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1.
J Cosmet Dermatol ; 19(4): 836-844, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32061047

RESUMEN

BACKGROUND: The use of platelet-rich plasma (PRP) combined with noninvasive, nonenergy procedures for atrophic acne scars has shown promise. To date, there has not been a systematic review or meta-analysis of the effectiveness of this therapy. AIMS: To use meta-analysis to compare Goodman and Baron qualitative scores, patient satisfaction outcomes, and adverse effects in patients undergoing combination procedures with PRP, combination procedures without PRP, and noninvasive monotherapy without PRP in the treatment of patients with atrophic acne scars. PATIENTS/METHODS: The Pubmed and Cochrane library databases were searched for relevant studies published before May 1, 2019. PRISMA guidelines were utilized. Studies that compared the use of PRP in combination with a noninvasive procedure and therapies without PRP for the treatment of atrophic acne scars were included. Cochrane's handbook was utilized to assess the individual biases of the included studies. Publication bias was assessed. RESULTS: A total of 311 participants (153 whole-face participants and 158 split-face participants) were reviewed across eight included studies. Quantitative analysis of 241 participants across six included studies showed a statistically significant reduction in scar severity scores in favor of microneedling or subcision with PRP (P < .001). Combination therapy with intradermal or topical PRP was significantly more effective than monotherapy alone and combination therapy with an adjunct other than PRP (P < .001 and .001, respectively). CONCLUSION: This systematic review and meta-analysis demonstrated that microneedling or subcision with PRP produced statistically significant improvement in validated outcomes over microneedling or subcision alone.


Asunto(s)
Acné Vulgar/complicaciones , Cicatriz/terapia , Técnicas Cosméticas , Plasma Rico en Plaquetas , Piel/patología , Atrofia/etiología , Atrofia/terapia , Cicatriz/diagnóstico , Cicatriz/etiología , Terapia Combinada/métodos , Punción Seca , Humanos , Satisfacción del Paciente , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
2.
Paediatr Anaesth ; 30(1): 25-33, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31733116

RESUMEN

BACKGROUND AND OBJECTIVES: Epidural analgesia is an effective, established perioperative intervention in all age-groups. In children, however, epidural-related data are limited compared to the adult population. The aim of this study was to examine the use of pediatric epidural analgesia in our institution and, thereby, add to the existing data pool. METHODOLOGY: Patients who received epidural analgesia as part of their perioperative management between 1996 and 2016 at Great Ormond Street Hospital, London, UK, were studied to determine how epidural practice has changed over time, associated incidence of serious adverse events, complications, and patient/parent satisfaction. Epidural use and monitoring were in accordance with standard hospital protocols. Data were prospectively collected and entered into a secure database by trained personnel. These data were subsequently extracted for retrospective analysis. RESULTS: A total of 3876 patients were included. The median age was 4.4 years (range 1 day to 20 years), and the median weight was 20.3 kg. Across all age-groups, the lumbar region was the most common site of epidural insertion while urology (42.2%) and general surgery (37.3%) were the specialities for which it was most utilized. Over the study period, the number of epidurals performed declined while the number of surgical procedures performed simultaneously increased. The infusate most commonly used was local anesthetic with preservative-free morphine (71.9%). In 923 (23.2%) patients, systemic opioids were additionally used for analgesic management by means of patient-controlled analgesia or nurse-controlled analgesia. There was one serious adverse event in the form of permanent nerve injury, giving an overall incidence of approximately 1:3800. Other complications included postoperative nausea and vomiting (35.9%), urinary retention (4.4%), and pruritus (31%). Overall global satisfaction with the service was generally high, with 95% providing a rating of "very good" or "good." CONCLUSION: This study evaluated two decades of epidural practice in our institution. Epidural analgesia remains a safe, effective option for postoperative analgesia, but its use has declined over time, and this trend is likely to continue. Rates of serious adverse events and complications were low and comparable to those published in other similar studies. Global satisfaction among patients/parents remains high.


