INTRODUCTION

Acute coronary syndrome (ACS) and end-stage renal disease (ESRD) are both prevalent globally. The diagnosis and management of ACS in ESRD is difficult because the interplay of cardiovascular and renal disease is complicated. The guidelines for ACS may not be applicable to the ESRD population because the trials from which these are drawn mostly excluded ESRD patients.

To determine the clinical profile and outcomes of CKD patients on dialysis admitted for ACS in the Philippine General Hospital (PGH).

We did a retrospective cohort study and employed a retrospective review of electronic medical records among ESRD patients presenting with ACS in PGH from May 2021 to November 2023. The collected data was analyzed using univariate and bivariate statistics using PRISM software.

A total of 48 patients with ESRD were admitted for ACS in this study – 8 with STEMI and 40 with NSTEMI. The mean age was 61 years old and 33 (68.8%) were male. Among those with STEMI, six (75%) presented with Kilip II or more. While among those with NSTEMI, 17 (42.5%) had a GRACE score >140 and 27 (67.5%) had an NSTEMI TIMI risk score >2. On average, the patients were on hemodialysis for 31 months prior to admission. The most common comorbidities were hypertension (91.7%) and heart failure (83.3%). On admission, 18 (37.5%) presented with SBP >160, 7 (14.6%) patients presented with shock, and 4 (8.3%) patients presented with cardiac arrest. 38 (79.2%) patients had anemia on admission. 21 (43.8%) patients had left ventricular hypertrophy on electrocardiogram while 34 (70.8%) patients had cardiomegaly on chest radiography. The average left ventricular ejection fraction on echocardiogram was 46% and 27 (90%) patients had segmental wall motion abnormalities. The most common angiographic finding was 3-vessel coronary artery disease seen in 50% of patients. Almost all patients received dualantiplatelet therapy, high dose statin, and beta-blocker. The mortality rate was high at 43.8% with cardiovascular causes being the most common cause of death.

This study demonstrates the high mortality rate among patients with ESRD presenting with ACS. Our study portrays that patients with ESRD present with higher risk features including abnormalities in vital signs, laboratories, imaging, high prognostications score, and high in-hospital morbidity.

Valacyclovir-associated neurotoxicity (VAN) is a recognized adverse effect in elderly patients with renal impairment but remains underdiagnosed due to its nonspecific presentation and overlap with acute neurologic emergencies. We report a 78-year-old Filipino female with end-stage renal disease on maintenance hemodialysis who developed acute disorientation, agitation, vivid visual hallucinations and generalized weakness shortly after initiation of valacyclovir for herpes zoster. Given the abrupt onset of neuropsychiatric symptoms, viral encephalitis was initially considered. Magnetic resonance imaging of the brain showed no evidence of acute infarction or encephalitis, while electroencephalography demonstrated diffuse generalized slowing consistent with an encephalopathic process. Review of the medication history revealed valacyclovir dosing that exceeded recommendations for patients with end-stage renal disease. Valacyclovir was discontinued and emergent hemodialysis was initiated resulting in marked improvement in sensorium after the second session and complete resolution of symptoms after the third. This case shows VAN as an important diagnostic mimic of acute encephalopathy in elderly patients with renal failure and emphasizes the critical role of early medication review in preventing unnecessary investigations and enabling prompt, reversible management.

BACKGROUND

Self-management is crucial for individuals with chronic illnesses. While mobile applications (mAPPs) have emerged to support diverse health needs, evidence regarding their efficacy for self-management among chronically ill Filipino patients is inconsistent and limited, particularly in provincial settings.

To investigate the effectiveness of the Health Storylines mAPP compared to a traditional pamphlet for enhancing self-management among individuals with chronic illnesses in Baguio City, Philippines.

We conducted a two-arm quasi-experimental study with 33 participants diagnosed with cancer, type 2 diabetes, or heart disease/hypertension. Participants were recruited via convenience sampling and allocated to an intervention group (n=17), which used the Health Storylines mAPP for four weeks, or a comparison group (n=16), which received a traditional pamphlet. Selfmanagement was assessed pre- and post-intervention using the Self-Management Assessment Scale (SMASc).

Participants demonstrated a high level of selfmanagement at baseline (μ=5.20, SD=0.70). After four weeks, the intervention group showed a non-significant decrease in self-management scores (from μ=5.25 to 5.00, p=0.27), while the comparison group exhibited a non-significant increase (from μ=5.19 to 5.37, p=0.61). There was no statistically significant difference in posttest self-management scores between the two groups (U=83.50, p=0.23).

