Clinical Fact Research Articles

A Broader Vision for Homeopathy: Medicine Needs Healing, and Homeopathy Has a Part to Play.

The controversial claim that homeopathic medicines actively stimulate the innate capacity of body and mind for healing and repair demands continuing and energetic investigation. But regardless of the outcome of this scientific controversy, the reported changes associated with applying the homeopathic method are matters of clinical fact. There is thus a case to be made that the homeopathic approach, the way that it studies and construes the experience of illness in individual patients, enriches our understanding of health, illness and healing; and is itself an essential contribution that homeopathy can make to the advancement of medicine. Practitioners and researchers involved in homeopathy can, and should, be more energetic and forceful in making that case.

A Theoretical-Clinical Reading of an Analysis: The Clinical Fact as a Methodological Operator

Resumo O presente artigo é oriundo de pesquisa acadêmica que teve como objetivo estudar a clínica psicanalítica e seus efeitos por meio da apresentação de fragmentos de uma análise já encerrada. Para alcançar esse objetivo, utilizamos a ferramenta metodológica do fato clínico, articulando o material clínico com alguns pontos da teoria psicanalítica. Como resultado, apontamos que é possível fazer uma leitura teórico-clínica de uma experiência de análise sob a perspectiva dos movimentos discursivos, em especial do sujeito do inconsciente ($) e do objeto a, conforme apresentados na proposição dos Quatro Discursos de Lacan. Acreditamos que este estudo enfatiza a importância da especificidade da pesquisa em psicanálise em sua dimensão clínica e os possíveis efeitos produzidos por esse processo terapêutico. Dessa maneira, entendemos que a divulgação deste trabalho pode contribuir para a discussão da prática clínica entre colegas do campo psicanalítico e acadêmico, bem como para a difícil tarefa da apresentação do material clínico com a sustentação teórica necessária, a fim de fortalecermos a sempre fundamental transmissão da psicanálise.

Behaviours of general practitioners in the city of douala’s in cameroon in front of depressive disorders

IntroductionIn Cameroon, skepticism and neglect of doctors towards patients with mental disorders is noted. In order to change this, it was important to have an objective assessment. Depressive disorders are the most common form of mental disorders and Douala has the second largest number of general practitioners in the country. Thus, we proposed to evaluate the behaviour of general practitioners in Douala in front of patients with depressive disorders.ObjectivesEvaluate the frequency of depressive disorders in outpatient general consultation Evaluate the competence of general practitioners at diagnosing depressive disorders Evaluate the practices of general practitioners towards depressive disorders Evaluate obstacles faced by general practitioners regarding depressive disordersMethodsWe conducted a cross-sectional descriptive study from February to June 2017 in the outpatient department. For each general practitioner include, we had 3 patients who complete the patient health questionnaire to find out if the patient has depression. During each consultation, we filled out a clinical fact sheet to determine if the general practitioner had diagnosed a depressive disorder. If so, what care has he taken? Finally, we gave the general practitioner a questionnaire to know his difficulties when facing depression.ResultsWe obtained a frequency of 32.5% of depressive disorders in consultation of general medicine in Douala and a rate of diagnosis by general practitioners of 1.92%. Diagnosed cases have just received counseling.Conclusionsin Cameroon, despite the low interest in depressive disorders, they constitute a public health issue in Douala, and surely in Cameroon; Because of its frequency and the harm, they inflict on patients.Conflict of interestI don’t have any conflict of interest

