Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 37
Filtrar
1.
SAGE Open Med ; 12: 20503121241258841, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38855003

RESUMEN

Introduction: Preventative foot self-care is vital for avoiding diabetic foot ulcer episodes and lowering the risk of amputations. Yet, it demands high levels of health literacy and cognitive function. Objective: To investigate health literacy and cognitive function in persons presenting with a diabetic foot ulcer. Methods: Participants with type 2 diabetes were recruited from the tertiary foot clinic at Steno Diabetes Center North Denmark. The European Health Literacy Survey Questionnaire and Addenbrooke's Cognitive Examination were applied. A semi-structured interview guide was developed to evaluate foot self-care knowledge, attitude, and practice. The qualitative data were analyzed with a deductive approach based on a qualitative thematic analysis model. Subsequently, an integrated analysis of the quantitative and qualitative results was conducted. Results: The participants (n = 12) had a mean age of 62.6 ± 8.4 years, and 11 were males. The mean diabetes duration was 15.9 ± 8.9 years. Eight participants had a recurrent diabetic foot ulcer. The health literacy level was sufficient in nine participants, and cognitive function was normal in five participants. Three different profiles related to foot self-care (proactive, active, or passive, respectively) were constructed by the final integrated analysis: a proactive profile refers to taking preventative action in concordance with knowledge and attitude, an active profile to taking action in response to a situation, but challenged by conflicting levels of knowledge and attitude, and a passive profile to not taking action. Conclusion: The study suggests that people presenting with a diabetic foot ulcer have different foot self-care profiles based on person-specific health literacy, cognitive function, and knowledge, attitude, and practice element characteristics, highlighting the need for individualized education and intervention strategy instead of a one-size-fits-all approach.

2.
Ugeskr Laeger ; 186(15)2024 Apr 08.
Artículo en Danés | MEDLINE | ID: mdl-38708699

RESUMEN

In the last decade, patients with chronic pain have expressed increasing interest in cannabis-derived products for adjuvant therapy when treatment is deemed refractory to conventional analgesics. At present, clinical evidence to support this treatment approach appears to be sparse. Not because clinical studies as such are lacking, but rather as a result of methodological bias in relation to study design, patient populations, and treatment protocols. In this review, research in cannabis medicine for relief of chronic pain is reviewed, mainly with reference to published meta-analytic studies.


Asunto(s)
Dolor Crónico , Marihuana Medicinal , Humanos , Dolor Crónico/tratamiento farmacológico , Marihuana Medicinal/uso terapéutico , Marihuana Medicinal/efectos adversos , Dronabinol/uso terapéutico , Analgésicos/uso terapéutico
3.
J Pers Med ; 14(5)2024 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-38793033

RESUMEN

Polymyalgia rheumatica (PMR) is an inflammatory disorder of unknown etiology, sharing symptoms with giant cell arthritis (GCA) and rheumatoid arthritis (RA). The pathogenic inflammatory roots are still not well understood, and there is a lack of extensive biomarker studies to explain the disease debut and post-acute phase. This study aimed to deeply analyze the serum proteome and inflammatory response of PMR patients before and after glucocorticoid treatment. We included treatment-naïve PMR patients, collecting samples before and after 3 months of treatment. For comparison, disease-modifying antirheumatic drug (DMARD)-naïve RA patients were included and matched to healthy controls (CTL). The serum proteome was examined using label-free quantitative mass spectrometry, while inflammation levels were assessed using multiplex inflammatory cytokine and cell-free DNA assays. The serum proteomes of the four groups comprised acute phase reactants, coagulation factors, complement proteins, immunoglobulins, and apolipoproteins. Serum amyloid A (SAA1) was significantly reduced by active PMR treatment. Cell-free DNA levels in PMR and RA groups were significantly higher than in healthy controls due to acute inflammation. Complement factors had minimal changes post-treatment. The individual serum proteome in PMR patients showed over 100 abundantly variable proteins, emphasizing the systemic impact of PMR disease debut and the effect of treatment. Interleukin (IL)-6 and interferon-gamma (IFN-γ) were significantly impacted by glucocorticoid treatment. Our study defines the PMR serum proteome during glucocorticoid treatment and highlights the role of SAA1, IL-6, and IFN-γ in treatment responses. An involvement of PGLYRP2 in acute PMR could indicate a response to bacterial infection, highlighting its role in the acute phase of the immune response. The results suggest that PMR may be an aberrant response to a bacterial infection with an exacerbated IL-6 and acute phase inflammatory response and molecular attempts to limit the inflammation.

