Complementary alternative treatments used by patients with cancer in eastern Turkey

Interest in complementary-alternative medicine therapies is growing rapidly in Turkey. Therefore, the purpose of this research was to determine the types and prevalence of alternative therapies used by the patients with a diagnosis of cancer, and to determine factors influencing the choices of their therapies in Erzurum, Turkey. Approximately 10-minute face-to-face interviews were conducted with each subject in the radiation oncology department. The factors associated with the use of alternative therapies after a diagnosis of cancer were assessed by chi-square analysis. The findings indicated that complementary-alternative medicine therapies were used by 41.1% of the subjects after their diagnosis, and that all of the alternatives they used were herbs. The most commonly used herb was stinging nettle leaf (urtica dioica) or seed of nettle. Almost all (93.2%) of the herbs used were nettle. In general, especially the women and the younger patients of both genders were more likely to be using alternative therapies. There was no difference in demographic and cancer characteristics between users of alternative therapy and nonusers. More than the half of the patients using alternative therapies (54.5%) reportedly did not discuss the use of herbs with their healthcare professionals. Most of the patients using stinging nettle and other herbs therapies reported that they had heard about the use of herbs from friends or relatives (52.3%), or from the other patients in this clinic (43.2%). This study found that there is a high prevalence of alternative therapies used by patients with cancer in eastern Turkey. The use of these alternative therapies requires that nursing professionals rethink staff competency, patient assessment, and patient-focused care. Communication between patients and healthcare professionals should initiate dialogues on this topic for a better understanding of patient choices with regard to treatment options.     

Complementary and alternative medicine use in pediatric oncology patients in eastern Turkey

The use of complementary and alternative medicines (CAM) among children with cancer is becoming increasingly popular. Therefore, it is important to gain insight into the prevalence and factors related to the use of CAM. This study presents findings from a study of parents of 88 children with cancer who were receiving or had received conventional therapy for treatment of childhood cancer at a pediatric oncology unit in eastern Turkey. The findings indicated that 48.9% of the respondents reported the use of 1 or more CAM therapies. The most commonly used modality was herbal products such as herbal tea and herbal meal, mostly stinging nettle (Urtica dioica). The findings of this study indicate that CAM users were children who were an average of 3 years older than nonuser children and that CAM use was more prevalent among the children who had been diagnosed with cancer for a longer time than nonusers. There were no significant difference between users and nonusers regarding sociodemographic characteristics (such as age education level, economic status), hopelessness score of parents, gender of child, and treatment status. Healthcare providers should remain informed about the benefits and adverse effects of complementary and alternative therapies to discuss treatment options with patients and their families and to monitor treatment efficacy.     

Sensitivity to Parietaria pollen in the Southampton area as determined by skin-prick and RAST tests

The pollen of Parietaria species is a well-recognized and important inhalant allergen in the Mediterranean area. Parietaria judaica (Pellitory-of-the-Wall) is native to the U.K., flowering from June to September, but is not usually considered to be of any clinical importance by U.K. allergists. We skin tested 62 patients with a clinical history of summer seasonal respiratory symptoms and a control group of 11 patients with perennial respiratory symptoms only. Each was skin tested in duplicate with extracts of grass pollen, birch pollen, Parietaria pollen, Dermatophagoides pteronyssinus, Cladosporium, Alternaria, nettle pollen and negative and positive controls, and serum samples were collected for RAST assays for Parietaria and nettle. Eight of the 62 patients in the main group showed skin reactivity to Parietaria. Five of these eight had never visited the Mediterranean area and therefore it is possible that sensitization occurred in the U.K. Thirteen of the 62 patients were skin reactive to nettle but there was no correlation between skin reactivity to Parietaria and nettle. This supports a recent report that, despite their close botanical relationship, no antigenic cross-reactivity exists between the two species. No correlation was seen between skin reactivity and serum RAST activity to Parietaria or nettle. It is not known whether exposure to Parietaria pollen contributes to the seasonal symptoms of the patients found to be skin reactive. None of the 11 patients in the control group was skin reactive to Parietaria.     

