Cutaneous tuberculosis (TB) occurs rarely, comprising only approximately 1% of all extrapulmonary TB cases worldwide. This report presents an atypical clinical manifestation of Lupus vulgaris, the most common form of cutaneous TB. Typically, Lupus vulgaris presents as chronic erythematous plaques over the head and neck area. The patient, a 24-year-old male with limited support and financial resources, presented with chronic painful, non-healing ulcerated lesions on his left upper extremity. Diagnostic tests specific to TB infection, including culture, all turned out negative for TB. No improvement in the lesions was noted with antibacterial and antifungal therapies. Clinical course of the condition and histopathologic findings, though non-specific to TB, became the basis for diagnosis and treatment. Patient currently is on the 3rd month of anti-Koch’s treatment with noted gradual improvement in the character and appearance of the lesions. Lupus vulgaris could appear as ulcers and over the extremities though much less common, posing challenges in both diagnosis and treatment. Malignant transformation could develop if left untreated. Thus, careful and thorough examination of the patient and diligent follow-up and re-evaluation of lesions while considering the patient’s values, concerns and financial capacity, were necessary in successfully addressing both the biomedical and psychosocial aspect of the illness.
Skin Diseases ; Lupus Vulgaris

INTRODUCTION

Burnout is becoming more common among healthcare professionals, notably during the COVID-19 pandemic. It can result in lower performance and effectiveness at work as well as employment withdrawal, all of which affects the standard of healthcare services provided.

OBJECTIVE

In order to ascertain the effectiveness of mindfulness meditation-based interventions (MMBIs) in reducing burnout among healthcare workers, a systematic review and meta-analysis was done.

METHODS

Two investigators searched records in CENTRAL, PubMed/MEDLINE, Google Scholar, Preprints, Grey Literature, and cross-referencing to acquire articles using search terms related to “mindfulness meditation”, “healthcare workers”, and “burnout”. Inclusion criteria included randomized controlled trials (RCTs) and nonrandomized controlled trials (NRTs) that assessed the effectiveness of MMBIs on burnout as measured by the Maslach Burnout Inventory (MBI) among healthcare workers in the hospital setting. Study selection, data extraction, risk of bias assessment were done by the investigators independently. Analysis was done using RevMan 5 software, forest plots were generated, and subgroup analyses were done.

RESULTS

Of 25,453 identified records, 28 studies were included. The studies were rated with low to unclear selection bias and high risk of performance bias. MMBIs were associated with significant reduction on the emotional exhaustion, depersonalization and personal accomplishment subscales with pooled mean differences of -2.60 (95% CI = -3.64, -1.55), -0.51 (95% CI = -0.77, -0.26), and 0.82 (95% CI = 0.24, 1.39), respectively. On subgroup analyses, the types of MMBI implemented had no influence in the intervention effect noted on all subscales among RCTs but had significant influence among NRTs. Reduction of burnout was noted to be higher in nurses compared with physicians and mixed healthcare workers. Overall quality of evidence for RCTs was low to moderate and very low to low for NRTs.

CONCLUSION

The results suggest that MMBIs can reduce the burnout symptoms of healthcare workers. To address the high risk of bias of included studies and improve quality of evidence, future research should be done with high-quality RCTs.

Meditation ; Burnout, Psychological ; Health Personnel ; Healthcare Workers

INTRODUCTION

Tobacco smoking is one of the most significant preventable lifestyle risk factors, causing a wide range of diseases and causing harm to millions of people worldwide. Nicotine replacement treatment (NRT) and behavioral counseling have long been used to help people quit smoking. However, because pharmacologic and behavioral therapy only have a 22% to 45% success rate in smoking cessation, a systematic review and meta-analysis was conducted to evaluate ear acupuncture’s usefulness as an adjunct to nicotine replacement therapy and behavioral counseling for smoking cessation.

METHODS

This systematic review only included randomized controlled trials which involved current smokers aged 19 years or older, and who were in the contemplation stage according to the Transtheoretical Model of Intentional Behavior of Change. The RevMan 5 software was used in the analysis of data. The primary outcome that was measured is the rate of continuous abstinence based on participant/patient report at the end of treatment and secondary outcome of the study was reporting of nicotine withdrawal symptoms.

RESULTS

Of the 1,661 identified records, only 2 studies were included (both RCTs) in the meta- analysis. The studies were rated with low to unclear selection bias and high risk of performance bias. The pooled estimates of effect were statistically significant in favor of ear acupuncture plus counseling (standard therapy), RR= 2.28, 95% CI 1.27, 4.08, p= 0.006, I2= 0%. Nicotine withdrawal symptoms were noted to be less pronounced in those who received the intervention of ear acupuncture even after 3 months post-treatment. The evidence was graded as low quality, indicating that more research is needed and would extremely likely have a significant impact on confidence in the estimate of effect.

CONCLUSION

The results of this systematic review and meta-analysis suggest that ear acupuncture produces an additive benefit on counseling (standard of care) as a means of smoking cessation. Future research should be conducted using RCTs of a high quality in order to address the substantial risk of bias that was present in the studies that were included and to improve the quality of the evidence.

Human ; Acupuncture, Ear ; Nicotine Replacement Therapy ; Smoking Cessation