4.
Palliat Med Rep ; 4(1): 326-333, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38098857

RESUMEN

Background: Cannabis may offer therapeutic benefits to patients with advanced cancer not responding adequately to conventional palliative treatment. However, tolerability is a major concern. Cognitive function is a potential adverse reaction to tetrahydrocannabinol containing regimens. The aim of this study was to test cognitive function in patients being prescribed dronabinol as an adjuvant palliative therapy. Methods: Adult patients with advanced cancer and severe related pain refractory to conventional palliative treatment were included in this case-series study. Patients were examined at baseline in conjunction with initiation of dronabinol therapy and at a two-week follow-up using three selected Wechsler's adult intelligence scale III neurocognitive tests: Processing Speed Index (PSI), Perceptual Organization Index (POI), and Working Memory Index (WMI). Patients were also assessed using pain visual analog scale, Major Depression Inventory, and Brief Fatigue Inventory. Results: Eight patients consented to take part in the study. Two patients discontinued dronabinol therapy, one due to a complaint of dizziness and another critical progression of cancer disease, respectively. The remaining six patients were successfully treated with a daily dosage of 12.5 mg dronabinol (p = 0.039). PSI (p = 0.020), POI (p = 0.034.), and WMI (p = 0.039). Conclusions: Cognitive function improved in this group of patients with advanced cancer in conjunction with low-dose dronabinol therapy. The cause is likely multifactorial including reported relief of cancer-associated symptoms. Further clinical investigation is required.

5.
J Intensive Care Soc ; 24(4): 442-445, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37841303

RESUMEN

The aim of this study was to assess the feasibility and outcome of a neuropsychiatric evaluation protocol intended for adult intensive care unit survivors in a Danish regional hospital, in which a follow-up consultation was conducted 2 months after hospital discharge. Twenty-three participants were able to finalize the neuropsychiatric evaluation, and 20 (87%) among those were detected with neuropsychiatric manifestations, including cognitive impairment (n = 17; 74%) and fatigue (n = 17, 74%). This study finds a high prevalence of neuropsychiatric manifestations and fatigue, and evaluates a follow-up protocol for the ICU patient population.

6.
Sci Rep ; 13(1): 14154, 2023 08 29.
Artículo en Inglés | MEDLINE | ID: mdl-37644069

RESUMEN

Male genital schistosomiasis (MGS) is hypothesized to increase seminal shedding of HIV-1. This prospective pilot study assessed seminal HIV-1 RNA shedding in men on long-term ART with and without a diagnosis of MGS. Study visits occurred at 0, 1, 3, 6 and 12 months. MGS was diagnosed by egg positivity on semen microscopy or PCR of seminal sediment. After optimization of the HIV-RNA assay, we examined 72 paired plasma and semen samples collected from 31 men (15 with and 16 without MGS) over 12 months. HIV-1 RNA was detected in 7/72 (9.7%) seminal samples and 25/72 (34.7%) plasma samples. When comparing sample pairs, 5/72 (6.9%) showed HIV-1 RNA detection only in the seminal sample. Overall, 3/31 (9.7%) participants, all with MGS, had detectable HIV-1 RNA in semen while plasma HIV-1 RNA was undetectable (< 22 copies/mL), with seminal levels ranging up to 400 copies/mL. Two participants showing HIV-1 RNA in seminal fluid from the MGS-negative group also had concomitant HIV-1 RNA detection in plasma. The findings suggest that MGS can be associated with low-level HIV-1 RNA shedding despite virologically suppressive ART. Further studies are warranted to confirm these observations and assess its implications.