Effect of complementary and alternative medicine during radiotherapy on radiation toxicity

Goal of work To examine the frequency and types of complementary and alternative medicine use in patients undergoing radiotherapy and to analyze the effects these therapies have on the toxicities of radiotherapy. Materials and methods A total of 210 consecutive cancer patients undergoing radiation therapy were included. After radiation therapy, each patient completed a standard questionnaire, and the association between radiation toxicity and complementary and alternative medicine use was analyzed. Main results Among the study population, 44.3% of patients reported using at least one form of complementary and alternative medicine during radiotherapy. The most commonly chosen complementary and alternative medicine was stinging nettle. Complementary and alternative medicine use decreased lower gastrointestinal (F = 3.26, P = .009) and genitourinary toxicities (F = 2.38, P = .043), while it increased laryngeal toxicity (F = 2.63, P = .028). A significant correlation between the type of complementary and alternative medicine used and the degree of these toxicities was not demonstrated. Conclusions Use of complementary and alternative medicine among cancer patients during radiation therapy may affect the degree of radiation toxicity. Further randomized controlled clinical trials are needed to determine the benefits and risks of complementary and alternative medicine use during radiation therapy.     

仙人掌外敷配合吸奶器挤奶治疗产后乳房胀痛效果观察

目的探讨仙人掌外敷配合吸奶器挤奶治疗产后乳房胀痛的效果。方法选择产后乳房胀痛的产妇120例,按住院先后顺序分为对照组和实验组各60例。实验组取适量新鲜仙人掌洗干净,去刺捣烂成泥状,焙热(以不烫为宜)后环形覆盖于乳房上,厚约2mm,乳晕部分不覆盖,外敷10min～15min,然后除去仙人掌,用热毛巾清洁乳房,再按摩乳房用吸奶器挤奶,每日4次。对照组采用传统方法,用湿毛巾热敷乳房10min～15min后按摩乳房后用手挤奶,每日4次。结果干预后2组患者乳房胀痛程度及硬度均得到缓解,但实验组疗效优于对照组,2组疗效比较差异具有统计学意义(p<0.05)。结论仙人掌外敷配合吸奶器挤奶可明显缓解产妇乳房胀痛,减轻乳房硬度。     

The use of complementary and alternative (non-conventional) medicine in cancer patients in Turkey.

The purpose of this study was to define various methods of complementary and alternative medicine (CAM) used by cancer patients and their characteristics in Turkey. The sample consisted of 100 cancer patients who were monitored in the oncology outpatient and inpatient departments of two hospitals. Almost all participating patients were receiving conventional treatment, 36% of which were also using CAM methods. Female patients and individuals with lower educational background showed a tendency to use CAM methods more often. The most frequently used CAM method appeared to be herbal therapy, and the most commonly used herb was the stinging nettle. Most patients obtained information about CAM methods from their friends, the media and from CAM vendors. Patients' responses indicate that "the desire to do everything possible to fight the disease" and "the idea that it may be helpful, at least it's not harmful" were the two most common reasons for using CAM. Of the patients, 79.3% acknowledged a varying degree of benefit from the methods they use. The most frequently indicated benefit was "feeling better both physically and emotionally". Most findings in this study are similar to the results of other research conducted on the subject in Turkey.     

Allergy in the Mediterranean area. II: Cross-allergenicity among Urticaceae pollens (Parietaria and Urtica)

Pollens of related species usually share common antigens and are cross-reacting but this is not always the case. The cross-allergenicity of two species of Urticaceae pollens (Parietaria and Urtica, nettle) was sought by means of RAST-inhibition and isoelectric focusing. A preliminary experiment in forty-two patients investigated by means of skin tests and RAST showed that most patients were either allergic to Parietaria or nettle and that both reactivities were uncommonly associated. The results of RAST-inhibition confirmed the total absence of cross-reactivity between these two related species. IEF patterns indicated that most proteins are in the acidic range of pH and did not reveal large discrepancies. Parietaria and Urtica pollens, although belonging to the same family and having close microscopic patterns, have very different allergenic activities. This study demonstrates that cross-allergenicity cannot be predicted.     

Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases

Stingray stings are common along coastal regions of this country and the world. The tail of the stingray contains a barbed stinger attached to a venom gland and contained within an integumentary sheath. During a sting, the stinger and sheath can become embedded in the soft tissue of the victim, and venom is injected into the wound. Stingray venom most often causes severe pain on contact, although the exact mechanism of toxicity is not certain. Hot water immersion of the stung extremity has been reported to be effective in relieving pain associated with the envenomation, but large studies of this therapy have not been performed. We retrospectively reviewed stingray stings presenting to our Emergency Department (ED) over an 8-year period. Cases were divided into acute (group 1, within 24 h of the sting) and subacute (group 2, 24 h or more after the sting) presentations. Charts were abstracted for information concerning the victim's history, physical examination, treatment, diagnostic imaging, and outcome, including the effectiveness of hot water immersion as analgesia, and use of antimicrobials. A total of 119 cases were identified and abstracted, 100 in group 1 and 19 in group 2. Of the group 1 patients initially treated with hot water immersion alone, 88% had complete relief of pain within 30 min without administration of any other analgesic. In the patients who initially received a dose of analgesic along with hot water immersion, none required a second dose of analgesics and all had complete pain relief before discharge. There were no adverse effects (such as thermal burns) with this therapy. Analysis of infectious complications in group 1 patients demonstrated a significant number of patients returning to the ED with wound infections when prophylactic antibiotics were not administered at initial presentation. Our findings suggest that hot water immersion was effective in decreasing or eliminating the pain associated with stingray envenomation in our series. Due to the high potential for bacterial contamination in these puncture wounds, standard antibiotic prophylaxis may be prudent. Although stingray barbs can be radio-opaque, radiography in our series failed to detect barbs or other foreign bodies in stung extremities, although no barbs or other stinger material were found on inspection of wounds.     

294例蜂蛰伤患者凝血功能分析

目的探讨蜂蛰伤患者凝血指标的变化。方法选取蜂蛰伤患者294例作为研究对象,根据蛰伤针数分为轻度蜂蛰伤组(A组,1~2针)、中度蜂蛰伤组(B组,3~10针)、重度蜂蛰伤组(C组,11~20针)和极重度蜂蛰伤组(D组,≥21针),同时选取健康人群40例作为健康对照组,观察凝血酶原时间(PT)、国际化比值(INR)、部分凝血活酶时间(APTT)和纤维蛋白原(FIB)等指标的变化。结果重度蜂蛰伤组、极重度蜂蛰伤组在蛰伤后4~9h内APTT、PT较健康对照组明显延长(P0.05),APTT、PT、INR分别与蛰伤针数之间呈明显的剂量-效应正相关(r值分别为0.583、0.340、0.327,P0.01)。结论 APTT与蛰伤针数及就医时间密切相关,可以作为蜂蛰伤治疗过程中的有效监测指标。     

Complementary and Alternative Medical Therapies in Multiple Sclerosis–The American Academy of Neurology Guidelines: A Commentary

BackgroundComplementary and alternative medicine (CAM) use in individuals with multiple sclerosis (MS) is common, but its use has been limited by a lack of evidence-based guidance.MethodsIn March 2014, the American Academy of Neurology published the most comprehensive literature review and evidence-based practice guidelines for CAM use in MS. The guideline author panel reviewed and classified articles according to the American Academy of Neurology therapeutic scheme, and recommendations were linked to the evidence strength.FindingsLevel A recommendations were found for oral cannabis extract effectiveness in the short term for spasticity-related symptoms and pain and ineffectiveness of ginkgo biloba for cognitive function improvement in MS. Key level B recommendations included: Oral cannabis extract or a synthetic cannabis constituent, tetrahydrocannabinol (THC) is probably ineffective for objective spasticity improvement in the short term; Nabiximols oromucosal cannabinoid spray is probably effective for spasticity symptoms, pain, and urinary frequency, but probably ineffective for objective spasticity outcomes and bladder incontinence; Magnetic therapy is probably effective for fatigue reduction in MS; A low-fat diet with fish oil supplementation is probably ineffective for MS-related relapses, disability, fatigue, magnetic resonance imaging lesions, and quality of life. Several Level C recommendations were made. These included possible effectiveness of gingko biloba for fatigue; possible effectiveness of reflexology for MS-related paresthesias; possible ineffectiveness of the Cari Loder regimen for MS-related disability, symptoms, depression, and fatigue; and bee sting therapy for MS relapses, disability, fatigue, magnetic resonance imaging outcomes, and health-related quality of life.ImplicationsDespite the availability of studies evaluating the effects of oral cannabis in MS, the use of these formulations in United States may be limited due to a lack of standardized, commercial US Food and Drug Administration–regulated preparations. Additionally, significant concern about prominent central nervous system–related adverse effects with cannabis was emphasized in the review.     

