Medicine Modalities Research Articles

A Clinical Evaluation of Haritaki Kashaya and Madhu as Kawala in the Management of Post Operative Sore Throat due to Tracheal Intubation Under General Anaesthesia

A sore throat is pain or irritation in the throat. It is usually caused by acute pharyngitis (inflammation of the pharynx). Although it can also appear as a result of trauma, diphtheria or other conditions. Post (Post Operative Sore Throat) is a common complaint in patients undergoing general anaesthesia following orotracheal intubation, with reported incidence of 21-65%. POST ranks among the most frequent subjective complaint after tracheal intubation under general anaesthesia. Post operative sore throat, cough and hoarseness of voice though minor sequel, but they may cause significant post operative morbidity and patient dissatisfaction. Various pharmacological and non-pharmacological trials have been used for attenuating POST with no single proven modality in modern medicine. Keeping this in mind, a thorough study was planned to search out for an ideal Ayurvedic preparation for the management of Post Operative Sore Throat due to tracheal intubation under general anaesthesia. As Haritaki has anti-inflammatory and anti-septic properties and Madhu has anti microbial and wound healing properties, A planned study was done on “Haritaki Kashaya and Madhu as Kawala” to evaluate its importance in treating post operative sore throat caused by tracheal intubation and the results were compared with the patients receiving normal saline gargles. Total effect of drug was evaluated on the basis of signs and symptoms relieved after completion of the trial. The data obtained in clinical study before and after the trial was expressed in terms of Mean, Standard Deviation (SD±) and Standard Error (SE±). Group-II (trial group) revealed better results than Group-I (control group) over total criteria of assessment. The trial drug was found to be efficient to relieve the symptoms like coughing, pain in throat and post operative sore throat in the patients who undergo orotracheal intubation after general anaesthesia

A qualitative investigation of the perceptions of complementary and alternative medicine among adults in Hawaiʻi

BackgroundComplementary and alternative medicine (CAM) is defined as a group of diverse medical and healthcare practices outside of conventional medicine modalities. The use of CAM is steadily increasing despite gaps in the scientific evidence supporting its use and the challenges of its regulation and integration into conventional healthcare practices. In this context, perceptions concerning CAM become important. The purpose of this study is to identify the perceptions of CAM among adult residents of Hawaiʻi.MethodsTwo researchers conducted audio-recorded interviews at the University of Hawaiʻi Mānoa (UHM) campus. Participants were over the age of 18, spoke English fluently, and self-identified as Hawaiʻi residents. Interviews were conducted to the point of data saturation and audio recordings were transcribed verbatim. Researchers collaboratively developed a codebook and used NVivo 12 to analyze transcripts. New codes were added as required. Inter-rater reliability was determined by calculating Cohen’s kappa coefficient. Key themes were identified by both researchers individually and then discussed and evaluated together.ResultsParticipants were mostly female, white, and affiliated with UHM. Perceptions were categorized as positive, negative, and neutral. The majority of participants had positive perceptions of CAM with few reporting negative perceptions. The positive perceptions were related to CAM’s perceived effectiveness, the desirability of CAM compared to conventional medicine, and CAM’s ability to foster well-being. Negative perceptions were attributed to the lack of scientific evidence and ineffective outcomes of CAM use. Neutral perceptions of CAM related to its safety and natural characteristics.ConclusionsThe study found mainly positive perceptions of CAM among Hawaiʻi residents. Use of CAM is on the rise despite CAM lacking robust empirical evidence demonstrating efficacy across various medical conditions. With insufficient data and understanding of current medical literature, CAM users place themselves at risk for harmful herb-herb and herb-drug interactions. These findings have implications for healthcare providers of both conventional medicine and CAM traditions.