In a population of chronically ill patients already proficient in managing their condition, the Health Storylines mAPP had a marginal impact on selfmanagement, while the use of a traditional pamphlet showed a slight positive effect. The findings suggest that for this population, familiar, low-barrier resources remain valuable, and mHealth interventions must account for baseline self-management capabilities and digital literacy. Chronic Illness; Health Storylines mAPP; Self-management; mHealth; Philippines.

OBJECTIVE

This paper reports a rare presentation of diffuse intraocular inflammation following reversed vaulted multipiece intraocular lens (IOL) implanted in the sulcus of a 7-year-old child.

This is a case report.

A 7-year-old child presented with persistent posterior pole inflammation and optic disc swelling after an improperly placed multipiece intraocular lens in the sulcus. Comprehensive eye and wholebody evaluations were performed with the aid of optical coherence tomography (OCT), magnetic resonance imaging (MRI) and systemic work-up to rule out other causes of uveitis to definitively diagnose the case. The reverse-vaulted lens was eventually explanted. After 1 week post-explantation, the visual acuity improved markedly to 20/100 with the appropriate spectacle prescription. The patient recovered from the ocular inflammation 8 months postoperatively.

This paper reports significant posterior pole inflammation as an uncommon yet potentially visually-disabling consequence of a reverse-vaulted sulcus placement of a multipiece intraocular lens in a child. Careful attention is warranted to ensure proper IOL orientation during implantation, especially in pediatric cataract surgery. Visual rehabilitation is important postoperatively

OBJECTIVE: To observe the skin surface temperature at the related back-shu points in the patients with the different levels of pulmonary ventilation function in chronic persistent asthma, and to explore the correlation between the skin temperature at the back-shu points and pulmonary ventilation function indexes based on "lung governing the skin and hair". METHODS: Sixty-one patients with chronic persistent asthma, based on the level of pulmonary ventilation function, were assigned into a reduced pulmonary ventilation function group (reduced function group, 32 cases) and a normal pulmonary ventilation function group (normal function group, 29 cases). In the two groups, the skin surface temperature was measured in the sites of bilateral Feishu (BL13), Geshu (BL17), Pishu (BL20) and Shenshu (BL23); and the pulmonary ventilation function indexes (the percentage of predicted value of forced vital capacity [FVC%pred], the percentage of predicted value of forced expiratory volume in the first second [FEV1%pred], the percentage of predicted value of FEV1/FVC [FEV1/FVC%pred] and the percentage of predicted value of the peak expiratory flow [PEF%pred]) were recorded. The correlation between the skin surface temperature of acupoints and pulmonary ventilation function was analyzed. RESULTS: Compared with the normal function group, the surface skin temperature at the bilateral Feishu (BL13), Geshu (BL17), Pishu (BL20) and Shenshu (BL23) was higher in the reduced function group (P<0.05, P<0.01). Compared with the normal function group, FEV1%pred, FEV1/FVC%pred and PEF%pred were decreased in the reduced function group (P<0.001). There was no significant difference in FVC%pred between the two groups (P>0.05). The skin surface temperature at the bilateral Feishu (BL13), Geshu (BL17), Pishu (BL20) and Shenshu (BL23) was negatively correlated with FVC%pred, FEV1%pred, FEV1/FVC%pred and PEF%pred in 61 patients with chronic persistent asthma (P<0.001, P<0.01, P<0.05). CONCLUSION The skin surface temperature at back-shu points is elevated in line with the the decline of pulmonary ventilation function in the patients with chronic persistent asthma, presenting a negative correlation with pulmonary ventilation function indexes. It is preliminarily verified that back-shu point is characterized by reflecting the visceral disorders.
Humans ; Female ; Male ; Asthma/therapy* ; Middle Aged ; Adult ; Skin Temperature ; Lung/physiopathology* ; Acupuncture Points ; Pulmonary Ventilation ; Aged ; Chronic Disease/therapy* ; Young Adult ; Hair