Asunto(s)
Seropositividad para VIH , VIH-1 , Esquistosomiasis , Humanos , Masculino , VIH-1/genética , Proyectos Piloto , Lagos , Malaui , Estudios Prospectivos , Genitales , ARN
7.
Eur J Radiol ; 166: 110997, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37499480

RESUMEN

PURPOSE: Use of computed tomography (CT) scans raises safety concern as lifetime cumulative ionising radiation exposure is associated with risk of developing malignancies. This study aimed to investigate use of abdominal CT scans in the Danish health care sector. METHODS: Data on abdominal CT scans performed annually in the North Denmark Region between 2005 and 2018 were extracted from the regional registry with emphasis on patients with a medical history of a repeated abdominal CT scan within 28 days. An audit of the medical files was subsequently conducted in 100 randomly selected patient cases to evaluate clinical information being provided, in addition to justification for a repeated abdominal CT scan, and finally if other radiology modalities could have been applied. RESULTS: Number of annually performed abdominal CT scans in this demographically stable regional population increased by a factor 4.3 from 15 in 2005 to 65 in 2018 per 1,000 inhabitants. The audit revealed that 31% of the secondabdominal CT scans within a 28 days period were categorized as either doubtful whether justified or not justified. Moreover, 20% of theCT scans were considered replaceable by ultrasonography. CONCLUSIONS: Annual performance of abdominal CT scans increased fourfold during the 14 years period. This tendency is probably attributable to changes in the Danish health care sector by which CT scan examination are used more frequently aiming at more accelerated patient investigation flow in conjunction with shorter length of hospitalization stay. Alertness is strongly warranted towards the associated risk of cancer due to life-time cumulative ionising radiation exposure by this strategy.


Asunto(s)
Seguridad del Paciente , Radiología , Humanos , Tomografía Computarizada por Rayos X/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Hospitalización , Dinamarca/epidemiología , Estudios Retrospectivos , Dosis de Radiación
9.
Eur J Pain ; 27(2): 234-247, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36394124

RESUMEN

BACKGROUND: Cannabinoids are considered a therapeutic option to patients suffering from treatment refractory chronic pain (TRCP) insufficiently relieved by conventional analgesics or experiencing intolerable adverse events (AEs) from those. This study aimed to explore safety and effectiveness of oral cannabinoids among patients with TRCP. METHODS: A retrospective study was conducted among Danish patients with TRCP being prescribed oral cannabinoids. Data on AEs and changes in pain intensity by numeric rating scale (NRS) before and after initiation of oral cannabinoid therapy were analysed. RESULTS: Among 826 eligible patients ≥18 years old, 529 (64%) were included for data analysis at first follow-up (F/U1) (median 56 days from baseline) and 214 (26%) for second follow-up (F/U2) (median 126 days from F/U1). Mean age was 60 ± 15.9 years and 70% were females. AEs were in general reported mild to moderate by 42% of patients at F/U1 and 34% at F/U2. AEs were mainly related to gastrointestinal (F/U1: 17% and F/U2: 13%) and nervous system disorders (F/U1: 14% and F/U2: 11%). Reduction in NRS was significantly different at both follow-up consultations compared with baseline (<0.0001). Clinically relevant pain reduction (NRS ≥30%) was reported by 17% at F/U1 and 10% of patients at F/U2 in intention-to-treat analysis whereas the figures were 32% and 45% respectively, in per-protocol analysis. CONCLUSION: Oral cannabinoid therapy seems to be safe and mildly effective in patients with TRCP. Randomized controlled trials with focus on comparable pain characteristics in diagnostical homogenous patient subgroups are needed for further improvement of evidence level for relief of chronic pain using oral cannabinoids. SIGNIFICANCE: The findings in this retrospective study conducted in a real-world clinical setting suggest a favourable safety profile of cannabinoids. Moreover, one-sixth (intention-to-treat) and one-third (per-protocol) of patients with chronic pain refractory to conventional analgesics, or experiencing intolerable adverse effects, benefited significantly from therapy with oral cannabinoid regimens. Combination of THC and CBD seems overall more effective than cannabinoid monotherapy. Conduction of randomized controlled trials investigating safety and efficacy of cannabinoid therapy to diagnosis specific patient subgroups with comparable clinical and pathophysiological chronic pain characteristics is warranted, hence contributing further to the process of clinical evidence clarification currently in progress.


