking a drug utilisation review. With patients’ consent, de-identified client-level data will be extracted from clinical information systems and pharmacists will record deidentified activity in an electronic logbook. Primary expected outcomes include improvements in biometric indices (glycated haemoglobin, systolic and diastolic blood pressure, lipids, cardiovascular risk, albumin-creatinine ratio) from baseline to end of study. Expected secondary outcomes include improvements in estimated glomerular filtration rate, prescribing indices (appropriateness, overuse and underuse), medication adherence, self-assessed health, and health service utilisation indices. A qualitative assessment of stakeholder and patient perceptions and a cost-effectiveness analysis will be undertaken.DiscussionNumerous inquiries have recommended evaluating the impact of pharmacists integrated within primary health care settings. This study is the first to explore this impact on the health of Aboriginal and Torres Strait Islander peoples who are medically underserved. Evaluation of innovative integrated workforce models is necessary to address the challenges of delivering quality care together with this population.     

裸花紫珠颗粒联合替硝唑、头孢呋辛钠治疗慢性盆腔炎患者的疗效评价

目的分析裸花紫珠颗粒联合替硝唑氯化钠注射液、头孢呋辛钠抗菌药物治疗慢性盆腔炎(CPID)患者的临床效果。方法选取2017年1月~2018年12月某院CPID患者126例,随机分为研究组(n=63)与对照组(n=63),对照组予以替硝唑氯化钠注射液、头孢呋辛钠治疗,研究组在对照组基础上加用裸花紫珠颗粒。对比两组疗效、临床症状改善时间(发热、白带异常、下腹痛)及治疗前后血清炎性因子水平[白细胞介素-1β(IL-1β)、单核细胞趋化蛋白-1(MCP-1)]变化。结果研究组总有效率92.06%(58/63)较对照组79.37%(50/63)高(P<0.05);研究组发热、白带异常、下腹痛改善时间较对照组短(P<0.05);治疗后,研究组血清IL-1β、MCP-1水平较对照组低(P<0.05)。结论裸花紫珠颗粒联合替硝唑氯化钠注射液、头孢呋辛钠抗菌药物治疗CPID患者效果显著,可减轻炎症反应,改善患者临床症状。     

荨麻疹汤联合枸地氯雷他定片治疗慢性荨麻疹临床疗效观察

目的观察荨麻疹汤联合枸地氯雷他定片治疗慢性荨麻疹的方法以及临床疗效。方法 120例慢性荨麻疹患者,随机分成治疗组和对照组,每组60例。对照组给予枸地氯雷他定片口服治疗,治疗组在对照组基础上加用自制荨麻疹汤治疗。比较两组临床疗效、不良反应发生情况。结果治疗组治疗总有效率93.3%明显高于对照组的76.7%,差异具有统计学意义(P<0.05)。治疗组发生轻度嗜睡、口干6例(10.0%),对照组发生轻度嗜睡、口干4例(6.7%),比较差异无统计学意义(P>0.05),且均不影响后续治疗,停药后症状缓解。结论荨麻疹汤联合枸地氯雷他定片治疗慢性荨麻疹临床疗效好,值得推广应用。     

兰索拉唑治疗慢性胃溃疡的效果及用药不良反应评价

目的评价兰索拉唑治疗慢性胃溃疡的效果及用药不良反应。方法100例慢性胃溃疡患者,通过随机数字编号分为对照组与研究组,每组50例。对照组给予奥美拉唑肠溶片治疗,研究组采用兰索拉唑肠溶胶囊治疗,比较两组生活质量评分、治疗效果、不良反应(腹泻、头痛)发生情况。结果治疗后,研究组生活质量评分(80.32±2.33)分高于对照组的(73.31±3.21)分,差异具有统计学意义(P<0.05)。研究组治疗总有效率96.00%高于对照组的84.00%,差异具有统计学意义(P<0.05)。研究组不良反应发生率4.00%低于对照组的16.00%,差异具有统计学意义(P<0.05)。结论兰索拉唑治疗慢性胃溃疡的临床效果显著,可以有效降低患者的用药后不良反应发生率,能够改善患者的生活质量水平。     

左氧氟沙星联合甲硝唑对慢性盆腔炎患者的炎症因子水平及安全性的影响

目的探讨左氧氟沙星与甲硝唑联用对慢性盆腔炎患者的安全性、疗效及炎症因子水平的影响。方法 100例慢性盆腔炎患者,按治疗方法的不同分为对照组和观察组,每组50例。对照组患者给予左氧氟沙星胶囊治疗,观察组患者在对照组基础上加用甲硝唑片治疗。比较两组患者治疗前后各炎症因子[全血白细胞计数(WBC)、中性粒细胞绝对值(NEUT#)、中性粒细胞百分比(NEUT%)、降钙素原(PCT)、C反应蛋白(CRP)]水平的变化情况、临床效果以及治疗期间不良反应发生情况。结果治疗后,观察组WBC、NEUT#、NEUT%、PCT、CRP分别为(6.35±0.90)×10^9/L、(5.60±1.20)×10^9/L、(58.00±2.10)%、(0.11±0.02)ng/L、(5.46±1.32)mg/L,对照组分别为(7.50±1.20)×10^9/L、(6.20±1.30)×10^9/L、(60.00±3.60)%、(0.18±0.12)ng/L、(6.32±1.26)mg/L;两组WBC、NEUT#、NEUT%、PCT、CRP均较治疗前降低,且观察组降低幅度大于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率8.0%与对照组的6.0%比较,差异无统计学意义(P>0.05)。观察组治疗总有效率96.0%高于对照组的84.0%,差异有统计学意义(P<0.05)。结论左氧氟沙星联合甲硝唑治疗慢性盆腔炎的疗效较为确切,明显改善了机体炎症因子水平,且安全性较高。     

Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge,Attitudes, and Practices of Health Care Professionals

ObjectiveTo systematically review health care professionals’ practices and attitudes toward addressing sexuality with people who are living with chronic disease and disability.Data SourcesScopus, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, and MEDLINE were searched to August 2020 for English language publications. Reference lists of relevant publications were also searched.Study SelectionEligible studies reported on knowledge, attitudes, and behaviors of health care professionals about addressing sexuality in the context of chronic disease and disability. The search yielded 2492 records; 187 full texts were assessed for eligibility and 114 documents were included (103 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool.Data ExtractionCharacteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or by a third author.Data SynthesisA sequential, exploratory mixed studies approach was used for synthesis. Pooled analysis showed that 14.2% (95% CI, 10.6-18.9 [I²=94.8%, P<.001]) of health professionals report routinely asking questions or providing information about sexuality. Professionals reported limited confidence, competence, and/or comfort when initiating conversations about sexuality or responding to patient questions. Sexual rehabilitation typically focused on the effect of disease, disability, and medication on sexual function. Broader dimensions of sexuality were rarely addressed.ConclusionDespite recognizing the value of sexuality to health and well-being, most health professionals regardless of clinical context fail to routinely include assessment of sexuality in their practice. Professionals have limited knowledge and confidence when addressing sexuality and experience significant discomfort when raising this topic with people living with chronic disease and disability. Multicomponent implementation programs are needed to improve health professionals’ knowledge, competence, and comfort when addressing sexuality for people living with chronic disease and disability.