OBJECTIVE: To observe the clinical effect of acupuncture-moxibustion therapy of Daoqi Tongluo (conducting qi and unblocking collateral) on chronic primary tinnitus. METHODS: A total of 32 patients with chronic primary tinnitus were included and treated with the acupuncture-moxibustion therapy of Daoqi Tongluo. This regimen was composed of abdominal acupuncture, body acupuncture, warm needling and posterior-auricular local flashing cupping, Zhongwan (CV12), Guanyuan (CV6) and Yindu (KI9), Tinggong (SI19), Cong'er point, Waiguan (TE5) of the affected side, etc. are selected. The treatment was given once every two days, 3 treatments a week; and one course of intervention was required, with 10 treatments included. Before and after treatment, the scores of tinnitus handicap inventory (THI), tinnitus evaluation questionnaire (TEQ), self-rating scale of sleep (SRSS), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were observed, and the clinical effect was evaluated. RESULTS: After interventions, the scores of THI, TEQ, SRSS, SAS and SDS were reduced in comparison with those before interventions in the patients (P<0.001, P<0.01, P<0.05), and the total effective rate was 71.9% (23/32). CONCLUSION Acupuncture-moxibustion therapy of Daoqi Tongluo is effective on chronic primary tinnitus and this therapy can alleviate tinnitus degree, improve sleep quality and attenuate the anxious and depressive emotion of the patients.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Acupuncture Points ; Acupuncture Therapy ; Chronic Disease/therapy* ; Moxibustion ; Tinnitus/psychology* ; Treatment Outcome

OBJECTIVE: To observe the effects of moxibustion at "Xinshu" (BL15) and "Feishu" (BL13) on myocardial transferrin receptor 1 (TfR1), ferroptosis suppressor protein 1 (FSP1), atrial natriuretic peptide (ANP), and typeⅠcollagen myocardial collagen fibers (CollagenⅠ) in rats with chronic heart failure (CHF), and to explore the mechanism of moxibustion for ameliorating myocardial fibrosis and improving cardiac function in CHF. METHODS: Fifty SD rats were randomly divided into a normal group (n=10) and a modeling group (n=40). The CHF model was established in the modeling group by ligating the left anterior descending coronary artery. After successful modeling, the rats were randomly divided into a model group (n=9), a moxibustion group (n=8), a rapamycin (RAPA) group (n=9), and a moxibustion+RAPA group (n=9). In the moxibustion group, moxibustion was delivered at bilateral "Feishu"(BL13) and "Xinshu" (BL15), 15 min at each point in each intervention, once daily, for 4 consecutive weeks. In the RAPA group, RAPA solution was administered intraperitoneally at a dose of 1 mg/kg, once daily for 4 consecutive weeks. In the moxibustion+RAPA group, RAPA solution was administered intraperitoneally after moxibustion. Ejection fraction (EF) and left ventricular fractional shortening (FS) were measured after modeling and intervention. After intervention, morphology of cardiac muscle was observed using HE staining and Masson's trichrome staining. Total iron content in myocardial tissue was detected using a colorimetric method. Western blot and qPCR were adopted to detect the protein and mRNA expression of TfR1, FSP1, ANP, and CollagenⅠ in myocardial tissue. RESULTS: Compared with the normal group, the EF and FS values decreased (P<0.01); necrosis, edema, degeneration, and arrangement disorder were presented in cardiomyocytes; inflammatory cells were obviously infiltrated, the structure of myocardial fibers was disarranged, the collagen fibers were obviously deposited and fibrosis increased (P<0.01); the total iron content and the protein and mRNA expression of TfR1, ANP, and CollagenⅠ in myocardial tissue were elevated (P<0.01), while the protein and mRNA expression of FSP1 were reduced (P<0.01) in the model group. Compared with the model group, the moxibustion group showed that EF and FS increased (P<0.01); myocardial cell morphology was improved, and myocardial fibrosis was alleviated (P<0.01); the total iron content and the protein and mRNA expression of TfR1, ANP, and CollagenⅠ in myocardial tissue decreased (P<0.01), while the protein and mRNA expression of FSP1 increased (P<0.01, P<0.05). Compared with the model group, the myocardial fibrosis was increased (P<0.05); the total iron content and the protein and mRNA expression of TfR1, ANP, CollagenⅠ in myocardial tissue were increased (P<0.01), while protein and mRNA expression of FSP1 decreased (P<0.01) in the RAPA group. When compared with the RAPA group and the moxibustion + RAPA group, EF and FS were elevated (P<0.01, P<0.05); myocardial cells were improved in morphology, the total iron content and the protein and mRNA expression of TfR1, ANP, and CollagenⅠ in myocardial tissue decreased (P<0.01), while protein and mRNA expression of FSP1 increased (P<0.01) in the moxibustion group. In comparison with the moxibustion + RAPA group, the RAPA group showed the decrease in EF and FS (P<0.01), the worsened myocardial fibrosis (P<0.01), the increase in the total iron content and the protein and mRNA expression of TfR1, ANP, and CollagenⅠ in myocardial tissue (P<0.01), and the decrease in the protein and mRNA expression of FSP1 (P<0.01). CONCLUSION Moxibustion at "Feishu" (BL13) and "Xinshu" (BL15) can slow down the process of myocardial fibrosis and improve cardiac function in CHF rats. The mechanism of moxibustion may be related to inhibiting ferroptosis through regulating autophagy.
Animals ; Rats ; Heart Failure/physiopathology* ; Moxibustion ; Rats, Sprague-Dawley ; Male ; Receptors, Transferrin/genetics* ; Myocardium/metabolism* ; Acupuncture Points ; Humans ; Chronic Disease/therapy* ; Antigens, CD/metabolism*