Enhanced confidence and ultrasound‐performance skills of medical students: A comparative study with and without prior videographic ultrasound exposure

INTRODUCTIONPoint‐of‐care ultrasonography (POCUS) is commonly used in many modalities of medicine. However, there is a lack of standardized protocol for integrating POCUS into preclinical medical education. Previous literature has detailed the benefits of POCUS in clinical diagnoses and reasoning, but many medical students still lack exposure to POCUS. At California University of Science and Medicine (CUSM), medical students will be exposed to POCUS in their preclinical years. We aim to compare the confidence levels and ultrasound‐performance skills of medical students with and without prior videographic ultrasound exposure.HypothesisPrior videographic ultrasound exposure will improve the confidence and ultrasound‐performance skills of medical students during a live ultrasound workshop compared to those without videographic exposure.MethodsParticipants will be divided into two groups. One group will watch a 5–10‐minute procedural video about ultrasound‐guided peripheral intravenous (IV) access prior to ultrasound training, while the other group will be ultrasound‐naive prior to ultrasound training. Ultrasound training will be led by three other medical students who are trained and approved by ultrasound physicians. After demonstrations, participants will practice ultrasound‐guided IV access on a practice pad. Instructors will grade students on the spot on their ability to perform ultrasound‐guided IV access correctly. The parameters measured will be proper positioning of the ultrasound probe, insertion of the needle, ultrasound probe movement, puncturing of the vein, and overall technique. The two study groups will then take surveys on their perceived performance and overall confidence levels.ResultsResults from participants will be scored using two measures. Firstly, their self‐reflection surveys will measure their level of confidence and perceived ultrasound‐performance skills. Secondly, on‐the‐spot grading by instructors will provide information on participants’ actual ultrasound‐performance skills. A standardized grading scheme will ensure fairness among different instructors and participants.ConclusionComparison of the effectiveness of an additional videographic ultrasound component prior to live demonstration will be elucidated. This study will help create elements within existing ultrasound curriculae that will enhance the confidence and ultrasound‐performance skills of preclinical medical students.

Application of Advanced Imaging Modalities in Veterinary Medicine: A Review.

Veterinary anatomy has traditionally relied on detailed dissections to produce anatomical illustrations, but modern imaging modalities, now represent an enormous resource that allows for fast non-invasive visualizations in living animals for clinical and research purposes. In this review, advanced anatomical imaging modalities and their applications, safety issues, challenges, and future prospects of the techniques commonly employed for animal imaging would be highlighted. The quality of diagnostic imaging equipment in veterinary practice has greatly improved. Recent advances made in veterinary advanced imaging specifically about cross-sectional modalities (CT and MRI), nuclear medicine (PET, SPECT), and dual imaging modalities (PET/CT, PET/MR, and SPECT/CT) have become widely available, leading to greater demands and expectations from veterinary clients. These modalities allow for the creation of three-dimensional representations that can be of considerable value in the dissemination of clinical diagnosis and anatomical studies. Despite, the modern imaging modalities well established in developed countries across the globe, it is yet to remain in its infancy stage in veterinary practice in developing countries due to heavy initial investment and maintenance costs, lack of expert interpretation, a requirement of specialized technical staff and need of adjustable machines to accommodate the different range of animal sizes. Therefore, veterinarians should take advantage of these imaging techniques in designing future experiments by considering the availability of these varied imaging modalities and the creation of three-dimensional graphical representations of internal structures.

Thymoquinone's Antiviral Effects: It is Time to be Proven in the Covid-19 Pandemic Era and its Omicron Variant Surge.

The COVID-19 pandemic has impacted every country in the world. With more than 400 million cases and more than 5.5 million deaths. The FDA either approved or authorized the emergency use for three vaccines against COVID-19. The treatment options of COVID-19 are very limited. Multiple complementary and alternative medicine modalities were suggested to be efficacious in the treatment of COVID-19 such as Thymoquinone. The effects of Thymoquinone have been examined and multiple studies indicate a promising beneficial effect. However, the current body of research is limited in terms of its scope, quality, and quantity. While higher-quality studies are required, physicians do not routinely recommend the use of marketed supplements of natural products, including Thymoquinone for COVID-19. Given the numerous suggested positive effects of Thymoquinone, including anti-inflammatory and antimicrobial properties, additional research is required to confirm or refute these promising benefits. Complementary and alternative medicine is an area that requires additional evidence-based practice and research to confirm effects observed in clinical practice.

