BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

METHODS

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

RESULTS

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

CONCLUSION

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Human ; Sars-cov-2 ; Covid-19 ; Philippines ; Adult ; Association ; Classification ; Collection ; Confidence Intervals ; Coronavirus ; Cross-sectional Studies ; Data Collection ; Demography ; Diagnosis ; Disease ; Exercise ; Eye ; Foreign Bodies ; History ; Hospitals ; Hospitals, General ; Hyperemia ; Laboratories ; Male ; Morbidity ; Ophthalmologists ; Pandemics ; Patients ; Population ; Prevalence ; Referral And Consultation ; Role ; Sensation ; Temperature ; Time ; Tissues ; Volition ; World Health Organization ; Writing

The spleen is a very hostile environment for tumor cells due to its anatomic location, blood supply, and rich immunological property – which makes it one of the most unique organ to be involved in metastatic diseases.15 Splenic metastases from non-hematologic malignancies are rare ranging from 0.6 to 7.1% base on autopsy reports of cancer patients, and 1.1 to 3.4% base on review of splenectomy cases.14 Moreover, isolated splenic metastases are more infrequent with only 31 cases reported from 1969 to October 2015.16 A splenic abscess is an unusual formation and is usually caused by hematogenous spread from an infection. Such expected frequency varies in different autopsy studies between 0.14% and 0.7%.1 Albeit rare, abscess can also result from migration of gut flora brought about by direct invasion of tumor cells from a neighboring neoplasm.17 This is a case of a 36-year-old female who came in with a history of abdominal pain, chills and fever for seven months. CT scan of the whole abdomen revealed splenic abscess with suspicion of a splenic rupture. The patient underwent exploratory laparotomy with abscess evacuation, splenectomy and double barrel colostomy and given with intravenous antibiotics. Histopathology results showed metastatic adenocarcinoma in the spleen. Thorough deliberation of her case was done and she was eventually managed as a case of Colon Cancer Stage IV and underwent chemotherapy. Splenic abscess developing from splenic metastasis from a colonic adenocarcinoma is rare and with concomitant high mortality rate. More often than not, splenic metastasis is discovered in advanced stage together with metastatic tumor in other organs while isolated splenic metastasis is even more uncommon. A splenic abscess as an initial demonstration of a colon cancer is not a common daily encounter of physicians hence a high index of suspicion coupled with sensitive and specific imaging is necessary in order to provide prompt medical and surgical intervention.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Adenocarcinoma ; Autopsy ; Colostomy ; Gastrointestinal Microbiome ; Pain ; Research Report ; Infections ; History ; Splenic Rupture ; World Health Organization ; Neoplasms ; Disease ; Fever ; Hematologic Neoplasms

The paper introduces Professor FANG Yigong 's experience in treating pelvic congestion syndrome with acupuncture. Professor FANG believes that the stagnation in the thoroughfare and conception vessels, retarded circulation of qi and blood, and the obstruction of blood flow in the uterus are implicated in the pathogenesis of pelvic congestion syndrome. In clinical practice, according to the pathogenesis, focusing on regulating the functions of the thoroughfare and conception vessels, the thinking of treatment is summarized as "resolving the stasis and stopping pain by regulating the thoroughfare and conception vessels", "selecting the points based on their indications" and "tranquilizing the mind and harmonizing the physical and mental states". The main points are Baihui (GV20), Shenting (GV24), Benshen (GB13), Zhongwan (CV12), Tianshu (ST25), Guanyuan (CV4), Dahe (KI12), and Zigong (EX-CA1). The supplementary points are used in terms of the etiology and symptoms. During acupuncture, attention should be paid to the application of Xiaoyao Tiaoshen technique of acupuncture and mutual harmonization of the mind in acupuncture operator and patient. This summary may provide a new approach to the treatment of pelvic congestion syndrome.
Female ; Humans ; Acupuncture Points ; Acupuncture Therapy ; History, 21st Century ; Pelvic Pain/therapy* ; Pelvis/pathology*

