National Medical Journal Research Articles

The characteristics and citation analysis of the publications in the National Medical Journal of China from 2017 to 2019

Objective: To analyze the characteristics and citation of National Medical Journal of China (NMJC) from 2017 to 2019, and provide reference for the development of the journal. Methods: All the literature published in NMJC during the period 2017 to 2019 was selected as the research objects, and the citation frequency data in Chinese core periodicals of science and technology from January 2018 to December 2021 were obtained through Institute of Scientific and Technical Information of China. The main indicators included the citation rate of published articles, average citation frequency of articles, citation status of individual papers, high citation authors and their affiliations from 2017 to 2019. Results: A total of 2 694 articles were published in 21 columns of NMJC from 2017 to 2019. The total number of published pages was 11 689, and the average number of articles was 4.34 pages. The total number of cited papers was 1 849, accounting for 68.63%. Among them, 845 papers were not cited, accounting for 31.37%. The total citation times was 6 578, with an average citation of 2.44 times. The highest citation frequency of a single paper was 217 times. A total of 54.27% articles obtained fund support, and the cited rate (72.78%) was slightly higher than that of articles without fund support (63.72%). Standard and specification articles were cited 1 817 times, with a citation rate of 96.67%, and 66 articles were cited more than 10 times. The columns with more than 30 articles but all cited less than 1 time included case report and difficult case analysis. The first author was from 31 provinces (autonomous regions, municipalities directly under the Central Government) in China. There were 21 corresponding authors whose papers have been cited more than 30 times, and 18 of them were from major hospitals and science academies in Beijing. Conclusions: NMJC has a wide coverage of contributions and strong academic influence during the period 2017 to 2019. The cited frequency of standard and specification articles is high, while case report and difficult case analysis evaluation column articles have very low cited frequencies. Therefore, NMJC should further adjust column setting, improve the academic quality, reduce the number of zero cited papers, and thus enhance the influence of the magazine.

Expert consensus on endoscopic diagnosis and treatment of the benign pancreaticobiliary junction disease (2023 edition)

The pancreaticobiliary junction (PBJ) stands as a pivotal "hub" where the bile and pancreatic ductsmerge, directing the flow rate and direction of bile and pancreatic juice. Benign pancreaticobiliary junction diseases(BPBJD) can lead to compromised outflow of bile and pancreatic secretions, resulting in elevated pressures within the bile and pancreatic ducts, causing ductal dilation, secretion stasis, and stone formation.Furthermore, BPBJD can shift the direction of bile and pancreatic juice, inducing pancreaticobiliary reflux, bile-pancreatic reflux, or enterobiliary reflux, thereby causing both acute and chronic inflammation and tumors in the biliopancreatic system. Owing to the unique anatomical position of the PBJ and the often intricate and elusive symptoms of benign diseases in this region, clinicians might mainly address standard biliary and pancreatic diseases, overlooking the primary issues associated with the PBJ.Such oversight can yield less-than-optimal clinical outcomes. In response to this, the Gallbladder-Preserving Surgery Committee, Endoscopy Specialist Branch of Chinese Medical Doctor Association and the editorial board of the National Medical Journal of China assembled renowned domestic experts from the fields of hepatobiliary and pancreatic surgery and digestive endoscopy. Drawing upon the latest domestic and international research findings, as well as the clinical expertise of specialists from related fields within China, they have collaboratively developed an expert consensus on the endoscopic diagnosis and treatment of BPBJD. The overarching aim is to propagate and standardize the diagnosis and treatment approaches for BPBJD.

Notice of Retraction: Guinea-worm (Dracunculus medinensis) infection presenting as a diabetic foot abscess: A case report from Kerala.

The article 'Guinea-worm (Dracunculus medinensis) infection presenting as a diabetic foot abscess: A case report from Kerala is being retracted based on a letter received from the Director of the National Centre of Disease Control, New Delhi where the centre has objected to the identification of the guinea-worm by the authors only on the basis of morphological observation, without any microscopic and histopathological examination. The author has agreed to the objection and to the withdrawal of the article. This article is therefore being retracted. PEUSH SAHNI Editor The National Medical Journal of India All India Institute of Medical Sciences, New Delhi, India nmji@nmji.in.