OBJECTIVE: To analyze the research progress, hotspots, frontier trends and existing limitations of acupuncture and moxibustion treatment for respiratory diseases in the past decade using bibliometric and scientific knowledge mapping methods. METHODS: Literature on acupuncture and moxibustion treatment for respiratory diseases published from January 1st, 2014 to June 30th, 2024, from CNKI, VIP, Wanfang, PubMed and Web of Science was retrieved. CiteSpace 6.1.R6 and VOSviewer V1.6.20 were used to perform visual analysis, including keyword co-occurrence and clustering, and to construct knowledge maps of acupuncture and moxibustion treatment for respiratory diseases. RESULTS: A total of 1,106 Chinese articles and 185 English articles were included. High-frequency keywords focused on clinical diseases, treatment methods, efficacy observation, mechanisms etc. The main respiratory diseases treated with acupuncture and moxibustion included chronic obstructive pulmonary disease (COPD), asthma and cough. Commonly used acupoints included Feishu (BL13), Zusanli (ST36), Dazhui (GV14) and Shenshu (BL23), primarily involving the bladder meridian of foot-taiyang, conception vessel and lung meridian of hand-taiyin. Among the treatment methods dominated by acupuncture and moxibustion, the primary treatment method was electroacupuncture combined with moxibustion, and acupoint application was supplemented, with increasing emphasis on integrative Chinese and Western medicine and acupuncture combined with medication. The therapeutic mechanisms involved anti-inflammatory effects and inhibition of airway remodeling, with targets mainly associated with the NF-κB signaling pathway. CONCLUSION Acupuncture and moxibustion demonstrates certain advantages in treating respiratory diseases such as COPD, asthma and cough, with mechanisms related to anti-inflammatory effects and inhibition of airway remodeling. Future research should focus on multi-center, large-sample, high-quality clinical and experimental studies to explore the optimal clinical treatment protocols and underlying mechanisms.
Moxibustion/trends* ; Humans ; Acupuncture Therapy/trends* ; Acupuncture Points ; Asthma/therapy* ; Pulmonary Disease, Chronic Obstructive/therapy*