The points of Chongmai (thoroughfare vessel) recorded in Huangdi Neijing (The Yellow Emperor 's Inner Classic) were shared with those of foot-shaoyin meridian in Zhenjiu Jiayi Jing (The Systematic Classic of Acupuncture and Moxibustion). Since the Song Dynasty, all of these points were gradually reassigned to the foot-shaoyin meridian, in the way of "the points of foot-shaoyin meridian, and the confluence points of Chongmai ". The paper presents the evolution of the meridian tropism of these points and analyzes the underlying causative factors. It is proposed that Chongmai was developed in the later time, based on the abdominal pulsating blood vessels and mixed with the theories of other meridians that had been earlier formed. It is pointed that the functions of these points on the abdomen are extensive, without the clear meridian specificity. It is rational why the association of these points with meridian is ambiguous. Besides, the relevant theory and practice of this specificity also affect the evolution of the attribution of Chongmai points. Based on the above analysis, the paper presents the exploration on the theories and the problems of theoretic construction such as the relationship between meridians and acupoints, between the regular meridians and the extraordinary meridians, and the ways of the related expressions and descriptions.
Humans ; Meridians ; Acupuncture Points ; History, Ancient ; Medicine in Literature/history* ; China

Through analyzing the every textual research literature on the origin of the location method of ashi points, it is pointed out that the location method of ashi points has been generalized. It is known through systematic research and theoretical identification that this method refers to the simple way to locate the points, originated from the folk, and it is widely used to find the sites for pain relief when compared to the official education of meridians and acupoints, as well as treatment. At the time with the shortage of medical services and supplies, the poor people had no alternative, which results in a certain limitation. Modern acupuncture practitioners must associate ashi points with the acupoints of fourteen meridians and the extraordinary points in clinical practice, and deepen the exploration with modern medical knowledge and technology adopted.
Humans ; Acupuncture Points ; Acupuncture Therapy/methods* ; Meridians ; History, Ancient ; Medicine in Literature ; China

OBJECTIVE: To analyze the disease patterns and acupoint selection characteristics of acupuncture for epilepsy in ancient acupuncture texts, providing references and ideas for clinical acupuncture treatment of epilepsy. METHODS: Texts from the Chinese Medical Classics (5th edition) regarding acupuncture for epilepsy are reviewed. The frequency of acupoints, meridian association, distribution, specific points, corresponding epilepsy subtypes, and needling techniques are statistically analyzed. The Apriori algorithm is used for association rule analysis, and a complex network analysis is conducted for high-frequency acupoints and their corresponding subtypes and treatments. RESULTS: A total of 205 acupuncture prescriptions are identified. Ancient texts favored differentiation-based treatments for epilepsy, primarily classified into epilepsy, wind epilepsy, and five epilepsy. Commonly used acupoints include Baihui (GV20), Jiuwei (CV15), Shenmen (HT7), Shenting (GV24), and Xinshu (BL15), with a focus on the acupoints of the governor vessel, the bladder meridian, and the conception vessel. The acupoints on the head, face are combined with the acupoints on the limbs, with skillful use of the five-shu points and intersection acupoints. The most frequent combinations are Shenmen (HT7)-Baihui (GV20), Shenting (GV24)-Baihui (GV20), and Xinshu (BL15)-Shenmen (HT7). Visual network analysis revealed that Baihui (GV20)-Shenting (GV24), Baihui (GV20)-Shenmen (HT7), and Baihui (GV20)-Zhaohai (KI6) are core acupoint combinations. Treatment mainly involved moxibustion or combined acupuncture and moxibustion. CONCLUSION The acupoint selection for epilepsy treatment in ancient texts is precise, frequently using Baihui (GV20), Jiuwei (CV15), Shenmen (HT7), Shenting (GV24), and Xinshu (BL15), etc., with emphasis on calming epilepsy, awakening the spirit, relaxing tendons, and nourishing the heart.
Acupuncture Points ; Humans ; Epilepsy/history* ; History, Ancient ; Acupuncture Therapy/history* ; Medicine in Literature/history* ; Meridians ; China