Asunto(s)
Cannabinoides , Dolor Crónico , Dolor Intratable , Femenino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Adolescente , Masculino , Cannabinoides/efectos adversos , Dolor Crónico/tratamiento farmacológico , Estudios Retrospectivos , Analgésicos/efectos adversos , Dinamarca
10.
Scand J Clin Lab Invest ; 82(6): 504-507, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35943415

RESUMEN

Fecal calprotectin is an established biomarker in inflammatory bowel disease, but its role in assessment of intestinal inflammation in ICU patients is yet to be explored. ICU patients tend to acquire diarrhea, which complicates the extraction of fecal calprotectin using a collection pin for stool sampling. Pipetting is an alternative sampling method. The aim of the study was to compare the collection pin method with the pipette method for measurement of fecal calprotectin in ICU patients with diarrhea. Stool samples were collected from fecal bags used in the patients and then analyzed for calprotectin using an extraction device and a piston pipette, respectively. In addition, a validation test for the pipette method of extraction was conducted on liquid stool samples. Eleven stool samples were collected from five randomly selected ICU patients. Calprotectin was detectable in all fecal samples. On average the collection pin measured 45% lower than the pipette method with a 95% confidence interval (30 - 59%). The coefficient of variation when using the pipette method was 13% in low calprotectin concentrations and 39% in high concentrations. In conclusion, the pipette method seems to be appropriate for measuring calprotectin in liquid feces, due to practicalities and a greater precision.


Asunto(s)
Enfermedades Inflamatorias del Intestino , Complejo de Antígeno L1 de Leucocito , Biomarcadores , Diarrea/diagnóstico , Heces , Humanos , Inflamación/diagnóstico , Enfermedades Inflamatorias del Intestino/diagnóstico , Unidades de Cuidados Intensivos
11.
PLoS Negl Trop Dis ; 16(7): e0009995, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35788749

RESUMEN

Female genital schistosomiasis (FGS) is characterized by a pattern of lesions which manifest at the cervix and the vagina, such as homogeneous and grainy sandy patches, rubbery papules in addition to neovascularization. A tool for quantification of the lesions is needed to improve FGS research and control programs. Hitherto, no tools are available to quantify clinical pathology at the cervix in a standardized and reproducible manner. This study aimed to develop and validate a cervical lesion proportion (CLP) measure for quantification of cervical pathology in FGS. A digital imaging technique was applied in which a grid containing 424 identical squares was positioned on high resolution digital images from the cervix of 70 women with FGS. CLP was measured for each image by observers counting the total number of squares containing at least one type of FGS associated lesion. For assessment of inter- and intra-observer reliability, three different observers measured CLP independently. In addition, a rubbery papule count (RPC) was determined in a similar manner. The intraclass correlation coefficient was 0.94 (excellent) for the CLP inter-rater reliability and 0.90 (good) for intra-rater reliability and the coefficients for the RPC were 0.88 and 0.80 (good), respectively. The CLP facilitated a reliable and reproducible quantification of FGS associated lesions of the cervix. In the future, grading of cervical pathology by CLP may provide insight into the natural course of schistosome egg-induced pathology of the cervix and may have a role in assessing praziquantel treatment efficacy against FGS. Trial Registration: ClinicalTrials.gov, trial number NCT04115072; trial URL https://clinicaltrials.gov/ct2/show/NCT04115072?term=Female+genital+schistosomiasis+AND+Madagascar&draw=2&rank=1.


Asunto(s)
Schistosoma haematobium , Esquistosomiasis Urinaria , Animales , Cuello del Útero/diagnóstico por imagen , Femenino , Humanos , Reproducibilidad de los Resultados , Esquistosomiasis Urinaria/diagnóstico por imagen , Esquistosomiasis Urinaria/tratamiento farmacológico , Vagina/patología
12.
Gait Posture ; 95: 121-128, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35487019