Evidence-based guideline of the European Association of Nuclear Medicine (EANM) on imaging infection in vascular grafts

PurposeConsensus on optimal imaging procedure for vascular graft/endograft infection (VGEI) is still lacking and the choice of a diagnostic test is often based on the experience of single centres. This document provides evidence-based recommendations aiming at defining which imaging modality may be preferred in different clinical settings and post-surgical time window.MethodsThis working group includes 6 nuclear medicine physicians appointed by the European Association of Nuclear Medicine, 4 vascular surgeons, and 2 radiologists. Vascular surgeons formulated 5 clinical questions that were converted into 10 statements and addressed through a systematic analysis of available literature by using PICOs (Population/problem–Intervention/Indicator–Comparator–Outcome) strategy. Each consensus statement was scored for level of evidence and for recommendation grade, according to the Oxford Centre for Evidence-based Medicine criteria.ResultsSixty-six articles, published from January 2000 up to December 2021, were analysed and used for evidence-based recommendations.ConclusionComputed tomography angiography (CTA) is the first-line imaging modality in suspected VGEI but nuclear medicine modalities are often needed to confirm or exclude the infection. Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) has very high negative predictive value but it should be performed preferably at least 4 months after surgery to avoid false positive results. Radiolabelled white blood cell (WBC) scintigraphy, given its high diagnostic accuracy, can be performed at any time after surgery.PreambleThe European Association of Nuclear Medicine (EANM) is a professional no-profit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. The EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The EANM recognizes that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized. These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the EANM suggests caution against the use of the current consensus document in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgement regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in the light of all the circumstances presented. Thus, there is no implication that an approach differing from the consensus document, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the consensus document when, in the reasonable judgement of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the consensus document. The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to this consensus document will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient, to deliver effective and safe medical care. The sole purpose of this consensus document is to assist practitioners in achieving this objective.

Complementary and alternative medicine modalities used to treat adverse effects of anti-cancer treatment among children and young adults: a systematic review and meta-analysis of randomized controlled trials

BackgroundDealing with the symptom burden of cancer diagnosis and treatment has led parents to seek different self-management strategies including Alternative and Complementary Medicine (CAM). The aim of this study was to perform a systematic review and meta-analysis about the use and effect of CAM modalities to treat adverse effects of conventional cancer treatment among children and young adults.MethodsSix scientific research databases were used to identify randomized controlled trials (RCTs) from 1990 to September 2020. Included studies investigated the use of CAM to treat cancer treatment related adverse effects in children and young adults compared to controls.ResultsTwenty RCTs comprising 1,069 participants were included in this review. The included studies investigated acupuncture, mind–body therapies, supplements, and vitamins for chemotherapy-induced nausea and vomiting (CINV), oral mucositis, and anxiety among children and young adults who underwent conventional cancer treatment. Seven studies (315 participants) were included in the meta-analysis. The overall effect of CAM (including acupuncture and hypnosis only) on chemotherapy-induced nausea and/or vomiting and controls was statistically significant with a standard mean difference of -0.54, 95% CI [-0.77, -0.31] I2 = 0% (p < 0.00001). There was a significant difference between acupuncture and controls (n = 5) for intensity and/or episodes of CINV with an SMD -0.59, 95% CI [-0.85, -0.33] (p < 0.00001). No significant difference was found between hypnosis and controls (n = 2) for severity or episodes of CINV with an SMD -0.41, 95% CI [-1.09, 0.27] I2 = 41% (p = 0.19).ConclusionCurrent evidence from this meta-analysis of randomized controlled trials shows that CAM, including acupuncture and hypnosis only, is effective in reducing chemotherapy-induced nausea and vomiting in children and young adults. More rigorous trials and long-term effects should be investigated if acupuncture and hypnosis are to be recommended for clinical use.