ARTERIAL HYPERTENSION REVEALING A TIGHT AORTIC COARCTATION IN A YOUNG PATIENT: ABOUT A CASE

Objective: Coarctation of the aorta is an obstructive lesion responsible for high blood pressure (hypertension). The diagnosis of coarctation is usually made during the first months of life but can be mentioned much later, especially when there is no other associated heart disease. Design and method: we report a case of a tight aortic coarctation in a young person revealed by arterial hypertension. Results: Mr K.H, 24 years old, with no notable pathological history, admitted for fever, cough and purulent sputum. At the examination the patient was polypneic, BP was 16/7, cardiac auscultation revealed a diastolic murmur to the aortic focus and reduced femoral pulses. Infectious endocarditis was suspected. Transesophageal ultrasound showed grade IV aortic insufficiency, aortic bicuspid, aneurysmal dilatation of the ascending aorta, and absence of endocardial adenoids. The thoracic angio scanner noted a short and tight stenosis of the aortic isthmus, a funnel dilation of the arch of the aorta with a significant aneurysmal dilation of the ascending aorta without signs of dissection, a focus of right lower lobar pneumonia. The diagnosis of hypertension secondary to coartation of the aorta was then retained. The patient was put on antibiotic therapy for his infectious lung disease, on antihypertensive treatment. Conclusions: This clinical fact underscores the importance of measuring blood pressure during any examination of a patient. Indeed, an isthmic coarctation can be easily ignored because, apart from hypertension, the damping of the femoral pulses is often the only clinical sign.

About subcutaneous emphysema during childbirth

In view of the rarity of the case, the author reports the clinical fact of the appearance of subcutaneous emphysema during childbirth in a primiparous woman, 24 years old, who does not have any pulmonary phenomena. After long and difficult periods of opening the throat and smoothing the neck, which lasted about 30 hours, almost at the end of the expulsion of the fetus, which lasted about 2 hours, the woman in labor suddenly had a swelling on her right cheek, of a soft consistency, which, when palpated, gives a sensation of subcutaneous tissue, characteristic of emphysema following a rupture in any part of the airways. Before the end of labor (voluntary), the tumor enlarged and spread to the neck and lower face on both sides. After holding on for 3-4 days, the tumor began to gradually subside and by the 6th day it disappeared completely without any treatment.

ASSESSMENT OF THE QUALITY OF LIFE IN MOROCCAN PARKINSON’S PATIENTS

Parkinson’s disease can lead to disability and reduce the quality of life of its patients. The purpose of this study is to evaluate the quality of life of a group of people with Parkinson’s disease. The clinical and progressive characteristics of the disease, its motor and neuropsychological impact were evaluated in each Parkinsonian subject included in the study. A quality of life assessment was performed and collected from 60 Parkinsonian patients followed and hospitalized at Hassan II University Hospital in Fez. Different instruments were used, the Hoenh and Yahr scale and the Parkinson’s disease questionnaire (PDQ-39) UPDRS engine, MMS, clinical fact sheet. According to our results, through the different tests and scale of evaluation, we observed an impaired quality of life in the areas of physical discomfort, cognitive disorder, activity of daily living, mobility, and emotional well-being, especially in patients with duration of evolution more than 5 years. There was no significant difference between the two sexes. In addition, the severity of the disease tended to give the impression of an impaired quality of life with respect to the dimensions of activities of daily living and cognition, which is relevant to improving the quality of life patient life and clinical interventions.

Systems of intraganglia and intraneural control over latent alpha-herpesvirus in sensory ganglia of peripheral nervous system

The article presents modern data on interferon‑dependent mechanisms of control of latent alpha herpesvirus in the sensory nerve ganglia of the peripheral nervous system. The data on intraganglionar control mechanisms presented by resident natural killers, natural killer T‑lymphocytes and cytotoxic T‑cells that are part of the satellite cells of the nerve node, and the system of intraneuronal defense contained in the centripetal fibers and presented by cascade system TLR‑3, which leads to the production of pre‑immune interferons‑alpha, ‑beta and ‑lambda with a visorathic action, thus counteracting the centripetal transneural spread of the virus from the periphery to the central nervous system. The joint functioning of the interferon‑dependent systems of intraganglionar and intraneuronal control of alpha herpes viruses ensures the maintenance of the latent state of the pathogen, and the disruption of their work is associated with the risk of reactivation of the virus from latency with the development of clinical symptoms. At the same time, lack of intraganglionar cellular immunity is associated with frequent herpetic eruptions on the skin and mucous membranes, while a deficiency of intraneuronal TLR‑3‑dependent immunity leads to the development of herpes virus lesions of the central nervous system — myelitis, encephalitis, and meningitis. It supports the well‑known clinical fact, that herpetic encephalitis often develops in patients without a history of frequent specific exanthema, and individuals with frequent herpetic eruptions on the skin and mucous membranes may never suffer from viral lesions of the brain and spinal cord. New knowledge about the mechanisms of retaining alpha herpesviruses in the latent state of the sensory ganglia can help in the selection of rational therapy for immunocompromised patients with episodes of herpesvirus neuroinfections with the inclusion of drugs of natural, recombinant and lymphoblastoid human alpha interferons and various inducers of interferonogenesis of chemical or natural origin.The article will be useful, first of all, to neurologists, neurosurgeons, infectious diseases specialists, clinical immunologists, pathologists, physiologists.