RESUMEN

BACKGROUND: Foot pain is frequent among people with rheumatoid arthritis (RA). Foot orthoses (FO) are commonly prescribed with the intention to reduce pain symptoms and improve function. RESEARCH QUESTION: How do a custom-made FO affect pain, gait biomechanics and daily activity among people with RA? METHODS: Twenty-five participants with RA and foot pain completed this quasi-experimental study using a control insole for four weeks and then a custom-made FO in the following four weeks. The foot orthoses were customized by plantar foot shape targeting optimal restoration of normal arch height. A visual analog scale was used to monitor changes in ankle/foot, knee, hip joints, and global arthritis pain. In addition, the perceived pain area was measured using a body chart analysis. Kinematics and kinetics of the hip, knee and ankle joints during gait were analyzed using 3D-motion capture. Daily steps were measured with a wrist-based activity tracker for both the control insole and custom-made FO period, respectively. RESULTS: In comparison to the control insole, the custom-made FO reduced ankle/foot pain intensity (p < 0.001) in addition to a reduction of the perceived pain areas in the feet (p < 0.001), legs (p = 0.012), as well as the arms and hands (p = 0.014). Ankle plantar flexion and eversion moments were also reduced (p < 0.001). No difference in daily steps was observed between the two periods (p = 0.657). SIGNIFICANCE: This study has demonstrated an ankle/foot pain-relieving effect in conjunction with alterations of the ankle joint moments in people with RA using custom-made FO. The pain relief is plausibly attributed to alterations of the ankle joint moments when using the custom-made FO. However, future studies are needed to explore further into therapeutic implication of custom-made FO in pain management of people with RA.


Asunto(s)
Artritis Reumatoide , Enfermedades del Pie , Ortesis del Pié , Artritis Reumatoide/complicaciones , Artritis Reumatoide/terapia , Fenómenos Biomecánicos , Marcha , Humanos , Dolor/etiología
13.
J Biomech ; 139: 110496, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-33994179

RESUMEN

Foot orthoses are a first line conservative treatment for foot impairments in patients with rheumatoid arthritis (RA), however their effect on gait mechanics is poorly understood. We aimed to compare changes in lower limb and foot mechanics between two types of commonly used foot orthoses (FO) with a control. Twenty-seven patients with rheumatoid arthritis participated in this crossover study. Two different types of FO (a medially wedged custom-made FO and a prefabricated FO with a metatarsal dome, respectively), were compared against a control insole. During gait, lower limb mechanics were analyzed using 3D motion capture, force plates, and an in-shoe pressure system. Inverse dynamics models were created in the Anybody Modeling System to calculate joint angles and joint moments during gait. Gait variables were analyzed using statistical parametric mapping. Compared to the control, the prefabricated FO had limited effect on gait mechanics. Compared to the control the custom-made FO reduced ankle plantarflexion moment with 0.4 %body weight * body height (BW * BH) between 66 and 76% of stance and ankle eversion moment was reduced 0.16% BW*BH between 3 and 40% of stance. Furthermore, it also reduced the average forefoot plantar pressure by 9 kPa between 20 and 62% of stance compared to the control. Changes in foot pressure distribution, joint moments and angles were most pronounced for custom-made FO compared to the prefabricated FO. The findings suggest that patients with RA and foot impairments may benefit more from an individualized FO strategy, if the aim of the treatment is to alter gait mechanics. (NCT03561688).


Asunto(s)
Artritis Reumatoide , Ortesis del Pié , Artritis Reumatoide/terapia , Fenómenos Biomecánicos , Estudios Cruzados , Pie , Marcha , Humanos
14.
JBI Evid Synth ; 19(11): 3102-3112, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34054038

RESUMEN

OBJECTIVE: The objective of this scoping review is to identify and characterize validated patient-reported outcome measures used to assess adult patients' health status in the emergency department to support clinical decision-making and to develop individual care and treatment plans. INTRODUCTION: In recent years, the workload in emergency departments has increased and patient management is characterized by a fast pace. The accelerated approach may lead to unintentional negligence by health care professionals of patient-reported signs and symptoms in the emergency department. Thus, use of patient-reported outcome measures in the emergency department may improve health care professionals' attention to the needs and health status of patients. INCLUSION CRITERIA: Studies assessing adult patients' health status in the emergency department using patient-reported outcome measures will be considered. The patient-reported outcome measures should be self-reported, assisted by a proxy, or administered through interviews. Only studies reporting on the measurement properties of patient-reported outcome measures will be included. Moreover, health-related information retrieved using patient-reported outcome measures should be applicable at an individual patient level. METHODS: A systematic literature search will be performed primarily in the databases MEDLINE, Embase, CINAHL, and PsycINFO. Both published and unpublished sources of information will be considered. Studies published from 2000 onwards in Danish, Swedish, Norwegian, German, and English will be included. Using the JBI methodology for scoping reviews, two reviewers will independently perform the study selection and data extraction. The results will be presented in a tabular form together with a narrative summary.