Liver Diseases and Adverse Reactions Induced by Medicinal Herbs and Herb-Drug Interactions

Integrative medicine encompasses several modalities of complementary and alternative medicine, of which the most relevant is the herbal medicine. Herbal formulations contain multiple pharmacologically active phytochemicals with isolated active compounds usually can achieve better therapeutic performance. In general, herbal medicines are believed to be more effective and safer than prescription drugs. Prescription drugs are approved and licensed only after well regulated clinical trials have been carried out, but a majority of marketed herbal products remain non-regulated without evidence of efficacy and safety. In this article, we review the potential risk of liver diseases or other organ toxicity related to herbs or the combined use of herb and drug. This article also discusses certain medicinal herbs as well as hepatotoxicy and adverse reactions induced by herb-drug interactions in liver disease patients.

Regenerative Rehabilitation and Stem Cell Therapy Targeting Chronic Spinal Cord Injury: A Review of Preclinical Studies

Stem cell medicine has led to functional recovery in the acute-to-subacute phase of spinal cord injury (SCI), but not yet in the chronic phase, during which various molecular mechanisms drastically remodel the tissue and render it treatment-resistant. Researchers are attempting to identify effective combinatorial treatments that can overcome the refractory state of the chronically injured spinal cord. Regenerative rehabilitation, combinatorial treatment with regenerative medicine that aims to elicit synergistic effects, is being developed. Rehabilitation upon SCI in preclinical studies has recently attracted more attention because it is safe, induces neuronal plasticity involving transplanted stem cells and sensorimotor circuits, and is routinely implemented in human clinics. However, regenerative rehabilitation has not been extensively reviewed, and only a few reviews have focused on the use of physical medicine modalities for rehabilitative purposes, which might be more important in the chronic phase. Here, we summarize regenerative rehabilitation studies according to the effector, site, and mechanism. Specifically, we describe effects on transplanted cells, microstructures at and distant from the lesion, and molecular changes. To establish a treatment regimen that induces robust functional recovery upon chronic SCI, further investigations are required of combinatorial treatments incorporating stem cell therapy, regenerative rehabilitation, and medication.

Evidence Mapping of 23 Systematic Reviews of Traditional Chinese Medicine Combined With Western Medicine Approaches for COVID-19.

Background: Coronavirus disease 2019 (COVID-19) has already spread around the world. The modality of traditional Chinese medicine (TCM) combined with Western medicine (WM) approaches is being used to treat COVID-19 patients in China. Several systematic reviews (SRs) are available highlighting the efficacy and safety of TCM combined with WM approaches in COVID-19 patients. However, their evidence quality is not completely validated. Purpose: We aimed to assess the methodological quality and the risk of bias of the included SRs, assess the evidence quality of outcomes, and present their trends and gaps using the evidence mapping method. Methods: PubMed, Cochrane Library, Embase, CNKI, CBM, and Wanfang Data were searched from inception until March 2021 to identify SRs pertaining to the field of TCM combined with WM approaches for COVID-19. The methodological quality of the SRs was assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), the risk of bias of the included SRs was assessed with the Risk of Bias in Systematic Review (ROBIS) tool, and the evidence quality of outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: In total, 23 SRs were found eligible. Twenty-one were rated of moderate confidence by AMSTAR 2, while 12 were rated at low risk using the ROBIS tool. In addition, most outcomes were graded as having moderate quality using the GRADE system. We found that the combined use of TCM and WM approaches could improve the CT recovery rate, effective rate, viral nucleic acid negative conversion rate, and the disappearance rate of fever, cough, and shortness of breath. Also, these approaches could decrease the conversion rate from mild to critical, white blood cell counts, and lymphocyte counts and shorten the time to viral assay conversion and the length of hospital stay. Conclusion: TCM combined with WM approaches had advantages in efficacy, laboratory, and clinical symptom outcomes of COVID-19, but the methodological deficiencies of SRs should be taken into consideration. Therefore, to better guide clinical practice in the future, the methodological quality of SRs should still be improved, and high-quality randomized controlled trials (RCTs) and observational studies should also be carried out.