Asunto(s)
Analgesia Epidural/efectos adversos , Analgesia Epidural/tendencias , Adolescente , Analgesia Epidural/estadística & datos numéricos , Analgésicos/administración & dosificación , Analgésicos/efectos adversos , Anestesia Local/efectos adversos , Niño , Preescolar , Estudios de Cohortes , Femenino , Hospitales Pediátricos/tendencias , Humanos , Lactante , Recién Nacido , Londres , Región Lumbosacra , Masculino , Náusea/inducido químicamente , Periodo Perioperatorio , Complicaciones Posoperatorias/inducido químicamente , Prurito/inducido químicamente , Insuficiencia Respiratoria/inducido químicamente , Estudios Retrospectivos , Retención Urinaria , Vómitos/inducido químicamente , Adulto Joven
3.
Aust Prescr ; 39(2): 40-6, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27340321

RESUMEN

Osteoporotic fractures are common resulting in increased morbidity and mortality. Exercise can help prevent osteoporosis. It can also benefit patients with osteoporosis, but the exercises must be tailored to the patient. Most Australians should be able to obtain adequate calcium in their diet and vitamin D from the sun. Supplements may be needed in some patients and they are recommended for use with other drugs for osteoporosis. Bisphosphonates, and in some patients denosumab, are first-line drugs for osteoporosis. Raloxifene and strontium ranelate can be considered in patients who cannot take bisphosphonates or denosumab. Teriparatide is reserved for patients with severe osteoporosis and the use of strontium ranelate is declining because of cardiovascular safety concerns.

4.
Fish Shellfish Immunol ; 41(2): 113-9, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25160796

RESUMEN

The effects of dietary Bacillus coagulans (MTCC 9872), Bacillus licheniformis (MTCC 6824) and Paenibacillus polymyxa (MTCC 122) supplementation on growth performance, non-specific immunity and protection against Aeromonas hydrophila infection were evaluated in common carp, Cyprinus carpio fry. Laboratory maintained B. coagulans, B. licheniformis and P. polymyxa were used to study antagonistic activity against fish pathogenic bacteria by agar well diffusion assay. Healthy fish fry were challenged by this bacterium for determination of its safety. Fish were fed for 80 days with control basal diet (B0) and experimental diets containing B. coagulans (B1), B. licheniformis (B2) and P. polymyxa (B3) at 10(9) CFU/g diet. Fish fry (mean weight 0.329 ± 0.01 g) were fed these diets and growth performance, various non-specific immune parameters and disease resistance study were conducted at 80 days post-feeding. The antagonism study showed inhibition zone against A. hydrophila and Vibrio harveyi. All the probiotic bacterial strains were harmless to fish fry as neither mortality nor morbidities were observed of the challenge. The growth-promoting influences of probiotic supplemented dietary treatments were observed with fish fry and the optimum survival, growth and feed utilization were obtained with P. polymyxa (B3) supplemented diet. Study of different non-specific innate immunological parameters viz. lysozyme activity, respiratory burst assay and myeloperoxidase content showed significant (p < 0.05) higher values in fish fry fed B3 diet at 10(9) CFU/g. The challenge test showed dietary supplementation of B. coagulans, B. licheniformis and P. polymyxa significantly (p < 0.05) enhanced the resistance of fish fry against bacterial challenge. These results collectively suggests that P. polymyxa is a potential probiotic species and can be used in aquaculture to improve growth, feed utilization, non-specific immune responses and disease resistance of fry common carp, C. carpio.


Asunto(s)
Adyuvantes Inmunológicos/farmacología , Carpas/crecimiento & desarrollo , Resistencia a la Enfermedad/efectos de los fármacos , Enfermedades de los Peces/inmunología , Enfermedades de los Peces/prevención & control , Infecciones por Bacterias Gramnegativas/veterinaria , Probióticos/farmacología , Análisis de Varianza , Animales , Acuicultura/métodos , Bacillus , Suplementos Dietéticos , Pruebas Antimicrobianas de Difusión por Disco/veterinaria , Relación Dosis-Respuesta a Droga , Infecciones por Bacterias Gramnegativas/inmunología , Infecciones por Bacterias Gramnegativas/prevención & control , Muramidasa/metabolismo , Peroxidasa/metabolismo , Estallido Respiratorio/efectos de los fármacos
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