Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline.

The main objective of this clinical practice guideline is to provide a series of recommendations for healthcare and exercise professionals, such as neurologists, physical therapists, and exercise physiologists, regarding exercise prescription for patients with migraine.This guideline was developed following the methodology and procedures recommended in the Appraisal of Guidelines for Research and Evaluation (AGREE). The quality of evidence and strength of recommendations were evaluated with the Scottish Intercollegiate Guidelines Network (SIGN). A systematic literature review was performed and an established appraisal process was employed to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology).The evaluation of the current evidence, the elaboration of the grades of recommendation, and their validation show a B grade of recommendation for aerobic exercise, moderate-continuous aerobic exercise, yoga, and exercise and lifestyle recommendations for the improvement of symptoms, disability, and quality of life in patients with migraine. Relaxation techniques, high-intensity interval training, low-intensity continuous aerobic exercise, exercise and relaxation techniques, Tai Chi, and resistance exercise obtained a C grade of recommendation for the improvement of migraine symptoms and disability.

Medication adherence to rivaroxaban and dabigatran in patients with non-valvular atrial fibrillation: a meta-analysis.

Several real-world studies have evaluated adherence to direct acting oral anticoagulants in patients with non-valvular atrial fibrillation (NVAF); however, these studies have not been systematically summarized. We performed a meta-analysis to compare adherence to rivaroxaban versus dabigatran therapy in United States (US) patients with NVAF in a real-world setting. Medline and Scopus were searched from January 2010 to August 2018 using keywords and MeSH terms related to adherence and oral anticoagulants. We included real-world studies of US adults with NVAF comparing adherence to dabigatran and rivaroxaban. Studies evaluating adherence by a measure other than proportion of days covered (PDC) were excluded. The proportion of patients with a PDC ≥ 80 (a commonly utilized definition of adherence) served as the primary outcome of interest. We conducted meta-analysis of non-overlapping studies using the Hartung-Knapp random-effects model to estimate risk ratios (RRs) with corresponding 95% confidence intervals (CIs). We included 5 studies evaluating 80,230 patients (range 2667-22,571). Median follow-up across studies was 6 months (range 3-12 months). The proportion of patients with a PDC ≥ 80 ranged from 59.5 to 83.5% for rivaroxaban users and 57.3 to 78.3% for dabigatran users. Upon meta-analysis, rivaroxaban use was associated with increased adherence compared with dabigatran use (RR 1.08; 95% CI 1.03-1.12; I2 = 88%). In conclusion, rivaroxaban was associated with increased adherence when compared to dabigatran in ~ 80,000 patients in a real-world setting. Possible explanations for this include dosing frequency or patient tolerance.

Evaluación de anemia post intervención nutricional en niños de comunidades rurales de Caazapá, Paraguay

Introducción: Se ha descrito la heterogeneidad del impacto de la anemia según el área geográfica; en el sector rural se ve agravado afectando a la población más vulnerable. Objetivo: evaluar el efecto del suplemento nutricional en niños anémicos menores de cinco años indígenas y no indígenas, en comunidades rurales del Departamento de Caazapá. Materiales y métodos: Estudio observacional transversal. Fueron estudiados una cohorte de 109 niños menores de cinco años indígenas y no indígenas cuyos padres brindaron su consentimiento informado, a quienes se les suministró sulfato ferroso según edad y peso. Resultados: Se encontró un aumento significativo de las medianas de hemoglobina, después de la intervención, de 5,0 g/L en el grupo anémico de indígenas y en los no indígenas de 6,0 g/L; el 31% de los niños indígenas y el 84% de los no indígenas dejaron de ser anémicos, post intervención. Conclusión: Ambas poblaciones de niños anémicos indígenas y no indígenas presentaron un aumento significativo de los niveles medios de hemoglobina post tratamiento con suplemento con hierro y una mayoría presentó una mejoría a un estado no anémico o del grado de la anemia.

Introduction: The heterogeneity of the impact of anemia has been described according to geographic area; in rural areas the impact is greater, affecting the most vulnerable populations. Objective: to evaluate the effect of nutritional supplementation in anemic children, both indigenous and non-indigenous, under five years of age, in rural communities in the Department of Caazapá. Materials and methods: This was a cross-sectional, observational study. We studied a cohort of 109 indigenous and non-indigenous children under five years of age whose parents gave their informed consent and were given ferrous sulfate based on age and weight. Results: There was a significant increase in hemoglobin medians, after the intervention, of 5.0 g / L in the anemic group of indigenous children and of 6.0 g / L in the non-indigenous children; 31% of indigenous children and 84% of non-indigenous children ceased to be anemic after the intervention. Conclusion: Both the indigenous and non-indigenous populations of anemic children showed a significant increase in their average levels of hemoglobin after iron supplementation and a majority improved to a milder degree of anemia or to a resolution of their anemia.

[Lithogenic risk in patients from Paraguay with urolithiasis]. / Perfil de riesgo litogénico en pacientes con urolitiasis en Paraguay.

UNLABELLED: The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. AIM: To determine the lithogenic risk profile in patients with urolithiasis. MATERIAL AND METHODS: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. RESULTS: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. CONCLUSIONS: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Perfil de riesgo litogénico en pacientes con urolitiasis en Paraguay / Lithogenic risk in patients from Paraguay with urolithiasis

The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. Aim: To determine the lithogenic risk profile in patients with urolithiasis. Material and Methods: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. Results: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. Conclusions: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

A relaxation technique enhances psychological well-being and immune parameters in elderly people from a nursing home: a randomized controlled study.

BACKGROUND: The aging process involves a decline in immune functioning that renders elderly people more vulnerable to disease. In residential programs for the aged, it is vital to diminish their risk of disease, promote their independence, and augment their psychological well-being and quality of life. METHODS: We performed a randomized controlled study, evaluating the ability of a relaxation technique based on Benson's relaxation response to enhance psychological well-being and modulate the immune parameters of elderly people living in a geriatric residence when compared to a waitlist control group. The study included a 2-week intervention period and a 3-month follow-up period. The main outcome variables were psychological well-being and quality of life, biomedical variables, immune changes from the pre-treatment to post-treatment and follow-up periods. RESULTS: Our findings reveal significant differences between the experimental and control groups in CD19, CD71, CD97, CD134, and CD137 lymphocyte subpopulations at the end of treatment. Furthermore, there was a decrease in negative affect, psychological discomfort, and symptom perception in the treatment group, which increased participants' quality of life scores at the three-month follow-up. CONCLUSIONS: This study represents a first approach to the application of a passive relaxation technique in residential programs for the elderly. The method appears to be effective in enhancing psychological well-being and modulating immune activity in a group of elderly people. This relaxation technique could be considered an option for achieving health benefits with a low cost for residential programs, but further studies using this technique in larger samples of older people are needed to confirm the trends observed in the present study. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register ISRCTN85410212.