CRISPR Genome Editing: Into the Second Decade

CRISPR Genome Editing: Into the Second Decade

Undetermined relationship between five modalities of mind-body medicine, and non-mind body complementary medicine practices among a subset of an indigenous culture in Miami-Dade County, Florida: An exploratory integrative medicine view in the COVID-19 Era

The concepts of Mind-body medicine (MBM), and non-mind body complementary medicine practices among Haitians in Little Haiti, Florida are unexplored. This article investigated five non-habituated MBM modalities and practices within the Haitian culture. An additional objective of this article was to determine whether a relationship could exist among the mbm and non-mbm modalities in the indigenous culture in Miami-Dade County, Florida, looking at the cultural and traditional medicine practices. A literature survey shows adherence through cultural health beliefs and spiritual conduits of the indigenous culture. The result shows that MBM modalities are salient within this group, and awareness or exposure to MBM and non-MBM modalities can be essential in cultural health beliefs formation, and practices. In a COVOD-19 era these modalities can help alleviate the ill-consequences. Knowledge and embrace of the modalities are paramount while maintaining traditional medicine and cultural traditions. Further research is needed.

Complementary Medicine Use in Sports Medicine

Background: Complementary medicine therapies are used globally. Around 88% of the countries that are members of the World Health Organization (WHO) reported using such practices while there is no information reported from the remaining 12% of countries 1. Cupping therapy is an ancient therapy trending to be used among athletes 2. Other complementary medicine therapies such as chiropractic are also used in sports medicine 3. This narrative review aims to provide an update on the current status of complementary medicine therapies used in sports medicine. Methods: A comprehensive search using three medical databases (PubMed, Cochrane, TRIIP) was conducted using this search Boolean: (“cupping therapy” + “sports medicine”), (“complementary medicine” +” Sports medicine”), (“cupping therapy” + “athletes”), (“complementary medicine” + ”athletes”) from inception to June 2021. Inclusion criteria were: articles in English language, systematic reviews, reviews, and clinical trials which are in direct relation to the aim of this narrative review. Results: From the 725 retrieved results, only 17 articles were included in this narrative review after excluding duplicates, non-relevant articles, and applying inclusion/exclusion criteria (Figure 1). Cupping therapy, chiropractic, and acupuncture were identified for their use in sports medicine (Table 1). Complementary medicine therapies were used among a variety of sports such as football, basketball, and martial art players for treating pain, musculoskeletal disorders, and rehabilitation. The use of complementary medicine modalities for sports performance had controversial results. Conclusion: Complementary medicine modalities such as cupping therapy, acupuncture, and chiropractic are used by a variety of athletes with promising effects. The current evidence is still limited. Hence; conducting high-quality clinical trials is highly encouraged.

Lymphoblastic Lymphoma: a Concise Review.

Lymphoblastic lymphoma (LBL) is a rare, highly aggressive non-Hodgkin lymphoma variant virtually indistinguishable from acute lymphoblastic leukemia (ALL). We review the advancements in diagnostics, staging, treatment, and response assessment. T-LBL displays a mediastinal mass with pleuro-pericardic effusions as key distinctive features and is far more frequent than B-LBL. LBL is exquisitely sensitive to ALL-type chemotherapy, achieving cure rates in the order of 70% in adults and even more in children. Positron-emission tomography, genetic risk classifications, and minimal disseminated/residual disease assays are increasingly used to detect occult sites of involvement and predict treatment outcome. Stem cell transplantation is effective and should be considered for very high-risk subsets and/or at salvage. Although curable in the majority of patients, about 25-30% of adults with LBL patients experience resistance or relapse following first-line therapy. It is essential to identify these cases early on and to explore new modalities of precision medicine with targeted agents.