La psicosis paranoica y el odio como hecho clínico

El presente texto trata de situar el fenómeno del odio como hecho clínico, en el marco de la sesión analítica de un caso de psicosis paranoica. Para ello se analizan las relaciones entre el sujeto, el odio y la cultura, teniendo en cuenta siempre las extensas referencias freudianas a las relaciones entre el fenómeno del odio y la paranoia.

Metformin in autosomal dominant polycystic kidney disease: experimental hypothesis or clinical fact?

BackgroundAutosomal dominant polycystic kidney disease (ADPKD) accounts for 8–10% of end-stage chronic kidney disease (CKD) patients worldwide. In the last decade, the advanced knowledge in genetics and molecular pathobiology of ADPKD focused some aberrant molecular pathways involved in the pathogenesis of the disease leading to controlled clinical trials aimed to delay its progression with the use of mTOR inhibitors, somatostatin or tolvaptan. Preclinical studies suggests an effective role of metformin in ADPKD treatment by activating AMPK sensor. Clinical trials are currently recruiting participants to test the metformin use in ADPKD patients.MethodsWe retrospectively examined the records of our ADPKD patients, selecting 7 diabetic ADPKD patients under metformin treatment and 7 matched non-diabetic ADPKD controls, to test the effect of metformin on renal progression during a 3 year follow-up.ResultsDuring the first year, the GFR decreased by 2.5% in Metformin Group and by 16% in Controls; thereafter, renal function remained stable in Metformin Group and further decreased in Controls, reaching a 50% difference after 3 years of observation. Accordingly, the overall crude loss of GFR, estimated by a linear mixed model, resulted slower in the Metformin than in Control Group (− 0.9; 95% C.I.: -2.7 to 0.9 vs - 5.0; 95% C.I.: -6.8 to − 3.2 mL/min/1.73 m2 per year, p = 0.002).ConclusionsOur data are suggestive of a beneficial effect of metformin on progression of ADPKD. Large, randomized, prospective trials are needed to confirm this hypothesis.

Invited commentary

Invited commentary

Loneliness as a Clinical Fact: Loneliness and Psychological Disorders

Yalnızlık, içinde bulunduğumuz yüzyılda, hızla değişen çevresel ve toplumsal koşullar nedeniyle her geçen gün daha fazla sorun haline gelmektedir. Yapılan araştırmalar yalnızlığın psikolojik bozukluklarla doğrudan ilişkili olduğunu göstermiştir. Psikolojik bozukluklarda yaşanan yalnızlık objektif olarak tanımlanabilmesine rağmen, deneyimin kendisinin sübjektif olmasından dolayı klinisyenler ve araştırmacılar tarafından bu deneyimin niteliğinin tanımlanması oldukça güçtür. Bu makalede, yardım almak amacıyla danışma merkezine başvuran vakalar üzerinden, psikolojik bozukluklarda yaşanan yalnızlığın niteliksel özellikleri ve kökenleri literatürdeki bilgiler ışığında tartışılmıştır. Seçilen psikolojik bozukluklarda yalnızlık temel bir bulgudur ya da bozukluğu yaşadığı sürede, kişi yalnızlığı ciddi bir sorun olarak deneyimlemektedir. Belirlenen psikolojik bozukluklar şunlardır: şizofreni, sosyal kaygı bozukluğu, otizm spektrum bozukluğu borderline kişilik bozukluğu, narsistik kişilik bozukluğu, şizoid kişilik bozukluğu, çekingen kişilik bozukluğu ve bağımlı kişilik bozukluğu. Makalede sunulan vaka örnekleri, Belediye’ye bağlı kadın danışma merkezine yardım almak amacıyla başvuran ve tanı kriterlerini karşılayan danışanlar arasından rastgele seçilmiştir. Başvuran danışanların tanı kriterlerini karşılayıp karşılamadığına DSM-5 Tanı Ölçütleri Başvuru El Kitabı kullanılarak bakılmıştır. Bu makalede tartışılan vaka örneklerinin alanda çalışan kişilerin, danışanın ihtiyacını ona uygun ve doğru bir şekilde karşılamasını sağlayacak müdahale yöntemlerini belirlemesine katkı sağlayacağı düşünülmüştür.