Chinese expert consensus on the use of human papillomavirus nucleic acid testing for cervical cancer screening (2022)

China is currently in a critical period of accelerating the elimination of cervical cancer, and scaling up screening coverage with high-quality methods is one of the main approaches to achieve this goal. World Health Organization (WHO) recommended human papillomavirus (HPV) nucleic acid testing as the preferred primary screening method of cervical cancer. However, no guidelines exist for its use in cervical cancer screening in China. Therefore, Branch of Cancer Prevention and Control, Chinese Preventive Medicine Association, Chinese Obstetrics and Gynecology Association Colposcopy and Cervical Neoplasia Committee, Chinese Society of Colposcopy and Cervical Pathology of China Health Birth Science Association, Beijing Medical Doctor (Technician) Society of Laboratory Medicine, and the editorial board of the National Medical Journal of China convened more than 50 domestic experts from multiple disciplines, including public health, obstetrics and gynecology, laboratory medicine, and pathology, to form a consensus based on domestic and international guidelines, medical evidence, and China's actual situation. These experts recommend HPV nucleic acid testing as the primary method for cervical cancer screening in China, and provide scientific suggestions on the pre-implementation assessment and preparation, specific applications and target populations, laboratory operating procedures, and post-implementation monitoring and assessment for the cervical cancer screening. These recommendations aim to promote a comprehensive, in-depth, standardized, orderly and high-quality development of HPV nucleic acid testing in China, for providing strong support for accelerating cervical cancer elimination in China.

Evaluation of the Efficacy of Pippalyadi Basti and Lekhan Basti in the Management of Medoroga with Special Reference to Obesity – A Protocol

Background: The conventional concept of etiopathogenesis, prognosis, and management of obesity is very similar and equally advanced to the Medoroga/Sthaulyaroga of Ayurveda, which was conceived in 1500 BC by Acharya Charaka. Overweight or obesity is mostly found in people with predominantly Kapha-type constitutions. According to Acharya Charak, apart from the genetic factors, diet (like shleshmakar, abhishayandi) & lifestyle (like avyayam, divaswapna) are the main contributing factors in the aetiopathogenesis of Medoroga. As per previous study Lekhana Basti was found to have moderate results in obesity. Pippalyadi has Chitraka and Pippali in addition to the other components of Lekahan basti so could have better results in correcting the vitiated Agni. Therefore, Pippalyadi basti is chosen for the current study. Objectives: • To evaluate efficacy of Pippalyadi Basti in the management of Medoroga. • To compare the efficacy with Lekhana Basti • Conceptual study of Medoroga in Ayurvedic texts and Obesity in modern medicine. • Effect of Pippalyadi Basti & Lekhan Basti on B.M.I. Methodology: D.Y. Patil Ayurved Hospital, Samhitas & modern books of medicine, Pharmacy attached to college for the preparations of the drugs, international & national medical journals and magazines, OPD, IPD , Labs , other provisions of the hospitals will be availed to do this intended work. Expected Results: Changes will be observed in objective outcomes. Conclusion: Conclusion will be drawn by suitably analyzing data.

The History of Medical Ethics in India

The History of Medical Ethics in India

Truth and Transparency, Compromise and Climate Change

Truth and Transparency, Compromise and Climate Change

Contribution of pioneer women hematologists in India in the 20th century

Purpose: There is an increasing interest in the contribution of women in science and various branches of medicine. Hematology is a recently developed specialty. The purpose of this review was to explore the contribution of pioneer women hematologists of India in the last century when the subject was developing across the world including India. Methods: PubMed database was searched up to 1999 with the following keywords – women, hematologist, hematopathologist, hemato-oncologist, and India. The Indian Journal of Hematology, Indian Journal of Pathology, Indian Journal of Pediatrics, National Medical Journal of India, and Indian Journal of Medical research were manually searched for hematology articles written by women hematologists before 1999. Authors own experience from the intimate knowledge in the field for more than 40 years helped in the search. Women involved purely in blood banking were not included in the study. So also, many women hematologists who grew up at the end of the 20th century and continued to contribute to the subject were not included as the pioneer hematologist. Results: Between the 1930s and early 1950s, only one lady from the UK came and worked in nutritional hematology in India. Subsequently rose quite a few of them in that specialty mainly from major academic medical centers in India. Their teaching, research, and institution-building capability were exemplary. Conclusion: Considering hematology and related specialty being a recently developing subject, the contribution of women hematologists as pioneers in the field is exemplary and worth emulating.

