Randomised controlled study in the primary healthcare sector to investigate the effectiveness and safety of auriculotherapy for the treatment of uncomplicated chronic rachialgia: a study protocol

<p>Abstract</p> <p>Background</p> <p>Uncomplicated chronic rachialgia is a highly prevalent complaint, and one for which therapeutic results are contradictory. The aim of the present study is to evaluate the effectiveness and safety of treatment with auriculopressure, in the primary healthcare sector, carried out by trained healthcare professionals via a 30-hour course.</p> <p>Methods/Design</p> <p>The design consists of a multi-centre randomized controlled trial, with placebo, with two parallel groups, and including an economic evaluation. Patients with chronic uncomplicated rachialgia, whose GP is considering referral for auriculopressure sensory stimulation, are eligible for inclusion. Sampling will be by consecutive selection, and randomised allocation to one of the two study arms will be determined using a centralised method, following a 1:1 plan (true auriculopressure; placebo auriculopressure). The implants (true and placebo) will be replaced once weekly, and the treatment will have a duration of 8 weeks. The primary outcome measure will be the change in pain intensity, measured on a visual analogue scale (VAS) of 100 mm, at 9 weeks after beginning the treatment. A follow up study will be performed at 6 months after beginning treatment. An assessment will also be made of the changes measured in the Spanish version of the McGill Pain Questionnaire, of the changes in the Lattinen test, and of the changes in quality of life (SF-12). Also planned is an analysis of cost-effectiveness and also, if necessary, a cost-benefit analysis.</p> <p>Discussion</p> <p>This study will contribute to developing evidence on the use of auriculotherapy using Semen vaccariae [wang bu liu xing] for the treatment of uncomplicated chronic rachialgia.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN01897462.</p

Spinal lesions by infectious spondylodiscitis and hepatocellular carcinoma presenting as spinal metastasis in an HIV-HCV co-infected patient

Back pain and spine tenderness over the involved spine segment are common clinical findings of a number of relative benign conditions. However, back pain may be the presenting symptom of vertebral metastases in patients with systemic cancer, including hepatocellular carcinoma, a not uncommon complication in HCV-HIV infected patients. We describe a case of a 51-year-old intravenous drug user with HIV and HCV co-infection who developed dorsal spondylodiscitis due to Pseudomonas aeruginosa, which improved following antibiotic therapy. Three months after the end of therapy, the patient referred recurrence of back pain. The MRI showed different vertebral lesions of the dorsal spine and costal arch which turned out to be hepatocellular carcinoma metastasis at the histological examination. The patient had never been treated with the interferon-ribavirine combination therapy because of a major depressive syndrome. Interferon-free regimens are urgently required for HIV-HCV coinfected patients, especially when interferon-based regimens are contraindicated

What are the possibilities of spontaneous resorption of a thoracic disc herniation occupying more than 20% of the spinal canal in the asymptomatic subject? Comparative study

Thoracic disc herniation is a rare pathology for which surgical treatment is difficult. The discovery of asymptomatic or only slightly symptomatic lesions can be problematic, especially in cases of marked canal stenosis. The possibility of spontaneous resorption has been documented by a few case reports but there is no study on this subject. Our objective was to compare the clinical and radiological data for two groups of patients with significant thoracic herniation (occupying more than 20% of the spinal canal): one showing spontaneous resorption (group 1) and the other persistence of the lesion during follow up (group 2). The physiological processes of thoracic herniation are also discussed. We present a retrospective study of our database of patients with thoracic hernia. Only subjects who initially showed signs of slight or absent myelopathy (Frankel D or E) were included. Group 1 and 2 are composed of 12 and 17 patients respectively. The clinical and radiological data are compared. The two groups were not different for the following parameters: age, sex ratio, disc calcification, size, trajectory, side, hernia level. Other parameters were evaluated and were not associated with a higher rate of resorption: disc calcification, intramedullary hypersignal in T2 sequence, calcification of the posterior common vertebral ligament, calcification of another disc and Scheuerman’s disease. Asymptomatic thoracic disc herniation is a condition that can disappear spontaneously, even in the case of a large lesion. To date, there are no clinical or radiological data that can predict such an evolution.None were declared