Methyldopa therapy and outcome in cadaveric renal transplantation

Methyldopa therapy for hypertension after renal transplantation could affect graft outcome adversely, since methyldopa inhibits suppressor cells. To study effects of methyldopa on transplant outcome, we analyzed prospective data on 1,648 hypertensive, first-allograft recipients; 545 patients used methyldopa and 1,103 patients did not. One-year graft functional survival was 66% and 67% for all patients using and not using methyldopa respectively. No increased acute rejection occurred related to methyldopa. During the one to six years of follow-up, no adverse effects on graft survival could be attributed solely to methyldopa except that graft survival among white recipients using methyldopa was diminished late after transplantation (P less than .05). Patient survival was not affected by methyldopa. Azathioprine and prednisone therapy may avert the suppressor cell inhibition by methyldopa. Its effect on kidney transplant outcome is not significant except in whites late in the course of graft function; methyldopa use when clinically indicated appears safe.     

The role of botulinum toxin a in the management of lower limb spasticity in patients with cerebral palsy

This study aimed to determine the effects of botulinum toxin-A (btA) on spasticity in children with cerebral palsy (CP). Thirty-five children with spastic CP were evaluated. The injection group consisted of 25 patients who were injected with btA and received conventional physical therapy. The control group consisted of 10 patients who were treated with conventional physical therapy only. In the injection group, btA was applied to the lower extremity spastic muscles at a total dose of 8-10 lU/kg. Spasticity was measured by the Ashworth scale. Gait function was evaluated by clinical gait assessment in all patients and temporal distance factors in 16 patients. All the parameters were recorded before treatment, after three days and after one month of therapy. Following injection of btA, significant improvement in all parameters was observed. No statistically significant progression was noted in the control group except clinical gait analysis scores. Comparing the three-day and one-month measurements of spasticity of the two groups, statistically significant results were obtained in favour of the injection group in all parameters except for clinical gait analysis scores. The findings of this study showed btA injection to be an effective treatment for reducing spasticity and improving gait function in patients with spastic CP     

音乐疗法在慢性精神分裂症康复治疗中的作用

目的 :利用音乐治疗改善慢性精神分裂症的阴性症状 ,延缓精神活动的衰退。方法 :选取64例精神分裂症病人进行了音乐治疗前后对照研究 ,进行了BPRS、SANS、NOSIE的测定。结果 :表明音乐治疗能提高慢性精神分裂症的社会功能、社会兴趣和活跃情绪 ,对缺乏活动的精神症状有改善作用(P<0.01)。主动性音乐治疗疗效优于被动性音乐治疗。但对思维贫乏、思维障碍等症状的改善作用欠佳(P>0.05)。结论 :音乐治疗是慢性精神分裂症康复疗法中的一种有效的辅助治疗 ,应长期进行。     

Immunotherapy of hypersensitivity to hymenoptera venom

Insect sting allergy is a common condition with a risk of life-threatening anaphylaxis. After a severe reaction, the fear of being restung can significantly reduce quality of life. Venom immunotherapy (VIT) is a highly effective treatment of the underlying type I-sensitisation. This review addresses the mechanisms of immune modulation by VIT and outlines current clinical application. Although highly effective in the majority of patients, VIT fails in a few individuals. It can also cause systemic allergic side effects, restricting its application to physicians trained in the treatment of anaphylaxis. This review discusses several new strategies to overcome these problems, which are presently a promising focus of research. These include the use of new adjuvants, of recombinant and genetically engineered venom allergens, as well as vaccination with peptides.     