Seroprevalence and burden of hepatitis C virus infection in WHO South-East Asia Region: A systematic review.

This systematic review was aimed to estimate hepatitis C virus (HCV) seroprevalence and burden in disease in WHO South East Asia Region (SEAR). Electronic databases (PubMed, Scopus, Embase, and Google Scholar) and websites of non-indexed national medical journals, government and international health agencies were searched to identify English language literature published between 1991 and June 2020. We selected the studies reporting HCV seroprevalence in asymptomatic general (low-risk) and high-risk adult populations, that is, persons living with HIV (PLHIV), persons who inject drugs (PWID), sex workers, persons on maintenance hemodialysis (MHD), people in prison, and men sex with men (MSM). Seroprevalence data were combined to estimate weighted pooled prevalence (95% confidence interval) in each group and in each country, using the random-effects model. Estimated pooled seroprevalences were multiplied with estimated populations at risk to estimate the overall HCV burden. The analysis included 538 studies (35 Bangladesh, 6 Bhutan, 2 DPR Korea, 323 India, 43 Indonesia, 2 Maldives, 18 Myanmar, 29 Nepal, 11 Sri Lanka, 67 Thailand, and 2 Timor-Leste). In SEAR, the weighted pooled anti-HCV seroprevalence was estimated as 0.84% (0.56-1.12) in low-risk population and 13.67% (10.95-16.40) in PLHIV, 51.44% (43.67-59.20) in PWID, 25.80% (20.34-32.09) in MHD, 8.39% (5.84-11.51) in prison inmates, 2.69% (1.43-4.13) in people with high-risk sex behavior, and 11.43% (8.61-14.74) in MSM. The total HCV burden in low-risk and high-risk populations in SEAR countries was estimated as 12.45 million and 1.65 million, respectively. Our estimates of HCV seroprevalence and burden should help the respective countries in planning their HCV elimination strategies.

An investigation into the pharmaceutical advertising in Iranian medical journals

BackgroundPharmaceutical advertising is not only considered a key factor in the successful launch of pharmaceutical products, but is also an important source of public health information with a significant impact on consumer choice and behavior. Nowadays, advertising has become the broadest dissemination channel for various products, including medicines, which may ultimately lead to the generalization of self-treatment or mistreatment. Improper drug promotion can exacerbate unhealthy outcomes by making false or misleading claims, using inferior references, and failing to meet international standards. This study aimed to examine the requirements for pharmaceutical advertising from regulatory perspective and the compliance of Iranian pharmaceutical advertisements to related standards and guidelines. It is limited to print advertisements in Iranian national medical journals and magazines.MethodThe present study is a descriptive–analytical study using bibliometric methods. As a first step, a comprehensive review of the national and international regulations on drug advertising was conducted and a comparison of different regulations was provided. In the second step, a checklist was created to evaluate the compliance of drug advertising with the extracted regulations.ResultThe results of the present study show that the claims made in Iranian drug advertisements are 29.10% valid, 27.67% exaggerated, 23.10% controversial, 12.62% misleading, and 6.8% invalid. In general, we found that most medical advertisements in Iranian journals and magazines comply with national laws and regulations. However, many international requirements are not met in these advertisements.ConclusionsAlthough we found that printed medical advertisements in Iran are roughly compliant with national regulations, there is still a long way to achieve full compliance. Monitoring processes should be improved and clearly defined penalties should be set to avoid misleading claims and their likely health consequences. It is very important in Iran to update the existing rules and regulations for medical advertisements according to international guidelines. More careful monitoring of the content of advertising and the accuracy of claims are also needed.