The academic thought of Professor GAO Shuzhong on acupuncture and moxibustion is investigated systematically and summarized as 5 aspects: establishing GAO 's theory and methodological method of "siguan santong" (four gates and three opens); structuring the theory of "yinyang, qi movement, ascending and descending" pivoted at the umbilicus; deepening the laws of "stereo-layered holographic correspondence in the human body"; proposing "the method of bi-location" of acupoint systems based on meridian and collateral theories; developing the characteristic differentiation theory of acupuncture and moxibustion. These summaries reflect the unique perspective and distinctive features of Professor GAO Shuzhong on the theory of acupuncture and moxibustion, and his clinical thinking; and bring the practical significance for the discipline and academic development of acupuncture and moxibustion.
Moxibustion/history* ; Humans ; China ; Acupuncture/education* ; Acupuncture Therapy/history* ; History, 20th Century

The paper summarizes Professor YANG Jun's experience in treatment of refractory facial paralysis with the refined mode of acupuncture and moxibustion, so as to provide new ideas and methods for the disease treated with acupuncture and moxibustion. Professor YANG Jun puts forward the refined mode of diagnosis and treatment of acupuncture and moxibustion for refractory facial paralysis. On the basis of syndrome/pattern differentiation of TCM, combined with meridian theory and modern anatomy, the symptom differentiation and meridian differentiation are performed accurately. By selecting local acupoints (e.g. Touwei [ST8], Sibai [ST2], Cuanzhu [BL2] and Yangbai [GB14]), distal acupoints (e.g. Zusanli [ST36], Hegu [LI4] and Jinsuo [GV8]), specific acupoints (e.g.Qianzheng [EX-HN16] and Touqiaoyin [GB11]) and the acupoints for regulating the mind (e.g. Dazhui [GV14] and Shuigou [GV26]), the prescription is composed. The different needling techniques are delivered at the acupoints (e.g. point-to-point needling with long needle, stuck needling by lifting and dragging, and balance needling on the healthy side). Besides, the facial rehabilitation is considered as the adjuvant treatment. This mode of treatment obtains the precise diagnosis and treatment to achieve the utmost therapeutic effects.
Humans ; Moxibustion ; Acupuncture Therapy/history* ; Facial Paralysis/therapy* ; Acupuncture Points ; Male ; Meridians ; Female ; History, 21st Century ; History, 20th Century

Professor LI Zhidao puts forward the application of "group acupoints" in his clinical practice by imitating the mutual reinforcement and mutual assistance of Chinese herbal medicine. It is based on the theory as "where is the acupoint located, what are the indications of this acupoint"; and consists with the specific actions of ancient needling techniques at acupoints. The distribution of "group acupoints" is in line with the "located by the region division of the head and trunk, and by the meridians on the four extremities", which is recorded in Zhenjiu Jiayi Jing (the Systematic Classic of Acupuncture and Moxibustion). It shows "the importance of the relationship between acupoints and zangfu", and "the emphasis on the distribution of nerves and muscles" respectively. In clinical practice, controlling needling sensation is the essence of this technique at "group acupoints", the integration of acupoints and needling technique is the basic requirement, and the step-by-step needling manipulation is critical for obtaining the therapeutic effect. "Group acupoints" combined with specific needling technique advance the application efficiency and the effect of acupoints.
Acupuncture Points ; Acupuncture Therapy/methods* ; Humans ; China ; History, 20th Century ; Meridians ; Medicine in Literature ; Acupuncture/history*

The paper introduces Professor ZHUANG Lixing's academic thought on Daoqi Tongjing (directing qi to preserve essence) needling technique and the clinical experience. Based on Huangdi Neijing (the Yellow Emperor's Inner Classic), Dongyuan needling technique and Professor JIN Rui 's Daoqi Tongjing needling method, and by inheriting the valuable experience from the ancient masters and associating with his own clinical practices, Professor ZHUANG Lixing fully displayes the characteristics of principles, methods, formulas, acupoints and techniques of acupuncture in diagnosis and treatment of diseases. He integrates the thought of regulating the mind with Daoqi Tongjing needling. This needling method focuses on directing qi through mind regulation and needle manipulation, in which, the operation steps are refined. Besides, this needling method involves both the reinforcing and reducing techniques. The satisfactory effect of this needling has been obtained in clinical treatment for many disorders such as qi reversion and disharmony of yin and yang.
Acupuncture Therapy/instrumentation* ; Humans ; Acupuncture Points ; China ; Qi ; History, Ancient ; Medicine in Literature