Workshop Compiled

Sex therapy is one of the oldest surviving treatment modality in sexual medicine. It has been found effective in diverse range of sexual disorders in both the men and women and has a good evidence base also. In last few decades, various pharmacological and somatic interventions are found useful in sexual disorders. However the existing pharmacological agents have certain limitations and non-pharmacological interventions still remains relevant for a significant number of clinical situations in sexual medicine. Classical Sex Therapy (CST) as proposed by Masters and Johnson, however, have certain requirements like trained experts of both the genders working together and distinctive set-up which may be restrictive in application for most of the practitioners of sexual medicine. Required kind of set up and availability of both male and female therapist which although can provide privacy to the patients is rare in most resource constrained countries and restricted mainly to only certain parts of the world. There has been a leap in research in psychosexual medicine in recent decade involving classification, new medicines and improved emphasis on female sexuality also. The advancements have also affected sex therapy and it has gone through several modifications to suit the need of current times and resources. CST is modified in context of increasing knowledge and evidence base of cognitive behavior therapy, mindfulness based therapies and couple therapy etc. Approaches to combine sex therapy with pharmacotherapeutic interventions, other physical therapies like vacuum devices and surgical interventions is also advancing. This symposium is planned to update recent developments in sex therapy including 1. Current understandings of sex therapy2. Its modification and blending with other form of psychological therapies3. Its use along with other pharmacological, somatic and surgical treatment modalities4. Future prospects and updates

Therapeutic possibilities of coriaria myrtifolia L. in high dilutions

Background: Homeopathy literature shows references about Coriaria myrtifolia L. at some important Homeopathic Materia Medica: Allen,TF [1], Voisin H [2] and Vijnovsky B [3]. Those reports are unsatisfactory to fulfill a contemporary standardized study basis on: origin and description, preparation, medicine general action, sensations and modalities; demanding a broader investigation.&#x0D; &#x0D; Aims: Identify therapeutic possibilities on Coriaria myrtifolia L. from ratifying and broadening the homeopathic materia medica knowledge.&#x0D; &#x0D; Methodology: Literature review on botanical, biochemical and pharmacological data [4-12]. The use of plant in various fields since XVIII century and analyzes of clinical-toxicological reports described in medical reviews published.&#x0D; &#x0D; Results: Coriaria myrtifolia L. is a toxic shrub, growing wild in western Mediterranean region. The entire plant contains a sesquiterpene-lactone called coriamyrtin, a potent convulsivant neurotoxin. Clinical manifestations of acute intoxication includes: Central Nervous System – generalized tonic-clonic seizures, recurrent, which may evolve to status epilepticus, coma, apnea and death. Respiratory Tract – respiratory depression due to anoxia, respiratory arrhythmia alternating with apnea, respiratory muscles tetanization evolving to respiratory arrest. Cardiovascular System – central excitatory action which may initially promote increased blood pressure followed by heart failure, as a result of the seizures, due to anoxia and acidosis, leading to cardiac arrest. Gastrointestinal Tract – nausea, vomiting and stomach pains that precede seizures; since there is no evidence of toxin direct action on mucosa, those symptoms may relate to Central Nervous System action (attributed to impairment of cranial nerve VIII). Knowledge of these aspects gave us possibility to build a Coriaria myrtifolia L. materia medica with broader clinical indications.&#x0D; &#x0D; Conclusion: Coriaria myrtifolia L. is a valuable source to be used in high dilutions as medicine indicated for epileptic syndromes treatment, characterized by tonic-clonic seizures, mainly presenting a malignant tendency, with recurrent seizures, which may evolve to status epilepticus and potential mortality risk. Among the clinical indications proposed stand out etiologies of great incidence at emergency rooms such as metabolic or vascular primary disorders, or resulting from systemic diseases (diabetes, hepatopathy, nephropathy), encephalitis and meningitis with or without Acquired Immunodeficiency Syndrome, withdrawal syndrome from alcohol or drugs, exogenous poisoning, poisoning or overdose of alcohol or drugs, traumatic brain injury and intracranial expanding lesions.

The Pragmatic Association of Southeast Asian Nations Approach of Traditional Chinese Medicine Education in Indonesia: A Case Review.