Composition of panels writing clinical practice guidelines

Journal of Paediatrics and Child HealthEarly View Heads UpFree Access Composition of panels writing clinical practice guidelines First published: 25 February 2022 https://doi.org/10.1111/jpc.15930 edited by Craig Mellis (craig.mellis@sydney.edu.au) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat We are often unaware or indifferent to how racism and gender disparity pervade our institutional structures. How many of us sitting on a panel writing clinical practice guidelines have paused to consider the composition of the panel, the balance of women and men, non-white and white? Canadian researchers1 argue that ‘guideline panels should comprise individuals positioned to make relevant recommendations, including those that reflect the diversity of the priority population’. They analysed all 237 clinical practice guidelines published in national general medical journals from Australia, Canada, the UK and the USA between June 2014 and June 2021. Of the 3696 unique guideline panel members, 1396 (38%) were women and 750 (20%) were non-white, which the authors call ‘racialised’ (see Fig. 1). Guideline panels had a median of 14 members (interquartile range 10–19), which included a median of 5 (3–8) women, 9 (5–11) men, 2 (1–4) non-white and 11 (7–14) white members. The selection process for panels was often unstated or unclear. Most guideline publications (55%) did not mention gender or race in the recommendations or supporting text. We should be vigilant for structural racism2 and gender disparities, which are pervasive within academic medicine and throughout society. Fig. 1Open in figure viewerPowerPoint Guideline panel members by gender and racialisation. The number of panel members who are women and men is represented by the width of the boxes, the number who are racialised and white by the height. References 1Persaud N, Ally M, Woods H et al. Racialised people in clinical guideline panels. Lancet 2022; 399: 139– 40. CrossrefPubMedGoogle Scholar 2Isaacs D, Tarnow-Mordi WO, Sherwood J. The black lives matter movement: The time for nice words and good intentions is over. J. Paediatr. Child Health 2020; 56: 1327– 9. Wiley Online LibraryPubMedWeb of Science®Google Scholar Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au, Children's Hospital at Westmead, Sydney Early ViewOnline Version of Record before inclusion in an issue FiguresReferencesRelatedInformation

Physicians\u2019 knowledge, attitude, and prescribing behavior regarding stress ulcer prophylaxis in China: a multi-center study

BackgroundPerioperative patients are at risk of developing stress ulcers (SU), which can cause clinically important bleeding. Stress ulcer prophylaxis (SUP) is widely applied to the patients in Intensive care unit (ICU) as well as the general ward, so it may lead to overmedication. However, there have been no surveys regarding SUP knowledge or prescribing habits.ObjectiveOur study assessed the knowledge, attitudes, and prescribing behavior of the surgeons toward perioperative patients regarding SUP and determined factors associated with low knowledge and high level of prescribing behaviors.MethodsWe performed a cross-sectional survey using questionnaires, randomly sampling 1266 surgeons on their current SUP practices.ResultsProton pump inhibitors for SUP were used the most (94%); 43% used lansoprazole. Guideline awareness was inconsistent; the most familiar guideline was the National Medical Journal of China, and 46% were unaware of any guidelines. The predictors of low knowledge score regarding SUP in multivariable analysis were the hospital grade (p = 0.000), the type of hospital (p = 0.044), attendance at continuing education programs (p = 0.037), the awareness of clinical practice guidelines (CPGs) for SUP (p = 0.000). Twenty-one percent of physicians were high prescribers. High prescribing behavior was associated with hospital grade(p = 0.000), education level(p = 0.010) and attendance at continuing education programs (p = 0.000).ConclusionWe found that most surgeons used SUP, primarily proton pump inhibitors. However, surgeons knew little about the SUP guidelines, which may lead to insufficient SUP knowledge and overmedication. In addition, hospital grade, the type of hospital and attendance at continuing education programs may also affect the low knowledge of SUP. Hospital grade, education level and attendance at continuing education programs may affect high prescribing behavior.

German Medical Data Sciences in Studies in Health Technology and Informatics - Reflections on the Fifth Volume.

Since 2017, the German Society for Medical Informatics, Biometry and Epidemiology e.V. (GMDS) offers the submission of full papers to the annual meetings, optional in Studies in Health Technologies and Informatics (Stud HIT) or in GMS Medical Informatics, Biometrics, and Epidemiology (MIBE). GMDS' aim is to increase the attractiveness of the conference and paper submission process in particular for young scientists and to increase the visibility of the conference. A standardized peer review process was established. Since 2017, a 25-35% of the contributions have been submitted as full papers. A total of 177 papers were published in Stud HTI. With an unofficial journal impact factor of 1.088 (2019) and 0.540 (2020), the papers were cited with a frequency similarly to national medical journals or full paper contributions of International medical informatics conferences.