Risk analysis for operating active wheelchairs in non-urban settings

Introduction A wheelchair is a special vehicle designed specifically for people with walking limitations. One of the types is an active wheelchair. This is a manually propelled wheelchair, the design and structure of which maximise the mobility of its given user at the expense of accepted instability. Objective The aim of this study was to identify and present a hierarchy of potential incidents causing a health hazard and reducing the mobility of individuals with ambulatory disability who use active wheelchairs in non-urban settings. Material and Methods Information about incidents connected with wheelchair use was collected from interviews with disabled individuals, based on a questionnaire. Recorded data were analysed using the Preliminary Hazard Analysis (PHA). Results The results comprise a list of hazards for wheelchair user with ascribed priority numbers metrising their significance. Conclusions An ordered list of hazards connected with wheelchair operation situations is useful when designing active wheelchairs and when learning the technique of wheelchair riding

Verso una moderna metodologia per la prevenzione, l'allenamento e la rieducazione della Lombalgia

Questa tesi nasce dall’esperienza di tirocinio formativo del corso di Laurea Specialistica, svolto in un noto centro Wellness all’avanguardia, in cui ho potuto conoscere, assistere e praticare il “Medical Fitness”, l’attività fisica nell’ottica di medicina preventiva e curativa. Descriverò un percorso posturale, con approccio Fitness Medicale, per il trattamento della Lombalgia, affezione dolorosa più comune nelle società occidentali ed una delle cause principali per la richiesta di visite mediche, in Italia. Durante la mia esperienza pratica ho seguito tre persone, per circa quattro mesi ciascuno, le quali hanno intrapreso un percorso mirato alla riduzione delle cause della Lombalgia e dei sintomi correlati. Le cause del “mal di schiena” erano diverse: una ascendente, quale il piede cavo; una discendente, quale il dorso curvo ed infine una centrale, quale l’ernia lombare dovuta a un’attività lavorativa che obbligava il soggetto a movimenti scorretti e ripetitivi. Essendo tre persone con caratteristiche diverse, tre casi differenti, riporterò tre percorsi personalizzati e individuali, combinati di più attività, offerte dal centro Fitness. Essendo un centro all’avanguardia, esso è dotato di un circuito di quattro sistemi tecnologici utili a valutare, allenare e mantenere una corretta postura. La “Postural Line”, frutto di approfonditi studi scientifici, integra l’iter valutativo e il training tradizionale posturale, con sistemi riguardanti la statica, la dinamica, il controllo propriocettivo del tronco e le catene muscolari. Ho voluto sottolineare l’aiuto che la tecnologia può dare in questo campo, sia come supporto tecnico all’operatore, in quanto offre una vasta gamma di dati oggettivi e quindi confrontabili, ma anche motivazionale per il cliente. Aiuto alla motivazione del soggetto, in quanto, oltre a contenere esercitazioni ludiche, offre la possibilità di vedere con i propri occhi un risultato comprensibile e immediato e quindi creare sul momento ogni minimo aggiustamento (feedforward). Nella stesura della tesi, ho introdotto la parte pratica attraverso quattro capitoli, trattando nei primi di postura e posturologia, descrivendo i sistemi “Postural Line” ed infine illustrando cause più comuni e sintomi della Lombalgia. Per concludere ho riportato, dopo i risultati dei trattamenti e i feedback dei clienti in questione, l’efficacia che ha “Postural Line” anche in soggetti non affetti da lombalgia o squilibri posturali che scatenano dolore o incapacità funzionale. Ho scelto questo argomento in quanto credo nelle potenzialità dell’esercizio fisico, nei suoi aspetti curativi, nella sua capacità di portare benessere, sia nella sfera psichica ed emotiva che a livello di salute fisica. Ritengo in prima persona che l’attività fisica sia un vero e proprio farmaco naturale, che deve essere alla portata di tutti

Facteurs Associés à la Consommation des AINS en Automédication chez les Patients vus en Rhumatologie à Abidjan