Осложнения и результаты хирургического лечения гастроэзофагеальной рефлюксной болезни

Recently gastroesophageal reflux disease (GERD) was associated only with reflux-esophagitis and appeared to be a harmless disease with the most frequently noted symptom - heartburn. However, prolonged gastroesophageal reflux often provokes attacks of bronchial asthma, ischemic heart disease, is the cause of severe caries, repeated pneumonia and even cancer of the larynx. Terrible complications of GERD are ulcers of the esophagus with blood loss of various degrees, as well as stricture of the esophagus. It is with the widespread prevalence of GERD and its complications (in particular, Barrett's esophagus) that some authors associate an increase in the incidence of adenocarcinoma of the distal esophagus (up to 50 %) among all cases of esophageal cancer. In addition, according to some authors, GERD contributes to the occurrence of laryngeal cancer. Previously, GERD was understood as peptic or terminal esophagitis, but it is known that in more than 50 % of patients with reflux symptoms there is no visible lesion of the esophageal mucosa. It was found that with duodeno-gastral reflux, against a background of decreased acid formation in combination with anthropyloroduodenal dyskinesia, the alkaline contents of the duodenum affect the mucosa of the esophagus. Inflammatory-destructive changes in the mucous membrane of the esophagus may be more pronounced than caused by acid aggression. An important clinical fact is their resistance to conventional therapy. Part of patients with GERD have expressed motor disorders of the esophagus. Obviously, the existing motor disorders lead to the development of GERD, and subsequently, as a result of the direct effect of the inflammatory process on the nerve plexuses in the wall of the esophagus, motor dysfunction is aggravated.

Virtual consultations: from science fiction to clinical fact

Virtual consultations: from science fiction to clinical fact

Pregnancy and the hair growth cycle: anagen induction against hair growth disruption using Nourkrin® with Marilex®, a proteoglycan replacement therapy

Postpartum effluvium is a well-known clinical fact. However, following some minor research activities in the 1960s, very little has happened on the research front of the subject. It was hypothesized that postpartum hair loss might be a manifestation of a change in the hair growth cycle occurring normally during pregnancy. Recently, new research has been published trying to explain the mechanism of action behind this frequently occurring hair growth disruption, and to develop a functional treatment schedule and regime. Under normal circumstances, postpartum effluvium will disappear by itself as a function of time, and therefore adequate information to the patient is important in order to reduce the anxiety that it will not be a permanent problem. However, in some subjects it can manifest itself for longer stages and even become permanent. At the present time, treatments aim at correcting underlying hormonal imbalances and at improving overall cosmetic appearance. Several treatments in the form of thyroid supplementation, topical progesterone and estradiol lotions, and even oral contraceptive have been studied. All the available studies have significant limitations in their scientific basis, such as small sample size, absence of control group, or highly subjective measurement of treatment response. It is evident from the available studies that no specific treatment has been investigated thoroughly enough to justify recommendation in clinical treatment or to be termed "effective." Without the ability to provide a pathogenic diagnosis or causality criteria, chances are low that a treatment by trial and error will adequately be able to control hair effluvium. Current hair treatment strategies are symptomatic and nonspecific; therefore, future research must aim at developing new and targeted methods with a point of departure in observing concomitant biological mechanisms. Based on the research in the 1960s, current knowledge about the hair follicle and the regulation of the hair cycles, we believe that an anagen inducer in the form of a specific proteoglycan replacement therapy (Nourkrin® with Marilex® from Pharma Medico) could be a proper solution to shorten the hair eclipse phenomenon - and give the patient a feeling of control and empowerment.