OBJECTIVE: To observe the effect of electroacupuncture (EA) on the intestinal flora in rats with chronic obstructive pulmonary disease (COPD) and explore its possible mechanism based on the gut-lung axis theory. METHODS: A total of 30 male SD rats of SPF grade were randomly divided into a normal control (NC) group, a model group and an EA group, 10 rats in each one. In the model group and the EA group, COPD model was established by intratracheal instillation of lipopolysaccharide combined with cigarette fumigation. In the EA group, EA was applied at bilateral "Feishu" (BL13) and "Zusanli" (ST36), with disperse-dense waves, in frequency of 4 Hz/20 Hz, current of 1-3 mA, 20 min a time, once a day for 14 days continuously. Before and after modeling, as well as after intervention, body weight was observed; after intervention, the lung function indexes (forced expiratory volume in 0.1 second [FEV_0.1], FEV_0.1/forced vital capacity [FVC]%, forced expiratory volume in 0.3 second [FEV_0.3] and FEV_0.3/FVC%) were measured, serum levels of inflammatory factors (tumor necrosis factor-α[TNF-α], interleukin-6[IL-6], interleukin-1β[IL-1β] and interleukin-10[IL-10]) were detected by ELISA, histopathology of lung and colon tissues was observed by HE staining, the intestinal flora were analyzed by 16S rRNA, and the correlations between lung function and intestinal flora were analyzed. RESULTS: Compared with the NC group, in the COPD group, the body weight and lung function indexes were reduced (P<0.01); the lung and colon tissues were damaged, the mean linear intercept (MLI) of alveolus and inflammatory cell numbers of 100 μm² in lung tissue were increased (P<0.01); the serum levels of TNF-α, IL-6 and IL-1β were increased (P<0.01, P<0.05), and the serum level of IL-10 was decreased (P<0.01); α-diversity indexes of intestinal flora were increased (P<0.01); the relative abundance of Bacteroidetes, Proteobacteria and Oscillospira, Bacteroides, Coprococcus was increased (P<0.01), the relative abundance of Firmicutes, Actinobacteria, Tenericutes, TM7 and Lactobacillus, Allobaculum, Bifidobacterium, YRC22 was decreased (P<0.01, P<0.05); 31 different expressed metabolic pathways were identified between the two groups. Compared with the COPD group, in the EA group, the body weight and lung function indexes were increased (P<0.01); the damage of lung and colon tissues was improved, the MLI of alveolus was decreased (P<0.05); the serum levels of TNF-α, IL-6 and IL-1β were decreased (P<0.05), and the serum level of IL-10 was increased (P<0.05); α-diversity indexes of intestinal flora were decreased (P<0.01); the relative abundance of Bacteroidetes, Proteobacteria and Oscillospira, Bacteroides, Coprococcus was decreased (P<0.01, P<0.05), the relative abundance of Firmicutes, Actinobacteria, Tenericutes, TM7 and Lactobacillus, Allobaculum, Bifidobacterium, YRC22 was increased (P<0.01); 35 different expressed metabolic pathways were identified between the two groups. The lung function was positive related with Actinobacteria, Tenericutes, TM7 and YRC22, and was negative related with Bacteroidetes, Proteobacteria and Oscillospira, Bacteroides, Coprococcus. CONCLUSION EA may ameliorate lung function and tissue injury of COPD by regulating intestinal flora dysbiosis and inflammatory response, suggesting an anti-inflammatory effect mediated via "gut-lung" axis.
Animals ; Pulmonary Disease, Chronic Obstructive/genetics* ; Male ; Electroacupuncture ; Rats ; Rats, Sprague-Dawley ; Lung/metabolism* ; Gastrointestinal Microbiome ; Humans ; Interleukin-6/immunology* ; Tumor Necrosis Factor-alpha/immunology* ; Intestines/microbiology* ; Interleukin-10/immunology*

OBJECTIVE: To evaluate the clinical efficacy of press needle exercise therapy for stable chronic obstructive pulmonary disease (COPD). METHODS: Sixty patients with stable COPD were randomly assigned to an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 2 cases dropped out). Basic treatment was applied to the two groups. The control group received pulmonary rehabilitation training, while the observation group received press needle exercise therapy. Press needle was applied at Dazhui (GV14), Danzhong (CV17), Qihai (CV6), Guanyuan (CV4), Zhiyang (GV9) and bilateral Feishu (BL13), Gaohuang (BL43), Jueyinshu (BL14), Xinshu (BL15), Geshu (BL17), Pishu (BL20), Shenshu (BL23). During the press needle intervention, patients also underwent pulmonary rehabilitation training. Treatments were administered once every other day, three times a week, for 8 weeks. Pulmonary function indexes including forced expiratory volume in the first second (FEV1), FEV1 to forced vital capacity ratio (FEV1/FVC), and percentage of predicted FEV1 (FEV1%) were measured before and after treatment in the two groups. Additional assessments included the 6-minute walk test (6 MWT) and COPD assessment test (CAT) score. Clinical efficacy was also compared between the two groups. RESULTS: After treatment, both groups showed improvements in FEV1, FEV1/FVC, FEV1%, and 6 MWT (P<0.05), and reductions in CAT scores (P<0.05); the observation group showed higher FEV1, FEV1/FVC, FEV1%, and 6 MWT values, and lower CAT scores compared to those in the control group (P<0.05). The total effective rate in the observation group was 86.2% (25/29), higher than 60.7% (17/28) in the control group (P<0.05). CONCLUSION Press needle exercise therapy could effectively alleviate clinical symptoms, improve pulmonary function and exercise tolerance, and enhance quality of life in patients with stable COPD.
Humans ; Pulmonary Disease, Chronic Obstructive/physiopathology* ; Male ; Female ; Middle Aged ; Aged ; Exercise Therapy/instrumentation* ; Acupuncture Therapy/instrumentation* ; Acupuncture Points ; Treatment Outcome ; Forced Expiratory Volume ; Quality of Life