Traditional Chinese Medicine (TCM) practice has been thriving for centuries throughout the world, but its educational system has not been standardized in many countries outside of China. The aim of this article is To share experiences in planning and executing TCM education adapted to Indonesian culture and conditions. TCM practice has thrived since centuries ago in Indonesia due to TCM's empirically proven effectiveness for maintaining health and wellness. However, formal bachelor's-degree education in TCM has just begun about a decade ago. The learning outcomes of TCM bachelor's-degree education in Indonesia and the Association of Southeast Asian Nations (ASEAN) at large differs from those of China mainly because of the nearly total integration of Western medicine modalities in China. The learning strategy of TCM education in Indonesia with a pragmatic acculturation approach has been effective for improving TCM acceptance, and has been beneficial in upgrading the social and academic status of Indonesian traditional health care based on ASEAN TCM standards.

Parental Attitude and Awareness of the Use of Complementary and Alternative Medicine for the Management of Respiratory Tract Infections in Children: A Cross-Sectional Study from Aseer Region, Saudi Arabia

Respiratory tract infections are considered the major cause of pediatric hospitalization requiring direct supervision by a clinician. The use of antibiotics that are commonly used for treatment is sometimes associated with the development of antibiotic resistance and less than desirable treatment outcome. Despite limited clinical evidence, complementary and alternative medicine is widely used as an alternative to antibiotics worldwide for treatment of respiratory tract infections in children. Therefore, we decided to explore the parental attitude and awareness regarding the use of the complementary and alternative medicine for the management or prevention of respiratory tract infections in children in Aseer region, Saudi Arabia. Over a 4-month period during influenza season, 1,192 parents were administered two sets of seven questionnaires dealing with attitude and awareness about the complementary and alternative medicine use. The results show that parents who felt that respiratory tract infections in children do need antibiotics supported the use of the complementary and alternative medicine modalities. More than half of the participants agreed that the complementary and alternative medicine would produce fewer side effects on their children's immunity than antibiotics and produce less bacterial resistance. In conclusion, the complementary and alternative medicine use for the treatment of respiratory tract infections in children should be based only on reliable and evidence-based advice.

Can Nanoparticles in Homeopathic Remedies Enhance Phototherapy of Cancer? A Hypothetical Model.

The continuous rise in cancer incidence places a massive burden on the health sector to increase efforts in the fight against cancer. As a holistic complementary medicine modality, homeopathy has the potential to assist in the supportive and palliative treatment of cancer patients. Recent empirical studies demonstrate the presence of silica and original source nanoparticles in ultra-high dilutions of several homeopathic medicines. Recent studies have also demonstrated the efficacy of phototherapy in inducing the ablation of cancer cells through laser-activated nanoparticle photosensitizers. A new hypothetical research model is presented herein, in an attempt to investigate and compare the phototherapeutic effects of homeopathic source nanoparticles with photosensitizing nanoparticle agents that have previously been tested.

Perspectives of patients on medical acupuncture in a primary care setting in Lebanon: a cross-sectional study.

There is paucity of data on the knowledge of acupuncture and its use among patients in Lebanon and the Arab countries. The primary objectives of this study were to determine the knowledge and attitude of patients in a primary care setting in Lebanon toward Western medical acupuncture and to determine factors that may affect their attitudes toward acupuncture use. The secondary objective was to compare the attitudes and knowledge of patients who had tried acupuncture with those who had not. This was a cross-sectional descriptive study about the perspectives of patients in a primary care setting in Lebanon on medical acupuncture. A total of 212 surveys were completed (78.5% response rate). 24% of participants had not tried and were unwilling to try acupuncture (group 1), 63.5% of participants had not tried but indicated they would be willing to try acupuncture (group 2), and 12.5% of participants had previously tried acupuncture (group 3). Most participants in group 1 (55.6%) stated they would be unwilling to try acupuncture even if referred for it by a physician. Participants who had tried acupuncture (12.5%) had done so for pain conditions. Group 3 scored higher on knowledge questions and had a more positive attitude toward the acupuncture procedure. Most patients who had tried it had done so to treat pain complaints. Patients in groups 2 and 3 were more knowledgeable about acupuncture, had tried more complementary and alternative medicine (CAM) modalities, and were more likely to try acupuncture as an add-on or last resort treatment, compared to group 1.