Asunto(s)
Servicio de Urgencia en Hospital , Personal de Salud , Adulto , Humanos , Diseño Interior y Mobiliario , Medición de Resultados Informados por el Paciente , Literatura de Revisión como Asunto
15.
Sci Rep ; 11(1): 2212, 2021 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-33500504

RESUMEN

Recent studies suggest that alterations in the female urinary microbiota is associated to development of bladder disease. However, the normal microbiota composition and variation in healthy women are poorly described. Moreover, the effects of hormonal changes on microbiota during menopause is not well understood. The aim of our study was to investigate the urinary microbiota in healthy pre- and postmenopausal women without urinary tract symptoms. Microbiota composition in catheterized urine samples was mapped using 16S rRNA gene sequencing. In total, 41 premenopausal and 42 postmenopausal women were initially included. Samples with first PCR amplification concentration below level of the negative control were excluded, resulting in 34 premenopausal and 20 postmenopausal women included in data analysis. Urine from postmenopausal women showed significantly higher alpha diversity compared to premenopausal women. Lactobacillus was the most abundant bacteria in both groups, however the relative abundance of Lactobacillus accounted for 77.8% in premenopausal versus 42.0% in postmenopausal women. In conclusion, urine from premenopausal mostly presented with Lactobacillus dominated urotypes, whereas urine from postmenopausal women presented a more diverse urinary microbiota with higher abundance of the genera Gardnerella and Prevotella. The clinical and pathophysiological implications of this difference remain to be elucidated.


Asunto(s)
Microbiota , Posmenopausia/orina , Premenopausia/orina , Orina/microbiología , Adulto , Bacterias/metabolismo , Femenino , Humanos , Persona de Mediana Edad
16.
Eur J Rheumatol ; 2020 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-32910755

RESUMEN

OBJECTIVE: To describe travel activities, preparations, and health problems encountered by patients with arthritis receiving biological therapy. METHODS: A travel survey was conducted in a Danish rheumatology outpatient clinic by distribution of a semistructured questionnaire to 300 consecutive patients with arthritis. RESULTS: Among the 273 (91%) patients returning the questionnaire, a history of traveling outside Denmark was reported by 203 (74%) respondents and outside Europe by 92 (34%). In 81% of the patients, travel activities had not decreased after the initiation of biological treatment. However, 24% reported that they had become more cautious regarding the choice of travel destination. Pre-travel advice was sought by less than one-third of the patients, whereas travel insurance was taken out by 86%, but only half of them had disclosed information about the biological treatment. Treatment was discontinued temporarily while traveling in 26% of patients on subcutaneous biologics. The main reason for discontinuation was concern about transport and storage of medicine. Only 6% of the travelers had experienced health problems, which were of only minor importance. CONCLUSION: Treatment with biologics seems not to have any major influence on international travel activity among Danish patients with arthritis. Health problems when traveling were of minor importance. However, pre-travel advice issues, including treatment compliance, transport of medicine, and insurance coverage, need to be addressed proactively by the outpatient clinic staff as part of patient consultation.

17.
J Clin Monit Comput ; 34(2): 387, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31016604

RESUMEN

The corresponding author has identified a calculation mistake in the original publication of the article. The corrected value is given in this Correction. Under the Results section, the median (range) age of the patients in the methodological study should read 76 (26-86) years instead of 56 (26-86) years.