Objectif: Identifier les facteurs associés à la consommation des AINS en automédication par les patients vus en rhumatologie à Abidjan. Méthodologie: Etude transversale et analytique menée au sein du service de rhumatologie du CHU de Cocody (Abidjan) du 1er Février 2023 au 31 Juillet 2023, portant sur 388 patients présentant des douleurs ostéoarticulaires venus en consultation de rhumatologie et ayant pratiqué une automédication aux AINS quel que soit la voie d’administration, la durée de consommation et l’ancienneté. Nous avons recherché une corrélation entre les facteurs socio-démographiques, cliniques et l’automédication aux AINS. Résultats : La fréquence hospitalière de consommation des AINS en automédication était de 76,67%&nbsp; soit 388 sur 506 personnes recensées pendant la période d’étude. L’effectif comprenait 257 femmes (66,20%) et 131 hommes (33,80%) avec un âge moyen de 52 +/- 16 ans [Extrêmes : 8&nbsp; et 84 ans]. La&nbsp; catégorie socio-professionnelle dominante était le secteur informel (35,80%). La majorité des patients était scolarisée (85,10%) avait un niveau socio-économique bas (77,30%) et vivait en milieu urbain (88,90%). Les AINS étaient consommés en majorité pour des rachialgies (70,10%) et des rachialgies avec radiculalgies (64,17%), chroniques (75,50%) mécaniques (63,70%) d’installation progressive (85,80%). Le diclofénac appartenant à la famille des arylcarboxyliques (89,20%) était l’AINS le plus utilisé (76,28%) pour une durée de consommation de moins de 14 jours (75,20 %). Le lieu de prédilection de fourniture en AINS des patients était la pharmacie (76%) et la rue (51,50%) avec une efficacité partielle sur la douleur (79,90%). Les patients avaient une satisfaction mitigée après la prise des AINS (64,70%) et jugeaient leur attitude d’automédication mauvaise (70,60%). Les principales raisons motivant l’automédication étaient l’accessibilité (66,85%) et le conseil d’un tiers (52,83). Le niveau d’étude (p =0,046), le niveau socio-économique (p=0,039) et l’intensité de la douleur (p=0,011) influençaient la prise d’AINS en automédication. Conclusion: La fréquence de consommation des AINS en automédication est très élevée à Abidjan et les facteurs déterminant cette consommation sont le niveau d’étude, le niveau socio-économique et l’intensité de la douleur.&nbsp;&nbsp; &nbsp; Objective: To identify the factors associated with self-medication with NSAIDs by patients seen in rheumatology in Abidjan. Methodology: A cross-sectional, analytical study was conducted in the rheumatology department of the CHU of Cocody (Abidjan) from 1st February 2023 to 31st July 2023, involving 388 patients with osteoarticular pain seen in rheumatology consultations who had done self-medication with NSAIDs, irrespective of the route of administration, duration of use and length of time on the drug. We looked for a correlation between socio-demographic, clinical factors, and self-medication with NSAIDs. Results: The hospital frequency of self-medication with NSAIDs was 76.67%, i.e. 388 out of 506 people surveyed during the study period. There were 257 women (66.20%) and 131 men (33.80%) with an average age of 52 +/- 16 years [extremes: 8 and 84 years]. The dominant socio-professional category was the informal sector (35.80%). The majority of patients were educated (85.10%), had a low socioeconomic level (77.30%) and lived in urban areas (88.90%). NSAIDs were mainly used for chronic (75.50%), mechanical (63.70%) and progressive (85.80%) rachialgia (70.10%) and rachialgia with radiculalgia (64.17%). Diclofenac, a member of the arylcarboxylic family (89.20%), was the most commonly used NSAID (76.28%), with a duration of use of less than 14 days (75.20%). The preferred place of supply for NSAIDs was the pharmacy (76%) and the street (51.50%), with partial efficiency on pain (79.90%). Patients had mixed satisfaction after taking NSAIDs (64.70%) and considered their self-medication attitude to be poor (70.60%). The main reasons for self-medication were accessibility (66.85%) and advice from a third party (52.83%). Level of education (p=0.046), socioeconomic status (p=0.039) and pain intensity (p=0.011) influenced self-medication with NSAIDs. Conclusion: The frequency of self-medication with NSAIDs is very high in Abidjan, and the factors determining this consumption are level of education, socio-economic status and pain intensity.&nbsp;&nbsp

Facteurs Déterminant la Consommation des AINS en Automédication chez les Patients vus en Rhumatologie à Abidjan