Recomendaciones para la Rehabilitación de Pacientes Adultos con COVID-19

Introduction: The SARS-CoV-2 coronavirus is a new pathogen causing COVID-19 disease, ranging from an asymptomatic infection to a critical condition dependent on mechanical ventilation. Rehabilitation interventions contribute for the prevention and treatment of related complications and associated disability. Objective: Evaluate the rehabilitation interventions for the care of patients with COVID-19 according to the available evidence. Methods: A systematic review was conducted through electronic and library searches of national and foreign medical journals over a 10-year horizon in Spanish, English, Chinese and Italian, as well as in textbooks with information related to COVID-19 and Physical Medicine and Rehabilitation. Conclusions: Rehabilitation interventions are essential and indispensable resources for the transdisciplinary treatment of patients with COVID-19, despite of the low quality of the available evidence.

Bodyflow as a Rehabilitation Strategy in the Treatment of Complex Regional Pain Syndrome

<i>Background</i>: Complex regional pain syndrome is a progressive painful chronic neuropathy with autonomic nervous system dysfunction, bone demineralization, and muscle weakness; whose appearance is associated with a traumatic event such as fracture, surgery or cardiovascular event, among others, which usually affects one or more extremities. Its treatment constitutes a great challenge for science, currently settling in physiotherapy the greatest expectations for the future for rehabilitation. Bodyflow is a low frequency electro stimulator that can be applied to reduce edema, stimulate circulation and lymphatic drainage. The method seeks to contract the tunica media of the arteries and veins, as a facilitating means for the transport of lymph and blood. Stimulation is applied to the muscle, using suction cups and electrodes located in different body segments. <i>Objective</i>: To present a review on Bodyflow as an effective rehabilitation strategy in the treatment of complex regional pain syndrome. <i>Methods</i>: To achieve this purpose, electronic and library searches of national and foreign medical journals indexed in Scielo, Imbiomed and Pubmed were carried out over a 10-year horizon. <i>Conclusions</i>: There are few studies that suggest the use of bodyflow therapy as an alternative for the treatment of complex regional pain syndrome and this article suggests its use due to its analgesic and motor effects.

The characteristics and citation analysis of the publications in National Medical Journal of China during 2016

Objective: To analyze the characteristics and citations of articles in National Medical Journal of China (NMJC) during 2016, and to discuss the academic level and quality of the journal. Methods: All the literature published in NMJC during 2016 were retrieved through the Chinese Medical Citation index, and the citation frequency data in China's core journals of science and technology from January 2017 to December 2018 was obtained through Institute of Scientific and Technical Information of China. The citation status of articles published in NMJC was statistically analyzed by the method of literature metrology. The main indicators included the citation rate of articles published in each year, the citation frequency of all articles, the citation status of individual papers and authors, the regional and high-yield institution distribution of cited authors, and the main citation journals. Results: In 2016, a total of 962 articles were published in 22 columns of NMJC. The total number of published pages was 3 940, and the average number of articles was 4.09 pages. A total of 28 key topics have been published. The total citation was 2 077 times, with 2.16 times per paper. Among them, 322 papers were not cited, accounting for 33.47%. The maximum citation frequency of a single paper was 66 times. There were good citations in the columns of Guidelines, Epidemiology, New technology and methods, Clinical research and Editorial. Oncology, neurology/psychiatry, imaging/ultrasound/radiology, respiratory medicine and orthopedics accounted for a large part [40.43% (389 articles)]. Articles in neurosurgery, respiratory medicine, preventive medicine and gastrointestinal surgery were all cited with high frequency (all ≥2.75 times/article). A total of 483(50.21%) articles had obtained fund support, and the rate (68.12%) of them cited was slightly higher than that of articles without fund support (64.93%). A total of 23 articles were cited ≥10 times, and 16 first authors were cited ≥10 times. In addation, 26 corresponding authors were cited ≥10 times and 10 institutions were cited more than 15 times. The authors of the cited papers were distributed in 29 provinces (autonomous regions, municipalities directly under the central government), and there were more articles and higher total citation frequency in Beijing, Shanghai, Jiangsu and Tianjin. From 2017 to 2018, papers published in NMJC were cited 2 077 times by a total of 490 journals. Conclusions: The guidelines published in NMJC is highly cited. The editorial department should adjust the column setting timely, strengthen the planning of key topic selection and the solicitation and publicity of excellent papers, and further improve the influence of the magazine.