18.
Gait Posture ; 72: 102-108, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31185371

RESUMEN

BACKGROUND: Foot pain and deformities are commonly encountered in patients with rheumatoid arthritis (RA). Likewise, Posterior tibial tendon dysfunction (PTTD) is commonly involved in development of foot and ankle abnormalities and has been reported with a prevalence in two-thirds of the RA patients. RESEARCH QUESTION: Redundancy in the physiological function between different muscles provides the central nervous system multiple options to perform the same movement but which muscles compensate for the impairment of the tibialis posterior (TP) muscle? And how does these changes affect ankle joint loading? METHODS: Experimental and computational disciplines were applied to investigate changes in muscle forces as result of induced pain in the right TP muscle. Twelve healthy subjects were enrolled in the study. Experimental pain was induced in the TP by a single ultrasound graphically guided injection of 1 mL hypertonic saline (5.0% Sodium Chloride). The participants' gait was assessed by skin marker-based motion capture and force plates. Musculoskeletal models were used to investigate compensation mechanisms systematically in the lower under extremity when TP muscle was recruited less as a consequence of the induced pain. RESULTS: Experimental TP muscle pain and simulated reduced strength caused altered muscle recruitment and made the flexor digitorum longus and flexor hallucis longus muscles compensated for the impairment of the TP muscle. Further, the resultant ankle joint force was increased as the strength of the TP muscle was reduced. SIGNIFICANCE: The compensation mechanism observed in the present study indicate that alterations in muscle recruitment and muscle force distribution as a result of the underlying disease inflammation itself may contribute to development of chronic foot pain and deformities in patients with RA. Further studies are required to understand the role of PTTD in occurrence of those late adverse musculoskeletal manifestations aiming at search for early preventive strategies.


Asunto(s)
Artritis Reumatoide/complicaciones , Músculo Esquelético/fisiología , Mialgia/fisiopatología , Adulto , Articulación del Tobillo/fisiopatología , Artritis Reumatoide/fisiopatología , Pie/fisiopatología , Marcha , Humanos , Mialgia/etiología , Pacientes
19.
Hum Mov Sci ; 66: 98-108, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30981150

RESUMEN

BACKGROUND: Tibialis posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of tibialis posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental tibialis posterior muscle pain on gait mechanics in healthy subjects. METHODS: Twelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right tibialis posterior muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale. FINDINGS: Decreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation. INTERPRETATION: The study has demonstrated that induced pain in the TP muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of tibialis posterior dysfunction.


Asunto(s)
Articulación del Tobillo/patología , Trastornos Neurológicos de la Marcha/patología , Articulación de la Cadera/patología , Articulación de la Rodilla/patología , Mialgia/patología , Disfunción del Tendón Tibial Posterior/patología , Adulto , Fenómenos Biomecánicos , Estudios Cruzados , Femenino , Marcha , Voluntarios Sanos , Humanos , Masculino , Mialgia/inducido químicamente , Dimensión del Dolor , Disfunción del Tendón Tibial Posterior/inducido químicamente , Solución Salina Hipertónica
20.
J Clin Monit Comput ; 33(4): 733-740, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30196470

RESUMEN

Arterial blood gas (ABG) analysis is an essential tool in the clinical assessment of acutely ill patients. Venous to arterial conversion (v-TAC), a mathematical method, has been developed recently to convert peripheral venous blood gas (VBG) values to arterialized VBG (aVBG) values. The aim of this study was to test the validity of aVBG compared to ABG in an emergency department (ED) setting. Twenty ED patients were included in this study. ABG and three aVBG samples were collected from each patient. The aVBG samples were processed in three different ways to investigate appropriate sample handling. All VBG samples were arterialized using the v-TAC method. ABG and aVBG samples were compared using Lin's concordance correlation coefficient (CCC), Bland-Altman plots and misclassification analysis. Clinical acceptable threshold of aVBG value deviance from ABG values were ± 0.05 pH units, ± 0.88 kPa pCO2 and ± 0.88 kPa pO2. CCC revealed an agreement in pH and pCO2 parameters for both aVBG in comparison to ABG. In all aVBG samples, an overestimation of pO2 compared to ABG was observed. Bland-Altman plot revealed clinically acceptable mean difference and limits-of-agreement intervals between ABG and aVBG pH and pCO2, but not between ABG and aVBG pO2. Arterialization of VBG using v-TAC is a valid method for measuring pH and pCO2, but not for pO2. Larger clinical studies are required to evaluate the applicability of v-TAC in different patient subpopulations.


Asunto(s)
Análisis de los Gases de la Sangre/métodos , Dióxido de Carbono/sangre , Oxígeno/sangre , Adulto , Anciano , Anciano de 80 o más Años , Arterias/patología , Bicarbonatos , Enfermedad Crítica , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Modelos Teóricos , Tamaño de la Muestra , Venas/patología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...