Immunotherapy of hypersensitivity to hymenoptera venom

Insect sting allergy is a common condition with a risk of life-threatening anaphylaxis. After a severe reaction, the fear of being restung can significantly reduce quality of life. Venom immunotherapy (VIT) is a highly effective treatment of the underlying type I-sensitisation. This review addresses the mechanisms of immune modulation by VIT and outlines current clinical application. Although highly effective in the majority of patients, VIT fails in a few individuals. It can also cause systemic allergic side effects, restricting its application to physicians trained in the treatment of anaphylaxis. This review discusses several new strategies to overcome these problems, which are presently a promising focus of research. These include the use of new adjuvants, of recombinant and genetically engineered venom allergens, as well as vaccination with peptides.     

Multiple bee stings

Multiple bee stings occur in Australia, but are rarely reported. The importance of this problem in the southern states of North America has recently been well publicised. This review examines the incidence of multiple bee stings, a comparison of European and Africanised honeybees, and the structural function of a bee sting. The toxic effects of bee venom components with reference to both pathophysiology and emergency department presentation and treatment are discussed. Aspects of immunotherapy are covered briefly. Advice for bee sting avoidance and best management of mass attack in the field are also presented.     

Hyperbaric Oxygen Therapy for Pain,Opioid Withdrawal,and Related Symptoms: A Pilot Randomized Controlled Trial

BackgroundPain, drug cravings, and opioid withdrawal symptoms can interfere with substance use disorder or opioid tapering treatment goals.AimThis pilot study investigated the feasibility of a protocol designed to test opioid withdrawal symptom relief relative to a sham condition after two consecutive days of hyperbaric oxygen therapy (HBOT) for adults prescribed daily methadone for opioid use disorder.MethodUsing a double-blind protocol, eight adults were randomized to receive either a full 90-minute HBOT dose in a pressurized chamber with 100% oxygen at 2.0 atmospheres absolute (ATA) or a sham condition receiving 21% oxygen (equivalent to room air within the chamber) at a minimal pressure of ≤1.3 ATA. Measures included study retention, treatment satisfaction, and pre- and post-intervention effects for opioid withdrawal symptoms, drug cravings, pain intensity and interference, sleep quality, and mood.ResultsStudy retention and treatment satisfaction was high. All measurements improved more, on average, for participants receiving full-dose HBOT treatment than among participants receiving sham treatments except for clinically observed withdrawal symptoms. The largest positive effects were observed in measurements of pain intensity and drug craving.ConclusionsThese pilot results provide evidence to support a fully powered study of HBOT as a potential treatment adjunct for adults receiving methadone for opioid use disorder. Trends towards symptom improvements were detected from pre- to post-HBOT in the full treatment arm versus sham condition. More research into novel non-pharmacologic options to relieve distressing symptoms related to pain and opioid use disorder is essential to improve clinical outcomes.     

Intra-aortic balloon pump (IABP) rescue therapy for refractory cardiogenic shock due to scorpion sting envenomation

Background: Cardiomyopathy, cardiogenic shock or acute pulmonary oedema are well recognised complications of scorpion sting envenomation occurring in about 1–3% of patients. Current treatment recommendations include afterload reduction using prazosin and improving cardiac contractility with inotropes like dobutamine. We report the use of intra-aortic balloon pump (IABP) as rescue therapy in a patient with refractory cardiogenic shock due to Mesobuthus tamulus (Indian red scorpion) envenomation. Case: A 32-year-old woman was referred 24 h after a scorpion sting. At presentation she was ventilated and in circulatory shock (systolic blood pressure?<50?mmHg). After admission, the patient had four cardiac arrests (three episodes of pulseless ventricular tachycardia/ventricular fibrillation and one episode of asystole) over the next few hours. Following resuscitation, despite a combination of dobutamine, noradrenaline, and adrenaline, blood pressure did not improve significantly. In view of persistent tachycardia (heart rate 160/min), catecholamine storm was suspected and prazosin was added. However, shock was refractory. Hence, IABP was considered as rescue therapy. Following initiation of IABP, there was improvement in cardiac function (improved ejection fraction) which translated to weaning of inotropes over 48 h and improved organ function (renal, respiratory) in the next 2–3 d. However, following extubation, on Day 8, she was noted to have features of hypoxic brain injury. This improved gradually. At discharge (Day 30) she was independent for activities of daily living and was able to mobilise without support. Conclusion: IABP could be generally considered as a rescue therapy in refractory cardiogenic shock in envenomations.