Atypical symptoms in patients with cervical spondylosis might be the result of stimulation on the dura mater and spinal cord

Patients with cervical spondylosis often present with some atypical symptoms such as vertigo, headache, palpitation, nausea, abdominal discomfort, tinnitus and blurred vision and hypomnesia. Although there are a few hypotheses about the etiology of those symptoms, none of them have provided evidence convincing enough to explain the clinical, pathological and anatomic manifestation of those symptoms. One of the more acceptable explanations is that those symptoms are the results of stimulation of the sympathetic nerves in the posterior longitudinal ligament. The clinical fact that dissection of the posterior longitudinal ligament significantly alleviates the severity of those symptoms seems like an evidence for the validity of this hypothesis. However, recent clinical studies showed that laminoplasty, which has no effect on the posterior longitudinal ligament, can achieve the similar effect. In this paper, we hypothesize that stimulation of the dura mater and spinal cord might be the cause of atypical symptoms in patients with cervical spondylosis.

Osteoblasts Have a Neural Origin in Heterotopic Ossification.

Heterotopic ossification (HO) is the process of bone formation at a nonskeletal site. Recently, we showed that the earliest steps occur in sensory nerves. We now extend these studies by identifying unique osteogenic progenitors within the endoneurial compartment of sensory nerves. We asked: (1) What is the nature of the osteoprogenitor in the endoneurium of peripheral nerves? (2) How do osteoprogenitors travel from the nerve to the site of new bone formation? HO was induced by intramuscular injection of Ad5BMP-2-transduced cells in mice. Osteoprogenitors were identified through immunohistochemistry and then quantified and further characterized by fluorescence-activated cell sorting and immunocytochemistry. The kinetics of the appearance of markers of extravasation was determined by quantitative reverse transcription-polymerase chain reaction. In each experiment mice were injected with bone morphogenetic protein-2 (BMP-2)-producing cells (experimental) or with cells transduced with empty vector or, in some cases, a group receiving no injection (control). Induction of HO leads to the expression, within 24 hours, of osteoblast-specific transcription factors in cells in the endoneurium followed by their coordinate disappearance from the nerve at 48 hours. They reappear in blood also at 48 hours after induction. During vessel entrance they begin to express the tight junction molecule, claudin 5. The cells expressing both the osteoblast-specific transcription factor, osterix, as well as claudin 5, then disappear from circulation at approximately 3 to 4 days by extravasation into the site of new bone formation. These endoneurial osteoprogenitors express neural markers PDGFRα, musashi-1, and the low-affinity nerve growth factor receptor p75(NTR) as well as the endothelial marker Tie-2. In a key experiment, cells that were obtained from mice that were injected with cells transduced with an empty vector, at 2 days after injection, contained 0.83% (SD, 0.07; 95% confidence interval [CI], 0.59-1.05) cells expressing claudin 5. However, cells that were obtained from mice 2 days after injection of BMP-2-producing cells contained 4.5% cells expressing claudin 5 (SD, 0.72%; 95% CI, 2.01-6.94; p < 0.0015). Further analysis revealed that all of the cells expressing claudin 5 were found to be positive for osteoblast-specific markers, whereas cells not expressing claudin 5 were negative for these same markers. The findings suggest that the endoneurial progenitors are the major osteogenic precursors that are used for HO. They exit the nerve through the endoneurial vessels, flow through vessels to the site of new bone formation, and then extravasate out of the vessels into this site. The biogenesis of osteoblasts in HO is very different than expected and shows that HO is, at least in part, a neurological disorder. This could result in a major shift in orthopaedic methodologies to prevent or treat this disease. The fact that nerves are intimately involved in the process may also provide clues that will lead to an explanation of the clinical fact that HO often occurs as a result of traumatic brain injury.

The Interactional Production of a Clinical Fact in a Case of Autism

The authority to diagnose is a distinguishing prerogative of modern medicine. While a growing body of research addresses various aspects of diagnosis, few studies analyze just how it is achieved through talk-in-interaction. This paper examines how clinicians assembled a diagnosis of a child who was evaluated for autism. Drawing on audio and video recordings at a clinic for developmental disabilities, I use a combination of ethnomethodology and conversation analysis to show how a critical fact about the child’s mental functioning was formulated, challenged, and transformed across three consecutive stages of his evaluation: (1) testing, (2) a case conference among clinicians, and (3) an informing interview where the diagnosis was delivered to the parents. I analyze how this fact emerged as an outcome of clinician-child interactions, and how clinicians used storytelling to render its diagnostic implications. In addition to examining how these stories are methodically produced, I argue that they frame the child’s behavior in ways that suggest a lack of competence while eliding the skills and competencies he may have been displaying.