Objectif: Identifier les facteurs déterminant&nbsp; la consommation des AINS en automédication par les patients vus en rhumatologie à Abidjan. Méthodologie: Etude transversale et analytique menée au sein du service de rhumatologie du CHU de Cocody (Abidjan) du 1er Février 2023 au 30 Juin 2023, portant sur 388 patients présentant des douleurs ostéoarticulaires venus en consultation de rhumatologie et ayant pratiqué une automédication aux AINS quel que soit la voie d’administration, la durée de consommation et l’ancienneté. Nous avons recherché une corrélation entre les facteurs socio-démographiques, cliniques et l’automédication aux AINS. Résultats: La fréquence hospitalière de consommation des AINS en automédication était de 76,67%&nbsp; soit 388 sur 506 personnes recensées pendant la période d’étude. L’effectif comprenait 257 femmes (66,20%) et 131 hommes (33,80%) avec un âge moyen de 52 +/- 16 ans [Extrêmes : 8&nbsp; et 84 ans]. La&nbsp; catégorie socio-professionnelle dominante était le secteur informel (35,80%). La majorité des patients était scolarisée (85,10%) avait un niveau socio-économique bas (77,30%) et vivait en milieu urbain (88,90%). Les AINS étaient consommés en majorité pour des rachialgies (70,10%) et des rachialgies avec radiculalgies (64,17%), chroniques (75,50%) mécaniques (63,70%) d’installation progressive (85,80%). Le diclofénac appartenant à la famille des arylcarboxyliques (89,20%) était l’AINS le plus utilisé (76,28%) pour une durée de consommation de moins de 14 jours (75,20 %). Le lieu de prédilection de fourniture en AINS des patients était la pharmacie (76%) et la rue (51,50%) avec une efficacité partielle sur la douleur (79,90%). Les patients avaient une satisfaction mitigée après la prise des AINS (64,70%) et jugeaient leur attitude d’automédication mauvaise (70,60%). Les principales raisons motivant l’automédication étaient l’accessibilité (66,85%) et le conseil d’un tiers (52,83). Le niveau d’étude (p =0,046), le niveau socio-économique (p=0,039) et l’intensité de la douleur (p=0,011) influençaient la prise d’AINS en automédication. Conclusión: La fréquence de consommation des AINS en automédication est très élevée à Abidjan et les facteurs déterminant cette consommation sont le niveau d’étude, le niveau socio-économique et l’intensité de la douleur.&nbsp;&nbsp; &nbsp; Objective: To identify the factors determining self-medication with NSAIDs by patients seen in rheumatology in Abidjan. Methodology: Cross-sectional, analytical study was conducted in the rheumatology department of the CHU of Cocody (Abidjan) from 1st February 2023 to 30th June 2023, involving 388 patients with osteoarticular pain seen in rheumatology consultations who had done self-medication with NSAIDs, irrespective of the route of administration, duration of use and length of time on the drug. We looked for a correlation between socio-demographic, clinical factors and self-medication with NSAIDs. Results: The hospital frequency of self-medication with NSAIDs was 76.67%, i.e. 388 out of 506 people surveyed during the study period. There were 257 women (66.20%) and 131 men (33.80%) with an average age of 52 +/- 16 years [extremes: 8 and 84 years]. The dominant socio-professional category was the informal sector (35.80%). The majority of patients were educated (85.10%), had a low socioeconomic level (77.30%) and lived in urban areas (88.90%). NSAIDs were mainly used for chronic (75.50%), mechanical (63.70%) and progressive (85.80%) rachialgia (70.10%) and rachialgia with radiculalgia (64.17%). Diclofenac, a member of the arylcarboxylic family (89.20%), was the most commonly used NSAID (76.28%), with a duration of use of less than 14 days (75.20%). The preferred place of supply for NSAIDs was the pharmacy (76%) and the street (51.50%), with partial efficiency on pain (79.90%). Patients had mixed satisfaction after taking NSAIDs (64.70%) and considered their self-medication attitude to be poor (70.60%). The main reasons for self-medication were accessibility (66.85%) and advice from a third party (52.83%). Level of education (p=0.046), socioeconomic status (p=0.039) and pain intensity (p=0.011) influenced self-medication with NSAIDs. Conclusion: The frequency of self-medication with NSAIDs is very high in Abidjan, and the factors determining this consumption are level of education, socio-economic status and pain intensity.&nbsp;&nbsp