Comparison of Application of Bio-Statistics in National and International Medical Journals

Comparison of Application of Bio-Statistics in National and International Medical Journals

Quality of evidence in a post-Soviet country: evaluation of methodological quality of controlled clinical trials published in national journals from Uzbekistan

BackgroundMost researchers in Uzbekistan prefer to publish their reports in journals of their home country. Moreover, the proportion of healthcare practitioners who prefer to use these national sources of information also remains high. However, the quality of publications from national journals, in post-Soviet countries, has not been systematically evaluated until now. The primary objective of this study was to evaluate the quality of randomized controlled trials’ (RCTs) reports published in medical journals from Uzbekistan. We supposed that reports had at least minimal quality to contribute to the higher quality of healthcare.MethodsTo evaluate the quality of RCTs, we selected two journals from the list of national medical journals for which background information was provided. We decided to select articles from journals that had the highest subscription rate and were likely to have the highest impact on clinical decisions. The journals were Medical Journal of Uzbekistan and Paediatrics. Only issues published in 2007–2017 were considered for evaluation. Two evaluators independently scored RCTs and controlled clinical trials (CCTs) reported in the journals. The 5-point scale developed by Jadad et al. was used to evaluate the quality of reports. Consensus-based decision was made about the final score of each report.ResultsWe reviewed 1311 studies in the two journals and found 380 clinical trials reports for the final evaluation. Our main finding was that none of the reports received a final score of more than 1, with an absolute agreement between evaluators. A median score of the studied reports was equal to 0, predicting a very low quality of controlled trials reported in the national journals (Wilcoxon signed-rank test p = 1.0; 95% CI = 0–0).ConclusionsWe believe that quality of reports about controlled trials, in Uzbekistan, can be considered insufficient to contribute to the higher quality of care and patients’ safety. In the worst case, such condition can cause serious damage to the public health and lead to ineffective use of resources in the country. Therefore, the better reporting and organization of RCTs and CCTs should become a main goal of all stakeholders interested in the effective and safe healthcare in the country.

External and internal nasal valve. Diagnostic and treatment methods for dysfunction

The purpose of the work is the analysis of diagnostic methods of nasal valve dysfunction according to Pubmed database and national medical journals during the period from 1997 to 2019. A brief analysis of the definition of the zones of the external and internal nasal valve, diagnostic methods, including external nasal dilators, spiral computed tomography, assessment of the degree of displacement of the nasal wing using various aspirators is given. Various methods for treating nasal valve dysfunction, such as external and internal dilators, strengthening the nasal wings, suture techniques, expanding the edge of the pear-shaped hole, implantation of absorbable polymers into the side wall of the nose are critically evaluated. Our own original correction method is described for dysfunction of the external nasal valve caused by the vertically located legs of the inferior lateral cartilage.

Haematohidrosis with headache- a rare phenomenon of sweating blood: A case report

Background: Haematohidrosis is an extremely rare clinical condition in which the patient experiences sweat mixed with blood. Till date only a few cases of haematohidrosis have been reported in national and international medical journals. Pathogenesis of the condition is not yet established but rupture of the blood vessels of sweat glands due to activation of sympathetic nervous system from stress, anxiety or any other reason have been proposed as the cause of bleeding.&#x0D; Objective: It was aimed to present the case who presented with episodes of sweat mixed with blood from different sites of her body.&#x0D; Methods: A case of haematohidrosis who experiences bloody sweat which comes with episodes of headache, was studied during in Bangabandhu Sheikh Mujib Medical University, Dhaka.&#x0D; Results: Interestingly, it was to be found that a child of the patient, who is a 4 year old boy and a nephew of her, are suffering from the same condition. No family history was found in any of the previous cases. All other history and the investigations were insignificant. It was to be diagnosed the headache as migraine.&#x0D; Conclusion: The patient was treated with propranolol and paracetamol. Her bloody sweat decreased significantly in both severity and frequency with the treatment.