20704 FDTD法による簡易モデルを用いた集束超音波加温システムの基礎検討

In the clinic, High Intensity Focused Ultrasound (HIFU) is used to non-invasive treatments for cancers. However, it is not easy to rapidly monitor temperature elevations which reach higher than 60℃ and may cause undesirable thermal injuries. On the other hand, hyperthermia treatment is based on the clinical fact that cancer cells are more weaker than healthy cells hi the temperature range of 42-43℃. In this study, we propose a new type of transducer for hyperthermia treatments with focused ultrasound heating energy to expand the heating area. First, we presented a new type of transducer model for computer simulations. Next, we calculated pressure distributions using a Finite-Difference Time-Domain (FDTD) method with the proposed transducer model. From these results, it was found that the proposed transducer was useful for hyperthermia treatments.

Intravitreal controlled release of dexamethasone from engineered microparticles of porous silicon dioxide

Dexamethasone is a glucocorticoid that is widely used in the ophthalmic arena. The recent FDA approved dexamethasone implant can provide a three month efficacy but with high rate of drug related cataract and high intraocular pressure (IOP). It seems that higher steroid in aqueous humor and around lens may be associated with these complications based on clinical fact that higher IOP was observed with intravitreal triamcinolone acetonide (TA) than with subtenon TA. We hypothesize that placing a sustained dexamethasone release system near back of the eye through a fine needle can maximize efficacy while mitigate higher rate of IOP rise and cataract.To develop a sustained intravitreal dexamethasone delivery system, porous silicon dioxide (pSiO2) microparticles were fabricated and functionalized with amines as well as carboxyl groups. Dexamethasone was conjugated to pSiO2 through the Steglich Esterification Reaction between hydroxyl of dexamethasone and carboxyl groups on the pSiO2. The drug loading was confirmed by Fourier transform infrared spectroscopy (FTIR) and loading efficiency was quantitated using thermogravimetric analysis (TGA). In vitro release was conducted for three months and dexamethasone was confirmed in the released samples using liquid chromatography-tandem mass spectrometry (LC/MS/MS). A pilot ocular safety and determination of vitreous drug level was performed in rabbit eyes. The drug loading study demonstrated that loading efficiency was from 5.96% to 10.77% depending on the loading reaction time, being higher with longer loading reaction time before reaching saturation around 7 days. In vitro drug release study revealed that dexamethasone release from pSiO2 particles was sustainable for over 90 days and was 80 days longer than free dexamethasone or infiltration-loaded pSiO2 particle formulation in the same setting. Pilot in vivo study demonstrated no sign of ocular adverse reaction in rabbit eyes following a single 3 mg intravitreal injection and free drug level at 2-week was 107.23 ± 10.54 ng/mL that is well above the therapeutic level but only around 20% level of dexamethasone released from OZURDEX® (dexamethasone intravitreal implant) in a rabbit eye model. In conclusion, dexamethasone is able to covalently load to the pSiO2 particles and provide sustained drug release for at least 3 months in vitro. Intravitreal injection of these particles were well tolerated in rabbit eyes and free drug level in vitreous at 2-week was well above the therapeutic level.

Becoming Related: the Education of a Psychoanalyst

The author uses a “professional memoir,” a story about his first experiences in clinical work, to illustrate what he believes to be certain fundamental aspects of an analytic attitude. Taking place in a psychiatric hospital, it is meant to highlight the central place of intuition, emotional receptivity, empathy, relatedness—and their inherent dangers—in engaging therapeutically with patients’ emotional disturbances. The author postulates that these and related aspects of clinical psychoanalysis are not sufficiently emphasized in psychoanalytic training and are often eclipsed by idealizations of psychoanalytic theories and their derivative techniques, third-party demands for evidence-based data, preoccupations with neurobiological correlates of experience, etc. Despite the clinical fact that psychoanalysis can be extraordinarily helpful to patients, he questions whether clinical psychoanalysis is rightly regarded as a “treatment.”